Hypertensive Intracerebral Hemorrhage Research Articles

Signature and function of plasma exosome-derived circular RNAs in patients with hypertensive intracerebral hemorrhage.

Intracerebral hemorrhage (ICH) is one of the major causes of death and disability, and hypertensive ICH (HICH) is the most common type of ICH. Currently, the outcomes of HICH patients remain poor after treatment, and early prognosis prediction of HICH is important. However, there are limited effective clinical treatments and biomarkers for HICH patients. Although circRNA has been widely studied in diseases, the role of plasma exosomal circRNAs in HICH remains unknown. The present study was conducted to investigate the characteristics and function of plasma exosomal circRNAs in six HICH patients using circRNA microarray and bioinformatics analysis. The results showed that there were 499 differentially expressed exosomal circRNAs between the HICH patients and control subjects. According to GO annotation and KEGG pathway analyses, the targets regulated by differentially expressed exosomal circRNAs were tightly related to the development of HICH via nerve/neuronal growth, neuroinflammation and endothelial homeostasis. And the differentially expressed exosomal circRNAs could mainly bind to four RNA-binding proteins (EIF4A3, FMRP, AGO2 and HUR). Moreover, of differentially expressed exosomal circRNAs, hsa_circ_00054843, hsa_circ_0010493 and hsa_circ_00090516 were significantly associated with bleeding volume and Glasgow Coma Scale score of the subjects. Our findings firstly revealed that the plasma exosomal circRNAs are significantly involved in the progression of HICH, and could be potent biomarkers for HICH. This provides the basis for further research to pinpoint the best biomarkers and illustrate the mechanism of exosomal circRNAs in HICH.

Predicting postoperative rehemorrhage in hypertensive intracerebral hemorrhage using noncontrast CT radiomics and clinical data with an interpretable machine learning approach

In hypertensive intracerebral hemorrhage (HICH) patients, while emergency surgeries effectively reduce intracranial pressure and hematoma volume, their significant risk of causing postoperative rehemorrhage necessitates early detection and management to improve patient prognosis. This study sought to develop and validate machine learning (ML) models leveraging clinical data and noncontrast CT radiomics to pinpoint patients at risk of postoperative rehemorrhage, equipping clinicians with an early detection tool for prompt intervention. The study conducted a retrospective analysis on 609 HICH patients, dividing them into training and external verification cohorts. These patients were categorized into groups with and without postoperative rehemorrhage. Radiomics features from noncontrast CT images were extracted, standardized, and employed to create several ML models. These models underwent internal validation using both radiomics and clinical data, with the best model’s feature significance assessed via the Shapley additive explanations (SHAP) method, then externally validated. In the study of 609 patients, postoperative rehemorrhage rates were similar in the training (18.8%, 80/426) and external verification (17.5%, 32/183) cohorts. Six significant noncontrast CT radiomics features were identified, with the support vector machine (SVM) model outperforming others in both internal and external validations. SHAP analysis highlighted five critical predictors of postoperative rehemorrhage risk, encompassing three radiomics features from noncontrast CT and two clinical data indicators. This study highlights the effectiveness of an SVM model combining radiomics features from noncontrast CT and clinical parameters in predicting postoperative rehemorrhage among HICH patients. This approach enables timely and effective interventions, thereby improving patient outcomes.

Relationship between changes in neurological deficit severity and adverse cardiac events in elderly patients with hypertensive intracerebral hemorrhage: a retrospective cohort study

Objective To explore the relationship between changes in neurological deficit severity and the occurrence of adverse cardiac events in elderly patients with hypertensive intracerebral hemorrhage. Methods Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of NIHSS scores for adverse cardiac events. Results There were significant differences between the two groups. Multivariate logistic regression analysis showed that advanced age, high NIHSS score, large intracerebral hemorrhage volume, and high CK level were independent risk factors for adverse cardiac events in elderly patients with hypertensive intracerebral hemorrhage (p < 0.05). The NIHSS scores of both groups gradually increased after admission, peaking at 48 h after admission. In Group A, this elevation persisted until 72 h after admission, while in Group B, there was a significant decrease at 72 h after admission (p < 0.05). From admission to 7 days after admission, the NIHSS scores in Group A were higher than those in Group B (p < 0.05). The area under the curve (AUC) of the NIHSS scores at 48 h after admission was 0.776, with sensitivity and specificity of 80.9% and 84.5%, respectively, which were higher than those of other indicators (p < 0.05). Conclusion The occurrence of adverse cardiac events in elderly patients with hypertensive intracerebral hemorrhage is influenced by multiple factors, and as the NIHSS score increases, the risk of such events gradually increases. Clinicians should pay attention to monitoring NIHSS scores after admission, as they have value in predicting adverse cardiac events in elderly patients with hypertensive intracerebral hemorrhage.

