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Purpose: To investigate the therapy effect of minimally invasive fourth-ventricle hematoma removal (MIFHR) for patients with intraventricular hemorrhage (IVH) casting and the influence of feedback early rehabilitation on post-operative neurological function., Methods: Eighty patients with IVH casting were enrolled from January 2019 to December 2020 in this retrospective study. Forty patients receiving MIFHR with feedback early rehabilitation were divided into the observational group, while the others receiving bilateral external ventricular drainage with traditional rehabilitation were divided into the control group. Glasgow Coma Scale (GCS) and neurological function before and after operation were compared between the two groups. In addition, hematoma clearance rate three days after surgery, drainage duration, hospitalization time, motor function and activity daily living (ADL) six months after surgery, and incidence of complications were also compared., Results: No significant differences were observed in GCS score and neurological function before surgery between the two groups (both P > .05). At the same time, there were significant differences GCS score and neurological function after surgery (both P < .05). Hematoma clearance rate three days after surgery, drainage duration, hospitalization time, and incidence of complications in the observational group were lower than those in the control group (all P < .05). In contrast, motor function and ADL six months after surgery were better in the observational group (both P < .05)., Conclusion: MIFHR combined with feedback early rehabilitation is conducive to the recovery of neurological function, motor function, and ADL without increasing the incidence of complications.

Background and Purpose: We assessed the elemental and biochemical effects of rehabilitation after intracerebral hemorrhage, with emphasis on iron-mediated oxidative stress, using a novel multimodal biospectroscopic imaging approach., Methods: Collagenase-induced striatal hemorrhage was produced in rats that were randomized to enriched rehabilitation or control intervention starting on day 7. Animals were euthanized on day 14 or 21, a period of ongoing cell death. We used biospectroscopic imaging techniques to precisely determine elemental and molecular changes on day 14. Hemoglobin content was assessed with resonance Raman spectroscopy. X-ray fluorescence imaging mapped iron, chlorine, potassium, calcium, and zinc. Protein aggregation, a marker of oxidative stress, and the distribution of other macromolecules were assessed with Fourier transform infrared imaging. A second study estimated hematoma volume with a spectrophotometric assay at 21 days., Results: In the first experiment, rehabilitation reduced hematoma hemoglobin content (P=0.004) and the amount of peri-hematoma iron (P<0.001). Oxidative damage was highly localized at the hematoma/peri-hematoma border and was decreased by rehabilitation (P=0.004). Lipid content in the peri-hematoma zone was increased by rehabilitation (P=0.016). Rehabilitation reduced the size of calcium deposits (P=0.040) and attenuated persistent dyshomeostasis of Cl - (P<0.001) but not K + (P=0.060). The second study confirmed that rehabilitation decreased hematoma volume (P=0.024)., Conclusions: Rehabilitation accelerated clearance of toxic blood components and decreased chronic oxidative stress. As well, rehabilitation attenuated persistent ion dyshomeostasis. These novel effects may underlie rehabilitation-induced neuroprotection and improved recovery of function. Pharmacotherapies targeting these mechanisms may further improve outcome., (© 2016 American Heart Association, Inc.)

Thalamic hemorrhages are associated with a variety of cognitive dysfunctions, and it is well known that such cognitive changes constitute a limiting factor of recovery of the activities of daily living (ADL). The relationship between cognitive dysfunction and hematomas is unclear. In this study, we investigated the relationship between aphasia/neglect and hematoma volume, hematoma type, and the ADL. One hundred fifteen patients with thalamic hemorrhage (70 men and 45 women) were studied. Their mean age was 68.9 ± 10.3 years, and patients with both left and right lesions were included. We calculated hematoma volume and examined the presence or absence of aphasia/neglect and the relationships between these dysfunctions and hematoma volume, hematoma type, and the ADL. Fifty-nine patients were found to have aphasia and 35 were found to have neglect. Although there was no relationship between hematoma type and cognitive dysfunction, hematoma volume showed a correlation with the severity of cognitive dysfunction. The ADL score and ratio of patient discharge for patients with aphasia/neglect were lower than those for patients without aphasia/neglect. We observed a correlation between the hematoma volume in thalamic hemorrhage and cognitive dysfunction. Aphasia/neglect is found frequently in patients with acute thalamic hemorrhage and may influence the ADL.

