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BACKGROUND: Multiple studies have shown that early decompressive surgery in patients with intracerebral hemorrhage can effectively limit hematoma expansion, reduce perihematomal edema, and improve prognosis. However, these studies are limited by small sample sizes and short follow-up times. OBJECTIVE: To analyze the effect of early decompressive surgery on the long-term prognosis of patients with cerebral hemorrhage and identify the influencing factors for poor prognosis. METHODS: A retrospective analysis of 78 patients with cerebral hemorrhage admitted between January 2020 and December 2022 was conducted. Patients were divided into early and delayed surgery groups for comparison of outcomes such as mortality rate, modified Rankin Scale score, and Short Form-36 scores. Additionally, factors influencing long-term prognosis were analyzed through logistic regression based on significant differences observed between groups. RESULTS: The early decompressive surgery group showed superior outcomes with lower mortality rates, modified Rankin Scale (mRS) scores, hematoma expansion rates, and perihematomal edema volumes compared to the delayed surgery group (P < 0.05). Additionally, age, preoperative Glasgow Coma Scale (GCS) score, preoperative hematoma volume, and a history of hypertension or diabetes were identified as independent prognostic factors for patients with cerebral hemorrhage, with odds ratios (ORs) greater than 1. CONCLUSIONS: Early decompressive surgery can improve the long-term prognosis and quality of life of patients with cerebral hemorrhage, reduce mortality rates, and decrease hematoma expansion and perihematomal edema. Older patients, those with higher preoperative hematoma volume and GCS score, and those with coexisting hypertension and diabetes should be given special attention to decrease the occurrence of adverse prognosis. [ABSTRACT FROM AUTHOR]

Magnetic induction phase shift is a promising technology for the detection of cerebral hemorrhage, owing to its nonradioactive, noninvasive, and real-time detection properties. To enhance the detection sensitivity and linearity, a zero-flow sensor was proposed. The uniform primary magnetic field and its counteraction were achieved. Phase-change responses to solutions of varying conductivities and rabbits with cerebral hemorrhage were investigated and compared with traditional sensors. The sensitivities in detecting solutions with different conductivities were 1.84, 1.39, and 1.22 times higher than those for a low-pass birdcage coil, planar gradiometer, and Bx-sensor, respectively. The results for rabbits with cerebral hemorrhage showed that the sensitivities increased by 1.17, 1.67, and 6.3 times compared with a low-pass birdcage coil, symmetric cancelation-type sensor, and single co-axial coil, respectively. This sensor could accurately detect three stages in the pathological process. Blood loss of 1 mL meant that the compensatory mechanism of cerebrospinal fluid began to fail, and 1.4 mL of blood loss meant that the compensatory mechanism failed completely. The adjusted R-squared value of the first-order linear fit was above 0.98 in both physical and animal experiments, indicating that high detection linearity was achieved. The proposed sensor provides a more accurate method for cerebral hemorrhage detection and facilitates the practical application of magnetic induction phase shift in pre-hospital and bedside real-time detection. [ABSTRACT FROM AUTHOR]

Incidental dural tear (DT) during cervical spine surgery is a feared complication. However, its impact on patient-reported outcomes (PROs) remains unclear. To determine the influence of DTs on PROs 1 year after cervical spine surgery. Retrospective cohort. Patients undergoing elective cervical spine surgery for cervical spondylosis, ossification of the posterior longitudinal ligament (OPLL), and cervical disc herniation. Analysis included patients' characteristics, perioperative complications, and PROs both preoperatively and at 1 year postoperatively. This study enrolled consecutive patients who underwent elective cervical spine surgery at 13 high-volume spine centers. All patients were required to complete questionnaires both preoperatively and 1 year postoperatively, which included PROs such as numerical rating scales of pain or dysesthesia for each part of the body, Neck Disability Index NDI, and Core Outcome Measures Index. Patients were divided into 2 groups based on the presence (DT+) or absence (DT-) of dural injury. Comparisons were made regarding patient background, perioperative complications, and pre and postoperative PROs. Propensity score matching was also utilized to adjust for patient background, and further comparisons were made regarding complication rates and PROs. Out of 2,704 patients, dural tears were identified in 97 (3.6%) cases. The DT+ group had a significantly higher proportion of fixation surgeries, upper cervical surgeries, OPLL, and revision surgeries. Perioperative complications were significantly higher in the DT+ group, including intraoperative nerve damage, postoperative paralysis, surgical site infections (SSI), and cerebrovascular complications. Outcomes collected from 2,163 patients (79.9%) revealed significantly more severe neck and upper limb pain in the DT+ group. After propensity score matching, significant differences persisted in postoperative paralysis and SSI in the DT+ group, but no significant differences were observed in PROs. Patients with dural tears showed nearly equivalent postoperative outcomes at 1 year following cervical spine surgery compared to those without dural tears. However, the incidence of perioperative complications was higher, emphasizing the need for careful management. [ABSTRACT FROM AUTHOR]

Objectives: Spontaneous intracerebral hemorrhage (ICH) poses high mortality and morbidity rates with limited evidence‐based therapeutic approaches. We aimed to evaluate the current evidence for the role of minimally invasive surgery (MIS) in the management of ICH. Methods: This systematic review and meta‐analysis followed recommended guidelines and protocols. Medline, Embase, Scopus, and the Cochrane Library were searched from inception up to April 12, 2024. The inclusion was restricted to randomized clinical trials (RCTs) of high quality, ensuring they were not deemed to have a high risk of bias in any of the Cochrane risk of bias tool (RoB2) domains. Primary outcomes were good functional outcome (modified Rankin scale, 0–3) and mortality beyond 90 days. Secondary outcomes were early mortality within 30 days and rebleeding rates. We pooled odds ratios (ORs) with corresponding 95% confidence intervals (CIs) using random‐effects models. Results: Fourteen high‐quality RCTs were included. There were 3,027 patients with ICH (1,475 randomized to MIS, and 1,452 randomized to medical management or craniotomy). Of included patients, 1,899 (62.7%) were males. MIS resulted in higher odds of achieving long‐term good functional outcome (OR, 1.51 [95% CI, 1.25–1.82]), lower odds of long‐term mortality (OR, 0.72 [95% CI, 0.57–0.90]) and lower odds of early mortality (OR, 0.73 [95% CI, 0.56–0.95]). Rebleeding rates were similar (OR, 1.10 [95% CI, 0.55–2.19]). The treatment effect of MIS was consistent across multiple sensitivity and subgroup analyses, including individuals with deep ICH. Interpretation: This meta‐analysis provides high‐quality clinical trial evidence supporting the use of MIS as a primary treatment strategy in the management of ICH. ANN NEUROL 2025;97:185–194 [ABSTRACT FROM AUTHOR]

Deep vein thrombosis and pulmonary embolism prophylaxis is an important part of trauma care. Despite an increased risk of thrombotic complications, the use of venous thrombosis chemoprophylaxis in penetrating traumatic brain injury (pTBI) patients is met with reluctance from neurosurgeons because of concern for the exacerbation of intracerebral hemorrhage. The objective of this study was to provide initial pre-clinical evidence of the effects of Lovenox (LVX) administration following pTBI with significant intracerebral hemorrhage. Sprague-Dawley rats received a penetrating ballistic-like brain injury. Animals were randomly divided into two groups following injury: LVX (25 mg/kg) or vehicle (VEH, saline). LVX or vehicle was administered subcutaneously beginning 24 h after the injury and continued daily for 7 days post-injury. A neurological assessment was performed daily and magnetic resonance imaging (MRI) was performed at baseline, 1, 2, 3, and 7 days post-injury. Following the final MRI, brains were isolated and prepared for histological analysis. Thromboelastography demonstrated dramatic anticoagulation effects which were confirmed by significant increases in partial thromboplastin time (p < 0.001). Daily neurological assessment revealed no worsening of functional deficits following LVX treatment. MRI analysis demonstrated no differences in cerebral edema or intracranial hemorrhage volumes between treatment groups at any tested post-injury time points. However, LVX elicited a significant reduction in fibrin deposition in the ipsilateral striatum and lesion site at 7 days post-injury (p < 0.05). Serum levels of beta-amyloid were decreased at 7 days following LVX treatment (p < 0.05) which may indicate neuroprotective effects but was not correlated to brain levels. The results presented indicate that administration of LVX at a dose capable of inducing anticoagulation is safe in a rodent model of pTBI without exacerbation of intracerebral hemorrhage within the first 7 days of injury. [ABSTRACT FROM AUTHOR]

Purpose: In the brain imaging based on electrical impedance tomography, it is sometimes not able to attach 16 electrodes due to space restriction caused by craniotomy. As a result of this, the number of boundary measurements decreases, and spatial resolution of reconstructed conductivity distribution is reduced. The purpose of this study is to enhance reconstruction quality in cases of limited measurement. Design/methodology/approach: A new data expansion method based on the shallow convolutional neural network is proposed. An eight-electrode model is built from which fewer boundary measurements can be obtained. To improve the imaging quality, shallow convolutional neural network is constructed which maps limited voltage data of the 8-electrode model to expanded voltage data of a quasi-16-electrode model. The predicted data is compared with the quasi-16-electrode data. Besides, image reconstruction based on L1 regularization method is conducted. Findings: The results show that the predicted data generally coincides with the quasi-16-electrode data. It is found that images reconstructed with the data of eight-electrode model are the poorest. Nevertheless, imaging results when the limited data is expanded by the proposed method show large improvement, and there is a minor difference with the images recovered with the quasi-16-electrode data. Also, the impact of noise is studied, which shows that the proposed method is robust to noise. Originality/value: To enhance reconstruction quality in the case of limited measurement, a new data expansion method based on the shallow convolutional neural network is proposed. Both simulation work and phantom experiments have demonstrated that high-quality images of cerebral hemorrhage and cerebral ischemia can be obtained when the limited measurement is expanded by the proposed method. [ABSTRACT FROM AUTHOR]

