Early acupuncture for traumatic intracerebral hematoma: a randomized controlled trial / 中国针灸

<p><b>OBJECTIVE</b>To observe the effect of early acupuncture intervention on brain edema in patients with traumatic intracerebral hematoma and explore its mechanism on the basis of conventional western medicine.</p><p><b>METHODS</b>With stratified block randomization, sixty-four patients with glasgow coma scale (GCS) of 6 to 12 were divided into an acupuncture combined with medicine group (a combination group) and a western medication group, 32 cases in each one. In the western medication group, dehydration to reduce intracranial pressure and nutritional nerves were given as the basic treatment. In the combination group, on the basis of the treatment as the western medication group, acupuncture was applied at Xuehai (SP 10), Taixi (KI 3), Fenglong (ST 40), Yinlingquan (SP 9), Zusanli (ST 36), etc. The treatment was given once every day, for 6 times as one course; there was an interval of 1 day between two courses; a total of 4 courses were required. GCS score and recovery time were recored before treatment and on the 7 th, 14 th and 28 th days. 90 days follow-up after treatment, the GOS was observed, and the mortality and effective survival rate were calculated. The Barthel index (BI) score was evaluated before treatment and on the 14th, 21st, 28th days and 90 days follow-up after treatment. Before treatment and 3rd, 7th, 14th, 21st, 28th days, cranial CT or MR scan was performed to calculate the brain edema index (BEI); Plasma interleukin-6 (6IL-6), neuropeptide Y (NPY) and nitric oxide (NO) were measured before treatment and on the 3rd, 7th and 14th days after treatment.</p><p><b>RESULTS</b>(1) The GCS scores increased gradually in the two groups during treatment, and there was significant difference between the 28th days and before treatment (both <0.05). There were no significant difference between the two groups about GCS score and average recovery time on the 28th days treatment (all >0.05). (2) The mortality rate of the combination group was 6.3% (2/32) on 90 days follow-up, 9.4% (3/32) in the western medication group (>0.05). The effective survival rate was 81.3% (26/32) in the combination group, which was higher than 59.4% (19/32) in the western medication group (<0.05). (3) The BI score was significantly higher than that before treatment on the 28th days and 90 days follow-up in the two groups (all <0.05), and the result in the combination group was superior to that in the western medication group (both <0.05). (4) The BEI decreased on the 14th, 21st and 28th days in the two groups (all <0.05), and on the 14th day, the BEI decreased more significantly in the combination group than that in the western medication group (<0.05). (5) The levels of IL-6, NPY and NO decreased on the 7th and 14th days in the two groups (all <0.05), and decreased more significantly in the combination group than that in the western medication group on the 7th day (<0.05).</p><p><b>CONCLUSION</b>On the basis of conventional western medicine, early acupuncture can reduce cerebral edema and improve the prognosis of patients, and acupuncture combined with medicine are superior to western medicine alone. Acupuncture mechanism may be related to reducing the expression of inflammatory response.</p>

Observation on the Clinic Effect of r-MHT and Hematoma Aspiration on the Traumatic Intracerebral Hematoma / 现代生物医学进展

Objective:To investigate the clinic effect of r-MHT and hematoma aspiration on the traumatic intracerebral hematoma.Methods:89 cases with traumatic intracerebral hematoma were given hematoma aspiration,47 of them were given r-MHT and hematoma aspiration,the clinic effect on the 1st,7th,14th day after treatment were evaluated by NIHSS,the hematoma volume before treatment on the 1st,7th,14th day after treatment were counted by Dotian formula.Results:The effective rate of treatment group was 93.6％,which was significantly higher than that of the control group (P＜0.05).The NIHSS score of treatment group was significantly higher than that of the control group(P＜0.05) on the 1 st day,1st,2nd week after treatment (P＜0.05).Conclusion:r-MHT and hematoma aspiration couldn effectively reduce the brain damage,improve the patient's neurological fumction in treating traumatic intracerebral hematoma.

