Hematoma Research Articles

Minimally Invasive Surgery for Spontaneous Intracerebral Hematoma. Real-Life Implementation Model and Economic Estimation.

ObjectiveSpontaneous intracerebral hemorrhage is characterized by high fatality outcomes, even under best medical treatment. Recently, minimally invasive surgical (MIS) evacuation of the hematoma has shown promising results and may soon be implemented in the clinical practice. Hereby, we intended to foresee the logistic requirements for an early hematoma evacuation protocol, as well as to evaluate in a real-life implementation model the cost-utility of the two main MIS techniques for hemorrhagic stroke (catheter evacuation plus thrombolysis and neuroendoscopic aspiration).MethodsData were obtained from the pool of hemorrhagic-stroke patients admitted to our institution during an annual period (2020–2021) and contrasted to the reported results in published trials of MIS techniques. Potential candidates for surgical treatment were identified according to the inclusion/exclusion criteria established in these trials. Then, a cost-utility analysis was performed, which explored the incremental cost per unit of health gained with a given treatment. The treatment effect was measured by differences in modified Rankin Score, and subsequently converted to quality-adjusted life years (QALY).ResultsOf the 137 patients admitted to our center with supratentorial spontaneous intracerebral hemorrhage in a 1-year period, 17 (12.4%) were potential candidates for the catheter evacuation plus thrombolysis technique (Minimally Invasive Surgery with Thrombolysis in Intracerebral Hemorrhage Evacuation trial, MISTIE III criteria) and 59 (43.0%) for the neuroendoscopic aspiration technique (Dutch Intracerebral Hemorrhage Surgery Trial Pilot Study, DIST criteria). The incremental cost-utility ratio was € 76,533.13 per QALY for the catheter-based evacuation and € 60,703.89 per QALY for the endoscopic-based technique.ConclusionAround 12–43% of patients admitted to hospital with spontaneous hemorrhagic stroke could be potential candidates to MIS early evacuation of the cerebral hematoma. In our real-life implementation model, the cost-utility analysis favored the neuroendoscopic evacuation over the catheter aspiration technique. Further studies are advisable as new data from the ongoing randomized trials becomes available.

Intracranial Haemorrhage in Haemophilia Patients Is Still an Open Issue: The Final Results of the Italian EMO.REC Registry.

Background: Intracranial hemorrhage (ICH) is a highly serious event in patients with haemophilia (PWH) which leads to disability and in some cases to death. ICH occurs among all ages but is particularly frequent in newborns. Aim: The primary aim was to assess the incidence and mortality due to ICH in an Italian population of PWH. Secondary aims were to evaluate the risk factors for ICH, the role of prophylaxis, and the clinical management of patients presenting ICH. Methods: A retrospective-prospective registry was established in the network of the Italian Association of Haemophilia Centers to collect all ICHs in PWH from 2009 to 2019 reporting clinical features, treatments, and outcomes. Results: Forty-six ICHs were collected from 13 Centers. The ICHs occurred in 15 children (10 < 2 years), and in 31 adults, 45.2% of them with mild hemophilia. Overall, 60.9% patients had severe haemophilia (15/15 children). Overall ICH incidence (×1000 person/year) was 0.360 (0.270–0.480 95% CI), higher in children <2 years, 1.995 (1.110–3.442 95% CI). Only 7/46 patients, all with severe haemophilia, had received a prophylactic regimen before the ICH, none with mild. Inhibitors were present in 10.9% of patients. In adult PWHs 17/31 suffered from hypertension; 85.7% of the mild subjects and 29.4% of the moderate/severe ones (p < 0.05). ICH was spontaneous in the 69.6% with lower rate in children (46.7%). Surgery was required in 21/46 patients for cerebral hematoma evacuation. Treatment with coagulation factor concentrates for at least three weeks was needed in 76.7% of cases. ICH was fatal in 30.4% of the cases. Of the survivors, 50.0% became permanently disabled. Only one-third of adult patients received long term prophylaxis after the acute treatment. Conclusion: The results from our Registry confirm the still high incidence of ICH in infants <2 years and in adults, particularly in mild PWHs presenting hypertension and its unfavorable outcomes. The majority of PWHs were treated on-demand before ICH occurred, suggesting the important role of prophylaxis in preventing such life-threatening bleeding.

