Resolution Of Hematoma Research Articles

Interventricular Septal Hematoma after Congenital Cardiac Defects Repair at a Single Institution

Background: Interventricular septal hematoma is a rare complication after congenital cardiac repair. The management varies according to the literature. We present our experience with this rare complication. Methods: Echocardiography database were reviewed with the term ‘‘hematoma’’ or “hypoechoic mass” for patients who underwent congenital heart surgery from January 2018 to December 2021 at our institution to identify potential interventricular septal hematoma cases. Relevant data of the patients identified were collected. Focus was put on the presentation, management, outcomes according to patent medical charts and serial echocardiographic report data. Results: In total, there were 5 patients included. The mean age and weight at surgery were 5.5 ± 3.6 months and 5.5 ± 1.4 kg, respectively. Four patients were diagnosed with ventricular septal defect and the other one being double outlet of the right ventricle. While all patients had intraoperative transesophageal echocardiography, 80% (4 of 5) of Interventricular septal hematoma were revealed intraoperatively. Only one patient received hematoma drainage intraoperatively while the other 3 identified in the operating room were only closely observed. One after ventricular septal defect repair presented continuous dysfunction of the left ventricle at the last follow-up, while the others were doing well. All hematomas resolved completely with a mean time to interventricular septal hematoma resolution of 35.8 ± 16.9 days. Conclusion: Infants seem to be at a higher risk for Interventricular septal hematoma following congenital heart surgery. While the majority of interventricular septal hematoma has a benign postoperative course, some may result in ventricular dysfunction. Management strategies may be chosen on a case-by-case basis.

Radiographic clearance of chronic subdural hematomas after middle meningeal artery embolization

BackgroundFew reports discuss variables associated with improved outcomes after middle meningeal artery (MMA) embolization for chronic subdural hematomas (cSDHs). We analyzed radiographic evidence of cSDH clearance after MMA embolization to...

Abstract 14028: N-formyl Peptide Receptor 2 Activation via Annexin A1 Up-Regulates Hematoma Resolution After Germinal Matrix Hemorrhage

Introduction: Germinal matrix hemorrhage (GMH) is one of the leading causes of morbidity and mortality in preterm infants in the United States with little progress made in its clinical management. Survivors are often afflicted with long-term neurological sequelae, which include cerebral palsy, mental retardation, and post-hemorrhagic hydrocephalus. Blood clots disrupting normal cerebrospinal fluid circulation and absorption after germinal matrix hemorrhage are key contributors towards post-hemorrhagic hydrocephalus development. n-formyl peptide receptor 2 (FPR2), a G-protein-coupled receptor, has been associated with the activation of scavenger receptor CD36. CD36, a transmembrane glycoprotein, plays an essential role in microglia phagocytic blood clot clearance after GMH. Currently, FPR2’s role in blood clot clearance after hemorrhagic stroke is unknown. Hypothesis: We hypothesize that FPR2 activation by Annexin A1 will enhance hematoma resolution via upregulation of the CD36 signaling pathway, thereby improving short- and long-term neurological outcomes. Methods: Bacterial collagenase (0.3 U) was infused intraparenchymally into the right hemispheric ganglionic eminence in male and female P7 rat pups to induce GMH. Annexin A1 and FPR2 Inhibitor (Boc2) were given at 1-hour post-GMH via intranasal administration. Short-term neurobehavior were assessed using negative geotaxis test. Hematoma volume was assessed using hemoglobin assay. Protein expression was assessed using western blots. Long-term neurocognitive deficits and motor coordination were assessed using Morris water maze, rotarod, and foot fault tests. Nissl staining was conducted on long-term samples to calculate ventricular dilation. Results: We have demonstrated that Annexin A1 treatment decreased hemoglobin content and improved neurobehavior at 72 hours post-ictus. Annexin A1 attenuated post-hemorrhagic hydrocephalus and neurological deficits 4 weeks post-ictus. Lastly, treatment increased FPR2 and CD36 protein expression. Conclusions: This present study demonstrates that FPR2 agonism via Annexin A1 enhances blood clot clearance, thereby improving outcomes after GMH.

Middle Meningeal Artery Embolization and the Treatment of a Chronic Subdural Hematoma.

