AUCTORES
Globalize your Research
Short Communication
*Corresponding Author: Grey Calculus,Department of Neurosurgery, Indonesia
Citation: Grey Calculus , Doohlckkey Parsons, Intracerebral Hemorrhage: A Retrospective Study in Metropolitan Population, J Neuroscience and Neurological Surgery. Doi: 10.31579/2578-8868/014
Copyright: © 2017 . Grey Calculus This is an open-access article distributed under the terms of The Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 17 February 2017 | Accepted: 28 February 2017 | Published: 09 March 2017
Keywords: nuerological disorders;tranumatic brain injury;nuerological degenerative diseases
Intracerebral hemorrhage, or ICH, is a devastating disease. The overall incidence of spontaneous ICH worldwide is 24.6 per 100,000 person-years with approximately 40,000 to 67,000 cases per year in the United States. The 30-day mortality rate ranges from 35% to 52% with only 20% of survivors expected to have full functional recovery at 6 months. Approximately half of this mortality occurs within the first 24 hours, highlighting the critical importance of early and effective treatment in the Emergency Department.
Intracerebral hemorrhage (ICH) is defined as bleeding in the brain parenchyma, whereas intracranial hemorrhage refers to any bleeding within the cranial vault. While traumatic ICH is by far the most common type of ICH, this review will focus on spontaneous, nontraumatic ICH, implying bleeding that occurs without trauma or known bleeding causes such as an arteriovenous malformation, cerebral aneurysm, or tumor.
Intracerebral hemorrhage is defined by its location within the brain parenchyma, with “deep” ICH being located within the basal ganglia and internal capsule (35%-70%), brain stem (5%-10%), and cerebellum (5%-10%). In contrast, “lobar” ICH (15%-30%) refers to hemorrhages located in cortical–subcortical areas and follows a “lobar” pattern across one or less often multiple lobes of the brain. Deep ICH accounts for about two third of spontaneous ICH cases, and lobar ICH accounts for the remaining one third.
Epidemiology and Risk Factors
Intracerebral hemorrhage is twice as common as aneurysmal subarachnoid hemorrhage (SAH).The incidence of ICH is 12 to 15 cases per 100 000 individuals or about 40 000 cases per year in the United States. Incidence varies among populations.
Hypertension is by far the most common attributable risk factor; it accelerates age-related “wear and tear” of cerebral arterioles at branch points. Cerebral amyloid angiopathy (CAA), a condition that increases with age, is the second most common risk factor. Cerebral amyloid angiopathy is an important cause of lobar ICH, especially in the elderly individuals.This condition results from amyloid protein deposition in cortical arterioles; such deposition is rare in the basal ganglia and brain stem (usual locations of HTN-related ICH and unusual locations of CAA-related ICH). Apolipoprotein E (ApoE) genotype plays an important role in the pathogenesis of CAA, but it is neither sensitive nor specific for the primary diagnosis of this condition. Recurrent lobar CAA-related ICH is relatively common.
Cerebral reperfusion syndrome is a rare but serious complication of carotid revascularization, seen both after endarterectomy (CEA) and angioplasty/stenting (CAS); it is a uncommon cause of ICH. It is due to increased cerebral blood flow (compared to pre-revascularization levels) in combination with impaired cerebrovascular autoregulation. It may occur up to several weeks after revascularization but usually in the first few days. The highest risk period is at 12 hours post CAS and at 6 days post CEA. Deterioration of consciousness, confusion, and headache are the typical presenting symptoms. Risk factors for this syndrome include long-standing elevated blood pressure, diabetes, advanced age, contralateral carotid occlusion, and recent contralateral carotid revascularization within 3 months, postoperative HTN, and use of anticoagulants. Treatment strategies are directed toward regulation of blood pressure and limitation of rises in cerebral perfusion.
Pathophysiology
Nontraumatic bleeding into the brain parenchyma results from rupture of small penetrating arteries. In deep hematomas, this has been attributed to degenerative changes in the vessel wall associated with advancing age, chronic HTN, diabetes, and other vascular risk factors. Charcot-Bouchard microaneurysms and lipohyalinosis of small arterioles have been suggested as mechanisms. In some circumstances, degenerative changes of these arterioles may be associated with lacunar stroke and in other cases they may lead to ICH.Cause and effect are not always clear-cut because ischemic and hemorrhagic stroke are both age- and HTN-related. Rigorous pathological studies in the era of modern imaging with computerized tomography (CT) and magnetic resonance imaging (MRI) are lacking. When ICH does occur, most bleeding occurs at or near the bifurcation of affected arterioles.
Treatment
The presence of coagulopathy (congenital or acquired) worsens the prognosis of ICH by increasing the rate of hematoma expansion and the duration of that expansion. Reversal of coagulopathy is of the essence, and specific antidotes should be used depending on the clinical scenario. Anticoagulant agents are discontinued immediately. In the case of warfarin, vitamin K, 10 mg, is administered slowly, intravenously, followed by either fresh frozen plasma (FFP) along with prothrombin complex concentrates (PCCs) or in some selected cases recombinant factor VIIa. The PCC dosage is calculated according to body weight, degree of INR prolongation, and desired level of correction; typical dosages are 25 to 50 IU/kg.
Blood Pressure
The management of acute HTN in the setting of ICH is a medical emergency. However, the exact therapeutic blood pressure target remains one of the considerable controversies in the context of incomplete evidence.Two contradicting theories, yet unproven, illustrate this uncertainty. The first theory is that there is a region of perihematomal “penumbra” or brain tissue at risk that can become ischemic if the blood pressure is reduced precipitously.The second theory is that acute HTN actually causes worsening hematoma growth.
Anticonvulsant Therapy
Early seizures occur in about 4% of ICH cases and in about 8% within 30 days. Lobar hematomas carry a higher risk of seizures than deep ICH.Clinical seizures in the setting of ICH should be treated with appropriate antiepileptic drugs. Initial medication choices include benzodiazepines, followed by fosphenytoin or phenytoin.
Deep Vein Thrombosis Prophylaxis
Intermittent pneumatic sequential compression devices (SCDs) are indicated for patients with ICH for deep vein thrombosis (DVT) prophylaxis, assuming there is no history of DVT or leg fracture to contraindicate use. Once the intracranial bleeding has stopped and after 3 to 4 days from onset of the ICH, low-dose molecular weight heparin or unfractionated heparin may be used for DVT prevention in patients with hemiplegia.
Conclusion
Intracerebral hemorrhage diagnosis and treatment have evolved over the past decade, in the setting of increasing knowledge about risk factors, pathophysiology, and management. Neuroimaging has advanced the field. Microbleeds detected by MRI may help predict underlying pathophysiology and help determine prognosis. Wider appreciation of hematoma growth and the utility of contrast-enhanced CT “spot sign” have increased the value of CT. Primary management of ICH involves rapid clinical evaluation, correction of any coagulation defects, admission to an ICU setting, and careful control of blood pressure. More specific blood pressure targets are being evaluated within the ATACH II and INTERACT 2 trials with the hopes of further reducing morbidity and mortality. The role of surgical hematoma evacuation is uncertain and likely not beneficial for most of the patients with ICH. Studies addressing minimally invasive surgical management for ICH and IVH are underway. The studies may answer whether these techniques offer more than medical management for patients with ICH. Further trials are needed to determine the best measures to halt early ICH growth, minimize cerebral edema, and attenuate the toxic effects of blood products.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
