Hypertensive Cerebellar Hemorrhage Research Articles

Neuronavigation-assisted neuroendoscopy versus conventional craniotomy for hypertensive cerebellar hemorrhage: A comparative analysis of efficacy and outcomes

ObjectiveHypertensive cerebellar hemorrhage is a severe condition in neurosurgery, associated with high disability and mortality rates. The present study compares the efficacy and outcomes of neuronavigation-assisted neuroendoscopy versus conventional microscope (craniotomy) in treating patients with hypertensive cerebellar hemorrhage. MethodsA retrospective study was conducted by analyzing medical records of patients with hypertensive cerebellar hemorrhage treated at Wuhan No.1 Hospital between February 2015 and February 2019. The study included 65 patients who underwent either neuronavigation-assisted neuroendoscopy (n = 35) or conventional microscopy treatment (n = 30). All patients underwent standard neurological and clinical examinations, as well as routine laboratory tests upon admission. The diagnosis of hypertensive cerebellar hemorrhage was based on computed tomography (CT) findings. Basic parameters, clinical status on admission, imaging results, management, and outcome measures were evaluated and compared between the two groups. ResultsNeuronavigation-assisted neuroendoscopy showed advantages over craniotomy in terms of surgical procedure time and intraoperative blood loss ((81.91 ± 17.77) min vs (195.20 ± 31.97) min, (63.66 ± 12.42) ml vs (335.00 ± 104.26) ml, P < 0.01). The hematoma evacuation rate was higher in neuroendoscopy group ((94.37 ± 5.174)% compared to the craniotomy group ((90.80 ± 5.404)%, P < 0.01). Additionally, the time of ventricular drainage was shorter in the neuroendoscopy group ((4.83 ± 1.671) days) than in the craniotomy group ((7.70 ± 1.878) days, P < 0.01). Neuroendoscopy group also resulted in fewer surgical complications and a shorter hospital stay (P < 0.05). There was no significant difference in the risk of rebleeding and mortality between the neuroendoscopy and craniotomy group (P > 0.05). ConclusionNeuronavigation-assisted neuroendoscopy is a rapid, safe, and effective minimally invasive technique for the treatment of hypertensive cerebellar hemorrhage. It offers potential benefits in reducing surgical complications and hospital stay compared to conventional craniotomy.

P.096 Iatrogenic pseudoaneurysm of the MCA secondary to VP shunt insertion

Background: Ventriculoperitoneal (VP) shunting is a common treatment for hydrocephalus. Complications of VP shunt include infection, malfunction, and hemorrhage. Vascular complications such as pseudoaneurysm are rare, and usually involve the choroid plexus or branches of the external carotid artery. We present the case of a fusiform pseudoaneurysm of the middle cerebral artery arising due to VP shunt insertion. Methods: A 36-year-old female presented with a hypertensive cerebellar hemorrhage and hydrocephalus. This was treated with VP shunt placement with limited dural opening. Three weeks afterward there developed a diffuse intraventricular hemorrhage associated with hemorrhage at the cortical insertion site of the ventricular catheter. CT and catheter angiography revealed a fusiform pseudoaneurysm of the M4 segment of the MCA immediately adjacent to the ventricular catheter. Results: The VP shunt was removed, and the aneurysmal segment was coagulated and occluded. Delayed repeat VP shunt insertion was performed through the same entry point and trajectory via a larger dural opening. Conclusions: Pseudoaneurysm formation secondary to catheter insertion is a rare complication. To our knowledge, this is the second reported case of a cortical branch pseudoaneurysm in an adult. Careful consideration should be given to vascular anatomy when planning shunt insertions, and cruciate dural opening for local cortex visualization may help avoid this complication.

Vascular endothelial growth factor gene is associated with hypertensive cerebellar hemorrhage and rehabilitative treatment.

