Management of Spontaneous Intracerebral Haemorrhage (sICH) at the University Hospital of Brazzaville (CONGO)

Spontaneous intracerebral haemorrhage (sICH) is characterised by bleeding within the brain parenchyma, without any accompanying vascular malformation, parenchymal abnormality or coagulation disorder. The study aimed to depict the management of sICH at the University Hospital of Brazzaville (UHB). It was an observational, descriptive, and cross-sectional analysis. Data collection was conducted retrospectively, covering the period from January 1, 2020 to August 31, 2022, spanning two years and eight months. The study examined socio-demographic, diagnostic, therapeutic, and evolutionary variables. We included 274 cases. We observed 160 men (58.4%) and 114 women (41.6%), resulting in a sex ratio of 1.4. The mean age was 55.3 ± 11.4 years, with ages ranging from 31 to 93 years. The detection of sICH was typically a result of experiencing motor deficits (59.5%) or disorders of consciousness (37.2%). The weightiness of one half of the body was the most common reason for seeking medical advice. Hematoma was capsulo-lenticular in 159 cases (58%) and capsulo-thalamic in 63 cases (23%). Hematomas were <30 ml in 162 cases (59.1%) and >30 ml in 112 cases (40.9%), and associated with hydrocephalus in 11.7% of cases. Conservative medical treatment was administered in 257 cases (94.2%) while surgical treatment was performed in 16 cases (5.8%). The surgical techniques used were external ventricular drainage (EVD) in 2 cases, ventriculo-peritoneal shunt in 5 cases, and hematoma evacuation in 10 cases. Death occurred before the 7th day of hospitalisation in 73 cases (57.8%) and after in 46 cases (42.2%). The median time to death was four days (Q1 = 2 days;Q3 = 7 days), with extremes of 0 and 216 days. .

Association of Satellite Sign with Postoperative Rebleeding in Patients Undergoing Stereotactic Minimally Invasive Surgery for Hypertensive Intracerebral Haemorrhage

There are few studies regarding imaging markers for predicting postoperative rebleeding after stereotactic minimally invasive surgery(MIS)for hypertensive intracerebral haemorrhage(ICH),and little is known about the relationship between satellite sign on computed tomography(CT)scans and postoperative rebleeding after MIS.This study aimed to determine the value of the CT satellite sign in predicting postoperative rebleeding in patients with hypertensive ICH who undergo stereotactic MIS.We retrospectively examined and analysed 105 patients with hypertensive ICH who underwent standard stereotactic MIS for hematoma evacuation within 72 h following admission.Postoperative rebleeding occurred in 14 of 65(21.5%)patients with the satellite sign on baseline CT,and in 5 of the 40(12.5%)patients without the satellite sign.This diiTerence was statistically significant.Positive and negative values of the satellite sign for predicting postoperative rebleeding were 21.5%and 87.5%,respectively.Multivariate logistic regression analysis verified that baseline ICH volume and intraventricular rupture were independent predictors of postoperative rebleeding.In conclusion,the satellite sign on baseline CT scans may not predict postoperative rebleeding following stereotactic MIS for hypertensive ICH.

Traditional craniotomy versus current minimally invasive surgery for spontaneous supratentorial intracerebral haemorrhage:A propensity-matched analysis

BACKGROUND Minimally invasive surgery(MIS)and craniotomy(CI)are the current treatments for spontaneous supratentorial cerebral haemorrhage(SSTICH).AIM To compare the efficacy and safety of MIS and CI for the treatment of SSTICH.METHODS Clinical and imaging data of 557 consecutive patients with SSTICH who underwent MIS or CI between January 2017 and December 2022 were retrospectively analysed.The patients were divided into two subgroups:The MIS group and CI group.Propensity score matching was performed to minimise case selection bias.The primary outcome was a dichotomous prognostic(favourable or unfavourable)outcome based on the modified Rankin Scale(mRS)score at 3 months;an mRS score of 0–2 was considered favourable.RESULTS In both conventional statistical and binary logistic regression analyses,the MIS group had a better outcome.The outcome of propensity score matching was unexpected(odds ratio:0.582;95%CI:0.281–1.204;P=0.144),which indicated that,after excluding the interference of each confounder,different surgical modalities were more effective,and there was no significant difference in their prognosis.CONCLUSION Deciding between MIS and CI should be made based on the individual patient,considering the hematoma size,degree of midline shift,cerebral swelling,and preoperative Glasgow Coma Scale score.

