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Patterns of intracerebral hemorrhage that result in unfavorable outcomes in patients with subarachnoid hemorrhage.

Clin Neurol Neurosurg 2021 Mar 19;205:106603. Epub 2021 Mar 19.

Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106 Freiburg, Germany.

Objective(s): Intracerebral hemorrhage (ICH) contributes considerably to the high morbidity and mortality of aneurysmal subarachnoid hemorrhage (aSAH). Specific patterns of aSAH-associated ICH that are not compatible with favorable outcome remain unknown. The main objective of this study is to report patterns of aSAH-associated ICH that result in unfavorable outcomes. Read More

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IL-33 as a Novel Serum Prognostic Marker of Intracerebral Hemorrhage.

Oxid Med Cell Longev 2021 26;2021:5597790. Epub 2021 Mar 26.

Department of Breast Surgery, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, 121000 Liaoning Province, China.

Objective: Interleukin 33 (IL-33) is a key cytokine involved in inflammation and oxidative stress. The significance of serum IL-33 levels on the prognosis of patients with intracerebral hemorrhage (ICH) has not been well studied. The purpose of this study is to determine whether there is a relationship between the serum IL-33 level and the prognosis of patients with ICH upon admission. Read More

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Characterization of stress degradation products of nintedanib by UPLC, UHPLC-Q-TOF/MS/MS and NMR: Evidence of a degradation product with a structure alert for mutagenicity.

J Pharm Biomed Anal 2021 Mar 24;199:114037. Epub 2021 Mar 24.

Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education and Research (NIPER), IDPL R&D Campus, Balanagar, Hyderabad, 500037, Telangana, India. Electronic address:

Nintedanib is an anti-cancer drug used for the treatment of idiopathic pulmonary fibrosis and non-small cell lung cancer. The purpose of this study was to explore its degradation chemistry under various stress conditions recommended in ICH guidelines Q1A R(2). The drug was subjected to hydrolytic, photolytic, thermal and oxidative (HO, AIBN, FeCl and FeSO) stress conditions. Read More

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Antiplatelet Therapy after Intracerebral Hemorrhage and Subsequent Clinical Events: A 12-Year South Korean Cohort Study.

Eur Neurol 2021 Apr 8:1-9. Epub 2021 Apr 8.

Department of Health Administration, College of Health Science, Dankook University, Cheonan, Republic of Korea.

Introduction: Antiplatelet agents are usually discontinued to reduce hemorrhagic tendency during the acute phase of intracerebral hemorrhage (ICH). However, their use after ICH remains controversial.

Methods: This study investigated the effect of antiplatelet agents in ICH survivors. Read More

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Discontinuation of preventive antiepileptic drugs in patients with intracerebral hemorrhage.

BMC Neurol 2021 Apr 7;21(1):150. Epub 2021 Apr 7.

Department of Neurology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, 539 Chung-Shao Road, Chia-Yi, Taiwan.

Background: The risk factors for seizures in patients with intracerebral hemorrhage (ICH) stroke and the effect of seizure prevention by anticonvulsant are not well understood. Limited studies have investigated the risk of seizure after discontinuing antiepileptic drugs in patients with ICH. This study aimed to investigate the role of valproic acid (VA) for seizure prevention and to access the risk of seizure after anticonvulsant withdrawal in patients with spontaneous ICH. Read More

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Prothrombin Complex Concentrate for Emergent Reversal of Intracranial Hemorrhage in Patients with Ventricular Assist Devices.

Neurocrit Care 2021 Apr 5. Epub 2021 Apr 5.

Department of Neurological Surgery, Northwestern Memorial Hospital, 676 N. St. Clair St., Suite 2210, Chicago, IL, USA.

Background: Intracranial hemorrhage (ICH) is a devastating complication for patients with ventricular assist devices (VADs). The safety of emergent anticoagulation reversal with four-factor prothrombin complex concentrate (PCC) and optimal timing of anticoagulation resumption are not clear. In addition, lactate dehydrogenase (LDH) is used as a biomarker for thromboembolic risk, but its utility in guiding anticoagulation management after reversal with PCC has not be described. Read More

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Prognostic Value of Various Hemostasis Parameters and Neurophysiological Examinations in Spontaneous Intracerebral Hemorrhage: The IRONHEART Study Protocol.