Introduction: The influence of COVID19 vaccination on the risk of different neurological diseases has been subject of intense investigation. No large scale results have been published so far in the population of around 10 million people of Lombardia in Italy. Methods: Linkable administrative health databases from the Lombardia region were used. By using the adapted self controlled case series (SCCS) method for event dependent exposures, we estimated the relative incidence of different neurological diseases following pre-specified windows at risk after vaccination and after COVID-19 infection in the over-12 population of Lombardia. Follow-up time before vaccination (Pre-Vax period) was compared with follow-up time 0–28 days (high-risk period) from the day of vaccination as well as for COVID infection. The SCCS model was fitted using a conditional Poisson regression model to estimate the relative incidences (RI) and their 95% Confidence Intervals (CI). Results: The 28-day post-vaccination period was associated with a significant increase in the occurrence of ischemic stroke, cerebral haemorrhage, TIAs and myelitis (IRR 1.44, 1.50, 1.67 and 2.65 respectively). When the risk conferred by COVID19 infection was assessed in the same cohort, significant IRR were greater in the occurrence of ischemic stroke, cerebral haemorrhage, and TIAs (IRR 5.6, 3.62, 6.83) and includes also Multiple Sclerosis, neuromyelitis, and polymyositis (5.25, 8.81, 5.67). Conclusions: Our data suggest that the increased risk of non-inflammatory CNS disorders following COVID-19 vaccination is lower than the risk conferred by COVID-19 infection, and that COVID-19 infection increases the risk of some inflammatory and non inflammatory neurological disorders. [ABSTRACT FROM AUTHOR]

Hemodynamic management, specifically blood pressure, is essential to reduce mortality and preserve functional capacity. However, the literature is uncertain about the best blood pressure target to be adopted after performing mechanical thrombectomy in patients with acute ischemic stroke. Randomized clinical trials that compared blood pressure goals after mechanical thrombectomy were searched in the following databases: MEDLINE/PubMed, Embase, Scopus, Biomedcentral, and Cochrane Library. The last search was on September 19, 2023. The results obtained were used to construct network meta-analyses. A total of 1556 participants were enrolled from 4 randomized controlled trials (OPTIMAL-BP, ENCHANTED2/MT, BP-TARGET, BEST-II). The last article was not included in the network meta-analysis because it did not have common blood pressure targets. The outcomes compared were: mRS (modified Rankin scale), eTICI/mTICI scale scores, symptomatic and any intracerebral hemorrhage, post-intervention NIHSS, and post-intervention infarct volume. The outcomes using the mRS scale showed that better outcomes were reached with less intensive blood pressure targets when comparing < 120 mmHg vs. ≤ 180 mmHg, OR: 0.71 (95% CI 0.54 – 0.94), in the outcome of mRS 0–1. And for the mRS 0–2 outcome with comparisons < 120 mmHg vs. ≤ 180 mmHg, with OR: 0.59 (95% CI 0.44 – 0.77) and < 140 mmHg vs. ≤ 180 mmHg, with OR: 0.61 (95% CI 0.41 – 0.89). In patients with large vessel occlusion treated with mechanical thrombectomy and who achieved good reperfusion, intensive blood pressure lowering is not effective and might be harmful respect to non intensive blood pressure control in recanalized patients. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to establish a hematoma expansion (HE) prediction model for hypertensive intracerebral hemorrhage (HICH) patients by combining CT radiomics, clinical information, and conventional imaging signs. Methods: A retrospective continuous collection of HICH patients from three medical centers was divided into a training set (n = 555), a validation set (n = 239), and a test set (n = 77). Extract radiomics features from baseline CT plain scan images and combine them with clinical information and conventional imaging signs to construct radiomics models, clinical imaging sign models, and hybrid models, respectively. The models will be evaluated using the area under the curve (AUC), clinical decision curve analysis (DCA), net reclassification index (NRI), and integrated discrimination improvement (IDI). Results: In the training, validation, and testing sets, the radiomics model predicts an AUC of HE of 0.885, 0.827, and 0.894, respectively, while the clinical imaging sign model predicts an AUC of HE of 0.759, 0.725, and 0.765, respectively. Glasgow coma scale score at admission, first CT hematoma volume, irregular hematoma shape, and radiomics score were used to construct a hybrid model, with AUCs of 0.901, 0.838, and 0.917, respectively. The DCA shows that the hybrid model had the highest net profit rate. Compared with the radiomics model and the clinical imaging sign model, the hybrid model showed an increase in NRI and IDI. Conclusion: The hybrid model based on CT radiomics combined with clinical and radiological factors can effectively individualize the evaluation of the risk of HE in patients with HICH. Clinical relevance statement: CT radiomics combined with clinical information and conventional imaging signs can identify HICH patients with a high risk of HE and provide a basis for clinical-targeted treatment. Key Points: HE is an important prognostic factor in patients with HICH. The hybrid model predicted HE with training, validation, and test AUCs of 0.901, 0.838, and 0.917, respectively. This model provides a tool for a personalized clinical assessment of early HE risk. [ABSTRACT FROM AUTHOR]

Aim Method Results Interpretation To examine the diagnostic accuracy of Early structural and diffusion‐weighted magnetic resonance imaging (MRI) (acquired at < 36 weeks postmenstrual age) to detect cerebral palsy (CP) or other adverse motor outcomes at or beyond 3 years corrected age in infants born preterm.In this systematic review and meta‐analysis, we searched the CINAHL, Embase, PubMed, and Web of Science databases for studies without language restrictions and a prospectively registered protocol up to October 2023. We extracted the study details, associations presented, and meta‐analyses conducted with pooled sensitivity and specificity.Twenty‐seven articles met the overall inclusion criteria. White matter injury, cerebellar haemorrhage, intraventricular haemorrhage, and lower thalamic volume were associated with poorer motor outcomes. Abnormal Early structural MRI detected infants with a later diagnosis of CP (n = 448, eight studies) with a pooled sensitivity of 98% (95% confidence interval [CI] = 86–100), specificity of 75% (95% CI = 51–93), and adverse motor outcomes (n = 215, four studies), with a pooled sensitivity of 39% (95% CI = 20–59) and a specificity of 90% (95% CI = 88–94).Early abnormal structural MRI predicted later CP with high sensitivity and specificity, while specificity was higher than sensitivity in predicting adverse motor outcomes using the Movement Assessment Battery for Children, Second Edition. Further research into diagnostic accuracy and association between Early MRI and long‐term motor outcomes is warranted. [ABSTRACT FROM AUTHOR]

Background: Early ischemic changes on baseline imaging are commonly evaluated for acute stroke decision-making and prognostication. Aims: We assess the association of early ischemic changes on clinical outcomes and whether it differs between intravenous tenecteplase and Alteplase. Methods: Data are from the phase 3, Alteplase compared to Tenecteplase (AcT) trial. Subjects with anterior circulation stroke were included. Early ischemic changes were assessed using the Alberta Stroke Program Early CT score (ASPECTS). Efficacy outcomes included modified Rankin scale (mRS) 0–1, mRS 0–2, and ordinal mRS at 90 days. Safety outcomes included 24-h symptomatic intracerebral hemorrhage (sICH), any hemorrhage on follow-up scan, and 90-day mortality rate. Mixed-effects logistic regression was used to assess the association of ASPECTS (continuous and categorical (0–4 vs 5–7 vs 8–10)) with outcomes and if these associations were modified by thrombolytic type after adjusting for age, sex, and baseline stroke severity. Results: Of the 1577 patients in the trial, 901 patients (56.3%; median age 75 years (IQR 65–84), 50.8% females, median National Institute of Health Stroke Scale (NIHSS) 14 (IQR 17–19)) with anterior circulation stroke were included. mRS 0–1 at 90 days was achieved in 1/14 (0.3%), 43/160 (14.7%), and 252/726 (85.1%) in the ASPECTS 0–4, 5–7, and 8–10 groups respectively. Every one-point decrease in ASPECTS was associated with 2.7% and 1.9% decrease in chances of mRS 0–1 and mRS 0–2 at 90 days, respectively, and 1.9% chances of increase in mortality at 90 days. Subgroup analysis in endovascular thrombectomy (EVT)-treated population showed similar results. Thrombolytic type did not modify this association between ASPECTS and 90-day mRS 0–1 (P-interaction 0.75). There was no significant interaction by thrombolytic type with any other outcomes. Conclusion: Similar to prior studies, we found that every one-point decrease in ASPECTS was associated with poorer clinical and safety outcomes. This effect did not differ between alteplase and tenecteplase. Data access statement: Data shall made available on reasonable request from the PI (BMM). [ABSTRACT FROM AUTHOR]

Erigerontis Herba (EH), the dried whole plant of Erigeron breviscapus, is well-known for circulating blood, activating meridians to alleviate pain, expelling wind, and clearing away cold. It has been extensively utilized in southern China for the treatment of stroke hemiplegia, chest stuffiness and pains, rheumatic arthralgia, headache, and toothache. This review focuses on the botany, ethnopharmacology, phytochemistry, pharmacology and toxicity of EH and its related prescriptions to offer new insights for prospective research of EH. Relevant information about EH was retrieved from ancient records and books, PubMed, China National Knowledge Infrastructure, Chinese Pharmacopoeia, Web of Science, Doctoral and Master's Theses, and various electronic databases. EH is a member of Compositae family and is mainly grown in southern China. Traditional Chinese medicine records that EH has the effects of circulating blood and removing blood stasis, expelling wind, and removing cold, as well as relieving rigidity of muscle and relieving pain. By now, nearly 200 ingredients have been characterized from EH, including flavonoids, caffeoyls, aromatic acids, coumarins, pentacyclic terpenoids, volatile oil and other compounds. EH extracts, EH related prescriptions (Dengzhan Xixin injection, Dengzhan Shengmai capsules, etc.) or compounds (scutellarin, scutellarein, etc.) possessed obvious therapeutic effects of ischemic stroke, cerebral hemorrhage, myocardial infarction, Alzheimer's disease, diabetes and its complications, gastric cancer, bone, and joint degenerative diseases. Scutellarin, the major active compound of EH, has been used as a quality marker. And no obvious toxicity of EH has been reported. According to its traditional applications, ethnopharmacology, phytochemistry, pharmacology, and toxicity, EH was applied as a valuable herb for clinical application in food and medicine fields. While several compounds have been shown to possess diverse biological activities, the underlying mechanisms of their actions remain elusive. To fully exploit the medicinal potential of EH, further studies on understanding the effective material basis and mechanisms are warranted. [ABSTRACT FROM AUTHOR]

The article discusses the case of an 18-year-old male who sustained a severe traumatic brain injury (TBI) and multiple fractures in a motor vehicle accident. Initially, he presented with a Glasgow Coma Scale of 7, left temporal subdural hematoma, bifrontal intraparenchymal hemorrhagic contusions, and fractures in the left upper extremity (LUE), requiring decompressive craniectomy, hematoma evacuation, and surgical fixation of fractures.

