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A A Pract 2020 May;14(7):e01215

From the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.

Administering anesthesia to patients with pheochromocytoma may cause an exacerbation of catecholamine secretion from the pheochromocytoma secondary to drug administration, stress, or manipulation of the tumor. We present a pediatric patient with undiagnosed multiple endocrine neoplasia type 2B (pheochromocytoma, thyroid carcinoma, and mucosal neuromas), initially diagnosed and treated for postviral myocarditis and cardiomyopathy, who presented for abdominal magnetic resonance imaging (MRI) under general anesthesia. Untreated cardiomyopathy poses an extra anesthesia mortality risk for patients with pheochromocytoma usually due to myocardial failure, myocardial infarction, or hypertensive hemorrhage into the myocardium or brain. Read More

Front Neurol 2019 12;10:1420. Epub 2020 Feb 12.

Université de Tours, INSERM, Centre d'Étude des Pathologies Respiratoires (CEPR)-UMR 1100, CHRU de Tours, Service de Médecine Intensive Réanimation, CIC 1415, Réseau CRICS-TRIGGERSEP, Tours, France.

Posterior reversible encephalopathy syndrome (PRES) is a rare clinical and radiological entity characterized by a typical brain edema. Although several case reports have described PRES in a context of poisoning, to our knowledge, a comprehensive assessment has not been performed. The aim of this systematic review was to raise awareness on poisoning-specific PRES features and to encourage consistent and detailed reporting of substance abuse-and drug overdose-associated PRES. Read More

Med Sci Monit 2019 Dec 28;25:10095-10104. Epub 2019 Dec 28.

Department of Neurosurgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China (mainland).

BACKGROUND This case series study evaluated the outcome and effect of portable 3D-head computed tomography (CT, MCT-I, 16 rows mobile CT made in China) navigation-guided key-hole microsurgery for supratentorial hypertensive hematomas. MATERIAL AND METHODS Thirty-five consecutive unconscious patients with a significant volume of hypertensive intracranial hemorrhages (HICH) were treated with 3D image-guided key-hole microsurgery, and the clinical features were summarized. Preoperative and postoperative hematoma volumes and reduction in midline shifts were calculated and recorded. Read More

Medicine (Baltimore) 2019 Dec;98(51):e18430

Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, China.

Rationale: The improvement of microneurosurgery and neuroimaging, as well as neuronavigation and neurophysiological monitoring, enables neurosurgeons to safely and accurately resect lesions on the brainstem.

Patient Concerns: A 54-year-old man, with 2-year history of hypertension, presented with sudden loss of consciousness for 1.5 hours. Read More

Radiol Clin North Am 2020 Jan 18;58(1):187-197. Epub 2019 Oct 18.

Neuroradiology, Department of Radiology, Zuckerberg San Francisco General Hospital, University of California, 1001 Potrero Avenue, Room 1X56, San Francisco, CA 94110, USA. Electronic address:

Neuroimaging is an invaluable diagnostic tool for sorting through the vast array of etiologies that underlie altered mental status (AMS). Head computed tomography (CT) without contrast is the primary modality for evaluation of AMS and should be complemented by MR imaging in cases of negative CT but high clinical concern. Studies to maximize brain imaging efficiency and improve the yield of positive scans through the utilization of clinical and laboratory pre-scan diagnostics are ongoing. Read More

Stroke 2020 01 15;51(1):202-208. Epub 2019 Nov 15.

Departments of Neurology (H.-H.T., L.-K.T., Y.-W.C., S.-C.T., J.-S.J.), National Taiwan University Hospital, Taipei.

Background and Purpose- The differentiation between cerebral amyloid angiopathy (CAA) and hypertensive small vessel disease in primary intracerebral hemorrhage is mainly based on hemorrhagic neuroimaging markers in the supratentorial regions, and the cause for cerebellar microbleeds remains unknown. Our aim was to investigate whether superficial cerebellar microbleeds are more likely to be related to CAA rather than hypertensive small vessel disease. Methods- Two hundred seventy-five consecutive patients with intracerebral hemorrhage were retrospectively reviewed from a prospectively maintained hospital-based stroke registry. Read More

Front Neurol 2019 23;10:1126. Epub 2019 Oct 23.

