Ventricular Hemorrhage Research Articles

How I do it: brainwashing for purulent ventriculitis.

The management of ventriculitis remains controversial, with no single management strategy that can provide a good outcome. There are few articles describing the brainwashing technique, and most for neonatal intraventricular hemorrhage. This technical note is important because it describes a practical way to perform brainwashing in case of ventriculitis, and it is more feasible compared to endoscopic lavage in developing countries. We describe in a stepwise fashion the surgical technique of ventricular lavage. Ventricular lavage is a neglected technique that can help to improve ventricular infection and hemorrhage prognosis.

Comparison of clinical outcomes between active and permissive blood pressure management in extremely preterm infants.

There remains uncertainty about the definition of normal blood pressure (BP), and when to initiate treatment for hypotension for extremely preterm infants. To determine the short-term outcomes of extremely preterm infants managed by active compared with permissive BP support regimens during the first 72 hours of life. This is a retrospective medical records review of 23 +0-28 +6 weeks' gestational age (GA) infants admitted to neonatal units (NNU) with active BP support (aimed to maintain mean arterial BP (MABP) >30 mmHg irrespective of the GA) and permissive BP support (used medication only when babies developed signs of hypotension) regimens. Babies admitted after 12 hours of age, or whose BP data were not available were excluded. There were 764 infants admitted to the participating hospitals; 671 (88%) were included in the analysis (263 active BP support and 408 permissive BP support). The mean gestational age, birth weight, admission temperature, clinical risk index for babies (CRIB) score and first haemoglobin of infants were comparable between the groups. Active BP support group infants had consistently higher MABP and systolic BP throughout the first 72 hours of life (p<0.01). In the active group compared to the permissive group 56 (21.3%) vs 104 (25.5%) babies died, and 21 (8%) vs 51 (12.5%) developed >grade 2 intra ventricular haemorrhage (IVH). Death before discharge (adjusted OR 1.38 (0.88 - 2.16)) or IVH (1.38 (0.96 - 1.98)) was similar between the two groups. Necrotising enterocolitis (NEC) ≥stage 2 was significantly higher in permissive BP support group infants (1.65 (1.07 - 2.50)). There was no difference in mortality or IVH between the two BP management approaches. Active BP support may reduce NEC. This should be investigated prospectively in large multicentre randomised studies.

Comparative study of postmortem computed tomography (PMCT) against traditional forensic autopsy findings in fatal road traffic accidents — a pilot analysis

BackgroundVirtopsy is “a virtual alternative to the traditional autopsy, conducted with scanning and imaging technology,” mainly with the use of postmortem computed tomography (PMCT). It is still in the budding stage in India. The Department of Forensic Medicine and Toxicology, All India Institute of Medical Science, New Delhi, is the first center in the country that has established a facility for virtual autopsy. This facility aims to supplement the traditional autopsy findings and also to replace/curtail internal dissection in autopsy in the future, for which there has always been an aversion in relatives of the deceased due to emotional and religious reasons. The PMCT being a noninvasive, preservative, and objective procedure would be preferred by relatives than traditional autopsy. So, in this regard, this pilot study was conducted with the objective for comparison of PMCT vs traditional autopsy findings in fatal road traffic accidents to analyze its advantages and limitations in order to replace/augment the traditional autopsy with PMCT in the near future in road traffic accident cases.ResultsThe authors evaluated 10 cases of road traffic accident victims. In each case, an autopsy was preceded by a PMCT examination using a 16-slice Multi-Slice CT spiral scanner. The fractures of the skull, facial bones, clavicle, scapula, and vertebra were located more precisely as compared to traditional autopsy. Interpretation of the ventricular hemorrhages of the brain is much better in PMCT. PMCT should be the investigation of choice for pneumothorax, pneumoperitoneum, pneumocephalus, and hemosiuns, while it needs further exploration to detect injuries of soft tissues as out of 14 injuries only 2 were identified by PMCT.ConclusionsThe procedure of whole-body PMCT followed by region-wise CT can be studied for a better PMCT acquisition to detect soft tissue injury findings more precisely. However, the PMCT in this study was able to conclude the cause of death in a more scientific way than the traditional autopsy.