Interleukin-18 mediated inflammatory brain injury after intracerebral hemorrhage in male mice.

Interleukin-18 (IL-18), a pro-inflammatory cytokine, is thought to be associated with inflammation in many neurological diseases such as ischemic stroke and poststroke depression, but the role of IL-18 in inflammatory injury after intracerebral hemorrhage (ICH) remains unclear. In this study, we established the ICH model in male mice and found that IL-18 expression including protein and mRNA levels was significantly increased in brain tissues after ICH. Meanwhile, exogenous IL-18 exacerbated cerebral hematoma and neurological deficits following ICH. In the IL-18 knockout group, the size of hematoma and neurological functions after ICH was decreased compared with the wild-type group, suggesting the critical role of IL-18 on the modulation of brain injury after ICH. Importantly, exogenous IL-18 increased microglial activation in brain tissues after ICH. Furthermore, IL-18 knockout resulted in the reduction of activated microglia after ICH. These results indicated that IL-18 may regulate the inflammatory response after ICH through the activation of microglia. Thus, IL-18 is expected to be a promising therapeutic target for secondary brain injury after ICH.

A Modified Dura Puncture Procedure to Reduce Brain Shift in Deep Brain Stimulation Surgery: One Institution's Experience.

ObjectiveThe therapeutic effect of deep brain stimulation (DBS) surgery mainly depends on the accuracy of electrode placement and the reduction in brain shift. Among the standard procedures, cerebrospinal fluid (CSF) loss or pneumocephalus caused by dura incision (DI) is thought to be the main reason for brain shift and inaccuracy of electrode placement. In the current study, we described a modified dura puncture (DP) procedure to reduce brain shift and compare it with the general procedure of DBS surgery in terms of electrode placement accuracy.Materials and MethodsWe retrospectively analyzed a series of 132 patients who underwent DBS surgery in Wuhan Union Hospital from December 2015 to April 2021. According to the different surgery procedures, patients were classified into two cohorts: the DI group (DI cohort) had 49 patients who receive the general procedure, and the DP group (DP cohort) had 83 patients who receive the modified procedure. Postoperative pneumocephalus volume (PPV) and CSF loss volume, electrode fusion error (EFE), and trajectory number were calculated. Meanwhile, intraoperative electrophysiological signal length (IESL), electrode implantation duration, and other parameters were analyzed.ResultsIn the current study, we introduced an improved electrode implantation procedure for DBS surgery named the DP procedure. Compared with the general DI cohort (n = 49), the modified DP cohort (n = 83) had a shorter electrode implantation duration (p < 0.0001), smaller PPV, lower CSF leakage volume (p < 0.0001), and smaller EFE (p < 0.0001). There was no significant difference in IESL (p > 0.05) or adverse events (perioperative cerebral haematoma, skin erosion, epilepsy, p > 0.05) between the two cohorts.ConclusionThe DP procedure is a modified procedure that can reduce brain shift and ensure implantation accuracy during DBS surgery without adverse events.

Management of Therapeutic Anticoagulation in Perioperative Period and Post Cerebral Haemorrhage: Which the Best Strategies?

Anticoagulation is essential for patients with mechanical heart valves; however, its management in peri operative period could be a dilemma. Frequently, bridging therapy is applied in this situation to prevent thromboembolic events. The risk and benefit of this strategy is not completely clarified. Furthermore, it become more complex if haemorrhagic complication was associated especially intracerebral localization. In lacking of data supporting a specific treatment strategy, The management of these patients often poses a significant challenge to balance between providing increasing bleeding events and providing ischemic complication. We report a case report of using bridging therapy in patient with mechanical valve in periprocedural cardiac resynchronization surgery complicated by hemorrhagic cerebral hematoma, through which we will discuss the therapeutic modalities of this patients in the light of studies and consensus of learned societies.

Raddeanin A (RA) reduced acute inflammatory injury in mouse experimental cerebral hemorrhage by suppression of TLR4.

