Spontaneous Thalamic Hemorrhage Research Articles

Comparative Analysis of the Patients with Spontaneous Thalamic Hemorrhage with Concurrent Intraventricular Hemorrhage and Those without Intraventricular Hemorrhage.

BackgroundThis study aimed to compare the characteristics of patients with spontaneous thalamic hemorrhage (STH) accompanied by intraventricular hemorrhage (IVH) with those of patients without IVH.MethodsThe medical records of consecutive patients with STH admitted to our institute between January 2000 and December 2018 were reviewed retrospectively. The laboratory and radiological results, mortality, and functional recovery were compared between the STH patients with IVH and those without IVH.ResultsAmong 2,389 patients with spontaneous intracerebral hemorrhage, 233 (9.8%) patients were included in this study. Concurrent IVH was detected in 159 (68.2%) patients with STH, and more frequently in those with body mass index ≥ 25, Glasgow Coma Scale score of 3–8, underlying disease, family history of stoke, posterior/medial/global location of hematoma, ventriculomegaly, large volume of hemorrhage, and midline shift ≥ 5 mm. The 3-month mortality was 25.8% and 8.1% (P = 0.039), the rate of good functional recovery at 6 months was 52.2% and 31.0% (P = 0.040), and incidence of delayed normal pressure hydrocephalus (NPH) at 12 months was 10.8% and 24.5% (P = 0.062) in the STH patients with IVH and those without IVH, respectively. At 12 months, delayed NPH developed in 28 of 47 (59.6%) patients who received external ventricular drainage (EVD)-based treatment, 5 of 45 (11.1%) patients who underwent endoscopic evacuation-based treatment, and 8 of 45 (17.8%) patients who underwent other surgeries.ConclusionConcurrent IVH is strongly associated with mortality in patients with STH. Delayed NPH may develop more frequently in STH patients with IVH who were treated with EVD.

Efficacy Analysis of Robot-Assisted Minimally Invasive Surgery for Small-Volume Spontaneous Thalamic Hemorrhage

To test whether robot-assisted surgery can improve prognosis of small-volume thalamic hemorrhage and to provide a surgical basis for treatment of small-volume thalamic hemorrhage. This retrospective study included patients with thalamic hemorrhage and hematoma volume of 5-15 mL treated from December 2015 to December 2018. Patients were divided into an operation group and a nonoperation group. General data, types of hematoma, incidence of complications, Scandinavian Stroke Scale score, and modified Rankin Scale score were recorded and analyzed. Retrospectively, 84 cases met inclusion criteria: 35 cases in operation group and 49 cases in nonoperation group. At 90 days after onset, mortality was 11.4% in the operation group and 4.1% in the nonoperation group (P > 0.05). The Scandinavian Stroke Scale score in the operation group (43.3 ± 8.5) was higher than in the nonoperation group (36.1 ± 10.0) (P < 0.05). The modified Rankin Scale score in the operation group (2.9 ± 0.3) was lower than in the nonoperation group (3.7 ± 0.2) (P < 0.05). The incidence of pneumonia (8.6%) and renal dysfunction (14.3%) was lower in the operation group than in the nonoperation group (28.6% and 34.7%, respectively) (P < 0.05). There was no significant difference between the 2 groups in the incidence of central fever (5.7% vs. 12.2%), stress ulcer (11.4% vs. 16.3%), and ion balance disturbance (20.0% vs. 26.5%) (P > 0.05). Robot-assisted drainage of thalamic hemorrhage can improve prognosis and reduce the incidence of pneumonia and renal dysfunction.

