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Correlations between hematoma, edema volume and perihematoma PS. The perihematomal edema volume correlated positively with the hematoma volume (β = 0.864, p < 0.001) (a) and perihematoma PS (β = 0.478, p < 0.001) (b). Perihematoma PS correlated positively with the hematoma volume (β = 0.373, p = 0.005) (c)
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Purpose:
Blood-brain barrier (BBB) damage aggravates perihematomal edema, and edema volume predicts prognosis independently. But the BBB permeability at the late stage of acute intracerebral hemorrhage (ICH) patients is uncertain. We aimed to assess the BBB permeability of spontaneous basal ganglia ICH using computed tomographic perfusion (CTP) an...
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Background:
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Citations
... In rodent models of ischemic stroke, BBB permeability increases as early as 25 min after reperfusion and may remain elevated for up to 5 weeks (Strbian et al., 2008;Durukan et al., 2009). In the case of hemorrhagic stroke, computerized tomography imaging studies have shown that BBB permeability is elevated around the hematoma from 24 to 48 h (Lampl et al., 2005;Xu et al., 2017). The time course for BBB disruption in hemorrhagic stroke have been refined by animal studies that indicate the BBB remains largely intact for the first few hours (Yang et al., 1994) but displays integrity loss around the hematoma 6-8 h later (Wagner et al., 1996) that is still evident 5 days later (Jia et al., 2021). ...
The neurovascular unit (NVU) is composed of vascular cells, glia, and neurons that form the basic component of the blood brain barrier. This intricate structure rapidly adjusts cerebral blood flow to match the metabolic needs of brain activity. However, the NVU is exquisitely sensitive to damage and displays limited repair after a stroke. To effectively treat stroke, it is therefore considered crucial to both protect and repair the NVU. Mitochondrial calcium (Ca ²⁺ ) uptake supports NVU function by buffering Ca ²⁺ and stimulating energy production. However, excessive mitochondrial Ca ²⁺ uptake causes toxic mitochondrial Ca ²⁺ overloading that triggers numerous cell death pathways which destroy the NVU. Mitochondrial damage is one of the earliest pathological events in stroke. Drugs that preserve mitochondrial integrity and function should therefore confer profound NVU protection by blocking the initiation of numerous injury events. We have shown that mitochondrial Ca ²⁺ uptake and efflux in the brain are mediated by the mitochondrial Ca ²⁺ uniporter complex (MCU cx ) and sodium/Ca ²⁺ /lithium exchanger (NCLX), respectively. Moreover, our recent pharmacological studies have demonstrated that MCU cx inhibition and NCLX activation suppress ischemic and excitotoxic neuronal cell death by blocking mitochondrial Ca ²⁺ overloading. These findings suggest that combining MCU cx inhibition with NCLX activation should markedly protect the NVU. In terms of promoting NVU repair, nuclear hormone receptor activation is a promising approach. Retinoid X receptor (RXR) and thyroid hormone receptor (TR) agonists activate complementary transcriptional programs that stimulate mitochondrial biogenesis, suppress inflammation, and enhance the production of new vascular cells, glia, and neurons. RXR and TR agonism should thus further improve the clinical benefits of MCU cx inhibition and NCLX activation by increasing NVU repair. However, drugs that either inhibit the MCU cx , or stimulate the NCLX, or activate the RXR or TR, suffer from adverse effects caused by undesired actions on healthy tissues. To overcome this problem, we describe the use of nanoparticle drug formulations that preferentially target metabolically compromised and damaged NVUs after an ischemic or hemorrhagic stroke. These nanoparticle-based approaches have the potential to improve clinical safety and efficacy by maximizing drug delivery to diseased NVUs and minimizing drug exposure in healthy brain and peripheral tissues.
... The elevated BBB permeability has been observed in the region around the hematoma at different time phases in intracerebral hemorrhage patients using computed tomographic perfusion (CTP) images, and the extent of perihematomal BBB compromise has been evaluated by permeability-surface area product (PS) value [14,15]. Some experimental longitudinal studies have revealed the dynamic alterations of BBB permeability in intracerebral hemorrhage progression [16,17], and BBB injury has been thought to be a crucial factor in edema formation and growth [18,19]. ...