Neurology Department, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.

Whether patients with both lobar and deep cerebral microbleeds (mixed CMB) have advanced cerebral amyloid angiopathy (CAA), hypertensive angiopathy (HA) or both is uncertain. To get insight into the underlying small vessel disease (SVD) associated with mixed CMB, we explored its association with cortical superficial siderosis (cSS), a key marker of CAA and other MRI markers of SVD in patients with intracerebral hemorrhage (ICH). Of 425 consecutive patients with acute ICH who had received brain MRIs, 260 had ≥1 CMB and were included in the analysis. Read More

Front Neurol 2019 26;10:997. Epub 2019 Sep 26.

Department of Neurology, University of Regensburg, Regensburg, Germany.

Acute intracerebral hemorrhage (ICH) requires rapid decision making toward neurosurgery or conservative neurological stroke unit treatment. In a previous study, we found overestimation of clinical symptoms when clinicians rely mainly on cerebral computed tomography (cCT) analysis. The current study investigates differences between neurologists and neurosurgeons estimating specific scores and clinical symptoms. Read More

Clin Neurol Neurosurg 2019 Oct 8;185:105459. Epub 2019 Aug 8.

UOC Radiologia e Neuroradiologia, Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Roma, Italy. Electronic address:

Objective: Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder of acute or subacute onset characterized by varied neurological symptoms including headache, impaired visual acuity or visual field deficits, confusion, disorders of consciousness, seizures, and motor neurological deficits. Even if recognition of severe forms of PRES has improved, mainly due to magnetic resonance imaging, pathogenesis is still unclear and management of these patients remains challenging. Moreover, prognosis is unpredictable varying from complete recovery to death and factors related to prognosis are still lacking. Read More

Neuropathol Appl Neurobiol 2020 Apr 11;46(3):219-239. Epub 2019 Sep 11.

Stroke Research Centre, Department of Brain Repair & Rehabilitation, UCL Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London, UK.

Deep perforator arteriopathy (DPA) and cerebral amyloid angiopathy (CAA) are the commonest known cerebral small vessel diseases (CSVD), which cause ischaemic stroke, intracebral haemorrhage (ICH) and vascular cognitive impairment (VCI). While thus far mainly considered as separate entities, we here propose that DPA and CAA share similarities, overlap and interact, so that 'pure' DPA or CAA are extremes along a continuum of age-related small vessel pathologies. We suggest blood-brain barrier (BBB) breakdown, endothelial damage and impaired perivascular β-amyloid (Aβ) drainage are hallmark common mechanisms connecting DPA and CAA. Read More

Eur J Nucl Med Mol Imaging 2019 Oct 29;46(11):2339-2347. Epub 2019 Jul 29.

Department of Neurology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Place Baylac, 31059, Toulouse Cedex 9, France.

Purpose: Enlarged perivascular spaces in the centrum semiovale (CSO-EPVS) have been linked to cerebral amyloid angiopathy (CAA). To get insight into the underlying mechanisms of this association, we investigated the relationship between amyloid-β deposition assessed by 18F-florbetapir PET and CSO-EPVS in patients with acute intracerebral hemorrhage (ICH).

Methods: We prospectively enrolled 18 patients with lobar ICH (suggesting CAA) and 20 with deep ICH (suggesting hypertensive angiopathy), who underwent brain MRI and 18F-florbetapir PET. Read More

Stroke 2019 08 5;50(8):2016-2022. Epub 2019 Jul 5.

From the Department of Neurology (A.C.L., L.H.S., G.J.F., K.N.S.), Yale School of Medicine, New Haven, CT.

Background and Purpose- It is unknown whether blood pressure (BP) reduction influences secondary brain injury in spontaneous intracerebral hemorrhage (ICH). We tested the hypothesis that intensive BP reduction is associated with decreased perihematomal edema expansion rate (PHER) in deep ICH. Methods- We performed an exploratory analysis of the ATACH-2 randomized trial (Antihypertensive Treatment of Acute Cerebral Hemorrhage-2). Read More

BMJ Case Rep 2019 Jun 21;12(6). Epub 2019 Jun 21.

Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.

We describe the case of a 35-year-old man with focal epilepsy since age 16. Due to a refractory course, several treatments were tried over the years, including insertion of a deep brain stimulator. At the time of his first assessment at our unit, he had recently been diagnosed with hypertension. Read More

Expert Rev Neurother 2019 07 12;19(7):679-694. Epub 2019 Jun 12.

a UCL Stroke Research Centre, Department of Brain Repair and Rehabilitation , UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery , London , UK.

: Spontaneous non-traumatic intracerebral hemorrhage (ICH) is most often caused by small vessel diseases: deep perforator arteriopathy (hypertensive arteriopathy) or cerebral amyloid angiopathy (CAA). Although ICH accounts for only 10-15% of all strokes it causes a high proportion of stroke mortality and morbidity, with few proven effective acute or preventive treatments. : We conducted a literature search on etiology, diagnosis, treatment, management and current clinical trials in ICH. Read More

Aging Dis 2019 Jun 1;10(3):570-577. Epub 2019 Jun 1.

Center of Cerebrovascular Disease, Department of Neurology, West China Hospital, Sichuan University.Chengdu, 610041, Sichuan Province, China.

The relationship between recurrent intracerebral hemorrhage (ICH) and total burden of cerebral small vessel disease (CSVD) is not completely investigated. We aimed to study whether recurrent intracerebral hemorrhage (ICH) had higher CSVD score than first-ever ICH. Lacunes, white matter hyperintensities (WMH), cerebral microbleeds (CMBs), enlarged perivascular spaces (EPVS), cortical superficial siderosis (cSS) and CSVD score were rated on brain magnetic resonance imaging (MRI) in primary ICH patients. Read More

Medicine (Baltimore) 2019 May;98(19):e15503

Background: We aimed to study the feasibility of body surface projection in neuroendoscopic treatment of intracranial hemorrhage (ICH), and to evaluate the prognosis of muscle strength using diffusion tensor imaging (DTI) technique.

Methods: We utilized 3D-SLICER software and adopted hematoma body surface projection orientation to eliminate ICH by using neuroendoscope for 69 cases of spontaneous intracerebral hemorrhage. The standard of correct location was determined by the direct view of hematoma at the first operation. Read More

World Neurosurg 2019 Jun 11;126:e888-e894. Epub 2019 Mar 11.

Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China. Electronic address:

Objective: Efficacy of minimally invasive craniopuncture with the YL-1 puncture needle (hard-channel) and soft drainage tube (soft-channel) in treating hypertensive intracerebral hemorrhage (HICH).

Materials And Methods: A total of 150 patients with HICH were randomly assigned into 3 groups: conservative group (n = 50), hard-channel group (n = 50), and soft-channel group (n = 50). Computed tomography, National Institutes of Health Stroke Scale (NIHSS) and the levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), superoxide dismutase (SOD), and malondialdehyde (MDA) in serum and in drainage fluid were examined on days 2, 4, and 6 after operation. Read More

Med Sci Monit 2019 Mar 1;25:1600-1610. Epub 2019 Mar 1.

Department of Urology, State Key Laboratory of Kidney Diseases, Chinese People's Liberation Army (PLA) General Hospital/Chinese PLA Medical Academy, Beijing, China (mainland).

BACKGROUND This article presents our experience in managing a rare kidney tumor - reninoma - by analyzing a relatively large series of cases from a single center. MATERIAL AND METHODS Nine cases of reninoma were reviewed. Clinical manifestations, imaging examinations, laboratory examinations, perioperative data, and pathological findings were summarized. Read More

Neurology 2019 02 23;92(8):e774-e781. Epub 2019 Jan 23.

