Asunto(s)

Migración de Cuerpo Extraño , Bulbo Raquídeo/lesiones , Atlas Cervical/diagnóstico por imagen , Femenino , Cuerpos Extraños , Humanos , Bulbo Raquídeo/diagnóstico por imagen , Traumatismos del Cuello/complicaciones , Agujas , Hueso Occipital/diagnóstico por imagen , Radiografía , Intento de Suicidio , Heridas Penetrantes , Adulto Joven

RESUMEN

OBJECT: Lowering the blood pressure (BP) of patients with intracerebral haemorrhage (ICH) can prevent haematoma enlargement but may also promote secondary infarction in areas adjacent to the haematoma, which can lead to neurological deterioration. Little is known about the effects of low BP on early neurological deterioration (END). We conducted a retrospective study to determine whether low BP after admission was associated with END in patients with acute ICH. METHODS: We investigated 100 consecutive patients diagnosed with spontaneous ICH. We obtained data on minimum systolic blood pressure (SBP) in the 24 h after admission and related factors and assessed END in this time window. RESULTS: END occurred in 38 patients. The frequencies of END by minimum SBP quartile were 52% ( 130 mmHg). A logistic regression model for predicting END was developed using SBP at admission, Glasgow Coma Scale at admission, haematoma volume, minimum SBP, and squared minimum SBP. A U-shaped relationship between minimum SBP and END (p = 0.02) was observed, with the lowest risk for END at a minimum SBP of 123 mmHg. The curve was nearly flat for a minimum SBP of 115-130 mmHg, indicating that the risk of END is relatively low across this range of minimum SBPs. CONCLUSIONS: Our findings suggest that a minimum SBP of approximately 120-125 mmHg after admission is associated with a beneficial impact on a reduced risk of END.

Asunto(s)

Antihipertensivos/uso terapéutico , Presión Sanguínea/fisiología , Hemorragia Cerebral/fisiopatología , Hematoma/fisiopatología , Enfermedades del Sistema Nervioso/prevención & control , Adulto , Anciano , Anciano de 80 o más Años , Presión Sanguínea/efectos de los fármacos , Hemorragia Cerebral/complicaciones , Femenino , Hematoma/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/etiología , Estudios Retrospectivos , Resultado del Tratamiento

RESUMEN

INTRODUCTION: Little information is available on the efficacy of aggressive treatment such as surgery in improving the outcome of severely affected patients after supratentorial intracerebral hemorrhage (ICH). Our objective was to assess the effect of hematoma removal and ventricular drainage on the mortality of patients with severe primary supratentorial ICH. METHODS: We studied 103 consecutive patients who were admitted to the intensive care unit and diagnosed with primary supratentorial ICH. The impacts of clinical factors on 30-day mortality were assessed, including surgery, Glasgow Coma Scale (GCS) score and pupillary abnormality at admission, hematoma volume, and other related factors. RESULTS: The 30-day mortality rate was 42%, and the median time between admission and death was 3 days (range: 1 to 27 days). Hematoma removal and ventricular drainage, within the first 24 hours of admission, were performed on 11 and 17 patients, respectively. Two patients who were treated with removal and four with drainage died. A logistic regression model for predicting 30-day mortality was performed. After controlling for GCS score, pupillary abnormality, hydrocephalus, and hematoma volume, hematoma removal was identified as an independent predictor of survival (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.02 to 0.92). Ventricular drainage also tended to decrease mortality rate greatly (OR, 0.31; 95% CI, 0.06 to 1.76). Patients with GCS scores of 3 or 4 were 4.01 times more likely to die (95% CI, 1.13 to 14.26) than those with GCS of at least 5. CONCLUSIONS: Hematoma removal may reduce the mortality rate of patients with severe supratentorial ICH.

