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Article
Performance of computed tomography indiagnosis and evaluation oftraumatic intracerebral hemorrhage

Author: Haider Q. Hamood حيدر حمود
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: PISSN: 00419419 / EISSN: 24108057 Year: 2011 Volume: 53 Issue: 2 Pages: 156-159
Publisher: Baghdad University جامعة بغداد

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Abstract

Background:The intracerebral hemorrhage (ICH) can be classified as traumatic and spontaneous. The frontal and temporal lobes are classic sites for traumatic ICH, which are less commonly affected by spontaneous episodes. Computed tomography (CT) scanning is the most accurate radiological method for demonstrating the acute lesion of intracerebral hemorrhage (ICH). Both types are of high density, but traumatic bleeding is more frequently multifocal, in this study we are dealing with traumatic type of intracerebralhematoma. Aim of the study is to identify the accuracy and performance of CT scan in diagnosis and evaluation of intracerebralhemorrhage.
Patients and methods: 60 patients were examined, their agesrange from 30-70 years with means age 48 years old, they were 36males (60%), and 24females (40%).
Results: Our study reveals, the male patients (36 patients) were more affected than femalepatients (24 patients). Most affected age group in our study was 60-70 years old, 18 patients (30%) with no gender difference. Acute ICH was more than other ICH types, patients with acute ICH were 24 patients (40%) 15 male patients and 9 female patients, patients with subacute ICH were 20 patients (33%) and patients with chronic ICH were 16 patients (27%). In our study, the RTA was the most causative mechanism of ICH, 27 patients with RTA were seen in our study (45%), followed by shell injury which were 24 patients (40%) and then the fall from hight (FFH)which were 9 patients (15%). The most common CT feature noted in our study is the brain edema and it is seen in 27 patients (45%). Basal ganglia were most affected brain region (45%) of cases.
Conclusion:CT is available,rapid imaging modality in the diagnosis of ICH, so it is suitable for diagnosis and evaluation of ICH as emergency cases in casualty department and it is valuable in evaluation of traumatic I.C.H. especially in acute stages.


Article
The Potential Effect of Lipid Profile on Deep Seated Versus Lobar Intracerebral Hemorrhage

Author: Saif M. Tawfeeq*, Hasan Azeez Al-Hamadani**, Munther Taher Hamzah***
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2017 Volume: 16 Issue: 1 Pages: 57-63
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Brain hemorrhage is defined as the extravasation of blood from the vascular bed into the intracranial space, resulting in clinical dysfunction of nervous system. Intracerebral hemorrhage is a heterogeneous disease with deep and lobar subtypes. The amount of serum lipid may also affect the integrity of blood vessel wall and abnormal lipid profile may consider as a risk factor for intracerebral hemorrhage.OBJECTIVE: The present study was designed to evaluate the relationship between serum lipids and the site of intracerebral hemorrhage.METHOD: A cross-sectional study for 100 patients (50 with deep seated, 50 with lobar intracerebral hemorrhage) from Al-Kadhymia teaching hospital and Bagdad Teaching Hospital between August 2012 and June 2014. Case subjects included those patients from 20 to 89 years of age experiencing ICH within first 48 hours of presentation. Total cholesterol (TC), High-density lipoprotein (HDL) cholesterol, Low-density lipoprotein (LDL) cholesterol and Triglycerides (TG) serum level, was compared in deep seated and lobar intracerebral hemorrhage.RESULTS: There was significant relationship between high HDL level in deep seated compared to lobar hemorrhage, while there was no statistical significant relationship between the site of hemorrhage by TC, LDL and TG levelCONCLUSION: High HDL level is a risk factor for deep seated rather for lobar intracerebral hemorrhage.TC, TG, LDL have no effect on the site of hemorrhage.


Article
Illustrated Correlation of Brain C.T. Scan Findings in Clinical Assessment of Spontaneous Intracerebral Haematoma in Patients with Positive Risk Factors

