Clinical Neuroscience

The evaluation of the relationship between risk factors and prognosis in intracerebral hemorrhage patients

SONGUL Senadim, MURAT Cabalar, VILDAN Yayla, ANIL Bulut

JANUARY 20, 2017

Clinical Neuroscience - 2017;70(01-02)

DOI: https://doi.org/10.18071/isz.70.0033

Objective - Patients were assessed in terms of risk factors, hematoma size and localization, the effects of spontaneous intracerebral hemorrhage (ICH) on mortality and morbidity, and post-stroke depression. Materials and methods - The present study evaluated the demographic data, risk factors, and neurological examinations of 216 ICH patients. The diagnosis, volume, localization, and ventricular extension of the hematomas were determined using computed tomography scans. The mortality rate through the first 30 days was evaluated using ICH score and ICH grading scale. The Modified Rankin Scale (mRS) was used to determine the dependency status and functional recovery of each patient, and the Hamilton Depression Rating Scale was administered to assess the psychosocial status of each patient. Results - The mean age of the patients was 65.3±14.5 years. The most common locations of the ICH lesions were as follows: lobar (28.3%), thalamus (26.4%), basal ganglia (24.0%), cerebellum (13.9%), and brainstem (7.4%). The average hematoma volume was 15.8±23.8 cm3; a ventricular extension of the hemorrhage developed in 34.4% of the patients, a midline shift in 28.7%, and perihematomal edema, as the most frequently occurring complication, in 27.8%. Over the 6-month follow-up period, 57.9% of patients showed a poor prognosis (mRS: ≥3), while 42.1% showed a good prognosis (mRS: <3). The mortality rate over the first 30 days was significantly higher in patients with a low Glasgow Coma Scale (GCS) score at admission, a large hematoma volume, and ventricular extension of the hemorrhage (p=0.0001). In the poor prognosis group, the presence of moderate depression (39.13%) was significantly higher than in the good prognosis group (p=0.0001). Conclusion - Determination and evaluation of the factors that could influence the prognosis and mortality of patients with ICH is crucial for the achievement of more effective patient management and improved quality of life.

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[Seldom, an acute aortic dissection can be the etiology of an acute ischemic stroke. The aortic dissection typically presents with severe chest pain, but in pain-free dissection, which ranges between 5-15% of the case, the neurological symptoms can obscure the sypmtos of the dissection. By the statistical data, there are 15-20 similar cases in Hungary in a year. In this study we present the case history of an acute ischemic stroke caused by aortic dissection, which is the first hungarian publication in this topic. A 59-year-old man was addmitted with right-gaze-deviation, acute left-sided weakness, left central facial palsy and dysarthric speech. An acute right side ischemic stroke was diagnosed by physical examination without syptoms of acute aortic dissection. Because, according to the protocol it was not contraindicated, a systemic intravenous thrombolysis was performed. The neurological sypmtoms disappeared and there were no complication or hypodensity on the brain computed tomography (CT). 36 hours after the thrombolysis, the patient become restlessness and hypoxic with back pain, without neurological abnormality. A chest CT was performed because of the suspition of the aortic dissection, and a Stanford-A type dissection was verified. After the acute aortic arch reconstruction the patient died, but there was no bleeding complication at the dissection site caused by the thrombolysis. This case report draws attention to the fact that aortic dissection can cause acute ischemic stroke. Although it is difficult to prove it retrospectively, we think the aortic dissection, without causing any symptoms or complain, had already been present before the stroke. In our opinion both the history of our patient and literature reviews confirms that in acute stroke the thrombolysis had no complication effect on the aortic dissection but ceased the neurological symptoms. If the dissection had been diagnosed before the thrombolysis, the aortic arch reconstruction would have been the first step of the treatment, without thrombolysis. ]

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Clinical Neuroscience

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Background - Weaning is an important period of life and its timing may influence the resilence for later stress. One of the most important stress-related disorder is gastric ulceration. Purpose and methods - Therefore we aimed to investigate the sensitivity of gastric mucosa to cold (at 16°C) water immersion stress (WIS for 3h) in adult (75-day-old) female and male rats after weaning them at different timepoints (at 17, 21, 30, 36 or 42 postnatal days). The connection with stress was studied by comparing control groups to those underwent WIS at the time of weaning and measuring corticosterone levels at the time of collecting the stomach samples. Results - The timing of weaning has strong impact on all studied parameters. Stress-induced erosion development was the smallest in rats weaned at 36-day independently from preconditioning with WIS at weaning, or sex, despite a clear sex-effect on blood corticosterone levels and body weight. WIS at weaning influenced only the body weight in adult rats weaned at 30-day, being higher in stressed than in control groups. There was no clear overall correlation between erosion area and blood corticosterone measures. Conclusions - Taken together our results confirm that the timing of weaning has long-lasting impact on the resiliance of gastric mucosa to ulcerogenic stressful events. In rats the postnatal day 30-36 seems to be optimal for weaning in both sexes as both earlier and later weaning increased vulnerability. Females seems to be more vulnerable to the effect of weaning than males.

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