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Objective Understanding the current status of disease perception, self-transcendence, and resilience levels in young and middle-aged patients with cerebral hemorrhage and their relationship to short-term prognosis.Methods General data of young and middle-aged cerebral hemorrhage patients admitted to the Department of Neurosurgery of the Second Affiliated Hospital of the Air Force Medical University from April 2020 to April 2023, were colected and the patients' disease perception, self- transcendence, and resilience levels were evaluated relevant questionnaires. Pearson correlation analysis was analyzed to explore the correlation among the three scores and multivariate Logistic regression analysis was performed to explore the risk factors for patients' short-term prognosis.Results A total of 142 young and middle-aged patients with cerebral hemorrhage were included, including 32 cases in the poor prognosis group and 110 cases in the good prognosis group. Positive perceptions of illness were positively correlated with self-transcendence (r=0.461) and resilience (r=0.449); negative perceptions of illness were negatively correlated with self-transcendence (r=-0.513) and resilience (r=-0.482); and self-transcendence was positively correlated with resilience (r=0.558). Multivariate Logistic regression analysis showed that irregular hematoma morphology [OR=2.065, 95%CI(1.750, 2.379)], high disease negative perception score [OR=2.230, 95%CI(1.902, 2.558)], low self-transcendence score [OR=2.423, 95%CI(1.954, 2.892)], low resilience score [OR=2.018, 95%CI(1.452, 2.584)], high level interleukin-6 [OR=2.044, 95%CI(1.701, 2.387)], high level ferritin [OR=2.081, 95%CI(1.635, 2.528)] were risk factors for short-term prognosis in young and middle-aged patients with cerebral hemorrhage (P

Background This study aims to establish the individual contributions of blood pressure variability (BPV) indexes, categorized into overall and linked variability, to mortality following intracerebral hemorrhage (ICH) by examining the risk factors. Methods Patients with spontaneous ICH (n = 1,036) were identified with valid blood pressures (BP) from the first 24-h systolic BP records in the Medical Information Mart for Intensive Care IV version 2.2 database (MIMIC IV). Information on the baseline characteristics, including age, sex, initial Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS) scores, ICH location, Charlson comorbidity index score, and presence of diabetes with or without complications, were collected. Three indexes of BPV—range, standard deviation (SD), and generalized BPV (GBPV)—were calculated using the first 24-h systolic BPs. An automated stepwise variable-selection procedure was used to develop the final logistic model for predicting in-hospital mortality. Results Out of 1,036 patients, 802 (77.4%) survived and were discharged after spontaneous ICH. Factors associated with mortality included age; male sex; ICH in the brainstem, ventricle, or multiple locations; low GCS score (< 9); high NIHSS score (> 20); and diabetes with complications. Mean systolic BP, SD, and GBPV were also linked to mortality. Higher GBPV notably increased the risk of in-hospital death, with an odds ratio of 3.21 (95% confidence interval, 2.10 to 4.97) for every + 10 mmHg/h change in GBPV. Conclusions This study underscores the additional impact of GBPV, herein linked to BPV, on mortality following ICH, providing further insights into the management of blood pressure in the early stages of ICH treatment.

Introduction The aim of the study was to observe the effect of Sanguiin on cerebral edema and behavior in a rat cerebral hemorrhage model. Material and methods A rat collagenase-induced cerebral hemorrhage model was established to detect the effects of drugs on brain edema. Results Through magnetic resonance imaging (MRI) analysis and brain weight content (BWC) determination, it was found that Sanguiin could significantly reduce the brain swelling index and BWC of the affected hemisphere after cerebral hemorrhage. Conclusions Sanguiin can significantly improve the neurological deficits in rats with cerebral hemorrhage, and down-regulate the expression of MMP-9 after cerebral hemorrhage, suggesting that Sanguiin has a certain protective effect on the blood-brain barrier after cerebral hemorrhage.

Abstract Background Scrub typhus, caused by Orientia tsutsugamushi, rarely leads to central nervous system involvement. Although intracerebral bleeding is rare due to endemicity and a significant proportion of underdiagnoses, it should be considered a noteworthy differential diagnosis in endemic regions in patients with relevant history and clinical findings. Case presentation We present the case of a 40-year-old Nepali woman who visited the emergency department with complaints of left-sided weakness for 6 hours and an acute febrile illness with an eschar for 7 days and was diagnosed with scrub typhus by immunoglobulin M enzyme-linked immunosorbent assay of the serum. Imaging revealed a right-sided frontotemporal hematoma, and further examination revealed pulmonary edema with multiple organ dysfunction syndrome. The patient was mechanically ventilated and was treated with antibiotics, steroids, vasopressors, and antipyretics. However, the hematoma was treated conservatively, with ongoing neurological recovery at the 6-month follow-up. Conclusion Although neurological complications and intracranial hemorrhage are uncommon, physicians must be cautious when making differential diagnoses and initiating appropriate therapies to avoid serious or fatal complications.

ObjectiveTo investigate the interventional effect of acupuncture at Baihui (GV 20) and Qubin (GB 7) acupoints on the expression of recombinant cluster of differentiation 36 (CD36) and Toll-like receptor 4 (TLR4) in rats with acute cerebral hemorrhage (ICH), and to explore the mechanism of acupuncture treatment for ICH.MethodsA total of 144 male Wistar rats were randomly divided into sham operation group, model group, acupuncture group and inhibitor group, with 36 cases in each group, and then each group was divided into three subgroups at the 1st, 3rd and 7th day, with 12 cases in each subgroup. The stereotaxic autologous blood injection method was used to establish a rat model of ICH. The model group only received ICH model preparation without any treatment. The sham operation group received various operations similar to the model group, but without blood injection. The inhibitor group received an intraperitoneal injection of the TLR4 inhibitor TAK242 at 6 hours after modeling, and the dose was 3 mg/kg, once daily for 5 days. At 12 hours after model establishment, all subgroups of the acupuncture group received penetrative needling at Baihui (GV 20) and Qubin (GV 25) acupoints. The needle was retained at a depth of 20 mm and twisted at a frequency of 100 r/min for three sessions of 2 min each at an interval of 5 min during the 30-min needle retention period. Acupuncture was given once a day and lasted for 1, 3, and 7 days in the three acupuncture subgroups, respectively. At the 1st, 3rd and 7th day after treatment, modified neurological severity score (mNSS) was used to assess neurological function. The volume of hematoma in brain tissue was detected. Western blot was used to detect the protein expression level of CD36 and TLR4 in brain tissue. Immunofluorescence method was used to detect the expression of CD36 and TLR4 in astrocytes.Results(1) mNSS score: compared with the sham operation group at the same time, mNSS score of the model group, the acupuncture group and the inhibitor group at 1, 3, 7 days after treatment increased significantly (PPPPPPPPPPP

