Redox nanoparticle treatment protects against neurological deficit in focused ultrasound-induced intracerebral hemorrhage

Nanomedicine ◽  
2012 ◽  
Vol 7 (7) ◽  
pp. 1029-1043 ◽  
Author(s):  
Pennapa Chonpathompikunlert ◽  
Ching-Hsiang Fan ◽  
Yuki Ozaki ◽  
Toru Yoshitomi ◽  
Chih-Kuang Yeh ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Neurological Deficit ◽  
Focused Ultrasound ◽  
Redox Nanoparticle

Minimally invasive treatment of intracerebral hemorrhage with magnetic resonance–guided focused ultrasound

2013 ◽  
Vol 118 (5) ◽  
pp. 1035-1045 ◽  
Author(s):  
Stephen J. Monteith ◽  
Sagi Harnof ◽  
Ricky Medel ◽  
Britney Popp ◽  
Max Wintermark ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Minimally Invasive ◽  
Intracerebral Hemorrhage ◽  
Focused Ultrasound ◽  
Safety Data ◽  
Surgical Techniques ◽  
Minimally Invasive Treatment ◽  
Swine Model ◽  
Invasive Treatment

Object Intracerebral hemorrhage (ICH) is a major cause of death and disability throughout the world. Surgical techniques are limited by their invasive nature and the associated disability caused during clot removal. Preliminary data have shown promise for the feasibility of transcranial MR-guided focused ultrasound (MRgFUS) sonothrombolysis in liquefying the clotted blood in ICH and thereby facilitating minimally invasive evacuation of the clot via a twist-drill craniostomy and aspiration tube. Methods and Results In an in vitro model, the following optimum transcranial sonothrombolysis parameters were determined: transducer center frequency 230 kHz, power 3950 W, pulse repetition rate 1 kHz, duty cycle 10%, and sonication duration 30 seconds. Safety studies were performed in swine (n = 20). In a swine model of ICH, MRgFUS sonothrombolysis of 4 ml ICH was performed. Magnetic resonance imaging and histological examination demonstrated complete lysis of the ICH without additional brain injury, blood-brain barrier breakdown, or thermal necrosis due to sonothrombolysis. A novel cadaveric model of ICH was developed with 40-ml clots implanted into fresh cadaveric brains (n = 10). Intracerebral hemorrhages were successfully liquefied (> 95%) with transcranial MRgFUS in a highly accurate fashion, permitting minimally invasive aspiration of the lysate under MRI guidance. Conclusions The feasibility of transcranial MRgFUS sonothrombolysis was demonstrated in in vitro and cadaveric models of ICH. Initial in vivo safety data in a swine model of ICH suggest the process to be safe. Minimally invasive treatment of ICH with MRgFUS warrants evaluation in the setting of a clinical trial.

scholarly journals Transcranial MR-guided focused ultrasound sonothrombolysis in the treatment of intracerebral hemorrhage

2013 ◽  
Vol 34 (5) ◽  
pp. E14 ◽  
Author(s):  
Stephen J. Monteith ◽  
Neal F. Kassell ◽  
Oded Goren ◽  
Sagi Harnof
Keyword(s):  
Minimally Invasive ◽  
Intracerebral Hemorrhage ◽  
Focused Ultrasound ◽  
Focal Point ◽  
Disruptive Technology ◽  
Invasive Approach ◽  
Blood Clots ◽  
Volume Blood

Intracerebral hemorrhage remains a significant cause of morbidity and mortality. Current surgical therapies aim to use a minimally invasive approach to remove as much of the clot as possible without causing undue disruption to surrounding neural structures. Transcranial MR-guided focused ultrasound (MRgFUS) surgery is an emerging technology that permits a highly concentrated focal point of ultrasound energy to be deposited to a target deep within the brain without an incision or craniotomy. With appropriate ultrasound parameters it has been shown that MRgFUS can effectively liquefy large-volume blood clots through the human calvaria. In this review the authors discuss the rationale for using MRgFUS to noninvasively liquefy intracerebral hemorrhage (ICH), thereby permitting minimally invasive aspiration of the liquefied clot via a small drainage tube. The mechanism of action of MRgFUS sonothrombolysis; current investigational work with in vitro, in vivo, and cadaveric models of ICH; and the potential clinical application of this disruptive technology for the treatment of ICH are discussed.

scholarly journals Correlation between serum S100β protein level with neurological deficit in patients with acute intracerebral hemorrhage

2018 ◽  
Vol 8 (1) ◽  
pp. 63
Author(s):  
Poppy Kristina Sasmita ◽  
Ismail Setyopranoto ◽  
Samekto Wibowo ◽  
Ahmad Hamim Sadewa
Keyword(s):  
Intracerebral Hemorrhage ◽  
Neurological Deficit ◽  
Protein Level ◽  
S100β Protein ◽  
Acute Intracerebral Hemorrhage