Spontaneous intracerebral hemorrhage (ICH) is associated with high mortality and disability rates. The microglia-induced inflammatory response is a critical factor determining brain tissue damage after ICH. Raddeanin A (RA) is a natural triterpenoid compound with anti-inflammatory effects, although its effects on ICH and the underlying molecular mechanism have not been elucidated. In this study, we found that RA reduced the volume of cerebral hematoma and cerebral edema, attenuated neuronal apoptosis and improved the behavioral indices in a murine model of acute cerebral hemorrhage. Mechanistically, RA downregulated the TLR4-mediated pro-inflammatory effectors, reduced infiltration of microglia in peri-intracerebral hemorrhage and inhibited apoptosis of neurons co-cultured with activated microglia. In conclusion, RA can alleviate ICH-related tissue damage and promote the recovery of neuronal function by suppressing microglia-induced inflammation and apoptosis.

A Review of Remote Intracerebral Hemorrhage after Chronic Subdural Hematoma Evacuation.

Remote intracerebral hemorrhage (RICH) is a severe complication following chronic subdural hematoma (cSDH) drainage, and only case reports and small case series have been reported to date. The authors present an emblematic patient affected by RICH following cSDH drainage. A systematic review of the literature on diagnosis and management of patients affected by RICH following cSDH evacuation has also been performed. A literature search according to the PRISMA statement was conducted using PubMed and Scopus databases with the following Mesh terms: [(remote) AND (intracerebral hemorrhage or cerebral hematoma or cerebral infarction or cerebellar hemorrhage or cerebellar hematoma or cerebellar infarction) AND (chronic subdural hematoma)]. The literature search yielded 35 results, and 25 articles met our inclusion criteria: 22 articles were case reports and 3 were case series including three to six patients. Overall, 37 patients were included in the study. Age was reported in all 37 patients, 26 males (70.3%) and 11 females (29.7%), with a male-to-female ratio of 2.4:1. The mean age at diagnosis was 64.6 years (range: 0.25-86 years). Only in 5 cases (13.5%) did the ICH occur contralaterally to the previously drained cSDH. The rapidity of drainage can lead to several types of intracranial hemorrhages, caused by a too rapid change in the cerebral blood flow (CBF) and/or tears of bridging veins. The average time interval between cSDH drainage and neurologic deterioration was 71.05 hours (range: 0-192 hours). RICH following cSDH represents a rare occurrence and a serious complication, associated with elevated morbidity. Careful monitoring of drain speed after cSDH evacuation surgery is recommended, and minimally invasive techniques such as twist drill craniostomy are suggested, especially for massive cSDHs.

Predictors of Early Outcome in Patients Admitted at the Emergency Department with Traumatic Brain Injury: a Retrospective Cross-Sectional Study

Aim: The purpose of this study was to determine the factors that help predict early mortality in patients in the emergency department that have suffered a severe traumatic brain injury. Study design: A retrospective cross-sectional study Place and duration: Chandka Medical College/ Civil Hospital Larkana. April 2018- March 2020 Methodology: Retrospective analysis was used to study 198 patients that were admitted to the emergency department due to severe traumatic brain injury. The radiological, clinical, basic demographical, and biological data were all recorded when the patient was first admitted and while they were staying in the emergency department. Results: The results showed that 42 patients died. According to the univariate analysis, the presence of low value of Glasgow coma scale, bilateral mydriasis, shock, the high value of injury severity score, and cardiac arrest played a major role in the deaths of such patients. Poor outcome was associated with cerebral hematoma, subdural hematoma, and meningeal hemorrhage. A link was seen between poor prognosis and cardiac arrest and cerebral hematoma. Conclusions: In our study, subdural hematoma, intracranial hematoma, and meningeal hemorrhage were associated with mortality. To improve the prognosis of severe traumatic brain injury, prehospital care has to be improved. Additionally, futile resuscitations should be avoided. It is also very important to take a CT scan of the head as urgently as possible to detect operable mass lesions. Keywords: traumatic brain injury, early outcome, emergency department

О возможности консервативного лечения травматических эпидуральных гематом

Работа основана на анализе 35 наблюдений изолированных травматических эпидуральных гематом. Отмечено, что при наличии переломов в зоне проекции эпидуральной гематомы последняя может дренироваться через перелом в мягкие ткани черепа. Это дренирование настолько достаточно, что позволило добиться рассасывания эпидуральных гематом без оперативного вмешательства у 8 пострадавших. Кроме того, признаки дренирования гематом наблюдались у 6 оперированных больных с переломами в зоне проекции гематомы. Таким образом, дренирование гематомы имело место у 14 больных.