Early rehabilitative therapy is important for patients with hypertensive cerebral hemorrhage to improve long-term function of the extremities. Vascular endothelial growth factor (VEGF) is closely associated with the pathogenesis of hypertension. To identify the markers contributing to the genetic susceptibility to hypertensive cerebellar hemorrhage (HCH) and rehabilitative treatment, we examined the potential association between HCH and 12 single nucleotide polymorphisms of the VEGF gene. Participants included 244 patients with HCH and 251 healthy controls from our rehabilitation department. The T allelic frequencies of the rs3025020 (intron 6) and rs3025039 (3'-UTR) polymorphisms were significantly higher in the patients with HCH than in the healthy controls (rs3025020 T allele: P = 0.0002, OR = 1.619, 95%CI = 1.256-2.088; rs3025039 T allele: P = 0.001, OR = 1.682, 95%CI = 1.246-2.270). Strong linkage disequilibrium was observed in three blocks (D' > 0.9), and significantly more C-G-C (rs3025020, rs3025030, and rs3025039) haplotypes (P = 0.001) were found in the controls in block 3. Significantly more T-G-C haplotypes were found in the patients with HCH (P = 0.046). Further genotype and clinical phenotype correlation study of the rs3025039 carriers showed that Fugl-Meyer and Barthel index scores were lower in the patients with the TT genotype relative to CT + CC genotypes (P < 0.01). These findings point to a role for VEGF polymorphism in HCH, and may be informative for future investigations on the pathogenesis of rehabilitative treatment.

A contrast study on the curative effect between trepanation and drainage and decompressive craniotomy for treating cerebellar hemorrhage

Thirty-three cases of hypertensive cerebellar hemorrhage were involved in this survey, with the bleeding volume over 10 ml. All of them were given external ventricular drainage and then taken continuous monitoring of intracranial pressure (ICP) after admission. Within 7-24 h after the onset, they all underwent trepanation and drainage under local anesthesia. In the same period, another 33 cases of cerebellar hemorrhage patients were collected as the control, who met the inclusion criteria and were treated with conventional posterior fossa decompressive craniotomy. As results, the total efficiency of the drilling group was 81.82% (27/33), which was much better than the control group (63.64%, 21/33). However, there was no statistical significance between 2 groups (χ 2 = 2.750, P = 0.097). doi: 10.3969/j.issn.1672-6731.2014.06.014

Stereotactic Burr Hole Aspiration Surgery for Spontaneous Hypertensive Cerebellar Hemorrhage

ObjectivePatients with severe spontaneous cerebellar hemorrhage typically undergo treatment with suboccipital craniectomy and hematoma evacuation. However, this is a stressful procedure for patients due to the long operating time and operation-induced tissue damage. In addition, the durotomy can result in pseudomeningocele. We investigated the efficacy of stereotactic or navigation-guided burr hole aspiration surgery as a treatment for spontaneous hypertensive cerebellar hemorrhage (SHCH).MethodsBetween January 2002 and December 2011, 26 patients with SHCH underwent surgery using the stereotactic or navigation-guided burr hole aspiration and catheter insertion technique in our institution.ResultsMean hematoma volume was 21.8 ± 5.8 cc at admission and 13.1 ± 5.4 cc immediately following surgery. Preoperative Glasgow Coma Scale (GCS) score was 12.5 ± 1.3 and postoperative GCS score was 13.1 ± 1.2. Seven days after surgery, the mean hematoma volume was 4.3 ± 5.6 cc, and there was no occurrence of surgery-related complications during the six-month follow-up period. The mean operation time for catheter insertion was 43.1 ± 8.9 min, and a mean 31.3 ± 6.0 min was also added for extra-ventricular drainage. The mean Glasgow Outcome Scale (GOS) score after six months was 4.6 ± 1.0.ConclusionStereotactic burr hole aspiration surgery for treatment of SHCH is less time-consuming and invasive than other interventions, and resulted in no surgery-related complications. Therefore, we suggest that this surgical method could be a safe and effective treatment option for selected patients with SHCH.

