Objective: To investigate the effects of the pyrin domain-containing protein 3 (NLRP3) inflammasome inhibitor MCC950 on nerve injury in rats with intracerebral hemorrhage(ICH). Methods: Seventy-two SD rats were randomly divided into three groups (n=24): Sham group, ICH group and MCC950 group. ICH group and MCC950 group rats were injected with autogenous non-anticoagulant blood to establish ICH model, and then the rats in MCC950 group were intraperitoneally injected with MCC950 at the dose of 10 mg/kg(2 mg/ml) for 3 days after ICH model was established. Seventy-two hours after the establishment of the model, the forelimb placement test, the corner test and mNSS score were performed to observe the neurological function of the rats with ICH. The volume of hematoma was observed in fresh brain tissue sections. HE staining was used to observe the pathological changes of brain tissue. The dry-wet weight ratio was calculated to evaluate the changes of brain tissue edema. The degeneration of neurons was observed by FJC staining. The neuronal apoptosis was observed by TUNEL staining. The protein expression and activation levels of NLRP3, ASC, caspase-1, IL-1β, IL-18 and GSDMD were determined by Western blot. Results: Compared with sham group, the percentage of successful placement of left forelimb and left turn was decreased significantly (P＜0.01, P＜0.05), mNSS score was increased significantly (P＜0.01) in ICH group. Hematoma volume was increased significantly, the number of microglial cells around the hematoma was increased, the number of neurons was decreased, nerve cell swelled, some cells showed pyknotic necrosis, and the staining was deepened. The water content of the right base was increased significantly (P＜0.05). The number of FJC positive and TUNEL positive cells around the hematoma was increased significantly (P＜0.05). The levels of NLRP3, ASC, caspase-1, pro-caspase-1, caspase-1/pro-caspase-1 ratio, GSDMD-N, GSDMD, GSDMD-N/GSDMD ratio, IL-1β and IL-18 were increased significantly (P＜0.01, P＜ 0.05). Compared with ICH group, the percentage of successful placement of left forelimb and left turn was increased significantly in MCC950 group (P＜0.05), while the mNSS score and the volume of hematoma were decreased significantly (P＜0.01), the swelling degree of nerve cells around the hematoma was reduced significantly, and the number of pyrotic necrotic cells was decreased. The water content of the right base was decreased significantly (P＜0.05), and the number of FJC positive and TUNEL positive cells around the hematoma was decreased significantly (P＜0.05). The levels of NLRP3, ASC, caspase-1, pro-caspase-1, caspase-1/pro-caspase-1 ratio, GSDMD-N, GSDMD, GSDMD-N/GSDMD ratio, IL-1β and IL-18 were decreased significantly (P＜0.05). Conclusion: MCC950 can ameliorate nerve injury after ICH by inhibiting NLRP3 inflammasome mediated inflammation and pyroptosis.
Animals ; Caspase 1/metabolism* ; Cerebral Hemorrhage/pathology* ; Furans ; Hematoma ; Indenes ; Inflammasomes/metabolism* ; Interleukin-18 ; NLR Family, Pyrin Domain-Containing 3 Protein/metabolism* ; Rats ; Rats, Sprague-Dawley ; Sulfonamides ; Water

