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Neurology 2021 May 24. Epub 2021 May 24.

Department of Neurology, Mayo Clinic, Rochester, MN, USA.

ObjectiveTo review the role of the acute hypertensive response in patients with intracerebral hemorrhage, current treatment options and areas for further research.MethodsReview of the literature to assess 1) Frequency of acute hypertensive response in intracerebral hemorrhage 2) Consequences of acute hypertensive response in clinical outcomes 3) Acute hypertensive response and secondary brain injury: hematoma expansion and perihematomal edema 4) Vascular autoregulation, safety data side effects of acute antihypertensive treatment, and 5) Randomized clinical trials and meta-analyses.ResultsAn acute hypertensive response is highly frequent in patients with acute intracerebral hemorrhage, and it is associated with poor clinical outcomes. Read More

J Clin Neurosci 2021 Jun 23;88:108-112. Epub 2021 Mar 23.

Neurology Department, Vall d'Hebron Universitary Hospital, Barcelona, Spain.

The novel human coronavirus disease (COVID-19) has been associated with vascular and thrombotic complications, some of which may result from endothelial dysfunction, including the posterior reversible encephalopathy syndrome (PRES). We report a case series of 8 patients with COVID-19 and PRES diagnosed at two academic medical centers between March and July of 2020. The clinical, laboratory and radiographic data, treatment, and short-term outcomes were retrospectively analyzed. Read More

Cureus 2021 Mar 31;13(3):e14212. Epub 2021 Mar 31.

Radiology, St Barnabas Hospital Health System, Bronx, USA.

Intracranial hemorrhage (ICH) as a unique image finding, is a rare presentation of glioblastoma (GBM), and can pose a diagnostic challenge. Hypertensive vascular changes are responsible for the majority of the ICH cases, where hemorrhage from brain tumors account only for 5.1% to 7. Read More

Neurology 2021 05 21;96(20):e2469-e2480. Epub 2021 Apr 21.

From the Department of Neurology (J.P.C., J.R.A., A.R.-T., S.M., P.K., A.C., C.K., Z.D., K.S., M.E.G., A.V., C.D.A., S.M.G., J.R., A.B.), Hemorrhagic Stroke Research Program (J.P.C., J.R.A., A.R.-T., S.M., P.K., A.C., C.K, Z.D., K.S., M.E.G., A.V., C.D.A., S.M.G., J.R., A.B.), Henry and Allison McCance Center for Brain Health (J.P.C., J.R.A., P.K., C.K., C.D.A., J.R., A.B.), and Center for Genomic Medicine (J.R.A., S.M., P.K., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston; University of Lille (M.P.), Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience & Cognition, France; School of Medicine (A.R.-T.), University of California, Irvine; Department of Neurology and Rehabilitation Medicine (S.D., L.G., M.L.F., D.W.), University of Cincinnati, OH; Department of Biostatistics and Data Sciences (C.D.L.), Wake Forest University, Winston-Salem, NC; Department of Neurology (A.T.), Keck School of Medicine, University of Southern California; and Los Angeles County Department of Health Services (A.T.), CA.

Objective: Black and Hispanic survivors of intracerebral hemorrhage (ICH) are at higher risk of recurrent intracranial bleeding. MRI-based markers of chronic cerebral small vessel disease (CSVD) are consistently associated with recurrent ICH. We therefore sought to investigate whether racial/ethnic differences in MRI-defined CSVD subtype and severity contribute to disparities in ICH recurrence risk. Read More

Stroke 2021 Apr 20:STROKEAHA120032139. Epub 2021 Apr 20.

Department of Neurology, National Taiwan University Hospital Bei-Hu Branch, Taipei (H.-H.T.).

Background And Purpose: We explored whether high-degree magnetic resonance imaging-visible perivascular spaces in centrum semiovale (CSO) are more prevalent in cerebral amyloid angiopathy (CAA) than hypertensive small vessel disease and their relationship to brain amyloid retention in patients with primary intracerebral hemorrhage (ICH).

Methods: One hundred and eight spontaneous ICH patients who underwent magnetic resonance imaging and Pittsburgh compound B were enrolled. Topography and severity of enlarged perivascular spaces were compared between CAA-related ICH (CAA-ICH) and hypertensive small vessel disease-related ICH (non-CAA ICH). Read More

Curr Pain Headache Rep 2021 Apr 7;25(6):40. Epub 2021 Apr 7.

Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.

Purpose Of Review: Preeclampsia and related hypertensive disorders of pregnancy affect up to 10% of pregnancies. Neurological complications are common and neurologists often become involved in the care of obstetric patients with preeclampsia. Here, we review the definition(s), epidemiology, clinical features, and pathophysiology of preeclampsia, focusing on maternal neurological complications and headache as a common presenting symptom of preeclampsia. Read More

J Magn Reson Imaging 2021 Jul 10;54(1):76-88. Epub 2021 Mar 10.

Department of Radiology, University of Cambridge, Cambridge, UK.

Background: Intracranial atherosclerotic plaque causing mild luminal stenosis might lead to acute ischemic events. However, the difference between culprit and nonculprit lesions is unclear, as are the factors associated with favorable treatment outcomes.

Purpose: To quantify characteristics of intracranial atherosclerosis with mild luminal stenosis and to identify factors associated with lesion type (culprit or nonculprit) and with clinical outcomes. Read More

Zhonghua Yi Xue Za Zhi 2021 Mar;101(9):620-623

Emergency Department, the Affiliated Wuxi No.2 Hospital of Nanjing Medical University, Wuxi 214002, China.

To explore the efficacy and safety of intraoperative ultrasound-assisted neuroendoscopy for treating hypertensive intracerebral hemorrhage (HICH) via lateral fissure and insula approach. The clinical data of 66 patients with HICH in basal ganglia who underwent intraoperative ultrasound-assisted neuroendoscopy via lateral fissure and insula approach for hematoma evacuation were retrospectively analyzed, including operative data and follow-up results. All patients had no brain hernia before operation. Read More

Neurology 2021 04 2;96(16):e2048-e2057. Epub 2021 Mar 2.

From the Department of Neurology (J.R., V.P., F.S., A.A., H.-J.H., S.S.) and Institute of Physics (O.S.), Otto-von-Guericke University; Institute of Cognitive Neurology and Dementia Research (IKND) (V.P., R.Y., J.O., H.-J.H., E.D.), Magdeburg, Germany; J. Philip Kistler Stroke Research Center (V.P.), Massachusetts General Hospital, Boston; German Center for Neurodegenerative Diseases (DZNE) (R.Y., F.S., L.D., O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Leibniz-Institute for Neurobiology (LIN) (O.S., H.-J.H., E.D.); Center for Behavioral Brain Sciences (CBBS) (O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Tenoke Limited (J.A.-C.), Cambridge, UK; and Institute of Cognitive Neuroscience (E.D.), University College London, UK.

Objective: Cerebral microbleeds (MBs) are a common finding in patients with cerebral small vessel disease (CSVD) and Alzheimer disease as well as in healthy elderly people, but their pathophysiology remains unclear. To investigate a possible role of veins in the development of MBs, we performed an exploratory study, assessing in vivo presence of MBs with a direct connection to a vein.

Methods: 7-Tesla (7T) MRI was conducted and MBs were counted on quantitative susceptibility mapping (QSM). Read More

Basic Clin Neurosci 2020 Sep-Oct;11(5):631-638. Epub 2020 Sep 1.

Department of Neurosurgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.

Introduction: The primary and definitive diagnosis of meningioma is based on histological assessment; however, employing imaging methods, like Magnetic Resonance Imaging (MRI) is very helpful to describe lesion's characteristics. Accordingly, we decided to study the effect of imaging factors, like MRI data on the volume of hemorrhage (estimated blood loss) during meningioma surgery.

Methods: This was a cross-sectional, retrospective, and analytical study. Read More

Handb Clin Neurol 2021 ;177:345-357

Department of Neurology, Massachusetts General Hospital, Boston, MA, United States. Electronic address:

Stroke prevention in patients with atrial fibrillation is arguably one of the fastest developing areas in preventive medicine. The increasing use of direct oral anticoagulants and nonpharmacologic methods such as left atrial appendage closure for stroke prevention in these patients has increased clinicians' options for optimal care. Platelet antiaggregants are also commonly used in other ischemic cardiovascular and or cerebrovascular conditions. Read More

Rev Neurol (Paris) 2021 Apr 19;177(4):422-430. Epub 2021 Jan 19.

Department of Neurology, Poitiers University Hospital, 2, rue de la Milétrie, 86021 Poitiers Cedex, France. Electronic address:

Background: Intracerebral hemorrhage (ICH) has been reported in few cases of Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL), mostly in hypertensive patients. We aimed to assess the clinical and radiological characteristics of patients with CADASIL who presented with ICH.

