Nontraumatic Cerebral Hemorrhage Research Articles

Association between high serum blood glucose lymphocyte ratio and all-cause mortality in non-traumatic cerebral hemorrhage: a retrospective analysis of the MIMIC-IV database.

This study aimed to evaluate the association between the glucose-to-lymphocyte ratio (GLR) and all-cause mortality in intensive care unit (ICU) patients with Non-traumatic cerebral hemorrhage. This is a retrospective cohort study. Baseline data and in-hospital prognosis from patients with non-traumatic cerebral hemorrhage admitted to the intensive care unit. Multivariate COX regression analysis was applied and adjusted hazard ratios (HR) and 95% predictive values with confidence intervals (CI) were calculated. Survival curves for the two groups of cases were plotted using K-M curves, and subgroup analyses were performed in one step. Using restricted cubic spline curves, we analyzed the potential linear relationship between GLR and outcome indicators. In the Medical Information Mart for Intensive Care IV (MIMIC-IV database), we extracted 3,783 patients with nontraumatic intracerebral hemorrhage, and 1,806 patients were finally enrolled in the study after exclusion of missing values and patients with a short hospital stay. The overall ICU mortality rate was 8.2% (148/1806) and the in-hospital mortality rate was 12.5% (225/1806). The use of curve fitting yielded a significant linear relationship between GLR and both ICU mortality and in-hospital mortality. It also suggested a reference point at GLR=3.9. These patients were categorized into high and low subgroups based on the median value of their GLR (GLR = 3.9). Model comparisons based on multivariate COX regression analysis showed that in-hospital mortality was higher in the high GLR group after adjusting for all confounders (HR = 1.31, 95% CI: 1.04-1.47), while the ICU mortality in the high GLR group was (HR = 1.73, 95% CI: 1.18-2.52). Stratified analyses based on age, gender, race, GCS, BMI, and disease type showed stable correlations between the high GLR group and in-hospital and ICU mortality. Based on our retrospective analysis, it is known that as the GLR increased, the in-hospital mortality rate and ICU mortality rate of patients with nontraumatic cerebral hemorrhage also increased progressively in the United States in a clear linear relationship. However, further studies are needed to confirm these findings.

Association of glycemic variability with death and severe consciousness disturbance among critically ill patients with cerebrovascular disease: analysis of the MIMIC-IV database

BackgroundThe association of glycemic variability with severe consciousness disturbance and in-hospital all-cause mortality in critically ill patients with cerebrovascular disease (CVD) remains unclear, This study aimed to investigate the association of glycemic variability with cognitive impairment and in-hospital death.MethodWe extracted all blood glucose measurements of patients diagnosed with CVD from the Medical Information Mart for Intensive Care IV (MIMIC-IV). Glycemic variability was defined as the coefficient of variation (CV), which was determined using the ratio of standard deviation and the mean blood glucose levels. Cox hazard regression models were applied to analyze the link between glycemic variability and outcomes. We also analyzed non-linear relationship between outcome indicators and glycemic variability using restricted cubic spline curves.ResultsThe present study included 2967 patients diagnosed with cerebral infarction and 1842 patients diagnosed with non-traumatic cerebral hemorrhage. Log-transformed CV was significantly related to cognitive impairment and in-hospital mortality, as determined by Cox regression. Increasing log-transformed CV was approximately linearly with the risk of cognitive impairment and in-hospital mortality.ConclusionHigh glycemic variability was found to be an independent risk factor for severe cognitive decline and in-hospital mortality in critically ill patients with CVD. Our study indicated that enhancing stability of glycemic variability may reduced adverse outcomes in patients with severe CVD.

