Efficacy of electroacupuncture on acute intracerebral hemorrhage and its effect on serum AQP4 in patients / 中国针灸

OBJECTIVE@#To observe the effects on neural function, living ability and mental state of the patients with acute intracerebral hemorrhage (ICH), as well as aquaporin 4 (AQP4) in the serum after treated with electroacupuncture (EA) on the base of routine therapy of western medicine.@*METHODS@#Seventy-two acute ICH patients were randomized into an observation group (36 cases, 4 cases dropped off) and a control group (36 cases, 2 cases dropped off). In the control group, the conventional treatment was delivered such as stopping bleeding, preventing re-hemorrhage, controlling blood pressure, mitigating neural edema and reducing intracranial pressure. In the observation group, on the base of the treatment in the control group, EA was supplemented. Acupoints included Shuigou (GV 26), bilateral Neiguan (PC 6) and Sanyinjiao (SP 6) etc. Electric stimulation was operated at Neiguan (PC 6) and Sanyinjiao (SP 6) on the same side, with disperse-dense wave, and 2 Hz/100 Hz in frequency, tolerable current intensity. Electric stimulation was delivered for 30 min in each treatment, once daily and for 6 times per week. The duration of treatment was 2 weeks in the two groups. Before and after treatment, changes of the scores of National Institutes of Health stroke scale (NIHSS), modified Barthel index (MBI) and mini-mental state examination (MMSE), as well as AQP4 content in the serum were observed in the two groups; the efficacy and safety were compared between the two groups.@*RESULTS@#The NIHSS scores and the serum AQP4 content decreased after treatment when compared with those before treatment in the two groups (P<0.05), while, MBI and MMSE scores increased (P<0.05). In the observation group, NIHSS score and serum AQP4 content were lower than those of the control group (P<0.05), and MBI and MMSE scores were higher (P<0.05). The total effective rate of the observation group was 93.8% (30/32), higher than that of the control group (73.5%, 25/34, P<0.05). The treatment in the two groups was safe, without adverse reactions and events occurring in the patients.@*CONCLUSION@#Electroacupuncture, on the base of conventional treatment of western medicine, can effectively improve the neural function, living ability, mental state and serum AQP4 content of the patients with acute ICH. It is suggested that the effective treatment by electroacupuncture may be related to the regulation of the serum AQP4 content.

Suppression of HMGB1 inhibits neuronal autophagy and apoptosis to improve neurological deficits in rats following intracerebral hemorrhage / 南方医科大学学报

OBJECTIVE@#To investigate the effect of suppressing high-mobility group box 1 (HMGB1) on neuronal autophagy and apoptosis in rats after intracerebral hemorrhage (ICH) in rats.@*METHODS@#Rat models of ICH induced by intracerebral striatum injection of 0.2 U/mL collagenase Ⅳ were treated with 1 mg/kg anti-HMGB1 mAb or a control anti-IgG mAb injected via the tail immediately and at 6 h after the operation (n=5). The rats in the sham-operated group (with intracranial injection of 2 μL normal saline) and ICH model group (n=5) were treated with PBS in the same manner after the operation. The neurological deficits of the rats were evaluated using modified neurological severity score (mNSS). TUNEL staining was used to detect apoptosis of the striatal neurons, and the expressions of HMGB1, autophagy-related proteins (Beclin-1, LC3-Ⅱ and LC3-Ⅰ) and apoptosis-related proteins (Bcl-2, Bax and cleaved caspase-3) in the brain tissues surrounding the hematoma were detected using Western blotting. The expression of HMGB1 in the striatum was detected by immunohistochemistry, and serum level of HMGB1 was detected with ELISA.@*RESULTS@#The rat models of ICH showed significantly increased mNSS (P < 0.05), which was markedly lowered after treatment with anti- HMGB1 mAb (P < 0.05). ICH caused a significant increase of apoptosis of the striatal neurons (P < 0.05), enhanced the expressions of beclin-1, LC3-Ⅱ, Bax and cleaved caspase-3 (P < 0.05), lowered the expressions of LC3-Ⅰ and Bcl-2 (P < 0.05), and increased the content of HMGB1 (P < 0.05). Treatment with anti-HMGB1 mAb obviously lowered the apoptosis rate of the striatal neurons (P < 0.05), decreased the expressions of Beclin-1, LC3-Ⅱ, Bax and cleaved caspase-3 (P < 0.05), increased the expressions of LC3-Ⅰ and Bcl-2 (P < 0.05), and reduced the content of HMGB1 in ICH rats (P < 0.05).@*CONCLUSION@#Down- regulation of HMGB1 by anti-HMGB1 improves neurological functions of rats after ICH possibly by inhibiting autophagy and apoptosis of the neurons.

