Basal Ganglia Intracerebral Hemorrhage Research Articles

The relationship between the extent of posterior limb of the internal capsule damage measured by non-contrast computed tomography and clinical outcomes after basal ganglia hemorrhage.

Assessing the extent of damage to the posterior limb of the internal capsule(PLIC) is important for early prediction of clinical outcomes in intracerebral hemorrhage (ICH) patients. Currently, using MRI to reconstruct the extent of damage to PLIC is not suitable for quick assessment of prognosis in emergency settings. We aimed to investigate whether the PLIC damage quantified by non-contrast computed tomography (NCCT) is associated with clinical outcomes after basal ganglia intracerebral hemorrhage (BG-ICH). This study retrospectively included 146 BG-ICH patients from the Department of Neurosurgery at the Second Affiliated Hospital of Chongqing Medical University. The damage to the PLIC was quantified using Tangency X measured by NCCT. The importance of features is determined using the Boruta algorithm and Least Absolute Shrinkage and Selection Operator (LASSO) regression. Multivariate logistic regression models were established to examine the impact of PLIC damage on outcomes. Restricted Cubic Splines (RCS) were used to explore potential nonlinear relationships, and Receiver Operating Characteristic (ROC) curves were used to compare the predictive performance of Tangency X with other scoring systems for 6-month neurological outcomes (poor outcomes [mRS: 3-6]). In the multivariate logistic regression adjusting for all covariates, Tangency X was independently associated with an increased risk of poor outcomes (OR = 1.32, 95% CI: 1.17-1.52) in BG-ICH patients. There is a nonlinear relationship between Tangency X and poor outcomes. Specifically, the risk of poor outcomes increases by 1.29 times (OR = 1.29, 95% CI: 1.09-1.67) for each additional 1mm increase in Tangency X beyond 4mm. We next observed that the AUC for Tangency X in predicting poor outcomes is 0.8511. The extent of PLIC damage measured by NCCT may represent a promising predictor of poor outcomes after BG-ICH.

The effect of different surgical methods and timing of surgery on the clinical efficacy in patients with hypertensive intracerebral hemorrhage in basal ganglia

Objective: To explore the effect of different surgical methods and timing on the clinical efficacy of patients with hypertensive intracerebral hemorrhage (HICH) in basal ganglia. Methods: A total of 200 patients with HICH in basal ganglia were divided into traditional craniotomy (TC) group, small bone window craniotomy (SBWC) group and neuroendoscopic minimally invasive surgery (NMIS) group. And they were also divided into ultra-early group, early group and delayed group, depending on the timing of surgery. The operation time, intraoperative blood loss, hematoma clearance rate and incidence of complications among different groups were recorded and analyzed. The National Institutes of Health Stroke Scale (NIHSS) and Glasgow outcome scale (GOS) were used to evaluate the neurological function and prognosis. Results: The NMIS group was superior to the TC group and SBWC group in terms of operation time, and intraoperative blood loss, hematoma clearance rate, complication 6-months NIHSS scores and the GOS scores (P<0.05). There was no significant differences in operation time, intraoperative blood loss, hematoma clearance rate and complication among the ultra-early group, the early group and the delayed group (P>0.05). While the ultra-early group was superior to the early group and the delayed group in terms of 6-month NIHSS scores and the GOS scores. Conclusion: NMIS could reduce the operation time, intraoperative blood loss, and complications, and improve the hematoma clearance rate and prognosis of patients with HICH in basal ganglia. And the ultra-early surgical treatment improved the prognosis of patients with IHCH in basal ganglia.

Single-cell RNA sequencing reveals the evolution of the immune landscape during perihematomal edema progression after intracerebral hemorrhage