Abstract 1122‐000216: Evacuation of Bilateral Intracerebral Hemorrhages Using a Novel Disposable Surgiscopic System: A Case Report

Introduction : Patients presenting with intracerebral hemorrhage (ICH) face higher rates of morbidity and mortality than other stroke patients. Currently, these patients are managed by surgical intervention and decompression or medical management, depending on categorization of the hemorrhage. Simultaneous, multifocal hemorrhages are a rare presentation of ICH that portend a worse prognosis. Here we report the treatment of bilateral simultaneous ICHs in a young patient with diagnostic cerebral angiography, biopsy, and bilateral minimally invasive surgiscopic ICH evacuation in a single procedure. Methods : The patient was a young female who presented to an outside hospital after two days of progressively worsening headaches and vomiting. Her medical history was significant for systemic lupus erythematosus (SLE), hypertension, chronic migraines, and opioid use disorder. In the emergency department, her mental status deteriorated, and she was intubated. Computed tomography (CT) scan was performed and showed a right parietal 43.3 cc ICH and a left parietal 38.7 cc ICH. MR angiogram and venogram showed no evidence of vascular malformations but were suggestive of potential cerebral venous sinus thrombosis. Upon arrival, the patient remained intubated but was able to open her eyes, follow commands, and respond to stimulation. The patient was brought to the angiosuite for diagnostic cerebral angiography which revealed diffuse intermittent arterial narrowing suggestive of vasculitis and patent venous sinuses. The patient was then positioned in the prone position and bilateral parietal 1.5 cm craniectomies were performed. Surgiscopic evacuation was performed sequentially using stereotactic navigation to access and evacuate each clot. A right parietal brain biopsy was performed at the minimally invasive cortical access point. Results : Active bleeding was encountered in both hematoma sites and was treated with a combination of irrigation and monopolar cautery transmitted through the Aurora Evacuator. After complete evacuation of the hematomas on both sides, an intraoperative conebeam CT was performed, demonstrating good right‐sided evacuation and resident left‐sided hematoma. Additional evacuation was performed on the left side and repeat conebeam CT demonstrated good bilateral evacuation. CT head on post operative day 1 showed 97.7% right‐sided evacuation and 81.5% left‐sided evacuation. The patient was treated with steroids for presumed vasculitis given the angiographic findings, which was later supported by the results of the brain biopsy. The patient made a good recovery and was discharged from the hospital alert and oriented, with CN II‐XII grossly intact, no focal deficits, and 5/5 strength in all extremities. Conclusions : Minimally invasive ICH evacuation can be performed in the angiosuite for ICH‐associated with vasculitis and even multifocal ICH when appropriate. Performing the procedure in the angiosuite permits completion of the diagnostic cerebral angiogram, brain biopsy, and hematoma evacuation at the same time, accelerating time to treatment for a patient with severe, symptomatic vasculitis.

Radiation risks during pediatric brain CT procedures in Morocco : A multicentre study

Head CT is a fast and non-invasive method of imaging the brain and skull. It can be used after a cerebral trauma to identify a skull fracture, cerebral edema or a cerebral hematoma. In other cases, it is prescribed in the presence of symptoms suggesting a lesion or a cerebral pathology such as violent headaches or epileptic fits. Children may be more sensitive to radiation and have a longer life span, leaving them at an increased risk of cancer than adults. The purpose of this study is to evaluate the detriment associated with exposure during pediatric CT examinations. Six radiology departments equipped with different CT machines calibrated according to international protocols were used in the study. In all, 180 patients underwent CT scans of the head. The effective radiation dose, cancer risk, and genetic risk were evaluated using the risk factor coefficients of the International Commission on Radiological Protection (ICRP). The effective dose for Moroccan hospitals is (2.70 ± 065) mSv. The cancer risk per head CT scan ranged from 42 to 428 with a mean value of 148 per 1 million head CT examinations. The hereditary risk per brain CT scan ranges from 2 to 16, with a mean value of 5 per 1 million head CT examinations. The effective dose and risk associated with head CT scans were above the average for one-third of the hospitals in this study. The likelihood of cancer and hereditary risk is significant when multiple images are acquired. Almost 66% of the procedures performed with normal results in the study. Yet, staff still need to further optimize the radiation dose during brain procedures.