Author: Yasir Mohammed Hasan Hamandi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2015 Volume: 14 Issue: 4 Pages: 270-275
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Spontaneous intracerebral hemorrhage (SICH) is defined as non-traumatic bleeding into the parenchyma of the brain that may extend into the . head computed tomography scan is the standard diagnostic toolOBJECTIVE: Find out the most important risk factor for SICH.and Illustrate the correlation between the sites of hemorrhage detected by CT scan images and patients presentations. PATIENTS AND METHODS:A prospective study between May 2010 and May 2012; this study was done in the CT unit in AL- Imamain Kadhimmain medical city, Baghdad, The study included 224 consecutive patients with the diagnosis of primary SICH.All the patients had primary spontaneous intracerebral hemorrhage clinically diagnosed plus CT findings that showed evidence of intra-cerebral hemorrhage. Statistical analysis was done using SPSS 15.RESULTS:This study included 224 patients, 128males and 96 females. Forty two patients lie in the age group of 50-59 years, 66 between 60-69 years, 48 between 70-79 years, 52 patients are seventy years old and older and only 16 are below fifty years of age. Regarding the site of bleeding 160 patients (71.4%) had bleeding in deep seated areas of the brain and 64 patients (28.6%) had bleeding in a superficial location. Regarding the deep seated hemorrhage basal ganglia was in 96 (42.8%) of the patients, followed by Thalamus in 48 (21.4%), and cerebellum in 16 (7.2%) of the patients. In the superficial sites of hemorrhage parietal lobe was in 40 patients (17.8%), then parieto-occipital hemorrhage was in 16 (7.2%) patients and 8 patients (3.6%) had temporal lobe hemorrhage. Hypertension was the most common risk factors, found in 75% of patients, followed by antigcoagulant use in 57.2% of patients. A history of diabetes mellitus was positive in 39.3% of the patients, 39.3% of them were smokers, and 25% patients had no history of any risk factors. A statistically significant difference between deep & superficial bleeding is seen in correlation with hypertension and smoking (P value is 0.00001 and 0.002 respectively) The focal neurological signs, found in 66 patients, facial palsy in 48 patients, loss of consciousness in 40 patients, 32 patients had both focal neurological signs and loss of consciousness as a presentation, 22 of them presented with speech difficulty, 8patients presented with ataxia and 8 with dementia. Significant relationship was found between the site of hemorrhage and patients’ presentation (P value 0.001). 120patients had intra-ventricular extension of hemorrhage in their CT films, 120 patients had pressure effect of the hemorrhage, and 104 were complicated by edema.CONCLUSION:Males are more affected than females by spontaneous intra-cerebral hemorrhage which tends to occur more commonly in a deep seated area of the brain.Hypertension is the most important risk factor. There is great correlation between patients’ presentations and the site of hemorrhage. Patients 50 years and older are more liable for spontaneous intra-cerebral hemorrhage..


Article
OBSERVING THE OUTCOME OF USING NEUROAID [MLC 601] ON A SAMPLE OF IRAQI STROKE PATIENTS

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Abstract

Background:Stroke is one of the major causes of morbidity and mortality throughout the world, and carries greater economic costs. [MLC 601] originates from Traditional Chinese Medicine approved in 7 countries as drug that can aids post-stroke recovery.Objective:To assess [MLC 601] efficacy in improving outcomes of Iraqi patients’ stroke.Methods:Two hundreds ischemic stroke patients and 17 intracerebral hemorrhage patients were participated in this study; they took [MLC601] at the onset of their disease for 3 months and were assessed monthly for the motor power using modified Rankin scale mRs scale, speech, and visual field assessments.Results:mRs grade [4-5] were changed from (zero out of 159) at onset to (89 out of 55) at first month and to 98 out of 134 ischemic stroke patients after 3 months; also mRs grade [4-5] were changed from (1 out of 17) at onset to (12 out of 17) at first month and to 12 out of 17 intracerebral hemorrhage patients after 3 months. In 44% of the enrolled patients with aphasia were improved. Visual field assessments showed improvement in 43% of the patients with homonymous heminopia after 3 months [MLC 601] treatment.Conclusion:[MLC 601] is associated with improvement in all post stroke disabilities and placebo controlled trial is crucial to assess the benefit of it.Key worlds:Stroke, intracerebral hemorrhage, MLC 601, NeuroAid


Article
Low Cholesterol as a Risk Factor for Spontaneous Intracerebral Hemorrhage