A 34-year-old man who did not use tobacco complained of hemoptysis with a small volume, severe dry cough, and low-grade fever for 5 months. He denied dyspnea, chest pain, night sweats, or weight loss. Chest CT scanning showed nodules with a cavity in the lower left lung. Pathogenic tests of BAL fluid were negative. Initially, he was diagnosed with pneumonia and received antibiotics. After a week, his symptoms resolved, and he was discharged from the hospital. Two months later, the patient presented again for the onset of dry cough and hemoptysis. Despite symptomatic treatment, his symptoms and chest CT scans had no improvement. Thereby, he was referred to our institution. He was prone to spontaneous bruising since childhood with a family history of spontaneous cerebral aneurysm. At 21 years of age, the patient underwent an appendectomy because of a suspected perforation. Also, he experienced cerebral hemorrhage 3 years earlier. [ABSTRACT FROM AUTHOR]

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Aim: To study the relationship between elevated C-reactive protein (CRP) levels, infection, and spontaneous intracerebral hemorrhage (ICH) outcomes. Methods: Patients were classified into four groups (Q1–Q4). Logistic regression was used to analyze the relationship between different CRP levels and functional disability (mRS score of 3– 5) at discharge, intracerebral hematoma evacuation, and in-hospital mortality. Subgroup analysis was conducted on patients with or without infection during hospitalization. Results: A total of 14,529 patients with ICH were enrolled in this study. In the multivariate logistic regression model, compared with the reference CRP quartile group (Q1), the Q4 group had a higher proportion of functional disability (adjusted OR, 1.30, 95% CI 1.16– 1.45) and hematoma evacuation (adjusted OR, 1.88, 95% CI 1.58– 2.23). In patients without infection, compared with the Q1 group, the Q4 group had a higher risk of functional disability (adjusted OR, 2.16, 95% CI 1.71– 2.73) and hematoma evacuation (adjusted OR, 1.15, 95% CI 1.00– 1.31). Conclusion: A significantly increased CRP level was associated with a higher risk of early functional disability and hematoma evacuation in patients with ICH, regardless of the presence or absence of infectious complications. Infection may increase the risk of poor outcomes in patients with ICH, but caution is needed when facing abnormally high CRP levels in patients with ICH without infection. [ABSTRACT FROM AUTHOR]

Background: Post-stroke spasticity (PSS) is a common complication after stroke and is an important cause of high rates of disability after stroke. At present, modern medicine has made great progress in the treatment of PSS, 'early detection, early treatment' has become a general consensus for the treatment of PSS in the clinic. Clarifying the risk factors of PSS can help to detect and treat the functional disorders caused by PSS at an earlier stage. Methods: This is a retrospective study. 436 stroke patients who visited the Neurology Department of the Third Affiliated Clinical Hospital of Changchun University of Chinese Medicine from June 2020 to November 2020 were selected as study subjects, and finally 257 patients were included in the final analysis, and divided into 101 cases with spasticity and 156 cases without spasticity, depending on whether or not the stroke victim had a spasm at the time of admission. Results: The multivariate regression analysis showed that basal ganglia as the cerebral hemorrhage or infarction site (OR = 4.930, 95%CI = 2.743–8.86, p = 0.000), cerebral hemorrhage or infarction volume (OR = 1.087, 95%CI = 1.016–1.164, p = 0.016) and NIHSS scores (OR = 1.232, 95%CI = 1.089–1.393, p = 0.001) are independent influencing factors and independent risk factors for spasticity (p < 0.05). A risk prediction model for spasticity in stroke patients is derived with the multivariate logistic regression analysis Logit (P) = 1.595 * Basal ganglia +0.084 * infarct volume + 0.208 * NIHSS scores – 2.092. An evaluation of the goodness of fit using the ROC curve showed AUC (95% CI) = 0.786 (0.730–0.843), an indication of a high degree of model fit. Conclusion: Independent risk factors for Post-stroke spasticity include basal ganglia as the cerebral hemorrhage or infarction site, cerebral hemorrhage or infarction volume and NIHSS scores. [ABSTRACT FROM AUTHOR]

Hematoma expansion (HE) is an independent predictor of poor outcomes and a modifiable treatment target in intracerebral hemorrhage (ICH). Evaluating HE in large datasets requires segmentation of hematomas on admission and follow-up CT scans, a process that is time-consuming and labor-intensive in large-scale studies. Automated segmentation of hematomas can expedite this process; however, cumulative errors from segmentation on admission and follow-up scans can hamper accurate HE classification. In this study, we combined a tandem deep-learning classification model with automated segmentation to generate probability measures for false HE classifications. With this strategy, we can limit expert review of automated hematoma segmentations to a subset of the dataset, tailored to the research team's preferred sensitivity or specificity thresholds and their tolerance for false-positive versus false-negative results. We utilized three separate multicentric cohorts for cross-validation/training, internal testing, and external validation (n = 2261) to develop and test a pipeline for automated hematoma segmentation and to generate ground truth binary HE annotations (≥3, ≥6, ≥9, and ≥12.5 mL). Applying a 95% sensitivity threshold for HE classification showed a practical and efficient strategy for HE annotation in large ICH datasets. This threshold excluded 47–88% of test-negative predictions from expert review of automated segmentations for different HE definitions, with less than 2% false-negative misclassification in both internal and external validation cohorts. Our pipeline offers a time-efficient and optimizable method for generating ground truth HE classifications in large ICH datasets, reducing the burden of expert review of automated hematoma segmentations while minimizing misclassification rate. [ABSTRACT FROM AUTHOR]

Background: Stroke caused by Intracerebral haemorrhage (ICH) has high mortality rate. Among various risk factors for ICH, hypertension is the most important factor. Certain population studies have reported a paradox of inverse association between serum cholesterol and risk of ICH. Aims and objectives: The study aim was to evaluate the serum lipid profile total cholesterol (TC), triglycerides (TGL), high density cholesterol (HDL-C), very low density cholesterol (VLDL-C) and low density cholesterol (LDL-C) in intracerebral haemorrhage patients and look for correlation. Methods: 50 patients with ICH admitted in Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar who fulfilled the inclusion and exclusion criteria were selected. The study design was a hospital based observational clinical study. History, clinical examination and investigations (CT & MRI Brain and basic blood biochemistry with serum lipid profile) were collected and the data were analysed statistically. Results: Majority of the ICH patients in our study were >55 years and were males. The total serum cholesterol was < 200mg/dl in 72 % of our patients, with a mean of 168.09 ±43.74mg%. Serum triglyceride level was patients, with mean of 108.26±43.31mg%. HDL-C was < 40 mg/dl in 76% of patients and VLDL-C was < 30mg/dl in 72% patients. The various lipid fractions observed were found to be low in majority of our ICH patients (p value < 0.05), suggesting a negative association between the two. The results obtained were comparable to other similar studies. Conclusion: Majority of intracerebral haemorrhage patients in our study had lower levels of total cholesterol, triglyceride, HDL-C, LDL-C and VLDL-C. Whether the inverse association between serum lipid levels and ICH is a true causal association or only by chance due to other common confounding factors needs to be evaluated with large scale studies. [ABSTRACT FROM AUTHOR]

Background The aim of our study was to find predictors of parenchymal hematoma (PH) and clinical outcome after mechanical thrombectomy (MT) in patients with large vessel occlusion (LVO) and baseline large infarct. Methods The databases of 16 stroke centers were retrospectively screened for patients with anterior circulation LVO and baseline Alberta Stroke Program Early CT Score (ASPECTS) ≤5 that received MT. Procedural parameters, including the number of passes during first and second technique of MT, were recorded. Outcome measures were occurrence of PH type 2 and any type of PH after MT, and the 90-day modified Rankin Scale (mRS) score of 0-3 and 0-2. Results In total, 408 patients were available for analysis. A higher number of passes in the second technique was predictive of PH type 2 (odds ratio (OR) -3.204, 95% confidence interval (CI) 1.140 to 9.005), whereas procedure conducted under general anesthesia was associated with lower risk (OR 0.127, 95% CI 0.002 to 0.808). The modified thrombolysis in cerebral infarction grade 2c-3 was associated with the mRS score 0-3 (OR 3.373, 95% CI 1.891 to 6.017), whereas occurrence of PH type 2 was predictive of unfavorable outcome (OR 0.221, 95% CI 0.063 to 0.773). Similar results were found for the mRS score 0-2 outcome measure. Conclusion In patients with large ischemic core, a higher number of passes during MT and procedure not conducted under general anesthesia are associated with increased rate of PH type 2, that negatively impact the clinical outcome. Our data outline a delicate balance between the need of a complete recanalization and the risk of PH following MT. [ABSTRACT FROM AUTHOR]