Objectives To investigate the morphologic characteristics of intramural hematoma (IMH) on CT angiography (CTA), and evaluate the possible correlation of serum C-reactive protein (CRP) with morphologic characteristics of IMH. Material and Methods Forty-two patients who were initially diagnosed as IMH by aortic CTA and also had serum CRP examination on the same day of CTA were enrolled in this retrospective study, including 30 males and 12 females, with the mean age of 61 ± 14 years old. The volumetric CT data were retrospectively processed and analyzed on post-processing workstation. Based on the thickness of IMH and the length-area curve, the cross-sectional area of true lumen and total vessel were measured, the hematoma-vessel ratio (HVR) was calculated. Imaging characteristics were compared between patients who had pathological elevated CRP (> 0.8 mg/dl) and those did not. Spearman correlation analyses of CRP level and morphological characteristics of IMH were performed, and the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic validity of CRP. Results Of all 42 IMH patients, the mean serum CRP was 3.94 ± 4.71 mg/dl, and the mean HVR was 46.7%± 14.2%. HVR in patients with elevated CRP was significantly higher than those with normal CRP (49.7% ± 15.0% vs. 40.7% ± 10.5 %, P = 0.030). HVR was mildly correlated with CRP in all patients (r =0.48, P < 0.001). CRP levels differed neither between patients with Stanford type A and B (P = 0.207), nor between patients with and without intimal disruption (P = 0.230). To discriminate HVR > 47% (the mean value), the area under curve (AUC) were 0.700 (95% CI: 0.535-0.865) for CRP at a cutoff point of 3.55 mg/dl, with a sensitivity of 54.5% and a specificity of 90.0%. Conclusion CRP was mildly correlated with the severity of cross-sectional hematoma area of IMH, but not with Stanford types and the presence of intimal disruption.
Adult ; Aged ; Aged, 80 and over ; Aorta/pathology* ; C-Reactive Protein/metabolism* ; Computed Tomography Angiography ; Female ; Hematoma/diagnostic imaging* ; Humans ; Image Processing, Computer-Assisted ; Male ; Middle Aged ; ROC Curve ; Statistics, Nonparametric

Organized hematoma is a pseudo-tumorous lesion mostly occurs at sinonasal cavity and often confused with malignant neoplasm. The initiation of this lesion is blood accumulation, probably due to trauma, and this hematoma develops into organized hematoma as it encapsulated with fibrous band and neo-vascularized. Since it is uninformed at temporomandibular joint (TMJ) region, imaging diagnosis might be challenging. Also, delayed detection of mass involving TMJ is not uncommon due to confusion with joint disorder. Thus, this report introduced the rare pathology, organized hematoma on TMJ with advanced imaging features. Also, diagnostic point for early detection was described for the TMJ tumors and pseudo-tumors considering complexity of surgical intervention in this region.
Diagnosis ; Hematoma ; Joints ; Magnetic Resonance Imaging ; Pathology ; Temporomandibular Joint ; Tomography, X-Ray Computed

PURPOSE: Neurogenic myositis ossificans (NMO) in patients with traumatic spinal cord or brain injuries can cause severe joint ankylosis or compromise neurovascularture. The purpose of this study was to evaluate the clinical and radiological outcomes of and review considerations relevant to surgical resection of NMO of the hip joint. MATERIALS AND METHODS: Six patients (9 hips) underwent periarticular NMO resection between 2015 and 2017. The medical records of these patients were retrospectively reviewed. Preoperative computed tomography including angiography was performed to determine osteoma location and size. Improvement in hip motion allowing sitting was considered the sole indicator of a successful surgery. The anterior approach was used in all patients. The ranges of motion (ROM) before and after surgery were compared. RESULTS: The mean time from accident to surgery was 3.6 years. Average ROM improved from 24.3°(flexion and extension) to 98.5°(flexion and extension) after surgery, and improvement was maintained at the last follow-up. No commom complications (e.g., deep infection, severe hematoma, deep vein thrombosis) occurred in any patient. Improvement in ROM in one hip in which surgical resection was performed 10 years after the accident was not satisfactory owing to the pathologic changes in the joint. CONCLUSION: Surgical excision of periarticular NMO of the hip joint can yield satisfactory results, provided that appropriate preoperative evaluation is performed. Early surgical intervention yields satisfactory results and may prevent the development of intra-articular pathology.
Angiography ; Ankylosis ; Brain Injuries ; Follow-Up Studies ; Hematoma ; Hip Joint ; Hip ; Humans ; Joints ; Medical Records ; Myositis Ossificans ; Myositis ; Osteoma ; Pathology ; Retrospective Studies ; Spinal Cord ; Veins