Chronic subdural hematoma (cSDH) is a common pathology that typically affects the elderly. It is believed to occur due to injury to the dural border cells, which creates an inflammation/proliferation reaction. Ineffective repair leads to the formation of a new external layer of cells and fragile capillaries, which damage easily and can worsen the condition. Conventionally, asymptomatic cSDH is managed by observation, and symptomatic cases are treated by surgical evacuation. Unfortunately, recurrence rates of the SDH following surgical evacuation can be high. One treatment option for SDH involves embolization of the middle meningeal artery (MMA). The MMA provides blood supply to the dura mater and feeds the membrane capillaries covering the SDH. MMA embolization blocks the blood flow to this system and can promote hematoma resolution. In this paper, we review the existing literature on MMA embolization and discuss the underlying pathophysiology of cSDH.

Role of Dexamethasone in Recurrent and Residual Chronic Subdural Hematoma

Objectives: To assess the effectiveness of dexamethasone in recurrent and residual chronic subdural hematoma as a monotherapy.
 Material and Methods: A prospective Quasi-Experimental study was conducted at the Neurosurgery Department, Peoples Medical College Hospital, Nawabshah from July 2014 to June 2020.Patients were assessed by Markwalder’s neurological grading and intravenous dexamethasone was used as monotherapy and effects were monitored.
 Results: Out of 280 patients100 patients had recurrent and 180 patients had a residual chronic subdural hematoma. Male n = 180, female n = 100 with male to female ratio 1.8:1. Patients with Markwalder Grade 0, 1, and 2 were included and Grade 3 & 4 with marked midline shift on plain Computed tomographic scan brain were excluded. Intravenous dexamethasone of 12 mg in three divided doses for 24 hours given for first 2 weeks then shifted on oral dexamethasone and gradually tapered in next 2 weeks. During this period patient was evaluated for fluctuation in blood sugar or epigastric pain. Serial follow-up of patient was done, 16.07% improved from Markwalder Grade – 2 to 0, Markwalder Grade 1 to 0 in 12.14%. Complete resolution of hematoma occurred in 53.57%. Radiological deterioration with increased volume of hematoma in n = 40 and worsening to Markwalder Grad – 3 n = 15 and Grade – 4 n = 25. Death in n = 11. 
 Conclusion: Monotherapy with dexamethasone in recurrent and residual chronic Subdural Hematoma results in clinical improvement and reduces the rate of re-operation.

ИЗУЧЕНИЕ КЛИНИКО-БИОХИМИЧЕСКИХ ПОКАЗАТЕЛЕЙ ПРИ МЫШЕЧНОЙ ПАТОЛОГИИ СРЕДИ БОЛЬНЫХ ГЕМОФИЛИЕЙ

Aim. Determine the state of the biochemical composition of blood in the midst and resolution of muscle hematomas in patients with hemophilia.Materials and methods. 118 patients with hemophilia were examined. These patients were inpatient treatment at the hemophilia center at the Republican Specialized Scientific and Practical Hematology Center of the Ministry of Health of the Republic of Uzbekistan. The control group consisted of 40 apparently healthy men of the same age. Results. Signs of massive hemorrhages in the tissue are an increase in the blood level of the activity of the cytoplasmic enzyme aspartate aminotransferase (54.1 ± 3.9 and 18 ± 4.1, respectively) and alanine aminotransferase (55.3 ± 5.2 and 27.3 ± 4.4, respectively). Depending on the severity of the breakdown of muscle fibers and the rate of progression of the complication, the increase in CPK activity in myopathies can be either sharp - 680.7 ± 14.2 IU / L (hemophilic tumor, tissue necrosis), or, conversely, insignificant 120.3 ± 11.1 IU / L (muscle tissue contracture or atrophy). Deficiency of serum iron (6.4 ± 1.1 μmol / L) was revealed in all groups of examined patients with hemophilia. There was a tendency to lower cholesterol content to 3.3 ± 0.2 mmol / L. The content of urea, as the end product of protein metabolism, was higher in hemophilia patients with a syndrome of necrotic changes in hematomas – in 4 patients (9.8 ± 2.2 mmol / l), which, in our opinion, is associated with an increase in the breakdown of hemoglobin and other proteins with massive hemolysis of erythrocytes in tissues. The study of trace elements in the blood serum revealed a deficiency of Mg²+ 1.6 times, Ca²+ 2.1 times.Conclision. In patients with hemophilia with hemorrhages in muscle tissue, there was a tendency to lower cholesterol and iron levels, and an increase in the amount of bilirubin. The “key” enzymes for the diagnosis and prognosis of complications can be a dynamic study of the activity of the levels of CPK (creatine phosphokinase) and ALT (alanine aminotransferase), AST (aspartate aminotransferase).

