Article
Medicine, General & Internal
Dianjun Zou, Xiaolong Zhu
Summary: The meta-analysis showed that there is a significant association between a history of hypertension and a higher rate of diffusion-weighted imaging lesions in intracerebral hemorrhage patients. However, no significant relationship was found between DWI lesions and other factors such as diabetes, smoking, and a history of hypercholesterolemia. Patients with DWI lesions experienced a greater decrease in systolic pressure during the acute phase of intracerebral hemorrhage.
INTERNATIONAL JOURNAL OF CLINICAL PRACTICE
(2021)
Article
Clinical Neurology
Weidong Liu, Xianbo Zhuang, Liyong Zhang
Summary: This meta-analysis of prospective studies found that increased systolic blood pressure variability is associated with a higher risk of poor functional outcomes in patients with intracerebral hemorrhage, regardless of the method used for assessment. The results suggest that systolic blood pressure variability can be a predictor of poor outcomes in this patient population.
FRONTIERS IN NEUROLOGY
(2021)
Article
Clinical Neurology
Kristin Tveitan Larsen, Maiken Nordahl Selseth, Silje Holt Jahr, Vigdis Hillestad, Nojoud Koubaa, Else Charlotte Sandset, Ole Morten Ronning, Espen Saxhaug Kristoffersen
Summary: This study investigated the relationship between prehospital blood pressure (BP) and clinical and radiological outcomes in acute intracerebral hemorrhage patients. The results showed that elevated prehospital BP parameters were associated with in-hospital death and hematoma expansion. Changes in prehospital BP were not consistently associated with outcome. A possible U-shaped association between prehospital BP and in-hospital death needs further investigation.
Review
Clinical Neurology
Maximiliano A. Hawkes, Alejandro A. Rabinstein
Summary: The acute hypertensive response is common in patients with intracerebral hemorrhage and is associated with poor clinical outcomes. It is unclear whether high blood pressure is a cause of poor outcomes or simply a marker of severity. Intensive blood pressure treatment may be beneficial for some patients with intracerebral hemorrhage but harmful for others.
Article
Cardiac & Cardiovascular Systems
Xiang Li, Bei Zhang, Mingwu Lou
Summary: According to this meta-analysis, lobar intracerebral hemorrhage was not significantly related to a higher rate of diffusion-weighted imaging lesions, while a history of hypertension may have an independent risk relationship with a higher rate of diffusion-weighted imaging lesions.
JOURNAL OF THROMBOSIS AND THROMBOLYSIS
(2021)
Article
Clinical Neurology
Nicholas A. Morris, Gaurav Jindal, Seemant Chaturvedi
Summary: The optimal blood pressure targets following successful mechanical thrombectomy are still uncertain. Observational studies have shown conflicting results, suggesting either a U-shaped curve or a linear relationship between blood pressure and outcomes. Recent trials have not found a benefit to intensive blood pressure lowering, but there are concerns regarding their generalizability and safety. Further research is needed to determine the most appropriate approach.
Article
Peripheral Vascular Disease
Kazunori Toyoda, Sohei Yoshimura, Mayumi Fukuda-Doi, Adnan Qureshi, Manabu Inoue, Kaori Miwa, Masatoshi Koga
Summary: This study found that continuous intravenous administration of nicardipine to lower systolic blood pressure was associated with reduced risks of hematoma expansion and 90-day death or disability in Japanese patients with acute intracerebral hemorrhage.
HYPERTENSION RESEARCH
(2023)
Article
Clinical Neurology
Ellis S. van Etten, Kanishk Kaushik, Wilmar M. T. Jolink, Emma A. Koemans, Merel S. Ekker, Ingeborg Rasing, Sabine Voigt, Floris H. B. M. Schreuder, Suzanne C. Cannegieter, Gabriel J. E. Rinkel, Willem M. Lijfering, Catharina J. M. Klijn, Marieke J. H. Wermer
Summary: This study identifies several trigger factors, such as caffeine consumption, lifting weights, sexual activity, and Valsalva maneuvers, that increase the risk of spontaneous intracerebral hemorrhage (ICH). These findings provide new insights into the pathophysiology of vessel rupture resulting in ICH.
