Background and Purpose-The prognosis of spontaneous intracerebral hemorrhage (sICH) is poor because of the mass effect arising from the hematoma and the associated peri-hemorrhagic edema, leading to increased intracranial pressure. Because the efficacy of surgical and anti-edematous treatment strategies is limited, we investigated the effects of mild induced hypothermia in patients with large sICH. Methods-Twelve patients with supratentorial sICH Ͼ25 mL were treated by hypothermia of 35°C for 10 days. Evolution of hematoma volume and perifocal edema was measured by cranial CT. Functional outcome was assessed after 90 days. These patients were compared to patients (nϭ25; inclusion criteria: sICH volume Ͼ25 mL, no acute restriction of medical therapy on admission) from the local hemorrhage data bank (nϭ312). Side effects of hypothermia were analyzed. Results-All patients from both groups needed mechanical ventilation and were treated in a neurocritical care unit. All hypothermic patients (mean age, 60Ϯ10 years) survived until day 90, whereas 7 patients died in the control group (mean age, 67Ϯ7 years). Absolute hematoma size on admission was 58Ϯ29 mL (hypothermia) compared to 57Ϯ31 mL (control). In the hypothermia group, edema volume remained stable during 14 days (day 1, 53Ϯ43 mL; day 14, 57Ϯ45 mL), whereas edema significantly increased in the control group from 40Ϯ28 mL (day 1) to 88Ϯ47 mL (day 14). ICH continuously dissolved in both groups. Pneumonia rate was 100% in the hypothermia group and 76% in controls (Pϭ0.08). No significant side effects of hypothermia were observed. Conclusions-Hypothermia prevented the increase of peri-hemorrhagic edema in patients with large sICH. (Stroke. 2010; 41:1684-1689.)
Threshold-based CT volumetry of PHE with a threshold range 5-33 HU is a reliable and observer independent method for quantification of PHE after spontaneous ICH.
Background and Purpose-Insulin-like growth factor (IGF) treatment has been shown to have trophic and neuroprotective effects in vitro and in vivo in different lesion models. IGF-I has potent neuroprotective effects after hypoxic-ischemic injury and global ischemia. The role of IGF-I in focal cerebral ischemia is only partially understood. Therefore, in the present study, we evaluated, by applying MRI monitoring, whether a clinically relevant systemic administration of IGF-I can achieve a long-lasting neuroprotective effect. ; group E, the placebo group [nϭ10]). Groups C and F served as sham-operated controls (nϭ5 and nϭ3, respectively). Treatment was begun 30 minutes after occlusion of the middle cerebral artery. Subcutaneously treated animals underwent MRI studies (diffusion-weighted imaging, perfusion imaging, and T2-weighted imaging) beginning 60 minutes after vessel occlusion at 6 hours and at days 1, 2, 5, and 7 after ischemia. The animals were weighed and neurologically assessed daily (rating scale ranged from 0, indicating no deficit, to 5, indicating death). On the third day (intraventricular trial) and on the seventh day (subcutaneous trial), animals were euthanized, and brain sections were stained with triphenyltetrazolium chloride. (PϽ0.05) at day 7 for control and IGF-I-treated animals, respectively. The relative regional cerebral blood volume was reduced to 50% before reperfusion in all regions of interest except for region of interest 1 (vessel territory of anterior cerebral artery), recovered during reperfusion, but was not different between the control and the growth factor-treated group at any imaging time point. There was no significant difference in weight loss. There was less neurological deficit after ischemia in intraventricularly and subcutaneously IGF-I-treated animals compared with control animals (PϽ0.05). Conclusions-Continuous treatment with intraventricularly and subcutaneously administered IGF-I achieved a longlasting neuroprotective effect as early as 24 hours after ischemia as measured by MRI. Therefore, IGF-I may represent a new approach to the treatment of focal cerebral ischemia. Methods-Male Results-The
Background and Purpose-The objective was to analyze the feasibility of a lumbar drainage (LD) for a communicating malresorptive hydrocephalus in patients with supratentorial hemorrhage (intracerebral hemorrhage) accompanied by severe ventricular involvement (intraventricular hemorrhage) who required an external ventricular drain (EVD). Methods-In this retrospective study, 16 patients received an EVD and concurrent LD and were compared with 39 historical patients treated with EVD alone. The duration of required EVD and need for permanent ventriculoperitonealshunt were analyzed. Results-LD was inserted after 12 (4 to 18) days. In LD-treated patients, the LD was capable to replace repeated EVD exchanges, resulting in a shorter EVD-duration (12 versus 16 days) compared with patients treated with EVD alone. The overall duration of extracorporal cerebrospinal fluid drainage was longer (16 days EVD versus 21 days EVDϩLD) and the frequency of ventriculoperitoneal-shunt lower (18.75% versus 33%; PϽ0.03) in LD-treated patients. Conclusion-Our data suggest that LD is safe and feasible for treatment of nonpersistent communicating hydrocephalus after intracerebral hemorrhage. After adequate treatment of the occlusive hydrocephalus using an EVD in the acute phase, LD discloses an alternative for further extracorporal cerebrospinal fluid drainage. (Stroke. 2007;38:183-187.)
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