Treatment studies in haemophilia focus on joint bleeds; however, some 10-25% of bleeds occur in muscles. This review addresses management of muscle haematoma in severe haemophilia, defines gaps in the published evidence, and presents a combined clinician and physiotherapist perspective of treatment modalities. The following grade 2C recommendations were synthesized: (i) Sport and activity should be based on individual factor levels, bleeding history and physical characteristics, (ii) Musculoskeletal review aids the management of children and adults, (iii) 'Time to full recovery' should be realistic and based on known timelines from the healthy population, (iv) Diagnosis should be carried out by both a clinician and physiotherapist, (v) Severe muscle bleeds should be treated similarly to surgical patients: a 50% trough for 10-14 days followed by high-level prophylaxis, (vi) Protection, rest, ice, compression and elevation should be implemented in the acute stage, and (vii) Physiotherapy and rehabilitation should be divided into: control of haemorrhage (phase 1); restoration of Range of Movement (ROM) and strength (phase 2); functional rehabilitation and return to normal living (phase 3). Recommendations specifically for inhibitor patients include: (i) Minor to moderate bleeds should be managed by home-treatment within 1 h of bleed onset using either one injection of rFVIIa 270 μg kg(-1), or two to three injections of rFVIIa 90 μg kg(-1) (2-3 h intervals), or FEIBA 50-100 U kg(-1) (repeated at 12-hourly intervals, if necessary) and (ii) Severe muscle bleeds should be supervised by the treatment centre and include bypassing agents until clinical improvement is observed., (© 2011 Blackwell Publishing Ltd.)

Objective: To analyze the clinical characteristics and effects of rehabilitation treatment on hemophiliacs with iliopsoas hemorrage., Methods: The hemophilia patients with iliopsoas bleeding treated in Peking Union Medical College Hospital between January 2006 to December 2010 were enrolled. The clinical characteristics including symptoms, signs, complications, and rehabilitation treatment were analyzed retrospectively., Results: All of the forty-one hemophiliacs with iliopsoas bleeding were male, 20 cases wee the left bleeding, 18 the right, and 3 the bilateral. The median median age was 18 (6 - 61) years old(y). The median age of the iliopsoas bleeding for the first time was 17 (6 - 20) y. 34 patients accompanied with femoral nerve injury, 19 of them had secondary knee bleeding on the same side. 20 patents had quadriceps atrophy. Pelvic pseudotumor developed in 2 patients and permanent abnormal posture in 2 patients. The main finding of the ultrasound image was low-echo mass in iliopsoas muscles or inguinal region. 34 patients received rehabilitation therapy for 8 - 12 weeks under the support of factor replacement, complete hematomas absorption in 33 of them, with hip range of motion recovering back to baseline. 27 of 32 (84.4%) cases with femoral nerve injury got quadriceps strength above 4/5 grade, 20 cases of femoral nerve injury (62.5%) still had numbness on front of their thigh after treatment., Conclusions: In this cohort of iliopsoas bleeding, most of the patients are adolescent. High prevalence of the femoral nerve injury and the secondary knee bleeding are found. Rehabilitation treatment under the support of factor replacement is safe and effective on hematoma absorption and neurological function recovery.

