Prevention Of Intracerebral Hemorrhage Research Articles

Grape Seed Extract Polyphenols Improve Resistance Artery Function in Pregnant eNOS-/- Mice.

Hypertension during pregnancy is a leading cause of maternal and fetal morbidity and mortality worldwide, increasing the risk of complications including preeclampsia, intracerebral hemorrhage and fetal growth restriction. Increased oxidative stress is known to contribute to poor vascular function; however, trials of antioxidant supplementation have raised concerns about fetal outcomes, including risk of low birthweight. Grape seed extract polyphenols (GSEP) have been suggested to promote cardiovascular protection, at least in part through antioxidant actions. We tested the hypothesis that administration of GSEP during pregnancy would reduce oxidative stress and improve resistance artery function with no detrimental effects on fetal growth, in an established model of maternal hypertension associated with vascular dysfunction, the endothelial NO synthase knockout (eNOS–/–) mouse. Pregnant C57BL/6J (WT) and eNOS–/– mice received either GSEP (200 mg/kg/day) or drinking water, between gestational (GD) day 10.5 and GD18.5. At GD17.5, maternal systolic blood pressure (SBP) was measured; at GD18.5, maternal malondialdehyde (MDA) concentrations, vascular function of aortic, mesenteric, uterine and posterior cerebral arteries was assessed, and fetal outcome evaluated. GSEP reduced maternal SBP (P < 0.01) and plasma MDA concentrations (P < 0.01) in eNOS–/– mice. Whilst there was no effect of GSEP on vascular reactivity of aortas, GSEP improved endothelial-dependent relaxation in mesenteric and uterine arteries of eNOS–/– mice (P < 0.05 and P < 0.001, respectively) and normalized lumen diameters of pressurized posterior cerebral arteries in eNOS–/– mice (P < 0.001). Supplementation with GSEP had no effect in WT mice and did not affect fetal outcomes in either genotype. Our data suggest that GSEP improve resistance artery function, potentially through antioxidant actions, and provide a basis to further investigate these beneficial effects including in the prevention of intracerebral hemorrhage. Maternal supplementation with GSEP may be a safe intervention to improve outcomes in pregnancies associated with hypertension and vascular dysfunction.

Seizure Outcomes in Patients With Surgically Treated Cerebral Arteriovenous Malformations

Epilepsy is the second most common symptom in cerebral arteriovenous malformation (AVM) patients. The consecutive reduction of life quality is a clinically underrated problem because treatment usually focuses on the prevention of intracerebral hemorrhage. To evaluate postoperative seizure outcome with the aim of more accurate counseling for postoperative seizure outcome. From 1985 to 2012, 293 patients with an AVM were surgically treated by J.S. One hundred twenty-six patients with preoperative seizures or epilepsy could be identified; 103 of 126 had a follow-up of at least 12 months and were included in the analysis. The different epilepsy subtypes were categorized (sporadic seizures, chronic epilepsy, drug-resistant epilepsy [DRE]). Preoperative workup and surgical technique were evaluated. Seizure outcome was analyzed by using International League Against Epilepsy classification. Sporadic seizures were identified in 41% of patients (chronic epilepsy and DRE were identified in 36% and 23%, respectively). Detailed preoperative epileptological workup was done in 13%. Seizure freedom was achieved in 77% (79% at 5 years, 84% at 10 years). Outcome was significantly poorer in DRE cases. More extensive resection was performed in 11 cases with longstanding symptoms (>24 months) and resulted in better seizure outcome as well as the short duration of preoperative seizure history. Patients presenting with AVM-associated epilepsy have a favorable seizure outcome after surgical treatment. Long-standing epilepsy and the progress into DRE markedly deteriorate the chances to obtain seizure freedom and should be considered an early factor in establishing the indication for AVM removal.

Neonatal Intracerebral Hemorrhage: Mechanisms, Managements, and the Outcomes

Intracerebral hemorrhage is a multifactorial disorder with heterogeneous etiologies and potentially long-term debilitating outcomes. We review all available evidence regarding the current strategies for management of intracerebral hemorrhage. It is clear that prompt detection and treatment does affect the outcome; nevertheless, prevention of intracerebral hemorrhage remains the best strategy.

Abstract 2267: Poor Long-Term Blood Pressure Control after Intracerebral Hemorrhage in a Predominantly African American Hypertensive Population

Objective: Hypertension is the most important risk factor for both primary and secondary prevention of intracerebral hemorrhage (ICH). We sought to determine the frequency of blood pressure control after ICH and explored predictors of higher blood pressure (BP) at presentation, 30 days, and 1 year in a prospective cohort study. Methods: Individuals with spontaneous non-traumatic ICH were prospectively enrolled in the DiffErenCes in the Imaging of Primary Hemorrhage based on Ethnicity or Race (DECIPHER) Project. BP was measured at 30 days and 1 year during in-person visits, and BP at presentation was abstracted from the medical record. Linear regression was used to determine factors associated with mean arterial pressure (MAP) at presentation, and longitudinal linear regression was used to determine baseline predictors of MAP at 30 days at 1 year. Results: A total of 143 patients had blood pressure data available at either 30 days (125 patients) or 1 year (85 patients). Mean age was 59, 57% were men, and 80% were African American (AA) and the rest were White (other race/ethnic groups excluded due to low numbers). AAs were younger (57 vs. 65, p=0.002), less likely to be married (37% vs. 61%, p=0.02), more likely to have a history of hypertension (90% vs. 71%, p=0.03), and more likely to be smokers (30% vs. 11%, p=0.03) than Whites. Average BP at presentation was 178±35/99±24mmHg. Multivariable linear regression revealed that AAs had a presenting MAP that was on average 14mmHg higher than Whites despite adjustment for age, gender, socioeconomic status, body mass index, private health insurance, marital status, smoking, cocaine, and ICH volume. Blood pressure control at follow-up was poor, with fewer than 20% of patients having a normal blood pressure (&lt;120/80) at 30 days and 1 year after ICH (no difference by race). The only factor significantly associated with lower MAP at follow up was being married at baseline (β=-5.2, p=0.047) despite adjustment for age, race, gender, socioeconomic status, private health insurance, smoking, cocaine use, National Institutes of Health Stroke Scale, time point of one year (reference: day 30), and living in a personal residence (reference: living in a facility). Other covariates in the model including race were not associated with MAP at follow up, though there was a trend toward living in a personal residence being associated with a higher MAP (β=4.4, p=0.10) Conclusions: AAs had a higher MAP than Whites at the time of presentation with ICH. Optimal blood pressure control at 1 year occurred in less than 20% of the cohort. The only factor predictive of lower MAP at follow up was being married at baseline. Additional efforts are urgently needed to improve blood pressure control in both AA and White ICH survivors.