Successful Nonoperative Management of Acute Spontaneous Idiopathic Spinal Epidural Hematoma Presenting as Cauda Equina Syndrome

Spontaneous spinal epidural hematoma (SSEH) is a rare neurosurgical condition with an estimated incidence of 0.1 in 1,00,000 population.[1] It has been most commonly described in the older age group in the 4th or 5th decade of life and most commonly found in the dorsal or dorsolumbar region.[2] It can present with a variety of clinical symptomatology, depending upon the site and extent of hematoma, usually in the form of acute cervical or back pain along with rapid onset of neurological deficits, often within first 12 hours of ictus and often requiring urgent neurosurgical intervention. However, its first manifestation as cauda equina syndrome is rare. Emergent surgical evacuation has remained the gold standard of treatment,[3] and only a handful of cases reported successful recovery with conservative management, and that too primarily in patients with a diffuse SSEH associated with blood dyscrasias or coagulopathy.[4] We describe a case of a 25-year-old healthy male, who presented with history of sudden onset severe back pain, followed by rapidly progressive paraplegia and cauda equina syndrome, four days after lifting heavy weight. He had to be catheterized for urinary retention. He presented to our clinic 1 month after the onset of symptoms, and by then, partial recovery of sensory, motor and autonomic deficits had already ensued. The coagulation profile was within normal parameters. His MRI performed immediately after the onset of symptoms demonstrated a T2-hyperintense lesion in posterior epidural space at L2-3 vertebral level, which was suggestive of a focal epidural hematoma with significant secondary canal compromise ( [Fig. 1 A,B] ). There was no evidence of associated flow-voids to suggest an associated vascular malformation. Due to delayed referral of patient and subacute stage of epidural hematoma with partial spontaneous recovery at the time of presentation, decision was taken to manage it conservatively with symptomatic pain management and limb physiotherapy. He recovered nearly completely over the next 1 month, and he was able to walk with minimal support and regained bladder function (American Spinal Injury Association [ASIA] D). His interval MRI demonstrated complete resolution of epidural hematoma ( [Fig. 2 A,B] ).

Use of Autologous Leucocyte- and Platelet-Rich Plasma (L-PRP) in the Treatment of Aural Hematoma in Dogs.

Leukocyte- and platelet-rich plasma (L-PRP) can accelerate the healing process by providing increased concentrations of platelet-derived growth factors. The objective of this study was to evaluate the clinical effect of L-PRP in the treatment of canine aural hematomas associated with otitis externa. Twenty mL of citrated whole blood was collected from each of the 17 dogs included and autologous L-PRP was produced. The aural hematoma was drained and 0.5–1 mL of L-PRP was injected. The dogs were examined weekly until 7 days after complete clinical healing. A final clinical follow-up was performed 6 weeks after the first treatment with L-PRP. If there was recurrence of the aural hematoma at the first follow-up, the treatment was repeated. In total, 2/17 cases were lost after the first follow-up. In 5/17 dogs, a short-term recurrence occurred. In 12/15 cases, complete clinical resolution was achieved with a single L-PRP application (Group A1) and in 3/15 with two treatments (Group A2). The mean time to complete clinical resolution was 16 ± 8.7 days (A1) and 23.3 ± 4 days (A2), respectively. No side effects were reported. The in situ administration of autologous L-PRP resulted in a complete resolution of the aural hematoma in all dogs that completed the clinical trial.

