Basal Ganglia Hemorrhage Research Articles

Endoscopic evacuation of basal ganglia hemorrhage via keyhole approach using an adjustable cannula in comparison with craniotomy.

Neuroendoscopic (NE) surgery as a minimal invasive treatment for basal ganglia hemorrhage is a promising approach. The present study aims to evaluate the efficacy and safety of NE approach using an adjustable cannula to treat basal ganglia hemorrhage. In this study, we analysed the clinical and radiographic outcomes between NE group (21 cases) and craniotomy group (30 cases). The results indicated that NE surgery might be an effective and safe approach for basal ganglia haemorrhage, and it is also suggested that NE approach may improve good functional recovery. However, NE approach only suits the selected patient, and the usefulness of NE approach needs further randomized controlled trials (RCTs) to evaluate.

Iatrogenic rupture of undiagnosed blood blister-like aneurysm during aneurysmal neck clipping.

Iatrogenic rupture of undiagnosed blood blister-like aneurysm during aneurysmal neck clipping.

Traumatic Basal Ganglia Hematoma

ABSTRACT Traumatic basal ganglia hemorrhage (TBGH) is characterized as a hemorrhagic lesion located in the basal ganglia or in internal capsule or thalamus. Outcome of TBGH is mainly determined by the extent of associated brain injuries particularly the larger the size, presence of coagulation disorders, diffuse, presence of intraventricular or brain stem hemorrhage, age ≥60, pupillary asymmetry, abnormal motor response, and severe head injury all are associated with poorer outcome. In present case, we discuss a case of adult male traumatic basal ganglia hemorrhage with good outcome. How to cite this article Agrawal A. Traumatic Basal Ganglia Hematoma. J Postgrad Med Edu Res 2014;48(3):154-156.

Cerebellar Hemorrhage in a Patient during the Convalescent Phase of Dengue Fever.

Cerebellar Hemorrhage in a Patient during the Convalescent Phase of Dengue Fever.

Pulmonary Artery Sling, Congenital Blindness and Basal Ganglia Hemorrhage: A Fortuitous Association?

Pulmonary artery sling (PAS) is a rare congenital vascular anomaly that typically presents in the first month of life with severe respiratory symptoms. A small subset of patients with this anomaly survives to adulthood with few or no symptoms. Several associated congenital anomalies were described. In this article, we describe an incidental finding of an asymptomatic PAS in an adult patient with congenital anisocoria and blindness 2 years after a spontaneous intracerebral hemorrhage. To the best of our knowledge, this is the first report on this association in an elderly patient. We believe that its documentation might contribute to a better understanding of this anomaly and its implications. J Med Cases. 2014;5(1):34-35 doi: http://dx.doi.org/10.4021/jmc1617w