BackgroundPerihematomal edema (PHE) after post-intracerebral hemorrhage (ICH) has complex pathophysiological mechanisms that are poorly understood. The complicated immune response in the post-ICH brain constitutes a crucial component of PHE pathophysiology. In this study, we aimed to characterize the transcriptional profiles of immune cell populations in human PHE tissue and explore the microscopic differences between different types of immune cells.Methods9 patients with basal ganglia intracerebral hemorrhage (hematoma volume 50-100 ml) were enrolled in this study. A multi-stage profile was developed, comprising Group1 (n = 3, 0–6 h post-ICH, G1), Group2 (n = 3, 6–24 h post-ICH, G2), and Group3 (n = 3, 24–48 h post-ICH, G3). A minimal quantity of edematous tissue surrounding the hematoma was preserved during hematoma evacuation. Single cell RNA sequencing (scRNA-seq) was used to map immune cell populations within comprehensively resected PHE samples collected from patients at different stages after ICH.ResultsWe established, for the first time, a comprehensive landscape of diverse immune cell populations in human PHE tissue at a single-cell level. Our study identified 12 microglia subsets and 5 neutrophil subsets in human PHE tissue. What’s more, we discovered that the secreted phosphoprotein-1 (SPP1) pathway served as the basis for self-communication between microglia subclusters during the progression of PHE. Additionally, we traced the trajectory branches of different neutrophil subtypes. Finally, we also demonstrated that microglia-produced osteopontin (OPN) could regulate the immune environment in PHE tissue by interacting with CD44-positive cells.ConclusionsAs a result of our research, we have gained valuable insight into the immune-microenvironment within PHE tissue, which could potentially be used to develop novel treatment modalities for ICH.

Preoperative systemic immune-inflammation index may predict prolonged mechanical ventilation in patients with spontaneous basal ganglia intracerebral hemorrhage undergoing surgical operation.

Prolonged mechanical ventilation (PMV) has been proven as a risk factor for poor prognosis in patients with neurocritical illness. Spontaneous basal ganglia intracerebral hemorrhage (ICH) is one common subtype of hemorrhagic stroke and is associated with high morbidity and mortality. The systemic immune-inflammation index (SII) is used as a novel and valuable prognostic marker for various neoplastic diseases and other critical illnesses. This study aimed to analyze the predictive value of preoperative SII for PMV in patients with spontaneous basal ganglia ICH who underwent surgical operations. This retrospective study was conducted in patients with spontaneous basal ganglia ICH who underwent surgical operations between October 2014 and June 2021. SII was calculated using the following formula: SII = platelet count × neutrophil count/lymphocyte count. Multivariate logistic regression analysis and receiver operating characteristics curve (ROC) were used to evaluate the potential risk factors of PMV after spontaneous basal ganglia ICH. A total of 271 patients were enrolled. Of these, 112 patients (47.6%) presented with PMV. Multivariate logistic regression analysis showed that preoperative GCS (OR, 0.780; 95% CI, 0.688-0.883; P < 0.001), hematoma size (OR, 1.031; 95% CI, 1.016-1.047; P < 0.001), lactic acid (OR, 1.431; 95% CI, 1.015-2.017; P = 0.041) and SII (OR, 1.283; 95% CI, 1.049-1.568; P = 0.015) were significant risk factors for PMV. The area under the ROC curve (AUC) of SII was 0.662 (95% CI, 0.595-0.729, P < 0.001), with a cutoff value was 2,454.51. Preoperative SII may predict PMV in patients with spontaneous basal ganglia ICH undergoing a surgical operation.

A retrospective study about association of dynamic systemic immune-inflammation index (SII) with 180-day functional outcome after basal ganglia intracerebral hemorrhage

ObjectivesThis study aimed to determine whether SII on different days of admission is associated with severity and 180-day functional outcomes after basal ganglia ICH. MethodsIn this retrospective study, data on baseline CT imaging characteristics, mRS, hematoma volume, and laboratory variables were included. The SII and NLR, LMR, and PLR were calculated from laboratory data collected on admission day, day 1, and days 5–7. Both univariate and multivariable logistic regression analyses were used to assess the association between the SII and the outcome. The receiver operating characteristic (ROC) analysis and area under the curve (AUC) were also used to evaluate the ability of the SII to predict outcomes. ResultA total of 245 patients were enrolled in the study. On different days, the NLR, PLR, and SII were significantly lower in patients with favorable outcomes than in those with poor outcomes, and the volume of hemorrhage was positively correlated with the SII. These parameters were associated with outcomes in the univariate logistic regression. In the adjusted analyses, the SII and PLR were independent predictors of basal ganglia ICH outcomes. ROC analysis revealed that the SII showed a stronger ability to predict the 6-month outcomes of patients after basal ganglia ICH than the PLR on different days (AUC = 0.642, 0.804, 0.827 vs. 0.592, 0.725, 0.757; all P < 0.001). ConclusionThe SII independently and strongly predicts the outcome of basal ganglia ICH. A high SII was associated with poor 6-month outcomes in patients with basal ganglia ICH.