Unusual clinical presentation of hypertensive cerebellar hemorrhage

Unusual clinical presentation of hypertensive cerebellar hemorrhage

Emotional adjustment after stroke: The role of early neuropsychotherapeutic interventions in patients following brain damage

von Wild KRH, Kemper B. Emotional adjustment after stroke: The role of early neuropsychotherapeutic interventions in patients following brain damage. Jpn J Compr Rehabil Sci 2011; 2: 42�47. Objective: Post-stroke depression has been considered the most common neuropsychiatric consequence of stroke, even in the presence of successful neurological recovery and good health-related quality of life. This report describes a patient’s catastrophic reactions to his unexpected illness, with a focus on the therapeutic process, to provide an understanding of managing denial and how to approach and engage brain-damaged patients. Methods: This is a case study of a 65-year-old businessman with mental-cognitive and behavioral impairments following hypertensive cerebellar massive hemorrhage and secondary hydrocephalus, who made a complete recovery following psychotherapeutic intervention. Results: Our supportive psychotherapeutic approach combined with cognitive interventions enabled this patient overcome moderate mental-cognitive and behavioral defi cits and extreme defensive coping strategies, and facilitated his successful social reentry. Conclusions: Brain-damaged patients with preserved self-awareness and a high level of independence in activities of daily living (ADL), who do not have preexisting psychiatric conditions, can benefi t from individualized psychotherapy over time. Attention needs to be focused on a recovery beyond functional outcomes, with an understanding of holistic neurorehabilitation as a method of reconstructing lives within a social context. Further research and education is needed for the development of proper psychotherapeutic approaches to address aspects such as emotional coping and fi nding sense in life following brain damage.

Endoscopic Hematoma Evacuation for Hypertensive Cerebellar Hemorrhage

The management of spontaneous cerebral hemorrhage remains controversial, particularly the surgical indications. Endoscopic surgery was evaluated for the treatment of spontaneous cerebellar hemorrhage. The records of 69 patients with hypertensive cerebral hemorrhage were retrospectively reviewed. Patients treated by endoscopic surgery (n = 10) were compared with patients treated by conventional surgical hematoma evacuation (n = 10) under the same surgical indications. The surgical procedure time, duration of ventricular drainage, extent of hematoma evacuation, necessity for cerebrospinal fluid (CSF) shunt, surgical complications, and outcome at discharge and at 3 months after onset were compared. The extent of hematoma evacuation was greater in the endoscopic group (95.2 %) than in the craniectomy group (90.6 %) but without significant difference. The endoscopic technique (64.5 min) took significantly less time than the craniectomy method (230.6 min, p < 0.0001). The period of ventricular drainage was significantly shorter in the endoscopic group (2.6 days) compared to the craniectomy group (12.3 days, p < 0.01). CSF shunt surgery was required in no patient in the endoscopic group compared to three in the craniectomy group. Endoscopic hematoma evacuation is a rapid, effective, and safe technique for the removal of hypertensive cerebellar hemorrhage. Reduction of the mass effect can be accomplished with low risk of recurrent hemorrhage. Release of obstructive hydrocephalus in the early stage may improve the patient's outcome and decrease the requirement for permanent shunt emplacement.

Epidemiologic predictors of 30-day survival in cerebellar hemorrhage

Background: Outcome after cerebellar hemorrhage is relatively poorly understood. Objectives: To describe cerebellar hemorrhage and to establish if there were epidemiologic risk factors associated with early mortality. Methods: Computerized records were searched to identify intracerebral hemorrhage (ICD-9-CM code 431) from 1986 to 1996 at 2 hospitals. Charts were abstracted using a standardized protocol. The provincial vital statistics registry was used to confirm mortality data. A multivariable logistic regression model was developed to identify predictors of 30-day mortality. Results: Of 629 identified cases of intracerebral hemorrhage, 79 (12.5%) were cerebellar. The 30-day mortality was 41.7%. Approximately one third (31.7%) had an identifiable underlying cause. The odds of survival at 30 days was significantly reduced (odds ratio = 0.24; 95% confidence interval, 0.08 to 0.74) if the hemorrhage was caused by an identifiable underlying cause. Conclusions: Cerebellar hemorrhage with an underlying cause is more likely to be fatal than idiopathic or hypertensive cerebellar hemorrhage. Copyright © 2001 by National Stroke Association

