In this editorial we comment on the article published by Zhang et al in the recent issue of World Journal of Clinical Cases.We evaluate their claims on the benefit of use of Aspirin in the early management of patients...In this editorial we comment on the article published by Zhang et al in the recent issue of World Journal of Clinical Cases.We evaluate their claims on the benefit of use of Aspirin in the early management of patients with ischemic stroke.We also comment on their contention of using aspirin in the early management of patients with intracranial hemorrhage,a practice not seen in modern medicine.Large clinical trials such as the International Stroke Trial and the Chinese Acute Stroke Trial have shown the benefit of Aspirin use within 48 h of patients with Acute Ischemic Stroke.The findings were corroborated in the open-label trial performed by Zhang et al in a smaller sample group of 25 patients where they showed improvement in functional scores at 90 days without an increase in adverse events.As such,this intervention is also recommended by the American Heart Association stroke guidelines from 2021.With regard to Intracranial hemorrhage,traditional practice has been to discontinue or avoid antiplatelet therapy in these patient groups.However,no studies have been done to evaluate this management strategy that is more borne out of the mechanism behind Aspirin’s effect on the coagulation pathway.Zhang et al evaluate the benefits of Aspirin on patients with low-volume intracranial hemorrhage,i.e.,less than 30 mL on computed tomo-graphy imaging,and show no increase in mortality.The caveat of this finding is that all outcomes were pooled into one group for results,and the number of patients was low.While more studies with larger patient groups are required,the data from Zhang et al suggests that patients with small-volume intracranial hemorrhages may benefit from Aspirin administration in the acute phase of management.展开更多
Intracranial hemorrhage(ICH)causes numerous neurological deficits and deaths worldwide each year,leaving a significant health burden on the public.The pathophysiology of ICH is complicated and involves both primary an...Intracranial hemorrhage(ICH)causes numerous neurological deficits and deaths worldwide each year,leaving a significant health burden on the public.The pathophysiology of ICH is complicated and involves both primary and secondary injuries.Hematoma,as the primary pathology of ICH,undergoes metabolism and triggers biochemical and biomechanical alterations in the brain,leading to the secondary injury.Past endeavors mainly aimed at biochemical-initiated mechanisms for causing secondary injury,which have made limited progress in recent years,although ICH itself is also highly biomechanics-related.The discovery of the mechanically-activated cation channel Piezo1 provides a new avenue to further explore the mechanisms underlying the secondary injury.The current article reviews the structure and gating mechanisms of Piezo1,its roles in the physiology/pathophysiology of neurons,astrocytes,microglia,and bone-marrow-derived macrophages,and especially its roles in erythrocytic turnover and iron metabolism,revealing a potential interplay between the biomechanics and biochemistry of hematoma in ICH.Collectively,these advances provide deeper insights into the secondary injury of ICH and lay the foundations for future research.展开更多
BACKGROUND Factor XIII(FXIII)deficiency is a rare yet profound coagulopathy.FXIII plays a pivotal role in hemostasis,and deficiencies in this factor can precipitate unchecked or spontaneous hemorrhaging.Immunological ...BACKGROUND Factor XIII(FXIII)deficiency is a rare yet profound coagulopathy.FXIII plays a pivotal role in hemostasis,and deficiencies in this factor can precipitate unchecked or spontaneous hemorrhaging.Immunological assays for detecting FXIII inhibitors are indispensable for diagnosing acquired FXIII deficiency;however,the availability of suitable testing facilities is limited,resulting in prolonged turnaround times for these assays.CASE SUMMARY In this case study,a 53-year-old male devoid of significant medical history presented with recurrent intracranial hemorrhages and a hematoma in the right hip.Subsequent genetic analysis revealed a homozygous mutation in the ACE gene,confirming the diagnosis of acquired FXIII deficiency.CONCLUSION This case underscores the significance of considering acquired deficiencies in clotting factors when evaluating patients with unexplained bleeding episodes.展开更多
BACKGROUND Intracranial hemorrhage after spinal surgery is a rare and devastating complication.AIM To investigate the economic burden,clinical characteristics,risk factors,and mechanisms of intracranial hemorrhage aft...BACKGROUND Intracranial hemorrhage after spinal surgery is a rare and devastating complication.AIM To investigate the economic burden,clinical characteristics,risk factors,and mechanisms of intracranial hemorrhage after spinal surgery.METHODS A retrospective cohort study was conducted from January 1,2015,to December 31,2022.Patients aged≥18 years,who had undergone spinal surgery were included.Intracranial hemorrhage patients were selected after spinal surgery during hospitalization.Based on the type of spinal surgery,patients with intracranial hemorrhage were randomly matched in a 1:5 ratio with control patients without intracranial hemorrhage.The patients'pre-,intra-,and post-operative data and clinical manifestations were recorded.RESULTS A total of 24472 patients underwent spinal surgery.Six patients(3 males and 3 females,average age 71.3 years)developed intracranial hemorrhage after posterior spinal fusion procedures,with an incidence of 0.025%(6/24472).The prevailing type of intracranial hemorrhage was cerebellar hemorrhage.Two patients had a poor clinical outcome.Based on the type of surgery,30 control patients were randomly matched in 1:5 ratio.The intracranial hemorrhage group showed significant differences compared with the control group with regard to age(71.33±7.45 years vs 58.39±8.07 years,P=0.001),previous history of cerebrovascular disease(50%vs 6.7%,P=0.024),spinal dura mater injury(50%vs 3.3%,P=0.010),hospital expenses(RMB 242119.1±87610.0 vs RMB 96290.7±32029.9,P=0.009),and discharge activity daily living score(40.00±25.88 vs 75.40±18.29,P=0.019).CONCLUSION The incidence of intracranial hemorrhage after spinal surgery was extremely low,with poor clinical outcomes.Patient age,previous stroke history,and dura mater damage were possible risk factors.It is suggested that spinal dura mater injury should be avoided during surgery in high-risk patients.展开更多
BACKGROUND Delayed intracranial hemorrhage(DICH),a potential complication of ventriculoperitoneal(VP)shunts,has been associated with high mortality,but its risk factors are still unclear.AIM To investigate the risk fa...BACKGROUND Delayed intracranial hemorrhage(DICH),a potential complication of ventriculoperitoneal(VP)shunts,has been associated with high mortality,but its risk factors are still unclear.AIM To investigate the risk factors of DICH after VP shunts.METHODS We compared the demographic and clinical characteristics of DICH and non-DICH adult patients with VP shunts between January 2016 and December 2020.RESULTS The 159 adult VP shunt patients were divided into 2 groups according to the development of DICH:the DICH group(n=26)and the non-DICH group(n=133).No statistically significant difference was found in age,sex,laboratory examination characteristics or preoperative modified Rankin Scale(mRS)score between the DICH and non-DICH groups(P>0.05);however,a history of an external ventricular drain(EVD)[P=0.045;odds ratio(OR):2.814;95%CI:1.024-7.730]and postoperative brain edema around the catheter(P<0.01;OR:8.397;95%CI:3.043-23.171)were associated with a high risk of DICH.A comparison of preoperative mRS scores between the DICH group and the non-DICH group showed no significant difference(P=0.553),while a significant difference was found in the postoperative mRS scores at the 3-mo follow-up visit(P=0.024).CONCLUSION A history of EVD and postoperative brain edema around the catheter are independent risk factors for DICH in VP shunt patients.DICH patients with a high mRS score are vulnerable to poor clinical outcomes.展开更多