... Some experimental longitudinal studies have revealed the dynamic alterations of BBB permeability in intracerebral hemorrhage progression [16,17], and BBB injury has been thought to be a crucial factor in edema formation and growth [18,19]. Several clinical studies have also shown the increased perihematomal BBB permeability within 24-72 h after hemorrhage [14,15]; however, the temporal evolution of BBB compromise and its effect on edema growth in intracerebral hemorrhage patients are still unclear. Therefore, further research is needed to get a comprehensive understanding of BBB compromise and edema growth after hemorrhage. ...
... ml) when undergoing CT and CTP examination. At baseline, the median (IQR) admission NIHSS score was 8 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14), and the admission GCS score was 13 (10)(11)(12)(13)(14)(15). The median (IQR) mRS score at 90 days was 2 (1-4). ...
Purpose
The aim of this study was to investigate the temporal evolution of perihematomal blood-brain barrier (BBB) compromise and edema growth and to determine the role of BBB compromise in edema growth.
Methods
Spontaneous intracerebral hemorrhage patients who underwent computed tomography perfusion (CTP) were divided into five groups according to the time interval from symptom onset to CTP examination. Permeability-surface area product (PS) maps were generated using CTP source images. Ipsilateral and contralateral mean PS values were computed in the perihematomal and contralateral mirror regions. The relative PS (rPS) value was calculated as a ratio of ipsilateral to contralateral PS value. Hematoma and perihematomal edema volume were determined on non-contrast CT images.
Results
In the total of 101 intracerebral hemorrhage patients, the ipsilateral mean PS value was significantly higher than that in contralateral region (z = −8.284, p < 0.001). The perihematomal BBB permeability showed a course of dynamic changes including an increase in the hyperacute and acute phases, a decrease in the early subacute phase and a second increase in the late subacute phase and chronic phase. Perihematomal edema increased gradually until the late subacute phase and then slightly increased. There was a relationship between rPS value and edema volume (β = 0.254, p = 0.006).
Conclusion
The perihematomal BBB permeability is dynamic changes, and edema growth is gradually increased in patients following intracerebral hemorrhage. BBB compromise plays an essential role in edema growth. The quantitative assessment of BBB compromise may provide valuable information in therapeutic interventions of intracerebral hemorrhage patients.
... Our study confirmed the superiority of the PHR-5 mm radiomics approach and suggested that the radiomics features of the surrounding area encompassing the hematoma may be a more unique and reliable indicator of the state of the hematoma microenvironment, which may differ according to the degree of PHE. The distance of the surrounding area was taken from previous studies [28,29]. ...
Purpose
The aim is to explore the potential value of CT-based radiomics in predicting perihematomal edema (PHE) volumes after acute intracerebral hemorrhage (ICH) from admission to 24 h.
Methods
A total of 231 patients newly diagnosed with acute ICH at two institutes were analyzed retrospectively. The patients were randomly divided into training (N = 117) and internal validation cohort (N = 45) from institute 1 with a ratio of 7:3. According to radiomics features extracted from baseline CT, the radiomics signatures were constructed. Multiple logistic regression analysis was used for clinical radiological factors and then the nomogram model was generated to predict the extent of PHE according to the optimal radiomics signature and the clinical radiological factors. The receiver operating characteristic (ROC) curve was used to evaluate the discrimination performance. The calibration curve and Hosmer-Lemeshow test were used to evaluate the consistency between the predicted and actual probability. The support vector regression (SVR) model was constructed to predict the overall value of follow-up PHE. The performance of the models was evaluated on the internal and independent validation cohorts.
