Expression of Sphingosine-1-phosphate (S1P) on the cerebral vasospasm after subarachnoid hemorrhage in rabbits

PURPOSE:To demonstrate the relationship between of sphingosine-1-phosphate (S1P) expression and subarachnoid hemorrhage (SAH).METHODS:The basilar arteries from a "double-hemorrhage" rabbit model of SAH were used to investigate the relation between S1P expression and SAH. Various symptoms, including blood clots, basilar artery cross-sectional area, and S1P phosphatase expression were measured at day 3, 5, 7, 9.RESULTS: The expression of S1P was enhanced in the cerebral vasospasm after subarachnoid hemorrhage in the rabbits. And S1P expression was consistent with the basilar artery cross-sectional area changes at day 3, 5, 7, 9.CONCLUSION: Sphingosine-1-phosphate expression in the cerebral arterial may be a new indicator in the development of cerebral vasospasm after subarachnoid hemorrhage and provide a new therapeutic method for SAH.

Forensic appraisal of subarachnoid hemorrhage / 法医学杂志

Subarachnoid hemorrhage (SAH) can be classified as traumatic SAH or spontaneous SAH based on etiology. The traumatic SAH is the common manifestation of head injury and difficult to make a diagnosis in forensic investigation. Based on practical experiences of forensic investigation and relevant references, the main points (SAH identification, examination, death mechanism) were summarized in this article. For the understanding, we try to classify the traumatic SAH into three subtypes: brain injury associated SAH, traumatic rupture of basal cerebral vessels SAH and traumatic focal SAH.

Analysis on clinical classification and injury certification in 30 cases of acute closed head trauma / 法医学杂志

OBJECTIVE@#In order to improve accuracy of forensic expert conclusion and provide scientific and reasonable accordance for revising identifying criteria for the injury degree, correlation between clinical classification and injury certification of acute closed head trauma were explored.@*METHODS@#A total of 30 cases about acute closed head trauma were selected. Comparison and analysis were made about their differences and the correlation between the clinical classification and the injury degree certification.@*RESULTS@#Mild craniocerebral injury is equal to mild or moderate injury, moderate craniocerebral injury is equivalent to mild or severe injury, severe craniocerebral injury is mostly equivalent to severe injury.@*CONCLUSION@#There are some correlation between the clinical classification and the injury certification in acute closed head trauma. It is necessary to refer to the criteria of clinical classification when revising identifying criteria for the injury degree so as to enhance scientific rigor and rationality.

Ultra-Early Surgery for Poor-Grade Intracranial Aneurysmal Subarachnoid Hemorrhage: A Preliminary Study

PURPOSE: To describe the therapeutic effect and possibility of the ultra-early surgery for poor-grade aneurysmal subarachnoid hemorrhage (Hunt-Hess grades IV - V). MATERIALS AND METHODS: Nine cases with intracranial aneurysms, demonstrated by computed tomographic angiography (CTA), were treated by ultra-early surgery under general anesthesia within 24 hours from subarachnoid hemorrhage (SAH), 5 cases were treated within 6 hours and 4 cases in 6 - 24 hours. Preoperative Hunt-Hess grade: 6 cases were IV and 3 cases were V. The clinical outcome was evaluated by Glasgow Outcome Scores (GOS). RESULTS: In operation, difficult dissection occurred in 5 cases (55.6%), and rupture of aneurysm occurred and temporary obstructions were performed in 4 cases (44.4%). After clipping of aneurysm, 2 cases underwent V-P shunt because of hydrocephalus, pulmonary infection occurred in 3 cases, hypothalamus reaction accompanied with upper gastrointestinal hemorrhage in 2 cases. The clinical outcome were favorable (GOS 4 - 5) in 4 cases (44.4%), dissatisfied (GOS 2 - 3) in 3 cases (33.3%), and dead (GOS 1) in 2 cases (22.2%) when patients departed from our hospital. CONCLUSION: The ultra-early surgery can avoid early rebleeding of intracranial aneurysm, therefore, should be considered in the treatment of Hunt-Hess grade IV-V intracranial aneurysms. The appliance of CTA can make it possible to use of ultra-early surgery and improve the therapeutic effect.

