Hematoma enlargement-related factors in hypertensive cerebral hemorrhage

BACKGROUND：Continuous hemorrhage or hematoma enlargement often occurs following cerebral hemorrhage attacks. OBJECTIVE： To retrospectively analyze the influential factors for hematoma enlargement in patients with hypertensive cerebral hemorrhage prior to minimally invasive surgery. DESIGN, TIME AND SETTING： A comparative analysis of 90 patients with cerebral hemorrhage undergoing minimally invasive surgery at the Department of Neurology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology between April 2005 and February 2007. PARTICIPANTS： Fifty-eight males and thirty-one females aged （52.7 ± 5.23） years （range, 28-73 years）. METHODS： Cranial CT was performed twice to objectively identify hematoma enlargement. Patients with hematoma enlargement prior to surgery were selected as the observation group （n = 30）, and those with no obvious hematoma changes served as the control group （n = 60）. Following cranial CT localization, the two groups underwent minimally invasive hematoma aspiration and drainage, according to Standardized Treatment Guidelines for Micro-invasive Aspiration and Drainage of Intracranial Hematoma. MAIN OUTCOME MEASURES： Hemorrhage site, coagulation function, diabetes history, and clinical symptoms. RESULTS： There were no significant differences in hemorrhage sites between the two groups （χ2 = 2.262, P 〉 0.05）. The percent of intemperance patients in the observation group was significantly larger than the control group （χ2 = 6.923, P 〈 0.01）. No significant differences in terms of percent of coagulation dysfunction or diabetes were determined between the two groups （χ2 = 0.03, 0.08, P 〉 0.05）. The percent of patients with clinical deterioration was significantly higher in the observation group, compared to the control group （χ2 = 25.57, P 〈 0.01）. CONCLUSION： Intemperance and preoperative clinical deterioration may increase incidence of hematoma enlargement prior to minimally invasive surgery in patients with hypertensive cerebral hemorrhage.

Electrocardiogram changes during hematoma enlargement in intracerebral hemorrhage patients

BACKGROUND： It has been reported that cerebrovascular disease causes changes in electrocardiogram results. OBJECTIVE： To investigate changes in electrocardiogram results in patients with intracerebral bematoma enlargement. DESIGN, TIME AND SETTING： The present case-retrospective analysis study was performed at the Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2005 to October 2006. PARTICIPANTS： A total of 225 intracerebral hemorrhage patients （142 males and 83 females） that were hospitalized at the Department of Neurology were enrolled the present study. The patient selection was in accordance with diagnostic criteria from the Fourth National Cerebrovascular Disease Congress of China in 1995, and diagnosis was confirmed using computed tomography. All patients underwent computed tomography twice within 24 hours following intracerebral hemorrhage, and were subjected to electrocardiogram examination after admission. METHODS： According to hematoma enlargement following intracerebral hemorrhage, all patients were divided into hematoma enlargement （n = 20） and non-hematoma enlargement （n = 205） groups. Because of the large patient number difference between the two groups, the hematoma enlargement group was matched with the non-hematoma enlargement group. Patients meeting these conditions were included in the non-hematoma enlargement group. Finally, 75 patients were included in the final analysis, 19 in the hematoma enlargement group and 56 in the non-hematoma enlargement group. Clinical data from the two groups were statistically analyzed. MAIN OUTCOME MEASURES： The incidence of electrocardiographic abnormalities between the hematoma enlargement and non-hematoma enlargement groups. RESULTS： In the hematoma enlargement group, 15 patients （79%） developed electrocardiographic abnormafities. In the non-hematoma enlargement group, 24 patients （43%） presented with electrocardiographic abnormalities. There were significant differences in electrocardiographic abnormalities between the groups （P 〈 0.01）. CONCLUSION： Patients with electrocardiographic abnormalities suffered from hematoma enlargement following admission.

A PROSPECTIVE STUDY TO EVALUATE THE SAFETY AND EFFICACY USING REMOVING BLOOD STASIS HERBALS FOR PATIENTS WITH INTRACRANIAL HEMORRHAGE OF HYPERACUTE STAGE AND RELATIVE FACTORS OF HEMATOMA ENLARGEMENT(A MULTICENTER PROSPECTIVE RANDOMIZED DOUBLE-BLIND PLACEBO

The aim was to investigate whether using a removing blood stasis method in hyperacute intracranial hemorrhage stage can lead to hematoma enlargement and its clinical efficacy.A multicenter retrospective randomized double-blind placebo-controlled clinical study.We recruited patients aged 18 years or older and presenting at less than 6 h from symptom onset in 8 research centers.All the patients

Relationship between enlargement of traumatic intracerebral hematoma and irregular rate of hematoma morphous

To study the relationship between incidence and time course of traumatic intracerebral hematoma enlargement and that between hematoma irregular rate (IR) and hematoma enlargement after brain injury.Methods After brain injury,164 cases with traumatic supratentorial intracerebral hematoma were examined by cranial CT scan within 72 hours thereafter reexamined 120 hours there after so as to compare the hematoma volumes (V1 and V2) and analyze the relation between hematoma IR and hematoma enlargement.Results After brain injury,enlargement of hematoma was confirmed in 70 cases (42.7%),in which the cutpoint for hematoma enlargement was determined as V2/V1=1.45 by using receiver operating characteristic curves (ROC).Hematoma IR had positive correlation with hematoma enlargement (r=0.857,P<0.01).Conclusion Since the incidence of traumatic hematoma enlargement is high,we can tell the possibility of hematoma enlargement based on hematoma IR in order to make a timely reexamination of CT scan and apply active treatments.7 refs,1 tab.

Aggressive Blood Pressure Lowing Therapy in Patients with Acute Intracerebral Hemorrhage is Safe： A Systematic Review and Meta-analysis

Background： The influence of blood pressure （BP） lowering on intracerebral hemorrhage （ICH） patients is unclear. To assess the safety and efficacy of aggressive antihypertensive therapies in acute ICH patients, we carried out a systematic review and meta-analysis. Methods： PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and VIP database up to July 2014 were searched. H igh-quality randomized controlled trials were included. Low-quality trials were excluded. Serious adverse events were defined as the primary outcome. The secondary outcomes were hematoma enlargement （HE） at 24 h after onset, mortality, and favorable clinical outcome at 90 days. Results： Four high-quality trials involving a total of 1427 patients met the inclusion criteria and were analyzed. Odds ratios （ORs） of primary outcome was 0.96 （95% confidence interval [CI]： 0.82-1.13, P = 0.61）. ORs of HE at 24 h after onset, mortality and favorable clinical outcome at 90 days were 0.91 （95% CI： 0.72-1.17, P = 0.47）, 0.97 （95% CI： 0.79-1.20, P = 0.81）, 1.13 （95% CI： 0.98-1.30. P = 0.09） respectively. Conclusions： Aggressive BP management policies are safe and might have a potency of reducing HE and improving clinical outcome.