Article
Clinical Neurology
Jatinder S. Minhas, Tom J. Moullaali, Gabriel J. E. Rinkel, Craig S. Anderson
Summary: Blood pressure is an important factor in managing intracerebral hemorrhage and aneurysmal subarachnoid hemorrhage. However, there are controversies surrounding the management of blood pressure for these conditions. Current research involves analyzing patient data to determine the strength and direction of blood pressure changes and provide recommendations for clinical practice and future research.
Review
Pharmacology & Pharmacy
Mingzhen Qin, Luda Feng, Chinyu Yang, Dawei Wei, Tingting Li, Ping Jiang, Jinzhi Guan, Xinyue Zhang, Xinyi Shi, Ning Liang, Xinxing Lai, Li Zhou, Chi Zhang, Ying Gao
Summary: Edaravone does not reduce mortality in patients with intracerebral hemorrhage when initiated within 7 days of onset. The effects on long-term functional outcomes are still unknown. Although it alleviates neurological deficits, improves activities of daily living, and reduces hematoma volume, the overall poor quality and high heterogeneity of the included trials make it insufficient to support edaravone as a routine treatment option for acute intracerebral hemorrhage.
FRONTIERS IN PHARMACOLOGY
(2022)
Article
Clinical Neurology
Kanta Tanaka, Masatoshi Koga, Mayumi Fukuda-Doi, Adnan Qureshi, Haruko Yamamoto, Kaori Miwa, Masafumi Ihara, Kazunori Toyoda
Summary: This study used group-based trajectory modeling to analyze blood pressure changes in patients with acute intracerebral hemorrhage receiving antihypertensive treatment, and found that different blood pressure trajectories were associated with different outcomes. Specifically, the high-to-low SBP group showed increased risks of death or disability and acute kidney injury.
Article
Critical Care Medicine
Rajeev K. Garg, Bichun Ouyang, Amer Zwein, Varoon Thavapalan, Ajit Indavarapu, Kathryn Cheponis, Nicholas Osteraas, Mohamad Ezzeldin, Vishal Pandya, Atul Ramesh, Thomas P. Bleck
Summary: This study evaluated the reliability of systolic blood pressure (SBP) in patients with acute spontaneous intracerebral hemorrhage (sICH). By comparing simultaneous measurements from cuff non-invasive blood pressure and radial arterial invasive blood pressure devices, it was found that SBP had a larger variance and significant differences compared to diastolic blood pressure and mean arterial pressure. Therefore, it was concluded that SBP is an unreliable blood pressure measurement in patients with sICH.
JOURNAL OF CRITICAL CARE
(2022)
Review
Clinical Neurology
Yu Guo, Xin-Mei Guo, Rui-Li Li, Kai Zhao, Qiang-Ji Bao, Jin-Cai Yang, Qiang Zhang, Ming-Fei Yang
Summary: Tranexamic acid (TXA) may reduce the risk of hematoma expansion (HE) in patients with acute spontaneous intracerebral hemorrhage (ICH), particularly in high-risk populations and patients treated within 4.5 hours of symptom onset. However, this protective effect was not observed in standard-risk populations and patients treated over 4.5 hours of symptom onset. There were no significant differences in poor functional outcome (PFO) or mortality at three months between patients who received TXA and placebo.
FRONTIERS IN NEUROLOGY
(2021)
Article
Clinical Neurology
Joseph P. Broderick, James C. Grotta, Andrew M. Naidech, Thorsten Steiner, Nikola Sprigg, Kazunori Toyoda, Dar Dowlatshahi, Andrew M. Demchuk, Magdy Selim, J. Mocco, Stephan Mayer
Summary: Research in the acute management of intracerebral hemorrhage (ICH) over the past 35 years has shown that early treatment to control bleeding and minimize brain injury is crucial. However, current medical and surgical interventions have not yet shown significant benefits in large-scale trials, emphasizing the need for further research and improvement in the delivery of ICH therapies for better outcomes.