Methods: A retrospective analysis of all neuroimaging exams of CADASIL patients hospitalized in our academic neurology department for acute cerebrovascular events was performed to find ICH. Read More

Neurology 2021 03 11;96(9):e1290-e1300. Epub 2021 Jan 11.

From the Department of Neurology (J.-M.K.), Seoul National University Hospital; Departments of Neurology (K.-Y.P., S.-H.H., H.-B.J., J.B.), Laboratory Medicine (H.R.K.), and Internal Medicine (H.Y.A.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea; Luigi Sacco Stroke and Dementia Lab (L.P.), Department of Biomedical and Clinical Sciences, University of Milan, Italy; and Department of Neurology (M.-S.P.), Seoul Hospital Ewha Womans University College of Medicine, South Korea.

Objective: To test the hypothesis that bone mineral loss is mechanistically related to cerebral small vessel disease (SVD), we investigated the relationship between bone mineral density and the prevalence and intensity of SVD among patients with stroke.

Methods: We analyzed data of 1,190 consecutive patients with stroke who were >50 years of age and underwent both brain MRI and dual-energy x-ray absorptiometry from the stroke registry of Chung-Ang University Hospital in Seoul, Korea. The patients were categorized into 3 groups according to their bone mineral density (normal, osteopenia, and osteoporosis). Read More

Eur J Neurol 2021 May 24;28(5):1581-1589. Epub 2021 Jan 24.

Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.

Background: Strains of Streptococcus mutans expressing the cell surface collagen-binding protein, Cnm, encoded by cnm (cnm-positive S. mutans), are associated with hypertensive intracerebral hemorrhage (ICH) and the occurrence of cerebral microbleeds (CMBs). Small diffusion-weighted imaging (DWI) hyperintensities in patients with acute ICH are also associated with CMBs. Read More

Neurology 2021 02 22;96(7):e995-e1004. Epub 2020 Dec 22.

From the Department of Neurology (H.-H.T., S.-J.C., Y.-L.L.), National Taiwan University Hospital Bei-Hu Branch; Departments of Neurology (H.-H.T., S.-J.C., L.-K.T., S.-C.T., J.-S.J.) and Medical Imaging (Y.-F.C.) and Graduate Institute of Clinical Medicine (H.-H.T.), National Taiwan University College of Medicine and Hospital, Taipei; and U1172-LilNCog-Lille Neuroscience & Cognition (M.P.), CHU Lille, Inserm, Univ Lille, France.

Objective: To determine whether mixed location intracerebral hemorrhages/microbleeds (mixed ICH) is a risk factor for vascular unfavorable outcome compared to cerebral amyloid angiopathy-related ICH (CAA-ICH) or strictly deep hypertensive ICH/microbleeds (HTN-ICH).

Methods: A total of 300 patients with spontaneous ICH were included. Clinical data, neuroimaging markers, and follow-up outcomes (recurrent ICH, ischemic stroke, and vascular death) were compared among mixed ICH (n = 148), CAA-ICH (n = 32), and HTN-ICH (n = 120). Read More

World J Nucl Med 2020 Jul-Sep;19(3):246-254. Epub 2020 Jul 11.

Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

Pathological and experimental studies indicate the existence of a "penumbra" of progressive tissue damage and edema in regions immediately surrounding a hematoma in patients of intracerebral hemorrhage (ICH). This zone of oligemia surrounding ICH has a potential for perfusion recovery. Improved understanding of the pathophysiology of perilesional blood flow changes and brain injury after ICH may result in improved treatment strategies. Read More

Curr Probl Diagn Radiol 2020 Nov 15. Epub 2020 Nov 15.

Department of Neuroradiology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore. Electronic address:

Posterior reversible encephalopathy syndrome (PRES) has traditionally been described as a reversible leukoencephalopathy with a distinct pattern of posteriorly distributed vasogenic oedema involving the subcortical regions of parietal and occipital lobes. PRES commonly occurs in the setting of hypertensive emergencies, pre-eclampsia/eclampsia, impaired renal function, and immunosuppressive therapy. The various clinical presentations of PRES include encephalopathy, seizures, headache, visual, and focal neurological deficits. Read More

J Stroke Cerebrovasc Dis 2021 Jan 11;30(1):105447. Epub 2020 Nov 11.