Key Risk Factors for Intracerebral Hemorrhage According to Regional Population-Based Stroke Registry

Introduction. Intracerebral hemorrhage (ICH) registry data allow assessing epidemiological parameters and risk factors in different age, gender, race, ethnicity, and other subgroups.&#x0D; This study aimed to evaluate the prevalence of key risk factors in a group of Yakutsk residents with primary hypertensive ICH included in the regional population-based stroke registry from 2015 to 2017.&#x0D; Materials and methods. This study of risk factors was conducted in patients with hypertensive ICH (n = 251) from the regional population-based stroke registry, including 133 (53%) men and 118 (47%) women of Asian or Caucasian races. We performed statistical analysis of data.&#x0D; Results. The analysis of risk factors showed that the prevalence of smoking and excessive alcohol consumption was higher in men with ICH compared with women (p 0.001). There were no statistically significant differences in the incidence of hypertension, history of myocardial infarction, dyslipidemia, or diabetes mellitus in patients with ICH in gender or ethnicity subgroups. Fibrillation and other heart diseases were more common in Caucasian patients than in Asian (p = 0.005). ICH was associated with high levels of low-density lipoproteins and triglycerides with low levels of total cholesterol and high-density lipoproteins compared with healthy individuals.&#x0D; Conclusions. We described gender and ethnic differences in the prevalence of risk factors in patients with hypertensive ICH.

Clinical Efficacy of Neuroendoscopy Combined with Intracranial Pressure Monitoring for the Treatment of Hypertensive Intracerebral Hemorrhage

ObjectiveTo compare the differences in postoperative complications and prognosis between patients treated with neuroendoscopy versus conventional craniotomy surgery for hypertensive intracerebral hemorrhage (HICH). MethodsIn this retrospective study, a total of 107 patients with HICH were included. Among them, 58 underwent neuroendoscopy (Group A), while 49 underwent conventional craniotomy under microscopic guidance (Group B). Intracranial pressure monitoring (ICPM) was applied in both groups. The clinical data, incidence of postoperative complications, preoperative and postoperative intracranial pressure values, and rate of favorable prognosis were compared between the two groups. ResultsNo significant difference in baseline clinical data upon admission was observed between the two groups (P > 0.05). The preoperative intracranial pressure did not differ between the two groups (P > 0.05), but the postoperative intracranial pressure in Group A was significantly lower than that in Group B (P < 0.05). After intervention with the different surgical approaches, Group A showed a significantly lower incidence of postoperative cerebral infarction and a significantly higher rate of favorable prognosis compared with Group B (P < 0.05). ConclusionNeuroendoscopy combined with ICPM is a safe and reliable approach for the treatment of HICH that reduces the incidence of postoperative cerebral infarction and improves the recovery of neurological function after surgery.

IV Flat Detector CT Angiography in Flat Detector CT Image-Guided Minimally Invasive Surgery for the Treatment of Intracerebral Hypertensive Hemorrhage.

Spontaneous intracerebral hemorrhage is a serious stroke subtype with high mortality and morbidity. Minimally invasive surgery plus thrombolysis is a promising treatment option, but it requires accurate catheter placement and real-time monitoring. The authors introduced IV flat detector CT angiography (ivFDCTA) into the minimally invasive surgery procedure for the first time, to provide vascular information and guidance for hematoma evacuation. Thirty-six patients with hypertensive intracerebral hemorrhage were treated with minimally invasive surgery under the guidance of ivFDCTA and flat detector CT (FDCT) in the angiography suite. The needle path and puncture depth were planned and calculated using software on the DSA workstation. The hematoma volume reduction, operation time, complications, and clinical outcomes were recorded and evaluated. The mean preoperative hematoma volume of 36 patients was 35 (SD, 12) mL, the mean intraoperative volume reduction was 19 (SD, 11) mL, and the mean postoperative residual hematoma volume was 15 (SD, 8) mL. The average operation time was 59 (SD, 22) minutes. One patient had an intraoperative epidural hematoma, which improved after conservative treatment. The mean Glasgow Outcome Scale score at discharge was 4.3 (SD, 0.8), and the mean mRS score at 90 days was 2.4 (SD, 1.1). The use of ivFDCTA in the evacuation of an intracerebral hemorrhage hematoma could improve the safety and efficiency of minimally invasive surgery and has shown great potential in hemorrhagic stroke management in selected patients.