Risk factors related to progressive traumatic intracerebral hematomas in the early post head injury period

PURPOSE: In this study, patients in whom two computed tomography (CT) scans had been obtained within 24 hours of injury were analyzed to determine the incidence, risk factors and clinical significance of a progressive intracerebral hematoma (PIH). METHODS: Participants were 182 patients with a traumatic intracerebral hematoma and contusion who underwent a repeat CT scan within 24 hours of injury. Univarite and multivariate statistics were used to define growth (volume increase) and to examine the relationship between the risk factors and hemorrhage expansion. RESULTS: Fifty-four percent of the patients experienced progression in the size of the lesion in the initial 24 hours postinjury. A PIH was independently associated with worsened Glasgow coma scale (GCS) score (2.99, 1.04~8.60), the presence of subarachnoid hemorrhage (6.29, 2.48~16.00), the presence of a subdural hematoma (6.18, 2.13~17.98), the presence of an epidural hematoma (5.73, 1.18~27.76), and the presence of a basal cistern effacement (10.93, 1.19~99.57). CONCLUSION: For patients undergoing scanning within 2 hours of injury, the rate of PIH approaches 61%. Early repeated CT scanning is indicated in patients with a nonsurgically-treated hemorrhage revealed on the first CT scan. Worsened GCS score, significant hematoma growth and effacement of the basal cisterns on the initial CT scan are powerful predictors of which patients will require surgery. These findings should be important factors in understanding and managing of PIH.

Clinical Analysis of Traumatic Intracerebral Hematoma Associated with Other Traumatic Intracranial Lesions

One hundreds eighty cases of traumatic intracerebral hematoma(TICH) among 1,633 head injury patients diagnosed with computerized tomography in neurosurgical department from Jan. 1990 to Jun. 1996. were classified into two TICH groups; TICH group associated with other traumatic intracranial lesions and TICH group without other traumatic intracranial lesions. The incidence of TICH was 11.0% and percentage of TICH with other traumatic intracranial lesions among 180 cases of TICH was 66.7%. TICH group with other traumatic intracranial lesions showed worse initial level of consciousness, more likely to have abnormal pupillary reflex, higher incidence of delayed traumatic intracerebral hematomas(DTICH), greater amount of hematoma, increased chance of surgery and worse outcome. In TICH group with other traumatic intracranial lesions, the factors affecting prognosis were initial Glasgow coma scale(GCS) score, pupillary reflex, amount of hematoma and treatment modality. In TICH only group, the factors affecting prognosis were initial GCS score, pupillary reflex, amount of hematoma and DTICH. The patients with 12-15 of GCS score, normal pupillary reflex, absence of DTICH, and amount of hematoma below 10cc, the presence of other traumatic intracranial lesions were found to be important prognostic factor. The overall mortality was 27.7% but in TICH group with other traumatic intracranial lesions, the mortality was 35.0% compared to 13.3% in TICH only group. It is concluded from this study that in the case with other traumatic intracranial lesions, TICH showed worse initial neurological status and prognosis compared to those without other lesions. Thus, these patients, although in conditions of good general clinical index at admission, should be considered to provide intensive care and treatment because these associated lesions will play as a bad prognostic factor.

A Clinical Analysis of the Patients Who "Talk and Deteriorate" as a Result of Delayed Traumatic Intracerebral Hematomas

During a six-year period, 15 cases of "Talk and Deteriorate"patients who were suffering from delayed traumatic intracerebral hematoma(DTICH) were found retrospectively among 1055 patients with head injuries. All fifteen had suffered initial mild head injury(GCS score, 13-15), and apoplectic events or progressive neurological deficits(GCS<8) requiring surgical intervention developed within 72 hours. Subsequent CT scanning showed worsening of the original contusional lesion in ten cases, new hematoma in six, and new lesion(contusion, ischemia and/or edema) in five. cases. The most common location of DTICH was the frontal lobe(11 cases) and the most common cause of injury was a fall(10 cases). The condition of most of these patients could not be predicted, and there was no clear evidence of secondary insults such as hypoxia, hypotension, anemia, or hypercarbia, but hyperglycemia and coagulopathy were seen. Our results demonstrated that in spite of an initially high GCS score, patients who had been injured during a fall and on initial CT scan showed frontal lobe hemorrhagic contusion and/or swelling should be observed closely for at least three days after the injury. Among patients in the "Talk and Deteriorate"group whose condition was caused by DTICH, early diagnosis and aggressive treatment may be the most important life-saving management strategy.

Stereotactic Surgical Management of Traumatic Intracerebral Hematoma

Nineteen patients suffering from post-traumatic intracerebral hematoma, being managed by stereotactic aspiration of hematoma were evaluated. The outcome in this series is quite satisfactory, with 58% of patients having a functional survival. Eight patients died, of which three patients died of brain swelling and 5 died of systemic causes such as respiratory failure, gastrointestinal(GI) bleeding, and renal failure. It is our belief that stereotactic aspiration is helpful in managing patients with traumatic intracerebral hematoma without herniation and wevere brain swelling.