Results
The perihematoma 5 mm radiomics signature (AUC: 0.875) showed good ability to discriminate the small relative PHE(rPHE) from large rPHE volumes, comparing to intrahematoma radiomics signature (AUC: 0.711) or perihematoma 10 mm radiomics signature (AUC: 0.692) on the training cohort. The AUC of the combined nomogram model was 0.922 for the training cohort, 0.945 and 0.902 for the internal and independent validation cohorts, respectively. The calibration curves and Hosmer–Lemeshow test of the nomogram model suggested that the predictive performance and actual outcome were in favorable agreement. The SVR model also predicted the overall value of follow-up rPHE (root mean squared error, 0.60 and 0.45; Pearson correlation coefficient, 0.73 and 0.68; P < 0.001).
Conclusion
Among patients with acute ICH, the established nomogram and SVR model with favorable performance can offer a noninvasive tool for the prediction of PHE after ICH.
... Decreased BBB integrity can facilitate the passage of water and plasma derived molecules into the interstitial tissue, thereby influencing the formation of edema (16,17). In patients with ICH, BBB permeability as estimated by dynamic contrast-enhanced MRI (DCE-MRI) has been associated with perihematomal edema (PHE) volumes (15,18,19). The formation of PHE has recently been associated with poor outcome after ICH (20)(21)(22)(23) and has gained increasing interest as a potential therapeutic target to prevent secondary brain injury after ICH. ...
Objective
Blood-brain barrier (BBB) dysfunction is implicated in the pathophysiology of cerebral small vessel disease (cSVD)-related intracerebral hemorrhage (ICH). The formation of perihematomal edema (PHE) is presumed to reflect acute BBB permeability following ICH. We aimed to assess the association between cSVD burden and PHE formation in patients with spontaneous ICH.
Methods
We selected patients with spontaneous ICH who underwent 3T MRI imaging within 21 days after symptom onset from a prospective observational multicenter cohort study. We rated markers of cSVD (white matter hyperintensities, enlarged perivascular spaces, lacunes and cerebral microbleeds) and calculated the composite score as a measure of the total cSVD burden. Perihematomal edema formation was measured using the edema extension distance (EED). We assessed the association between the cSVD burden and the EED using a multivariable linear regression model adjusting for age, (log-transformed) ICH volume, ICH location (lobar vs. non-lobar), and interval between symptom onset and MRI.
Results
We included 85 patients (mean age 63.5 years, 75.3% male). Median interval between symptom onset and MRI imaging was 6 days (IQR 1–19). Median ICH volume was 17.0 mL (IQR 1.4–88.6), and mean EED was 0.54 cm (SD 0.17). We found no association between the total cSVD burden and EED (B = −0.003, 95% CI −0.003–0.03, p = 0.83), nor for any of the individual radiological cSVD markers.
Conclusion
We found no association between the cSVD burden and PHE formation. This implies that mechanisms other than BBB dysfunction are involved in the pathophysiology of PHE.
... PHE can be seen in the hyperacute phase of cerebral hemorrhage and can be divided into three phases: Phase I (within 6 h of onset), also known as the compensation period; Phase II (6 h-2 days), also known as the period of increased intracranial pressure, belonging to the decompensated period; Phase III (2 days after onset), also known as the critical stage, belonging to the terminal stage of PHE. The rapid progression of PHE can increase the mortality and disability rate of patients [40,75]. Therefore, how to control or reduce secondary brain injury caused by PHE is considered as a potential intervention target to improve the therapeutic effects in patients with ICH [32]. ...
Spontaneous intracerebral hemorrhage (ICH) has high morbidity and mortality. Computed tomography (CT) plays an important role in the diagnosis, treatment, and research of cerebrovascular diseases. Non-contrast CT is widely used in the clinical diagnosis of ICH because of its high imaging speed and high sensitivity and specificity in the detection of stroke. Many markers-based CT imaging, quantitative parameters, and artificial intelligence (AI) methods based on CT are increasingly used for the prediction of hematoma expansion (HE), prognosis of ICH, and the evaluation of perihematomal edema (PHE). Therefore, we performed a comprehensive review of studies, focusing on current research evidence related to CT use for the prediction of HE and prognostic. This review discusses recent insights into, outlines current limitations, and puts forward suggestions for the challenges and directions of future research. Although at present the prognosis for ICH is not optimistic, the treatment methods remain controversial. However, identifying imaging markers that can evaluate and predict existing possible existing therapeutic targets could help to provide individualized advice for patients and achieve patient risk stratification, which is a key step in improving treatment outcomes.
