Background

Mesenchymal stem cells (MSCs) are multipotent stromal cells currently being tested as therapy for a variety of diseases. MSC therapy and hematoma evacuation using a minimally invasive approach are being studied separately to improve clinical outcomes after stroke. We report the first case of a patient with intracerebral hemorrhage (ICH) treated with combination MSC therapy and endoscopic hematoma evacuation.

Case report

A 36-year-old woman with a past medical history of essential chronic hypertension and right lung bronchial atresia presented to the emergency department with acute neurologic decline (National Institute of Health Stroke Scale [NIHSS] score, 22). Computed tomography showed a 4.4 × 3.5 × 3.5 cm right basal ganglia hemorrhage with intraventricular extension. An external ventricular drain was placed, and she was enrolled in a Phase I clinical trial investigating intravenous MSC therapy for acute ICH. Continued neurologic deterioration due to increased intracranial pressure led to minimally invasive hematoma evacuation using the Artemis Neuro Evacuation Device (Penumbra, Inc.) on hospital day 4. Follow-up scans showed decreased density and extent of hemorrhage. She was discharged on day 41 with improved neurologic function scores (NIHSS score, 2). At 3-month follow-up, she was walking on her own, but had residual left arm and hand weakness (modified Rankin Score, 2).

Conclusions

This case report suggests that the combination of MSC therapy and minimally invasive hematoma evacuation may be safe and well tolerated. Further larger randomized clinical trials are required to identify whether MSC therapy in combination with minimally invasive hematoma evacuation is safe, tolerable, and potentially improves outcomes than either alone.

中文翻译：

---

脑出血的组合方法：静脉间充质干细胞疗法与最小浸润性血肿清除术。

背景

间充质干细胞（MSCs）是多能干基质细胞，目前正在测试作为多种疾病的疗法。为了改善中风后的临床结果，正在分别研究使用微创方法进行的MSC治疗和血液肿疏散。我们报道了首例合并MSC治疗和内镜下血肿清除术治疗的脑出血（ICH）患者。

案例报告

一名36岁的女性，有既往的原发性慢性高血压和右肺支气管闭锁的病史，因急性神经功能下降而被送往急诊科（美国国立卫生研究院卒中量表[NIHSS]评分，22）。计算机体层摄影术显示右脑基底节出血为4.4×3.5×3.5 cm，脑室内延伸。放置了一个外部心室引流管，她被纳入了一项I期临床试验，该试验研究了急性ICH的静脉MSC治疗。颅内压升高引起的持续神经功能恶化导致在医院第4天使用Artemis神经排空装置（Penumbra，Inc.）进行微创血肿排空。随访扫描显示密度和出血程度降低。她在第41天出院时神经功能评分得到改善（NIHSS评分为2）。

结论

该病例报告表明，MSC治疗与微创血肿清除术的结合可能是安全且耐受性良好的。还需要进行更大范围的随机临床试验，以确定MSC疗法与微创血肿清除术联合使用是否安全，可耐受，并可能改善治疗效果。