Laser navigation combined with XperCT technology–assisted puncture of basal ganglia intracerebral hemorrhage

Basal ganglia hemorrhage, which is characterized by excessive incapacity charge and high mortality rates, is surgically treated by minimally invasive hematoma puncture and drainage. We aimed at determining the efficacy of laser-guided minimally invasive hematoma puncture and drainage for treatment of basal ganglia hemorrhage. A total of 61 patients with hypertensive basal ganglia hemorrhage were recruited at the Binzhou Medical University Hospital, between October 2019 and January 2021, and their clinical information retrospectively analyzed. Based on the surgical approach used, patients were assigned into either laser navigation or small bone window groups depending on the surgical approach. Then, we compared the operation times, intraoperative blood loss, clinic stay, Glasgow Outcome Score (GOS) rating at 30 days, Barthel index (BI) rating at 6 months, postoperative pneumonia incidences, and intracranial contamination complications between groups. Intraoperative blood loss, operation time, and sanatorium were significantly low in laser navigation group, relative to the small bone window group. At the same time, there were no significant differences between the groups with regard to postoperative hematoma volume, lung contamination, cerebrospinal fluid (CSF) leak, and intracranial contamination, as well as the 6-month BI and 30-day GOS rating. There were no deaths in either group. Compared with the traditional small bone window surgery, laser-guided puncture and drainage is a low-cost, accurate, and safe method for the treatment of basal ganglia hemorrhage, which is suitable for promotion in developing countries and economically underdeveloped areas.

Admission neutrophil-to-lymphocyte ratio to predict 30-day mortality in severe spontaneous basal ganglia hemorrhage.

Spontaneous intracerebral hemorrhage (ICH) usually occurs in the basal ganglia and is highly lethal and disabling. The aim of this study was to evaluate the predictors of 30-day mortality in patients with severe spontaneous basal ganglia hemorrhage. This retrospective study included patients with severe basal ganglia intracerebral hemorrhage treated in the Third Affiliated Hospital of Soochow University from 2012 to 2018. Demographic, clinical, laboratory and neuroradiological data were collected. The short-term prognosis was evaluated and divided into death within 30-days and survival over 30-days. We studied the factors affecting the prognosis of patients with severe intracerebral hemorrhage, analyzed the parameters related to neutrophil-to-lymphocyte (NLR) at admission, and evaluated the predictive effect of NLR on 30-day mortality. A total of 105 patients was included in this retrospective study. The 30-day death group had a larger hematoma, a higher probability of ventricular hemorrhage, a higher ICH score and a lower Glasgow Coma Scale (GCS) score on admission. Meanwhile, the patients in the death group had higher White blood cells (WBC) counts, neutrophil counts, NLRs and C-reactive protein (CRP) levels. The risk factors for 30-day death were related to the ICH volume, GCS score, ICH score, WBC count, neutrophil count, NLR and CRP. The univariate receiver operating characteristic (ROC) curve of the risk factors showed that the NLR had the best prediction performance. Mathematical predictive models for ICH patients showed that the model with NLR had better prediction accuracy. The NLR is expected to be a potential biomarker for predicting the prognosis of patients with severe basal ganglia hemorrhage.

Montreal Cognitive Assessment of cognitive dysfunction after basal ganglia stroke

ObjectiveThe Montreal Cognitive Assessment (MoCA) was used to evaluate cognitive dysfunction after basal ganglia stroke, and factors affecting total MoCA score were examined.MethodsData were retrospectively analyzed for 30 patients with basal ganglia intracerebral hemorrhage or basal ganglia cerebral infarction, who were admitted to The Second Affiliated Hospital of Fujian Traditional Medical University (Fujian, China) from January 2017 to March 2020. Cognitive impairment was assessed using the MoCA, and potential correlations were explored between clinicodemographic characteristics (sex, age, stroke location and etiology) and MoCA dimensions or total MoCA score.ResultsUnivariate linear regression showed that the total MoCA score was significantly associated with sex, age, executive function, naming, attention, abstract generalization ability, memory ability, and visuospatial orientation. However, multivariate linear regression identified only executive function, naming, attention, memory ability, and visuospatial orientation as significantly associated with the total MoCA score.ConclusionsWe showed that the MoCA test can be used for patients with basal ganglia stroke. The total MoCA score of basal ganglia stroke was significantly associated with impairments in executive function, naming, attention, memory ability, and visuospatial orientation.