“The Fainted Man:” Hypoperfusion Encephalopathy in a Patient With Moyamoya

Back to table of contents Previous article Next article LettersFull Access“The Fainted Man:” Hypoperfusion Encephalopathy in a Patient With MoyamoyaAna Filipa Santos, M.D., João Pinho, M.D., Carla Ferreira, M.D., Celeste Pereira, M.D., Manuel Ribeiro, M.D., and Jaime Rocha, M.D.Ana Filipa SantosSearch for more papers by this author, M.D., João PinhoSearch for more papers by this author, M.D., Carla FerreiraSearch for more papers by this author, M.D., Celeste PereiraSearch for more papers by this author, M.D., Manuel RibeiroSearch for more papers by this author, M.D., and Jaime RochaSearch for more papers by this author, M.D.Published Online:1 Jan 2014https://doi.org/10.1176/appi.neuropsych.13020026AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Moyamoya disease is a progressive cerebral vasculopathy of unknown etiology, characterized by severe bilateral stenosis/occlusion of the main arteries of the circle of Willis, with a pattern of collateral vessels that look like a “puff of smoke” on angiography.1 It is more common in Asian populations and more prevalent in women.1 The diagnosis peaks in two age-groups: children approximately 5 years old, and adults in their mid-40s.1 It may have variable clinical presentation: ischemic stroke, transient ischemic attack, intracranial hemorrhage, headache, seizures, involuntary movements, cognitive deficits, and psychiatric changes.1 In adults, it usually presents with intracranial hemorrhage or ischemic symptoms.2 Acute cerebral ischemia occurring after intracranial bleeding has rarely been reported and is not well understood.2,3 We describe a case of hypoperfusion encephalopathy after intracerebral hemorrhage occurring as the first manifestation of moyamoya disease.A 77-year-old male patient, with a long-standing history of uncontrolled hypertension, was admitted to our stroke unit upon being found unconscious. His blood pressure was 174/100 mmHg and Glasgow Coma Scale rated 3 (no eye opening, no verbal response, no motor response), with reactive pupils and right extensor plantar reflex. Computed tomographic (CT) scan showed left basal ganglia hemorrhage, extending into the ventricles and subarachnoid space. Antihypertensive and hyperosmotic therapy was started, and the initial evolution was favorable, with recovery of consciousness, confused verbal response, and right hemiparesis Grade 3 (MRC). By Day 14, multifocal myoclonus appeared, with decreased arousal and ensuing severe encephalopathy. Follow-up CT revealed hemorrhage reabsorption and no hydrocephaly. Laboratory studies were unrevealing. An electroencephalogram showed only slow background activity (5–6 Hz). Infections, metabolic, and toxic causes were also excluded. Brain diffusion-weighted imaging (DWI) MRI was negative for acute ischemic lesions. At this point, hypoperfusion encephalopathy was suspected and confirmed by perfusion CT (Figure 1). CT angiography disclosed stenosis of the distal intracranial internal carotid artery (ICA) bilaterally, extending to the proximal anterior (ACA) and middle cerebral (MCA) arteries. Moyamoya disease was diagnosed and was classified as Grade IV (Suzuki Grading System) by conventional angiography (Figure 2). Because of his clinical condition, revascularization was not considered.FIGURE 1. Transverse Perfusion CT Map Shows Global Decreased Cerebral Blood Flow (CBF), Mainly in Middle Cerebral Arteries (MCA) and Anterior Cerebral Arteries (ACA) AreasFIGURE 2. Right (A1/A3) and Left (A2/A4) Internal Carotid Angiograms (ICAs) Show Severe Stenosis of the Bilateral Distal Internal Carotid Artery, With Retrograde Filling of the Peri-Callosal Branches (*) of the ACAs and Basal Moyamoya Vessels “Puff of Smoke” Sign (arrow)We report this case because of the rarity of moyamoya diagnosis in elderly persons and because of the atypical presentation. Our patient seemed to be permanently “fainted;” he had global hypoperfusion, but no real ischemic changes. The initial manifestation was interpreted as a hypertensive intracerebral hemorrhage. Later, when we detected hypoperfusion encephalopathy, Moyamoya was diagnosed. Vasospasm, in association with both subarachnoid and intraventricular hemorrhage, and hypotension and dehydration, resulting from the administration of hyperosmotic agents to control hemorrhage-related increased intracranial pressure, may have caused hemodynamic compromise, being possible contributing factors to the hypoperfusion encephalopathy in our patient. Other factors, such as hypocapnia and shrinkage of the moyamoya vessels, have also been proposed as mechanisms in acute cerebral ischemia occurring after intracranial bleeding.2,3 The initial clinical presentation of hemorrhage and the presence of severe bilateral ICA stenosis affecting cerebral perfusion are predictors of very poor outcome in our patient.Neurology Department, Hospital de Braga, Braga, PortugalInternal Medicine Department, Hospital Santa Maria Maior Barcelos, Barcelos, PortugalNeuroradiology Department, Hospital de Braga, Braga, PortugalCorrespondence: Ana Filipa Santos, M.D.; e-mail: [email protected]comReferences1 Scott RM, Smith ER: Moyamoya disease and moyamoya syndrome. N Engl J Med 2009; 360:1226–1237Crossref, Medline, Google Scholar2 Kim DS, Jang DK, Huh PW, et al.: Ischaemic stroke after acute intracranial haemorrhage in patients with moyamoya disease: six new cases and a short literature review. Acta Neurochir (Wien) 2011; 153:1253–1261Crossref, Medline, Google Scholar3 Shibamoto K, Aoyama K, Taki H, et al.: Acute cerebral ischemia after intracranial bleeding in unilateral moyamoya disease: case report. Neurol Med Chir (Tokyo) 2012; 52:346–349 [Tokyo]Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited ByNone Volume 26Issue 1 Winter 2014Pages E31-E33 Metrics PDF download History Published online 1 January 2014 Published in print 1 January 2014

