The effect of neutrophil/lymphocyte ratio on the early-stage condition judgment and prognosis of intracercbral hemorrhage / 中国医师进修杂志

Objective:To investigate the relationship of neutrophil/lymphocyte ratio (NLR) and early hematoma enlargement (HE) of intracerebral hemorrhage (ICH).Methods:Retrospectively analyzed the clinical data of 360 patients with ICH who were diagnosed and admitted to the Affiliated Hospital of Xuzhou Medical University from January 2017 to December 2017.Among them, 198 patients were selected for this study. According to the 24 h checked CT, they were divided into the hematoma expansion (HE) group (87 patients) and the non-HE group (111 patients). The clinical data of the two groups and the changes of hematology and imaging were compared.Results:Univariate analysis showed statistically significant differences of two groups in systolic blood pressure, diastolic blood pressure, Glasgow coma scale (GCS) score, hematoma volume at admission: (180.45 ± 25.90) mmHg(1 mmHg = 0.133 kpa) vs. (171.81 ± 25.87) mmHg, (103.29 ± 14.26) mmHg vs. (97.98 ± 14.81) mmHg, (11.05 ± 2.02) scores vs. (13.04 ± 1.58) scores, (25.14 ± 14.88) ml vs. (13.57 ± 11.98) ml; and GCS score, NLR , hematoma volume at 24 h after admission: (7.54 ± 2.04) scores vs. (11.04 ± 2.12) scores, 12.79 ± 7.24 vs. 5.59 ± 3.59, (17.07 ± 8.95) ml vs. (7.97 ± 3.56) ml, there were significant differences ( P<0.05). Logistic regression analysis showed that NLR, GCS, hematoma volumeat 24 h after admission and number of island sign were independent correlated factors of HE ( P<0.05). Receiver operation characteristic(ROC) curve analysis showed that when the NLR at 24 h after admission cut off value was 7.65, the sensitivity of predicting HE in patients with ICH was 78.16%, the specificity was 81.98%, and the area under the ROC curve was 0.852 (95% CI 0.798-0.907, P<0.001). Conclusions:HE have association with NLR, hematoma volume change.

Hematoma heterogeneity prediction of intracranial hematoma enlargement and establishment of predictive scoring system / 中国脑血管病杂志

Objective To investigate the influence of hematoma heterogeneity for the enlargement of primary supratentorial intracerebral hemorrhage and established predictive scoring model of hematoma enlargement. Methods From June 2015 to December 2017, a total of 208 patients with primary cerebral hemorrhage treated first at the First Affiliated Hospital of Jishou University were analyzed retrospectively. 3D software was used to conduct hematoma imaging and calculate hematoma volume and surface area. The patients were divided into enlarged hematoma group (n =44) and non-enlarged hematoma group (n = 164) according to whether the hematomas were enlarged or not. The standard deviation of CT value (CTSD) of hematoma and irregular ratio (IR) of hematoma morphology were used to reflect the heterogeneity of hematoma. Univariate analysis and Multivariate Logistic regression analysis were used to analyze the Influencing factors of hematoma enlargement with SPSS 22. 0 software,and the predictive value of predictive scoring model to hematoma enlargement was evaluated with receiver operating characteristic (ROC) curve. Results The incidence of hematoma enlargement in primary cerebral hemorrhage was 21. 2% (44/208). Compared with the non-enlarged hematoma group,the increased volume of hematoma in the enlarged hematoma group increased significantly (15 ± 11 ml vs. 4 ± 6 ml ,t =45. 568,P 2. 0 and CTSD was 10. 85, the heterogeneity of hematomas increased. Multivariate analysis showed that CCS 10 score at admission (OR, 4. 141,95% CI 1. 526 - 11. 237,/'=0. 005) ,CTSDs5 10. 85 (OR, 3. 593,95% CI 1.354 - 9.540, P =0.010), and IR5s2.0 (OR, 93. 487,95%CI 27. 656 -316.012,P<0.01) were the independent risk factors for hematoma enlargement, and based on this,a predictive scoring model of CIG (CTSD,IR,and GCS) was established ROC curve analysis showed that the sensitivity and specificity of CIG score model predicting the hematoma enlargement were 86. 9% and 95. 1% , respectively when the predictive score was 9. 5 score. Conclusion The heterogeneity of hematoma was first quantified by the density heterogeneity and morphological irregularity of hematoma through individualized imaging processing, and a scoring model of hematoma enlargement was established based on this,which provided a new idea for clinical identification of hematoma enlargement.

