Effects of prostaglandin E1 on perihematomal tissue after hypertensive intracerebral hemorrhage.
OBJECTIVE
To observe the effects of Prostaglandin E1 (PGE1) on hematoma, perihematomal tissue and the impairment of neurological function in patients with hypertensive intracerebral hemorrhage (HICH).


METHODS
A total of 40 patients with HICH were enrolled according to the inclusion criteria and randomly divided into two groups: the control group (n=20) and the PGE1 treatment group (n=20). In each group, 99mTc-ethyl cysteinate dimer (ECD) SPECT brain perfusion imaging was performed on days 5 and 20 after stroke, and the regional cerebral blood flow of the hematoma area, the proximal and distal regions of the hematoma surrounding tissue and the frontal and parietal lobe areas were calculated with semiquantitative methods (the Ra value was shown as an uptake ratio). The volumes of hematoma and perihematomal tissue of the subjects (low-density areas around the hematoma as observed in the skull CT) were recorded by skull CT scan. Meanwhile, the NIHSS score for each patient was assessed upon admission and on the 5th, 12th, and 20th days of hospital stay. The mRS scores of each patient were recorded on the 1st and 20th days of admission. The NIHSS and mRS assessments were also performed three months following admission.


RESULTS
In the PGE1 treatment group, the Ra values of the proximal and distal regions of the perihematomal tissue were significantly higher than those in prior treatment, and were significantly higher than the values in control group. The Ra values in the frontal and parietal lobes showed no significant differences before and after treatment. The volumes of hematomas in the PGE1 group were obviously reduced on the 12th and 20th days when compared with the 1st day and the 5th day, and these differences showed statistical significance. The volumes of hematomas in the control group were obviously reduced on the 20th when compared with the 1st day. On the 20th day, volumes of hematomas were significantly reduced in the PGE1 group than in control group . Moreover, the volume of perihematomal tissue in the PGE1 group was significantly reduced on the 20th day when compared with on the 5th day and the control group. NIHSS scores showed statistically significant differences on the 20th day of admission and the follow-up three months later when the PGE1 treatment group and control group were compared. mRS scores in the three-month follow-up also showed statistically significant differences between the two groups .


CONCLUSIONS
The application of PGE1 therapy for patients with hypertensive intracerebral hemorrhage started on the 5th day after stroke was capable of enhancing rCBF of perihematomal tissue. This treatment significantly improved the prognosis of and recovery from neurological deficits in HICH patients.
Departmemt of Neurology, Nantong University, Nantong, China.
Maohong
M
Cao
Kaifu
K
Ke
Haihua
H
Sun
Annette
A
Robertson
D000328:Adult; D000368:Aged; D000527:Alprostadil / Q000627:therapeutic use*; D001921:Brain / Q000000981:diagnostic imaging; D002560:Cerebrovascular Circulation / Q000187:drug effects; D005260:Female; D006406:Hematoma / Q000188:drug therapy*; D006801:Humans; D020299:Intracranial Hemorrhage, Hypertensive / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015899:Tomography, Emission-Computed, Single-Photon; D014665:Vasodilator Agents / Q000627:therapeutic use*
D014665:Vasodilator Agents; D000527:Alprostadil