BACKGROUND: Uncontrolled hypertension in acute intracerebral hemorrhages (ICH) may cause hematoma expansion within the first 24 hours, and increase patient mortality. We investigated whether there was an association between ICH location and the difficulty in lowering BP in patients with acute hypertensive non- lobar ICH.

METHODS: This is a retrospective cohort study of adults diagnosed with non-lobar ICH admitted at a tertiary hospital over a 2-year period. We documented the time to attain target mean arterial pressure (MAP) of 110-130 mmHg, as well as the use of antihypertensive medications.

RESULTS: Of 357 patients admitted for non-lobar ICH,47 patients fulfilled the study criteria. Basal ganglia hemorrhages were the most common (47%), followed by thalamic (34%), cerebellar (11%), and pontine hemorrhages (8%). While there were no significant differences in baseline MAP among the different sites of hemorrhage, those with thalamic ICH had a significantly longer time-to-target MAP (p=0.02) and required three or more classes of oral antihypertensive medications (p

CONCLUSIONS: Acute thalamic intracerebral hemorrhages may require multiple classes of antihypertensives to lower blood pressure to safer levels.

Human ; Male ; Female ; Middle Aged ; .humans ; Adult ; Antihypertensive Agents ; Blood Pressure ; Tertiary Care Centers ; Retrospective Studies ; Basal Ganglia Hemorrhage ; Cerebral Hemorrhage ; Hypertension ; Hematoma

BACKGROUND: Transcranial Doppler (TCD) is a non-invasive sonographic procedure with various proven and potential use in clinical practice. It is however available only in a few tertiary centers in the Philippines. Local data of patients who have had the procedure, such as clinical and sonographic characteristics, are also limited.

OBJECTIVE: Describe the clinical profile, and sonographic findings of patients referred for TCD at the UP-PGH Diosdado Macapagal Stroke Center Vascular Laboratory from 2006-2007.

METHOD: Records of patients referred for TCD were reviewed. The patients were mostly adults (96.4%), with a 1. 1:1 male-to-female ratio. Ischemic stroke (84.5%) was the most common clinical diagnosis. Intracranial atherosclerosis was noted in 33.6% of patients. Generalized increase pulsatility index and poor temporal window were noted in 19.3% and 22.4% of patients, respectively. Of the 13 subarachnoid hemorrhage patients included, 9 (69.2%) have sonographic evidence of vasospasm.

CONCLUSION: The patients referred for transcranial doppler were mostly adult ischemic stroke patients. Intracranial atherosclerosis was noted in a third of these patients. Other sonographic findings noted were generalized increase in pulsatility index and poor temporal window. Vasospasm was also documented by TCD in patients with subarachnoid hemorrhage.

Human ; Male ; Female ; Aged 80 And Over ; Aged (a Person 65 Through 79 Years Of Age) ; Middle Aged (a Person 45-64 Years Of Age) ; Stroke ; Neurosciences ; Neurology ; Patients

OBJECTIVES

To evaluate the cost ofboculinum toxin A (BTX-A) treatment in the Philippine setting, and determine the dose, clinical response, and adverse events to BTX-A therapy.

METHODOLOGY

We identified all patients injected with BTX-A from a Movement Disorders Clinic database between May 200 1 and August 2007. Their medical records were reviewed and obtain demographic and clinical data using a standardized data collection form. The number of injections and dose given, clinical response and adverse effects, and cost of treatment were determined. Positive clinical response was defined as any degree of improvement of presenting symptoms.

RESULTS

A total of 1 68 patients were included, wherein 378 BTX-A injections were done. There were 85 males (50.6%). The mean age of patients was 48.0 ± 1 6.2 years old (range:7 -Sr years). The majority of patients have dystonia (n= 71, 42.2%), hemifacial spasms (n= 66, 39.3%) and spasticity (n=22, 13.1 %). Clinical improvement was documented in 89.7% (n=87) and 90.8% (n=79) of patients given with Botox® and Dysport®, respectively. The mean duration ofbenefit is 3.8 ± 1 .3 months (range: 0 - 8 months). For patients injected with Botox®, the mean duration of effect is 3.7 ± 1.1 months compared to 3.9 ± 1 .4 months for those injected with Dysport®. Adverse effects were noted in 9.5% (n= l 6) of patients. These were noted in 1 2.4% (n= 1 2) of patients injected with Botox® and 8.0% (n=8) of patients given with Dysport®. The most common adverse effect was ptosis. The overall average cost per injection is PhP 1 5,429. 1 1, while the overall mean cost of the BT)(-A alone (both with Botox® and Dysport®) per injection is PhP I 0,706.46. Of the disorders included, cervical dystonia had the highest mean expenditure of PhP 30,504.51 per injection.

CONCLUSIONS

Although, the cost of individual injection is high, other cost factors such as indirect and intangible costs contribute to the burden of management of these various neurologic disorders. The subjective and objective relief noted, after treatment, may compensate the expenditure with use of BTX-A.

Botulinum Toxins ; Medical Records ; Data Collection ; Costs And Cost Analysis