Clinical significance and the expression of NT-proBNP and copeptin in patients with acute cerebral hemorrhage / 重庆医学

Objective To investigate the relationship of plasma concentration of NT-proBNP,copeptin and glasgow coma scale(GCS)scores,hematoma volumes in patients with acute cerebral hemorrhage.Methods 109 patients with acute cerebral hem-orrhage(the cerebral hemorrhage group)and 32 healthy individuals (the control group)admitted in our hospital from December 2011 to June 2013 were selected and detected for plasma NT-proBNP and copeptin.The levels of NT-proBNP,copeptin,glasgow co-ma scale(GCS)scores and hematoma volumes were compared between the two groups.Results The levels of plasma NT-proBNP and copeptin in the cerebral hemorrhage group were significantly higher than that in control group(P <0.05).The levels of plasma NT-proBNP and copeptin were significantly increased with the severity and the hematoma volume of the acute cerebral hemorrhage. The levels of NT-proBNP and copeptin are positively correlated with hematoma volumes(r=0.63,r=0.58,P <0.01)and negative-ly correlated with Glasgow Coma Scale(GCS)scores(r=-0.52,r=-0.46,P <0.01).Conclusion The levels of NT-proBNP and copeptin are positively correlated with hematoma volumes and negatively correlated with glasgow coma scale(GCS)scores.They are important clinical parameters to reflect the severity and hematoma volumes of the acute cerebral hemorrhage.

Factors influencing the outcome of patients with acute extradural haematomas undergonig surgery.

Background: Acute extradural haematoma (EDH) remains most common cause of mortality and disability resulting from traumatic brain injury. In the last three decades, improvements in rescue, neuromonitoring, diagnostic procedure and intensive care have led to better outcomes. The purpose of this study was to evaluate the factors influencing the outcome in patients with EDH undergoing surgery treated in a tertiary hospital in Bangladesh. Methods: In this retrospective study, 102 consecutive patients with acute EDH who underwent craniotomy were included. The study was carried out from July 2003 to December 2005. The diagnosis was made clinically and radiologically by CT scan. Patients were grouped on the basis of Glasgow Coma Scale (GCS) and operative outcomes were evaluated by Glasgow Outcome Scale (GOS) Results: More than half sampled respondents’ (57%) age were more than 20 years while rests of the patients below 20 years with male predominance (Male: Female -12:1). About 7 in 10 respondents (70.6%) were working. Similarly, majority of the respondents (79.4%) had lost more than 30 ml blood. A notable proportion of the respondents (73.5%) had good GCS score (9-15 score) during admission. Similarly majority of the respondents (70.6%) had GCS score 9-15 and 29.4% had GCS score 3-8 before surgery. Road Traffic Accident (RTA) (65%) is the most common cause of EDH followed by assault (20%) and fall from height (12%). Temporal and temporo-parietal locations were the most common site of EDH (56%). Patients with good GCS before surgery had significantly better outcome (89%) compare to those who had bad GCS (10%). Conclusion: Level of consciousness before surgery is the most important factor affecting the outcome. Hence, early diagnosis and surgical intervention is very essential.

The Clinical Analysis of Alcohol and Creatine Kinase-BB(CK-BB) in Acute Head Injury

Patients suffering a head-injury were often drinking alcohol shortly before the trauma, and it has been suggested that the degree of brain damage may be exacerbated due to high alcohol serum levels. To evaluate this, we assessed the level of consciousness, alcohol and creatinine kinase-bb(CK-BB) serum levels in 140 consecutive head-injured patients. Level of consciousness(GCS score) was strongly correlated to outcome(p<0.001) and serum CK-BB(P<0.05), but not to alcohol serum levels.

Comparative Analysis of Management of Intracerebral Hematoma

Retrospective analysis of 46 patients with intracerebral hematoma showed that the attack was most frequent in sixth decade and more prevalent in female. The most common cause of the attack was hypertension(80%) and the site of hemorrhage was putamen 32%, thalamic area 15%, subcortical area 7%, cerebellum 17%, ventricle 3%, and brain stem 4%. Mortality of total cases was 36% and there was no difference of mortality in both conservatively or operatively treated group(38% in conservative group, and 35% in operative group). The prognosis of the patient was unfavorable in the group of poor pretreatment Glasgow coma scale(GCS) and those of cases demonstrated more than 30cc of hematoma on computerized tomography(CT) of the brain. The improvement of GCS after management was better in operative group than in the conservative group.

Clinical Analysis of Interhemispheric Subdural Hemorrhage and Tentorial Hemorrhage

A propecive analysis of 50 patients with acute interhemisphric subdural hemorrhage and tentorial hemorrhage, an unusual pattern of acute subdural hematoma, who were managed in a uniform way was analyzed to related outcome to hemorrhagic site, initial Glasgow Coma Scale(GCS) and combined injuries. The incidence of acute interhemisphric subdural hemorrhage(ISH) and tentoria hemorrhage(TH) after head trauma was 3.83%, 50 cases among 1303 head injured cases. And 80% of the above hemorrhage disapperaed within two weeks after trauma. There was no significant relationship between feature of hemorrhage and intial GCS(P>0.05), but there was highly significant relationship between initial GCS and Glasgow Outcome Scale(GOS) (p<0.001). There noted significant relationship between initial combined injury and GOS(p<0.01), and also brainstem injury and GOS(p<0.001).

Clinical Analysis of Cranial Nerve Injuries in Craniocerebral Trauma

The clinical analysis of cranial nerve injuries was performed on 435 cases with cranoicrerbral trauma. This prospective study included the correlation between cranial nerve injuries and risk factors such as intracranial hematoma, initial Glasgow Coma Scale(GCS) score, pneumocephalus, and other combined injuries. The results were revealed as follows : 1) 133 cranial nerve injuries(on 97 patients) were noted among 435 craniocerebral trauma victims(97/435=22.2%). 2) The order of frequent cranial nerve injuries was facial nerve(7.3%), olfactory nerve(6.9%), oculomotor nerve(4.4%), abducens nerve(3.9%), optic nerve(3.2%), etc. 3) Bilateral involvment of cranial nerve injuries was noted in 16.5%(22/133). 4) The incidence of immediate onset of cranial nerve injuries was 66.9%(89/133). 5) The incidence of cranial nerve injuries was significantly high in patients with pneumocephalus and low initial GCS score. 6) The functional recovery of injured cranial nerve within 3 months was noted in 30.1%(40/133).

Clinical Analysis of Traumatic Basal Ganglia Hematoma(TBGH)

Recently, the detection of traumatic intracerebral hematoma has been greatly expedited by the advent of computed tomography. However, Traumatic Basal Ganglia Hematoma(TBGH) has remained rare and its prognosis has been regarded as poor. The authors obtained following results from the analysis of clinical features and outcome on 50 cases of TBGH who has been treated at the department of neurosurgery, Wonju Christian Hospital from January, 1984 to June, 1988. 1) The incidence of TBGH was 2% of all head-injured patients. 2) The average age of patient was 26.6 years, and the most common cause was motorvehicular accident(80%). 3) The clinical features revealed mental deterioration on 44 cases, followed by motor weakness(23 cases), and decerebrate rigidity(16 cases). 4) The frequent location of hematoma was putamen(27 cases, >50%), internal capsule(9 cases, 14%). 5) The combined lesion showed mostly lower GCS(Glasgow Coma Scale) than solitary lesion(P<0.001). 6) The groups of both GCS above 8(P<0.001) and small hematoma volume below < 15ml(P<0.001) showed relatively good outcome.