Abstract T P315: Wake-up Intracerebral Hemorrhage Is Not Different From Intracerebral Hemorrhage With Known Onset Time

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Joan Martí-Fàbregas ◽  
Luis Prats ◽  
Alejandro Martínez-Domeño ◽  
Rebeca Marín ◽  
Francesca Casoni ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Scale Score ◽  
Neurological Deficit ◽  
Onset Time ◽  
Vascular Risk Factors ◽  
Neurological Deterioration ◽  
Vascular Risk ◽  
Nihss Score

Background: The frequency of wake-up Intracerebral Hemorrhage (WU-ICH) is uncertain. It is also unknown whether there are clinical, radiological and prognostic differences between WU-ICH and non-WU-ICH. We assessed the hypothesis that both types of ICH do not differ. Methods: This is a multicentre (n=6 tertiary hospitals) registry of consecutive patients with ICH. We collected the following variables: Time of onset. WU onset was defined as stroke detected on awakening, independently of the time of the day; Demographics (age, sex); Traditional vascular risk factors; Severity of the neurological deficit at admission (NIHSS score and/or Glasgow coma scale score -GCS-); Neurological deterioration (decrease in >1 point in GCS and/or increase in >3 points in NIHSS score); Etiology; Neuroimaging at admission (location, secondary intraventricular hemorrhage, hematoma volume); Blood pressure, blood glucose, platelet count and INR at admission; and Outcome (modified Rankin scale score -mRS- at discharge and at 3 months; favourable outcome when mRS ≤ 2). Patients were treated according to national guidelines of ICH. Comparison between groups was achieved with Student’s t-test, Chi-square test and Mann-Whitney’s U test. Results: We included a total of 270 patients, whose mean age was 70.2 ± 14.4 years, and 60% of them were men. WU-ICH was diagnosed in 49 (18%) patients. We found no significant differences between groups in demographics, frequency of vascular risk factors, severity of the neurological deficit, etiology, blood pressure, blood analysis and neuroradiological findings. Patients with WU-ICH had a lower frequency of neurological deterioration when assessed by the NIHSS scale (p= 0.04) but not by the GCS scale. The outcome at discharge and at 3-months was equivalent between groups. Conclusions: In conclusion, 18% of ICHs are detected on awakening. Patients with wake-up ICH do not differ from patients with known onset time either in most clinical and radiological variables or in the long-term prognosis. WU-ICH patients may have a lower likelihood of neurological worsening within the acute stage.

scholarly journals Histotripsy Clot Liquefaction in a Porcine Intracerebral Hemorrhage Model

Neurosurgery ◽  
2019 ◽  
Vol 86 (3) ◽  
pp. 429-436 ◽  
Author(s):  
Tyler Gerhardson ◽  
Jonathan R Sukovich ◽  
Neeraj Chaudhary ◽  
Thomas L Chenevert ◽  
Kim Ives ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Focused Ultrasound ◽  
Neurological Dysfunction ◽  
Control Group ◽  
Average Volume ◽  
Ultrasound Technique ◽  
Significant Disability ◽  
Magnetic Resonance Imaging Mri ◽  
The Brain

Abstract BACKGROUND Intracerebral hemorrhage (ICH) is characterized by a 30-d mortality rate of 40% and significant disability for those who survive. OBJECTIVE To investigate the initial safety concerns of histotripsy mediated clot liquefaction and aspiration in a porcine ICH model. Histotripsy is a noninvasive, focused ultrasound technique that generates cavitation to mechanically fractionate tissue. Histotripsy has the potential to liquefy clot in the brain and facilitate minimally invasive aspiration. METHODS About 1.75-mL clots were formed in the frontal lobe of the brain (n = 18; n = 6/group). The centers of the clots were liquefied with histotripsy 48 h after formation, and the content was either evacuated or left within the brain. A control group was left untreated. Pigs underwent magnetic resonance imaging (MRI) 7 to 8 d after clot formation and were subsequently euthanized. Neurological behavior was assessed throughout. Histological analysis was performed on harvested brains. A subset of pigs underwent acute analysis (≤6 h). RESULTS Histotripsy was able to liquefy the center of clots without direct damage to the perihematomal brain tissue. An average volume of 0.9 ± 0.5 mL was drained after histotripsy treatment. All groups showed mild ischemia and gliosis in the perihematomal region; however, there were no deaths or signs of neurological dysfunction in any groups. CONCLUSION This study presents the first analysis of histotripsy-based liquefaction of ICH in vivo. Histotripsy safely liquefies clots without significant additional damage to the perihematomal region. The liquefied content of the clot can be easily evacuated, and the undrained clot has no effect on pig survival or neurological behavior.

