Neuroendoscopic Parafascicular Evacuation of Spontaneous Intracerebral Hemorrhage (NESICH Technique): A Multicenter Technical Experience with Preliminary Findings

Neurology and Therapy, Journal Year: 2024, Volume and Issue: 13(4), P. 1259 - 1271

Published: June 24, 2024

Intracerebral hemorrhage (ICH) is a severe manifestation of stroke, demonstrating notably elevated global mortality and morbidity. Thus far, effective therapeutic strategies for ICH have proven elusive. Currently, minimally invasive techniques are widely employed management, particularly using endoscopic hematoma evacuation in cases deep ICH. Exploration to achieve meticulous surgery diminish iatrogenic harm, especially the corticospinal tract, with objective enhancing neurological prognosis patients, needs further efforts. We comprehensively collected detailed demographic, clinical, radiographic, surgical, postoperative treatment recovery data patients who underwent removal. This thorough inclusion intends offer comprehensive overview our technical experience this study. One hundred fifty-four eligible supratentorial intracerebral removal were included The mean volume was 42 ml, 74 instances left-sided 80 right-sided hematoma. median Glasgow Coma Scale (GCS) score at admission 10 (range from 4 15), time symptom onset 18 2 96) h. clearance rate 89%. rebleeding rates within 1 month after 3.2% 7.8%, respectively. At 6-month mark, proportion modified Rankin (mRS) scores 0–3 58.4%. Both reduction surgery-related injury protection residual tract through may potentially enhance functional outcomes ICH, warranting validation forthcoming multicenter clinical

Language: Английский

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Predictors and lesion patterns of dysphagia and swallowing outcomes after acute intracerebral hemorrhage

Therapeutic Advances in Neurological Disorders, Journal Year: 2025, Volume and Issue: 18

Published: Jan. 1, 2025

Dysphagia is a common complication following intracerebral hemorrhage (ICH) and associated with an increased risk of aspiration pneumonia poor outcomes. This study aimed to explore lesion patterns contributing factors post-ICH dysphagia, predict dysphagia outcomes ICH. A multicenter, prospective study. Patients ICH from two stroke centers within 72 h symptom onset received baseline bedside swallowing evaluations. Dysphagia-related were identified using support-vector regression-based lesion-symptom mapping. Predictors impairment on the 7th 30th day, as well stroke-associated (SAP), determined through multiple logistic regression analyses, nomograms developed. total 153 patients included in final analysis. Of those, 28 had dysphagia. lesions predominantly affected bilateral subcortical adjacent cortical regions. Stroke severity, hematoma expansion, basal ganglia significantly initial Baseline age independent predictors impaired function days 7 30, SAP. Moreover, volume was correlated day SAP occurrence. Midline shift remained 30. Predictive models for SAP, demonstrated strong calibration discriminatory ability, C indices 0.867, 0.895, 0.773, respectively. Post-ICH can be predicted based hemorrhage. Incorporating imaging evaluation further improve identification at high both 1 week month after

Language: Английский

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Risk factors of posthemorrhagic seizure in spontaneous intracerebral hemorrhage

Neurosurgical Review, Journal Year: 2025, Volume and Issue: 48(1)

Published: Jan. 23, 2025

Language: Английский

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Validation of the Boston Criteria Version 2.0 for Cerebral Amyloid Angiopathy in Patients Presenting With Intracerebral Hemorrhage

Neurology, Journal Year: 2025, Volume and Issue: 104(7)

Published: March 3, 2025

Cerebral amyloid angiopathy (CAA) is a leading cause of lobar intracerebral hemorrhage (ICH) in older individuals, associated with significant morbidity and recurrence. The updated Boston criteria version 2.0 (v2.0) incorporate new MRI biomarkers to improve diagnostic accuracy. This study aimed validate the performance v2.0 compared 1.5 (v1.5) patients spontaneous ICH undergoing surgical evacuation brain biopsy. retrospective single-center cohort was conducted at Mount Sinai Health System from 2015 2021. Patients who underwent biopsy preoperative were included. markers assessed included hemorrhagic lesions (ICH, cerebral microbleeds [CMBs], cortical siderosis [cSS]) nonhemorrhagic (severe visible perivascular spaces centrum semiovale [CSO-PVS] multispot white matter hyperintensities [WMHs]). Pathologic confirmation CAA based on modified Vonsattel grading, which evaluates β-amyloid deposition vessel walls. Diagnostic v1.5 using sensitivity, specificity, predictive values. Logistic regression models calculated odds ratios (ORs) 95% CIs for associations between pathologically confirmed CAA. Among 186 (median age: 63 years; 38% female), 24% had demonstrated higher sensitivity probable (0.75 vs 0.57) while maintaining specificity (0.96 0.99). For possible CAA, improved modestly (0.82 0.77) comparable (0.84 0.87). markers, cSS (OR 4.14, CI 1.35-13.00, p = 0.013) CMBs 3.03, 1.31-7.10, 0.009) significantly CSO-PVS strongly 5.49, 2.37-13.06, < 0.001) WMHs not 1.10, 0.45-2.56, 0.834). enhance diagnosing without compromising largely due inclusion such as CSO-PVS. Limitations include design, absence formal inter-rater reliability measures, modest sample size. These findings underscore potential framework