The effect of tracheotomy timing on short- term prognosis in hypertensive intracerebral haemorrhage patients after craniectomy: a retrospective analysis of early vs late intervention

Objective: The present study aimed to compare the clinical outcomes and short-term prognosis in patients with hypertensive intracerebral haemorrhage (HICH) with basal ganglia haematoma volume ≥ 60 mL who underwent early tracheotomy versus late tracheotomy post-craniectomy. Methods: A retrospective analysis was conducted based on the data of 102 patients with basal ganglia haematoma volume ≥ 60 mL after craniectomy between 2016 and 2021. Patients were divided into two groups: early tracheotomy and late tracheotomy. This study evaluated the effect of early tracheotomy on prognosis within 90 days and the impact of tracheotomy timing on overall survival in patients with HICH. Results: Patients in the early tracheotomy group showed a significant reduction in duration of ventilation and intracranial pressure (ICP) at 24 hours (post-tracheotomy) compared to those in the late tracheotomy group. Multivariable logistic regression indicated that late tracheotomy after craniectomy, old age, Glasgow Coma Scale (GCS) ≤ 6, large haematoma volume, and pneumonia after tracheotomy were risk factors for poor prognosis within 90 days in patients with HICH undergoing tracheotomy postoperatively. In terms of the impact of tracheotomy timing on overall survival in patients with HICH, 46 patients died within a follow-up period of 90 days; 19 in the early tracheotomy group (overall survival rate 62.7%), and 27 in the late tracheotomy group (overall survival of 47.1%). Conclusions: Early tracheotomy significantly improved the short-term prognosis of patients with HICH, with a higher overall survival rate compared to late tracheotomy within 90 days of illness.

Puncture and Drainage Surgery for Intracerebral Hemorrhage Guided by 3D Printing Puncture Guide Plate.

Accurate puncture is the key to ensure the effect of puncture and drainage surgery for intracerebral hemorrhage. It usually uses CT to guide the drainage tube to reach the center of the hematoma cavity, which has the problems of inaccurate positioning using 2D images and high requirements for surgeon's experience in brain anatomy and imaging diagnosis. The aim of this study was to use a 3D printing puncture guide plate to guide the puncture and drainage surgery for intracerebral hemorrhage. The CT images were imported into 3D Slicer software to reconstruct 3D models of the head skin and intracerebral hematoma. The target was set in the center of the hematoma and the puncture path from the target to the entry point was designed, the 3D model of puncture guide plate was constructed and saved as stereolithography format file, which was imported into 3D printer to print. During surgery, the drainage tube was placed in the center of the hematoma guided by the 3D printing puncture guide plate, and the blood clot was extracted by the suction syringe. Eight patients with hypertensive intracerebral hemorrhage were treated with puncture and drainage surgery guided by 3D printing puncture guide plate. The average operation time of the 8 surgeries was 17.63 minutes. The drainage tubes were all precisely placed in the center of the hematoma, and the blood clots were all successfully extracted. The positioning errors of the 8 drainage tubes were between 1.76mm and 2.68mm, and the mean value was 2.10±0.32mm. The hematoma clearance rate of the 8 patients was between 74.18% and 96.73%, and the mean value was 85.14±6.71%. The puncture and drainage surgery for intracerebral hemorrhage guided by 3D printing puncture guide plate helps to quickly and effortlessly localize intracerebral hematoma and achieves satisfactory hematoma clearance rate.

Comparison of therapeutic effects of endoscopic assisted different surgical approaches in hypertensive intracerebral hemorrhage: A retrospective cohort study.