Methylprednisolone is related to lower incidence of postoperative bleeding after flow diverter treatment for unruptured intracranial aneurysm.

Regarding the anti-inflammatory effect, methylprednisolone is a candidate to prevent patients with unruptured intracranial aneurysms (UIAs) from postoperative bleeding (PB) after flow diverter (FD) treatment. This study aimed to investigate whether methylprednisolone is related to a lower incidence of PB after FD treatment for UIAs. This study retrospectively reviewed UIA patients receiving FD treatment between October 2015 and July 2021. All patients were observed until 72 h after FD treatment. The patients receiving methylprednisolone (80 mg, bid, for at least 24 h) were considered as standard methylprednisolone treatment (SMT) users, otherwise as non-SMT users. The primary endpoint indicated the occurrence of PB, including subarachnoid hemorrhage, intracerebral hemorrhage, and ventricular bleeding, within 72 h after FD treatment. This study compared the incidence of PB between SMT users and non-SMT users and investigated the protective effect of SMT on PB after FD treatment using the Cox regression model. Finally, after controlling the potential factors related to PB, we performed subgroup analysis to further confirm the protective effect of SMT on PB. This study finally included 262 UIA patients receiving FD treatment. PB occurred in 11 patients (4.2%), and 116 patients (44.3%) received SMT postoperatively. The median time from the end of surgery to PB was 12.3 h (range: 0.5-48.0 h). SMT users had a lower incidence of PB comparing with non-SMT users (1/116, 0.9% vs. 10/146, 6.8%, respectively; p = 0.017). The multivariate Cox analysis demonstrated that SMT users (HR, 0.12 [95%CI, 0.02-0.94], p = 0.044) had a lower risk of PB postoperatively. After controlling the potential factors related to PB (i.e., gender, irregular shape, surgical methods [FD and FD + coil] and UIA sizes), the patients receiving SMT still had a lower cumulative incidence of PB, comparing with patients receiving non-SMT (all p < 0.05). SMT was correlated with the lower incidence of PB for patients receiving FD treatment and may be a potential method to prevent PB after the FD treatment.

Does preventive external ventricular drainage benefit patients with mild ventricular hemorrhage?

External ventricular drainage (EVD) is the routine intraventricular hemorrhage (IVH) treatment. Neurological deterioration and symptomatic hydrocephalus are often the default indications for EVD insertion. However, the outcome of preventive EVD is unclear in patients with mild IVH. This study aimed to determine whether EVD is beneficial in patients with mild IVH. This study aimed to determine whether EVD is beneficial in patients with mild IVH. Data from IVH patients treated conservatively or with EVD at two hospitals from January 2017 to December 2022 were analyzed retrospectively. Patients with a Glasgow Coma Scale (GCS) score of 12-14 and a modified Graeb score (mGS) ≥ 5 at admission were included. The primary outcome was poor functional status, defined as a modified Rankin Scale (mRS) score of 3-6 at 90days. Secondary outcomes included the distribution of mRS score categories, the resolution time of intraventricular blood clots, and complications. Forty-nine patients were enrolled in the study: 21 patients in the EVD group, 28 in the non-EVD group, and 13 in the EVD group who received urokinase injections. ICH volume was an independent predictor of poor functional status. Currently, no evidence supports that preventive EVD benefits patients with mild IVH.