Author: Hawar Adnan Mykhan *, Nawfal Madhi Sheaheed** , Akram Mohammad Almahdawi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2018 Volume: 17 Issue: 3 Pages: 278-284
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Epidemiological studies indicate a higher incidence of intracerebral hemorrhage among persons with low total serum cholesterol level.OBJECTIVE: To examine the prospective relationship of total serum cholesterol with a subsequent intracerebral hemorrhage in an Iraqi population sample.PATIENTS AND METHODS: A case-control study was performed to assess the relationship between spontaneous intracerebral hemorrhage (ICH) and low serum cholesterol. Eighty patients were admitted, from April 2007 to April 2008, to both Baghdad Teaching Hospital and Sulaimaniyah General Teaching Hospital with a diagnosis of spontaneous ICH. All the patients aged 50 or more years. After the initial review for exclusion criteria, 62 patients were enrolled. The other patients were excluded because of secondary causes of hemorrhages. Brain CT scan was done at the radiology department of both hospitals and read by radiologists. Fasting serum lipid profile was evaluated by the laboratory staff of the hospitals.RESULTS: It was noticed that the cholesterol values fall acutely after hemorrhage. Mean total cholesterol was significantly lower within 48 h (total cholesterol 1TC1) and 1-2 weeks (total cholesterol 2TC2) than in 3 months (total cholesterol 3TC3), following hemorrhage. In addition, no significant change between TC1 and TC2 groups was noticed, though TC1 values proved to be somewhat higher. A significantly increased proportion (42%) of hemorrhage cases had TC3 values that were in the sex specific lowest quintile of the control group (20%). Dividing the cases according to likely etiology demonstrated similar overrepresentations within the hypertensive and non-hypertensive subgroups.CONCLUSION: Our data in patients with proved spontaneous ICH confirm the population based observation that individuals with the lowest cholesterol levels are at increased risk of ICH.


Article
Acute Kidney Injury in Patients with Acute Stroke

Author: Zaid Waleed Ali*, Ali A. Allawi, Hasan A. Al-Hamadani
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2019 Volume: 18 Issue: 3 Pages: 234-241
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

BACKGROUND:According to world health organization, about 15 million people suffer from stroke worldwide eachyear. Acute kidney injury complicates 5-7% of acute care hospital admissions and up to 30% ofcritical care patients. These in turn lead to increase disability, decreased quality of life anddisproportionate burden on healthcare resources. Patients admitted for diagnosis and treatmentof acute stroke are at high risk of developing acute kidney injury due to comorbid conditions, poororal intake and exposure to nephrotoxic agents.OBJECTIVE:to determine the incidence of acute kidney injury in patients admitted with acute stroke andevaluates associated comorbidities and possible risk factors.PATIENTS AND METHODS:in a cross-sectional study, a cohort of 436 patients admitted with acute stroke, (327 with ischemicstroke and 109 with intracerebral hemorrhage) entailed in this study.Serum creatinine readings using Jaffe method was obtained at first day of insult, after 48 hours and 7days after onset of stroke, KDIGO criteria was used to define patients who developed acute kidneyinjury which include elevation of serum creatinine of 0.3 mgdl or more within 48 hours or 1.5 foldor more increment of baseline serum creatinine within 7 days.RESULTS:Acute kidney injury was a common complication in acute stroke population with total incidence13.5%, with significantly higher incidence in intracerebral hemorrhage group (22.9%) than inischemic group (10.4%) p=0.000919. The study also show significant sex difference with higherincidence in males than females in ischemic group (13.4% vs 6.7%; p= 0.049) intracerebralhemorrhage group (31.5% vs 12.3%; p=0.0246).Study also shows significant relation between developing acute kidney injury and history ofhypertension in both groups with p=0.00229, and significant relation with diabetes mellitusp=0.009096.Study shows that there is significant elevation of serum creatinine on consecutive measures betweenfirst day and day 7 with p=0.000.We found that there is significant direct relation between increasing age and incidence of acutekidney injury with p=0.040 in ischemic group and p= 0.015 in intracerebral hemorrhage group.CONCLUSION:The incidence of acute kidney injury in acute stroke patients was 13.5% with significantly higherincidence in intracerebral hemorrhage group with significant relation between development of acutekidney injury and being male, has hypertension, diabetes mellitus or advance age.


Article
Medico-Legal Comparative Study Between Traumatic and Spontaneous Intracerebral Hemorrhage

Authors: Yasser Salem Selman. Al-Yessary --- Nabeel Ghazi Hashim Al-Khateeb --- Ahmed Samir Al-Naaimi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 2 Pages: 259-267
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