高血圧性小脳出血の手術適応と機能予後 : 多変量解析による検討

高血圧性小脳出血81例を保存的治療群(50例)と後頭下開頭血腫除去術群(31例)の2群に分け, おのおのの予後良好因子を多変量解析により検討した.その結果, 保存的治療群ではGCS14-15, 血腫最大径4cm以下, 四丘体槽開存の3項目が予後良好因子として示され, 開頭血腫除去術群では, GCS11-15, 四丘体槽開存, 血腫最大径5cm未満, 側脳室内出血なしの4項目が統計上有意とされた.これらの結果より, 高血圧性小脳出血においてmoderate disability以上の機能予後を求めた開頭術の適応は, かなりの部分で保存的治療の適応範囲と重複しており, 手術の適応域は狭く, 従来のややもすると安易に意識状態や血腫の大きさのみから行っていた手術適応の決定は避けるべきと思われた.本検討より, 良好な機能予後を期待できる手術適応は血腫径として5cm以下, 意識状態としてGCS11-13という結果であった.また, これらのみで治療方針を決定するのではなく, 保存的治療中にCT所見上, 脳幹周囲脳槽の血腫が脳幹部に影響しつつある, あるいは水頭症が発現しつつあると判断された症例についてはただちに手術的治療に変換すべきと考えられた.

Mutism in an Adult Following Hypertensive Cerebellar Hemorrhage: Nosological Discussion and Illustrative Case

Mutism after cerebellar injury has been associated with tumors, hemorrhage, and surgery of midline cerebellar structures. Literature review identified 54 cases, primarily in children after surgical splitting of the inferior vermis. We present a 47-year-old who developed transient mutism after cerebellar hemorrhage. This represents the first report of transient mutism in an adult with neither tumor nor brainstem infarction and documents the importance of cerebellar structures for initiation and production of speech in adulthood. This case further differs from those previous because of the long mute period and the subsequent return of continued ataxic and dysarthric speech.

Treatment of Hypertensive Cerebellar Hemorrhage–Surgical or Conservative Management?

Treatment of Hypertensive Cerebellar Hemorrhage–Surgical or Conservative Management?

Treatment of Hypertensive Cerebellar Hemorrhage???Surgical or Conservative Management?

Treatment of Hypertensive Cerebellar Hemorrhage???Surgical or Conservative Management?

Treatment of Hypertensive Cerebellar Hemorrhage???Surgical or Conservative Management?

Treatment of Hypertensive Cerebellar Hemorrhage???Surgical or Conservative Management?

Treatment of Hypertensive Cerebellar Hemorrhage–Surgical or Conservative Management?

One hundred and one consecutive patients with hypertensive cerebellar hemorrhage were analyzed to determine the criteria for surgery. New criteria based on the patient's Glasgow Coma Scale score at admission and the maximum diameter of the hematoma, as disclosed by computed tomography, are proposed from a retrospective analysis of 52 earlier cases. The criteria are as follows: 1) patients with Glasgow Coma Scale scores of 14 or 15 and with a hematoma of less than 40 mm in maximum diameter are treated conservatively; 2) for the patients with Glasgow Coma Scale scores of 13 or less at admission or with a hematoma measuring 40 mm or more, hematoma evacuation with decompressive suboccipital craniectomy should be a treatment of choice; and 3) for the patient whose brain stem reflexes are entirely lost with flaccid tetraplegia or whose general condition is poor, intensive therapy is not indicated. The validity of these criteria was tested and confirmed in 49 recent cases.

Treatment of Hypertensive Cerebellar Hemorrhage–Surgical or Conservative Management?

ONE HUNDRED AND one consecutive patients with hypertensive cerebellar hemorrhage were analyzed to determine the criteria for surgery. New criteria based on the patient's Glasgow Coma Scale score at admission and the maximum diameter of the hematoma, as disclosed by computed tomography, are proposed from a retrospective analysis of 52 earlier cases. The criteria are as follows: 1) patients with Glasgow Coma Scale scores of 14 or 15 and with a hematoma of less than 40 mm in maximum diameter are treated conservatively; 2) for the patients with Glasgow Coma Scale scores of 13 or less at admission or with a hematoma measuring 40 mm or more, hematoma evacuation with decompressive suboccipital craniectomy should be a treatment of choice; and 3) for the patient whose brain stem reflexes are entirely lost with flaccid tetraplegia or whose general condition is poor, intensive therapy is not indicated. The validity of these criteria was tested and confirmed in 49 recent cases.

