Cerebral Hemorrhage Patients Research Articles

Development and validation of a nomogram for cerebral hemorrhage in patients with carotid stenosis undergoing stenting: a multicenter retrospective study

BackgroundHyperperfusion-induced cerebral hemorrhage (HICH) is a rare but severe complication in patients with carotid stenosis undergoing stent placement for which predictive models are lacking. Our objective was to develop a...

The efficacy of robot-assisted surgery on minor basal ganglia cerebral hemorrhage with neurological dysfunction.

This study aims to compare the outcomes of robot-assisted drainage and conservative treatment in minor basal ganglia hemorrhage (10ml< hemorrhage volume ≤ 30ml) patients with neurological dysfunction, and analyze patients treated with robot-assisted drainage in order to optimize this treatment strategy. In a retrospective study conducted in December 2021 to December 2023, minor basal ganglia cerebral hemorrhage patients with neurological dysfunction were enrolled from the Department of Neurosurgery, Shanghai Ninth People's Hospital. The patients included both the surgical (robot-assisted drainage) and conservative groups. The efficacy of robot-assisted drainage compared with conservative treatment in patients with minor cerebral hemorrhage and neurological dysfunction was evaluated by modified Rankin Scale (mRS) score after 3 months, muscle strength (grade 1 to 5) and cost of hospitalization. Of the patients included, 23 received robot-assisted drainage and 20 received conservative treatment. There were no significant differences in gender, age, history of hypertension and diabetes, muscle strength and mRS score at admission. Female patients accounted for 32.6%, and male patients accounted for 67.4%. About 90% of the patients enrolled had a pre-existing hypertension history. The mRS score after 3 months indicated that prognosis of the patients was significantly better in the surgical treatment group than the conservative treatment group (favorable prognosis 69.57% VS. 35%, P = 0.034) while the patients underwent surgery paid higher hospital bills than patients treated conservatively. Compared with traditional conservative treatment, robot-assisted drainage surgery is more helpful to improve the prognosis of patients with minor basal ganglia hemorrhage (volume ≤ 30mL) accompanied by neurological dysfunction. Robot assisted surgery can safely and effectively remove the hematoma of minor basal ganglia hemorrhage, and there were 69.6% of surgery group patients had a good prognosis in this study.

Machine learning-based model for predicting outcomes in cerebral hemorrhage patients with leukemia

Background and purposeIntracranial hemorrhage (ICH) in leukemia patients progresses rapidly with high mortality. Limited data are available on imaging studies in this population. The study aims to develop prediction models for 7-day and short-term mortality risk based on the non-contrast computed tomography (NCCT) image features. MethodsThe NCCT image features of ICH in 135 leukemia patients between 2007–2023 were retrospectively extracted using manual assessment and radiomics methods. After multiple imputation of missing laboratory data, univariate logistic regression and least absolute shrinkage and selection operator (LASSO) were used for feature selection. Random forest models were built with comprehensive evaluation and ranking of feature importance. Result135 and 129 patients were included in the studies for 7-day and short-term prognostic models, respectively. The median age of all enrolled patients was 35 years, and there were 86 male patients (63.7 %). Clinical models (validation: AUC [area under the curve] = 0.78, AUPRC [area under the precision-recall curve] = 0.73; AUC = 0.84, AUPRC = 0.86), radiomics models (validation: AUC = 0.82, AUPRC = 0.78; AUC = 0.75, AUPRC = 0.77), and the combined models (validation: AUC = 0.84, AUPRC = 0.83; AUC = 0.87, AUPRC = 0.89) predicted 7-day and short-term mortality with good predictive efficacy. Clinical decision curve analysis showed that the combined models predicted 7-day and 30-day risk of death would be more beneficial than other models. Shape features contributed significantly more than semantic features in both radiomics models and combined models (93.3 %, 52.1 %, as well as 85.2 %,37.4 %, respectively) for 7-day and 30-day mortality. ConclusionsCombined models constructed based on NCCT perform well in predicting the risk of 7-day and short-term mortality in ICH patients with leukemia. Shape features extracted by radiomics are important markers for modeling the prognosis.

