Basal Ganglia Hemorrhage Research Articles

Non-surgical Recovery of a Chronic Subdural Hemorrhage Patient via the Exclusive Administration of <italic>Oryeong-san</italic>: A Case Report

Introduction: Chronic subdural hemorrhage (CSDH) primarily affects the elderly, and its incidence is rising due to aging trends. Although burr-hole craniostomy is a common treatment for CSDH, it often has a high recurrence rate and can sometimes result in poor outcomes. Oryeong-san, a traditional Korean medicine, is emerging as a potential remedy, with documented cases in both Korea and Japan.Case Presentation: In March 2021, a patient was diagnosed with an intracerebral hemorrhage in the left basal ganglia. A subsequent brain computed tomography in June 2022 revealed CSDH. Given the potential need for surgery if no CSDH absorption occurred, the patient was treated with <i>Oryeong-san</i>. Later computed tomography scans indicated that surgery was no longer necessary.Conclusions: This study evaluated the efficacy of <i>Oryeong-san</i> in treating CSDH. The results demonstrated complete CSDH absorption with no observed side effects, highlighting <i>Oryeong-san</i> as a promising and safe therapeutic option.

Application effect of head-mounted mixed reality device combined with 3D printing model in neurosurgery ventricular and hematoma puncture training

BackgroundThe purpose of this study was to explore the applicability of application effect of head-mounted mixed reality (MR) equipment combined with a three-dimensional (3D) printed model in neurosurgical ventricular and haematoma puncture training.MethodsDigital Imaging and Communications in Medicine (DICOM) format image data of two patients with common neurosurgical diseases (hydrocephalus and basal ganglia haemorrhage) were imported into 3D Slicer software for 3D reconstruction, saved, and printed using 3D printing to produce a 1:1-sized head model with real person characteristics. The required model (brain ventricle, haematoma, puncture path, etc.) was constructed and imported into the head-mounted MR device, HoloLens, and a risk-free, visual, and repeatable system was designed for the training of junior physicians. A total of 16 junior physicians who studied under this specialty from September 2020 to March 2022 were selected as the research participants, and the applicability of the equipment and model during training was evaluated with assessment score sheets and questionnaires after training.ResultsAccording to results of the assessment and questionnaire, the doctors trained by this system are more familiar with the localization of the lateral anterior ventricle horn puncture and the common endoscopic surgery for basal ganglia haemorrhage, as well as more confident in the mastery of these two operations than the traditional training methods.ConclusionsThe use of head-mounted MR equipment combined with 3D printing models can provide an ideal platform for the operation training of young doctors. Through holographic images created from the combination of virtual and real images, operators can be better immersed in the operation process and deepen their understanding of the operation and related anatomical structures. The 3D printed model can be repeatedly reproduced so that doctors can master the technology, learn from mistakes, better achieve the purpose of teaching and training, and improve the effect of training.

Endoport Assisted Endoscopic Surgery for Hypertensive Basal Ganglia Hemorrhage by Transsylvian Approach: Technical Nuances and Preliminary Clinical Results

There is no clear evidence on the indication and surgical approaches on evacuating basal ganglia hemorrhage caused by hypertensive bleeding. Some studies have shown that minimally invasive approaches have therapeutic potentials, but its benefits remain inconclusive. We describe an endoport assisted endoscopic transsylvian approach for basal ganglia hemorrhage evacuation. We evaluate the safety and efficacy of this approach in a cohort study. We included 19 patients (mean age 57years) who underwent the surgery at a single county-level hospital in Yunan Province, China. The majority had a Glasgow coma scale between 9 and 12 on admission. The midline shift ranged from 16-29mm (mean 19mm). Hematoma volume ranged from 46 to 106ml (mean 67ml). Six patients (31.6%) presented with intraventricular hemorrhage. All patients achieved greater than 90% decrease in hematoma volume at postoperative computed tomography scan. The average operative time was 115 minutes and average blood loss of 44ml. The most common postoperative complication was pulmonary infection (63.2%). No rebleeding, seizure, infectious meningitis, or postoperative mortality was observed. A total of 17 patients (89.5%) achieved good functional recovery at follow up within 90days after surgery (Glasgow outcome scale 4-5) and 2 patients had severe disability (Glasgow outcome scale 3). Endoport assisted endoscopic surgery through transsylvian approach is safe and effective treatment for hypertensive basal ganglia hemorrhage. The majority of patients have good functional recovery and the rate of severe complications is low.