Department of Radiology, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou 215009, China. Electronic address:

Background: Hand motor function is often severely affected in patients with hemorrhagic stroke. The present study aimed to investigate the feasibility of predicting hand function recovery after hypertensive intracerebral hemorrhage using diffusion tensor imaging (DTI).

Methods: A total of 75 patients with hypertensive intracerebral hemorrhage were prospectively included. Read More

Stroke 2020 12 5;51(12):3632-3639. Epub 2020 Nov 5.

Department of Neurology (S.H., S.S., S.T., H. Ishiyama, T.Y., S.I., H. Ikenouchi, Y.H., M.I.), National Cerebral and Cardiovascular Center, Suita, Japan.

Background And Purpose: Cerebral microbleeds (CMB) are associated with stroke and cognitive impairment. We previously reported a high prevalence of CMB in people with expressing Cnm, a collagen-binding protein in the oral cavity. is a major pathogen responsible for dental caries. Read More

J Neurol Sci 2020 Dec 9;419:117173. Epub 2020 Oct 9.

Department of Neurology, Otto-von-Guericke University, Leipziger Straße 44, 39120 Magdeburg, Germany; German Center for Neurodegenerative Diseases (DZNE), Leipziger Straße 44, 39120 Magdeburg, Germany; Center for Behavioral Brain Sciences (CBBS), Universitätsplatz 2, 39106 Magdeburg, Germany. Electronic address:

Objective: To investigate underlying cerebral small vessel disease (CSVD) in patients with mixed cerebral hemorrhages patterns and phenotype them according to the contribution of the two most common sporadic CSVD subtypes: cerebral amyloid angiopathy (CAA) vs. hypertensive arteriopathy (HA).

Methods: Brain MRIs of patients with intracerebral hemorrhages (ICHs) and/or cerebral microbleeds (CMBs) were assessed for the full spectrum of CSVD markers using validated scales: ICHs, CMBs, cortical superficial siderosis (cSS), white matter hyperintensities, MRI-visible perivascular spaces (PVS). Read More

Neurology 2021 01 16;96(2):e182-e192. Epub 2020 Oct 16.

From U 1172-LilNCog-Lille Neuroscience and Cognition (M.P.), Université de Lille, Inserm, CHU Lille, France; Department of Neurology (M.P., L.S., L.X., A.C., T.P., S.S., C.K., K.S., S.M.G., C.D.A., M.E.G., J.R., A.V., A.B.), Hemorrhagic Stroke Research Program (L.S., A.C., S.M.G., C.D.A., M.E.G., J.R., A.V., A.B.), and Henry and Allison McCance Center for Brain Health (C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston; Department of Neuroradiology (G.B.), Centre Hospitalier Sainte-Anne, Université Paris-Descartes, INSERM UMR 894, Paris, France; Department of Pharmacology, Faculty of Medicine (T.P.), Chulalongkorn University; and Chulalongkorn Stroke Center (T.P.), King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.

Objective: To determine whether MRI-based cerebral small vessel disease (CSVD) burden assessment, in addition to clinical and CT data, improved prediction of cognitive impairment after spontaneous intracerebral hemorrhage (ICH).

Methods: We analyzed data from ICH survivors enrolled in a single-center prospective study. We employed 3 validated CSVD burden scores: global, cerebral amyloid angiopathy (CAA)-specific, and hypertensive arteriopathy (HTNA)-specific. Read More

J Stroke Cerebrovasc Dis 2020 Dec 18;29(12):105302. Epub 2020 Sep 18.

Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea.

Background & Objective: Homocysteine is possibly associated with cerebral small vessel diseases such as leukoaraiosis, silent brain infarction and cerebral microbleeds, which are in turn associated with cognitive dysfunction. We aimed to examine the relationships between cerebral microbleeds (CMBs) and plasma total homocysteine (tHcy) level, methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism and cognitive function.

Methods: A total of 819 patients with memory disturbance who visited a dementia clinic consecutively were included in this study. Read More

Am J Obstet Gynecol 2020 Sep 24. Epub 2020 Sep 24.

Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX.

The reported incidence of eclampsia is 1.6 to 10 per 10,000 deliveries in developed countries, whereas it is 50 to 151 per 10,000 deliveries in developing countries. In addition, low-resource countries have substantially higher rates of maternal and perinatal mortalities and morbidities. Read More

J Stroke Cerebrovasc Dis 2020 Oct 29;29(10):105153. Epub 2020 Jul 29.