Muscle injuries are common in sports. They are usually caused by either acute (mostly eccentric mechanisms) or chronic overloading with a lack of muscle coordination. They present in clinical practice as bruises and muscle sprains. Due to the rigours of a modern society and the high economic cost of time off work, an effective treatment needs to be employed. The key to an optimised therapy rests in the appropriate timing between immobilisation and mobilisation. The interval to muscle repair might be shortened by certain adjuvant therapies. In doing so, it is important that no physiological phases of wound healing are overlooked. Muscle healing can be accelerated by externally induced higher metabolic turnover. Surgical therapy is sometimes necessary in selected cases and in serious injuries.

A conservative, non-operative physiotherapeutic regime for the management of chronic haematomata and pseudotumours in patients suffering from haemophilia is described in this article. Two cases are described where physiotherapy treatment is applied to large masses at the shoulder and femur respectively, where therapy commenced within the first 6 months following onset. These are presented relative to a case that was managed over a much longer period without early physiotherapy input, and the relative outcomes are examined. While both the early physiotherapy-managed cases showed a complete resolution at follow-up examination, the more established chronic pseudotumour required surgical excision, with significant residual muscle contractility, length and strength issues noted on clinical and magnetic resonance imaging reviews. No adverse symptoms or haemostatic issues were reported in response to this less invasive treatment regime by either patient in the two conservative physiotherapy cases.

The diffusion tensor tractography (DTT) allows the corticospinal tract(CST) to be visualized at the subcortical level and functional MRI (fMRI) is capable of precisely identifying activation sites at the cortex. Therefore, it seems that combined DTT/fMRI would allow more accurate evaluation of the state of the CST. We have attempted to demonstrate cortical reorganization in a patient with cortical hemorrhage using DTT analyzed by fMRI activations. Six normal subjects and a 12-year-old female patient with a hemorrhage in the left fronto-parietal cortex were recruited. fMRI was performed at 1.5-T with timed hand grasp-release movements, and DTT was performed using 1.5-T with a Synergy-L Sensitivity Encoding head coil. Three-dimensional reconstructions of the fiber tracts were obtained using the fMRI activation as the seed region of interest and the CST area of the anterior pons as the target region of interest. The tract of the affected hemisphere originated from the lateral area of the injured precentral knob and descended along the known corticospinal tract pathway. It seems that the motor function of the affected hand was reorganized into the lateral area of the injured precentral knob. Therefore, these combined modalities would be helpful in elucidating the state of the CST.

Experience is presented gained with the use of ultratonotherapy, low-intensity laser radiation of infrared actions, and a number of drug electrophoreses in the treatment of 358 surgical patients over 1994-1996. A complex of combinations of different techniques common in physiotherapy has been designed with those of drug therapy during different phases of surgical disorders. Methods and complexes of the therapy treatments to be administered are submitted together with relevant indications. The proposed variants of complex physiotherapy make for earlier recovery, shorter treatment courses, longer remission.

The aim of this study was to determine the factors that influence the prognosis of hypertensive putaminal hemorrhage. We investigated the outcome of the activity of daily living (ADL 1: full recovery at social life, 2: self cared, 3: required partial care at home, 4: remained bedridden, 5: vegetative state, 6: dead) one year after the onset of putaminal hemorrhage in comparison with initial data obtained on the day when it occurred. The following parameters were assessed: sex, age, side of hematoma, classification of computed tomography (CT) findings, neurological grade, degree of muscle power, hematoma volume, treatment, past history of cerebrovascular disease, and laboratory data. In 67 patients with putaminal hemorrhage, the relationships among these parameters were examined using Spearman's rank correlation analysis. Additionally, in 55 patients (24 male and 31 female) with complete data from the day of onset, multiple regression analysis was performed. The data of muscle power were handled by the quantification method. The result of Spearman's rank correlation coefficient indicated that the outcome had a positive correlation with age (correlation coefficient = 0.375), CT classification (0.595), neurological grade (0.714), hematoma volume (0.689), a past history of cerebrovascular disease (0.475), the white blood cell count (0.541), and the lactate dehydrogenase level (0.347). The outcome had a negative correlation with muscle power (-0.579) and the cholinesterase (-0.340).(ABSTRACT TRUNCATED AT 250 WORDS)