Triglyceride glucose index is a significant predictor of severe disturbance of consciousness and all-cause mortality in critical cerebrovascular disease patients

ObjectiveThe association of the triglyceride-glucose (TyG) index with severe consciousness disturbance and in-hospital mortality in patients with cerebrovascular disease in the intensive care unit (ICU) is unclear. This study aimed to investigate the TyG index’s predictive ability on the severity of impaired consciousness and in-hospital mortality in patients with cerebrovascular disease in the ICU.MethodPatients diagnosed with non-traumatic cerebral hemorrhage and cerebral infarction were extracted from the MIMIC-IV database and analyzed as two cohorts. The association between the TyG index and the severity of patients’ impairment of consciousness and in-hospital mortality was analyzed using logistic regression models. Using restricted cubic spline curves, we analyzed potential nonlinear relationships between TyG indices and outcome indicators. receiver operating characteristic (ROC) curves were utilized to evaluate the predictive ability of the TyG index for outcome indicators.ResultThe study’s last two cohorts comprised 537 patients with traumatic cerebral hemorrhage and 872 patients with cerebral infarction. TyG index was a significant predictor of the severity of impaired consciousness and in-hospital mortality in patients with cerebrovascular disease, as determined by logistic regression. The risk of severe consciousness impairment and in-hospital mortality increased roughly linearly with increasing TyG index.ConclusionThe TyG index was found to be a significant predictor for severe impairment of consciousness and in-hospital death in patients with cerebrovascular disease in the ICU, and it provides some predictive value for the severity of consciousness disturbances and in-hospital mortality in cerebrovascular disease patients.

Construction of Nanomaterials and the Role of Rutin in the Treatment of Cerebral Hemorrhage

Cerebral hemorrhage generally refers to nontraumatic cerebral parenchymal hemorrhage. In China, about 20%–30% of all stroke in a month after the mortality rate can be as high as 40%. And most of the survivors have obvious neurological dysfunction, to the patient’s family and society from all walks of life caused great psychological pressure, which will seriously affect the human physical and mental health. This article aims at studying the construction of nanomaterials and the role of rutin in the treatment of ICH. It first introduces the characteristics of nanomaterials; nanomaterials have some special effects based on their special internal structural properties and surface states. These effects derive many physical and chemical properties that general substances do not possess, such as optical, electrical, magnetic, catalytic, and photocatalytic properties. A simple analysis of cerebral hemorrhage then gives the nanomaterials the first-principles algorithm. Practical application of nanomaterials is a class of nanomaterials, which have many strange chemical characteristics such as special light, electric, magnetic, thermal, mechanical, mechanical physical, and chemical characteristics. Then, the nanocomposite of rutin electrochemical detection is analyzed, and finally rutin and analog brain drug dynamics is discussed. The experimental results showed that the RSD of samples at room temperature, freeze-thaw cycles, and long-term stability of the mice were less than 5.0%, and the stability of mouse brain tissue homogenate samples completely meets the requirements of troxerutin, rutin, and troxerutin aglycone.

Correlation of serum ferritin levels with neurological function-related indices and cognitive dysfunction in patients with cerebral hemorrhage

The purpose of this study was to explore the correlation of serum ferritin (FS) levels with neurological function-related indices, such as neuron-specific enolase (NSE) and S100β protein levels, and cognitive dysfunction in patients with cerebral hemorrhage. Patients with acute non-traumatic cerebral hemorrhage (cerebrovascular disease (VD), n = 128) and healthy controls (CON, n=128) were included. FS, NSE, and S100β levels were measured using ELISA. Cognitive functions were evaluated using the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE). The receiver operating characteristic (ROC) curve was used to assess the ability of SE, NSE, and serum S100β to predict the diagnosis of cognitive dysfunction in patients with cerebral hemorrhage. Multivariate logistic regression analysis was used to assess the risk factors of cognitive impairment in patients with cerebral hemorrhage. Cognitive impairment in patients with VD was closely related to the increased levels of SE, NSE, and S100β. There was a strong correlation between MoCA and MMSE scores and the levels of FS, NSE, and S100β. The independent risk factors leading to cognitive impairment in cerebral hemorrhage mainly include family history of cerebrovascular disease, body mass index, hypertension, smoking frequency, and elevated levels of low-density lipoproteins, NSE, FS, and S100β. NSE, FS, and S100β can be used as important markers for the diagnosis of cognitive impairment in patients with cerebral hemorrhage.