Interventricular septal hematoma detected by transesophageal echocardiography after congenital heart surgery in an infant: a case report

BackgroundInterventricular septal hematoma is an extremely rare complication following congenital heart surgery. During cardiac surgery, interventricular septal hematomas can be detected only by intraoperative transesophageal echocardiography. Here, we report an interesting case of interventricular septal hematoma that was accidentally found in an infant following ventricular septal defect (VSD) closure.Case presentationTransesophageal echocardiography images were acquired from a 1-month-old boy after surgical repair of a large (6.5 mm) perimembranous outlet VSD with interventricular septal flattening. Surgical correction was performed with auto-pericardium and 7–0 Prolene sutures. The patient was successfully weaned from cardiopulmonary bypass, and transesophageal echocardiography showed no VSD leakage and good ventricular function. However, approximately 30 min later, two anechoic masses were found within the interventricular septum, which were suspected to be interventricular septal hematomas; the larger mass measured 1.51 times 1.48 cm. The swollen interventricular septum showed decreased contractility and compressed both the right and left ventricles. However, there was no change in the size of hematomas or a significant hemodynamic instability for 30 min of observation. Therefore, expecting spontaneous resolution of the hematomas, the interventricular septum was not explored, and the patient was removed from cardiopulmonary bypass. On postoperative day 4, follow-up transthoracic echocardiography revealed thrombi filling the hematomas. The patient was discharged on postoperative day 15 and followed up with regular echocardiographic evaluations.ConclusionsWe describe a unique case of interventricular septal hematoma after VSD closure. Surgical manipulation of perimembranous VSD and injury of the septal perforating artery may contribute to the development of an interventricular septal hematoma. Moreover, conservative treatment and serial echocardiographic evaluation generally show gradual hematoma resolution in hemodynamically stable patients. Pediatric cardiac anesthesiologists should be aware of this rare complication after VSD repair.

Comparative study of subdural drain (SDD) versus sub periosteal drain (SPD) in treating patient with chronic subdural hematoma (CSDH).

Background: Chronic subdural hematoma (CSDH) is common neurosurgical condition encountered in daily practice. Burr holes evacuation is standard treatment for symptomatic cases. Both subdural drain (SDD) and subperiosteal drain (SPD) have been reported to lower the recurrence rate when used in conjunction with burr holes. A randomized controlled trials were done to see if there were any differences in clinical and radiographic outcomes between the two types of drains.Methods: A total of 42 CSDH patients were enrolled and allocated to one of two groups: SDD (n = 21) or SPD (n = 21). Demographic data, perioperative imaging characteristics, clinical outcome, and recurrence rate were recorded for comparison.Results: In both groups, demographic characteristics such as sex ratio, mean age of patients, concomitant disease, and antithrombotic agent use were similar. At 6 months, 20 (95.2%) and 21 (100%) cases in the SDD and SPD groups, respectively, had a favorable outcome (mRS 0–3). Complete hematoma resolution at 6 months was achieved in 21 (100%) and 19 (90.5%) cases of the SDD and SPD groups, respectively. The amount of drain within 48 h was not difference between the two groups. None of the SDD recurred, but two of the SPD group did, necessitating reoperation, which had no effect on the final outcome.Conclusion: These findings indicate that the drain type (SDD or SPD) has no effect on the outcome. The surgeon’s preference determines which procedure is used. Except in symptomatic circumstances, routine postoperative imaging may not be required.

Aesthetic medicine without hematomas: myth or reality

Background. Invasive aesthetic medicine is associated with various rehabilitation manifestations: hematomas, edema, pain after the procedure. Hematomas are an unpleasant, but often inevitable for the patient. In this case, hematomas appear when a vessel is directly injured by a needle during the procedure, which is always associated with skin trauma and an increased risk of infection.
 Aim. Application of an effective treatment regimen without pronounced side effects for minimizing rehabilitation phenomena after aesthetic procedures.
 Materials and methods. The study involved 50 patients, 25 of whom received anti hematoma therapy with external and systemic forms of Arnica montana (Boiron) before and after the procedure. 25 remaining (control group) did not receive therapy before the procedure, as well as during rehabilitation after the procedure. The analysis of the course of the rehabilitation period was assessed using a questionnaire, which contained questions on assessing the degree of intensity of such adverse events after the procedure as pain, edema, hyperemia, the size of hematomas according to a scale from 0 to 5, where 0 no manifestations, 5 significantly pronounced manifestations.
 Results. An analysis of many clinical cases shows the effectiveness of antihematoma therapy with Arnica montana preparations in various forms [Arnica montana C9 (Boiron) and Arnigel] before and after procedure, manifested in a faster resolution of hematomas, a decrease in edema, a decrease in pain after the procedure, as well as an overall reduction in the rehabilitation period by at least 23 days compared with the course of rehabilitation without the appointment of anti-hematoma therapy.
 Conclusion. Based on the above data, confirmed by numerous studies, we can conclude about the effectiveness of prescribing Arnica drugs [Arnica montana C9 (Boiron) and Arnigel] before and after invasive aesthetic procedures.