The prevalence of nasopharyngeal carcinoma(NPC) is higher in southern China, Hong Kong, and Taiwan than in other areas in the world. Radiotherapy is an important part of treatment for NPC patients, especially those wi...The prevalence of nasopharyngeal carcinoma(NPC) is higher in southern China, Hong Kong, and Taiwan than in other areas in the world. Radiotherapy is an important part of treatment for NPC patients, especially those with stage Ⅲ/Ⅳ disease. Subdural empyema is a rare but life-threatening complication in postradiotherapy NPC patients which should be paid more attention. Here, we present the case of a 64-year-old female postradiotherapy NPC patient with subdural empyema complicated with intracranial hemorrhage. She was treated by burr-hole surgery but unfortunately died because of recurrent intracranial hemorrhage. The mechanisms potentially underlying the formation of subdural empyema in postradiotherapy NPC patients and the surgical strategies that can be used in these patients are discussed in this report.展开更多
Treatment with bevacizumab,an antiangiogenic agent,in patients with metastatic or unresectable colorectal cancer was approved less than 4 years ago in Japan.Bevacizumab improves the survival of patients with metastati...Treatment with bevacizumab,an antiangiogenic agent,in patients with metastatic or unresectable colorectal cancer was approved less than 4 years ago in Japan.Bevacizumab improves the survival of patients with metastatic colorectal cancer;however,it may lead to complications such as bleeding,which are sometimes fatal.Bevacizumab should be administered only after careful consideration because the potential risks of therapy outweigh its benefits.Therefore,pharma-ceutical companies do not recommend bevacizumab therapy for patients with brain metastases.While some reports support the cautious use of bevacizumab,others report that it is not always necessary to prohibit its use in patients with metastases to the central nervous system(CNS),including the brain.Thus,bevacizumab therapy in colorectal cancer patients with brain metastases is controversial,and it is unclear whether brainmetastases are a risk factor for intracranial hemor-rhage during anti-vascular endothelial growth factor(VEGF)therapy.We report a 64-year-old man and a 65-year-old man with recurrent colorectal cancer with-out brain metastases;these patients developed multifocal and solitary intracranial hemorrhage,respectively,after the administration of bevacizumab.Our findings suggest that intracranial hemorrhage can occur even if the patient does not have brain metastases prior to bevacizumab treatment and also suggest that brain metastases are not a risk factor for intracranial hemor-rhage with bevacizumab treatment.These findings also question the necessity of excluding patients with brain metastases from clinical trials on anti-VEGF therapy.展开更多
BACKGROUND: Delayed vitamin K deficiency is characterized by acute onset, severe illness and high fatality rate. 33%-50% survivors accompany with other various nervous system sequelas. Therefore, diagnosis and treatme...BACKGROUND: Delayed vitamin K deficiency is characterized by acute onset, severe illness and high fatality rate. 33%-50% survivors accompany with other various nervous system sequelas. Therefore, diagnosis and treatment of intracranial hemorrhage in time become a key factor for improving healing rate and reducing fatality rate and incidence of sequela. OBJECTIVE: To investigate the clinical situation, experimental characteristics, CT examination and terminative characteristics of infants with intracranial hemorrhage induced by delayed vitamin K deficiency. DESIGN: Case analysis. SETTING: Department of Pediatrics, Zhongshan Hospital Affiliated to Xiamen University. PARTICIPANTS: A total of 17 infants with intracranial hemorrhage induced by delayed vitamin K deficiency aged 1-3 months including 11 boys and 6 girls were selected from Department of Pediatrics, Zhongshan Hospital Affiliated to Xiamen University from January 1994 to December 2005. All infants had drowsiness, rejective milk, spiting milk, gaze of both eyes, tic, coma, full anterior fontanelle, high muscular tension and cerebral hernia, etc. Experimental examination demonstrated that infants had anemia at various degrees; prothrombin time and partial thromboplastin time were prolonged; platelet count was normal. CT examination indicated that screenages of subarachnoid hemorrhage, subdural hematoma, cerebral parenchyma hemorrhage and intraventricular hemorrage were changed. Hemorrhage was stopped by the application of vitamin K. All patients provided informed consent. METHODS: ① Clinical situation and physical sign of infants were observed after hospitalization and scanned with rapid spiral CT scanning system. The thickness and average space of layers were 8-10 mm and the scanning time was 5 s with window width of 30-80 Hu and window position of 28-35 Hu. ② After hospitalization, four items of blood coagulation was measured with Futura meter and biochemical indexes of blood, such as serum calcium, serum alkaline phosphatase, total bilirubin, direct bilirubin and indirect bilirubin, were detected with Roche Modular PPI automatic biochemistry analyzer. ③ After hospitalization, infants were given 5-10 mg vitamin K1 for 3-5 days, and then, they were transfused with 10-15 mL/kg fresh plasma or whole blood for 1-3 times and received other relative therapies. Therapeutic effects were evaluated based on clinical diagnosis and criteria. MAIN OUTCOME MEASURES: ① Clinical situation, physical sign and CT examination; ② results of experimental examination; ③ treatment and termination. RESULTS: A total of 17 infants with intracranial hemorrhage were involved in the final analysis. ① Clinical situation, physical sign and CT examination: All infants had pale facial expression and full or bossing anterior fontanelle. Among them, 13 infants had drowsiness or dysphoria, 12 rejective milk or emesis, 11 tic, 13 injection site hemorrhage, 2 gastrointestinal hemorrhage, 3 cerebral hernia, 11 high muscular tension and 6 cervical rigidity. CT examination demonstrated that most infants (88%, 15/17) had subarachnoid hemorrhage; 10 (59%, 10/17) had subdural hematoma; 8 (47%, 8/17) had cerebral parenchyma hemorrhage; few had intraventricular hemorrhage. In addition, results of CT examination also indicated that 17 infants had intracranial hemorrhage. Hemorrhage sites of 12 infants were equal to or more than 2, which was accounted for 70% (12/17); meanwhile, partial cases accompanied with a large area of focus of cerebral infarction or cerebral hypoxia-ischemia lesion. ② Results of experimental examination: There were 6 infants with elongation of prothrombin time, 5 with partial elongation of prothrombin time, 4 with decrease of serum calcium (1.69-2.25 mmol/L), 3 with increase of serum alkaline phosphatase, 3 with increase of total bilirubin, 3 with increase of direct bilirubin, and 3 with increase of indirect bilirubin. ③ Treatment and termination: After treatment, 12 infants were cured well, 3 improved, 1 given up and 1 died. Later, ten infants received CT re-examination at 3 months after treatment. The results indicated that 3 infants had simple subarachnoid hemorrhage and 4 had subarachnoid hemorrhage accompanying with subdural hematoma. Their focuses were absorbed well and not show as obvious sequela. One infant had subdural hematoma accompanying with subarachnoid hemorrhage, cerebral parenchyma hemorrhage, intraventricular hemorrage and cerebral hypoxia ischemia, and then, after hematom