- [Neurosurgery for strokes in elderly people]. [Journal Article]
- SGSoins Gerontol 2019 Jul - Aug; 24(138):20-22
- While neurosurgery plays a marginal role in the treatment of ischemic strokes, and while the development of endovascular techniques has reduced its contribution to the treatment of subarachnoid haemo…
While neurosurgery plays a marginal role in the treatment of ischemic strokes, and while the development of endovascular techniques has reduced its contribution to the treatment of subarachnoid haemorrhages resulting from an aneurysm, it still has a role to play in the event of a compressive haematoma. The overall improvement of the health status of elderly patients and the progress made in different medical fields have resulted in a more aggressive surgical approach in patients in the third, or even fourth age.
- Activation of TrkB/Akt signaling by a TrkB receptor agonist improves long-term histological and functional outcomes in experimental intracerebral hemorrhage. [Journal Article]
- JBJ Biomed Sci 2019 Jul 15; 26(1):53
- CONCLUSIONS: Our findings demonstrate that the activation of TrkB signaling by 7,8-DHF protects against ICH via the Akt, but not the Erk, pathway. These data provide new insights into the role of TrkB signaling deficit in the pathophysiology of ICH and highlight TrkB/Akt as possible therapeutic targets in this disease.
- Management of tracheostomized patients after poor grade subarachnoid hemorrhage: Disease related and pulmonary risk factors for failed and delayed decannulation. [Journal Article]
- CNClin Neurol Neurosurg 2019 Jul 08; 184:105419
- CONCLUSIONS: Successful decannulation is possible in the majority of sSAH patients and particularly, in all patients with WFNS grade III. WFNS grading, age, the necessity for decompressive craniectomy and pneumonia are significantly associated with the TTD. WFNS grade and pneumonia are significantly associated with DF. The mean cannulation time of sSAH patients is shorter in relation to stroke patients.
- Factors Affecting Prognosis in Patients With Spontaneous Supratentorial Intracerebral Hemorrhage Under Medical and Surgical Treatment. [Journal Article]
- JCJ Craniofac Surg 2019 Jul 12
- Spontaneous intracerebral hemorrhage (ICH) is a vascular brain disease that causes very high rates of death and disability. Whether surgical or medical treatment is more appropriate is controversial.…
Spontaneous intracerebral hemorrhage (ICH) is a vascular brain disease that causes very high rates of death and disability. Whether surgical or medical treatment is more appropriate is controversial.The purpose of the study was to examine the morbidity and mortality rates of surgical and medical therapy and their differences in order to determine which patients should be operated.In our study, the authors selected randomly and evaluated retrospectively 49 patients who were operated in Haydarpaşa Numune Research and Education Hospital Neurosurgery Clinic and 51 patients who received medical therapy at Neurology Clinic for spontaneous supratentorial ICH between January 2007 and December 2011.The authors documented a detailed history of each patient featuring their neurological examination, Glasgow Coma Scale (GCS), Modified Rankin Disability Scale (MRDS), imaging, age, gender, and history of stroke, hypertension, diabetes mellitus, smoking and alcohol use, aspirin, or coumadin usage.As a result, the mortality rate found in our study was similar to previous studies (49%). Mortality of patients who underwent surgery (63%) found a higher rate of disability. This is because hematoma of the patients who were operated on larger volumes and diameters, GCS lower than and the higher MRDS scores, higher rates of herniation is connected. The authors concluded that very early operation does not create a difference in treatment between mortality rates. The authors observed that the most important factors for the prognosis of ICH patients whether operated or not are the GCS of patients at the time of arrival to the hospital and the nature of the hematoma.
- Subtype Specificity of Genetic Loci Associated With Stroke in 16 664 Cases and 32 792 Controls. [Journal Article]
- CGCirc Genom Precis Med 2019; 12(7):e002338
- CONCLUSIONS: Heterogeneity in the influence of stroke-associated loci on stroke subtypes is pervasive, reflecting differing causal pathways. However, overlap exists between hemorrhagic and ischemic stroke, which may reflect shared pathobiology predisposing to small vessel arteriopathy. Stroke is a complex, heterogeneous disorder requiring tailored analytic strategies to decipher genetic mechanisms.
- Prognostic impact of leukocytosis in intracerebral hemorrhage: A PRISMA-compliant systematic review and meta-analysis. [Journal Article]
- MMedicine (Baltimore) 2019; 98(28):e16281
- CONCLUSIONS: Baseline leukocytosis could be helpful in predicting prognosis in ICH patients. However, its prognostic value should be verified by further studies.
