ObjectiveTo study the brain tissue oxygen and prognosis index of the postoperative patients with hypertensive intracerebral hemorrhage (HICH) associated with secondary brain insults. MethodsA total of 120 patients with HICH from January 2006 to June 2013 were treated by neurosurgical intervention. Postoperative monitoring of factors affecting the secondary brain insults in the 120 patients and of brain tissue oxygen in 10 patients was performed and statistically analysis was carried out. ResultsSecondary brain insults had a significant influence on the prognosis of postoperative patients with hypertensive intracerebral hemorrhage, and was correlated with brain tissue oxygen metabolism. ConclusionAbnormal secondary brain insults affect brain tissue oxygen metabolism, which may further deteriorate the brain damage and can lead to poor prognosis.
ObjectiveTo explore the influencing factors for the prognosis of intracerebral hemorrhage in extremely old patients. MethodsWe retrospectively analyzed the clinical data of 104 extremely old intracerebral hemorrhage patients (≥80 years old) treated between June 2010 and June 2013. According to Glass Outcome Score, the patients were divided into good outcome group (with a score of 4-5) and poor outcome group (with a score of 1-3). The age, gender, consciousness on admission, mean arterial pressure, systolic blood pressure on admission, and complication rate were analyzed and compared between the two groups of patients. ResultsA total of 104 patients were recruited in our study, with 62 in the good outcome group and 42 in the poor outcome group. The gender, age, average arterial pressure on admission between the two groups were not significantly different (P>0.05). The consciousness score at admission in the good outcome group (13.79±2.38) was significantly higher than that of the poor outcome group (8.24±3.80, P<0.05). The complication rate (45.2% vs. 88.1%) and systolic blood pressure on admission [(168.87±25.03) vs. (181.83±29.82) mm Hg (1 mm Hg=0.133 kPa] in the good outcome group were both significantly lower than those in the poor outcome group (P<0.05). ConclusionFor extremely old intracerebral hemorrhage patients, consciousness score and systolic blood pressure at admission, and complication rate are the influencing factors for the prognosis. In addition, a systolic pressure on admission above 180 mm Hg can be a risk factor for poor prognosis in extremely old patients.
ObjectiveTo systematically review the effectiveness and safety of intensive blood pressure lowering in intracerebral hemorrhage (ICH). MethodsRandomised controlled trials (RCTs) and quasi-RCTs about ICH patients receiving intensive blood pressure lowering were searched from PubMed, EMbase, SCIE, The Cochrane Library (Issue 2, 2013), CBM, CNKI, VIP and WanFang Data until March, 2014. Literature was screened according to the exclusion and inclusion criteria by two reviewers independently and meta-analysis was conducted using RevMan 5.2 software after data extraction and quality assessment. ResultsA total of 24 studies were included involving 6 299 patients, of which 10 were RCTs and 14 were quasi-RCTs. The results of meta-analysis showed that intensive blood pressure lowering was superior to guideline-recommended intervention in reducing 24-h hematoma expansion rates (OR=0.36, 95%CI 0.28 to 0.46, P < 0.05), 24-h hematoma expansion volume (MD=-3.71, 95%CI-4.15 to-3.28, P < 0.05) and perihematomal edema volume (MD=-1.09, 95%CI-1.92 to-0.22, P < 0.05). Meanwhile, intensive blood pressure lowering improved 21-d NIHSS score (MD=-3.44, 95%CI-5.02 to-1.87, P < 0.05). But there was no significant difference in mortality and adverse reaction between the two groups. ConclusionCurrent evidence shows that intensive blood pressure lowering could reduce hematoma expansion volume and perihematomal edema volume, which is beneficial to recovery of neurological function, but ICH patients' long-term prognosis needs to be further studied. Due to the limited quantity and quality of the included studies, high quality studies are needed to verify the above conclusion.
