Monomeric C-Reactive Protein and Cerebral Hemorrhage: From Bench to Bedside

To observe the effect of early intensive blood pressure (BP)–lowering treatment on rebleeding and perihematomal edema (PE) in patients with acute intracerebral hemorrhage (ICH). A total of 121 patients with ICH were randomly assigned to an early intensive antihypertensive treatment group (IG) (n = 62) or control group (CG) (n = 59). For both groups, 25 mg of urapidil injection was slowly administered intravenously in 6 hours of the onset. For the IG, 100 mg of urapidil and 30 mL of 0.9% sodium chloride were then slowly administered. Repeat computed tomography imaging was performed at 24 hours, 72 hours, day 7, and day 14 to detect any rebleeding via changes in hematoma volume and the changes in PE. Finally, NIHSS scores and Barthel Index (BI) were calculated at 24 hours, 72 hours, day 7, day 14, day 30, and day 90. The average hematoma volume in IG patients was significantly smaller than that of CG patients after 24 hours (P < .05). The volume of PE in the CG increased more than in the IG within 24 hours of onset, but was not statistically significant (P > .05); however, this trend was statistically significant after 72 hours (P < .05). On day 30 and day 90, the average NIHSS score of IG patients was lower than that of CG patients, and the BI was higher (P < .05) than that of CG patients. There was no significant difference in mortality between the two groups. Early intensive antihypertensive treatment in ICH patients reduces rebleeding and PE, improving short‐term quality of life.

Section: Limitationsmentioning

confidence: 99%

Therapeutic effect of early intensive antihypertensive treatment on rebleeding and perihematomal edema in acute intracerebral hemorrhage

Zang

Zhang

Song

et al. 2019

“…In the hyperacute phase, PHE involves clot retraction, trans‐capillary efflux of electrolytes, water and osmotically active serum proteins, and cytotoxic edema from neuronal energy failure. In the acute phase, during the first few days, PHE is sustained by coagulation cascade, thrombin production, immune reaction, and inflammatory cells . Finally, beginning from approximately 72 hours after ICH, PHE formation involves erythrocyte lysis and hemoglobin‐induced toxicity .…”

Section: Primary and Secondary Brain Injury Following Cerebral Hematomamentioning

confidence: 99%

Managing blood pressure in acute intracerebral hemorrhage

Lattanzi

Brigo

Silvestrini

2019

Self Cite

| INTRODUC TI ONIntracerebral hemorrhage (ICH) results from the rupture of cerebral vessels leading to the development of a hematoma in the brain. It comprises approximately 15%-30% of all strokes and affects more than 1 million people every year worldwide. 1 Hypertension is the most common cause of ICH, and less frequent etiologies include coagulopathies, cerebral amyloid angiopathy, vascular abnormalities, brain trauma or tumors, and infections.Cerebral hemorrhage is the stroke subtype characterized by the highest mortality and morbidity: the fatality rate is about 40% at 1 month from bleeding and most survivors retain a severe residual disability, with only 20%-40% of patients living independently at 1 year. 2 Currently, medical and surgical strategies have substantially failed to improve outcome, and the management of ICH consists mainly of supportive therapies. The understanding of the mechanisms underlying the course of hematoma and the progression of the injury in surrounding parenchyma is, hence, of paramount relevance to identify therapeutic targets and effective treatment approaches. | PRIMARY AND S ECONDARY B R AIN INJ URY FOLLOWING CEREB R AL HEMATOMASeveral mechanisms are involved in brain injury related to ICH. Primary brain injury, which occurs at the time of hemorrhage, is due to the mass effect caused by extravasation of blood, physical disruption of adjacent tissue and mechanical compression of local structures. The hematoma can also increase the intracranial pressure, impair cerebral blood flow, and lead to brain herniation. 3 Although damage occurring immediately after ICH is untreatable, it is worth noticing that around one third of patients undergo hematoma expansion (HE) within the first days after stroke. 4 Hematoma growth contributes to midline shift and early neurological deterioration, and is consistently associated with higher fatality and poorer clinical outcome. 5 Remarkably, the intensive blood pressure reduction in acute cerebral hemorrhage trial (INTERACT-1) demonstrated that each 1 mL increase in HE is associated with a raise in the risk of death and dependency by 5%. 6 Secondary brain injury is due either to the body and tissue response to the hematoma or to the toxic effects of clot components, and includes a cascade of events, as inflammation, iron-mediated oxidative stress, apoptosis, necrosis, and autophagy, which mainly result in the development of peri-hemorrhagic edema (PHE). 7Cerebral edema occurs within hours of ICH, peaks several days later and can last for weeks. 5 In the hyperacute phase, PHE involves clot retraction, trans-capillary efflux of electrolytes, water and osmotically active serum proteins, and cytotoxic edema from neuronal energy failure. In the acute phase, during the first few days, PHE is sustained by coagulation cascade, thrombin production, immune reaction, and inflammatory cells. 8,9 Finally, beginning from approximately 72 hours after ICH, PHE formation involves erythrocyte lysis and hemoglobin-induced toxicity. 10 PHE may contribute to an overall ...