Levetiracetam (LEV) is not frequently recommended as a preventative medication for seizures after intracerebral hemorrhage (ICH). Although there are differing opinions among clinicians, current recommendations do not support its use. We aim to assess the effectiveness of LEV in seizure prophylaxis in patients with ICH. We systematically searched PUBMED, SCOPUS, and other databases. Clinical trials and observational studies that enrolled patients in Spontaneous ICH and provided independent data on LEV were included. The pooled proportions of reported findings were determined using the random-effects model and forest plots were created. We identified six studies with a total of 1,166 patients for the analyses of primary and secondary outcomes. There were no significant differences in the total frequency of seizures between LEV treatment and placebo (OR=0.52; 95% CI-0.21–1.31; P=0.17) and also LEV treatment did not lower the death rate. (OR=1.14, 95% CI-0.57–2.26, P- 0.71). In half of the investigations (n=3), the poor clinical outcomes were defined using the mRS (i.e. score >3). The results showed that taking the placebo resulted in worse outcomes (OR-6.24, 95% CI-3.97-9.81, P.00001). Overall, there were no appreciable differences between LEV and placebo regarding the change in NIHSS of less than 25 (MID, 1.98; 95%CI, 0.15–4.12; P=0.07). However, these two trials showed a significant amount of heterogeneity (I2=83%). LEV did not significantly reduce mortality and seizure occurrences on average than those on other anti-epileptic medications. Our study is the first to analyze the efficacy of this newer-generation anti-epileptic drug for seizure prophylaxis in patients with ICH.

Abstract Objective This study assessed the predictive value of electrical activity of the diaphragm (EAdi) and the EAdi-derived monitoring index in the prognosis of patients with severe cerebral hemorrhage. Methods Ninety patients with severe cerebral hemorrhage were admitted to the Neurosurgery Intensive Care Unit of Yijishan Hospital from April 2019 to June 2021 and were divided into the good prognosis group (Glasgow Outcome Scale [GOS] ≥ 4) and poor prognosis group (GOS ≤ 3). The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate prediction accuracy. Results EAdi, neuro-ventilatory efficiency (NVE), and neuro-muscular efficiency (NME) in patients with good prognosis were significantly higher than those in patients with poor prognosis (4.707 µV vs 2.80 µV, P

Platelet elevation is a rare manifestation in the peripheral blood of patients with chronic myeloid leukemia (CML). In this paper, we report for the first time a case of CML combined with cerebral hemorrhage manifested by abnormally elevated platelets. The patient had elevated platelets in the peripheral blood, showed normal coagulation function, and underwent intracranial hematoma removal due to cerebral hemorrhage. After the operation, bleeding from the operated area and other systems occurred, and the patient was diagnosed as having accelerated CML after combining bone marrow biopsy and genetic testing. His condition was controlled after administration of flumatinib through a jejunal tube. Based on this patient's experience, the feasibility ofadministering flumatinib via a jejunostomy tube was determined, which is the first report of its kind in China and abroad.This article summarizes the diagnosis and treatment process of this patient, with the aim of providing a warning and reference for clinicians.

In this review, we will discuss the neuroimaging findings of patients with COVID-19 from the outbreak (late December 2019) to the end of October 2021. PubMed, Scopus, Google Scholar, Science Direct, ProQuest, Web of Science and the World Health Organization database (January 01, 2020, to October 30, 2021) were searched for related published articles. In each of the databases, the appendix search strategies were performed and the below keywords were used: COVID-19”OR“coronavirus disease 2019” AND “brain MRI” OR “brain magnetic resonance imaging” OR “brain CT” OR “neuroimaging”. In total, neuroimaging findings of 1550 patients, with ages from 1-96 years, were analyzed. Most brain neuroimaging findings include hyperintensity, Cerebral venous thrombosis, intraventricular and subarachnoid hemorrhage, infarction, leukoencephalopathy, acute ischemic strokes and posterior reversible encephalopathy syndrome (PRES) in adult patients and severe encephalopathy, stroke, infarction, CNS infection/demyelination, neuritis or polyradiculitis, venous thrombosis, Guillain-Barré syndrome, and longitudinally extensive myelitis, and myositis in pediatric patients. Our findings showed that the most important complication of the coronavirus is not just respiratory complications, because although transiently, COVID-19-related brain complications are seen in pediatrics as well as adults, and families should pay more attention to health care.

Abstract Background and purpose Hemorrhagic transformation (HT) after intravenous thrombolysis (IVT) in acute ischemic stroke seriously affects the prognosis of patients. This study aimed to investigate the risk factors of different types of HT and their correlation with prognosis after IVT. Methods Based on the CASE II registry, we included patients with acute ischemic stroke who received IVT within 4.5 h of onset. HT was further divided into hemorrhagic infarction (HI) and parenchymal hemorrhage (PH). Poor outcome was defined as a modified Rankin Scale (mRS) score of 3–6 at 3 months. Multivariate logistic regression analysis was used to determine the independent influencing factors of HT subtypes and clinical outcome. Results Among 13108 included patients, 541 (4.1%) developed HI and 440 (3.4%) developed PH. In multivariate analysis, age (OR 1.038, 95% CI 1.028 to 1.049, p