Clinical Analysis on 96 Cases of Traumatic Intracerebral Hematoma Treated with Operation

The authors had studied 96 cases of traumatic intracerebral hematoma surgically treated in the Department of Neurosurgery, Masan Koryo Hospital from January 1987 to December 1991. The results were as follows: 1) The patients' age ranged from 8 to 73 years and sex distribution was dominant in male. 2) The most common cause of traumatic intracerebral hematoma was fall. 3) The most common site of hematoma was frontal lobe, followed by temporal lobe. 4) The neurologic status on admission was closely related to prognosis. 5) DTICH(Delayed traumatic intracerebral hematoma) was found in 7 cases(28.1%) which had poor prognosis. 6) Total mortality rate was 28.1%.

Clinical Study on 22 Cases of Delayed Traumatic Intracerebral Hematoma

The authors studied 22 patients with delayed traumatic intracerebral hematoma (DTICH) who had been admitted to Hanyang University Hospital from March 1987 to February 1988. The results of the study were summerized as follows : 1) DTICH occurred most frequently on frontal and temporal lobe and closely associated with contusion of the brain at initial brain computed tomographic scan. 2) 20 cases of DTICH discovered within 10 days after trauma and remained 2 cases occurred at 20 day and 30 day, respectively. 3) The prognosis of DTICH was mostly affected by the neurological status at admission and good results of the surgery was obtained from the patients operated within 48 hours. 4) It was though that closed observation of the neurological status, repeated computed tomographic scanning and prevention of the systemic insults such as hypoxia and hemorrhagic shock would be improved the clinical outcome of the DTICH.

The Use of Urokinase in Traumatic Intracerebral Hematoma Treatment

Urokinase use after stereotaxic evacuation of hematoma became a popular method in treatment of hypertensive intracerebral hematoma. We obtained excellent result in evacuaIon of the hematoma which was remained after stereotaxic evacuation or direct approach for 24 raumatic intracerebral hematoma cases. And we found several advantages in this method compared with standard treatment modalities. We think that this is a new, effective treatment method for traumatic intracerebral hematoma.

Traumatic Intracerebral Hematoma

During a 36-month period, clinical outcome in 170 patients with traumatic intracerebral hematoma(TICH) was analysed. These patients represented 5.1% of 3328 consecutive patients with head injuries admitted to the Soonchunhyang University Chunan Hospital. The overall mortality was 33.5%. A significant number of patients(52.6%), who were not comators at the time of admission(GCS0.005) ; 2) the presence of associated lesions(p>0.01) ; 3) time delay of two hours or more from admission to operation(p>0.05) ; 4) actual midline shift of 4.5mm or above on initial CT scan(p>0.005) ; 5) obliteration of suprasellar cistern(p>0.005) ; 6) the presence of delayed traumatic intracerebral hematoma(DTICH) in non-surgical patients with GCS score of 8 or above(p>0.01). Age and location of hematoma did not affect outcome, but the patients with multiple located hematoma showed higher mortality than the others. Time delay in the treatment of TICH and DTICH contribute significantly to poor outocme. Rapidly progressive DTICH within 48 hours after trauma is high in mortality. Follow-up CT scan might as well be performed till 48 hours after injury and 8 hours after initial operation, even though neurological status did not alter for the worse.

The Value of Early Diagnosis in the Management and the Prognosis of Delayed Traumatic Intracerebral Hematoma

Ten cases of delayed traumatic intracerebral hematomas(DTICH) were found retrospectively among 129 patients with traumatic intracranial hematoma in about 3-year period. The interval from cranial injury to diagnosis of DTICH varied from 1 day to 13 day. The diagnosis was made on repeat computerized tomographic(CT) scans, obtained following neurological deterioration, lack of improvement and/or increase of intracranial pressure(ICP). For early diagnosis of DTICH, continuous ICP monitoring was more effective than routinely repeating CT scan and neurological observation. To analyse the factors influencing the prognosis, we divided DTICH into four groups by initial CT findings:Group I, one case, had negative CT scan on admission. In group II, two cases, an area of parenchymal contusion was noted on the initial CT scan with DTICH subsequently developing in the contused region. In group III, six cases, the initial CT scan showed intracranial hematoma and prior surgical management was done on admission. Group IV, one case, showed generalized brain edema. The prognoses of group III and IV were poorer than those of group I and II. The overall mortality was about 20%. We also discussed the pathogenesis and prognostic factors of DTICH in light of pertinent literatures.