BMC Neurology最新文献

{"title":"Effect of Statin Therapy on Neurological Outcomes in Aneurysmal Subarachnoid Hemorrhage: A Meta-Analysis of 1464 Patients.","authors":"Abdelrahman Hafez, Ahmed Abdelaziz, Ibrahim Kamal, Ahmed Farid Gadelmawla, Rehab Adel Diab, Shrouk Ramadan, Mohamed Hatem Ellabban, Ahmed Elaraby, Karim Atta, Mohamed Mahmoud Gomaa, Mohamed Abdelaziz, Ahmed O Sena, Ahmed Nasr, Mazen Hassanin, Omar Abdelgawwad, Ahmed Almahdy Mohamed, Ahmed Bahnasy, Emad Singer","doi":"10.1186/s12883-025-04286-2","DOIUrl":"https://doi.org/10.1186/s12883-025-04286-2","url":null,"abstract":"<p><strong>Background: </strong>Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening condition complicated by cerebral vasospasm and deterioration of neurological functions. Statins have been proven to reduce the incidence of vasospasm and limit the neurological deterioration with controversial data. We aimed to give a comprehensive assessment of statins in patients with aSAH.</p><p><strong>Methods: </strong>We retrieved PubMed, Scopus, WOS, and the Cochrane library for RCTS assessing the efficacy of statins in patients with aSAH from inception to April 2024. Cerebral vasospasm and neurological deterioration were the primary efficacy outcomes of interest. Other secondary efficacy outcomes were delayed ischemic neurological deficits, and all-cause mortality. Safety outcomes were cerebral infarction, rhabdomyolysis, and elevated transaminase levels. STATA 18MP was used to analyze the data using a random-effect model.</p><p><strong>Results: </strong>A total of nine RCTs comprising 1464 patients, with a mean follow-up of 6 months were included in the final analysis. After 2 weeks of administration, statins were associated with a lower risk of cerebral vasospasm (OR: 0.74, 95% CI: 0.57 to 0.96, p = 0.03; I² = 0.00, p = 0.91), with no significant difference in the incidence of neurological deterioration (OR: 0.92, 95% CI: 0.75 to 1.14, p = 0.45; I² = 0.00, p = 0.84). There were no significant differences were observed in other reported outcomes.</p><p><strong>Conclusion: </strong>Statins were associated with reduced vasospasm with no notable improvement in neurological prognosis. However, the 2-week time window of statins is powered by small sample size, and further large-volume RCTs are warranted.</p>","PeriodicalId":9170,"journal":{"name":"BMC Neurology","volume":"25 1","pages":"349"},"PeriodicalIF":2.2,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12376394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Occurrence of fatal vertebrobasilar dolichoectasia after occlusion of unilateral internal carotid artery.","authors":"Haochen Huang, Zhe Ji, Simin Wang, Tongyu Zhang, Jingwei Li, Chuan He, Hongqi Zhang","doi":"10.1186/s12883-025-04376-1","DOIUrl":"10.1186/s12883-025-04376-1","url":null,"abstract":"<p><strong>Background: </strong>Vertebrobasilar dolichoectasia (VBD) is a rare cerebrovascular disorder. The natural history of patients with VBD is generally poor, and current treatments do not appear to provide significant clinical benefit. Therefore, understanding the underlying mechanisms of VBD and implementing appropriate strategies in advance are particularly important.</p><p><strong>Case presentation: </strong>In the first case, a 15-year-old boy initially presented in July 2020 with recurrent mild nausea and vomiting. He was diagnosed with left internal carotid artery (ICA) occlusion secondary to a giant fusiform aneurysm, along with a cerebellar arachnoid cyst. The patient received conservative treatment but did not adhere to the recommendation for regular follow-up. In August 2023, he developed hydrocephalus and severe brainstem compression caused by VBD. Ventriculoperitoneal (V-P) shunting failed to prevent rapid clinical deterioration, which eventually led to fatal intracranial hemorrhage. The second case involved a 9-year-old boy who initially presented in June 2013 with hydrocephalus and underwent V-P shunting. In June 2020, he was diagnosed with right ICA dolichoectasia during an evaluation for neck discomfort and subsequently underwent ligation of the right ICA. In March 2022, he experienced an acute onset of altered consciousness, and neuroimaging confirmed brainstem compression due to VBD. Considering the high anesthetic risk and the limited potential benefit of further surgical intervention, treatment was withdrawn, and the patient ultimately died of brainstem infarction.</p><p><strong>Conclusions: </strong>These cases highlight the importance of close monitoring in pediatric patients with ICA occlusion, given the associated risk of VBD. Further research into the pathogenesis of VBD, particularly in pediatric patients, is essential to develop more effective preventive and therapeutic strategies.