This report describes a case of a 62-year-old woman with microscopic polyangiitis (MPA) who developed acute spinal subdural hemorrhage. MPA was confirmed by positive autoantibodies to myeloperoxidase and focal segmental necrotizing and pauci-immune crescentic glomerulonephritis on renal biopsy. She did not recover from paraplegia due to acute spinal subdural hemorrhage, despite decompression operation and aggressive immunosuppression. Although spontaneous spinal hemorrhage in MPA patients is very rare, the prognosis for such patients is poor. Considering the possibility of ongoing vasculitis activity in extra-renal organs, clinicians should be very cautious to attenuate the strength of immunosuppressant drugs, even in patients with chronic or irreversible renal pathology.
Autoantibodies ; Biopsy ; Decompression ; Female ; Glomerulonephritis ; Hematoma, Subdural* ; Hematoma, Subdural, Spinal ; Hemorrhage ; Humans ; Immunosuppression ; Microscopic Polyangiitis* ; Middle Aged ; Paraplegia ; Pathology ; Peroxidase ; Prognosis ; Vasculitis

Spontaneous chronic subdural hematoma (SDH) is a rare condition that could develop in association with hematologic disease. A 66-year-old male developed a chronic SDH as an initial manifestation of chronic myelomonocytic leukemia (CMML). He experienced recurrent chronic subdural hemorrhage and newly developed intracerebral hemorrhage. Considering the scheduled long-term chemotherapy, bilateral middle meningeal artery (MMA) embolization was performed to prevent recurrence of subdural hemorrhage. Although pancytopenia occurred during the 7 months' follow-up period, residual chronic subdural hemorrhage was absorbed without recurrence. To our best knowledge, this is the first report of CMML with spontaneous chronic SDH. MMA embolization is potentially a useful and safe treatment option in the challenging clinical situations with underlying pathologies.
Aged ; Cerebral Hemorrhage ; Drug Therapy ; Follow-Up Studies ; Hematologic Diseases ; Hematoma, Subdural* ; Hematoma, Subdural, Chronic ; Humans ; Leukemia ; Leukemia, Myelomonocytic, Chronic ; Male ; Meningeal Arteries ; Pancytopenia ; Pathology ; Recurrence

Multiloculated hydrocephalus (MLH) is a condition in which patients have multiple, separate abnormal cerebrospinal fluid collections with no communication between them. Despite technical advancements in pediatric neurosurgery, neurological outcomes are poor in these patients and the approach to this pathology remains problematic especially given individual anatomic complexity and cerebrospinal fluid (CSF) hydrodynamics. A uniform surgical strategy has not yet been developed. Current treatment options for MLH are microsurgical fenestration of separate compartments by open craniotomy or endoscopy, shunt surgery in which multiple catheters are placed in the compartments, and combinations of these modalities. Craniotomy for fenestration allows better visualization of the compartments and membranes, and it can offer easy fenestration or excision of membranes and wide communication of cystic compartments. Hemostasis is more easily achieved. However, because of profound loss of CSF during surgery, open craniotomy is associated with an increased chance of subdural hygroma and/or hematoma collection and shunt malfunction. Endoscopy has advantages such as minimal invasiveness, avoidance of brain retraction, less blood loss, faster operation time, and shorter hospital stay. Disadvantages are also similar to those of open craniotomy. Intraoperative bleeding can usually be easily managed by irrigation or coagulation. However, handling of significant intraoperative bleeding is not as easy. Currently, endoscopic fenestration tends to be performed more often as initial treatment and open craniotomy may be useful in patients requiring repeated endoscopic procedures.
Brain ; Catheters ; Cerebrospinal Fluid ; Craniotomy* ; Endoscopy* ; Hematoma ; Hemorrhage ; Hemostasis ; Humans ; Hydrocephalus* ; Hydrodynamics ; Length of Stay ; Membranes ; Neurosurgery ; Pathology ; Subdural Effusion