BSTRACT: INTRODUCTION:Intracerebral hemorrhage may be pathological ortraumatic in nature. It may be primary orsecondary BACKGROUND: Traumatic intracerebral hemorrhage (TICH) is a subtype of intracranial hemorrhage that occurswithin the brain tissue itself and lead to displacement or destruction of brain tissue with high rate.Spontaneous intracerebral hemorrhage (SICH) is defined as a blood clot that arises in the brainparenchyma in the absence of trauma or surgery. OBJECTIVE: The aim of this study is to determine the frequency of fatal traumatic and spontaneous intracerebralhemorrhage, and to differentiate between them in postmortem examination. METHODS: This cross-sectional study is performed in the medico-legal institute of Baghdad for (6) monthsduration from (1-10-2011) to (1-4-2012). Complete medico-legal history was obtained, and fullproper autopsy including external and internal examination of all corpuses was performed speciallythe head. RESULTS: The study included (38) cases of intracerebral hemorrhage; (27) of them were (TICH). Their agesranged between (5 –65) years, and (11) of them were (SICH) with an age ranging between (15 –75)years. Traumatic group was associated with male preponderance and younger age, whilespontaneous group were females and older age. The most common cause of head injuries in thetraumatic group was "missiles" followed by road traffic accidents. Comminuted fractures were themost common type of skull fracture. Brain laceration and contusion were the two most frequentlyobserved associated lesions in the traumatic cases. The "intraventricular" Site was the most frequent in traumatic group, while the "Basal ganglia" was the most frequent inthe spontaneous group. The anterior cerebral artery was the most frequently affected artery intraumatic group, while the middle cerebral artery was the most frequently affected artery inspontaneous group. CONCLUSION: we identified seven basic rules that can be used during autopsy examination in all cases ofintracerebral hemorrhage to differentiate easily between traumatic and spontaneous intracerebralhemorrhage


Article
Predictors of Outcome for Spontaneous Intracerebral Hemorrhage in Iraqi Stroke Patients

Authors: Zaki N. Al Mousawi --- Kareem M. Al Tameemi --- Ghazi Farhan Haji
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2012 Volume: 11 Issue: 4 Pages: 503-509
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACK GROUND:Primary intracerebral hemorrhage (ICH) is one of the common vascular insults with a relatively high rate of morbidity and mortality and there are many factors which influence the outcome.OBJECTIVE:The aim of this study is to determine potential early predictors of outcome within first six days of primary spontaneous supratentorial hemorrhage and to evaluate the influence of those various factors on the mortality and morbidity of patients with intracerebral hemorrhage (ICH).METHOD:70 patients (48 men and 22 women) were admitted to Baghdad teaching hospital, for the period from January 2010 to January 2011. They were diagnosed with supratentorial hemorrhage by brain CT. Total Serum cholesterol, the vital signs and the size of hematoma were arranged for each patient at the time of admission, then a modified Rankin scale (mRS) was calculated at 6th day after the onset of this catastrophe.RESULT:Of the 70 patients (48 men and 22 women) consecutively admitted with ICH, 24 (38%) were died in the hospital: 31.5% on the first and second days and 82.5% by the fourth, fifth and sixth day of the event. The mRS outcome results were as follow: 8 (12.9%) good outcome mRS = (2), 38 (62.9%) were dependent mRS= (3-5) and 24 (34.3%) were died mRS = (6).CONCLUSION:High mortality and morbidity (high mRS scores value) were observed in patient with large hematoma size, low serum cholesterol, and high vital signs readings.


Article
Prevalence of Intracerebral Hemorrhage and Its Risk Factors among Stroke Cases Admitted to Sulaimani General Teaching Hospital

Author: Mohammed Tahir Kurmanji
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2018 Volume: 11 Issue: 2 Pages: 3993-4001
Publisher: Kerbala University جامعة كربلاء

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Abstract

background: Although hypertension remains the most common cause of non-traumatic Intracerebral hemorrhage (ICH), several other conditions and lifestyle factors have been associated with ICH such as age, gender, race differences, cigarette smoking, alcohol, drug abuse, anticoagulant treatment, dyslipidemia, and others .Aim: Our aims are to estimate a prevalence and incidence of ICH among stroke cases within Sulaimani’s people, in addition to investigate the main risk factors of patients with ICH among stroke cases admitted to General teaching hospital in Sulaimani city.Patients and method: In this study, 108 patients with either ischemic stroke or non-traumatic ICH were enrolled; these patients were recorded in Sulaimani General Teaching Hospital with a special form of demographic data. All patients were thoroughly examined and investigated with brain CT scan for all and brain MRI for some of them.Discussion: Out of 108 stroke patient admitted, 33 patients (30.6%) had ICH, while 75 patients (69.4%) had ischemic stroke, 19 cases (out of 33) (57.58%) of ICH patients were females, while 14 (42.42%) of them were males. Among the modifiable risk factors of ICH, hypertension remains the most common risk which was present in 25 patients out of 33 (75.8%), but dyslipidemia and diabetes mellitus were other less common risk factors which might have predisposed to the occurrence of ICH.In conclusions: Spontaneous intracerebral hemorrhage, which is a common cause of mortality and morbidity, is relatively a common form of stroke in our locality which is more predominant in females. Hypertension is the main risk factor for spontaneous ICH