O-GlcNAcase inhibitor has protective effects in intracerebral hemorrhage by suppressing the inflammatory response.

Intracerebral hemorrhage (ICH) is aggravated by immune cells that participate in the inflammatory response from the blood-brain barrier (BBB). O-Glycosylation has been reported to regulate the inflammatory response in the central nervous system but its cerebral protective effects remain unknown. Therefore, this study was carried out to investigate the protective effects of O-GlcNAcylation in a murine model of ICH and the possible mechanisms involved. The effects of O-GlcNAcylation on hematoma and edema formation were tested using pathological and dry/wet weight methods, whereas its effects on neural function were determined using neurologic tests. The effect of O-GlcNAcylation on BBB integrity was determined by Evans blue dye extrusion. Flow cytometry was used to quantify the immune cells in the central nervous system. Immunofluorescence was used to detect the protective effect of O-GlcNAcylation in ICH. The hematoma volume was significantly lower in the prevention and treatment groups than in the control group after ICH induction, indicating that O-GlcNAcylation had reduced the formation of cerebral hematoma in ICH. In the prevention and treatment groups, the modified neurological severity score, corner turn test and rotating rod test results were improved and the BBB integrity was better than that in the control group. O-GlcNAcylation also regulated the microglia, neutrophils and other central nervous system immune cells after ICH, effectively reducing the inflammatory response. O-GlcNAcylation played an important role in suppressing the inflammatory response, enhancing the BBB integrity and reducing edema after ICH.

An assessment on the use of infra-scanner for the diagnosis of the brain hematoma in head trauma

PurposeTimely identification and treatment of intracranial hematomas in patients with brain injury is essential for successful treatment. This study evaluates Infra-scanner as a handy medical screening tool for diagnosing, on-site, cerebral hematomas in patients with head injury. Materials and methodsPatients referred to the emergency department of university hospitals with mild to moderate brain trauma, up to 12 h from injury were included. NIR sensors of infra-scan device were placed on the right and left frontal, temporal, peritoneal and occipital parts of the head and light absorption was recorded. Positive or negative cerebral hemorrhage cases were compared with contrast-enhanced CT scan results as the gold standard. Diagnostic parameters of the device and cases related to bleeding were analyzed and reported. ResultsA total of 300 patients were studied. Sensitivity of the infrasound scanner in the Iranian study population was 94.8 (95% CI: 88% -100) and its specificity was 86.9 (95% CI: 79% -99% 99). Negative predictive value (NPV) was 90.3% and positive predictive value (PPV) was 92.9%. Sensitivity in men (95.7%) (95%CI, 90% -1) was more than women (95% CI, 81% -99%)90%. At the ages of less than 36 years, sensitivity (95.3%) and specificity (87.1%) were more than sensitivity (94.4%) and specificity (86.5%) over 36 years old. If the test had been performed in less than / equal to two hours from trauma, the sensitivity (94.9%) and the specificity (92%) were greater than the sensitivity (94.6%) and the specificity (75%) during when the scan had been performed in more than two hours from trauma. In general, in extra-axial bleeding including EDH, SAH, SDH, the sensitivity was 95.1% and the specificity was 84.5%, while in intra-axial bleeding, including ICH and IVH, the sensitivity was lower (93.9%) and the specificity was 91.7. The sensitivity of the device in detecting bleeding in the occipital lobe (95.8%) was higher than other brain lobes. ConclusionThis study shows that Infra-scanner is useful in initial examination and screening of patients with head injury and can be used as an adjunct to a CT scan or when not available and may allow earlier treatment which reduce the secondary damage to the hematoma.