Blend sign, black hole sign and its combined signs with CT scanning for the predictive value of early hematoma enlargement in patients with intracerebral hemorrhage / 中国脑血管病杂志

Objective To investigate the value of blend sign and/or black hole sign with CT scanning for predicting early hematoma enlargement in patients with primary intracerebral hemorrhage.Methods From July 2011 to July 2016,244 consecutive patients with primary intracerebral hemorrhage in the First Affiliated Hospital of Chongqing Medical University were enrolled prospectively.From the onset to the first CT time were all ≤ 6 h.They were randomly divided into either an early hematoma enlargement group (n =82) or a non-hematoma enlargement group (n =162) according to whether they had early hematoma enlargement or not.The general data of patients were collected and compared between the groups,including previous history,clinical features,Glasgow coma scale (GCS) at admission,imaging features (black hole sign,blend sign and black hole sign and/or blend sign),etc.Multivariate logistic regression analysis was performed on the factors influencing early hematoma enlargement.The predictive value of imaging signs of early hematoma enlargement was analyzed.Results (1) In patients with early hematoma enlargement,there were 27 (32.9％) patients had black hole sign,33 (40.2％) had blend sign,and 50(61.0％) had blend sign and/or black hole sign.(2) The volume of hematoma according to 1 ml,the first CT time from onset to admission according to 1 h,and GCS on admission according to 1,the black hole sign and blend sign were included in the multivariate logistic regression analysis.The results showed that both the blend sign (OR,14.04,95％ CI 5.16-38.18) and the black hole sign (OR,5.69,95％ CI 2.12-15.30) were the independent risk factors for early hematoma enlargement (all P ＜ 0.01).After further adjustment,it showed that the blend sign and/or black hole sign were also the independent risk factors for early hematoma enlargement (OR,14.08,95％ CI 5.99-33.08,P ＜0.01).(3) After the analysis of the receiver operating characteristic curve,the sensitivity,specificity,positive predictive value,negative predictive value,and Youden Index of the blend sign and/or black hole sign of predicting early hematoma enlargement were 61.0％,90.1％,76.0％,82.0％,and 0.511,respectively.Its Youden Index was closer to 1 than the black hole sign (Youden Index:0.280) and the blend sign (Youden Index:0.346).Conclusion Compared with the single sign,the blend sign combined with black hole sign has better predictive ability for early hematoma enlargement after intracerebral hemorrhage.

Effect of hyperacute intensive antihypertensive treatment on the prognosis of intracerebral hemorrhage in basal ganglia region / 中国脑血管病杂志

Objective To investigate the effect of hyperacute intensive antihypertensive treatment on the prognosis of intracerebral hemorrhage in basal ganglia region. Methods From January 2013 to December 2015,100 patients with intracerebral hematoma in basal ganglia region (onset ≤3 h)at the Neurological Intensive Care Unit,the First Affiliated Hospital of Dalian Medical University were enrolled prospectively. They all randomly received the intensive antihypertensive or standard antihypertensive treatment voluntarily. They were divided into either an intensive antihypertensive group or a standard antihypertensive group according to the random number table (n = 50 in each group). Within 1 h after beginning to treatment,the target systolic blood pressure was controlled in 130 -140 mmHg in the intensive antihypertensive group,the target systolic blood pressure was controlled in 160 -180 mmHg in the standard antihypertensive group,and the target systolic blood pressure was maintained respectively in the following 7 d. Head CT was performed gain at 24 h after treatment. The intracranial hematoma expansion was evaluated. The National Institutes of Health Stroke Scale (NIHSS)and the modified Rankin scale (mRS)were used to evaluate their prognoses. The differences of the cumulative mortality in both groups were compared at the same time. Results The incidences of hematoma expansion of the intensive antihypertensive group and the standard antihypertensive group were 12. 0% (6/ 50)and 30. 0% (15/ 50)respectively. There was significant difference between the 2 groups (χ2 = 4. 882,P = 0. 027). There were no significant differences in NIHSS scores within or between both groups at each time points (all P > 0. 05). They were followed up for 90 d,no adverse events occurred in both groups. The favorable prognosis rates of the neurological function were 36. 0% (18 / 50)and 18. 0% (9 / 50)respectively in the intensive antihypertensive group and the standard antihypertensive group. There was significant difference between the 2 groups (χ2 = 0. 411,P =0. 043). Kaplan-Meier curves showed that the cumulative mortality at 24 h,within 7 d and 90 d in the intensive antihypertensive group and the standard antihypertensive group were 4. 0% (2 / 50),6. 0%(3 / 50),and 10. 0% (5 / 50),respectively,those of the standard antihypertensive group were 10. 0%(5 / 50),24. 0%(12 / 50),and 30. 0%(15 / 50),respectively. The results of Log-rank test found that there was significant difference in cumulative mortality between the 2 groups (χ2 =6.280,P =0.012). Conclusions The intensive antihypertensive treatment in the hyperacute cerebral hemorrhage is safe and feasible in basal ganglia region. It contributes to improve prognosis of neurological function,and reduce the incidence of hematoma expansion and the 90 d cumulative mortality.