Intensive Management of Spontaneous Basal Ganglia Hemorrhage: A Case Report

Background: Simultaneous non-traumatic bilateral basal ganglia haemorrhage is an infrequent entity. ICH accounts for 10 to 20 % of all cerebrovascular events in the US, with 30-day mortality up to 40%. The predisposing factors and pathophysiological processes leading to simultaneous bilateral basal ganglia development are not well known.
 Case presentation: A 43-year-old female patient was diagnosed with spontaneous intracerebral haemorrhage in the left basal ganglia and intraventricular haemorrhage. The patient underwent an urgent ICH evacuation craniotomy. After the procedure, the patient was treated in the intensive care unit. The patient was intubated for 4 days. Then, on the fifth day of stay in the ICU, a tracheostomy was performed on the patient.
 Conclusion: Spontaneous ICH has high mortality and morbidity. ICH management is mainly on timely targeted blood pressure management, effective and rapid reversal of coagulopathy to prevent hematoma expansion, and uncompromising intracranial pressure management.

Prediction of Basal Ganglia Hematoma Expansion Based on Radiomics and Clinical Characteristics: A Novel Multivariate Predictive Nomogram

Background. This study is aimed at formulating and authenticating a pioneering nomogram integrating noncontrast computed tomography (NCCT) mean CT densities (m-CTD) of hematoma, morphological indicators from NCCT hematoma, and clinical manifestations to foresee hematoma expansion (HE) in patients suffering from spontaneous basal ganglia hemorrhage (BGH). Methods. A predictive model was constructed by retrospectively evaluating the data from 406 patients. This model was externally validated using an independent dataset of 174 patients. Multivariate logistic regression analysis was deployed to discern independent prognostic indicators and to generate a nomogram for HE prediction. Model calibration was examined using 1000 bootstrap samples for internal validation. Results. Multivariate logistic regression disclosed that m-CTD (odds ratio (OR) 0.846, 95% confidence interval (CI) 0.782-0.909), baseline hematoma volume (BHV) (OR 1.055, 95% CI 1.017-1.095), NCCT blend sign (BS) (OR 3.320, 95% CI 1.704-6.534), NCCT black hole sign (BHS) (OR 2.468, 95% CI 1.293-4.729), systolic blood pressure (SBP) (OR 1.027, 95% CI 1.014-1.040), and homocysteine (Hcy) (OR 1.075, 95% CI 1.038-1.114) were independent predictors of HE. The area under the curve (AUC) for the training and validation datasets yielded 0.874 and 0.883, respectively. The calibration curve for the nomogram closely approximated the optimal diagonal. The decision curve analysis (DCA) indicated that the prediction model offers substantial net benefits. Conclusions. The innovative predictive nomogram, leveraging radiomics and clinical traits of hematoma, presents a potent and noninvasive tool for HE risk stratification. The method of quantifying mean hematoma density holds significant prognostic value in forecasting HE.

Comparison of endoscopic evacuation, craniotomy, and puncture aspiration for the treatment of spontaneous basal ganglia intracerebral hematoma

ObjectiveTo compare the prognosis of patients with spontaneous basal ganglia intracerebral hematoma treated by endoscopic evacuation, craniotomy, or puncture aspiration. MethodsThis retrospective observational study included information from patients with basal ganglia hematoma who received craniotomy, endoscopic evacuation, or puncture aspiration in the Department of Neurosurgery of the First Affiliated Hospital of USTC between January 2016 and May 2021. Patients were grouped according to their treatment method for comparison. ResultsFrom a total of 184 patients, 62 cases (51 males, aged 54.44 ± 9.92 years) received craniotomy, 64 cases (45 males, aged 53.97 ± 11.87 years) received endoscopic evacuation, and 58 cases (43 males, aged 54.25 ± 10.35 years) received puncture aspiration. No significant difference was found in baseline characteristics among three surgical procedures. Patients in the endoscopy group had the shortest hospital stay (15.16 ± 4.89 days vs. 17.88 ± 5.97 and 20.77 ± 6.96 days), lowest infectious meningitis [1(1.6 %) vs. 2(3.4%) and 8(12.9%)] and pulmonary infection [3(4.7%) vs. 5(8.6%) and 13(21.0%)] rates, and highest hematoma removal rate (90.39 ± 5.22% vs. 35.87 ± 6.23 and 84.76 ± 4.91%) and Glasgow outcome scale 6 months after surgery (4.41 ± 0.53 vs. 3.74 ± 1.09 and 3.81 ± 1.03). The occurrence of gastrointestinal bleeding, epilepsy, and mortality were similar (all p > 0.05) among the groups. ConclusionPatients with spontaneous basal ganglia intracerebral hematoma who received endoscopic evacuation might have better prognosis than those treated with craniotomy or puncture aspiration. In future, endoscopic surgery could become the most common method for treating spontaneous basal ganglia hemorrhages.

