No abstract available.
Intracranial Hemorrhages* ; Thrombolytic Therapy*

Background:Cerebral vasospasm is a proved reaction and nimodipin revolutionised the treatment of subarrachnoid hemorrhage in adult. However, the effectiveness of Nimodipin in cerebral vasospasm remained controversial in intracranial hemorrhage (lCH) in children. Objectives:This study aims to estimate the effectiveness of nimodipin in treatment of children with intracranial hemorrhage.Subjects and method:A descriptive, prospective study was conducted on all children patients diagnosed intracranial hemorrhage and treated at Neurology department of National Hospital for Pediatric, Vietnam from 2004 to June 2007. They applied the Transcranial Doppler sonography (TCD) in diagnosis of vasospasm in intracranial hemorrhage in children and follow-up the evolution after treatment with nimodipin. Results:The results showed that cerebral vasospasm with hight resistance index (RI) on TCD (RI = 0.78 \xb1 0.08) and cerebral ischemie with low systolic velocity (Vs = 68 \xb1 12.2 crn/s) and hight pulsality index (PI = 1.4 \xb1 0.13) were observed in 100% of cases after 3 days with ICH. Nimodipine improved clinical status (71.2%) and CT scan (52%), also RI, PI, Vs returned to normal when used nimodipin within 7 days of ICH. Conclusion: The treatment method for intracranial hemorrhage with nimodipin supplement had proved to have initial effecacy in comparison with traditional method.
Intracranial Hemorrhages/ therapy ; Nimodipine/ therapeutic use ; Infant

Background: The intracranial hemorrhage (lCH) in infant due to vitamin K deficiency were been informed a lot at all over the world since the year of 80's. In Viet Nam, in recent years, this disease still most occurs which account for 110-130 children/100000 alive infant. The intracranial hemorrhage (lCH) in infant causes severe neurological, psychiatric sequelae. Objectives: This study aims to analyze the characteristics of epilepsy, changing of electroencephalogram and lesions of brain after intracranial hemorrhage in infant. Subjects and method:A descriptive, cross sectional study was conducted on 97 infant patients with the age ranged from 8 days to 3 months years old whom treated in National Hospital for Peadiatric. Results: Epilepsy was common (45.3%), with generalized seizures in 24.7% , partial seizures in 20.6%. The main intracranial lesions were cerebral cyst and atrophy in right or left hemisphere or both sides. Electroencephalic activity was found impaired in most of patients: Disorder of background waves in 19.6 %, low localized waves in 31%, proxystic ativity with spike in 45.3% and decrease in electroencephalographic amplitude in cystic areas. Conclusion: The epilepsy, abnormal electroencephalographic activities, severe lesions of brain were common after intracranial hemorrhage in infant.
Intracranial Hemorrhages/ diagnosis ; pathology ; therapy ; Infant

No abstract available.
Humans ; Intracranial Hemorrhages* ; Plasminogen Activators* ; Plasminogen* ; Rivaroxaban* ; Thrombolytic Therapy

BACKGROUND AND PURPOSE: Decreasing the time delay for thrombolysis, including intravenous thrombolysis (IVT) with tissue plasminogen activator and intra-arterial thrombectomy (IAT), is critical for decreasing the morbidity and mortality of patients experiencing acute stroke. We aimed to decrease the in-hospital delay for both IVT and IAT through a multidisciplinary approach that is feasible 24 h/day. METHODS: We implemented the Stroke Alert Team (SAT) on May 2, 2016, which introduced hospital-initiated ambulance prenotification and reorganized in-hospital processes. We compared the patient characteristics, time for each step of the evaluation and thrombolysis, thrombolysis rate, and post-thrombolysis intracranial hemorrhage from January 2014 to August 2016. RESULTS: A total of 245 patients received thrombolysis (198 before SAT; 47 after SAT). The median door-to-CT, door-to-MRI, and door-to-laboratory times decreased to 13 min, 37.5 min, and 8 min, respectively, after SAT implementation (P<0.001). The median door-to-IVT time decreased from 46 min (interquartile range [IQR] 36–57 min) to 20.5 min (IQR 15.8–32.5 min; P<0.001). The median door-to-IAT time decreased from 156 min (IQR 124.5–212.5 min) to 86.5 min (IQR 67.5–102.3 min; P<0.001). The thrombolysis rate increased from 9.8% (198/2,012) to 15.8% (47/297; P=0.002), and the post-thrombolysis radiological intracranial hemorrhage rate decreased from 12.6% (25/198) to 2.1% (1/47; P=0.035). CONCLUSIONS: SAT significantly decreased the in-hospital delay for thrombolysis, increased thrombolysis rate, and decreased post-thrombolysis intracranial hemorrhage. Time benefits of SAT were observed for both IVT and IAT and during office hours and after-hours.
Ambulances ; Cerebral Infarction ; Humans ; Intracranial Hemorrhages ; Mortality ; Stroke* ; Thrombectomy ; Thrombolytic Therapy ; Tissue Plasminogen Activator

Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Intracranial Hemorrhages ; diagnosis ; therapy ; Male