Streptococcus mutans (S. mutans) is the main pathogenic bacterium causing dental caries, and the modes in which its traits, such as acid production, acid tolerance, and adhesion that contribute to the dental caries process, has been clarified. However, a growing number of animal experiments and clinical revelations signify that these traits of S. mutans are not restricted to the detriment of dental tissues. These traits can assist S. mutans in evading the immune system within body fluids; they empower S. mutans to adhere not merely to the surface of teeth but also to other tissues such as vascular endothelium; they can additionally trigger inflammatory reactions and inflict damage on various organs, thereby leading to the occurrence of systemic diseases. These traits mostly originate from some correlative findings, lacking a comprehensive evaluation of the impact of S. mutans on systemic diseases. Therefore, this review mainly centers on the dissemination route of S. mutans : "Entering the blood circulation - Occurrence of tissue adhesion - Extensive possible proinflammatory mechanisms - Concentration in individual organs" and analyses the specific effects and possible mechanisms of S. mutans in systemic diseases such as cerebral hemorrhage, inflammatory bowel disease, tumors, and infective endocarditis that have been identified hitherto. [ABSTRACT FROM AUTHOR]

Introduction: Intracerebral haemorrhage (ICH) is one of the lethal and most debilitating type of stroke affecting more than 1 million people globally every year. Most common cause of ICH is hypertension and responsible for about 70% of all ICH. Case report: Sealed dead body of 45 years old unknown male brought for autopsy to find out the cause of death. Patient was admitted to district hospital with unconscious state. Status of vital at time of admission was 210/110. Autopsy finding: No external injury was present on the body. No internal injury or abnormality seen on opening neck, chest and abdomen. Facial bone intact. No abnormality detected at scalp, cranial bone and meninges. Externals urface of brain was normal and intact. Brain was soft and congested. On sectioning of cerebral hemisphere huge hematoma of size 6.0×4.5 cm was present in deep left cerebral hemisphere. Conclusion: Hypertension is one of the most important risk factors for ICH. ICH is a medical emergency with high chances of morbidity as well as mortality. Advancement in early diagnosis and neurocritical care have improved and increased the survival. [ABSTRACT FROM AUTHOR]

Background Aims Methods Results Conclusions Cerebral microbleeds (CMBs) are small brain haemorrhages, identified by magnetic resonance imaging (MRI). They indicate potential for cognitive decline and mortality in memory clinic attendees. The presence of more than four CMBs is exclusionary for some clinical trials of disease‐modifying therapies for Alzheimer's disease (AD). The prevalence and clinical relevance of CMBs in Australian memory clinic populations has not been reported.To highlight the prevalence of CMBs in an Australian memory clinic cohort and explore associations with diagnoses, topography and cognitive performance.We conducted a retrospective cohort study of 393 patients who attended a memory clinic (CDAMS) in Melbourne, Australia from January 2014 to December 2016 who underwent brain MRI. Data collected included age, gender, clinical diagnosis and cognitive scores. Univariable and multivariable regression analyses were performed to identify associations of CMBs with clinical and cognitive findings.The prevalence of CMBs was 27% (n=107) with good inter‐rater reliability (κ=0.75). CMBs were significantly associated with increasing age. Prevalence of CMBs was higher in people with mild cognitive impairment (MCI) (32%) and dementia (39%) compared with other diagnostic groups (p<0.001). Lobar‐predominant CMB distribution was associated with AD diagnosis. Presence of multiple CMBs was associated with poorer cognitive performance overall.CMBs are common in an Australian memory clinic population and are associated with poorer cognitive performance. “Real world” prevalence of CMBs may limit accessibility to disease‐modifying therapies for many people. [ABSTRACT FROM AUTHOR]

Objective To explore the mediating effect of social support level on the coping styles and perceived benefit from illness among family members of cerebral hemorrhage patients. Methods A total of 128 family members of cerebral hemorrhage patients admitted to the hospital from December 2020 to December 2023 were selected. Questionnaires were conducted using the Benefit Finding Scale (BFS), Medical Coping Modes Questionnaire (MCMQ), and Social Support Rating Scale (SSRS). The correlation between social support, coping styles, and perceived benefit from illness among family members of cerebral hemorrhage patients was analyzed, as well as the mediating effect of social support on coping styles and perceived benefit from illness. Results The score for perceived benefit from illness among family members of cerebral hemorrhage patients was (78.52±10.56), the total social support score was (42.39±5.22), the confrontation dimension score of coping styles was (24.35±3.76), the submission dimension score was (6.06±1.58), and the avoidance dimension score was (13.30±2.44). The total social support score and each dimension were positively correlated with confrontation coping and perceived benefit from illness (P<0.05) and negatively correlated with submission and avoidance coping (P<0.05). Perceived benefit from illness was positively correlated with confrontation coping (P<0.05) and negatively correlated with submission and avoidance coping (P< 0.05). Results of forced entry regression analysis showed that when the predictor variable was confrontation coping and the dependent variable was perceived benefit from illness, the coefficient of determination (R) during regression analysis was 0. 635, the unstandardized regression coefficient (B) was 1.588, and P<0.001. When the predictor variable was confrontation coping and the dependent variable was social support, R during regression analysis was 0. 483, B was 0.274, and P<0.001. When the predictor variables were confrontation coping and social support, and the dependent variable was perceived benefit from illness, R during regression analysis was 0.642, B was 1.522, and P<0.001. When the predictor variable was avoidance coping and the dependent variable was social support, R during regression analysis was 0. 410, B was 0.014, and P=0.790. When the predictor variables were social support and avoidance coping, and the dependent variable was perceived benefit from illness, R during regression analysis was 0. 421, B was 0.393, and P=0.001. Social support played a mediating role in predicting perceived benefit from illness in both confrontation and avoidance coping. Conclusion Social support has a mediating effect on the coping styles and perceived benefit from illness among family members of cerebral hemorrhage patients. Interventions can be formulated clinically starting with social support to improve family members' perceived benefit from illness. [ABSTRACT FROM AUTHOR]

Intracerebral haemorrhage (ICH) is the most severe subtype of stroke, with a 2-year mortality of nearly 50% and the greatest rate of disability amongst stroke survivors. Whilst treatment options for ICH remain limited, the condition requires prompt identification and rapid intervention to reduce permanent brain damage, with diagnosis traditionally confirmed by CT imaging. Although imaging is excellent at determining the presence of an intracranial bleed, biomarkers may help to identify the type of stroke or when the stroke began. Kisspeptin is a neuropeptide best known for its functions in reproductive biology, but recent preclinical studies have demonstrated that kisspeptins are upregulated in rodent models of haemorrhagic stroke. Here we report for the first time that kisspeptin immunoreactivity is significantly higher in post-mortem human brain tissue after both ICH and ICH associated with cerebral amyloid angiopathy. Machine learning and artificial intelligence-enabled image analysis of multiplexed immunolabeled brain tissues demonstrated that kisspeptin immunoreactivity was higher in cells of the microvasculature (CD105+), but not in neurons or astrocytes when compared to controls. Further spatial analysis indicated that kisspeptin immunoreactivity was concentrated to the region of haemorrhage. These results indicate that following ICH, kisspeptin is significantly higher in the human brain, suggesting expression from local vasculature or recruitment to the haematoma. Further work is required to determine the biological mechanisms underlying kisspeptin elevation within the ICH microenvironment and its potential utility as a novel biomarker or therapeutic target for ICH. [ABSTRACT FROM AUTHOR]

Iatrogenic cerebral amyloid angiopathy, a disease caused by contact with neurosurgical material or human growth hormone contaminated by beta‐amyloid peptide (Aβ), has a prion‐like transmission mechanism. We present a series of three patients under 55 years of age who underwent cranial surgery. All of them developed multiple cerebral hemorrhages, transient focal neurological deficits, and/or cognitive impairment after 3–4 decades. MRI was compatible with CAA, and Aβ deposition was confirmed. The third patient, who had a ventriculoperitoneal valve, also showed Aβ deposition in the peritoneum and diagnostic biomarkers of Alzheimer's disease. Co‐pathology with Alzheimer disease and its iatrogenic transmission should be considered. [ABSTRACT FROM AUTHOR]

Background and purpose: External drainage represents a well-established treatment option for acute intracerebral hemorrhage. The current standard of practice includes post-operative computer tomography imaging, which is subjectively evaluated. The implementation of an objective, automated evaluation of postoperative studies may enhance diagnostic accuracy and facilitate the scaling of research projects. The objective is to develop and validate a fully automated pipeline for intracerebral hemorrhage and drain detection, quantification of intracerebral hemorrhage coverage, and detection of malpositioned drains. Materials and methods: In this retrospective study, we selected patients (n = 68) suffering from supratentorial intracerebral hemorrhage treated by minimally invasive surgery, from years 2010–2018. These were divided into training (n = 21), validation (n = 3) and testing (n = 44) datasets. Mean age (SD) was 70 (±13.56) years, 32 female. Intracerebral hemorrhage and drains were automatically segmented using a previously published artificial intelligence-based approach. From this, we calculated coverage profiles of the correctly detected drains to quantify the drains' coverage by the intracerebral hemorrhage and classify malpositioning. We used accuracy measures to assess detection and classification results and intraclass correlation coefficient to assess the quantification of the drain coverage by the intracerebral hemorrhage. Results: In the test dataset, the pipeline showed a drain detection accuracy of 0.97 (95% CI: 0.92 to 0.99), an agreement between predicted and ground truth coverage profiles of 0.86 (95% CI: 0.85 to 0.87) and a drain position classification accuracy of 0.88 (95% CI: 0.77 to 0.95) resulting in area under the receiver operating characteristic curve of 0.92 (95% CI: 0.85 to 0.99). Conclusion: We developed and statistically validated an automated pipeline for evaluating computed tomography scans after minimally invasive surgery for intracerebral hemorrhage. The algorithm reliably detects drains, quantifies drain coverage by the hemorrhage, and uses machine learning to detect malpositioned drains. This pipeline has the potential to impact the daily clinical workload, as well as to facilitate the scaling of data collection for future research into intracerebral hemorrhage and other diseases. [ABSTRACT FROM AUTHOR]