Neuroanatomical correlates of cognitive impairment following basal ganglia-thalamic post-hemorrhagic stroke: Uncovering network-wide alterations in hemispheric gray matter asymmetry

Cognitive impairment and recovery are central issues in hemorrhagic stroke. This study aimed to investigate whether post-hemorrhagic stroke cognitive impairment (PhSCI) is associated with cortical gray matter (GM) loss and hemispheric asymmetry changes and whether these changes could predict improvements in cognitive function during the recovery. Nineteen patients with PhSCI, comprising 10 with basal ganglia hemorrhage and 9 with thalamic hemorrhage, were recruited. Among them, 9 completed a course of repetitive transcranial magnetic stimulation (rTMS). Additionally, 19 demographically and comorbidity-matched healthy controls were also included. Structural brain MRI and cognitive assessments were performed. Voxel-wise GM volume and hemispheric asymmetry were analyzed. The PhSCI patients exhibited bilateral, yet asymmetric, GM losses in the hippocampus, fusiform, lateral temporal, prefrontal, somatomotor, and inferior parietal regions. The analysis of GM asymmetry revealed that patients showed rightward GM in the lateral temporal, somatomotor, and inferior parietal regions. Among the 9 PhSCI patients who completed rTMS, there was a marginal trend of regional GM increase and leftward GM, and these changes were in parallel with the improvements in cognitive tests. Further lesion connectivity and metanalytic mapping identified two interconnected systems linked to the lesions, which were anchored in the default mode, somatomotor, and salience/cognitive control networks and in the cognitive domains of memory, language, decision-making, and executive function. In conclusion, PhSCI patients exhibited network-wide cortical GM losses, distal to subcortical hemorrhagic lesions, and hemisphere asymmetry changes. These changes appear to predict rTMS-related cognitive improvements, suggesting that even subcortical focal lesions can lead to alterations in distal cortical neuroanatomical architecture. Our preliminary findings provide new insights into the neuroanatomical basis of PhSCI.

Hematoma evacuation based on active strategies versus conservative treatment in the management of moderate basal ganglia hemorrhage: A retrospective study.

The internal capsule of the basal ganglia is vulnerable to direct pressure from the hematoma and to secondary damage from toxic products of hemorrhage. Our study evaluated the risk and benefits of active strategies including ultra-early surgery and hematoma evacuation through a transsylvian-transinsular approach for moderate basal ganglia hemorrhage. We retrospectively collected patients with moderate basal ganglia hemorrhage in two hospitals. The conservative group contained 51 patients who had the best medical treatment, and the surgery group contained 36 patients who were treated with hematoma evacuation through a transsylvian-transinsular approach within 6 h from ictus. Motor function of upper and lower limbs recorded with the motor sub-score of NIHSS (m-NIHSS) at the baseline, 7 days, 30 days, and 90 days, the modified Rankin Scale (mRS), and Barthel Index (BI) scores at 30 and 90 days were compared between the two groups. Good recovery was defined as an m-NIHSS of 0-2 and poor recovery as 3-4. Favorable prognosis was defined as an mRS of 0-3 and unfavorable prognosis as 4-5. The mean time from ictus to surgery was 250.3 ± 57.3 min. The good recovery proportions of upper and lower limbs in the surgery group were significantly higher than that in the conservative group (p < 0.05) at 7 days after hemorrhage. The good recovery proportion of upper limbs was significantly higher in the surgery group than in the conservative group (p < 0.05) at 3 months after hemorrhage. Living ability using BI scores was significantly higher in the surgery group than the conservative group (p < 0.05) at 3 months after hemorrhage. The favorable prognosis proportion had no statistically significant difference between the two groups at 3 months after hemorrhage. Ultra-early hematoma evacuation through a transsylvian-transinsular approach are active strategies for moderate basal ganglia hemorrhage and have potential advantages in improving motor function recovery and daily living. The postoperative rebleeding rate does not increase simultaneously.