Is Conservative Treatment Better than Surgical Treatment for Basal Ganglia Hemorrhage in a Conventionally Non-Surgical Indication Group with Poor Motor Function?

Background: The treatment options for basal ganglia intracerebral hemorrhage (ICH), either surgical or conservative, remain controversial. A previous study developed “A new modified ICH (MICH) score” that suggests which treatment option will be better for basal ganglia ICH. According to this scoring system, a MICH score of 0 or 1 indicates that conservative treatment is better than surgical treatment. The purpose of this study was to determine whether conservative treatment is still a better option for a basal ganglia hemorrhage in patients with MICH scores of 0 and 1, with initial poor motor grades. Methods: This retrospective study was comprised of 41 patients with a spontaneous basal ganglia hemorrhage. These patient groups had no previous brain lesions, their initial MICH score was 0 or 1, and the manual muscle test (MMT) of their hand was grade 2+ or lower in the initial evaluation. All patients were transferred to the Department of Rehabilitation Medicine and received rehabilitation treatment. Ten patients had an operative intervention, which was burr-hole aspiration or craniotomy with hematoma removal. The control group included 31 patients who underwent conservative treatment. Outcome evaluations used the Berg Balance Scale (BBS), Modified Barthel Index (MBI), and Brunnstrom recovery stage (BRS) which were evaluated at initial and regular follow-ups after 1, 3, and 6 months. We defined an improvement state if the BRS of their hand became 4 or more in 6 months, which means an escape from the synergic pattern. Results: Demographic characteristics showed no significant differences in age, sex, hemiplegic side, initial GCS score, presence of IVH and hydrocephalus, or distribution of MICH scores 0 and 1. There was only a significant difference in the distribution of hematoma volume between groups of less than 20 mL and groups from 21 to 50 mL (p = 0.049). There were no significant differences in MBI values in 1 month or improvement of BRS of their hand in 6 months between the two groups. Conclusions: Even in the group classified as predominantly conservative in basal ganglia hemorrhage patients, if the initial muscle strength is low, it is necessary to reconsider whether conservative treatment is superior to surgical treatment in terms of functional improvement.

Application of Urapidil Blood Pressure Regulation and Mechanical Ventilation Combined with Bone Window Craniotomy in the Treatment of Hypertensive Basal Ganglia Intracerebral Hemorrhage

Application of Urapidil Blood Pressure Regulation and Mechanical Ventilation Combined with Bone Window Craniotomy in the Treatment of Hypertensive Basal Ganglia Intracerebral Hemorrhage

Central Hyperthermia Due to Intracerebral Hemorrhage Treated with Baclofen: A Case Report

We report the treatment of a rare case of central hyperthermia due to intracerebral hemorrhage (ICH) in the basal ganglia with baclofen. Central hyperthermia is associated with a high mortality rate and poor prognosis among patients with failure of the thermoregulation system. A 35-year-old man arrived at the emergency room with the sudden loss of consciousness and right-sided hemiparesis. Computed tomography revealed an ICH in the left basal ganglia with a midline shift. Following craniotomy and evacuation of the ICH, the patient developed persistent hyperthermia. Laboratory investigations for fever did not aid in determining the origin, and the fever did not respond to any antibiotics or antipyretics. Oral baclofen was started at a dose of 30 mg/day, which was increased to 90 mg/day. The patient’s temperature markedly decreased to the normal range. Baclofen can be considered for treating suspected central hyperthermia in patients with ICH.

Different Effects of Hematoma Expansion on Short-Term Functional Outcome in Basal Ganglia and Thalamic Hemorrhages.

