Abstract Oridonin was extracted and purified from Rabdosia rubescens and its protective effect on intracerebral hemorrhage (ICH)-induced brain injury in rats was investigated. The rats were divided into sham, model, low-dose oridonin, middle-dose oridonin and high-dose oridonin groups. The ICH-induced brain injury model was established in latter four groups. After modeling, the low-, middle- and high-dose oridonin groups were treated with 10, 20, and 40 mg/kg oridonin at 2h and 24 h after modeling, respectively. Results showed that, after 48 after modeling, compared with model group, in middle- and high-dose oridonin groups the modified Neurological Severity Score was significantly decreased (P < 0.05), the brain water content was significantly decreased (P < 0.05), the brain tissue tumor necrosis factor α, interleukin 1β, interleukin 6 and nuclear factor-kappa B (NF-κB) p65 protein levels were significantly decreased (P < 0.05), and the brain tissue erythroid 2-related factor 2 (Nrf2) and heme oxygenase 1 (HO-1) protein levels were significantly increased (P < 0.05). In conclusion, oridonin from Rabdosia rubescens can mitigate the ICH-induced brain injury in rats. The mechanism may be related to its reduction of inflammatory response and oxidative stress by inhibiting NF-κB inflammatory pathway and promoting Nrf2/HO-1 antioxidant pathway in brain tissues.

Spontaneous intracerebral hemorrhage (SICH) still presents a great heterogeneity in its clinical evaluation, demonstrating differences in the enrollment criteria used for the study of intracerebral hemorrhage (ICH) treatment. The aim of the current study was to assess the ICH Score, a simple and reliable scale, determining the 30-day mortality and the one-year functional outcome. Consecutive patients admitted with acute SICH were prospectively included in the study. ICH Scores ranged from 0 to 4, and each increase in the ICH Score was associated with an increase in the 30-day mortality and with a progressive decrease in good functional outcome rates. However, the occurrence of a pyramidal pathway injury was better related to worse functional outcome than the ICH Score. The ICH Score is a good predictor of 30-day mortality and functional outcome, confirming its validity in a different socioeconomic populations. The association of the pyramidal pathway injury as an auxiliary variable provides more accurate information about the prognostic evolution.

We report four cases of surgically treated intracranial arachnoid cysts, one with cyst-peritoneal shunt and three with craniotomy and arachnoid membrane resection. Their classification and etiopathogeny are discussed, and especially the different methods of treatment comparing the drastic complications (adversities) with the favorable solutions in severe clinical cases (plasticity) treated at our institution.

The decline of stroke mortality rates has been described in Brazil; however, there is no data about stroke subtypes. We described the changes of stroke mortality rates in the city of Sao Paulo (1996-2003) emphasizing intracerebral hemorrhage and cerebral infarction. We categorized mortality data by gender and 10-year age-strata from 30 to 79 years-old. For men, an annual reduction of all types of stroke (-3.9%), and of stroke subtypes as intracerebral hemorrhage (-3.0%) and cerebral infarction was observed (-2.7%) as well as, a decline of ill-defined stroke (-7.4%). For women, a decline was observed for all types of stroke (-3.3%) and for ill-defined stroke (-12%). However, the switch of ill-defined cases to stroke subtype categories due to a better clinical diagnosis blurred a real decline of both cerebral infarction and intracerebral hemorrhagic stroke among women.

The case of a 70 year-old, previously healthy woman who developed a severe bleeding diathesis shortly after touching a Lonomia obliqua caterpillar and finally died from multiple intracerebral hemorrhages is described. Brain hemorrhages are the leading cause of death in patients envenomed by the Lonomia species. The pertinent literature is reviewed and the most relevant clinical features highlighted, with emphasis on diagnosis. The use of new therapeutic options such as anti-Lonomia serum is discussed.

ABSTRACT Left atrial appendage occlusion (LAAO) appears as a therapeutic option for some atrial fibrillation patients not suitable for oral anticoagulation because an increased hemorrhagic risk or recurrent ischemic events despite anticoagulant treatment. Methods Report of consecutive atrial fibrillation patients treated with LAAO with Amplatzer Cardio Plug because contraindication or failure of oral anticoagulation with acenocumarol. CHA2DS2VASC, HAS-BLED, NIHSS, mRS, procedural complications and outcome were assessed. Seven patients (73 ± 6 year-old) were treated after intracerebral (n = 5) and gastrointestinal (n = 1) hemorrhages or ischemic stroke recurrence while on acenocumarol (n = 1). Results Mean follow up was 18 months. Baseline CHA2DS2Vasc y HAS-BLED scores were 5.6 ± 0.7 and 4.1 ± 0.3 respectively. There were no strokes or deaths. There was only one non-serious adverse event. Conclusion LAAO with ACP appears as a feasible therapeutic option for stroke prevention in patients with atrial fibrillation and failure or contraindication to acenocumarol.

BACKGROUND: Blood biomarkers are a potential tool for early stroke diagnosis. We aimed to perform a pilot and exploratory study on untargeted blood biomarkers in patients with suspected stroke by using mass spectrometry analysis. METHODS AND RESULTS: This was a prospective observational study of consecutive patients with suspected stroke admitted within 6 hours of last being seen well. Blood samples were collected at admission. Patients were divided into 3 groups: ischemic stroke (IS), intracerebral hemorrhage (ICH), and stroke mimics. Quantitative analysis from mass spectrometry data was performed using a supervised approach. Biomarker-based prediction models were developed to differentiate IS from ICH and ICH+stroke mimics. Models were built aiming to minimize misidentification of patients with ICH as having IS. We included 90 patients, one-third within each subgroup. The median age was 71 years (interquartile range, 57–81 years), and 49 participants (54.4%) were women. In quantitative analysis, C3 (complement component 3), ICAM-2 (intercellular adhesion molecule 2), PLGLA (plasminogen like A), STXBP5 (syntaxin-binding protein 5), and IGHV3-64 (immunoglobulin heavy variable 3-64) were the 5 most significantly dysregulated proteins for both comparisons. Biomarker-based models showed 88% sensitivity and 89% negative predictive value for differentiating IS from ICH, and 75% sensitivity and 95% negative predictive value for differentiating IS from ICH+stroke mimics. ICAM-2, STXBP5, PLGLA, C3, and IGHV3-64 displayed the highest importance score in our models, being the most informative for identifying patients with stroke. CONCLUSIONS: In this proof-of-concept and exploratory study, our biomarker-based prediction models, including ICAM-2, STXBP5, PLGLA, C3, and IGHV3-64, showed 75% to 88% sensitivity for identifying patients with IS, while aiming to minimize misclassification of ICH. Although our methodology provided an internal validation, these results still need validation in other cohorts and with different measurement techniques.