Recent investigations have indicated the importance of secondary brain damage in the pathophysiology of intracerebral hemorrhage (ICH), which includes ischemic brain damage and edema formation around a hematoma. The purpose of the current study is to investigate chronological changes of perihematomal edema in patients with human ICH and also the correlation between volume of perihematomal edema and neurological status. Fourteen patients with medium-sized putaminal hemorrhage (29.4 ± 13.2 ml) without hematoma enlargement were included in this study. To investigate chronological changes of perihematomal edema, we performed CT scans prospectively on the day of hemorrhage and repeated them on days I, 3, 7, 14, and 28. We evaluated the patients neurologically using the NIH stroke scale on the day a CT scan was performed. The volume of perihematomal edema in human ICH increased rapidly three days after hemorrhage and the score on the NIH stroke scale showed a deterioration. The volume of perihematomal edema then increased slowly until day 14 after hemorrhage, and decreased thereafter. Despite progression of perihematomal edema , the score on the NIH stroke scale improved gradually after day 3.

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SUMMARYThe effect of induced hypertension on the blood-brain barrier (BBB) change in Mongolian gerbils exposed to various periods of ischemia was studied. EVANS blue dye was used to determine the BBB change In animals subjected to different levels of hypertension after 3 h ischemia. Horseradish peroxidase (HRP) was used in electronmicroscopic studies of animals subjected to 30 min, 1,3 or 6 h ischemia and subsequently exposed for 30 min to varying periods and sequences of nonno-and hypertension. Furthermore, HRP-labeled vesicle counts were performed in animals from the 30-min ischemia group.Our findings revealed that hypertension, after blood flow restoration following ischemia, induces and/or accelerates BBB damage by enhancing endotheiial vesicular and/or tubuio-channel transport.Stroke, Vol 11, No 6, 1980WHETHER AN INCREASE of blood pressure has a beneficial effect on the ischemic brain is still a matter of debate in clinical studies.1 -* The ischemic brain has been reported to be highly-resistant to blood-brain barrier (BBB) M change which induces vasogenic edema.8 However, it has been reported that a BBB change can occur after restoration of the blood flow to the ischemic brain. "10 The present study was undertaken to determine how a slight change in blood pressure after blood flow restoration might affect the BBB after ischemia, and to elucidate the ultrastructural mechanisms of this BBB change.The results of this line of inquiry may be of clinical importance in managing patients after the surgical restoration of blood flow to ischemic brain, and in the treatment of cerebral apoplexy without angiographic evidence of vascular obstruction 11 '1J and/or with evidence of rich collateral circulation. Materials and MethodsIschemia was produced in adult Mongolian gerbils of either sex under light ether anesthesia by clipping the left carotid artery with Scovill's aneurysmal clip. Polyethylene tubing (PE 10, Clay-Adams, USA) was inserted through the femoral artery to the abdominal aorta of all ischemia-sensitive animals, selected according to previously described criteria."• M Systemic arterial blood pressure was monitored continuously on a Statham transducer. Under pentobarbital anesthesia (1 mg/100 g body weight, i.p.), 0.1-0.5 mg/kg body weight metaraminol bitartrate was repeatedly injected i.v. to maintain the mean arterial blood pressure (MABP) at different levels of elevation. In each animal, MABP was measured at 5 min intervals after blood flow restoration. BBB Change after 3 h Ischemia Demonstrated by Evans Blue PermeabilityAll animals received an i.v. injection of 0.1 ml/100 g body weight of 2% Evans blue dye immediately before clip release. They were sacrificed 5 min to 5 h thereafter by 10% buffered paraformaldehyde perfusion. Abnormal permeability of the BBB to the dye was assessed by visual inspection of coronal blocks of the perfused brains.The animals were divided into 4 groups according to the different levels of MABP (table). Animals were considered to be positive for BBB change when a blue spot ...

We describe a 40-year-old male who developed an isolated recurrence of granulocytic sarcoma (GS) of the brain 2 years following successful treatment of acute myeloblastic leukemia (AML; M2). Computed tomography (CT) scans and magnetic resonance (MR) images demonstrated a homogeneously enhanced tumor mass in the left temporal lobe and massive peritumoral edema. There was no evidence of relapse in the bone marrow. The patient underwent an emergency surgical resection of the tumor. Five courses of injection with cytarabine and prednisolone through an Ommaya reservoir and whole brain irradiation (total 40 Gy) were performed. Furthermore, prophylactic systemic chemotherapy with cytarabine and etoposide was added. He has been in complete remission for 21 months. Our results, together with other reported cases, indicate that a favorable outcome could be obtained by intensive and combined treatment for an isolated recurrence of GS of the brain if the bone marrow remained in complete remission.

We investigated the existence of the "no-reflow" phenomenon in focal cerebral ischemia. Regional cerebral blood flow was studied in Mongolian gerbils perfused with a carbon-black particle suspension after cerebral ischemia prior to decapitation and compared with 14C-antipyrine autoradiographic images. The correlation between the occurrence of the "no-reflow" phenomenon and systemic arterial blood pressure change was also examined. We found that the phenomenon was transient in character and that its manifestation was related to the transient fall in arterial blood pressure observed immediately after clip release and with stagnation of venous blood flow. The phenomenon disappeared in animals in which the arterial blood pressure was artificially increased after clip release.

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Background: Non-adherence to inhalation regimens is common in asthmatic patients. The Adherence Starts with Knowledge-12 (ASK-12) survey was developed to detect and address patient-specific barriers to medication adherence. Our objective is to investigate the clinical usefulness of the ASK-12 for assessing and addressing adherence to inhalation therapy in asthma. Methods: The ASK-12 was administered to 138 asthmatic patients. Using pharmacy-refill data, we examined the cut-off value of the ASK-12 to identify patients who were non-adherent to inhalation regimens and identify factors associated with non-adherence. To verify the usefulness of the ASK-12, inhalation regimens were prospectively switched to less-expensive and simpler (once-daily) dosing regimens in eight non-adherent asthmatic patients who reported specific-barriers in "inconvenience of twice-daily inhaler use" and "cost".Results: Valid responses were received from 114 (82.6%) patients. A significant correlation was found between pharmacy-refill rates and the ASK-12 total score (r=−0.55, P<0.0001). The optimal cut-off value of the ASK-12 total score to discriminate non-adherent patients (defined by pharmacy-refill rate <80%) was 23, with 71.4% specificity and 93.3% sensitivity. Using this value, 52 (45.6%) patients were classified as nonadherent. Univariate followed by multivariate analysis identified younger age as a predictor of non-adherence to inhalation regimens (odds ratio, 2.67; 95% CI, −0.95 to −0.06; P=0.027). Switching inhaled medicines in eight patients resulted in significant improvements in both ASK-12 scores and asthma control. Conclusions:The ASK-12 is a brief, practical, and clinically useful measure for assessing and addressing adherence to inhalation regimens in asthma.