Background The inflammatory response is a major factor in the progression of intracerebral hemorrhage (ICH). Artesunate (ART) has antibacterial and anti-inflammatory pharmacological activity with high concentrations in the brain, but its neuroprotective effect on cerebral hemorrhage injury remains unclear. Objective To observe the effect of ART on inflammatory response after intracerebral hemorrhage and explore its mechanism. Methods From March 2022 to February 2023, 108 male C57BL/6 mice aged 8 to 10 weeks were selected and randomly divided into the sham-operated group (Sham group, n=36), ICH control group (ICH+Vehicle group, n=36) and ART treatment group (ICH+ART group, n=36). ICH model was established. The mice in the ICH+ART group were intraperitoneally injected with 150 mg·kg-1·d-1 2 h after modeling, and the mice in the ICH+Vehicle group were intraperitoneally injected with 5% sodium bicarbonate solution for 3 consecutive days. The behavioral indicators of mice were observed. The brain tissue damage of mice in each group was observed by HE staining; the number of positive cells per unit area of interleukin (IL) 6, IL-1β and myeloperoxidase (MPO) were detected by immunohistochemical staining; the activation of microglia/macrophages was observed by IBA1 immunofluorescence staining. TUNEL/NeuN immunofluorescence double staining was performed to observe neuronal death. The levels of MPO, IL-1β, tumor necrosis factor α (TNF-α), Nod-like receptor protein 3 (NLRP3), apoptosis-related granuloid protein (ASC) and cysteine aspartic protease 1 (Caspase-1) were compared by western blotting. Results The modified neurological severity scores and percentages of right turn of mice were higher in the ICH+Vehicle group than the Sham group, and lower in the ICH+ART group than the ICH+Vehicle group (P

Abstract Background Emicizumab is a novel prophylactic medication used to treat patients with hemophilia A. It is indicated to minimize the frequency of bleeding episodes and the severity of serious bleeding in patients with hemophilia A utilizing inhibitors. However, some cases of bleeding episodes have been reported, and more data are needed regarding their management and expected outcomes. Case presentation We report a case of a 4-year-old Saudi Arabian boy with severe hemophilia A who presented with a post-traumatic cerebral hemorrhage. The patient, with high titer inhibitors, was on emicizumab prophylaxis therapy. On hospital admission, he received tranexamic acid (10 mg intravenously, every 6 hours), and recombinant activated factor VII 120 µg/kg every 2 hours for 2 days then every 4 hours for 4 days. On follow-up, the patient showed no signs of neurological deficit. There was no need for emergency neurosurgical intervention since the bleeding had been controlled throughout the first 2 days. There were no recorded thrombotic sequelae or neurological complications, with complete resolution within 10 days. Conclusions This case implies that low-dose recombinant activated factor VII might be used safely and effectively with patients with hemophilia A on emicizumab prophylaxis, to reduce the risk of cerebral hemorrhage or another episode of serious bleeding along with its long-term complications.

Introduction: Stroke is a major cause of morbidity and mortality worldwide, with hemorrhagic stroke being the deadliest form of acute stroke. Therefore, the cause of the event should be determined to direct the associated therapy and take preventive measures. Hyperhomocysteinemia has been described as a rare etiology of stroke. Although hyperhomocysteinemia has been associated with venous thrombotic events, altered endothelial function, and procoagulant states, its clinical role in stroke remains controversial. Case description: We present a case of a 60-year-old male patient with primary autoimmune hypothyroidism who presented with dysarthria, facial paresis, and left upper-limb monoparesis after sexual intercourse. A simple skull computed tomography scan showed hyperintensity in the right basal ganglion, indicating an acute hemorrhagic event. Etiological studies were performed, including ambulatory blood pressure monitoring, cerebral angiography, and transthoracic echocardiogram, which ruled out underlying vascular pathology. During follow-up, vitamin B12 deficiency and hyperhomocysteinemia were detected, without other blood biochemical profile alterations. Supplementation was initiated, and homocysteine levels gradually decreased, without new neurological deficits observed during follow-up. Conclusion: Quantification of homocysteine should be considered in patients with a cerebrovascular disease without apparent cause, as documenting hyperhomocysteinemia and correcting its underlying etiology are essential not only for providing appropriate management but also for preventing future events.

The aim of the study was to develop criteria for predicting the outcome of the acute period of spontaneous supratentorial intracerebral hemorrhage (SSICH) on the background of conservative therapy, taking into consideration the lesion localization in conjunction with neuroimaging parameters of the quantitative severity assessment of the damage to cerebral structures. Materials and methods. Prospective cohort examination of 314 patients in acute period of SSICH on the ground of conservative treatment. Clinical and neurological examination consisted of using the Full Outline of Unresponsiveness coma scale and NIHHS, neuroimaging with the help of computed tomography with detection of SSICH localization, volume of intracranial hemorrhage, secondary intraventricular hemorrhage and midline shift. Disease acute period outcome was evaluated on the 21st day by the Rankin scale. Results. It was detected that integrated neuroimaging SSICH’s type considering its localization and quantitative severity estimation of cerebral structure injury was closely associated with the disease acute period outcome on the ground of conservative therapy (χ2 Pearson = 308.6, Р < 0.0001). Thus, mortality rate was the highest in patients with posteromedial type of thalamic hemorrhage (50.0 %), global type of thalamic hemorrhage (91.7 %) and massive type of striatocapsular hemorrhage (89.8 %). Unfavorable functional outcome as the modified Rankin scale score 4–5 on 21st disease day predominated among patients with posterolateral types of thalamic hemorrhage (76.5 %) and striacapsular hemorrhage (64.3 %). Whereas the frequency of favorable outcome was the highest among patients with anterior/dorsal type of thalamic hemorrhage (100.0 %), posteromedial (88.0 %), middle (95.0 %), lateral types of striatocapsular hemorrhage (61.9 %) and lobar (74.5 %) hemorrhage. Conclusions. Posteromedial type of thalamic hemorrhage, global type of thalamic hemorrhage and massive type of striatocapsular hemorrhage are the predictors of lethal outcome of the acute period of SSIСH on the background of conservative therapy. Criteria for unfavorable short-term functional outcome are posterolateral types of thalamic and striatocapsular hemorrhage, while anterior/dorsal type of thalamic hemorrhage, posteromedial/middle type of striatocapsular hemorrhage and lobar hemorrhage are associated with favorable outcome of the acute period of the disease.