Efficacy of neuroendoscopy combined with urokinase in the treatment of spontaneous intraventricular hemorrhage

Objective To investigate the efficacy of neuroendoscopy combined with urokinase in the treatment of spontaneous intraventricular hemorrhage. Methods From August 2014 to August 2017, 91 spontaneous thalamic hemorrhage ruptured into ventricles patients in Affiliated Hospital of the Yangzhou University were enrolled, who were underwent surgical treatment in this retrospective study.The patients were divided into the study group(n=41) and control group(n=50) based on different methods of treatment. The patients in the study group were given with remove visible intraventricular hematoma by neuroendoscopy, followed by External Ventricular Drainage(EVD) combined with urokinase fibrinolysis. The patients in control group were given with EVD combined with urokinase fibrinolysis.The time of postoperative drainage, ICU stay, duration of onset of fever, the number of intracranial infections, and the proportion of Glasgow outcome scale (GOS) (1 to 5) at 6 months postsurgery were compared between two groups.Measurement data were expressed as (Mean±SD), and t test was used for measurement data. The count data were analyzed by χ2 test or nonparametric rank sum test. Results The time of postoperative drainage, the number of intracranial infections, ICU stay in study group were(6.19±1.1) d, 5 cases, (2.8±1.6) d, the indexes in control group were(7.06±1.3) d, 15 cases, (5.2±2.0) d. The time of postoperative drainage, ICU stay, the number of intracranial infections were superior to those of the control group, and the difference was statistically significant.The proportion of GOS (1 to 5) at 6 months after surgery was 5 cases(12.2%), 5 cases(12.2%), 10 cases(24.4%), 14 cases(34.1%), 7 cases(17.1%)in study group, the indexes in control group were 10 cases(20.0%), 13 cases(26.0%), 11 cases(22.0%), 10 cases(20.0%), 6 cases(12.0%). The 6-month postoperative GOS of the study group were superior to those of the control group, and the difference was statistically significant (P<0.05). Conclusion Neruendoscopy combined with urokinase in the treatment of spontaneous intraventricular hemorrhage can reduce the time of postoperative drainage and the incidence of intracranial infection, shorten the time of ICU stay and improve the functional prognosis of the patients. Key words: Urokinase-type plasminogen activator; Intracranial hemorrhages; Neuroendoscopy; Spontaneous intraventricular hemorrhage

Novel Anatomic Classification of Spontaneous Thalamic Hemorrhage Classified by Vascular Territory of Thalamus.

Spontaneous thalamic hemorrhage has increased in incidence in recent years. Analysis of the characteristics of thalamic hemorrhage was based on the vascular territories of the thalamus. Retrospective analysis included 303 consecutive patients with spontaneous thalamic hemorrhage. Thalamic hemorrhage was classified into 4 types: anterior type (supplied mainly by the tuberothalamic artery), medial (mainly paramedian thalamic-subthalamic artery), lateral (mainly thalamogeniculate artery), and posterior (mainly posterior choroidal artery). The baseline characteristics, complications, and functional outcomes were assessed. The anterior type was found in 10 patients (3.3%), the medial type in 47 (15.5%), the lateral type in 230 (75.9%), and the posterior type in 16 (5.3%). Intracerebral hemorrhage volume was smallest in the anterior type, and significantly smaller than in the medial (P= 0.002) and lateral types (P < 0.001). Intraventricular hemorrhage (IVH) or acute hydrocephalus was significantly associated with the medial type (P < 0.01 or P < 0.01, respectively). Non-IVH or non-acute hydrocephalus was significantly associated with the anterior (P < 0.05 or P < 0.05, respectively) and lateral (P < 0.05 or P < 0.05, respectively) types. Emergency surgery was correlated only with the medial type (P < 0.01). The independent predictors of poor outcome were age (odds ratio [OR], 1.07; P= 0.002), admission National Institutes of Health Stroke Scale score (OR, 1.32; P < 0.001), and type of thalamic hemorrhage (OR, 2.08; P= 0.038). The present study proposed a novel anatomic classification of thalamic hemorrhage according to the major thalamic vascular territories.

Minimally invasive thalamic hematoma drainage can improve the six-month outcome of thalamic hemorrhage.