Front Neurol 2021 17;12:615177. Epub 2021 Mar 17.

Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.

Stroke is one of the leading causes of death in all developed countries. In Hungary, more than 10,000 patients die annually due to cerebrovascular diseases according to the WHO Mortality Database. Of these patients, 10-15 % suffer non-traumatic intracerebral hemorrhage (ICH). Read More

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Circulating AQP4 Levels in Patients with Cerebral Amyloid Angiopathy-Associated Intracerebral Hemorrhage.

J Clin Med 2021 Mar 2;10(5). Epub 2021 Mar 2.

Neurovascular Research Laboratory, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain.

Cerebral amyloid angiopathy (CAA) is a major cause of lobar intracerebral hemorrhage (ICH) in elderly patients. Growing evidence suggests a potential role of aquaporin 4 (AQP4) in amyloid-beta-associated diseases, including CAA pathology. Our aim was to investigate the circulating levels of AQP4 in a cohort of patients who had suffered a lobar ICH with a clinical diagnosis of CAA. Read More

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Topical tacrolimus nanocapsules eye drops for therapeutic effect enhancement in both anterior and posterior ocular inflammation models.

J Control Release 2021 Mar 30;333:283-297. Epub 2021 Mar 30.

Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel; BioNanoSim Ltd., Jerusalem, Israel. Electronic address:

Tacrolimus has shown efficacy in eye inflammatory diseases. However, due to the drug lability, its formulation into a stable ophthalmic product remains a challenge. Tacrolimus-loaded nanocapsules (NCs) were designed for ocular instillation. Read More

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Repeated surgery for hemorrhagic brain metastases from hepatocellular carcinoma: palliation or effective part of a multimodal treatment? A case-based approach.

Br J Neurosurg 2021 Mar 24:1-4. Epub 2021 Mar 24.

Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy.

Brain metastases from hepatocellular carcinoma (HCCBM) are encountered very rarely in clinical practice, especially in western countries. Only a minority of patients undergoes resective surgery, as clinical picture is usually complex and presentation is often catastrophic with intra-cerebral hemorrhage (ICH). Neurosurgical intervention can be not only life-saving but may also alleviate significantly the burden of symptoms. Read More

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sTWEAK is a marker of early haematoma growth and leukoaraiosis in intracerebral haemorrhage.

Stroke Vasc Neurol 2021 Mar 23. Epub 2021 Mar 23.

Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain

Objective: To study the association between early growth of haematoma with biomarkers of endothelial dysfunction such as leukoaraiosis (LA) and the soluble tumour necrosis factor-like weak inducer of apoptosis (sTWEAK) in patients with intracerebral haemorrhage (ICH).

Methods: This is a retrospective observational study of patients with nontraumatic ICH. Clinical and biochemical parameters were analysed. Read More

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Increased mortality after post-stroke epilepsy following primary intracerebral hemorrhage.

Epilepsy Res 2021 Feb 17;172:106586. Epub 2021 Feb 17.

Department of Neurosurgery, Oulu University Hospital, Box 25, 90029 OYS, Finland. Electronic address:

Objectives: This study aimed to determine whether post-stroke epilepsy (PSE) predicts mortality, and to describe the most prominent causes of death (COD) in a long-term follow-up after primary intracerebral hemorrhage (ICH).

Methods: We followed 3-month survivors of a population-based cohort of primary ICH patients in Northern Ostrobothnia, Finland, for a median of 8.8 years. Read More

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February 2021

Development and validation of a clinical score to predict late seizures after intracerebral hemorrhage in Chinese.

Epilepsy Res 2021 Mar 5;172:106600. Epub 2021 Mar 5.