</p>","PeriodicalId":9170,"journal":{"name":"BMC Neurology","volume":"25 1","pages":"350"},"PeriodicalIF":2.2,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12379313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case report of autoimmune glial fibrillary acidic protein astrocytopathy combined with Epstein-Barr virus infection.","authors":"Qi An, Limei Liu","doi":"10.1186/s12883-025-04363-6","DOIUrl":"https://doi.org/10.1186/s12883-025-04363-6","url":null,"abstract":"<p><strong>Background: </strong>This report provides a comprehensive overview of the clinical manifestations, diagnostic evaluations, treatment, and prognosis of a 36-year-old male patient diagnosed with autoimmune glial fibrillary acidic protein astrocytopathy (GFAP-A) in conjunction with Epstein-Barr virus (EBV) infection at our institution. Reports of GFAP-A associated with viral infections are infrequent.</p><p><strong>Case presentation: </strong>The patient exhibited a range of symptoms, including fever, gait instability resembling ataxia, a sensation akin to stepping on cotton, diminished responsiveness, cognitive decline, urinary and bowel dysfunction, and persistent hiccups. Enhanced imaging of the thoracic spine revealed patchy meningeal enhancement, with central canal-like enhancement observed in coronal views. Additionally, radiating perivascular linear enhancement was noted in the ventricular white matter, cerebellum, and other regions, alongside the aforementioned central canal-like enhancement. Next-generation sequencing (NGS) of cerebrospinal fluid (CSF) confirmed the presence of human herpesvirus type 4 (EBV). Both cell-based assay (CBA) and tissue-based assay (TBA) tests validated the presence of GFAP antibodies in the CSF. Following treatment with acyclovir for antiviral therapy and high-dose corticosteroid therapy, the patient demonstrated significant clinical improvement.</p><p><strong>Conclusions: </strong>It is postulated that the viral infection may have precipitated autoimmune meningoencephalitis. Providing more related cases for the diagnosis of this disease.</p>","PeriodicalId":9170,"journal":{"name":"BMC Neurology","volume":"25 1","pages":"347"},"PeriodicalIF":2.2,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12376438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravenous tenecteplase thrombolysis and endovascular bridging intra-arterial tirofiban injection therapy in a pediatric case of acute ischemic stroke.","authors":"Ying Zhang, Chang-Xing Jiang, Hong-Gang Wang, Hao-Ran Gao, Dan Li, Lei Zhao, Li-Hong Gao","doi":"10.1186/s12883-025-04358-3","DOIUrl":"https://doi.org/10.1186/s12883-025-04358-3","url":null,"abstract":"<p><strong>Background: </strong>Acute ischemic stroke (AIS) in pediatric patients is a significant contributor to neurological impairment and long-term disability. Due to the absence of specific pediatric treatment guidelines, management strategies are frequently adapted from adult protocols. This report details the application of intravenous tenecteplase thrombolysis, endovascular bridging therapy, and tirofiban in treating a pediatric case of AIS.</p><p><strong>Case description: </strong>A pediatric patient presented with AIS involving the left limb, lasting 2.5 h. The stroke occurred during physical activity without loss of consciousness or seizures. Head magnetic resonance imaging (MRI) combined with clinical manifestations confirmed the diagnosis of acute cerebral infarction. Intravenous thrombolytic therapy using tenecteplase was initiated in the ultra-early phase of infarction. Subsequent cerebral angiography revealed occlusion of the superior trunk of the right middle cerebral artery. Three-dimensional rotational imaging identified multiple aneurysms at its bifurcation. A targeted intra-arterial injection of tirofiban (6 mL) was administered to stabilize plaque and enhance blood flow. The patient underwent 11 days of antiplatelet therapy and supportive care. At the 90-day postoperative follow-up, notable recovery of limb function was observed.</p><p><strong>Conclusions: </strong>Pediatric AIS exhibits variable clinical manifestations, requiring head MRI for definitive diagnosis. Early initiation of intravenous thrombolysis with tenecteplase, combined with targeted intra-arterial tirofiban injection, demonstrates potential as a safe and effective therapeutic approach in pediatric ischemic stroke management.