Departments of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan; Departments of Medical Imaging, National Taiwan University Hospital Hsin-Chu Branch, HsinChu, Taiwan. Electronic address:

Background: Concomitant asymptomatic striatocapsular slit-like hemorrhage (SSH) is occasionally found in patients of spontaneous intracerebral hemorrhage (ICH), but was seldomly described in the literature. In this study, we described the clinico-radiological features of asymptomatic SSH in ICH patients with hypertensive microangiopathy.

Methods And Results: 246 patients with strictly deep or mixed deep and lobar ICH/microbleeds were included. Read More

Forensic Sci Med Pathol 2020 12 25;16(4):571-576. Epub 2020 Aug 25.

Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, 8057, Zurich, Switzerland.

This paper aims to demonstrate that post-mortem CT (PMCT) can locate intracranial hemorrhages, even in decomposed cases. This is of relevance in that post-mortem decomposition is particularly damaging to the brain tissue's consistency, resulting in great difficulties to reliably diagnose and locate intracranial hemorrhages. We searched our case database of the last 11 years to find cases with decomposition of the body, where PMCT and an autopsy had been performed. Read More

World Neurosurg 2020 11 20;143:1-6. Epub 2020 Jul 20.

Division of Neurosurgery, Department of Surgery, Khoo Teach Puat Hospital, Singapore.

Background: Spontaneous intracerebral hemorrhage (ICH) is a devastating cerebrovascular disease with high morbidity and mortality. Branching pattern of the lenticulostriate arteries from the middle cerebral artery makes them susceptible to formation of microaneurysms, which have been implicated in hypertensive ICH. Recurrence of hematoma due to delayed development of pseudoaneurysm after initial surgical evacuation is uncommon. Read More

Sichuan Da Xue Xue Bao Yi Xue Ban 2020 Jul;51(4):578-581

Department of Neurological Intensive Critical Care, West China Hospital, Sichuan University, Chengdu 610041, China.

Objective: To investigate the monitoring effect and application of transcranial Doppler ultrasound (TCD) in patients with severe neurovascular cerebrovascular diseases.

Methods: From December 2016 to October 2018, 96 patients with cerebrovascular disease in Department of Neurology and ICU, West China Hospital, Sichuan University were monitored by bedside TCD, including the detection of bilateral middle cerebral arteries (MCAs) through temporal window, and the detection of the basilar artery (BA) through occipital window, characterized by the peak systolic blood flow velocity, peak diastolic blood flow velocity, average peak blood flow velocity, vascular pulsatility index, vascular pulsatility index, vascular resistance index and blood flow spectrum morphology in local hemodynamic changes. According to the monitoring results, it was divided into vasospasm group, increased blood flow group and insufficient blood supply group. Read More

JAMA Neurol 2020 Nov;77(11):1390-1397

Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Importance: The etiology and significance of diffusion-weighted imaging (DWI) lesions in patients with acute intracerebral hemorrhage (ICH) remain unclear.

Objective: To evaluate which factors are associated with DWI lesions, whether associated factors differ by ICH location, and whether DWI lesions are associated with functional outcomes.

Design, Setting, And Participants: This analysis pooled individual patient data from 3 randomized clinical trials (Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation phase 3 trial, Antihypertensive Treatment of Acute Cerebral Hemorrhage trial, and Intracerebral Hemorrhage Deferoxamine phase 2 trial) and 1 multicenter prospective study (Ethnic/Racial Variations of Intracerebral Hemorrhage). Read More

J Neurol 2020 Dec 8;267(12):3602-3608. Epub 2020 Jul 8.

Department of Neurology, University of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany.

Background: The key imaging features of cerebral amyloid angiopathy (CAA) are lobar, cortical, or cortico-subcortical microbleeds, macrohaemorrhages and cortical superficial siderosis (cSS). In contrast, hypertensive angiopathy is characterized by (micro) haemorrhages in the basal ganglia, thalami, periventricular white matter or the brain stem. Another distinct form of haemorrhagic microangiopathy is mixed cerebral microbleeds (mixed CMB) with features of both CAA and hypertensive angiopathy. Read More

N Z Med J 2020 06 26;133(1517):123-125. Epub 2020 Jun 26.

Internal Medicine Department, Midcentral DHB, Palmerston North.