Events that occur in premature babies before death during their hospital stay

Background: Globally, more than 80% of newborn babies die due to LBW. PT/LBW babies usually die because of complications from prematurity rather than the prematurity itself. Due to prematurity, they face several problems during their early life, like temperature control, feeding problem, poor immunity, respiratory insufficiency etc. and especially during SCANU and NICU stay they develop sepsis, NEC leading to their death. The aim of this study was to find out the events that occur before the death of premature neonates admitted in the NICU. Methods: A retrospective study conducted in the NICU of Department of neonatology of Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh during the period from January, 2021 to December, 2021. During this period preterm babies who died were analyzed. Result: During study period total 95 preterm babies died. Their mean± SD of birth weight was 1228.26±115.60. Majority (40%) of neonates were 28-31 weeks old and majority (59%) neonates were male. We found 27.3% had PNA, 12% had PDA, 19% had RDS and 33.6% had only prematurity during admissions. Among all neonates, 51.58% developed sepsis, 40% pneumonia, 34% pulmonary hemorrhage 20% intra ventricular hemorrhage, 25% NEC, 13.6% BPD and 12% PDA respectively and finally died. Conclusion: In our study, 32 (33.6%) babies admitted with only prematurity and rest were admitted with other diagnosis like PNA (27.3%), RDS (19%,) PDA (12%) and CHD (9.4%). However, they finally died of Sepsis 49 (51%), Pneumonia 38 (40%), IVH 19 (20%), NEC 24 (25.2%), BPD 13 (13.6%), Pulmonary Hemorrhage 33 (34.7%).

Predictive performance for prognosis of aneurysmal subarachnoid hemorrhage with ventricular hemorrhage by imaging combined with clinical and laboratory quantitative index model

Objective: To explore the predictive performance of image quantitative index model, clinical-laboratory index model and image-clinical multi-dimensional fusion model in predicting the prognosis of patients with aneurysmal subarachnoid hemorrhage (aSAH) with intraventricular hemorrhage (IVH). Methods: A total of 349 patients with aSAH and IVH, including 122 males and 227 females, aged 22 to 85 (59±11) years underwent CT scan in the General Hospital of Eastern Theater Command from January 2010 to December 2019 were used as dataset 1 to construct a prognostic model. A prognostic model was constructed for data set 1, and the functional recovery of patients 12 months after discharge was evaluated using the modified Rankin Scale (mRS). According to the results, those patients were divided into two groups: good outcome group (n=267) and poor outcome group (n=82). In addition, 63 aSAH patients with IVH, including 27 males and 36 females, aged 32 to 87 (61±12) years who were admitted to the General Hospital of Eastern Theater Command from January 2020 to December 2021 were collected as dataset 2 for independent verification of the model, including 30 patients with poor prognosis. Clinical information (age and gender), laboratory indicators (blood routine and blood biochemistry), and imaging quantitative indicators (such as volume, density, shape of each ventricle hemorrhage area outlined and extracted on head CT scan etc.) were recorded for all patients (dataset 1 and 2). The clinical, laboratory and imaging quantitative indicators of dataset 1 were screened by using L1 regularization and multiple logistic regression method was used to construct the clinical-laboratory index model, image quantitative index model and image-clinical multi-dimensional fusion model, according to the weight coefficient of features in the clinical-laboratory index model and image quantitative index model, screen out the main features. The model was trained and internally validated by 5-fold cross-validation. The model was validated independently in dataset 2. Results: The AUC (area under the ROC curve) of clinical-laboratory index model, image quantitative index model and multidimensional fusion model constructed based on dataset 1 were 0.75 (95%CI: 0.69-0.81), 0.68 (95%CI: 0.61-0.74) and 0.86 (95%CI: 0.82-0.91). The Delong test showed that there were statistically significant differences between the performance of the multi-dimensional fusion model and the clinical-laboratory index model or image quantitative index model (all P<0.05). The AUC of clinical-laboratory index model, image quantitative index model and multidimensional fusion model of dataset 2 were 0.79 (95%CI: 0.68-0.91), 0.70 (95%CI: 0.57-0.83) and 0.81 (95%CI: 0.70-0.92). In addition, in the clinical-laboratory index model and imaging quantitative index model constructed based on data 1, age, Hunt-Hess grade on admission, Neutrophil/Lymphocyte (N/L) (the weight coefficients in the clinical-laboratory index model were 1.00, -0.59 and 0.44) and the standard deviation of third ventricle hemorrhage density, minimum hemorrhage density of the fourth ventricle, and left ventricle hemorrhage sphericity (the weight coefficients in the image quantitative index model were -1.00, 0.85 and -0.84) were the main features of the screening. Conclusions: Quantitative imaging indicators of ventricular hemorrhage (standard deviation of third ventricular hemorrhage density, minimum density of fourth ventricular hemorrhage, and left ventricular sphericity) are helpful to predict the poor prognosis of patients with aSAH with ventricular hemorrhage. Dimensional fusion model has greater value in predicting poor prognosis of patients.