Overview of systematic reviews/Meta-analysis of Xingnaojing Injection in treatment of intracerebral hemorrhage

To overview of systematic reviews/Meta-analysis of Xingnaojing Injection(XNJ) in the treatment of intracerebral hemorrhage(ICH). The systematic reviews concerning XNJ in the treatment of ICH were retrieved from four Chinese databases, four English databases, Chinese Clinical Trial Registry and ClinicalTrail.gov, with the retrieval time set from their inception to September 2020. Following the independent screening and data extraction by two researchers, a measurement tool to assess systematic evaluation 2(AMSTAR 2) and grades of recommendation, assessment, development and evaluation(GRADE) system were used to evaluate the metho-dological, reporting and evidence qualities of the 10 included systematic reviews. The results showed that XNJ was superior to the wes-tern medicine or conventional treatment in improving the effective rate and National Institutes of Health stroke scale(NIHSS) score, Barthel index(BI), and Glasgow coma scale(GCS) score and Chinese stroke scale(CSS) score, and reducing the mortality and cerebral hematoma volume, without inducing obvious adverse reactions. In general, the methodological, reporting and evidence qualities of the 10 included systematic reviews were poor. The AMSTAR 2 scores showed that key items No. 2 and No. 16 failed to meet the stan-dard, resulting in poor methodological quality. There was only one outcome indicator graded by GRADE as intermediate quality, 43% indicators as low quality, 42% indicators as extremely low quality, and none as high quality. These available evidences have suggested that the methodological, reporting and evidence qualities of the systematic evaluation concerning XNJ for the treatment of ICH need to be improved. Most evidences support that XNJ was better than the western medicine or conventional treatment in the treatment of ICH, but the methodological quality and the reliability of outcome indicators in relevant systematic review were low. More high-quality studies are still required for further verification.

Intracranial primary synovial sarcoma mimicking a spontaneous cerebral hematoma–a case report and review of the literature

BackgroundSynovial sarcoma is a soft tissue sarcoma, of uncertain histological origin, usually located near large joints and concerning mainly young adults. Intracranial presentation in the form of metastasis from a primitive body sarcoma has been rarely reported. However, intracranial primitive synovial sarcoma (IPSS) is extremely rare and only a few cases have been reported in the literature. Case descriptionWe present the case of a 48-year-old man, with no particular medical history, that was referred to our hospital for severe headache with a normal neurological exam and a CT cerebral scan showing a left frontal lobe hematoma. The initial cerebral CT scan didn’t show any vascular malformation and the body CT scan was negative for a primitive lesion. A close follow-up with a cerebral MRI three months later, demonstrated a T1 enhanced lesion with an important volume progression. The patient underwent a complete surgical removal of this lesion and the first pathology diagnosis was compatible with a meningioma. After further proofreading by an expert and molecular analysis, the diagnosis of monophasic synovial sarcoma was confirmed. Nine months after the first surgery, the follow-up MRI showed the progressive recurrence of the lesion and in this context the patient underwent a second surgery with total resection of the tumor and frontal thin margin excision. Afterwards, the patient was treated with adjuvant radiotherapy, with a good clinical evolution, and till now the follow-up shows no recurrence. ConclusionIPSS is an extremely rare sarcoma, with challenging diagnosis and difficult management. Specific molecular analysis is necessary. Complete resection followed by radiotherapy seem to be the most appropriate therapeutic approach. However, the prognosis is still poor. Our case is even rarer because of the initial presentation as a cerebral hematoma.

Recognition and Volume Measurement of Intracranial Hematoma through CT Images under Intelligent Recognition Algorithm