Intracerebral hemorrhage with a favorable outcome in a patient with childhood primary angiitis of the central nervous system / Hemorragia intracerebral com evolução favorável em paciente com angiíte primária do sistema nervoso central juvenil

ABSTRACT Childhood primary angiitis of the central nervous system (cPACNS) is a rare inflammatory brain disease of unknown etiology. Of note, brain hemorrhage has been rarely reported in cPACNS patients, generally associated with a delayed clinical diagnosis, or with a diagnosis only at necropsy. We present the case of a boy with cPACNS that previously suffered an ischemic stroke. At the age of 7 years and 10 months, he presented a sudden and severe headache, vomiting and reduction in consciousness level (Glasgow coma scale 7), requiring prompt tracheal intubation. Brain computed tomography demonstrated intraparenchymal hematoma in the right parieto-occipital lobe and a small focus of bleeding in the right frontal lobe, vasogenic edema, herniation of the uncus and a 10 mm deviation to the left from the midline. C-reactive protein (9.2 mg/dL) and von Willebrand factor (vWF) antigen (202%) were elevated. Decompressive craniotomy was performed and methylprednisolone and cyclophosphamide were administered. One week later, the patient had left hemiparesis without other sequelae. Importantly, motor deficits have been improving progressively. Our case reinforces the inclusion of this vasculitis as a differential diagnosis in children and adolescents with CNS hemorrhage.

RESUMO Angiíte primária do sistema nervoso central juvenil (APSNCJ) é uma doença inflamatória cerebral rara e de etiologia desconhecida. Hemorragia cerebral tem sido raramente reportada em pacientes com APSNCJ, geralmente associada com atraso diagnóstico, ou com um diagnóstico somente por necrópsia. Relata-se um caso de um paciente do gênero masculino com APSNCJ e que previamente sofreu um acidente vascular cerebral isquêmico. Aos 7 anos e 10 meses de idade, o menino apresentou subitamente cefaleia intensa, vômitos e redução do nível de consciência (escala de coma de Glasgow 7), requerendo imediata intubação traqueal. Uma tomografia computadorizada cerebral demonstrou hematoma intraparenquimatoso no lobo parieto-occipital direito e um pequeno foco de sangramento no lobo frontal direito, edema vasogênico, herniação do úncus e um desvio de 10 mm da linha média para a esquerda. A proteína C-reativa (9.2 mg/dL) e o fator antígeno de von Willebrand (202%) estavam elevados. Foi realizada uma craniotomia descompressiva, seguida pela administração de metilprednisolona e ciclofosfamida. Transcorrida uma semana, o paciente apresentava hemiparesia esquerda, sem outras sequelas. É digno de nota que o déficit motor tem melhorado progressivamente. Nosso caso reforça a inclusão dessa vasculite como diagnóstico diferencial em crianças e adolescentes com hemorragia do sistema nervoso central.

