To determine the etiologies and risk factors of intracerebral hemorrhage in young people.
 Methods: A total of 401 young patients with intracerebral hemorrhage were enrolled, and they were assigned into a 20-29 , a 30-39, and a 40-45 age group. The differences of various etiologies and risk factors among the three groups were analyzed.
 Results: There were 273 men and 128 women in the 401 young patients. The etiologies of 294 patients (73.32%) were identified while 107 patients (26.68%) were unknown. Among those with identified etiology, 226 patients (56.36%) suffered from hypertension, 41 patients (10.22%) congenital cerebrovascular malformation (including 25 patients with cerebral arteriovenous malformation, 8 intracranial cavernous hemangioma, and 8 intracranial aneurysm), and 27 other etiologies (including 9 patients with moyamoya disease, 6 cerebral venous sinus thrombosis, 4 drug abuse, 3 hemorrhagic brain tumor, 2 intracranial infection, 1 systemic lupus erythematosus, 1 drug-induced, and 1 eclampsia). Risk factors included hypertension (237 cases, 59.10%), smoking (123 cases, 30.67%), alcohol consumption (74 cases, 18.45%), and others (19 cases, 4.74%; including 8 cases of pregnancy or in the puerperium, 8 family history of intracerebral hemorrhage, and 3 taking anti-platelet aggregation/anticoagulation agents). The rate of hypertension induced hemorrhage significantly increased with age (P<0.01); the rate of vascular malformations in 20-29 age group was obviously higher than other groups (P<0.01); the rate of unknown cause in the 40-45 age group was significantly lower than other groups (P<0.01) and the rate of other etiologies showed no significant difference in the 3 groups. The rate of hypertension was significantly elevated with the age (P<0.01), while smoking, alcohol consumption, and other risk factors showed no significant difference in the 3 groups.
 Conclusion: The rate of intracerebral hemorrhage in young people increases with the increasing of age and hemorrhage affects men more than women; hypertension may be the main cause and congenital cerebrovascular malformation is the second cause, which may be more common in younger patients. Hypertension, smoking, and alcohol consumption may be the major controllable risk factors in intracerebral hemorrhage in young people.
Adult ; Cerebral Hemorrhage ; etiology ; Female ; Humans ; Hypertension ; complications ; Intracranial Aneurysm ; complications ; Intracranial Arteriovenous Malformations ; complications ; Male ; Middle Aged ; Pregnancy ; Risk Factors ; Young Adult

Adult ; Basal Ganglia Hemorrhage ; complications ; diagnostic imaging ; Humans ; Hypohidrosis ; diagnostic imaging ; etiology ; Intracranial Arteriovenous Malformations ; complications ; diagnostic imaging ; Intracranial Hemorrhages ; complications ; diagnostic imaging ; Magnetic Resonance Imaging ; Male ; Rupture ; Thalamus ; diagnostic imaging ; Third Ventricle ; diagnostic imaging ; Tomography, Optical Coherence

OBJECTIVEto explore the characteristic factors of arteriovenous malformation (AVM) which have statistically significant correlation with hemodynamic aneurysms.

METHODSfrom August 1999 to July 2009, the clinical and imaging indices of 363 consecutive patients with AVM were retrospectively reviewed and entirely statistically analyzed. There were 229 male patients and 137 female patients, the mean age at the time of presentation was 28 ± 13 years. By using SPSS 16.0 medical statistic software, the correlation were analyzed between hemodynamic aneurysms and 13 characteristic factors associated with AVM through the methods of unit-factor and multi-factor analysis. Finally, the risk of the correlative factors filtered were evaluated.

RESULTSthe crosstabs analysis of unit-factor strongly suggested that the following factors, including age, location (supertentorium, subtentorium), size, number of main feeding arteries, number of drainage veins, ectasis of drainage veins, contralateral supply, and supply by both anterior and posterior circulation, were correlated with hemodynamic aneurysms. And the results of regression analysis of multi-factors indicated the following factors, including age, number of main feeding arteries, and contralateral supply, were positively correlated with hemodynamic aneurysms and the number of drainage veins were negatively correlated with hemodynamic aneurysms.

CONCLUSIONthe factors including age, number of main feeding arteries, number of drainage veins and contralateral supply, are highly correlated with hemodynamic aneurysms.