The way to a man\u2019s heart is through his stomach: a case of myocardial infarction mimic and pseudo-tamponade in a polytrauma patient

BackgroundThere exists a therapeutic conflict between haemorrhage control and prevention of thromboembolic events following polytrauma and complications are not uncommon. Such opposing therapies can result in unexpected pathophysiology and there is a real risk of misdiagnosis resulting in harm. This case presents a previously unreported complication of prevention and management of thromboembolism- STEMI (ST elevation myocardial infarction) and tamponade mimic secondary to retroperitoneal haematoma.Case presentationWe present a 50-year-old male polytrauma patient who following treatment for presumed pulmonary embolus demonstrated classical clinical findings of myocardial infarction and pericardial tamponade secondary to a retroperitoneal haematoma. This is an event not previously reported in the literature. The risk of adverse outcome by management along the standard lines of STEMI (ST elevation myocardial infarction) was averted through awareness for alternative aetiology via a multi-team approach which resulted in percutaneous drainage of the haematoma and complete resolution of symptoms.ConclusionsThis manuscript highlights the therapeutic conflict between haemorrhage control and prevention of thromboembolic events in critically injured, the importance of high index of suspicion in this patient cohort and the benefits of multidisciplinary decision making in the complex patient through a not previously published pathophysiologic phenomenon.

Resolution of Posterior Fossa Extradural Haematoma by Conservative Treatment: A Case Report

Surgical intervention in posterior fossa extradural haematoma (PFEDH) carries very good results. But there are no defined indications for surgical evacuation when patient is asymptomatic and normal neurologically, even in the guidelines for surgical management of traumatic brain injury by 'the brain trauma foundation & the congress of neurological surgeons'. Haematoma volume > 10 ml, haematoma thickness > 15 mm, perimesencephalic cisterns obliteration, fourth ventricle displacement and hydrocephalus, arethe criteria considered for surgical evacuation by most of neurosurgeons.

Function and Biomarkers of the Blood-Brain Barrier in a Neonatal Germinal Matrix Haemorrhage Model.

Germinal matrix haemorrhage (GMH), caused by rupturing blood vessels in the germinal matrix, is a prevalent driver of preterm brain injuries and death. Our group recently developed a model simulating GMH using intrastriatal injections of collagenase in 5-day-old rats, which corresponds to the brain development of human preterm infants. This study aimed to define changes to the blood-brain barrier (BBB) and to evaluate BBB proteins as biomarkers in this GMH model. Regional BBB functions were investigated using blood to brain 14C-sucrose uptake as well as using biotinylated BBB tracers. Blood plasma and cerebrospinal fluids were collected at various times after GMH and analysed with ELISA for OCLN and CLDN5. The immunoreactivity of BBB proteins was assessed in brain sections. Tracer experiments showed that GMH produced a defined region surrounding the hematoma where many vessels lost their integrity. This region expanded for at least 6 h following GMH, thereafter resolution of both hematoma and re-establishment of BBB function occurred. The sucrose experiment indicated that regions somewhat more distant to the hematoma also exhibited BBB dysfunction; however, BBB function was normalised within 5 days of GMH. This shows that GMH leads to a temporal dysfunction in the BBB that may be important in pathological processes as well as in connection to therapeutic interventions. We detected an increase of tight-junction proteins in both CSF and plasma after GMH making them potential biomarkers for GMH.

Resolution of Asymptomatic Significant Volume Extradural Haematoma on Clinico-Radiological Assessment: A Case Report

According to guidelines of the brain trauma foundation and the congress of neurological surgeons for managing traumatic brain injury, surgical evacuation recommended for extradural haematoma with volume more than 30 cm³ regardless Glasgow coma scale (GCS) of patient. A case of asymptomatic extradural haematoma (volume 40.5 cm³) treated on regular clinico-radiological assessment (CRA) showed near complete resolution of extradural haematoma.

Hyaluronidase for Treating Complications Related to HA Fillers: A National Plastic Surgeon Survey.