absorption, obvious cerebral malacia focus, hydrocephalus, brain atrophy and inferior accumulating fluid of dura mater were observed; 2 had subdural hematoma accompanying with subarachnoid hemorrhage and cerebral hypoxia ischemia, and then, after bleeding absorption, brain atrophy was changed remarkably; changes of hydrocephalus were observed in one infant. CONCLUSION: ① Symptoms of pale facial expression, full or bossing anterior fontanelle, drowsiness and dysphoria are observed in infants with delayed vitamin K deficiency . ② Experimental indexes demonstrate that prothrombin time and partial prothrombin time are prolonged, and numbers of infants having decrease of serum calcium are in the third place. ③ Poly-intracranial hemorrhage is a notable characteristic of CT examination. Partial infants who have poly-intracranial hemorrhage always accompany with cerebral hypoxia-ischemia lesion or cerebral infarction. Clinical situation and prognosis of infants who have a large area of intracranial hemorrhage and cerebral hypoxia-ischemia changes are poor; however, those of infants who have simple subarachnoid hemorrhage or combination of subarachnoid hemorrhage with subdural hematoma are well. ④ Effect of vitamin K on this kind of disease is well.展开更多
The thrombocytopenia-absent radius (TAR) syndrome is an autosomal recessive disease characterized by bilateral absence of radius with the presence of both thumbs and thrombocytopenia, many times associated with cardia...The thrombocytopenia-absent radius (TAR) syndrome is an autosomal recessive disease characterized by bilateral absence of radius with the presence of both thumbs and thrombocytopenia, many times associated with cardiac anomalies, intolerance or allergy to cow’s milk and phocomelia. Imaging study is important for the correct diagnosis at birth and documentation of one of the diagnosis criteria (absence of radius) in prenatal care. The main hematologic symptoms and the most feared of them, intracranial bleeding, occurs when platelets levels are below 10,000/mm<sup>3</sup>, which is more common during the first months. Therefore, imaging study is crucial to quickly identify complications and correctly manage the case. In this case report, the patient had upper limps alterations at birth and at first week presented seizures, with transfontanellar ultrasound and head computed tomography without contrast demonstrating intracranial hemorrhage. Laboratory results and imaging review were able to diagnose TAR syndrome. The patient was treated with platelets transfusion and thrombocytopenia was solved. She is currently under specialized medical care, with no neurological deficits and showing satisfactory development.展开更多
Objective To study perioperative management in treatment of traumatic intracranial hemorrhage in patients with pretraumatic anticoagulation therapy of oral warfarin.Methods 10 patients of traumatic intracranial hemorr...Objective To study perioperative management in treatment of traumatic intracranial hemorrhage in patients with pretraumatic anticoagulation therapy of oral warfarin.Methods 10 patients of traumatic intracranial hemorrhage with pretraumatic anticoagulation therapy of oral warfarin received vitamin K,FFP and PCC展开更多
Background:Admission to the intensive care unit(ICU)is frequently required for patients with acute leukemia(AL)because of life-threatening complications such as intracranial hemorrhage(IH).In this study,we evaluated t...Background:Admission to the intensive care unit(ICU)is frequently required for patients with acute leukemia(AL)because of life-threatening complications such as intracranial hemorrhage(IH).In this study,we evaluated the impact of IH on survival and neurological outcomes in this population.Methods:This was a single-center retrospective cohort study including adult patients with AL requiring ICU ad-mission and experiencing IH between 2002 and 2019 at Saint Louis Hospital.Leukemia type was determined according to the French-American-British classification.Brain imaging(either computed tomography or mag-netic resonance imaging)was available for all the patients.The primary endpoint of the study was to describe the clinical and biological characteristics and evaluate the mortality and neurological outcome of patients hospi-talized in the ICU with newly diagnosed AL and IH.The secondary endpoint was to identify predictive factors of IH in these patients.Results:Thirty-five patients with AL were included,median age of the patients was 59.00(interquartile range[IQR]:36.00-66.00)years.Twenty-nine patients(82.9%)had acute myeloid leukemia,including 12 patients with acute promyelocytic leukemia.Thrombocytopenia was constant,and 48.5% of patients had disseminated intravascular coagulation(DIC).At ICU admission,the median Sequential Organ Failure Assessment score was 5(IQR:3-9).The median time between AL onset and IH was 2.0(IQR:0.0-9.5)days.The ICU and hospital mortality rates were 60.0%(n=21)and 65.7%(n=23),respectively.In univariate analysis,mechanical ventilation and stupor were associated with mortality,but DIC and acute promyelocytic leukemia were not.Upon multivariate analysis,stupor or coma was the only factor significantly associated with a poor outcome(odds ratio=8.56,95% confidence interval:2.40 to 30.46).Conclusion:IH is associated with a high mortality rate in AL patients,with stupor or coma at the onset of intracranial bleeding being independently associated with poor outcomes.展开更多
Objective:To explore the clinical and pathological characteristics of cerebral venous sinus thrombosis(CVST)with subarachnoid hemorrhage(SAH)and intracerebral hemorrhage(ICH),and to investigate the diagnosis,radiograp...Objective:To explore the clinical and pathological characteristics of cerebral venous sinus thrombosis(CVST)with subarachnoid hemorrhage(SAH)and intracerebral hemorrhage(ICH),and to investigate the diagnosis,radiographic changes,and prognosis over the course of treatment.Methods:The clinical data and radiographic findings of a young male CVST patient,who presented with initial symptoms of SAH and ICH,were collected and analyzed.The relevant literature was also reviewed.Results:The patient had no specific clinical symptoms except for headache.The brain computed tomography(CT)scan revealed SAH,a high-density shadow in the right posterior fossa and cerebellar hemisphere,and ICH in the left frontal lobe.Magnetic resonance venography(MRV)further revealed bilateral thrombosis in the transverse and sigmoid sinuses.Conclusion:CVST with SAH and ICH is rare and difficult to diagnose.Careful radiological study and clinical analysis are important for the correct and early diagnosis of this condition.Anticoagulation therapy is considered the primary treatment for CVST.展开更多
Background Cerebral amyloid angiopathy （CAA） is one of the main causes of spontaneous intracranial hemorrhage （ICH）. No established link is available between pathological scores of CAA and its outcome. This study ...Background Cerebral amyloid angiopathy （CAA） is one of the main causes of spontaneous intracranial hemorrhage （ICH）. No established link is available between pathological scores of CAA and its outcome. This study aimed to identify the correlations between pathological severity and poor postoperative outcome in the Chinese population. Methods Between May 2006 and April 2011, 367 consecutive patients who underwent surgery for CAA-related ICH in 71 hospitals throughout the mainland of China were enrolled in this study. Twelve months after surgery, we evaluated these patients＇ outcomes according to the modified Rankin Scale （mRS） and statistically correlated risk factors （demographics, medical history, pathological results, and surgical details） that are associated with a favorable （mRS 〈3） and poor （mRS 〉3） outcome groups. Results Risk factors for poor postoperative outcome in 367 patients with CAA-related ICH included advanced age （OR 1.034, 95% CI 1.001-1.067, P=0.042）, CAA pathology severity （OR 2.074, 95% CI 7.140-16.25, P 〈0.001）, lobar hematoma （OR 0.225, 95% CI 0.104-0.486, P 〈0.001）, presence of intraventricular hemorrhage （OR 0.478, 95% CI 0.229-1.001, P=0.050）, and/or subarachnoid hemorrhage （OR 2.629, 95% CI, 1.051-6,577, P=0.039）. Conclusions Poor postoperative outcome of patients with CAA-related ICH was more related to the severe pathological manifestation instead of other factors. Prior ischemia may present an early stage of CAA.展开更多