The Potential Role of Radiology in Diagnosis of Traumatic Versus Non-Traumatic Cerebral Hemorrhages for Medicolegal Application

Background: Radiography is traditionally used as a complement tool for forensic examination. CT applications became widely used. Traumatic cerebral hemorrhage occurs in up to 15% of patients following head injury and non-traumatic cerebral hemorrhage accounts for up to 44% of all strokes. These two disorders are therefore very common. So there is a need for accurate diagnosis of cerebral hemorrhage form medicolegal aspect. This study aims to differentiate between traumatic and non-traumatic cerebral hemorrhage by using CT. Methods: This prospective study, was conducted on 100 patients with intracranial hemorrhage and divided in two equal groups (traumatic and non-traumatic cerebral hemorrhage) both groups were examined by CT head and the results were analyzed. Results: There was statistically significant difference between traumatic and non-traumatic cerebral hemorrhage groups in CT finding as regard type of hemorrhage with epidural, subarachnoid and intraventricular with P value (0.001, 0.005 and 0.001) respectively. Also according to site of hemorrhage in frontal lobe and subcortical with P value (0.001) equally. Conclusion: we conclude that equation Function (f) = - 0.976 (constant) + 2.873(Epidural) + 2.017 (Subarachnoid) - 0.416 (Intraventricular) + 0.984 (Frontal) -3.047 (Subcortical) If the function (f) = + values, it will be traumatic hemorrhage and if the function (f) = - values it will be pathological hemorrhage

Frequency and risk factors of polypharmacy and drug interactions among patients in general intensive care unit of Golestan Hospital, Ahvaz, southwest of Iran

<abstract><sec> <title>Objective</title> <p>This study was aimed to evaluate polypharmacy and drug interactions in intensive care units.</p> </sec><sec> <title>Materials and methods</title> <p>This epidemiologic-descriptive study was performed on the records of 80 patients admitted to the intensive care unit with a duration of more than 48 hours from 2018-10-23 to 2019-01-21. The patients' records, including polypharmacy, type and number of drug interactions as well as factors such as age, gender, hospitalization duration, number of drug-prescribing physicians were investigated. To determine drug interactions, Free <italic>Lexi-Comp</italic> <italic>iOS</italic> software version 4.0.1 was used.</p> </sec><sec> <title>Findings</title> <p>Of 80 participants in this study, 58, and 22 patients (72.5%, and 27.5%) were respectively male and female, with a mean age of 39.9 years; besides, 46.2%, and 25.3% of patients were hospitalized due to trauma, and non-traumatic cerebral hemorrhage, respectively. The average hospitalization was six days. The average number of drug-prescribing physicians and medications received was 5 and 10, respectively. The majority of patients (91.2%) received over five drugs. The majority of drug interactions (70%) were in C-Class, and 1.2% were in X-Class. Also, 85% of the studied samples had at least one drug interaction.</p> </sec><sec> <title>Conclusion</title> <p>Polypharmacy and drug interactions were common in patients hospitalized in the intensive care unit ward. Risk factors for increasing drug interactions were the length of stay and number of medications prescribed, and for polypharmacy, length of stay, number of medications-prescribing physicians, and number of prescription medications.</p> </sec></abstract>

Diagnostic value of serum glial fibrillary acidic protein and S100B serum levels in emergency medicine patients with traumatic versus nontraumatic intracerebral hemorrhage.