Tratamiento quirúrgico en las hemorragias intracerebrales lobares espontáneas supratentoriales sin extensión ventricular / Surgical treatment for supratentorial spontaneous lobarintracerebral hemorrhage without ventricular extension

Objetivo: Evaluar los resultados en el manejo de pacientes con hemorragias intracerebrales lobares espontaneas, supratentoriales y sin extensión ventricular a través de la comparación entre el tratamiento quirúrgico y el tratamiento médico. Material y Método: Se realizó un estudio de casos y controles en el Hospital General “Roberto Rodríguez Fernández” de Morón, Ciego de Ávila, Cuba, en el período comprendido entre enero de 2009 y diciembre de 2013. La muestra quedó conformada por aquellos que reunieron los siguientes criterios de inclusión: 1) Edad de 18-60 años; 2) 48 horas de inicio de las manifestaciones clínicas; 3) volumen de la hemorragia entre 20 y 60 cm3 ; 4) Escala de coma de Glasgow al ingreso superior a 4 puntos. Se constituyeron dos grupos, en el Grupo I fueron incluidos los enfermos que recibieron tratamiento quirúrgico y médico. En el Grupo II se incluyeron los que recibieron tratamiento médico solamente. La inclusión en uno de los dos grupos quedó sujeta al criterio del médico que recibió al paciente en el departamento de emergencias, no existió aleatorización en el proceso. Resultados: Se incluyeron en el estudio un total de 147 pacientes 54 (36,73 por ciento) en el Grupo I y 93 (63,27 por ciento) en el Grupo II. En el Grupo I la mortalidad a los seis meses del egreso fue de 16 pacientes (29,64 por ciento), mientras que en el grupo II murieron 33 (35,48 por ciento). Conclusiones: Se obtuvo un discreto pero relevante predominio de los resultados satisfactorios en el grupo de pacientes operados y la mortalidad fue también menor en este grupo.

The aim of this paper was to evaluate the surgical versus medical treatment in patients with supratentorial spontaneous intracerebral hemorrhage without ventricular extension. Methods: A case-control study was carried out in the “Roberto Rodríguez Fernández” general hospital in Moron, Ciego de Avila, Cuba, in the period between January 2009 and December 2013. The sample was conformed by those patients that gathered the following inclusion criteria: 1) Age of 18-60 years; 2) 48 hours of beginning of clinical manifestation; 3) Volume of the hemorrhage between 20-60 cm3; 4) GCS superior to 4 points. Two groups were constituted. In the group I the patients whom received medical and surgical treatment were included. In the group II were included patients whom received medical treatment only. The inclusion in one of the two groups was subject to the doctor´s criteria in the emergency department, randomization didn’t exist in the process. Results: They were included in the study a total of 147 patients, 54 (36,73 percent) in the Group I and 93 (63,27 percent) in the Group II. The mortality at 6 month of discharge was 29,64 percent in Group I and 35,48 percent in Group II. Conclusions: A discreet but outstanding of the satisfactory results was obtained in the group of operated patients and the mortality was also smaller in this group.

Hemorragia intracerebral supratentorial espontânea: aspectos determinantes para melhor prognóstico funcional / Spontaneous supratentorial intracerebral hemorrhage: determining aspects for better functional prognosis

Objetivo: Detectar quais aspectos das hemorragias intracerebrais supratentoriais espontâneas lobares e de núcleos da base se correlacionam com melhor prognóstico funcional, além de analisar se os pacientes admitidos com GCS = 9 (Escala de Coma de Glasgow – GCS) que atingiram melhor prognóstico funcional após 30 dias do íctus foram beneficiados pelo tratamento cirúrgico. Método: Sessenta e sete pacientes (18 a 80 anos) com hematomas intraparenquimatosos espontâneos lobares e de núcleos da base foram avaliados quanto a idade, nível de consciência à admissão hospitalar, profundidade da lesão, volume do hematoma, ausência de hemoventrículo, desvio de linha média (DLM), tempo entre íctus e cirurgia, além da opção de tratamento (cirúrgico ou conservador), sendo correlacionados com a evolução funcional em 30 dias após o íctus da hemorragia (Escala de Resultados de Glasgow – GOS), considerando-se melhor prognóstico funcional se GOS = 3. Resultados: Nas hemorragias lobares, pacientes admitidos com GCS = 9 e com volume do hematoma < 50 ml alcançaram bom prognóstico funcional (p < 0,001). Houve tendência a bom resultado se DLM = 5 mm (p = 0,051), quando tratamento é cirúrgico (p = 0,098) e se não há hemoventrículo (p = 0,073). Nas hemorragias de núcleos da base, apenas pacientes admitidos com GCS = 9 atingiram bom resultado funcional (p = 0,009). Pacientes admitidos com GCS = 9 e que atingiram GOS = 3 foram beneficiados quando volume do hematoma é menor que 50 ml (p = 0,048). Pacientes com hemorragias lobares admitidos com GCS = 9 em deterioração neurológica tendem a ser beneficiados pela cirurgia. Conclusão: Todos os pacientes admitidos com GCS = 9 têm melhor prognóstico funcional. Pacientes com hemorragias lobares e lesões menores que 50 ml também são significativamente favorecidos, além de existir tendência à melhor evolução quando operados, sem hemoventrículo e com DLM = 5 mm. Se admitidos não comatosos (GCS = 9), hematomas pequenos colaboram para melhor resultado funcional, e pacientes com hemorragias lobares em deterioração neurológica tendem a se beneficiar com a cirurgia.

