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Objective To explore the risk factors,mechanism and treatment strategies of secondary brain injury (cerebral hemorrhage or cerebral infarction/encephaledema) adjacent to acute epidural hematoma after surgical evacuation.Methods Forty-four patients with acute epidural hematoma underwent craniotomy in our hospital from March 2013 to December 2018 were chosen in this study.According to postoperative CT or MR imaging examination results,patients were divided into group of secondary brain injury (n=11) and group of non-secondary brain injury (n=33).The clinical data of the two groups were compared,and the significance of epidural hematoma thickness in assessing secondary brain injury was analyzed by receiver operating characteristic (ROC) curve.Binary Logistic regression analysis was used to analyze the independent risk factors affecting secondary brain injury.Results After surgery,11 showed secondary brain injury:3 occurred cerebral hemorrhage,one of whom was diagnosed as having cerebral venous hemorrhage in the cortical vein drainage area caused by traumatic cerebral venous circulation disorder;6 had cerebral infarction/encephaledema,and 2 occurred hemorrhagic cerebral infarction/encephaledema;two underwent secondary craniotomy and both achieved satisfactory effect.As compared with patients from the non-secondary brain injury group,patients fromsecondary brain injury group had significantly higher percentage of patients with epidural hematoma thickness ≥ 33.5 mm (P＜0.05).ROC curve analysis showed that the thickness of epidural hematoma had predictive value in secondary brain injury after surgery (P＜0.05),and area under the curve was 0.722 and diagnostic threshold was 33.5 mm.Binary Logistic regression analysis revealed that epidural hematoma thickness ≥33.5 mm was an independent risk factor for secondary brain injury adjacent to epidural hematoma after surgery (odds ratio=7.367,P=0.024,95％CI=1.298-41.797).Conclusions Acuteepidural hematoma thickness ≥33.5 mm is a high-risk factor associated with secondary brain injury adjacent to epidural hematoma after surgery.Intracranial venous circulatory disorders have non-negligible effect on occurrence of secondary brain injury.
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Objective To investigate the effect of combined application of mannitol and monosialoganglioside on neurological function and its efficacy in brain edema after intracerebral hemorrhage. Methods 92 cases of cerebral edema in patients with cerebral hemorrhage in our hospital, were randomly divided into groups, each group of 46 cases, the control group on the basis of the treatment of mannitol (125mL per times, once per 8h) treatment, the study group on the basic of control group received monosialogangliosides (20mg per times, once daily), 10d for a course of treatment, determination of serum indexes, neurological functions were recorded. Results The effective rate of control group was 71.74%, which was lower than 91.30% of the study group, there was significant difference (P < 0.05); compared with control group after treatment , in study group the intracranial pressure, intracranial hematoma, edema decreased, the urine volume increased, National Institutes of Health Stroke Scale (NIHSS) and quality of life score decreased, interleukin (IL-1β), high sensitive C reaction protein (Hs-CRP), IL-6 and IL-8 levels decreased, Na+-K+-ATP enzyme increased, the ratio of cerebrospinal fluid albumin and serum albumin, matrix metalloproteinase (MMP-2) and MMP-9 decreased, there were significant differences (P < 0.05). Conclusion The effect of the combined application of mannitol and monosialoganglioside on cerebral edema after cerebral hemorrhage is exact and could improve neurologic function.