Intracranial hemorrhage is common and is caused by diverse pathology, including trauma, hypertension, cerebral amyloid angiopathy, hemorrhagic conversion of ischemic infarction, cerebral aneurysms, cerebral arteriovenous malformations, dural arteriovenous fistula, vasculitis, and venous sinus thrombosis, among other causes. Neuroimaging is essential for the treating physician to identify the cause of hemorrhage and to understand the location and severity of hemorrhage, the risk of impending cerebral injury, and to guide often emergent patient treatment. We review CT and MRI evaluation of intracranial hemorrhage with the goal of providing a broad overview of the diverse causes and varied appearances of intracranial hemorrhage.
Arteriovenous Malformations ; Central Nervous System Vascular Malformations ; Cerebral Amyloid Angiopathy ; Cerebral Infarction ; Craniocerebral Trauma ; Hematoma, Subdural ; Hemorrhage ; Humans ; Hypertension ; Intracranial Aneurysm ; Intracranial Hemorrhages* ; Magnetic Resonance Imaging ; Neuroimaging ; Pathology ; Sinus Thrombosis, Intracranial ; Subarachnoid Hemorrhage ; Vasculitis

The brain necrosis induced by radiation therapy (RT) is an uncommon pathology of brain. A case of spontaneous hemorrhage at necrotic brain is also rare. A 52-year-old man who had nasopharyngeal carcinoma and had been treated with RT, presented with gait disturbance, dizziness, ataxia, dysarthria, and dysphagia. Magnetic resonance imaging (MRI) demonstrated progressed radiation necrosis of pons, and spontaneous hemorrhage at the site of necrosis. The hematoma was diminished by conservative treatment. However, the patient’s neurologic symptoms did not recover. Two years later, spontaneous bleeding recurred at necrotic brain. His neurologic symptoms worsened. One year later, his neurologic symptoms were more progressed. He showed severe dysphagia, profound weakness and respiratory failure. This case provides the description of relapsed spontaneous hemorrhage and medullary dysfunction caused by pontine necrosis and progressed post-radiation injury, complicated with hemorrhage, and urges caution in that the necrotic brain tissue may be vulnerable to bleeding.
Ataxia ; Brain ; Deglutition Disorders ; Dizziness ; Dysarthria ; Gait ; Hematoma ; Hemorrhage* ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Necrosis* ; Neurologic Manifestations ; Pathology ; Pons ; Respiratory Insufficiency

STUDY DESIGN: Retrospective case–control study PURPOSE: To clarify the prevalence and risk factors for spinal subdural lesions (SSDLs) following lumbar spine surgery. OVERVIEW OF LITERATURE: Because SSDLs, including arachnoid cyst and subdural hematoma, that develop following spinal surgery are seldom symptomatic and require reoperation, there are few reports on these pathologies. No study has addressed the prevalence and risk factors for SSDLs following lumbar spine surgery. METHODS: We conducted a retrospective analysis of the magnetic resonance (MR) images and medical records of 410 patients who underwent lumbar decompression surgery with or without instrumented fusion for degenerative disorders. SSDLs were classified into three grades: grade 0, no obvious lesion; grade 1, cystic lesion; and grade 2, lesions other than a cyst. Grading was based on the examination of preoperative and postoperative MR images. The prevalence of SSDLs per grade was calculated and risk factors were evaluated using multivariate logistic regression analysis. RESULTS: Postoperative SSDLs were identified in 123 patients (30.0%), with 50 (12.2%) and 73 (17.8%) patients being classified with grade 1 and 2 SSDLs, respectively. Among these, one patient was symptomatic, requiring hematoma evacuation because of the development of incomplete paraplegia. Bilateral partial laminectomy was a significantly independent risk factor for SSDLs (odds ratio, 1.52; 95% confidence interval, 1.20–1.92; p<0.001). In contrast, a unilateral partial laminectomy was a protective factor (odds ratio, 0.11; 95% confidence interval, 0.03–0.46; p=0.002). CONCLUSIONS: The prevalence rate of grade 1 SSDLs was 30%, with no associated clinical symptoms observed in all but one patient. Bilateral partial laminectomy increases the risk for SSDLs, whereas unilateral partial laminectomy is a protective factor.
Arachnoid ; Arachnoid Cysts ; Decompression ; Hematoma ; Hematoma, Subdural ; Hematoma, Subdural, Spinal ; Humans ; Laminectomy ; Logistic Models ; Medical Records ; Paraplegia ; Pathology ; Prevalence* ; Protective Factors ; Reoperation ; Retrospective Studies ; Risk Factors* ; Spine*