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Intracerebral hemorrhage (ICH) is the most serious form of stroke, with more than two-thirds of the patients either dying or left permanently disabled from the condition. Despite considerable research effort, there is still no treatment of proven efficacy for ICH and the chances of surviving an ICH has failed to improve in recent decades. The brain...
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... following processes have been shown to occur in ICH: (i) early hematoma expansion and secondary edema-induced brain compression and consequent neuronal death; (ii) cyto- toxic (intracellular) and vasogenic (extracellular) edema result- ing from disruption of the blood-brain barrier; (iii) reductions in cerebral perfusion pressure (CPP) from mass effect and raised intracranial pressure (ICP); (iv) brain herniation; and finally, (v) in those who survive, residual brain atrophy from the original lesion. 4,5 Along with hematoma expansion, perihe- matomal edema is implicated in many of the fundamental pro- cesses driving the neuronal damage in ICH (Figure 1), although the prognostic significance of perihematomal edema on its own remains uncertain. 6,7 However, while it is widely accepted that hematoma-induced brain damage is irreversible, the injury arising from perihematomal edema may be reversible, and thereby presents a potential therapeutic target for intervention. ...
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Background:
Monitoring of intracranial pressure (ICP) and ICP pulse wave amplitude (PWA) is an integrated part of neurosurgery. An increase in ICP usually leads to an increase in PWA. These findings have yet to be replicated during the positional shift from supine to upright, where we only know that ICP decreases. Our main aim is to clarify whethe...
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... Lastly, haemolysis of RBC occurs due to the development of Membrane Attack Complex (MAC) following complement cascade activation and haemoglobin mediated toxicity occurs. 24,37,41 In humans, perihaematoma oedema increases rapidly in the first 48 to 72 hours after ICH and thereafter continues to increase at a slower rate for 1 to 2 weeks and then starts to decrease. 37 It has been established that haematoma induced brain damage is irreversible, however, the injury arising from perihaematoma oedema may be reversible. ...
... 24,37,41 In humans, perihaematoma oedema increases rapidly in the first 48 to 72 hours after ICH and thereafter continues to increase at a slower rate for 1 to 2 weeks and then starts to decrease. 37 It has been established that haematoma induced brain damage is irreversible, however, the injury arising from perihaematoma oedema may be reversible. 37 Animal Studies showed that brain oedema peaks on the 3 rd and 4 th day after ICH and neurotoxicity of haemoglobin is Iron mediated. ...
... 37 It has been established that haematoma induced brain damage is irreversible, however, the injury arising from perihaematoma oedema may be reversible. 37 Animal Studies showed that brain oedema peaks on the 3 rd and 4 th day after ICH and neurotoxicity of haemoglobin is Iron mediated. 24 Free iron released from RBC lysis and from ferritin stores may have a role in oxidative stress, glutamate release and inflammatory response after haemorrhagic brain injury. ...
Background: Stroke (ischaemic & haemorrhagic) is a major cause of mortality and morbidity in the developed as well as in the developing countries. Perihaematoma oedema and haematoma expansion are two important points to be considered when deciding outcome of patients with ICH. Brain damage due to haematoma may be irreversible but the injury from perihaematoma oedema may be reversible. It has been seen that S. ferritin is the most reliable indicator of body iron. Treatment with iron chelators may give better outcome after ICH. Objective: This study was under taken to assess the association between serum ferritin and relative perihaematoma oedema volume. Methodology: This study was a cross sectional observational study that was conducted in the Departments of Neurosurgery & Neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU) and Dhaka Medical College Hospital (DMCH) from 1st March, 2014 till 30th September, 2015 on 32 patients (32) who fulfilled the selection criteria were enrolled in this study. Results: In this study, male female ratio was 1:1 and the mean age was 56±15 years. Most of the ICH patients fell in the age group between 41-60 years (53%). During admission, grade-1 (GCS 3- 8) level of consciousness was reported among 45% of patients. All the patients in this study presented with motor deficit that include hemiplegia 20 (62.5%) and hemiparesis 12 (37.5%). Mean value of serum ferritin was found elevated on day 4 (344±406 μg/L) in comparison to day 1 (213.4±123.5μg/ L). Mean value of relative perihaematoma oedema was elevated on day 4 (4±2.7) than day 1 (1.9±1) but it was not statistically significant. Conclusion: In this study after statistical analysis by Pearson’s correlation test we found that there was no significant association between serum ferritin concentration and relative perihaematoma oedema on day-1 and day-4. Bang. J Neurosurgery 2019; 8(2): 77-86
... However, it is a complex process that involves several pathophysiological mechanisms, ranging from the hydrostatic pressure of the hematoma to subsequent toxic effects of breakdown products resulting from coagulation cascade activation and erythrocyte lysis as part of the natural process of hematoma resolution. [3] Thus, although perihematoma edema and hematoma volumes are strongly correlated, there is less conclusive evidence regarding role of perihematomal edema itself as being an independent prognostic factor over and above the hematoma. ...