Glial fibrillary acidic protein (GFAP) is a brain-specific astroglial protein that is released into the blood soon after traumatic brain injury by mature astrocytes. S100B is rapidly released into the cerebrospinal fluid and bloodstream after brain damage. We compared the serum concentrations of these proteins in patients with severe head trauma (bleeding and/or fracture) or nontraumatic intracerebral hemorrhage and healthy individuals. The study included 63 patients (33 males and 30 females) with traumatic cerebral hemorrhage and/or cranial bone fractures or nontraumatic cerebral hemorrhage and 30 healthy control subjects. The reasons for attending the emergency department were as follows: fall from a height (n = 32), traffic accident (n = 18), nontraumatic intracerebral hemorrhage (n = 6), animal kick to the head (n = 4), and blow to the head (n = 3). Of the 63 patients included in the study, 33 (52.4%) were male and 30 (47.6%) were female. Of the 30 healthy controls, 12 (40%) were male and 18 (60%) were female. The average age of the patients was 27 years (range, 1 month to 86 years) and the average age of the control group was 21 years (range, 18-30 years). The mean serum GFAP concentrations were 86.37 ng/mL in the patients and 38.07 ng/mL in the controls (P < 0.05). The mean serum S100B concentrations were 428.37 pg/mL in the patients and 103.44 pg/mL in the controls (P < 0.05). Eight (12.7%) patients died in the hospital; of those, the mean GCS score was 4.6, and the mean GFAP and S100B levels were 127.8 ng/mL and 860.6 pg/mL, respectively. The GFAP and S100B concentrations were significantly higher in patients with traumatic or nontraumatic brain injury than in healthy individuals, indicating that serum levels of these biomarkers may provide an alternative to computed tomography for the diagnosis of brain injury.

An increase of blood anti-β2-glycoprotein-i antibody associates with cerebral hemorrhage in patients without antiphospholipid antibody syndrome

Although an increase of blood anti-beta2-glycoprotein I antibody (aβGPI) is known to raise the risk for cerebral ischemia in patients without antiphospholipid antibody syndrome or systemic lupus erythrematosus, there is no case of cerebral hemorrhage mentioned yet. We reported 6 patients who suffered from nontraumatic cerebral hemorrhage who were identified to have an increase of aβGPI. The frequency of increased aβGPI in cerebral hemorrhage was 9.7%. Hematoma was predilected at putamen in patients with increased aβGPI. The activity of coagulation factors was normal. Multiple brain infarcts compatible with small artery occlusion were illustrated in all of them. Accordingly, cerebral hemorrhage may arise out of small artery vasculopathy in these patients. These results highlight a relationship between autoimmunity, such as aβGPI, and cerebral hemorrhage, especially in the case of an absence of traditional risk factor.

The potential of capillary birthmarks as a significant marker for capillary malformation–arteriovenous malformation syndrome in children who had nontraumatic cerebral hemorrhage

Background/Purpose Capillary malformation–arteriovenous malformation (CM-AVM) is a new autosomal dominant disorder with cutaneous capillary malformations (CM) and high-flow cerebral arteriovenous malformations (AVM). Patients may have Parkes-Weber syndrome. This study determined if cutaneous CM are a significant indicator of CM-AVM in children with cerebral bleeds. Methods Children with cerebral AVMs between 1991 and 2009 were reviewed. A family history of brain hemorrhage, AVMs, or cutaneous birthmarks was elicited. Patients and siblings were examined for CM and a family tree recorded. A brief questionnaire determined the family's opinion regarding screening for this syndrome. Results Of 30 families, 1 family had Parkes-Weber syndrome. In 3 families, both patient and relatives had CM. In 9 families, patients had no CM, but relatives had them. One family had hereditary hemorrhagic telangiectasia. From the survey, 80% of families would be concerned about vascular marks, and 87% of families would allow screening for cerebral AVMs. Conclusion A family history of vascular marks may predict families at risk of having a cerebral AVM with hemorrhage. Most families would agree to screening. However, family history and physical examination alone do not confirm CM-AVM but form a useful screening tool to identify families needing further investigations with genetic testing and/or magnetic resonance imaging.