Resolvin D1 (RvD1) is an endogenous anti-inflammatory mediator that modulates the inflammatory response and promotes inflammation resolution. RvD1 has demonstrated neuroprotective effects in various central nervous system contexts; however, its role in the pathophysiological processes of intracerebral hemorrhage (ICH) and the potential protective mechanisms when combined with exercise rehabilitation remain unclear. A mouse model of ICH was established using collagenase, and treatment with RvD1 combined with three weeks of exercise rehabilitation significantly improved neurological deficits, muscle strength, learning, and memory in ICH mice while reducing anxiety-like behavior. RvD1 combined with exercise rehabilitation upregulated anti-inflammatory factors, inhibited the inflammatory state, and activated the BDNF/TrkB/PI3K/AKT pathway. TUNEL staining confirmed a decrease in residual apoptotic neurons, while transmission electron microscopy showed an increase in mitochondrial autophagosomes with combined treatment. Mendelian randomization and molecular docking further confirmed the association of RvD1 with targets related to mitophagy and inflammatory factors, clarifying the mechanism of RvD1 involvement. In summary, RvD1 combined with exercise rehabilitation activates the BDNF/TrkB/PI3K/AKT signaling pathway, effectively reduces neuronal apoptosis and inflammatory responses following ICH in mice, and participates in mitochondrial autophagy-related states. This comprehensive therapeutic strategy promotes neurological recovery and provides insights for clinical management of this condition. [ABSTRACT FROM AUTHOR]

Intracerebral hemorrhage (ICH) is a common cerebrovascular disease characterized by a high incidence, disability rate, and mortality. Epigallocatechin gallate (EGCG), a key catechin compound found in green tea, has received increasing attention for its potential neuroprotective and therapeutic effects in neurological disorders. Studies have indicated that EGCG may influence various signaling pathways and molecular targets, including the inhibition of oxidative stress, reduction of inflammatory responses, suppression of cell apoptosis, regulation of cell survival, and enhancement of autophagy. Although the exact mechanism of action of EGCG is not fully understood, it has become a focal point of research in various disciplines due to its promising potential. This study aims to investigate the effects of EGCG on oxidative stress, iron deposition, and cell apoptosis in rats with ICH, as well as to uncover the underlying mechanisms. An ICH rat model was created to simulate cerebral hemorrhage, while an in vitro model utilizing primary cortical neurons was developed. The neurons were pre-treated with EGCG before being exposed to Erastin and RSL3 to induce iron death. The levels of oxidative stress, iron deposition, and cell apoptosis were evaluated in both models. In the ICH model, EGCG was discovered to enhance the activation of the Keap1/P62/Nrf2 signaling pathway in both in vivo and in vitro studies. Furthermore, EGCG significantly elevated the levels of GPX4 and XCT proteins, as well as the nuclear expression of Nrf2. It was noted that the Nrf2 inhibitor ML385 partially decreased the expression of these proteins. Through the activation of the Keap1/P62/Nrf2 pathway, EGCG inhibits inflammation, oxidative stress and iron deposition in rats with cerebral hemorrhage. EGCG inhibits oxidative stress, iron deposition and apoptosis in rats with ICH by activating Keap1/P62/Nrf2 pathway. [ABSTRACT FROM AUTHOR]

Background: Intracerebral hemorrhage (ICH) is a severe condition associated with high mortality and disability rates. Oxidative stress plays a critical role in the development of secondary brain injury (SBI) following ICH. Previous research has demonstrated that Annao Pingchong decoction (ANPCD) treatment for ICH has antioxidant effects, but the exact mechanism is not yet fully understood. Objective: This study aimed to investigate the neuroprotective effects of ANPCD on oxidative stress and neuronal apoptosis after ICH by targeting the receptor for advanced glycation end products (RAGE)-NADPH oxidase (NOX) 2/4 signaling axis. Methods: The research involved the creation of rat ICH models, the mNSS assay to assess neurological function, Nissl staining to evaluate neuronal damage, and biochemical assays to measure oxidative and antioxidant levels. The expression of RAGE-NOX2/4 axis proteins was analyzed using western blotting and immunofluorescence, while neuronal apoptosis was assessed with TUNEL staining. Furthermore, after performing quality control of drug-containing serum using UPLC-MS/MS, we employed an in vitro model of heme-induced injury in rat cortical neurons to investigate the neuroprotective mechanisms of ANPCD utilizing RAGE inhibitors. Results: The findings indicated that ANPCD improved neurological deficits, reduced neuronal damage, decreased ROS and MDA levels, and increased the activities enzymatic activities of SOD, CAT, GSH and GPX. Additionally, it suppressed the RAGE-NOX2/4 signaling axis and neuronal apoptosis. Conclusion: ANPCD exhibits neuroprotective effects by inhibiting the RAGE-NOX2/4 signaling axis, thereby alleviating neuronal oxidative stress and apoptosis following ICH. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the function of the glymphatic system (GS) and its association with neuropsychological tests in spontaneous intracerebral hemorrhage (sICH) by diffusion tensor imaging analysis along the perivascular space (DTI-ALPS). Methods: This retrospective study included 58 patients with sICH and 63 age- and sex-matched healthy controls (HCs). Partial correlation analyses were performed to examine the relationships between the DTI-ALPS index and radiological as well as clinical data. Mediation analyses were performed to explore the mediating role of the grey matter proportion (GM%) in the relationship between DTI-ALPS index and Montreal Cognitive Assessment (MoCA) score. Results: Significantly lower DTI-ALPS index values were observed in sICH compared with HCs (FDR- p < 0.001). In the acute-subacute sICH group, the ALPS index was significantly correlated with hematoma volume (r = −0.572, FDR- p = 0.031). In the chronic sICH group, the ALPS index was significantly correlated with MoCA scores (r = 0.425, FDR- p = 0.014). In chronic sICH groups, GM% served as a significant mediator in the relationship between the DTI-ALPS index and MoCA scores (indirect effects β = 4.925, 95%CI: 0.028, 11.841). The ALPS index was identified as an independent prognostic indicator for unfavorable outcomes in sICH (β = −9.851, p = 0.018). Conclusion: Our study demonstrated that the DTI-ALPS index decreased in sICH patients, suggesting potential functional impairment of the lymphoid system. Additionally, the DTI-ALPS index served as an independent predictor of poor 90-day prognosis. In the acute-subacute stage of sICH, the DTI-ALPS index had negative correlation with hematoma volume. In the chronic sICH group, the GM% partially mediated the relationship between the GS and cognitive function. [ABSTRACT FROM AUTHOR]

Microglial-mediated neuroinflammation is crucial in the pathophysiological mechanisms of secondary brain injury (SBI) following intracerebral hemorrhage (ICH). Mitochondria are central regulators of inflammation, influencing key pathways such as alternative splicing, and play a critical role in cell differentiation and function. Mitochondrial ATP synthase coupling factor 6 (ATP5J) participates in various pathological processes, such as cell proliferation, migration, and inflammation. However, the role of ATP5J in microglial activation and neuroinflammation post-ICH is poorly understood. This study aimed to investigate the effects of ATP5J on microglial activation and subsequent neuroinflammation in ICH and to elucidate the underlying mechanisms. We observed that ATP5J was upregulated in microglia after ICH. AAV9-mediated ATP5J overexpression worsened neurobehavioral deficits, disrupted the blood-brain barrier, and increased brain water content in ICH mice. Conversely, ATP5J knockdown ameliorated these effects. ATP5J overexpression also intensified microglial activation, neuronal apoptosis, and inflammatory responses in surrounding tissues post-ICH. ATP5J impaired microglial dynamics and reduced the proliferation and migration of microglia to injury sites. We used oxyhemoglobin (OxyHb) to stimulate BV2 cells and model ICH in vitro. Further in vitro studies showed that ATP5J overexpression enhanced OxyHb-induced microglial functional transformation. Mechanistically, ATP5J silencing reversed dynamin-related protein 1 (Drp1) and mitochondrial fission 1 protein (Fis1) upregulation in microglia post-OxyHb induction; reduced mitochondrial overdivision, excessive mitochondrial permeability transition pore opening, and reactive oxygen species production; restored normal mitochondrial ridge morphology; and partially restored mitochondrial respiratory electron transport chain activity. ATP5J silencing further alleviated OxyHb-induced mitochondrial dysfunction by regulating mitochondrial metabolism. Our results indicate that ATP5J is a key factor in regulating microglial functional transformation post-ICH by modulating mitochondrial dysfunction and metabolism, thereby positively regulate neuroinflammation. By inhibiting ATP5J, SBI following ICH could be prevented. Therefore, ATP5J could be a candidate for molecular and therapeutic target exploration to alleviate neuroinflammation post-ICH. [ABSTRACT FROM AUTHOR]