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OBJECTIVE:To investigate the effects of Butylphthalide and sodium chloride injection on neurological function and prognosis of elderly patients with hypertensive intracerebral hemorrhage(HICH)after trepanation and drainage surgery. METH-ODS:During Jan. 2015 to Jun. 2016,80 elderly HICH patients were selected from our hospital and then divided into control group and observation group according to random number table,with 40 cases in each group. Both group received trepanation and drain-age surgery. Control group was given routine treatment. Observation group was given Butylphthalide and sodium chloride injection 100 mL,ivgtt,bid,on the fifth day after surgery,on the basis of control group. Both groups received treatment for 14 d. Clinical efficacies of 2 groups were observed. CSS scores were compared between 2 groups before surgery and 28 d after operation;volume of encephaledema,serum levels of homocysteine(HCY)and substance P(SP)were compared between 2 groups before surgery and 14 d after operation. RESULTS:The total response rate of observation group was 87.5％,which was significantly higher than 67.5％ of control group, with statistical significance (P0.05). CSS scores 28 d after operation, SP levels 14 d after operation were significanthy increased,volume of encephaledema and serum levels of HCY in 2 groups were significantly decreased,and the observation group was significantly better than the control group,with statistical significance(P<0.05). CONCLUSIONS:Butylphthalide and sodium chloride injection can significantly improve clinical efficacy and hepatic func-tion damage,relieve postoperative encephaledema,reduce serum levels of HCY and increase SP levels in elderly HICH patients af-ter trepanation and drainage surgery.
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Objective To observe the inhibitory effect of epigallocatechin gallate (EGCG) on encephaledema following traumatic brain injury (TBI) in rats and its mechanism.Methods 200 Wistar rats were randomly divided into three groups: sham operation (n= 20), model (n= 90) and EGCG (n= 90) groups. The classic Feeney free fall drop method was used to establish the model of TBI. In EGCG group, intraperitoneal injection of EGCG in normal saline 100 mg/kg (10 mL/kg) was immediately given to the rats after model establishment, and in model group, equal amount of normal saline was administered with the same method, once 24 hours for 2 days in all the groups. At 24, 48, and 72 hours after the administration in various groups, the changes of water content, superoxide dismutase (SOD) activity and malondialdehyde (MDA) level in brain tissues were determined, cerebral vascular permeability was evaluated by evans blue (EB) content in the brain tissues, the changes of expressions of aquaporin-4 (AQP4) and glial fibrillary acidic protein (GFAP) in brain tissues were determined by immunohistochemical and Western Blot, and the cerebral histopathological changes were observed in various groups.Results Compared with sham operation group, the water content, the vascular permeability and MDA level in brain tissues were significantly higher, while the cerebral SOD activity was significant lower in the model group; the scores of cells with positive AQP4 and GFAP expressions (IHC score) were obviously increased at 24 hours and 72 hours after model establishment, and the levels of expressions of AQP4 and GFAPprotein [integral absorbance (IA) value] were markedly enhanced in model group than those in the sham operation group, the changes being more remarkable at 72 hours after model formation [water content in brain tissues: (89.71±0.94)% vs. (78.34±0.87)%, EB content (μg/g): 9.13±0.66 vs. 2.71±0.72, SOD activity (U/mg): 63.53±12.57 vs. 130.85±9.91, MDA (nmol/mg): 10.19±1.47 vs. 4.57±0.74, IHC score of AQP4: 8.81±1.75 vs. 2.76±0.82, IHC score of GFAP: 9.47±1.32 vs. 6.71±0.52, expression of AQP4 protein (IA value): 1.53±0.05 vs. 0.42±0.05, expression of GFAP protein (IA value): 1.45±0.05 vs. 0.62±0.04, allP < 0.01]. Compared with the model group, the cerebral water content, MDA, IHC scores and protein expressions of AQP4 and GFAP, and cerebral vascular permeability were significantly decreased, while the SOD activity was obviously increased in the EGCG group, and the changes being more significant at 72 hours after model establishment [water content of brain tissues: (86.59±0.89)%, EB content (μg/g): 7.82±0.32, SOD activity (U/mg): 107.58±10.87, MDA (nmol/mg): 5.61±1.64, IHC score of AQP4: 6.92±0.71, IHC score of GFAP: 6.71±0.52, expression of AQP4 protein (IA value): 1.14±0.06, expression of GFAP protein (IA value): 1.21±0.07, all P < 0.01]. Imunohistochemical assay showed: the cerebral contents of AQP4 and GFAP positive cells in the rats of EGCG group were decreased, and their color became lighter.Conclusion The inhibition of EGCG on encephaledema following TBI in rats is related to its effects of decreasing the cerebral vascular permeability, enhancing the level of SOD activity, depressing MDA level and the expressions of AQP4 and GFAP.