Wearable mixed-reality holographic guidance for catheter-based basal ganglia hemorrhage treatment

BackgroundBedside freehand catheter insertion for the treatment of basal ganglia hemorrhage currently remains the major method due to its simplicity and efficiency, but it is associated with low precision. We retrospectively evaluated the feasibility and accuracy of using a wearable mixed-reality holographic computer to guide catheter-based basal ganglia hemorrhage treatment compared to the freehand method. MethodsWe collected 30 patients who initially underwent either mixed-reality holographic guided catheter insertion (holographic guidance group) or freehand catheter insertion (freehand group). Data of pre- and postoperative CT images in both groups and surgical plans of the holographic guidance group were retrieved from the database. The additional time for holographic guidance was quantified. For both groups, we calculated the number of cases in which the catheter tip was initially outside the hematoma and the number of times for catheter repositioning. Catheter insertion accuracy was quantitatively evaluated using the target deviation. ResultsThe average additional time required for holographic guidance was 36.65 ± 15.18 min. In the holographic guidance group, all the cases had catheter tips initially inside the hematoma, and none of them needed catheter repositioning. In the freehand group, 3 cases had their catheter tips initially outside the hematoma, and 5 catheter repositioning procedures were performed. The mean target deviation was 5.46 ± 2.22 mm in the holographic guidance group and 12.57 ± 6.77 mm in the freehand group (p < 0.001). ConclusionsWe preliminarily demonstrated the feasibility and accuracy of wearable mixed-reality holographic guidance for the treatment of basal ganglia hemorrhage.

Clinical characteristics of spontaneous intracranial basal ganglia hemorrhage and risk factors for hematoma expansion in the plateaus of China.

The clinical features of intracranial cerebral hemorrhage (ICH) and the risk factors for hematoma expansion (HE) have been extensively studied. However, few studies have been performed in patients who live on a plateau. The natural habituation and genetic adaptation have resulted in differences in disease characteristics. The purpose of this study was to investigate the differences and consistency of clinical and imaging characteristics of patients in the plateaus of China compared with the plains, and to analyze the risk factors for HE of intracranial hemorrhage in the plateau patients. From January 2020 to August 2022, we undertook a retrospective analysis of 479 patients with first-episode spontaneous intracranial basal ganglia hemorrhage in Tianjin and Xining City. The clinical and radiologic data during hospitalization were analyzed. Univariate and multivariate logistic regression analyzes were used to assess the risk factors for HE. HE occurred in 31 plateau (36.0%) and 53 plain (24.2%) ICH patients, and HE was more likely to occur in the plateau patients compared with the plain (p = 0.037). The NCCT images of plateau patients also showed heterogeneity of hematoma imaging signs, and the incidence of blend signs (23.3% vs. 11.0%, p = 0.043) and black hole signs (24.4% vs. 13.2%, p = 0.018) was significantly higher than in the plain. Baseline hematoma volume, black hole sign, island sign, blend sign, and PLT and HB level were associated with HE in the plateau. Baseline hematoma volume and the heterogeneity of hematoma imaging signs were independent predictors of HE in both the plain and plateau. Compared with the plain, ICH patients in the plateau were more prone to HE. The patients showed the same heterogeneous signs on the NCCT images as in the plain, and also had predictive value for HE.

A case of spontaneous basal ganglia hemorrhage with contralateral extension utilizing the canal of Gratiolet

BackgroundIntracranial hemorrhage accounts for 10–20% of stroke etiologies annually. Basal ganglia is the most common site for intracranial hemorrhage accounting for 50% of all cases. Bilateral spontaneous basal ganglia hemorrhages (BGH) are rare with few reported cases.Case presentationWe report an unusual case of a 69-year-old female who presented with a spontaneous bilateral basal ganglia hemorrhage secondary to a right BGH with contralateral extension through the anterior commissure (AC) utilizing the Canal of Gratiolet. Clinical course and imaging findings are discussed.ConclusionsTo our knowledge, this is the first case to specifically detail the extension of spontaneous hemorrhage across the AC via the Canal of Gratiolet, and imaging findings provide a novel depiction of AC anatomy and fiber distribution in a clinical context. These findings may explain the mechanism behind this rare clinical entity.

