Effects of mild hypothermia therapy combined with minimally invasive debridement in patients with hypertensive intracranial hemorrhage: a randomized controlled study.

OBJECTIVE: To investigate the clinical effect of mild hypothermia therapy (MHT) combined with minimally invasive debridement (MID) in patients with severe hypertensive intracranial hemorrhage (HICH). METHODS: A total of 120 patients with severe HICH who received clinical intervention in our hospital were enrolled as study subjects. In this randomized, controlled, double-blind trial, they were divided into a study group (SG, n=70) and a control group (CNG, n=50). The CNG was treated with MID, and the SG was treated with MID combined with MHT. The general surgical indices, short-term postoperative outcomes, postoperative neurological and recovery in activities of daily living, and complications were compared between the two groups. Patients' Glasgow prognosis (Glasgow Outcome Scale, GOS) scores at 1 year after surgery were analyzed. RESULTS: The operative time, intraoperative blood loss and intensive care unit (ICU) admission were shorter/lower in the SG than in the CNG (P<0.05). The SG had higher hematoma clearance rate at 1 d and 3 d postoperatively, and lower residual hematoma volume at 3 d and 7 d postoperatively than the CNG (P<0.05). Patients in the SG had higher Barthel scores and lower National Institutes of Health Stroke Scale (NIHSS) scores than the CNG at 1-12 months after intervention (P<0.05). The incidence of complications in the SG was lower than that in the CNG (P<0.05). The percentage of GOS grade IV and V was significantly higher in the SG than in the CNG 1 year after surgery (P<0.05). CONCLUSION: The combination of MID and MHT in patients with severe HICH has better clinical results in the short and long term, and improves the postoperative outcomes and quality of life. It can also reduce the incidence of perioperative complications.

Guillain-Barré syndrome as a complication of hypertensive basal ganglia haemorrhage.

We aimed to study the potential relationship of Guillain-Barré syndrome (GBS) and intracranial haemorrhage (ICH). We present a case of a 70-year-old hypertensive woman who developed global weakness, eventually becoming quadriplegic, during an inpatient stay for treatment of a basal ganglia haemorrhagic stroke. Guillain-Barré syndrome was confirmed and treatment initiated. She responded well to intravenous immunoglobulin treatment and then subsequently continued with rehabilitation. There have been a few case reports of GBS as a complication of spontaneous intracranial haemorrhage (ICH) or traumatic brain injury. It may not be a coincidence that our patient developed GBS shortly after presentation. There may be an immunological explanation with immune activation following neuronal injury after ICH with associated blood-brain barrier breakdown. GBS following ICH adds further complexity to treating patients who are already critically ill. If patients develop new weakness after ICH, there should be a high index of suspicion for GBS. It should be distinguished from critical illness neuropathy/myopathy and other causes of weakness in critical care patients because the treatment is very different. Immune activation and sensitization to myelin-associated proteins may be the underlying pathophysiological basis.

Recent progress of minimally invasive surgery for hypertensive intracranial hemorrhage / 第二军医大学学报

Hypertensive intracranial hemorrhage (HICH) has high incidence and mortality, causing great economic and health burden. However, HICH is the only subgroup of stroke that has no clear treatment standard. Though traditional craniotomy still enjoys popularity in treating HICH, yet no clear clinical evidence support its benefit to neuronal function and prognosis. Recently minimally invasive surgery (MIS) begin to show great advantage to treat HICH. This review presented the current situation and recent progress of common MIS procedures for HICH, including stereotactic aspiration, neuroendoscopic evacuation and fibrinolysis treatment.

Clinical contrast study on minimally invasive hematoma quenching aspiration and hematoma evacuation for hypertensive cerebral hemorrhage / 中国基层医药

Objective To compare the effect of minimally invasive hematoma the quenching aspiration and hematoma evacuation in the treatment of hypertensive basal ganglia brain hemorrhage.Methods 92 patients with hypertensive cerebral basal ganglia hemorrhage underwent surgical treatment were randomly divided into two groups:minimally invasive quenching suction group of 46 patients,craniotomy group of 46 patients.The mortality,complications and activities of daily living(ADL) postoperative three months were observed.Results The mortality rate of the minimally invasive quenching suck group was lower than that of the craniotomy group (8.7％ vs 21.7％,P ＜ 0.05).The postoperative rebleeding and the incidence rate of complications such as lung infections in the minimally invasive quenching suction group were lower than those of the craniotomy group(all P ＜ 0.05).ADL score 3 months postoperatively of the minimally invasive quenching suction group was higher than that of the craniotomy group [(85.53 ± 13.47) points vs (56.12 ± 11.72) points,P ＜ 0.05].Conclusion Minimally invasive hematoma the quenched aspiration in treatment of hypertensive basal ganglia brain bleeding trauma can reduce the mortality,reduce the occurrence of postoperative complications,increase quality of life in patients,has better efficacy for treatment of hypertensive intracerebral hemorrhage.

Effect of portable head computed tomography navigation-guided surgery on patients with hypertensive hematoma / 中华神经医学杂志

Objective To evaluate the outcome and safety of portable 3D head computed tomography (CT) navigation-guided keyhole microsurgery in patients with hypertensive intracranial hematomas (HICH).Methods Thirty-five consecutive unconscious patients with a volume of HICH at 24-90 mL,admitted to our hospital from January 2010 to December 2012,were treated with 3D image-guided keyhole microsurgery.The preoperative and postoperative neurological status determined by Glasgow Coma Scale (GCS) and modified Rankin Scale (mRS).Outcome at six months was assessed by Glasgow Outcome Scale (GOS).Results Average time from admission to the operation room,time for CT scan,and average operation time were (11.22±6.37) h and (19±13.11) min and (108.49±26.61)min,respectively.The total and near total (＞90％) hematoma evacuation rate was 96.9％.The mRS and GCS scores were significantly improved at discharge as compared with those before surgery (F=6.487,P＜0.05).Six months after the surgery,57.1％ patients achieved good recovery (GOS scores 4-5),and two patients died.Conclusion Keyhole minimally invasive hematoma with the help of portable head 3D reconstructed CT scan is highly effective in obtaining immediate and complete hematoma evacuation;portable CT is reliably and effective for preoperative navigation,and is very helpful for surgical management of patients with HICH.

