Current approaches to diagnosing in intracerebral hemorrhage

Кулеш, А. А.

doi:10.14412/2074-2711-2020-2-4-11

RJTAO

2020

DOI: 10.14412/2074-2711-2020-2-4-11

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Current approaches to diagnosing in intracerebral hemorrhage

А. А. Кулеш

Abstract: Внутримозговое кровоизлияние (ВМК) занимает 10-20% в структуре инсульта, и его частота варьируется в зависимости от популяции [1]. ВМК представляет собой наиболее частый вид внутричерепного кровоизлияния и ежегодно развивается у 2 млн человек в мире, при этом более трети пациентов умирают в течение первого месяца и 54% -в ближайший год. Лишь 12-39% пациентов достигают долгосрочной функциональной независимости. В отличие от ишемического инсульта, при котором актив-но применяются методы реперфузионной терапии, п… Show more

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Cited by 4 publications

References 38 publications

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Ten rules for oral anticoagulants prescription after a stroke

Kulesh,

Demin,

Kucherenko

2024

RJTAO

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Every third or fourth ischemic stroke is cardioembolic. Prescribing oral anticoagulants can significantly reduce the risk of recurrent stroke, but this strategy requires the physician to have a firm orientation in the “efficacy – safety” coordinate system. We formulate 10 rules that should help any interested specialist (neurologist, cardiologist, therapist) to decide on the prescription of oral anticoagulants for cardioembolic stroke in daily clinical practice. We discuss issues of selection of an anticoagulant in atrial fibrillation, mitral stenosis and mechanical heart valves, the timing of prescription (also in haemorrhagic transformation of ischemic stroke and after intracerebral hemorrhage), the special features of anticoagulant prophylaxis in comorbid and “fragile” patients are discussed, the development of a stroke while taking an anticoagulant, the timing of discontinuation and resumption of therapy during surgical interventions, the choice of dose and peculiarities of therapy in cognitively impaired patients.

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Ten rules for oral anticoagulants prescription after a stroke

Kulesh,

Demin,

Kucherenko

2024

RJTAO

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Cerebrovascular disease with neurocognitive impairment

Парфенов

Кулеш

2021

Z. nevrol. psikhiatr. im. S.S. Korsakova

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Clinical and non-hemorrhagic neuroimaging indicators of probable cerebral amyloid angiopathy as a cause of non-traumatic lobar hematomas

Novosadova,

Grigoryeva,

Astanin

et al. 2024

Perm Medical Journal

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Objective. To identify clinical and non-hemorrhagic neuroimaging indicators of probable CAA in patients with acute non-traumatic lobar hematomas. Cerebral amyloid angiopathy (CAA) is a microangiopathy affecting the leptomeningial and cortical vessels of the brain due to the deposition of pathological b-amyloid in them. The most common clinical manifestation of CAA is lobar hematomas (LH) – spontaneous intracerebral hemorrhages localized between the cerebral cortex and basal ganglia. LH can also occur in hypertensive cerebral microangiopathy (hCMA) in patients with arterial hypertension. Since the tactics of managing patients with CAA and hCMA differ, it is important to determine the genesis of LH correctly. Materials and methods. A comparative analysis of clinical and neuroimaging characteristics of acute non-traumatic hypertension in 32 patients with probable CAA and hCMA was carried out. Along with neurological examination and neuroimaging, all patients underwent a study using the Montreal Cognitive Assessment Scale and the Benson Complex Figure Test to reveal visuospatial impairments. The diagnosis of probable CAA was carried out in accordance with the updated Boston criteria of 2010, the diagnosis of hCMA was based on clinical data, anamnesis and results of neuroimaging of the brain. Results. Probable CAA was diagnosed in 16 patients, and in all these cases it was combined with hCMA (1st subgroup). Isolated hCMA as a cause of LH was also observed in 16 patients (2nd subgroup). Patients of subgroup 1 were statistically significantly more likely to have clinically pronounced visual impairments, performed the MoCA subtest and the Benson Complex Figure Test worse, and the overall assessment of their cognitive functions according to Mo SA was lower than in patients of subgroup 2. According to neuroimaging data, in the 1st subgroup of patients, an expansion of perivascular spaces in the semi-oval center and a zero or negative value of the front-occipital gradient were more often detected. The application of the logistic regression method made it possible to integrate potential CAA indicators and create a prognostic model for revealing this pathology in patients with hypertension. Conclusions. Clinically pronounced disorders of primary and higher visual functions, a negative front-occipital gradient and expansion of perivascular spaces in the semi-oval centers can serve as indicators of probable CAA in patients with acute lobar hematoma. On admission of such patients to the vascular center, it is advisable to include iron-sensitive pulse sequences in the neuroimaging screening protocol to verify the diagnosis of CAA.

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Current approaches to diagnosing in intracerebral hemorrhage

Cited by 4 publications

References 38 publications

Ten rules for oral anticoagulants prescription after a stroke

Ten rules for oral anticoagulants prescription after a stroke

Cerebrovascular disease with neurocognitive impairment

Clinical and non-hemorrhagic neuroimaging indicators of probable cerebral amyloid angiopathy as a cause of non-traumatic lobar hematomas

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