Abstract Background and purpose Oropharyngeal dysphagia (OD) affects 40–81% of patients after stroke. A recent systematic review on the costs of OD and its main complications showed higher acute and long-term costs for those patients who developed OD, malnutrition and pneumonia after stroke. These results suggest that appropriate management of post-stroke OD could reduce clinical complications and costs. The purpose of this systematic review is to assess the available literature for healthcare interventions that are efficient or cost-effective in the management of OD. Methods A systematic review on economic evaluations of health care interventions will be performed on post-stroke patients with OD following PRISMA recommendations. Four bibliographic databases will be searched and a subsequent reference check will be done. English and Spanish literature will be included without date restrictions. Studies will be included if they refer to economic evaluations or in which cost savings were reported in post-stroke patients suffering OD. Studies will be excluded if they are partial economic evaluation studies, if they refer to esophageal dysphagia, or if OD is caused by causes different from stroke. Evidence will be presented and synthetised with a narrative method and using tables. Quality evaluation will be done using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Discussion The protocol for this systematic review is the first step to assess the cost-effectiveness of the healthcare interventions that have been described as potential treatments for post-stroke OD. This systematic review will summarise the current evidence on the relation between cost and benefits associated with the appropriate management of OD in post-stroke patients. Trial registration PROSPERO CRD42020136245

As a classic cell signal transduction pathway, PI3K/Akt pathway plays a role in a variety of biological processes, such as cell growth, proliferation, differentiation and apoptosis. As a kind of cerebrovascular disease with high disability and high mortality, the role of this signaling pathway in the incidence and development of cerebral hemorrhage has attracted more and more attention. In this article, the PI3K/Akt signal pathway was regarded as the main topic to analyze the structural and biological characteristics of this pathway, its relationship with cerebral hemorrhage and review the efficacy of drugs for cerebral hemorrhage based on the PI3K/Akt signaling pathway, aiming to provide novel ideas for the clinical treatment of cerebral hemorrhage.

Aim:The study aimed to compare Siriraj Stroke Score (SSS) with computed tomography (CT) in differentiating stroke subtypes.Materials and Methods:This cross-sectional study consists of eighty consecutive patients admitted to the emergency department of the tertiary care-teaching center within four hours of the onset of stroke. A single experienced emergency medicine physician observed the patients for Siriraj score. An independent radiologist analyzed the CT of the patients who were not aware of the clinical condition. CT findings were considered the gold standard. Siriraj score findings were considered as a screening test. The sensitivity, specificity, predictive values, and diagnostic accuracy of the screening test, along with their 95% confidence interval (CI), were presented.Results:A total of 80 subjects were included in the study. The mean age of the participants was 56.4 years, with the majority being males (58.8%). The sensitivity and specificity for SSS were 96.92% and 90.91%, respectively. The SSS had excellent predictive validity in predicting CT findings, as indicated by the area under the curve of 0.994 (95% CI 0.983 to 1.000, p value

Abstract Background The signs and symptoms of pheochromocytoma can imitate those of many other diseases, which may result in confusion. Therefore, diagnosing and treating secondary hypertension due to pheochromocytoma in deteriorating patients becomes challenging. Case presentation A 63-year-old female patient presented to the emergency room with severe and progressive nausea. The initial diagnosis was an acute myocardial infarction based on ST-segment depression on electrocardiogram and elevated cardiac markers. Elective coronary angiography revealed nonobstructive coronary arteries. However, she suffered from a complicated clinical course for several weeks during her life-or-death crisis. She was subsequently diagnosed with a cerebral hemorrhage and a pheochromocytoma. It is unclear whether her initial presentation was due to the neurogenic stunned myocardium caused by a cerebral hemorrhage or type 2 myocardial infarction caused by a pheochromocytoma, or both. However, this case showed the significance of accurately diagnosing and treating underlying causes in patients presenting with myocardial infarction with nonobstructive coronary arteries. Early diagnosis and treatment of the pheochromocytoma may have prevented the complications experienced by the patient. Conclusions A catecholamine surge and blood pressure fluctuation caused severe complications. When a patient presents with an unusual clinical presentation, secondary hypertension due to pheochromocytoma should be suspected.

Abstract Background Intravitreal injections of anti-vascular endothelial growth factor are commonly used to treat macular diseases, including diabetic macular edema. Anti-vascular endothelial growth factor drugs can enter the systemic circulation after intravitreal injections and appear to suppress circulating vascular endothelial growth factor levels. However, whether this can cause any systemic adverse events remains unknown. Case presentation A 70-year-old Japanese man diagnosed with diabetic macular edema in both eyes was treated with anti-vascular endothelial growth factor intravitreal injections. One month after receiving two intravitreal injections of aflibercept 1 week apart for diabetic macular edema in both eyes, he complained of a severe acute headache. The patient was diagnosed with hypertensive cerebral hemorrhage of the occipital lobe based on an elevated blood pressure of 195/108 mmHg and the results of computed tomography and magnetic resonance imaging of his brain. The patient was treated with an intravenous injection of nicardipine hydrochloride to lower his systemic blood pressure. Two days after the stroke, the patient began oral treatment with 80 mg/day telmisartan, which was continued for 3 days, and the telmisartan dose was reduced to 40 mg/day thereafter. His blood pressure promptly dropped to 130/80 mmHg, and his severe headache disappeared. One year after the cerebrovascular stroke, the telmisartan was discontinued because his blood pressure stabilized at a normal level. His plasma vascular endothelial growth factor levels were measured via specific enzyme-linked immunosorbent assay before and after the intravitreal injections of aflibercept. Immediately before the injections, the vascular endothelial growth factor level was 28 pg/ml, but it rapidly fell below the detection limit within 1 week, where it remained for over 2 months. Two days before the cerebral hemorrhage, his plasma vascular endothelial growth factor level was below the detection limit, and 2 months later after the stroke, his plasma vascular endothelial growth factor level recovered to 41 pg/ml. Conclusion This case suggests that hypertension and resultant cerebral hemorrhage can occur in patients with diabetic macular edema when plasma vascular endothelial growth factor levels are systemically decreased below the detection limit for a prolonged time after local injections of anti-vascular endothelial growth factor agents into the vitreous cavity. Therefore, severely reduced plasma vascular endothelial growth factor levels could be a higher risk factor to develop generally infrequent stroke. Ophthalmologists should be aware of possible severe reduction of plasma vascular endothelial growth factor levels and resultant increase in blood pressure after intravitreal injections of an anti-vascular endothelial growth factor drug. If the plasma vascular endothelial growth factor levels could be monitored more easily and quickly during the treatment, it would help to prevent adverse events.