Safety and Efficacy of Stereotaxic Surgery Combined with Urokinase in the Treatment of Ventricular Hemorrhage: A Retrospective Propensity-Matched Score Analysis

Intraventricular hemorrhage (IVH) is a severe and devastating stroke. Research on existing treatment options has been controversial. Therefore, we aimed to evaluate the safety and efficacy of minimally implanted stereotactic puncture combined with urokinase (uPA) in the treatment of IVH. The clinical data of 122 IVH patients admitted to our department from 2018 to 2022 were retrospectively analyzed. According to the modified RanKin score (mRS) after 30days, the patients were divided into good prognosis (mRS 0-3) and poor prognosis (mRS 4-6), and the factors affecting the prognosis were screened by univariate and multivariate analysis, and then the tendency Score matching and paired patient screening were performed for comparative analysis between uPA and non-uPA groups. Patients' age, uPA usage, initial Glasgow Coma Scale and primary blood volume all could affect the mRS score of patients. One hundred patients were finally included, including 50 cases in the uPA group and 50 cases in the non-uPA group. The analysis showed that at follow-up after 30days, 46.0% of the patients in the uPA group and 28.0% in the non-uPA group had an mRS score of 0-3; however, they were not statistically significantly different. The postoperative hematoma clearance rate in the uPA group was significantly higher than that in the non-uPA group (P<0.001), and the incidence of postoperative complications was not increased (P>0.05). uPA treatment can improve the treatment efficiency. However, its effect in improving patient outcomes does not appear to be significant.

Comparison of clinical outcomes between active and permissive blood pressure management in extremely preterm infants

Background There remains uncertainty about the definition of normal blood pressure (BP), and when to initiate treatment for hypotension for extremely preterm infants. To determine the short-term outcomes of extremely preterm infants managed by active compared with permissive BP support regimens during the first 72 hours of life. Method This is a retrospective medical records review of 23+0–28+6 weeks’ gestational age (GA) infants admitted to neonatal units (NNU) with active BP support (aimed to maintain mean arterial BP (MABP) &gt;30 mmHg irrespective of the GA) and permissive BP support (used medication only when babies developed signs of hypotension) regimens. Babies admitted after 12 hours of age, or whose BP data were not available were excluded. Results There were 764 infants admitted to the participating hospitals; 671 (88%) were included in the analysis (263 active BP support and 408 permissive BP support). The mean gestational age, birth weight, admission temperature, clinical risk index for babies (CRIB) score and first haemoglobin of infants were comparable between the groups. Active BP support group infants had consistently higher MABP and systolic BP throughout the first 72 hours of life (p&lt;0.01). In the active group compared to the permissive group 56 (21.3%) vs 104 (25.5%) babies died, and 21 (8%) vs 51 (12.5%) developed &gt;grade 2 intra ventricular haemorrhage (IVH). Death before discharge (adjusted OR 1.38 (0.88 – 2.16)) or IVH (1.38 (0.96 – 1.98)) was similar between the two groups. Necrotising enterocolitis (NEC) ≥stage 2 was significantly higher in permissive BP support group infants (1.65 (1.07 – 2.50)). Conclusions There was no difference in mortality or IVH between the two BP management approaches. Active BP support may reduce NEC. This should be investigated prospectively in large multicentre randomised studies.

Admission neutrophil-to-lymphocyte ratio to predict 30-day mortality in severe spontaneous basal ganglia hemorrhage.