Introduction: Radiological scores used to assess the extent of subarachnoid hemorrhage are limited by intrarater and interrater variability and do not utilize all available information from the imaging. Image segmentation enables precise identification and delineation of objects or regions of interest and offers the potential for automatization of score assessments using precise volumetric information. Our study aims to develop a deep learning model that enables automated multiclass segmentation of structures and pathologies relevant for aneurysmal subarachnoid hemorrhage outcome prediction. Methods: A set of 73 non-contrast CT scans of patients with aneurysmal subarachnoid hemorrhage were included. Six target classes were manually segmented to create a multiclass segmentation ground truth: subarachnoid, intraventricular, intracerebral and subdural hemorrhage, aneurysms and ventricles. We used the 2d and 3d configurations of the nnU-Net deep learning biomedical image segmentation framework. Additionally, we performed an interrater reliability analysis in our internal test set (n = 20) and an external validation on a set of primary intracerebral hemorrhage patients (n = 104). Segmentation performance was evaluated using the Dice coefficient, volumetric similarity and sensitivity. Results: The nnU-Net-based segmentation model demonstrated performance closely matching the interrater reliability between two senior raters for the subarachnoid hemorrhage, ventricles, intracerebral hemorrhage classes and overall hemorrhage segmentation. For the hemorrhage segmentation a median Dice coefficient of 0.664 was achieved by the 3d model (0.673 = 2d model). In the external test set a median Dice coefficient of 0.831 for the hemorrhage segmentation was achieved. Conclusion: Deep learning enables automated multiclass segmentation of aneurysmal subarachnoid hemorrhage-related pathologies and achieves performance approaching that of a human rater. This enables automatized volumetries of pathologies identified on admission CTs in patients with subarachnoid hemorrhage potentially leading to imaging biomarkers for improved outcome prediction. [ABSTRACT FROM AUTHOR]

Introduction: The study aimed to analyze the characteristics of patients admitted to the neurology department of a tertiary hospital who subsequently died, focusing on those with high disease severity. Materials and methods: We conducted a retrospective cohort study of patients who died among those admitted to the neurology department of a regional tertiary hospital from 2013 to 2021. Clinical, radiological, and laboratory results of the included patients were collected, and their primary diagnoses, duration from time of admission to death, and direct causes of death were analyzed. Furthermore, the patients were categorized into subgroups based on sex (male and female), primary diagnosis (ischemic and non-ischemic stroke), and cancer diagnosis for comparative analysis. Results: Of 187 deaths, the primary diagnoses were ischemic stroke (131 cases), seizures (19 cases), encephalitis and encephalopathy (18 cases), and other conditions (19 cases). The direct causes of death included ischemic stroke in 68 patients, sepsis in 33, cerebral hemorrhage in 19, pneumonia in 15, acute kidney injury in nine, status epilepticus in seven, and other causes in 36. Pneumonia, cerebral hemorrhage, acute kidney injury, and status epilepticus were the more prevalent direct causes of death in men, whereas ischemic stroke and sepsis were more prevalent in women. Additionally, sepsis, pneumonia, acute kidney injury, and status epilepticus, as direct causes of death, were significantly higher among patients with a primary diagnosis of non-ischemic stroke than among those with a primary diagnosis of ischemic stroke. Furthermore, there were differences in some pre-existing diseases and laboratory findings when comparing between the cancer group and the non-cancer group. Discussion: Ischemic stroke was the primary diagnosis and direct cause of death in a high proportion of patients. Other noteworthy direct causes of death were cerebral hemorrhage and infections such as sepsis and pneumonia. Based on these findings, the characteristics and prognoses of patients admitted to neurology departments can be predicted and used for management. [ABSTRACT FROM AUTHOR]

Objective: Consuming soy in the diet is beneficial for health, and tofu possess the richest source of dietary soy. However, the specific association with stroke and related subtypes remains controversial. In this study, the genetic causal relationship among tofu and stroke as well as the subtypes was investigated by utilizing the data in a number of genome-wide association study (GWAS) based on population. Methods: The tofu intake GWAS analysis is derived from the Medical Research Council (MRC) Integrative Epidemiology Unit at the University of Bristol (MRC-IEU) Consortium. The two-sample Mendelian randomization (MR) study was carried out, utilizing multiple analysis methods to analyze the associations with stroke and related subtypes. The sensitivity, heterogeneity, and potential pleiotropy could be investigated by multiple analysis method. Results: We found that tofu intake had no causal relationship with stroke. However, in stroke subtype, there is a causal relationship among tofu intake with the risk of intracerebral hemorrhage (ICH) (odds ratio, OR = 1.24 × 10-5, 95% CI: 1.54 × 10-8-9.95 × 10-3, p = 9.300 × 10-4), while tofu intake does not affect the risk of ischemic stroke (OR = 1.07 × 10-1, 95% CI: 3.84 × 10-4-2.97 × 101, p = 4.362 × 10-1) and subarachnoid hemorrhage (SAH) (OR = 3.33 × 10-3, 95% CI: 1.79 × 10-6-6.18, p = 1.373 × 10-1). Both the Mendelian randomization PRESSO (MR-PRESSO) global test and Cochran's Q test did not detect any sensitivity and heterogeneity. Conclusions: While tofu consumption is associated with a higher risk of ICH, it does not show a significant relationship with ischemic stroke or SAH. The varying effects of tofu on different stroke subtypes underscore the need for considering potential confounding dietary and lifestyle factors in future studies. [ABSTRACT FROM AUTHOR]

Objective: This study aims to evaluate the efficacy and safety of deep brain stimulation (DBS) of the medial pulvinar nucleus (PuM) in reducing seizure frequency and addressing comorbidities in patients with drug and vagal nerve-resistant focal epilepsy. Methods: This is an open-label prospective treatment trial with a planned enrollment of 12 patients suffering from medically refractory epilepsy (Clinical trial gov NCT04692701), for which the interim 12-month post-implantation results for the first 6 patients are being reported. Inclusion criteria were focal epilepsy not suitable for or after failed surgical intervention and previous failure of neurostimulation therapies (vagus nerve stimulation or anterior thalamic nucleus DBS). Evaluations included seizure diaries, neuropsychological assessments, and scales for depression, anxiety, quality of life, and seizure severity. PuM DBS was performed using ROSA robotic assistance, with follow-ups every 3 months for 1 year. Results: Out of six patients, five completed 1-year follow-up (one patient died prematurely). A non-significant trend toward seizure reduction was observed at 6 months, becoming more pronounced at 1 year (mean reduction: 45%; responders: 2/5). Seizure severity significantly improved (p = 0.02), with a reduction in the NHS3 scale scores. Quality of life improved significantly at 1 year (p = 0.03). Psychiatric assessments indicated a non-significant trend toward improvement in depression (mean improvement: 26%) and anxiety (mean improvement: 20%) scores. Neuropsychological testing showed stable or improved cognitive performance in three out of five patients. Adverse events included one case of cerebral hemorrhage, one infection leading to device removal, and one possible SUDEP. Significance: Preliminary results suggest that PuM DBS may offer a promising therapeutic option for reducing seizure severity and improving quality of life and cognitive functions in patients with drug-resistant epilepsy. Despite the small sample size and the presence of serious adverse events, the findings warrant further investigation with larger cohorts to confirm these trends and optimize the treatment protocol. [ABSTRACT FROM AUTHOR]

Background: Neuroimaging plays a vital role in the diagnosis of intracerebral hemorrhage (ICH) and in identifying the underlying etiology for appropriate therapeutic approach. This study aims to determine the significance and potential advantages of using early magnetic resonance imaging (MRI) as a diagnostic tool for ICH. Methods: This retrospective study included 359 patients with ICH treated at the Department of Neurology, Mannheim University Hospital between January 2017 and December 2021. Patient characteristics, stroke severity and imaging procedures were descriptively analyzed. Factors associated with the choice of imaging modalities were evaluated. The etiology of hemorrhage was retrospectively analyzed using the existing data. We recorded the reassignment of ICH etiology by comparing the assessment after first sole review of CT scan and then subsequent MRI review. The overall rate of reassignments and the reassignments per CT-based initial etiology were analyzed. Results: In the sample of 359 patients with ICH (mean age 73.1 years, 55.4% male), patients receiving an additional MRI were significantly younger (p <.001) and were less severely affected by stroke (median NIHSS score 5 vs. 15, p <.001). MRI was performed significantly less frequently in patients who died during hospitalization (11.7% vs. 63.9%, p <.001). MRI led to a reassignment of ICH etiology in 48.2% of cases (80/166), uncovering unknown underlying causes in 69% of cases (49/71). Reassignment occurred most frequently in patients with a CT-based diagnosis of hypertensive ICH (18/50). The most frequent reassigned etiologies after MR imaging were cerebral amyloid angiopathy (CAA; 36 patients) and secondary hemorrhage of an ischemic stroke (30 patients). Conclusions: Early MR imaging in patients with ICH improves the determination of underlying etiology and the conception of an appropriate treatment approach, potentially contributing to better patient outcomes. [ABSTRACT FROM AUTHOR]

Experimental rat models of stroke and hemorrhage are important tools to investigate cerebrovascular disease pathophysiology mechanisms, yet how significant patterns of functional impairment induced in various models of stroke are related to changes in connectivity at the level of neuronal populations and mesoscopic parcellations of rat brains remain unresolved. To address this gap in knowledge, we employed two middle cerebral artery occlusion models and one intracerebral hemorrhage model with variant extent and location of neuronal dysfunction. Motor and spatial memory function was assessed and the level of hippocampal activation via Fos immunohistochemistry. Contribution of connectivity change to functional impairment was analyzed for connection similarities, graph distances and spatial distances as well as the importance of regions in terms of network architecture based on the neuroVIISAS rat connectome. We found that functional impairment correlated with not only the extent but also the locations of the injury among the models. In addition, via coactivation analysis in dynamic rat brain models, we found that lesioned regions led to stronger coactivations with motor function and spatial learning regions than with other unaffected regions of the connectome. Dynamic modeling with the weighted bilateral connectome detected changes in signal propagation in the remote hippocampus in all 3 stroke types, predicting the extent of hippocampal hypoactivation and impairment in spatial learning and memory function. Our study provides a comprehensive analytical framework in predictive identification of remote regions not directly altered by stroke events and their functional implication. [ABSTRACT FROM AUTHOR]