Asunto(s)

Lesiones Encefálicas , Encéfalo/anatomía & histología , Hemorragia Cerebral , Adulto , Anciano , Anciano de 80 o más Años , Encéfalo/diagnóstico por imagen , Lesiones Encefálicas/complicaciones , Lesiones Encefálicas/mortalidad , Lesiones Encefálicas/cirugía , Hemorragia Cerebral/etiología , Hemorragia Cerebral/mortalidad , Hemorragia Cerebral/cirugía , Ventrículos Cerebrales/cirugía , Femenino , Escala de Coma de Glasgow , Humanos , Hidrocefalia/epidemiología , Hidrocefalia/etiología , Hidrocefalia/cirugía , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/métodos , Pronóstico , Trastornos de la Pupila/epidemiología , Trastornos de la Pupila/etiología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Succión , Tasa de Supervivencia , Tomografía Computarizada por Rayos X

RESUMEN

BACKGROUND AND PURPOSE: The association between elevated blood pressure (BP) and hematoma enlargement in acute intracerebral hemorrhage (ICH) has not been clarified. We investigated the association between maximum systolic BP (SBP) and hematoma enlargement, measuring SBP between a baseline and a second CT scan in patients with hypertensive ICH. METHODS: We assessed 76 consecutive patients with hypertensive ICH retrospectively. We usually attempted to lower SBP below targets of 140, 150, or 160 mm Hg. Recordings of serial BP from admission until the second CT scan were assessed. A neuroradiologist, who was not informed of the aim of this study, reviewed CT films. Hematoma enlargement was defined as an increase in volume of > or =140% or 12.5 cm3. RESULTS: Hematoma enlargement occurred in 16 patients. Maximum SBP was significantly associated with hematoma enlargement (P=0.0074). A logistic regression model for predicting hematoma enlargement was constructed with the use of maximum SBP, hematoma volume, and Glasgow Coma Scale score at admission. After adjustment for these factors, maximum SBP was independently associated with hematoma enlargement (odds ratio per mm Hg, 1.04; 95% CI, 1.01 to 1.07). Target SBPs of > or =160 mm Hg were significantly associated with hematoma enlargement compared with those of < or =150 mm Hg (P=0.025). CONCLUSIONS: Our findings suggest that elevated BP increases the risk of hematoma enlargement. Efforts to lower SBP below 150 mm Hg may prevent this risk.

Asunto(s)

Hemorragia Cerebral/tratamiento farmacológico , Hemorragia Cerebral/etiología , Hematoma/tratamiento farmacológico , Hematoma/etiología , Hipertensión/tratamiento farmacológico , Enfermedad Aguda , Adulto , Anciano , Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Hemorragia Cerebral/diagnóstico por imagen , Femenino , Hematoma/diagnóstico por imagen , Humanos , Hipertensión/complicaciones , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía Computarizada por Rayos X

RESUMEN

OBJECT: Spontaneous subarachnoid hemorrhage (SAH) has an aspect of graded transient global cerebral ischemia. The purpose of the present study was the documentation of sequential changes in body temperature immediately after SAH-induced transient global cerebral ischemia in humans. METHODS: Patients admitted within 12 hours after the initial onset of SAH were examined retrospectively (426 patients). Patients with unruptured cerebral aneurysms served as a control group (73 patients). Body temperature measured at the axilla on admission was analyzed. The grade of SAH was established according to the Glasgow Coma Scale (GCS): Grade I, GCS Score 15; Grade II, GCS Score 11 to 14; Grade III, GCS Score 8 to 10; Grade IV, GCS Score 4 to 7; and Grade V, GCS Score 3. The mean body temperature of patients in the control group was 36.49 +/- 0.45 degrees C (mean +/- standard deviation). The mean body temperature of patients in the SAH group who had been admitted within 4 hours of onset for Grades I to V were significantly different (p < 0.001, analysis of variance [ANOVA]): 36.26 +/- 0.7 degrees C, 59 patients; 35.98 +/-0.85 degrees C, 73 patients; 35.52 +/- 0.79 degrees C, 25 patients; 35.9 +/- 1.09 degrees C, 108 patients; and 35.56 +/- 1.14 degrees C, 73 patients, respectively. These values were significantly lower than those in control volunteers, except for patients with Grade I SAH. The reduction in body temperature was unrelated to the location of the cerebral aneurysm and was not the product of circadian rhythm. The temperatures of patients in the SAH group who were admitted beyond 4 hours after onset for each grade were significantly different (p < 0.01, ANOVA): 36.8 +/- 0.91 degrees C, 36 patients; 36.74 +/- 0.68 degrees C, 31 patients; 36.73 +/- 0.38 degrees C, three patients; 37.41 +/- 1.37 degrees C, 17 patients; and 38.9 degrees C, one patient, respectively. These values were significantly higher than those in patients admitted within 4 hours of SAH onset for all grades except Grade V, and significantly higher than control values in patients with Grades I and IV SAH. CONCLUSIONS: These results indicate that body temperature falls and then rises immediately after the SAH-induced transient global cerebral ischemia without cardiac arrest in humans. The reduction in temperature may be a natural cerebral protection mechanism that is activated shortly after ischemic insult.