We aimed to explore the therapeutic effects of endoscopically assisted surgical approaches for HICH. In this retrospective cohort study, we retrospectively analyzed the treatment status of 118 patients with HICH who underwent surgery for hematoma removal. Among them, 61 patients underwent endoscopically assisted hematoma removal surgery through the frontal lobe approach (frontal lobe group); 57 patients underwent endoscopic hematoma assisted via the temporal lobe approach (temporal lobe group). Treatment effects, cerebral hemodynamic status before and after treatment, postoperative prognosis at one month, and incidence of complications were compared between the 2 groups. We found that the total effective treatment rate in the frontal lobe group was higher than that in the temporal lobe group (P < .05). After surgery, the R during the contraction period of the common cerebral artery in both groups decreased compared to that before surgery, and the frontal lobe group was significantly lower than the temporal lobe group; the V and Q were higher than those before surgery, and the frontal lobe group was significantly higher than the temporal lobe group (P < .05). The prognosis of the frontal lobe group was better than that of the temporal lobe group (P < .05). Compared to the endoscopic-assisted temporal approach, the endoscopic-assisted frontal lobe approach for the treatment of HICH can improve cerebral hemodynamic status, enhance treatment efficacy, and improve prognosis.

Predicting the 90-day prognosis of stereotactic brain hemorrhage patients by multiple machine learning using radiomic features combined with clinical features.

Hypertensive Intracerebral Hemorrhage (HICH) is one of the most common types of cerebral hemorrhage with a high mortality and disability rate. Currently, preoperative non-contrast computed tomography (NCCT) scanning-guided stereotactic hematoma removal has achieved good results in treating HICH, but some patients still have poor prognoses. This study collected relevant clinical and radiomic data by retrospectively collecting and analyzing 432 patients who underwent stereotactic hematoma removal for HICH from January 2017 to December 2020 at the Liuzhou Workers Hospital. The prognosis of patients after 90 days was judged by the modified Rankin Scale (mRS) scale and divided into the good prognosis group (mRS ≤ 3) and the poor prognosis group (mRS > 3). The 268 patients were randomly divided into training and test sets in the ratio of 8:2, with 214 patients in the training set and 54 patients in the test set. The least absolute shrinkage and selection operator (Lasso) was used to screen radiomics features. They were combining clinical features and radiomic features to build a joint prediction model of the nomogram. The AUCs of the clinical model for predicting different prognoses of patients undergoing stereotactic HICH were 0.957 and 0.922 in the training and test sets, respectively, while the AUCs of the radiomics model were 0.932 and 0.770, respectively, and the AUCs of the combined prediction model for building a nomogram were 0.987 and 0.932, respectively. Compared with a single clinical or radiological model, the nomogram constructed by fusing clinical variables and radiomic features could better identify the prognosis of HICH patients undergoing stereotactic hematoma removal after 90 days.

Enlarged Perivascular Space in the Basal Ganglia is Associated with Cerebral Venous Reflux in Patients with Recent Small Subcortical Infarction.

Research has linked enlarged perivascular spaces (EPVS) to cerebral venous reflux (CVR) in patients with hypertensive intracerebral hemorrhage, but it is unclear whether this association exists in recent small subcortical infarct (RSSI) patients. This study aimed to investigate the correlation between EPVS and CVR in patients with RSSI. This study included 297 patients, selected from patients with RSSI in the lenticulostriate artery admitted to the Department of Neurology of the First Affiliated Hospital of Zhengzhou University. CVR was assessed by time-of-flight magnetic resonance angiography (TOF-MRA). The relationship between EPVS and CVR was studied using multiple logistic regression analysis. This study included patients with an average age of 59.84±12.27 years, including 201 males (67.7%). CVR was observed in 40 (13.5%) patients. Compared to the group without CVR, the proportions of male patients and patients with a history of smoking and drinking were higher in the CVR group. The proportions of high-grade EPVS in the centrum semiovale region [23 cases (57.5%) vs. 108 cases (42.0%), p =0.067] and the basal ganglia region [30 cases (75.0%) vs. 133 cases (51.8%), p =0.006] were higher in the CVR group. After multiple logistic regression analysis, high-grade EPVS in the basal ganglia region was still associated with CVR (OR, 2.68; 95% CI, 1.22-5.87; p =0.014). In the population with RSSI, EPVS in basal ganglia is significantly associated with CVR, suggesting a close relationship between venous dysfunction and the formation of EPVS.

Efficacy of robot‐assisted minimally invasive stereotactic puncture therapy for supratentorial hypertensive intracerebral hemorrhage

AbstractObjectiveTo evaluate the efficacy of robot‐assisted minimally invasive stereotactic puncture therapy (MISPT) for supratentorial hypertensive intracerebral hemorrhage (HICH).MethodsWe retrospectively analyzed 133 patients with supratentorial HICH treated using robot‐assisted MISPT (RM group; n = 77) or conventional craniotomy (CC group; n = 56). In our primary analysis, we evaluated the hematoma volume at discharge. In our secondary analyses, we evaluated the Glasgow Coma Scale (GCS) score at discharge; the operation time, intraparenchymal drainage catheter removal time, the length of hospital stay, and complications during hospitalization; the early and 6‐month postoperative mortality; and functional scores 6‐month postoperatively.ResultsThere were no statistical differences in the preoperative characteristics between the groups, such as age distribution (52.8 ± 9.6 vs. 55.3 ± 7.8 years), hematoma volume (38.4 ± 10.4 vs. 41.1 ± 11.0 mL), and GCS score (10.7 ± 2.2 vs. 9.8 ± 2.8). Hematoma volume at discharge did not significantly differ between the groups (2.6 ± 2.1 mL vs. 2.4 ± 2.1 mL). The GCS score at discharge was significantly higher in the RM group (13.5 ± 2.1 vs. 11.6 ± 3.1; p &lt; .001). Operation time (40.3 ± 7.0 min vs. 143.1 ± 61.3 min;p &lt; .001), intraparenchymal drainage catheter removal time (1.2 ± 0.4 vs. 2.1 ± 0.7 days; p &lt; .001), and length of hospital stay (9.3 ± 2.7 vs. 11.1 ± 4.8 days; p = .013) were significantly shorter in the RM group. The incidence rates of pneumonia, gastrointestinal bleeding, and intracranial infection were significantly lower in the RM group. Although the incidence of rebleeding was lower in the RM group (1.3% vs. 5.4%), the difference was not significant. Six months after surgery, the Barthel Index, Glasgow Outcome Scale, and Karnofsky performance status scores were significantly higher, whereas the modified Rankin scale score was significantly lower in the RM group (p = .002, p = .007, p = .001, and p = .018, respectively). Two RM group patients (3.1%) and six CC group patients (12.2%) died between hospital discharge and 6 months after surgery (p = .127).ConclusionThe main advantages of robot‐assisted MISPT for supratentorial HICH were shown in minimally invasive, precision, and low incidences of complications. In addition, it may improve the prognosis significantly. Thus, it has great potential to be popularized and clinically applied in the future.

Postoperative Care for Patients with Hypertensive Intracerebral Hemorrhage

This article summarizes the postoperative care plan for patients with hypertensive intracerebral hemorrhage (HICH). Nursing strategies are analyzed in terms of the level of consciousness, pupil care, vital sign care, temperature care, complication care, and early rehabilitation care, with the goal of providing reference for follow-up care of HICH patients.

The predictive role of the nomogram based on clinical characteristics and thromboelastography markers for rebleeding after hypertensive intracerebral hemorrhage

ObjectivesRebleeding after hypertensive intracerebral hemorrhage is a common and serious postoperative complication in neurosurgery, with high mortality and mental disability rates. The aim of this study was to establish a nomogram to analyze the role of thromboelastography in predicting rebleeding after hypertensive intracerebral hemorrhage. Basic methodsWe selected 375 patients with hypertensive intracerebral hemorrhage who underwent surgical treatment in Yuebei People's Hospital of Shaoguan City, Guangdong Province from May 2018 to August 2022, and retrospectively analyzed the relevant data of hypertensive intracerebral hemorrhage patients (including general data and clinical thromboelastography data), and analyzed the factors and thromboelastography parameters that affect rebleeding after surgery (45 cases, defined as re-examination of head CT within 72 h after surgery showed that the hematoma in the surgical area exceeded 20 ml). Main resultsTime from symptom onset to surgery, taking antiplatelet drugs, taking anticoagulant drugs, diabetes mellitus, difficulty in hemostasis during surgery, R value and EPL value in thromboelastography were risk factors for rebleeding after hypertensive intracerebral hemorrhage (P < 0.05). Logistic regression was used to determine the independent risk factors, and based on these risk factors, a nomogram was established and internally validated using a bootstrap method. ROC curve analysis showed that the nomogram model had high diagnostic value for rebleeding after hypertensive intracerebral hemorrhage, with AUC of 0.7314. The calibration curve of the nomogram showed good consistency between the predicted probabilities and the observed values. The decision curve analysis and clinical impact curve also revealed the potential clinical usefulness of the nomogram. ConclusionsThe nomogram based on clinical characteristics and thromboelastography markers may be useful for predicting rebleeding after hypertensive intracerebral hemorrhage.