Background Differential diagnosis of intracranial hemorrhage and calcification is a common problem encountered in clinical imaging diagnosis. The purpose of this study was to investigate the feasibility of T2＊ measur...Background Differential diagnosis of intracranial hemorrhage and calcification is a common problem encountered in clinical imaging diagnosis. The purpose of this study was to investigate the feasibility of T2＊ measurement on gradient echo （GRE） T2＊-weighted imaging （T2＊WI） in differential diagnosis of intracranial hemorrhage and calcification. Methods Thirty-eight hemorrhagic foci in 18 patients and 11 calcification foci in seven patients were included in this study. The diagnosis of hemorrhage and calcification was confirmed in all cases with enhanced T2＊ weighted angiography （ESWAN） magnetic resonance imaging （MRI） and CT respectively. The significance for the difference of T2＊ value between the central and peripheral areas of hemorrhage and calcification lesions was tested with univariate analysis of variance, Results The detection rate of GRE T2＊WI on intracranial hemorrhage was 1.9-fold higher than that of CT, especially for the hemorrhage in the brainstem and cerebellum. However, GRE T2＊WI was far less sensitive to calcification than CT. There was a significant difference in the T2＊ value between the central area of hemorrhage and calcification （P 〈0.001）, though no difference in the T2＊ value was obtained between the peripheral area of hemorrhage and calcification （P 〉0.05）. Conclusions Quantitative measurement of T2＊ value on GRE T2＊WI with a single MRI examination provides a fast, convenient, and effective means in differential diagnosis between intracranial hemorrhage and calcification, which may thus reduce the medical cost and save precious time for clinical management.展开更多
Background: Intracerebral hemorrhage (ICH) is one of the most severe complications during veno-venous extracorporeal membrane oxygenation (VV-ECMO). This study aimed to determine the risk factors for ICH and mortality...Background: Intracerebral hemorrhage (ICH) is one of the most severe complications during veno-venous extracorporeal membrane oxygenation (VV-ECMO). This study aimed to determine the risk factors for ICH and mortality in such patients.Methods: We analyzed the clinical data of 77 patients who received VV-ECMO due to severe respiratory failure from July 2013 to May 2019 at China-Japan Friendship Hospital. Demographical data, laboratory indices, imaging characteristics, and other clinical information were collected. Multivariable logistic regression analyses were performed to identify risk factors for ICH and mortality.Results: Of 77 patients, 11 (14.3%) suffered from ICH, and 36 (46.8%) survived. The survival rate was significantly lower (18.2% [2/11]vs. 51.5% [34/66],P = 0.040) in patients with ICH than in those without ICH. Multivariable analysis revealed that factors independently associated with ICH were diabetes mellitus (adjusted odds ratio [aOR]: 12.848, 95% confidence interval [CI]: 1.129-146.188,P = 0.040) and minimum fibrinogen during ECMO (aOR: 2.557, 95% CI: 1.244-5.252,P = 0.011). Multivariable analysis showed that factors independently associated with mortality were acute hepatic failure during ECMO (aOR: 9.205, 95% CI: 1.375-61.604,P = 0.022), CO2 retention before ECMO (aOR: 7.602, 95% CI: 1.514-38.188,P = 0.014), and minimum platelet concentration during ECMO (aOR: 0.130, 95% CI: 0.029-0.577,P = 0.007).Conclusions: Diabetes mellitus and minimum fibrinogen concentration during ECMO are risk factors for ICH in patients with severe respiratory failure managed using VV-ECMO. This indicated that anticoagulants use and nervous system monitoring should be performed more carefully in patients with diabetes when treated with VV-ECMO due to severe respiratory failure.展开更多
Background： Antithrombotic therapy using new oral anticoagulants （NOACs） in patients with atrial fibril- lation （AF） has been generally shown to have a favorable risk-benefit profile. Since there has been dispute...Background： Antithrombotic therapy using new oral anticoagulants （NOACs） in patients with atrial fibril- lation （AF） has been generally shown to have a favorable risk-benefit profile. Since there has been dispute about the risks of gastrointestinal bleeding （GIB） and intracranial hemorrhage （ICH）, we sought to conduct a systematic review and network meta-analysis using Bayesian inference to analyze the risks of GIB and ICH in AF patients taking NOACs. Methods： We analyzed data from 20 randomized controlled trials of 91 671 AF patients receiving anticoagulants, antiplatelet drugs, or placebo. Bayesian network meta-analysis of two different evidence networks was performed using a binomial likelihood model, based on a network in which different agents （and doses） were treated as separate nodes. Odds ratios （ORs） and 95% confidence intervals （CIs） were modeled using Markov chain Monte Carlo methods Results： Indirect comparisons with the Bayesian model confirmed that aspirin＋clopidogrel significantly increased the risk of GIB in AF patients compared to the placebo （OR 0.33, 95% CI 0.01-0.92）. Warfarin was identified as greatly increasing the risk of ICH compared to edoxaban 30 mg （OR 3.42, 95% CI 1.22-7.24） and dabigatran 110 mg （OR 3.56, 95% CI 1.10-8.45）. We further ranked the NOACs for the lowest risk of GIB （apixaban 5 mg） and ICH （apixaban 5 mg, dabigatran 110 mg, and edoxaban 30 mg）. Conclusions： Bayesian network meta-analysis of treatment of nonvalvular AF patients with anticoagulants suggested that NOACs do not increase risks of GIB and/or ICH, compared to each other.展开更多
Aspirin has been widely used clinically since 1899. For patients with cerebral ischemia and implanted intravascular stents, aspirin has been used routinely prevention of intracranial hemorrhage and for for anticoagula...Aspirin has been widely used clinically since 1899. For patients with cerebral ischemia and implanted intravascular stents, aspirin has been used routinely prevention of intracranial hemorrhage and for for anticoagulation treatment. However, many multi-center, large sample,展开更多
In patients with acute promyelocytic leukemia(APL),intracranial hemorrhage(ICH),if not identified promptly,could be fatal.It is the leading cause of failure of induction and early death.Thus,biomarkers that could prom...In patients with acute promyelocytic leukemia(APL),intracranial hemorrhage(ICH),if not identified promptly,could be fatal.It is the leading cause of failure of induction and early death.Thus,biomarkers that could promptly predict severe complications are critical.Here,cytokine differences between patients with APL with and without ICH were investigated to develop predictive models for this complication.The initial cytokine profiling using plasma samples from 39 patients and 18 healthy donors found a series of cytokines that were remarkedly different between patients with APL and healthy controls.The APL patients were subsequently divided into high and low white blood cell count groups.Results showed that tumor necrosis factor a and interleukin 8(IL-8)were vital in distinguishing patients with APL who did or did not develop ICH.In addition,verification in 81 patients with APL demonstrated that the two cytokines were positively correlated with the cumulative incidence of ICH.Finally,in-vitro and in-vivo experimental evidence were provided to show that IL-8 influenced the migration of APL-derived NB4 cells and impaired the blood-brain barrier in PML/RARαpositive blast-transplanted FVB/NJ mice.These assessments may facilitate the early warning of ICH and reduce future mortality levels in APL.展开更多