Asunto(s)

Temperatura Corporal/fisiología , Hipotermia/etiología , Hipotermia/fisiopatología , Ataque Isquémico Transitorio/etiología , Ataque Isquémico Transitorio/fisiopatología , Hemorragia Subaracnoidea/complicaciones , Hemorragia Subaracnoidea/fisiopatología , Adulto , Anciano , Ritmo Circadiano/fisiología , Femenino , Escala de Coma de Glasgow , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Estaciones del Año , Factores de Tiempo

RESUMEN

BACKGROUNDS AND PURPOSE: Body temperature in the acute phase of cerebrovascular disorders(CVDs) may influence the outcome. However, the natural course of body temperature after CVDs has not yet been clarified. The purpose of this study was to elucidate the natural courses of body temperature after CVDs. PATIENTS AND METHODS: We retrospectively investigated 681 patients with CVDs(subarachnoid hemorrhage(SAH): 478, cerebral ischemia: 47, intracerebral hemorrhage(ICH): 156) who were admitted within 24 h after onset. The body temperature was measured with an electronic thermometer at the axilla on admission. The body temperatures of 73 patients with non-ruptured cerebral aneurysms on admission(admitted between 09:00 and 15:00) were used as normal control group. RESULTS: The body temperature in the control group was 36.49 +/- 0.45 degrees C. In comparison, the temperature in the SAH group was significantly lower(35.88 +/- 1.00 degrees C, n = 338, p < 0.001) when the patients were admitted within 4 h after onset, and significantly higher (36.80 +/- 0.85 degrees C, n = 140, p < 0.05) when they were admitted after 4 h and up to 24 h. There was a significant negative correlation between the severity of the SAH and body temperature within 4 h and a significant positive correlation beyond 4 h. Body temperature in the cerebral ishcemia group was significantly lower than in the control group(36.09 +/- 0.59 degrees C, n = 17, p < 0.05) when the patients were admitted within 2 h, but was close to that in the control group when they were admitted beyond 2 h and up to 24 h after onset (36.45 +/- 0.58 degrees C, n = 30). The falls of body temperature in the super-acute phase in the SAH and the cerebral ischemia groups were observed in patients admitted between 09:00 and 15:00. Although body temperature in the ICH group was slightly lower when the patients were admitted within 4 h and slightly higher when admitted beyond 4 h and up to 24 hours after onset, no significant differences were observed in comparison with the control group. In the super-acute phase of the cerebral ischemia and the ICH, body temperature tended to be lower in the patients with worse condition. CONCLUSION: This study clearly demonstrated that body temperatures in patients with CVDs changed rapidly within 24 h after onset. Body temperature in the SAH group within 4 h and that in the cerebral ischemia group within 2 h after onset was significantly lower than in the control group. These temperature falls were not the products of circadian rhythm. The temperature in the SAH group beyond 4 h and up to 24 h after onset rose significantly. Comparison with normal controls and consideration of the circadian rhythm are important when studying changes of body temperature in patients with CVDs.

Asunto(s)

Reacción de Fase Aguda/fisiopatología , Temperatura Corporal , Hemorragia Subaracnoidea/fisiopatología , Adulto , Anciano , Isquemia Encefálica/fisiopatología , Hemorragia Cerebral/fisiopatología , Ritmo Circadiano/fisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo