Thesis defence in the University of Oulu

Doctoral Candidate

Neurosurgeon Cheng Qian

Faculty and research unit

University of Oulu Graduate School, Faculty of Medicine, Research unit of clinical neuroscience

Field of study

Neurosurgery

Date and time of the thesis defence

29.5.2020 12:00

Place of the thesis defence

Remote access: https://oulu.zoom.us/j/67251993802

Topic of the dissertation

Complications after primary intracerebral hemorrhage

Opponent

Professor Jaakko Rinne, Turku university central hospital

Custos

Docent Sami Tetri, Oulu university hospital

Complications after primary intracerebral hemorrhage

Primary intracerebral hemorrhage (ICH) is a devastating disease associated with high morbidity and mortality despite modern medicine. Complications such as infections, epileptic seizures and thromboembolic events following ICH worsen an already dim outcome. The purpose of this thesis is to investigate complications following ICH and its treatment.

In our population-based study of 961 ICH patients we found that high CRP level was associated with poor outcome in ICH patients. This effect was apparent even after excluding infectious diseases. Patients who later developed pneumonia and had increased CRP levels on consecutive days had poor outcome. High CRP at admission, in the absence of silent aspiration pneumonia may suggest severe brain injury in ICH patients. We also studied factors predicting seizures over a different timeline after ICH. In patients with young age, subcortically located hematoma and low Glasgow coma score (GCS) at admission increased the risk of epileptic seizures after ICH. Hematoma evacuation seemed to be associated with late-onset seizures (>2 weeks). We suggest that prophylactic antiepileptic drug (AED) should be considered for the subgroups of patients mentioned above.

In our most recent, double blinded, randomized trial with 139 patients we found that in ICH patients, thromboembolic complications are rare when adequate medical and mechanical thrombosis prophylaxis are applied. Administering low-molecular-weight heparin (LMWH) enoxaparin 20mg x 2/day early (1 day after onset) does not increase the risk of rebleeding. Administering enoxaparin later (3 days after onset) is not associated with higher risk of thromboembolic events.

Dissertation

Last updated: 28.5.2020