A commentary on 'Association of follow-up neutrophil-to-lymphocyte ratio and systemic inflammation response index with stroke-associated pneumonia and functional outcomes in cerebral hemorrhage patients: a case controlled study'.

A commentary on 'Association of follow-up neutrophil-to-lymphocyte ratio and systemic inflammation response index with stroke-associated pneumonia and functional outcomes in cerebral hemorrhage patients: a case controlled study'.

General anesthesia versus conscious sedation in mechanical thrombectomy for patients with acute ischemic stroke: systematic review and meta-analysis.

After recently published randomized clinical trials, the choice of the best anesthetic procedure for mechanical thrombectomy (MT) in acute ischemic stroke (AIS) due to large vessel occlusion (LVO) is not definite. To compare the efficacy and safety of general anesthesia (GA) versus conscious sedation (CS) in patients with AIS who underwent MT, explicitly focusing on procedural and clinical outcomes and the incidence of adverse events. PubMed, Embase, and Cochrane were systematically searched for randomized controlled trials (RCTs) comparing GA versus CS in patients who underwent MT due to LVO-AIS. Odds ratios (ORs) were calculated for binary outcomes, with 95% confidence intervals (CIs). Random effects models were used for all outcomes. Heterogeneity was assessed with I2 statistics. Eight RCTs (1,300 patients) were included, of whom 650 (50%) underwent GA. Recanalization success was significantly higher in the GA group (OR 1.68; 95% CI 1.26-2.24; p < 0.04) than in CS. No significant difference between groups were found for good functional recovery (OR 1.13; IC 95% 0.76-1.67; p = 0.56), incidence of pneumonia (OR 1.23; IC 95% 0.56- 2,69; p = 0.61), three-month mortality (OR 0.99; IC 95% 0.73-1.34; p = 0.95), or cerebral hemorrhage (OR 0.97; IC 95% 0.68-1.38; p = 0.88). Despite the increase in recanalization success rates in the GA group, GA and CS show similar rates of good functional recovery, three-month mortality, incidence of pneumonia, and cerebral hemorrhage in patients undergoing MT.

Association of follow-up neutrophil-to-lymphocyte ratio and systemic inflammation response index with stroke-associated pneumonia and functional outcomes in cerebral hemorrhage patients: a case-controlled study.

The neutrophil-to-lymphocyte ratio (NLR) and systemic inflammation response index (SIRI) at admission are independent diagnostic biomarkers in stroke-associated pneumonia (SAP). Our study aimed to investigate the association between NLR, SIRI, specifically follow-up NLR and SIRI, and SAP, as well as their relationship with functional outcomes. We retrospectively included 451 consecutive intracerebral hemorrhage patients from May 2017 to May 2019. We conducted univariate and multivariable analyses to identify the factors independently associated with SAP and poor functional outcomes. Compared to 127 (28.16%) patients diagnosed with SAP, those without SAP had both lower baseline and follow-up NLR and SIRI values ( P <0.001). After adjustments, we found that baseline NLR [OR, 1.039 (95% CI, 1.003-1.077); P =0.036] and follow-up NLR [OR, 1.054 (95% CI, 1.011-1.098); P =0.012] were independently associated with SAP. The follow-up NLR was also associated with a higher mRS [OR, 1.124 (95% CI, 1.025-1.233); P =0.013] and lower ADL-MBI score [OR, 1.167 (95% CI, 1.057-1.289); P =0.002] at discharge. Multivariable analysis indicated that advanced age and nasogastric tube feeding were independently associated with SAP ( P <0.05). We constructed a dynamic nomogram to identify SAP risk. Further subgroup analysis revealed that baseline NLR [OR, 1.062 (95% CI, 1.007-1.120); P =0.026] is independently associated with SAP in the nasogastric feeding group, while follow-up NLR [OR, 1.080 (95% CI, 1.024-1.139); P =0.005] was associated with the occurrence of SAP in non-nasogastric feeding patients. We found elevated baseline and follow-up NLR values were associated with SAP occurrence, and increasing follow-up NLR indicated poor functional outcomes. Inflammatory markers at different stages may offer individualized guidance for patients receiving various treatments.

