The Impact of Intracerebral Hemorrhage on the Progression of White Matter Hyperintensity

Comparative analysis of stereotactic aspiration via supraorbital keyhole versus Kocher's point for basal ganglia intracerebral hematoma: computational simulation and propensity score-matched study

Catheter placement via the supraorbital keyhole (SOK) for removing spontaneous intracerebral hemorrhage (sICH) in the basal ganglia may result in improved aspiration rates and functional outcomes than those by the conventional Kocher's point (KP) route. Verification was performed using he results of computational simulations and retrospective clinical data matched by propensity scores. We retrospectively enrolled 50 patients who underwent stereotactic hematoma aspiration of 'typical' shape of basal ganglia sICH. After propensity score matching (PSM), comparative analyses between the two groups (n = 36) were performed. A computational simulation of hematoma aspiration was conducted in eight patients using 2-mm thin-sliced brain computed tomography images obtained preoperatively. After PSM, eighteen patients in each group were newly matched and the logit propensity score of the was 0.04 ± 0.0726. The aspiration rate was significantly higher in the SOK group (31.841 ± 40.131 in KP vs. 55.191 ± 25.387 in SOK, p = 0.045), and the proportion of patients who achieved good functional outcomes (mRS score, 0-2 at 6 months) was significantly higher in the SOK group (27.8% vs. 61.1%, p = 0.044). The computational simulations also demonstrated a lower residual volume rate in the SOK group than in the KP group in those with a typical ICH type (21.5% vs. 43.4%). Stereotactic hematoma aspiration via the SOK route in patients with typical basal ganglia ICH is a safe and effective method with an enhanced aspiration rate and favorable functional outcomes.

Deep Learning to Decipher the Progression and Morphology of Axonal Degeneration

Axonal degeneration (AxD) is a pathological hallmark of many neurodegenerative diseases. Deciphering the morphological patterns of AxD will help to understand the underlying mechanisms and develop effective therapies. Here, we evaluated the progression of AxD in cortical neurons using a novel microfluidic device together with a deep learning tool that we developed for the enhanced-throughput analysis of AxD on microscopic images. The trained convolutional neural network (CNN) sensitively and specifically segmented the features of AxD including axons, axonal swellings, and axonal fragments. Its performance exceeded that of the human evaluators. In an in vitro model of AxD in hemorrhagic stroke induced by the hemolysis product hemin, we detected a time-dependent degeneration of axons leading to a decrease in axon area, while axonal swelling and fragment areas increased. Axonal swellings preceded axon fragmentation, suggesting that swellings may be reliable predictors of AxD. Using a recurrent neural network (RNN), we identified four morphological patterns of AxD (granular, retraction, swelling, and transport degeneration). These findings indicate a morphological heterogeneity of AxD in hemorrhagic stroke. Our EntireAxon platform enables the systematic analysis of axons and AxD in time-lapse microscopy and unravels a so-far unknown intricacy in which AxD can occur in a disease context.

Association of neuroimaging markers of cerebral small vessel disease with short-term outcomes in patients with minor cerebrovascular events

Background

Increasing evidences have showed that neuroimaging markers of SVD can predict the short-term outcome of acute ischemic stroke (AIS). It is unclear that whether neuroimaging markers of SVD are also associated with short-term outcomes of minor cerebrovascular events. In the present study, we investigate neuroimaging markers of SVD in order to explore their roles in prediction of short-term outcome in patients with minor cerebrovascular events.

Methods

Consecutive first-ever stroke patients (n = 546) from the Affiliated Jiangning Hospital of Nanjing Medical University were enrolled. A total of 388 patients were enrolled according to minor cerebrovascular events definition (National Institutes of Health Stroke Scale Score ≤ 3) and exclusion criteria. MRI scans were performed within 7 days of stroke onset, and then neuroimaging markers of SVD including WMH, lacunes, cerebral microbleeds (CMB), and perivascular spaces (PVS), SVD burden scores were assessed. We completed baseline characteristics and evaluated the relationships of short-term outcomes to SVD neuroimaging markers and SVD scores. The 90-day modified Rankin Scale (mRS) was thought as primary outcome and was dichotomized as good functional outcome (mRS 0–1) and poor outcome (mRS 2–6). Secondary outcomes were stroke progression and stroke recurrence.

Results

Higher age, National Institutes of Health Stroke Scale (NIHSS) upon admission, lipoprotein-associated phospholipase A2 (LP-PLA2) and lacunes, Fazekas score were correlated with poor functional outcome (P < 0.05), But after adjusting for confounding variables, among the neuroimaging markers of cerebral small vessel disease, only Fazekas score (OR, 1.343; 95% confidence interval, 1.020–1.770; P = 0.036) was found to be associated with poor outcome at 90 days. Higher Fazekas and SVD scores were not associated with stroke progression or stroke recurrence.

Conclusion

WMH can predict the poor functional outcome of minor cerebrovascular events. Adding other neuroimaging markers of SVD and total SVD burden score, however, does not improve the prediction, which indicated WMH can as neuroimaging markers for guiding the treatment of minor cerebrovascular events.

Progression of White Matter Injury After Intracerebral Hemorrhage: A Magnetic Resonance Imaging Study

BACKGROUND

White matter injury (WMI) has been observed after experimental intracerebral hemorrhage (ICH). The supporting clinical data have been sparse. We assessed the presence, extent, and progression of WMI in patients with ICH.

METHODS

We performed a retrospective review of data from 65 consecutive patients with spontaneous supratentorial ICH who had undergone baseline brain magnetic resonance imaging (MRI) within 7 days of ICH onset and repeat MRI afterward. We used the Fazekas scale (FZKS) to grade the severity of WMI. The clinical and imaging characteristics of the patients with and without WMI progression (WMIP) were compared using uni- and multivariate logistic regression analyses.

RESULTS

We observed WMIP in 23 patients (35.4%). WMIP was noted in both hemispheres but more commonly ipsilateral to the ICH (33% vs. 21%). The mean total FZKS score had increased from 3 (interquartile range [IQR], 1-4) at baseline to 4 (IQR, 2-5) on repeat MRI (P < 0.0001). Patients with lobar ICH had a greater median FZKS score than those with deep ICH (median, 3; IQR, 2-4; vs. 1.5, IQR, 1-3.25; P = 0.027). The baseline parenchymal ICH volume (odds ratio [OR], 1.067; 95% confidence interval [CI], 1.018-1.119; P = 0.007) and ventricular volume on baseline MRI (OR, 1.073; 95% CI, 1.019-1.130; P = 0.007) were predictors of WMIP after adjustment. Multivariate analyses showed an independent association between WMIP and unfavorable 3-month outcomes (OR, 5.196; 95% CI, 1.059-25.483; P = 0.042).

CONCLUSIONS

WMI will progress over time in patients with ICH, and WMIP has been associated with worse outcomes. This novel finding could represent a potential therapeutic target. Future prospective larger studies are needed to confirm our findings.