Neuropathologic analysis of hematomas evacuated from patients with spontaneous intracerebral hemorrhage

Spontaneous intracerebral hemorrhage (ICH) is a devastating cause of morbidity and mortality. Intraparenchymal hematomas are often surgically evacuated. This generates fragments of perihematoma brain tissue that may elucidate their etiology. The goal of this study is to analyze the value of these specimens in providing a possible etiology for spontaneous ICH as well as the utility of using immunohistochemical markers to identify amyloid angiopathy. Surgically resected hematomas from 20 individuals with spontaneous ICH were examined with light microscopy. Hemorrhage locations included 11 lobar and nine basal ganglia hemorrhages. Aβ immunohistochemistry and Congo red stains were used to confirm the presence of amyloid angiopathy, when this was suspected. Evidence of cerebral amyloid angiopathy (CAA) was observed in eight of the 20 specimens, each of which came from lobar locations. Immunohistochemistry confirmed CAA in the brain fragments from these eight individuals. Patients with immunohistochemically confirmed CAA were older than patients without CAA, and more likely to have lobar hemorrhages (OR 3.0 and 3.7, respectively). Evidence of CAA was not found in any of the basal ganglia specimens. One specimen showed evidence of CAA-associated angiitis, with formation of a microaneurysm in an inflamed segment of a CAA-affected arteriole, surrounded by acute hemorrhage. In another specimen, Aβ immunohistochemistry showed the presence of senile plaques suggesting concomitant Alzheimer's disease (AD) changes. Surgically evacuated hematomas from patients with spontaneous ICH should be carefully examined, paying special attention to any fragments of included brain parenchyma. These fragments can provide evidence of the etiology of the hemorrhage. Markers such as Aβ 1-40 can help to identify underlying CAA, and should be utilized when microangiopathy is suspected. Given the association of (Aβ) CAA with AD, careful examination of entrapped brain fragments may also provide evidence of AD in a given patient.

Application of water jet dissection technique in surgical treatment of hypertensive basal ganglion hemorrhage through transsylvian transinular or temporal lobe approach

目的 探讨水分离技术在高血压基底节区脑出血手术治疗中的应用及体会。方法 回顾性分析2011年1月至2012年12月收治的62例高血压基底节区脑出血,其中43例采用常规手术清除血肿，19例术中应用水分离技术解剖侧裂和清除血肿。对比两组手术时间及术后血肿清除范围。结果 常规方式组手术时间在（3±0.30）h；水分离技术组(2.5±0.30)h。常规组20例血肿完全清除，16例血肿清除大于90%，7例小于90%；水分离技术组17例血肿完全清除，2例血肿清除大于90%(c 2 =10.40， P ＜0.05)。结论 水分离技术是一种安全简便的微创技术，在经侧裂岛叶入路清除血肿中能很好的帮助解剖侧裂,在经颞叶清除血肿时,也能很容易将血肿整块清除,且对周围脑组织损伤小，血肿清除彻底。

Brain MR Findings in Patients with Systemic Lupus Erythematosus with and without Antiphospholipid Antibody Syndrome