Purpose To investigate the impact of hematoma expansion (HE) on short-term functional outcome of patients with thalamic and basal ganglia intracerebral hemorrhage. Methods Data of 420 patients with deep intracerebral hemorrhage (ICH) that received a baseline CT scan within 6 hours from symptom onset and a follow-up CT scan within 72 hours were retrospectively analyzed. The poor functional outcome was defined as modified Rankin score (mRS) > 3 at 30 days. Receiver operating characteristic (ROC) curves for relative and absolute growth of HE were generated and compared. Multivariable logistic regression models were used to analyze the impact of HE on the functional outcome in basal ganglia and thalamic hemorrhages. The predictive values for different thresholds of HE were calculated, and correlation coefficient matrices were used to explore the correlation between the covariables. Results Basal ganglia ICH showed a higher possibility of absolute hematoma growth than thalamic ICH. The area under the curve (AUC) for absolute and relative growth of thalamic hemorrhage was lower than that of basal ganglia hemorrhage (AUC 0.71 and 0.67, respectively) in discriminating short-term poor outcome with an AUC of 0.59 and 0.60, respectively. Each threshold of HE independently predicted poor outcome in basal ganglia ICH (P < 0.001), with HE > 3 ml and > 6 ml showing higher positive predictive values and accuracy compared to HE > 33%. In contrast, thalamic ICH had a smaller baseline volume (BV, 9.55 ± 6.85 ml) and was more likely to initially involve the posterior limb of internal capsule (PLIC) (85/153, 57.82%), and the risk of HE was lower without PLIC involvement (4.76%, P = 0.009). Therefore, in multivariate analysis, the effect of thalamic HE on poor prognosis was largely replaced by BV and the involvement of PLIC, and the adjusted odds ratios (ORs) of HE was not significant (P > 0.05). Conclusion Though HE is a high-risk factor for short-term poor functional outcome, it is not an independent risk factor in thalamic ICH, and absolute growth is more predictive of poor outcome than relative growth for basal ganglia ICH.

Spontaneous intracerebral hemorrhage after anticoagulation therapy in a 57-year-old man with SARS-COV-2 infection: A case report

Background and aims: Anticoagulation regimens are now being considered for COVID-19. Anticoagulation is known to increase the risk for adverse bleeding events, of which intracerebral hemorrhage (ICH). Methods: Case Report. Results: We report a 57-year-old man was admitted to hospital due decreased oxygen saturation, increased blood glucose levels and RT-PCR of oropharyngeal swab confirmed COVID-19. The patient had a previous history of type 2 DM and ischemic stroke. The first 5 days, the patient was receiving a prophylactic dose of low molecular weight heparin, enoxaparin, then continued with unfractionated heparin. The patient also received antiplatelet clopidogrel and convalescent plasma. The laboratory results are leucocyte 18.9 K/μL, ureum 79 mg/dL, creatinine 2.0 mg/dL, D-Dimer 0.22 μg/mL, INR 1.03, NLR 15.82, ALC 547, HbA1C 9.2, blood glucose level 336 mg/dL, CRP 41.2 mg/dL. On day ten of hospitalization, the patient had sudden right-sided hemiplegia and Broca's aphasia. A CT head demonstrated an ICH in the left basal ganglia with a volume approximately 77cc. Three days later the patient's condition had decreased consciousness and a craniotomy was performed. After being intubated for 4 days post craniotomy, because his condition improved, he was extubated. On day nine after surgery, the patient's condition decreased to coma, a repeat chest X-ray showed a worsening of the bilateral infiltrates and pleural effusion. His oxygen requirement was progressively increasing, so he was shifted to mechanical ventilation again. Conclusions: The risk of intracerebral hemorrhage in patients with COVID-19 is of paramount importance to inform the risk-benefit assessment of the use of anticoagulation in this patient.

Analysis of echocardiographic characteristics in patients with acute intracerebral hemorrhage

PurposeThe aim of this article is to evaluate the effect of basal ganglia hemorrhage on cardiac functions in the acute stage using transthoracic echocardiography. MethodsBased on the data regarding computerize tomography and echocardiography data on the PACS imaging system of a single comprehensive medical center, a total of 110 cases with acute basal ganglia hemorrhage were analyzed retrospectively. The patients were further divided into four groups depending on the localization and extension of the hemorrhage as right basal ganglia hemorrhage (group 1), left basal ganglia hemorrhage (group 2), right basal ganglia hemorrhage with expansion into the ventricles (group 3) and left basal ganglia hemorrhage with expansion into the ventricles (group 4). Cardiac functions based on echocardiography findings were compared between groups. ResultsThere were 70 males (63.6%) and 40 females (36.7%) in this cohort with average an age of 59.45±10.26 years. The thickness of the diastolic interventricular septum was less than 11 mm. The difference in the amount of bleeding was significantly different between group 3 compared with group 1 (p = 0.041). The end systolic left ventricular diameter (LVDS) was significantly different between group 4 compared with group 1 (p = 0.030). The blood loss correlated with Pearson peak of mitral valve e′ (p = 0.034), and with Pearson peak of mitral annulus e′ (p = 0.037). There was no statistical significance in other echocardiographic parameters. ConclusionAcute intracerebral hemorrhage in basal ganglia is associated with left ventricular diastolic dysfunction.