Background:Repeated intracranial hemorrhages caused by cardiac myxoma is very rare.It is essential for physicians to be aware of such uncommon clinical feature of myxoma.Case presentation:We report a-49-year-old femal...Background:Repeated intracranial hemorrhages caused by cardiac myxoma is very rare.It is essential for physicians to be aware of such uncommon clinical feature of myxoma.Case presentation:We report a-49-year-old female patient complained of repeated multiple intracranial hemorrhages,with no sign of cardiac dysfunction or cerebral infarction before admission.Cavernous angioma (CA) was misdiagnosded due to the clinical and magnetic resonance (MR) presentation.A sudden ischemic event after admission led to the finding of a left atrial myxoma.Conclusions:Repeated intracranial hemorrhages can be the early and primary clinical presentation of cardiac myxoma,probably caused by its metastasis,without obvious ischemic stroke or cardiac symptoms.展开更多
The aim was to investigate whether using a removing blood stasis method in hyperacute intracranial hemorrhage stage can lead to hematoma enlargement and its clinical efficacy.A multicenter retrospective randomized dou...The aim was to investigate whether using a removing blood stasis method in hyperacute intracranial hemorrhage stage can lead to hematoma enlargement and its clinical efficacy.A multicenter retrospective randomized double-blind placebo-controlled clinical study.We recruited patients aged 18 years or older and presenting at less than 6 h from symptom onset in 8 research centers.All the patients展开更多
文摘In this editorial we comment on the article published by Zhang et al in the recent issue of World Journal of Clinical Cases.We evaluate their claims on the benefit of use of Aspirin in the early management of patients with ischemic stroke.We also comment on their contention of using aspirin in the early management of patients with intracranial hemorrhage,a practice not seen in modern medicine.Large clinical trials such as the International Stroke Trial and the Chinese Acute Stroke Trial have shown the benefit of Aspirin use within 48 h of patients with Acute Ischemic Stroke.The findings were corroborated in the open-label trial performed by Zhang et al in a smaller sample group of 25 patients where they showed improvement in functional scores at 90 days without an increase in adverse events.As such,this intervention is also recommended by the American Heart Association stroke guidelines from 2021.With regard to Intracranial hemorrhage,traditional practice has been to discontinue or avoid antiplatelet therapy in these patient groups.However,no studies have been done to evaluate this management strategy that is more borne out of the mechanism behind Aspirin’s effect on the coagulation pathway.Zhang et al evaluate the benefits of Aspirin on patients with low-volume intracranial hemorrhage,i.e.,less than 30 mL on computed tomo-graphy imaging,and show no increase in mortality.The caveat of this finding is that all outcomes were pooled into one group for results,and the number of patients was low.While more studies with larger patient groups are required,the data from Zhang et al suggests that patients with small-volume intracranial hemorrhages may benefit from Aspirin administration in the acute phase of management.
基金supported by the National Natural Science Foundation of China(Grant No.82271426).
文摘Intracranial hemorrhage(ICH)causes numerous neurological deficits and deaths worldwide each year,leaving a significant health burden on the public.The pathophysiology of ICH is complicated and involves both primary and secondary injuries.Hematoma,as the primary pathology of ICH,undergoes metabolism and triggers biochemical and biomechanical alterations in the brain,leading to the secondary injury.Past endeavors mainly aimed at biochemical-initiated mechanisms for causing secondary injury,which have made limited progress in recent years,although ICH itself is also highly biomechanics-related.The discovery of the mechanically-activated cation channel Piezo1 provides a new avenue to further explore the mechanisms underlying the secondary injury.The current article reviews the structure and gating mechanisms of Piezo1,its roles in the physiology/pathophysiology of neurons,astrocytes,microglia,and bone-marrow-derived macrophages,and especially its roles in erythrocytic turnover and iron metabolism,revealing a potential interplay between the biomechanics and biochemistry of hematoma in ICH.Collectively,these advances provide deeper insights into the secondary injury of ICH and lay the foundations for future research.
基金Supported by the Medical and Health Science Foundation of Zhejiang,No.2023KY186Hangzhou Science and Technology Development Plan Guide Project,No.20220919Y023the Hangzhou Medical Key Discipline Construction Program,No.2021.
文摘BACKGROUND Factor XIII(FXIII)deficiency is a rare yet profound coagulopathy.FXIII plays a pivotal role in hemostasis,and deficiencies in this factor can precipitate unchecked or spontaneous hemorrhaging.Immunological assays for detecting FXIII inhibitors are indispensable for diagnosing acquired FXIII deficiency;however,the availability of suitable testing facilities is limited,resulting in prolonged turnaround times for these assays.CASE SUMMARY In this case study,a 53-year-old male devoid of significant medical history presented with recurrent intracranial hemorrhages and a hematoma in the right hip.Subsequent genetic analysis revealed a homozygous mutation in the ACE gene,confirming the diagnosis of acquired FXIII deficiency.CONCLUSION This case underscores the significance of considering acquired deficiencies in clotting factors when evaluating patients with unexplained bleeding episodes.
基金“Xue Ke Xin Xing”of Beijing Jishuitan Hospital,Beijing,China,No.XKXX201611。
文摘BACKGROUND Intracranial hemorrhage after spinal surgery is a rare and devastating complication.AIM To investigate the economic burden,clinical characteristics,risk factors,and mechanisms of intracranial hemorrhage after spinal surgery.METHODS A retrospective cohort study was conducted from January 1,2015,to December 31,2022.Patients aged≥18 years,who had undergone spinal surgery were included.Intracranial hemorrhage patients were selected after spinal surgery during hospitalization.Based on the type of spinal surgery,patients with intracranial hemorrhage were randomly matched in a 1:5 ratio with control patients without intracranial hemorrhage.The patients'pre-,intra-,and post-operative data and clinical manifestations were recorded.RESULTS A total of 24472 patients underwent spinal surgery.Six patients(3 males and 3 females,average age 71.3 years)developed intracranial hemorrhage after posterior spinal fusion procedures,with an incidence of 0.025%(6/24472).The prevailing type of intracranial hemorrhage was cerebellar hemorrhage.Two patients had a poor clinical outcome.Based on the type of surgery,30 control patients were randomly matched in 1:5 ratio.The intracranial hemorrhage group showed significant differences compared with the control group with regard to age(71.33±7.45 years vs 58.39±8.07 years,P=0.001),previous history of cerebrovascular disease(50%vs 6.7%,P=0.024),spinal dura mater injury(50%vs 3.3%,P=0.010),hospital expenses(RMB 242119.1±87610.0 vs RMB 96290.7±32029.9,P=0.009),and discharge activity daily living score(40.00±25.88 vs 75.40±18.29,P=0.019).CONCLUSION The incidence of intracranial hemorrhage after spinal surgery was extremely low,with poor clinical outcomes.Patient age,previous stroke history,and dura mater damage were possible risk factors.It is suggested that spinal dura mater injury should be avoided during surgery in high-risk patients.