Abstract Background Anemia is common in neurocritically ill patients. Considering the limited clinical evidence in this population, preclinical data may provide some understanding of the potential impact of anemia and of red blood cell transfusion in these patients. We aim to estimate the association between different transfusion strategies and neurobehavioral outcome in animal models. Methods We will conduct a systematic review of comparative studies of red blood cell transfusion strategies using animal models of traumatic brain injury, ischemic stroke or cerebral hemorrhage. We will search MEDLINE, EMBASE, and Web of Science databases for eligible studies from inception onwards. Two independent reviewers will perform study selection and data extraction. We will report our results in a descriptive synthesis focusing on characteristics of included studies, reported outcomes, risk of bias, and construct validity. Our primary outcome is the neurological function (neurobehavioral performance) and our secondary outcomes include mortality, infarct size, intracranial pressure, cerebral perfusion pressure, cerebral blood flow, and brain tissue oxygen tension. If appropriate, we will also perform a quantitative synthesis and pool results using random-effect models. Heterogeneity will be expressed with I 2 statistics. Subgroup analyses are planned according to animal model characteristics, co-interventions, and risks of bias. Discussion Our study is aligned with the efforts to better understand the level of evidence on the impact of red blood cell transfusion strategies from preclinical studies in animal models of acute brain injury and the potential translation of information from the preclinical to the clinical research field. Systematic review registration PROSPERO CRD42018086662 .

The aim of the study was to evaluate the diagnostic and prognostic value of serum hepcidin concentration in patients with acute spontaneous supratentorial intracerebral hemorrhage (SSICH). Materials and methods. Prospective cohort study of 88 patients with acute SSICH receiving the conservative therapy was conducted. Level of neurological deficit was evaluated using the Full Outline of UnResponsiveness Scale, the Glasgow Coma Scale and the National Institute of Health Stroke Scale. Computed tomography was performed to detect an intracerebral hemorrhage volume (ICHV), secondary intraventricular hemorrhage volume (SIVHV) and total volume of intracranial hemorrhage (TVICH). Laboratory blood samples were taken within 24 hours of hospitalization. Hepcidin levels, serum iron concentrations and total iron-binding capacity were determined, followed by calculations of transferrin saturation coefficient. Early neurological deterioration (END) and unfavorable variants of the acute period of SSICH (lethal outcome, modified Rankin score 4-5 on the 21st day of the disease) were considered as endpoints. Statistical processing of the obtained results included a correlation analysis, logistic regression analysis and ROC-analysis. Results. It was identified, that serum hepcidin level in the patients with SSICH was correlated with ICHV (R = 0.44, P ˂ 0.01), SIVHV (R = 0.45, P ˂ 0.01) and TVICH (R = 0.57, P ˂ 0.01). Hepcidin serum concentrations in the patients with ICHV >30 ml exceeded the value of those in cases of ICHV ≤30 ml by 69.0 % (P ˂ 0.0001). Serum levels of hepcidin were significantly higher in the patients with an unfavorable course and outcome of the disease in the acute period on the 1st day of admission (P ˂ 0.0001). Informative multipredictor models were developed via multiple logistic regression analysis, which include hepcidin values coupled with clinical and neurovisualization findings and are predictive of lethal and unfavorable acute period functional outcomes (AUC = 0,93, P ˂ 0.0001). Conclusions. The level of serum hepcidin in patients with acute SSICH is associated with the severity of cerebral lesions. The integration of serum hepcidin concentration with clinical and neuroimaging findings in the structure of multipredictor logistic regression models allows to determine the vital and functional prognosis of the acute period of SSICH with an accuracy of >85 %

Objective: To compare the antiplatelet effect and major adverse cerebrovascular events of Pipeline for intracranial aneurysms using glycoprotein IIb/IIIa antagonists (GPI) eptifibatide and tirofiban. Methods: Retrospective analysis of relevant data of patients using GPIs combined with oral antiplatelet therapy in Nanfang Hospital of Southern Medical University from December 2017 to December 2019. The study was approved by the ethics Committee of Nanfang Hospital of Southern Medical University. According to the random use of GPIs drugs, they were assigned to the eptifibatide group and tirofiban group. Basic data, platelet inhibition rates at baseline, 24h and 72h after administration, short-term major adverse cerebrovascular events, and bleeding complications were compared between the two groups. Results: A total of 47 patients were included in this study, including 24 patients in eptifibatide group and 23 patients in tirofiban group. There was no significant difference in average age (53.75 vs. 53.91 years) and body mass index (BMI) (24.39 vs. 22.73 ​kg/m2) between eptifibatide group and tirofiban group. There was no significant difference in coagulation factor function (R), fibrinogen function (K), fibrinolysis function (EPL), comprehensive coagulation index (Cl), arachidonic acid pathway inhibition rate (AA%) and adenosine diphosphate inhibition rate (ADP%). However, the baseline level of residual platelet function MA (ADP) in eptifibatide group was significantly higher than that in tirofiban group (50.79 vs. 35.29 ​mm, P ​= ​0.0026). There was a statistical difference in the platelet aggregation function MA (65.38 vs. 62.54 ​mm, p ​= ​0.0442), the rate of spontaneous hemorrhagic stroke (4.3% vs. 0%) and the rate of asymptomatic minor bleeding (26.08% vs. 4.1%) in the two groups (P ​