... 1 The underlying mechanisms may include vasogenic and cytotoxic edema that caused by ischemia and hypoxia, inflammatory reactions, and blood-brain barrier (BBB) destruction. 2,3 Previous studies revealed that the volume of perihematomal edema (PHE) closely related to poor outcomes of ICH. 2 Intensive control of PHE may inhibit further deterioration of neurological dysfunction after ICH. ...
Background:
We investigate the probable effect of anatomic asymmetry of transverse sinus (TS) on the outcomes of acute intracerebral hemorrhage (ICH), to provide reference for customized treatment.
Methods:
Consecutive patients with imaging-confirmed acute ICH were enrolled from October 2015 through October 2019, and divided into 2 groups: symmetrical and unilateral (left or right) slender TS groups, based on the status of TS in imaging maps. Brain computed tomography (CT) maps of all patients at baseline and half-month post-ICH were obtained, and the volumes of hematoma and the perihematomal edemas (PHE), as well as the modified Rankin Scale (mRS) scores at the month-3 post-ICH between the 2 groups were assessed and analyzed.
Results:
A total of 46 eligible patients entered into final analysis, including 18 cases in the slender TS group (14 cases involved the left side while 4 cases involved the right side), and 28 cases in the symmetrical TS group. The mRS scores, hematoma absorption rates, and the residual volumes of PHE of all patients in the 2 groups at half-month post-ICH showed no statistical significance (all P >0.05), and all of the items mentioned above were related to the hematoma volume at baseline (all P <0.001). At the month-3 follow-up post-ICH, the mRS scores between the 2 groups showed no statistical significance as well ( P =0.551).
Conclusions:
Anatomic asymmetry of TS may not affect the prognosis of PHE and clinical outcome after ICH.
... Additionally, utilizing TEM, we demonstrated that the ECs were swollen, and TJs were shorter and blurred after ICH compared to sham controls. Moreover, the basement membrane was thinner in the c-ICH model on day 3 compared to that in the b-ICH model on day 5. Therefore, combined with the characteristics of clinical ICH patients with locally elevated perihematomal permeabilitysurface area product (PS) derived from computed tomographic perfusion (CTP) imaging within 24 to 72 h after ICH (Xu et al., 2017), we conclude that the c-ICH model might be a more suitable model for studying early BBB damage and protection comparing to the b-ICH model. ...
Disruption of the blood-brain barrier (BBB) and the subsequent formation of brain edema is the most severe consequence of intracerebral hemorrhage (ICH), leading to drastic neuroinflammatory responses and neuronal cell death. A better understanding of ICH pathophysiology to develop effective therapy relies on selecting appropriate animal models. The collagenase injection ICH model and the autologous arterial whole blood infusion ICH model have been developed to investigate the pathophysiology of ICH. However, it remains unclear whether the temporal progression and the underlying mechanism of BBB breakdown are similar between these two ICH models. In this study, we aimed to determine the progression and the mechanism of BBB disruption via the two commonly used murine ICH models: the collagenase-induced ICH model (c-ICH) and the double autologous whole blood ICH model (b-ICH). Intrastriatal injection of 0.05 U collagenase or 20 μL autologous blood was used for a comparable hematoma volume in these two ICH models. Then we analyzed BBB permeability using Evan’s blue and IgG extravasation, evaluated tight junction (TJ) damage by transmission electron microscope (TEM) and Western blotting, and assessed matrix metalloproteinase-9 (MMP-9) activity and aquaporin 4 (AQP4) mRNA expression by Gelatin gel zymography and RT-PCR, respectively. The results showed that the BBB leakage was associated with a decrease in TJ protein expression and an increase in MMP-9 activity and AQP4 expression on day 3 in the c-ICH model compared with that on day 5 in the b-ICH model. Additionally, using TEM, we found that the TJ was markedly damaged on day 3 in the c-ICH model compared with that on day 5 in the b-ICH model. In conclusion, the BBB was disrupted in the two ICH models; compared to the b-ICH model, the c-ICH model presented with a more pronounced disruption of BBB at earlier time points, suggesting that the c-ICH model might be a more suitable model for studying early BBB damage and protection after ICH.