Prevalence and Characteristics of Intracranial Aneurysms and Cerebral Hemorrhage in Patients with Autosomal Dominant Polycystic Kidney Disease in the Japanese Nationwide Database

Prevalence and Characteristics of Intracranial Aneurysms and Cerebral Hemorrhage in Patients with Autosomal Dominant Polycystic Kidney Disease in the Japanese Nationwide Database

Initial Treatment of Cerebral Hemorrhage:Determining the Cause without Preconceived Notions

In Japan, cerebral hemorrhage accounts for 19.5% of stroke patients, and its prognosis is poorer than that of cerebral infarction, with a mortality rate of 14.6%. In the initial treatment of cerebral hemorrhage, the airway, respiration, and circulation should be stabilized, and the intracranial pressure and body temperature should be controlled. Hypertensive cerebral hemorrhage is the most common cause; however, the cause should be carefully examined, and the treatment method should be selected according to the degree of urgency. Cerebral hemorrhage patients undergoing antithrombotic therapy show poor outcomes owing to increased hematoma. Therefore, antithrombotic drugs should be discontinued immediately. Blood products and neutralizing drugs should be administered in response to the administration of antithrombotic drugs. In young individuals, cerebrovascular disorders may be caused by the abuse of sympathomimetic drugs, such as stimulants and cocaine. Whether individuals or their family members are using illegal drugs should be confirmed.

Inverse Problem Algorithm-Based Time-Resolved Imaging of Head and Neck Computed Tomography Angiography Contrast Kinetics with Clinical Testification.

This study mitigated the challenge of head and neck CT angiography by IPA-based time-resolved imaging of contrast kinetics. To this end, 627 cerebral hemorrhage patients with dizziness, brain aneurysm, stroke, or hemorrhagic stroke diagnosis were randomly categorized into three groups, namely, the original dataset (450), verification group (112), and in vivo testified group (65), in the Affiliated BenQ Hospital of Nanjing Medical University. In the first stage, seven risk factors were assigned: age, CTA tube voltage, body surface area, heart rate per minute, cardiac output blood per minute, the actual injected amount of contrast media, and CTA delayed trigger timing. The expectation value of the semi-empirical formula was the CTA number of the patient's left artery (LA). Accordingly, 29 items of the first-order nonlinear equation were calculated via the inverse problem analysis (IPA) technique run in the STATISTICA 7.0 program, yielding a loss function and variance of 3.1837 and 0.8892, respectively. A dimensionless AT was proposed to imply the coincidence, with a lower AT indicating a smaller deviation between theoretical and practical values. The derived formula was confirmed for the verification group of 112 patients, reaching high coincidence, with average ATavg and standard deviation values of 3.57% and 3.06%, respectively. In the second stage, the formula was refined to find the optimal amount of contrast media for the CTA number of LA approaching 400. Finally, the above procedure was applied to head and neck CTA images of the third group of 65 patients, reaching an average CTA number of LA of 407.8 ± 16.2 and finding no significant fluctuations.

Systemic inflammation response index (SIRI) on the 3rd postoperative day are associated with severe pneumonia in cerebral hemorrhage patients: A single-center retrospective study.

Inflammatory response was involved in the progression of cerebral hemorrhage. We sought to explore the associations of easily obtained inflammatory indicators including blood cell counts and the ratios of different blood cells counts with pneumonia and severe pneumonia in cerebral hemorrhage patients. We carried 1 retrospective study including 200 patients with cerebral hemorrhage and surgeries. The associations of neutrophils, lymphocytes, monocytes, platelets, systemic immune inflammation index (SII), systemic inflammation response index (SIRI), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) with pneumonia and severe pneumonia in cerebral hemorrhage patients were estimated by univariate analysis and multivariate logistic regression model. Among the 200 patients included, there were a total of 163 (81.5%) had pneumonia after surgeries. Among 163 cerebral hemorrhage patients with pneumonia, 60 (36.8%) cases were evaluated as severe pneumonia. The level of SIRI on the 1st postoperative day in patients with severe pneumonia was higher than non-severe pneumonia (10.89 ± 12.10 × 109/L vs 7.14 ± 9.76 × 109/L, P = .003). The level of SIRI on the 3rd postoperative day in patients with severe pneumonia was more significantly higher (7.98 ± 7.46 × 109/L vs 4.10 ± 3.74 × 109/L, P < .001). The results of multivariate analysis showed that SIRI level on the 3rd postoperative day (>6.5 × 109/L) was associated with severe pneumonia in cerebral hemorrhage patients (OR: 4.409, 95% CI: 1.799-10.806, P = .001). SIRI was possibly a superior predictor for severe pneumonia in cerebral hemorrhage patients compared with other inflammatory indicators. On the one hand, we intend to validate the cutoff value of SIRI for predicting severe pneumonia in larger samples and multicenter studies. On the other hand, we also intend to use this index to guide the choice of antibacterial drugs in order to better benefit patients.