TIE2 expression in hypertensive ICH and its therapeutic modulation with AKB-9778: Implications for brain vascular health

Hypertensive intracerebral hemorrhage (ICH) is a devastating condition, the molecular underpinnings of which remain not fully understood. By leveraging high-throughput transcriptome sequencing and network pharmacology analysis, this study unveils the significant role of the tyrosine kinase with immunoglobulin-like and EGF-like domains 2 (TIE2) in ICH pathogenesis. Compared to controls, a conspicuous downregulation of TIE2 was observed in the cerebral blood vessels of hypertensive ICH mice. In vitro assays with human brain microvascular endothelial cells (HBMEC), HBEC-5i revealed that modulation of TIE2 expression significantly influences cellular proliferation, migration, and angiogenesis, mediated via the Rap1/MEK/ERK signaling pathway. Notably, the small molecule AKB-9778 was identified to target and activate TIE2, affecting the functional attributes of HBEC-5i. In vivo experiments further demonstrated that combining AKB-9778 with antihypertensive drugs could mitigate the incidence and volume of bleeding in hypertensive ICH mouse models, suggesting potential therapeutic implications.

Comparison of two minimally invasive surgical approaches for hypertensive intracerebral hemorrhage: a study based on postoperative intracranial pressure parameters

BackgroundIncreased intracranial pressure (ICP) in patients with hypertensive intracerebral hemorrhage (HICH) has been associated with poor prognosis. The transsylvian insular approach (TIA) and the transcortical (TCA) approach are applied for patients with HICH. We aimed to compare the postoperative ICP parameters of TIA and TCA to identify which procedure yields better short-term outcomes in patients with basal ganglia hematoma volumes ranging from 30 to 50 mL.MethodsEighty patients with basal ganglia hematomas 30–50 mL were enrolled in this study. Patients were implanted with ICP probes and divided into TIA and TCA groups according to the procedure. The ICP values were continuously recorded for five days at four-hour intervals. Short-term outcomes were evaluated using the length of hospitalization and postoperative consciousness recovery time.ResultsNo statistically significant differences were found in age, sex, GCS score at admission, hematoma volume, and hematoma clearance rate (p > 0.05). The results showed that postoperative initial ICP, ICP on the first postoperative day, mean ICP, DICP20 mmHg × 4 h, postoperative consciousness recovery time, the length of hospitalization, mannitol utilization rate and the mannitol dosage were lower in the TIA group than in the TCA group (p < 0.05). Postoperative consciousness recovery time was positively correlated with ICP on the first postoperative day, and the length of hospitalization was positively correlated with mean ICP.ConclusionsTIA is more effective than TCA in improving the short-term outcomes of patients with basal ganglia hematoma volumes ranging from 30 to 50 mL according to comparisons of postoperative ICP parameters.

Synergistic effects of neuroendoscopic minimally invasive surgery with mannitol and furosemide in managing hypertensive intracerebral hemorrhage