Article
Clinical Neurology
Xia Wang, Gian Luca Di Tanna, Tom J. Moullaali, Renee' H. Martin, Virginia B. Shipes, Thompson G. Robinson, John Chalmers, Jose Suarez, Adnan Qureshi, Yuko Y. Palesch, Craig S. Anderson
Summary: This study found that moderate rapid reductions in systolic blood pressure (SBP) in patients with acute intracerebral hemorrhage (ICH) are associated with improved functional outcomes, but large SBP reductions within 1 hour (e.g. from > 200 to target < 140 mmHg) are associated with a reduction or reversal of such benefits.
INTERNATIONAL JOURNAL OF STROKE
(2022)
Article
Clinical Neurology
Lan Gao, Marj Moodie, Christopher Levi, Longting Lin, Xin Cheng, Timothy Kleinig, Ken Butcher, Bernard Yan, Andrew Bivard, Mark Parsons
Summary: The study aims to evaluate the long-term health outcomes and costs of using endovascular thrombectomy (EVT) in patients with large ischaemic core. Both clinical trials and real-world evidence were used, showing varied health benefits and costs from EVT treatment in everyday practice. Offering EVT to stroke patients with large ischaemic core was associated with greater benefits and lower or higher costs, depending on trial and real-world data.
CEREBROVASCULAR DISEASES
(2023)
Article
Clinical Neurology
Klearchos Psychogios, Magoufis Georgios, Apostolos Safouris, Odysseas Kargiotis, Andrikopoulou Athina, Lina Palaiodimou, Maria Chondrogianni, Eleni Bakola, Georgios Tsivgoulis
Summary: Neurovascular sonography serves as a valuable tool for screening and follow-up of dural arteriovenous fistulas (dAVFs) in the transverse sinuses/sigmoid sinuses. This case report presents a rare case of bilateral dAVFs diagnosed through neurovascular ultrasonography, which was subsequently confirmed by further imaging. The findings highlight the importance of neurovascular sonography in the diagnosis of dAVFs in the transverse sinuses/sigmoid sinuses.
EUROPEAN JOURNAL OF NEUROLOGY
(2023)
Review
Clinical Neurology
Christos S. Katsouras, Michail I. Papafaklis, Sotirios Giannopoulos, Theodoros Karapanayiotides, Georgios Tsivgoulis, Lampros K. Michalis
Summary: Numerous observational studies have shown a decline in cerebro-/cardiovascular admissions during the early phase of the COVID-19 pandemic, but recent studies suggest that the overall decrease is smaller than initially reported. The main cause of this decline is believed to be collateral damage from the COVID-19 outbreak, including the effects of imposed measures such as social distancing and self-isolation. However, there may also be a smaller true decline in CV events due to a lack of triggers associated with acute syndromes. It is important to prepare healthcare systems for a potential increase in CV hospitalizations in the future.
JOURNAL OF CLINICAL NEUROLOGY
(2023)
Review
Clinical Neurology
Aikaterini Theodorou, Lina Palaiodimou, Konark Malhotra, Christina Zompola, Aristeidis H. Katsanos, Ashkan Shoamanesh, Efstathios Boviatsis, Efthimios Dardiotis, Martha Spilioti, Simona Sacco, David J. Werring, Charlotte Cordonnier, Andrei Alexandrov, George R. Paraskevas, Georgios Tsivgoulis
Summary: This study conducted a systematic review and meta-analysis on the clinical, neuroimaging, genetic, and cerebrospinal fluid biomarker characteristics of patients with cerebral amyloid angiopathy-related inflammation (CAA-ri). The results showed that cognitive decline was the most common clinical feature, while hyperintense T2/fluid-attenuated inversion recovery white matter lesions and lobar cerebral microbleeds were the most prevalent neuroimaging findings. 34% of patients with CAA-ri had the ApoE epsilon 4/epsilon 4 genotype.