- [Clinical and image features for 12 cases of cerebral autosomal dominant arteriopathy with the subcortical infarcts and leukoencephalopathy]. [Journal Article]
- ZNZhong Nan Da Xue Xue Bao Yi Xue Ban 2019 May 28; 44(5):549-554
- To analyze the clinical and image features for 12 patients of cerebral autosomal dominant arteriopathy with subcortical infarct and leucoencephalopathy (CADASIL). Methods: A total of 12 CADASIL patie…
To analyze the clinical and image features for 12 patients of cerebral autosomal dominant arteriopathy with subcortical infarct and leucoencephalopathy (CADASIL). Methods: A total of 12 CADASIL patients were collected in Xiangya Hospital of Central South University from January 2013 to December 2018. The clinical manifestation, risk factors, MRI imaging data and NOTCH3 mutations were analyzed retrospectively. Results: The mean age of 12 patients was (47.25±9.49) years. The clinical manifestation was most common in cognitive impairment (75%) and stroke events (58.3%), and 2 cases showed cerebral hemorrhage. Migraine was only seen in 25% patients. All MRI showed white matter hyperintensity (WMH), lacune and enlarged perivascular space (PVS). WMH mainly occurred in the frontal parietal lobe (100%), temporal lobe (83.3%), external capsule (66.7%), occipital lobe (41.6%), callosum 41.6% and the temporal pole (33.3%), while lacune mainly appeared in frontal lobe (91.6%), parietal lobe(83.3%), temporal lobe(66.7%), basal ganglia (66.7%), brain stem (41.6%), occipital lobe (33.3%), cerebellum (8.3%). Enlarged PVS located in the basal ganglia (100%), partly under the cortex (45.4%). WMH of the patient with intracerebral hemorrhage was mild (Fezakas score 1-2), which was not found in external capsule. 16.7% of the patients had intracranial arterial stenosis. In 12 patients, 8 different Notch3 mutations were detected. The c1013G>c p.(Cys338Ser) located in exon 6, which was a new pathogenic mutation of CADASIL. Conclusion: The patients with cerebral hemorrhage have mild WMH and specific genotype, indicating that the clinical characteristics of CADASIL with cerebral hemorrhage may be related to image features and genotype.
- Patterns and Outcomes of Endovascular Therapy in Mild Stroke. [Journal Article]
- SStroke 2019 Jul 15; :STROKEAHA118023893
- Background and Purpose- We aimed to evaluate the current practice patterns, safety and outcomes of patients who receive endovascular therapy (EVT) having mild neurological symptoms. Methods- From Jan…
Background and Purpose- We aimed to evaluate the current practice patterns, safety and outcomes of patients who receive endovascular therapy (EVT) having mild neurological symptoms. Methods- From Jan 2010 to Jan 2018, 127,794 ischemic stroke patients were enrolled in the Florida-Puerto Rico Stroke Registry. Patients presenting within 24 hours of symptoms who received EVT were classified into mild (National Institutes of Health Stroke Scale [NIHSS] ≤5) or moderate/severe (NIHSS>5) categories. Differences in clinical characteristics and outcomes were evaluated using multivariable logistic regression. Results- Among 4110 EVT patients (median age, 73 [interquartile range=20] years; 50% women), 446 (11%) had NIHSS ≤5. Compared with NIHSS >5, those with NIHSS ≤5 arrived later to the hospital (median, 138 versus 101 minutes), were less likely to receive intravenous alteplase (30% versus 43%), had a longer door-to-puncture time (median, 167 versus 115 minutes) and more likely treated in South Florida (64% versus 53%). In multivariable analysis younger age, private insurance (versus Medicare), history of hypertension, prior independent ambulation and hospital size were independent characteristics associated with NIHSS ≤5. Among EVT patients with NIHSS ≤5, 76% were discharged home/rehabilitation and 64% were able to ambulate independently at discharge as compared with 53% and 32% of patients with NIHSS >5. Symptomatic intracerebral hemorrhage occurred in 4% of mild stroke EVT patients and 6.4% in those with NIHSS >5. Conclusions- Despite lack of evidence-based recommendations, 11% of patients receiving EVT in clinical practice have mild neurological presentations. Individual, hospital and geographic disparities are observed among endovascularly treated patients based on the severity of clinical symptoms. Our data suggest safety and overall favorable outcomes for EVT patients with mild stroke.
- Harlequin Syndrome in Acute Thalamic Hemorrhage. [Journal Article]
- JSJ Stroke Cerebrovasc Dis 2019 Jul 10
- Harlequin syndrome is a disorder of the autonomic nervous system. It clinically presents as a distinct line of hemifacial sympathetic denervation. We describe a case of Harlequin syndrome with co-exi…
Harlequin syndrome is a disorder of the autonomic nervous system. It clinically presents as a distinct line of hemifacial sympathetic denervation. We describe a case of Harlequin syndrome with co-existing central first-order Horner syndrome in the setting of a large thalamic hemorrhage with intraventricular extension.
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- Tripartite motif containing protein 37 involves in thrombin stimulated BV-2 microglial cell apoptosis and interleukin 1β release. [Journal Article]
- BBBiochem Biophys Res Commun 2019 Jul 10
- Intracerebral hemorrhage (ICH) is the most common of stroke with high mortality and severe morbidity. Peroxisome proliferator-activated receptor gamma (PPARγ) plays a neuronprotective role in ICH. In…
Intracerebral hemorrhage (ICH) is the most common of stroke with high mortality and severe morbidity. Peroxisome proliferator-activated receptor gamma (PPARγ) plays a neuronprotective role in ICH. In the current study, TRIM37 mRNA expression in peripheral blood mononuclear cells (PBMCs) was found to be increased in ICH patients compared to that in healthy controls (n = 15). TRIM37 bound to PPARγ and enhanced its ubiquitination in mouse microglial BV-2 cell line. According to previous studies, thrombin is produced in the brain instantaneously after ICH and triggers the activation of microglia. Here, thrombin induced TRIM37 expression, cell apoptosis and interleukin-1β (IL-1β) release in BV-2 cells, while TRIM37 knockdown partially reversed the effects of thrombin on BV-2 cells. TRIM37 overexpression showed similar effects as thrombin on BV-2 cells, and PPARγ agonist rosiglitazone abolished the effects of TRIM37. In summary, TRIM37 involved in apoptosis and IL-1β release in BV-2 microglia by regulating PPARγ ubiquitination. The present data established a potential biological role of TRIM37 in ICH-induced brain damage and may provide insight into the development of therapy strategies for ICH.