The haematoma expansion paradoxes. A study of haematoma expansion in acute primary intracerebral haemorrhage

Introduction: intracerebral haemorrhage (ICH) accounts for approximately 10-15% of all new strokes that occur each year, but results in disproportionately high morbidity and mortality. Outcome has not improved significantly in recent decades due to the lack of clear beneficial medical or surgical therapies. One of the four factors thought to be responsible for the praecox clinical and radiological deterioration of ICH patients is haematoma expansion (HE). Aims of our study were to analyze the haematoma expansion phenomenon, any risk factors and its influence on outcome, and to evaluate ICH patient characteristics, investigating elements that could contribute to determining ICH outcome. Methods: we conducted an observational longitudinal study on retrospectively collected data on 206 consecutive patients with primary or anticoagulant-associated ICH admitted to the Stroke Units of the Neurology Units of Treviso Hospital and St. Anthony's Hospital of Padova, from January 2011 to December 2015. Patients with a secondary cause of ICH were excluded. We recorded baseline history, radiological, laboratory and clinical admission data, and follow-up information. Results: our ICH population was characterized by elderly Caucasian patients with a slight prevalence of males, small haematoma volumes and mild-moderate clinical severity. While male patients seemed to have a higher incidence of ICH, at a younger age, with a different vascular risk-factor profile and a higher risk of haematoma expansion, outcome was not poorer than in female patients. Of our population, 28.6% presented significant HE and the risk factors for HE proved to be male sex and higher NIHSS score. At follow up, mortality was 24.7% at three months and 28.4% at one year; based on the mRS, the average patient was dependent at three months. At follow up, there was a slightly higher percentage of ICH relapses than of ischemic strokes. Age, haemorrhage characteristics, as baseline volume and ventricular invasion, haematoma expansion and clinical severity are the strongest predictors of outcome. Conclusions and Discussion: the analysis has confirmed the complexity of the haematoma expansion phenomenon, which still remains partially unknown. Our findings have yielded several paradoxes and we wonder whether haematoma expansion can be truly considered a prognostic factor or represents one step in the natural history of every ICH. Considering the natural history of ICH patients, none of the identified prognostic factors is modifiable at the time of medical evaluation. ICH pathology and the haematoma expansion phenomenon are still not sufficiently understood and more studies are warranted to positively influence the prognosis of these patients

Clinical and virological findings in patients with Usutu virus infection, northern Italy, 2018

Background Usutu virus (USUV) is a mosquito-borne flavivirus, which shares its transmission cycle with the phylogenetically related West Nile virus (WNV). USUV circulates in several European countries and its activity has increased over the last 5 years. Aim To describe human cases of USUV infection identified by surveillance for WNV and USUV infection in the Veneto Region of northern Italy in 2018. Methods From 1 June to 30 November 2018, all cases of suspected autochthonous arbovirus infection and blood donors who had a reactive WNV nucleic acid test were investigated for both WNV and USUV infection by in-house molecular methods. Anti-WNV and anti-USUV IgM and IgG antibodies were detected by ELISA and in-house immunofluorescence assay, respectively; positive serum samples were further tested by WNV and USUV neutralisation assays run in parallel. Results Eight cases of USUV infection (one with neuroinvasive disease, six with fever and one viraemic blood donor who developed arthralgia and myalgia) and 427 cases of WNV infection were identified. A remarkable finding of this study was the persistence of USUV RNA in the blood and urine of three patients during follow-up. USUV genome sequences from two patients shared over 99% nt identity with USUV sequences detected in mosquito pools from the same area and clustered within lineage Europe 2. Conclusions Clinical presentation and laboratory findings in patients with USUV infection were similar to those found in patients with WNV infection. Cross-reactivity of serology and molecular tests challenged the differential diagnosis

The haematoma expansion paradoxes. A study of haematoma expansion in acute primary intracerebral haemorrhage

