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Complications and therapy after subarachnoid haemorrhage  

Microsoft Academic Search

Subarachnoid haemorrhage (SAH) is a subset of stroke with a poor prognosis, up to 40% of patients die. Besides the impact of the initial haemorrhage, several neurological and systemic complications contribute to a poor clinical outcome.\\u000a\\u000aThe first part of this thesis describes several complications after SAH. It is well known that SAH patients often have hyperglycaemia, and in chapter

S. M. Dorhout Mees



Nosocomial ventriculitis due to Roseomonas gilardii complicating subarachnoid haemorrhage  

Microsoft Academic Search

Roseomonas gilardii is a pink-pigmented, non-fermentative, Gram-negative coccobacillus that has been recognized as a rare cause of human infections. We report the first case of ventriculitis caused by R. gilardii in a 54-year-old man with a subarachnoid haemorrhage secondary to a vertebral artery aneurysm; discuss previous reports of this organism as a nosocomial and community-acquired pathogen, laboratory diagnosis, and patient

Jason S. Nolan; Ken B. Waites



Prevention and treatment of medical and neurological complications in patients with aneurysmal subarachnoid haemorrhage  

Microsoft Academic Search

Treatment of patients with aneurysmal subarachnoid haemorrhage not only involves securing the aneurysm by endovascular coiling or surgical clipping but also prevention and treatment of the medical and neurological complications of the bleed. These acutely ill patients should be looked after in specialised centres by a multidisciplinary team that is available 24 h a day, 7 days a week. No

G J E Rinkel; C J M Klijn



Current diagnostic approaches to subarachnoid haemorrhage  

Microsoft Academic Search

Over the past decade, significant advances have been made in the field of subarachnoid haemorrhage (SAH). Prompt diagnosis with high-resolution CT and intensive critical care support remain key aspects of good patient management. Early identification and definitive treatment of underlying ruptured aneurysms is generally advocated to reduce the risk of re-bleeding, a complication with high mortality and morbidity. Although intra-arterial

Jean Marie U-King-Im; Brendan Koo; Rikin A. Trivedi; Nicholas J. Higgins; Keng Y. Tay; Justin J. Cross; Nagui M. Antoun; Jonathan H. Gillard



Thrombus formation in a dilated torcula following aneurysmal subarachnoid haemorrhage.  


A case of thrombus formation occurring within a dilation of the dural venous sinuses following aneurysmal sub-arachnoid haemorrhage is presented. Acute neurological deterioration accompanied propagation of the thrombus. The patient was anticoagulated on day 5 post-SAH with no haemorrhagic complications and made a full recovery. The optimum time to commence anticoagulation is not clear and is discussed. PMID:23451941

Haynes, H R; Visca, A; Renowden, S; Malcolm, G



[Meningitis can resemble subarachnoid haemorrhage].  


A 70 year-old man was admitted under the diagnosis of subarachnoid haemorrhage and presented with a history of ear pain, followed by acute onset of severe headache, nausea, vomiting, impaired consciousness, and fever. However, a computed tomography (CT) showed an acute mastoiditis and pneumocephalus, and a lumbar puncture confirmed the diagnosis meningitis. The increased middle ear pressure relative to the intracranial pressure had caused air and bacteria to penetrate intracerebrally. This case illustrates the importance of a rapid diagnostic workup in acute onset headache including a careful anamnesis, CT and lumbar puncture. PMID:22579098

Elghoura, Nour Foad Diab



Acute cardiac injury after subarachnoid haemorrhage: two case reports  

PubMed Central

It is well known that cardiopulmonary complications are often associated to subarachnoid haemorrhage. For appropriate therapeutic managing it is very important to distinguish acute coronary syndrome from neurogenic myocardial injury, which is a reversible condition. Furthermore, because the hearts of brain dead patients may be utilized for therapeutic purpose, it has became of importance to rule out erroneous diagnosis of cardiac ischemia in order to avoid rejection of hearts potential suitable for transplantation. We present a report of two female patients affected by cardiac complications caused by aneurismal subarachnoid haemorrhage admitted to our neurosurgical intensive care department.



Acute cardiac injury after subarachnoid haemorrhage: two case reports.  


It is well known that cardiopulmonary complications are often associated to subarachnoid haemorrhage. For appropriate therapeutic managing it is very important to distinguish acute coronary syndrome from neurogenic myocardial injury, which is a reversible condition. Furthermore, because the hearts of brain dead patients may be utilized for therapeutic purpose, it has became of importance to rule out erroneous diagnosis of cardiac ischemia in order to avoid rejection of hearts potential suitable for transplantation.We present a report of two female patients affected by cardiac complications caused by aneurismal subarachnoid haemorrhage admitted to our neurosurgical intensive care department. PMID:20062617

Marcì, Marcello; Savatteri, Paolino; Pizzuto, Antonino; Giammona, Giuseppe; Renda, Baldassare; Lojacono, Francesca; Sanfilippo, Nicola



Terson's syndrome: subarachnoid haemorrhage presenting as sudden visual loss.  


Subarachnoid haemorrhage is a condition that usually presents with headache and altered mental state. We report the case of a 50-year-old man with subarachnoid haemorrhage who presented with Terson's syndrome. This is a condition where there is retinal or vitreous haemorrhage secondary to subarachnoid or subdural haemorrhage. PMID:22862765

Moynihan, Gerard; Robinson, Kent



Spinal arachnoiditis and cyst formation with subarachnoid haemorrhage.  


We present the case of a 58-year-old lady with p-ANCA vasculitis who suffered a WFNS grade 1 subarachnoid haemorrhage (Fisher grade 1) secondary to a ruptured left posterior inferior cerebellar artery aneurysm and then developed a rare complication of radiologically progressive spinal arachnoiditis despite maintained clinical response to definitive treatment measures. PMID:22299598

Abhinav, Kumar; Bradley, Marcus; Aquilina, Kristian; Patel, Nikunj K



Acute cardiac injury after subarachnoid haemorrhage: two case reports  

Microsoft Academic Search

It is well known that cardiopulmonary complications are often associated to subarachnoid haemorrhage. For appropriate therapeutic managing it is very important to distinguish acute coronary syndrome from neurogenic myocardial injury, which is a reversible condition. Furthermore, because the hearts of brain dead patients may be utilized for therapeutic purpose, it has became of importance to rule out erroneous diagnosis of

Marcello Marcì; Paolino Savatteri; Antonino Pizzuto; Giuseppe Giammona; Baldassare Renda; Francesca Lojacono; Nicola Sanfilippo



Multimodal evoked potentials after subarachnoid haemorrhage.  


In 59 comatose patients after subarachnoid haemorrhage somatosensory, visual, auditory and magnetic motor evoked potentials were registered. Evoked potentials proved to be of much less predictive value than in other causes of coma, such as head injury and others. While loss of cortical function was a safe predictor of a fatal outcome, preservation of evoked potentials has little prognostic relevance. PMID:7913522

Firsching, R



Unusual case of subarachnoid haemorrhage in patient with Fabry's disease: case report and literature review.  


Fabry's disease is a rare, X linked recessive disease affecting 1 in 40 000 persons. The symptoms result from a lack of or a non-functioning enzyme ? galactosidase, which leads to globotriaosylceramide accumulation in the walls of blood vessels. Mortality is generally from cardiac or renal complications and death from subarachnoid haemorrhage is distinctly rare. The authors report a man with Fabry's disease who died after subarachnoid haemorrhage from a progressively enlarging fusiform basilar aneurysm. PMID:22761201

Cormican, Michael T; Paschalis, Thanasis; Viers, Angela; Alleyne, Cargill H



Triple-H therapy in the management of aneurysmal subarachnoid haemorrhage  

Microsoft Academic Search

Cerebral vasospasm is a recognised but poorly understood complication for many patients who have aneurysmal subarachnoid haemorrhage and can lead to delayed ischaemic neurological deficit (stroke). Morbidity and mortality rates for vasospasm are high despite improvements in management. Since the middle of the 1970s, much has been written about the treatment of cerebral vasospasm. Hypervolaemia, hypertension, and haemodilution (triple-H) therapy

Jon Sen; Antonio Belli; Helen Albon; Laleh Morgan; Axel Petzold; Neil Kitchen



[Endovascular treatment of vasospasm following subarachnoid aneurysmal haemorrhage].  


An endovascular treatment of vasospasm following a subarachnoid aneurysmal haemorrhage is to be implemented if the patient presents clinical or biological symptoms arguing for brain ischemia in conjunction with increased Doppler velocities despite well controlled systemic haemodynamic. Treatment might be either pharmacological or haemodynamic. Calcium and phosphodiesterase inhibitors can be administered. The former could also provide a neuroprotective effect as compared to the latter. In Europe, nimodipine is widely used whereas nicardipine and verapamil are the major molecules administered in North America where iv nimodipine is not FDA approved. Papaverine is less used nowadays because of its short duration of action and of the risk of aggravation of raised intracranial pressure. Balloon angioplasty has a long lasting effect but can be applied only to proximal spasm. Complications of its use are rare but life threatening. In some cases, both the pharmacological approach and the mechanical approach are used in combination. PMID:17935940

Abdennour, L; Lejean, L; Bonneville, F; Boch, A-L; Puybasset, L



Spinal dural arteriovenous fistula with perimesencephalic subarachnoid haemorrhage  

Microsoft Academic Search

A case is reported of a 66 year old woman presenting with perimesencephalic subarachnoid haemorrhage (SAH) which was caused by a spinal dural arteriovenous fistula at the C1 level. The fistula drained into the venous system of the posterior cranial fossa through a perimedullary vein. The bleeding was thought to result from venous hypertension induced by the fistula. This case

Hiroyuki Hashimoto; Jun-ichi Iida; Yasushi Shin; Yasuo Hironaka; Toshisuke Sakaki



Extradural vertebral artery dissecting aneurysm causing subarachnoid haemorrhage  

Microsoft Academic Search

The authors report the case of a 37-year-old man who presented with subarachnoid haemorrhage (SAH) after rupture of an extradural vertebral artery dissecting aneurysm. The patient underwent a left lateral suboccipital craniotomy with removal of the medial part of the occipital condyle and the fusiform dilatation was coated. The angiograms 3 months after surgery showed aneurysm resolution and normal vessel

Javier Fandino; Yasuhiro Yonekawa; Werner W Wichmann; Peter Roth



Incidence of intracerebral and subarachnoid haemorrhage in southern Sweden  

PubMed Central

OBJECTIVES—Spontaneuos intracranial haemorrhage—that is, mainly subarachnoid haemorrhage (SAH) and primary intracerebral haemorrhage (PICH)—constitutes an important part of all strokes. As previous epidemiological studies have demonstrated highly variable incidence rates, we conducted a large prospective investigation of all haemorrhagic strokes during a 1 year period.?METHODS—Twelve hospitals serving a defined population of 1.14 million in southern Sweden registered all cases with spontaneous intracranial haemorrhage, including those found dead outside hospitals, during 1996. All patients were examined with CT of the brain or underwent necropsy. Incidence rates adjusted to the Swedish population for age and sex, as well as location of haematoma and prevalence of risk factors were calculated.?RESULTS—A total of 106 patients with SAH and 341 patients with PICH were identified. The annual incidence/100 000 was 10.0 (6.4 for men and 13.5 for women) for SAH and 28.4 (32.2 for men and 24.7for women) for PICH when adjusted to the Swedish population. Subarachnoid haemorrhage affected twice as many women as men. The incidence of both types of haemorrhage increased with advancing age, but in particular, this was the case for supratentorial PICH. Lobar haematomas were the most common (51.6%) type of PICH. Among patients with PICH, 37% had hypertension, 41% other vascular disease, and 12% were on oral anticoagulation. Among patients with SAH, 28% had hypertension and 18% vascular disease before the haemorrhage but no one was on treatment with oral anticoagulation.?CONCLUSIONS—The incidence of PICH was high, especially for the older age groups. PICH was, on average, three times as common as SAH. The study underscores the importance of PICH and SAH as significant stroke subgroups.??

Nilsson, O; Lindgren, A; Stahl, N; Brandt, L; Saveland, H



Transcranial Cerebral Oximetry Related to Transcranial Doppler After Aneurysmal Subarachnoid Haemorrhage  

Microsoft Academic Search

Summary  ?Noninvasive methods for detecting cerebral artery vasospasm, still a serious complication following aneurysmal subarachnoid\\u000a haemorrhage, are of vital interest. Up-to-date transcranial Doppler ultrasound (TCD) has proved to be sensitive in detecting\\u000a vasospasm in the middle cerebral artery, but has less accuracy for other cerebral arteries. Transcranial cerebral oximetry\\u000a (TCCO) is a new noninvasive technique which may increase the reliability for

A. Ekelund; P. Kongstad; H. Säveland; B. Romner; P. Reinstrup; K.-A. Kristiansson; L. Brandt



Long term follow up after perimesencephalic subarachnoid haemorrhage  

PubMed Central

OBJECTIVES—To evaluate the long term sequelae of perimesencephalic subarachnoid haemorrhage (PMSAH).?METHODS—Twenty one consecutive patients were studied. All patients were examined by CT, angiography, MRI, multimodal evoked potentials, and transcranial Doppler sonography. All relevant clinical data during hospital stay and outcome at discharge were obtained by reviewing the charts. Long term follow up was evaluated by reviewing the outpatient files and dedicated outpatient review. Patients were specifically questioned about their perceived recovery, residual complaints, and present occupational status.?RESULTS—Apart from the initial CT confirming the diagnosis of PMSAH all other examinations disclosed no abnormalities. None of the patients developed any complications during hospital stay, and all patients were discharged in good clinical condition and without neurological deficits. At long term follow up 62% of the patients had residual complaints consisting of headaches, irritability, depression, forgetfulness, weariness, and diminished endurance. Apart from four patients who had already retired before the PMSAH, only seven of the remaining 17 patients (41%) returned to their previous occupation, whereas nine patients (53%) retired from work and one man became unemployed. One patient had a recurrence of PMSAH 31 months after the first event.?CONCLUSION—PMSAH can have considerable long term psychosocial sequelae, and may also recur. Prognosis may not be as good as previously reported.??

Marquardt, G.; Niebauer, T.; Schick, U.; Lorenz, R.



Clinical relevance of cerebral autoregulation following subarachnoid haemorrhage.  


Subarachnoid haemorrhage (SAH) is a form of stroke that is associated with substantial morbidity, often as a result of cerebral ischaemia that occurs in the following days. These delayed deficits in blood flow have been traditionally attributed to cerebral vasospasm (the narrowing of large arteries), which can lead to cerebral infarction and poor neurological outcome. Data from recent studies, however, show that treatment of vasospasm in patients with SAH, using targeted medication, does not translate to better neurological outcomes, and argue against vasospasm being the sole cause of the delayed ischaemic complications. Cerebral autoregulation-a mechanism that maintains stability of cerebral blood flow in response to changes in cerebral perfusion pressure-has been reported to fail after SAH, often before vasospasm becomes apparent. Failure of autoregulation, therefore, has been implicated in development of delayed cerebral ischaemia. In this Review, we summarize current knowledge about the clinical effect of disturbed cerebral autoregulation following aneurysmal SAH, with emphasis on development of delayed cerebral ischaemia and clinical outcome, and provide a critical assessment of studies of cerebral autoregulation in SAH with respect to the method of blood-flow measurement. Better understanding of cerebral autoregulation following SAH could reveal mechanisms of blood-flow regulation that could be therapeutically targeted to improve patient outcome. PMID:23419369

Budohoski, Karol P; Czosnyka, Marek; Kirkpatrick, Peter J; Smielewski, Peter; Steiner, Luzius A; Pickard, John D



Cerebellar low-grade oligoastrocytoma presenting with subarachnoid haemorrhage.  


Subarachnoid haemorrhage (SAH) associated with intra-axial tumours is extremely uncommon and is usually seen in association with intratumoural bleed. Tumours located near the ventricle or subarachnoid spaces have a higher propensity for SAH compared to intraparenchymal lesions. Low-grade tumours rarely demonstrate any evidence of bleed on imaging. Oligoastrocytomas of the posterior fossa are rare tumours in adults and their presentation with intratumoural haemorrhage and SAH is unknown. We report a unique case of cerebellar low-grade oligoastrocytoma that mimicked a tentorial-based extraaxial lesion on imaging and presented with SAH. Susceptibility-weighted magnetic resonance imaging is a useful imaging modality to demonstrate blood within and outside the tumour. PMID:22665014

Viswanathan, Gopalakrishnan; Nair, Suresh; Chandrasekhar, Kesavadas; Vishnupuri, Radhakrishnan



Beta-blockade benefits patients following a subarachnoid haemorrhage.  


Previous studies have shown that ECG changes following a subarachnoid haemorrhage are associated with increased catecholamine levels, necrotic myocardial lesions, and a poor prognosis. Furthermore, beta-blockade using propranolol reverses some of the ECG changes and prevents necrotic myocardial lesions. This study was established to assess the affects of adrenergic blockade on morbidity and mortality following subarachnoid haemorrhage. Patients were admitted to the randomized double-blind between-patients study if they presented at the neurosurgical unit within 48 hours of a subarachnoid haemorrhage confirmed by lumbar puncture. Of 224 patients, the first 118 received an alpha-blocker, phentolamine 20 mg three-hourly, and either the beta-blocker propranolol 80 mg eight-hourly, or placebo. The last 106 patients received either propranolol or placebo. Treatment was continued for three weeks. Assessment at four weeks revealed significant improvements in the treated group for neurological deficit (p = 0.003) and death (p = 0.02). More treated patients underwent operation and those that did had a better outcome (p = 0.01). Assessment at one year showed that although patients had improved in both groups, patients in the treated group had significantly fewer neurological deficits (p = 0.003). There were fewer deaths in the treated group but this difference was not significant (p = 0.09). Possible mechanisms for this protective effect of propranolol may include a reduction in plasma renin activity, a reduction in pulmonary oedema, prevention of myocardial infarcts, and a reduction in cerebral oxygen requirements. It is concluded that early beta-blockade benefits patients with subarachnoid haemorrhage, in terms of fewer neurological deficits, for up to one year. PMID:2865145

Neil-Dwyer, G; Walter, P; Cruickshank, J M



Intracranial transthecal subarachnoid fat emboli and subarachnoid haemorrhage arising from a sacral fracture and dural tear  

PubMed Central

We present the case of a 28-year-old man with an unusual aetiology of lipid-dense material in the subarachnoid space. CT of the head at presentation was normal. MRI of the spine revealed a defect in the dura at L5/S1, with avulsed left L5 and S1 nerve roots. Haematoma and marrow fat were observed in close relation to the dural tear adjacent to the sacral fracture. Head CT and MRI subsequently demonstrated new lipid-dense material and haemorrhage in the subarachnoid space after sacral instrumentation, presumably owing to transthecal displacement of fatty marrow.

Woo, J K H; Malfair, D; Vertinsky, T; Heran, M K S; Graeb, D



[New trends in neuromonitoring patients with with aneurysmal subarachnoid haemorrhage].  


Neurointensive care of patients with subarachnoid haemorrhage is based on the theory that clinical outcome is the consequence of the primary haemorrhage and a number of secondary insults in the acute post haemorrhage period. Several neuromonitoring techniques have been introduced or accomplished into clinical practice in the last decade with the purpose of monitoring different but related aspects of brain physiology, such as cerebral blood flow (CBF), pressure within the cranial cavity, metabolism, and oxygenation. The aim of these techniques is to obtain information that can improve knowledge on brain pathophysiology, and especially to detect secondary insults which may cause permanent neurological damage if undetected and untreated in "real time", at the time when they can still be managed. These techniques include intracranial pressure (ICP) measurements, jugular venous oxygen saturation, near-infrared spectroscopy, brain tissue monitoring, and transcranial Doppler. The available devices are limited because they measure a part of complex process indirectly. Expense, technical difficulties, invasiveness, limited spatial or temporal resolution and the lack of sensitivity add to the limitation of any individual monitor. These problems have been partially addressed by the combination of several monitors known as multimodality monitoring. In this review, we describe the most common neuromonitoring methods in patients with subarachnoidal hemorrhage that can assess nervous system function, cerebral haemodynamics and cerebral oxygenation. PMID:18792577

Dostani?, M M; Stosi?, M M; Milakovi?, B D; Baljozovi?, B V; Jovanovi?, I B; Koji?, Z Z; Marinkovi?, D M; Markovi?, D J; Mili?, I S



Effect of nimodipine on outcome in patients with traumatic subarachnoid haemorrhage: a systematic review  

Microsoft Academic Search

Background Despite several randomised controlled trials, there is still much debate whether nimodipine improves outcome in patients with traumatic subarachnoid haemorrhage. A 2003 Cochrane review reported improved outcome with nimodipine in these patients; however, because the results of Head Injury Trial (HIT) 4 were only partly presented there is still discussion whether patients with traumatic subarachnoid haemorrhage should be treated

Mervyn DI Vergouwen; Marinus Vermeulen; Yvo BWEM Roos



Risk of cardiovascular events and death in the life after aneurysmal subarachnoid haemorrhage: a nationwide study.  


BACKGROUND AND AIM: The increased mortality rates of survivors of aneurysmal subarachnoid haemorrhage have been attributed to an increased risk of cardiovascular events in a registry study in Sweden. Swedish registries have however not been validated for subarachnoid haemorrhage and Scandinavian incidences of cardiovascular disease differ from that in Western European countries. We assessed risks of vascular disease and death in subarachnoid haemorrhage survivors in the Netherlands. METHODS: From the Dutch hospital discharge register, we identified all patients with subarachnoid haemorrhage admission between 1997 and 2008. We determined the accuracy of coding of the diagnosis subarachnoid haemorrhage for patients admitted to our centre. Conditional on survival of three-months after the subarachnoid haemorrhage, we calculated standardized incidence and mortality ratios for fatal or nonfatal vascular diseases, vascular death, and all-cause death. Cumulative risks were estimated with survival analysis. RESULTS: The diagnosis of nontraumatic subarachnoid haemorrhage was correct in 95·4% of 1472 patients. Of 11?263 admitted subarachnoid haemorrhage patients, 6999 survived more than three-months. During follow-up (mean 5·1 years), 874 (12·5%) died. The risks of death were 3·3% within one-year, 11·3% within five-years, and 21·5% within 10 years. The standardized mortality ratio was 3·4 (95% confidence interval: 3·1 to 3·7) for vascular death and 2·2 (95% confidence interval: 2·1 to 2·3) for all-cause death. The standardized incidence ratio for fatal or nonfatal vascular diseases was 2·7 (95% confidence interval: 2·6 to 2·8). CONCLUSIONS: Dutch hospital discharge and cause of death registries are a valid source of data for subarachnoid haemorrhage, and show that the increased mortality rate in subarachnoid haemorrhage survivors is explained by increased risks for vascular diseases and death. PMID:22973950

Nieuwkamp, Dennis J; Vaartjes, Ilonca; Algra, Ale; Rinkel, Gabriel J E; Bots, Michiel L



Beneficial effects of adrenergic blockade in patients with subarachnoid haemorrhage.  

PubMed Central

A total of 148 patients presenting within 48 hours of subarachnoid haemorrhage were assigned at random to receive standard management only or standard management and treatment with the adrenergic-blocking agents propranolol and phentolamine (or propranolol alone) for three weeks. One hundred and thirty-four patients completed the study. Assessment at four weeks showed a strong trend for less neurological deficit in the treated group, almost statistically significant (p=0.053) in the women. During the first month the treated group suffered fewer episodes of clinical deterioration consistent with cerebral arterial spasm: thus more treated patients underwent operation and those who did had a better outcome (p=0.030). At one year fewer were dead or disabled (unable to work) in the treated group; a significant difference for women (p=0.030). Possible mechanisms for these actions may include a reduction in pulmonary oedema, prevention of myocardial infarcts, a reduction in plasma renin activity, nd a reduction in cerebral oxygen requirements. It is concluded that early adrenergic blockade benefits patients (particularly women) with subarachnoid haemorrhage for up to one year in terms of lesser neurological deficit. Beta-blocker rather than alpha-blockade appears to be the useful component. A randomised, blind extension of the present study using long-acting propranolol and placebo has shown a significant (p=0.026) decrease in deaths and significantly (p=0.003) fewer poor results in the treatment group.

Walter, P; Neil-Dwyer, G; Cruickshank, J M



Beneficial effects of adrenergic blockade in patients with subarachnoid haemorrhage.  


A total of 148 patients presenting within 48 hours of subarachnoid haemorrhage were assigned at random to receive standard management only or standard management and treatment with the adrenergic-blocking agents propranolol and phentolamine (or propranolol alone) for three weeks. One hundred and thirty-four patients completed the study. Assessment at four weeks showed a strong trend for less neurological deficit in the treated group, almost statistically significant (p=0.053) in the women. During the first month the treated group suffered fewer episodes of clinical deterioration consistent with cerebral arterial spasm: thus more treated patients underwent operation and those who did had a better outcome (p=0.030). At one year fewer were dead or disabled (unable to work) in the treated group; a significant difference for women (p=0.030). Possible mechanisms for these actions may include a reduction in pulmonary oedema, prevention of myocardial infarcts, a reduction in plasma renin activity, nd a reduction in cerebral oxygen requirements. It is concluded that early adrenergic blockade benefits patients (particularly women) with subarachnoid haemorrhage for up to one year in terms of lesser neurological deficit. Beta-blocker rather than alpha-blockade appears to be the useful component. A randomised, blind extension of the present study using long-acting propranolol and placebo has shown a significant (p=0.026) decrease in deaths and significantly (p=0.003) fewer poor results in the treatment group. PMID:6805647

Walter, P; Neil-Dwyer, G; Cruickshank, J M



LP or not LP, that is the question: gold standard or unnecessary procedure in subarachnoid haemorrhage?  


OBJECTIVE: To measure the sensitivity of modern CT in patients presenting to the emergency department and evaluated for possible subarachnoid haemorrhage, with particular attention to those presenting within 12 h of ictus. DESIGN: Retrospective cohort study. SETTING: Large district general hospital emergency department seeing 73 500 new attendances per year. PARTICIPANTS: Patients presenting to the emergency department and screened for suspected subarachnoid haemorrhage. OUTCOME MEASURES: Subarachnoid haemorrhage was defined by either the presence of subarachnoid blood on CT, positive CSF spectrophotometry defined by national guidelines or aneurysm identified on subsequent angiography if either of the former were equivocal. RESULTS: 244 patients were screened for subarachnoid haemorrhage during the 24 months between March 2006 and April 2008 (mean age 48.5 years). The sensitivity of CT overall for subarachnoid haemorrhage was 93.8% (95% CI 84% to 98%) increasing to 95% (95% CI 82% to 99%) if performed within 12 h of ictus. CONCLUSIONS: While modern CT has a high sensitivity for the diagnosis of acute subarachnoid haemorrhage, particularly within 12 h of ictus, it is still not sufficient to act as the sole diagnostic tool, and patients with a negative CT will require further investigation with a lumbar puncture. PMID:23756363

Stewart, Hannah; Reuben, Adam; McDonald, James



Long term outcome after subarachnoid haemorrhage of unknown aetiology  

PubMed Central

Background and purpose The aim of this study was to assess the long term outcome after non-aneurysmal subarachnoid haemorrhage (SAH). Methods 1154 patients with SAH were treated in our hospital between 1989 and 1999. From this patient population, 97 patients had a non-aneurysmal SAH. All hospital records and death certificates were studied and 33 patients were examined by MRI and MR angiography more than 9?years (mean 12?years) after the initial bleeding. Results The cohort consisted of 97 patients. Mean follow-up time was 9?years (range 0–19). During the follow-up period, 13 patients (13%) died. Four (4%) died from the initial bleeding less than 5?weeks after the initial haemorrhage. There was no delayed mortality due to SAH or subsequent bleedings. MR angiography revealed no new findings in 33 surviving patients. Conclusions Excess mortality during the first year after SAH was higher than 4%, and remained thereafter comparable with the general population. There were no rebleedings and MR imaging did not reveal any vascular pathology that could explain the earlier SAH.

Niskakangas, Tero T; Keski-Nisula, Leo H; Kahara, Veikko J; Ohman, Juha E



Characteristics of intracranial aneurysms and subarachnoid haemorrhage in patients with polycystic kidney disease  

Microsoft Academic Search

.   Background and Purpose: Subarachnoid haemorrhage is a common cause of death in patients with autosomal dominant polycystic kidney disease (ADPKD),\\u000a but little is known about specific characteristics of subarachnoid haemorrhage and intracranial aneurysms in this group of\\u000a patients. We performed a systematic review on site, size and number of aneurysms, age at time of rupture, gender, and family\\u000a history

Esther W. Gieteling; Gabriel J. E. Rinkel



Spinal arachnoiditis as a consequence of aneurysm-related subarachnoid haemorrhage.  


Only a few case reports currently exist regarding symptomatic spinal arachnoiditis following aneurysm-related subarachnoid haemorrhage. We present three patients who developed symptomatic spinal arachnoiditis following spontaneous aneurysm rupture. Following initial aneurysm and subarachnoid haemorrhage management (including ventriculo-peritoneal shunt placement), all three patients developed gradually worsening neurological abnormalities, and subsequent imaging demonstrated spinal arachnoiditis. Despite spinal decompression, all three patients experienced progressively worsening neurological decline. PMID:23374556

van Heerden, Jolandi; McAuliffe, William



Primary cerebellar haemorrhage: complications, treatment and outcome.  


Given its anatomical proximity to the brainstem and the ventricular system, cerebellar haemorrhage may lead to immediate life-threatening complications such as brainstem compression and hydrocephalus, or to herniation through the foramen magnum or the tentorium. This situation mandates fast diagnosis and precise emergency treatment strategies. However, the treatment protocols in current use are based on little evidence and the indication criteria for surgical intervention are unclear. Early suboccipital decompressive surgery may be life-saving, but the potential risk involved is unnecessary if the haemorrhage is benign and can be managed conservatively or with insertion of an external ventricular drain. Deterioration of the patients' state of consciousness has often been used as an indication for surgery, but clinical decline can be a fulminant process leading to death within a short time. Research on cerebellar haemorrhage so far has focused on identifying outcome predictors from which treatment algorithms can be derived. Large randomised controlled trials (RCTs) are lacking. However, RCTs are urgently needed, in order to improve the level of evidence, treatment decisions may be based on. Here, we review the available literature on complications, treatment and outcome of primary cerebellar haemorrhage (PCH). Finally we propose the design of a potential RCT. PMID:23659765

Witsch, Jens; Neugebauer, Hermann; Zweckberger, Klaus; Jüttler, Eric



Electrocardiographic changes and their prognostic significance in subarachnoid haemorrhage  

PubMed Central

In a study on the prognostic significance of catecholamine-linked ECG changes in 40 cases of subarachnoid haemorrhage, there were 16 men of mean age 41 years (range 13-56) and 24 women of mean age 42 years (range 11-65). There were six deaths, and five of these patients had consistently abnormal ECGs. Analysis of the abnormal components of ECGs revealed that the presence of either a pathological Q wave or a raised S-T segment indicated a poor prognosis. The two patients with pathological Q waves both died, and the three patients with raised S-T segments all developed cerebral arterial spasm, one of whom died. A high incidence of peaked P waves, short P-R intervals, a long Q-Tc, and tall U waves occurred in the ECGs of six patients who died, the 15 patients with cerebral arterial spasm, and the seven patients who were later to develop cerebral arterial spasm. Three of the latter eventually died, in contrast with the single death in the 22 patients who did not develop cerebral arterial spasm and had a low incidence of P wave peaking, short P-R intervals, a long Q-Tc, and tall U waves. Various combinations of these four ECG changes, in addition to peaking of the T wave, indicated a bad prognosis irrespective of the type of treatment. The criteria for prognosis on the role of catecholamines in causing the ECG abnormalities are discussed.

Cruickshank, J. M.; Neil-Dwyer, G.; Brice, J.



Three years prospective investigation of pituitary functions following subarachnoid haemorrhage.  