From the Department of Neurology (H.H.T.), National Taiwan University Hospital Bei-Hu Branch, Taipei; Departments of Neurology (H.H.T., L.-K.T., S.-C.T., J.-S.J.), Medical Imaging (Y.-F.C., B.-C.L.), and Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei; Department of Neurology (M.P., P.F., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA; Graduate Institute of Clinical Medicine (H.H.T.) and Division of Cardiology (C.-Y.H.), Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei.

Objective: To test the hypothesis that patients with concomitant lobar and deep intracerebral hemorrhages/microbleeds (mixed ICH) have predominantly hypertensive small vessel disease (HTN-SVD) rather than cerebral amyloid angiopathy (CAA), using in vivo amyloid imaging.

Methods: Eighty Asian patients with primary ICH without dementia were included in this cross-sectional study. All patients underwent brain MRI and C-Pittsburgh compound B (PiB)-PET imaging. Read More

J Neurol 2019 Mar 8;266(3):625-630. Epub 2019 Jan 8.

Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, 175 Cambridge Street, #300, Boston, MA, 02114, USA.

Background: Spontaneous cerebellar-intracerebral hemorrhage (ICH) can be associated with both cerebral amyloid angiopathy (CAA) and hypertensive small vessel disease (HTN-SVD, i.e. arteriolosclerosis). Read More

Virchows Arch 2019 Feb 7;474(2):235-245. Epub 2019 Jan 7.

Department of Neuropathology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, Karnataka, 560029, India.

Cerebral amyloid angiopathy (CAA) is the second most common cause of non-traumatic intracerebral haemorrhage (ICH) accounting for 12-15% of lobar haemorrhages in the elderly. Definitive diagnosis of CAA requires histological evaluation. We aimed to evaluate the spectrum of cerebrovascular changes in CAA-related ICH. Read More

Hypertension 2019 02;73(2):342-349

From the Neurovascular Research Lab, Vall Hebron Research Institute (J.J.-B., I.R.-L., O.A., E.G., A.P., E.O., O.M., J.M., M.N., O.V., J.P., P.D.).

Hypertension is one of the principal risk factors for cerebral small vessel disease progression and cognitive impairment. We aimed to investigate how changes in cerebral small vessel disease lesions relate to cognitive decline and incident mild cognitive impairment in hypertensive patients. Data were obtained from the ISSYS cohort (Investigating Silent Strokes in Hypertensives: a Magnetic Resonance Imaging Study)-a longitudinal population-based study on hypertensive patients aged 50 to 70 years without dementia and stroke at baseline. Read More

Stroke 2018 Dec 7:STROKEAHA118021407. Epub 2018 Dec 7.

From the Normandie University, UNICAEN, Inserm U1237, Caen, France (M.B., M.Z., E.T.).

Background and Purpose- Diffusion-weighted imaging (DWI) hyperintensities in intracerebral hemorrhage (ICH) are associated with increased risk of recurrent ICH, cognitive impairment, and death, but whether these lesions are specific to a subtype of ICH remains uncertain. We investigated the association between DWI lesions and ICH subtype and explored the risk factors for DWI lesions. Methods- In a systematic review of ICH studies, we identified those reporting prevalence of DWI lesions. Read More

Neurol India 2018 Nov-Dec;66(6):1800-1802

Department of Neurology, Indo-American Hospital: Brain and Spine Centre, Vaikom, Kerala, India.

Neurol India 2018 Nov-Dec;66(6):1694-1703

Department of Neurosurgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India.

Introduction: Although there are controversies about the optimal management of spontaneous intracerebral hemorrhage (ICH), benefits of endoscopic procedures in ICH have been reported. This study is aimed to evaluate the result of 270 patients undergoing endoscopic treatment of ICH.

Methods: This was a retrospective study from July 2008 to June 2017. Read More

Front Neurol 2018 12;9:926. Epub 2018 Nov 12.

Department of Neurology, Center for Neuroscience, Donders Institute for Brain Cognition & Behaviour, Radboud University Medical Center, Nijmegen, Netherlands.