Antiphospholipid syndrome may affect the incidence and pathogenesis of cerebrovascular diseases in patients with systemic lupus erythematosus. We compared the spectrum of MR findings in patients with systemic lupus erythematosus with and without antiphospholipid syndrome. We identified 256 patients with systemic lupus erythematosus (45 with, 211 without antiphospholipid syndrome) who underwent MR studies; in 145 (57%), we detected abnormalities. These were categorized as large territorial, lacunar, localized cortical, and borderzone infarctions and as microembolisms, basal ganglia lesions, callosal lesions, hemorrhages, and white matter hyperintensity on T2-weighted and/or FLAIR images, and as stenotic arterial lesions on MR angiograms. Logistic regression analysis was performed to compare the MR findings in patients with systemic lupus erythematosus with and without antiphospholipid syndrome, with patient age and antiphospholipid syndrome as the covariates. Abnormal MR findings were more common in patients with systemic lupus erythematosus with antiphospholipid syndrome (73% versus 53%). Large territorial (P = .01), lacunar (P = .01), localized cortical (P < .01), borderzone infarcts (P < .01), basal ganglia lesions (P = .03), stenotic arterial lesions (P = .04), and the rate of positive findings on MR imaging (P = .01) were significantly associated with antiphospholipid syndrome. Irrespective of age, significantly more patients with antiphospholipid syndrome manifested lacunar infarcts in the deep white matter (P < .01), localized cortical infarcts in the territory of the MCA (P < .01), bilateral borderzone infarcts (P < .01), and anterior basal ganglia lesions (P = .01). Abnormal MR findings were more common in patients with systemic lupus erythematosus with than in those without antiphospholipid syndrome. Large territorial infarctions, lacunar infarctions in the deep white matter, localized cortical infarctions in the MCA territory, bilateral borderzone infarctions, anterior basal ganglia lesions, and stenotic arterial lesions are common MR findings in patients with systemic lupus erythematosus with antiphospholipid syndrome.

Epidemiological and clinical characteristics of 266 cases of intracerebral hemorrhage in Hangzhou, China

Ethnicity and socioeconomic factors can influence disease susceptibility, clinical presentation, and outcome. We investigated the clinical characteristics (age, sex, seasonal variation, lesion site, symptoms, complications, prognosis, and sequelae) and risk factors for intracerebral hemorrhage (ICH) in 266 cases treated at our hospital in Hangzhou City, China, from January 2011 to December 2011. Risk of ICH increased dramatically with age; only 4.3% of cases were <30 years old, while 44.4% were >60 years of age. Men outnumbered women by 2:1 (67.3% vs. 32.7%). Single hemorrhage was most often located in the cerebral lobes (37.2% of cases), basal ganglia (34.2%), thalamus (8.3%), cerebellum (6.8%), ventricle (1.5%), and brainstem (1.1%), while 10.9% of cases exhibited hemorrhages at multiple sites. Hypertension was also a major risk factor for ICH, as 47% of all patients were hypertensive and the percentage increased with age. In hypertensive patients, the most common hemorrhage site was the basal ganglia and ICH was often associated with thrombopenia. In patients with leukemia (all forms), most hemorrhages were lobar. Warfarin- and encephalic operation-associated ICHs were all lobar. Headache was the major symptom of occipital, temporal, and frontal lobe hemorrhage. Dizziness, nausea, and vomiting were the major symptoms of cerebellum hemorrhage. Limb dysfunction was the major symptom of thalamic and basal ganglia hemorrhage. Disturbed level of consciousness was the major symptom in multisite, ventricular, parietal lobe, and brainstem hemorrhage. Hyperspasmia occurred most often in lobar hemorrhage and blurred vision in occipital lobe hemorrhage. Hospital mortality was 24.4% (n=65) with a mean delay from presentation to death of (10.5±18.5) d. The majority of fatalities were cerebral hernia cases (58.5%) and these patients also had the shortest time to death [(2.9±3.5) d]. Mortality was 100% in brainstem ICH and hemorrhagic conversion of cerebral infarct. Thrombopenia-associated ICH also had a high mortality rate (81.0%), while patients with cerebrovascular malformations and cerebral aneurysms demonstrated a much better prognosis (46.2% recovery).

Analysis of clinical characteristics and outcomes in very elderly patients with primary intracerebral hemorrhage