Perioperative Nursing Influence on Cerebrospinal Fluid Biochemical Markers in Cerebral Hemorrhage Patients Undergoing Minimally Invasive Intracranial Hematoma Removal Surgery

Background: Cerebral hemorrhage refers to a hemorrhagic disease caused by primary non-traumatic rupture of blood vessels in the brain parenchyma. It is a common acute cerebrovascular disease in the elderly. Objectives: To observe the effect of perioperative nursing on minimally invasive intracranial hematoma removal surgery in patients with cerebral hemorrhage. Methods: This randomized controlled trial study was conducted on 106 patients undergoing treatment for minimally invasive internal hematoma (MIRIH) at the First Hospital of Jilin University, Jilin, China, between January and December 2022. These patients were randomly divided into two groups, namely the control and observation groups (n=53 each). The observation group received perioperative care in addition to routine care. Differences between groups were compared using t-tests and Chi-square tests. Results: On the first day, there were no significant differences in the baseline characteristics between the groups. However, on the 7th and 14th days of admission, the observation group showed an increase in potassium ions and a decrease in chloride ions, lactate dehydrogenase, trace microalbumin, and the National Institutes of Health Stroke Scale (NIHSS) scores, compared to the control group (P&lt;0.05). The observation group also had a lower incidence of postoperative complications, including pneumonia, lower limb vein thrombosis, and cerebral hernia, compared to the control group (P&lt;0.05). NIHSS scores on days 7 and 14 were significantly lower in the observation group than in the control group (day 7: 9.60±4.11 vs 12.02±2.83, P&lt;0.05; day 14: 6.77±3.47 vs 9.19±2.86, P&lt;0.05). Conclusion: Perioperative nursing leads to improvement in electrolyte/metabolic levels, neurological recovery, and reduction in post-MIRIH surgical complications.

Effect of remifentanil co-administered with propofol on stress response and postoperative complications in patients with cerebral hemorrhage undergoing surgical anesthesia

Purpose: To determine the anesthetic effect and related indicators following concurrent administration of remifentanil and propofol in cerebral hemorrhage surgery patients.Methods: A total of 88 cerebral hemorrhage patients admitted in Lishui People’s District Hospital, Nanjing, China, from December 2019 to December 2020, were assigned to two groups, viz, control group which received fentanyl and propofol for anesthesia, while study group was administered remientanil combined with propofol for anesthesia There were 44 patients in each group. Hemodynamic index, brain injury marker index, stress response index, awakening condition, propofol dosage, anesthetic effect, and adverse reactions were assessed and recorded.Results: Heart rate (HR), diastolic blood pressure (DBP), and systolic blood pressure (SBP) at T2 and T3 of the two groups were less than those at T1. At T3, the study group’s HR, DBP, and SBP were substantially higher than those of control group (p &lt; 0.05); At 12 and 24 h after operation, brain injury markers and stress response indices in study group were significantly lower compared to control group (p &lt; 0.05), while in comparison to control group (79.55 %), the degree of anesthesia in the study group was higher (95.45 %; p &lt; 0.05). The incidence of adverse reactions in the study group (15.91 %) was lower than in control group (43.18 %; p &lt; 0.05).Conclusion: Remifentanil, when combined with propofol anesthesia, stabilizes hemodynamics, protects against brain injury, and reduces stress reactions in patients undergoing cerebral hemorrhage surgery. The combination is also highly effective and safe. However, validation of these findings in larger clinical trials is required.