Neurological complications in patients undergoing veno-venous extracorporeal membrane oxygenation (V-V ECMO) are challenging, with new intracranial pathologies posing a grave risk. We aimed to evaluate the utility of neuron-specific enolase (NSE) and S100B biomarkers for predicting outcomes in new-onset intracranial pathology during V-V ECMO. A retrospective analysis spanning 2013–2021 at a German university hospital was conducted. Cases with electronically available data on NSE and S100B serum levels, new intracranial pathologies (intracerebral hemorrhage [ICH], subarachnoid hemorrhage [SAH], cerebral ischemia, hypoxic-ischemic encephalopathy [HIE]), and survival during or after V-V ECMO were screened. The primary objective was to assess the prognostic value of NSE and S100B for in-hospital survival during V-V ECMO. Secondary objectives included analyzing clinical characteristics, outcome parameters, and biomarker distribution in V-V ECMO patients. Additionally, the prognostic value of NSE and S100B for in-hospital death and occurrence of intracranial pathology was calculated. Among 744 ECMO recipients, 426 underwent V-V ECMO. No significant differences in disease severity or organ failure scores were observed between groups, except for SAPS at discharge, which was higher in patients with new intracranial pathologies. Patients with new intracranial pathologies had lower median survival and higher in-hospital mortality. Weaning success from ECMO was also significantly reduced in these patients. Cut-off values of 58.4 µg/lfor NSE and 1.52 µg/l for S100B were associated with detrimental outcomes, characterized by significantly reduced median survival. A significant difference in maximum serum NSE concentration was found between patients with and without new intracranial pathology. All screened cases with new intracranial pathology had an unfavorable neurological outcome (modified Rankin Score [mRS] > 3) at discharge, with a higher proportion having an mRS of 6 in the high NSE group. The emergence of intracranial pathology during V-V ECMO significantly increases the risk of death. Changes in NSE and S100B levels serve as valuable follow-up parameters for predicting new intracranial pathology and survival during V-V ECMO therapy. [ABSTRACT FROM AUTHOR]

Objective: This study aims to describe clinical variables and quality care indicators in pediatric stroke management at a high-complexity pediatric care center in Latin America. Methods: Retrospective study of patients with stroke, aged 2–18 years from 2011 to 2021. The principal outcomes were the mRs and mortality. Differences between groups were assessed using Fisher's exact test and the Mann–Whitney U test. We used logistic regression to explore the association between characteristics reported as relevant in literature and mortality. Results: One hundred thirty six patients included, with a median age of 11 years, 54% were male. 47% were hemorrhagic strokes, followed by ischemic strokes at 39%. One-third of the cases presented in hospital. 51% of the patients had no prior medical history. The most common symptoms were altered consciousness, headache, and hemiparesis. The median door-to-image time was 123 min. The most frequent etiologies in ischemic stroke were arteriopathies and cardiac pathology, while vascular malformation and coagulopathies were predominant in hemorrhagic stroke. No patient received reperfusion therapy. At discharge, 48% of patients had a favorable mRs. The mortality rate was 21%. Patients with in-hospital stroke have approximately 7.37 times the odds of dying compared to those with out-of-hospital stroke. Patients with hemorrhagic stroke have approximately 7.46 times the odds of dying compared to those with ischemic stroke. Conclusion: Significant gaps exist in the epidemiology and quality indicators of pediatric stroke care compared to adult protocols. Implementing a "Pediatric code stroke" protocol and conducting prospective studies are crucial for improving pediatric stroke care and outcomes. [ABSTRACT FROM AUTHOR]

Objective: To construct a nomogram model based on clinical risk factors and CT radiohistological features to predict the prognosis of hypertensive intracerebral hemorrhage (HICH). Methods: A total of 148 patients with HICH from April 2022 to July 2024 were retrospectively selected as the research subjects. According to the modified Rankin scale at the time of discharge, they were divided into good group (Rankin scale score 0–2) and bad group (Rankin scale score 3–6). To compare the clinical data and the changes of CT radiographic characteristics in patients with different prognosis. Relevant factors affecting the prognosis were analyzed, and nomogram model was established based on the influencing factors. The fitting degree, prediction efficiency and clinical net benefit of the nomogram model were evaluated by calibration curve, ROC curve and clinical decision curve (DCA). Results: Compared with the good group, the hematoma volume in the poor group was significantly increased, the serum thromboxane 2(TXB2) and lysophosphatidic acid receptor 1(LPAR1) levels were significantly increased, and the energy balance related protein (Adropin) level was significantly decreased. The proportions of irregular shape, promiscuous sign, midline displacement, island sign and uneven density were all significantly increased (p < 0.05). In Logistic multivariate analysis, hematoma volume, Adropin, TXB2, LPAR1 and CT radiological features were all independent factors influencing the poor prognosis of HICH (p < 0.05). A nomogram prediction model was established based on the influencing factors. The calibration curve showed that the C-index was 0.820 (95% CI: 0.799–0.861), the goodness of fit test χ2 = 5.479, and p = 0.391 > 0.05, indicating a high degree of fitting. The ROC curve showed that the AUC was 0.896 (95% CI: 0.817–0.923), indicating that this model had high prediction ability. The DCA curve shows that the net benefit of the nomogram model is higher when the threshold probability is 0.1–0.9. Conclusion: The nomogram prediction model established based on hematoma volume, Adropin, TXB2, LPAR1 and other clinical risk factors as well as CT radiographic characteristics has high accuracy and prediction value in the diagnosis of poor prognosis in patients with HICH. [ABSTRACT FROM AUTHOR]

BACKGROUND: The preterm infants are at risk of cerebellar injury and the risk factors for necrotizing enterocolitis (NEC) associated cerebellar injury are not fully understood. AIM: Determine the risk factors of cerebellar injury in infants with surgical necrotizing enterocolitis (NEC). METHODS: Retrospective study compared clinical/pathological information between surgical NEC infants with and those without cerebellar injury detected on brain MRI obtained at term equivalent age. Cerebellar Injury patterns that we identified on MRI brain were cerebellar hemorrhage, siderosis and/or cerebellar volume loss. RESULTS: Cerebellar injury (21/65, 32.3%) in preterm infants with NEC was associated with patent ductus arteriosus (PDA) (18/21(85.7%) vs. 25/44(56.8%); p = 0.021), blood culture positive sepsis (13/21 (61.9%) vs. 11/44 (25%); p = 0.004) following NEC, predominantly grew gram positive bacteria (9/21(42.9%) vs. 4/44(9.1%); p = 0.001), greater red cell transfusion, higher rates of cholestasis following NEC and differences in intestinal histopathology (more hemorrhagic and reparative lesions) on univariate analysis. Those with cerebellar injury had higher grade white matter injury (14/21 (66.7%) vs. 4/44(9.1%) p = 0.0005) and higher-grade ROP (70.6% vs. 38.5%; p = 0.027) than those without cerebellar injury. On multilogistic regression, the positive blood culture sepsis (OR 3.9, CI 1.1–13.7, p = 0.03), PDA (OR 4.5, CI 1.0–19.9, p = 0.04) and severe intestinal pathological hemorrhage (grade 3-4) (OR 16.9, CI 2.1–135.5, p = 0.007) were independently associated with higher risk of cerebellar injury. CONCLUSION: Preterm infants with surgical NEC with positive blood culture sepsis, PDA, and severe intestinal hemorrhagic lesions (grade 3-4) appear at greater risk for cerebellar injury. [ABSTRACT FROM AUTHOR]

Background: Intracerebral hemorrhages (ICH) and perihematomal edema (PHE) are respective imaging markers of primary and secondary brain injury in hemorrhagic stroke. In this study, we explored the potential added value of PHE radiomic features for prognostication in ICH patients. Methods: Using a multicentric trial cohort of acute supratentorial ICH (n = 852) patients, we extracted radiomic features from ICH and PHE lesions on admission non-contrast head CTs. We trained and tested combinations of different machine learning classifiers and feature selection methods for prediction of poor outcome—defined by 4-to-6 modified Rankin Scale scores at 3-month follow-up—using five different input strategies: (a) ICH radiomics, (b) ICH and PHE radiomics, (c) admission clinical predictors of poor outcomes, (d) ICH radiomics and clinical variables, and (e) ICH and PHE radiomics with clinical variables. Models were trained on 500 patients, tested, and compared in 352 using the receiver operating characteristics Area Under the Curve (AUC), Integrated Discrimination Index (IDI), and Net Reclassification Index (NRI). Results: Comparing the best performing models in the independent test cohort, both IDI and NRI demonstrated better individual-level risk assessment by addition of PHE radiomics as input to ICH radiomics (both p < 0.001), but with insignificant improvement in outcome prediction (AUC of 0.74 versus 0.71, p = 0.157). The addition of ICH and PHE radiomics to clinical variables also improved IDI and NRI risk-classification (both p < 0.001), but with a insignificant increase in AUC of 0.85 versus 0.83 (p = 0.118), respectively. All machine learning models had greater or equal accuracy in outcome prediction compared to the widely used ICH score. Conclusions: The addition of PHE radiomics to hemorrhage lesion radiomics, as well as radiomics to clinical risk factors, can improve individual-level risk assessment, albeit with an insignificant increase in prognostic accuracy. Machine learning models offer quantitative and immediate risk stratification—on par with or more accurate than the ICH score—which can potentially guide patients' selection for interventions such as hematoma evacuation. [ABSTRACT FROM AUTHOR]