Influence of hyperbaric oxygen treatment on blood pressure and the rebleeding in patients with hypertensive intracranial hemorrhage / 中国综合临床

Objective To investigate the influence of hyperbaric oxygen treatment (HBOT) on blood pressure (BP) and the incidence of rebleeding in patients with hypertensive intracranial hemorrhage (HICH)Methods One hundred and twenty patients with HICH were treated for 60 min with 100% oxygen at 2.0 absolute atmospheres (ATA) daily when the condition was stable and BP was controlled ideally. Blood pressure was measured before the patients were sent into the HBO chamber and remeasured following completion of each HBOT session and 1 hour later. Rebleeding was monitored during and after each HBO session . Results HBOT caused a significant elevation of systolic BP in 25.83% (31/120) patients and a significant decrease in 16.67% (20/120) patients (P ＜0. 05 ),whereas the rest 57.5% (69/120) patients had no significant changes,when the BP was measured right after the HBOT session. The mean diastolic BP increased in 69 (57. 50% ) patients and decreased in 4. 17%(5/120) patients (P ＜ 0. 05 ), whereas we found no significant changes in the rest 46 (38. 33% ) patients. No differences were found in the comparison of BP before and 1 hour after the HBOT session and no one suffered from rebleeding during and after HBOT session. Conclusions HBOT may cause temporal blood pressure changes in most patients with HICH, however, it will not cause an increasing incidence of rebleeding if the patient's condition is stable and the blood pressure has been well controlled.

Chronic subdural hematoma with sudden clinical uncal herniation and coma: case report

Context: Chronic subdural hematomas are frequent diseases in neurosurgery units. Decreased level of consciousness is observed in 28 to 100 percent of cases, nevertheless in rare cases are seen comatous patients. We describe a case of a patient with clinical uncal herniation elapsed by a chronic subdural hematoma. Case report: Patient with previous diagnosis of breast cancer, presented sudden occurrence of a headache followed by decreasing level of consiousness the day before reaching our service. The patient was taken than to another Hospital at 1:00 AM in Glasgow Coma Scale (GCS) 13, with isochonic pupils. At 7:00 AM the GCS went to 7 and the pupils became anisochonic L > R and than transferred to our Unit and immediatly submitted to a computed tomohraphy scanning of the head that showed a chronic subdural hematoma with midline shift. The patient promptly was taken to surgical room and treated with a single burr hole with drainage of hypertensive chronic subdural hematoma. The level of consiousness increased few hours after surgery, being in GCS 15 just 6 hours after, without motor deficits. Conclusion: In spite of commonly progressive evolution chronic subdural hematomas can present with herniation, becoming itself a neurosurgical emergency.

Pure V1 Trigeminal Sensory Neuropathy due to Primary Pontine Hemorrhage

No abstract available.

Clinical Analysis of Hypertensive Intracranial Hemorrhage

367 patients with hypertensive intracranial hemorrhage, admitted to Masan Koryo neurosurgical department from Jan. 1988 to Dec. 1991, have been clinically analyzed. The results were as follows: 1) The group consisted of 176 males and 191 females. The peak age of the patients was at their 6th decade. Seasonal distribution of the incidence was peaked at spring and autumn. 2) 51.0% of these hemorrhage was located in putamen, 19.9% in thalamus, 12.5% in subcortex, 8.7% in cerebellum and 7.9% in brain stem. Patients with brain stem hemorrhage showed relatively poor prognosis compared with subcortex or cerebellar hemorrhage. 3) The level of consciousness at admission has significant relation to prognosis especially in non-operative group. 4) 130 patients underwent surgical treatment. In delayed operation group which was performed after at least 3 days from attack, good prognosis was obtained. 5) In 146 patients(39.8%), IVH was accompanied, which lead to poor prognosis. Especially in patients with thalamic hemorrhage, the incidence of IVH reached to 71.2%. 6) Overall outcome of 367 patients was good in 40.9%, and poor in 25.9%. Total motality rate was 33.2%.

Clinical Analysis of Hypertensive Intracranial Hemorrhage

367 patients with hypertensive intracranial hemorrhage, admitted to Masan Koryo neurosurgical department from Jan. 1988 to Dec. 1991, have been clinically analyzed. The results were as follows: 1) The group consisted of 176 males and 191 females. The peak age of the patients was at their 6th decade. Seasonal distribution of the incidence was peaked at spring and autumn. 2) 51.0% of these hemorrhage was located in putamen, 19.9% in thalamus, 12.5% in subcortex, 8.7% in cerebellum and 7.9% in brain stem. Patients with brain stem hemorrhage showed relatively poor prognosis compared with subcortex or cerebellar hemorrhage. 3) The level of consciousness at admission has significant relation to prognosis especially in non-operative group. 4) 130 patients underwent surgical treatment. In delayed operation group which was performed after at least 3 days from attack, good prognosis was obtained. 5) In 146 patients(39.8%), IVH was accompanied, which lead to poor prognosis. Especially in patients with thalamic hemorrhage, the incidence of IVH reached to 71.2%. 6) Overall outcome of 367 patients was good in 40.9%, and poor in 25.9%. Total motality rate was 33.2%.