</p>","PeriodicalId":9170,"journal":{"name":"BMC Neurology","volume":"25 1","pages":"348"},"PeriodicalIF":2.2,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12376366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144942986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between acid-suppressant use and self-reported stroke.","authors":"Xiaoqu Zuo, Xinghai Yue, Hongwu Tao","doi":"10.1186/s12883-025-04334-x","DOIUrl":"https://doi.org/10.1186/s12883-025-04334-x","url":null,"abstract":"<p><strong>Background: </strong>The association between proton pump inhibitors (PPIs) and stroke remains controversial, while H₂ receptor antagonists (H₂RAs) have been less studied in relation to stroke. This study aimed to explore the relationship between PPIs, H₂RAs, and overall acid-suppressant medications with stroke using data from the National Health and Nutrition Examination Survey (NHANES) 1999-2018.</p><p><strong>Methods: </strong>Data on acid-suppressant use were obtained from the NHANES prescription medication survey for the past month, classifying individuals using PPIs or H2RAs as acid-suppressant users. Stroke data were derived from the disease questionnaire. Propensity score matching (PSM) was applied to reduce intergroup differences, followed by weighted multivariable logistic regression and subgroup analyses to examine the association between acid-suppressant use (including the use of PPIs and H2RAs) and stroke.</p><p><strong>Results: </strong>A total of 54,918 participants were included before matching, among whom 5,776 (10.5%) were acid-suppressant users. Stroke was reported in 551 (9.5%) acid-suppressant users and in 1,643 (3.3%) of the 49,142 non-users. After 1:3 propensity score matching, 14,390 participants were retained, including 3,740 acid-suppressant users and 10,650 non-users. Among them, 316 users (8.4%) and 614 non-users (5.8%) reported having had a stroke. Weighted logistic regression analysis indicated a significant association between acid-suppressant use and stroke. The association remained statistically significant both before matching (OR: 1.37, 95% CI: 1.15-1.63, P < 0.001) and after matching (OR: 1.33, 95% CI: 1.10-1.60, P = 0.003). In addition, the association between H2RA use and stroke remained significant before and after matching, whereas the association between PPI use and stroke appeared less stable, showing borderline significance.</p><p><strong>Conclusion: </strong>Our findings suggest a significant association between the use of acid-suppressive medications and stroke; however, due to the limitations of cross-sectional study design and self-reported data, this result requires further verification in future research.</p>","PeriodicalId":9170,"journal":{"name":"BMC Neurology","volume":"25 1","pages":"346"},"PeriodicalIF":2.2,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12376369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cauda equina nerve root enhancement in adult intestinal toxemia botulism.","authors":"Ruiji Jiang, Benjamin Beland, Vinil Shah, Min Kang, Douglas B Pet","doi":"10.1186/s12883-025-04365-4","DOIUrl":"https://doi.org/10.1186/s12883-025-04365-4","url":null,"abstract":"<p><strong>Background: </strong>Adult botulism is a rare, life-threatening condition typically caused by exposure to preformed botulinum neurotoxin (BoNT). Acute intestinal toxemia botulism (AITB) is an uncommon subtype resulting from colonization of Clostridium botulinum in the intestines. Diagnosis is made by detecting BoNT in the patient's blood, stool, or gastric fluid. AITB is confirmed when C. botulinum is isolated in culture. Electrodiagnostic studies may support the diagnosis, while imaging-when performed-is generally used to exclude alternative conditions.</p><p><strong>Case presentation: </strong>A 74-year-old man presented with acute dysarthria and ophthalmoparesis, which rapidly progressed to quadriparesis and respiratory failure requiring intubation. Magnetic resonance imaging (MRI) revealed thickening and enhancement of the cauda equina nerve roots. Due to high clinical suspicion for botulism, heptavalent botulinum antitoxin was administered. Intravenous immunoglobulin was also given, as the imaging findings raised concern for an alternative diagnosis of Guillain-Barré syndrome (GBS). Blood and stool samples later tested positive for BoNT type A, and C. botulinum was isolated from the stool, confirming AITB. The patient experienced a gradual but prolonged recovery of motor function following treatment.