基金Supported by Shantou Medical Healthcare Science and Technology Program,No.~([2019])70Natural Science Foundation of Guangdong Province of China,No. 2022A1515010407Guangdong Provincial Science and Technology Fund ("major special project+Task list") for high-level hospital construction,No. STKJ2021119
文摘BACKGROUND Delayed intracranial hemorrhage(DICH),a potential complication of ventriculoperitoneal(VP)shunts,has been associated with high mortality,but its risk factors are still unclear.AIM To investigate the risk factors of DICH after VP shunts.METHODS We compared the demographic and clinical characteristics of DICH and non-DICH adult patients with VP shunts between January 2016 and December 2020.RESULTS The 159 adult VP shunt patients were divided into 2 groups according to the development of DICH:the DICH group(n=26)and the non-DICH group(n=133).No statistically significant difference was found in age,sex,laboratory examination characteristics or preoperative modified Rankin Scale(mRS)score between the DICH and non-DICH groups(P>0.05);however,a history of an external ventricular drain(EVD)[P=0.045;odds ratio(OR):2.814;95%CI:1.024-7.730]and postoperative brain edema around the catheter(P<0.01;OR:8.397;95%CI:3.043-23.171)were associated with a high risk of DICH.A comparison of preoperative mRS scores between the DICH group and the non-DICH group showed no significant difference(P=0.553),while a significant difference was found in the postoperative mRS scores at the 3-mo follow-up visit(P=0.024).CONCLUSION A history of EVD and postoperative brain edema around the catheter are independent risk factors for DICH in VP shunt patients.DICH patients with a high mRS score are vulnerable to poor clinical outcomes.
文摘The prevalence of nasopharyngeal carcinoma(NPC) is higher in southern China, Hong Kong, and Taiwan than in other areas in the world. Radiotherapy is an important part of treatment for NPC patients, especially those with stage Ⅲ/Ⅳ disease. Subdural empyema is a rare but life-threatening complication in postradiotherapy NPC patients which should be paid more attention. Here, we present the case of a 64-year-old female postradiotherapy NPC patient with subdural empyema complicated with intracranial hemorrhage. She was treated by burr-hole surgery but unfortunately died because of recurrent intracranial hemorrhage. The mechanisms potentially underlying the formation of subdural empyema in postradiotherapy NPC patients and the surgical strategies that can be used in these patients are discussed in this report.
文摘Treatment with bevacizumab,an antiangiogenic agent,in patients with metastatic or unresectable colorectal cancer was approved less than 4 years ago in Japan.Bevacizumab improves the survival of patients with metastatic colorectal cancer;however,it may lead to complications such as bleeding,which are sometimes fatal.Bevacizumab should be administered only after careful consideration because the potential risks of therapy outweigh its benefits.Therefore,pharma-ceutical companies do not recommend bevacizumab therapy for patients with brain metastases.While some reports support the cautious use of bevacizumab,others report that it is not always necessary to prohibit its use in patients with metastases to the central nervous system(CNS),including the brain.Thus,bevacizumab therapy in colorectal cancer patients with brain metastases is controversial,and it is unclear whether brainmetastases are a risk factor for intracranial hemor-rhage during anti-vascular endothelial growth factor(VEGF)therapy.We report a 64-year-old man and a 65-year-old man with recurrent colorectal cancer with-out brain metastases;these patients developed multifocal and solitary intracranial hemorrhage,respectively,after the administration of bevacizumab.Our findings suggest that intracranial hemorrhage can occur even if the patient does not have brain metastases prior to bevacizumab treatment and also suggest that brain metastases are not a risk factor for intracranial hemor-rhage with bevacizumab treatment.These findings also question the necessity of excluding patients with brain metastases from clinical trials on anti-VEGF therapy.
文摘BACKGROUND: Delayed vitamin K deficiency is characterized by acute onset, severe illness and high fatality rate. 33%-50% survivors accompany with other various nervous system sequelas. Therefore, diagnosis and treatment of intracranial hemorrhage in time become a key factor for improving healing rate and reducing fatality rate and incidence of sequela. OBJECTIVE: To investigate the clinical situation, experimental characteristics, CT examination and terminative characteristics of infants with intracranial hemorrhage induced by delayed vitamin K deficiency. DESIGN: Case analysis. SETTING: Department of Pediatrics, Zhongshan Hospital Affiliated to Xiamen University. PARTICIPANTS: A total of 17 infants with intracranial hemorrhage induced by delayed vitamin K deficiency aged 1-3 months including 11 boys and 6 girls were selected from Department of Pediatrics, Zhongshan Hospital Affiliated to Xiamen University from January 1994 to December 2005. All infants had drowsiness, rejective milk, spiting milk, gaze of both eyes, tic, coma, full anterior fontanelle, high muscular tension and cerebral hernia, etc. Experimental examination demonstrated that infants had anemia at various degrees; prothrombin time and partial thromboplastin time were prolonged; platelet count was normal. CT examination indicated that screenages of subarachnoid hemorrhage, subdural hematoma, cerebral parenchyma hemorrhage and intraventricular hemorrage were changed. Hemorrhage was stopped by the application of vitamin K. All patients provided informed consent. METHODS: ① Clinical situation and physical sign of infants were observed after hospitalization and scanned with rapid spiral CT scanning system. The thickness and average space of layers were 8-10 mm and the scanning time was 5 s with window width of 30-80 Hu and window position of 28-35 Hu. ② After hospitalization, four items of blood coagulation was measured with Futura meter and biochemical indexes of blood, such as serum calcium, serum alkaline phosphatase, total bilirubin, direct bilirubin and indirect bilirubin, were detected with Roche Modular PPI automatic biochemistry analyzer. ③ After hospitalization, infants were given 5-10 mg vitamin K1 for 3-5 days, and then, they were transfused with 10-15 mL/kg fresh plasma or whole blood for 1-3 times and received other relative therapies. Therapeutic effects were evaluated based on clinical diagnosis and criteria. MAIN OUTCOME MEASURES: ① Clinical situation, physical sign and CT examination; ② results of experimental examination; ③ treatment and termination. RESULTS: A total of 17 infants with intracranial hemorrhage were involved in the final analysis. ① Clinical situation, physical sign and CT examination: All infants had pale facial expression and full or bossing anterior fontanelle. Among them, 13 infants had drowsiness or dysphoria, 12 rejective milk or emesis, 11 tic, 13 injection site hemorrhage, 2 gastrointestinal hemorrhage, 3 cerebral hernia, 11 high muscular tension and 6 cervical rigidity. CT examination demonstrated that most infants (88%, 15/17) had subarachnoid hemorrhage; 10 (59%, 10/17) had subdural hematoma; 8 (47%, 8/17) had cerebral parenchyma hemorrhage; few had intraventricular hemorrhage. In addition, results of CT examination also indicated that 17 infants had intracranial hemorrhage. Hemorrhage sites of 12 infants were equal to or more than 2, which was accounted for 70% (12/17); meanwhile, partial cases accompanied with a large area of focus of cerebral infarction or cerebral hypoxia-ischemia lesion. ② Results of experimental examination: There were 6 infants with elongation of prothrombin time, 5 with partial elongation of prothrombin time, 4 with decrease of serum calcium (1.69-2.25 mmol/L), 3 with increase of serum alkaline phosphatase, 3 with increase of total bilirubin, 3 with increase of direct bilirubin, and 3 with increase of indirect bilirubin. ③ Treatment and termination: After treatment, 12 infants were cured well, 3 improved, 1 given up and 1 died. Later, ten infants received CT re-examination at 3 months after treatment. The results indicated that 3 infants had simple subarachnoid hemorrhage and 4 had subarachnoid hemorrhage accompanying with subdural hematoma. Their focuses were absorbed well and not show as obvious sequela. One infant had subdural hematoma accompanying with subarachnoid hemorrhage, cerebral parenchyma hemorrhage, intraventricular hemorrage and cerebral hypoxia ischemia, and then, after hematom absorption, obvious cerebral malacia focus, hydrocephalus, brain atrophy and inferior accumulating fluid of dura mater were observed; 2 had subdural hematoma accompanying with subarachnoid hemorrhage and cerebral hypoxia ischemia, and then, after bleeding absorption, brain atrophy was changed remarkably; changes of hydrocephalus were observed in one infant. CONCLUSION: ① Symptoms of pale facial expression, full or bossing anterior fontanelle, drowsiness and dysphoria are observed in infants with delayed vitamin K deficiency . ② Experimental indexes demonstrate that prothrombin time and partial prothrombin time are prolonged, and numbers of infants having decrease of serum calcium are in the third place. ③ Poly-intracranial hemorrhage is a notable characteristic of CT examination. Partial infants who have poly-intracranial hemorrhage always accompany with cerebral hypoxia-ischemia lesion or cerebral infarction. Clinical situation and prognosis of infants who have a large area of intracranial hemorrhage and cerebral hypoxia-ischemia changes are poor; however, those of infants who have simple subarachnoid hemorrhage or combination of subarachnoid hemorrhage with subdural hematoma are well. ④ Effect of vitamin K on this kind of disease is well.