Spontaneous intracerebral hemorrhage (ICH) usually occurs in the basal ganglia and is highly lethal and disabling. The aim of this study was to evaluate the predictors of 30-day mortality in patients with severe spontaneous basal ganglia hemorrhage. This retrospective study included patients with severe basal ganglia intracerebral hemorrhage treated in the Third Affiliated Hospital of Soochow University from 2012 to 2018. Demographic, clinical, laboratory and neuroradiological data were collected. The short-term prognosis was evaluated and divided into death within 30-days and survival over 30-days. We studied the factors affecting the prognosis of patients with severe intracerebral hemorrhage, analyzed the parameters related to neutrophil-to-lymphocyte (NLR) at admission, and evaluated the predictive effect of NLR on 30-day mortality. A total of 105 patients was included in this retrospective study. The 30-day death group had a larger hematoma, a higher probability of ventricular hemorrhage, a higher ICH score and a lower Glasgow Coma Scale (GCS) score on admission. Meanwhile, the patients in the death group had higher White blood cells (WBC) counts, neutrophil counts, NLRs and C-reactive protein (CRP) levels. The risk factors for 30-day death were related to the ICH volume, GCS score, ICH score, WBC count, neutrophil count, NLR and CRP. The univariate receiver operating characteristic (ROC) curve of the risk factors showed that the NLR had the best prediction performance. Mathematical predictive models for ICH patients showed that the model with NLR had better prediction accuracy. The NLR is expected to be a potential biomarker for predicting the prognosis of patients with severe basal ganglia hemorrhage.

Retracted: Clinical Application of Microsurgery Using the Cerebellar Medulla Fissure Approach in Severe Ventricular Hemorrhage with Casting of the Fourth Ventricle and Its Influence on Neurological Recovery.

[This retracts the article DOI: 10.1155/2021/3699233.].

The impact of subarachnoid and ventricular hemorrhage extension on ventriculostomy-related infections in patients with aneurysmal subarachnoid hemorrhage

The impact of subarachnoid and ventricular hemorrhage extension on ventriculostomy-related infections in patients with aneurysmal subarachnoid hemorrhage

Surgical treatment of distal aneurysms on superior cerebellar artery: two case reports

Distal aneurysms of the superior cerebellar arteries (SCA) present a rare subgroup of intracranial aneurysms. Only few case reports describe this condition. Therefore, the surgical approach to treating distal SCA aneurysms remains controversial.We are demonstrating surgical treatments of previously unavailable, distal SCA aneurysms as a number of multimodal case reports.We describe two different ways to treat two patients with distal SCA aneurysms and provide a literature review. First, a 38-year-old patient presented with an acute subarachnoid ventricular hemorrhage due to distal SCA aneurysm rupture. Microsurgical clipping of the aneurysm was performed. Then the aneurysm ruptured intraoperatively, which required temporary clipping of the SCA trunk. The postoperative period was complicated by a progressive and eventually lethal cerebral angiospasm. Another, 36-year-old female patient was admitted in acute condition after recurrent ruptures of a distal SCA aneurysm associated with subarachnoid parenchymal hemorrhage. The patient underwent endovascular SCA deconstruction at the aneurysm level. No complications or neurological symptoms were observed postoperatively. The patient was discharged for outpatient treatment on day 4.Endovascular surgery should be considered as a method of choice for ruptured distal SCA aneurysms. Microsurgical intervention may be an option when endovascular repair is impossible and when other surgical procedures such as removal of hematoma and prevention of occlusive hydrocephalus are required. Received 31 August 2022. Revised 14 November 2022. Accepted 18 November 2022. Informed consent: The patient’s informed consent to use the records for medical purposes is obtained. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Contribution of the authors: The authors contributed equally to this article.

Elevated serum AST and LDH levels are associated with infant death in premature babies with neonatal leukemoid reaction: a cohort study.