Hypertensive vasculopathy and cerebral amyloid angiopathy are the two most common forms of cerebral small vessel disease. Both forms are associated with the development of primary intracerebral hemorrhage, but the pathophysiological mechanisms underlying spontaneous vessel rupture remain unknown. This work constitutes a systematic review on blood-brain barrier dysfunction in the etiology of spontaneous intracerebral hemorrhage due to cerebral small vessel disease. Read More

Endokrynol Pol 2019 23;70(3):298-303. Epub 2018 Oct 23.

Medical Faculty, University of Belgrade, Belgrade, Serbia.

Pheochromocytomas and sympathetic paragangliomas are rare catecholamine-secreting tumours that represent very rare causes of intracerebral haemorrhage in the young, with only a few cases reported. A 32-year-old man presented to our emergency department because of sudden onset of severe headache. He had a six-month history of paroxysmal headache, palpitations, and sweating. Read More

World Neurosurg 2018 Dec 21;120:430-434. Epub 2018 Sep 21.

Department of Neurosurgery, Maharaja Agrasen Medical College, Agroha, India.

Background: Treatment of arteriovenous malformations (AVMs) is currently performed at specialized neurosurgical centers well equipped with microscopes with green filters, neurosurgical catheterization laboratories, and experienced neurosurgical teams. Patients in whom AVMs are diagnosed at smaller hospitals should be referred to such specialized centers. This case report describes the unavoidable worst-case scenario of an emergency unplanned surgical excision of an undiagnosed ruptured AVM with large hematoma. Read More

Wiad Lek 2018;71(2 pt 2):408-412

Katedra I Klinika Neurologii Uniwersytetu Medycznego W Lublinie, Lublin, Polska.

Brain microbleeds are defined as small, circular hypointense changes in T2-sequensec of brain MRI, well demarcated from the surrounding tissue. They represent the phagocytized products of blood distribution extravasated from pathologically altered vessels. The echo-T2-dependent gradient (GRE) and magnetic susceptibility testing (SWI) sequences are usually used to visualize them. Read More

Front Neurol 2018 2;9:284. Epub 2018 May 2.

College of Medicine, Chang Gung University, Taoyuan, Taiwan.

Background: Chronic kidney disease (CKD) has been closely associated with hypertension and stroke. Although studies have reported the relationship between CKD and cerebral small vessel disease (SVD), the link between CKD, hypertension, and SVD is uncertain. The aim of this study was to investigate the association between CKD and SVD in patients with strictly hypertensive intracerebral hemorrhage (ICH). Read More

Stroke 2018 06 25;49(6):1515-1517. Epub 2018 Apr 25.

Department of Neurology (H.-H.T., L.-K.T., S.-C.T., J.-S.J.).

Background And Purpose: We evaluated whether lacunes in centrum semiovale (lobar lacunes) were associated with cerebral amyloid angiopathy (CAA) markers in an Asian intracerebral hemorrhage (ICH) population.

Methods: One hundred ten patients with primary ICH were classified as CAA-ICH (n=24; mean age, 70.9±13. Read More

Stroke 2018 05 18;49(5):1279-1281. Epub 2018 Apr 18.

From the Neurovascular Laboratory, Vall Hebron's Research Institute, Barcelona, Spain (I.R.-L., J.J.-B., X.C., A.L.-R., J.M., P.D.).

Background And Purpose: We assessed whether the load of cerebral small vessel disease (cSVD) and its individual markers, including lacunes, white matter hyperintensities, microbleeds, and enlarged perivascular spaces (EPVS), are associated with arterial stiffness.

Methods: We evaluated cSVD markers in a cohort of 782 hypertensive individuals without history of stroke or dementia. The load of the disease was calculated using an ordinal scale ranging from 0 to 4 (1 point was given for each of the 4 markers examined). Read More

Neurocrit Care 2018 10;29(2):180-188

Division of Neurosciences Critical Care, Department of Neurology, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Phipps 455, Baltimore, MD, 21287, USA.

Background: Concomitant acute ischemic lesions are detected in up to a quarter of patients with spontaneous intracerebral hemorrhage (ICH). Influence of bleeding pattern and intraventricular hemorrhage (IVH) on risk of ischemic lesions has not been investigated.