... Research on the processing and automatic classification of these signals is the key technology and difficulty of smart medical equipment. For the classification of biological signals, support vector machine (SVM) classification of biological signal recognition algorithms can be used [26]. Support vector machine (SVM) classification is based on the principle of minimizing structural risk, seeking an optimal hyperplane, which maximizes the blank area on both sides of the hyperplane while ensuring the accuracy of the training sample classification [27,28]. ...
The medical and health industry has successively experienced three stages of digital medical treatment, local area network medical treatment, and internet medical treatment. With the rapid development of technologies such as the Internet of Things, big data, and artificial intelligence, emerging applications and service models have gradually penetrated into all aspects of the medical and health field. At this point, the informatization development process of the medical industry has entered the stage of smart medical treatment. (Smart medical system is a new medical system that improves users’ medical experience and provides users with better services. Due to the cumbersome, complicated, and mechanically rigid environment of the past medical service, there was no uniform standard. In order to create a reliable and open medical service environment, an intelligent medical system came into being.). A diversified technical foundation and smart medical protection, conducive to providing patients with high-quality medical services, are established. This article mainly introduces the analysis of the therapeutic effect of smart medical electronic endoscopic hematoma removal on hypertensive basal ganglia cerebral hemorrhage and aims to inject advanced technology and vitality of smart medical treatment into the treatment of hypertensive basal ganglia cerebral hemorrhage by hematoma removal and help the doctor to treat the patient. This article proposes the research methods of smart medical application in the treatment of hypertensive basal ganglia cerebral hemorrhage with electronic endoscopic hematoma removal, including smart medical overview, intracranial hematoma removal for hypertensive basal ganglia cerebral hemorrhage, and smart medical bioelectric signal classification. The recognition algorithm is used to realize the smart medical application of the electronic endoscopic hematoma removal in the treatment of hypertensive cerebral hemorrhage in the basal ganglia area. The experimental results show that the removal of intracranial hematoma based on smart medicine can effectively improve the removal rate of intracranial hematoma, with a recovery rate of 26.73% and a significant efficiency of 36.49%.
1. Introduction
With the rapid development of information technology in the medical industry, smart medical technology has become the focus of widespread attention at home and abroad. Smart healthcare is user-centric, with medical information as the main line, using big data, Internet of Things, cloud computing, artificial intelligence, and other technologies to achieve close interaction among patients, medical staff, medical institutions, and medical equipment and establish scientific, accurate, efficient, and reasonable medical service system. Smart medical technology plays an important role in alleviating the conflicts between doctors and patients caused by information asymmetry and regional health differences caused by unreasonable allocation of medical resources and improving the level of medical services.
The smart medical treatment service system uses big data, cloud computing technology, and Internet of Things technology to establish an electronic medical record database. Paper medical records are inconvenient to store, inconvenient to carry, and easy to lose. It will cause difficulties for doctors to read and make it impossible for doctors to fully understand the patient’s past medical history. A big data electronic medical record database is established so that doctors can view the patient’s past disease history online and have a comprehensive understanding of the patient’s physical condition and medication contraindications. The big data medical record database can also provide a wealth of pathological cases for medical research, provide sufficient data support for the occurrence, development, and prognosis of the disease, provide medical advice for disease prevention and control, and push the development of the medical industry. Now with the popularization of mobile payment methods such as Alipay and WeChat Pay, users can use mobile payment. With the payment of inspection fees and the trouble of queuing for free and cash payment, this extremely user-friendly function will also be retained in our design. At the same time, an online communication platform between doctors and patients is designed so that doctors and patients can rate each other after seeing a doctor, improving service efficiency.