The aim of this study was to define electroencephalographic predictors of unfavorable functional outcome of spontaneous supratentorial intracerebral hemorrhage (SSICH) in the acute period. Materials and methods. Prospective, cohort and comparative study was conducted in 114 patients (mean age 67.4 ± 0.8 years) in the acute period of SSICH. Electroencephalography (EEG) was conducted on the 1st–2nd day of the disease. The values of relative band spectral powers of delta rhythm (0.5–4.0 Hz), theta (4–8 Hz), alpha (8–13 Hz), beta (13–35 Hz), theta1 (4–6 Hz), theta2 (6–8 Hz), alpha1 (8–10 Hz), alpha2 (10–13 Hz), beta1 (13–25 Hz) and beta2 (25–35 Hz) were determined in the affected and intact hemispheres. The fronto-occipital rhythm gradient and the severity of interhemispheric rhythm asymmetry were calculated. The functional outcome of the disease in the acute period was assessed on day 21 based on the modified Rankin Scale (mRS), and the value of mRS score >3 was considered as an unfavorable functional outcome. Results. Unfavorable functional outcome of the SSICH in the acute period was registered in 53 (46.5 %) patients. Independent association with the risk of unfavorable functional outcome of SSICH in the acute period was proved for the following indexes of the spectral analysis of EEG pattern in the first 2 days from the onset of the disease: the relative delta band spectral power in the affected hemisphere (OR (95 % CI) = 1.18 (1.11–1.25), P ˂ 0.0001) and the fronto-occipital rhythm gradient of beta band in the affected hemisphere (OR (95 % CI) = 0.0007 (0.0001–0.0293), P = 0.0001). These predictors were integrated in the mathematical model for the determination of an individual risk of unfavorable functional outcome of SSICH in the acute period (AUC (95 % CI) = 0.94 (0.88–0.98), P ˂ 0.0001; forecast accuracy = 87.7 %). Conclusions. Bilateral shift of EEG spectral power pattern of rhythms towards slow-wave activity of the hemisphere with the formation of interhemispheric asymmetry of delta band rhythms in the frontal areas, bilateral reduction in zonal differences of alpha band rhythms, the inversion of the fronto-occipital rhythm gradient of beta band in the affected hemisphere and the reduction in zonal differences of beta band rhythms due to beta2 band in the intact hemisphere with the formation of multidirectional interhemispheric asymmetry in the frontal and occipital parts of the brain in the first 2 days upon the onset of SSICH are considered as EEG criteria for unfavorable functional outcome of the disease in the acute period.

The new coronavirus disease (COVID-19) is actually a pandemic according to the World Health Organization. It affects both the adult and pediatric population, however the most published information correspond to the first one, generating a knowledge gap regarding children. Pulmonary involvement appears to be the most frequently manifestation of the disease, although extrapulmonary complications such as pericardial effusion and cerebrovascular diseases have been reported in adults, and according to our review none have been reported in children. We present a case of a 7 year old patient with previous history of asthma and overweight that present COVID-19, and was admitted through the pediatric emergency department for pneumonia and developed a respiratory failure that requires ventilatory support. During its hospitalization presents cardiac tamponade and intracerebral hemorrhage with adverse evolution and fatal outcome.

Introduction Vasospasm is a common and potentially devastating complication in patients with subarachnoid hemorrhage, causing high morbidity and mortality. There is no effective and consistent way to prevent or treat cerebral vasospasm capable of altering the morbidity and mortality of this complication. Animal and human studies have attempted to show improvement in aneurysmal vasospasm. Some sought their prevention; others, the treatment of already installed vasospasm. Some achieved only angiographic improvement without clinical correlation, others achieved both, but with ephemeral duration or at the expense of very harmful associated effects. Endovascular techniques allow immediate and aggressive treatment of cerebral vasospasm and include methods such as mechanical and chemical angioplasty. These methods have risks and benefits. Objectives To analyze the results of chemical angioplasty using nitroglycerin (GTN). In addition, to perform a comprehensive review and analysis of aneurysmal vasospasm. Methods We describe our series of 77 patients treated for 8 years with angioplasty for vasospasm, either mechanical (with balloon), chemical (with GTN) or both. Results Eleven patients received only balloon; 37 received only GTN; 29 received both. Forty-four patients (70.1%) evolved with delayed cerebral ischemia and 19 died (mortality of 24.7%). Two deaths were causally related to the rupture of the vessel by the balloon. The only predictors of poor outcome were the need for external ventricular drainage in the first hours of admission, and isolated mechanical angioplasty. Conclusions Balloon angioplasty has excellent results, but it is restricted to proximal vessels and is not without complications. Chemical angioplasty using nitroglycerin has reasonable but short-lived results and further research is needed about it. It is restricted to vasospasm angioplasties only in hospitals, like ours, where better and more potent vasodilator agents are not available.

We report a case of a patient with metastatic colon cancer without central nervous system metastases who presented with a spontaneous intraparenchymal hematoma using bevacizumab, without coagulation disorders or metastatic cells in the pathological examination. Bevacizumab is a monoclonal antibody against vascular endothelial growth factor (VEGF) that inhibits binding of the normal VEGF ligand to its receptor and is used to treat various tumors. Its therapeutic effect is believed to occur by limiting the formation of new blood vessels in tumors and decreasing their oxygenation. Fatal cerebrovascular events have been reported with the use of bevacizumab, raising the discussion of the safety of its use, especially in patients with brain metastases. At present, controversial remains as to bevacizumab increases the risk of cerebrovascular events.

Abstract Background Acute cerebrovascular disease (ACVD) could cause abnormal metabolism of thyroid hormones (TH), mostly represented as a euthyroid sick syndrome or low T3 syndrome. However, the changes in serum thyroid-stimulating hormone (TSH) are controversial. The aim of this study is to investigate the clinical significance of TSH alteration in patients with ACVD. Method Patients with ACVD admitted in our hospitals between January 2013 and September 2017 were enrolled in this study (n = 245, including 176 cerebral infarctions and 69 cerebral hemorrhages). Their thyroid hormones were measured and compared with healthy individuals (n = 75). The correlation of TSH with severity and prognosis of ACVD were analyzed by receiver operating characteristic curve. Results Serum TSH in ACVD group was higher than the control group (1.64 ± 1.08 vs. 1.26 ± 0.36 μIU/mL, P