Subarachnoid haemorrhage (SAH) is known to be related to pituitary dysfuntion in retrospective and short-term prospective studies. We aimed to investigate pituitary functions in patients with SAH in longer follow-up periods to demonstrate if pituitary hormone deficiencies recover, persist or new hormone deficiencies occur. Twenty patients with SAH, who were followed up for 3 years, were included in the present study. Patients were evaluated with basal hormone levels and glucagon stimulation test (GST).Serum basal cortisol and adrenocorticotropic hormone (ACTH) levels were found to be significantly elevated at 3rd year of SAH compared to 1st year. Other basal hormone levels at 3rd year did not show a significant change from the levels found at 1st year. One of the patients had ACTH deficiency at 1st year of SAH and recovered at 3rd year. Growth hormone (GH) deficiency, according to GST,was diagnosed in 4 patients. One patient with GH deficiency at first year was still deficient, 3 of them recovered and 3 patients were found to have new-onset GH deficiency 3 years after SAH. SAH is associated with anterior pituitary dysfunction and GH is the most frequently found deficient hormone in the patients. Although one year after SAH seems to be an appropriate time for the evaluation of pituitary functions, further follow-up may be required at least in some cases due to recovered and new-onset hormone deficiencies at 3rd year of SAH. PMID:22315089

Karaca, Z; Tanriverdi, F; Dagli, A T; Selcuklu, A; Casanueva, F F; Unluhizarci, K; Kelestimur, F



Disordered cerebro-vascular physiology in aneurysmal subarachnoid haemorrhage.  


The technical problems of surgery for anterior circle aneurysm have in large measure been solved. The problem of reduced perfusion to the brain which characterises the patient with aneurysmal subarachnoid haemorrhage in a poor clinical condition demands more subtle physiological handling. It appears likely that maintenance of an intact cell membrane and blood brain barrier may be aided by the exhibition of pre and post-operative steriods, and that concentration on regional perfusion should be the main aim in post-operative management of such cases. This demands maintenance of adequate blood volume, avoidance of platelet stickiness, and utilisation of the pathological paralysis of autoregulation to improve flow to ischaemic zones by hypertensive agents if necessary. The possibility that early operation with evacuation of blood from the basal cisterns may in the end prevent the vascular damage and disordered vaso-reactivity which encourages the development of transient ischaemic deficits, is a concept which has to be actively pursued. The problem is a continuing one which has bedevilled aneurysm surgery for 25 years, but the omens suggest that a solution is appreciably nearer at hand. PMID:665340

Symon, L



Delayed Positivization of Cerebral Angiography in Reversible Cerebral Vasoconstriction Syndrome (RCVS) Presenting with Recurrent Subarachnoid Haemorrhage  

PubMed Central

Benign angiopathy of the central nervous system is a clinical syndrome with evidence of reversible cerebral vasoconstriction (RCVS). Haemorrhagic stroke, either subarachnoid or intracerebral is an unusual presentation of RCVS. We describe a case of RCVS presenting with a subarachnoid haemorrhage (SAH), with rebleeding and onset of hydrocephalus during the first week, and, notably, delayed evidence of typical angiographic features after two negative prior exams. Normalization of the angiographic vasculitic-like lesions was documented at month +6. Repeated cerebral angiograms are mandatory to exclude this kind of disease, and the uncommon presentation of this case reinforces this concept.

Quartuccio, Luca; Tuniz, Francesco; Petralia, Benedetto; Zanotti, Bruno; Skrap, Miran; De Vita, Salvatore



Effect of propranolol and phentolamine on myocardial necrosis after subarachnoid haemorrhage  

Microsoft Academic Search

A study was set up to assess the effect on the clinical course of subarachnoid haemorrhage (SAH) of giving propranolol 80 mg eight-hourly plus phentolamine 20 mg three-hourly by mouth for three weeks. Out of the 90 patients studied, 14 died. Two of the deaths occurred in an open pilot study of 10 patients, the remaining 12 deaths occurring in

G Neil-Dwyer; P Walter; J M Cruickshank; B Doshi; P OGorman



Revised national guidelines for analysis of cerebrospinal fluid for bilirubin in suspected subarachnoid haemorrhage  

Microsoft Academic Search

It is crucially important to detect subarachnoid haemorrhage (SAH) in all patients in whom it has occurred to select patients for angiography and preventative surgery. A computerized tomography (CT) scan is positive in up to 98% of patients with SAH presenting within 12 h, but is positive in only 50% of those presenting within one week. Cerebrospinal fluid (CSF) bilirubin

Anne Cruickshank; Peter Auld; Robert Beetham; Gillian Burrows; William Egner; Ian Holbrook; Geoff Keir; Emma Lewis; Dina Patel; I. Watson; P. White



Criteria for the diagnosis of noninfectious and infectious complications after aneurysmal subarachnoid hemorrhage in DISCHARGE-1.  


Patients with aneurysmal subarachnoid hemorrhage (aSAH) frequently develop secondary noninfectious and infectious complications that have an important impact on clinical course and outcome. We here report on criteria for the diagnosis of the most important complications after aSAH based on clinical status, neuroimaging, and laboratory tests, including cerebrospinal fluid parameters. These criteria will be used for a retrospective analysis of aSAH patients who were recruited at the Charité Berlin for the CoOperative Study on Brain Injury Depolarisations (COSBID) before the Depolarisations in Ischaemia after Subarachnoid Haemorrhage-1 (DISCHARGE-1) trial started. Moreover, they serve for the survey of complications in DISCHARGE-1. We also report on a customized, Web-based database that has been developed for the documentation of the clinical course after aSAH. This database is used for the COSBID outcome study on aSAH and for DISCHARGE-1. PMID:22890662

Drenckhahn, Christoph; Brabetz, Claudia; Major, Sebastian; Wiesenthal, Dirk; Woitzik, Johannes; Dreier, Jens P



Pulmonary and cardiac sequelae of subarachnoid haemorrhage: time for active management?  

Microsoft Academic Search

Cardiac injury and pulmonary oedema occurring after acute neurological injury have been recognised for more than a century.\\u000a Catecholamines, released in massive quantities due to hypothalamic stress from subarachnoid haemorrhage (SAH), result in specific\\u000a myocardial lesions and hydrostatic pressure injury to the pulmonary capillaries causing neurogenic pulmonary oedema (NPO).\\u000a The acute, reversible cardiac injury ranges from hypokinesis with a normal

C. S. A. Macmillan; I. S. Grant; P. J. D. Andrews


Possible mechanism to induce protein kinase C-dependent arterial smooth muscle contraction after subarachnoid haemorrhage  

Microsoft Academic Search

Summary A possible mechanism for the induction of protein kinase C (PKC)-dependent vascular contraction independent to the increase of intracellular Ca++ was investigated in the pathogenesis of cerebral vasospasm in the double subarachnoid haemorrhage (SAH) model. The level of 1,2-diacylglycerol (DAG), which is an intrinsic PKC activator, significantly increased from days 4 to 7 in the basilar artery after the

S. Ohta; J. Nishihara; Y. Oka; H. Todo; Y. Kumon; S. Sakaki



Intra-Arterial Infusion of Fasudil Hydrochloride for Treating Vasospasm Following Subarachnoid Haemorrhage  

Microsoft Academic Search

Summary  ?In this pilot study we treated cerebral vasospasm in patients with subarachnoid haemorrhage to assess intra-arterial fasudil\\u000a hydrochloride. We analysed effects of intra-arterial infusion on angiographically evident cerebral vasospasm in 10 patients\\u000a including 3 with symptoms of vasospasm. Over 10 to 30 min 15 to 60 mg was administered via the proximal internal carotid artery\\u000a or vertebral artery following standard

E. Tachibana; T. Harada; M. Shibuya; K. Saito; M. Takayasu; Y. Suzuki; J. Yoshida



Aneurysmal Subarachnoid Haemorrhage in Pregnancy: A Case Series  

PubMed Central

Summary Pregnancy is a recognized risk factor for aneurysmal subarachnoid hemorrhage (SAH). Headache is very frequent in normal pregnancy and it is a common sign shared between several intracranial diseases. We present a case series of 10 women in the third trimester of pregnancy admitted to our intensive care unit (ICU) with neurological signs and symptoms. 4 of these patients were diagnosed with SAH. Data in this study suggest that a timely diagnosis and an appropriate treatment is crucial for mother and baby.

Guida, Maurizio; Altieri, Roberto; Palatucci, Valeria; Visconti, Federica; Pascale, Renato; Marra, Marialuisa; Locatelli, Giampiero; Saponiero, Renato; Tufano, Rosalba; Bifulco, Francesca; Piazza, Ornella



Cerebrospinal fluid analyses for the diagnosis of subarachnoid haemorrhage and experience from a Swedish study. What method is preferable when diagnosing a subarachnoid haemorrhage?  


Abstract Subarachnoid haemorrhage (SAH) has a high mortality and morbidity rate. Early SAH diagnosis allows the early treatment of a ruptured cerebral aneurysm, which improves the prognosis. Diagnostic cerebrospinal fluid (CSF) analyses may be performed after a negative computed tomography scan, but the precise analytical methods to be used have been debated. Here, we summarize the scientific evidence for different CSF methods for SAH diagnosis and describe their implementation in different countries. The principle literature search was conducted using PubMed and Scopus with the search items "cerebrospinal fluid", "subarachnoid haemorrhage", and "diagnosis". CSF analyses for SAH include visual examination, red blood cell counts, spectrophotometry for oxyhaemoglobin or bilirubin determination, CSF cytology, and ferritin measurement. The methods vary in availability and performance. There is a consensus that spectrophotometry has the highest diagnostic performance, but both oxyhaemoglobin and bilirubin determinations are susceptible to important confounding factors. Visual inspection of CSF for xanthochromia is still frequently used for diagnosis of SAH, but it is advised against because spectrophotometry has a superior diagnostic accuracy. A positive finding of CSF bilirubin is a strong indicator of an intracranial bleeding, whereas a positive finding of CSF oxyhaemoglobin may indicate an intracranial bleeding or a traumatic tap. Where spectrophotometry is not available, the combination of CSF cytology for erythrophages or siderophages and ferritin is a promising alternative. PMID:23729569

Nagy, Karin; Skagervik, Ina; Tumani, Hayrettin; Petzold, Axel; Wick, Manfred; Kühn, Hans-Jürgen; Uhr, Manfred; Regeniter, Axel; Brettschneider, Johannes; Otto, Markus; Kraus, Jörg; Deisenhammer, Florian; Lautner, Ronald; Blennow, Kaj; Shaw, Leslie; Zetterberg, Henrik; Mattsson, Niklas



Aneurysmal subarachnoid haemorrhage in pregnancy: a case series.  


Pregnancy is a recognized risk factor for aneurysmal subarachnoid hemorrhage (SAH). Headache is very frequent in normal pregnancy and it is a common sign shared between several intracranial diseases. We present a case series of 10 women in the third trimester of pregnancy admitted to our intensive care unit (ICU) with neurological signs and symptoms. 4 of these patients were diagnosed with SAH. Data in this study suggest that a timely diagnosis and an appropriate treatment is crucial for mother and baby. PMID:23905045

Maurizio, Guida; Roberto, Altieri; Valeria, Palatucci; Federica, Visconti; Renato, Pascale; Marialuisa, Marra; Giampiero, Locatelli; Renato, Saponiero; Rosalba, Tufano; Francesca, Bifulco; Piazza, Ornella



Listening to the head and not the heart: subarachnoid haemorrhage associated with severe acute left ventricular failure.  


Headache is a very common presenting symptom in the emergency department, and distinguishing subarachnoid haemorrhage from more benign causes of headache can be challenging. This particular presentation of subarachnoid haemorrhage was made more difficult by concurrent-related cardiac pathophysiology. This case report describes the evolving differential diagnosis of a 54-year-old woman initially presenting with headache and confusion, with signs and investigations suggestive of ST elevation myocardial infarction and resultant left ventricular failure. The importance of prompt primary percutaenous coronary intervention left clinicians with a difficult decision about which specialty was most appropriate for the patient to be transferred to. Ultimately the symptoms were explained by radiographic confirmation of subarachnoid haemorrhage and subsequent adrenergic storm, causing myocyte injury and myocardial contractile dysfunction. This patient was transferred for coiling of a ruptured cerebral artery berry aneurysm. Her left ventricular failure improved from severe to mild within 48 h of presentation. PMID:23988819

King, Christopher



Pituitary apoplexy can mimic acute meningoencephalitis or subarachnoid haemorrhage  

PubMed Central

Pituitary apoplexy is an uncommon but life-threatening condition that is often overlooked and underdiagnosed. We report a 45-year-old man who presented to our emergency department with a sudden onset headache, acute confusion, signs of meningeal irritation and ophthalmoplegia. An initial diagnosis of acute meningoencephalitis was made, which was amended to pituitary apoplexy following thorough investigation within the emergency department. A 45-year-old man was brought to our emergency department by ambulance with a history of sudden onset of frontal headache and acute confusion. His wife provided the history. There was no significant past medical history of diabetes, hypertension, recent travel abroad, exposure to sick contacts, involvement in outdoor pursuits such as hiking/cave diving, or trauma. He worked in a bank and had been well until 24 h prior to the onset of sudden headache, which was gradually worsening in nature and associated with increasing confusion. The patient's wife reported that he had neither experienced any fevers, night sweats, or coryzal symptoms nor received any recent vaccinations. He was not on any regular medications. He was a non-smoker and occasionally consumed alcohol. There was no significant family history. On examination in the ED, his temperature was 37.6°C, his pulse was 110/min, and he was normotensive and normoglycaemic. A macular blanching rash was noted over the patient's trunk. The patient was disoriented to time and place. Neurological examination revealed reduced GCS (11/15-E3, M6, V2), marked neck stiffness, a positive Kernig's sign and a right sixth nerve palsy. A provisional diagnosis of acute meningoencephalitis was made and the patient was started on a course of intravenous antibiotics with benzyl penicillin 1.2 g, cefotaxime 2 g and acyclovir 750 mg. Baseline blood investigations revealed hyponatraemia (122 mmol/l), a white-cell count of 11 × 109/l and a C-reactive protein > 250. Due to the sudden onset of the symptoms and lack of prodrome, an urgent CT head scan was performed to rule out a cerebrovascular event. The scan demonstrated an enlarged pituitary gland (3 cm in diameter) with impingement of the optic chiasm. The centre of the enlarged pituitary gland was noted to be hypodense in comparison to its periphery, which was consistent with a diagnosis of pituitary apoplexy. A subsequent MRI confirmed the diagnosis (Figure 1) of an enlarged sella containing abnormal soft tissue with increased signal intensity suggestive of haemorrhage (Figure 1A). Post-MRI a lumbar puncture was performed revealing glucose 3.4 mmol/l, protein 1.0 g/l, red cells of 53/mm3 and white cells of 174/mm3 with predominant neutrophilia. No organisms were seen, and CSF cultures and HSV DNA tests were found to be negative. Endocrinological investigations demonstrated low concentrations of thyroid hormones [TSH: 0.14 mIu/l (0.35-5.5 mlU/l), FT3: 1.1 nmol/l (1.2-3.0 nmol/l), FT4: 9.6 pmol/l (8-22 pmol/l)], gonadal hormones (LH: < 1 u/l) and prolactin: 16 u/l (<450 u/l). Serum FSH was 2.9 u/l (0.8-11.5 u/L) and cortisol 575 nmol/l (450-700 nmol/l). The patient was treated for hypopituitarism based on clinical and radiological findings with intravenous fluids, hydrocortisone (100 mg) and thyroxine (50 ?g) as loading doses in the ED. Within 24 h of commencement of therapy the patient's GCS rose to 15, and within 48 h there was marked improvement in the right sixth cranial nerve palsy. Formal visual field assessment demonstrated temporal visual field loss in the left eye. The patient was discharged to his usual residence a week later and follow-up was organised with both the endocrinologists and ophthalmologists. Follow-up MRI demonstrated that there was no significant change in either size or signal characteristics of the pituitary fossa mass (Figure 1B).



Pituitary apoplexy can mimic acute meningoencephalitis or subarachnoid haemorrhage.  


Pituitary apoplexy is an uncommon but life-threatening condition that is often overlooked and underdiagnosed. We report a 45-year-old man who presented to our emergency department with a sudden onset headache, acute confusion, signs of meningeal irritation and ophthalmoplegia. An initial diagnosis of acute meningoencephalitis was made, which was amended to pituitary apoplexy following thorough investigation within the emergency department.A 45-year-old man was brought to our emergency department by ambulance with a history of sudden onset of frontal headache and acute confusion. His wife provided the history. There was no significant past medical history of diabetes, hypertension, recent travel abroad, exposure to sick contacts, involvement in outdoor pursuits such as hiking/cave diving, or trauma. He worked in a bank and had been well until 24 h prior to the onset of sudden headache, which was gradually worsening in nature and associated with increasing confusion. The patient's wife reported that he had neither experienced any fevers, night sweats, or coryzal symptoms nor received any recent vaccinations. He was not on any regular medications. He was a non-smoker and occasionally consumed alcohol. There was no significant family history. On examination in the ED, his temperature was 37.6°C, his pulse was 110/min, and he was normotensive and normoglycaemic. A macular blanching rash was noted over the patient's trunk. The patient was disoriented to time and place. Neurological examination revealed reduced GCS (11/15-E3, M6, V2), marked neck stiffness, a positive Kernig's sign and a right sixth nerve palsy.A provisional diagnosis of acute meningoencephalitis was made and the patient was started on a course of intravenous antibiotics with benzyl penicillin 1.2 g, cefotaxime 2 g and acyclovir 750 mg. Baseline blood investigations revealed hyponatraemia (122 mmol/l), a white-cell count of 11 × 109/l and a C-reactive protein > 250. Due to the sudden onset of the symptoms and lack of prodrome, an urgent CT head scan was performed to rule out a cerebrovascular event. The scan demonstrated an enlarged pituitary gland (3 cm in diameter) with impingement of the optic chiasm. The centre of the enlarged pituitary gland was noted to be hypodense in comparison to its periphery, which was consistent with a diagnosis of pituitary apoplexy. A subsequent MRI confirmed the diagnosis (Figure 1) of an enlarged sella containing abnormal soft tissue with increased signal intensity suggestive of haemorrhage (Figure 1A).Post-MRI a lumbar puncture was performed revealing glucose 3.4 mmol/l, protein 1.0 g/l, red cells of 53/mm3 and white cells of 174/mm3 with predominant neutrophilia. No organisms were seen, and CSF cultures and HSV DNA tests were found to be negative. Endocrinological investigations demonstrated low concentrations of thyroid hormones [TSH: 0.14 mIu/l (0.35-5.5 mlU/l), FT3: 1.1 nmol/l (1.2-3.0 nmol/l), FT4: 9.6 pmol/l (8-22 pmol/l)], gonadal hormones (LH: < 1 u/l) and prolactin: 16 u/l (<450 u/l). Serum FSH was 2.9 u/l (0.8-11.5 u/L) and cortisol 575 nmol/l (450-700 nmol/l). The patient was treated for hypopituitarism based on clinical and radiological findings with intravenous fluids, hydrocortisone (100 mg) and thyroxine (50 ?g) as loading doses in the ED.Within 24 h of commencement of therapy the patient's GCS rose to 15, and within 48 h there was marked improvement in the right sixth cranial nerve palsy. Formal visual field assessment demonstrated temporal visual field loss in the left eye. The patient was discharged to his usual residence a week later and follow-up was organised with both the endocrinologists and ophthalmologists. Follow-up MRI demonstrated that there was no significant change in either size or signal characteristics of the pituitary fossa mass (Figure 1B). PMID:21975129

Sadek, Ahmed-Ramadan; Gregory, Stephen; Jaiganesh, Thiagarajan



Differential diagnostic yield of lumbar puncture in investigation of suspected subarachnoid haemorrhage: a retrospective study.  


The diagnostic algorithm of computerized tomography (CT) and lumbar puncture (LP) for suspected subarachnoid haemorrhage (SAH) has lately been challenged by the advancement of radiological techniques, such as higher resolution offered by newer generation CT-scanners and increased availability of CT-angiography. A purely radiological workup of suspected SAH offers great advantages for both patients and the health care system, but the risks of abandoning LP in this setting are not well investigated. We have characterized the differential diagnostic yield of LP in the investigation of suspected SAH by a retrospective study. From the hospital laboratory database, we analyzed the medical records of all patients who had undergone CSF-analysis in search of subarachnoid bleeding during 2009-2011. A total of 453 patients were included. In 14 patients (3%) the LP resulted in an alternative diagnosis, the most common being aseptic meningitis. Two patients (0.5%) received treatment for herpes meningitis. Five patients (1%) with subarachnoid haemorrhages were identified. Among these, the four patients presenting with thunderclap headache had non-aneurysmal bleedings and did not require surgical intervention. We conclude that the differential diagnostic yield of LP in investigation of suspected SAH is low, which indicates that alternative diagnoses is not a reason to keep LP in the workup when a purely radiological strategy has been validated. However, algorithms should be developed to increase the recognition of aseptic meningitis. One hundred and fifty-three patients (34%) were admitted to undergo LP, which estimates the number of hospital beds that might be made available by a radiological diagnostic algorithm. PMID:23358626

Brunell, Anna; Ridefelt, Peter; Zelano, Johan



An audit of aneurysmal subarachnoid haemorrhage: earlier resuscitation and surgery reduces inpatient stay and deaths from rebleeding.  

PubMed Central

OBJECTIVE--To audit the outcome in patients with subarachnoid haemorrhage (SAH) after a change in management strategy. METHODS--A retrospective analysis of patients with aneurysmal subarachnoid haemorrhage over a 20 month period (phase 1) was followed by a prospective analysis of patients presenting during the next 20 months (phase 2) in which a protocol driven management regime of immediate intravenous fluid resuscitation and earlier surgery was pursued. Patients in this phase were grouped into those receiving early (within four days of subarachnoid haemorrhage) and late (after four days of subarachnoid haemorrhage) surgery. In phase 1, 75 out of a total of 92 patients underwent surgery on (median) day 12. From phase 2, 109 patients out of a total of 129 underwent surgery on (median) day 4, 58 of which had their surgery within 4 days of the subarachnoid haemorrhage. Patients in each phase/group were well matched for demographic features, site of aneurysm, and severity of subarachnoid haemorrhage. RESULTS--The surgical morbidity and mortality were no different in the two phases (P < 0.92; chi2 test). The management outcomes in the two phases of the study were also no different (P < 0.52). However, there was a significant reduction in the rebleed rate in patients undergoing surgery within four days of the subarachnoid haemorrhage in phase 2 (P < 0.0001) with an associated trend towards reduced incidence of postoperative ischaemia (P = 0.06) and mortality (P = 0.11). Operating earlier in phase 2 of the trial resulted in a lower total hospital inpatient stay of 15.8 (95% CI 13.1-18.5) days for survivors compared with 25.7 (95% CI 21.6-29.8) days in the late group (P < 0.00001; t test). CONCLUSIONS--surgical morbidity and mortality seemed independent of the timing of aneurysm surgery. Early surgery within four days was associated with a highly significant reduction in rebleed rate, and in the duration of total hospital inpatient stay. Images

Whitfield, P C; Moss, H; O'Hare, D; Smielewski, P; Pickard, J D; Kirkpatrick, P J



Subarachnoid haemorrhage with bilateral intracranial vertebral artery dissecting aneurysms treated by staged endovascular stenting.  


Bilateral vertebral artery dissecting aneurysms (VADAs) presenting with subarachnoid haemorrhage (SAH) are an exceedingly rare and deadly clinical dilemma. Prompt intervention in the case of unilateral VADAs is advocated to prevent rebleed; however, in the case of bilateral VADAs, the optimal therapeutic intervention is unclear. We describe the case of a patient presenting with SAH with bilateral VADAs treated by staged endovascular stenting. This led to resolution of the aneurysms with patency of both vertebral arteries. Stent-based therapy of the symptomatic aneurysm followed by staged stenting of the asymptomatic, contralateral aneurysm appears to be a viable treatment option. This method allows the ability to preserve flow in both vertebral arteries with minimal changes in flow characteristics that may threaten the contralateral, asymptomatic VADA, and appears to be the ideal treatment in these rare cases. PMID:23417929

Wilkinson, David Andrew; Wilson, Thomas J; Stetler, William R; Pandey, Aditya S



Effect of propranolol and phentolamine on myocardial necrosis after subarachnoid haemorrhage.  


A study was set up to assess the effect on the clinical course of subarachnoid haemorrhage (SAH) of giving propranolol 80 mg eight-hourly plus phentolamine 20 mg three-hourly by mouth for three weeks. Out of the 90 patients studied, 14 died. Two of the deaths occurred in an open pilot study of 10 patients, the remaining 12 deaths occurring in patients in a randomised double-blind placebo-controlled study. Postmortem examination was carried out on 12 of the patients, six of whom had been receiving placebo and six propranolol plus phentolamine. Necrotic myocardial lesions were present in the hearts of all six patients (age range 30-59 years) who died while taking placebo (all had had abnormal electrocardiograms (ECGs). In contrast, no necrotic lesions were found in the hearts of the six patients (age range 28-59) who died while receiving the drugs (all had previously had normal ECGs). We conclude that the necrotic myocardial lesions were induced by catecholamines and that propranolol had a cardioprotective effect. While death from a further haemorrhage in cases of SAH is not affected by propranolol and phentolamine, propranolol may have a beneficial effect in other potentially lethal stresses. PMID:361155

Neil-Dwyer, G; Walter, P; Cruickshank, J M; Doshi, B; O'Gorman, P



Effect of propranolol and phentolamine on myocardial necrosis after subarachnoid haemorrhage.  

PubMed Central

A study was set up to assess the effect on the clinical course of subarachnoid haemorrhage (SAH) of giving propranolol 80 mg eight-hourly plus phentolamine 20 mg three-hourly by mouth for three weeks. Out of the 90 patients studied, 14 died. Two of the deaths occurred in an open pilot study of 10 patients, the remaining 12 deaths occurring in patients in a randomised double-blind placebo-controlled study. Postmortem examination was carried out on 12 of the patients, six of whom had been receiving placebo and six propranolol plus phentolamine. Necrotic myocardial lesions were present in the hearts of all six patients (age range 30-59 years) who died while taking placebo (all had had abnormal electrocardiograms (ECGs). In contrast, no necrotic lesions were found in the hearts of the six patients (age range 28-59) who died while receiving the drugs (all had previously had normal ECGs). We conclude that the necrotic myocardial lesions were induced by catecholamines and that propranolol had a cardioprotective effect. While death from a further haemorrhage in cases of SAH is not affected by propranolol and phentolamine, propranolol may have a beneficial effect in other potentially lethal stresses. Images FIG 2

Neil-Dwyer, G; Walter, P; Cruickshank, J M; Doshi, B; O'Gorman, P



Fasudil, a protein kinase inhibitor, prevents the development of endothelial injury and neutrophil infiltration in a two-haemorrhage canine subarachnoid model  

Microsoft Academic Search

We examined the possible prophylactic potential of fasudil, a protein kinase inhibitor, on the development of endothelial injury and neutrophil infiltration after subarachnoid haemorrhage (SAH). Using the two haemorrhage canine model, fasudil (3 mg\\/kg) was infused intravenously for 30 min twice daily (days 1–7) and related histological changes were observed by light and electron microscopy. On day 7 characteristic features

Shin-ichi Satoh; Yasuhiro Yamamoto; Yoshinori Toshima; Ichiro Ikegaki; Toshio Asano; Yoshio Suzuki; Masato Shibuya



Relationship between presence of vasoconstrictor activity in cerebrospinal fluid and time after subarachnoid haemorrhage from rupture of cerebral arterial aneurysms.  

PubMed Central

The relationship between clinical condition and vasoconstrictor factors in cerebrospinal fluid was studied in 19 patients for up to six weeks after subarachnoid haemorrhage. Vasoconstrictor activity was assayed biologically. Sixteen of 19 patients improved as vasoconstrictor activity declined; this pattern was not significantly influenced by surgery. Serial angiography was performed on three patients and a qualitative relationship was shown between arterial dilatation, clinical improvement, and reduced pharmacological activity.

Hunt, T M; Du Boulay, G H; Blaso, W P; Forster, D M; Boullin, D J



How well do we investigate patients with suspected subarachnoid haemorrhage? The continuing need for cerebrospinal fluid investigations  

Microsoft Academic Search

Objective: To demonstrate the extent of compliance with established guidelines for the investigation of suspected subarachnoid haemorrhage (SAH) and the implications of non-compliance.Design: Prospective observational study of practice in three hospitals in the Trent region.Setting: One teaching hospital with a tertiary neuroscience referral centre and two large district general hospitals.Participants: 50 consecutive patients from each centre referred for suspected SAH

M L A Schofield; E Lorenz; T J Hodgson; S Yates; P D Griffiths



Recurrent non-aneurysmal subarachnoid haemorrhage in Takayasu arteritis: is the cause immunological or mechanical?  


Aneurysmal subarachnoid haemorrhage (SAH) is rarely associated with Takayasu's arteritis (TA). The present report describes a 21-year-old woman with recurrent SAH and TA. In addition, she also had recurrent spells of postural weakness in the bilateral lower limb occurring at the same time. Sequential CT of the head and MRI showed bilateral cortical SAH. Vascular imaging with MR angiogram and CT angiogram showed bilateral subclavian arteries and left common carotid artery occlusion with multiple hypertrophied collaterals vessels in the neck. There was no evidence of aneurysms in the intracranial vasculature in the conventional angiogram. The CT angiogram of the aorta showed severe stenosis of the abdominal aorta above the renal arteries. The patient was treated with immunomodulatory therapy and had a favourable outcome without further recurrence at end of 1 year of follow-up. A review of the literature showed 21cases with aneurysmal SAH and three cases non-aneurysmal SAH in patients with TA have been reported. Various factors are responsible for the reorganisation of the intracranial of the arteries in patients with chronic vasculitis in the presence of extracranial stenosis and occlusion, which could possibly explain the SAH in absence of aneurysm in patients with TA. PMID:23771963

Shuaib, Umar Ashfaq; Kate, Mahesh; Homik, Joanne; Jerrakathil, Thomas



Measurement of total circulating blood volume following subarachnoid haemorrhage: methodological aspects.  

PubMed Central

The total circulating blood volume (TCBV) and total body/venous haematocrit ratio (Htb/Hv) was determined by simultaneous measurement of the red cell volume (RCV) and the plasma volume (PV) in 10 subarachnoid haemorrhage (SAH) patients, 10 supine bedresting control patients and 20 ambulant out-patients. The mean Htb/Hv of the SAH patients, 0.866, was found to be significantly lower than that of the supine controls, 0.908, and the ambulant patients, 0.909, (p less than 0.01). Using the ratio 0.866 the total circulating blood volume of the SAH patients was calculated from either their RCV or their PV and compared with their measured TCBV. Expressed as a percentage of measured TCBV the mean errors of these single volume determinations were 2.84% and 1.76% respectively. The significance of these changes in the Htb/Hv ratio of SAH patients is discussed in relation to the circulatory disturbances they suffer.

Nelson, R J; Roberts, J; Ackery, D M; Pickard, J D



Lumbar drains may reduce the need for permanent CSF diversion in spontaneous subarachnoid haemorrhage.  


Subarachnoid haemorrhage (SAH) is well known to induce hydrocephalus. This is often, initially, treated with external ventricular drainage (EVD). We recently started, also, using lumbar drains (LD) in patients refractory to removal of their EVD as a bridge to permanent CSF diversion. LD were placed in 25 patients with spontaneous SAH. LD remained in place a mean of 6.7 days (range 4-16) prior to removal. Patients had a median Fisher Grade of 4, Hunt-Hess score of 4, and WFNS score of 4. Only 4 of 25 patients (16%) progressed to the need of permanent shunting, one of which occurred after delayed recurrent aneurysm rupture. Only 7 of 25 patients developed symptomatic vasospasm despite their high median Fisher Grade. Both the shunt rate and the symptomatic vasospasm rate in this series are much less than the historical series predict. This suggests that lumbar drains may reduce the need for shunting and decrease the rate of symptomatic vasospasm. PMID:23190179

Ormond, D R; Dressler, A; Kim, S; Ronecker, J; Murali, R



Nicardipine in the treatment of aneurysmal subarachnoid haemorrhage: a meta-analysis of published data.  