Objective To investigate the clinical characteristics and outcomes in very elderly patients with primary intracerebral hemorrhage (PICH).Methods Patients with PICH,who were admitted to the Department of Neurosurgery and Department of Neurology,West China Hospital,Sichuan University between January,2009 and December,2010,were consecutively and prospectively enrolled in this study.Data on PICH patients were collected which included demographics,risk factors,blood pressure and GCS on admission,treatment and neurological imaging results.Patients were divided into two groups:the very elderly (≥80 years old) group and the control group.Patients were followed up at time points of 1-month,3-month and 6-month to verify their death and disability.Results Of the 909 cases,60 patients were in very elderly group.The very elderly patients had apparently lower diastolic pressure than patients in control group on admissi on (89.5 mm Hg vs 99.5 mm Hg,P ＜ 0.001),and had lower proportion of recieving surgery treatment (13.3％vs 28.6％,P =0.01).Compared to the control group,the very elderly patients had a lower frequency of basal ganglia hemorrhage (30.0％ vs 54.2％,P ＜ 0.001),but a higher proportion of cerebellar hemorrhage(15.0％ vs 6.8％,P =0.035).Moreover,the very elderly patients had higher rates of death and disability in 1-month,3-month and 6-month follow-up,but the difference was not statistically significant.Multivariate logistic regression determined that age and GCS score were the independent factor for the 6-month death of very elderly patients with PICH (P =0.025,P =0.004).Conclusions There were some differences in clinical characteristics,intracerebral hemorrhage location and treatment between the very elderly patients and yonger people with PICH,however,these differences do not seem to influence long-term outcome. Key words: Primary intracerebral hemorrhage; Very elderly; Clinical characteristics; Outcome

Neural substrate in a case of foreign accent syndrome following basal ganglia hemorrhage

Abstract Foreign accent syndrome (FAS) is a rare expressive language output disorder due to acquired inability to make the normal phonetic and phonemic contrasts of one's native dialect. A 37-year-old woman who was monolingual in Korean developed FAS after a left basal ganglia hemorrhage. We assessed perceived speech by phonetic analysis and diffusion tensor tractography (DTT) and performed functional magnetic resonance imaging (fMRI) using a picture naming task. One year after the onset of FAS, her initial English-like accent substantially improved to a Seoul accent, but was not completely recovered to the prestroke level. DTT showed disconnected and decreased numbers of fibers in the left arcuate fasciculus (AF), and these findings were unchanged when the patient was assessed at follow-up. The fMRI analysis showed activation on the bilateral cortical and subcortical speech-motor network: 1) the left cortical language area including Broca's area, the oromotor cortex, and the bilateral superior cerebellum, and 2) the right subcortical structures, including the caudate and thalamus. Our findings suggest that FAS may be caused by the disruption of the cortico-subcortical language network and that subcortical structures, including the basal ganglia, may have an important role in the development of speech motor control deficits in FAS. We also found that neuroplastic change in the damaged cortico-subcortical speech-motor network compensates for FAS and induces clinical improvement.

The correlation between lateralization of intracerebral hemorrhage in basal ganglia and handedness

To investigate the correlation between lateralization of cerebral basal ganglia hemorrhage and handedness. Medical records and computed tomography (CT) scans for 84 patients with primary hypertensive intracerebral hemorrhage (ICH) in basal ganglia were reviewed. Data of gender, age, handedness, and location of basal ganglia hematoma were statistically analyzed. Data of age, gender, handedness, health condition, and mean blood flow velocity (BFV) in middle cerebral arteries (MCAs) and anterior cerebral arteries (ACAs) on both sides of 114 healthy individuals were statistically analyzed. We found out that the patients with right basal ganglia hemorrhage were mostly left-handed, while patients with left basal ganglia hemorrhage were mostly right handed (p=0.021, r=0.251). And the mean BFV in the right MCAs of left-handed ones are relatively higher, the mean BFV in the left MCAs of right-handers are relatively higher (p=0.008, r=0.248). There 's a correlation between lateralization of cerebral basal ganglia hemorrhage and handedness.

Surgical treatment for large spontaneous basal ganglia hemorrhage: retrospective analysis of 253 cases

Objectives. Spontaneous intracerebral hemorrhage (ICH) is a challenge to both neurologists and neurosurgeons. We aim to summarize the surgical treatment of ICH based on retrospective analysis of our patients. Methods. Two hundred and fifty-three patients with spontaneous ICH from August 2008 to August 2011 were retrospectively analyzed. Clinical data, including preoperative ICH score, pre- and postoperative GCS score, hematoma volume, postoperative brain infarction, 30-day mortality, and GOS 3 months postictus, were collected. One hundred and fifty patients had their intracranial pressure (ICP) monitored, and data were recorded and analyzed. All patients underwent craniotomy and clot removal under general anesthesia. Outcome analysis was stratified using hematoma volume, ICH score, preoperative GCS score, and decompressive craniectomy (DC). Results. The mean hematoma volume was 70.8 mL, and 68 patients (26.9%) underwent DC. The mean postoperative ICP was 28.8 ± 6.7 mmHg for patients without DC, and only 17.5 ± 8.6 mmHg for patients with DC. Twenty-five patients (9.9%) died within 30 days of operation, and 88 patients (34.8%, GOS ≥ 4) had good outcome 3 months after surgery. ICH volume > 50 mL, preoperative GCS score ≤ 8, and ICH score ≥ 3 are risk factors for unfavorable outcomes. Conclusions. DC can be used for patients with low preoperative GCS score, and it effectively reduces ICP and 30-day mortality. Hematoma volume, preoperative GCS score, and ICH score are of predictive value for surgical outcome of large basal ganglia hemorrhage.