Efficiency of Citicoline in Increasing Muscular Strength of Patients with Nontraumatic Cerebral Hemorrhage: A Double-blind Randomized Clinical Trial

Brain infarction cerebrovascular accident is the most common neurologic disease throughout the world. Currently, there is no proven therapeutic effect for drugs other than thrombolytic ones in treatment of the acute phase of cerebrovascular accident. Some recent studies indicate that neuroprotective compounds such as citicoline can be of benefit in the acute phase of cerebrovascular accidents, including the bleeding form. This study was carried out to assess the efficiency of citicoline in increasing muscular strength of patients with nontraumatic cerebral hemorrhage. This was a double-blind randomized clinical trial on 32 patients with hemorrhagic nontraumatic supratentorial cerebral infarction, who were divided into two groups of 16, the first of which was treated with citicoline (250 mg intravenously twice a day) for 14 days. The second group was given placebo and their muscular strength was measured through physical examination before treatment and then 3 months later. The groups were matched in terms of age, sex, and amount of bleeding. The muscular strength of the two groups was compared using Mann-Whitney nonparametric test. Half of the patients were male and the mean of muscular strength in both groups before intervention was 2.5 (0-4.5) and after intervention was 4 in the group receiving citicoline and 3.12 and in the group receiving placebo, which indicates a meaningful difference (P = .019). The findings of this study showed that muscular strength in patients with cerebral hemorrhage receiving citicoline increased and indicated that citicoline may be efficient in treatment of patients with cerebral hemorrhage.

Deceased Donors With a Past History of Malignancy: An Organ Procurement and Transplantation Network/United Network for Organ Sharing Update

Approximately 2% of deceased donor organ transplants result from donors with a past history of cancer. An analysis of Organ Procurement and Transplantation Network/United Network for Organ Sharing data on 39,455 deceased donors from 2000 to 2005 showed 1069 donors had a PHC, resulting in 2508 transplants, including 1236 kidneys, 891 livers, 199 hearts, 100 lungs, and 82 miscellaneous organs. The most common type of previous cancer in the donor was nonmelanoma skin cancer (n=776) followed by central nervous system malignancies (n=642) and carcinoma of the uterine cervix (n=336). One donor with a glioblastoma multiforme transmitted fatal tumors to three recipients. One donor with a history of melanoma 32 years earlier transmitted a fatal melanoma to a single recipient and, therefore, donors with a history of melanoma should not be used. Donors with a past history of cancer who have a nontraumatic cerebral hemorrhage cause concern because this hemorrhage may be the result of an unrecognized metastatic tumor.

Cerebral beta-amyloid angiopathy in aged squirrel monkeys.

Cerebral beta-amyloid angiopathy (CAA) is an age-related disorder of the brain vasculature that is involved in up to 20% of non-traumatic cerebral hemorrhage in humans. CAA is a risk factor for cognitive decline, and may exacerbate the dementia of Alzheimer's disease. Progress in discovering the cause and potential therapies for this disorder has been hindered by the paucity of animal models, particularly models of idiopathic CAA. The squirrel monkey (Saimiri spp) develops significant CAA in the natural course of aging. To evaluate the suitability of Saimiri as a model of human CAA, we studied the distribution and composition of Abeta subtypes in CAA and parenchymal (senile plaque) deposits in the brains of aged squirrel monkeys, as well as the relationship between vascular beta-amyloid deposition and comorbid vasculopathies that occur in aged humans. Our findings show that: 1) CAA consists ultrastructurally of classical amyloid fibrils and is the principal type of cerebral beta-amyloidosis in squirrel monkeys; 2) The two primary isoforms of Abeta (Abeta40 and Abeta42) coexist in most microvascular and parenchymal lesions of Saimiri, although Abeta40 tends to predominate in larger arterioles; 3) CAA and parenchymal plaques overlap to a considerable degree in most affected brain areas, and are distributed symmetrically in the two hemispheres; 4) Both CAA and plaques are particularly abundant in rostral regions and comparatively sparse in the occipital lobe; 5) Capillaries are especially vulnerable to CAA in squirrel monkeys; and 6) When CAA is severe, it is associated with a small, but significant, increase in other vasculopathies, including microhemorrhage, fibrinoid extravasation and focal gliosis. These findings, in the context of genetic, vascular and immunologic similarities between squirrel monkeys and humans, support the squirrel monkey as a biologically advantageous model for studying the basic biology of idiopathic, age-related CAA, and for testing emerging therapies for human beta-amyloidoses such as Alzheimer's disease.