Retinal examination with ophthalmic endoscopy in forensic autopsy / 法医学杂志

Autopsy by forensic pathologist is a main mean currently to determine the cause of sudden unexpected death. Retinal examination is important but seldom performed during a forensic autopsy for various reasons. The value of retina examination has not been recognized. With invention of ophthalmic endoscopy and its subsequent application in postmortem retina examination, it has proved to be useful adjunct to determine the cause of death and to estimate the postmortem interval.

Immunohistochemical study on contents of beta-amyloid, alpha-actin and collagen IV in cerebral small vessels with unknown type of pathological lesion / 法医学杂志

OBJECTIVE@#To investigate the structural characteristics of the cerebral small vessels with an unknown type of pathological lesion (UTPL).@*METHODS@#Contents of beta-amyloid, alpha-actin and collagen IV in cerebral small vessels with UTPL were studied by Congo red staining, immunohistochemical staining and computer image analysis.@*RESULTS@#The low expression levels of alpha-actin and collagen IV (P<0.05) were observed in tunica media of the vessels with UTPL, and no positive expression of beta-amyloid (P>0.05) was observed in these vessel walls. The expressions of proteins mentioned above in UTPL were different from those of cerebral amyloid angiopathy(CAA) and hyaline arteriolosclerosis.@*CONCLUSION@#UTPL was different from CAA or hyaline arteriolosclerosis in pathologic feature.

Aneurisma paraclinóideo: técnica cirúrgica e resultados em 51 pacientes / Paraclinoid aneurysms: surgical technique and results in 51 patients

Analisam-se 51 pacientes portadores de 55 aneurismas paraclinóideos (APC) submetidos a tratamento cirúrgico. Em decorrência de tratar-se de procedimento de alta complexidade, descrevemos em pormenor os seus aspectos técnicos. O processo clinóideo anterior foi removido por via extradural após secção da duplicação dural da tenda da fissura orbitária superior e/ou por via intradural. Conseguiu-se exclusão do APC nos 51 pacientes. Em dois casos a clipagem foi parcial e, em três, ocorreu oclusão da ACI. Em 42 (82 por cento) pacientes ocorreu bom resultado; em 5 (10 por cento), incapacidade moderada; em 1 (2 por cento), incapacidade grave e três (6 por cento) faleceram por infarto cerebral. Sete (13,7 por cento) pacientes tiveram lesão adicional do nervo óptico, sendo parcial em 4 (7,7 por cento) e total em 3 (6 por cento).

Mortalidad por hemorragias intracerebrales espontáneas: estudio clinicopatológico / Death from spontaneous intracranial hemorrhage: a clinicopathological study

Se realizó un estudio observacional-descriptivo de 75 pacientes fallecidos por hemorragias intracerebrales espontáneas, en el período comprendido entre enero de 1986 y diciembre de 1997, de los cuales 40 (53,34 porciento) pertenecían al sexo masculino y los restantes 35 (46,66 porciento) al femenino, con una edad promedio de 64,35 años. La hipertensión arterial fue el factor de riesgo más encontrado, 33 (44 porciento), seguido por la insuficiencia cardíaca congestiva, 17 (22,67 porciento), mientras que la causa más frecuente estuvo representada por la hemorragia del hipertenso, 40 (53,34 porciento). Los hallazgos anatomopatológicos intracraneales más significativos fueron la hemorragia intraventricular en 26 pacientes (34,67 porciento), el edema cerebral, 24 (32 porciento) y la hemorragia subaracnoidea, 23 (30,67 porciento)(AU)

We carried out an observational and descriptive study of 75 patients who died from spontaneous intracrainial hemorrhages from January 1986 to December 1997, 40 percent of whom (53.34 percent) were males and 35 (46.66 percent) females with and average age of 64.35 years. Blood hypertension was the most prevailing risk factors in 33 patients (44 percent) followed by congestive heart failure in 17 (27.67 percent) whereas the most common cause was represented by hemorrhage in hypertension with 40 patients (53.34 percent). The most significant intracranial anatomopathological findings were intraventricular hemorrhage in 26 patients (34.67 percent), cerebral edema in 24 (32 percent) subarachnoid hemorrhage in 23 cases (30.67 percent)(AU)

Distal calcarine fusiform aneurysm: a case report and review of literature.