The efficacy of stereotactic minimally invasive thrombolysis at different catheter positions in the treatment of small- and medium-volume basal ganglia hemorrhage (SMITDCP I): a randomized, controlled, and blinded endpoint phase 1 trial.

The aim of this study was to evaluate the effects of stereotactic minimally invasive puncture with different catheter placement positions when combined with urokinase thrombolysis for the treatment of small- and medium-volume basal ganglia hemorrhage. Our goal was to identify the best minimally invasive catheter placement position to enhance therapeutic efficacy for patients with cerebral hemorrhage. The stereotactic minimally invasive thrombolysis at different catheter positions in the treatment of small- and medium-volume basal ganglia hemorrhage (SMITDCPI) was a randomized, controlled, and endpoint phase 1 trial. We recruited patients with spontaneous ganglia hemorrhage (medium-to-small and medium volume) who were treated in our hospital. All patients received stereotactic, minimally invasive punctures combined with an intracavitary thrombolytic injection of urokinase hematoma. A randomized number table method was used to divide the patients into two groups concerning the location of catheterization: a penetrating hematoma long-axis group and a hematoma center group. The general conditions of the two groups of patients were compared, and the data were analyzed, including the time of catheterization, the dosage of urokinase, the amount of residual hematoma, the hematoma clearance rate, complications, and the National Institute of Health stroke scale (NIHSS) score data at 1 month after surgery. Between June 2019 and March 2022, 83 patients were randomly recruited and assigned to the two groups as follows: 42 cases (50.60%) to the penetrating hematoma long-axis group and 41 cases (49.40%) to the hematoma center group. Compared with the hematoma center group, the long-axis group was associated with a significantly shorter catheterization time, a lower urokinase dose, a lower residual hematoma volume, a higher hematoma clearance rate, and fewer complications (P < 0.05). However, there were no significant differences between the two groups in terms of the NIHSS scores when tested 1 month after surgery (P > 0.05). Stereotactic minimally invasive puncture combined with urokinase for the treatment of small- and medium-volume hemorrhage in the basal ganglia, including catheterization through the long axis of the hematoma, led to significantly better drainage effects and fewer complications. However, there was no significant difference in short-term NIHSS scores between the two types of catheterization.

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

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

Nontraumatic spontaneous bilateral intracerebral haemorrhage in a young patient: a rare case report.

Twenty-three-year-old male with no prior comorbidities presented to emergency with sudden onset loss of consciousness and 1 episode of seizure. No history of intoxication or trauma was given. Glasgow Coma Scale at presentation was E1V2M2. CT scan head revealed bilateral basal ganglia haematoma along intraventricular haemorrhage. The patient was managed conservatively in the Neurosurgical Intensive care unit. Supportive management was provided. The patient's motor response was improving and a repeat CT scan showed a resolving haematoma. However, due to poor economic conditions, the patient party left against medical advice. Spontaneous bilateral basal ganglia haemorrhage is a rare surgical emergency with no clear consensus on a management approach. This case highlights the importance of undiagnosed hypertension in causing intracerebral haemorrhage in poor economic groups.

Diabetic Striatopathy; A Differential Worth Considering in Diabetic Patients with Acute Onset Hyperkinetic Movements or Basal Ganglia (Striatal) Abnormalities on Imaging. (P8-4.007)