The Families In Recovery From Stroke Trial (FIRST): Primary Study Results

Social support and family ties are strong predictors of functional recovery after stroke; however, development of successful psychosocial intervention programs has been difficult. This study examined whether a family-systems intervention designed to influence social support and self-efficacy affects functional outcome in older stroke patients. Two hundred ninety-one community-residing survivors of ischemic stroke or nontraumatic cerebral hemorrhage from eight acute-care hospitals and rehabilitation centers were randomized to either psychosocial intervention (PSI) or usual care (UC). PSI involved up to 16 sessions conducted in the home by a mental health worker. Functional recovery (measured by the Barthel Index [BI] at 6 months postrandomization, inability to assess functioning because of illness or death) was the primary end point. Functional recovery did not differ between UC and PSI in intention-to-treat analyses. In adjusted logistic regression, the odds of being functionally independent at 6 months was 60% higher in the intervention group, but this difference was not statistically significant (p = .31). Subgroup analyses revealed that PSI may be more effective in subjects with better psychologic and cognitive functioning and who required less inpatient rehabilitation. This study does not provide evidence for the efficacy of psychosocial intervention to improve functional recovery in stroke. Although PSI showed greater improvement than UC, the differences were not statistically significant.

Hemorragia ventricular primaria

Primary intraventricular hemorrhage is non-traumatic cerebral hemorrhage limited to the ventricular system which presents on rare occasions, forming 3% of the spontaneous cerebral hemorrhages. The diagnosis may be suspected when there is sudden onset of headache, nausea and vomiting with reduced level of consciousness. On examination there are signs of meningism, bilateral positive Babinski signs and absence of localizing neurological signs. However, cases of more subacute onset or with a normal state of consciousness are also seen. Therefore, in spite of clinical suspicion, diagnosis is made on cerebral computerized tomography. The aetiology is varied and it should be emphasized that vascular malformations cause 34% and in 21-47% no cause is found. Probably arterial hypertension is a major cause of primary intraventricular haemorrhage (38.5% in one series). Arteriography is necessary as well as computerized tomography for diagnosis of the aetiology. The prognosis is relatively good. The mortality is 29% and most survivors become asymptomatic or are left with only minor sequelae, often characterized by memory problems. In elderly patients there is a worse prognosis if there is an initial alteration in consciousness and if hydrocephaly occurs, but the prognosis does not appear to be affected by the volume of the hemorrhage. There is no specific treatment, but promising results have been obtained with intrathecal administration of fibrinolytic agents followed by external drainage.

Nontraumatic cerebral hemorrhage in the young: A study of 107 cases

Reports on intracerebral hemorrhage (ICH) in the young are rare, and information on the cause and prognosis of ICH in this age-group is sparse. All cases of ICH admitted to three major hospitals in Saudi Arabia over a 15-year period were retrospectively reviewed. Patients aged between 6 months and 45 years at stroke onset were studied. Pooling of our data with those published from other centers was used for final analysis. One hundred seven cases (69 male, 38 female), including 12 children younger than 10, were analyzed. The causes of hemorrhage were as follows: arteriovenous malformations (AVMs), 23%; systemic hypertension, 20%; blood dyscrasias, 16%; berry aneurysms, 8%; other causes, 7%. No cause was found in 26%. Sixty-two percent of the ICHs were lobar and 3% multiple. Early death rate was high (27%). Twelve percent of the patients were lost to follow-up, and only 26% returned to a state of complete autonomy. The pooling of the causative data from our cases and the 253 others reported in the literature showed that even before 45 years of age systemic hypertension is the leading cause of ICH. It accounts for approximately 30% of the cases, with AVMs (20%) being next. The pooled overall early mortality rate is approximately 20%, and only one third of the patients return to independent living.

