Neutrophil and Platelet to Lymphocyte Ratios in Associating with Blood Glucose Admission Predict the Functional Outcomes of Patients with Primary Brainstem Hemorrhage.

BACKGROUND: Because of a lack of markers for predicting prognosis and an underlying mechanism, patients with primary brainstem hemorrhage (PBH) are currently treated with multiple strategies, but most of them have poor outcomes in a comparison with patients with supratentorial intracranial hemorrhage. Recently, it has been reported that the neutrophil-to-lymphocyte ratio (NLR) represents a novel composite inflammatory marker to predict the prognosis of patients with intracranial hemorrhage, a majority of whom have supratentorial hemorrhage. In this report, we aim to assess the potential predictive value of NLR in patients with PBH. In addition, other available laboratory parameters, including platelet-to-lymphocyte ratio (PLR), and admission blood glucose level (ABG), will be also investigated as markers for prognosis in patients with PBH. METHODS: This study retrospectively enrolled 225 patients with acute PBH who were admitted West China Hospital from January 2012 to December 2016. ABG and absolute numbers of neutrophils, lymphocytes, white blood cells, and platelets were extracted from electronic medical records. ABG, NLR, and PLR were calculated and further assessed using multivariable logistic regression analysis for understanding the associations of treatment outcomes. The comparison of predictive power of independent predictors was evaluated using receiver operating characteristic. RESULTS: Of 225 inpatients, NLR (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.24-2.62, P < 0.01), PLR (OR, 1.43; 95% CI, 1.11-2.36; P = 0.013), and ABG (OR, 6.57; 95% CI, 2.78-15.52; P < 0.01) were independently associated with 90-day status in 112 patients with unfavorable outcomes. All 3 parameters also correlated with admission Glasgow Coma Scale score (r = -0.244, P < 0.001; r = -0.292, P < 0.001; r = -0.661, P < 0.01) and absolute neutrophil counts (r = 0.645, P < 0.001; r = 0.347, P < 0.001; r = 0.695, P < 0.01). Meanwhile, NLR exhibits a comparable predictive power by comparing with PLR (area under the curve [AUC], 0.694; 95% CI, 0.626-0.764; P < 0.001; versus AUC, 0.662; 95% CI, 0.596-0.724; P < 0.001). In addition, ABG shows a positive predictive value (AUC, 0.784; 95% CI, 0.725-0.832; P < 0.001). The best independent predictive cutoff points were 6.65, 59.3, and 7.81 mmol/L for NLR, PLR, and ABG, respectively. Nevertheless, a combination of 3 parameters shows the best predictive ability (AUC, 0.835; 95% CI, 0.781-0.883; P < 0.001). CONCLUSIONS: NLR, PLR, and ABG can be used to independently predict 90-day functional outcome in patients after PBH. When combined, they have better predictive power in identifying PBH patients with a poor prognosis. To our knowledge, this study is the first to reveal the associations between NLR, PLR, and hyperglycemia and the functional outcomes of patient with PBH. In associating with previously studies on hemorrhage site, our results provide a good opportunity to elucidate the underlying mechanisms of PBH.

Intraparenchymal Atypical Meningioma in Basal Ganglia Region in a Child: Case Report and Literature Review

Intraparenchymal meningiomas without dural attachment are extremely rare, especially when they occur in basal ganglia region in child. An 8-year-old boy was admitted at our hospital, complaining of recurrent headache and vomiting for 3 months. Neurological examination showed impaired vision and mild paresis of the left extremities. Magnetic resonance imaging demonstrated a lesion located in the right basal ganglia region extending to superasellar cistern with solid, multiple cystic and necrotic components. Computed tomography revealed calcification within the mass. Due to the anterior cerebral artery involvement, a subtotal resection was achieved and postoperative radiotherapy was recommended. Histopathological examination indicated that the lesion was an atypical meningioma. The postoperative rehabilitation was uneventful. Mildly impaired vision and motor weakness of left extremities improved significantly and the patient returned to normal life after surgery. To our knowledge, intraparenchymal atypical meningioma in basal ganglia extending to superasellar cistern was never reported. The significance in differential diagnosis of lesions in basal ganglia should be emphasized.

Intraparenchymal Atypical Meningioma in Basal Ganglia Region in a Child: Case Report and Literature Review

Intraparenchymal meningiomas without dural attachment are extremely rare, especially when they occur in basal ganglia region in child. An 8-year-old boy was admitted at our hospital, complaining of recurrent headache and vomiting for 3 months. Neurological examination showed impaired vision and mild paresis of the left extremities. Magnetic resonance imaging demonstrated a lesion located in the right basal ganglia region extending to superasellar cistern with solid, multiple cystic and necrotic components. Computed tomography revealed calcification within the mass. Due to the anterior cerebral artery involvement, a subtotal resection was achieved and postoperative radiotherapy was recommended. Histopathological examination indicated that the lesion was an atypical meningioma. The postoperative rehabilitation was uneventful. Mildly impaired vision and motor weakness of left extremities improved significantly and the patient returned to normal life after surgery. To our knowledge, intraparenchymal atypical meningioma in basal ganglia extending to superasellar cistern was never reported. The significance in differential diagnosis of lesions in basal ganglia should be emphasized.

Blood-Brain Barrier Disruption and Perivascular Beta-Amyloid Accumulation in the Brain of Aged Rats with Spontaneous Hypertension: Evaluation with Dynamic Contrast-Enhanced Magnetic Resonance Imaging

OBJECTIVE: Whether blood-brain barrier (BBB) disruption induced by chronic spontaneous hypertension is associated with beta-amyloid (Aβ) accumulation in the brain remains poorly understood. The purpose of this study was to investigate the relationship between BBB disruption and Aβ influx and accumulation in the brain of aged rats with chronic spontaneous hypertension. MATERIALS AND METHODS: Five aged spontaneously hypertensive rats (SHRs) and five age-matched normotensive Wistar-Kyoto (WKY) rats were studied. The volume transfer constant (Ktrans) obtained from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) was used to evaluate BBB permeability in the hippocampus and cortex in vivo. The BBB tight junctions, immunoglobulin G (IgG), Aβ, and amyloid precursor protein (APP) in the hippocampus and cortex were examined with immunohistochemistry. RESULTS: As compared with WKY rats, the Ktrans values in the hippocampus and cortex of the SHRs increased remarkably (0.316 ± 0.027 min−1 vs. 0.084 ± 0.017 min−1, p < 0.001 for hippocampus; 0.302 ± 0.072 min−1 vs. 0.052 ± 0.047 min−1, p < 0.001 for cortex). Dramatic occludin and zonula occludens-1 losses were detected in the hippocampus and cortex of SHRs, and obvious IgG exudation was found there. Dramatic Aβ accumulation was found and limited to the area surrounding the BBB, without extension to other parenchyma regions in the hippocampus and cortex of aged SHRs. Alternatively, differences in APP expression in the hippocampus and cortex were not significant. CONCLUSION: Blood-brain barrier disruption is associated with Aβ influx and accumulation in the brain of aged rats with chronic spontaneous hypertension. DCE-MRI can be used as an effective method to investigated BBB damage.