This study aimed to assess the therapeutic efficacy of neuroendoscopic minimally invasive surgery combined with mannitol and furosemide for treating hypertensive intracerebral hemorrhage. We retrospectively analyzed clinical data from 200 patients with hypertensive intracerebral hemorrhage treated at our hospital between July 2020 and July 2022. The patients were categorized into either the experimental group (undergoing neuroendoscopic minimally invasive surgery combined with mannitol and furosemide) or the control group (undergoing neuroendoscopic minimally invasive surgery alone). Then, we compared the efficacy and impact on patients between the two groups. After treatment, the experimental group exhibited a smaller edema area compared to the control group and a reduced hematoma volume (p &lt; 0.001). The total effective rate was significantly higher in the experimental group compared to the control group (p &lt; 0.05). At 7 days post-treatment, patients in the experimental group demonstrated a significantly lower National Institutes of Health Stroke Scale (NIHSS) score compared to the control group (p &lt; 0.001). Additionally, 3 and 7 days after treatment, levels of lipid peroxidation (LPO), neuron-specific enolase (NSE), and S-100β were significantly lower in the experimental group compared to the control group (p &lt; 0.001). Similarly, carotid total blood flow volume (Q) and blood flow velocity (V) were significantly higher in the experimental group at 3 and 7 days post-treatment, with lower peripheral resistance (R) compared to the control group (p &lt; 0.001). The incidence rate of complications was significantly lower in the experimental group compared to the control group (p &lt; 0.05). The integration of neuroendoscopic minimally invasive surgery with mannitol and furosemide administration demonstrates potential in alleviating brain edema, reducing related cytokine levels, facilitating neurological function recovery, and improving cerebral hemodynamic parameters in hypertensive intracerebral hemorrhage patients. These findings merit clinical promotion and application.

Analysis of the diagnostic informativity of non-contrast computed tomography markers of intracerebral hemorrhage expansion in assessment of the individual risk of early neurological deterioration in patients with hemorrhagic hemispheric stroke

The aim of the study was to evaluate the diagnostic informativity of non-contrast computed tomography (NCCT) markers of intracerebral hemorrhage (ICH) expansion in assessment of the individual risk of early neurological deterioration (END) in patients with hemorrhagic hemispheric stroke (HHS). Materials and methods. A prospective, cohort study was conducted involving 333 patients in the acute period of hypertensive spontaneous supratentorial ICH on the background of conservative therapy. The level of neurological deficit was assessed using the Full Outline of Unresponsiveness (FOUR) coma scale and the National Institute of Health Stroke Scale (NIHSS). The computed tomography of the brain was used to verify the ICH volume, the midline shift (MS), the secondary intraventricular hemorrhage volume (IVHV) and NCCT markers of intracerebral hemorrhage expansion. As a combined clinical endpoint, END was considered (decrease of the FOUR scale score ≥2 or/and increase of the NIHSS score ≥4 or/and lethal outcome within 48 hours of hospitalization). Results. Early neurological deterioration was registered in 112 patients. On the basis of a comparative analysis, it was established that the specific weight of END was significantly higher in subcohorts of patients with individual NCCT markers of intracerebral hemorrhage expansion, than it was in subcohorts of patients without corresponding NCCT signs (p ˂ 0.0001). It was established that the following NCCT markers of ICH expansion are the most sensitive predictors of END: hypodensity, swirl sign and irregular shape (sensitivity &gt;90.0 %). The most specific NCCT markers were island sign, black hole sign, blend sign, satellite sign and heterogeneous density (specificity &gt;87.0 %). In accordance with the multiple logistic regression analysis, hypodensity (OR (95 % CI) = 13.56 (4.54–40.49), p &lt; 0.0001) and island sign (OR (95 % CI) = 5.94 (2.05–17.16), p = 0.0010) are independently associated with the risk of END. A highly sensitive multi-prediction logistic regression model was elaborated in order to predict END in patients with HHS which takes into account the most informative NCCT markers of ICH expansion (hypodensity, island sign) and quantitative neuroimaging indicators (MS, IVHV) (AUC ± SE (95 % CI) = 0.92 ± 0.02 (0.89–0.95), р ˂ 0.0001). Conclusions. Non-contrast computed tomography markers of ICH expansion are associated with increased risk of END in patients with HHS. Hypodensity and island sign are independent predictors of END. The integration of NCCT markers of ICH expansion with quantitative neuroimaging indicators (MS, IVHV) in the structure of the multi-prediction logistic regression model allows to assess the individual risk of END with an accuracy of &gt;85.0 %.