Background: Perioperative ischemic stroke is a rare but devastating complication. Mechanical thrombectomy is a promising therapeutic method, but very little data is available on its efficacy and safety. This study aims to answer this question by comparing the clinical outcomes of perioperative and community-onset stroke patients after endovascular therapy. Methods: A retrospective cohort study was conducted on a total of 35 perioperative and 584 community-onset acute ischemic stroke patients who underwent endovascular thrombectomy at our hospital over the past 3.5 years. The recanalization rate, clinical recovery and cerebral hemorrhage within 90 days after therapy were compared between these two patient groups. Results: Endovascular thrombectomy provided perioperative and community-onset ischemic stroke patients with comparable rates of successful reperfusion (mTICI ≥2b grade) (97.1% vs. 97.3%; p = 0. 967) and favorable functional recovery (mRS ≤ 2) (51.4% vs. 43.3%, p = 0.348), with no increase in severe intracranial hemorrhage (0% vs. 2.6 and 1.0%, for hematoma ≥30% of infarcted tissue and intraventricular hemorrhage, respectively) within 90 days. In addition, perioperative stroke patients had higher prevalence of atrial fibrillation (42.9% vs. 26.7%; p = 0.038) and intracranial cerebral artery stenosis without clear embolism (17.1% vs. 3.8%; p < 0.001) than community-onset stroke patients. Conclusion: Endovascular thrombectomy is an effective and safe therapeutic approach for patients with perioperative ischemic stroke, although the results need to be validated by further studies with larger populations. Atrial fibrillation and large artery stenosis may contribute to the pathogenesis of perioperative ischemic stroke. [ABSTRACT FROM AUTHOR]

Background: Traditional Post-Intensive Care Recovery Clinics (PIRCs) often exclude neurocritical care patients. In 2020, a multidisciplinary team started Post Neuro Intensive Care Virtual Clinic (PREVAIL) that uses telemedicine to provide consultative care for patients with a primary neurologic injury who are at risk for post-intensive care syndrome. During clinic, critical care pharmacists perform medication reconciliations and provide drug therapy recommendations. Objectives: The objective of this observational review is to describe the pharmacists’ interventions and role in a novel PIRC. Methods: A retrospective, observational review was conducted for patients who were seen in PREVAIL from December 2020 to January 2022. The pharmacist completed a medication reconciliation and provided drug therapy recommendations. Results: Amongst fifty-two PREVAIL patients, the most common neurologic diagnosis was intracerebral hemorrhage, seizures, and acute ischemic stroke. All patients were mechanically ventilated during their ICU stay, with a median ICU length of stay of 17 days [IQR 10-26]. After medication reconciliation, 93% of patients required adjustments to their medication list. After patient examination, 89% of patients required a drug therapy recommendation, with a median of three interventions per patient. Various medication classes were intervened on, most frequently antipsychotics, anti-seizure medications, antihypertensives, anticoagulants, neuromodulators, and antidepressants. Conclusion: This is the first study to evaluate pharmacist contributions at a consultative telemedicine PIRC that focuses on providing care for patients with a primary neurologic injury. PREVAIL pharmacists have a crucial role in the multidisciplinary team. Future research is required to determine the pharmacist’s impact on clinical outcomes. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Rapid diagnosis of stroke and its subtypes is critical in early stages. We aimed to discover and validate blood‐based protein biomarkers to differentiate ischemic stroke (IS) from intracerebral haemorrhage (ICH) using high‐throughput proteomics.We collected serum samples within 24 h from acute stroke (IS & ICH) and mimics patients. In the discovery phase, SWATH‐MS proteomics identified differentially expressed proteins, which were validated using targeted proteomics in the validation phase. We conducted interaction network and pathway analyses using Cytoscape 3.10.0. We determined cut‐off points using the Youden Index. We developed three prediction models using multivariable logistic regression analyses. We assessed the model performance using statistical tests.We included 20 IS and 20 ICH in the discovery phase and 150 IS, 150 ICH, and six stroke mimics in the validation phase. We quantified 375 proteins using SWATH‐MS. Between IS and ICH, we discovered 20 differentially expressed proteins. In the validation phase, the combined prediction model including three biomarkers: GFAP (aOR 0.04; 95%CI .02–.11), MMP‐9 (aOR .09; .03–.28), APO‐C1 (aOR 5.76; 2.66–12.47) and clinical variables independently differentiated IS from ICH (accuracy: 92%, negative predictive value: 94%). Adding biomarkers to clinical variables improved discrimination by 26% (p < .001). Additionally, nine biomarkers differentiated IS from ICH within 6 h, while three biomarkers differentiated IS from mimics.Our study demonstrated that GFAP, MMP‐9 and APO‐C1 biomarkers independently differentiated IS from ICH within 24 h and significantly improved the discrimination ability of prediction models. Temporal profiling of these biomarkers in the acute phase of stroke is warranted. [ABSTRACT FROM AUTHOR]

Recently, neuroathletic training has been increasingly applied in competitive sports, in therapy, and in prevention. Scientific evidence on the effectiveness of this approach, however, has been poorly developed. Potentials of neuropathologic perceptual exercises to potentially improve balance control in the context of movement therapy in stroke rehabilitation appear promising. To investigate the possible effects of neuroathletic exercises on the balance ability of poststroke patients with ischemic infarcts and intracerebral hemorrhages, a controlled trial of a standardized protocol of daily neuroathletic exercises compared to traditional movement therapy during a four-week period of medical rehabilitation was conducted (n = 19). Patients were assessed with the Berg-Balance Scale (BBS), which represents the Gold standard for clinical measurement of balance. The results of the prepost BBS measurement showed significant balance improvements in the intervention and control groups, whereas the intervention group reached a higher total score by half the size of the standard deviation. A comparison of the results of both groups supported the general effectiveness of movement therapy for improving balance in stroke rehabilitation. However, neuroathletic training exercises did not lead to a stronger effect. Moreover, the intervention group did not score significantly lower than the control group. A negative influence can therefore not be assumed. For further investigations of neuroathletic training compared to treatment-as-usual training to improve balance in stroke rehabilitation, additional studies with larger sample sizes and longer treatment periods should be conducted. Trial registration United States National Library of Medicine, NCT06391801, date: 04.29.2024. [ABSTRACT FROM AUTHOR]

Objective To investigate the relationship between the changes of serum neurotransmitters and stress hormones and secondary brain injury (SBI) in acute stage of cerebral hemorrhage. Methods The data of 149 patients with intracerebral hemorrhage admitted to the hospital from January 2020 to December 2023 were retrospectively analyzed. The patients with intracerebral hemorrhage who developed SBI 5 days after treatment were divided into the group with SBI and the group without SBI. Serum neurotransmitters and stress hormones were measured before treatment and 3 days after treatment. The levels of serum neurotransmitters and stress hormones in patients with and without SBI were compared, the factors affecting the occurrence of SBI were analyzed, and the value of serum neurotransmitters and stress hormones in predicting the occurrence of SBI in patients with cerebral hemorrhage was analyzed. Results Logistic regression analysis showed acute physiological and chronic health status score Ⅱ, cerebral hemorrhage volume, gamma-aminobutyric acid (GABA) level and adrenocorticotropin releasing hormone (CRH) were the factors affecting the complication of SBI in patients with cerebral hemorrhage (P < 0.05). ROC curve analysis results showed that the sensitivity of GABA, CRH and their combined prediction of SBI in patients with cerebral hemorrhage were 68.29%, 70.73% and 85.37%, the specificity was 70.37%, 72.22% and 89.81%, and the AUC was 0.708（95%CI：0.604 ~ 0.813), 0.711（95%CI：0.597 ~ 0.825), 0.882 (95%CI：0.812 ~ 0.951). Conclusion Serum neurotransmitter GABA and stress hormone CRH are related to the complication of SBI in patients with cerebral hemorrhage, and the combination of GABA and CRH is effective in predicting the complication of SBI in patients with cerebral hemorrhage. [ABSTRACT FROM AUTHOR]

Background: Endoscopic hematoma evacuation is an efficient and secure minimally invasive procedure for intracerebral hemorrhages, characterized by a greater evacuation rate and reduced complications. Method: Pure endoscopic surgery without decompressive craniectomy was used to remove the clot in individuals with large putaminal intracerebral hemorrhage. The intracranial pressure was monitored after surgery. Conclusion: Endoscopic hematoma evacuation without decompressive craniectomy is safe and effective for patients with large putaminal intracerebral hemorrhage. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to investigate the relationship between platelet-to-red cell distribution width ratio (PRR) and all-cause mortality in critically ill patients with non-traumatic cerebral hemorrhage (NCH). Methods: The Medical Information Mart for Intensive Care (MIMIC-IV) database was used to identify patients with NCH who needed to be admitted to intensive care unit (ICU). The outcomes of the study included both ICU and in-hospital mortality. Restricted cubic splines and Cox proportional hazards regression analysis were used to clarify the relationship between PRR and clinical outcomes in critically ill patients with NCH. Results: A total of 3,094 patients (54.0% male) were included in the study, with in-hospital mortality and ICU mortality rates of 16.5 and 11.8%, respectively. A substantial correlation was found by multivariate Cox proportional hazards analysis between increased PRR and a lower risk of in-hospital and ICU mortality. Following adjustment for confounding factors, patients with elevated PRR exhibited a significantly decreased risk of in-hospital death (HR, 0.98; 95% CI, 0.96–0.99; p = 0.006) and ICU death (HR, 0.98; 95% CI, 0.96–0.99; p = 0.027). As PRR increased, restrictive cubic splines showed a progressive decrease in the probability of all-cause mortality. Stratified analyses indicated a consistent association between PRR and both in-hospital and ICU mortality. Conclusion: Among critically ill patients with NCH, lower PRR was substantially correlated with the increased probability of all-cause mortality in both the ICU and hospital. According to this research, PRR might be a valuable indicator for identifying NCH patients at risk of all-cause mortality. [ABSTRACT FROM AUTHOR]