BACKGROUND AND PURPOSE: Although arbitrary blood pressure (BP) thresholds exist for acute ischemic stroke (AIS) patients eligible for intravenous thrombolysis (IVT), current international recommendations lack clarity on the impact of mean pre- and post-IVT BP levels on clinical outcomes. METHODS: Eligible studies involving IVT-treated AIS patients were identified that reported the association of mean systolic BP (SBP) or diastolic BP levels before and after IVT with the following outcomes: 3-month favorable functional outcome (modified Rankin Scale [mRS] scores of 0–1) and 3-month functional independence (mRS scores of 0–2), 3-month mortality and symptomatic intracranial hemorrhage (sICH). Unadjusted analyses of standardized mean differences and adjusted analyses of studies reporting odds ratios (ORadj) per 10 mm Hg BP increment were performed using random-effects models. RESULTS: We identified 26 studies comprising 56,513 patients. Higher pre- (P=0.02) and posttreatment (P=0.006) SBP levels were observed in patients with sICH. Patients with 3-month functional independence had lower post-treatment (P < 0.001) SBP whereas trended towards lower pre-treatment (P=0.06) SBP. In adjusted analyses, elevated pre- (ORadj, 1.08; 95% confidence interval [CI], 1.01 to 1.16) and post-treatment (ORadj, 1.13; 95% CI, 1.01 to 1.25) SBP levels were associated with increased likelihood of sICH. Increasing pre- (ORadj, 0.91; 95% CI, 0.84 to 0.98) and post-treatment (ORadj, 0.70; 95% CI, 0.57 to 0.87) SBP values were also related to lower odds of 3-month functional independence. CONCLUSIONS: We found that elevated BP levels adversely impact AIS outcomes in patients receiving IVT. Future randomized-controlled clinical trials will provide definitive data on the aforementioned association.
Blood Pressure ; Humans ; Intracranial Hemorrhages ; Mortality ; Odds Ratio ; Stroke ; Thrombolytic Therapy

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.
Adult ; Anticoagulants ; Extracorporeal Membrane Oxygenation ; Humans ; Intracranial Hemorrhages ; Respiratory Insufficiency/therapy* ; Retrospective Studies ; Risk Factors

Ischemic strokes result from thrombotic or embolic occlusion of one of the vessels that supply blood to the brain. The primary constituents of the initial thrombus are platelets and fibrin, with erythrocytes and other blood cells becoming trapped as thrombosis continues. Therefore, the recent improvements in therapy have focused on inhibiting platelets and dissolving fibrin. A new generation of thrombolytic agents (plasminogen activators) has been developed over the last decade. However, the clinical improvement has at best been marginal and the frequency of serious intracranial hemorrhage remains unchanged. Therefore, we have extensively reviewed the medical literature to determine the reason for the unsatisfactory clinical outcomes with current pharmacological therapies.
Blood Cells ; Brain ; Erythrocytes ; Fibrin ; Fibrinolytic Agents ; Intracranial Hemorrhages ; Stroke* ; Thrombolytic Therapy ; Thrombosis

BACKGROUND AND PURPOSE: In a recent pooled analysis of randomized clinical trials (RCTs), intravenous tissue plasminogen activator (TPA) improves the outcome in patients aged > or =80 years. However, it is uncertain whether the findings are applicable to clinical practice in Asian populations. METHODS: From a multicenter stroke registry database of Korea, we identified patients with acute ischemic stroke who were aged > or = 80 years. Using multivariable analysis and propensity score (PS)-matched analyses, we assessed the effectiveness and safety of intravenous TPA within 4.5 hours. RESULTS: Among 2,334 patients who met the eligible criteria, 236 were treated with intravenous TPA (mean age, 83+/-5; median NIHSS, 13 [IQR, 8-17]). At discharge, the TPA group compared to the no-TPA group had a favorable shift on the modified Rankin Scale (mRS) score (multivariable analysis, OR [95% CI], 1.51 [1.17-1.96], P=0.002; PS-matched analysis, 1.54 [1.17-2.04], P=0.002) and was more likely to achieve mRS 0-1 outcome (multivariable analysis, 2.00 [1.32-3.03], P=0.001; PS-matched analysis, 1.59 [1.04-2.42], P=0.032). TPA treatment was associated with an increased risk of symptomatic intracranial hemorrhage (multivariable analysis, 5.45 [2.80-10.59], P<0.001; PS-matched analysis, 4.52 [2.24-9.13], P<0.001), but did not increase the in-hospital mortality (multivariable analysis, 0.86 [0.50-1.48], P=0.58; PS-matched analysis, 0.88 [0.52-1.47], P=0.61). CONCLUSIONS: In the setting of clinical practice, intravenous TPA within 4.5 hours improved the functional outcome despite an increased risk of symptomatic intracranial hemorrhage in very elderly Korean patients. The findings, consistent with those from pooled analysis of RCTs, strongly support the use of TPA for this population.
Aged* ; Asian Continental Ancestry Group ; Hospital Mortality ; Humans ; Intracranial Hemorrhages ; Korea ; Propensity Score ; Stroke* ; Thrombolytic Therapy ; Tissue Plasminogen Activator*