Nicardipine is a dihydropyridine-type Ca(2+) channel blocker with a powerful antihypertensive activity and a unique cerebrovascular profile. Recent studies have examined nicardipine for the treatment of patients with aneurysmal subarachnoid haemorrhage (SAH), but have shown inconsistent results. In the current study, a meta-analysis was performed to assess the clinical effectiveness of nicardipine in the prevention of cerebral vasospasm in patients who had suffered from aneurysmal SAH. Medline, EMBASE, and PubMed databases were searched for the controlled trials evaluating nicardipine for treating SAH after a ruptured aneurysm, without language restrictions. Moreover, a manual search of the bibliographies of relevant articles was also conducted. Two researchers of the present study independently performed the literature search and the data extraction. The meta-analyses were performed using the software RevMan 4.2.10 (provided by the Cochrane Collaboration, Oxford, UK). Five published manuscripts involving 1,154 patients were included in this meta-analysis. Nicardipine infusion reduced the risk of poor outcome (death, vegetative state, or dependency) and mortality, with an odds ratio (OR) of 0.58 [95 % confidence interval (CI) 0.37-0.90] and 0.45 (95 % CI 0.15-1.29), respectively. This meta-analysis suggests that nicardipine therapy reduces the likelihood of poor outcome and mortality in patients after aneurysmal SAH. PMID:23111775

Huang, Ren-qiang; Jiang, Fu-gang; Feng, Zi-min; Wang, Tian-yi



Cerebrospinal fluid from subarachnoid haemorrhage patients causes excessive oxidative metabolism compared to vascular smooth muscle force generation.  


Cerebrospinal fluid (CSF) from subarachnoid haemorrhage (SAH) patients can stimulate vascular smooth muscle to generate force in vitro. CSF from SAH patients suffering from delayed ischaemic neurological deficits due to cerebral vasospasm can generate near maximal force in vitro and previous experiments have ascribed this generation of force to be a calcium mediated event. The intracellular calcium concentration has been demonstrated to rise during the vasospastic process. Calcium also stimulates oxidative metabolism as does adenosine diphosphate (ADP), the product of adenosine triphosphate (ATP) hydrolysis. Significant alteration in high energy metabolites such as ATP, ADP and phosphocreatine have also been demonstrated in various models of SAH mediated vasospasm. Vascular smooth muscle predominantly uses oxidative metabolism for force generation and reserves glycolytic metabolism for ion homeostasis. A decrease in oxidative metabolism during force generation would imply failing mitochondria and increased glycolytic high-energy phosphate supply. Increased oxidative metabolism would imply a decreased efficiency of the contractile apparatus or mitochondria. The aim of this study was to see if SAH CSF stimulation of porcine carotid artery oxidative metabolism was altered during force generation when compared with incremental calcium stimulation with potassium chloride depolarisation. CSF from patients (n = 10) who had subarachnoid haemorrhage stimulated force generation but with a significant 'right shift' in oxygen consumption. This 'right shift' is indicative of an increased energy cost for contractile work. These results suggest that vascular smooth muscle contractile apparatus, when stimulated by subarachnoid cerebrospinal fluid, is consuming excess adenosine triphosphate during force generation. PMID:11345719

Pyne, G J; Cadoux-Hudson, T A; Clark, J F



Cognitive domain deficits in patients with aneurysmal subarachnoid haemorrhage at 1 year  

PubMed Central

Background Cognitive domain deficits can occur after aneurysmal subarachnoid haemorrhage (aSAH) though few studies systemically evaluate its impact on 1-year outcomes. Objective We aimed to evaluate the pattern and functional outcome impact of cognitive domain deficits in aSAH patients at 1?year. Methods We carried out a prospective observational study in Hong Kong, during which, 168 aSAH patients (aged 21–75?years and had been admitted within 96?h of ictus) were recruited over a 26-month period. The cognitive function was assessed by a domain-specific neuropsychological assessment battery at 1?year after ictus. The current study is registered at of the US National Institutes of Health (NCT01038193). Results Prevalence of individual domain deficits varied between 7% to 15%, and 13% had two or more domain deficits. After adjusting for abbreviated National Institute of Health Stroke Scale and Geriatric Depressive Scale scores, unfavourable outcome (Modified Rankin Scale 3–5) and dependent instrumental activity of daily living (Lawton Instrumental Activity of Daily Living<15) were significantly associated with two or more domain deficits and number of cognitive domain deficits at 1?year. Two or more domain deficits was independently associated with age (OR, 1.1; 95% CI 1.1 to 1.2; p<0.001) and delayed cerebral infarction (OR, 6.1; 95% CI 1.1 to 33.5; p=0.036), after adjustment for years of school education. Interpretation In patients with aSAH, cognitive domain deficits worsened functional outcomes at 1?year. Delayed cerebral infarction was an independent risk factor for two or more domain deficits at 1?year.

Wong, George Kwok Chu; Lam, Sandy Wai; Ngai, Karine; Wong, Adrian; Siu, Deyond; Poon, Wai Sang; Mok, Vincent



From multidimensional neuropsychological outcomes to a cognitive complication rate: The International Subarachnoid Aneurysm Trial  

PubMed Central

Background The neuropsychological arm of the International Subarachnoid Aneurysm Trial (N-ISAT) evaluated the cognitive outcome of 573 patients at 12 months following subarachnoid haemorrhage (SAH). The assessment included 29 psychometric measures, yielding a substantial and complex body of data. We have explored alternative and optimal methodologies for analysing and summarising these data to enable the estimation of a cognitive complication rate (CCR). Any differences in cognitive outcome between the two arms of the trial are not however reported here. Methods All individual test scores were transformed into z-scores and a 5th percentile cut-off for impairment was established. A principal components analysis (PCA) was applied to these data to mathematically transform correlated test scores into a smaller number of uncorrelated principal components, or cognitive 'domains'. These domains formed the basis for grouping and weighting individual patients' impaired scores on individual measures. In order to increase the sample size, a series of methods for handling missing data were applied. Results We estimated a 34.1% CCR in all those patients seen face-to-face, rising to 37.4% CCR with the inclusion of patients who were unable to attend assessment for reason related to the index SAH. This group demonstrated significantly more self and carer/relative rated disability on a Health Related Quality of Life questionnaire, than patients classified as having no functionally significant cognitive deficits. Conclusion Evaluating neuropsychological outcome in a large RCT involves unique methodological and organizational challenges. We have demonstrated how these problems may be addressed by re-classifying interval data from 29 measures into a dichotomous CCR. We have presented a 'sliding scale' of undifferentiated individual cognitive impairments, and then on the basis of PCA-derived cognitive 'domains', included consideration of the distribution of impairments in these terms. In order to maximize sample size we have suggested ways for patients who did not complete the entire protocol to be included in the overall CCR. ISAT trial registration ISRCTN49866681

Scott, Richard B; Eccles, Fiona; Lloyd, Andrew; Carpenter, Katherine



Effect of different components of triple-H therapy on cerebral perfusion in patients with aneurysmal subarachnoid haemorrhage: a systematic review  

Microsoft Academic Search

ABSTRACT: INTRODUCTION: Triple-H therapy and its separate components (hypervolemia, hemodilution, and hypertension) aim to increase cerebral perfusion in subarachnoid haemorrhage (SAH) patients with delayed cerebral ischemia. We systematically reviewed the literature on the effect of triple-H components on cerebral perfusion in SAH patients. METHODS: We searched medical databases to identify all articles until October 2009 (except case reports) on treatment

Jan W Dankbaar; Arjen JC Slooter; Gabriel JE Rinkel; Irene C van der Schaaf



Subarachnoid-pleural fistula: unusual complication of thoracotomy.  


A case of subarachnoid-pleural fistula caused by a traction injury of the intercostal neurovascular bundle during thoracotomy is presented. Headaches, air within the ventricles of the brain, and clear drainage from the chest catheter should alert the surgeon to the presence of a subarachnoid-pleural fistula. If spontaneous closure of the fistula does not occur after a brief trial of chest catheter drainage, early operative intervention is advised. PMID:6246314

Frantz, P T; Battaglini, J W



How well do we investigate patients with suspected subarachnoid haemorrhage? The continuing need for cerebrospinal fluid investigations  

PubMed Central

Objective: To demonstrate the extent of compliance with established guidelines for the investigation of suspected subarachnoid haemorrhage (SAH) and the implications of non-compliance. Design: Prospective observational study of practice in three hospitals in the Trent region. Setting: One teaching hospital with a tertiary neuroscience referral centre and two large district general hospitals. Participants: 50 consecutive patients from each centre referred for suspected SAH with negative computed tomography. Main outcome measures: Diagnosis of SAH confirmed or excluded according to guidelines. Results: When the data from the three centres were combined (n = 150 computed tomography negative cases) cerebrospinal fluid (CSF) investigation was not performed in 60/150 (40%). In the 90 cases where CSF studies were performed SAH was confirmed in 11 (12%). Conclusion: There is significant non-compliance in following the established guidelines for the investigation of SAH at the centres studied. As the primary cause of non-traumatic SAH is ruptured aneurysm, which is associated with high morbidity and mortality from second haemorrhage, this highlights a major source of concern for clinical governance.

Schofield, M; Lorenz, E; Hodgson, T; Yates, S; Griffiths, P



Spinal Subarachnoid Hematoma as a Complication of an Intramuscular Stimulation : Case Report and a Review of Literatures  

PubMed Central

Intramuscular stimulation (IMS) is widely used to treat myofascial pain syndrome. IMS is a safe procedure but several complications have been described. To our knowledge, spinal subarachnoid hematoma has never been reported as a complication of an IMS. The authors have experienced a case of spinal subarachnoid hematoma occurring after an IMS, which was tentatively diagnosed as intracranial subarachnoid hemorrhage because of severe headache. Patient was successfully treated with surgery. Here, we report our case with a review of literature.

Lee, Myeong Jong



Epidural haemorrhage during embolisation: a rare complication of intra-arterial embolisation of vertebral metastases  

PubMed Central

Pre-operative embolisation of vertebral metastases has been known to effectively devascularise hypervascular vertebral tumours and to reduce intra-operative bleeding. However, the complications that occur during the procedure are rarely reported. This case study attempts to highlight one rare complication, which is epidural tumoural haemorrhage intra-procedure. It may occur due to the fragility of the tumour and presence of neovascularisation. A small arterial dissection may also have occurred due to a slightly higher pressure exerted during injection of embolising agent. Haemostasis was secured via injection of Histoacryl into the area of haemorrhage. The patient was able to undergo the decompression surgery and suffered no direct complication from the haemorrhage.

Hashim, H; Abdul Kadir, KA



Interleukin-1 receptor antagonist is beneficial after subarachnoid haemorrhage in rat by blocking haem-driven inflammatory pathology.  


Subarachnoid haemorrhage (SAH) is a major contributor to the burden of stroke on society. Treatment options are limited and animal models of SAH do not always mimic key pathophysiological hallmarks of the disease, thus hindering development of new therapeutics. Inflammation is strongly associated with brain injury after SAH in animals and patients, and inhibition of the pro-inflammatory cytokine interleukin-1 (IL-1) represents a possible therapeutic target. Here we report that a rupture of the middle cerebral artery in the rat produces heterogeneous infarct patterns similar to those observed in human SAH. Administration of the IL-1 receptor antagonist (IL-1Ra) reduced blood-brain barrier breakdown, and the extent of breakdown correlated with brain injury. After SAH, haem oxygenase-1 (HO-1) was strongly expressed around the bleed site and in the cortex and striatum, indicating the presence of free haem, a breakdown product of haemoglobin. HO-1 expression was also found in the same regions as microglial/macrophage expression of IL-1?. The direct effect of haem on IL-1? expression was confirmed in vitro using organotypic slice culture (OSC). Haem-induced cell death was dependent on IL-1 signalling, with IL-1Ra completely blocking cellular injury. Furthermore, stimulation of mouse primary mixed glial cells with haem induced the release of IL-1?, but not IL-1?. Thus, we suggest that haem, released from lysed red blood cells (RBCs) in the subarachnoid space, acts as a danger-associated molecular pattern (DAMP) driving IL-1-dependent inflammation. These data provide new insights into inflammation after SAH-induced brain injury and suggest IL-1Ra as a candidate therapeutic for the disease. PMID:22679224

Greenhalgh, Andrew D; Brough, David; Robinson, Emily M; Girard, Sylvie; Rothwell, Nancy J; Allan, Stuart M



Levels of immunoreactive cysteinyl-leukotrienes in CSF after subarachnoid haemorrhage correlate with blood flow-velocity in TCD.  


Lipid peroxidation and enhanced arachidonic acid metabolism is activated after blood-brain cell contact. Previous studies have indicated that cysteinyl-leukotrienes (cys-LT) have the capacity to constrict arterial vessels in vivo and in vitro suggesting their involvement in the pathogenesis of cerebral vasospasm. The purpose of this study was to measure the amount of cyst-LT in the cerebro-spinal fluid (CSF) in correlation with transcranial Doppler findings (TCD) in patients with aneurysmal subarachnoid haemorrhage (SAH). In all patients early surgery was performed. In the first cisternal CSF-sample which was already collected intra-operatively an initial peak of cys-LT was detected, followed by decreasing amounts of cys-LT during the next 5 days. The CSF-levels of immunoreactive cys-LT were significantly higher in those patients who showed signs of vasospasm on transcranial Doppler sonography (TCD) (p < 0.001). Normalization of TCD values was accompanied by decreasing levels of CSF-cys-LT. We found a significant correlation between the amounts of immunoreactive cys-LT in cerebrospinal fluid and cerebral vasospasm measured by TCD. PMID:9309293

Winking, M; Müller, H W; Deinsberger, W; Joedicke, A; Boeker, D K



Likelihood of aneurysmal subarachnoid haemorrhage in patients with normal unenhanced CT, CSF xanthochromia on spectrophotometry and negative CT angiography.  


Background: Patients with suspected subarachnoid haemorrhage, a normal noncontrast computed tomography (CT) and cerebrospinal fluid (CSF) evidence of haemoglobin breakdown products often undergo CT angiography (CTA). If this is normal, then invasive catheter angiography may be offered. In current clinical practice, haemoglobin breakdown products are detected by spectrophotometry rather than visible xanthochromia, and CTA is performed on multidetector scanners. The aim of this study was to determine if such patients should still have a catheter angiography, given the associated risks. Methods: Patients positive for CSF spectrophotometry (n=26) were retrospectively identified from the clinical biochemistry information system and imaging data from the electronic radiology records were reviewed. Discharge letters were consulted to relate the biochemistry and radiology results to the final diagnosis. Results: 15 patients with CT angiography were found. Nine patients had normal CT angiography. No causative aneurysms had been missed. One patient had small, coincidental aneurysms missed on initial reading of the CTA. Conclusion: The likelihood of a clinically significant aneurysm in a patient who is CT negative, lumbar puncture positive and CTA negative is low. Double reporting of negative CT angiograms may be advisable. PMID:24087797

Rana, A K; Turner, H E; Deans, K A



Psychosocial outcomes at three and nine months after good neurological recovery from aneurysmal subarachnoid haemorrhage: predictors and prognosis  

PubMed Central

Objectives: To investigate (1) the prevalence of various aspects of cognitive and psychosocial dysfunction, including post-traumatic stress symptoms, over nine months after subarachnoid haemorrhage (SAH); (2) whether SAH is preceded by increased life stress; (3) to what extent adverse outcomes may be predicted from preillness life stress, early neurological impairment, age, and sex; and (4) relations between emotional and functional outcomes. Methods: 52 patients with good neurological recovery after surgery for SAH were each matched for age, sex, and occupation with a healthy control participant. SAH patients were assessed three and nine months postdischarge on measures of cognitive functioning, mood, and social functioning. Objective stressors and subjective life change during the preceding year were rated retrospectively. Controls completed measures of mood and social functioning once only. Results: Compared with controls, SAH patients showed increased mood disturbance, subtle cognitive impairment, and abnormally low independence and participation on measures of social functioning. 60% showed clinically significant post-traumatic stress symptomatology (intrusive thoughts or avoidance of reminders) at three months and 30% at nine months. Independence in activities of daily living was greatly reduced in half to a third of the sample at both three and nine months. Productive employment was below the 10th percentile of the control group for 75% of patients at three months and for 56% at nine months; this outcome could not be predicted from selected demographic, premorbid, or clinical variables but dependence on others for organisational activities was predicted by impaired prose recall. Mood at nine months was strongly predicted by prior mental health problems, poor physical health, dysphasia, and impaired prose recall at three months. There was no evidence of an abnormally high level of stressful life events in the year before SAH, although patients rated their subjective level of stress in this period slightly more highly than did the control participants. Conclusions: These findings highlight the need for structured support and treatment after surgery for SAH to reduce persisting mood disturbance and increase independence and participation.

Powell, J; Kitchen, N; Heslin, J; Greenwood, R



Achieved serum magnesium concentrations and occurrence of delayed cerebral ischaemia and poor outcome in aneurysmal subarachnoid haemorrhage  

PubMed Central

Background Magnesium therapy probably reduces the frequency of delayed cerebral ischaemia (DCI) in subarachnoid haemorrhage (SAH) but uncertainty remains about the optimal serum magnesium concentration. We assessed the relationship between serum magnesium concentrations achieved with magnesium sulphate therapy 64?mmol/day and the occurrence of DCI and poor outcome in patients with SAH. Methods Differences in magnesium concentrations between patients with and without DCI and with and without poor outcome were calculated. Quartiles of last serum magnesium concentrations before the onset of DCI, or before the median day of DCI in patients without DCI, were related to the occurrence of DCI and poor outcome at 3?months using logistic regression. Results Compared with the lowest quartile of serum magnesium concentration (1.10–1.28?mmol/l), the risk of DCI was decreased in each of the higher three quartiles (adjusted odds ratio (OR) in each quartile 0.2; lower 95% CI 0.0 to 0.1; upper limit 0.8 to 0.9). The OR for poor outcome was 1.8 (95% CI 0.5 to 6.9) in the second quartile, 1.0 (95% CI 0.2 to 4.5) in the third quartile and 4.9 (95% CI 1.2 to 19.7) in the highest quartile. Discussion Magnesium sulphate 64?mmol/day results in a stable risk reduction of DCI over a broad range of achieved serum magnesium concentrations, and strict titration of the dosage therefore does not seem necessary. However, concentrations ?1.28?mmol/l could decrease the effect on DCI while concentrations ?1.62 might have a negative effect on clinical outcome.

Mees, Sanne M Dorhout; van den Bergh, Walter M; Algra, Ale; Rinkel, Gabriel J E



Cerebrospinal fluid and plasma cytokines after subarachnoid haemorrhage: CSF interleukin-6 may be an early marker of infection  

PubMed Central

Background Cytokines and cytokine receptor concentrations increase in plasma and cerebrospinal fluid (CSF) of patients following subarachnoid haemorrhage (SAH). The relationship between plasma and CSF cytokines, and factors affecting this, are not clear. Methods To help define the relationship, paired plasma and cerebrospinal fluid (CSF) samples were collected from patients subject to ventriculostomy. Concentrations of key inflammatory cytokines, interleukin (IL)-1ß, IL-1 receptor antagonist (IL-1Ra), IL-1 receptor 2, IL-6, IL-8, IL-10, tumour necrosis factor (TNF)-?, and TNF receptors (TNF-R) 1 and 2 were determined by immunoassay of CSF and plasma from 21 patients, where samples were available at three or more time points. Results Plasma concentrations of IL-1ß, IL-1Ra, IL-10, TNF-? and TNF-R1 were similar to those in CSF. Plasma TNF-R2 and IL-1R2 concentrations were higher than in CSF. Concentrations of IL-8 and IL-6 in CSF were approximately10 to 1,000-fold higher than in plasma. There was a weak correlation between CSF and plasma IL-8 concentrations (r = 0.26), but no correlation for IL-6. Differences between the central and peripheral pattern of IL-6 were associated with episodes of ventriculostomy-related infection (VRI). A VRI was associated with CSF IL-6 >10,000 pg/mL (P = 0.0002), although peripheral infection was not significantly associated with plasma IL-6. Conclusions These data suggest that plasma cytokine concentrations cannot be used to identify relative changes in the CSF, but that measurement of CSF IL-6 could provide a useful marker of VRI.



Results of Direct Surgery for Aneurysmal Subarachnoid Haemorrhage: Outcome of 2055 Patients who Underwent Direct Aneurysm Surgery and Profile of Ruptured Intracranial Aneurysms  

Microsoft Academic Search

Summary  \\u000a ?Background and Purpose. The purpose of this study is to evaluate the therapeutic value of our surgical treatment of subarachnoid haemorrhage in\\u000a a large series with standardized surgical principles.\\u000a \\u000a \\u000a \\u000a ?Methods. Results of 2055 direct operations on ruptured intracranial aneurysms, treated in our institutions, where surgical indications,\\u000a instruments and techniques were standardized, between 1988 and 1998, were retrospectively evaluated and

M. Osawa; K. Hongo; Y. Tanaka; Y. Nakamura; K. Kitazawa; S. Kobayashi



Brain damage complicating septic shock: acute haemorrhagic leucoencephalitis as a complication of the generalised Shwartzman reaction.  

PubMed Central

The neuropathological findings in six patients who developed neurological signs after the onset of "septic shock" caused by Gram-negative septicaemia are described. The changes in the brains were characteristic of acute haemorrhagic leucoencephalitis, and there was evidence, particularly in the kidneys, of disseminated intravascular coagulation with tubular necrosis and, in some, appearances indistinguishable from membrano-proliferative glomerulonephritis. It is agreed that acute haemorrhagic leucoencephalitis is another manifestation of a generalised Shwartzman reaction, and it is suggested that activation of complement is the final common pathway that produces tissue damage in the brain and kidney. Images

Graham, D I; Behan, P O; More, I A



QT and QT-peak interval measurements. A methodological study in patients with subarachnoid haemorrhage compared to a reference group.  


To study the properties of QT and QT-peak intervals, ECGs were compared between 56 consecutive patients who were suffering from subarachnoid haemorrhage (SAH) and 50 reference subjects. The routine QTc interval was compared to the mean QTc from all of the 12 leads with identifiable U waves and to the mean QT-peakc. The interval between peak and end of T(Tp-Te) was subsequently calculated. In the reference group the mean QT-peak correlated with the mean QT (r = 0.925). The rate-dependence of the mean QT-peak was not different from that of the mean QT and showed the same correlation (r = -0.607 and -0.630, respectively). No rate-dependence for the Tp-Te interval could be demonstrated. Following SAH, ECG abnormalities were most pronounced after 8-9 days, and increased with age and the degree of cerebral dysfunction. Two patient groups, where the mean QTc of each particular patient was either below (n = 27) or above (n = 29) the reference limit, were analysed. For the group without an abnormally prolonged mean QTc, the average of the individual mean QTc was significantly longer than in the reference group. Both groups had longer mean QT-peakc intervals than the reference group. About 70% of the patients with an abnormally prolonged mean QTc also had a prolonged mean QT-peakc interval, while the rest had a prolonged Tp-Tc interval; simultaneous prolongation of these two intervals also occurred. Prolongation of the Tp-Te interval did not occur in the group without an abnormally prolonged mean QTc. Routine QTc and mean QT-peakc had sensitivities of 96% and 67% respectively, specificities of 76% and 96% and predictive values of 81% and 95%. In conclusion, the routine QTc measurements, without reference to an identified U wave, may result in falsely prolonged estimates of cardiac repolarization time. In this respect the mean QT-peakc may provide additional information. In the majority of patients the prolonged mean QTc was dependent on a disturbed rate-dependent function (prolonged mean QT-peakc) while some patients had an increased asymmetry of the repolarization process within the myocardium (prolonged Tp-Tc). PMID:3943284

Rudehill, A; Sundqvist, K; Sylvén, C



A Late Haemorrhagic Complication in an ArterioVenous Malformation Cured with Radiosurgery  

PubMed Central

Summary Radiosurgery is a recognized safe form of treating and usually curing arteriovenous malformations (AVMs). Complications related to radiosurgery, especially late sequelae, are rare. Such sequelae may be secondary to incomplete treatment of the original lesion such as haemorrhage, or secondary to the radiation damage to the tissue, or both. Sometimes treatment may induce new lesions. We report a patient who had an AVM cured with radiosurgery, but developed hemisensory loss acutely and had changes on MRI in keeping with a haematoma. We discuss the possible differential diagnosis that should be considered.

Le Feuvre, D.E.J.; Parkes, J.D.; Mukheiber, P.; James, R.; Taylor, A.G.



Genetic elimination of eNOS reduces secondary complications of experimental subarachnoid hemorrhage.  


Delayed complications of subarachnoid hemorrhage (SAH) such as angiographic vasospasm, cortical spreading ischemia, microcirculatory dysfunction, and microthrombosis are reported in both patients and animal models of SAH. We demonstrated previously that SAH is associated with increased oxidative stress in the brain parenchyma, and that this correlates with dysfunction of endothelial nitric oxide synthase (eNOS) (homodimeric uncoupling). Uncoupling of eNOS exacerbated oxidative stress and enhanced nitric oxide (NO) depletion, and was associated with multiple secondary complications such as microthrombosis, neuronal apoptosis, and release of reactive oxygen species. Thus, we hypothesized that genetic abbrogation of eNOS would confer a beneficial effect on the brain after SAH. Using a prechiasmatic injection model of SAH, we show here that eNOS knockout (KO) significantly alleviates vasospasm of the middle cerebral artery and reduces superoxide production. Endothelial nitric oxide synthase KO also affected other nitric oxide synthase isoforms. It significantly increases neuron nitric oxide synthase expression but has no effect on inducible nitric oxide synthase. Endothelial nitric oxide synthase KO decreases Zn(2+) release after SAH, reduces microthrombi formation, and prevent neuronal degeneration. This work is consistent with our findings where, after SAH, increased oxidative stress can uncouple eNOS via Zn(2+) thiolate oxidation, or theoretically by depletion or oxidation of tetrahydrobiopterin, resulting in a paradoxical release of superoxide anion radical, further exacerbating oxidative stress and microvascular damage. PMID:23549379

Sabri, Mohammed; Ai, Jinglu; Lass, Elliot; D'abbondanza, Josephine; Macdonald, R Loch



Abdominal Wall Haemorrhage After Robotic-Assisted Radical Prostatectomy: Is it a Complication of Robotic Surgery?  


OBJECTIVE: Robotic-assisted radical prostatectomy (RARP) is the minimally invasive surgical treatment for patients with localized prostate cancer. Perioperative or postoperative complications following RARP have been reported in some studies and severe postoperative bleeding after RARP is rare, but hemodynamic instability may necessitate open surgical exploration and be associated with considerable morbidity. We reported postoperative bleeding cases, which is a kind of complication associated with robotic surgery and requiring massive transfusion after RARP. PATIENTS AND METHODS: From August 2009 to May 2012, 317 consecutive patients who underwent RARP performed at our institution were analyzed. Patients with serious postoperative bleeding that caused hemodynamic instability after surgery were enrolled. RESULTS: A total of 5 among 317 (1.6%) patients had bleeding requiring postoperative transfusion. In these cases, mean operative time was 114minutes. The mean estimated blood loss was 110ml during operation. In these patients, hematocrit (Hct) levels gradually fell after surgery and ecchymosis was detected on the side and posterior walls of the abdomen on the second day. The mean preoperative Hct was 44.3% and mean lowest Hct was 23.1%. All patients were successfully treatment without surgical exploration. CONCLUSIONS: Robotic radical prostatectomy has proven to be a safe surgical treatment with low morbidity. However, postoperative bleeding can reach serious problems. This is the first study to explain haemorrhage, associated with possible risk of robotic surgery. PMID:23768503

Tasci, A I; Simsek, A; Tugcu, V; Bitkin, A; Sonmezay, E; Torer, B D



Continuous cerebral spinal fluid drainage associated with complications in patients admitted with subarachnoid hemorrhage.  


Object Cerebral artery vasospasm is a major cause of death and disability in patients recovering from subarachnoid hemorrhage (SAH). Although the exact cause of vasospasm is unknown, one body of research suggests that clearing blood products by CSF drainage is associated with a lower frequency and severity of vasospasm. There are multiple approaches to facilitating CSF drainage, but there is inadequate evidence to determine the best practice. The purpose of this study was to explore whether continuous or intermittent CSF drainage was superior for reducing vasospasm. Methods The authors performed a randomized clinical trial. Within 72 hours of admission for SAH, patients with an external ventricular drain (EVD) were randomized to undergo continuous CSF drainage with intermittent intracranial pressure (ICP) monitoring (open-EVD group) or continuous ICP monitoring with intermittent CSF drainage (monitor-ICP group). Results After 60 patients completed the study, an interim analysis was performed. The complication rate of 52.9% for the open-EVD group was significantly higher than the 23.1% complication rate for the monitor-ICP group (OR 3.75, 95% CI 1.21-11.66, p = 0.022). These results were reported to the Data Safety and Monitoring Board and enrollment was terminated. The odds ratio of vasospasm for the open-EVD versus monitor-ICP group was not significant (OR 0.44, 95% CI 0.13-1.45, p = 0.177). Conclusions Continuous CSF drainage with intermittent ICP monitoring is associated with a higher rate of complications than continuous ICP monitoring with intermittent CSF drainage, but there is no difference between the two types of monitoring in vasospasm. Clinical trial registration no.: NCT01169454 ( ). PMID:23957382

Olson, Daiwai M; Zomorodi, Meg; Britz, Gavin W; Zomorodi, Ali R; Amato, Anthony; Graffagnino, Carmelo



Spinal cord haemorrhage following herpes zoster: a possible complication of warfarin therapy  

Microsoft Academic Search

Haemorrhage is the most serious and common side-effect of warfarin therapy. Bleeding had commonly been observed in the gastrointestinal and genitourinary tracts as well as in the skin and subcutaneous tissue. Central nervous system bleeding has also been reported and has usually been associated with marked prolongation of the prothrombin time. Spinal cord haemorrhage has been infrequently observed. The patient

M. L. Friedland; E. G. Wittels



Timing of surgery in patients with aneurysmal subarachnoid haemorrhage: rebleeding is still the major cause of poor outcome in neurosurgical units that aim at early surgery  

PubMed Central

OBJECTIVE—To investigate prospectively the proportion of patients actually operated on early in units that aim at surgery in the acute phase of aneurysmal subarachnoid haemorrhage (SAH) and what is the main current determinant of poor outcome.?METHODS—A prospective analysis of all SAH patients admitted during a one year period at three neurosurgical units that aim at early surgery. The following clinical details were recorded: age, sex, date of SAH, date of admission to the neurosurgical centre, whether a patient was referred by a regional hospital or a general practitioner, Glasgow coma scale and grade of SAH (World Federation of Neurological Surgeons (WFNS) score) on admission at the neurosurgical unit, results of CT and CSF examination, the presence of an aneurysm on angiography, details of treatment with nimodipine or antifibrinolytic agents, and the date of surgery to clip the aneurysm. At follow up at three months, the patients' clinical outcome was determined with the Glasgow outcome scale and in cases of poor outcome the cause for this was recorded.?RESULTS—The proportion of patients that was operated on early—that is, within three days after SAH—was 55%. Thirty seven of all 102admitted patients had a poor outcome. Rebleeding and the initial bleeding were the main causes of this in 35% and 32% respectively of all patients with poor outcome.?CONCLUSIONS—In neurosurgical units with what has been termed "modern management" including early surgery, about half of the patients are operated on early. Rebleeding is still the major cause of poor outcome.??

Roos, Y; Beenen, L; Groen, R; Albrecht, K; Vermeulen, M



Subarachnoid Hemorrhage  


... into the compartment surrounding the brain, the subarachnoid space and is therefore also known as a subarachnoid ... leak into the CSF (cerebrospinal fluid) in the space around the brain (subarachnoid space). The pool of ...