A 50 year old female who was operated for atrial septal defect 8 years back, presented with clinical features suggestive of subarachnoid haemorrhage (grade I, Hunt and Hess). CT scan of brain revealed haemorrhage in all the supratentorial basal cisterns, sylvian cistern and small haematoma in the left occipital lobe. Conventional CT and MR angiography revealed aneurysm in relation to distal part of the calcarine branch of the left posterior cerebral artery (PCA). Left occipital craniotomy in prone position followed by deep dissection in the occipital lobe showed fusiform aneurysm of the distal part of the calcarine branch. PCA aneurysms constitute only 0.2 to 1% of all intracranial aneurysms and among them distal PCA aneurysms are most rare, constituting only 1.3%. They too are mostly seen at the bifurcation of the PCA. The present case however, is unique in the sense that it has developed as a fusiform aneurysm in the distal part of the calcarine branch. To the best of our knowledge this is rare among the rarest.

Injúria hipóxico-isquêmica de padräo hemorrágico em encéfalos de neomortos do Hospital de Clínicas de Curitiba: análise de 1028 casos de necrópsia entre 1960 e 1995 / Brain hypoxic-injury of haemorrhagic pattern in newborns: analysis of 1028 autopsies from 1960 to 1995

A injúria hipóxico-isquêmica do sistema nervoso central em neomortos é entidade altamente prevalente, acometendo de 1 a 6 para cada 1000 nascidos vivos. Quando severa provoca o óbito de muitas crianças ou deixa sequelas neurológicas importantes. Relatamos 1028 casos consecutivos de injúria hipóxico-isquêmica de padrão hemorrágico em encéfalos de neomortos do Hospital de Clínicas da Universidade Federal do Paraná - Curitiba, no período compreendido entre 1960 e 1995. Pode-se demonstrar que a prevalência destas lesões nos encéfalos de recém-nascidos autopsiados é alta (49,73 por cento). Os principais tipos de hemorragia encontrados foram as micro-hemorragias intraparenquimatosas cerebrais, as hemorragias intraventriculares, as hemorragias periventriculares e as hemorragias subaracnóideas. Os resultados obtidos demonstram a propensão dos prematuros ao desenvolvimento de hemorragias encefálicas, indicando a necessidade de medidas preventivas que diminuam o risco de complicações neurológicas.

Arachnoid granulation affected by subarachnoid hemorrhage

Por microscopia óptica foram estudados os componentes fibrosos das granulaçöes aracnódes de indivíduos acometidos por hemorragia subaracnóide de tipo moderado ou severo. Os eritrócitos estavam presentes nos canais delimitados por feixes de fibras elásticas, colágenas e células aracnóides. Os canais tortuosos e intercomunicantes eram observados desde o pediculo até a cápsula fibrosa da granulaçäo aracnóide. O principal trajeto dos eritrócitos e do líquido cáfalo-raquidiano ocorria no interior do pedículo e centro da granulaçäo aracnóide. Na hemorragia severa, os compoentes fibro-musculares estavam desorganizados e os canais extra-celulares aumentados. A presença de células com grandes núcleos, observada no material hemorrágico, é sugestiva de transformaçöes das células aracnóides em células fagocitárias, para promover a digestäo intracelular dos eritrócitos

Hemorragia subaracnoidea: análisis de 52 casos en un Hospital General y revisión de la literatura