文摘The thrombocytopenia-absent radius (TAR) syndrome is an autosomal recessive disease characterized by bilateral absence of radius with the presence of both thumbs and thrombocytopenia, many times associated with cardiac anomalies, intolerance or allergy to cow’s milk and phocomelia. Imaging study is important for the correct diagnosis at birth and documentation of one of the diagnosis criteria (absence of radius) in prenatal care. The main hematologic symptoms and the most feared of them, intracranial bleeding, occurs when platelets levels are below 10,000/mm<sup>3</sup>, which is more common during the first months. Therefore, imaging study is crucial to quickly identify complications and correctly manage the case. In this case report, the patient had upper limps alterations at birth and at first week presented seizures, with transfontanellar ultrasound and head computed tomography without contrast demonstrating intracranial hemorrhage. Laboratory results and imaging review were able to diagnose TAR syndrome. The patient was treated with platelets transfusion and thrombocytopenia was solved. She is currently under specialized medical care, with no neurological deficits and showing satisfactory development.
文摘Objective To study perioperative management in treatment of traumatic intracranial hemorrhage in patients with pretraumatic anticoagulation therapy of oral warfarin.Methods 10 patients of traumatic intracranial hemorrhage with pretraumatic anticoagulation therapy of oral warfarin received vitamin K,FFP and PCC
文摘Background:Admission to the intensive care unit(ICU)is frequently required for patients with acute leukemia(AL)because of life-threatening complications such as intracranial hemorrhage(IH).In this study,we evaluated the impact of IH on survival and neurological outcomes in this population.Methods:This was a single-center retrospective cohort study including adult patients with AL requiring ICU ad-mission and experiencing IH between 2002 and 2019 at Saint Louis Hospital.Leukemia type was determined according to the French-American-British classification.Brain imaging(either computed tomography or mag-netic resonance imaging)was available for all the patients.The primary endpoint of the study was to describe the clinical and biological characteristics and evaluate the mortality and neurological outcome of patients hospi-talized in the ICU with newly diagnosed AL and IH.The secondary endpoint was to identify predictive factors of IH in these patients.Results:Thirty-five patients with AL were included,median age of the patients was 59.00(interquartile range[IQR]:36.00-66.00)years.Twenty-nine patients(82.9%)had acute myeloid leukemia,including 12 patients with acute promyelocytic leukemia.Thrombocytopenia was constant,and 48.5% of patients had disseminated intravascular coagulation(DIC).At ICU admission,the median Sequential Organ Failure Assessment score was 5(IQR:3-9).The median time between AL onset and IH was 2.0(IQR:0.0-9.5)days.The ICU and hospital mortality rates were 60.0%(n=21)and 65.7%(n=23),respectively.In univariate analysis,mechanical ventilation and stupor were associated with mortality,but DIC and acute promyelocytic leukemia were not.Upon multivariate analysis,stupor or coma was the only factor significantly associated with a poor outcome(odds ratio=8.56,95% confidence interval:2.40 to 30.46).Conclusion:IH is associated with a high mortality rate in AL patients,with stupor or coma at the onset of intracranial bleeding being independently associated with poor outcomes.
文摘Objective:To explore the clinical and pathological characteristics of cerebral venous sinus thrombosis(CVST)with subarachnoid hemorrhage(SAH)and intracerebral hemorrhage(ICH),and to investigate the diagnosis,radiographic changes,and prognosis over the course of treatment.Methods:The clinical data and radiographic findings of a young male CVST patient,who presented with initial symptoms of SAH and ICH,were collected and analyzed.The relevant literature was also reviewed.Results:The patient had no specific clinical symptoms except for headache.The brain computed tomography(CT)scan revealed SAH,a high-density shadow in the right posterior fossa and cerebellar hemisphere,and ICH in the left frontal lobe.Magnetic resonance venography(MRV)further revealed bilateral thrombosis in the transverse and sigmoid sinuses.Conclusion:CVST with SAH and ICH is rare and difficult to diagnose.Careful radiological study and clinical analysis are important for the correct and early diagnosis of this condition.Anticoagulation therapy is considered the primary treatment for CVST.
文摘Background Cerebral amyloid angiopathy （CAA） is one of the main causes of spontaneous intracranial hemorrhage （ICH）. No established link is available between pathological scores of CAA and its outcome. This study aimed to identify the correlations between pathological severity and poor postoperative outcome in the Chinese population. Methods Between May 2006 and April 2011, 367 consecutive patients who underwent surgery for CAA-related ICH in 71 hospitals throughout the mainland of China were enrolled in this study. Twelve months after surgery, we evaluated these patients＇ outcomes according to the modified Rankin Scale （mRS） and statistically correlated risk factors （demographics, medical history, pathological results, and surgical details） that are associated with a favorable （mRS 〈3） and poor （mRS 〉3） outcome groups. Results Risk factors for poor postoperative outcome in 367 patients with CAA-related ICH included advanced age （OR 1.034, 95% CI 1.001-1.067, P=0.042）, CAA pathology severity （OR 2.074, 95% CI 7.140-16.25, P 〈0.001）, lobar hematoma （OR 0.225, 95% CI 0.104-0.486, P 〈0.001）, presence of intraventricular hemorrhage （OR 0.478, 95% CI 0.229-1.001, P=0.050）, and/or subarachnoid hemorrhage （OR 2.629, 95% CI, 1.051-6,577, P=0.039）. Conclusions Poor postoperative outcome of patients with CAA-related ICH was more related to the severe pathological manifestation instead of other factors. Prior ischemia may present an early stage of CAA.
