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)


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.



Further articles in this publication

Clinical Neuroscience

Symptom profiles and parental bonding in homicidal versus non-violent male schizophrenia patients

HALMAI Tamás, TÉNYI Tamás, GONDA Xénia

Objective - To compare the intensity and the profile of psychotic symptoms and the characteristics of parental bonding of male schizophrenia patients with a history of homicide and those without a history of violent behaviour. Clinical question - We hypothesized more intense psychotic symptoms, especially positive symptoms as signs of a more severe psychopathology in the background of homicidal behaviour. We also hypothesized a more negatively perceived pattern (less Care more Overprotection) of parental bonding in the case of homicidal schizophrenia patients than in non-violent patients and non-violent healthy controls. Method and subjects - Symptom severity and symptom profiles were assessed with the Positive and Negative Syndrome Scale in a group of male schizophrenia patients (n=22) with the history of committed or attempted homicide, and another group (n=19) of male schizophrenia patients without a history of violent behaviour. Care- and Overprotection were assessed using the Parental Bonding Instrument (PBI) in a third group of non-violent healthy controls (n=20), too. Results - Positive, negative and general psychopathology symptoms in the homicidal schizophrenia group were significantly (p<0.005) more severe than in the non-violent schizophrenia group. Non-violent schizophrenia patients scored lower on Care and higher on Overprotection than violent patients and healthy controls. Homicidal schizophrenia patients showed a pattern similar to the one in the healthy control group. Conclusions - It seems imperative to register intense positive psychotic symptoms as predictive markers for later violent behaviour. In the subgroup of male homicidal schizophrenia patients negatively experienced parental bonding does not appear to be major contributing factor to later homicidal behaviour.

Clinical Neuroscience

Combination of severe facial and cervical vascular malformation with obstructive sleep apnea syndrome: diagnostic and therapeutic approaches

FALUDI Béla, IMRE Marianna, BÜKI András, KOMOLY Sámuel, LUJBER László

The combination of obstructive sleep apnea syndrome and vascular malformation within the head and neck region is a rare condition, and interestingly, only a few cases have recently been published. Propagation of the vascular mass to the larynx and pharynx can cause breathing and swallowing difficulties. Due to these sypmtoms, examination and initiation of appropriate therapy for such patients are indeed challenging. We reviewed the literature available and present our case of a 64 year old woman emphasizing the complaints of sleep apnea syndrome and vascular malformation of the face and neck region. Polygraphic examination detected severe obstructive sleep apnea syndrome. The MR examination of the neck revealed extensive vascular mass narrowing the pharyngo-laryngeal region, thereby causing temporal bone destruction on the right side with intracranial propagation. ENT examination demonstrated significant narrowing of the pharyngeal lumen and the laryngeal aditus caused by multiple hemangiomas. CPAP titration showed the minimalization of the apnea-hypopnea index on the effective pressure level. Regular CPAP usage resulted in diminishing a majority of the patient’s complaints. Our examination clearly demonstrates, obstructive sleep apnea syndrome coupled with significantly obstructing vascular malformation in the head and neck region can be effectively treated safely with a CPAP device, if surgical therapy is not possible. We summarized our findings and the data available in the literature to set up recommendations for the appropriate examination and therapy (including mask fit, etc.) of vascular malformations and hemangiomas causing pharyngo-laryngeal obstruction.

Clinical Neuroscience

The timing of weaning alters the vulnerability to stress-induced gastric erosion in adult rats

LUDMILA Filaretova, LUDMILA Vataeva, ZELENA Dóra

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.

Clinical Neuroscience

Eating behaviors among the participants of an inpatient weight loss treatment


Background and purpose - Eating behaviors play a crucial role in the development and maintenance of excess weight. The aim of the study was to explore the predictors and changes in eating behaviors among overweight and obese patients. Methods - The sample of the 6-month prospective survey consisted of patients who participated in the inpatient weight loss treatment program in the Lipidological Department of the Szent Imre Hospital (baseline: N=339, 19% men; follow-up: N=175, 16% men). The mean age was 50.2 years (SD=13.47), the mean BMI was 38.6 (SD=7.58) at baseline. Measures: self-reported anthropometric data, Three-Factor Eating Questionnaire Revised 21-Items, CES-D Depression Scale. Results - According to the results of Multiple Indicators and Multiple Causes analysis, older age predicted greater cognitive restraint (b=0.12, p=0.047). Women were more prone to emotional eating than men (b=0.21, p<0.001). Higher levels of education predicted greater uncontrolled eating (b=0.16, p=0.007) and emotional eating (b=0.12, p=0.039). Depression showed a positive relationship with emotional eating (b=0.19, p=0.001), and mediated the relationship between gender and emotional eating (b=0.04, p=0.009), and BMI and emotional eating (b=0.03, p=0.015). Those whose weight loss was at least 5% showed a greater improvement in the eating behaviors than those whose weight loss was below 5% (cognitive restraint: t(168)=-4.765, p<0.001, uncontrolled eating: t(168)=-2.442, p=0.016, and emotional eating: Z=-2.011, p=0.044). Conclusions - Results reveal certain determinants of eating behaviors that enhance or obstruct successful long term weight loss and highlight the role of eating behavior changes in weight loss. These mark intervention points for the optimization of results achievable by weight loss treatments.