</p><p><strong>Conclusions: </strong>Botulism in both infants and adults is not typically associated with abnormal neuroimaging findings. To our knowledge, this is the first reported case of cauda equina nerve root thickening and enhancement on MRI in AITB-or in adult botulism more broadly. We outline the differential diagnosis, pathophysiology, and treatment of botulism. This case underscores that abnormal neuroimaging should not delay prompt empiric treatment for botulism when clinical suspicion is high.</p>","PeriodicalId":9170,"journal":{"name":"BMC Neurology","volume":"25 1","pages":"343"},"PeriodicalIF":2.2,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12372212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The management outcomes of chronic subdural hematoma in HIV-Infected individuals.","authors":"Kuzolunga Xulu, Nomusa Shezi, Basil Enicker","doi":"10.1186/s12883-025-04364-5","DOIUrl":"10.1186/s12883-025-04364-5","url":null,"abstract":"<p><strong>Background: </strong>Chronic subdural hematoma (CSDH) typically affects the elderly and is associated with significant morbidity and mortality. However, data on its presentation and outcomes in individuals living with HIV are limited. The purpose of the study was to describe the clinical profile and management outcomes of CSDH in HIV-infected patients.</p><p><strong>Methods: </strong>A retrospective review was conducted between January 2006 and December 2022. Patients were stratified into two groups based on CD4 count ≥ and < 200 cells/µL. Variables analyzed included demographics, clinical characteristics, anti-retroviral therapy (ART) status, radiological findings, surgical management and outcomes.</p><p><strong>Results: </strong>Forty-eight patients were included, with a median age of 38 years. The majority (52.1%) had a CD4 count ≥ 200 cells/µL. Males comprised 50% of the cohort, with a higher proportion of males in the CD4 count ≥ 200 group (p = 0.029). The median admission Glasgow Coma Scale (GCS) was 14. Common clinical presentations included headaches (47.9%) and hemiparesis (43.8%). ART coverage was 58.3%, and bilateral CSDH was diagnosed in 25%. Most patients (72.9%) received two burr holes. Postoperative complications included recurrence (16.7%), septicemia (10.4%), and subdural empyema (2.1%). Mortality rate was 14.6%. Factors significantly associated with mortality included low GCS, INR > 1.2 and septicemia.</p><p><strong>Conclusions: </strong>CSDH in HIV-infected individuals presents at a younger age than in the general population. While most patients had CD4 count of ≥ 200 cells/µL, CD4 level was not a predictor of surgical outcome. Mortality was associated with low GCS, increased INR, and septicemia.</p>","PeriodicalId":9170,"journal":{"name":"BMC Neurology","volume":"25 1","pages":"341"},"PeriodicalIF":2.2,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Favorable responses to upadacitinib, a JAK1 inhibitor, in long COVID patients with predominant neuropsychiatric symptoms: case reports in 2 autistic patients and one typically developing patient.","authors":"Harumi Jyonouchi, Jeffery Kornitzer, Lee Geng","doi":"10.1186/s12883-025-04341-y","DOIUrl":"10.1186/s12883-025-04341-y","url":null,"abstract":"<p><p>The long-term impact of coronavirus disease 2019 (COVID-19) has become evident over the past 3-4 years, with the recognition of post-COVID long-term sequelae, often referred to as long COVID. Neuropsychiatric symptoms are one of the hallmarks of long COVID. In severe cases, it can even present features of encephalopathy. Since some of the neuropsychiatric symptoms associated with long COVID overlap symptoms found in neuropsychiatric disorders, it has been difficult to sort out the effects of long COVID in such subjects. This is especially true in patients diagnosed with autism spectrum disorders (ASD), given their difficult behavioral symptoms and other co-morbid conditions. COVID-19 is thought to affect the onset or progress of encephalopathy symptoms by activation of the immune system through the type 1 interferon (IFN) signaling pathway. In that case, treatment would require an immunomodulating agent that targets such pathways. However, such measures may not be applied to ASD subjects, in whom long COVID may not even be considered as the cause of their symptoms. In this study, we present the beneficial effects of upadacitinib, a JAK (janus kinase) 1 inhibitor, that blocks downstream signaling of type 1 IFNs, on 3 patients, 2 with ASD and one without ASD. In these patients, long COVID was thought to have triggered or aggravated encephalopathy-like symptoms. The beneficial effects of upadacitinib were not only noted by an improvement of their behavioral symptoms but also shown by an improvement of monocyte cytokine profiles (less activated state); peripheral blood monocytes were used as surrogates of microglial cells. These three cases presented highlight a possible use of JAK inhibitors for treating long COVID-associated neuropsychiatric symptoms in both ASD and non-ASD subjects. The presented cases highlight the inherent difficulty of diagnosing long COVID in ASD cases.