Language: Английский

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The clinical value of triglyceride to high-density lipoprotein cholesterol ratio for predicting stroke-associated pneumonia after spontaneous intracerebral hemorrhage

BMC Neurology, Journal Year: 2025, Volume and Issue: 25(1)

Published: April 9, 2025

Stroke-associated pneumonia (SAP) is relevant to the poor functional outcomes of patients with spontaneous intracerebral hemorrhage (SICH). It unclear if triglyceride (TG) high-density lipoprotein cholesterol (HDL-C) ratio (TG/HDL-C) related risk SAP in SICH patients. This study aimed investigate association between TG/HDL-C and Consecutive were enrolled this retrospective study. Relevant clinical variables extracted from electronic medical records. All participants divided into (n = 71) non-SAP 187) groups. Multivariate binary logistic regression analysis was used explore SAP. The optimal cutoff value defined by receiver operating characteristic (ROC). Among 258 patients, 71 (27.5%) had Patients older (72.75 ± 11.10 vs. 64.81 12.70 years), a lower TG, higher HDL-C, than group. an independent protective factor for (adjusted OR 0.516, 95% CI 0.339-0.784) after adjusting factors. According ROC analysis, > 1.09 decreased [area under curve (AUC) 0.705; sensitivity 76.1% specificity 59.4%]. independently associated 0.285, 0.138-0.591 ) adjustment. suggests that increased SICH.

Language: Английский

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A Prospective Cohort Study of Elevated Serum NLRP1 Levels to Prognosticate Neurological Outcome After Acute Intracerebral Hemorrhage at a Single Academic Institution

Neuropsychiatric Disease and Treatment, Journal Year: 2024, Volume and Issue: Volume 20, P. 737 - 753

Published: March 1, 2024

Background: Nucleotide-binding oligomerization domain-like receptor family pyrin domain-containing 1 (NLRP1) participates in neuroinflammation.This study aimed to identify serum NLRP as a potential prognostic biomarker of acute intracerebral hemorrhage (ICH).Methods: This prospective cohort enrolled 145 patients with supratentorial ICH and 51 healthy controls.Serum NLRP1 levels were quantified on admission all patients, days 1, 3, 5, 7, 10 after stroke at entry into the controls.Poststroke 6-month modified Rankin Scale (mRS) scores 3-6 signified poor prognosis.Results: Compared controls, had prominently increased until day ICH, highest 3. Serum independently correlated National Institutes Health Stroke (NIHSS) scores, hematoma volume six-month mRS predicted bad prognosis.A linear relationship was observed between risk prognosis restricted cubic spline.Under receiver operating characteristic (ROC) curve, efficiently discriminated prognosis.Serum NLRP1, NIHSS, merged prediction model, which portrayed using nomogram.Good performance model verified calibration decision ROC curve.Conclusion: are elevated during early period following related hemorrhagic severity prognosis, suggesting that may represent promising ICH.

Language: Английский

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Predicting the recurrence of spontaneous intracerebral hemorrhage using a machine learning model

Frontiers in Neurology, Journal Year: 2024, Volume and Issue: 15

Published: May 22, 2024

Background Recurrence can worsen conditions and increase mortality in ICH patients. Predicting the recurrence risk preventing or treating these patients is a rational strategy to improve outcomes potentially. A machine learning model with improved performance necessary predict recurrence. Methods We collected data from two hospitals for our retrospective training cohort prospective testing cohort. The outcome was within one year. constructed logistic regression, support vector (SVM), decision trees, Voting Classifier, random forest, XGBoost models prediction. Results included age, NIHSS score at discharge, hematoma volume admission PLT, AST, CRP levels admission, use of hypotensive drugs history stroke. In internal validation, regression demonstrated an AUC 0.89 precision 0.81, SVM showed 0.93 0.90, forest achieved 0.95 0.93, scored 0.92. external 0.81 0.79, obtained 0.87 0.76, reached 0.92 0.86, recorded 0.91. Conclusion performed better predicting than traditional statistical models. best comprehensive