Metformin Attenuates Neurological Deficit after Intracerebral Hemorrhage by Inhibiting Apoptosis, Oxidative Stress and Neuroinflammation in Rats

2017 ◽  
Vol 42 (10) ◽  
pp. 2912-2920 ◽  
Author(s):  
Boxiang Qi ◽  
Libao Hu ◽  
Lei Zhu ◽  
Lei Shang ◽  
Xuecheng Wang ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Intracerebral Hemorrhage ◽  
Neurological Deficit

scholarly journals Practice Patterns for Neurosurgical Utilization and Outcome in Acute Intracerebral Hemorrhage: Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trials 1 and 2 Studies

Neurosurgery ◽  
2017 ◽  
Vol 81 (6) ◽  
pp. 980-985 ◽  
Author(s):  
Rui Guo ◽  
David J. Blacker ◽  
Xia Wang ◽  
Hisatomi Arima ◽  
Pablo M. Lavados ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Neurological Deficit ◽  
Cerebral Hemorrhage ◽  
Intraventricular Hemorrhage ◽  
Blood Pressure Reduction ◽  
Pressure Reduction ◽  
Nihss Score ◽  
Neurosurgical Intervention ◽  
Intensive Blood Pressure

Abstract BACKGROUND The prognosis in acute spontaneous intracerebral hemorrhage (ICH) is related to hematoma volume, where >30 mL is commonly used to define large ICH as a threshold for neurosurgical decompression but without clear supporting evidence. OBJECTIVES To determine the factors associated with large ICH and neurosurgical intervention among participants of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trials (INTERACT). METHODS We performed pooled analysis of the pilot INTERACT1 (n = 404) and main INTERACT2 (n = 2839) studies of ICH patients (<6 h of onset) with elevated systolic blood pressure (SBP, 150-220 mm Hg) who were randomized to intensive (target SBP < 140 mm Hg) or contemporaneous guideline-recommended (target SBP < 180 mm Hg) management. Neurosurgical intervention data were collected at 7 d postrandomization. Multivariable logistic regression was used to determine associations. RESULTS There were 372 (13%) patients with large ICH volume (>30 mL), which was associated with nonresiding in China, nondiabetic status, severe neurological deficit (National Institutes of Health stroke scale [NIHSS] score ≥ 15), lobar location, intraventricular hemorrhage extension, raised leucocyte count, and hyponatremia. Significant predictors of those patients who underwent surgery (226 of 3233 patients overall; 83 of 372 patients with large ICH) were younger age, severe neurological deficit (lower Glasgow coma scale score, and NIHSS score ≥ 15), baseline ICH volume > 30 mL, and intraventricular hemorrhage. CONCLUSIONS Early identification of severe ICH, based on age and clinical and imaging parameters, may facilitate neurosurgery and intensive monitoring of patients.

Spinal Subdural Empyema

Neurosurgery ◽  
1978 ◽  
Vol 3 (3) ◽  
pp. 400-403
Author(s):  
Ralph G. Dacey ◽  
Richard H. Winn ◽  
John A. Jane ◽  
Albert B. Butler
Keyword(s):  
Back Pain ◽  
Intracerebral Hemorrhage ◽  
Lumbar Puncture ◽  
Spontaneous Abortion ◽  
Neurological Deficit ◽  
Nerve Root ◽  
Clinical Manifestations ◽  
Subdural Empyema ◽  
Nerve Root Compression

Abstract Spinal subdural empyema (SSE) is a rare variety of intraspinal infection. SSE should be suspected in patients presenting with fever, back pain, and signs of cord or nerve root compression. Two patients with SSE are presented. The first patient complained of fever and back pain. She had no neurological deficit but was found to have SSE. The second patient, who presented with intracerebral hemorrhage in the fifth month of pregnancy and spontaneous abortion, was found to have SSE at lumbar puncture. The clinical manifestations and management are discussed.

scholarly journals Resveratrol attenuates neurological deficit and neuroinflammation following intracerebral hemorrhage

2018 ◽  
Author(s):  
Jia‑Chen Cai ◽  
Wei Liu ◽  
Fei Lu ◽  
Wen‑Bing Kong ◽  
Xin‑Xuan Zhou ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Neurological Deficit

scholarly journals Rosuvastatin Nanomicelles Target Neuroinflammation and Improve Neurological Deficit in a Mouse Model of Intracerebral Hemorrhage

2021 ◽  
Vol Volume 16 ◽  
pp. 2933-2947
Author(s):  
Liu Zi ◽  
Wencheng Zhou ◽  
Jiake Xu ◽  
Junshu Li ◽  
Ning Li ◽  
...  
Keyword(s):  
Mouse Model ◽  
Intracerebral Hemorrhage ◽  
Neurological Deficit
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