“…4,5 In the current issue of The Journal of Clinical Hypertension, the study by Dr Hua and colleagues aimed to examine the association between sleep duration and stroke risk in middle-aged and elderly population. 1 Worldwide, fifteen million people suffer a stroke every year, nearly six million die, and around five million are left permanently disabled.…”

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confidence: 99%

“…1 Worldwide, fifteen million people suffer a stroke every year, nearly six million die, and around five million are left permanently disabled. 4,5 In the current issue of The Journal of Clinical Hypertension, the study by Dr Hua and colleagues aimed to examine the association between sleep duration and stroke risk in middle-aged and elderly population. 4,5 In the current issue of The Journal of Clinical Hypertension, the study by Dr Hua and colleagues aimed to examine the association between sleep duration and stroke risk in middle-aged and elderly population.…”

mentioning

confidence: 99%

“…2,3 The identification of the risk factors of stroke, especially those that can be modified, is of paramount relevance to control the burden of cerebrovascular diseases. 4,5 In the current issue of The Journal of Clinical Hypertension, the study by Dr Hua and colleagues aimed to examine the association between sleep duration and stroke risk in middle-aged and elderly population. 6 The cross-sectional study included 10 516 participants aged ≥45 years from the China Hypertension Survey study, a nationally representative cross-sectional survey designed to provide reliable and evidence-based data on the current status of hypertension and associated factors in Chinese adults.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Sleep and brain health

Lattanzi

Brigo

Silvestrini

2019

Self Cite

Stroke is the second cause of death and one of the leading causes of disability. 1 Worldwide, fifteen million people suffer a stroke every year, nearly six million die, and around five million are left permanently disabled. 2,3 The identification of the risk factors of stroke, especially those that can be modified, is of paramount relevance to control the burden of cerebrovascular diseases. 4,5 In the current issue of The Journal of Clinical Hypertension, the study by Dr Hua and colleagues aimed to examine the association between sleep duration and stroke risk in middle-aged and elderly population. 6 The cross-sectional study included 10 516 participants aged ≥45 years from the China Hypertension Survey study, a nationally representative cross-sectional survey designed to provide reliable and evidence-based data on the current status of hypertension and associated factors in Chinese adults. Longer sleep duration was associated with higher prevalence of stroke: the relationship resulted linear in non-hypertensive patients with a turning point of the smooth curve at 8 hours, whereas a threshold effect was found in hypertensive individuals. 6 Despite methodological issues inherent to the cross-sectional and self-reported nature of data, which may be subjected to recall biases and possible residual or unmeasured confounders, the study can offer intriguing insights for the understanding of behavioral contributors to stroke. | S LEEP DUR ATI ON AND S TROK E RIS KSleep is a tightly regulated phenomenon that takes up approximately to one-third of our lifetime. Although the actual purposes of sleep are still to be fully elucidated, there is indisputable evidence that it serves essential functions and affects many physiological processes.The average need for adults is between 7 and 9 hours of sound sleep per day on a regular basis, and deviations from such rhythm can have negative consequences for health. Epidemiological studies investigating the putative effect of habitual sleep on cerebrovascular risk demonstrated a J-shaped association between sleep duration and stroke incidence. Both insufficient and excessive sleep are predictors for future stroke, and the association is stronger for long than short sleep. 7 It has been estimated that every 1-hour increase in sleep duration can increase the risk of stroke by 10%-15% and individuals sleeping more than 8 hours can be approximately 50% more susceptible to stroke than those with normal sleep duration through 10 years of observation. 8Notably, this trend has been consistently identified across studies irrespective of nationality or ethnicity and after the adjustment for potential confounders like education, employment status, family income, depression, physical activities, and sleep-disordered breathing-related symptoms.Interestingly, sleep duration can significantly affect the traditional risk factors for stroke. The Sleep Hearth Health Study was the first one to suggest that the relationship between sleep duration and hypertension follows a U-shaped curve, being both sho...