ObjectiveTo explore and compare the therapeutic effects of neuro-endoscopic and craniotomic hematoma evacuation for hypertensive hematomas in the basal ganglia region. MethodsEighty-six patients with hypertensive hematomas in the basal ganglia regions treated between January 2010 and September 2014 were divided into neuro-endoscopy and craniotomy groups randomly with 43 in each. Hematoma was removed directly under neuro-endoscope in the endoscopic group, while it was removed under the operating microscope in the craniotomy group. The average operation bleeding amount, residual hematoma after operation, hematoma evacuation rate, the changes of National Institutes of Health Stroke Scale (NIHSS) and Barthel index (BI) scores before operation, 1 and 3 months after operation were compared between the two groups. All data were analyzed statistically. ResultsThe average amount of operation bleeding was (127±26) mL, postoperative residual hematoma was (6±4) mL, and the hematoma clearance rate was (86±9)% in the neuro-endoscopy group, while those three numbers in the craniotomy group were respectively (184±41) mL, (11±6) mL, and (72±8)%, with all significant differences (P < 0.05). The NIHSS and BI scores were not significantly different between the two groups before surgery (P > 0.05). Seven days, one month and three months after surgery, the NIHSS score was significantly lower, and the BI score was significantly higher in the neuro-endoscopy group than the craniotomy group (P < 0.05). ConclusionNeuro-endoscopic surgery for hypertensive hematomas in basal ganglia region is proved to have such advantages as mini-invasion, direct-vision, complete clearance and good neural function recovery after surgery, which is a new approach in this field.
ObjectiveTo conduct an objective record of stroke patient’s retinal diseases by retinal photography, and analyze the incidence of various retinal diseases between different subtypes of stroke.MethodsFrom June to October 2007, the consecutive cases of stroke admitted to the Department of Neurology, West China Hospital of Sichuan University were prospectively registered. Ischemic stroke patients were classified into different subtypes by the Oxfordshire Community Stroke Project criteria, and intracerebral hemorrhage (ICH) patients were classified based on the clinical manifestation and neuroimaging. We collected other clinical data associated with the incidence of stroke. The retinal abnormalities including retinopathy, arteriovenous nicking and arteriolar narrowing were recorded. Multivariate logistic regression was performed to investigate the relationship between retinal abnormalities and stroke.ResultsThis study included 199 patients with ischemic stroke and 95 patients with ICH. Among the patients with ischemic stroke, 43 (21.6%) had retinopathy, 52 (26.1%) presented with arteriovenous nicking, and 43 (21.6%) developed arteriolar narrowing. Among the patients with ICH, retinopathy occurred in 23 (24.2%), arteriovenous nicking occurred in 14 (14.7%), and arteriolar narrowing occurred in 25 (26.3%). In multivariate analysis, retinopathy was independently associated with partial anterior circulation infarct (PACI) (P=0.029) and anterior ICH (P=0.041).ConclusionsRetinopathy is independently associated with PACI and anterior ICH. Further community-based study with large sample should be conducted to confirm the predictive value of retinal diseases on the incidence of anterior stroke.
The incidence, mortality, and disability rate of spontaneous intracerebral hemorrhage (SICH) are high, and its surgical and medical treatment is still controversial. With the development of micro-neurosurgical technology, minimally invasive surgery (MIS) has made great progress in the treatment of SICH. It can remove intracerebral hematoma in the early stage after SICH and minimize or eliminate secondary brain injury, which is of great significance to reducing the mortality and disability rate. For many years, due to its continuous progress, MIS has been more and more widely used in the treatment of SICH. This article mainly reviews the progress of MIS in SICH and related clinical research at home and abroad, and briefly describes several innovative techniques related to MIS, which aims to promote the exchange of clinical experience in MIS of SICH.
Resuming oral anticoagulant (OAC) after intracerebral hemorrhage (ICH) is still a dilemma to clinical decision. To date, no high-quality randomized controlled trials demonstrate the timing and mode of safely resuming OAC. In recent years, some moderate-quality researches have suggested that OAC resuming after ICH can decrease the incidence of thromboembolic events and long-term mortality, without significantly increasing the risk of ICH; it is safer to resuming OAC in patients with non-lobar ICH than in patients with lobar-ICH; new OACs are superior to vitamin K antagonists; patients with high thromboembolic risk should resume OAC 2 weeks or even earlier after ICH, otherwise, a time-window for optimal resumption is between 4-8 weeks; meanwhile, individual patient characteristics should be considered and blood pressure should be strictly controlled.