Surgical And Clinical Studies On Cerebral Amyloid Angiopathy-related Hemorrhage And Hypertensive Cerebral Hemorrhage

Objective: To make a comparative study on the clinical and surgical treatment as well as the prognosis ofcerebral amyloid angiopathy hemorrhage (CAAH) and hypertensive intracerebral hemorrhage in Xinjiang.Methods: To collect the clinical (age, gender, hematoma location, bleeding), radiological and surgical dataof the162patients with acute spontaneous intracranial hemorrhage, all the data was collected in the past4years in Xinjiang People’s Hospital. The admitted162patient include104male patients and58femalepatients,119of the162patients are proved to have the history of hypertension, and the left ones are provednot, all the data was provided by the patient’s family members. Among the21cases of CAAH,8patientsare complicated with hypertension when they were on admission. To testify the presence of cerebralamyloid angiopathy, patients in the group are carried out the craniotomy operation from which thespecimens are taken. All the taken specimens are stained by HE, then followed the Congo Red stained inthe polarized light microscope and the Beta amyloid protein immunohistochemical detection. Confirmed bythe histopathological diagnosis, all the specimens are divided into21cases of CAAH and19cases of HICH.Then a statistical analysis is conducted on the clinical manifestation, imaging features as well as thepostoperative score.Results: There are21cases of CAAH, accounting for12.96%while119cases of HICH accounts for73.45%and the average age of the CAAH patients is higher than that of HICH. As to the bleeding location,CAAH group has a shallow location, such as in the cerebral cortex, especially in the occipital lobe, and itcan be rarely seen in basal ganglia and cerebellum. Contrastively, the bleeding location of HICH group isusually in the basal ganglia and also visible in lobes and cerebellum. It can be observed that9cases are ofmoderate lesions, the left are of severe lesions. As to the pathological type,11cases are Congophilicangiopathy,2cases are plaque-like angiopathy and the left8cases are mixed type ones. According to theNIHSS (USA National Institutes of Health Stroke Scale), the score of preoperative3months andpostoperative3months is of statistical significance (P<0.05).2of the21cases of CAHH are re-bleeding,7cases (accounting for33.33%) died after the operation.4of the14discharged survival cases of CAAH arelost to follow-up,3of the10followed-up cases died during the follow-up, among which1case isre-bleeding and died in the local hospital because of giving up the treatment,2cases died of non-cerebralhemorrhage-related disease.Conclusion: First, it can be concluded from the clinical analysis that CAAH is positively related to age, theage of the CAAH patients is much higher than that of HICH group, so the age is of statistical significance.However, the gender ratio of the two groups is of none statistical significance. Second, the two groups havetheir own imaging features to follow. The intracranial bleeding in patients with CAAH locate in cortical orsubcortical superficial lobe, while the bleeding in patients with HICH often seen in the basal ganglia, butimaging cannot distinguish them accurately. Third, pathological examination of all the patients with CAAHsuggest that all the brain slice specimens are of moderate amyloidosis. The pathological type is featureswith Congophilic angiopathy, few are plaque-like angiopathy and others are mixed types. Fourth, operationis beneficial to the consciousness and neurological function of the patients with obvious operationindications, so it is advocated to operate with those with clear indications as soon as possible. Re-bleedingand complications will affect the operation effect, so in order to improve the curative effect, it’s better to prevent re-bleeding and reduce the time in bed.