Predictive effect of back propagation neural network model on hematoma enlargement in patients with cerebral hemorrhage / 中国脑血管病杂志

Objective To study predicting results of the back propagation (BP)neural network model for hematoma enlargement (HE)in patients with intracerebral hemorrhage. Methods The clinical data of 128 patients with cerebral hemorrhage admitted to the 309th hospital of People′s Liberation Army from January 2011 to December 2014 were analyzed retrospectively. The Matlab 7. 14 software was used to achieve BP neural network model for predicting hematoma enlargement within 24 hours in patients with intracerebral hemorrhage (HE ≥6. 0 ml and HE ≥12. 5 ml). The mean square error (MSE)of the model and the accuracy of the overall prediction were calculated. The receiver operation characteristic (ROC) curve was drawn for predicting HE. Results When the BP neural network predicted HE ≥6. 0 ml and HE ≥12. 5 ml,the mean square deviations of the training set,validation set,and test set were 0. 061, 0. 143,0. 052 and 0. 023,0. 057,and 0. 065,respectively. The best fitting performance verification of hematoma enlargement was as follows:≥ 6. 0 ml for network training 11 times and the error value 0. 224;≥12. 5 ml for network training 20 times,and the error value 0. 057. The overall accuracies of predicting HE ≥6. 0 ml and HE ≥12. 5 ml were 92. 2% (118/ 128)and 96. 9% (124/ 128)respectively. Conclusion The BP neural network model have no special limitation for data. It can accurately fit the hematoma expansion model of cerebral hemorrhage.

Multivariate logistic regression analysis of risk factors of hematoma enlargement in patients of hypertensive intracerebral hemorrhage within 24hrs of onset: A retrospective study of 265 cases from a single center in China / 解放军医学杂志

Objective To study the risk factors of hematoma enlargement in acute hypertensive cerebral hemorrhage (AHCH) patients within 24 hours after onset. Methods A retrospective review of clinical data of consecutive patients with AHCH who met the inclusion and exclusion criteria and admitted from Mar. 2008 to Mar. 2013 was performed. The patients' data included patients' demography, previous medical history, clinical features, findings of CT, results of laboratory examinations, and the use of traditional medicines for promoting blood circulation. Patients were divided into hematoma enlargement group and non-hematoma-enlargement group. Univariate analysis was performed on the above factors first, and then with the statistically significant factors used as independent variables, hematoma growth as dependent variables, logistic regression analysis was performed to investigate the possible independent relevant factors for the early enlargement of hematoma in AHCH patients. The risk factors and enlargement of hematoma served as independent variables, the data of mRS scale obtained from 3-month follow up as dependent variables, logistic regression was then performed to investigate the influence of acute hematoma enlargement during 3-month follow up in AHCH patients. mRS 0-2 was assigned as good recovery, and mRS 3-6 as serious disability or death. The inspection level was ct=0.05. Results Among 256 patients, 43 (16.8%) were found to have hematoma enlargement. Univariate analysis showed the risk factors led to hematoma enlargement in AHCH patients were gender (male), Glasgow coma scale at admission, NIHSS (National Institute of Health Stroke Scale) at admission, course of disease, and liver function (AST). However, only two factors, namely gender (male) and course of disease, were the independent risk factors of the hematoma enlargement in AHCH patients according to the multivariate regression analysis. In addition, logistic regression revealed that the hematoma enlargement was the independent risk factor influencing the final outcome of AHCH patients, and the hematoma volume, NIHSS, and course of disease were the independent risk factors influencing the outcome of 3 month follow up. ConclusionsA male AHCH patient with shorter duration from onset to admission (within 2 hours) should alert attending physician there would be a risk of hematoma expansion. Larger amount of bleeding, enlarged hematoma, higher NIHSS and shorter duration from onset to admission herald a poor prognosis.