Further Haemorrhage after Admission to Hospital for Gastrointestinal Haemorrhage  

PubMed Central

During 1967 and 1968 817 episodes of acute alimentary tract haemorrhage were treated in Aberdeen hospitals. In 229 cases further haemorrhage occurred in hospital, with a mortality of 28·8%; the mortality among patients who did not have this complication was 7·8%. This was true of any kind of further haemorrhage. As judged by transfusion requirements and mortality the severity of the further haemorrhage was unaffected by its occurrence as haematemesis and melaena or as melaena only or by whether it took place before or after 48 hours from the time of admission. The occurrence of further haemorrhage did not appear to be affected by the sex or blood group of patients, by aspirin ingestion, or by a history of a previous haemorrhage. The effects of the occurrence of further haemorrhage, of the age being over 60 years, or of coincidental disease being present were of descending importance in regard to mortality. Among 151 patients with peptic ulcer and further haemorrhage half required urgent surgery and 20% died. Further haemorrhage is a dangerous condition and its occurrence should immediately signal the need for vigilance and for urgent consultation between physician and surgeon. Any delay in treatment entails increased mortality.

Jones, Peter F.; Johnston, Shirley J.; McEwan, Arthur B.; Kyle, James; Needham, Charles D.



Partial gastrectomy for haemorrhage  

PubMed Central

An analysis was made of the results of 566 partial gastrectomies for haemorrhage from gastroduodenal ulceration between 1953 and 1962 with regard to mortality, morbidity, and long-term follow up. With rigid criteria for selection of patients for surgery, the overall mortality rate for ulcerative gastroduodenal haemorrhage was 8·6%. The actual operative mortality rate more than doubles if an emergency operation is performed later than four days after the patient's admission with haemorrhage. Postoperative and later bleeding complications occurred in 5% of patients. Regardless of the length of ulcerative history, over 92% of patients have clinically satisfactory long-term results. Six per cent required further operation, after which, they too had clinically satisfactory results.

Cocks, J. R.; Desmond, A. M.; Swynnerton, B. F.; Tanner, N. C.



Subarachnoid hemorrhage  


... snapping feeling in the head. Other symptoms: Decreased consciousness and alertness Eye discomfort in bright light ( photophobia ) ... time, the outlook is much worse. Changes in consciousness and alertness due to a subarachnoid hemorrhage may ...


Intracerebral haemorrhage  

PubMed Central

Intracerebral haemorrhage is an important public health problem leading to high rates of death and disability in adults. Although the number of hospital admissions for intracerebral haemorrhage has increased worldwide in the past 10 years, mortality has not fallen. Results of clinical trials and observational studies suggest that coordinated primary and specialty care is associated with lower mortality than is typical community practice. Development of treatment goals for critical care, and new sequences of care and specialty practice can improve outcome after intracerebral haemorrhage. Specific treatment approaches include early diagnosis and haemostasis, aggressive management of blood pressure, open surgical and minimally invasive surgical techniques to remove clot, techniques to remove intraventricular blood, and management of intracranial pressure. These approaches improve clinical management of patients with intracerebral haemorrhage and promise to reduce mortality and increase functional survival.

Qureshi, Adnan I; Mendelow, A David; Hanley, Daniel F



Significance of placental pathology in transplacental haemorrhage  

Microsoft Academic Search

Placentae were examined from 120 women whose pregnancy and delivery was normal, from 264 women whose pregnancy or delivery was complicated, and from 98 women who were Rh-negative without antibodies and 35 women Rh-negative with antibodies. The presence of Kline's haemorrhages, intervillous thrombi, infarcts, and retroplacental haemorrhages was positively correlated with the presence of foetal cells in the maternal circulation.

Banti Devi; R. F. Jennison; F. A. Langley



Spontaneous perinatal epidural haemorrhage in a newborn.  


A full-term neonate, born by caesarean section, presents with focal seizures. EEG and cranial ultrasound are normal. MRI of the cerebrum shows an epidural haematoma. Perinatal intracranial haemorrhage in the full-term newborn is an important cause of morbidity and mortality. Most perinatal intracranial haemorrhages are located either subdural or intracerebral, rarely epidural. Epidural haemorrhage is usually a complication of assisted delivery, however it may also occur without forcipal or vacuum extraction, as demonstrated in this case. An epidural haemorrhage should be suspected on clinical findings, even in the absence of an assisted delivery. As cranial ultrasound sonography often misses epidural haemorrhage due to parietal location of the haemorrhage, the diagnosis needs either cerebral CT or MRI. PMID:22665463

Kroon, Elke; Bok, Levinus A; Halbertsma, Feico



Cardiac manifestations of subarachnoid hemorrhage.  


Subarachnoid hemorrhage (SAH) is a devastating condition. It carries a high mortality rate, with 12% of patients dying before reaching the hospital. Aside from its neurological morbidities, SAH is associated with significant medical complications. Cardiac manifestations are common and can impact morbidity and mortality in SAH patients. This article will discuss the cardiac manifestations of SAH. PMID:21438809

Behrouz, Réza; Sullebarger, John T; Malek, Ali R



Critical care management of subarachnoid hemorrhage  

Microsoft Academic Search

Successful critical care management of patients with aneurysmal subarachnoid hemorrhage requires a thorough understanding\\u000a of the disease and its complications and a familiarity with modern multimodality neuromonitoring technology. This article\\u000a reviews the natural history of aneurysmal subarachnoid hemorrhage and strategies for disease management in the acute setting.\\u000a Available tools for monitoring brain function are discussed.

Joshua M. Levine



[Endoscopic methods of treatment of variceal haemorrhages].  


Haemorrhages from oesophagal varices are one of the most lifethreatening complications of the portal hypertension. Among various methods of treatment, endoscopic techniques are accepted and acknowledged as basic ones. The object of this paper is:--to present the variety of endoscopic procedures--to analyse the methodology and techniques of endoscopic procedures--to compare the effectiveness, safety and possible complications of different endoscopic techniques--to analyse the recommendations for treatment of acute variceal haemorrhages, primary and secondary prophylaxis. Endoscopic methods of haemostasis are essential in the treatment of acute variceal haemorrhages. Medical centres having at their disposal endoscopic methods of treating variceal haemorrhages can use the following techniques: EIS-endoscopic injection sklerotherapy--obliterating bleeding varices by injecting polidocanol or alcohol); rubber bands (EVL-Endoscopic Variceal Ligation); clipsing (closing varices with metal clipses). There are also different possibilities of combining methods mentionned above. In the primary prophylaxis of variceal haemorrhages, as the results of different studies are ambiguous, the endoscopic methods are used cautiously and for special indications only; pharmacological methods (non-selective b-blockers) have a leading role here. In the secondary prophylaxis of haemorrhages (in patients with history of previous variceal haemorrhages) endoscopic techniques have an acknowledged and leading role among other therapeutic methods. When comparing different endoscopic methods, crucial differences can be observed between their effectiveness, safety and technical possibilities of performing the procedures. PMID:17679386

Jaklewicz, Dariusz; Róza?ski, Waldemar; Wojtu?, Stanis?aw; Gil, Jerzy



Spinal subarachnoid hemorrhage accompanied with intraventricular hemorrhage  

PubMed Central

Spinal hematoma is a rare and usually severe neurological disorder that, without adequate treatment, often leads to death or permanent neurological deficit. Epidural as well as subdural and subarachnoid hematomas have been investigated in some studies. A 66-year-old man referred to our hospital because of acute onset paraplegia and incontinency started 3 h before admission. With impression of spinal hemorrhage, emergent cervicothoracic spinal MRI performed. On magnetic resonance imagination (MRI) mixed hyper/iso intense lesion in anterior subarachnoid space from C7 to T5 was seen. On brain A computerised tomography (CT) scan, subarachnoid hemorrhage and intraventricular hemorrhage in posterior parts of brain was seen. Unfortunately, the patient died 10 days later. About our patient, severe back pain accompanying by immediate paraplegia, sphincter disturbances, sensory level, and prominent meningeal signs guided us clinically to spinal subarachnoid hemorrhage. Further brain CT scan revealed diffusion of blood to brain subarachnoid space and ventricles. An outstanding finding on brain CT was the presence of blood only in posterior horn of lateral ventricles and dorsal fissures of brain supporting our theory that blood has diffused from spinal subarachnoid space to dorsal subarachnoid space of brain because of supine position of patient. In this patient anticoagulation may be the only sinister factor for developing complications.

Fatehi, Farzad; Basiri, Keivan; Ghorbani, Askar



Spinal syringomyelia following subarachnoid hemorrhage.  


Subarachnoid blood has been reported as a cause of chronic spinal arachnoiditis. Although syringomyelia has been thought to be caused by spinal arachnoiditis, reports of syringomyelia following aneurysmal subarachnoid hemorrhage (SAH) are very rare. We describe two patients with syringomyelia associated with chronic spinal arachnoiditis following SAH. From January 2001 to December 2010, 198 patients with aneurysmal SAH were treated at Kinki University School of Medicine. Two of the 198 patients had syringomyelia following aneurysmal SAH; thus the rate of syringomyelia associated with aneurysmal SAH was 1.0%. Patient 1 was a 54-year-old woman who presented with back pain, back numbness and gait disturbance 20 months after SAH. Her MRI revealed syringomyelia of the spinal cord from C2 to T10. She underwent shunting of the syrinx to the subarachnoid space. Patient 2 was a 49-year-old man, who was admitted to the hospital with headache, diplopia, hoarseness, dysphagia and ataxia five months after SAH. MRI revealed syringomyelia from the medulla oblongata to C6, and an enlargement of the lateral and fourth ventricles. After foramen magnum decompression and C1 laminectomy, a fourth ventricle-subarachnoid shunt was placed by insertion of a catheter. Spinal arachnoiditis and spinal syringomyelia are rare but important chronic complications after SAH. PMID:22285478

Nakanishi, Kinya; Uchiyama, Takuya; Nakano, Naoki; Fukawa, Norihito; Yamada, Kimito; Yabuuchi, Tomonari; Kato, Amami



Viral haemorrhagic fevers of man.  


This article reviews the current state of knowledge on the viral haemorrhagic fevers that infect man, namely smallpox, chikungunya fever, dengue fever, Rift Valley fever, yellow fever, Crimean haemorrhagic fever, Kyasanur Forest disease, Omsk haemorrhagic fever, Argentinian haemorrhagic fever (Junin virus), Bolivian haemorrhagic fever (Machupo virus), Lassa fever, haemorrhagic fever with renal syndrome, and Marburg and Ebola virus diseases. PMID:310725

Simpson, D I



Viral haemorrhagic fevers of man*  

PubMed Central

This article reviews the current state of knowledge on the viral haemorrhagic fevers that infect man, namely smallpox, chikungunya fever, dengue fever, Rift Valley fever, yellow fever, Crimean haemorrhagic fever, Kyasanur Forest disease, Omsk haemorrhagic fever, Argentinian haemorrhagic fever (Junin virus), Bolivian haemorrhagic fever (Machupo virus), Lassa fever, haemorrhagic fever with renal syndrome, and Marburg and Ebola virus diseases.

Simpson, D. I. H.



Massive obstetric haemorrhage  

Microsoft Academic Search

Massive obstetric haemorrhage is a major cause of maternal death and morbidity; abruptio placentae, placenta praevia and postpartum haemorrhage being the main causes. A delay in the correction of hypovolaemia, a delay in the diagnosis and treatment of defective coagulation and a delay in the surgical control of bleeding are the avoidable factors in most maternal deaths caused by haemorrhage.

John Bonnar



Haemorrhagic pure motor stroke.  


To describe the clinical characteristics of haemorrhagic pure motor stroke (PMS). Twelve patients with haemorrhagic PMS were identified. Haemorrhagic PMS accounted for 3.2% of all cases of pure motor hemiparesis (n = 380) and 3.3% of intracerebral haemorrhage (n = 364) entered in the database. When compared with PMS of ischaemic origin, patients with haemorrhagic PMS were more likely to be younger (62.2 vs. 75.2 years, P = 0.003) and to have headache (33% vs. 6.3%, P =0.007) and thalamus involvement (25% vs. 2.4%, P = 0.005). Limb weakness (100% vs. 74.1%; P = 0.03), involvement of the internal capsule (50% vs. 17.3%, P = 0.012) and symptom free at discharge (25% vs. 3.7%, P = 0.012) were significantly more frequent in patients with haemorrhagic PMS than in the remaining cases of haemorrhagic stroke, whereas nausea and vomiting (0% vs. 25.9%, P = 0.03), altered consciousness (0% vs. 42.9%, P = 0.001), sensory symptoms (8.3% vs. 46.9%, P =0.007) and ventricular haemorrhage (0% vs. 26.1%, P = 0.028) were significantly less frequent. Haemorrhagic PMS is a very infrequent stroke subtype. Headache at stroke onset may be useful sign for distinguishing haemorrhagic PMS from other causes of lacunar stroke. There are important differences between haemorrhagic PMS and the remaining intracerebral haemorrhages. PMID:17250733

Arboix, A; García-Eroles, L; Massons, J; Oliveres, M; Balcells, M



A spontaneous suprachoroidal haemorrhage: a case report  

PubMed Central

Introduction We present a case of spontaneous suprachoroidal haemorrhage in a patient taking Warfarin. This is only the second case reported of a patient whose anticoagulation was within the therapeutic range. Case presentation An 84 year old white male with a history of end stage atrophic age related macular degeneration presented with angle closure glaucoma. The patient was taking warfarin and had a therapeutic International Normalized Ratio (INR). Ultrasound examination revealed a spontaneous suprachoroidal haemorrhage. Conclusion Anticoagulation is common in those with cardiovascular disease, which increases the risk of haemorrhagic complications. These patients are also more likely to suffer from age related macular degeneration. Suprachoroidal haemorrhage should be considered in such patients presenting with suspicious signs and a low threshold should be had for investigating for this condition in such circumstances. Early detection may reduce the morbidity.



Management of severe postpartum haemorrhage: an updated protocol  

Microsoft Academic Search

Intractable postpartum haemorrhage (PPH) is exceedingly rare. Most complications result from procrastination or lack of adherence to a structured protocol of management. Active management of the third stage of labour is highly effective in preventing PPH. If haemorrhage nevertheless occurs, the following measures are implemented in rapid succession until the bleeding stops: 1) methylergometrine maleate is administered, 2) the uterus

J. J. Amy



Epizootic Haemorrhagic Disease  

Technology Transfer Automated Retrieval System (TEKTRAN)

Epizootic haemorrhagic disease (EHD) is an infectious non contagious viral disease transmitted by insects of the genus Culicoides which affects wild and domestic ruminants. The causative agent, the epizootic haemorrhagic disease virus (EHDV), belongs to the family Reoviridae, genus Orbivirus and sha...


Spontaneous orbital haemorrhage.  

PubMed Central

A 57-year-old housewife, with controlled hypertension, presented with acute right proptosis and visual loss with external ophthalmoplegia due to spontaneous orbital haemorrhage. Vision and ocular motility were returned to normal by the rapid surgical evacuation of the blood. Acute orbital haemorrhage is an ocular emergency requiring urgent treatment to prevent the usual previously reported outcome of permanent visual loss. Images

Brooks, A. M.; Finkelstein, E.



Does the association of antepartum haemorrhage complicating a pregnancy that resulted in mid-trimester miscarriage or preterm birth affect risk of delivery before term?  

Microsoft Academic Search

BackgroundPreterm birth (PTB) is the end result of a heterogenous group of complications of pregnancy. Women with a previous mid-trimester spontaneous abortion or PTB are at higher risk of PTB in a subsequent pregnancy.1 No studies have compared the risk conferred to a subsequent pregnancy if the spontaneous abortion or PTB was immediately preceded by a vaginal bleeding, to those

T Nippita; N L Hezelgrave; P Seed; A H Shennan



Risk factors for aneurysmal subarachnoid haemorrhage: the Troms? study  

PubMed Central

Methods: The Tromsø health study is a population based survey of risk factors for cardiovascular disease in 27 161 subjects. 26 cases of aneurysmal SAH were identified in which risk factors were registered before the bleeding. Four age and sex matched controls were selected for each case. A backward logistic regression analysis was conducted and odds ratios (ORs) for significant risk factors were calculated. Systolic and diastolic blood pressure, cigarette smoking habits, serum concentrations of lipoproteins, body mass index, and coffee consumption were analysed. Results: The crude annual incidence rate of aneurysmal SAH was 8.84/100 000 population. The proportion of current smokers was significantly (p = 0.003) higher in patients with SAH (73.1%) than in controls (41.3%). Drinking more than five cups of coffee per day was more common among patients (85%) than controls (59%) (p = 0.004). Mean (SD) systolic blood pressure was higher (p = 0.017) in patients (154.0 (32.5)) than in controls (136.3 (23.3)). Regression analysis showed that cigarette smoking (p = 0.04), systolic blood pressure (p < 0.0001), and coffee consumption (p = 0.004) were independent risk factors for SAH. The OR of current smokers versus never smokers was 4.55 (95% confidence interval (CI) 1.08 to 19.30) and the OR of drinking more than five cups of coffee a day was 3.86 (95% CI 1.01 to 14.73). The OR of an increase in systolic blood pressure of 20 mm Hg was 2.46 (95% CI 1.52 to 3.97). Conclusions: Cigarette smoking and hypertension are significant independent risk factors for aneurysmal SAH. A high coffee consumption may also predispose patients to aneurysmal SAH.

Isaksen, J; Egge, A; Waterloo, K; Romner, B; Ingebrigtsen, T



Thalamic haemorrhage vs internal capsule-basal ganglia haemorrhage: clinical profile and predictors of in-hospital mortality  

PubMed Central

Background There is a paucity of clinical studies focused specifically on intracerebral haemorrhages of subcortical topography, a subject matter of interest to clinicians involved in stroke management. This single centre, retrospective study was conducted with the following objectives: a) to describe the aetiological, clinical and prognostic characteristics of patients with thalamic haemorrhage as compared with that of patients with internal capsule-basal ganglia haemorrhage, and b) to identify predictors of in-hospital mortality in patients with thalamic haemorrhage. Methods Forty-seven patients with thalamic haemorrhage were included in the "Sagrat Cor Hospital of Barcelona Stroke Registry" during a period of 17 years. Data from stroke patients are entered in the stroke registry following a standardized protocol with 161 items regarding demographics, risk factors, clinical features, laboratory and neuroimaging data, complications and outcome. The region of the intracranial haemorrhage was identified on computerized tomographic (CT) scans and/or magnetic resonance imaging (MRI) of the brain. Results Thalamic haemorrhage accounted for 1.4% of all cases of stroke (n = 3420) and 13% of intracerebral haemorrhage (n = 364). Hypertension (53.2%), vascular malformations (6.4%), haematological conditions (4.3%) and anticoagulation (2.1%) were the main causes of thalamic haemorrhage. In-hospital mortality was 19% (n = 9). Sensory deficit, speech disturbances and lacunar syndrome were significantly associated with thalamic haemorrhage, whereas altered consciousness (odds ratio [OR] = 39.56), intraventricular involvement (OR = 24.74) and age (OR = 1.23), were independent predictors of in-hospital mortality. Conclusion One in 8 patients with acute intracerebral haemorrhage had a thalamic hematoma. Altered consciousness, intraventricular extension of the hematoma and advanced age were determinants of a poor early outcome.

Arboix, Adria; Rodriguez-Aguilar, Raquel; Oliveres, Montserrat; Comes, Emili; Garcia-Eroles, Luis; Massons, Joan



Haemorrhagic septicaemia vaccines  

Microsoft Academic Search

Haemorrhagic septicaemia (HS), an economically important disease of cattle and buffaloes, is caused by Pasteurella multocida (6:B). Vaccination against this disease is widely practised. Plain broth bacterins, or alum precipitated and aluminium hydroxide gel vaccines are administered twice a year since these vaccines offer an immunity of 4–6 months. Many countries use oil adjuvant vaccine (OAV), which gives both a

Rishendra Verma; T. N. Jaiswal



Arenaviral haemorrhagic fevers.  


Three arenaviruses--Lassa, Junin and Machupo--cause severe haemorrhagic disease in humans: Lassa fever, Argentine haemorrhagic fever and Bolivian haemorrhagic fever, respectively. These conditions are a source of considerable economic hardship in endemic areas and remain a worldwide concern for public-health officials. They are characterised by an insidious onset of influenza-like symptoms followed, in severe cases, by a generalised bleeding diathesis, encephalopathy and death. Central to studies of their pathogenesis is evidence for cellular dysfunction disproportionate to overt histopathology. Recent studies of patients with Lassa fever indicate that platelet and possibly endothelial-cell dysfunction play an important role in the bleeding tendency. The platelet defect appears to be mediated by an inhibitory factor in plasma; the nature of this is uncertain but it seems to be neither viral protein nor virus antibody. A similar inhibitor has since been demonstrated in patients with Argentine haemorrhagic fever. Plasma from patients with Lassa fever also profoundly modulates the amount of superoxide generated by normal neutrophils in response to the chemotactic peptide f-met-leu-phe, suggesting the inhibitor(s) has global effects on cellular function. These findings may have important implications for future therapeutic strategies. PMID:1777745

Cummins, D



Zoonoses and haemorrhagic fever.  


Virus zoonoses causing haemorrhagic fever have been recognized in three major families: Arenaviridae, Bunyaviridae and Filoviridae. All are negative-stranded RNA viruses, with genomes in two segments, three segments, or non-segmented, respectively. Acquisition of haemorrhagic fever in man generally requires close contact with a vertebrate vector species, usually rodents, for the arenaviruses and bunyaviruses. In the case of filoviruses, the vector is currently unknown, but these viruses may infect monkeys, and may contaminate cell cultures prepared from them. Both bunyavirus and arenavirus haemorrhagic fevers have arisen in humans following exposure to rodents, and in the case of Hantaan, a virus causing haemorrhagic fever with renal syndrome (HFRS), there have been numerous laboratory-acquired infections among animal care workers. As the technology to differentiate virus species has improved, it has become clear that there are numerous potentially hazardous viruses capable of causing HFRS or hantavirus pulmonary syndrome (HPS) within the feral rodent population. In many cases it would be desirable to introduce screening methods for such viruses before preparing cell cultures from these rodent or simian species that will be used to prepare biological products for human use. PMID:9737374

Mahy, B W



[Spontaneous subarachnoid hemorrhage].  


The diagnosis, management and long-term implications of non-traumatic subarachnoid hemorrhage continue to be a multidisciplinary challenge. Often, the patients present to emergency or primary care physicians not particularly experienced in the differential diagnosis of headache. In most cases of a proven hemorrhage (aneurysm rupture in 85%), further treatment will require the discussion between experienced neurosurgeons and neuroradiologists whether to "clip or coil". Thus, subarachnoid hemorrhage is the first cerebrovascular disorder where a multidisciplinary approach has become the evidence-based standard of care. Patients with this condition are relatively young, and the survivors have a good life expectancy. Their neurologic, cognitive and psychiatric morbidity, risk of recurrent bleeding and elevated risk of other vascular diseases remain underestimated tasks for long-term care. PMID:22349626

Steinmetz, H



Ebola haemorrhagic fever  

PubMed Central

Ebola viruses are the causative agents of a severe form of viral haemorrhagic fever in man, designated Ebola haemorrhagic fever, and are endemic in regions of central Africa. The exception is the species Reston Ebola virus, which has not been associated with human disease and is found in the Philippines. Ebola virus constitutes an important local public health threat in Africa, with a worldwide effect through imported infections and through the fear of misuse for biological terrorism. Ebola virus is thought to also have a detrimental effect on the great ape population in Africa. Case-fatality rates of the African species in man are as high as 90%, with no prophylaxis or treatment available. Ebola virus infections are characterised by immune suppression and a systemic inflammatory response that causes impairment of the vascular, coagulation, and immune systems, leading to multiorgan failure and shock, and thus, in some ways, resembling septic shock.

Feldmann, Heinz; Geisbert, Thomas W



Ebola haemorrhagic fever.  


Ebola viruses are the causative agents of a severe form of viral haemorrhagic fever in man, designated Ebola haemorrhagic fever, and are endemic in regions of central Africa. The exception is the species Reston Ebola virus, which has not been associated with human disease and is found in the Philippines. Ebola virus constitutes an important local public health threat in Africa, with a worldwide effect through imported infections and through the fear of misuse for biological terrorism. Ebola virus is thought to also have a detrimental effect on the great ape population in Africa. Case-fatality rates of the African species in man are as high as 90%, with no prophylaxis or treatment available. Ebola virus infections are characterised by immune suppression and a systemic inflammatory response that causes impairment of the vascular, coagulation, and immune systems, leading to multiorgan failure and shock, and thus, in some ways, resembling septic shock. PMID:21084112

Feldmann, Heinz; Geisbert, Thomas W



Clarithromycin-induced haemorrhagic colitis.  


Haemorrhagic colitis by Klebsiella oxytoca has been described as an antibiotic-associated colitis, particularly with the use of ampicillin. Here we report a patient with haemorrhagic colitis caused by K oxytoca after the use of clarithromycin. A 67-year-old Japanese woman with diabetes presented with mucobloody diarrhoea and abdominal pain. Stool culture grew K oxytoca. Colonoscopy showed the appearance of haemorrhagic colitis. Further history taking revealed that she had received a course of oral clarithromycin for upper respiratory tract infection. She had recovered by conservative treatment. We should be careful about gastrointestinal symptoms in patients on clarithromycin, which can cause haemorrhagic colitis associated with K oxytoca. PMID:23964038

Miyauchi, Ryosuke; Kinoshita, Kensuke; Tokuda, Yasuharu



Occult pulmonary haemorrhage in leukaemia.  

PubMed Central

Through gleeding into the lung parenchyma is responsible for morbidity and mortality in patients with leukaemia pulmonary haemorrhage is seldom diagnosed during life. We diagnosed occult pulmonary haemorrhage in five leukaemic patients with unexplained infiltrates on chest roetgenograms by examining alveolar macrophages retrieved by bronchopulmonary lavage. Macrophage haemosiderin content was greatly increased in the patients with pulmonary haemorrhage as compared to normal and thrombocytopenic control subjects. Haemoglobin and intact erythrocytes in alveolar macrophages were taken as evidence of recent haemorrhage. Intrapulmonary bleeding may occur often in patients with leukaemia, and bronchopulmonary lavage offers a safe approach to diagnosis and allows for concomitant identification of pulmonary infection. Images FIG. 1 FIG. 2

Golde, D W; Drew, W L; Klein, H Z; Finley, T N; Cline, M J



Cerebral haemorrhagic infarction in young patients with hereditary protein C deficiency: evidence for "spontaneous" cerebral venous thrombosis.  

PubMed Central

Among 53 patients with hereditary protein C deficiency belonging to 20 families three women were encountered who, aged 27, 34, and 38 respectively, had had cerebral haemorrhagic infarction, probably due to intracranial venous thrombosis. All three had also had venous thrombosis of the leg and pulmonary embolism either before or after their cerebral infarction. One patient sustained cerebral infarction while receiving an oral contraceptive, but infarction in the two others occurred "spontaneously." One patient also had an intraventricular and subarachnoid haemorrhage during the induction phase of coumarin treatment, which was assumed to have resulted from haemorrhagic infarction of the chorioid plexus, analogous to coumarin provoked haemorrhagic skin necrosis in protein C deficiency. Hereditary protein C deficiency should be considered in young patients with acute or subacute cerebral symptoms, especially if they have a family or personal history of venous thromboembolism. Images FIG 1 FIG 2 FIG 3 FIG 4 FIG 5 FIG 6

Wintzen, A R; Broekmans, A W; Bertina, R M; Briet, E; Briet, P E; Zecha, A; Vielvoye, G J; Bots, G T



Spinal syringomyelia following subarachnoid hemorrhage  

Microsoft Academic Search

Subarachnoid blood has been reported as a cause of chronic spinal arachnoiditis. Although syringomyelia has been thought to be caused by spinal arachnoiditis, reports of syringomyelia following aneurysmal subarachnoid hemorrhage (SAH) are very rare. We describe two patients with syringomyelia associated with chronic spinal arachnoiditis following SAH. From January 2001 to December 2010, 198 patients with aneurysmal SAH were treated

Kinya Nakanishi; Takuya Uchiyama; Naoki Nakano; Norihito Fukawa; Kimito Yamada; Tomonari Yabuuchi; Amami Kato


[Neonatal subgaleal haemorrhage; a potential life-threatening extracranial haemorrhage  

Microsoft Academic Search

A female neonate delivered at term developed hypovolemic shock due to a subgaleal haemorrhage, i.e. extracranial bleeding between the galea aponeurotica and the cranial periosteum. The subgaleal haemorrhage was most likely the result of a traumatic vacuum extraction. The patient was treated with large volumes of fluids and blood products and received additional circulatory and respiratory support. The clinical features

J. Fuijkschot; T. A. J. Antonius; P. W. Meijers; S. L. A. G. Vrancken



Intracranial haemorrhage and use of selective serotonin reuptake inhibitors  

PubMed Central

Aims In the past few years an increasing number of bleeding disorders have been reported in association with the use of selective serotonin reuptake inhibitors (SSRIs), including serious cases of intracranial haemorrhage, raising concerns about the safety of this class of drugs. The present study was performed to test the hypothesis of an increased risk of intracranial haemorrhage associated with the use of SSRIs. Methods We carried out a case-control study nested in a cohort of antidepressants users with the UK-based General Practice Research Database (GPRD) as the primary source of information. The study cohort encompassed subjects aged between 18 and 79 years who received a first-time prescription for any antidepressant from January, 1990 to October, 1997. Patients with presenting conditions or treatments that could be associated with an increased risk of intracranial haemorrhage were excluded from the cohort. Patients were followed-up until the occurrence of an idiopathic intracranial haemorrhage. Up to four controls per case, matched on age, sex, calendar time and practice were randomly selected from the study cohort. We estimated adjusted odds ratios and 95% confidence intervals of intracranial haemorrhage with current use of SSRIs and other antidepressants as compared with nonuse using conditional logistic regression. Results We identified 65 cases of idiopathic intracranial haemorrhage and 254 matched controls. Current exposure to SSRIs was ascertained in 7 cases (10.8%) and 24 controls (9.7%) resulting in an adjusted OR (95%CI) of 0.8 (0.3,2.3). The estimate for ‘other antidepressants’ was 0.7 (0.3,1.6). The effect measures were not modified by gender or age. No effect related to dose or treatment duration was detected. The risk estimates did not change according to the location of bleeding (intracerebral or subarachnoid). Conclusions Our results are not compatible with a major increased risk of intracranial haemorrhage among users of SSRIs or other antidepressants at large. However, smaller but still relevant increased risks cannot be ruled out.

de Abajo, Francisco J; Jick, Hershel; Derby, Laura; Jick, Susan; Schmitz, Stephen



Severe intracranial haemorrhage in neonatal alloimmune thrombocytopenia.  


Neonatal alloimmune thrombocytopenia is a rare (1/1000-5000 births) life-threatening disorder, caused by fetomaternal incompatibility for a fetal human platelet alloantigen inherited from the father, with production of maternal alloantibodies against fetal platelets, leading to severe thrombocytopenia and potential bleeding. Intracranial haemorrhage is the most feared complication. This report presents the case of a term newborn infant, born from caesarean section after a normal pregnancy, presenting signs of skin bleeding with different ages. Obstetric history included a previous spontaneous abortion after amniocentesis. Severe thrombocytopenia (4×10(9)/l platelets) was found and brain ultrasound showed multiple intracranial haemorrhages. Human platelet antigen (HPA) phenotyping showed maternal negative HPA-1a and paternal positive HPA-1a platelets. Strongly positive anti-HPA-1a and weakly positive anti-human leukocyte antigen class I alloantibodies were found in the mother. Multiple platelet transfusions, intravenous immunoglobulin and corticosteroid were given but favourable response was accomplished only after a compatible platelet transfusion. Brain MRI showed multiple subacute and chronic haemorrhages. PMID:22679192

Silva, Francisco; Morais, Sofia; Sevivas, Teresa; Veiga, Ricardo; Salvado, Ramon; Taborda, Adelaide



Intravitreal gas for submacular haemorrhage.  


Submacular haemorrhage is an important cause for sudden visual loss needing immediate intervention. We report a case of submacular haemorrhage causing profound visual loss, which resolved after intravitreal injection of perfluoropropane (C3F8) gas followed by strict prone positioning. PMID:14750625

Mahesh, Gopalakrishnan; Giridhar, Anantharaman; Saikumar, Seshadri J; Elias, Anna



Subaponeurotic haemorrhage in Malaysian neonates.  