Language: Английский

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The Venular Side of Cerebral Amyloid Angiopathy: Proof of Concept of a Neglected Issue

Biomedicines, Journal Year: 2023, Volume and Issue: 11(10), P. 2663 - 2663

Published: Sept. 28, 2023

Small vessel diseases (SVD) is an umbrella term including several entities affecting small arteries, arterioles, capillaries, and venules in the brain. One of most relevant prevalent SVDs cerebral amyloid angiopathy (CAA), whose pathological hallmark deposition fragments walls cortical leptomeningeal vessels. CAA frequently coexists with Alzheimer’s Disease (AD), both are associated cerebrovascular events, cognitive impairment, dementia. AD share pathophysiological, histopathological neuroimaging issues. The venular involvement has been neglected, although animal models human studies found a beta venules. This review aimed to summarize available information about CAA, starting from biological level putative pathomechanisms damage, passing through definition peculiar angioarchitecture cortex functional organization consequences arteriolar occlusion, ending hypothesized links between main markers disease.

Language: Английский

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Remote Ischemic Conditioning to Reduce Perihematoma Edema in Patients with Intracerebral Hemorrhage (RICOCHET): A Randomized Control Trial

Journal of Clinical Medicine, Journal Year: 2024, Volume and Issue: 13(9), P. 2696 - 2696

Published: May 3, 2024

Background: Early perihematomal edema (PHE) growth is associated with worse functional outcomes at 90 days. Remote Ischemic conditioning (RIC) may reduce inflammation if applied early to patients intracerebral hemorrhage (ICH). We hypothesize that RIC, delivered for seven days in spontaneous ICH, PHE growth. Methods: ICH presenting within 6 h of symptom onset and hematoma volume < 60 milliliters (mL) were randomized an RIC + standard care or (SC) group. The primary outcome measure was calculated extension distance (EED), the cm assessed on day seven. Results: Sixty a mean ± SD age 57.5 10.8 years, twenty-two (36.7%) female. relative baseline median similar (RIC group 0.75 (0.5–0.9) mL vs. SC 0.91 (0.5–1.2) mL, p = 0.30). EEDs 0.58 (0.3–0.8) 0.51 cm, 0.76). There no difference 7 EED 1.1 (0.6–1.2) 1 (0.9–1.2) 0.75). Conclusions: therapy daily feasible. However, decrease noted intervention.

Language: Английский

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Etiology, Risk Factors and Outcome of Spontaneous Intracerebral Hemorrhage in Young Adults Admitted to Tertiary Care Hospital in Mogadishu, Somalia

International Journal of General Medicine, Journal Year: 2024, Volume and Issue: Volume 17, P. 2865 - 2875

Published: June 1, 2024

Introduction: Spontaneous Intracerebral hemorrhage (ICH) in young patients is less common and not well studied compared to ICH older patients. The etiology, risk factors outcome of may have regional ethnic differences. study aims investigate the clinical characteristics, factors, etiology spontaneous intracerebral adults Somalia. Methods: enrolled 168 with (16– 50 years) admitted neurology department a tertiary hospital from 2019 2022. information about demographic details, documented patients' status were retrieved. was determined based on clinical, laboratory radiological findings. Intra-hospital survival associated assessed. Results: mean age 35± 8.6 years. 99 (59%) male while 69 (41%) females. Hypertension 48 (29%) most factor, followed by substance abuse. Hypertensive 60 (35.7%), cerebral venous thrombosis (CVT) 5(15%), abuse 23 (13.7%) arteriovenous malformation (AVM) 10 (6%). AVM, CVT, cavernoma, eclampsia, cryptogenic more 2nd 3rd decades whereas hypertension 4th 5th decade. Intrahospital mortality 28% this study. Factors predicting intrahospital hematoma volume greater than 30mL, thrombolytic brainstem location, related presence mass effect, low GCS score admission, high systolic blood pressure chronic renal failure. Conclusion: In study, hypertension, abuse, CVT vascular are leading causes adults. has different spectrum etiologies short-term Keywords: hemorrhages, patients,

Language: Английский

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