</p>","PeriodicalId":9170,"journal":{"name":"BMC Neurology","volume":"25 1","pages":"342"},"PeriodicalIF":2.2,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12366086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infantile ruptured acom aneurysm treated with endovascular stent-coil embolization: case report.","authors":"Yigit Can Senol, Halis Emre Ciftci, Naime Dilara Ozkan, Bige Sayin, Ergun Daglioglu","doi":"10.1186/s12883-025-04366-3","DOIUrl":"10.1186/s12883-025-04366-3","url":null,"abstract":"<p><p>A 15-month-old infant presented with an episode of acute agitation, characterized by crying, refusal to feed, and a focal seizure involving the left arm and leg lasting 1-2 min. Following the seizure, the infant fell asleep but experienced another brief seizure during transport to the hospital. Initial assessment at a private hospital in Mersin, Turkey, led to a referral to our center, where imaging revealed an intraparenchymal hemorrhage in the left frontobasal region. The hemorrhage extended into all ventricles and the right retrosellar area, with notable rightward shift and ventricular enlargement. CTA confirmed a ruptured Acom aneurysm with a bleb. Diagnostic angiography was performed, and an endovascular stent coiling procedure was performed without hematoma evacuation. At 1-year follow-up, patients' symptoms improved without neurological sequelae, and MR angiography revealed no residual filling in the aneurysm.</p>","PeriodicalId":9170,"journal":{"name":"BMC Neurology","volume":"25 1","pages":"334"},"PeriodicalIF":2.2,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12344916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144844457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heterogeneous hematoma density predicts poor outcome in patients with supratentorial intracerebral hemorrhage after craniotomy.","authors":"Li Luo, Yuanyuan Fu, Likun Wang, Jinhua Yang, Guofeng Wu, Siying Ren, Lian He, Shiqi Lin, Yuanyi Liu","doi":"10.1186/s12883-025-04348-5","DOIUrl":"10.1186/s12883-025-04348-5","url":null,"abstract":"<p><strong>Background and objective: </strong>The density of hematoma is an imaging marker that has been used to predict hematoma expansion (HE) in patients with supratentorial intracerebral hemorrhage (SICH). However, its relationship with postoperative rebleeding and outcomes in surgical patients remains unclear. This study aimed to evaluate the impact of hematoma density on postoperative rebleeding and outcomes in patients with spontaneous supratentorial ICH after craniotomy.</p><p><strong>Methods: </strong>This retrospective study included 331 patients with spontaneous SICH who underwent craniotomy at the affiliated Jinyang Hospital of Guizhou Medical University, between January 2019 and October 2023. Hematoma density was classified as heterogeneous if there were ≥ 3 low-density lesions within the ICH. The primary outcome measure was major disability, defined as a modified Rankin Scale score of 4-6. Patients were divided into homogeneous (n = 182) and heterogeneous (n = 149) groups based on computed tomography (CT) features at admission. A multivariate logistic regression model was used to analyze the independent correlation between hematoma density and postoperative rebleeding and poor outcomes.</p><p><strong>Results: </strong>At 30 days and 6 months after craniotomy, among the 149 patients with heterogeneous density, 95 (63.8%) and 79 (53.0%) patients had a poor outcome, respectively. In contrast, among the 182 patients with homogeneous density, 74 (40.7%) and 61 (33.5%) had poor outcomes. Multivariate logistic regression analysis demonstrated that heterogeneous density independently predicts poor outcomes at 30 days (odds ratio 2.354; 95% confidence interval [1.446-3.833]; P<0.001) and 6 months (odds ratio 2.039; 95% confidence interval [1.268-3.279]; P=0.003) in patients with ICH after craniotomy but not rebleeding after craniotomy.</p><p><strong>Conclusions: </strong>Heterogeneous hematoma density predicts poor outcomes at 30 days and 6 months in patients with spontaneous supratentorial ICH after craniotomy.</p>","PeriodicalId":9170,"journal":{"name":"BMC Neurology","volume":"25 1","pages":"336"},"PeriodicalIF":2.2,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12351923/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144844455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}