Presentation of intracerebral haemorrhage in a community

Zahuranec, Darin B.; Gonzales, Nicole R.; Brown, Devin L.; Lisabeth, Lynda D.; Longwell, P. J.; Eden, Sonia V.; Smith, Melinda A.; Garcia, Nelda; Hoff, Julian T.; Morgenstern, Lewis B.

doi:10.1136/jnnp.2005.077164

Cited by 68 publications

(51 citation statements)

References 29 publications

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“…10,14 CT scans were reviewed for volume and location of hemorrhage by study investigators as previously described. 10,15 Hemorrhage volume was calculated using the ABC/2 method. 16 Intraventricular hemorrhage was coded as present or absent.…”

Section: Methods Case Identification and Data Collectionmentioning

confidence: 99%

Do-not-resuscitate orders and predictive models after intracerebral hemorrhage

et al. 2010

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Objective: To quantify the accuracy of commonly used intracerebral hemorrhage (ICH) predictive models in ICH patients with and without early do-not-resuscitate orders (DNR).Methods: Spontaneous ICH cases (n ϭ 487) from the Brain Attack Surveillance in Corpus Christi study (2000 -2003) Conclusions: ICH prognostic model performance is substantially impacted when stratifying by early DNR status, possibly giving a false sense of model accuracy when DNR status is not considered. Clinicians should be cautious when applying these predictive models to individual patients. Many predictive models have been proposed to stratify risk of death following intracerebral hemorrhage (ICH) based on factors known early in the hospital course. 1-5 While many of these models have been shown to perform well on average, 1,6-8 using them to predict the outcome for an individual patient may be problematic.None of the commonly used predictive models have accounted for the impact of do-notresuscitate (DNR) orders on mortality after ICH. Early DNR orders are common after ICH 9,10 and have been associated with a doubling in the chances of death after ICH even despite adjusting for traditional predictors of mortality.10 While the association between DNR orders and death is strong and consistently seen in several studies, 9-11 the interpretation of this association is complex. DNR orders may simply represent a proxy for disease severity or comorbidities not accounted for in statistical models 12 ; alternatively, there is evidence to suggest that DNR orders after ICH may be

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Section: Methods Case Identification and Data Collectionmentioning

confidence: 99%

Do-not-resuscitate orders and predictive models after intracerebral hemorrhage

et al. 2010

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“…During various vascular operations the iUS helps localize lesions and characterize their internal structure, and distance from the surface to the target can be calculated. 57,58 The relation of various lesions to the surrounding brain can be appreciated before, during, and after excision of vascular pathological entities.…”

Section: Ultrasound-guided Evacuation Of Ichmentioning

confidence: 99%

Modern intraoperative imaging modalities for the vascular neurosurgeon treating intracerebral hemorrhage

Goren

Monteith

Hadani

et al. 2013

FOC

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This paper reviews the current intraoperative imaging tools that are available to assist neurosurgeons in the treatment of intracerebral hemorrhage (ICH). This review shares the authors' experience with each modality and discusses the advantages, potential limitations, and disadvantages of each. Surgery for ICH is directed at blood clot removal, reduction of intracranial pressure, and minimization of secondary damage associated with hematoma breakdown products. For effective occlusion and safe obliteration of vascular anomalies associated with ICH, vascular neurosurgeons today require a thorough understanding of the various intraoperative imaging modalities available for obtaining real-time information. Use of one or more of these modalities may improve the surgeon's confidence during the procedure, the patient's safety during surgery, and surgical outcome. The modern techniques discussed include 1) indocyanine green–based video angiography, which provides real-time information based on high-quality images showing the residual filling of vascular pathological entities and the patency of blood vessels of any size in the surgical field; and 2) intraoperative angiography, which remains the gold standard intraoperative diagnostic test in the surgical management of cerebral aneurysms and arteriovenous malformations. Hybrid procedures, providing multimodality image-guided surgeries and combining endovascular with microsurgical strategies within the same surgical session, have become feasible and safe. Microdoppler is a safe, noninvasive, and reliable technique for evaluation of hemodynamics of vessels in the surgical field, with the advantage of ease of use. Intraoperative MRI provides an effective navigation tool for cavernoma surgery, in addition to assessing the extent of resection during the procedure. Intraoperative CT scanning has the advantage of very high sensitivity to acute bleeding, thereby assisting in the confirmation of the extent of hematoma evacuation and the extent of vascular anomaly resection. Intraoperative ultrasound aids navigation and evacuation assessment during intracerebral hematoma evacuation surgeries. It supports the concept of minimally invasive surgery and has undergone extensive development in recent years, with the quality of ultrasound imaging having improved considerably. Image-guided therapy, combined with modern intraoperative imaging modalities, has changed the fundamentals of conventional vascular neurosurgery by presenting real-time visualization of both normal tissue and pathological entities. These imaging techniques are important adjuncts to the surgeon's standard surgical armamentarium. Familiarity with these imaging modalities may help the surgeon complete procedures with improved safety, efficiency, and clinical outcome.

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“…4,10,11,38,44,57 The prognosis for patients with ICH remains poor, with up to 30% mortality and nearly 90% of patients left with some form of disability. 4,10,44,58 Although much has been learned about the mechanisms of injury in ICH, successful disease-modifying strategies remain elusive.…”

confidence: 99%

Alpha-7 nicotinic acetylcholine receptor agonists in intracerebral hemorrhage: an evaluation of the current evidence for a novel therapeutic agent

Sussman¹,

Kellner²,

McDowell³

et al. 2013

FOC

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Intracerebral hemorrhage (ICH) is the most deadly and least treatable subtype of stroke, and at the present time there are no evidence-based therapeutic interventions for patients with this disease. Secondary injury mechanisms are known to cause substantial rates of morbidity and mortality following ICH, and the inflammatory cascade is a major contributor to this post-ICH secondary injury. The alpha-7 nicotinic acetylcholine receptor (α7-nAChR) agonists have a well-established antiinflammatory effect and have been shown to attenuate perihematomal edema volume and to improve functional outcome in experimental ICH. The authors evaluate the current evidence for the use of an α7-nAChR agonist as a novel therapeutic agent in patients with ICH.

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Presentation of intracerebral haemorrhage in a community

Cited by 68 publications

References 29 publications

Do-not-resuscitate orders and predictive models after intracerebral hemorrhage

Do-not-resuscitate orders and predictive models after intracerebral hemorrhage

Modern intraoperative imaging modalities for the vascular neurosurgeon treating intracerebral hemorrhage

Alpha-7 nicotinic acetylcholine receptor agonists in intracerebral hemorrhage: an evaluation of the current evidence for a novel therapeutic agent

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