The authors studied 58 patients, under 12 years of age, admitted to the Emergency Room of the Sao Paulo University Hospital between September 1987 and November 1991 with the diagnosis of traumatic extradural hematoma. Emphasis was given to the etiology of injury, the time interval from head injury to emergency room evaluation, the clinical features and the outcome after surgical and nonsurgical management. The site of hematoma was defined and correlated with the presence of skull fractures. Computerized tomography is the main diagnostic method, although it is not definitive. Fifteen patients were treated nonsurgically according to rigid clinical and radiological parameters. The overall mortality rate was 3.4%.

An original method of qualification for surgical treatment of patients with non-traumatic intracerebral haematoma is described. The qualification is based on the main elements of the intracranial volume compensation: 1. function of midline structures (F), 2. intracranial pressure features (I), 3. midline structure shift (S). The FIS method was applied in 134 patients; 83 of them were treated surgically and 51 were treated conservatively. The control group comprised 60 patients treated surgically or conservatively with qualification based on other criteria. The use of the FIS method in the preliminary management of patients with non-traumatic intracerebral haematoma made possible a great increase of the survival rate and improvement of the late results of treatment.

The choice of treatment in intracerebral hematoma remains controversial as long as there are no prospective, randomized trials from multiple centers. Recent experiences showed a lower mortality rate after stereotactic evacuation of intracerebral hematoma. However according to the present study (60 patients) the quality of survival and duration of hospital stay seems to be dependent on early and intensified rehabilitation and physiotherapy.

Echo-eg, EEG, dopplerography and computer-aided tomography of the brain were employed to examine 8 patients with spontaneous cerebellar hematomas. Clinically, minor intracerebellar hematomas are characterized by acutely occurring intensive systemic dizziness, nausea, moderate coordination disorders without consciousness derangement or pyramidal and sensible disturbances. It is demonstrated that cerebellar hemorrhages may run a favourable course without any surgical treatment.

Patients with intracerebral haematomas (ICH) secondary to aneurysmal bleeds usually have a poor prognosis or die if treated conservatively. Younger patients with rupture of a middle cerebral artery (MCA) aneurysm and temporal haematomas have the potential to return to useful life. They should be assessed separately from other subarachnoid haemorrhage (SAH) patients and considered for emergency surgery. Seven such cases are presented, five made an acceptable recovery. The experience of other units as represented in the literature is considered.

Author discuss problems of rehabilitation in patients affected by intracerebral hemorrhage. In the first, acute, phase attention has to be pointed on the prevention of osteoarticular lesions, pulmonary dysfunctions and sphincteric disturbances. In a second phase the most important topic is represented by a complete functional recovery. It is of great importance an intensive treatment of aphasia also in patients presenting a complete deficit.

The present study deals with the factors affecting the prognosis in the acute stage of 29 cases with hypertensive thalamic hemorrhage diagnosed by CT scan. It was thought that the following factors were significantly related to the outcome of the patients who were unable to lead daily life, remained in vegetative state or died. (1) Consciousness level was below 10 in the so-called 3-3-9 formula. (2) Bilateral Babinski's signs was observed. (3) Localization of the hematoma was all the thalamic nuclei type. (4) Hematoma volume was above 10 ml. (5) As for the size of hematoma, the maximum dimension of hematoma was over 30 or 35 mm, maximum width over 30 mm, maximum length over 25 mm and maximum height over 30 or 40 mm. (6) Ventricles were dilatated. It was seemed that the prognosis had no significant relationship with the age of the patients, the difference between left and right side of hematoma, with the presence or the absence of ventricular penetration of hematoma, and with the existence of midline shift. We thought that in the acute stage of hypertensive thalamic hemorrhage of the prognosis could be forecasted by neurological findings, accurate calculation of the hematoma volume and size, localization of hematoma and presence or absence of ventricular dilatation by CT scan.