Introduction: intracerebral haemorrhage (ICH) accounts for approximately 10-15% of all new strokes that occur each year, but results in disproportionately high morbidity and mortality. Outcome has not improved significantly in recent decades due to the lack of clear beneficial medical or surgical therapies. One of the four factors thought to be responsible for the praecox clinical and radiological deterioration of ICH patients is haematoma expansion (HE). Aims of our study were to analyze the haematoma expansion phenomenon, any risk factors and its influence on outcome, and to evaluate ICH patient characteristics, investigating elements that could contribute to determining ICH outcome. Methods: we conducted an observational longitudinal study on retrospectively collected data on 206 consecutive patients with primary or anticoagulant-associated ICH admitted to the Stroke Units of the Neurology Units of Treviso Hospital and St. Anthony's Hospital of Padova, from January 2011 to December 2015. Patients with a secondary cause of ICH were excluded. We recorded baseline history, radiological, laboratory and clinical admission data, and follow-up information. Results: our ICH population was characterized by elderly Caucasian patients with a slight prevalence of males, small haematoma volumes and mild-moderate clinical severity. While male patients seemed to have a higher incidence of ICH, at a younger age, with a different vascular risk-factor profile and a higher risk of haematoma expansion, outcome was not poorer than in female patients. Of our population, 28.6% presented significant HE and the risk factors for HE proved to be male sex and higher NIHSS score. At follow up, mortality was 24.7% at three months and 28.4% at one year; based on the mRS, the average patient was dependent at three months. At follow up, there was a slightly higher percentage of ICH relapses than of ischemic strokes. Age, haemorrhage characteristics, as baseline volume and ventricular invasion, haematoma expansion and clinical severity are the strongest predictors of outcome. Conclusions and Discussion: the analysis has confirmed the complexity of the haematoma expansion phenomenon, which still remains partially unknown. Our findings have yielded several paradoxes and we wonder whether haematoma expansion can be truly considered a prognostic factor or represents one step in the natural history of every ICH. Considering the natural history of ICH patients, none of the identified prognostic factors is modifiable at the time of medical evaluation. ICH pathology and the haematoma expansion phenomenon are still not sufficiently understood and more studies are warranted to positively influence the prognosis of these patients.Introduction: intracerebral haemorrhage (ICH) accounts for approximately 10-15% of all new strokes that occur each year, but results in disproportionately high morbidity and mortality. Outcome has not improved significantly in recent decades due to the lack of clear beneficial medical or surgical therapies. One of the four factors thought to be responsible for the praecox clinical and radiological deterioration of ICH patients is haematoma expansion (HE). Aims of our study were to analyze the haematoma expansion phenomenon, any risk factors and its influence on outcome, and to evaluate ICH patient characteristics, investigating elements that could contribute to determining ICH outcome. Methods: we conducted an observational longitudinal study on retrospectively collected data on 206 consecutive patients with primary or anticoagulant-associated ICH admitted to the Stroke Units of the Neurology Units of Treviso Hospital and St. Anthony's Hospital of Padova, from January 2011 to December 2015. Patients with a secondary cause of ICH were excluded. We recorded baseline history, radiological, laboratory and clinical admission data, and follow-up information. Results: our ICH population was characterized by elderly Caucasian patients with a slight prevalence of males, small haematoma volumes and mild-moderate clinical severity. While male patients seemed to have a higher incidence of ICH, at a younger age, with a different vascular risk-factor profile and a higher risk of haematoma expansion, outcome was not poorer than in female patients. Of our population, 28.6% presented significant HE and the risk factors for HE proved to be male sex and higher NIHSS score. At follow up, mortality was 24.7% at three months and 28.4% at one year; based on the mRS, the average patient was dependent at three months. At follow up, there was a slightly higher percentage of ICH relapses than of ischemic strokes. Age, haemorrhage characteristics, as baseline volume and ventricular invasion, haematoma expansion and clinical severity are the strongest predictors of outcome. Conclusions and Discussion: the analysis has confirmed the complexity of the haematoma expansion phenomenon, which still remains partially unknown. Our findings have yielded several paradoxes and we wonder whether haematoma expansion can be truly considered a prognostic factor or represents one step in the natural history of every ICH. Considering the natural history of ICH patients, none of the identified prognostic factors is modifiable at the time of medical evaluation. ICH pathology and the haematoma expansion phenomenon are still not sufficiently understood and more studies are warranted to positively influence the prognosis of these patients

Spinal Cord Herniation: A Missing Piece in the Pathogenesis of Amyotrophic Lateral Sclerosis and Multiple Sclerosis?

&lt;i&gt;Background:&lt;/i&gt; Idiopathic spinal cord herniation (SCH) is a rare and often misdiagnosed condition characterized by displacement of the spinal cord through an anterior defect of the dural sac. This condition determines continuous focal trauma of the spinal cord, causing slowly progressive myelopathy. The peculiar MR scan findings, particularly sagittal T&lt;sub&gt;2&lt;/sub&gt;-weighted images, allow its recognition. &lt;i&gt;Objective:&lt;/i&gt; Herein, we report 3 cases of SCH and suggest a possible association with trauma-related neurodegenerative or chronic inflammatory diseases. &lt;i&gt;Methods:&lt;/i&gt; We reviewed the clinical files of all patients admitted to our hospital with a history and signs of progressive myelopathy (paraparesis and/or lower extremity hypoesthesia) who were diagnosed with SCH by MRI. &lt;i&gt;Results:&lt;/i&gt; We found 3 female patients (37, 69 and 68 years of age) with a diagnosis of SCH. Two of them presented with concomitant, relatively rare disabling neurological diseases, namely amyotrophic lateral sclerosis and multiple sclerosis. The third patient underwent surgery and gradually recovered over 6 months. &lt;i&gt;Conclusions:&lt;/i&gt; Persistent central nervous system trauma due to idiopathic SCH might provide an unexpected hint about the pathogenesis of amyotrophic lateral sclerosis and multiple sclerosis.</jats:p