Objective: This study aimed to evaluate the demographic, etiologic, and clinical characteristics of patients with the diagnosis of stroke, as well as the incidence of stroke in Ardahan province, which is the gateway from our country to the Caucasus (Caucasia). Materials and Methods: This study has a descriptive design. The hospital records of patients who were diagnosed as having stroke or cerebrovascular disease between June 2015 and June 2016 in Ardahan State Hospital were retrospectively investigated. Results: In the defined one year period, 196 individuals were admitted to our hospital with the diagnosis of acute stroke. The incidence of stroke was 199/100.000 per person-year. Of these patients, 71.4% (n=140) were diagnosed as having ischemic stroke and 20.4% (n=40) had hemorrhagic stroke. The incidence of ischemic stroke was determined as 142/100.000 per person-year. The incidence of hemorrhagic stroke was determined as 41/100.000 per person-year. Ipsilateral muscle weakness was the most common symptoms in 78.1% (n=153) of the patients. Of the patients, 3.6% (n=7) were admitted to the hospital within 3 hours after the onset of symptoms and 75.5% (n=148) were brought to our hospital by ambulance Conclusion: Although the results of this study are generally compatible with other studies in the literature, they also show differences. The incidence of stroke in our country and the demographic characteristics of patients with stroke differ from other countries, at the same time there may be regional differences. For this reason, the data in this study are important because they provide information about our country and its northeastern region.

Objective:To explore the effect of different acupuncture manipulation duration on the blood-brain barrier tight junction protein in rats with cerebral hemorrhage.Methods:A total of twenty SD male rats were divided into sham-operated group, model group, acupuncture 5s group and acupuncture 60s group by random number table method, with 5 rats in each group. Caudate nucleus autologous blood injection was used in cerebral hemorrhage model. After the establishment of cerebral hemorrhage model, the acupuncture groups received acupuncture on"shuigou"point and bilateral"neiguan"points, and received acupuncture on 5s or 60s every day. The sham-operated and model groups did not receive acupuncture. Five days later, the expressions of Occludin, Claudin-5 and JAM-1 immunofluorescence positive cells in the cerebral hematoma area of rats under light microscope(×400)were compared.Results:(1)Expression of Occludin immunofluorescence positive cells:Compared with the sham-operated group, the Occludin expression in the model, acupuncture 5s and 60s groups decreased significantly(PPPPPP>0.05). The JAM-1 level in the acupuncture 60s group increased significantly(P

The main purpose of the study was to analyze a diagnostic informative value of modified variants of the Intracerebral Hemorrhage Scale as techniques for detecting adverse functional outcome risk in the acute period of spontaneous supratentorial intracerebral hemorrhage (SSICH). Materials and methods. A total of 122 conservatively treated patients (mean age was 64.7 ± 1.1 years old) in the acute period of SSICH were enrolled in a prospective study. Clinical and neuroimaging assessment of the patients’ condition severity was conducted on admission to hospital using the ICH Scale and its modified versions (mICH-A, mICH-B). The value >3 in accordance with the modified Rankin Scale on the 21st day of disease was considered as unfavourable functional outcome in SSICH. The ROC analysis was used for the comparative analysis of the scales’ informative value and for the criteria development. Results. The unfavourable functional outcome in the acute period of SSICH was registered in 50 (41.0 %) patients. These patients at the disease onset had significantly higher values in accordance with the mICH-A Scale (4 (3; 5) versus 2 (1; 3), P < 0.0001) and the mICH-B Scale (3 (2; 4) versus 1 (0; 2), P < 0.0001). It was determined that modified versions of the ICH Scale was more accurate than the original ICH Scale as for a short-term functional prognosis verification (AUCmICH-A 0.81 ± 0.04 (0.73–0.88) versus AUCICH 0.74 ± 0.04, P = 0.0062; AUCmICH-B 0.80 ± 0.04 (0.72–0.87) versus AUCICH 0.74 ± 0.04, P = 0.0104), whereas the mICH-A Scale scores >2 became the predictors of an unfavourable functional outcome in the acute period of disease (sensitivity = 76.0 %; specificity = 69.4 %; RR = 3.6 (3.1–4.1), P ˂ 0.0001) as well as the mICH-B Scale scores >1 (sensitivity = 76.0 %; specificity = 68.1 %; RR = 3.2 (2.8–3.6), P ˂ 0.0001). Conclusions. Modified versions of the ICH Scale are informative tools for the verification of a short-term functional prognosis in patients with SSICH.

The main purpose of the study was to conduct the informative value of Intracerebral Hemorrhage Functional Outcome Score (ICH-FOS) assessment for the determination of a short-term vital prognosis in patients with spontaneous supratentorial intracerebral hemorrhage (SSICH). Materials and methods. A prospective, cohort study was conducted among 191 patients (117 men and 74 women, the mean age was 65.1 ± 0.8 years) with SSICH treated in a conservative manner. This study included clinical assessment (National Institute of Health Stroke Scale, Glasgow Coma Scale), neuroimaging and biochemistry examination. The ICH-FOS was used in order to conduct a complex assessment of the patients’ state severity on admission. The functional outcome of the SSICH acute period was assessed on the 21st day of the disease in accordance with the modified Rankin Scale. Results. Lethal outcome was noted in 22 patients (11.5 %). The patients with the lethal outcome during the acute period had a higher value of the ICH-FOS (8 (7–10) versus 4 (3–6), P < 0.0001) in the onset of SSICH. Based on a ROC-analysis it was determined that the ICH-FOS >6 is the predictor of the lethal outcome in the acute period of SSICH (Se = 77.3 %; Sp = 81.1 %; AUC ± SE (95 % CI) = 0.86 ± 0.04 (0.80–0.91), P < 0.0001). In the group of patients with the ICH-FOS value >6 (n = 49) lethal outcome was noted in 34.7 % of cases, whereas in the group of patients with the ICH-FOS value ≤6 (n = 142) it was noted only in 3.5 % of cases. Conclusions. The Intracerebral Hemorrhage Functional Outcome Sсore is a highly informative tool for the determination of a short-term vital prognosis of SSICH acute period outcome. The ICH-FOS >6 is associated with a 9.9-fold increased risk of lethal outcome (RR 95 % CI 3.8–25.3, P < 0.0001).

