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@#Objective This study aimed to analyze the difference of clinical characteristics and risk factors for poor outcome between young patients and senior patients with spontaneous brainstem hemorrhage. Methods This was a retrospective study.The patients with spontaneous brainstem hemorrhage who presented to the Nanjing Drum Tower Hospital from January 2013 to January 2021 were enrolled in this study.They were divided into two groups:Youth group (18-59 years old) and Senior group (60-90 years old).General information and clinical data were collected.Univariate analysis was used to compare the clinical characteristics of the two groups,and multivariate logistic regression was used to analyze the independent risk factors for poor prognosis. Results A total of 202 eligible patients were enrolled in this study,including 136 patients in the Youth group and 66 patients in the Senior group.Univariate analysis of the clinical data from the two groups demonstrated that the prevalence of poor outcome,the proportion of male patients,coma on admission,surgery operation,complicated pneumonia and the average NIHSS score,volume of hematoma,DBP,TG were significantly higher in the Youth group than the Senior group (P<0.05).The average GCS score was remarkably lower in the Youth group(P<0.05).Early coma,low GCS score,high NIHSS score,large volume of hematoma,poor glycemic control,complicated pneumonia and Acinetobacter baumannii infection were risk factors for poor prognosis of both group.Multivariate logistic regression showed that low GCS score was an independent predictor for poor prognosis of both group. Conclusion Young patients with spontaneous brainstem hemorrhage had worse prognosis than elderly patients.Avoiding or effective control of risk factors might ameliorate the final outcome.
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The incidence of spontaneous brainstem hemorrhage is about 10% of primary intracerebral hemorrhage, but its mortality and disability rate are much higher than other diseases.The anatomical characteristics and dense functional nuclei of the brain stem are closely related to the high difficulty of operation for brain stem hemorrhage.The surgical treatment of primary brain stem hemorrhage is divided into two types: craniotomy hematoma removal and hematoma aspiration.At present, there is no unified consensus on the surgical indications for brainstem surgery, and the support of large-scale multicenter clinical observation results and evidence-based medicine evidence is lacking.None of the existing treatment methods has made a breakthrough in the treatment of brainstem hemorrhage, and doctors are often confused because of the lack of evidence in clinical work.It is of positive significance to seek an effective treatment for brainstem hemorrhage.
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Objective To investigate the role of three-dimensional (3D) reconstruction based parameters of hematoma cavity and encephalocoele in predicting hematoma expansion and hospitalized poor outcome in patients with primary brainstem hemorrhage (PBH). Methods Thirty-two PBH patients met research criterion were enrolled from intensive care unit (ICU) between June 2015 and December 2017. Baseline clinical characteristics, CT images on admission and within 48 h of admission were collected. The 3D reconstruction of hematoma cavity and encephalocoele based on CT images was performed by Mimics10.0, and quantity of triangles per square milimet surface (TQOT/mm2), and hematoma volume (HV) and encephalocoele volume (EV) were obtained. All patients were divided into hematoma expansion group and non-hematoma expansion group according to whether hematoma expansion appeared (hematoma expanded>33％ within 48 h of admission as compared with that on admission), and hospitalized poor outcome group and hospitalized non-poor outcome group according to whether hospitalized poor outcome appeared (modified Rankin scale scores>4 at discharge or hospitalized deaths), respectively. The risk factors of hematoma expansion were investigated by multivariable Logistic regression analysis. Multivariable Cox hazard regression was used to analyze the risk factors of poor outcome; Kaplain-Meier survival curve analysis and Log-rank test were used to compare the differences in survival curves between independent risk factors screened by Cox regression analysis. Results There were 11 patients (34.4％) with hematoma expansion and 14 (43.8％) with ventriculomegaly in 32 patients; in these 11 patients with hematoma expansion, 8 had ventriculomegaly, and the two had positive correlation (rp=0.423, P=0.016). Fifteen patients (46.9％) had poor outcome, in which 11 (34.4％) died in hospital; 5 had hematoma expansion and 8 had ventriculomegaly. Multivariate Logistic regression analysis showed that baseline lactate >2.0 mmol/L (OR=11.986, 95％CI: 1.084-132.552, P=0.043) and TQOT/mm2>2 (OR=10.223, 95％CI: 1.424-73.396, P=0.021) were independent risk factors of hematoma expansion. Baseline HV (HR=1.102, 95％ CI: 1.020-1.143, P=0.002) and EV (HR=3.485, 95％ CI:1.071-11.463, P=0.040) were risk factors of hospitalized poor outcome identified by multivariable Cox analysis. Kaplan-Meier survival analysis showed that the hospitalization days of hospitalized poor outcome were (74.0±10.6) d and (25.5±7.0) d between patients have hematoma expansion Cut-off value of 7 mL, with significant difference (Log-rank: χ2=11.832, P=0.001), and the hospitalization days of hospitalized poor outcome in patients with and without ventriculomegaly were (68.1±9.0) d and (29.9± 8.8) d, respectively, with significant difference (Log-rank: χ2=7.483, P=0.006). Conclusions There is correlation between hematoma expansion and ventriculomegaly; patients with TQOT/mm2>2 might have high risk of hematoma expansion; patients with baseline HV>7 mL and ventriculomegaly would sooner have hospitalized poor outcome.