Neonatal leukemoid reaction (NLR) is often accompanied by infectious or non-infectious diseases, a low birth weight, sepsis, prematurity, ventricular hemorrhage, and bronchial dysplasia. It has an incidence rate of 1.3-15% and a mortality rate of about 41.4%. Previous studies on NLR have largely focused on its pathogenesis and clinical cases, but little is known about its prognostic laboratory indicators. We found that some of the NLR exhibited obviously elevation in liver function tests like aspartate transaminase (AST) and lactate dehydrogenase (LDH) which were not took by all the LR infants. The necessity for liver function tests for the prognosis of NLR was still unclear. A total of 39 premature infants with NLR at the First Hospital of Jilin University between March 2016 and March 2017 were included in this retrospective cohort study. The infants were divided into death and cured group based on the clinical outcomes. Premature infants with LR and death were defined as the case group (n=14), while infants without death were defined as the control group (n=25). Confounding factors such as age and gender between the two groups were controlled. Blood routine tests, including the white blood cell (WBC) count and subtypes, and liver function, and clinical features were recorded and analyzed. T tests were used to examine the differences in the laboratory indicators between the NLR and control groups. Receiver operating characteristic curves (ROCs) and areas under the curve (AUCs) were used to examine laboratory indicators for prognosis. For predicting clinical outcomes, the ROC curves showed that the cut-off values for AST and LDH were 279 and 1,412 U/L, respectively. The sensitivity and specificity for AST were 92% and 71.43%, respectively, with an AUC of 0.894, while the sensitivity and specificity for LDH were 88% and 78.57%, respectively, with an AUC of 0.911. This innovative study investigated the NLR prognosis depending on laboratory tests. We found that serum AST and LDH levels had reliable predictive value in determining adverse outcomes of NLR.

Complications of External Ventricular Drainage at CHU-JRA Antananarivo Madagascar

The external ventricular drainage (EVD) is a device indicated in cases of acute hydrocephalus and in certain cases of intracranial hypertension. The main objective of our study is to determine the frequency of the complication of an EVD at the Centre HospitalierUniversitaire Joseph Ravohangy Andrianavalona (CHU-JRA). This is a retrospective and descriptive study. During the targeted period, 64 patients were operated for EVD, of which 45 had a complication (70.31%). The infectious complication predominated in 43.75% of cases. All patients were operated for ventricular hemorrhage. Antibiotic prophylaxis before surgery was systematic for all patients. The most frequent germ was Coagulase-negative Staphylococcus. The average duration of catheterization was 14.47 days, the average duration of onset of the complication was 7.96 days. Despite systematic insertion of the EVD in the operating room and the existence of a dedicated care protocol, the rate of an EVD-related complication remains high in our center.

FINDINGS AND OUTCOMES OF HEAD INJURY PATIENTS USING COMPUTED TOMOGRAPHY: A CROSS-SECTIONAL STUDY

Background: Trauma resulting from (RTA) road trafc accidents is a common cause of head damage now a days. Every victim to trauma who has lost consciousness should be checked for a brain damage. With the introduction of computed tomography (CT), radiological examination has changed dramatically since it can clearly characterize the kind and location of the culprit lesion(s). This is a cross-sectional study i Method: ncluding 250 patients who were hospitalized to our hospital's emergency department between October 2020 and October 2022. The ndings of a CT examination of the kind and location of the detected lesion are presented. CT scans has revealed sku Results: ll fractures (59.60%), intra-cerebral hematoma (45.20%), epidural hematoma (29.20%), subdural hematoma (19.60%), subarachnoid hematoma (28.40%), Cerebral edema (60.40%), midline shift (24%), pneumocranium (11.20%) and intra ventricular hemorrhage (10%) in our study. CT scan has detected and precisely localized the parenchymal damage of brain Conclusion: and effectively predicted the functional outcome

Evaluation of hemostasis clinical and laboratory indicators of patients with stroke and coronavirus infection (COVID-19) on the basis of a multidisciplinary hospital in the period of its conversion to an infectious diseases hospital