Treatment of Hypertensive Cerebellar Hemorrhage???Surgical or Conservative Management?

Treatment of Hypertensive Cerebellar Hemorrhage???Surgical or Conservative Management?

CT-guided stereotactic fibrinolysis of spontaneous and hypertensive cerebellar hemorrhage: long-term results

The surgical indication for spontaneous cerebellar hemorrhage is not as controversial as the operative management of intracranial hemorrhage. Timing of the operation is crucial: intervening too early can produce an additional strain on the patient and an increased risk, while waiting too long to evacuate the hematoma can be fatal. This dilemma may be a factor in the relatively high mortality and morbidity rates following both operative and conservative treatment that have been reported in the literature (42.5% and 30%, respectively). In long-term studies on 14 patients, the authors have shown that stereotactic puncture and fibrinolysis for cerebellar hemorrhage is a valuable alternative to treatments used currently. The method consists of computerized tomography (CT)-guided stereotactic puncture and partial evacuation of the hematoma. After fibrinolysis with urokinase, the residual hematoma can be completely evacuated via a catheter introduced into the cavity of the hematoma. Only one of the 14 patients died in the direct postoperative phase; the remaining patients were enjoying a good to very good quality of life 6 months after the acute event. Two patients subsequently died as a result of pneumonia and cerebral infarction, respectively; both conditions were unrelated to the hemorrhage. The authors conclude that the CT-guided stereotactic method is simple, effective, and safe, and can be applied to patients of any age.

Hypertensive cerebellar hemorrhage and cerebellar hemorrhage caused by cryptic angioma: analysis of clinical observations, CT findings and outcome.

A series of 44 patients with hypertensive cerebellar hemorrhage and nine patients with cerebellar hemorrhage caused by small angiomas is described. Hypertensive hemorrhage occurred most frequently in the patients in their seventies, whereas the onset of angiomacaused hemorrhage was often seen below the age of 40. Clinical syndromes of cerebellar hemorrhages can be categorized into three basic types: the vertigo syndrome, cerebellar dysfunction syndrome and brain stem compression syndrome. Patients with small ( ≥2 cm in diameter in CT scans) and medium-sized (2 cm <3 cm in diameter) hematomas usually presented one of the former two syndromes with no or only mild impairment of consciousness. However, unless prompt surgical decompression was carried out, most patients with large ( ≥3 cm) hematomas deteriorated into unresponsive conditions and developed signs of brain stem compression. Surgical mortality was 32% in the hypertensive group, while it was 0% in the angioma group. Mortality as well as morbidity in both groups was strongly influenced by the preoperative status of consciousness. Our results suggest that substantial improvement could be obtained in the overall outcome of this disease by emergency craniectomy and removal of hematomas in all patients with large hematomas regardless of the levels of consciousness and regardless of the causes of bleeding. Furthermore, when clinical information and CT findings are suggestive of a “cryptic” angioma as the causative lesion, posterior fossa surgery may be indicated to extirpate the lesion, even if the hematoma is small.

Hypertensive cerebellar hemorrhage: its symptoms and management.

A series of 18 patients with hypertensive cerebellar hemorrhages diagnosed with computed tomography (CT) is described. The clinical course appeared to fall into three groups. Group I (56%) did not exhibit consciousness disturbances and improved spontaneously. Group II (22%) developed gradual deterioration of consciousness. Group III (22%) became comatose within 12 hours and developed signs of brain stem dysfunction. The CT findings reflected the three clinical groups. The CT of Group I revealed a small hematoma ( ≥24 mm) with or without ventricular hemorrhage. The scans of Group II demonstrated hematomas of moderate volume (34 ?? 52 mm) with a partial defect of the perimesencephalic cisterns. The CT of Group III showed a large hematoma ( ≥43 mm) with massive ventricular hemorrhaging and obstructive hydrocephalus. Severe mass effects on the brain stem were also seen. The patients of Group I should be treated by conservative therapy and Group II by emergent suboccipital craniectomy and evacuation of the hematoma. Surgical indication for the patients in Group III could not be determined.