No abstract available.
Cerebral Hemorrhage* ; Pathology*

OBJECTIVETo investigate the impact of obstructive sleep apnea-hypopnea syndrome (OSAHS) on cerebral microbleeds (CMBs) in patients with cerebral infarction.

METHODSConsecutive patients with acute cerebral infarction who had cerebral microbleeds shown by susceptibility-weighted imaging (SWI) were enrolled to undergo polysomnography (PSG). The patients were divided into two groups, namely non-OSAHS group with apnea-hypopnea index (AHI) less than 5 and OSAHS group with greater AHI, and the clinical and radiological features of cerebral microbleeds were compared between them.

RESULTSForty-nine patients were enrolled in this study, including 27 (55.1%) with both cerebral infarction and OSAHS and 22 (44.9%) with cerebral infarction but not OSAHS. A comparison of the risk factors showed that hypertension, a smoking history, and a history of stroke were more prevalent in patients with OSAHS than in those without OSAHS (P<0.05). The incidences of subclinical stroke in OSAHS and non-OSAHS patients were 37.0% (10/27) and 9.0% (2/22) (P<0.05), respectively. Neurological imaging revealed a greater number of cerebral microbleeds in OSAHS group than in non-OSAHS group (P<0.05). In OSAHS patients, 77.8% of the microbleeds were distributed in cortical-subcortical areas, 55.6% in the basal ganglia area, and 25.9% in the infratentorial area, as compared to the percentages of 50.0%, 40.9% and 50.0% in non-OSAHS patients, respectively (P<0.05). In OSAHS patients, 40.7% also had leukoaraiosis, and 48.1% had two or more causes, as compared to the percentages of 13.6% and 18.2% in non-OSAHS patients, respectively (P<0.05).

CONCLUSIONSOSAHS can be a risk factor for cerebral microbleeds. Patients with both cerebral infarction and OSAHS tend to have greater and more extensive lesions of cerebral microbleeds, more complicated cause of the disease, and a grater likeliness of stroke recurrence.

Aged ; Cerebral Hemorrhage ; etiology ; pathology ; Cerebral Infarction ; pathology ; Female ; Humans ; Male ; Middle Aged ; Risk Factors ; Sleep Apnea, Obstructive ; complications ; pathology

OBJECTIVETo examine the proliferation of the neural progenitor cells in the subventricular zone (SVZ) and around the hematoma after intracerebral hemorrhage (ICH) in adult rats.

METHODSICH was induced by stereotactic injection of type VII collagenase into the corpus striatum of adult rats, followed by pulse or continuous intrapenitoneal injection of bromodeoxyuridine (Brdu) to label the proliferating cells. The rats were sacrificed on days 2, 7, 14 and 28 following the ICH for immunohistochemistry of the tissues in the SVZ and around the hemotoma to determine the number of Brdu- immunoreactive cells.

RESULTSWith pulse Brdu labeling, a significant increase in the number of Brdu-immunoreactive cells in the ipsilateral and contralateral tissues in the SVZ and around the hematoma was observed 2-14 days, and the cell number reached the maximum on day 7 after ICH as compared with that of the sham-operated group. With continuous Brdu injection, the increase was observed on day 14 after ICH, and till day 28, the Brdu-immunoreactive cells in the SVZ decreased to the control level, but some positive cells still persisted in the tissues around the hematoma.

CONCLUSIONICH induces transient and regional increase in the cell proliferation in the ipilateral and contraletral SVZ and tissues around the hematoma, and the proliferating cells in the SVZ may migrate towards the hematoma area.

Animals ; Cell Proliferation ; Cerebral Hemorrhage ; pathology ; Cerebral Ventricles ; pathology ; Hematoma ; pathology ; Male ; Neurons ; pathology ; Rats ; Rats, Sprague-Dawley ; Stem Cells ; pathology

The damage degree of neurons in perilesion at different time points was observed in order to explore the optimal operation occasion. Piglet lobar hematomas were produced by pressure-controlled infusions of 2.5 mL autonomous blood into the right frontal hemispheric white matter over 15 min, and the metabolic changes were ambulatorily detected with MRS at 3rd, 12th, 24th and 48th h after hematoma induction. Brain tissues of perihematoma were also obtained at different time points. The transcription level of Bax gene was detected by in situ hybridization and apoptosis by TUNEL technique, and the pathologic change of neurons was observed under an electron microscope. The results showed that the number of Bax positive cells reached the peak at 24 h (79.00 +/- 4.243/5 fields). There was no significant difference in A values between 3 h and 6 h, 12 h (P > 0.05), but there significant difference between 24 h and 3 h, 6 h, 12 h (P < 0.05). The number of apoptotic cells reached the peak at 24 h (P < 0.001), and there was no significant difference between 3 h and 6 h (P = 0.999). The area of the apoptotic cells showed no significant difference between 3 h and 6 h or among 3 h, 6 h and 6 h (P > 0.05). Lac peak mainly occurred at 24 h and 48 h, while on the healthy side, no Lac peak was detectable. The ratio of NAA/Cr presented a descent tendency, but there was no significant difference among the groups before 12 h (P > 0.05), there was very significant difference between 3, 6 and 24, 48 h (P < 0.01). Under electronic microscopy, the neuronal damage surrounding hematoma in 3 to 6 h was milder than in 24 h to 48 h. It was concluded that the secondary apoptosis, damage and metabolic disturbance of the neurons surrounding hematoma was milder in 3-6 h in acute intracerebral hemorrhage, while obviously aggravated in 24-48 h. An effective intervention is needed to reduce secondary damage as soon as possible.
Brain/*pathology ; Cerebral Hemorrhage/*pathology ; Hematoma/*pathology ; Magnetic Resonance Imaging ; Neurons/pathology ; Random Allocation ; Swine ; Swine, Miniature ; Time Factors