<h3>Objective:</h3> To describe a rare but interesting neurologic complication of uncontrolled diabetes; diabetic striatopathy, and to discuss its presentation as an uncommon etiology of acute hyperkinetic movement disorders. <h3>Background:</h3> Diabetic striatopathy is described as a hyperglycemic state in conjunction with striatal abnormalities on imaging and or the presence of hyperkinetic movements such as chorea. Imaging abnormalities described include hyperdense appearance of the striatum on CT and hyperintensity of the striatum on T1 MRI sequence. Associated hyperkinetic movements are thought to be reversible with correction of hyperglycemia. Given its rarity and ease of being misdiagnosed, we present a case of a 74-year-old woman with imaging findings consistent with Diabetic striatopathy. She presented in-extremis from an outside hospital for neurosurgical evaluation of a left basal ganglia hemorrhage. Her past medical history included uncontrolled type 2 diabetes and hypertension. <h3>Design/Methods:</h3> Not Applicable <h3>Results:</h3> Physical examination revealed an intubated, comatose, hypotensive patient with an irregular pulse. Her Laboratory values suggested uncontrolled diabetes with a hemoglobin A1C of “&gt; 17.0%” (beyond the laboratory’s upper limit) and serum glucose of 611. She had profound diabetic ketoacidosis. A non-contrasted head CT revealed what was initially thought to be a left basal ganglia hemorrhage; same interpretation as the outside hospital but was later favored to likely represent “nonketotic hyperglycemic chorea” and less likely a basal ganglia hemorrhage by the attending radiologist. MRI confirmed this with T1 hyperintensity in the left striatum. <h3>Conclusions:</h3> Our patient passed away from her severe metabolic derangements and no hyperkinetic movements were observed. However, her presentation highlighted to us an important and underrecognized differential of basal ganglia hemorrhage on imaging especially in the setting of uncontrolled diabetes. The paucity of information surrounding its pathophysiology, poses an area of potential research. Often cited as associated with hyperglycemic nonketotic state, it was enlightening to see it in diabetic ketoacidosis. <b>Disclosure:</b> Dr. Durojaye has nothing to disclose. Dr. Sammond has nothing to disclose. Dr. Moosavi has nothing to disclose.

Standardizing prognostication and management of spontaneous basal ganglia hemorrhage: A novel scoring system

BackgroundFactors that are used in spontaneous ICH prognostication score cannot be generalized to basal ganglia haemorrhages. Our study aimed in developing a novel scoring system for prognosticating and management of basal ganglia haemorrhages, including factors likely to influence mortality or survival. MethodsA prospective study was performed of 351 patients with spontaneous basal ganglia haemorrhage. Mortality at 90 days was recorded. Using univariate and multivariable logistic regression, the association between various plausible factors and 90-day mortality was tested. Factors found to be significant were used to develop a novel scoring system and the association between 90-day mortality and modified ICH score was calculated. This score was subsequently used to standardize the management with a score correlation to treatment guidelines, thus advocating either conservative or operative management depending upon the score. ResultsWe analyzed 339 cases, overall, 90-day mortality was 37.75 % (n = 128). The survival rate in patients having modified ICH score of 7 or less than 7 was 91.66 %, however, it decreased to 12.19 % in patients having a score > 7. A modified ICH score of 7 or less than 7 could predict the survival in 93.8 % (95 % CI 89.7–96.7) of patients and had a specificity of 85.9 %%. The positive predictive value of modified ICH score 7 or < 7 was 91.7 % (95 %CI 87.1–95.0). In patients with score of 6, surgery was advisable in almost 50 % of cases and the mortality was 100 percent even after surgical intervention in patients having score of 10 or more. ConclusionModified ICH score is a useful tool for predicting 90-days mortality, the area under the ROC curve was 93% which was higher than any other studies for spontaneous ICH. This scoring system can also aid in deciding the line of management of basal ganglia bleed patients.

A 14-year-old boy with multiple trauma and bilateral basal ganglia hemorrhage due to coronavirus disease 2019: a case report

BackgroundIn December 2019, coronavirus disease 2019 spread worldwide, causing acute respiratory distress syndrome. Coronavirus disease 2019 presents from an asymptomatic infection to severe disease causing multiorgan failure. Neurological manifestations were observed in some patients, including intracerebral hemorrhage. Bilateral basal ganglia hemorrhage is rare due to trauma.Case presentationOur patient was a 14-year-old Iranian boy with multiple trauma and loss of consciousness who tested positive for coronavirus disease 2019. The brain computed tomography scan reported bilateral basal ganglia hemorrhage. Bilateral ground glass opacity was reported through a chest computed tomography scan.Discussion and conclusionsIn this study, we reported a 14-year-old boy referred to the emergency room due to multiple trauma. Through the medical interventions, bilateral basal ganglia hemorrhage was discovered incidentally. Coronavirus disease 2019 was detected in this patient on the basis of findings in chest computed tomography scan and positive real reverse transcription polymerase chain reaction test. Several clinical reports and series exploring the relationship between coronavirus disease 2019 and ischemic strokes have been published. Coronavirus disease 2019, like other acute respiratory syndromes, can invade the central nervous system through hematogenous and neuronal dissemination or it can be an immune response to the cytokine storm. In conclusion, it is vital to know the pathophysiology of the neurological manifestations of coronavirus disease 2019 and prevent the mild neurological manifestations leading to severe conditions.