Objective: Determine which aspects of the lobar and basal ganglia spontaneous supratentorial intracerebral hemorrhage correlates with better functional outcome, and to analyze whether patients admitted with GCS = 9 (Glasgow Coma Scale – GCS) who achieved better functional outcome after 30 days of ictus were benefited by surgical treatment. Method: Sixty-seven patients (18-80 years) with spontaneous lobar and basal ganglia intraparenchymal hematomas were evaluated based as age, level of consciousness at hospital admission, lesion depth, hematoma volume, absence of ventricular hemorrhage, midline shift (MLS), time between hemorrhage and surgery, treatment option (surgery or conservative), being correlated with the functional evolution in 30 days after the bleeding (Glasgow Outcome Scale – GOS), considering good functional prognosis if GOS = 3. Results: In lobar hemorrhages, patients admitted with GCS = 9 and hematoma volume < 50 ml achieved good functional outcome (p < 0.001). There was a trend of good result if MLS = 5 mm (p = 0.051), choice of surgical treatment (p = 0.098) and absence of ventricular hemorrhage (p = 0.073). In basal ganglia hemorrhages only patients admitted with GCS = 9 achieved a good functional outcome (p = 0.009). Patients admitted with GCS = 9 and reached GOS = 3 were benefited when hematoma volume < 50 ml (p = 0.048). Patients with lobar hemorrhage admitted with GCS = 9 and were in neurological deterioration appear to be benefited by surgery. Conclusion: All patients admitted with GCS = 9 has better functional prognosis. Patients with lobar hemorrhages and lesions smaller than 50 ml are also significantly favored, besides there is a trend to better evolution when patients are operated, when there is an absence of ventricular hemorrhage and MLS = 5 mm. If not admitted comatose (GCS = 9), small bleeding (< 50 ml) collaborate to better functional outcome. Surgery shows a trend to benefit patients with lobar hemorrhage in neurological deterioration.

Hemodynamic effects of mannitol infusion in patients with acute intracerebral hemorrhage

PURPOSE: To evaluate hemodynamic effects of mannitol infusion in patients with acute intracerebral hemorrhage. METHODS: Thirty patients with acute intracerebral hemorrhage were enrolled. Transcranial doppler was used to detect variables of bilateral middle cerebral arteria (MCA) including mean velocity (Vm) and pulsitility index (PI) before and after125ml and 250ml mannitol infusion (0, 30, 60, 90, 120, 180, 240 min). RESULTS: When 125ml or 250ml mannitol was infused in patients with acute intracerebral hemorrhage, Vm of bilateral MCA elevated, and reached the top at 30min, and then decreased. PI decreased in the affected MCA (250ml) and in the unaffected MCA (125ml and 250ml). CONCLUSION: Mannitol infusion in patients with acute intracerebral hemorrhage can improve cerebral blood flow in bilateral hemispheres and decrease intracranial pressure in the hemorrhagic hemisphere (250ml) and in the nonhemorrhagic hemisphere (125ml and 250ml).