Intracerebral hemorrhage: toward physiological imaging of hemorrhage risk in acute and chronic bleeding.

Despite improvements in management and prevention of intracerebral hemorrhage (ICH), there has been little improvement in mortality over the last 30 years. Hematoma expansion, primarily during the first few hours is highly predictive of neurological deterioration, poor functional outcome, and mortality. For each 10% increase in ICH size, there is a 5% increase in mortality and an additional 16% chance of poorer functional outcome. As such, both the identification and prevention of hematoma expansion are attractive therapeutic targets in ICH. Previous studies suggest that contrast extravasation seen on CT Angiography (CTA), MRI, and digital subtraction angiography correlates with hematoma growth, indicating ongoing bleeding. Contrast extravasation on the arterial phase of a CTA has been coined the CTA Spot Sign. These easily identifiable foci of contrast enhancement have been identified as independent predictors of hematoma growth, mortality, and clinical outcome in primary ICH. The Spot Sign score, developed to stratify risk of hematoma expansion, has shown high inter-observer agreement. Post-contrast leakage or delayed CTA Spot Sign, on post contrast CT following CTA or delayed CTA respectively are seen in an additional ∼8% of patients and explain apparently false negative observations on early CTA imaging in patients subsequently undergoing hematoma expansion. CT perfusion provides an opportunity to acquire dynamic imaging and has been shown to quantify rates of contrast extravasation. Intravenous recombinant factor VIIa (rFVIIa) within 4 h of ICH onset has been shown to significantly reduce hematoma growth. However, clinical efficacy has yet to be proven. There is compelling evidence that cerebral amyloid angiopathy (CAA) may precede the radiographic evidence of vascular disease and as such contribute to microbleeding. The interplay between microbleeding, CAA, CTA Spot Sign and genetic composition (ApoE genotype) may be crucial in developing a risk model for ICH.

Ten-year clinical epidemiological trends of intracerebral hemorrhage in Chongqing, China

Background: The combination of an increase in aged population and adaptation of Western lifestyle is modifying the epidemiological status of intracerebral hemorrhage in China. The purpose of this study is to analyse and characterize the changing trends of intracerebral hemorrhage in Chongqing, the largest city in Southwest China, over the past 10 years.Methods: We retrospectively reviewed the medical records of patients diagnosed with intracerebral hemorrhage who visited the First Affiliated Hospital of Chongqing Medical University from 1 January 1998 to 31 December 1998 and from 1 January 2008 to 31 December 2008, respectively. Relevant variable information of these two populations for the two time periods was compared and discussed.Results: There were a total of 404 intracerebral hemorrhage patients who met the study criteria and registered in the First Affiliated Hospital in 1998 (128 cases) and 2008 (276 cases). The highest incidence of intracerebral hemorrhage was noted in the 1960s and 1970s age groups. The mean onset age of intracerebral hemorrhage was 2·65 years older in 2008 compared to 1998, specifically 2·10 years older for men and 3·38 years for women. In 1998, male intracerebral hemorrhage patients outnumbered female patients (1·42:1). This gender disproportion became higher in 2008 (1·63:1). Hypertension accounts for the highest proportion of all risk factors. The number of patients had minimally invasive interventions (intracranial hematoma drainage) was increased, and the in-hospital mortality rate decreased to 14·13% in 2008 from 19·53% in 1998.Conclusions: We identified changes in population characteristics of patients with intracerebral hemorrhage during a period of economic development in China. These changes in patterns of intracerebral hemorrhage have raised new challenges and the needs for priority adjustment in the campaign for intracerebral hemorrhage prevention in China and other developing countries.

Prevention of Intracerebral Haemorrhage

Nontraumatic intracerebral haemorrhages arise from a wide range of causes falling into two broad groups: discreet vascular "ictohaemorrhagic" lesions such as aneurysms, arteriovenous malformations, cavernomas, tumours, and dural fistulae; and more generalised amyloid or hypertension related conditions. It is now possible using family history, associated risk factors and gradient echo MRI to predict cases at high risk of hypertensive or amyloid related haemorrhage. There is considerable potential for prevention of hypertensive haemorrhages by treatment of high risk cases with antihypertensive medication. As yet no effective preventative treatment for amyloid angiopathy related ICH has emerged although a variety of drugs are under investigation. Prevention of haemorrhage from ictohaemorrhagic lesions revolves around removal or obliteration of the lesion. Although there is a wide range of such lesions available treatments come down to three modalities. These are surgical excision, stereotactic radiosurgery and endovascular embolisation.