Clinical Neuroscience

[Thrombolysis in case of ischemic stroke caused by aortic dissection]

LANTOS Judit, NAGY Albert, HEGEDŰS Zoltán, BIHARI Katalin

[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. ]

All articles in the issue

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Clinical Neuroscience

Risk factors for ischemic stroke and stroke subtypes in patients with chronic kidney disease

GÜLER Siber, NAKUS Engin, UTKU Ufuk

Background - The aim of this study was to compare ischemic stroke subtypes with the effects of risk factors, the relationship between grades of kidney disease and the severity of stroke subtypes. Methods - The current study was designed retrospectively and performed with data of patients who were hospitalised due to ischemic stroke. We included 198 subjects who were diagnosed with ischemic stroke of Grade 3 and above with chronic kidney disease. Results - In our study were reported advanced age, coronary artery disease, moderate kidney disease as the most frequent risk factors for cardioembolic etiology. Hypertension, hyperlipidemia, smoking and alcohol consumption were the most frequent risk factors for large-artery disease. Female sex and anaemia were the most frequent risk factors for small-vessel disease. Dialysis and severe kidney disease were the most frequent risk factors in unknown etiologies, while male sex, diabetes mellitus, prior stroke and mild kidney disease were the most frequent risk factors for other etiologies. National Institute of Health Stroke Scale (NIHSS) scores were lower for small-vessel disease compared with other etiologies. This relation was statistically significant (p=0.002). Conclusion - In order to improve the prognosis in ischemic stroke with chronic kidney disease, the risk factors have to be recognised and the treatment options must be modified according to those risk factors.

Clinical Neuroscience


GULÁCSI László, MÁJER István, KÁRPÁTI Krisztián, BRODSZKY Valentin, BONCZ Imre, NAGY Attila, BERECZKI Dániel

[The aim of our research was to assess the incidence and the 12- and 24-month mortality of hospitalized stroke in Hungary. We analyzed the rate of mortality after stroke and compared it to the standard mortality rate of the population. To assess the incidence we extracted the data of “new” stroke patients (ICD- 10 diagnoses: I60-64) hospitalized in May 2003 from the database of the National Health Insurance Fund Administration. We regarded those as “new” patients who had not been treated with these primary or secondary diagnoses in the previous 24 months. Data were collected by sex and age (age groups: 25-44, 45-64, 65 and over). We analyzed the patients' survival on the basis of their April 2004 and April 2005 data. The incidence of the “new” hospitalized stroke patients was higher in men than in women; the incidence in the age group of 65 and over was 2112/100.000 in males and 1582/100.000 in females, the corresponding values in the 45-64 age group were 623 vs. 366 per 100.000, respectively. In 2003 more than 42 thousand “new” stroke patients were hospitalized in Hungary of whom over 10 thousand died in the first year, followed by a further 2 thousand in the second year. Women’s survival is more favourable than men's: in the first year it is 71.47% vs. 69.24% (65+ group), and 88.18% vs. 83.16% (45-64 group); in the second year the corresponding values are 66.95% vs. 61.62% (65+), and 85.45% vs. 80.90% (45-64), respectively. The risk of death in the first year after stroke, compared to the standard population, is 5.17- fold in women and 4.70-fold in men in the total sample, and 10-15-fold in the 45-64 group. There are large differences by gender, particularly in men of the working age groups (25-44, 45-64), whose mortality is twice as high as that of women of the same age.]