Introduction. The COVID-19 impact on hemostasis of stroke survivors with community-acquired pneumonia is an urgent problem. The aim of the study is to analyze the features of clinical and laboratory parameters in cerebral stroke combined with community-acquired pneumonia caused by the SARS-Co-V-2 virus. Materials and methods. The instrumental and laboratory examination results of 88 patients aged 73.0 (12.3) years in the acute period of stroke with community-acquired viral pneumonia symptoms were analyzed. The present study included 39.8 % (n=53) male and 60.2 % female (n=35) with duration of diagnosed infectious disease less than 7 days. The symptoms of cerebral stroke were compared with the results of laboratory testing of the hemostasis system, lipid metabolism, and the activity of the systemic inflammatory response. The severity of lung tissue damage and the outcomes of the diagnosed changes were assessed. Results. All patients had mild or moderate COVID-19. In 87.5 % (n=77) cases unspecified (40.2 %, n=31), cardioembolic (36.4 %, n=28), lacunar (3.9 %, n=3) and atherothrombotic (19.5 %, n=15) ischemic stroke subtype was diagnosed. Focal ischemia lesion in the left middle cerebral artery (LMCA) territory was detected in 45.6 % (n=35), in the right middle cerebral artery (RMCA) territory in 41.6 % (n=32). Manifestations of hemorrhagic stroke were noted in 12.5 % (n=11) with signs of parenchymal hemorrhage in 54.5 % (n=6), ventricular hemorrhage in 27.3 % (n=3), subarachnoid hemorrhages were noted in 18.2 % (n=2). The indicators of the coagulation system in terms of the number of platelets corresponded to 251.3 (90.7); the APTT value was in the range of 29.2 (26.7 33.0) (s); the INR parameter was 1.16 (1.05 1.25); the value of prothrombin ( %) corresponded to the value of 85.9(23.4). Conclusion. We do not observe the great disorders of haemostasis in the most acute period of the stroke. When combined with COVID-19 the most common stroke is ischemic stroke. The stroke survivors with the community-acquired pneumonia caused by SARS-CoV-2 laboratory tests show that increase of inflammatory markers are above the reference range.

Development and validation of a clinical-radiomics nomogram for predicting a poor outcome and 30-day mortality after a spontaneous intracerebral hemorrhage

BackgroundNoncontrast computed tomography (NCCT) is often performed for patients with a suspected spontaneous intracerebral hemorrhage (ICH) at the time of admission. Both clinical and radiomic features on the initial NCCT can predict the outcomes of those with ICH, but satisfactory model performance remains challenging.MethodsA total of 258 acute ICH patients from the Central Hospital of Wuhan (CHW) between January 2018 and December 2020 were retrospectively assigned to training and internal validation cohorts at a ratio of 7:3. An independent external testing cohort of 87 patients from January 2021 to July 2021 from the Fifth Affiliated Hospital of Nanchang University (FAHNU) was also used. Based on the least absolute shrinkage and selection operator (LASSO) algorithm, radiomics (rad)-scores were generated from 9 quantitative features on the initial NCCT images. Three models (radiomics, clinical, and hybrid) were established using stepwise logistic regression analysis. The Akaike information criterion and the likelihood ratio test were used to compare the goodness of fit of the three models. Receiver operating characteristic (ROC) curve analysis was performed and bar charts were constructed to evaluate the discrimination of constructed model for predicting a poor outcome following ICH.ResultsThe three cohorts had similar baseline clinical characteristics, including demographic features and outcomes. In the clinical model, hematoma expansion [2.457 (0.297, 2.633); P=0.014], intracerebral ventricular hemorrhage [2.374 (0.180, 1.882); P=0.018], and location [−2.268 (−2.578, −0.188); P=0.023] were independently associated with a poor clinical outcome. In the hybrid model, location [−2.291 (−2.925, −0.228); P=0.022], and rad-score [5.255 (0.680, 11.460); P<0.001] were independently associated with a poor outcome. The hybrid model achieved satisfactory discriminability, with areas under curve (AUCs) of 0.892 [95% confidence interval (CI): 0.847 to 0.937], 0.893 (95% CI: 0.820 to 0.966), and 0.838 (95% CI: 0.755 to 0.920) in the training, internal validation, and external testing cohorts, respectively. The hybrid model also achieved good discriminability in the prediction of 30-day mortality, with AUCs of 0.840, 0.823, and 0.883 in the training, internal validation, and external testing cohorts, respectively. The rad-score [2.861 (1.940, 4.220); P<0.001] was the predominant risk factor associated with 30-day mortality.ConclusionsRadiomic analysis based on initial NCCT scans showed added value in predicting a poor outcome after ICH. A clinical-radiomics model yielded improved accuracy in predicting a poor outcome and 30-day death following ICH compared with radiomics alone.