MiR-124-3p Inhibits Microglial Secondary Inflammation After Basal Ganglia Hemorrhage by Targeting TRAF6 and Repressing the Activation of NLRP3 Inflammasome.

Objectives: Intracerebral hemorrhage (ICH) represents a serious central nervous system emergency with high morbidity and mortality, and the basal ganglia is the most commonly affected brain region. Differentially expressed microRNAs (miRs) have recently been highlighted to serve as potential diagnostic biomarkers and therapeutic targets for ICH. This study investigated the mechanism of miR-124-3p in microglial secondary inflammation after ICH.Methods: In this study, 48 patients with primary basal ganglia ICH and 48 healthy volunteers were selected and venous blood was collected from all patients on the second morning of admission (within 24 h of stroke onset). The expression of miR-124-3p in serum was detected by RT-qPCR. Three months after ICH, the patients were assessed by modified Rankin Scale (mRS), and the correlation between miR-124-3p expression and mRS score was analyzed by Pearson. The inflammatory response of microglia was induced by lipopolysaccharide (LPS) to establish the cell model of microglial inflammation. miR-124-3p expression patterns were detected in the serum of ICH patients and healthy volunteers, normal microglia, and LPS-induced microglia. The miR-124-3p mimic was transfected into LPS-induced microglia, followed by measurement of the inflammatory factors, apoptosis rate, and cell viability. The target gene of miR-124-3p was predicted and verified. The expression patterns of tumor necrosis factor receptor-associated factor 6 (TRAF6) were detected. pcDNA3.1 and pcDNA3.1-TRAF6 were transfected into LPS-induced HMC3 cells, and nucleotide-binding oligomerization domain-like receptor (NLR) pyrin domain-containing 3 (NLRP3) expression patterns were determined. Lastly, the effects of TRAF6 overexpression on apoptosis, cell viability, and inflammation in HMC3 cells were measured.Results: miR-124-3p was downregulated in the serum of basal ganglia ICH patients and LPS-induced microglia, and miR-124-3p expression was negatively correlated with mRS. Overexpression of miR-124-3p reduced the inflammatory factors and apoptosis rate and promoted cell activity in LPS-induced microglia. miR-124-3p was found to target TRAF6. Overexpression of TRAF6 enhanced the expression of NLRP3 inflammasome, inflammatory factors and apoptosis rate, and reduced cell viability.Conclusion: Our findings indicate that miR-124-3p repressed the activation of NLRP3 inflammasome by targeting TRAF6, thus inhibiting microglial secondary inflammation after ICH in basal ganglia.

Comparing the results of surgical and conservative treatment of patients with supratentorial hypertensive intracerebral hemorrhage. A new look at previously known randomized studies

Hemorrhagic stroke is a medical and social problem, with an incidence of 15–35 per 100 000 people per year. It is characterized by high patient mortality (up to 53% in the first year) and disability, with most of the surviving patients having persistent neurological deficits and about 20% of them requiring continuous assistance. The advantages of surgical or conservative treatment of patients with supratentorial hypertensive intracerebral hemorrhage (ICH) are still under discussion. This literature review is based on 12 open-source articles on prospective randomized trials comparing conservative and surgical treatment results in patients with supratentorial ICH, which demonstrate contradictory results. Based on an analysis of all the works, we can conclude that surgical treatment has an advantage when performed early (within 12–72 hours) in patients whose level of consciousness is 9–12 points on the Glasgow Coma Scale. Needle aspiration and local fibrinolysis are effective for basal ganglia ICH, while open surgery and endoscopic aspiration are effective in subcortical ICH. For subcortical ICHs that are 20–80 cm 3 in size, surgical treatment improved functional outcomes, while in ICHs larger than 50 cm 3 , it helped to reduce mortality. For citation: Godkov I.M., Dashyan V.G. [Comparing the results of surgical and conservative treatment of patients with supratentorial hypertensive intracerebral hemorrhage. A new look at previously known randomized studies]. Annals of clinical and experimental neurology. 2021; 15(1): 71–79. (In Russ.) https://doi.org/10.25692/ACEN.2021.1.9

Effect of coagulation function on cerebral microbleeds in intracerebral hemorrhage.