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OBJECTIVE:To observe therapeutic efficacy and safety of Shensong yangxin capsules in the treatment of brainsten hemorrhage complicated with cerebrocardiac syndrome(CCS)accompanied by arrhythmia. METHODS:Medical information of 98 patients with brainstem hemorrhage complicated with CCS arrhythmia were analyzed retrospectively and divided into control group (49 cases)and observation group(49 cases)according to drug use. Control group was given routine treatment as mannitol and pi-racetam. Observation group was additionally given Shensong yangxin capsules 1.2 g orally or via nasal feeding,3 times a day,on the basis of control group. Treatment course of 2 groups lasted for 4 weeks. Clinical efficacies of 2 groups were observed as well as the levels of catecholamine [norepinephrine(NE),epinephrine(E),dopamine(DA)],ET-1 and NO,the occurrence of ADR be-fore and after treatment. RESULTS:Total response rate of observation group was significantly higher than that of control group (75.5% vs. 46.93%),with statistical significance(P0.05). 3 and 7 d after treatment,the levels of NE,E,DA,ET-1 and NO in 2 groups were significantly lower than before,and the observation group was significantly lower than the control group,with statisti-cal significance(P0.05). CONCLU-SIONS:Based on routine treatment,Shensong yangxin capsules shows significant therapeutic efficacy for CCS,can reduce levels of catecholamine and doesn't increase the occurrence of ADR.
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Objective To investigate the clinical and imaging features of hypertrophic olivary degeneration (HOD) secondary to brain-stem hemorrhage. Methods The clinical data of one patient with HOD secondary to brainstem hemorrhage was retrospectively analyzed. Re-sults The patient was hospitalized with paroxysmal and body involuntary jitter and other extrapyramidal symptoms. After admission, MRI scan showed bilateral inferior olive nucleus of medulla oblongata were localized hypertrophy. Conclusion The main clinical manifestation of HOD secondary to brainstem hemorrhage is extrapyramidal symptom. The imaging features are abnormal signals and localized hypertro-phy at inferior olive nucleus.
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Objective To study the surgical indication,surgical method and effectiveness of endoscope-assisted microscopic surgery for brainstem hemorrhage with hematoma breaking into the forth ventricle.Methods Eleven patients having brainstem hemorrhage with hematoma breaking into the forth ventricle,admitted to our hospital from October 2002 to February 2012 and performed endoscope-assisted microscopic surgery via suboccipital trans-fourth ventricle approach,were chosen in our study; retrospective analysis of their clinical data and outcomes was performed.Results Postoperative CT scan on all 11 patients showed that 87.2％-98.9％ (average 94.3％) of the brainstem hematomas in volume were removed.Follow up for 4 months to 2 years showed that neurological outcome improved significantly in 2 patients,moderate disability in 3 patients,severe disability in 2 patients and vegetative state in 1 patient.Three patients died.Conclusion Endoscope-assisted microscopic surgery of brainstem hemorrhage with hematoma breaking into the forth ventricle is minimally invasive and effective with direct-vision; it also improve good neurological outcomes.
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Objective - To analyze the relation between classes and prognosis of the brain.stem hemorrhage.Methods 37 patients with spontaneous brainstem hemorrhage were divided into three groups according to con-sciousness and breathing function: Ⅰ group 13 cases with consciousness; Ⅱ group 11 cases without consciousness; Ⅲgroup 13 cases without consciousness and respiration, according to the classes, using different ways and means. Re-suits Ⅰ group 13 cases survival in 13 cases; Ⅱ group 10 cases survival and 1 case death in 11 cases; Ⅲ group 1 case survival and 12 cases death in 13 eases. Conclusion The classes of the brain.stem hemorrhage is propitious to select therapeutic measure and prognostic estimate. The intensive care and the surgery can reduce mortality rate.