Effect of tibialis anterior muscle resistance training on ankle and foot dorsum extension function in hypertensive cerebral hemorrhage hemiplegia patients: A randomized controlled trial.

This study aimed to investigate the effect of tibialis anterior muscle resistance training on ankle and foot dorsum extension function in patients with hemiplegia caused by hypertensive cerebral hemorrhage. Fifty cases of hypertensive cerebral hemorrhage in patients with hemiplegia were selected according to the random number table method. The patients were divided into the treatment group and control group. Each group included 25 cases, and the treatment group was given routine rehabilitation treatment and passive and active foot back stretch training (300 times/d). The control group received conventional rehabilitation treatment. The conventional rehabilitation treatment included stretching, muscle strengthening and other conventional rehabilitation treatment techniques. Surface electromyography was used to evaluate the muscle strength and tension of the triceps and tibialis anterior muscles of the affected side of the patients before and after treatment. The root mean square value of the surface electromyography (RMS) of the passive triceps extension before and after treatment was used to evaluate the muscle strength and tension of the affected side. The ratio of passive traction and relaxation of the triceps before and after treatment and the ratio of active contraction and relaxation of the tibialis anterior muscle before and after treatment were recorded. There was no significant difference in surface electromyography between the 2 groups before treatment (P > .05). After 2 months of treatment, the results of patients in both groups improved compared with those before treatment. The RMS of triceps in the treatment group was significantly lower than that in the control group, and the ratio of RMS of triceps in the treatment group was significantly lower than that in the control group. The RMS during active contraction and the RMS ratio between active contraction and relaxation of the tibialis anterior muscle in the treatment group were significantly higher than those in the control group (P < .05). Tibialis anterior muscle resistance training can effectively improve the strength of the tibialis anterior muscle in patients with hemiplegia caused by hypertensive cerebral hemorrhage, reduce tension in the triceps calf muscle, and improve ankle joint function and foot dorsum extension.

Correlation of levels of lactic acid and glucose in cerebrospinal fluid of cerebral hemorrhage patients with the occurrence of postoperative intracranial infection and clinical prognosis.

Cerebral haemorrhage is a critical condition that often requires surgical treatment, and postoperative intracranial infection can significantly impact patient outcomes. The aim of the study was to examine the relationship between the levels of lactic acid and glucose in cerebrospinal fluid (CSF) of patients with cerebral haemorrhage and their postoperative intracranial infection and clinical prognosis. The study selected the clinical data of 324 patients with cerebral haemorrhage who underwent surgical treatment in our hospital from March 2020 to March 2022 for retrospective analysis and divided these patients into the intracranial infection group (Group A, n=22, leukocyte values in CSF>5×106/L) and the non-intracranial infection group (Group B, n=302, leukocyte values in CSF 5×106/L) according to the occurrence of postoperative intracranial infection in patients to detect the levels of lactic acid and glucose in CSF at different times in the two groups. Pearson method was adopted to analyze the correlation of the levels of lactic acid and glucose in CSF of patients with intracranial infection, and the Glasgow Outcome Scale (GOS) was used to assess the clinical prognosis of patients. According to their scores, these patients were divided into the good prognosis group (GPG, scores of 4-5 points, n=178) and the poor prognosis group (PPG, scores of 1-3 points, n=146). The levels of lactic acid and glucose in the CSF of patients in the two groups were measured, and the Pearson method was adopted to analyze the relationship between these levels and clinical prognosis.

Clinical analysis of 15 pregnant women complicated with moyamoya disease

Objective: To explore the effects of pregnancy complicated with moyamoya disease on maternal and fetal outcomes. Methods: The general clinical data and maternal and fetal outcomes of 20 pregnancies of 15 patients with moyamoya disease admitted to the First Affiliated Hospital of Zhengzhou University from January 2012 to October 2022 were retrospectively analyzed. Results: (1) General information: among the 20 pregnancies of 15 clearly diagnosed pregnant women complicated with moyamoya disease, 12 were diagnosed before pregnancy (60%, 12/20), 3 were diagnosed during pregnancy (15%, 3/20), and 5 were diagnosed during puerperal period (25%, 5/20). There were 7 cases of primipara (35%, 7/20) and 13 cases of multipara (65%, 13/20). (2) Pregnancy complications and maternal and infant outcomes: among the 20 pregnancies of 15 pregnant women with moyamoya disease, there were 9 pregnancy complications (45%, 9/20), including 5 gestational hypertension (25%, 5/20), 2 severe pre-eclampsia (10%, 2/20), 1 hyperlipidemia and 1 gestational diabetes mellitus (5%, 1/20). There were 2 case of drug abortion in the first trimester, 3 cases of labor induction in the second trimester, and 15 cases of delivery during the third trimester. All the 15 deliveries were cesarean section, of which 11 (11/15) were cesarean sections with medical indications, and 4 (4/15) were cesarean sections caused by personal factors. General anesthesia was used in 5 cases (5/15), epidural block anesthesia in 7 cases (7/15), and combined spinal and epidural anesthesia in 3 cases (3/15). The median gestational age of 15 neonates was 37.2 weeks (34.0 to 40.8 weeks), with 10 cases (10/15) were full-term infants, and 5 (5/15) were preterm infants (3 of which were associated with hypertensive disorder complicating pregnancy). The birth weight of 15 neonates was (2 853±454) g. Four neonates were admitted to neonatal intensive care unit (NICU), of which 3 cases were admitted to NICU due to premature delivery and 1 case was admitted to NICU due to neonatal jaundice. There was no neonatal asphyxia or death. All neonates were followed up from 4 months to 6 years after birth, and all grew well. (3) Neurological symptoms during pregnancy: 8 cases (40%, 8/20) had neurological symptoms during pregnancy, and 6 cases (30%, 6/20) had hemorrhagic symptoms, of which 3 cases occurred during the puerperal period (3/6). There were 2 cases of ischemic symptoms (10%, 2/20), all of which occurred during the puerperal period (2/2). (4) Analysis of factors related to the occurrence of cerebral hemorrhage: the incidence of cerebral hemorrhage in patients with moyamoya disease diagnosed before pregnancy was significantly lower than that in those without a clear diagnosis, and the incidence of cerebral hemorrhage in women with moyamoya disease was lower than that in primipara (all P<0.01). The incidence of cerebral hemorrhage in moyamoya patients without hypertensive disorder complicating pregrancy was lower than that in patients with hypertensive disorder complicating pregrancy, but the difference was not statistically significant (P>0.05). Conclusions: Pregnancy combined with moyamoya disease has adverse effects on maternal and infant outcomes, and the incidence of pregnancy complications increases. Cerebral hemorrhage occurres in prenatal and puperium, while cerebral ischemia occurres mainly in puperium.

Machine learning-based prediction of cerebral hemorrhage in patients with hemodialysis: A multicenter, retrospective study.

Intracerebral hemorrhage (ICH) is one of the most serious complications in patients with chronic kidney disease undergoing long-term hemodialysis. It has high mortality and disability rates and imposes a serious economic burden on the patient's family and society. An early prediction of ICH is essential for timely intervention and improving prognosis. This study aims to build an interpretable machine learning-based model to predict the risk of ICH in patients undergoing hemodialysis. The clinical data of 393 patients with end-stage kidney disease undergoing hemodialysis at three different centers between August 2014 and August 2022 were retrospectively analyzed. A total of 70% of the samples were randomly selected as the training set, and the remaining 30% were used as the validation set. Five machine learning (ML) algorithms, namely, support vector machine (SVM), extreme gradient boosting (XGB), complement Naïve Bayes (CNB), K-nearest neighbor (KNN), and logistic regression (LR), were used to develop a model to predict the risk of ICH in patients with uremia undergoing long-term hemodialysis. In addition, the area under the curve (AUC) values were evaluated to compare the performance of each algorithmic model. Global and individual interpretive analyses of the model were performed using importance ranking and Shapley additive explanations (SHAP) in the training set. A total of 73 patients undergoing hemodialysis developed spontaneous ICH among the 393 patients included in the study. The AUC of SVM, CNB, KNN, LR, and XGB models in the validation dataset were 0.725 (95% CI: 0.610 ~ 0.841), 0.797 (95% CI: 0.690 ~ 0.905), 0.675 (95% CI: 0.560 ~ 0.789), 0.922 (95% CI: 0.862 ~ 0.981), and 0.979 (95% CI: 0.953 ~ 1.000), respectively. Therefore, the XGBoost model had the best performance among the five algorithms. SHAP analysis revealed that the levels of LDL, HDL, CRP, and HGB and pre-hemodialysis blood pressure were the most important factors. The XGB model developed in this study can efficiently predict the risk of a cerebral hemorrhage in patients with uremia undergoing long-term hemodialysis and can help clinicians to make more individualized and rational clinical decisions. ICH events in patients undergoing maintenance hemodialysis (MHD) are associated with serum LDL, HDL, CRP, HGB, and pre-hemodialysis SBP levels.

Effects of Propofol Combined with Sufentanil Target-Controlled Intravenous Anesthesia on Expression of Bax, Bcl-2, and Caspase-3 Genes in Spontaneous Hypertensive Rats with Cerebral Hemorrhage: a Prospective Case-Controlled Study.

It is a well-known fact that general anesthesia leads to cerebral hemorrhage in patients with spontaneous hypertension apart of the fact that the hypertension is under control. The literature is already flooded with this debate, and still, there appears a lag regarding the effects of high blood pressure on pathological changes in the brain after cerebral hemorrhage. They are still not well recognized. Furthermore, it is the stage of anesthesia resuscitation which is known to have adverse effects on the body during cerebral hemorrhage. Owing to the lag of knowledge in the above said facts, the objectives of this study were to evaluate the effects of propofol combined with sufentanil on the expression of Bax, BCL-2, and caspase-3 genes in spontaneously hypertensive rats suffering with cerebral hemorrhage. The initial sample consisted of 54 male Wrister rats. All were of the age of 7 to 8months with a weight of 500 ± 100 gm. All the rats were evaluated by the investigators before enrolment. A total of 0.5mg/kg ketamine followed by a 10mg/kg intravenous injection of propofol was introduced to each included rat. It was followed by a total of 1 μG/kg/h of sufentanil which was administered to rats who had cerebral hemorrhage (n = 27). The rest 27 normal rats were not administered with sufentanil. Hemodynamic parameters, biochemistry, western blot assay, and immunohistochemical staining were performed. The results were statistically analyzed. Heart rate (p < 0.0001) was higher for rats who had a cerebral hemorrhage. The cytokine levels of rats who had cerebral hemorrhage were higher than those of normal rats (p < 0.01 for all). Bacl-2 (p < 0.01), bax (p < 0.01), and caspase-3 (p < 0.01) expressions were reported to be disturbed in rats who had cerebral hemorrhage. Urine volume was reduced in rats who had cerebral hemorrhage (p < 0.01). It was concluded that in spontaneously hypertensive rats with cerebral hemorrhage, propofol combined with sufentanil target-controlled intravenous anesthesia increased hemodynamic parameters and cytokine levels. Furthermore, cerebral hemorrhage disturbs the expression of bacl-2, Bax, and caspase-3 expressions.