Methods: Retrospective study of all 500 patients enrolled in the CLEAR III randomized controlled trial of thrombolytic removal of obstructive IVH using external ventricular drainage. Read More

Harefuah 2018 03;157(3):158-161

Department of Neurology, Hadassah Medical Center, Jerusalem Israel.

Introduction: Non-traumatic intracranial hemorrhage (ICH) is a devastating event associated with a high rate of morbidity and mortality. Patient age, hemorrhage location, number of foci, and underlying diseases are important clues to the etiology. Non-contrast head CT, given its availability and high sensitivity in detecting blood products, is frequently the first tool to readily detect ICH; however, different types of hemorrhages may share a common appearance on CT and the optimal therapeutic approach varies depending on etiology. Read More

J Stroke Cerebrovasc Dis 2018 Jul 20;27(7):1878-1884. Epub 2018 Mar 20.

Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore, Singapore.

Background And Purpose: Hypertension is an important etiology of intracerebral hemorrhage (ICH) in neurosurgical practice. Contrast extravasation on computed tomography angiography, known as the "spot sign", has been described as an independent predictor of hematoma progression and clinical deterioration. However, its role in hypertensive ICH alone has not been determined and is the primary aim of this study. Read More

Cerebrovasc Dis 2018 20;45(3-4):124-131. Epub 2018 Mar 20.

INSERM LVTS (Laboratory for Vascular Translational Science) 1148 and Paris-Diderot University, Sorbonne Paris Cité, Paris, France.

Background: Risk factors for intracerebral hemorrhage (ICH) include hypertension and cerebral amyloid angiopathy (CAA). The objective of this study was to determine the autopsy prevalence of CAA and the potential overlap with other risk factors among patients who died from ICH and also the correlation of CAA with cerebral microbleeds.

Methods: We analyzed 81 consecutive autopsy brains from patients with ICH. Read More

Clin Nucl Med 2018 Jun;43(6):396-401

From the Department of Neurosurgery and Cyclotron Research Center, Iwate Medical University, Morioka, Japan.

Purpose: Whereas SPECT images obtained 180 minutes after administration of I-iomazenil (IMZ) (late images) are proportional to the distribution of central benzodiazepine receptor-binding potential, SPECT images obtained within 30 minutes after I-IMZ administration (early images) correlate with regional brain perfusion. The aim of the present study was to determine whether crossed cerebellar tracer uptake on acute-stage I-IMZ SPECT imaging predicts 3-month functional outcome in patients with nonfatal hypertensive putaminal or thalamic hemorrhage.

Methods: Forty-six patients underwent early and late SPECT imaging with I-IMZ within 7 days after the onset of hemorrhage. Read More

Medicine (Baltimore) 2018 Mar;97(10):e0106

Department of Neurology and Neuroscience Center, First Hospital of Jilin University, Jilin, P.R. China.

Rationale: Hemorrhage rarely occurs in a solitary brain metastasis from lung carcinoma.

Patient Concerns: We report on a 54-year-old man who presented with a severe headache for 4 days.

Diagnoses: Based on computed tomography and magnetic resonance imaging enhancement, the patient was diagnosed with a suspected hemorrhagic brain metastasis from lung carcinoma. Read More

Curr Treat Options Neurol 2018 Feb 3;20(1). Epub 2018 Feb 3.

Division of Neurosciences Critical Care, Departments of Neurology, Neurosurgery, and Anesthesiology/Critical Care Medicine, The Johns Hopkins Hospital, 1800 Orleans Street/Phipps 455, Baltimore, MD, 21287, USA.

Purpose Of Review: Spontaneous intraparenchymal hemorrhage (IPH) is a prominent challenge faced globally by neurosurgeons, neurologists, and intensivists. Over the past few decades, basic and clinical research efforts have been undertaken with the goal of delineating biologically and evidence-based practices aimed at decreasing mortality and optimizing the likelihood of meaningful functional outcome for patients afflicted with this devastating condition. Here, the authors review the medical and surgical approaches available for the treatment of spontaneous intraparenchymal hemorrhage, identifying areas of recent progress and ongoing research to delineate the scope and scale of IPH as it is currently understood and treated. Read More

BMC Ophthalmol 2018 Feb 2;18(1):25. Epub 2018 Feb 2.

Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok, 10400, Thailand.

Background: Cavernous carotid aneurysm (CCA) represents 2-9% of all intracranial aneurysms and 15% of internal carotid artery (ICA) aneurysms; additionally, giant aneurysms are those aneurysms that are > 25 mm in size. Bilateral CCAs account for 11-29% of patients and are commonly associated with structural weaknesses in the ICA wall, secondary to systemic hypertension. CCAs are considered benign lesions, given the low risk for developing major neurologic morbidities (i. Read More

Sci Rep 2018 01 24;8(1):1492. Epub 2018 Jan 24.

Department of Epidemiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, Barcelona, Spain.

We investigated whether pre-treatment with statins is associated with surrogate markers of amyloid and hypertensive angiopathies in patients who need to start long-term oral anticoagulation therapy. A prospective multicenter study of patients naive for oral anticoagulants, who had an acute cardioembolic stroke. MRI was performed at admission to evaluate microbleeds, leukoaraiosis and superficial siderosis. Read More

JAMA Neurol 2018 03;75(3):373

Department of Neurology, University of Texas Health Science Center at Houston.

Neth J Med 2017 Dec;75(10):448-450

Quantitative Neuroimaging Group, Academic Unit of Neurology, Trinity College Dublin, Ireland.

Khat consumption is an under-recognised cause of hypertensive encephalopathy and intraparenchymal brain haemorrhage. We report the radiological findings of extensive periventricular, subcortical and brain stem white matter pathology of a patient who had consumed excessive amounts of Khat. The Khat plant contains cathinone, an amphetamine-like alkaloid which has been associated with chronic hypertensive end-organ damage, but is seldom considered a cause of cerebrovascular events in northern Europe. Read More

Neurology 2018 01 15;90(2):e119-e126. Epub 2017 Dec 15.

From the Hemorrhagic Stroke Research Program (M.P., A.C., G.B., E.A., A.A., K.M.S., A.V., S.M.G., M.E.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; NEUROFARBA Department (M.P., L.P.), Neuroscience Section, University of Florence, Italy; Université Paris-Descartes (G.B.), INSERM UMR 894, Department of Neuroradiology, Centre Hospitalier Sainte-Anne, France; and Division of Neurocritical Care and Emergency Neurology (J.N.G., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston.

Objective: To assess the predominant type of cerebral small vessel disease (SVD) and recurrence risk in patients who present with a combination of lobar and deep intracerebral hemorrhage (ICH)/microbleed locations (mixed ICH).

Methods: Of 391 consecutive patients with primary ICH enrolled in a prospective registry, 75 (19%) had mixed ICH. Their demographics, clinical/laboratory features, and SVD neuroimaging markers were compared to those of 191 patients with probable cerebral amyloid angiopathy (CAA-ICH) and 125 with hypertensive strictly deep microbleeds and ICH (HTN-ICH). Read More

Brain Behav 2017 11 16;7(11):e00856. Epub 2017 Oct 16.

Department of Neurology Mie University Graduate School of Medicine Tsu Mie Japan.

Objectives: Cerebral microbleeds (CMBs) are often observed in memory clinic patients. It has been generally accepted that deep CMBs (D-CMBs) result from hypertensive vasculopathy (HV), whereas strictly lobar CMBs (SL-CMBs) result from cerebral amyloid angiopathy (CAA) which frequently coexists with Alzheimer's disease (AD). Mixed CMBs (M-CMBs) have been partially attributed to HV and also partially attributed to CAA. Read More

Stroke 2017 12 3;48(12):3384-3386. Epub 2017 Nov 3.