Monash University, Central Clinical School, Alfred Hospital, Department of Neuroscience, Melbourne, Australia; University of Melbourne, Royal Melbourne Hospital, Department of Neurology, Melbourne, Australia. Electronic address:

Background: Seizures are a frequent complication after intracerebral hemorrhage (ICH). The CAVE score was developed in Europeans to predict late seizures after ICH. Given the higher incidence of ICH in Asians, we aimed to develop and validate a clinical scoring tool for predicting post-ICH late seizures in Chinese. Read More

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Early Laboratory Predictors for Necessity of Renal Replacement Therapy in Patients With Spontaneous Deep-Seated Intracerebral Hemorrhage.

Front Neurol 2021 25;12:636711. Epub 2021 Feb 25.

Department of Anesthesiology and Critical Care Medicine, University Hospital Bonn, Bonn, Germany.

The need for continuous renal replacement therapy (CRRT) in patients with deep-seated intracerebral hemorrhage (ICH) requires sustained intensive care and often postpones further rehabilitation therapy. Therefore, an early identification of patients at risk is essential. From 2014 to 2019, all patients with deep-seated ICH who were admitted to intensive care for >3 days were included in the further analysis and retrospectively reviewed for the need for CRRT. Read More

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February 2021

A 56-Year-Old Woman with Recurrent Strokes: A Clear Case with a Therapeutic Dilemma.

Case Rep Neurol 2021 Jan-Apr;13(1):100-107. Epub 2021 Feb 15.

Section of Rheumatology, Regions Hospital, St. Paul, Minnesota and Division of Rheumatology, Minneapolis, Minnesota, USA.

A 56-year-old woman with a history of cerebral amyloid angiopathy (CAA) complicated by prior intracranial hemorrhage (ICH) was evaluated for an asymptomatic ischemic stroke discovered on screening brain MRI. On echocardiogram, she was found to have a mass on her mitral valve and strongly positive antiphospholipid antibodies. She was diagnosed with nonbacterial thrombotic (Libman-Sacks) endocarditis associated with the primary antiphospholipid syndrome (APS). Read More

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February 2021

Antibiotics for secondary prevention of coronary heart disease.

Cochrane Database Syst Rev 2021 02 23;2:CD003610. Epub 2021 Feb 23.

Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.

Background: Coronary heart disease is the leading cause of mortality worldwide with approximately 7.4 million deaths each year. People with established coronary heart disease have a high risk of subsequent cardiovascular events including myocardial infarction, stroke, and cardiovascular death. Read More

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February 2021

Predictors of Outcome After Mechanical Thrombectomy in Stroke Patients Aged ≥85 Years.

Can J Neurol Sci 2021 Mar 9:1-6. Epub 2021 Mar 9.

Department of Medicine (Neurology), Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada.

Background: The effectiveness of mechanical thrombectomy (MT) in elderly stroke patients remains debated. We aimed to describe outcomes and their predictors in a cohort of patients aged ≥ 85 years treated with MT.

Methods: Data from consecutive patients aged ≥ 85 years undergoing MT at two stroke centers between January 2016 and November 2019 were reviewed. Read More

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A new model outperforming RPA and DS-GPA scores for individualized survival prediction of patients following whole brain irradiation for brain metastasis.

Cancer Radiother 2021 Mar 4. Epub 2021 Mar 4.

Department of Radiation Oncology, Institut Godinot, Reims, France.

Purpose: Survival after whole brain radiation therapy (WBRT) in patients with multiple brain metastases (BM) is currently predicted by group-based scoring systems with limited usability for decision. We aimed to develop a more relevant individualized predictive model than Radiation Therapy Oncology Group - Recursive Partitioning Analysis (RTOG-RPA) and Diagnosis - Specific Graded Prognostic Assessment (DS-GPA) for patients with limited life-expectancy.

Methods: Based on a Discovery cohort of patients undergoing WBRT, multivariable piecewise Cox regression models with time cut-offs at 1 and 3 months were developed to predict overall survival (OS). Read More

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Prophylactic anticoagulation in patients with glioblastoma or brain metastases and atrial fibrillation: an increased risk for intracranial hemorrhage?

J Neurooncol 2021 Mar 5. Epub 2021 Mar 5.

Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.

Purpose: Patients with glioblastoma (GBM) or brain metastases (MET) and atrial fibrillation (AF) might be at an increased risk of intracranial hemorrhage (ICH) due to anticoagulation (AC). Our aim was to assess this risk.

Methods: Our institution's database (from 2005 to 2017) was screened for patients with GBM or MET and AF with an indication for AC according to their CHADSVASc stroke risk score (≥ 2). Read More

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Effect of Race-Ethnicity and CT Angiography on Renal Injury During Blood Pressure Treatment for Intracerebral Hemorrhage.

Neurocrit Care 2021 Mar 5. Epub 2021 Mar 5.

Department of Neurology, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 1365, Miami, FL, 33136, USA.

Background: Lowering blood pressure intensively in acute intracerebral hemorrhage (ICH) is associated with adverse renal events; Blacks and Hispanics have a higher incidence of ICH and kidney disease than Whites. In addition, CT angiography (CTA), which may also be associated with acute kidney injury (AKI), is often done in acute ICH. Our objective was to investigate the relationship between aggressive BP management, CTA, race-ethnicity and the risk of developing AKI in patients presenting with ICH. Read More

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Intraoperative Neuromonitoring for Cerebral Arteriovenous Malformation Embolization: A Propensity-Score Matched Retrospective Database Study.

Cureus 2021 Jan 27;13(1):e12946. Epub 2021 Jan 27.

Radiology, Stanford University School of Medicine, Stanford, USA.

Introduction The treatment of cerebral arteriovenous malformations (AVMs) may result in neurologic morbidity, particularly when an AVM is located in or adjacent to eloquent brain regions. Intraoperative neurophysiologic monitoring (IONM) may be utilized to reduce the risk of iatrogenic injury during endovascular AVM embolization; however, IONM for endovascular AVM embolization is not ubiquitously the standard of care. Methods Admissions for AVM embolization were assessed from the IBM MarketScan® Commercial and Medicare Supplemental databases (IBM Watson Health, Somers, NY). Read More

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January 2021

Secondary Hematoma Evacuation and Outcome After Initial Conservative Approach for Patients with Cerebellar Hematoma Larger than 3 cm.

Neurocrit Care 2021 Mar 2. Epub 2021 Mar 2.

Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.

Background: In patients with spontaneous cerebellar intracerebral hemorrhage (ICH) guidelines advocate evacuation when the hematoma diameter is > 3 cm. We studied outcome in patients with cerebellar ICH > 3 cm who did not undergo immediate hematoma evacuation.

Methods: We included consecutive patients with cerebellar ICH > 3 cm at two academic hospitals between 2008 and 2017. Read More

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Hospital admissions of acute cerebrovascular diseases during and after the first wave of the COVID-19 pandemic: a state-wide experience from Austria.

J Neurol 2021 Feb 27. Epub 2021 Feb 27.

Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8042, Graz, Austria.

We investigated hospital admission rates for the entire spectrum of acute cerebrovascular diseases and of recanalization treatments for ischaemic stroke (IS) in the Austrian federal state of Styria during and also after the first coronavirus disease 2019 (COVID-19) wave. We retrospectively identified all patients with transient ischaemic attack (TIA), IS and non-traumatic intracranial haemorrhage (ICH; including intracerebral, subdural and subarachnoid bleeding types) admitted to one of the 11 public hospitals in Styria (covering > 95% of inhospital cerebrovascular events in this region). Information was extracted from the electronic medical documentation network connecting all public Styrian hospitals. Read More

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February 2021

Clinical condition of 120 patients alive at 3 years after poor-grade aneurysmal subarachnoid hemorrhage.

Acta Neurochir (Wien) 2021 04 25;163(4):1153-1166. Epub 2021 Feb 25.

Neurosurgery of NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland.

Background: To study the clinical condition of poor-grade aneurysmal subarachnoid hemorrhage (aSAH) patients alive at 3 years after neurointensive care.

Methods: Of the 769 consecutive aSAH patients from a defined population (2005-2015), 269 (35%) were in poor condition on admission: 145 (54%) with H&H 4 and 124 (46%) with H&H 5. Their clinical lifelines were re-constructed from the Kuopio Intracranial Aneurysm Database and Finnish nationwide registries. Read More

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Usage of Angiotensin-Converting Enzyme Inhibitor or Angiotensin II Receptor Blocker in Hypertension Intracerebral Hemorrhage.

Neuropsychiatr Dis Treat 2021 9;17:355-363. Epub 2021 Feb 9.

Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, People's Republic of China.

Background: Inflammation plays an essential role in secondary brain injury after intracerebral hemorrhage (ICH). Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) have been suggested to suppress neuroinflammation after central nervous system (CNS) damage in animal models. However, the role of ACEIs and ARBs in ICH patients with hypertension remains unresolved in clinic. Read More

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February 2021

Dual-Energy CT Angiography Improves Accuracy of Spot Sign for Predicting Hematoma Expansion in Intracerebral Hemorrhage.

J Stroke 2021 Jan 31;23(1):82-90. Epub 2021 Jan 31.

Department of Radiology and Nuclear Medicine, MHeNS School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands.

Background And Purpose: Spot sign (SS) on computed tomography angiography (CTA) is associated with hematoma expansion (HE) and poor outcome after intracerebral hemorrhage (ICH). However, its predictive performance varies across studies, possibly because differentiating hyperdense hemorrhage from contrast media is difficult. We investigated whether dual-energy-CTA (DE-CTA), which can separate hemorrhage from iodinated contrast, improves the diagnostic accuracy of SS for predicting HE. Read More

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January 2021

Where to make burr hole for endoscopic hematoma removal against intracerebral hemorrhage at the basal ganglia to increase the hematoma removal rate - Comparison between trans-forehead and along-the-long-axis approaches.

Surg Neurol Int 2021 3;12:41. Epub 2021 Feb 3.

Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.

Background: Endoscopic hematoma removal is performed to treat intracerebral hemorrhage (ICH) at the basal ganglia. In our hospital, young neurosurgical trainees perform it for the only 1 to the 3 time. We perform a "trans-forehead approach" and hypothesized that our technique would contribute to higher hematoma removal rate and easiness despite their inexperience. Read More

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February 2021

Neck Circumference Is Associated With Poor Outcome in Patients With Spontaneous Intracerebral Hemorrhage.

Front Neurol 2020 1;11:622476. Epub 2021 Feb 1.

Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.

This study aimed to assess the association between neck circumference (NC) and functional outcome in intracerebral hemorrhage (ICH) patients. We prospectively analyzed data from ICH patients who received treatment at our institution from January 2018 to November 2019. Patients were categorized into two groups according to 180-day modified Rankin scale (MRS) scores. Read More

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February 2021

Somatic symptoms following sexual assault in adolescents: a prospective longitudinal study.

Psychol Health Med 2021 Feb 11:1-13. Epub 2021 Feb 11.

The Havens. King's College Hospital NHS Foundation Trust , London, UK.

Adults and young people with somatoform disorders and somatic symptoms retrospectively report high rates of sexual abuse. We aimed to assess somatic symptoms in young people in the aftermath of a sexual assault and to document links with assault characteristics, with psychopathology and with related functional impairment. This was a prospective cohort study of adolescents seen in specialized clinics in London in the first 6 weeks following a sexual assault and at 4-5 months follow-up. Read More

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February 2021

Ruptured Brain Arteriovenous Malformations: Surgical Timing and Outcomes-A Retrospective Study of 25 Cases.

J Neurosci Rural Pract 2021 Jan 4;12(1):4-11. Epub 2020 Nov 4.

Department of Neurological Sciences, Neurosurgery, "La Sapienza" University of Rome, Rome, Italy.

 One important problem in treatment of ruptured brain arteriovenous malformations (bAVMs) is surgical timing. The aim of the study was to understand which parameters affect surgical timing and outcomes the most.  Between January 2010 and December 2018, 25 patients underwent surgery for a ruptured bAVM at our institute. Read More

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January 2021