In a 30-month prospective study, between January 1987 and June 1989, 101 of 64,424 Malaysian neonates (1.6 per 1000 livebirths) born in the Maternity Hospital, Kuala Lumpur were found to have subaponeurotic haemorrhage shortly after delivery. The incidence was highest in neonates weighting 4000 gm or more. There was no significant difference in incidence of this condition in neonates of different ethnic origins. Hypoprothrombinemia was present in only 5/101 (5.0%) of the affected neonates. Sixty seven (66.3%) of the neonates with subaponeurotic haemorrhage had history of trial of vacuum extraction. The incidence of subaponeurotic haemorrhage was significantly higher in neonates delivered by vacuum extraction than by other modes of delivery in this hospital (41.4 per 1000 livebirths in neonates delivered by vacuum extraction versus 1.0 per 1000 livebirths in neonates delivered by other modes). Those neonates who developed subaponeurotic haemorrhage without trial of vacuum extraction had a history of either prolonged labour or difficult delivery. Thirty-three (32.7%) of the neonates with subaponeurotic haemorrhage developed anaemia which required blood transfusion and 3/33 (9.1%) were in shock. Fifty seven (56.4%) of the neonates with subaponeurotic haemorrhage developed hyperbilirubinemia due to the haemorrhage. Four (7.0%) of them had severe unconjugated hyperbilirubinemia which required exchange transfusion. The results of this study suggest that subaponeurotic haemorrhage in Malaysian neonates was commonly associated with vacuum extraction and was not a benign condition. PMID:2392696

Boo, N Y



Intraventricular haemorrhage and posthaemorrhagic hydrocephalus: pathogenesis, prevention and future interventions  

Microsoft Academic Search

Intraventricular haemorrhage (IVH) is still a major complication of preterm birth with serious disability resulting. The fragile blood vessels in the germinal matrix below the ventricular lining and the instability of blood flow to this highly vascular area are the main mechanisms behind IVH. There is good evidence that corticosteroid therapy before preterm delivery reduces mortality and IVH substantially with

Andrew Whitelaw



Pulmonary haemorrhage in a patient with Kikuchi disease.  


Kikuchi disease is an immunologic disease and most commonly presents with cervical lymphadenopathy. It is usually self-limiting [1]. It is sometimes associated with systemic lupus erythematosus (SLE) [2], and can be associated with many complications including aseptic meningitis, neuropathy, brachial neuritis. It can also be associated with lymphoma, and may sometimes be misdiagnosed as such [3]. The following is the first reported case of Kikuchi disease associated with pulmonary haemorrhage. The patient died and no other cause of the pulmonary haemorrhage could be identified at post mortem. PMID:11499298

Wong, C Y; Law, G T; Shum, T T; Wong, K Y; Li, Y K



Haemorrhage and perforation of gastrointestinal neoplasms during chemotherapy.  

PubMed Central

Gastrointestinal haemorrhage and perforation are known complications of cytotoxic therapy for chemosensitive tumours involving the wall of the gut, in particular non-Hodgkin's lymphoma. These complications can be avoided by aggressive surgery before chemotherapy is started. When they do occur, early operative intervention is essential to reduce morbidity and mortality. We report 4 cases in whom delay in diagnosis and surgery led to 3 deaths and suggest a policy for the management of such cases in the future.

Randall, J.; Obeid, M. L.; Blackledge, G. R.



Haemorrhagic Enteropathies in Red Deer (Cervus Elaphus)  

Microsoft Academic Search

Sir, — I would like to draw your readers’ attention to the occurrence of post-stress haemorrhagic enteropathies in red deer (Cervus elaphus). Haemorrhagic enteropathy has been observed in approximately 75 percent of red deer necropsied at the Invermay Animal Health Laboratory and has also been seen in wapiti (Cervus canadensis). Deer dying with post-stress haemorrhagic enteropathy commonly have splash haemorrhages

H. J. F. McAllum



Subarachnoid hemorrhage due to retained lumbar drain.  


Intrathecal spinal catheters (lumbar drains) are indicated for several medical and surgical conditions. In neurosurgical procedures, they are used to reduce intracranial and intrathecal pressures by diverting CSF. They have also been placed for therapeutic access to administer drugs, and more recently, vascular surgeons have used them to improve spinal cord perfusion during the treatment of thoracic aortic aneurysms. Insertion of these lumbar drains is not without attendant complications. One complication is the shearing of the distal end of the catheter with a resultant retained fragment. The authors report the case of a 65-year-old man who presented with a subarachnoid hemorrhage due to the migration of a retained lumbar drain that sheared off during its removal. To the best of the authors' knowledge, this is the first case of rostral migration of a retained intrathecal catheter causing subarachnoid hemorrhage. The authors review the literature on retained intrathecal spinal catheters, and their findings support either early removal of easily accessible catheters or close monitoring with serial imaging. PMID:21905770

Guppy, Kern H; Silverthorn, James W; Akins, Paul T



Postpartum haemorrhage: prevention  

PubMed Central

Introduction Loss of more than 500 mL of blood following childbirth is usually caused by failure of the uterus to contract fully after delivery of the placenta, and occurs in over 10% of deliveries, with a 1% mortality rate worldwide. Other causes of postpartum haemorrhage include retained placental tissue, lacerations to the genital tract, and coagulation disorders. Uterine atony is more likely in women who have had a general anaesthetic or oxytocin, an over-distended uterus, a prolonged or precipitous labour, or who are of high parity. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of non-drug interventions and of drug interventions to prevent primary postpartum haemorrhage? We searched: Medline, Embase, The Cochrane Library, and other important databases up to March 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 40 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: active management of the third stage of labour, carboprost injection, controlled cord traction, ergot compounds (ergometrine/methylergotamine), immediate breastfeeding, misoprostol (oral, rectal, sublingual, or vaginal), oxytocin, oxytocin plus ergometrine combinations, prostaglandin E2 compounds, and uterine massage.



[Traumatic basal subarachnoid hemorrhage].  


Massive subarachnoid hemorrhage may occur on a traumatic basis. The injury is most often sustained by a blow with a clenched fist against the posterolateral part of the cranial basis, but the injury may also occur in relation to an accident. The condition is rare, most often occurring in alcohol intoxicated men. The victim typically collapses immediately and usually dies within a few minutes. The origin of the bleeding may be the vertebral artery on the neck or the intercranial basal brain arteries. In some cases the origin of the bleeding cannot be located. The pathogenetic mechanisms have been a subject of discussion. The damage to the artery may occur in relation to a fracture of the transverse process of the atlas or in relation to subluxations in the cervical vertebral column. The arterial rupture may occur in both normal and abnormal arteries. In many of the cases the trauma may be very slight. This has, of course, important legal implications. PMID:12772392

Lundgaard, Peter; Leth, Peter Mygind; Gregersen, Markil



Acute Hydrocephalus After Subarachnoid Hemorrhage  

Microsoft Academic Search

BackgroundAcute hydrocephalus as a consequence of subarachnoid hemorrhage is a relatively frequent problem. It is associated with more neurologic impairment and mortality than subarachnoid hemorrhage without hydrocephalus. A review of the literature was done to determine its frequency of presentation, the associated causes of morbidity and mortality, its clinical presentation, and treatment options.MethodsA search was done through the Med-Line system

Oscar Suarez-Rivera



[Fatal alveolar haemorrhage following a "bang" of cannabis].  


The new methods of cannabis consumption (home made water pipe or "bang") may be responsible for fatal respiratory complications. We present a case, with fatal outcome, of a man of 19 years with no previous history other than an addiction to cannabis using "bang". He was admitted to intensive care with acute dyspnoea. A CT scan showed bilateral, diffuse alveolar shadowing. He was anaemic with an Hb of 9.3g/l. Bronchoalveolar lavage revealed massive alveolar haemorrhage. Investigations for infection and immunological disorder were negative and toxicology was negative except for cannabis. Antibiotic treatment was given and favourable progress allowed early discharge. Death occurred 15 days later due to alveolar haemorrhage following a further "bang" of cannabis. Autopsy showed toxic alveolar haemorrhage. The probable mechanism is pulmonary damage due to acid anhydrides released by the incomplete combustion of cannabis in contact with plastic. These acids have a double effect on the lungs: a direct toxicity with severe inflammation of the mucosa leading to alveolar haemorrhage and subsequently the acid anhydrides may lead to the syndrome of intra-alveolar haemorrhage and anaemia described in occupational lung diseases by Herbert in Oxford in 1979. It manifests itself by haemoptysis and intravascular haemolysis. We draw attention to the extremely serious potential consequences of new methods of using cannabis, particularly the use of "bang" in homemade plastic materials. PMID:21943539

Grassin, F; André, M; Rallec, B; Combes, E; Vinsonneau, U; Paleiron, N



Transient lower limb pain following accidental thoracic subarachnoid insertion of an epidural catheter  

Microsoft Academic Search

Transient sensory disturbances, including dysesthesia or neurologic deficits in the lower extremities or buttocks have been\\u000a described as complications of neuraxial anesthesia. We report a case of transient lower limb pain following the accidental\\u000a placement of an epidural catheter into the thoracic subarachnoid space. A 31-year-old woman was scheduled to undergo laparoscopic\\u000a myomectomy. An epidural catheter was accidentally inserted subarachnoid

Masaki Fuyuta; Yoshihiro Takasugi; Masahiro Morimoto; Toru Shirai; Mitsuo Morimoto; Yoshihisa Koga



Work in progress report - Cardiac general Factors associated with deep sternal wound infection and haemorrhage following cardiac surgery in Victoria  

Microsoft Academic Search

Serious non-fatal complications of cardiac surgery include deep sternal wound infection (DSWI) and haemorrhage. Understanding the factors associated with these complications (both pre-operatively and intra-operatively) may aid in the prevention and avoidance of such complications. The aim of the current report is to identify factors associated with DSWI and haemorrhage for all patients undergoing cardiac surgical procedures in Victorian public

Penelope J. Robinson; Baki Billah; Karin Leder; Christopher M. Reida; Australia Baker



Massive post-partum haemorrhage  

Microsoft Academic Search

Death from haemorrhage occurs in 5.5 per million maternities in the UK. Sadly, this figure has not fallen since the 1985–1987 triennium and care remains sub-standard in 66% of cases. While various risk factors can be identified for post-partum haemorrhage, further improvements in care can only occur with dissemination of good practice and adoption of local protocols designed to deliver

S. Macphail; J. Fitzgerald



Neurological complications of childhood leukaemia  

Microsoft Academic Search

We have reviewed the neurological complications not directly attributable to leukaemic infiltration in a group of 438 children with leukaemia or lymphoma. 61 children had one or more complications due chiefly to bleeding, infection, or drug toxicity. Early death from intracranial haemorrhage occurred in 1% of children with lymphoblastic leukaemia and 7% of children with myeloblastic leukaemia. Measles and chicken

R H Campbell; W C Marshall; J M Chessells



An Unusual Cause of Subarachnoid Hemorrhage  

PubMed Central

A 47-year-old man presented to our hospital with collapse secondary to a subarachnoid hemorrhage. A careful history taking revealed symptoms of anaphylaxis before his collapse. This case illustrates an unusual cause of subarachnoid hemorrhage.



Cerebral microdialysis for detection of bacterial meningitis in aneurysmal subarachnoid hemorrhage patients: a cohort study  

PubMed Central

Introduction Bacterial meningitis (BM) is a severe complication in patients with aneurysmal subarachnoid haemorrhage (SAH). Clinical signs of meningitis are often masked by SAH-related symptoms, and routine cerebrospinal fluid (CSF) analysis fails to indicate BM. Microdialysis (MD) is a technique for monitoring cerebral metabolism in patients with SAH. A cohort study was performed to investigate the value of MD for the diagnosis of BM. Methods Retrospectively, 167 patients with SAH in an ongoing investigation on cerebral metabolism monitored by MD were analysed for the presence of BM and related MD changes. Diagnosis of BM was based on microbiological CSF culture or clinical symptoms responding to antibiotic treatment, combined with an increased CSF cell count and/or fever. Levels of MD parameters before and after diagnosis of BM were analysed and compared with the spontaneous course in controls. Results BM developed in 20 patients, of which 12 underwent MD monitoring at the time of diagnosis. A control group was formed using 147 patients with SAH not developing meningitis. On the day BM was diagnosed, cerebral glucose was lower compared with the value three days before (p = 0.012), and the extent of decrease was significantly higher than in controls (p = 0.044). A decrease in cerebral glucose by 1 mmol/L combined with the presence of fever ? 38°C indicated BM with a sensitivity of 69% and a specificity of 80%. CSF chemistry failed to indicate BM, but the cell count increased during the days before diagnosis (p < 0.05). Conclusions A decrease in MD glucose combined with the presence of fever detected BM with acceptable sensitivity and specificity, while CSF chemistry failed to indicate BM. In patients with SAH where CSF cell count is not available or helpful, MD might serve as an adjunct criterion for early diagnosis of BM.

Schlenk, Florian; Frieler, Katja; Nagel, Alexandra; Vajkoczy, Peter; Sarrafzadeh, Asita S



Haemorrhagic septicaemia vaccines.  


Haemorrhagic septicaemia (HS), an economically important disease of cattle and buffaloes, is caused by Pasteurella multocida (6:B). Vaccination against this disease is widely practised. Plain broth bacterins, or alum precipitated and aluminium hydroxide gel vaccines are administered twice a year since these vaccines offer an immunity of 4-6 months. Many countries use oil adjuvant vaccine (OAV), which gives both a higher degree and a longer duration of immunity up to 1 year. A double emulsion and multiple emulsion vaccine consisting of a thin viscosity have also been experimentally developed that gave an immunity parallel to OAV. Recently, a live vaccine developed from a fallow deer strain (B:3,4) has been used in Myanmar that offers an immunity for more than a year but is not free from constraints. The present review provides information on HS vaccines developed from time to time using whole bacteria or their components. The kinetics and isotype of antibody and cell-mediated immune responses have also been poorly understood so far, and hence information on their role in protection against HS is reviewed. PMID:9682378

Verma, R; Jaiswal, T N



Unattended fatal haemorrhage due to spontaneous peripheral varicose vein rupture--two case reports.  


Venous haemorrhage is a rare complication of varicose veins of the legs. Varicosis is found in 15-50% of the population. Haemorrhage from ruptured varicose veins of the legs can occur spontaneously or after a minor trauma. More frequent complications of varicosis include peripheral oedema of the ankles, skin pigmentation and skin ulcers. In case of venous haemorrhage simple possibilities of first aid can be applied, therefore fatal haemorrhage is a rarity. Two cases of fatal varicose vein rupture are presented. A 58-year-old man and a 76-year-old woman, both living alone, were found dead in the bathrooms of their apartments. Significant traces of blood were found in all rooms. Both corpses showed typical signs of death from exsanguination. No traumatic lesion was found. Cause of the haemorrhage was a small lesion of the skin of the lower legs of the victims with continuation to an underlying superficial varicose vein. Misinterpretation of life-threatening varicose haemorrhage, unconsciousnous, alcohol or drug influence, old age and dementia can promote the death. In case of fatal haemorrhage the death scene can simulate crime due to massive traces of blood and may focus primarily on a non-natural death. However, police investigations and autopsy will disclose the rare cause of spontaneous natural death. PMID:20655677

Doberentz, E; Hagemeier, L; Veit, C; Madea, B



Rest tremor and extrapyramidal symptoms after midbrain haemorrhage: clinical and 18F-dopa PET evaluation.  

PubMed Central

A 25 year old man had an acute subarachnoid haemorrhage due to the rupture of a right peduncular subthalamic arteriovenous malformation. Seven months later he developed a left rest tremor associated with mild bilateral extrapyramidal symptoms and responsive to levodopa treatment. Surface EMG recording showed synchronous activity of agonist and antagonist muscles in the left limbs. A PET 18F-dopa study showed a large decrease of the Ki value in the right striatum. One year after the stroke a persistent postural component developed in the tremor. Images

Defer, G L; Remy, P; Malapert, D; Ricolfi, F; Samson, Y; Degos, J D



Risk factors for haemorrhage during local intra-arterial thrombolysis for lower limb ischaemia.  


Assessment of clinical risk factors for haemorrhagic complications in patients undergoing intra-arterial thrombolysis for lower limb ischaemia. Retrospective reviews of consecutive patients subjected to intra-arterial thrombolysis due to lower limb ischemia at the Vascular Center, Malmö University Hospital, during a 5-year period from 2001 to 2005. Two hundred and twenty intra-arterial thrombolytic procedures were carried out in 195 patients (46% women), median age 73 years. Haemorrhagic complications were recorded in 72 procedures (33%), of which 13 were discontinued. Haemorrhage at the introducer and distant sites occurred in 53 and 32 procedures, respectively. Thrombolysis for occluded synthetic grafts was associated with higher risk of haemorrhage (P = 0.043). The platelet count was lower (P = 0.017) and the dose of alteplas higher (P = 0.041) in bleeders than in non-bleeders. Age was not associated with haemorrhage (P = 0.30). Two patients died during thrombolysis, one of them due to intracerebral haemorrhage. The grade of thrombolysis was an independent predictor of both in-hospital amputation (P < 0.001; OR 3.5 [95% CI 2.1-5.8]) and mortality (P = 0.021; OR 3.0 [95% CI 1.2-7.9]). The in-hospital amputation-free survival rate was 85% (188/220). Haemorrhage associated with thrombolysis is common, but does seldom require discontinuation of treatment. Insertion of introducers for local thrombolysis through synthetic grafts, lower platelet count and higher alteplas dose were found to be risk factors for haemorrhage. An algorithm for clinical management of haemorrhage has been proposed. PMID:20848161

Kuoppala, M; Åkeson, J; Svensson, P; Lindblad, B; Franzen, S; Acosta, S



Early heparin therapy in patients with spontaneous intracerebral haemorrhage.  

PubMed Central

In 68 patients with spontaneous intracerebral haemorrhage the effect of heparin treatment beginning on the second, fourth or tenth day was investigated. Early (day 2) low-dose heparin medication significantly lowered the incidence of pulmonary embolism. An increase in the number of patients with rebleeding was not observed. The results indicate that the early use of heparin in these patients is safe and can be recommended for the prevention of thromboembolic complications.

Boeer, A; Voth, E; Henze, T; Prange, H W



Subarachnoid-Pleural Fistula: Applied Anatomy of the Thoracic Spinal Nerve Root  

PubMed Central

Subarachnoid-pleural fistula (SPF) is a rare complication of chest or spine operations for neoplastic disease. Concomitant dural and parietal pleural defects permit flow of cerebrospinal fluid into the pleural cavity or intrapleural air into the subarachnoid space. Dural injury recognized intraoperatively permits immediate repair, but unnoticed damage may cause postoperative pleural effusion, intracranial hypotension, meningitis, or pneumocephalus. We review two cases of SPF following surgical intervention for chest wall metastatic disease to motivate a detailed review of the anatomy of neural, osseous, and ligamentous structures at the intervertebral foramen. We further provide recommendations for avoidance and detection of such complication.

Shamji, Mohammed F.; Sundaresan, Sudhir; Da Silva, Vasco; Seely, Jean; Shamji, Farid M.



Massive large-bowel haemorrhage.  

PubMed Central

Operative intervention for massive colonic haemorrhage is fortunately rarely necessary, but planned, low-risk segmental resections can only be performed if the bleeding site is known. This information can most frequently be obtained by using a combination of sigmoidoscopy, barium enema examination, and selective mesenteric angiography.

Roberts, P.; Thomas, P. A.



Neuroradiological aspects of subdural haemorrhages  

Microsoft Academic Search

Aims: To review the neuroimaging of a series of infants and young children admitted to hospital with subdural haemorrhage (SDH).Methods: Neuroradiological investigations of 74 children under 2 years of age, from South Wales and southwest England, in whom an SDH or subdural effusion had been diagnosed between 1992 and 2001, were reviewed. Two paediatric neuroradiologists blinded to the original radiological

S Datta; N Stoodley; S Jayawant; S Renowden; A Kemp



Immediate postpartum complications.  


Two hundred and sixty-nine (5.4%) of the 4,998 patients who delivered in Westmead Hospital, New South Wales in 1985 had immediate postpartum complications. This analysis was compared with figures from a major institution in another state of Australia. Early detection and prompt management without procrastination was the key to a successful outcome in the fourth stage of labour (i.e. within 24 hours of delivery). Nearly three-quarters of the complications were due to postpartum haemorrhage (PPH). The contributory factors are analysed and discussed. Reappraisal of the indications for induction of labour, epidural analgesia and forceps delivery is necessary to reduce the incidence of postpartum haemorrhage. The study reinforces the need for undiminished vigilance in the fourth stage of labour even if the first 3 stages are uncomplicated. PMID:2346452

St George, L; Crandon, A J



Subarachnoid hemorrhage and cerebral vasospasm - Literature review  

PubMed Central

Subarachnoid hemorrhage represents a serious disease with high mortality and morbidity. Two important areas are becoming the central research interest of subarachnoid hemorrhage: cerebral vasospasm and early brain injury. The authors have reviewed the major contributions in experimental subarachnoid hemorrhage documented in the medical literature in the past 5 years. Treatments interfering with nitric oxide - or endothelin-pathways continue to show antispasmotic effects in experimental models of subarachnoid hemorrhage. Inflammation and oxidative stress play a vital role in the pathophysiology of cerebral vasospasm. Apoptosis, a relevant cause of early brain injury after subarachnoid hemorrhage, also underline the etiology of cerebral vasospasm. Future research studies will continue to elucidate the pathophysiological pathways and treatment modalities targeting cerebral vasospasm and early brain injury, enabling an improvement in outcome for patients with subarachnoid hemorrhage.

Ciurea, AV; Palade, C; Voinescu, D; Nica, DA



Symptomatic Tarlov Cyst Following Spontaneous Subarachnoid Hemorrhage  

PubMed Central

Most of Tarlov or perineurial cysts remain asymptomatic throughout the patient's life. The pathogenesis is still unclear. Hemorrhage has been suggested as one of the possible causes and trauma with resultant hemorrhage into subarachnoid space has been suggested as an origin of these cysts. However, Tarlov cysts related to spontaneous subarachnoid hemorrhage has not been reported. The authors report a case of Tarlov cyst which was symptomatic following spontaneous subarachnoid hemorrhage.

Kong, Woo Keun; Hong, Seung-Koan



Symptomatic tarlov cyst following spontaneous subarachnoid hemorrhage.  


Most of Tarlov or perineurial cysts remain asymptomatic throughout the patient's life. The pathogenesis is still unclear. Hemorrhage has been suggested as one of the possible causes and trauma with resultant hemorrhage into subarachnoid space has been suggested as an origin of these cysts. However, Tarlov cysts related to spontaneous subarachnoid hemorrhage has not been reported. The authors report a case of Tarlov cyst which was symptomatic following spontaneous subarachnoid hemorrhage. PMID:22053232

Kong, Woo Keun; Cho, Keun-Tae; Hong, Seung-Koan



[Intracerebral haemorrhage and postpartum cerebral angiopathy associated with the administration of sulprostone and norepinephrine].  


We report the case of a 29-year-old female who had developed a postpartum cerebral angiopathy (PCA) complicated by an intracerebral haematoma and convulsions, after a postpartum haemorrhage with sulprostone and norepinephrine infusion. PCA is an under diagnosed neurovascular pathology, responsible of reversible and non-specific symptoms. However, it can be complicated by haemorrhagic or ischemic stroke with vital or functional risks. As PCA is favored by vasoactive treatments, their administration in peripartum period, when it is imperative, should be strictly controlled. PMID:22154454

Ruzic, Y; Tran-Van, D; Omarjee, A; Boukerrou, M; Winer, A



Circumstances Precipitating Aneurysmal Subarachnoid Hemorrhage  

Microsoft Academic Search

To determine the precipitating factors of aneurysmal rupture, the medical records of 425 consecutive patients with aneurysmal subarachnoid hemorrhage were reviewed. As for the time of onset, a significantly higher incidence was found between 06.00 and 09.00 h and 18.00 and 21.00 h. Aneurysmal rupture occurred most frequently during talking, watching TV or staying home without any strenuous physical activity.

Masayuki Matsuda; Michiaki Ohashi; Akihiko Shiino; Kenichi Matsumura; Jyoji Handa



Hemorrhagic stroke: aneurysmal subarachnoid hemorrhage.  


Non-traumatic subarachnoid hemorrhage (SAH) represents approximately 5-6% of all strokes. Morbidity and mortality rates remain high, but accurate diagnosis using clinical assessment and neuroimaging, critical care management, and early treatment using either surgical or interventional techniques have improved overall outcomes. This, the fifth in a Missouri Medicine series on stroke, summarizes the clinical and imaging aspects of making the diagnosis of SAH, critical care management of the patient, treatment options, and factors important in prognosis. PMID:21568235

Martin, Coleman O; Rymer, Marilyn M


[Buttock necrosis after subtotal hysterectomy, bilateral internal iliac arteries ligature and pelvic embolization for control of severe post-partum haemorrhage].  


Post-partum haemorrhage remains a major cause of maternal mortality. Surgical management may be needed in patients with hemodynamic instability. Arterial embolization may be needed in case of persisting haemorrhage despite initial surgical management. We report a case of buttock necrosis occurring after pelvic embolization to control refractory post-partum haemorrhage and failed subtotal hysterectomy with bilateral internal iliac arteries ligation. To the best of our knowledge, this is the first case of buttock necrosis complicating a severe post-partum haemorrhage reported in the literature. PMID:19896781

Zanati, J; Resch, B; Roman, H; Brabant, G; Sentilhes, L; Verspyck, E; Henriet, E; Sergent, F; Houzé de L'aulnoit, D; Marpeau, L; Clavier, E



Fetal complications of obstetric cholestasis  

Microsoft Academic Search

Among 56 pregnancies complicated by obstetric cholestasis five intrauterine deaths and one neonatal death occurred between 33 and 39 weeks, and a further six infants required urgent delivery for intrapartum asphyxia. Eighteen spontaneous premature deliveries occurred. Five mothers required specific treatment for unexplained postpartum haemorrhage. Cholestasis of pregnancy is therefore not a condition benign to the fetus, and it may

RICHARD REID; K J Ivey; R H Rencoret; B Storey



Neuroradiological aspects of subdural haemorrhages  

PubMed Central

Aims: To review the neuroimaging of a series of infants and young children admitted to hospital with subdural haemorrhage (SDH). Methods: Neuroradiological investigations of 74 children under 2 years of age, from South Wales and southwest England, in whom an SDH or subdural effusion had been diagnosed between 1992 and 2001, were reviewed. Two paediatric neuroradiologists blinded to the original radiological report reviewed all the relevant images. Results: Neuroradiological review of images identified radiological features which were highly suggestive of non-accidental head injury (NAHI). Interhemispheric haemorrhages and SDHs in multiple sites or of different densities were almost exclusively seen in NAHI. MRI was more sensitive in identifying SDHs of different signal characteristics, posterior and middle cranial fossa bleeds, and parenchymal changes in the brain. CT scans, if performed with suboptimal protocols, were likely to miss small subdural bleeds. Conclusions: Guidelines for neuroimaging in suspected NAHI are recommended. A radiologist with experience in NAHI should report or review these scans. The initial investigation should be CT, but MRI will also be necessary in most cases. Head CT should be an integral part of the skeletal survey in all infants less than 6 months of age referred for child protection investigation, and in children less than 2 years where child abuse is suspected and there are neurological signs, retinal haemorrhages, or fractures.

Datta, S; Stoodley, N; Jayawant, S; Renowden, S; Kemp, A



Early detection of vasospasm after acute subarachnoid hemorrhage using continuous EEG ICU monitoring  

Microsoft Academic Search

The neurologic morbidity of delayed ischemic deficits from vasospasm following aneurysmal subarachnoid hemorrhage (SAH) continues to be the most debilitating complication from this devastating illness. Neurologic critical care is focused on recognition and treatment of these secondary insults but often the treatment is withheld until an irreversible deficit becomes manifest. Continuous EEG (cEEG) monitoring provides a unique potential to recognize

Paul M. Vespa; Marc R. Nuwer; Csaba Juhász; Michael Alexander; Valeriy Nenov; Neil Martin; Donald P. Becker



Disc haemorrhages, precursors of open angle glaucoma  

Microsoft Academic Search

In a long-term study of 1270 patients with at least one of the findings, open-angle glaucoma, disc haemorrhages or retinal vein occlusions, disc haemorrhages were witnessed in approximately 20% of the cases with open-angle glaucoma, and were a precursor of glaucomatous disc changes and associated visual field defects. Disc haemorrhages also preceded a rising intraocular pressure (IOP) in the destructive

Bo Sonnsjö; Yvonne Dokmo; Torsten Krakau



Pseudo-subarachnoid hemorrhage and death after a bee sting.  


We report a case of a 33-year-old woman who developed severe brain edema and pseudo-subarachnoid hemorrhage (SAH) at 36-hour follow-up after successful cardiopulmonary resuscitation for anaphylactic shock as a result of a bee sting. The patient died on the sixth day of the follow-up due to multiple organ failure and brain herniation. Our case suggests that the SAH-like indings on computed tomography scanning were not a new complication ("real" SAH) arising from the bee sting; rather, it was a pseudo-SAH related to prolonged cardiopulmonary resuscitation). PMID:23348190

Yasar Tekelioglu, Umit; Demirhan, Abdullah; Akkaya, Akcan; Gurel, Kamil; Ocak, Tarik; Duran, Arif; Kocoglu, Hasan



Arteriovenous fistula after ventriculostomy in aneurysmal subarachnoid hemorrhage.  


A 66-year-old woman was found unresponsive after complaining of severe headache several days prior. She was comatose upon initial evaluation and a cranial CT revealed diffuse subarachnoid hemorrhage. A right posterior communicating artery aneurysm (figure, A, arrow) was successfully treated with endovascular embolization. Conventional angiography performed 7 days following ventriculostomy placement for hydrocephalus demonstrated interval development of a traumatic arteriovenous fistula (AVF) filling by the middle meningeal artery (figure, C, D, arrow). The AVF was treated with intra-arterial embolization. Ventriculostomy-associated AVF has rarely been reported.(1) Outcomes of untreated iatrogenic AVF are unknown, but could lead to hemorrhagic complications. PMID:23733553

Meisel, Karl; Yee, Alan; Stout, Charles; Kim, Warren; Cooke, Daniel; Halbach, Van



Treatment of retrobulbar haemorrhage in accident and emergency departments.  


Retrobulbar haemorrhage is a rare complication of orbital injury or surgery. After injury the first clinicians to see these patients are often the staff of accident and emergency departments. This survey was instigated after several patients had been referred to our care irreversibly blind. A multiple choice questionnaire was devised and sent to 90 doctors working in accident and emergency departments in Scotland. A total of 57 (63%) were returned of which 55 were complete enough to analyse. The range of respondents was: consultants (n = 6), associate specialists (n = 3), senior registrars (n = 3), registrars (n = 4), senior house officer (n = 35), and clinical assistants (n = 4). Twenty nine of the 35 senior house officers (83%) were unable to diagnose and treat retrobulbar haemorrhage. Most consultants, senior registrars, registrars and associate specialists were significantly better in the diagnosis and treatment of this condition (P = 0.001). We conclude that there is an unacceptably high incidence of blindness as a result of inappropriate diagnosis and treatment of retrobulbar haemorrhage. We have therefore designed a protocol for accident departments which should help reduce the incidence of blindness. PMID:8866062

Hislop, W S; Dutton, G N; Douglas, P S



'Pseudocirrhosis' in hereditary haemorrhagic telangiectasia.  