La hemorragia subaracnoidea secundaria a ruptura de aneurismas intracraneales, representa una patología frecuente en nuestro medio, predominando en individuos previamente sanos y en la edad productiva de la vida. Se analizaron retrospectivamente 52 historias clínicas de pacientes con HSA que ingresaron al HUAL entre 1978-88, con los siguientes resultados: predominio en el sexo femenino y mayores de 61 años, siendo los signos meníngeos y la cefalea los datos clínicos más resaltantes. Al ingreso la evaluación de la escala de Boterell permitió clasificar más pacientes en el grado II. La HTA fue la enfermedad más frecuentemente asociada. Las alteraciones del LCR son las descritas tradicionalemente. La TAC de cráneo fue normal en el 34 por ciento de los casos realizados. La ubicación de los aneurismas a través de la arteriografía fue más frecuente en la interna. el tratamiento utilizado fue: antiedema, hipotensores, protección gastroduodenal, anticonvulsivantes, calcioantagonistas. Sólo en el 5,8 por ciento de los casos hubo resolución quirúrgica. la mortalidad fue del 19,2 por ciento. En los años estudiados existió una alta mortalidad en nuestro medio inherente a la falta de recursos diagnósticos y bajo índice quirúrgico, lo cual en la actualidad ha cambiado. Aún no existen agentes farmacológicos que garanticen la prevención efectiva del vasoespasmo y/o resangramiento. La expansión del volumen vascular sigue siendo el único tratamiento efectivo en la isquemia secundaria al casiespasmo ayudado por los calcioantagonistas, pero involucra el riesgo de resangramiento. Por lo tanto sigue siendo la solución quirúrgica precoz y la poeterior expansión vascular los pilares fundamentales para reducir la morbimortalidad por esta patología

Accidentes cerebrovasculares en jóvenes / Cerebrovascular accidents in the young

Dado el interés mundial en el estudio de Accidentes Cerebro Vasculares en Adultos Jóvenes, a la ausencia de estudios precedentes en nuestro país y a la observación no poco frecuente en nuestra práctica diaria en el Hospital Vargas de Caracas, decidimos emprender este estudio descriptivo con el objeto de determinar nuestra casuística en sujetos entre 15 a 44 años desde 1986 a 1988. Se revisaron 57 historias clínicas correspondientes al 14,9

Cerebromeningeal hemorrhage: analysis of autopsies performed over a 10-year period

Foram analisados 353 pacientes que faleceram por hemorragia subaracnóidea autopsiados nos últimos 10 anos no Hospital das Clínicas da Faculdade de Medicina de Ribeiräo Preto. A hemorragia subaracnóidea estava associada a hipertensäo arterial em 180 casos, a ruptura de aneurisma em 102 e a outras patologias em 71 casos. O sexo masculino predominou nos pacientes com hemorragia associada a hipertensäo arterial e o feminino mas hemorragias por ruptura de aneurismas. As hemorragias associadas a hipertensäo arterial predominaram em faxias etárias mais altas em relaçäo à hemorragias por aneurismas. Dos pacientes com aneurismas, 36 (35,3%) apresentaram aneurismas no complexo cerebral anterior/comunicante anterior, 30 (29,4%) na carótida interna e 23 (22,5%) na cerebral média. Nos casos de aneurismas, o vasoespasmo predominou no período do 3§ ao 10§ dia e o ressangramento predominou no período do 9§ ao 16§ e respectivamente 59,1% e 61,5½ desses pacientes apresentaram-se nos graus I e II na admissäo e evoluiram para o grau IV após estas intercorrências. Ambas as intercorrências foram mais freqüentes entre os pacientes com aneurismas do complexo cerebral anterior/comunicante anterior. Sessenta e oito por cento dos óbitos por aneurismas ocorreram nos 9 primeiros dias após a hemorragia. Os pacientes admitidos em grau I e II e que sofreram vasoespasmo ou ressangramento e que poderiam beneficiar-se do tratamento cirúrgico precoce näo tiveram esta oportunidade porque a nossa conduta naquela época era de operar sistematicamente no final da segunda ou no início da terceira semana após a hemorragia subaracnóidea