From the Departments of Neuroradiology (C.H., S.N., M.B.), Medical Biometry and Informatics (L.U.), and Neurology (M.S., T.S.), University of Heidelberg, Germany; Department of Neurology, Frankfurt Hoechst Hospital, Frankfurt am Main, Germany (T.S.); and Department of Neurology, St. John's Hospital Vienna, Austria (M.S.).

Background And Purpose: Numerous studies have investigated the influence of meteorologic factors and seasons on the incidence of spontaneous intracerebral hemorrhage (ICH) with ambiguous results. In the present study, data from a large, international multicenter trial in patients with ICH were used to identify seasonal and meteorologic determinants for hypertensive-ICH with greater applicability.

Methods: Patients were grouped according to the presumptive ICH cause, that is, hypertensive when located in the basal ganglia brain stem as well as cerebellum and nonhypertensive when located lobar. Read More

Stroke 2017 11 10;48(11):2964-2972. Epub 2017 Oct 10.

From the Departments of Neurology (J.G.R., D.S.K.) and Radiology (K.K., C.R.J., P.V.), Mayo Clinic, Rochester, MN; Department of Data Science, Gertrude Ford MIND Center (J.S., M.E.G.) and Department of Medicine (T.H.M., B.G.W.), University of Mississippi Medical Center, Jackson; Department of Neurology (M.S.A., R.F.G.), Johns Hopkins University, Baltimore, MD; and Department of Epidemiology (A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

Background And Purpose: Cerebral microbleed (CMB) location (deep versus strictly lobar) may elucidate underlying pathology with deep CMBs being more associated with hypertensive vascular disease and lobar CMBs being more associated with cerebral amyloid angiopathy. The objective of this study was to determine whether neuroimaging signs of vascular disease and Alzheimer pathology are associated with different types of CMBs.

Methods: Among 1677 nondemented ARIC (Atherosclerosis Risk in Communities) participants (mean age=76±5 years; 40% men; 26% black) with 3-Tesla MRI scans at the fifth examination (2011-2013), we fit multinomial logistic regression models to quantify relationships of brain volumes (Alzheimer disease signature regions, total gray matter, frontal gray matter, and white matter hyperintensity volumes), infarct frequencies (lacunar, nonlacunar, and total), and apolipoprotein E (number of ε4 alleles) with CMB location (none, deep/mixed, or strictly lobar CMBs). Read More

Cureus 2017 Aug 1;9(8):e1532. Epub 2017 Aug 1.

Creighton University Medical Center, CHI Creighton University.

Value-based care emphasizes achieving the greatest overall health benefit for every dollar spent. We present an interesting case of stroke, which made us consider how frequently health care providers are utilizing value-based care. A 73-year-old Caucasian, who was initially admitted for a hypertensive emergency, was transferred to our facility for worsening slurring of speech and left-sided weakness. Read More

JMIR Res Protoc 2017 Aug 31;6(8):e173. Epub 2017 Aug 31.

Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.

Background: Dramatic hemodynamic changes occur upon removal of an arteriovenous malformation of the brain (bAVM) with a number of potentially serious perioperative complications, such as intracranial hemorrhage and venous occlusive hypertensive syndrome. As these complications largely occur in the postoperative inpatient period, a rapid, repeatable noninvasive investigation to serially monitor relevant intracranial hemodynamics may be of benefit. Though, transcranial Doppler (TCD) and transcranial color duplex (TCCD) are techniques used and available to provide hemodynamic measurements postoperatively, the time course of hemodynamic sequences following bAVM resection remains uncertain. Read More

World Neurosurg 2017 Nov 24;107:877-880. Epub 2017 Aug 24.

Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Brain Research Institute, Zhejiang University, Hangzhou, Zhejiang, China; Collaborative Innovation Center for Brain Science, Zhejiang University, Hangzhou, Zhejiang, China.

Background: Perimesencephalic nonaneurysmal subarachnoid hemorrhage (PNSAH) is a benign form of subarachnoid hemorrhage (SAH) with a favorable prognosis. The risk of recurrent hemorrhage of this benign entity is extremely low.

Case Description: We describe a rare case of recurrent, spontaneous PNSAH in a 56-year-old man. Read More