Basal Ganglia Hemorrhage: Minimally Invasive and Neuro-Navigation Guided Treatment by Injection of Recombinant Tissue-Type Plasminogen Activator (rtPA)

Objective: Since open surgical evacuation of basal ganglia hemorrhage (BGH) as had been proved did not lead to the desired benefit for the patients, we used minimally invasive clot lysis by injection of recombinant tissue-type plasminogen activator (rtPA). Methods: Patients with spontaneous BGH with or without accompanied intraventricular hemorrhage were included in the study. Following diagnosis of BGH by CT scanning, a catheter was inserted through a small burr hole under neuro-navigation assistance into the centre of hemorrhage and three mg rtPA was injected for three consecutive days. CT scans were performed daily to determine the volume of the hemorrhage. The size of hemorrhage was calculated using the ABCs measuring method. The clinical condition of the patients was classified using the Glasgow coma scale (GCS) and Glasgow outcome scale (GOS). Statistical analysis was performed using the Fisher’s exact test and Chi-square with Yates’ correction. The p-values were calculated with two tails and statistical significance was estimated as p-value <0.05. Results: The procedure was performed on 22 patients (11 females and 11 males). The mean age of the patients was 64 years (range: 44–80 years). Among the patients, 7 (31.8%) were considered in a poor clinical condition, 11 (50%) in an intermediate condition and 4 (18.2%) in a good clinical condition. The total mortality was calculated with n=3 (13.64%). The mean volume of hemorrhage before treatment was 35.14 mL (range 11.5 mL – 67.15 mL). After the third injection, a mean volume reduction of 73.05% could be achieved. Considering the accuracy of the neuro- navigation dataset, correct placement of the drainage in the assumed center of hemorrhage was confirmed in all cases by CT scanning after the first injection. Re-bleeding occurred in 4 cases (18.2%). Conclusion: Treatment with rt-PA in BGH seems an easy, safe and minimally invasive alternative to open surgical hematoma evacuation and it might be more favorable compared to conservative treatment. In our study, we achieved a mean volume of hemorrhage reduction of 73% after 3 days. Clot lysis alone was not the only predictive factor for a better outcome. Outcome prognosis should take several other co-factors into account such as the age of the patient and the GCS at the time of Admission. Large prospective and randomized trials are still necessary to answer these open questions

Severe Posterior Reversible Encephalopathy in Pheochromocytoma: Importance of Susceptibility-Weighted MRI

Pheochromocytoma is a rare cause of hypertension in children. Hypertension is one of the common reasons of posterior reversible encephalopathy. Intracerebral hemorrhage is a serious and unexpected complication of hypertensive encephalopathy due to pheochromocytoma, and very rarely seen in the childhood. Intracerebral hemorrhages should be searched if there are hypertensive reversible signal changes on the brain. Susceptibility weighted imaging (SWI) is a more sensitive method than conventional MRI when demonstrating cerebral microhemorrhagic foci. This is the first report of SWI findings on intracerebral hemorrhages in basal ganglia, brain stem and periventricular white matter due to hypertensive encephalopathy in a child with pheochromocytoma.