PubMed Central

Telangiectasia-associated hepatic fibrosis (TAHF) in a 68-year-old woman with hereditary haemorrhagic telangiectasia (HHT) is described. The patient died of oat-cell carcinoma of the lung. In addition to the structural alterations which have been described previously in HHT, the liver exhibited focal midlobular hepatocytic necrosis and tumour metastases. The possibility that treatment of HHT was causally related to some of the hepatic abnormalities found in our patient and the differentiation of TAHF from true cirrhosis are discussed. Images

Cooney, T; Sweeney, E C; Coll, R; Greally, M



Crimean–Congo haemorrhagic fever in Eurasia  

Microsoft Academic Search

Crimean–Congo haemorrhagic fever (CCHF) is a tick-borne infectious disease characterized by fever, malaise, headache, nausea, vomiting, diarrhoea, sore throat, muscle aches, haemorrhage and thrombocytopenia. It is a challenge for the population of endemic rural areas, and for healthcare workers, and carries a considerable mortality. The disease is widely distributed in Africa, Europe and Asia, and has become a serious threat

Hakan Leblebicioglu



Intraperitoneal haemorrhage from anterior abdominal wall varices.  

PubMed Central

Patients with oesophageal varices frequently present with gastrointestinal haemorrhage but bleeding from varices at other sites is rare. We present a patient with hepatitis C-induced cirrhosis and partial portal vein occlusion who developed spontaneous haemorrhage from anterior abdominal wall varices into the rectus abdominus muscle and peritoneal cavity. Images Figure 1

Hunt, J. B.; Appleyard, M.; Thursz, M.; Carey, P. D.; Guillou, P. J.; Thomas, H. C.



Anaesthesia in a patient with subarachanoidal haemorrhage and high oxygen affinity haemoglobinopathy (HB york): case report  

PubMed Central

Background Approximately 90 haemoglobinopathies have been identified that result in abnormally high oxygen affinity. One of these is haemoglobinopathy York (HbY), first described in 1976. HbY causes an extreme leftward shift of the oxygen dissociation curve with the P50 value changing to 12.5 - 15.5 mmHg (normal value 26.7 mmHg), indicating that approximately half of the haemoglobin is not available as oxygen carrier. Patients with haemoglobinopathies with increased oxygen affinity could suffer from the risk developing ischaemic complications due to a lack of functional oxygen carriers. This is, to best of our knowledge, the first case report on a patient with HbY published in connection with anesthesia. Case Presentation A 42-year-old female with a severe headache and Glasgow coma scale (GCS) of 15 was admitted to the neurosurgical intensive care unit with a ruptured, right sided ICA aneurysm with consecutive subarachnoid haemorrhage [Fisher III, World Federation of Neurosurgical Societies (WFNS) I)]. The medical history of the patient included an erythrocytosis (Hb 17.5?g/dl) on the base of a high-oxygen-affinity haemoglobinopathy, called Hb York (HbY). With no time available to take special preoperative precautions, rapid blood loss occurred during the first attempt to clip the aneurysm. General transfusion procedures, according to the guidelines based on haemoglobin and haematocrit values, could not be applied due to the uncertainty in the oxygen carrier reduction. To maintain tissue oxygen supply, clinical indicators of ischaemia were instead utilized to gauge the appropriate required blood products, crystalloids and colloids replacements. Despite this, the patient survived the neurosurgical intervention without any neurological deficit. Conclusions Family members of patients with HbY (and other haemoglobinopathies with increased oxygen affinity) should undergo clinical assessment, particularly if they are polycythaemic. If the diagnosis of HbY is confirmed, they should carry an "emergency anaesthesiology card" in order to avert perioperative risks arising from their "hidden" anemia.



Intracerebral haemorrhage after the neonatal period.  

PubMed Central

Intracerebral haemorrhage is rare in childhood. We have reviewed the last 10 years' experience, in our referral area, of parenchymatous intracerebral haemorrhage in children from 1 month to 16 years of age. There were 27 cases, five of which were intracerebellar and two predominantly intraventricular. The commonest aetiology was vascular malformation (10), followed by haemorrhage into tumour (four), and coagulopathies (five). Clinical features were non-specific, but altered consciousness, headache, vomiting, and focal signs were the most common. Focal signs were, however, rare in the patients with intracerebellar haemorrhage. There was an overall mortality of 54% (14 out of 27). Nine patients were handicapped on follow up, but none severely so. For the diagnosis of intracerebral haemorrhage a high level of clinical suspicion is needed with early use of computed tomography. Maintenance of homeostasis, relief of raised intracranial pressure, and evacuation of haematoma are the aims of management.

Livingston, J H; Brown, J K



Contrast mimicking a subarachnoid hemorrhage after lumbar percutaneous epidural neuroplasty: a case report  

PubMed Central

Introduction Subarachnoid hemorrhage is one of the most feared acute neurologic events. Accurate diagnosis of subarachnoid hemorrhage is essential, and computed tomography of the brain is the first diagnostic imaging study. However, in rare circumstances, a similar appearance may occur in the absence of blood in the subarachnoid space. The contrast enhancement of subarachnoid space is a rare complication after lumbar percutaneous epidural neuroplasty, with, to the best of our knowledge, no previous report in the literature. Case presentation A 42-year-old Korean male patient, who underwent a spinal operation five years previously at the level of L4 to S1, visited our clinic with persistent and aggravating low back pain. An imaging study revealed the focal and diffuse disc protrusion at the level of L4/5 and L5/S1. The clinician decided to perform a lumbar percutaneous epidural neuroplasty. During the procedure, dural adhesion was suspected at the previously operated level, and the neuroplasty catheter was malpositioned into the intradural space on the first attempt. After the catheter was repositioned, the scheduled epidural neuroplasty was completed. Our patient had no definite abnormal neurological signs. But, after a day, our patient complained of severe headache with sustained high blood pressure without neurological disorientation. Computed tomography of his brain showed a subarachnoid hemorrhage-like appearance with intracranial air. Sequential angiography, subtractional magnetic resonance imaging and examination of the cerebrospinal fluid revealed no abnormalities. Follow-up computed tomography after one day revealed no definite intracranial hemorrhage, and our patient was discharged with improved low back pain without neurological deficit. Conclusion We report a rare case of contrast mimicking a subarachnoid hemorrhage after lumbar percutaneous epidural neuroplasty. The physician should keep in mind a rare case like this, and the supine position with head elevation is necessary to avoid a similar complication after lumbar percutaneous epidural neuroplasty.



High frequency of spinal involvement in patients with basal subarachnoid neurocysticercosis  

PubMed Central

Objective: To determine the frequency of spinal neurocysticercosis (NCC) in patients with basal subarachnoid NCC compared with that in individuals with viable limited intraparenchymal NCC (?20 live cysts in the brain). Methods: We performed a prospective observational case-control study of patients with NCC involving the basal cisterns or patients with only limited intraparenchymal NCC. All patients underwent MRI examinations of the brain and the entire spinal cord to assess spinal involvement. Results: Twenty-seven patients with limited intraparenchymal NCC, and 28 patients with basal subarachnoid NCC were included in the study. Spinal involvement was found in 17 patients with basal subarachnoid NCC and in only one patient with limited intraparenchymal NCC (odds ratio 40.18, 95% confidence interval 4.74–340.31; p < 0.0001). All patients had extramedullary (intradural) spinal NCC, and the lumbosacral region was the most frequently involved (89%). Patients with extensive spinal NCC more frequently had ventriculoperitoneal shunt placement (7 of 7 vs 3 of 11; p = 0.004) and tended to have a longer duration of neurologic symptoms than those with regional involvement (72 months vs 24 months; p = 0.062). Conclusions: The spinal subarachnoid space is commonly involved in patients with basal subarachnoid NCC, compared with those with only intraparenchymal brain cysts. Spinal cord involvement probably explains serious late complications including chronic meningitis and gait disorders that were described before the introduction of antiparasitic therapy. MRI of the spine should be performed in basal subarachnoid disease to document spinal involvement, prevent complications, and monitor for recurrent disease.

Callacondo, D.; Garcia, H.H.; Gonzales, I.; Escalante, D.; Gilman, Robert H.; Tsang, Victor C.W.; Gonzalez, Armando; Lopez, Maria T.; Gavidia, Cesar M.; Martinez, Manuel; Alvarado, Manuel; Porras, Miguel; Saavedra, Herbert; Rodriguez, Silvia; Verastegui, Manuela; Mayta, Holger; Herrera, Genaro; Lescano, Andres G.; Zimic, Mirko; Gonzalvez, Guillermo; Moyano, Luz M.; Ayvar, Viterbo; Diaz, Andre



Spontaneous spinal epidural haemorrhage complicating transjugular intrahepatic portosystemic stent shunting.  

PubMed Central

A patient with chronic liver disease and portal hypertension who developed acute spinal cord compression following transjugular intrahepatic portosystemic stent shunting is described. Radiological and pathological examinations revealed an epidural haematoma. Images Figure

McLellan, S.; de Silva, R.; Sandercock, P. A.; Hayes, P. C.; Dillon, J.; Redhead, D.



Intra-arterial Administration of Fasudil Hydrochloride for Vasospasm Following Subarachnoid Haemorrhage: Experience of 90 Cases  

Microsoft Academic Search

\\u000a \\u000a Background: We investigated the clinical efficacy of intra-arterial administration of fasudil hydrochloride for cerebral vasospasm.\\u000a \\u000a \\u000a \\u000a Method: We reviewed 90 cases treated with intra-arterial administration of fasudil hydrochloride between August 1998 and April 2009\\u000a and investigated the clinical efficacy for cerebral vasospasm.\\u000a \\u000a \\u000a \\u000a \\u000a Findings: Angiographic improvement of vasospasm was noted in all procedures. Eight had ischemic lesion on CT at discharge in

S. Iwabuchi; T. Yokouchi; M. Hayashi; K. Sato; N. Saito; Y. Hirata; J. Harashina; H. Nakayama; M. Akahata; K. Ito; H. Kimura; K. Aoki


Repeat intra-arterial papaverine for recurrent cerebral vasospasm after subarachnoid haemorrhage  

Microsoft Academic Search

We assessed the prevalence of recurrent vasospasm following failure of intra-arterial papaverine and the efficacy of repeat\\u000a intra-arterial infusions of papaverine for control of recurrent vasospasm. Of 24 patients treated with intra-arterial papaverine\\u000a for vasospasm following aneurysm surgery, 12 did not improve clinically after the initial treatment; 9 received second or\\u000a third infusions on consecutive days; 6 received only a

Y. Numaguchi; G. H. Zoarski; J. E. Clouston; M. T. Zagardo; J. M. Simard; E. F. Aldrich; M. A. Sloan; P. K. Maurer; S. H. Okawara



Cerebral Energy Metabolism after Subarachnoid Hemorrhage.  

National Technical Information Service (NTIS)

The purpose of this study was to determine the effects of subarachnoid hemorrhage (SAH) on cerebral blood flow and cerebral oxidative metabolism. Average total hemispheric flow was measured utilizing a polarographic technique and the metabolic consumption...

J. M. Fein



Elevation of intracranial pressure following transjugular intrahepatic portosystemic stent-shunt for variceal haemorrhage.  


Increased intracranial pressure and cerebral oedema in patients with chronic liver disease is rare and is more typical of acute liver failure. Transjugular intrahepatic portosystemic stent-shunt is being increasingly used in the management of uncontrolled variceal haemorrhage in patients with cirrhosis. In our institution, a total of 160 patients has undergone transjugular intrahepatic porto-systemic stent-shunt for variceal haemorrhage; 56 of these procedures were emergencies for uncontrolled variceal haemorrhage. Four of these 56 patients developed features of acute liver failure, with marked deterioration in liver function tests and elevated intracranial pressure. This unusual but important complication of transjugular intrahepatic portosystemic stent-shunt has not been reported in the literature previously, and may have important consequences both for clinical practice and in the provision of further clues to understanding the pathogenesis of increased intracranial pressure in patients with liver diseases. PMID:9382983

Jalan, R; Dabos, K; Redhead, D N; Lee, A; Hayes, P C



Cardiac bypass surgery with haemorrhagic endocrine sequelae.  

PubMed Central

Cardiac bypass surgery is associated with changes in haemostatis which can lead to bleeding. This report highlights two examples of such bleeding which led to unusual clinical presentations and endocrinological consequences: adrenal and pituitary haemorrhage. Images Figure 1 Figure 2

Khardori, R.; Bussing, R. C.; Burns, G. M.; Soler, N. G.



Disc haemorrhages, precursors of open angle glaucoma.  


In a long-term study of 1270 patients with at least one of the findings, open-angle glaucoma, disc haemorrhages or retinal vein occlusions, disc haemorrhages were witnessed in approximately 20% of the cases with open-angle glaucoma, and were a precursor of glaucomatous disc changes and associated visual field defects. Disc haemorrhages also preceded a rising intraocular pressure (IOP) in the destructive process among open-angle glaucoma cases. Similar glaucomatous development appears among cases independent of IOP or detection of exfoliation syndrome. Retinal vein occlusions and disc haemorrhages behave similarly with respect to glaucoma. The large number of transgressions is an argument against dividing glaucoma into different types. These findings support a vascular genesis to open-angle glaucoma, presented in earlier epidemiological studies. PMID:11906810

Sonnsjö, Bo; Dokmo, Yvonne; Krakau, Torsten



[Brain natriuretic peptide in subarachnoid hemorrhage].  


Because of the known correlation between the brain natriuretic peptide (BNP) level and the severity of cardiac failure, cardiac function assessment often involves measuring BNP levels. In addition, BNP is produced in the hypothalamus; high BNP levels are reported in patients with subarachnoid hemorrhage (SAH), although the details of this mechanism remain to be clarified. Furthermore, there are unconfirmed reports of high BNP levels during follow up in cases of post-SAH cerebral vasospasm (CVS). In the present study, we retrospectively investigated the correlation between plasma BNP levels and severity of SAH at onset and the utility of the BNP level as a predictor for CVS. Of 149 SAH cases treated as inpatients at our institution between November 2008 and March 2010, our subjects comprised 28 SAH cases in which the plasma BNP level was measured at the time of hospitalization (?48 hours after SAH onset). There was no significant correlation between BNP levels and SAH severity at the onset, but BNP levels tended to be high in cases accompanied by intracerebral hematoma, particularly in patients with an anterior communicating aneurysm rupture. This is thought to be the result of direct damage to the hypothalamus. The cases with normal BNP levels at the onset of SAH were apt to have favorable outcomes. The incidence of delayed ischemic neurological deficit (DIND) was investigated in 15 cases in which the BNP level was measured multiple times during follow up. The ratio of BNP at SAH onset compared to at days 3 to 7 of the illness was not significant; however, BNP levels tended to be high in cases with DIND complications. BNP levels may constitute a useful early marker for CVS, despite BNP susceptibility to surgical invasion and perioperative management. PMID:23180743

Kawamura, Yoichiro; Inoue, Kohei; Sakai, Hideki; Nakashima, Susumu



Worst Headache of Life: Evaluation of Nontraumatic Subarachnoid Hemorrhage.  

National Technical Information Service (NTIS)

While the 'worst headache of life' has a differential diagnosis, acute subarachnoid hemorrhage must be the primary diagnostic consideration. Approximately l%-4% of patients presenting to the emergency department with severe headache have subarachnoid hemo...

P. M. Sherman



Comparison of Intracerebral Hemorrhage and Subarachnoid Hemorrhage in Patients with Autosomal-Dominant Polycystic Kidney Disease  

Microsoft Academic Search

Background\\/Aims: Subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH) are two subtypes of hemorrhagic stroke that may cause severe complications in patients with autosomal-dominant polycystic kidney disease (ADPKD). The differences in clinical features between SAH and ICH associated with ADPKD are not known. Methods: Among 647 ADPKD patients hospitalized between 1997 and 2007 in our hospital, 11 with ICH (1.7%) and

Ming-Yang Chang; Chi-Man Kuok; Yung-Cheng Chen; Shan-Jin Ryu; Ya-Chung Tian; Yah-Huei Wu-Chou; Fang-Ji Tseng; Chih-Wei Yang



Early posttraumatic subarachnoid hemorrhage due to dissecting aneurysms in three children.  


Subarachnoid hemorrhage (SAH) due to a ruptured saccular aneurysm is uncommon in children. Pediatric traumatic aneurysms have been reported relatively frequently, tending to bleed after an interval of weeks after head injury. The authors describe three children with acute SAH after head injury caused by intracranial dissecting aneurysms. When head trauma in children is complicated by SAH in basal cisterns, dissecting aneurysms should be considered and treated, because rebleeding may occur. PMID:16301503

Kneyber, M C J; Rinkel, G J E; Ramos, L M P; Tulleken, C A F; Braun, K P J



Severe aortic stenosis and subarachnoid hemorrhage: Anesthetic management of lethal combination  

PubMed Central

Despite advances in various modalities of management, subarachnoid hemorrhage (SAH) continues to be associated with high mortality, which is further increased by associated comorbidities. Aortic stenosis (AS) is one such disease which can further complicate the course of SAH. We recently managed a known patient of severe AS, who presented with aneurysmal SAH. Patient was planned for eurovascular intervention. With proper assessment and planning, patient was managed with favorable outcome despite the restrictions faced in the neurovascular intervention laboratory.

Sharma, Rakesh; Mehta, Yatin; Sapra, Harsh



Life threatening intracerebral haemorrhage following saw- scaled viper (Echis carinatus) envenoming-authenticated case report from Sri Lanka  

PubMed Central

Background Echis carinatus (Saw scaled viper {SSV}) is a venomous snake found in the parts of Middle East and Central Asia. SSV envenoming is characterized by local swelling and coagulopathy. Various bleeding manifestations are commonly seen with SSV envenoming. In contrast to other part of Asia, saw scale viper envenoming has not been reported to cause life threatening haemorrhagic manifestations in Sri Lanka. Case presentation We report a 19 years old healthy boy who developed massive left temporo-parietal intra cerebral haemorrhage following Echis carinatus (Saw scaled viper) bite in Sri Lanka. Conclusion Although subspecies of SSV in Sri Lanka is regarded as a ‘non lethal venomous snake’, the occurrence of rare potentially fatal complications such as intracerebral haemorrhage should be considered in their management. This case report is intended to bring the awareness of this fatal complication of SSV envenoming in Sri Lanka.



Laparoscopic management of massive spontaneous external haemorrhage from the umbilical varix due to recanalisation of the paraumbilical vein in a patient with 'Child's Class A' liver cirrhosis.  


Spontaneous external haemorrhage from the umbilical varix is an extremely rare complication of portal hypertension. Bleeding is usually into the peritoneal cavity and the treatment involves urgent laparotomy and ligation of the bleeding varices. We describe a cirrhotic 38-year-old man who presented with spontaneous external haemorrhage from the umbilical varix which was successfully managed laparoscopically by in-situ distal clipping and proximal transcutaneous ligation of the recanalised paraumbilical veins. We therefore feel that laparoscopy can be safely and effectively employed to control external haemorrhage from the umbilical varix associated with liver cirrhosis. This novel technique can help avoid a laparotomy and also help preserve the umbilicus. PMID:22623827

Zachariah, Sanoop K; Krishnankutty, Sreejith L; Raja, Nirmalan



Laparoscopic management of massive spontaneous external haemorrhage from the umbilical varix due to recanalisation of the paraumbilical vein in a patient with 'Child's Class A' liver cirrhosis  

PubMed Central

Spontaneous external haemorrhage from the umbilical varix is an extremely rare complication of portal hypertension. Bleeding is usually into the peritoneal cavity and the treatment involves urgent laparotomy and ligation of the bleeding varices. We describe a cirrhotic 38-year-old man who presented with spontaneous external haemorrhage from the umbilical varix which was successfully managed laparoscopically by in-situ distal clipping and proximal transcutaneous ligation of the recanalised paraumbilical veins. We therefore feel that laparoscopy can be safely and effectively employed to control external haemorrhage from the umbilical varix associated with liver cirrhosis. This novel technique can help avoid a laparotomy and also help preserve the umbilicus.

Zachariah, Sanoop K; Krishnankutty, Sreejith L; Raja, Nirmalan



Colocutaneous Fistula Complicating Therapeutic Mesenteric Embolisation  

PubMed Central

Percutaneous embolotherapy has now assumed an important role in the management of massive colonic haemorrhage. However, this therapeutic option is associated with a significant risk of irreversible segmental colonic ischaemia. We present a case where distal segmental ischaemia led to a colocutaneous fistula, a complication not reported so far in the literature.

Camprodon, Ram; Jacob, S; George, ML; Karani, JB; Leather, AJM



Intracranial haemorrhage among a population of haemophilic patients in Brazil.  


Intracranial haemorrhage (ICH) is a common cause of morbidity and mortality in haemophilic patients. The overall incidence of ICH has been reported to range from 2.2% to 7.5% in patients with haemophilia. From 1987 to 2001, 401 haemophilic patients from the Serviço de Hemofilia, Disciplina de Hematologia e Hemoterapia, Universidade Federal de São Paulo were evaluated. The episodes of ICH were documented by CT scan and the anatomic location, clinical presentation, relationship to trauma and clinical factors, including the presence of HIV infection and the presence of inhibitor, were reviewed. Among 401 haemophilic patients, 45 ICH episodes in 35 (8.7%) patients with age ranging from 4 days to 49 years (mean 10.6 years) were observed. A history of recent trauma was documented in 24 (53.3%) cases. Seventeen (37.8%) episodes occurred in more than one site of bleeding, 12 (26.7%) were subdural, seven (15.5%) subarachnoid, four (8.9%) epidural, two (4.4%) intracerebral and one (2.2%) intraventricular. The most frequent symptoms were headache and drowsiness. All patients were submitted to replacement therapy and neurosurgical intervention was performed in eight (17.8%) patients. Despite the treatment, three (8.6%) haemophilia A patients died due to the ICH event and three presented late sequelae. The most important aspect of ICH management is the early replacement therapy in haemophilic patients. This prompt treatment will increase the chances of a better prognosis. Another impact measure consists in the administration of the deficient coagulation factor after every head trauma, even when considered minor. PMID:14511296

Antunes, S V; Vicari, P; Cavalheiro, S; Bordin, J O



Risk factors associated with delayed haemorrhage after pancreatic resection  

PubMed Central

Background Delayed haemorrhage (DH) is a life-threatening complication of pancreatic resection (PR) and the mortality rate for DH is very high. However, the risk factors and prognostic factors associated with DH are rarely evaluated. Methods A pancreatic resection was performed on 457 patients. Delayed haemorrhage was defined as bleeding from the surgical site ?5 days after PR. Risk factors for DH were assessed according to demographics and pathological and operative parameters. Prognostic factors after DH were evaluated for the shock index (heart rate/systolic blood pressure) and systemic inflammatory response syndrome (SIRS) scores. Results Of the 457 patients, 11 (2.4%) experienced DH after PR. Logistic regression analysis showed that age >60 years and a diagnosis of malignant disease were risk factors for DH. The shock index and SIRS scores at the onset of DH were significantly higher in patients who died as compared with those patients that survived (P < 0.05). Discussion PR-associated DH carries an increased risk for patients aged >60 years with malignant disease. Prognostic factors were a shock index score ?0.7 and SIRS at the onset of DH.

Nakahara, Osamu; Takamori, Hiroshi; Ikeda, Osamu; Kuroki, Hideyuki; Ikuta, Yoshiaki; Chikamoto, Akira; Beppu, Toru; Yamashita, Yasuyuki; Baba, Hideo



Skull fracture and haemorrhage pattern among fatal and nonfatal head injury assault victims - a critical analysis  

PubMed Central

Abstract: Background: The global incidence of fatal head injuries as the result of assault is greater than the number of non-fatal cases. The important factors that determine the outcome in terms of survival of such head injury cases include the type of weapon used, type and site of skull fracture, intra cranial haemorrhage and the brain injury. The present study aims to highlight the role of skull fractures as an indirect indicator of force of impact and the intra cranial haemorrhage by a comparative study of assault victims with fatal and nonfatal head injuries. Methods: 91 head injury cases resulting from assault were studied in the Department of Forensic Medicine, IMS, BHU Varanasi over a period of 2 years from which 18 patients survived and 73 cases had a lethal outcome. Details of the fatal cases were obtained from the police inquest and an autopsy while examination of the surviving patients was done after obtaining an informed consent. The data so obtained were analyzed and presented in the study. Results: Assault with firearms often led to fatality whereas with assault involving blunt weapons the survival rate was higher. Multiple cranial bones were involved in 69.3% cases while comminuted fracture of the skull was common among the fatal cases. Fracture of the base of the skull was noted only in the fatal cases and a combination of subdural and subarachnoid haemorrhage was found in the majority of the fatal cases. Conclusions: The present study shows skull fractures to be an important indicator of severity of trauma in attacks to the head. Multiple bone fracture, comminuted fracture and base fractures may be considered as high risk factors in attempted homicide cases.

Chattopadhyay, Saurabh; Tripathi, Chandrabhal



Complications of Embolization for Cerebral Arteriovenous Malformations  

PubMed Central

Summary Embolization is recognized as an important adjunct in the treatment of cerebral arteriovenous malformations (AVMs). We reviewed our results of embolizations for AVMs and discussed procedure-related complications. Eleven complications were recorded in 68 consecutive patients (16%). Of these, four were technical problems including a glued catheter, inability to withdraw the catheter, vessel perforation by the microcatheter, and coil migration. Other complications included three cases of ischemic symptoms due to retrograde thrombosis, two cases of asymptomatic cerebral infarction, one case of asymptomatic small haemorrhage due to venous occlusion, and one case of post-embolization haemorrhage of unknown etiology. Our morbidity rate was 7%, mortality rate was 0%, and asymptomatic complication torospectively. Further improvements to endovascular techniques and devices are required.

Sugiu, K.; Tokunaga, K.; Sasahara, W.; Watanabe, K.; Nishida, A.; Ono, S.; Nishio, S.; Date, I.; Rufenacht, D. A.



Circulatory and vascular changes after aneurysmal subarachnoid hemorrhage.  


Delayed cerebral ischemia (DCI) is a major complication that afflicts approximately 30% of patients who suffer an aneursymal subarachnoid hemorrhage (SAH). DCI is often associated with neurological infarction, poor outcome and mortality. Though the pathogenesis of DCI is not yet clear, it is traditionally been attributed to angiographic vasospasm. Unfortunately, clinical trials based on this premise have mostly been disappointing, predominantly unable to prevent ischemic damage and improve patient outcome despite reducing angiographic vasospasm. More recently, increasing concern that vasospasm could not fully account for DCI development has incited novel proposals as to the pathogenesis of DCI. A general theme exists among these theories (microcirculatory constriction, cortical spreading depression, blood brain barrier breakdown, microthrombosis) in that a majority seems to revolve around dysfunction and changes to the microvasculature. This purpose of this review was then to juxtapose macrovascular and microvascular changes after SAH, and provide an overview of current and prospective treatments. PMID:22198585

Wan, H; Loch Macdonald, R



Nonaneurysmal Subarachnoid Hemorrhage after Udenafil Intake.  


We report a 67-year-old man who presented with severe headache after taking 50 mg of udenafil, a new phosphodiesterase 5 inhibitor. Computed tomographic imaging of the brain revealed a small amount of acute subarachnoid hemorrhage localized around basal cisterns (anterior to midbrain and pons). There were no aneurysms in the cerebral arteries, although vein of Galen stenosis was suspected after magnetic resonance venography. This case anecdotally suggests that phosphodiesterase 5 inhibition might trigger perimesencephalic subarachnoid hemorrhage with venous hypertension possibly associated with vein of Galen stenosis. PMID:23643478

Bae, Eun-Kee; Ahn, Jong-Hyeon; Park, Jeong-Jin



Haemorrhagic effects of sodium heparin and calcium heparin prophylaxis in patients undergoing mastectomy.  


In a double-blind prospective clinical trial 75 consecutive patients undergoing mastectomy were randomly allocated to one of three groups. Twenty-five patients received perioperative anti-thromboembolic therapy with sodium heparin and 25 with calcium heparin. The remaining 25 patients were given anti-embolism stockings but no heparin. The total postoperative blood loss and period of drainage did not differ between the two groups given heparin, but a total of 10 of these 50 patients suffered haemorrhagic complications in the form of severe bruising or haematoma postoperatively. Of the patients given no heparin, none suffered haemorrhagic complications and the blood loss following the first 24-hour postoperative period was significantly less than in the groups given heparin. PMID:2681717

Lee, R E; Ho, K N; Karran, S J; Taylor, I



Formalin dab for haemorrhagic radiation proctitis.  

PubMed Central

BACKGROUND: Haemorrhagic radiation proctitis frequently presents as a problem in management. We analysed the technique of formalin dab in its management. PATIENTS AND METHODS: Twenty patients presenting with haemorrhagic radiation proctitis and treated with formalin dab were prospectively analysed. RESULTS: Twelve patients ceased to bleed following one session of formnalin dab. Six patients needed more than one session to effect haemostasis. Two of three patients with torrential bleeding failed to respond to formalin dab and required surgical excision of the rectum. CONCLUSION: Formalin dab is a simple, effective and safe treatment modality in the management of chronic haemorrhagic radiation proctitis, and hence should be considered as the initial treatment modality for such a condition.

Ismail, M. A.; Qureshi, M. A.



Effects of the selective endothelin A (ET A ) receptor antagonist Clazosentan on cerebral perfusion and cerebral oxygenation following severe subarachnoid hemorrhage – preliminary results from a randomized clinical series  

Microsoft Academic Search

Summary  \\u000a Objective. To study the effects of clazosentan, a new selective endothelin receptor subtype A antagonist, on cerebral perfusion and\\u000a cerebral oxygenation following severe aneurysmal subarachnoid haemorrhage (aSAH).\\u000a \\u000a \\u000a Methods. All 12 patients treated at our institution in the context of a phase IIa, multicenter, randomized trial on clazosentan’s\\u000a safety and efficacy in reducing the incidence of angiographic cerebral vasospasm were

M. Barth; H.-H. Capelle; E. Münch; C. Thome ´; F. Fiedler; P. Schmiedek; P. Vajkoczy



Haemorrhagic strokes in pregnancy and puerperium.  


There is an increased risk of strokes in pregnancy and puerperium. Intracranial haemorrhage is the rarer of the two stroke subtypes but carries a greater morbidity and mortality for both the mother and the child. This review highlights the causes of pregnancy-related intracranial haemorrhage and its management. The incidence varies from region to region with the highest being reported from China and Taiwan. Majority of these haemorrhages are secondary to hypertensive disorders of pregnancy with smaller proportions related to aneurysm and arteriovenous malformation rupture. A small but important contributor is cortical venous thrombosis which, although predominantly gives rise to ischaemic lesions, may lead to parenchymal haemorrhages as well. Presentation is usually with headaches or seizures, with or without focal deficits. Diagnosis requires brain imaging with computerized tomography or magnetic resonance imaging, and the necessity of investigation when this diagnosis is suspected supersedes the small risk of fetal malformation. Management follows the general management principles for intracranial haemorrhage management. Blood pressures need to be strictly monitored and medicines used for controlling them may differ slightly due to teratogenic effects. For preeclampsia, early but safe delivery is the best treatment. For cortical venous thrombosis, low-molecular-weight heparin is the preferred agent. Aneurysms and vascular malformations need to be definitively treated to prevent re-bleed and this can be achieved through surgical or endovascular procedures. The timing of surgery depends on neurosurgical considerations. However, the timing and mode of delivery are governed by obstetric factors. Risk of future haemorrhage depends on whether the underlying aetiology can be and has been definitively treated. PMID:22863273

Khan, Maria; Wasay, Mohammad



Intracranial haemorrhage following lumbar myelography: case report and review of the literature  

Microsoft Academic Search

We describe a subacute intracranial subdural haematoma following lumbar myelography. This rare but potentially life-threatening\\u000a complication has been reported both after lumbar myelography and following lumbar puncture for spinal anaesthesia. We review\\u000a 16 previously reported cases of intracranial haemorrhage following lumbar myelography, and discuss the pathogenesis. In all\\u000a reported cases post-puncture headache was the leading symptom and should therefore be

O. Suess; R. Stendel; S. Baur; A. Schilling; M. Brock



Intraventricular haemorrhage and periventricular leucomalacia: ultrasound and autopsy correlation  

Microsoft Academic Search

The brains of 30 infants who died after at least one real time ultrasound scan were examined after fixation. The ultrasound diagnosis of either periventricular haemorrhage or periventricular leucomalacia was compared with the macroscopic and histological appearances. Each hemisphere was considered separately for both periventricular haemorrhage and periventricular leucomalacia. The accuracy of ultrasound diagnosis for periventricular haemorrhage was 88%, with

J Q Trounce; D Fagan; M I Levene



Acute haemorrhage associated with pancreatic pseudocyst and chronic pancreatitis.  