Article
Medicine, General & Internal
Eleni Bakola, Georgia Papagiannopoulou, Lina Palaiodimou, Konstantinos Lagios, Eftychios Archontakis, Aikaterini Theodorou, Aristeidis H. Katsanos, Sokratis Triantafyllou, Vasiliki Zouvelou, Stefanos Lachanis, Dimitrios Tzanetakos, John S. Tzartos, Sotirios Giannopoulos, Georgios Tsivgoulis
Summary: This article describes the clinical presentation, radiological findings, treatment, and outcomes of three patients with delayed leukoencephalopathy after endovascular treatment (EVT) for cerebral aneurysms, which is a rare but recurring complication. Symptoms appeared 6 to 12 months following the EVT. Characteristic imaging findings included high-signal changes on T2 images in the white matter without diffusion restriction, mainly at the distribution of the catheterized arteries, with patchy gadolinium enhancement or low susceptibility weighted imaging signals. Steroid pulse therapy is the preferred treatment option, improving clinical and imaging findings promptly. Tapering or cessation of steroids may lead to relapses; close and long-term follow-up is necessary for patients with this complication.
JOURNAL OF CLINICAL MEDICINE
(2023)
Article
Clinical Neurology
Ghil Schwarz, Sara Bonato, Silvia Lanfranconi, Marius Matusevicius, Isabella Ghione, Gloria Valcamonica, Georgios Tsivgoulis, Ana Paiva Nunes, Michelangelo Mancuso, Andrea Zini, Paolo Candelaresi, Viiu-Marika Rand, Giacomo P. P. Comi, Michael V. V. Mazya, Niaz Ahmed
Summary: This study compared the safety and efficacy of IVT plus EVT with IVT alone in LVO patients, and found that IVT+EVT was associated with poorer functional outcome at 3 months, but had similar safety outcomes compared to IVT alone.
EUROPEAN JOURNAL OF NEUROLOGY
(2023)
Article
Clinical Neurology
Magnus Thoren, Irene Escudero-Martinez, Tomas Andersson, Shih-Yin Chen, Nicole Tsao, Dheeraj Khurana, Simone Beretta, Andre Peeters, Georgios Tsivgoulis, Christine Roffe, Niaz Ahmed
Summary: This study investigated the association between reperfusion and the development of early cerebral edema after stroke thrombectomy. The results showed that successful reperfusion was associated with a lower risk of early cerebral edema. Severe early neurological deficits may weaken the association between reperfusion and lower risk of cerebral edema.
INTERNATIONAL JOURNAL OF STROKE
(2023)
Editorial Material
Clinical Neurology
Odysseas Kargiotis, Klearchos Psychogios, Apostolos Safouris, Athina Andrikopoulou, Andreas Eleftheriou, Stavros Spiliopoulos, Georgios Magoufis, Georgios Tsivgoulis
Article
Clinical Neurology
Fahad S. Al-Ajlan, David J. Gladstone, Dongbeom Song, Kevin E. Thorpe, Rick H. Swartz, Kenneth S. Butcher, Martin del Campo, Dar Dowlatshahi, Henrik Gensicke, Gloria Jooyoung Lee, Matthew L. Flaherty, Michael D. Hill, Richard I. Aviv, Andrew M. Demchuk, SPOTLIGHT Investigators
Summary: In the SPOTLIGHT trial, the impact of delays in drug administration on hematoma expansion in acute intracerebral hemorrhage patients was investigated, and it was found that the use of rFVIIa did not significantly reduce hematoma expansion. Future hemostatic trials should aim to minimize the delay between baseline CT and drug administration in order to improve treatment outcomes.