P11.01.B Lower-extremity deep vein thrombosis and bleeding complications in primary brain tumor patients: A prospective study

Abstract Background Primary brain tumor patients have a high risk of venous thromboembolism (VTE). Bleeding risk with prophylactic and therapeutic anticoagulation is an important concern in these patients, and data on the management of asymptomatic VTE events in this population are lacking. The aim of this prospective study is to investigate risk and risk factors for asymptomatic lower-extremity deep-vein thrombosis (LE-DVT) in patients with primary brain tumors, and to estimate the rate of bleeding complications on full, prophylactic or no anticoagulation. Material and Methods We included consecutive patients with primary brain tumours undergoing surgery. Screening for asymptomatic LE-DVT by compression ultrasound (CUS) was performed pre-operatively and postoperatively within 2 months after surgery. Telephone follow-up was done 6 and 12 months after surgery. The protocol pre-specified therapeutic doses of low-molecular-weight heparin (LMWH) in case of detection of an asymptomatic LE-DVT. Results Fifty patients were included (female: 34%, median age 58 years, WHO grade IV tumors: 78%, prophylactic-dose LMWH at baseline: 12%). During a median observation period of 9.1 months, LE-DVT was detected in 9 patients (18%). LE-DVTs included two asymptomatic events (4%) at pre-operative screening, five asymptomatic events (10%) at postoperative screening, and two symptomatic events (4%, both 4-level LE-DVT) at telephone follow-up. This corresponded to a 12-month cumulative incidence of LE-DVT of 14.9% (95%CI: 6.4-26.6). At postoperative screening, n=10 patients were on prophylactic-dose LMWH, and one of these patients had an LE-DVT event detected by screening. The two patients with symptomatic LE-DVT were not on thromboprophylaxis at the time of event. Among a variety of investigated potential risk factors, only higher age (Odds Ratio (OR) per 5 years increase=1.46, 95%CI: 1.01-2.13, p=0.05), higher neurologic assessment in neuro-oncology (NANO) scale (OR per 1 point increase=1.59, 1.00-2.54, p=0.05), higher serum Galectin-3 levels (OR per 1ng/ml increase=1.20, 1.01-1.42, p=0.041) but not D-Dimer (OR per 1mg/L increase=1.89, 0.75-4.77, p=0.178) emerged as significant predictors of any LE-DVT. Six patients (12%) developed bleeding events, including n=3 operative intracranial bleedings without LMWH, n=1 spontaneous ventricular hemorrhage without LMWH, n=1 minor subcutaneous bleeding without LMWH, and 1 intracerebral hematoma during therapeutic-dose LMWH initiated for asymptomatic distal LE-DVT. Conclusion In our study we detected a high-frequency of asymptomatic LE-DVT in patients with primary brain tumours. Conversely, symptomatic LE-DVT risk was low, which may be related to prior screening. Patients with primary brain tumors appear to have LE-DVT risk factors specific to this entity. Prophylactic-dose LMWH did not show any adverse safety signals regarding bleeding.

Ruptured dural arteriovenous fistula and sinus venous thrombosis following surgical resection of a vestibular schwannoma: Case report and review of the literature

Dural arteriovenous fistula (DAVF) is a rare vascular malformation. Strong evidence suggests that the development of DAVF in adults is acquired and multifactorial.The link between cerebral venous thrombosis and DAVF is probably explained by dynamic changes in the venous drainage pattern.We report the case of a 34-year-old man admitted to the emergency department for seizure and headaches. The patient had a medical history of right vestibular schwannoma resection 9 months earlier, complicated by untreated asymptomatic sigmoid sinus thrombosis.At admission, CT scan revealed a spontaneous temporal intracerebral hemorrhage associated with ventricular hemorrhage due to the rupture of a DAVF diagnosed by complementary CT angiography.External ventricular drainage was performed in emergency, followed by endovascular exclusion of the DAVF. Good neurological outcome was achieved, with complete exclusion of the vascular malformation.This clinical case underlines the absence of guidelines on the use of anticoagulation drugs to treat postoperative venous sinus thrombosis and to potentially prevent DAVF as a late complication following cerebellopontine angle surgery.