Early hematoma enlargement in patients with spontaneous intracerebral hemorrhage and related factors analysis / 中国医师进修杂志

Objective To explore the related factors of early hematoma enlargement in patients with spontaneous intracerebral hemorrhage.Methods The clinical data of 142 patients with spontaneous intracerebral hemorrhage were analyzed.The first CT was performed within 6 h of onset and the second within 24 h of onset.Single factor analysis and multiple Logistic regression analysis were performed to determine the related factors of early hematoma enlargement.Results The incidence of early hematoma enlargement was 24.6％ (35/142).Multiple Logistic regression analysis revealed that the following four factors were independently associated with early hematoma enlargement:age (OR =1.069,P =0.003),systolic pressure (OR =1.865,P =0.026),sharp of hematoma (OR =2.712,P =0.028),using mannitol (OR =2.939,P =0.020).Location of hemorrhage and volume of hemorrhage were not associated with early hematoma enlargement (P ＞ 0.05).Conclusions Age,systolic pressure,sharp of hematoma and using mannitol are the important predictors of early hematoma enlargement with spontaneous intracerebral hemorrhage.In patients with older age,higher systolic pressure,irregularly shaped hematoma,close observation of hematoma enlargement should be made CT-scanning check.And the caution in the early use of dehydrating agent should be careful.

Relationship between Hematoma Enlargement after Iintracerebral and Level of Blood Glucose / 中国康复理论与实践

@#Objective To explore the relationship between the hematoma enlargement after intracerebral and level of blood glucose after admitted.Methods Data of all patients with intracerebral hemorrhage were reviewed retrospectively.All 225 patients with intracerebral hemorrhage were divided into the hematoma enlargement group and non-hematoma enlargement group according to Brott's diagnostic criteria.The relationship between the hematoma enlargement and level of blood glucose in patients after admitted was analyzed statistically.Results The incidence of hematoma enlargement correlated significantly with level of blood glucose after admitted(P<0.01).The level of blood glucose of patients with hematoma enlargement after admitted increases more than those of patients without hematoma enlargement(P<0.01).Conclusion If blood glucose over 7.8 mmol/L,the attention should be paid for occurrence of hematoma enlargement,and some effective treatment to lower the level of blood glucose should be taken to improve prognosis of the patients.

Is Extravasation of Radiographic Contrast a Predictor of Hematoma Enlargement in Spontaneous Supratentorial Intracerebral Hemorrhage? / 대한뇌혈관외과학회지

BACKGROUND AND PURPOSE: The enlargement of a hematoma occurs commonly in patients with spontaneous intracerebral hemorrhage (ICH) after hospitalization and can worsen the clinical outcome. We conducted this study to determine whether extravasation of a radiographic contrast agent is a predictor of hematoma enlargement occurring after admission in patients with spontaneous ICH. METHODS: We reviewed the clinical records and computerized tomography (CT) scan findings of 384 patients with spontaneous ICH admitted within 24 hours of ictus from 2002 to 2005. Only 71 patients with primary ICH in the basal ganglia or thalamus were included in the study. The first CT scan was preformed within 24 hours of onset and the second CT scan was preformed within 72 hours of onset. We compared patients with and without hematoma enlargement according to the radiological findings, clinical characteristics and laboratory data. RESULTS: Seventeen patients (23.9%) showed hematoma enlargement after admission. Extravasation of the radiographic contrast agent on a CT scan was seen in 23 patients (32.4%). The presence of contrast extravasation on a CT scan closely correlated with evidence of hematoma enlargement, as seen on a follow-up CT scan (p = 0.000). Other variables did not reach statistical significance for the independent association with hematoma enlargement. CONCLUSIONS: Due to a high risk for hematoma enlargement, patients with spontaneous ICH in the basal ganglia and thalamus, especially those with evidence of contrast extravasation on a CT scan, should be closely observed. Short term followup radiological studies are needed for the verification of hematoma enlargement.

