Management of spontaneous large intra cerebral hematoma with minimal invasive procedure (twist drill burr hole) with fibrinolytic therapy

Background: Spontaneous intracerebral haemorrhage (ICH) is associated with the high mortality among cerebrovascular events, and most of the survivors end with significant morbidity. Spontaneous intracerebral haemorrhage (ICH) is the second most common cause of stroke comprising 7.5-30% of all strokes. Surgery mainly helps in decrease in secondary injury and early rehabilitation. Aim: To analyse the outcome and advantages of minimal invasive surgery i.e., burr hole or twist drill craniostomy with intraclot streptokinase injection to dissolve clot and aspiration to reduce mass effect in primary intracerebral hematoma, this help to prevent secondary injury and recovery of salvageable brain. Materials and methods: Prospective study was done over from November 2014 to January 2017 in our department for the patients of spontaneous large intra cerebral hematoma > 80ml who underwent clot evacuation with fibrinolytic therapy with minimally invasive procedure with twist drill burr hole. Total 62 patients were included in the study. All the patients were followed with CT sequential scans to see for the clot size and followed with clinical status. Karla Ravi, Nandigama Pratap Kumar, Ginjupally Dhanunjaya Rao, Savarapu Sai Kalyan, Gollapudi Prakash Rao. Management of spontaneous large intra cerebral hematoma with minimal invasive procedure (twist drill burr hole) with fibrinolytic therapy. IAIM, 2017; 4(11): 229-240. Page 230 Results: Our analysis of 62 patients was consistent with the hypothesis that hematoma evacuation leads to improved neurological outcome, the outcome has been correlated with the rate of clot reduction. Conclusion: Minimally invasive surgery is a safe and effective option in the management of spontaneous ICH especially in the patients whom major surgical procedures pose a significant risk. MIS is associated with lower mortality and better outcomes compared to surgical evacuation or conservative management. Our study have clearly shown an improved outcome after minimally invasive surgery and still there is some emptiness to determine the exact protocol to insist these type of studies to deal with bed occupancy and a burden to the society.

Clinical Study of the Time-effect Relationship between Acupuncture and the Absorption of Cerebral Hematoma and Edema in the Acute Stage of Cerebral Hemorrhage / 上海针灸杂志

Objective To observe the time-effect relationship between acupuncture treatment and the absorption of cerebral hematoma and edema in the acute stage of cerebral hemorrhage to determine the optimal time for acupuncture intervention in cerebral hemorrhage.Methods Three hundred patients with cerebral hemorrhage in the acute stage were randomly allocated to treatment groups 1, 2, 3 and 4, and control group, 60 cases each. The control group received symptomatic treatment for regulating blood pressure, reducing intracranial pressure by dehydration, maintaining electrolyte balance, nourishing nerves and preventing and treating complications. The treatment groups were given acupuncture in addition. Treatment group 1 received acupuncture at 24 hrs after the attack; treatment group 2, at 72 hrs; treatment group 3, at one week; treatment group 4, at two weeks. Pre-/post-treatment hematoma size parameter difference value and cerebral peripheral edema grade parameters were observed in every group.Results There were statistically significant pre-/post-treatment differences in hematoma size and cerebral edema grade in every group (P<0.01,P<0.05). There were statistically significant post-treatment differences in hematoma size and cerebral edema grade between every treatment group and the control group (P<0.05). There were statistically significant post-treatment differences in hematoma size and cerebral edema grade between treatment group 1, 2 or 3 and treatment group 4 (P<0.05), between treatment group 1 or 2 and treatment group 3 (P<0.05) and between treatment groups 1 and 2 (P<0.05).Conclusions Acupuncture has a positive therapeutic effect in patients with cerebral hemorrhage in the acute stage. The earlier acupuncture intervention in the acute stage of cerebral hemorrhage, the more remarkable the effect.

Strategies for the treatment of hypertensive cerebral hemorrhage: Minimally invasive puncture approach or key hole in the evacuation / 中国综合临床

Objective To compare the efficacy, complications, safety and prognosis of the minimally invasive puncture approach and key hole in the treatment of hypertensive cerebral hematoma.Methods A totol of 68 patients with hypertensive cerebral hematoma confirmed by CT from April 2012 to October 2013 in Nongken Sanya Hospital were randomly divided into key hole evacuation group(n=32) and minimally invasive puncture group (n =36).Comparisons were made between the two surgical methods in the operative time, postoperative complications, the fatality and the postoperative re-haemorrhagia rate, neurological function deficit score also been observed and evaluated in the 1 st,2nd and 4th weeks after surgery.Results The NFDS scores of the two groups both decreased in the 1st week after surgery,but compare with preoperative the difference was not statistically significant (P ＞ 0.05).In the 2nd weeks and 4th weeks after surgery, NFDS scores further decreased in both group,and there was statistically significant compare with preoperative(the key hole evacuation group : (26.2±4.5) vs.(17.8 ± 3.6) vs.(44.1 ± 5.4) scores;the minimally invasive puncture group: (22.1 ± ±3.7) vs.(15.4±2.8) vs.(43.9±6.2)scores;P＜0.05) ,but during the same period there was no significant difference between the two groups with NFDS scores(P＞0.05).The rebleeding rate of the minimally invasive puncture group was significantly lower than the key hole evacuation group (4.08％ vs.16.33％, x2=6.56, P＜0.05).There was no significant difference in mortality rate and long term total effect between two groups (P＞0.05).Conclusion Although both key hole and minimally invasive puncture are effective measures for treatment of hypertensive cerebral hemorrhage, but minimally invasive puncture with less trauma, definite curative effect and higher security advantages in clinical.

Herpes Meningoencephalitis Complicated by Cerebral Hematomas During Acyclovir Therapy / 대한뇌졸중학회지

Petechial cortical hemorrhages are common in Herpes simplex virus (HSV) encephalitis, however, cerebral hematoma is extremely rare. We report a case of a 47-year-old immunocompetent woman diagnosed with herpes encephalitis but complicated by cerebral hematoma despite of early diagnosis and treatment.

Cerebral Protection by Zhuyu Annao Pill against Cerebral Hemorrhage in Model Rats / 中国药房

OBJECTIVE:To observe the protective effect of Zhuyu annao pill on model rats against cerebral hemorrhage. METHODS:The experimental rats were randomized to 6 groups:blank group,model group,Angong liuhuang pill group,Zhuyu annao pill high,medium and low dosage groups. Cephalophyma model of rats were duplicated with rats' autoblood clot; the neurologic impairment change was recorded by integration method; the water content of the brain tissue was measured by dry-wet specific density method; meanwhile,the changes in hemorheology,blood coagulation (4 parameters),the blood coagulation time and the histology of the morphology of brain tissue were observed. RESULTS:In rats treated with Zhuyu annao pill (high,medium or low dosage) as compared with model group,no significant change was noted in the water content and neurological impairment; however,the pro-time (PT) was significantly prolonged(P