Background: Hyaluronic acid (HA) fillers have become a popular modality to address changes in the ageing face. There are many described indications of hyaluronidases in aesthetic medicine which include their use in the management of HA-associated complications. To better understand the current practice patterns, we surveyed Canadian plastic surgeons on their use of hyaluronidases. Methods: With the approval of the Canadian Society of Plastic Surgeons, an electronic survey was emailed to members. A total of 350 surveys were distributed and 98 surveys were completed for a response rate of 28%. Results: Approximately half (48%) of the survey respondents used HA fillers in their practice. Skin testing for hypersensitivity reactions was performed by less than 10% of hyaluronidase users. Nearly all respondents used hyaluronidase for filler over-correction (95.5%) and asymmetry (86.4%). Over half of the respondents have used hyaluronidase for inflammatory or infectious nodules and the Tyndall effect. Other reported applications included restoration of vascular compromise, and one respondent reported using hyaluronidase for assisting with haematoma resolution. When compared with the most recent guidelines, there was a wide range of doses used for common side effects and complications. Twenty-four percent of the respondents reported that their hyaluronidase formulation was prepared by a compounding pharmacy, and 20% of respondents who inject HA fillers did not stock hyaluronidase. Conclusion: There are many indications for hyaluronidase in aesthetic plastic surgery. Plastic surgeons should stock hyaluronidase and develop a specific plan in anticipation of adverse events. Although hyaluronidase is commonly used by plastic surgeons for over-correction and asymmetry, the dosages used in aesthetic practice is rather diverse and heterogeneous. When possible, plastic surgeons should perform allergy testing before hyaluronidase use.

Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Case Series

BACKGROUND: Chronic subdural hematoma (CSDH) represents a common neurosurgical condition particularly in the elderly. Middle meningeal artery embolization (MMAE) has been proposed as a treatment option for this condition. OBJECT: To demonstrate the feasibility of MMAE for the treatment of CSDH avoiding the risk of interrupting anticoagulation and reducing the perioperative risk in a Canadian health care institution. METHODS: A retrospective chart review of patients receiving MMAE as primary treatment for CSDH is presented. Baseline demographics are collected (age, sex, and side of hematoma). Outcomes of interest include hematoma thickness pre-intervention and at follow up, procedural and post-operative complications, and length of hospital stay. Clinical outcomes (subdural hematoma resolution) are supplemented by computed tomography (CT) imaging. RESULTS: Patients (N=4) underwent MMAE for the treatment of CSDH to avoid risk of cessation of anticoagulation and expected perioperative risk. Median age was 74 years. Two patients were on antithrombotic therapy at the time of intervention. Patient follow-up occurred at 1, 3, 6, and 9 months post-operatively. Resolution of symptoms and significant reduction of hematoma thickness was evident (up to 14 mm) at follow-up. Improvement in all cases was confirmed by CT and clinical evaluation. No patients suffered from complications or recurrence. CONCLUSION: The MMAE is a safe and practical treatment for CSDH, even in this rather frail patient cohort with some on anticoagulation.

Leech therapy in the treatment of a penile haematoma in a stallion

Treatment of penile haematomas includes conventional therapy and/or surgical intervention which may not always result in the recovery of all penile functions. For valuable breeding stallions, a safe and effective treatment is necessary and medical leech therapy meets these criteria. Additionally, the proven efficiency and safety of the use of leeches in the resolution of haematomas makes this method applicable to other fields of veterinary medicine. A 14-year-old stallion was presented and assigned to the university hospital with a swollen and prolapsed penis. The owner reported that the stallion was likely kicked in the penis while mating. There were no deviations in the physiological indicators during the general examination. A drainage was inserted and a compression bandage was applied. After an initial slight subsidence of the oedema, the healing process slowed down. Hence, the experimental leech treatment was applied. The hirudotherapy was performed twice, five days apart. The hirudotherapy proved to be safe and effective, and with the addition of hydrotherapy, anti-inflammatory drugs and antibiotics, resulted in the full recovery of the horse within 45 days. The erectile functions of the penis were restored and the stallion successfully continued its breeding career.