ObjectiveOur study aimed to confirm whether coagulation function of patients presenting with intracerebral hemorrhage (ICH) was associated with onset of cerebral microbleeds (CMBs).MethodsA total of 174 patients with basal ganglia ICH were divided into CMBs and non‐CMBs groups. Indicators of coagulation function and other clinical data that included fibrinogen (FBI), prothrombin time (PT), activated partial thromboplastin time (APTT), and the international normalized ratio (INR) were compared by univariate and multivariate analysis between the two groups. A receiver operating characteristic (ROC) curve was plotted to determine the predictive value of coagulation function indicators for CMBs.ResultsUnivariate analysis showed that APTT levels was significantly higher in the CMBs group than the non‐CMBs group (30.20 ± 5.18 vs. 27.95 ± 4.19; p = .004), while there was no significant difference between PT, INR, and FBI. The proportion of male patients in the CMBs group was significantly higher than the non‐CMBs group (76.58% vs. 52.38%, p = .001). Multifactor logistic regression analysis demonstrated that APTT and male gender were independent risk factors for CMBs in patients with ICH (OR 1.100, 95% CI: 1.026–1.180, p = .008; OR 2.957, 95% CI: 1.500–5.826, p = .002; respectively). ROC curve analysis indicated that the area under the curve of APTT and male gender for CMBs in patients with ICH was 0.641 and 0.621, respectively (p = .002 and .008; respectively).ConclusionAPTT was an independent risk factor for CMBs in patients with ICH.

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.

Stroke : Highlights of Selected Articles

<i>Stroke</i> : Highlights of Selected Articles

Intensive Blood Pressure Reduction and Perihematomal Edema Expansion in Deep Intracerebral Hemorrhage.

Background and Purpose- It is unknown whether blood pressure (BP) reduction influences secondary brain injury in spontaneous intracerebral hemorrhage (ICH). We tested the hypothesis that intensive BP reduction is associated with decreased perihematomal edema expansion rate (PHER) in deep ICH. Methods- We performed an exploratory analysis of the ATACH-2 randomized trial (Antihypertensive Treatment of Acute Cerebral Hemorrhage-2). Patients with deep, supratentorial ICH were included. PHER was calculated as the difference in perihematomal edema volume between baseline and 24-hour computed tomography scans divided by hours between scans. We used regression analyses to determine whether intensive BP reduction was associated with PHER and if PHER was associated with poor outcome (3-month modified Rankin Scale score 4-6). We then used interaction analyses to test whether specific deep location (basal ganglia versus thalamus) modified these associations. Results- Among 1000 patients enrolled in ATACH-2, 870 (87%) had supratentorial, deep ICH. Of these, 780 (90%) had neuroimaging data (336 thalamic and 444 basal ganglia hemorrhages). Baseline characteristics of the treatment groups remained balanced (P>0.2). Intensive BP reduction was associated with a decrease in PHER in univariable (β= -0.15; 95% CI, -0.26 to -0.05; P=0.007) and multivariable (β=-0.12; 95% CI, -0.21 to -0.02; P=0.03) analyses. PHER was not independently associated with outcome in all deep ICH (odds ratio, 1.14; 95% CI, 0.93-1.41; P=0.20), but this association was modified by the specific deep location involved (multivariable interaction P=0.02); in adjusted analyses, PHER was associated with poor outcome in basal ganglia (odds ratio, 1.42; 1.05-1.97; P=0.03) but not thalamic (odds ratio, 1.02; 95% CI, 0.74-1.40; P=0.89) ICH. Conclusions- Intensive BP reduction was associated with decreased 24-hour PHER in deep ICH. PHER was not independently associated with outcome in all deep ICH but was associated with poor outcome in basal ganglia ICH. PHER may be a clinically relevant end point for clinical trials in basal ganglia ICH.