Influence of Traditional Chinese Medicine Constitution Type on the Susceptibility of Hypertensive Cases to Intracerebral Haemorrhage

Objective：To explore the influence of Chinese medicine constitution type on the susceptibility of hypertensive patients to intracerebral haemorrhage.Methods：Primary hypertensive patients were studied and divided into the hypertension and the hypertensive intracerebral haemorrhage groups,depending on whether or not the patients had intracerebral haemorrhage.The demographic characteristics,physiological characteristics,living habits,biochemical tests,other chronic diseases,Chinese medicine constitution type,etc.were collected and compared between the two groups.The neurological deficit in the hypertensive intracerebral haemorrhage group was also compared among the different constitution types.Results：A total of 304 patients participated in this investigation,including 213 cases in the hypertension group and 91 cases in the hypertensive intracerebral haemorrhage group.The percentages of dampness-heat and qi-depression types in the intracerebral haemorrhage group were greater than those with the same types in the hypertension group（20.9%vs 6.1%,22.0%vs 8.0%;P〈0.05）.The percentages of each constitution type were different between genders in both groups.In addition,there were more male cases（14/20） with qi-depression type and more female cases（7/8） with phlegm-dampness type in the hypertensive intracerebral haemorrhage group than those with the same types（3/17 and 9/34,respectively） in the hypertension group（P〈0.05）.The cases with phlegm-dampness and qi-depression types had greater levels of blood lipids in the intracerebral haemorrhage group than those with the same types in the hypertension group（P〈0.05）.Furthermore,the cases with the qi-deficiency type presented with a more severe neurological deficit than those with the other types（P〈0.05）.Conclusions：Chinese medicine constitution type might have an impact on the susceptibility of hypertensive patients to have an intracerebral haemorrhage.The heat-dampness and qi-depression types might lead to greater susceptibility than the other types.In addition,the patient＇s gender and blood lipids might also influence the susceptibility along with the constitution type.

Spontaneous Intracerebral Hemorrhage: Epidemiology, Clinical Profile and Short-Term Outcome in a Tertiary Hospital in Sub-Saharan Africa

Background: Data on spontaneous intracerebral haemorrhagic (SICH) are scarce in Africa. Our objectives were to determine the prevalence of SICH, describe the clinical profile, aetiology and evaluate the prognosis (fatality case, functional outcome) of patients in a tertiary health care hospital in Cameroon. Methods: This was a hospital-based retrospective cohort which included patients with SICH and followed up for 6 months after stroke. Subarachnoid haemorrhage, cerebral venous thrombosis with bleeding or bleeding related with ischemic or brain tumour were excluded. Predictive factors were obtained using multiple logistic regression and survival by Kaplan Meier method. Results: The prevalence of SICH was 37% with male predominance (64.0%), a mean age of 55.6 ± 11.8 years. Deep coma was found in 30.3% on admission. The basal ganglion was the most frequent location of haemorrhage (85.1%) while intraventricular blood effusion, mass effect, cerebral oedema and herniation occurred in 31.4%, 25.7%, 8.8% and 5.0% respectively. Hypertension (57.5%) was the most common aetiology. The mean length of hospitalization was 9.0 ± 7.7 days and chest infection (30.7%) was the most frequent complication. The cumulative case fatality rate after 24 hours (day 1), during admission, month 1 and month 3 was 9.6%, 39.9%, 46.0%, 59.8% respectively. On multivariate analysis, GCS < 9 [OR (95% CI) = 3.538 (1.086 - 11.526), p = 0.036] and NIHSS 15 - 24 [OR (95% CI) = 7.498 (1.306 - 43.029), p = 0.024] were independent predictors of in-hospital mortality while mass effect [OR (95% CI) = 3.563 (1.217 - 10.432), p = 0.020] and hyperthermia [OR (95% CI) = 4.645 (1.341 - 16.085), p = 0.015] predict poor functional outcome. Six-month survival was 37.8%. Conclusion: About one-third of stroke patient were haemorrhagic. Hypertension is the leading CVRF and aetiology of spontaneous ICH. About 1 over 2 patients with SICH would die within 3 months while 50% of survivors would have a poor functional outcome at 6th month.

Phase Ⅰ/Ⅱ randomized controlled trial of autologous bone marrow-derived mesenchymal stem cell therapy for chronic stroke

AIM To examine the safety and efficacy of mesenchymal stem cell(MSC) therapy for intracerebral haemorrhage with neurological dysfunctions for a year.METHODS MSC were ex vivo expanded from 29 mL(17-42 mL) autologous bone marrow. Patients were randomized to have two intravenous injections of autologous MSC or placebos in four weeks apart. Neurological functions and clinical outcomes were monitored before treatment and at 12^(th), 16^(th), 24^(th), 36^(th) and 60^(th) week upon completion of^(th)e treatment. RESULTS A mean of 4.57 × 10~7(range: 1.43 × 10~7-8.40 × 10~7) MSC per infusion was administered accounting to 8.54 × 10~5(2.65 × 10~5-1.45 × 10~6) per kilogram body weight in two occasions. There was neither adverse event at time of administration nor sign of de novo tumour development among patients after monitoring for a year post MSC therapy. Neuro-restoration and clinical improvement in terms of modified Barthel index, functional independence measure and extended Glasgow Outcome Scale were evident among patients having MSC therapy compared to patients receiving placebos. CONCLUSION Intravenous administration of autologous bone marrowderived MSC is safe and has the potential of improving neurological functions in chronic stroke patients with severe disability.