Glioma Mimicking a Hypertensive Intracerebral Hemorrhage

Here, we report a rare case of an anaplastic astrocytoma masquerading as a hypertensive basal ganglia hemorrhage. A 69-year-old woman who had been under medical management for hypertension during the past 3 years suddenly developed right hemiparesis with dysarthria. Brain computed tomography (CT) scans with contrast and CT angiograms revealed an intracerebral hemorrhage (ICH) in the left basal ganglia, without an underlying lesion. She was treated conservatively, but underwent a ventriculoperitoneal shunt operation 3 months after the initial attack due to deteriorated mental status and chronic hydrocephalus. Three months later, her mental status deteriorated further. Magnetic resonance imaging (MRI) with gadolinium demonstrated an irregular enhanced mass in which the previous hemorrhage occurred. The final histological diagnosis which made by stereotactic biopsy was an anaplastic astrocytoma. In the present case, the diagnosis of a high grade glioma was delayed due to tumor bleeding mimicking hypertensive ICH. Thus, a careful review of neuroradiological images including MRI with a suspicion of tumor bleeding is needed even in the patients with past medical history of hypertension.

A study of the therapeutic effect of transfrontal craniopuncture and drainage in treating moderate basal ganglia hemorrhage

In this study, 198 patients with moderate basal ganglia hemorrhage (30-60 ml) were treated with craniopuncture and drainage through frontal approach within 7 d after onset. Conventional symptomatic treatment was adopted after the operation. Two patients died and 5 were in persistent vegetative state [Glasgow Outcome Scale (GOS) Ⅱ]. All survivals were followed up for 6 months after operation, and 171 patients achieved good results [Activity of Daily Living Scale (ADL) and Barthel Index (BI) of moderate, mild dependence or complete independence]. The total efficiency was 86.36%(171/198). Transfrontal craniopuncture and drainage is a safe and effective method for the treatment of moderate basal ganglia hemorrhage.

Superselective intracranial arterial thrombolysis with rt-PA, mechanical fragmentation and (or) solitairAB sent thrombectomy in patients with acute cerebral artery occlusion

Objective To study the clinical effects and safety of the treatment in acute cerebral artery occlusion with superselective intracranial arterial thromblysis by rt-PA,mechanical fragmentation by microcatheter and microguid wire and (or) solitairAB sent thrombectomy.Methods 42 patients of acute cerebral artery occlusion were treated by superselective intracranial arterial thrombolysis,mechanical fragmengation and (or) solitairAB sent thrombectomy from October 2010 to March 2012 and the data were retrospectively reviewed.Results Occluded arteries of 42 patients were dredged totally or partialy,the recanalization rate or partial recanalization rate of blocked blood vessel was 100％,including 37 cases with total recanalization (88％).After operation one case suffered from cerebral hemorrhage of basal ganglia,one subarachnoid hemorrhage,and one died of ardent fever after 8 days.9 cases (21％) remained functional impairments to some extents after medical therapy.The ranks of NIHSS between preoperation and 1 week after operation were discrepant obviously.Conclusions Superselective intracrainal arterial thrombolysis by rt-PA and papaverine,mechanical fragmentation by microcagheter and micoguide wire and (or) solitairAB sent thrombectomy in patients of acute cerebral artery occlusion is a safe and an effective therapy within the right time. Key words: Mechanical fragmentation ; Sent thrombectomy; Cerebrovascular occlusion ; Arterial thrombolysis

High concentrations of visfatin in the peripheral blood of patients with acute basal ganglia hemorrhage are associated with poor outcome

Higher plasma visfatin concentration has been associated with clinical outcomes of traumatic brain injury. No published information exists to date about change in plasma visfatin after intracerebral hemorrhage. This study included one hundred and twenty-eight healthy controls and 128 patients with intracerebral hemorrhage. The unfavorable outcome was defined as modified Rankin Scale score >2 at 6 months. The patients had higher plasma visfatin measurements than control subjects. Plasma visfatin levels were highly correlated with National Institutes of Health Stroke Scale score and plasma C-reactive protein levels in the patients. A multivariate analysis identified plasma visfatin level as an independent predictor for 6-month mortality and unfavorable outcome. According to receiver operating characteristic curve analysis, the predictive value of the plasma visfatin concentration was similar to National Institutes of Health Stroke Scale score. In a combined logistic-regression model, visfatin improved the predictive value of National Institutes of Health Stroke Scale score for 6-month unfavorable outcome. Thus, increased plasma visfatin level is associated with 6-month clinical outcomes after intracerebral hemorrhage.