The Burden and In-Hospital Mortality of Stroke Admissions at a Tertiary Level Hospital in Namibia: A Retrospective Cohort Study.

Despite stroke being a leading cause of morbidity and mortality globally, there is a dearth of information on the burden and outcomes of stroke in sub-Saharan Africa and Namibia in particular. A hospital-based, retrospective cohort study was conducted to analyse non-electronic medical records of all consecutive stroke patients who were admitted to one of the highest tertiary-level hospitals in Namibia for 12 months (2019-2020). The primary outcome of the study was to establish the in-hospital mortality, stroke subtypes, and associated complications. In total, 220 patients were included in the study, their mean age was 53 (SD13.8) years, and 55.5% were males. 61.0% had an ischaemic stroke (IS), and 39.0% had a haemorrhagic stroke (HS). The mean age was significantly lower in patients with HS vs. IS (48.2 ± 12.2 vs. 56.1 ± 13.3, p < 0.001). Of the IS patients, the majority (29.0%) had total anterior circulation infarct (TACI), while in the HS group, 34.0% had basal ganglia haemorrhage with or without intraventricular extension. Hypertension (p = 0.015), dyslipidaemia (p = 0.001), alcohol consumption (p = 0.022), and other cardiovascular diseases (p = 0.007) were more prevalent in patients with IS compared to those with HS. The prevalence rate of intravenous thrombolysis was 2.2% in IS and use of intravenous antihypertensives in 25.9% of patients with HS than IS. The in-hospital mortality was 26.4% with complications such as raised ICP, aspiration pneumonia, hydrocephalus, and sepsis significantly high in those that died. Aspiration pneumonia (OR 2.79, 95% CI 1.63-4.76, p < 0.001) and increased ICP (OR 0.30, 95% CI 0.16-057, p < 0.001) were independent predictors of in-hospital mortality on the multivariate analysis. Our findings showed a younger mean age for stroke and mortality rate comparable to other low- to middle-income countries (LMICs). Hypertension and alcohol consumption were the main risk factors for both stroke subtypes, while aspiration pneumonia and raised intracranial pressure predicted in-hospital mortality.

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

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

Postoperative hemorrhage after biomedical glue sling technique in microvascular decompression for vertebrobasilar artery-associated cranial nerve diseases: A retrospective study of 14 cases.

The biomedical glue sling technique is a convenient and effective method for vertebrobasilar artery-associated cranial nerve diseases but postoperative hemorrhage is poorly understood. We retrospectively reviewed 14 of 1157 patients associated with cranial nerve diseases who were subjected to the biomedical glue sling technique in microvascular decompression at our hospital from January 2015 to January 2020. There were 14 patients with cranial nerve diseases included in this study. A clinical diagnosis of postoperative hemorrhage was made after an average of 41.75 h (ranging between 0.5 and 95 h). A cerebellopontine angle hemorrhage was presented in 5 patients, while basal ganglia hemorrhage was observed in 2 patients. Both a cerebellopontine angle and brainstem hemorrhage was seen in 1 patient. Distal supratentorial subdural hemorrhage was recorded in 6 patients. The correlation coefficient was -0.1601 (p = 0.7094) between the standard deviation of systolic blood pressure and the Hemphill Score, -0.2422 (p = 0.5633) between the coefficient of variation of systolic blood pressure and the Hemphill Score, and -0.0272 (p = 0.9489) between the range of systolic blood pressure and the Hemphill Score. The incidence of postoperative hemorrhage after MVD with the biomedical glue sling technique is higher than with traditional MVD and most cases have a favorable prognosis. Postoperative symptoms are the main area of concern and changes in symptoms usually suggest the occurrence of hemorrhage. Several factors, including surgical procedures, the release of CSF, and blood pressure might be associated with hemorrhaging. We still believe such a technique is an efficient approach to treating complicated cranial nerve diseases.