In order to realize the automatic recognition of intracranial hematoma and accurate measurement of hematoma volume in patients with ICH (intracerebral hemorrhage), the FCM algorithm (fuzzy c-means algorithm) was improved in this study, and a new level set segmentation algorithm based on FCM was obtained, FCRLS (fuzzy c-means regularized level set). Then, 120 ICH patients were used as the research objects, and the FCRLS algorithm was evaluated by the recall, precise, and F1-score values to evaluate the effect of intracranial hematoma recognition. The CT images of 48 patients with intracranial hematoma were used as the data set of the FCRLS algorithm. The hematoma was segmented, and the DSC (Dice similarity coefficient) value and running time were used to evaluate the segmentation results of the algorithm. At the same time, the LS (level set) algorithm and the FCM algorithm were introduced for comparison. The results show that the recall value of the FCRLS algorithm is 0.89, the precise value is 0.94, the F1-score value is 0.91, the Dice coefficient is 94.81%, and the running time is 14.48 s. Compared with the LS algorithm and the FCM algorithm, the above five indicators have significant differences ( P &lt; 0.05 ). Hematoma volume measurement found that the average error of FCRLS algorithm from expert measurement results was 5.62%, which was statistically significant compared with LS algorithm and FCM algorithm ( P &lt; 0.05 ). In summary, the FCRLS algorithm can accurately identify the cerebral hematoma area of ICH patients, has an ideal segmentation effect on the hematoma, and can accurately measure the true volume of the hematoma, which is worthy of clinical application.

Fulminant Guillain\u2013Barr\xe9 syndrome developed after surgical treatment of intracranial hemorrhage due to arteriovenous malformation: a case report

Guillain–Barré syndrome (GBS) is a rare autoimmune disorder. GBS after surgical treatment of intracranial hemorrhage due to arteriovenous malformation (AVM) is even rarer. We present a 62-year-old man diagnosed with intracranial AVM and cerebral hemorrhage. He developed GBS after the operation for AVM and cerebral hemorrhage. Following surgical excision of AVM and cerebral hematoma, the patient developed generalized weakness, with subsequent quadriplegia and life-threatening dyspnea. The diagnosis was confirmed to be the acute motor–sensory axonal neuropathy subtype of GBS after cerebrospinal fluid analysis and antibody tests. The patient responded poorly to immunoglobulin and steroid therapy. His family abandoned further management and signed out of the hospital against medical advice. Despite being rare, GBS can occur after intracranial hemorrhage and surgery. Clinicians should rule out GBS when patients show no improvement or develop new neurologic

Segmentation and 3D Reconstruction of Cerebral Hematoma Based on Deep Learning

Cerebral hemorrhage is a common clinical disease. Because of its rapid onset, high mortality and disability rate, in the treatment of cerebral hemorrhage, it is very important to accurately calculate the brain hematoma volume and feedback its location information in a short period of time. This paper proposes a method for precise segmentation and three-dimensional reconstruction of cerebral hematoma area based on deep learning. This method highlights the image information by expanding the CT image and eliminating the skull information, then accurately segments the cerebral hematoma areathrough the neural network model to build a three-dimensional model. We verify the experimental results based on the data set collected by the Affiliated Hospital of Xiangnan University, which proves the effectiveness of this method and its ability to significantly improve the speed incerebral hemorrhage area judgment and grasp information in clinical diagnosis.

Neuroprotective efficacy of 4-Hydroxyisoleucine in experimentally induced intracerebral hemorrhage.

Intracerebral hemorrhage (ICH) is a severe form of brain injury, which is a major cause of mortality in humans. Hydrocephalus and cerebral hematoma lead to severe neurological deficits. A single autologous blood (ALB) injection in rats' brains induces hemorrhage and other conditions that regularly interfere with the standard treatment of several cellular and molecular pathways. Several studies have found that IGF-1/GLP-1 decreases the production of inflammatory markers in peripheral tissues, while some have found that they also have pro-inflammatory functions. Since these receptors are down-regulated in hemorrhagic situations, we looked into the potential neuroprotective effect of 4-hydroxyisoleucine (4-HI); 50mg/kg and 100mg/kg, an active compound Trigonellafoenum-graecum, on post-hemorrhagic deficits in rats. Long-term oral administration of 4-HI for 35days has improved behavioral and neurochemical deficits and severe pathological changes and improved cellular and molecular markers, apoptotic markers in the ALB-induced ICH experimental model. Furthermore, the findings revealed that 4-HI also improved the levels of other neurotransmitters (Ach, DOPA, GABA, glutamate); inflammatory cytokines (TNF-alpha, IL-1β, IL-17), and oxidative stress markers (MDA, nitrite, LDH, AchE, SOD, CAT, GPx, GSH) in the brain when evaluated after Day 35. There is no proven treatment available for the prevention of post-brain hemorrhage and neurochemical malfunction; available therapy is only for symptomatic relief of the patient. Thus, 4-HI could be a potential clinical approach for treating post-brain haemorrhage and neurochemical changes caused by neurological damage. Furthermore, 4-HI may be linked to other standard therapeutic therapies utilized in ICH as a potential pharmacological intervention.