Aged, 80 and over ; Amyloid beta-Peptides ; metabolism ; Brain ; pathology ; Cerebral Amyloid Angiopathy ; complications ; metabolism ; pathology ; Cerebral Hemorrhage ; etiology ; pathology ; Consciousness Disorders ; etiology ; pathology ; Humans ; Male

Brain ; pathology ; Cerebral Hemorrhage ; pathology ; Female ; Humans ; Infant, Newborn ; Infant, Premature ; Leukomalacia, Periventricular ; pathology ; Magnetic Resonance Imaging ; methods ; Male

Computed Tomography(CT) has been of great value in planning treatment for patients with hypertensive intracerebral hemorrhage. The patient with a moderate-sized extracapsular hematoma is usually mild. Such a patient, as a rule, should be treated conservatively. However if the patients shows progressive deterioration or mass signs on the CT, he will be subjected to surgery. The patient with putaminal hemorrhage involving the internal capsule is also indicated for surgery. The patient with a large hematoma extending to the thalamus and the hypothalamus extending to the thalamus and the hypothalamus shows poor prognosis and never indicated for surgery. From the viewpoint of hematoma volume, more than 25ml in size, indicates surgical removal. The acute hydrocephalus following intracerebral hemorrhage confirmed by CT, requires a ventricular drainage, especially if the case of ventricular component is present, in the third and/or fourth ventricles. In the management of hypertensive intracerebral hemorrhage, the choice of treatment, surgical or conservative, is a very important decision. In spite of the fact that surgical treatment of the disease has been actively carried out for the last decade in various facilities in Japan, the indication for surgery is still in controversy in the field of neurosurgery. Today, it is noted that preoperative conditions of the patient such as age, state of consciousness, location of hematoma and timing of operation are closely related to operative results3). As it is well known, computed tomography(CT) will be of great help in the choice of treatment for hypertensive intracerebral hemorrhage. CT gives us not only definite diagnosis of intracerebral hemorrhage but also shows us variable intracranial pathology. Information relating to the exact location of hematoma, estimated hematoma-volume, presence or absence of ventricular component, size of the ventricles and mass effect from displacement of midline structures on CT, will be of extremely valuable in planning further treatment.
Cerebral Hemorrhage ; Consciousness ; Diagnosis ; Drainage ; Fourth Ventricle ; Hematoma ; Hemorrhage* ; Humans ; Hydrocephalus ; Hypothalamus ; Internal Capsule ; Intracranial Hemorrhage, Hypertensive ; Japan ; Neurosurgery ; Pathology ; Prognosis ; Putaminal Hemorrhage ; Thalamus

There is extensive evidence that moyamoya disease has a tendency for multifactorial inheritance, although the pathogenesis of moyamoya disease is not clear. The authors report a case of familial moyamoya disease involving a 51-year-old female and her 24-year-old daughter, both of whom initially presented, within a 1-year period, withintracerebral hemorrhage and intraventricular hemorrhage. Cerebral angiography showed typical features of moyamoya disease in both patients, but the cause of the pathology remains obscure. The pertinent literature is reviewed.
Cerebral Angiography ; Female ; Hemorrhage ; Humans ; Middle Aged ; Moyamoya Disease* ; Multifactorial Inheritance ; Nuclear Family ; Pathology ; Young Adult

Intracerebral hemorrhage (ICH) and lacunar infarction (LI) are the major acute clinical manifestations of cerebral small vessel diseases (cSVDs). Hypertensive small vessel disease, cerebral amyloid angiopathy, and hereditary causes, such as Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL), constitute the three common cSVD categories. Diagnosing the underlying vascular pathology in these patients is important because the risk and types of recurrent strokes show significant differences. Recent advances in our understanding of the cSVD-related radiological markers have improved our ability to stratify ICH risk in individual patients, which helps guide antithrombotic decisions. There are general good-practice measures for stroke prevention in patients with cSVD, such as optimal blood pressure and glycemic control, while individualized measures tailored for particular patients are often needed. Antithrombotic combinations and anticoagulants should be avoided in cSVD treatment, as they increase the risk of potentially fatal ICH without necessarily lowering LI risk in these patients. Even when indicated for a concurrent pathology, such as nonvalvular atrial fibrillation, nonpharmacological approaches should be considered in the presence of cSVD. More data are emerging regarding the presentation, clinical course, and diagnostic markers of hereditary cSVD, allowing accurate diagnosis, and therefore, guiding management of symptomatic patients. When suspicion for asymptomatic hereditary cSVD exists, the pros and cons of prescribing genetic testing should be discussed in detail in the absence of any curative treatment. Recent data regarding diagnosis, risk stratification, and specific preventive approaches for both sporadic and hereditary cSVDs are discussed in this review article.
Anticoagulants ; Atrial Fibrillation ; Blood Pressure ; CADASIL ; Cerebral Amyloid Angiopathy ; Cerebral Hemorrhage ; Cerebral Small Vessel Diseases ; Diagnosis ; Genetic Testing ; Humans ; Pathology ; Stroke ; Stroke, Lacunar*

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