Minimally invasive puncture combined with a high frequency of urokinase therapy improves outcomes in patients with HICH

Minimally invasive puncture combined with urokinase is widely used in the treatment of hypertensive intracerebral hemorrhage (HICH). However, the appropriate frequency of urokinase following minimally invasive puncture in patients is still unclear. In total, 55 patients were enrolled in this study. According to the frequency of urokinase (10.0 ​× ​104 units) administration, 30 patients received urokinase at Q4h, while the other 25 patients received urokinase at Q8h. In the univariate analysis, preoperative GCS (p ​= ​0.0002), postoperative GCS (p ​= ​0.0007), the volume of residual hematoma (p ​= ​0.0179), and the frequency of urokinase (p ​= ​0.0110) were associated with unfavorable outcomes in patients with HICH in the basal ganglia. The multivariate analysis revealed that the frequency of urokinase was independently associated with unfavorable outcomes in patients with HICH in the basal ganglia (p ​= ​0.038, 1.109–35.380). The drainage time was significantly shorter in the Q4h group (14.17 ​± ​0.86 ​h) than in the Q8h group (27.36 ​± ​1.39 ​h) (p ​< ​0.0001). The GOS (4.37 ​± ​0.18), BI (75.52 ​± ​2.39), and mRS (1.67 ​± ​0.24) in the Q4h group were significantly ameliorated compared to those in the Q8h group (GOS 3.56 ​± ​0.18, BI 64.13 ​± ​2.22, and mRS 2.64 ​± ​0.28, respectively) (p ​= ​0.0004, p ​= ​0.0002, and p ​= ​0.0018) at 3 months of follow-up. Thus, minimally invasive puncture combined with urokinase is safe and efficient. Increasing the frequency of urokinase administration can produce faster and better postoperative recovery for patients with HICH in the basal ganglia.

Hypertensive supratentorial intracerebral hemorrhage: clinical picture, diagnosis, treatment

Background. The paper analyzed the severity and prevalence of hypertensive supratentorial intracerebral hemorrhages (ICH). This pathology is an urgent problem in the global health context, as it leads to severe consequences, including disability and death of patients. Recent discoveries and clinical guidelines provide physicians and researchers with new opportunities to improve clinical practice and improve the effectiveness of treatment for these complications. An increase in the number of cases of hypertensive supratentorial intracerebral hemorrhages and their impact on public health makes this problem extremely relevant in the field of medicine. Materials and methods. Two hundred and thirty-two patients with supratentorial intracerebral hemorrhages caused by hypertension were examined and treated in 2019–2020 at the Kyiv City Clinical Emergency Hospital. The average age of patients was 60 years: for men, it was 56 years, for women 69 years. They were observed during treatment in the hospital for up to 21 days. On the 21st day, the degree of disability was assessed. All patients underwent a neurological examination with an assessment of consciousness according to the Glasgow Coma Scale, Intracerebral Hemorrhage Score, Barthel index, modified Rankin scale, National Institutes of Health Stroke Scale (NIHSS). We have used neuroimaging methods (computed tomography, magnetic resonance angiography, if necessary). Clinical and laboratory studies were conducted. Results. It was found that 127 (57 %) patients had putaminal supratentorial hemorrhage, 24 (10 %) — thalamic, 34 (15 %) — subcortical (in the white matter of the cerebral hemispheres), 47 (20 %) — mixed. Seventy-seven (33 %) patients were hospitalized in a coma (Glasgow Coma Scale ≤ 8 points), 36 (16 %) in a sopor, 81 (35 %) in a stunned state, and 31 (13 %) patients were conscious. Patients over 60 years of age had ICH of deep localization, while young patients had cortical ones. Ninety-four surgical interventions were performed in 84 patients with lobar and lateral hematomas, as well as with breakthrough into the ventricular system (liquid drainage surgery). General mortality was 39.5 %, surgical — 46.4 %. Contraindications for surgical interventions were as follows: an existing severe coma, unstable hemodynamics, the need for constant administration of vasopressors, as well as severe comorbid conditions. Conclusions. It was found that the clinical picture of acute supratentorial intracerebral hemorrhages against the background of hypertension is characterized by polymorphic neurological symptoms according to the localization of the hematoma, its volume, cerebral edema, and intracranial hypertension. The results of the treatment of patients with hypertensive ICH indicate the need for early hospitalization, early computed tomography scan, and a differentiated approach to surgical removal of the hematoma. The favorable outcome of supratentorial ICH is more typical for patients with initial mild and moderate neurological symptoms in case of a hemorrhage volume of less than 30 cm3. The presence of blood breakthrough into the ventricular system increases the risk of death by 35 times.