Editorial Material
Clinical Neurology
Athanasios Tsibonakis, Aikaterini Theodorou, Penelope Korkolopoulou, Georgios Tsivgoulis
ANNALS OF NEUROLOGY
(2023)
Article
Clinical Neurology
Georgios Tsivgoulis, Lina Palaiodimou, Maria-Ioanna Stefanou, Aikaterini Theodorou, Janika Korv, Ana Paiva Nunes, Paolo Candelaresi, Elisa Dall'Ora, Payam Sariaslani, Leandro Provinciali, Adriana B. B. Conforto, Alan Alves de Lima Cidrao, Theodore Karapanayiotides, Niaz Ahmed
Summary: This study aimed to identify predictors of good functional outcome after symptomatic intracerebral hemorrhage (SICH) following intravenous thrombolysis for acute ischemic stroke. The study analyzed patient data from the Safe Implementation of Treatment in Stroke-International Stroke Thrombolysis Register (SITS-ISTR) and found that higher baseline National Institutes of Health Stroke Scale (NIHSS) score and 24-hour NIHSS score were associated with lower likelihood of achieving good and excellent functional outcomes at 3 months. Age, baseline NIHSS score, 24-hour NIHSS score, admission glucose values, and hematoma location were identified as predictors of mortality and disability at 3 months.
EUROPEAN JOURNAL OF NEUROLOGY
(2023)
Article
Clinical Neurology
Aristeidis H. Katsanos, Abhilekh Srivastava, Demetrios J. Sahlas, Kanjana Perera, Kelvin K. H. Ng, Raed A. Joundi, Brian Van Adel, Ramiro Larrazabal, Kanchana Ratnayake, Georgios Tsivgoulis, Oscar Benavente, Robert Hart, Mukul Sharma, Ashkan Shoamanesh, Luciana Catanese
Summary: TCD can identify patients at risk of HT following successful EVT. TCD could serve as an inexpensive ancillary test to guide participant selection for clinical trials targeting postprocedural reperfusion injury.
JOURNAL OF NEUROIMAGING
(2023)
Review
Clinical Neurology
Lina Palaiodimou, Amrou Sarraj, Apostolos Safouris, Georgios Magoufis, Robin Lemmens, Else Charlotte Sandset, Guillaume Turc, Marios Psychogios, Georgios Tsivgoulis
Summary: This study conducted a systematic review and meta-analysis, finding that endovascular treatment (EVT) can significantly reduce disability, improve independent ambulation, and lead to good functional outcomes for large-core acute ischaemic stroke (AIS). However, it has no significant impact on excellent functional outcomes and carries a risk of intracranial hemorrhage. Overall, EVT is effective and safe for large-core AIS.
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY
(2023)
Review
Medicine, General & Internal
Lina Palaiodimou, Georgia Papagiannopoulou, Aristeidis H. Katsanos, Andreas Eleftheriou, Theodore Karapanayiotides, Panayiotis D. Mitsias, Robin Lemmens, Carlos A. Molina, Andrei Alexandrov, Valeria Caso, Ashkan Shoamanesh, Mukul Sharma, Georgios Tsivgoulis
Summary: Despite preventive measures, stroke rates remain high in the primary and secondary prevention settings. Factor XIa inhibition may offer a novel, safe and effective antithrombotic option for stroke prevention. However, the results of this meta-analysis showed that treatment with factor XIa inhibitors did not reduce the risk of ischemic stroke compared to controls.
JOURNAL OF CLINICAL MEDICINE
(2023)
Article
Clinical Neurology
Lina Palaiodimou, Raed A. Joundi, Aristeidis H. Katsanos, Niaz Ahmed, Joon-Tae Kim, Nitin Goyal, Ilko L. Maier, Adam de Havenon, Mohammad Anadani, Marius Matusevicius, Eva A. Mistry, Pooja Khatri, Adam S. Arthur, Amrou Sarraj, Shadi Yaghi, Ashkan Shoamanesh, Luciana Catanese, Marios-Nikos Psychogios, Konark Malhotra, Alejandro M. Spiotta, Sofia Vassilopoulou, Konstantinos Tsioufis, Else Charlotte Sandset, Andrei Alexandrov, Nils Petersen, Georgios Tsivgoulis
Summary: This study found a significant association between blood pressure variability after endovascular thrombectomy (EVT) and mortality and disability. This association was independent of mean blood pressure levels within the first 24 hours post EVT. Therefore, blood pressure variability in the first 24 hours may be a new therapeutic target to improve outcomes after EVT for acute ischemic stroke.
EUROPEAN STROKE JOURNAL
(2023)