Adolescent ; Adult ; Age Factors ; Aged ; Child ; Female ; Humans ; Intracranial Aneurysm ; etiology ; Intracranial Arteriovenous Malformations ; complications ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Retrospective Studies ; Young Adult

Subarachnoid hemorrhage (SAH) can be classified as traumatic SAH or spontaneous SAH based on etiology. The traumatic SAH is the common manifestation of head injury and difficult to make a diagnosis in forensic investigation. Based on practical experiences of forensic investigation and relevant references, the main points (SAH identification, examination, death mechanism) were summarized in this article. For the understanding, we try to classify the traumatic SAH into three subtypes: brain injury associated SAH, traumatic rupture of basal cerebral vessels SAH and traumatic focal SAH.
Aneurysm, Ruptured/complications* ; Cause of Death ; Craniocerebral Trauma/complications* ; Diagnosis, Differential ; Forensic Pathology ; Hematoma, Epidural, Cranial/complications* ; Humans ; Intracranial Aneurysm/complications* ; Intracranial Arteriovenous Malformations/complications* ; Rupture/complications* ; Subarachnoid Hemorrhage/pathology* ; Subarachnoid Hemorrhage, Traumatic/pathology*

BACKGROUND: Advances in the field of interventional and diagnostic radiology have resulted in anesthesiologists becoming involved in angiographic suites. In the present study, we evaluated the characteristics of patients and the anesthetic management in an angiographic suite, to determine what factors influenced the patient outcome. METHODS: Data pertaining to patients that were anesthetized at an angiographic suite in a university hospital between 1 January 2007 and 31 December 2007 were evaluated retrospectively. Specifically, we evaluated the patient characteristics and the types of anesthesia administered, to determine which factors were related to patient outcome. RESULTS: Sixty-four percent of the patients enrolled in this study were women. Cases involving coiling for unruptured and ruptured aneurysm, embolization for intracranial arteriovenous malformation and fistula, pediatric diagnostic angiography, embolization for extracranial arteriovenous malformation, and implantable cardioverter-defibrillator (ICD) implantation all required the involvement of anesthesiologists. Major postoperatve complications included pneumonia, atelectasis, and hydrocephalus. In addition, GCS, net fluid balance, and anesthesia time had influence on patient outcome. CONCLUSIONS: We evaluated the characteristics of patient groups, procedures, and postoperative complications in an angiographic suite. The results of our analysis revealed that a through understanding of nervous and vascular pathology, as well as knowledge of current interventional radiology, neuroanesthesia and vascular anesthesia techniques is essential for development of safe and effective care.
Anesthesia ; Aneurysm ; Aneurysm, Ruptured ; Angiography ; Arteriovenous Malformations ; Defibrillators, Implantable ; Female ; Fistula ; Humans ; Hydrocephalus ; Intracranial Arteriovenous Malformations ; Pneumonia ; Postoperative Complications ; Pulmonary Atelectasis ; Radiology, Interventional ; Retrospective Studies ; Water-Electrolyte Balance

INTRODUCTIONWhile paediatric strokes are fairly uncommon, they are often associated with significant long-term disability. Diagnosis is often delayed because of the need to exclude conditions that mimic stroke. Understanding the outcomes related to stroke in children is important in the development of secondary prevention strategies. The aim of this study was to evaluate the epidemiology of childhood stroke in a tertiary paediatric unit in Singapore and to assess factors influencing outcome in these children.

MATERIALS AND METHODSA retrospective case-note review of all childhood strokes presenting to the Children's Medical Institute (CMI) at the National University Hospital (NUH), Singapore between October 1999 and May 2006. Data collected include demographic factors, clinical presentation, diagnosis, subsequent management and follow-up using specific outcome measures.

RESULTSTwenty-six children with a median age of 8.0 years at presentation were identified, comprising 15 ischaemic strokes (57.7%), 10 haemorrhagic strokes (38.5%) and 1 patient with both ischaemic and haemorrhagic lesions. The most common symptoms at presentation were seizures (15/26, 57.7%), lethargy (11/26, 42.3%), hemiparesis (10/26, 38.5%) and altered levels of consciousness (10/26, 38.5%). Vascular abnormalities accounted for 50% of strokes in our study population. The average length of follow-up was 33.2 months (range, 1 to 120) with only 11 children (11/26, 42.3%) achieving full recovery. Significant prognostic factors include altered consciousness and seizures at presentation, lesions in both cortical and subcortical locations, systemic disease aetiology, neurological deficits at discharge and seizures at the time of discharge.