Clinical Neuroscience

[Prevalence of stroke/cardiovascular risk factors in rural Hungary - A cross-sectional descriptive study (in English language)]

BODO Michael, THURÓCZY György, PÁNCZÉL Gyula, SIPOS Kornél, ILIÁS Lajos, SZÕNYI Péter, BADÓ Mike Jr, NEBELLA Tamás, BÁNYÁSZ Attila, NAGY Zoltán

[A multi-faceted survey was conducted in 1992-94 to ascertain the somatic, mental and socio-economic conditions of the residents of a village in eastern Hungary. Here we report data on prevalence of somatic disorders from the survey. Objectives - a) To collect and compare prevalence of known cardiovascular disease, including stroke risk factors, in a specific population (a Hungarian village); b) to test a computer-based mass screening device ("Cerberus") designed to identify individuals in the test population at high risk for stroke; c) to compare results obtained with Cerberus with known stroke risk/cardiovascular disease factors and traditional medical records. Methods - A cross-sectional survey (546 subjects) was conducted in Csengersima in the early 1990s, using the Cerberus screening system, which includes: 1. a questionnaire addressing the risk factors for stroke/cardiovascular disease; 2. amplifiers to record the pulse waves of cerebral (rheoencephalography) and peripheral arteries, electrocardiogram and electroencephalogram. Additionally, subjects were measured for carotid stenosis by Doppler ultrasound and 12-lead electrocardiogram; they were also screened for blood cholesterol, glucose, and triglyceride levels. Findings - Prevalence of the following stroke risk factors was identified: overweight, 63.25%; sclerotic brain arteries by rheoencephalogram, 54.29%; heart disease, 37.92%; pathologic carotid flow, 34.24%; smoking, 30.55%; high blood cholesterol, 28.70%; hypertension, 27.83%; high triglyceride, 24.35%; abnormality of electrocardiogram, 20%; high glucose, 15.95%; symptoms of transient ischemic attack, 16.07%; alcohol abuse, 6.74%; and diabetes, 4.53%. Conclusion - The study demonstrates a possible model for primary cardiovascular disease/stroke prevention. The simple, noninvasive test uses the bioimpedance method of measurement. This method offers a standardizable, costeffective, practical technique for mass screenings by identifying the population at high risk for cardiovascular disturbances, especially cerebrovascular disease. In this model, the rheoencephalogram can detect cerebrovascular arteriosclerosis in the susceptibility/presymptomatic phase, earlier than the Doppler ultrasound technique. The method also provides a model for storing analog physiological signals in a computer-based medical record and the first steps of turning it into an expert system also tested.]

Hypertension and nephrology

[Guide for using methods of cardiovascular risk estimation]


[Author analyzes the most frequently used, reliable cardiovascular risk estimation methods. Only those methods are useful that meet to the american and european prevention guidelines and were edited by processing of the great databases. The best known risk estimation methods are continuously is expanding by growing body of knowledge and by another iseful risk factors, because the only way in order to successfully prevent the cardiovascular diseases. Two types of method-groups are known: 1. Traditional narrowed form for the general practisers and for the large section of population, 2. Methods with a broader analysis and more risk factors for the specialists and scientists. In Europe PROCAM and Heart Score and their variations are most useful for the practical medical work, but it is possible to use the american ASCVD and Reynolds risk estimation methods as well using the help of the national correction factors. The methods with wider analysis and much more risk factors as the Mayo Clinic mode, Qrisk2 and IHMRS are suitable in assisting of the epidemiologic studies or scientific work.]

Clinical Neuroscience

[Epilepsy in the elderly]

NIKL János

[The incidence of epilepsy is higher among the elderly, the most rapidly growing segment of the population, than in any other age group. New-onset seizures in elderly patients are typically symptomatic or cryptogenic partial seizures that require long-term treatment. Epilepsy in the elderly is a frequently occuring pathology, differing in etiology, clinical presentation and prognosis from those of young people. Establishing the diagnosis of epilepsy in old age can be more difficult than in younger patients due to the extensive range of differential diagnoses and a higher prevalence of concomitant disease. Beyond a certain age physiological and pathophysiological changes can affect the pharmacokinetics and pharmacodynamics of antiepileptic drugs(AEDs), increasing the risk of pharmacological interactions due to polypharmacy. Furthermore, the elderly people are sensitive to advers events of AEDs, as for example, to cognitive disturbances, osteoporosis. Several of newer AEDs have good safety and cognitive effect profiles and have no interactions with other drugs. The treatment strategies are demanding: they must take into consideration the co-morbidity, co-medication, alterations in drug metabolism, and the effects on aging body. These factors make the management of epilepsy in the elderly particulary challenging, but with appropiate pharmacological treatment most elderly people with epilepsy will remain seizurefree.]