Appropriateness Of Prescribing Of Direct Oral Anticoagulants: A Prospective Cohort Study At CHU UCL Mont-Godinne-Dinant

Background and Objective Direct oral anticoagulants (DOACs) have been developed to address some of the limitations of Vitamin-K antagonists (VKAs) and are claimed to be easier to use. However, deviations from the recommended use have been reported, sometimes leading to serious adverse events (Sorensen R et al. BMJ Open 2013, Hussain S et al. Eur J Hosp Pharm 2013, Lim SL et al. Med J Aust 2013, Legrand M et al. Arch Intern Med 2011, Bene J et al. Ann Pharmacother 2012). Our objective was to evaluate the appropriateness of prescribing DOACs in real-life clinical practice. Setting and Method We conducted a prospective cohort study including patients admitted to a 450-bed teaching hospital (Belgium) from April to July 2013, who were taking rivaroxaban (Xarelto®) or dabigatran etexilate (Pradaxa®). A clinical pharmacist interviewed each patient to collect clinical and pharmaceutical data. Additional relevant information was retrieved from the electronic medical record. Appropriateness of prescribing was evaluated using the 10 criteria of the Medication Appropriateness Index (Samsa GP et al. J Clin Epidemiol 1994, Hanlon JT et al. J Clin epidemiol 1992). Explicit instructions were added, based on EU summary of the product characteristics and (inter)national guidelines. Due to limited cost-effectiveness data in Belgium, the tenth criterion of the MAI was not used. Main outcome measures The primary outcome measure was the prevalence of inappropriate prescribing, namely the proportion of patients with ≥1 inappropriate criterion. Secondary outcome measures included (a) a description of the main categories of inappropriateness prescribing, (b) comparison of results for patients on Xarelto® as compared to those on Pradaxa®, (c) the prevalence of adverse drug events and their relationship to inappropriate prescribing and (d) a description of interventions made by the clinical pharmacist to optimize prescribing. Results Fifty-two patients were evaluated (median age 74 years, range 51-89; 29 and 23 taking Xarelto® and Pradaxa®, respectively). Twenty-eight (53.8%) patients had at least one inappropriate rating: 1 inappropriate criterion in 26.9% and >1 in 26.9% of patients ([Figure 1][1]). The most frequent inappropriate criteria were: wrong dosage (32.7%, e.g. dose not adapted to renal function); inappropriate choice and modalities of administration (28.8%, e.g. prescription of a NOAC in a VKA-naive patient with extreme body weight, once daily administration of Pradaxa®); and unpractical modalities of administration (25.0%, e.g. Pradaxa® in non-adherent patients) ([Table 1][2]). Results were overall similar when comparing Pradaxa® and Xarelto®, indicating that the trend of inappropriate prescribing might not be related to one specific DOAC. Twenty-four patients (47.0%) had experienced one adverse event (e.g. 8 patients had a stroke or a transient ischemic accident, 6 had hematomas or non-characteristic bleedings, 3 had epistaxis incidents and 2 patients reported dyspepsia); and 7.8% more than one adverse event. The clinical pharmacist made 29 interventions during the study period; e.g. 11 request for specific coagulation assay, 8 switches to another oral anticoagulant, 3 dose adjustments and 3 therapeutic education. Thirteen patients had one clinical pharmacist intervention and 8 patients benefited from 2 interventions. ![Figure 1][3] Figure 1 Percentage of inappropriate ratings (C) per patient, using the Medication Appropriateness Index View this table: Table 1 Detailed ratings of appropriateness using the Medication Appropriateness Index (N) Conclusion The quality of prescribing DOACs was suboptimal. Off-label use was frequent and suggests that reinforcing education of health care professionals is needed. This should be a priority for the future. Disclosures: No relevant conflicts of interest to declare. [1]: #F1 [2]: #T1 [3]: pending:yes