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Objective To establish mouse models of intracerebral hemorrhage using autologous arterial blood,to study the physiological property of hippocampal neurons,brain edema changes and learning ability in the mouse models after intracerebral hemorrhage.Methods Eighty male C57/BL6 mice were randomly divided into intracerebral hemorrhage group and control group (n=40); 20 μL arterial blood from the tail arteries or normal saline were injected into the caudate nucleus of intracerebral hemorrhage group and control group by stereotactic technique,respectively.One,three,five and seven d after injection,the neurological impairment was scored; the behavioral changes of the mice in the Morris water maze (navigation test and space exploration experiment) were observed; brain edema was measured by wet and dry weight method and electrophysiological differences of hippocampal neurons were recorded by whole-cell patch-clamp technique and computer software.Results As compared with those in the control group,significantly increased neurological deficit scores one,three,five and seven d after injection,statistically decreased residence time in the platform on the fifth d of training,obviously increased water content around the brain edema one,three,five and seven d after injection,and significantly decreased resting membrane potential and input resistance in the hippocampal CA1 pyramidal cells five d after injection of mice in the intracerebral hemorrhage group were noted (P＜0.05).Conclusion The hippocampus-dependent spatial leaming ability of intracerebral hemorrhage mice is decreased,and the permeability of potassium channels is enhanced.
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Objective To investigate the pathological characteristics of acute brain injury in rat models of intraventricular hemorrhage (IVH).Methods Thirty-eight male Sprague-Dawley rats were randomly divided into control group and IVH group; stereotactic technique was employed to perform a 200-μL injection of either saline (control group) or autologous blood (IVH group) into the right lateral ventricle and these rats were euthanized at different time points.The weight loss of the rats was observed at 24 h after injection.The morphological changes of the cerebral ventricle were investigated using Micro-CT and brain samples.The brain water content by wet-dry weighting method was used to evaluate brain edema after IVH.Finally,blood brain barrier (BBB) injury was investigated by Evans blue (EB) staining (24 h after injection) and IgG immunofluorescent tests (48 h after injection).Results The weight loss in the IVH group was significantly more obvious than that in the control group 24 h after the injection (P＜0.05).Ventricular dilatation and cast form of ventricle were noted at the IVH group.The brain water content of the IVH group significantly increased in bilateral cerebral hemispheres as compared with that of the control group (P＜0.05).Evans blue exudation into the brain tissue and IgG expression in ventricle choroid plexus in the IVH group obviously increased as compared with those in the control group.Conclusion Besides hydrocephalus,acute brain injury after IVH might also accompany with acute ecephaledema and BBB damage,which are probably important pathological characteristics in acute brain injury after IVH.
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Objective To observe the curative effect of Shuxuetong injection on intracerebral hemorrhage at acute phase. Methods Sixty patients with intracerebral hemorrhage at acute phase were randomly divided into treatment group and control group (n=30). The treatment group intravenously received 6 mL Shuxuetong daily for 15 consecutive d and control group was treated with routine treatment. CT was performed to evaluate the volumes of hematomas, the changes of low-density areas surrounding the hematomas on the 1st, 7th and 15th d of treatment, respectively. The neurologic impairment evaluation scores were recorded with National Institutes of Health Stroke Scale (NIHSS). Monitor on plasma fibrinogen level was performed in both groups. Results No significant differences on the volumes ofhematomas, low-density areas surrounding the hematomas, neurologic impairment evaluation scores, and plasma fibrinogen level were noted between the 2 groups on the admission day (P＞0.05). On the 7th and 15th d of treatment, volumes of hematomas, low-density areas surrounding the hematomas and neurologic impairment evaluation scores in the treatment group reduced significantly as compared with those in the control group (P＜0.05), however, plasma fibrinogen level was not statistically different between the 2 groups (P＞0.05). Conclusion Shuxuetong injection is superior to routine treatment in reduction of volumes of hematomas, low-density areas surrounding the hematomas, neurologic impairment evaluation scores, but not in reduction of plasma fibrinogen level.