The present study reports 18 patients operated on for chronic pancreatitis complicated by bleeding in the upper gastrointestinal tract, the peritoneal cavity or the retroperitoneal space. Damage to the splenic artery by a pancreatic pseudocyst was the most common reason for the bleeding (10 patients, 56%) and the most common site was the duodenum (10 patients, 56%). Eleven patients were treated by transcystic multiple suture ligations combined with external drainage of the pseudocyst, and seven by pancreatic resection or total pancreatectomy. Hospital mortality was 33% (6 patients); two patients had undergone transcystic suture ligation, and four pancreatic resection. Five patients needed a reoperation because of further bleeding, four of them having been treated initially by transcystic suture ligation. Our results suggest that haemostasis by suture ligation is a method to be recommended if the patient's condition has been exacerbated by severe haemorrhage. PMID:6334475

Kiviluoto, T; Schröder, T; Kivilaakso, E; Lempinen, M



Haemorrhagic Corpus Lutem Mimic Appendicitis  

Microsoft Academic Search

Haemoperitoneum secondary to ruptured corpus luteum is a rare complication for women of reproductive life. The differential diagnosis of hemoperitoneum includes various types of acute abdomen that usually associated with acute lower abdominal pain and swelling lower abdomen. The differential diagnosis includes ruptured ectopic pregnancy, ruptured chocolate cyst, twisted ovarian tumor, pelvic inflammatory disease and pelvic peritonitis . Ruptured hemorrhagic

Hasina Afroz; Rabeya Akhter; Shahela Jesmin



Severe postpartum haemorrhage from ruptured pseudoaneurysm: successful treatment with transcatheter arterial embolization.  


The purpose of this retrospective study was to evaluate the role of transcatheter arterial embolization in the management of severe postpartum haemorrhage due to a ruptured pseudoaneurysm and to analyse the clinical symptoms that may suggest a pseudoaneurysm as a cause of postpartum haemorrhage. A retrospective search of our database disclosed seven women with severe postpartum haemorrhage in whom angiography revealed the presence of a uterine or vaginal artery pseudoaneurysm and who were treated using transcatheter arterial embolization. Clinical files were reviewed for possible clinical findings that could suggest pseudoaneurysm as a cause of bleeding. Angiography revealed extravasation of contrast material in five out of seven patients. Transcatheter arterial embolization allowed to control the bleeding in all patients and subsequently achieve vaginal suture in four patients with vaginal laceration. No complications related to transcatheter arterial embolization were noted. Only two patients had uterine atony, and inefficiency of sulprostone was observed in all patients. Transcatheter arterial embolization is an effective and secure technique for the treatment of severe postpartum haemorrhage due to uterine or vaginal artery pseudoaneurysm. Ineffectiveness of suprostone and absence of uterine atony should raise the possibility of a ruptured pseudoaneurysm. PMID:18270711

Soyer, Philippe; Fargeaudou, Yann; Morel, Olivier; Boudiaf, Mourad; Le Dref, Olivier; Rymer, Roland



Effect of recombinant human erythropoietin on cerebral ischemia following experimental subarachnoid hemorrhage  

Microsoft Academic Search

Erythropoietin exerts a neuroprotective effect during cerebral ischemia. We investigated the effect of systemic administration of recombinant human erythropoietin in a rabbit model of subarachnoid hemorrhage-induced acute cerebral ischemia. The animals were divided into three groups: group 1, subarachnoid hemorrhage; group 2, subarachnoid hemorrhage plus placebo; group 3, subarachnoid hemorrhage plus recombinant human erythropoietin (each group, n=8). Experimental subarachnoid hemorrhage

Concetta Alafaci; Francesco Salpietro; Giovanni Grasso; Alessandra Sfacteria; Marcello Passalacqua; Antonio Morabito; Eliana Tripodo; Gioacchino Calapai; Michele Buemi; Francesco Tomasello



[Viral haemorrhagic fevers--evolution of the epidemic potential].  


In this review modern data on dangerous and particularly dangerous viral haemorrhagic fevers caused by a group of viruses belonging to the families of phylo-, arena-, flavi-, bunya- and togaviruses are presented. Morbidity rates and epidemics caused by Marburg virus, Ebola fever virus, Lassa fever virus, Argentinian and Bolivian haemorrhagic fever viruses, dengue haemorrhagic fever virus, Crimean haemorrhagic fever virus, Hantaviruses are analyzed. Mechanisms of the evolution of the epidemic manifestation of these infections are considered. The importance of the development of tools and methods of diagnosis, rapid prevention and treatment of exotic haemorrhagic fevers is emphasized. PMID:11949268

Markin, V A; Markov, V I


A case report of orbital haemorrhage associated with endoscopic sinus surgery and reversible sight loss: a multidisciplinary approach to management.  


We report a case of intraoperative orbital haemorrhage as a complication of endoscopic sinus surgery performed under general anaesthesia. Initial unilateral complete visual loss occurred, but recovered due to accurate and early diagnosis combined with urgent surgical intervention. This patient's case is reported to illustrate the importance of early recognition of clinical signs and how a stepwise approach to management can result in a favourable visual outcome. Moreover, the mechanisms and pathophysiology of visual loss due to orbital haemorrhage following endoscopic sinus surgery are discussed. PMID:23387463

Sood, Vaneeta; Rejali, Darius; Stocker, Judith; Pagliarini, Sergio; Ahluwalia, Harpreet; Mehta, Purnima



The neuropathology of infant subdural haemorrhage  

Microsoft Academic Search

Subdural haemorrhage (SDH) in the infant has a different pattern from that seen in the older child and adult. It is usually a widespread, bilateral, thin film, unlike the thick, space-occupying and often unilateral clot seen in older children and adults after trauma. Whether both arise by the same mechanism is unknown, but it seems unlikely. Most SDH is said

Waney Squier; Julie Mack



Risk assessment after acute upper gastrointestinal haemorrhage  

Microsoft Academic Search

The aim of this study was to establish the relative importance of risk factors for mortality after acute upper gastrointestinal haemorrhage, and to formulate a simple numerical scoring system that categorizes patients by risk. A prospective, unselected, multicentre, population based study was undertaken using standardised questionnaires in two phases one year apart. A total of 4185 cases of acute upper

T A Rockall; R F Logan; H B Devlin; T C Northfield



Hyperbaric oxygen treatment for haemorrhagic radiation cystitis  

Microsoft Academic Search

SummaryRadiation-induced severe haemorrhagic cystitis is difficult to treat. Conventional treatments may decrease haematuria but do not affect the radiocystitis itself. Hyperbaric oxygen treatment has been reported to do both. We report the results of a prospective study of hyperbaric oxygen (20 sessions of 100% oxygen inhalation at 3 bar for 90 min in a multiplace hyperbaric chamber) to 40 patients

R. F. M Bevers; K. H Kurth; D. J Bakker



Rheumatoid leptomeningitis: rare complication of rheumatoid arthritis  

Microsoft Academic Search

Rheumatoid leptomeningitis is a rare complication of rheumatoid arthritis (RA). We describe a woman with rheumatoid leptomeningitis\\u000a presenting with acute-onset behavioral changes and consciousness disturbance in the early stage of RA. On fluid-attenuated\\u000a inversion recovery images or diffusion-weighted images, high-signal-intensity lesions in the subarachnoid spaces of the right\\u000a frontal lobe were observed. Biopsies of brain tissues and the dura mater

Reiji Koide; Ayako Isoo; Kazuhiko Ishii; Akinori Uruha; Mitsuaki Bandoh



Postoperative haemorrhage following transurethral resection of the prostate (TURP) and photoselective vaporisation of the prostate (PVP)  

PubMed Central

INTRODUCTION Intractable haemorrhage after endoscopic surgery, including transurethral resection of the prostate (TURP) and photoselective vaporisation of the prostate (PVP), is uncommon but a significant and life-threatening problem. The knowledge and technical experience to deal with this complication may not be wide-spread among urologists and trainees. We describe our series of TURPs and PVPs and the incidence of postoperative bleeding requiring intervention. PATIENTS AND METHODS We retrospectively reviewed 437 TURPs and 590 PVPs over 3 years in our institution. We describe the conservative, endoscopic and open prostatic packing techniques used for patients who experienced postoperative bleeding. RESULTS Of 437 TURPs, 19 required endoscopic intervention for postoperative bleeding. Of 590 PVPs, two patients were successfully managed endoscopically for delayed haemorrhage at 7 and 13 days post-surgery, respectively. In one TURP and one PVP patient, endoscopic management was insufficient to control postoperative haemorrhage and open exploration and packing of the prostatic cavity was performed. CONCLUSIONS Significant bleeding after endoscopic prostatic surgery is still a potentially life-threatening complication. Prophylactic measures have been employed to reduce peri-operative bleeding but persistent bleeding post-endoscopic prostatic surgery should be treated promptly to prevent the risk of rapid deterioration. We demonstrated that the technique of open prostate packing may be life-saving.

Lynch, Mark; Sriprasad, Seshadri; Subramonian, Kesavapillai; Thompson, Peter



Combined subarachnoideal-extradural anesthesia for high-risk patients during surgery on the musculo-skeletal system.  


Background. Patients in advanced age undergoing surgery for musculo-skeletal disorders are at risk for failure of vital systems under anesthesia. Thus the choice of anesthetic technique for high-risk patients can have a vital impact on treatment outcome. Material and method. Our research involved 344 patients ranging in age from 69 to 93 (mean 76.4 +/- 7.8) at high risk during extensive orthopedic surgery on the lower limbs. The patients were divided into three groups depending on the anesthetic technique used: Group I - general anesthesia with esophageal intubation or laryngeal mask; Group II - subarachnoid anesthesia; and Group III - combined subarachnoid-extradural anesthesia. The Goldman heart risk and ASA anesthesia risk were determined for each patient. The frequency and type of post-operative complications were also specified. Results. Altogether complications occurred in 15.6% of the patients: 6.1% in Group I, 6.8% in Group II, and 2.9% in Group III. Acute myocardial ischemia and infarct occurred only in patients with high Goldman indices. Pulmonary complications were seen in groups I and II, but not in Group III. Conclusions. Combined subarachnoid-extradural anesthesia enables deeper anesthesia during a prolonged operation, and thus makes it possible to avoid general anesthesia. The post-surgical application of continuous extradural analgesia using bupivacaine with phentanyl enables the introduction of respiratory rehabilitation and rapid mobilization, reducing the number of cardiac and pulmonary complications, and by the same token shortening the duration of hospitalization. PMID:17675997

Grabowska-Gawe?, Anna



Surgeons' attitudes to the operative management of duodenal ulcer perforation and haemorrhage.  

PubMed Central

The currently preferred operative management of duodenal ulcer haemorrhage and perforation was assessed by means of a questionnaire sent to 274 consultant general surgeons in England. A 70% response rate was achieved. Simple closure, with or without H2 antagonist treatment, was the most popular management of a perforated acute duodenal ulcer. For perforation of a chronic duodenal ulcer occurring during H2 antagonist therapy, truncal vagotomy and drainage was the definitive procedure of choice. There was no consensus about the operative management of perforation complicating non-steroidal anti-inflammatory drug treatment in the elderly patient. Proximal gastric vagotomy appears to have few advocates in the definitive management of either duodenal ulcer perforation or haemorrhage. Of our sample 70% selected truncal vagotomy and drainage with underrunning of the ulcer as the operative treatment of choice for bleeding. Endoscopic coagulation appears to be used only rarely.

Stringer, M. D.; Cameron, A. E.



Cervical tourniquet in case of uncontrollable haemorrhage during caesarean section owing to a placenta accreta.  


This case report describes a 38-year-old woman in whom a primary caesarean section for placenta previa was complicated by postpartum haemorrhage due to a placenta accreta. Despite tamponade with a Bakri balloon and placement of a B-Lynch suture, the amount of blood loss could not be effectively reduced. The blood loss was eventually minimised by the placement of a Penrose drain around the cervix as a cervical tourniquet. We think that a cervical tourniquet is an effective method of stopping haemorrhage during caesarean section, as shown in this case report, and we consider this technique to be a valuable addition to several existing methods through which fertility is preserved by preventing emergency hysterectomy. PMID:23608864

Huijgen, Q C A; Gijsen, A F; Hink, E; Van Kesteren, P J M



High-grade intracranial chondrosarcoma presenting with haemorrhage.  


Chondrosarcomas are rare sarcomas that produce malignant cartilage, infrequently arising as a primary intracranial tumour. We present a patient with intracranial chondrosarcoma with intratumoural haemorrhage arising in an unusual location and with unusual imaging findings. A 46-year-old man presented with headache, nausea, and vomiting over the previous 24hours. Physical and neurological examinations were normal. Cranial CT scans and MRI revealed a large right pre-frontal (subdural) and interhemispheric heterogeneous density associated with a frontal, partially calcified mass and midline shift. An awake craniotomy was performed. With the intra-operative quick section favouring subdural hematoma, the lesion was subtotally resected. Follow-up imaging confirmed residual mass. Pathology examination revealed a high-grade malignant neoplasm with chondroid differentiation, diagnosed as conventional Grade III chondrosarcoma. The patient was referred to oncology for follow-up and radiation therapy. Intracranial chondrosarcoma was first reported in 1899, and since then continues to be an extremely rare malignancy of the brain. These tumours commonly present as extra-axial masses, originating from the skull base, and produce symptoms due to progressive enlargement and compression of local structures. Unusual presentations of these tumours, such as vascularity, intratumoural haemorrhage, and intra-axial location, may complicate pre-surgical decision making by altering the provisional diagnosis prior to intervention. This patient emphasises the importance of careful analysis and incorporation of imaging findings into surgical decision making. Specific imaging characteristics that, in such unusual situations, are suggestive of chondrosarcoma should motivate an aggressive surgical approach to optimise adjuvant interventions. PMID:23746570

Little, Anjuli; Chung, Caroline; Perez-Ordonez, Bayardo; Mikulis, David; Valiante, Taufik A



Pituitary deficiency after aneurysmal subarachnoid hemorrhage  

PubMed Central

OBJECTIVE: Aneurysmal subarachnoid hemorrhage puts patients at high risk for the development of pituitary insufficiency. We evaluated the incidence of pituitary dysfunction in these patients and its correlation with clinical outcome. METHODS: Pituitary function was tested in 66 consecutive patients in the first 15 days after aneurysmal subarachnoid hemorrhage. The following were measured in all patients: thyroid-stimulating hormone, free thyroxine, triiodothyronine, luteinizing hormone, follicle-stimulating hormone, total testosterone (in males), estradiol (in females), prolactin, serum cortisol, plasma adrenocorticotropic hormone, growth hormone and insulin growth factor. RESULTS: The endocrine assessment was made at a mean of 7.4 days (standard deviation ±6.6) after subarachnoid hemorrhage. Forty-four (66.7%) female and 22 (33.3%) male patients were evaluated. Thirty-nine patients (59.1%) had some type of pituitary dysfunction. Follicle-stimulating hormone/luteinizing hormone deficiency was the most frequent disorder (34.8%), followed by growth hormone/insulin growth factor (28.7%), adrenocorticotropic hormone (18.1%) and thyroid-stimulating hormone (9%). Seventeen (25.7%) patients showed deficiencies in more than one axis. A greater incidence of hormone deficiency was observed in patients with a Glasgow Coma Scale score ?13 (t test, p?=?0.008), Hunt-Hess grade ?4 (t test, p<0.001), or Fisher grade 4 (t test, p?=?0.039). Hormone deficiency was not significantly associated (p>0.05) with increased hospitalization or clinical outcome. CONCLUSION: Pituitary dysfunction was identified in a substantial portion of patients with previous aneurysmal subarachnoid hemorrhage, but no association was found between this dysfunction and poor clinical outcome.

Pereira, Julio Leonardo Barbosa; de Albuquerque, Lucas Alverne Freitas; Dellaretti, Marcos; de Carvalho, Gervasio Teles Cardoso; Jr, Gerival Vieira; Brochado, Vitor Michelstaedter; Drummond, Austen Venancio; de Morais, Joyce Espeschit; Ferreira, Leticia Maia; Miranda, Paulo Augusto Carvalho; de Sousa, Atos Alves



Myocardial stunning secondary to aneurysmal subarachnoid hemorrhage  

Microsoft Academic Search

BackgroundAlthough subarachnoid hemorrhage (SAH) is often associated with electrocardiographic abnormalities, profound effects on cardiac performance are rare.CASE DESCRIPTIONA 57-year-old woman who developed loss of consciousness, respiratory distress, severe hypotension, and left ventricular hypokinesis with minimal coronary artery disease is described. Despite normal appearance of the coronary arteries on angiography, left ventricle function was so severely depressed that she required intra-aortic

Jill W Donaldson; Michael B Pritz



Maternal intracranial hemorrhage complicating severe superimposed preeclampsia. A case report.  


Subarachnoid hemorrhage as a result of superimposed preeclamptic toxemia is a well-known complication but fortunately not a common one. The maternal and fetal mortality rates are high. In one such patient the outcome for both mother and infant was excellent. PMID:2795571

Lazebnik, N; Pazmino, R; Dierker, L R; Takaoka, Y; Warf, B C



Postmortem diagnosis of acute haemorrhagic pancreatitis.  


Forensic pathologists can help in the investigation of sudden unexpected deaths in co-operation with the officials responsible for the maintenance of law and order to administer justice. Sudden unexpected deaths form the subject of medicolegal investigation if they occur in apparently healthy individuals, wherein an autopsy would shed light regarding the cause of death. A 4 year retrospective review of autopsy files at the Department of Forensic Medicine, Kasturba Medical College, Mangalore, South India was undertaken for cases of sudden unexpected deaths due to acute haemorrhagic pancreatitis occurring between May 2004 and April 2008. A total of seven cases of acute haemorrhagic pancreatitis diagnosed at autopsy as the cause of sudden unexpected death during the study period are discussed herein. PMID:20650420

Shetty, B Suresh Kumar; Boloor, Archith; Menezes, Ritesh G; Shetty, Mahabalesh; Menon, Anand; Nagesh, K R; Pai, Muktha R; Mathai, Alka Mary; Rastogi, Prateek; Kanchan, Tanuj; Naik, Ramadas; Salian, Preetham Raj; Jain, Vipul; George, Aneesh T



Haemorrhagic pulmonary oedema: post-pulmonary embolectomy.  

PubMed Central

A case of haemorrhagic pulmonary oedema after successful pulmonary embolectomy is presented. The relevant literature is reviewed. Thirteen cases are analysed as well as the four survivors. The aetiology appears to be ischaemic damage of the capillary bed. This had previously been called incomplete infarction by Castleman. The incidence is low after acute pulmonary embolectomies but appears to be much higher after chronic endarterectomies, especially with severe pulmonary hypertension. Therapy is outlined. Images

Garvey, J W; Wisoff, G; Voletti, C; Hartstein, M



Spontaneous cerebellar haemorrhage following lumbar fusion  

Microsoft Academic Search

Spontaneous cerebellar haemorrhage following spinal surgery is rare, with fewer than 20 patients reported in the literature. We present a 70-year-old woman who underwent a L5–S1 posterior lumbar interbody fusion for spondylolisthesis. Intraoperatively, an incidental durotomy occurred and was repaired uneventfully. A large amount of serosanguinous fluid was noted in the subfascial drain post-operatively. The patient became increasingly drowsy 36

Peter Khong; M. Jerry Day



Transcatheter coil embolotherapy: a safe and effective option for major colonic haemorrhage  

PubMed Central

Background—The management of major colonic bleeding is problematic. A proportion of patients require emergency surgery which is associated with high morbidity and mortality. Percutaneous embolotherapy, previously considered a high risk procedure in the colon, may provide an alternative treatment in this group of patients. ?Aims—To assess the safety and efficacy of embolotherapy in the treatment of life threatening colonic haemorrhage. ?Patients and methods—Thirty eight patients with fresh haemorrhage per rectum were referred for surgery because of failed conservative treatment. All underwent angiography; in 14 a bleeding site or vascular abnormality was detected. A coaxial catheter was directed to the most distal bleeding artery and this was embolised with platinum coils. ?Results—Detection of a bleeding site correlated with haemodynamic stability at the time of angiography (r=1 for a systolic blood pressure less than 100 mm Hg). Bleeding sites or vascular abnormalities were detected and embolised in 14 patients (37%). In 12/14 there was immediate and sustained haemodynamic improvement; two continued to bleed and required emergency hemicolectomy (14%). Three developed ischaemic complications (21.4%); these were managed conservatively and required no intervention. The 30 day mortality was 7.1% in the embolotherapy group and 10.5% in the overall group of 38patients. ?Conclusion—Colonic embolotherapy for life threatening haemorrhage is an effective, relatively safe procedure with a low incidence of major complications. Its use depends on the identification of a focal bleeding point or vascular abnormality, which in turn depends on the haemodynamic stability of the patient at the time of angiography. ?? Keywords: colonic haemorrhage; embolisation; angiography; angiodysplasia; diverticular disease

Nicholson, A; Ettles, D; Hartley, J; Curzon, I; Lee, P; Duthie, G; Monson, J



Successful allogeneic stem cells transplantation in severe aplastic anaemia complicated by dengue Fever.  


Aplastic anaemia is characterized by severe compromise of haematopoiesis and hypocellular bone marrow. Haemorrhagic episodes in patients with aplastic anemia occur usually secondary to thrombocytopenia and require frequent support with platelet concentrates and other blood products. Infection with dengue virus (particularly dengue sero type-2 of South Asian genotype) is associated with dengue haemorrhagic fever. Dengue infection further worsens the disease process in patients with aplastic anaemia due to uncontrolled haemorrhagic diathesis and major organ failure, which may prove fatal in these already immunocompromised patients, if not treated in time. Recent epidemics of dengue haemorrhagic fever has not only affected the southern region of our country but also spread to other areas of the country. With this background, we report a case of aplastic anaemia complicated by dengue haemorrhagic fever who achieved successful engraftment after allogeneic stem cell transplantation from sibling brother and is having normal healthy post transplant life. PMID:17999860

Ullah, Khalil; Satti, Tariq Mahmood; Ahmed, Parvez; Raza, Shahid; Tariq, Waheed-Uz-Zaman; Kamal, Muhammad Khalid; Chaudhry, Qamar-Un-Nisa; Akhtar, Farrukh Mahmood



Acute Lower Gastrointestinal Haemorrhage Secondary to Small Bowel Ascariasis  

PubMed Central

Acute lower gastrointestinal haemorrhage secondary to small bowel ascariasis is extremely rare. A high level of suspicion should be maintained when dealing with acute gastrointestinal haemorrhage in migrants and travellers. Small bowel examination is warranted when carefully repeated upper and lower endoscopies have failed to elicit the source of bleeding. Appropriate test selection is determined by the availability of local expertise. We present a case of acute lower gastrointestinal haemorrhage secondary to jejunal ascariasis and a literature search on lower gastrointestinal haemorrhage associated with jejunal infestation with Ascaris.

Daphne Dewi, Stephen; Sze Li, Siow



Preventing Vasospasm Improves Outcome After Aneurysmal Subarachnoid Hemorrhage: Rationale and Design of CONSCIOUS2 and CONSCIOUS3 Trials  

Microsoft Academic Search

Cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH) is a frequent but unpredictable complication associated\\u000a with poor outcome. Current vasospasm therapies are suboptimal; new therapies are needed. Clazosentan, an endothelin receptor\\u000a antagonist, has shown promise in phase 2 studies, and two randomized, double-blind, placebo-controlled phase 3 trials (CONSCIOUS-2\\u000a and CONSCIOUS-3) are underway to further investigate its impact on vasospasm-related outcome after

R. Loch Macdonald; Randall T. Higashida; Emanuela Keller; Stephan A. Mayer; Andy Molyneux; Andreas Raabe; Peter Vajkoczy; Isabel Wanke; Aline Frey; Angelina Marr; Sébastien Roux; Neal F. Kassell



Ultrasonographic measurement of subarachnoid space in normal term newborns  

Microsoft Academic Search

This study was conducted in order to assess the normal range of subarachnoid space width in healthy term newborns. A total of 230 healthy newborns were evaluated within the first 28 days of life. Measurements were correlated with body weight, height and head circumference. Mean measurements for falx-cortex and craniocortical widths and the correlations are given in tables. Subarachnoid space

Nejat Narli; Süreyya Soyupak; Hacer Y. Yildizda?; Ercan Tutak; Kenan Özcan; Ya?ar Sertdemir; Mehmet Satar



Cauda equina syndrome resulting from lumbar arachnoiditis after intracranial subarachnoid hemorrhage: a case report.  


Spinal arachnoiditis is a known but very rare late complication of subarachnoid hemorrhage (SAH). Since 1943, 17 cases of spinal arachnoiditis after intracranial hemorrhage have been reported internationally. The vast majority of these cases were related to aneurysmal SAH. All previously published cases have involved spinal arachnoiditis at the cervical and thoracic levels. In this report, we present an adult woman with lumbar spinal arachnoiditis causing cauda equina syndrome as a result of posterior circulation aneurysmal SAH. We believe this is the first reported case of this specific condition causing cauda equina syndrome. PMID:23790823

Whetstone, Kirk E; Crane, Deborah A



The distribution of intravenous nicardipine in rat brain after subarachnoid hemorrhage  

SciTech Connect

The distribution of intravenously injected nicardipine in rat brain was investigated, as well as the influence of subarachnoid hemorrhage on its distribution. Autoradiographic studies demonstrated the accumulation of {sup 3}H-nicardipine only in the ventricles and subarachnoid spaces around pial vessels in normal brains. Thirty minutes after subarachnoid hemorrhage, the concentration of {sup 3}H-nicardipine was higher in the ventricles and in the subarachnoid space than that found in normal brains. It is concluded that nicardipine penetrates into the subarachnoid spaces and ventricles from pial vessels and/or choroid plexus, and that subarachnoid hemorrhage increases the penetration of nicardipine from vessels into the subarachnoid space.

Tsukahara, T.; Arista, A.; Kassell, N.F. (Univ. of Virginia School of Medicine, Charlottesville (USA))




Microsoft Academic Search

(20.9%), prolonged labour 21 (21.9%), retained placental tissues, 11 (12.5%), retained placenta, 11 (11.4%) Couvelliar uterus, 10 (10.4%), placenta preavia, 8 (8.3%), placenta increta, 7 (7.3%), chorioamnionitis 5 (5.2%), and multiple pregnancy, 2 (2.1%). Risk factors, grand multiparity 70 (51.5%), antepartum haemorrhage 12 (8.9%), instrumental delivery 10(7.3%), previous PPH, 6 (4.5%), choreoamnionitis, 5 (3.6%), multiple pregnancy, 2 (1.5%), no risk

Shamshad Bibi; Nargis Danish; Anisa Fawad; Muhammad Jamil


Mycotic aneurysm of the small bowel presenting as gastrointestinal haemorrhage.  


Since the advent of modern antibiotic therapy and active surgical treatment of bacterial endocarditis, septic embolization of the systemic circulation is rarely seen. An unusual presentation of a mycotic aneurysm with gastrointestinal haemorrhage in a patient with non-Hodgkin's lymphoma and aortic valvular endocarditis which had been managed by aortic valve replacement six weeks before the haemorrhage occurred is reported. PMID:6610817

Wilson, J W; Ellis, D; Leyden, M J; Thomas, R; Sullivan, J R



Identification of the virus of rabbit haemorrhagic disease in Tunisia  

Microsoft Academic Search

During 1992 and 1993, outbreaks of an acute, highly fatal disease mainly affecting adult rabbits were observed in Tunisia. The clinical and pathological findings were consistent with rabbit haemorrhagic disease. A monoclonal antibody designated PG4G3 specific for surface determinants of the rabbit haemorrhagic disease virus was used to identify the aetiological agent by ELISA and by colloidal gold immunoelectron microscopy;

A. Bouslama; G. M. De Mia; S. Hammami; T. Aouina; H. Soussi; T. Frescura



Intraventricular recombinant tissue plasminogen activator for lysis of intraventricular haemorrhage  

Microsoft Academic Search

A prospective series of 20 patients with moderate to severe intraventricular haemorrhage (IVH) was studied for the effect of intraventricular administration of recombinant tissue plasminogen activator (rt-PA) on reduction of haematoma volume and prognosis. On the day of haemorrhage ventriculostomy was performed and 2 to 5 mg of rt-PA were injected via the external ventricular drainage, followed by drainage closure

V Rohde; C Schaller; W E Hassler



Epizootic occurrence of haemorrhagic nephritis enteritis virus infection of geese  

Microsoft Academic Search

Recent outbreaks of haemorrhagic nephritis enteritis in geese flocks of 3 to 10 weeks in age in Hungary were investigated. Mortality varied between 4% and 67%. Affected birds generally died suddenly. Occasional clinical signs included tremors of the head and neck, subcutaneous haemorrhages and excretion of faeces containing partly digested blood. At necropsy the most frequent findings were a turgid

Vilmos Palya; Éva Ivanics; Róbert Glávits; Ádám Dán; Tamás Mató; Péter Zarka



An unusual cause of delayed postpartum haemorrhage following caesarean section  

Microsoft Academic Search

Although less common in the UK, postpartum haemorrhage (PPH)—defined as blood loss of 500 ml or more within the first 24 h of delivery— remains a significant cause of maternal death worldwide. Haemorrhage between 24 h and 6 weeks post partum is termed “delayed PPH”. Common causes include retention of gestational products or endometritis. Bleeding can be sudden and profound,

S Samad; P Jonetzko; A P Hawkins; J Booth; G Thorpe-Beeston; R Marwood



Complicated retinal detachment and its management with pars plana vitrectomy  

Microsoft Academic Search

Fifty patients with retinal detachment accompanied by vitreous haemorrhage, perforating eye injuries, intraocular foreign bodies, massive preretinal retraction,.giant tears greater than 180 degrees, and proliferative retinopathies underwent pars plana vitrectomy, cryocoagulation, scleral buckling, and intravitreal gas injection. Intraoperative complications included minimal to moderate bleeding and iatrogenic retinal tears, but no retinal dialysis was produced at the pars plana sclerotomy site.

F U Huamont; G A Peyman; M F Goldberg



Gastrointestinal complications of the Ehlers-Danlos syndrome  

Microsoft Academic Search

The gastrointestinal abnormalities encountered in 125 patients with the Ehlers-Danlos syndrome have been described. Spontaneous perforation of the intestine and massive gastrointestinal haemorrhage are uncommon but potentially lethal complications of the Ehlers-Danlos syndrome. Less dangerous abnormalities, such `as external hernia, hiatus hernia, eventration of the diaphragm, intestinal diverticula, and rectal prolapse were all encountered in patients in the series. Abdominal

Peter H. Beighton; J. Lamont Murdoch; Theodore Votteler



Major haemorrhage related to surgery in patients with type 1 and possible type 1 von Willebrand disease  

Microsoft Academic Search

Summary Patients with von Willebrand disease (VWD) frequently bleed under a challenge.The aim of our study was to identify predictive markers of perioperative major haemorrhage in type 1 (VWF:RCo = 15-30 IU dl-1) and possible type 1 (VWF:RCo = 31-49 IU dl-1)VWD patients.We recorded perioperative bleeding complications previous to diagnosis and laboratory parameters in 311 patients with 498 surgical procedures.The

Adriana Inés Woods; Alicia Noemí Blanco; Roberto Chuit; Susana Sara Meschengieser; Ana Catalina Kempfer; Cristina Elena Farías; María Angela Lazzari



[Analysis of therapeutic methods used in puerperium complicated by hemorrhagic shock].  


Methods of intensive treatment of puerperium with severe haemorrhagic shock of a dramatic course are analysed in the paper. In 20% of patients shock occurred due to non-obstetric reasons. It is stated, that haemorrhagic shock predisposes to various complications, which in turn require multidirectional treatment. It is stressed, that monitored therapy by means of adequately selected fluids should be supplemented by immediate and appropriate oxygen therapy. PMID:8655024

Skorupa, A; Dyaczy?ska-Herman, A



Seizures and anticonvulsants after aneurysmal subarachnoid hemorrhage.  