Intracerebral hemorrhage

To study intracerebral hemorrhage [ICH] at Jordan University Hospital [JUH] with the aim of assessing prevalence, age/gender distribution, causes, clinical manifestations, and location of ICH on CT brain, treatment modalities and outcome, and to compare these findings with those from Middle Eastern and Western literature. Among 1498 patients with stroke seen over a 6-year-period, from January 2002 to December 2007 at JUH, Amman, Jordan, 100 patients with spontaneous ICH were studied retrospectively. The prevalence of ICH was 6.7%. The mean age was 61 years, with 71 males, and 29 females. The most common cause was hypertension, alone or combined with the use of aspirin and/or warfarin. The most common clinical manifestations were hemiparesis/plegia, impaired level of consciousness [mean Glasgow coma scale [GCS] score = 7.3] and headache/vomiting. The most common location on CT brain was in the basal ganglia [61 patients]. Seventy-nine patients received medical treatment and 21 had surgery. Forty-two patients died after a mean of 7 days [ranging from one day to 6 weeks]. The factors related to mortality were old age >68 years, GCS <8, intraventricular extension of ICH on CT brain and the presence of other comorbidities. Among 58 survivors, 50 were left with neurological deficit, predominantly hemiparesis/plegia in 46 patients. Twelve patients were left with chronic epilepsy. This study shows a lower prevalence of ICH compared to developed countries, a similar age and gender distribution, and hypertension as the major risk factor, which should be the focus of public health in Jordan and the Arab World

Hematomas intracerebrales no traumáticos: factores pronósticos / No traumatic intracerebral hematomas: pronostic factors

Los eventos hemorrágicos cerebrales de origen no traumático tienen un alto impacto medico y social. Para el medico de urgencia no existen muchas herramientas pronosticas en las primeras horas para predecir la mortalidad, necesidad de cirugía y grado de discapacidad en caso de sobrevida. Nosotros presentamos una estudio de cohorte prospectivo de 44 pacientes ingresados al Hospital van Buren de Valparaíso de hematoma intracerebral. Las localizaciones de las lesiones, fueron en 21 casos ubicadas en regiones profundas, en 19 pacientes se trato de hematomas lobares, 3 fueron cerebelosos y uno en protuberancia. El volumen calculado de las lesiones fue como promedio de 43, 2 cc, los varones alcanzaron mayores volúmenes con un promedio de 57cc +/-56cc contra 32cc +/-28cc diferencia significativa entre ambos grupos p < 0.05 Se intervinieron 11 pacientes, Los volúmenes de la lesión no fueron criterios en la indicación quirúrgica. El análisis de t-student demostró que los factores determinantes para realizar la cirugía fueron; desviación de línea media y la inundación ventricular (p<0.05). Fallecieron 10 de 44 pacientes estudiados. Las variables predictivas de muerte fueron el Glasgow de ingreso <8, volumen >55 cc y efecto de masa con desplazamiento de la línea media (p<0.05). En cuanto resultados malos en la calidad de sobrevida (GOS 1, 2 y 3), se pudo predecir estadísticamente (p<0.05) con un Glasgow menor a 8 al ingreso, volumen > 55 cc, efecto de masa y desviación de línea media y lesiones de tronco cerebral. El postular una Malformación vascular resultó un factor protector.

Actualizaciones en el manejo del síndrome cerebrovascular hemorrágico / Updates in the handling of the syndrome to cerebrovascular hemorrhagic

El síndrome cerebrovascular (SCV) constituye unas de las causas más frecuentes de mortalidad y morbilidad en todo el mundo. En Chile, es la quinta causa de muerte en el hombre y la tercera en la mujer. Un tipo de SCV es el hemorrágico que representa el 20 por ciento del total de Síndromes cerebro vasculares (SCV). Este trabajo pretende actualizar y resumir las principales intervenciones a realizar en el paciente con SCV hemorrágico. Estas incluyen, la valorización con distintas técnicas de neuroimagen; el manejo de la presión arterial; el control del aumento de la presión intracraneana y otros cuidados generales, así como el tratamiento quirúrgico, cuando corresponda al igual que la prevención secundaria.