Cerebral hemorrhage is a common disease among cerebrovascular diseases. Although its incidence is not as high as that of cerebral infarction, the potential recovery ability of brain function is also stronger than that of cerebral infarction, but its fatality rate is also significantly higher than that of cerebral infarction. With the improvement of living conditions, the age of onset of cerebral hemorrhage has gradually become younger, significantly reducing the quality of life of middle-aged patients, and effective treatment of cerebral hemorrhage has become a concern of most scholars. (There are two main treatment methods for hypertensive cerebral hemorrhage: one is conservative treatment, and the other is craniotomy. Minimally invasive removal between these two methods can not only remove most of the hematoma, but also avoid the major trauma to the brain caused by surgery.) The fatality rate within the first month after the onset of hypertensive intracerebral hemorrhage is 30%∼50%, and more than 30% of the survivors also have dysfunction; the fatality rate of traditional internal and surgical treatment is 46.7%∼90% and 67.9%; the recovery of nerve defect function is low. The introduction of smart medical technology into the treatment of intracranial hematoma to remove hypertensive basal ganglia cerebral hemorrhage is beneficial to improve the precision and stability of the operation and reduce the occurrence of complications. Basal ganglia hemorrhage has symptoms and signs such as putamen hemorrhage, thalamic hemorrhage, caudate nucleus hemorrhage, and serious sequelae. The study of basal ganglia hemorrhage has become one of the current medical research focuses.
From the perspective of sustainability, Hao et al. first proposed a three-dimensional evaluation model representing the original medical data, then proposed a sustainable treatment plan strategy based on the representative model, and, finally, conducted a case study on the patient’s treatment plan. In the research to prove the feasibility and availability of the strategy, this method is less theoretically described, which is not conducive to reference research [1]. Zhang et al. found that the Internet of Things is rapidly spreading as a new communication paradigm, so many research studies have been conducted on various applications, especially the application of the Internet of Things in intelligent medical systems. In an intelligent medical system, many medical devices are distributed in popular areas such as stations and medical centers, and the distribution of such high-density medical devices can cause severe communication performance degradation, which is called a coexistence problem. The high cost of this research is not conducive to popularization in practice [2]. Jiang et al. believed that, with the development of medical technology based on multimedia and pattern recognition, smart medical applications in smart hospitals and personal smart medical care play an important role in our lives. He proposed an energy-saving multicast routing method in multihop wireless networks for smart medical applications. This method uses topology control and sleep mechanisms to obtain the best routing strategy with the highest network energy efficiency to construct network multicast routing. This study lacks the support of experimental data and is impractical [3].
The innovations of this paper are as follows: (1) the application of smart medical treatment in the treatment of hypertensive cerebral hemorrhage in the basal ganglia area with electronic endoscopic hematoma is proposed; (2) the application design of smart medical system is carried out.
2. Electronic Endoscopic Hematoma Removal in the Treatment of Hypertensive Basal Ganglia Cerebral Hemorrhage in Smart Medical Application Research Methods
2.1. Overview of Smart Medical Technology
Smart medical technology is the use of new ideas and new models of new generation information technologies such as the Internet of Things and cloud computing to promote the intelligentization of medical diagnosis, management, and services. Smart medical technology is an important part and important evaluation index of a smart city. At present, research on smart medicine is emerging. The implementation of smart medical technology can reduce the workload of medical staff and improve work efficiency; medical institutions can be connected with healthcare institutions, and medical information can be shared between patients and medical institutions. It can provide patients with a more scientific and effective medical service plan, which reduces the cost of medical services to a certain extent and can use data mining technology to predict diseases and provide a scientific basis for doctors’ decisions [4]. The smart medical application of the Internet of Things is shown in Figure 1 (picture from ocamar.com). The current diagnostic methods are CT examination, MRI examination, DSA examination, and cerebrospinal fluid examination.