文摘Background Differential diagnosis of intracranial hemorrhage and calcification is a common problem encountered in clinical imaging diagnosis. The purpose of this study was to investigate the feasibility of T2＊ measurement on gradient echo （GRE） T2＊-weighted imaging （T2＊WI） in differential diagnosis of intracranial hemorrhage and calcification. Methods Thirty-eight hemorrhagic foci in 18 patients and 11 calcification foci in seven patients were included in this study. The diagnosis of hemorrhage and calcification was confirmed in all cases with enhanced T2＊ weighted angiography （ESWAN） magnetic resonance imaging （MRI） and CT respectively. The significance for the difference of T2＊ value between the central and peripheral areas of hemorrhage and calcification lesions was tested with univariate analysis of variance, Results The detection rate of GRE T2＊WI on intracranial hemorrhage was 1.9-fold higher than that of CT, especially for the hemorrhage in the brainstem and cerebellum. However, GRE T2＊WI was far less sensitive to calcification than CT. There was a significant difference in the T2＊ value between the central area of hemorrhage and calcification （P 〈0.001）, though no difference in the T2＊ value was obtained between the peripheral area of hemorrhage and calcification （P 〉0.05）. Conclusions Quantitative measurement of T2＊ value on GRE T2＊WI with a single MRI examination provides a fast, convenient, and effective means in differential diagnosis between intracranial hemorrhage and calcification, which may thus reduce the medical cost and save precious time for clinical management.
基金This study was supported by grants from the National Key Research and Development Program of China(No.2016YFC1304300)National Natural Science Foundation of China(No.81870072)Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(No.2018-I2M-1-003)。
文摘Background: Intracerebral hemorrhage (ICH) is one of the most severe complications during veno-venous extracorporeal membrane oxygenation (VV-ECMO). This study aimed to determine the risk factors for ICH and mortality in such patients.Methods: We analyzed the clinical data of 77 patients who received VV-ECMO due to severe respiratory failure from July 2013 to May 2019 at China-Japan Friendship Hospital. Demographical data, laboratory indices, imaging characteristics, and other clinical information were collected. Multivariable logistic regression analyses were performed to identify risk factors for ICH and mortality.Results: Of 77 patients, 11 (14.3%) suffered from ICH, and 36 (46.8%) survived. The survival rate was significantly lower (18.2% [2/11]vs. 51.5% [34/66],P = 0.040) in patients with ICH than in those without ICH. Multivariable analysis revealed that factors independently associated with ICH were diabetes mellitus (adjusted odds ratio [aOR]: 12.848, 95% confidence interval [CI]: 1.129-146.188,P = 0.040) and minimum fibrinogen during ECMO (aOR: 2.557, 95% CI: 1.244-5.252,P = 0.011). Multivariable analysis showed that factors independently associated with mortality were acute hepatic failure during ECMO (aOR: 9.205, 95% CI: 1.375-61.604,P = 0.022), CO2 retention before ECMO (aOR: 7.602, 95% CI: 1.514-38.188,P = 0.014), and minimum platelet concentration during ECMO (aOR: 0.130, 95% CI: 0.029-0.577,P = 0.007).Conclusions: Diabetes mellitus and minimum fibrinogen concentration during ECMO are risk factors for ICH in patients with severe respiratory failure managed using VV-ECMO. This indicated that anticoagulants use and nervous system monitoring should be performed more carefully in patients with diabetes when treated with VV-ECMO due to severe respiratory failure.
基金Project supported by the National Natural Science Foundation of China(No.30800999)
文摘Background： Antithrombotic therapy using new oral anticoagulants （NOACs） in patients with atrial fibril- lation （AF） has been generally shown to have a favorable risk-benefit profile. Since there has been dispute about the risks of gastrointestinal bleeding （GIB） and intracranial hemorrhage （ICH）, we sought to conduct a systematic review and network meta-analysis using Bayesian inference to analyze the risks of GIB and ICH in AF patients taking NOACs. Methods： We analyzed data from 20 randomized controlled trials of 91 671 AF patients receiving anticoagulants, antiplatelet drugs, or placebo. Bayesian network meta-analysis of two different evidence networks was performed using a binomial likelihood model, based on a network in which different agents （and doses） were treated as separate nodes. Odds ratios （ORs） and 95% confidence intervals （CIs） were modeled using Markov chain Monte Carlo methods Results： Indirect comparisons with the Bayesian model confirmed that aspirin＋clopidogrel significantly increased the risk of GIB in AF patients compared to the placebo （OR 0.33, 95% CI 0.01-0.92）. Warfarin was identified as greatly increasing the risk of ICH compared to edoxaban 30 mg （OR 3.42, 95% CI 1.22-7.24） and dabigatran 110 mg （OR 3.56, 95% CI 1.10-8.45）. We further ranked the NOACs for the lowest risk of GIB （apixaban 5 mg） and ICH （apixaban 5 mg, dabigatran 110 mg, and edoxaban 30 mg）. Conclusions： Bayesian network meta-analysis of treatment of nonvalvular AF patients with anticoagulants suggested that NOACs do not increase risks of GIB and/or ICH, compared to each other.
文摘Aspirin has been widely used clinically since 1899. For patients with cerebral ischemia and implanted intravascular stents, aspirin has been used routinely prevention of intracranial hemorrhage and for for anticoagulation treatment. However, many multi-center, large sample,
基金supported by the National Natural Science Foundation of China(Nos.81890994,81770144,81870119,81800141,and 81770153)the National Key Research and Development Program(No.2019YFA0905900).
文摘In patients with acute promyelocytic leukemia(APL),intracranial hemorrhage(ICH),if not identified promptly,could be fatal.It is the leading cause of failure of induction and early death.Thus,biomarkers that could promptly predict severe complications are critical.Here,cytokine differences between patients with APL with and without ICH were investigated to develop predictive models for this complication.The initial cytokine profiling using plasma samples from 39 patients and 18 healthy donors found a series of cytokines that were remarkedly different between patients with APL and healthy controls.The APL patients were subsequently divided into high and low white blood cell count groups.Results showed that tumor necrosis factor a and interleukin 8(IL-8)were vital in distinguishing patients with APL who did or did not develop ICH.In addition,verification in 81 patients with APL demonstrated that the two cytokines were positively correlated with the cumulative incidence of ICH.Finally,in-vitro and in-vivo experimental evidence were provided to show that IL-8 influenced the migration of APL-derived NB4 cells and impaired the blood-brain barrier in PML/RARαpositive blast-transplanted FVB/NJ mice.These assessments may facilitate the early warning of ICH and reduce future mortality levels in APL.
基金The authors sincerely thank Dr.zakaria shahab for editorial assistance,and this study was sponsored by the National Natural Science Foundation of China (Nos.81400962，81571102
文摘Background:Repeated intracranial hemorrhages caused by cardiac myxoma is very rare.It is essential for physicians to be aware of such uncommon clinical feature of myxoma.Case presentation:We report a-49-year-old female patient complained of repeated multiple intracranial hemorrhages,with no sign of cardiac dysfunction or cerebral infarction before admission.Cavernous angioma (CA) was misdiagnosded due to the clinical and magnetic resonance (MR) presentation.A sudden ischemic event after admission led to the finding of a left atrial myxoma.Conclusions:Repeated intracranial hemorrhages can be the early and primary clinical presentation of cardiac myxoma,probably caused by its metastasis,without obvious ischemic stroke or cardiac symptoms.
文摘The aim was to investigate whether using a removing blood stasis method in hyperacute intracranial hemorrhage stage can lead to hematoma enlargement and its clinical efficacy.A multicenter retrospective randomized double-blind placebo-controlled clinical study.We recruited patients aged 18 years or older and presenting at less than 6 h from symptom onset in 8 research centers.All the patients