Lesões isquêmicas cerebrais no recém-nascido pré-termo de muito baixo peso / Ischemic brain damage in very low birth weight preterm newborn infants

OBJETIVO: Apresentar uma revisão crítica e atualizada sobre as lesões cerebrais isquêmicas no recém-nascido pré-termo de muito baixo peso. FONTES DE DADOS: As referências foram obtidas através do banco de dados MEDLINE, sendo selecionadas as mais representativas a critério dos autores. SíNTESE DOS DADOS: A hemorragia com evolução para lesão isquêmica cerebral, a leucomalácia periventricular cística e a lesão difusa da substância branca cerebral são as lesões isquêmicas mais freqüentes em recém-nascidos pré-termo de muito baixo peso. Todas são doenças de causas multifatoriais, em que podem estar envolvidos fatores vasculares, hemodinâmicos, inflamatórios e infecciosos. São doenças que podem causar seqüelas neuropsicomotoras importantes e levar à paralisia cerebral e/ou déficit cognitivo e comportamental. CONCLUSÕES: O diagnóstico precoce e uma estratégia terapêutica adequada podem minimizar as seqüelas causadas por essas doenças. A prevenção da prematuridade é a principal medida preventiva a ser tomada.

Utilização do fator VII recombinante ativado (rFVIIa) como adjuvante na neuroproteção à zona de penumbra nas hemorragias intracranianas / Activated recombinant factor VII (rFVIIa) as adjunct neuroprotection therapy to the penumbra zone in intracranial hemorrhage

As hemorragias intracranianas constituem-se num grave distúrbio, geralmente de origem vascular, que acomete a inexpansível caixa craniana. Acometimentos cerebrais envolvem a formação de uma área perilesional denominada zona de penumbra adicionada a edemas e efeitos de massa com elevação da pressão intracraniana. Muito se discute sobre o comportamento desta zona de penumbra nas situações de acidentes vasculares cerebrais isquêmicos. Hoje em dia, estudos mostram que esta mesma zona de penumbra está presente também nos acidentes vasculares hemorrágicos e, sendo assim, o neurocirurgião deve a qualquer custo evitar a expansão dos hematomas intracranianos que sabidamente crescem devido a hemorragias secundárias com posteriores déficits neurológicos. Numa meta-análise envolvendo 58 pacientes, várias foram as indicações para uso de rFVIIa, mostrando-se sempre eficácia na melhora dos parâmetros hematimétricos. Dentre as indicações para sangramentos em SNC, pode ser uma arma de utilidade na redução da disseminação da lesão inicial, protegendo a zona de penumbra e minimizando as seqüelas.

Enfermedad cerebrovascular hemorrágica en la región central de Cuba / The hemorrhagic cerebrovascular disease in the central region of Cuba

Se realizó un estudio para determinar el comportamiento de la enfermedad cerebrovascular hemorrágica en la región central del país y definir sus tasas, curvas de tendencia, meteorolabilidad, porcentajes según sus tipos, marcadores de riesgo principales, evolución, pilares de tratamiento más empleados, unidades de atención y complicaciones. Es un estudio, descriptivo, retrospectivo, con revisión de 1 401 expedientes clínicos para obtención de datos procesados por sistema EPI 6.0 con determinación de media, desviación estándar y chi cuadrado, los principales resultados se expresaron en figuras y tablas. Se observó una tasa media total de 8,76 por 10 000 habitantes con una curva de tendencia variable por número de enfermos durante los 3 años analizados. Se asoció la enfermedad con posibles factores meteorológicos y el mayor porcentaje correspondió a la hemorragia intraparenquimatosa con 38,54 porciento y las edades avanzadas de la vida (p<0,001), el marcador de riesgo más reportado fue la hipertensión arterial (p<0,01). Se empleó el tratamiento quirúrgico en 81 enfermos con hemorragia subaracnoidea, predominaron las malformaciones de arteria cerebral media y anterior, los pilares de tratamiento más empleados fueron depletantes y anticálcicos, la ventilación mecánica y el apoyo vasoactivo fueron necesarios en considerable número de casos, la mayoría fueron atendidos en unidades de Terapia Intermedia Polivalente y la principal complicación fue la sepsis