... 3 A computed tomography (CT) perfusion study indicated that the perihematoma permeability-surface area product is higher in larger hematomas and is associated with a larger edema volume. 4 Although surgical repair is important to prevent chronic hypoxia, survival of patients with BGCH is poor. Therefore, prognostic monitoring is important to evaluate the degree of recovery of patients with BGCH. ...
Objective:
This study was performed to analyze the relationships of the early glycosylated hemoglobin (GHb) level and blood glucose level (BGL) with prognosis in patients with basal ganglia cerebral hemorrhage (BGCH).
Methods:
In total, 186 patients with BGCH were included in this prospective study. The GHb level, fasting BGL, bleeding volume, degree of consciousness disorder, intracerebral hemorrhage (ICH) score, functional outcome in patients with primary ICH (FUNC) score, ICH grading scale (ICH-GS) score, and neurological impairment were recorded during a 30-day observation period.
Results:
The mean BGCH volume was 58.42 mL. The 30-day mortality rate was 22.32%. The ICH-GS score [odds ratio (OR) = 0.815, 95% confidence interval (95% CI) = 0.504-0.688, R = 0.624] and bleeding volume (OR = 0.882, 95% CI = 0.785-0.918, R = 0.784) were significant predictors of 30-day mortality. The GHb level (OR = 6.138, R = 0.705) and BGL (OR = 1.055, R = 0.418) were independent predictors of 30-day mortality according to the multivariate logistic regression analysis.
Conclusion:
The GHb level and BGL are strong predictors of 30-day mortality in patients with BGCH and accurately predict the prognosis in these patients.
... Of the sixteen included studies, one assessed BBB dysfunction in HV-related ICH (n = 82) (36) six in CAA-related ICH (n = 117) (37)(38)(39)(40)(41)(42), and nine did not specify the underlying etiology of the ICH (n = 489; Tables 2A, 2B, S4) (44)(45)(46)(47)(48)(49)(50)(51)(52). ...
... One of these studies found increased permeability in the hemisphere ipsilateral to the ICH relative to the contralateral hemisphere (n = 53) within 26 h after symptom onset (46). In contrast, the other study could not identify any difference in BBB permeability between the hemisphere ipsilateral to the ICH and the contralateral hemisphere (n = 54) between 24 and 72 h after ICH onset (47). No control group was included in any of these imaging studies. ...
Background and Purpose: Hypertensive vasculopathy and cerebral amyloid angiopathy are the two most common forms of cerebral small vessel disease. Both forms are associated with the development of primary intracerebral hemorrhage, but the pathophysiological mechanisms underlying spontaneous vessel rupture remain unknown. This work constitutes a systematic review on blood-brain barrier dysfunction in the etiology of spontaneous intracerebral hemorrhage due to cerebral small vessel disease.
Methods: We searched Medline (1946–2018) and Embase (1974–2018) for animal and human studies reporting on blood-brain barrier dysfunction associated with intracerebral hemorrhage or cerebral microbleeds.
Results: Of 26 eligible studies, 10 were animal studies and 16 were in humans. The authors found indications for blood-brain barrier dysfunction in all four animal studies addressing hypertensive vasculopathy-related intracerebral hemorrhage (n = 32 hypertensive animals included in all four studies combined), and in four of six studies on cerebral amyloid angiopathy-related intracerebral hemorrhage (n = 47). Of the studies in humans, five of six studies in patients with cerebral amyloid angiopathy-related intracerebral hemorrhage (n = 117) and seven out of nine studies examining intracerebral hemorrhage with mixed or unspecified underlying etiology (n = 489) found indications for blood-brain barrier dysfunction. One post-mortem study in hypertensive vasculopathy-related intracerebral hemorrhage (n = 82) found no evidence for blood-brain barrier abnormalities.
Conclusions: Signs of blood-brain barrier dysfunction were found in 20 out of 26 studies. Blood-brain barrier integrity deserves further investigation with a view to identification of potential treatment targets for spontaneous intracerebral hemorrhage.