Objective:To observe the effect of acupuncture at different time points on the expression of matrix metalloproteinase-2/9 (MMP-2/9) and vascular endothelial growth factor (VEGF) in rats at acupoints Neiguan and Shuigou, so as to explore the mechanism of acupuncture on angiogenesis and neural protection.Methods:A total of 135 male Wistar rats were randomly divided into mock surgical group, model 3 h group, model 9 h group, model 24 h group, model 48 h group, 3 h acupuncture group, 9 h acupuncture group, 24 h acupuncture group, 48 h acupuncture group, with 15 animals in each group; the ICH model was made by the caudate nucleus autologous slow blood injection method and the MMP-2/9 and VEGF positive cell counts were detected by immunohistochemistry.Results:The blood-brain barrier MMP-2,MMP-9 and VEGF positive cells in the 3,9,24,48 h acupuncture groups were significantly lower than those of model group at the same time, compared with the 9,24,48 h acupuncture groups, the reduction of MMP-2 and MMP-9 positive cells was more obvious in the 3 h acupuncture group. The VEGF-positive cells in the blood-brain barrier of 3,9 h acupuncture groups were significantly lower than the model group at the same time point, but, VEGF-positive cells of 24,48 h acupuncture groups was significantly more than the model group at the same time point, with statistically significant differences (P

Introduction: Cavernous hemangioma is a bening blood vessel malformation that can be located in the central nervous system. Although most patients who are found to have a CNS hemangioma are asymptomatic, the entity can cause a wide spectrum of symptoms including severe ones like epileptic seizures, stroke, diplopia, dysfasia or cognitive functions’ disorders. Case report: A 21-year-old female patient was admitted to the Department Of Neurology due to transient vision impairment, dysfasia, headache and tinnitus. Physical examination revealed no focal neurological signs. A brain MRI was performed. A cavernous hemangioma of 7-8 mm in size was found. The patient was examined by neurosurgeon as well, who did not qualify her for an immediate surgery. Discussion: Although cavernous hemangiomas are often asymptomatic, sometimes they can be a causative factor of different neurological symptoms. One should always take into account a possibility of cerebral hemangioma presence in young patients that suffer from headaches, tinnitis or have impaired vision.

The main purpose of the study was to conduct a comparative analysis of the neuroimaging parameters informative value for the determination of vital and functional outcomes prognosis of the spontaneous supratentorial intracerebral hemorrhage (SSICH) in the acute period, depending on the secondary intraventricular hemorrhage (SIVH) presence or absence at the disease onset. Materials and methods. A prospective cohort study was conducted in 154 patients (88 men and 66 women, mean age 64.4 ± 0.9 years) with SSICH on the basis of conservative treatment. This study included clinical assessment and visualization of cerebral structures. Intracerebral hemorrhage volume (ICHV), average midline shift (AMS) and intraventricular hemorrhage volume (IVHV) were detected. The modified Rankin Scale (mRS) score >3 on the 21st day of the disease was considered as an unfavourable functional outcome of SSICH in the acute period. Results. Secondary intraventricular hemorrhage was revealed in 70 (45.5 %) patients. It was found that ICHV was less informative than IVHV in patients with SIVH for the vital outcome prognosis of disease in the acute period determination (AUCICHV = 0.72 ± 0.09 (0.60–0.82) versus AUCIVHV = 0.94 ± 0.04 (0.86–0.98), P = 0.026), whereas the informative value of ICH volume and AMS were not significantly different in patients without SIVH for the vital outcome prognosis determination (AUCICHV = 0.77 ± 0.11 (0.67–0.86) versus AUCAMS = 0.87 ± 0.05 (0.78–0.94), P = 0.257) in the acute period of disease. It was detected, that IVHS >24.5 mL was the predictor of SSICH lethal outcome in the acute period (Se = 84.6 %, Sp = 96.5 %). Conclusions. Predictive value of the neuroimaging parameters at SSICH onset depends on SIVH presence or absence. Intracerebral hemorrhage volume is less informative than IVHV and AMS for the vital and functional outcomes prognosis determination in the acute period of SSICH with SIVH. The informative value of neuroimaging parameters for the vital outcome prognosis of SSICH in the acute period determination is higher than the one for the functional prognosis determination.

The main causes of intracerebral hemorrhage differ between young adults and older adults. Data regarding potential targets for early intervention in young adult patients with intracerebral hemorrhage are lacking.

The purpose of this study was to develop integrated clinical and neuroimaging criteria for the prediction of spontaneous supratentorial intracerebral hemorrhage (SSICH) acute period outcome. Materials and methods. Complex clinical and neuroimaging study was conducted in 105 patients (56 men and 49 women, mean age 63.6 ± 1.2 years) with SSICH in acute period of the disease receiving conservative therapy. The examination included computer tomography of the brain and clinical assessment using National Institute of Health Stroke Scale (NIHSS), Glasgow Coma Scale (GCS). The disability level was detected in accordance with the modified Rankine Scale (mRS) on the 21st day of the disease. Results. Lethal outcome (21.9 %), unfavourable functional outcome in the form of 4–5 points in accordance with the mRS (33.4 %) and favourable functional outcome in the form of ≤3 points in accordance with the aforementioned scale on the 21st day of SSICH (45.7 %) were registered. The mathematical model has been elaborated for the prediction of lethal outcome of SSICH acute period, which takes into account the initial level of neurological deficit in accordance with NIHSS, the lesion volume and septum pellucidum displacement at the onset of the disease (AUC = 0.91 (0.84–0.96), P < 0.01). The mathematical model has been elaborated for the prediction of functional outcome of SSICH acute period, which takes into account the patient’s age, the level of neurological deficit in accordance with NIHSS, the lesion volume at the onset of the disease (AUC = 0.89 (0.80–0.95), P < 0.01). Conclusions. Integral clinical and neuroimaging predictors of the lethal outcome of SSICH acute period (Se = 91.3 %; Sp = 82.9 %; accuracy of prediction = 85.7 %) and mRS score ≤3 on the 21st day of the disease (Se = 85.4 %; Sp = 82.4 %; accuracy of prediction = 80.5 %) were determined.

One of the most important reasons why the use of the intravenous (IV) tissue plasminogen activator (tPA), which is one of the key elements of acute ischemic stroke treatment, is not sufficiently widespread is the fact that many common questions have not been adequately answered. In this review, questions about systemic nonneurologic conditions, problems related with IV tPA treatment and complications of treatment, which were collected from our colleagues practicing in Turkey and which are more important in clinical practice, were answered on the basis of the current literature and clear recommendations are made