Hemorragias intracraneanas secundarias a terapéutica trombolítica con estreptoquinasa en el infarto agudo de miocardio / Intracranial hemorrhages secondary to thrombolytic therapy with streptokinase in acute myocardial infarction

La trombolisis coronaria con Estreptoquinasa se emplea cada vez más frecuentemente en el tratamiento del Infarto Agudo de Miocardio, pero se puede complicar con hemorragias encefálicas hasta en un 3 por ciento de los casos. Hay una serie de factores que predisponen a su aparición, como ser: la edad avanzada, la hipertensión arterial, el uso previo de anticoagulantes orales, etc. La hemorragia encefálica secundaria al uso de Estreptoquinasa, es de pronóstico sumamente grave, con un porcentaje de mortalidad de aproximadamente el 70 por ciento. Los autores analizan una pequeña serie de 5 pacientes que durante el tratamiento con Estreptoquinasa por Infarto Agudo de Miocardio presentaron hematomas cerebrales y/o de cerebelo. La mortalidad de la serie fue del 60 por ciento. En todos los casos había claros factores predisponentes para la complicación. Tres fueron operados y de ellos, dos fallecieron

Prognóstico e evoluçäo cronológica das hemorragias intra-ventriculares de grau III bilateral (HIV-III-III) / The unreliability of neurologic examination in the diagnosis of neonatal perivPrognosis and evolution of bilateral grade III intraventricular - hemorhages (III-III-IVH)

Objetivo : Descrever a evoluçäo da HPIV para definir a melhor época para o início do tratamento terepêutico. Método: Estudo longitudinal com ecografia transfontanelar (ETF) do primeiro dia aos três meses de vida. Esta equipe qualifica como "massivas" as hemorragias intra-ventriculares III (HIV III) em que o diâmetro do coágulo é > 8mm em corte coronal pelo forame de Monro no máximo da hemorragia. Os 90 recém-nascidos (RN) estudados, foram distribuídos em quatro grupos. Grupo I de 29 pré-termos que morreram nos 7 primeiros dias pós-natais, peso de nascimento (PN)1.114+-253g, idade gestacional (IG) 28 semanas e 3 dias, apresentaram HIV III massiva uni ou bilateral com invasäo precoce de todo o sistema ventricular e fossa posterior. Grupo II de sete pré-termos mortos na 2ª semana pós-natal, similar e PN e IG, mais heterogênio. Dois grupos de Rn sobreviveram mais de 14 dias: Grupo III de 30 pré-termos (PN 1.299+-260g, IG 29 semanas e 1 dia), apresentando 20 HIV III-III clássicas,...

Conceitos atuais sobre o tratamento da hemorragia cerebral / Modern management of the patient with intracerebral haemorrhage

As hemorragias cerebrais constituem entre 10 por cento e 30 por cento dos casos de acidente vascular encefálico. Sua alta letalidade justifica esforços terapêuticos no ambiente de terapia intensiva. O tratamento das hemorragias cerebrais fundamenta-se na monitorizaçäo intensiva e freqüentemente invasiva e no controle agressivo das funçöes vitais e da hipertensäo intracraniana. As indicaçöes de tratamento cirúrgico nas hemorragias cerebelares estäo razoalvelmente esclarecidas, porém seu papel nas hemorragias supratentoriais permanece controverso. A evacuaçäo cirúrgica é provavelmente útil em indivíduos com lesöes lobares de volume intermediário (30 a 50 ou 80 cm3) e depressäo progressiva do nível de consciência. Abordagens alterantivas, principalmente aspiraçäo estereotáxica, guiada por tomografia computadorizada ou sob visualizaçäo direta, säo objeto atual de intenso estudo. A comparaçäo direta entre a cirurgia e estas novas técnicas deverá esclarecer seu papel relativo em hemorragias hemisféricas profundas.