ObjectiveTo explore predictors of the 6-month clinical outcome of thalamic hemorrhage, and evaluate if minimally invasive thalamic hematoma drainage (THD) could improve its prognosis.MethodsA total of 54 patients with spontaneous thalamic hemorrhage were evaluated retrospectively. Clinical data, including demographics, stroke risk factors, neuroimaging variables, Glasgow Coma Score (GCS) on admission, surgical strategy, and outcome, were collected. Clinical outcome was assessed using a modified Rankin Scale, six months after onset. Univariate analysis and multivariate logistic regression analysis were performed to determine predictors of a poor outcome.ResultsConservative treatment was performed for five patients (9.3%), external ventricular drainage (EVD) for 20 patients (37.0%), THD for four patients (7.4%), and EVD combined with THD for 25 patients (46.3%). At six months after onset, 21 (38.9%) patients achieved a favorable outcome, while 33 (61.1%) had a poor outcome. In the univariate analysis, predictors of poor 6-month outcome were lower GCS on admission (P = 0.001), larger hematoma volume (P < 0.001), midline shift (P = 0.035), acute hydrocephalus (P = 0.039), and no THD (P = 0.037). The independent predictors of poor outcome, according to the multivariate logistic regression analysis, were no THD and larger hematoma volume.ConclusionsMinimally invasive THD, which removes most of the hematoma within a few days, with limited damage to perihematomal brain tissue, improved the 6-month outcome of thalamic hemorrhage. Thus, THD can be widely applied to treat patients with thalamic hemorrhage.

Spontaneous Thalamic Hemorrhage as the First Presentation of Anaplastic Astrocytoma

The purpose of the study was to heighten awareness of anaplastic astrocytoma and the incidence of tumor apoplexy. A 47-year-old man with spontaneous thalamic hemorrhage as the first presentation of anaplastic astrocytoma was studied. Examination of the biopsy specimen revealed an anaplastic astrocytoma (WHO grade 3). Anaplastic astrocytoma rarely occurs as the first presentation in the thalamus with spontaneous intracranial hemorrhage. Misdiagnosis of tumor as stroke more commonly occurs in patients with a vascular risk factor, but with no history of neoplasia.

Teaching Neuro Images Spontaneous thalamic hemorrhage causing convergence excess

A 61-year-old man had acute stupor and left-sided weakness. Head CT showed right thalamic hemorrhage (figure 1, A and B). Regaining consciousness the next day, he had bilateral convergence excess and upward gaze limitation (figure 2) with preserved light and oculocephalic reflexes. The phenomenon disappeared in sleep. The authors thank Chia-Huei Yen, who helped with the illustration of the anatomy.

Prognostic Factors of Motor Recovery after Stereotactic Evacuation of Intracerebral Hematoma

Spontaneous intracerebral hemorrhage represents 20 to 30% of all stroke patients in Japan. However, the treatment strategy of intracerebral hematoma remains controversial. Stereotactic hematoma evacuation is minimally invasive surgery and is beneficial for clot removal with limited tissue damage. The purpose of this study was to investigate the factors affecting motor recovery after stereotactic hematoma evacuation. This retrospective analysis included 30 patients with spontaneous thalamic or putaminal hemorrhage who underwent stereotactic hematoma evacuation. We compared age, presurgical muscle strength, hematoma volume and removal rate between the patients who showed improvement of motor function (improved group) and the patients associated with no motor improvement (unchanged group). Twenty-one patients were classified into the improved group and nine patients into the unchanged group. Statistical analysis revealed that age in the improved group was significantly younger than in the unchanged group (p < 0.01), whereas there was no significant difference in presurgical muscle strength, hematoma volume and removal rate between the two groups. The present results revealed that stereotactic hematoma evacuation is attributable to the improvement of motor function, especially in the younger population, indicating the importance of cortical reorganization during post-surgical rehabilitation. In addition, this procedure could provide functional improvement in severely disabled patients. Proper patient selection to receive this therapy would be beneficial for further advances of this technique. The present result might be useful in elucidating the mechanism of motor recovery and proper patient selection for this technique.

Evacuation of Spontaneous Thalamic and Intraventricular Hemorrhage under the Operating Microscope Improves Mortality Compared with External Ventricular Drainage——Mini-Cranioctomy for Thalamic and Ventricular Hemorrhage

We performed direct hematoma evacuation of thalamic and intraventricular hemorrhage using mini-craniotomy in recent years. The present study evaluated the outcome and complications in 18 patients with spontaneous thalamic and intraventricular hemorrhage treated by mini-craniotomy hematoma evacuation with external ventricular drainage and 24 patients treated by only external ventricular drainage. Patients treated by mini-craniotomy were less likely to require days of ventricular drainage settlement, had a less suffering meningitis, had good hematoma evacuation rate and had a less mortality rate compared with those undergoing only external ventricular drainage. Frontal mini-craniotomy microscope operation is a simple and effective method for hematoma evacuation that causes fewer complications.

脳室内出血を伴う視床出血に対する前頭部小開頭血腫除去術

When thalamic hemorrhage is accompanied by severe intraventricular hematoma, the prognosis is poor. Spontaneous thalamic and intraventricular hemorrhage is usually treated by external ventricular drainage for obstructive hydrocephalus. However, drainage occlusion, meningitis and residual hematoma are often troublesome in actual clinical practice. For such severe cases, we performed direct hematoma evacuation by the frontal mini-craniotomy transcortical approach in recent years. The present study evaluated the outcome and complications in 14 patients with spontaneous thalamic and intraventricular hemorrhage treated by frontal mini-craniotomy hematoma evacuation with ventricular drainage and 16 patients treated by only external ventricular drainage. There were no significant differences between the 2 groups with respect to age, clinical grade, hematoma volume, hematoma location and postoperative epilepsy. There was also no significant difference in postoperative outcome between the 2 groups. However, patients treated by frontal mini-craniotomy were less likely to require days of ventricular drainage settlement, had suffered meningitis less frequently and had good hematoma evacuation rate compared with those undergoing only external ventricular drainage. Frontal mini-craniotomy is a simple and effective method for hematoma evacuation that causes fewer complications.

経口的抗凝固療法中の頭蓋内出血の治療

We evaluated 5 patients with intracranial hemorrhage associated with oral anticoagulant therapy (OACT) over a 15-month period. All patients were taking warfarin. They had a mean age of 69 years (age range, 61 to 78). One patient had suffered from spontaneous thalamic hemorrhage while walking. Each of the other 4 patients had a history of minor head trauma. Three patients' symptoms had progressed slowly and were diagnosed as intracranial hemorrhage more than 12 hours after head trauma. Four patients had intracerebral hematoma and 3 had acute subdural hematoma. Two had both. One had hematomas in both the supra- and infratentorial space. All patients had been on OACT for less than 5 years. Three of the patients were taking OACT for peripheral vascular disease, (2 of whom received arterial grafts), and 2 who were suffering from cardiac valve disease received bioprosthetic valves. Two patients underwent prosthetic surgery within less than a week, and started OACT only 3 and 4 days, respectively, before having intracranial hemorrhage. Two received bucolome, 2 received antiplatelet drugs and 1 received heparin to support warfarin. Two patients were alcohol abusers. All of their international normalized ratios (INRs) of prothrombin time were higher than 1.5, and 3 of them were higher than 3.0 (mean 3.7). Surgical treatment was selected for 3 patients who showed consciousness disturbance. Vitamin K2 only, was used for warfarin reversal in the 3 early cases. Fresh frozen plasma (FFP) only was used for 1 patient and both were used for the other 1. Treatment with vitamin K2 needs more than 24 hours to reverse the effects of warfarin completely. FFP needs less than 6 hours. FFP is more effective for emergency operations. In the surgical cases, hemorrhage was difficult to stanch while the INR was higher than 2.0, and it was easy when the INR was lower than 1.3. One patient had rebleeding 5 hours after diagnosis of thalamic hemorrhage and died on the same day. Only 1 patient's prognosis was good 3 months after the onset of the hemorrhage. He restarted warfarin 6 days after the diagnosis of intracranial hemorrhage.

Stereotactic Aspiration of Thalamic

Among 145 cases of spontaneous thalamic hemorrhage, stereotactic aspiration of the hematoma was done in 75 cases in which the hematoma was greater than 6 ml and the limbs on the affected side could not be elevated. Thirty-one of 40 operated cases with a long axis greater than 3.3 cm were capable of returning to useful activity 6 months postoperatively (excellent to fair). The results 6 months from onset in the 145 cases were as follows: 43% excellent or good, 32% fair, 11% poor and 13% dead. These results appear to indicate that stereotactic aspiration can produce improvements in therapeutic results for cases of thalamic hemorrhage.