Cerebral Amyloid Angiopathy: A Common Cause of Intracerebral Hemorrhage in the Elderly - A casereport

Cerebral amyloid angiopathy, defined as deposition of amyloid in the walls of brain vessels, is belived to be a common cause of intracerebral hemorrhage in the elderly. It differentiates from the intracerebral hemorrhage of hypertension by its specific location of bleeding. The hematoma from cerebral amyloid angiopathy, sometimes multilobar, is always located in the brain cortices and the white matter beneath them. In the previous reports, the presence of cerebral amyloid angiopathy accounts for 5-10% of non-traumatic cerebral hemorrhage. However, it has been overlooked or misdiagnosed all the time because of the lack of tissue proof. Recurrent bleeding occurs so often, as it is rare in hypertensive intracerebral hemorrhage, that we should know how to detect cerebral amyloid angiopathy and prevent rebleeding. We report a case of intracerebral hemorrhage which was misdiagnosed as tumor bleeding. The patient underwent craniotomy for evacuation of hematoma and tumor excision. There was no tumor tissue in the specimen but it showed amyloid angiopathy. We presented her clinical course and discussed the differential diagnosis of intracerebral hemorrhage. We remind all the physiatrists that cerebral amyloid angiopathy is a possible cause of intracerebral hemorrhage, and not rare.

Seasonal variation of cerebral hemorrhage in 236 consecutive cases in Brussels.

Seasonal variation in the incidence of cerebral hemorrhage has been previously demonstrated. In this study, we sought to identify the climatological data best correlated with this seasonal variation. In a retrospectively studied sequential series of 236 patients with nontraumatic cerebral hemorrhage observed in Brussels over a period of 8 years, we cumulatively grouped the dates of stroke occurrence into a single calendar year. We found marked seasonal variation in incidence, with the highest value (23%) observed in November-December and the lowest (10%) in July-August. Seasonal variations in incidence of cerebral hemorrhage were shown to be correlated not only with the inverse of ambient temperature, but also with the inverse of hours of sunshine and with ambient humidity. We found no difference between hypertensive and normotensive patients. Our study fails to bear out the hypothesis that the higher incidence of cerebral hemorrhage in late autumn and winter is due to the influence of low ambient temperature on blood pressure.

Cerebrovascular amyloidosis with cerebral hemorrhage.

More than 1400 necropsies performed on patients with either a nontraumatic cerebral hemorrhage (400 cases) or with dementia over the age of 55 (1010 cases), or both, have been reviewed. There were 15 cases in which a cerebral hemorrhage had occurred together with cerebral amyloid angiopathy all of whom had been demented. Eight of the 15 patients were hypertensive. The 7 non-hypertensives showing only the amyloid change included two cases of "atypical" Alzheimer's disease with acute neurological features, and 5 cases of senile dementia (aged 72 to 78 years) coupled with focal neurological disorders. In the hypertensive patients, aged 67 to 86 years, with a progressive dementing syndrome and acute neurological signs, multiple ball-like hemorrhages (7 cases) and/or cerebral hematomas (3 cases) were associated with a combination of amyloid and hyalinar (hypertensive) angiopathy, often affecting segments of the same pial and cortical vessels. From these data and recent reports on lethal cerebral hemorrhage occurring spontaneously or after neurosurgical procedures in demented old people, cerebral amyloid angiopathy, which is not necessarily associated with systemic amyloidosis or severe (pre)senile cerebral degeneration, may be considered a rare but important cause of cerebral hemorrhage in the aged. The "vascular" type of presenile dementia, occasionally complicated by focal cerebrovascular lesions or bleeds, is considered a variant of Alzheimer's disease. The mechanism leading to formation of cerebral amyloid is unknown.