Furosemide Test Predicts Hematoma Enlargement in Patients of Hypertensive Cerebral Hemorrhage / 中华高血压杂志

Objective To study the validity of furosemide test for predicting the hematoma enlargement in pa- tients with hypertensive cerebral hemorrhage.Methods Four hundred fifty-one patients with hypertensive cerebral hemorrhage were diagnosed using CT after oneset of the disease and 24 h reexamined 24 h after.The incidence of enlarged hematoma was evaluated by comparison the baseline and 24 h CT scanning.Furosemide(20 mg iv)was ad- ministered and blood pressure was measured 30 min after furosemide.Results The decreasing level of MAP after furosemide was significantly inversely related with incidence rate of hematoma enlargement{ r=-0.94,t=58.4,P 10 mmHg as the cut-off point,with the rate of hematoma enlargement as being 6.4 %,MAP decreased≤10 mmHg was associated with increases in prevalence of hematome to 33.2 %(?~2=51.82, P

Early Hematoma Enlargement in Spontaneous Intracerebral Hemorrhage / 国际脑血管病杂志

Early hematoma enlargement in intracerebral hemorrhage seriously influences the prognosis of patients.This article reviews the incidence,diagnostic criteria,influence factors and prevention and treatment of early hematoma enlargement in intracerebral hemorrhage.

Significance of an Early Clinical Course during the External Ventricular Drainage in Thalamic Hemorrhage

OBJECTIVE: The purpose of this study is to investigate the significance of an early clinical course during the external ventricular drainage(EVD) in patients with thal amic hemorrhage. METHODS: During the last 11 years(1990-2000), a hundred patients with thalamic hemorrhage who underwent EVD were studied. Thirty-four patients underwent temporary closing of EVD at the mean interval of 4.5 days after EVD. The clinical course was divided into 3 groups according to change of Glasgow Coma Scale(GCS) scores of 2 or more within 3 days after EVD compared with those just before EVD: deteriorated, unchanged, and improved. RESULTS: The factors affecting mortality were unchanged(odds ratio [OR] 0.05, 95% confidence interval [CI]0.01-0.38, p=0.0028) and deteriorated clinical course(OR 0.06, 95% CI 0.01-0.38, p=0.0033), GCS scores at the time of admission(OR 1.3, 95% CI 1.02-1.66, p=0.0346), amount of hematoma(OR 0.91, 95% CI 0.83-1.00, p=0.0461) and hematoma enlargement(OR 0.06, 95% CI 0.01-0.65, p=0.0198). The factor affecting the early clinical deterioration was the hematoma enlargement(OR 0.11, 95% CI 0.03-0.38, p=0.0005). The shunt operation was predicted in patients who showed the clinical improvement after EVD followed by the clinical deterioration within 48 hours after temporary closing of EVD. CONCLUSION: It is suggested that an early clinical course during the maintenance of EVD is important to predict mortality and necessity of shunt operation.

Enhanced Focus in Hypertensive Intracerebral Hematoma on CT Scan and Hematoma Enlargement / 대한뇌혈관외과학회지

OBJECTIVE: Although most of hypertensive intracerebral hematoma (HICH) are static after ictus, a minority of them can enlarge in the acute phase after onset. This study performs to find the predicting factors and signs of hematoma enlargement in patients with HICH. METHODS: Among 140 cases of HICH treated during 1.5 years, the authors selected 107 cases who underwent contrast enhanced and nonenhanced initial CT scanning within 12 hours after symptom onset and a follow-up CT scan in order to investigate the enlargement of hematoma. Those cases were divided into two groups:hematoma enlargement (group I) and non-enlargement group (group II). The comparison of predicting factors (bleeding tendency, abnormal liver function and blood pressure) and signs (enhanced focus in hematoma on CT) of hematoma enlargement between group I and II was performed. RESULTS: There were 8 cases in group I and 99 cases in group II. The incidence of an enhanced focus in hematoma on CT scan was higher in group I than group II (87.5% vs. 9.1%, p<0.05). The systolic blood pressure (BP) at 6 hours after symptom onset and at the time of the first CT scan was higher in group I than group II (172.5 vs. 152.0 mm Hg, and 182.5 vs. 158.6 mm Hg, respectively, p<0.05). There was no difference in the incidence of bleeding tendency and abnormal liver function between group I and II. CONCLUSION: Contrast enhanced brain CT scan to detect the enhanced focus in the hematoma is one of useful methods to predict the early enlargement of hematoma in patients with HICH. The continuance of a high BP in spite of medication of antihypertensive drugs during the acute period after the onset of symptoms is another predictive sign of hematoma enlargement in patients with HICH.

Risk Factors for Enlargement of Spontaneous Putaminal Hemorrhage

OBJECTIVE: The purpose of this study is to investigate the risk factors for hematoma enlargement(HE) in the patients with spontaneous putaminal hemorrhage. METHODS: Among the 620 patients with putaminal hemorrhage admitted to our hospital during the period of 1990-2000, sixty patients(9.7%) had HE on the second computed tomographic(CT) scan at the interval of mean 38 hours after attack(range 1.8-168 hours). Clinical features and CT findings of these 60 patients with HE were compared with those of the remaining 560 patients without HE. RESULTS: Multivariate logistic regressional analysis revealed that the independent risk factors for HE were CT finding showing the separation of hematoma(odds ratio[OR] 3.5, 95% confidence interval [CI] 1.7-7.3, p=0.0006) or the hypodensity around or within hematoma(OR 2.5, 95% CI 1.2-5.6, p=0.0194), alcoholism(OR 4.8, 95% CI 2.0-11.7, p=0.0004), hematoma volume of 20-39cc(OR 2.54, 95% CI 1.0-6.3, p=0.0424), Glasgow Coma Scale(GCS) score of 8-11(OR 3.1, 95% CI 1.4-6.9, p=0.0046) and glutamic-pyruvic transaminase>50 IU/L(OR 6.54, 95% CI 2.1-20.5, p= 0.0013). CONCLUSION: Alcoholism and liver dysfunction appear to increase the risk of HE in putaminal hemorrhage. Particularly, careful observation for HE is needed in the patients who are GCS score of 8-11 at the time of admission, who have hematoma volume of 20-39cc and the CT finding showing the separation of hematoma or the hypodensity around or within hematoma.

The Factors Affecting Enlargement of Spontaneous Intracerebral Hemorrhage

OBJECTIVE: The goal of this study is to evaluate the incidence and factors of hematoma enlargement in patients with spontaneous intracerebral hemorrhage(ICH). METHODS: We analyzed 149 cases with spontaneous ICH who underwent computerized tomography (CT) scans from January, 1995 to December, 1998. The clinical characteristics, past medical history, laboratory findings, time intervals between onset of ICH and CT scan, CT findings and results of treatment were reviewed. RESULTS: Of the total 149 patients, 28(18.8%) had hematoma enlargement, of whom 24(85.7%) underwent a first CT scan within 3 hours after onset of ICH. The incidence of hematoma enlargement significantly decreased in patients who had CT scans 3 hours later after attack. Age, sex, and site of hematoma were not related to hematoma enlargement. Patients with an irregularly shaped hematoma, inhomogenous hematoma and large hematoma had a high risk of hematoma enlargement. Hematoma enlargement was associated with a poor clinical outcome and high mortality(46.7%). CONCLUSION: Patients admitted to a hospital within 3 hours of onset of ICH, and patients with inhomogenous hematoma on CT scan, irregularly shaped hematoma, or large hematoma should be closely observed for hematoma enlargement.

Relevant factors of hematoma enlargement in patients with hypertensive intracerebral hemorrhage at acute stage / 临床神经病学杂志

Objective To explore the relevant factors of hematoma enlargement in patients with hypertensive intracerebral hemorrhage(CH) at acute stage.Methods The clinical data of 208 patients with CH(29 patients with hematoma enlargement) were retrospectively analyzed.Results 27 cases(93.1%)of hematoma enlargement group onset at ≤ 24 h after CH.Compared with non-hematoma enlargement group,systolic blood pressure in the hematoma expansion group was significantly increased;and the rates of Glasgow coma scale(GCS) score decreased,basal ganglia hemorrhage,hepatic dysfunction,long-term alcohol drinking,taking Aspirin and diabetes in hematoma expansion group were significantly higher than those in the non-hematoma enlargement group(P

Investigation of blood pressure control to prevent hypertensive cerebral hemorrhage with hematoma enlargement / 临床神经病学杂志

Objective Investigate the effect on blood pressure(BP)control to prevent hypertensive cerebral hemorrhage with hematoma enlargement.Methods 96 patients with hypertensive brain hemorrhage in course of disease less than 3 hours and mean arterial pressure(MAP)more than 130 mmHg(1 mmHg=0.133 kPa)were divided into randomly treatment group(48 cases)and control group(48 cases).The patients in treatment group were administered 12.5～25 mg Captopril sublingually per 3～4 h to control MPA≤130 mmHg and keep 24 hours since disease onset.However,the patients in control group were disused any hypotensive drug.Two groups were compared with the incidence rate of enlarged hematoma.Results Captopril sublingually had its effect after 15 minutes administered,and MPA was controlled≤130 mmHg during 60 minutes administered and keep well.The difference between two groups was statistically significant.The enlarged hematoma incidence rate of treatment group was 8.3% and that of the control group was 22.9%.The difference between two groups was significant(P

Analysis of the Risk Factors of Hematoma Enlargement in Patients with Spontaneous Intracerebral Hemorrhage

OBJECTIVE: The purpose of this study was to evaluate the risk factors of hematoma enlargement in patients with spontaneous intracerebral hemorrhage(ICH). METHODS: A series of 214 ICH patients diagnosed by brain CT scan in our neurosurgery department from June 1995 to July 1998 were reviewed with clinical status, past medical histories, laboratory findings, CT findings and prognosis. RESULTS: In 27 patients(12.6%), the second CT scan showed an enlarged hematoma. Age, sex, and site of hematoma were not related to hematoma enlargement. A long interval(>6 hours) between the onset and the 1st CT scan strongly reduced the incidence of hematoma enlargement. The incidence of hematoma enlargement significantly increased in patients with previous history of hypertension, cerebral infarction and ICH. This analysis also demonstrated the following independent factors predisposed to hematoma enlargement: initial high systolic blood pressure, high serum total protein, low serum albumin, low serum sodium, prolonged prothrombin time(>14 sec) and activated partial thromboplastin time(>29.5 sec), irregular hematoma shape, and combined intraventricular hemorrhage. Prognosis in the group of hematoma enlargement showed high mortality(48.1%) and poor outcome. CONCLUSION: Patients with previous history of hypertension, cerebral infarction and ICH, and with high systolic blood pressure, prolonged coagulation time, irregular hematoma shape and intraventricular hemorrhage in CT scan should be observed carefully. And, early surgical therapy of large hematoma and meticulous control of blood pressure may decrease the mortality and morbidity in patients with spontaneous ICH.

Study the fibrinolytic activity of hematoma enlargement in patients with spontaneous intracerebral hemorrhage / 临床神经病学杂志

Objective To evaluate the relationship of fibrinolytic activity with hematoma enlargement in spontaneous intracerebral hemorrhage (ICH).Methods 107 patients with ICH were divided into two distinct groups according to the change of hematoma after admission: patients with hematoma enlargement and patients without hematoma enlargement. The activity of tissue-type plasminogen activator (tPA:A) and plasminogen activator inhibitor (PAI:A) in plasma were assayed by meaos of synthetic chromogenic substrate method, and the levels of plasminogen activator inhibitor-1 (PAI-1) antigen and D-dimer (D-D) were measured with an enzyme-linked immunosorbent assay (ELISA). The blood samples were obtained at 0～3 d, 4～9 d and 14～21 d after onset of the disease, respectively. All of the parameters were compared with healthy subjects. Results The tPA:A in ICH patient group at 0～3 d and 4～9 d after onset were significantly lower than those in control group (P

Outcome of Nonoperative Management for Intracranial Acute Epidural Hematomas: Analysis of 43 Cases

The authors present 43 cases of intracranial acute epidural hematomas(EDH's) managed by close observation. In each of 43 cases, the following criteria were met:1) the patient was conscious soon after head injury;2) the volume of hematoma was under 30ml(10ml in case of posterior fossa EDH's);3) there was no severe effacement of basal cistern or 4th ventricle;4) there was no associated intradural lesion;5) the patient showed neither cerebral herniation nor cardiorespiratory abnormalies. Of the 43 patients, 31(72%) showed no hematoma enlargement, and showed rsolution of hematoma on computerized tomography(CT) scans over a period of 4 to 11 weeks. Repeat CT scans within 24 hours of initial CT revealed enlargement of EDH in 12 of 43 patients(28%), of these 12 EDH's, 5 were reabsorbed spontaneously from 6 to 10 weeks, and 7 were evacuated surgically. All patients recovered without morbidity except one who had craniotomy during observation. There was no specific location of EDH which was indicated or contraindicated for conservative treatment. Factors that influence outcome include the age of patient, initial CT finding, cerebrospinal fluid(CSF) leakage, the use of mannitol, and recovery from shock. Hematoma enlargement did not always accompany deterioration of consciousness, therefore repeat CT scans within 24 hours is strongly recommended.