CONCLUSIONLong-term neurological, neuropsychological and functional impairment are common in survivors of paediatric strokes. Certain clinical features and lesion characteristics are useful indicators of prognosis in these children.

Adolescent ; Age Factors ; Asian Continental Ancestry Group ; Brain Ischemia ; epidemiology ; etiology ; rehabilitation ; Cerebral Hemorrhage ; etiology ; Child ; Child, Preschool ; Developmental Disabilities ; etiology ; Female ; Humans ; Infant ; Intracranial Arteriovenous Malformations ; complications ; Length of Stay ; statistics & numerical data ; Male ; Neuropsychological Tests ; Prognosis ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Singapore ; epidemiology ; Stroke ; epidemiology ; etiology ; Stroke Rehabilitation ; Treatment Outcome ; Vascular Diseases ; complications

A 36-year-old man was diagnosed with a right temporal lobe grade II cerebral arteriovenous malformation (cAVM) and was treated with radiosurgery. At nine months after the cAVM radiosurgery, the patient began to develop bilateral focal narrowing at the M1 segments of the bilateral middle cerebral arteries. The narrowing progressively deteriorated as was demonstrated on longitudinal serial follow-up MR imaging. X-ray angiography performed at 51 months after radiosurgery confirmed that the cAVM was cured and a diagnosis of moyamoya disease. To the best of our knowledge, this is the first case of cAVM-associated moyamoya disease that developed after radiosurgery. Given the chronological sequence of disease development and radiation dose distribution of radiosurgery, it is proposed that humoral or unknown predisposing factors, rather than direct radiation effects, are the cause of moyamoya disease associated with cAVM.
Adult ; Humans ; Intracranial Arteriovenous Malformations/diagnosis/*surgery ; Magnetic Resonance Imaging ; Male ; Moyamoya Disease/*etiology ; Postoperative Complications ; Radiosurgery

Adolescent ; Cerebellum ; diagnostic imaging ; pathology ; Cerebral Angiography ; Female ; Humans ; Intracranial Arteriovenous Malformations ; complications ; diagnostic imaging ; pathology ; Moyamoya Disease ; complications ; diagnostic imaging ; pathology

BACKGROUNDStereotactic radiosurgery is an alternative to resection of intracranial cerebral arteriovenous malformations (AVMs), while it will fail in some cases. This study aimed to evaluate the changes after stereotactic radiosurgery for AVMs.

METHODSNineteen cases with cerebral AVMs had failure after stereotactic radiosurgery therapy. The symptoms and angiography were assessed. All patients underwent microsurgery. Pathologic examination was performed for all cases and electron microscopic examination was carried out in 6 patients.

RESULTSSeven cases had hemorrhage from 12 to 98 months after stereotactic radiosurgery, 5 had headache, 4 had refractory encephalon edema, 2 had epilepsy as a new symptom and 1 had a pressure cyst 5 years after radiosurgery. Angiography in 18 cases, 8 - 98 months after radiation therapy, demonstrated no significant changes in 5 cases, slight reduction in 9, near complete obliteration in 1 and complete obliteration in 3. An abnormal vessel was found on pathologic examination in 17 cases, even one case had obliterated in angiography. Electron microscopy examination showed vessel wall weakness, but the vessels remained open and blood circulated. One case died because of a moribund state before surgery. The other 18 cases had no new neurological deficiencies, seizure control and no hemorrhage occurred after microsurgery at an average follow-up of 3 years.

CONCLUSIONStereotactic radiotherapy for AVMs should have a long period follow-up. If serious complications occur, microsurgery can be performed as salvage treatment.

Adult ; Cerebral Angiography ; Cerebral Hemorrhage ; etiology ; Female ; Headache ; etiology ; Humans ; Intracranial Arteriovenous Malformations ; diagnostic imaging ; pathology ; surgery ; Male ; Middle Aged ; Postoperative Complications ; Radiosurgery ; adverse effects ; Treatment Outcome

Adult ; Dura Mater ; blood supply ; Humans ; Intracranial Arteriovenous Malformations ; complications ; diagnosis ; Male ; Tinnitus ; etiology