Efficacy and safety of endovascular embolization of cerebral AVM

Background; Endovascular embolization of cerebral arteriovenous malformations (AVM) has several benifits including AVM occlusion and flow reduction in preparation for other treatment techniques. Aim and objectives; To assess the efficacy and safety of endovascular embolization of cerebral AVM with different techniques and materials. Patients and methods; In a prospective and retrospective study, 22 patients diagnosed as AVM or arteriovenous fistula (AVF) and underwent endovascular embolization at Neurosurgical intervention Unit at Al Hussein University Hospital were recruited in the period from beginning of Jan, 2020 to the end of May, 2022. We included patients aged above one month, diagnosed to have cerebral AVM or AVF. Recent cerebral hemorrhage patients were delayed for at least two weeks. We excluded patients with vein of Galen malformation, neonatal AVM, patients underwent surgical excision, patients with contraindication to radiation or dye injection, and inaccessible endovascular techniques such as severely tortuous vessels. Results: In the current study, the mean age was 24.5 ± 14.7 years. Most cases were male (68.2%). Most cases (86.4% ) manifested headache, 40.9% had hemorrhage, 31.8% had side weakness and 27.3% had fits. Spetzler and Martin grade (SMG) of the cerebral AVMs was significantly improved after embolization compared to the initial grading score (P=0.002). Eight patients showed complete occlusion of nidus and 14 had partial occlusion according to SMG . After 3 months follow up, Modified Rankin scale, epilepsy, and headache were improved. No patient had procedure-related complications.

C- REACTIVE PROTEIN - AN OUTCOME PREDICTOR IN ACUTE INTRA CEREBRAL HEMORRHAGE

Background Inammation is considered to play an important role in the pathogenesis of cerebrovascular disease. C-reactive protein (CRP) is a hallmark of acute inammatory response. There are growing evidences that inammations are involved in atherosclerosis, plaque formation and ischemic event. There are many studies showing that the levels of CRP (hsCRP) have been found to be raised in cerebral ischemia, but there are few studies about the association of CRP level and intracerebral hemorrhage. This study was done to observe the levels of CRP (hsCRP) in patients with acute intracerebral hemorrage, and to assess the severity and outcome. Methods Study was conducted in 30 patients admitted in medical ward and medical ICU of LLR and associated hospitals, G.S.V.M. medical college Kanpur. All patients of acute intra cerebral hemorrhage fullling the Inclusion and exclusion criteria were enrolled in the study. Serum CRP (hs-CRP) was measured by Turbidimetric immunoassay. Statistical analysis was done by using T test and chi square test. Results Maximum numbers of our patients were in the age group of 40-79 years with mean age of 64 years. Intra cerebral hemorrhage was more prevalent in males. CRP level was found to be elevated statistically signicant in intra cerebral hemorrhage patients as compared to controls. There was signicant rise from rst day to third day (P&lt;0.05). Mean CRP level of expired patients was elevated as compared to whole study group (P&lt;0.05). Conclusions We concluded that higher C reactive protein level may be associated with worse prognosis and poor outcome in intra cerebral hemorrhage patients and CRP level can be an important factor of prognostic signicance in these patients.

Characteristic of Non–Sinus-Type Parasagittal Dural Arteriovenous Fistulas: Clinical and Cadaveric Experiences

BACKGROUND: In parasagittal dural arteriovenous fistulas (DAVFs), the shunt point is on the falx cerebri and drains directly into the cortical vein. The venous structure anatomy of the falx cerebri is not well understood. OBJECTIVE: To describe a parasagittal DAVF as a non–sinus-type DAVF using clinical expertise and cadaver analysis. We focused on the clinical characteristics of parasagittal DAVFs, anatomy of the cortical vein directly flowing into the falx cerebri, and venous route in the falx cerebri. METHODS: Six patients with parasagittal DAVFs were examined between April 2009 and March 2019. In 7 cadaver heads, we examined the entire falx cerebri length and the cortical veins flowing into it were noted. The falx cerebri was divided down from the midline into the dura propria to examine the venous pattern. RESULTS: Clinically, all 6 cases were classified as parasagittal DAVFs. Intracerebral hemorrhage occurred in 2 patients (33.3%). In all 6 cases, only the cortical vein was the draining vein ipsilateral to the shunt point. One patient (16.7%) underwent transarterial embolization, 2 (33.3%) underwent direct surgery, and 2 (33.3%) underwent combined transarterial embolization with direct surgery. In the anatomic study, 7 (50.0%) venous structures directly flowed into the falx cerebri and 5 (35.7%) were located in the parasinus portion. The veins directly flowing into the falx ran through the dura propria on each side. CONCLUSION: Based on the clinical characteristics and anatomic features, clinicians must pay attention to cerebral hemorrhage in patients with parasagittal DAVFs to manage aggressive symptoms.