Article
Accuracy of clinical scores in differentiatingstroke subtypes in Mosul

Authors: Mahmood Mal-Allah محمود مال الله --- Khalid Gh. Hameed Al-Abachi خالد غانم حامد العباجي --- Hakki Mohammed Majdal حقي محمد مجدل
Journal: Annals of the College of Medicine Mosul مجلة طب الموصل ISSN: 00271446 23096217 Year: 2010 Volume: 36 Issue: 1&2 Pages: 49-55
Publisher: Mosul University جامعة الموصل

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Abstract

ABSTRACT
Objectives: To study the validity of clinical scores in differentiating intracerebral hemorrhage and ischemic stroke and to see which of them is more applicable in our hospitals.
Methods: A prospective study of 100 consecutive patients with acute neurological deficit admitted as inpatient to the neurological unit in Ibn-Sina Teaching Hospital in the city of Mosul, evaluated with computed tomography and Allen and Siriraj scores to determine the pathological type of stroke during the period from September 15th 2008 and January 28th 2009.
Results: The prevalence of hemorrhage (diagnosed with computed tomography) was 19%. Allen scores were "uncertain" in 13 cases and Siriraj scores in 17 cases; Sensitivity, specificity, positive and negative predictive values, for haemorrhage were 0.53, 0.96, 0.77 and 0.90, for Allen scores and 0.79, 0.97, 0.88, and 0.95 for Siriraj scores; such values for infarction were 0.91, 0.89, 0.97, and 0.71 for Allen scores and 0.80, 0.95, 0.98 and 0.53 for Siriraj scores.
Conclusion: When CT-Scan is not immediately available and the clinician wishes to start antithrombotic treatment, the Siriraj score (and possibly the Allen score) can be useful to identify patients at low risk of intracerebral hemorrhage and The Siriraj score is simple, cheap, reliable and practical method which can be used immediately after the stroke.

Keywords: Ischemic stroke IS, intracerebral hemorrhage ICH, computerized tomography (CT-Scan), Allen Hospital score (AS), Siriraj stroke Score (SS).

الهدف من البحث: لدراسة مصداقية المقاييس السريرية في التفريق بين السكتة الدماغية التعطشية والنزف داخل المخ، ومعرفة أي من المقاييس أكثر عملية للتطبيق في مستشفياتنا.الوسائل: الدراسة شملت 100 مريض كانوا يعانون من خلل عصبي حاد، أدخلوا وحدة الإمراض العصبية في مستشفى ابن سينا التعليمي في الموصل للفترة من 25/9/2008م – 28/1/2009م، وأجري لهم فحص مفراس الدماغ وقيمت حالاتهم بواسطة كلا المقياسين ألين وسيريراج لتحديد نوع السكتة الدماغية أهي تعطشية أم نزف داخل المخ.النتائج: نسبة حدوث النزف داخل المخ (المشخص بواسطة جهاز المفراس) كانت 19%. مقياس ألين كان غير واضح في 13% من الحالات، بينما مقياس سيريراج كان غير واضح في 17% من الحالات بينما كانت الحساسية والدقة والقيمة التنبؤية الموجبة لحالات النزف داخل المخ حسب مقياس ألين هي (0,53) (0,96) (0,77) على التعاقب، بينما كانت حسب مقياس سيريراج هي (0,79) (0,97) (0,88). أما لحالات السكتة الدماغية التعطشية فكانت (0,91) (0,89) (0,97) حسب مقياس ألين على التعاقب وكانت حسب مقياس سيريراج (0,80) (0,95) (0,98) على التعاقب.الاستنتاجات: في حالة عدم التمكن من إجراء فحص المفراس بصورة فورية للمرضى وعند رغبة الطبيب المعالج بإعطاء علاج مانع التخثر، مقياس سيريراج (ومن الممكن أيضا مقياس ألين) يمكن أن يكون مفيدا لتحديد المرضى ذو الخطورة الأقل للإصابة بنزف داخل المخ. مقياس سيريراج هو مقياس بسيط، غير مكلف، عملي ومن السهل استعماله مباشرة بعد حصول السكتة الدماغية .

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