CD47 blocking antibody accelerates hematoma clearance and alleviates hydrocephalus after experimental intraventricular hemorrhage

BackgroundCD47, a glycoprotein on red blood cell membranes, inhibits phagocytosis via interaction with signal regulatory protein α on phagocytes. Our previous research has demonstrated that blocking CD47 accelerates hematoma clearance and reduces brain injury after intracerebral hemorrhage. The current study investigated whether phagocytosis or erythrocyte CD47 impacts hematoma resolution and hydrocephalus development after intraventricular hemorrhage (IVH).MethodsAdult (3-month-old) male Fischer 344 rats were intraventricularly injected with 200 μl autologous blood, mixed with either CD47 blocking antibody or isotype IgG, or 200 μl saline as control. In subgroups of CD47 blocking antibody treated rats, clodronate liposomes (to deplete microglia/monocyte-derived macrophages) or control liposomes were co-injected. Magnetic resonance imaging (MRI) was used to evaluate ventricular volume and intraventricular T2* lesion volume (estimating hematoma volume). The brains were harvested after 4 or 72 h for histology to evaluate phagocytosis.ResultsIn adult male rats, CD47 blocking antibody alleviated hydrocephalus development by day 3. In addition, the CD47 blocking antibody reduced intraventricular T2* lesion and T2* non-hypointense lesion size after IVH through day 1 to day 3. Erythrophagocytosis was observed as soon as 4 h after IVH and was enhanced on day 3. Furthermore, intra-hematoma infiltration of CD68, heme oxygenase-1 and ferritin positive phagocytes were upregulated by CD47 blockade by day 3. Clodronate liposomes co-injection caused more severe hydrocephalus and weight loss.ConclusionBlocking CD47 in the hematoma accelerated hematoma clearance and alleviated hemolysis and hydrocephalus development after IVH, suggesting CD47 might be valuable in the future treatment for IVH.

Safety and efficacy of remote ischemic conditioning for the treatment of intracerebral hemorrhage: A proof-of-concept randomized controlled trial.

Remote ischemic conditioning can promote hematoma resolution, attenuate brain edema, and improve neurological recovery in animal models of intracerebral hemorrhage. This study aimed to evaluate the safety and preliminary efficacy of remote ischemic conditioning in patients with intracerebral hemorrhage. In this multicenter, randomized, controlled trial, 40 subjects with supratentorial intracerebral hemorrhage presenting within 24-48 h of onset were randomly assigned to receive medical therapy plus remote ischemic conditioning for consecutive seven days or medical therapy alone. The primary safety outcome was neurological deterioration within seven days of enrollment, and the primary efficacy outcome was the changes of hematoma volume on CT images. Other outcomes included hematoma resolution rate at 7 days ([hematoma volume at 7 days - hematoma volume at baseline]/hematoma volume at baseline), perihematomal edema (PHE), and functional outcome at 90 days. The mean age was 59.3 ± 11.7 years and hematoma volume was 13.9 ± 4.5 mL. No subjects experienced neurological deterioration within seven days of enrollment, and no subject died or experienced remote ischemic conditioning-associated adverse events during the study period. At baseline, the hematoma volumes were 14.19 ± 5.07 mL in the control group and 13.55 ± 3.99 mL in the remote ischemic conditioning group, and they were 8.54 ± 3.99 mL and 6.95 ± 2.71 mL at seven days after enrollment, respectively, which is not a significant difference (p > 0.05 each). The hematoma resolution rate in the remote ischemic conditioning group (49.25 ± 9.17%) was significantly higher than in the control group (41.92 ± 9.14%; MD, 7.3%; 95% CI, 1.51-13.16%; p = 0.015). The absolute PHE volume was 17.27 ± 8.34 mL in the control group and 12.92 ± 7.30 mL in the remote ischemic conditioning group at seven days after enrollment, which is not a significant between-group difference (p = 0.087), but the relative PHE in the remote ischemic conditioning group (1.77 ± 0.39) was significantly lower than in the control group (2.02 ± 0.27; MD, 0.25; 95% CI, 0.39-0.47; p = 0.023). At 90-day follow-up, 13 subjects (65%) in the remote ischemic conditioning group and 12 subjects (60%) in the control group achieved favorable functional outcomes (modified Rankin Scale score ≤ 3), which is not a significant between-group difference (p = 0.744). Repeated daily remote ischemic conditioning for consecutive seven days was safe and well tolerated in patients with intracerebral hemorrhage, and it may be able to improve hematoma resolution rate and reduce relative PHE. However, the effects of remote ischemic conditioning on the absolute hematoma and PHE volume and functional outcomes in this patient population need further investigations.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT03930940.