Seizures and seizure-like activity may occur in patients experiencing aneurysmal subarachnoid hemorrhage. Treatment of these events with prophylactic antiepileptic drugs remains controversial. An electronic literature search was conducted for English language articles describing the incidence and treatment of seizures after aneurysmal subarachnoid hemorrhage from 1980 to October 2010. A total of 56 articles were included in this review. Seizures often occur at the time of initial presentation or aneurysmal rebleeding before aneurysm treatment. Seizures occur in about 2% of patients after invasive aneurysm treatment, with a higher incidence after surgical clipping compared with endovascular repair. Non-convulsive seizures should be considered in patients with poor neurological status or deterioration. Seizure prophylaxis with antiepileptic drugs is controversial, with limited data available for developing recommendations. While antiepileptic drug use has been linked to worse prognosis, studies have evaluated treatment with almost exclusively phenytoin. When prophylaxis is used, 3-day treatment seems to provide similar seizure prevention with better outcome compared with longer-term treatment. PMID:21751102

Lanzino, Giuseppe; D'Urso, Pietro Ivo; Suarez, Jose



Thalamic haemorrhage vs internal capsule-basal ganglia haemorrhage: clinical profile and predictors of in-hospital mortality  

Microsoft Academic Search

BACKGROUND: There is a paucity of clinical studies focused specifically on intracerebral haemorrhages of subcortical topography, a subject matter of interest to clinicians involved in stroke management. This single centre, retrospective study was conducted with the following objectives: a) to describe the aetiological, clinical and prognostic characteristics of patients with thalamic haemorrhage as compared with that of patients with internal

Adrià Arboix; Raquel Rodríguez-Aguilar; Montserrat Oliveres; Emili Comes; Luis García-Eroles; Joan Massons



The neuropathology of infant subdural haemorrhage.  


Subdural haemorrhage (SDH) in the infant has a different pattern from that seen in the older child and adult. It is usually a widespread, bilateral, thin film, unlike the thick, space-occupying and often unilateral clot seen in older children and adults after trauma. Whether both arise by the same mechanism is unknown, but it seems unlikely. Most SDH is said to be due to trauma but in infants there are other, atraumatic causes. Birth is also important; recent MRI studies show an incidence of almost 50% in asymptomatic neonates. Traumatic SDH is said to result from rupture of bridging veins but new insights into the anatomy of infant dura suggest a dural origin for thin film subdural bleeding in young babies. Acute SDH usually rapidly resolves, but sometimes develops into a chronic fluid collection. Healing of SDH is by formation of a granulating membrane which may confer vulnerability to rebleeding, either spontaneously or after an otherwise innocuous event. SDH has a particular significance as one of the features of the triad (together with retinal haemorrhage and encephalopathy) associated with non-accidental injury. As the possibility of non-accidental injury is often first raised by a radiologic report of subdural bleeding, it becomes critically important in the interpretation of the scan appearances to understand the unique physiology and anatomy of the infant dura. PMID:19303229

Squier, Waney; Mack, Julie



[About stepwise uterine devascularization in early post-partum haemorrhages].  


Bleedings are the leading cause for mother's mortality rate worldwide and that is why the authors face once more the abdominal operative methods for definite copying the early post partum haemorrhages (EPH). They share their experience gained already with 46 cases when EPH has definitively been copied by means of stepwise uterine devascularization of the vessels with atonic bleedings and ligation of a. iliaca interna presenting with laceration of the lower uterine segment and vagina as well. Hysterectomy has been performed only when the uterus has already exhausted its fertile capacities in a structural and functional aspect, e.g. after numerous abortions, deliveries and experienced Caesarean sections, intra-partum septic conditions, appoplexio uteri, etc. According to authors' opinion, the stepwise uterine devascularization is the method of choice for EPH surgical copying during which woman' fertility is, in fact, preserved. With this method, no complications typical of the various compression methods applied to overcome the puerperal bleedings such as B-Linch sutures, haemostatic sutures of 'multiple squares' type as well as U-shape compression sutures have been observed at all. PMID:19230260

Tsvetkov, K; Angelova, M; Monastirska, M; Tsvetkov, Ts



[The risk of complications of cerebral angiography in patients with cerebral aneurysms in relation to the time of its use].  


The authors analysed the effect of cerebral angiography on the condition of the patients after haemorrhage from an intracranial aneurysm. The studied material comprised 242 patients in whom cerebral angiography was carried out at various times after the haemorrhage by the method of direct percutaneous needle insertion into the carotid artery. Complications of angiography included: worsening of the general condition or neurological condition during the angiography and within 24 hours after it. Such complications were found in 14 patients (5.8%). In only 3 cases they appeared during the angiography. No cases of repeated haemorrhage from the aneurysm were observed. The greatest risk of complications was after 7-9 days from the haemorrhage which was connected with the greatest intensity of arteriospasm at that time. All carotid angiographies were done using a contrast medium hypersmolar and hypertonic in relation to the blood and cerebrospinal fluid (Uropolinum-Polfa 60%). PMID:2454415

Zareba, A; Sadowski, Z; Dowzenko, A


LASIK Complications  

Microsoft Academic Search

Laser in situ keratomileusis (LASIK) is a rapidly evolving ophthalmic surgical procedure. Several anatomic and refractive complications have been identified. Anatomic complications include corneal flap abnormalities, epithelial ingrowth, and corneal ectasia. Refractive complications include unexpected refractive outcomes, irregular astigmatism, decentration, visual aberrations, and loss of vision. Infectious keratitis, dry eyes, and diffuse lamellar keratitis may also occur following LASIK. By

Samir A Melki; Dimitri T Azar



Pregnancy complications of grandmultiparity at a rural setting of South Africa  

Microsoft Academic Search

Background: Intrapartam complications such as foetal malpresentation, placental abruption, dysfunctional labour, and postpartum haemorrhage are associated with grandmultiparity. In developing countries and many parts of Africa and sub-Saharan Africa, there is limited access to medical care. There is a need in these areas to identify women whose pregnancies are at risk of complication and it is an important part of

Monjurul Hoque; Ehsanul Hoque; Suriya B Kader


Endovascular and Surgical Management of Vertebral Artery Dissecting Aneurysms Presenting With Subarachnoid Haemorrhage: Medium-term Experience  

Microsoft Academic Search

Introduction: Dissecting aneurysms of the vertebral artery are associated with a high incidence of rebleeding and mortality if untreated. Current endovascular alternatives to surgery are being evaluated. Materials and Methods: We conducted a retrospective review of our experience with endovascular as well as surgical treatments of dissecting vertebral artery aneurysms in 6 patients. Three patients were treated with a combination

K Sheah; W Lim; Chumpon Chan


Ultrasonographic measurement of subarachnoid space in normal term newborns.  


This study was conducted in order to assess the normal range of subarachnoid space width in healthy term newborns. A total of 230 healthy newborns were evaluated within the first 28 days of life. Measurements were correlated with body weight, height and head circumference. Mean measurements for falx-cortex and craniocortical widths and the correlations are given in tables. Subarachnoid space widths increased as weight, height and head circumference increased and the correlation was statistically significant. PMID:16406435

Narli, Nejat; Soyupak, Süreyya; Yildizda?, Hacer Y; Tutak, Ercan; Ozcan, Kenan; Sertdemir, Ya?ar; Satar, Mehmet



Current concepts of pathophysiology and management of cerebral vasospasm following aneurysmal subarachnoid hemorrhage.  


Approximately 10 in 100,000 persons suffer rupture of a saccular intracranial aneurysm annually, and roughly 60% of these will survive the initial catastrophe in reasonable neurological condition. Of the many ensuing complications of aneurysmal subarachnoid hemorrhage, the most frustrating continues to be a form of delayed-onset cerebral arterial narrowing known as vasospasm. Because it is caused by thick subarachnoid blood clots coating the adventitial surface of cerebral arteries, the distribution and severity of vasospasm correlates closely with location and volume of subarachnoid hematoma as visualized on computed tomography (CT). Critical vasospasm causes cerebral ischemia and infarction: the "second stroke." It is now know that vasospasm represents sustained arterial contraction rather than structural thickening of the vessel wall with lumen encroachment. A large body of evidence points to oxyhemoglobin, released from lysing erythrocytes, as the principal component of blood clot responsible for this contraction. The precise mechanism by which oxyhemoglobin causes prolonged vascular smooth muscle cell constriction has not yet been established, but possibilities include secondary generation of vasoactive free radicals, lipid peroxides, eicosanoids, bilirubin, and endothelin. Vasospasm treatments are directed at preventing or reversing arterial narrowing, or at preventing or reversing cerebral ischemia. Several treatments from the latter category, namely, hypertensive, hypervolemic hemodilutional therapy and the calcium channel blocker nimodipine, have proven moderately effective and are in widespread clinical use. It has also been possible to mechanically dilate vasospastic vessels with transluminal angioplasty improving cerebral blood flow to ischemic brain. However we are still in need of an effective agent to prevent arterial narrowing, and several hopeful candidates in this category of treatment are clot lytic agent tissue plasminogen activator (rt-PA) and an inhibitor of iron-dependent peroxidation, 21-aminosteroid U74006F (tirilazad mesylate). PMID:1772740

Findlay, J M; Macdonald, R L; Weir, B K



Microangiography of the pancreas in experimental oedemic and haemorrhagic pancreatitis.  


Microangiography of the pancreas was performed in five normal piglets and in 10 piglets with oedemic and haemorrhagic pancreatitis in order to evaluate the role of microcirculatory changes in experimental pancreatitis. Acute haemorrhagic pancreatitis was induced by intraductal infusion of trypsin-taurocholate and oedematous pancreatitis correspondingly by infusion of autologous diluted bile. Both types of pancreatitis were confirmed by histological examination. Microangiography of the control animals revealed well-filled arteries, arterioles and capillaries, which formed a dense capillary network. In the areas of histologically documented haemorrhagic pancreatitis, unfilled capillary nets were observed as empty areas in the microangiography. Other areas of focal extravasation of the contrast material could be seen. Arteries and arterioles were well filled. In oedematous pancreatitis, the microangiography was unchanged compared with the control. Conclusion: Acute experimental haemorrhagic pancreatitis is associated with severe disturbances in the capillary circulation of the pancreas, whereas in oedematous pancreatitis the microangiography of the pancreas is normal. PMID:3494299

Nuutinen, P; Kivisaari, L; Standertskjöld-Nordenstam, C G; Lempinen, M; Schröder, T



Prevention of experimental haemorrhagic septicaemia with a live vaccine  

Microsoft Academic Search

Pasteurella multocida serotype B:3,4 isolated from a fallow deer in England was used as a vaccine to prevent haemorrhagic septicaemia. The deer strain was less virulent for calves than typical serotype B:2 of haemorrhagic septicaemia strains. It elicited antibodies in cattle that protected mice against serotype B:2 infection. The live deer vaccine containing 2 X 10(7) viable organisms per dose

A Myint; GR Carter; TO Jones



Specialized gastrointestinal units for the management of upper gastrointestinal haemorrhage.  

PubMed Central

In 1986, 292 patients were admitted to a joint medical-surgical gastrointestinal unit with upper gastrointestinal haemorrhage. Fourteen patients died (4.8%) a mortality considerably lower than recorded in most series. The low mortality may result from the use of a specialized gastrointestinal unit to which all patients with upper gastrointestinal haemorrhage are admitted and managed with strict protocols for resuscitation, transfusion and surgery.

Sanderson, J. D.; Taylor, R. F.; Pugh, S.; Vicary, F. R.



Postpartum Haemorrhage and Eclampsia: Differences in Knowledge and Care-seeking Behaviour in Two Districts of Bangladesh  

PubMed Central

In high- and low-performing districts of Bangladesh, the study explored the demand-side of maternal healthcare by looking at differences in perceived knowledge and care-seeking behaviours of women in relation to postpartum haemorrhage or eclampsia. Haemorrhage and eclampsia are two major causes of maternal mortality in Bangladesh. The study was conducted during July 2006–December 2007. Both postpartum bleeding and eclampsia were recognized by women of different age-groups as severe and life-threatening obstetric complications. However, a gap existed between perception and actual care-seeking behaviours which could contribute to the high rate of maternal deaths associated with these conditions. There were differences in care-seeking practices among women in the two different areas of Bangladesh, which may reflect sociocultural differences, disparities in economic and educational opportunities, and a discrimination in the availability of care.

Anwar, Iqbal; Khan, Jasmin; Blum, Lauren S.; Moran, Allisyn C.; Botlero, Roslin; Koblinsky, Marge



Aneurysmal Subarachnoid Hemorrhage in Third and Fourth Decades of Life  

PubMed Central

Objective The aim of this study was to compare clinical characteristics of ruptured aneurysms in young adults, of the third and fourth decades of life, and to compare several clinical characteristics affecting the outcome of patients. Methods We retrospectively investigated 1459 patients who underwent surgery and endovascular treatment for ruptured cerebral aneurysms from June 1992 to December 2010 and compared clinical characteristics. We also reviewed pre-existing medical conditions and perioperative complications. Results Among 1459 patients, there were 21 patients (1.44%) in the third decade and 104 patients (7.13%) in the fourth decade of life. Within two age groups, 88 (70.4%) were male and 37 (29.6%) were female, a ratio of 2.37 : 1. In both groups, we observed the anterior cerebral artery (ACA) aneurysm with the most frequency (p=0.028). In general, favorable outcome was achieved in both age groups (90.5% and 81.7%, respectively). An initial univariate analysis showed Hunt-Hess grade, Fisher grade, location of aneurysm, and rebleeding significantly associated with outcome after aneurysm rupture. Further, multivariate analysis demonstrated that only Hunt-Hess grade (grade 4-5) was a risk factor for the outcome (odds ratio=9.730, 95% confidence interval 2.069-45.756, p=0.004). Conclusion The incidence of subarachnoid hemorrhage (SAH) was higher in the male population of the third and fourth decades of life. Aneurysms on the ACA were most frequently occurred in both age groups and the outcome of aneurysmal SAH among the third and fourth decades was favorable. Multivariate analysis revealed that high Hunt-Hess grade was a risk factor for patient's outcome.

Kim, Su-Yong; Park, In Sung; Hwang, Jae Ha; Hwang, Soo Hyun; Han, Jong Woo



AANA journal course: update for nurse anesthetists-improving the safety of subarachnoid and epidural blocks--Part A.  


Hypotension caused by reduced venous return to the heart is a common hazard during subarachnoid and epidural anesthesia. Reduced venous return can also cause severe bradycardia and even cardiac arrest. The infusion of a crystalloid intravenous preload prior to the injection of local anesthetic helps prevent these complications. Unfortunately, intravenous fluid preloading prior to subarachnoid or epidural block is neither appropriate for all patients nor is it always effective. Vasopressor infusions and lower extremity compression, though not completely studied, may allow for further decreases in the incidence of hypotension and bradycardia. When dosing an epidural catheter, making each dose a test dose and observing for signs of subarachnoid or intravascular injection decreases the incidence of hypotension, seizure, and cardiotoxicity. The pathophysiology of cardiac arrest and resuscitation is different during major conduction block due primarily to changes in peripheral vascular tone and venous return to the heart. Neural injury associated with regional anesthesia is due to needle trauma, hematoma, injectate toxicity, ischemia, and compression. Though neural injury is rare, it is more commonly associated with blocks performed in the lumbar region (spinals and epidurals) than in other types of blocks. PMID:9281920

Fiedler, M A



Rabbit haemorrhagic disease (RHD) and rabbit haemorrhagic disease virus (RHDV): a review  

PubMed Central

Rabbit haemorrhagic disease virus (RHDV) is a calicivirus of the genus Lagovirus that causes rabbit haemorrhagic disease (RHD) in adult European rabbits (Oryctolagus cuniculus). First described in China in 1984, the virus rapidly spread worldwide and is nowadays considered as endemic in several countries. In Australia and New Zealand where rabbits are pests, RHDV was purposely introduced for rabbit biocontrol. Factors that may have precipitated RHD emergence remain unclear, but non-pathogenic strains seem to pre-date the appearance of the pathogenic strains suggesting a key role for the comprehension of the virus origins. All pathogenic strains are classified within one single serotype, but two subtypes are recognised, RHDV and RHDVa. RHD causes high mortality in both domestic and wild adult animals, with individuals succumbing between 48-72 h post-infection. No other species has been reported to be fatally susceptible to RHD. The disease is characterised by acute necrotising hepatitis, but haemorrhages may also be found in other organs, in particular the lungs, heart, and kidneys due to disseminated intravascular coagulation. Resistance to the disease might be explained in part by genetically determined absence or weak expression of attachment factors, but humoral immunity is also important. Disease control in rabbitries relies mainly on vaccination and biosecurity measures. Such measures are difficult to be implemented in wild populations. More recent research has indicated that RHDV might be used as a molecular tool for therapeutic applications. Although the study of RHDV and RHD has been hampered by the lack of an appropriate cell culture system for the virus, several aspects of the replication, epizootology, epidemiology and evolution have been disclosed. This review provides a broad coverage and description of the current knowledge on the disease and the virus.



Recurrent pulmonary haemorrhage in an infant with tetralogy of Fallot and absent pulmonary valve: interventional treatment by coil occlusion of systemic-to-pulmonary collateral arteries.  


Although clinically silent in the majority of cases, enlarged bronchial arteries or systemic-to-pulmonary collateral arteries may complicate congenital heart disease in infants, causing significant left-to-right shunting with subsequent pulmonary congestion and respiratory compromise. So far, pulmonary haemorrhage, a well-known complication in older patients with cyanotic congenital heart disease, has not been described in infancy. We describe the case of a 6-month-old girl with tetralogy of Fallot and absent pulmonary valve who developed haemoptysis with severe respiratory distress following corrective surgery of the cardiac malformation. High-resolution computed tomography of the thorax followed by selective angiography revealed a systemic-to-pulmonary collateral artery originating from the left internal mammary artery. Pulmonary haemorrhage stopped immediately following coil occlusion of the collateral. A second episode of pulmonary haemorrhage occurred at the age of 9 months during mechanical ventilation for treatment of pneumonia. Repeat angiography revealed two more collateral vessels. Again coil occlusion resulted in prompt resolution of pulmonary haemorrhage. According to our experience, enlarged bronchial arteries or systemic-to-pulmonary collateral arteries should be considered in infants with cyanotic heart disease with unexplained pulmonary congestion or prolonged respiratory problems. PMID:22800809

Kumpf, Matthias; Schäfer, Jürgen; Hofbeck, Michael



Evaluation of neurotoxicity after subarachnoid injection of large volumes of local anesthetic solutions.  


Recent case reports describing prolonged neurologic deficit after accidental spinal anesthesia with large volumes of 2-chloroprocaine have led to the suggestion that chloroprocaine may be more likely to cause such complications than other local anesthetics. We evaluated the neurologic effects of lumbar puncture alone and of large-volume subarachnoid administration of 2-chloroprocaine (3%), bupivacaine (0.75%), lidocaine (2%), Elliott's solution B (which is similar to CSF), or the carrier solution of 2-chloroprocaine (Nesacaine) in 48 sheep and 8 monkeys. Cerebrospinal fluid of sheep was collected on days 1 and 7 for biochemical and biological analyses, and CSF pressures of monkeys were recorded before and after injection. Animals were observed for neurologic deficits for seven days. Twelve sheep were unable to stand. Monkeys, on the other hand, had no apparent neurologic deficits. Autopsies revealed that 5 of the 12 sheep had lumbar subpial demyelination with macrophage infiltration: two of the five had received lidocaine; two received 2-chloroprocaine; and one had only a lumbar puncture. Two other sheep also had subpial demyelination: one had received lidocaine and one received 2-chloroprocaine. Three of the eight monkeys had lumbar subpial demyelination with macrophage invasion; two had received bupivacaine, and one received 2-chloroprocaine. No solution produced significant abnormalities in sheep CSF composition. We conclude that no local anesthetic or solution was more neurotoxic than another when injected in large volumes into the subarachnoid space of sheep or monkeys. PMID:6881568

Rosen, M A; Baysinger, C L; Shnider, S M; Dailey, P A; Norton, M; Curtis, J D; Collins, M; Davis, R L



The relationship between localized subarachnoid inflammation and parenchymal pathophysiology after spinal cord injury.  


Subarachnoid inflammation following spinal cord injury (SCI) can lead to the formation of localized subarachnoid scarring and the development of post-traumatic syringomyelia (PTS). While PTS is a devastating complication of SCI, its relative rarity (occurring symptomatically in about 5% of clinical cases), and lack of fundamental physiological insights, have led us to examine an animal model of traumatic SCI with induced arachnoiditis. We hypothesized that arachnoiditis associated with SCI would potentiate early parenchymal pathophysiology. To test this theory, we examined early spatial pathophysiology in four groups: (1) sham (non-injured controls), (2) arachnoiditis (intrathecal injection of kaolin), (3) SCI (35-g clip contusion/compression injury), and (4) PTS (intrathecal kaolin+SCI). Overall, there was greater parenchymal inflammation and scarring in the PTS group relative to the SCI group. This was demonstrated by significant increases in cytokine (IL-1? and IL-1?) and chemokine (MCP-1, GRO/KC, and MIP-1?) production, MPO activity, blood-spinal cord barrier (BSCB) permeability, and MMP-9 activity. However, parenchymal inflammatory mediator production (acute IL-1? and IL-1?, subacute chemokines), BSCB permeability, and fibrous scarring in the PTS group were larger than the sum of the SCI group and arachnoiditis group combined, suggesting that arachnoiditis does indeed potentiate parenchymal pathophysiology. Accordingly, these findings suggest that the development of arachnoiditis associated with SCI can lead to an exacerbation of the parenchymal injury, potentially impacting the outcome of this devastating condition. PMID:22655536

Austin, James W; Afshar, Mehdi; Fehlings, Michael G



Observations on haemorrhagic septicaemia in Pakistan livestock.  


Information based on field observations of Veterinary Officers in nine districts of Punjab, Pakistan showed 11% incidence, 9% mortality and 78% case fatality rates of haemorrhagic septicaemia in buffalo, whereas these values were 4%, 2.5% and 62% in cattle. Disease incidence was higher in 0-24-month-old animals and groups of less than 10 animals. The disease was seasonal, occurring only in rainy seasons of the year, and victims were only cattle and buffalo. The clinical course of the disease was generally 1-2 days. symptoms included high temperature, salivation, swelling of the throat and difficulty in breathing and could result in death. Successful treatment was reported if antibiotics were given at the initial stages of the disease. Various combinations of sulphur drugs and antibiotics were considered more effective. The results of the questionnaire survey suggest that a favourable response was obtained using clamoxyl LA, farmox 15%, vesulong, gentakel and chloramphenicol. Previous vaccination of livestock with the alum-precipitated formalinized broth culture of Pasteurella multocida vaccine (bacterin) was not considered to protect against field outbreaks. PMID:8779811

Sheikh, M A; Anzam, M; Shakoori, A R



Are Complications Less Common in Deep Brain Stimulation than in Ablative Procedures for Movement Disorders?  

Microsoft Academic Search

The side effects and complications of deep brain stimulation (DBS) and ablative lesions for tremor and Parkinson’s disease were recorded in 256 procedures (129 DBS and 127 lesions). Perioperative complications (seizures, haemorrhage, confusion) were rare and did not differ between the two groups. The rate of hardware-related complications was 17.8%. In ventral intermediate (Vim) thalamotomies, the rate of side effects

Patric Blomstedt; Marwan I. Hariz



Complicated Grief  


... type of psychological counseling (psychotherapy) called complicated grief therapy. It's similar to psychotherapy techniques used for post-traumatic stress disorder (PTSD). You may explore such topics as grief ...


Urokinase infusion for severe intraventricular haemorrhage  

Microsoft Academic Search

Summary The purpose of this study was to explore in patients with intraventricular haematomas the effectiveness and complication rate of a treatment protocol including standard ventriculostomy and application of urokinase via the catheter.

N. G. Rainov; W. L. Burkert



Klippel-Trenaunay syndrome complicating pregnancy.  


The Klippel-Trenaunay syndrome is a rare congenital disorder that affects one or more limbs. It is characterised by cutaneous vascular nevi, venous malformations and hypertrophy of soft tissues and bone. There are very few cases reported in pregnant women, so the level of uncertainty is high when it appears during gestation. It is a disease that increases obstetric risk and can exacerbate complications, mainly thromboembolic and haemorrhagic. We report below the case of a pregnant woman diagnosed with this syndrome and the multidisciplinary management held in our centre. PMID:22854239

González-Mesa, Ernesto; Blasco, Marta; Andérica, José; Herrera, José



Fibreoptic colonoscopy. Indications, results and complications.  


Fibreoptic colonoscopy was commenced in the Edward Wilson Colon and Rectum Unit at Sydney Hospital in June, 1973. The experience of the first five years of its use is reported. Six hundred and twenty-six examinations have been performed in 568 patients. Fibreoptic colonoscopy has been of particular value in the diagnosis and treatment of colonic polyps. A total of 318 polyps were removed from 184 patients. Their distribution, size and histological features are recorded. Eight complications occurred in the 628 examinations (1.6%). There were six colonic perforations (1.2%) with one death, and two significant haemorrhages (0.4%). This incidence of complications is acceptably low, especially in view of the great benefits obtained by the patient from fibreoptic colonoscopy. The newer instruments, especially the medium length Olympus MB3 colonoscope, have greatly facilitated the examination and, combined with increasing experience, may significantly lower the incidence of complications in the future. PMID:492001

Stuart, M; Failes, D; Killingback, M; De Luca, C



Extensive subarachnoid venous angiomatosis with hydrocephalus in phacomatosis pigmentovascularis.  


An 8-month-old boy with cutaneous vascular malformations and dermal melanocytosis (Mongolian spots, figure, A) on the face and trunk was diagnosed with phacomatosis pigmentovascularis type 2. He had normal neurodevelopment, but progressive macrocephaly (figure, B). Linear brain ultrasonography showed extensive venous angiomatosis in the prominent subarachnoid space (figure, C and D). MRI revealed cortical sulcal widening, prominent leptomeningeal vessels in an enlarged subarachnoid space (figure, E and F), and communicating hydrocephalus (figure, F). Neurologic involvement in phacomatosis pigmentovascularis is uncommon except in Sturge-Weber and Klippel-Trenaunay syndromes.(1,2) Communicating hydrocephalus due to subarachnoid angiomatosis may be underdiagnosed in phacomatosis pigmentovascularis, and should be considered in case of progressive macrocephaly. PMID:24019387

Chen, Li-Wen; Tsai, Yi-Shan; Lee, Jung-Shun; Tu, Yi-Fang; Huang, Chao-Ching



A case report of haemorrhagic-aneurismal bone cyst of the mandible  

PubMed Central

Haemorrhagic-aneurismal bone cysts (HABCs) are quite rare, benign, non-neoplastic, expansive, and vascular locally destructive lesions. They are generally considered sequelae of an earlier trauma causing an overflow of blood into the bone. HABCs are classified as pseudocysts and they should be differentiated from true cysts because their treatment is different. Since few of these cysts involve subjective symptoms, most are discovered accidentally during radiography, while a sure diagnosis is likely to be obtained only during surgery, on discovery of a non-epithelialised cavity. Here, we report a typical case of a haemorrhagic-mandibular cyst in a 13-year-old girl, which was treated by opening the cavity and scraping its walls following diagnostic arteriography and post-operative transcutaneous intralesional embolization. No further complications were recorded in the post-operative period, although the convalescence lasted for a time longer than expected, because of anemia. No further surgery was performed. She has been disease-free for two years. Evaluation of intralesional blood flow is important for HABCs because of the hemorrhagic risk in surgery. Embolization seems to be a useful procedure in the treatment of HABCs and could be tried as the treatment modality in the standard protocol for the treatment of HABCs.

Grecchi, Francesco; Zollino, Ilaria; Candotto, Valentina; Gallo, Francesco; Rubino, Giuseppe; Bianco, Raffaella; Carinci, Francesco



Delayed cerebral ischemia after subarachnoid hemorrhage: from vascular spasm to cortical spreading depolarizations.  


Non-traumatic subarachnoid hemorrhage (SAH) represents about 5 to 6% of the overall incidence of stroke and is associated with high morbidity and mortality. Despite the substantial research and clinical efforts, delayed cerebral ischemia (DCI) is still the major complication after SAH and represents an important factor for severe neurological deficits. Cerebral vasospasm (VSP) has been recognised for a long time as an important underlying pathophysiologic cause of DCI, but it is now clearer that the mechanisms underlying DCI are multifactorial. Among other pathomechanisms proposed, ischemia-producing cortical spreading depolarizations (CSDs) are likely to be involved in DCI development. Understanding the plethora of different pathophysiological derangements after SAH is very important for the development of new therapies, in order to abolish secondary ischemic brain injuries early-on and improve patients' outcome. In this review, we strive to summarise the mechanisms and therapeutic developments of DCI. PMID:22873726

Zheng, Zelong; Sanchez-Porras, Renan; Santos, Edgar; Unterberg, Andreas W; Sakowitz, Oliver W



Subarachnoid Hemorrhage Misdiagnosed as an Acute ST Elevation Myocardial Infarction  

PubMed Central

Without significant coronary artery stenosis, ischemic electrocardiographic change including ST segment elevation, segmental wall motion abnormality and elevated serum cardiac-specific markers (creatine kinase-MB, Troponin-T) may develop after central nervous system injuries such as subarachnoid, intracranial or subdural hemorrhage. Misdiagnosing these patients as acute myocardial infarction may result in catastrophic outcomes. By reporting a case of a 55-year old female with subarachnoid hemorrhage mimicking acute ST elevation myocardial infarction, we hope to underline that careful attention of neurologic abnormality is critical in making better prognosis.

Heo, Woon Je; Jeong, Woo Shin; Jeong, Mi Yeon; Lee, Sang Hyuk; Seo, Jeong Yeun; Jo, Sang Won



Subarachnoid Hemorrhage as a Presentation of Basilar Artery Dissection  

Microsoft Academic Search

Introduction  Subarachnoid hemorrhages caused by intracranial dissections are rare. The management of dissections in these cases not clear.\\u000a \\u000a \\u000a \\u000a Methods  Case report.\\u000a \\u000a \\u000a \\u000a Results  An 82-year-old woman presented with acute drowsiness and vomiting. CT scan demonstrated extensive subarachnoid hemorrhage\\u000a and hydrocephalus that subsequently required placement of ventriculoperitoneal shunt. Angiography revealed extensive basilar\\u000a artery dissection and no aneurysms. The dissection did not produce a critical stenosis

Alexander Y. Zubkov; Amit N. Sanghvi; Harry J. Cloft; Eelco F. M. Wijdicks; Alejandro A. Rabinstein



Chronic Hydrocephalus after Experimental Subarachnoid Hemorrhage  

PubMed Central

Chronic communicating hydrocephalus is a significant health problem affecting up to 20% of survivors of spontaneous subarachnoid hemorrhage (SAH). The development of new treatment strategies is hampered by the lack of well characterized disease models. This study investigated the incidence of chronic hydrocephalus by evaluating the temporal profile of intracranial pressure (ICP) elevation after SAH, induced by endovascular perforation in rats. Twenty-five adult male Sprague-Dawley rats (260–320g) were subjected to either endovascular perforation or sham surgery. Five animals died after SAH induction. At 7, 14 and 21 days after surgery ICP was measured by stereotaxic puncture of the cisterna magna in SAH (n=10) and SHAM (n=10) animals. On day 21 T-maze test was performed and the number of alterations and latency to decision was recorded. On day 23, samples were processed for histological analyses. The relative ventricle area was evaluated in coronal Nissl stained sections. On day 7 after surgery all animals showed normal ICP. The absolute ICP values were significantly higher in SAH compared to SHAM animals on day 21 (8.26±4.53 mmHg versus 4.38±0.95 mmHg) but not on day 14. Observing an ICP of 10mmHg as cut-off, 3 animals showed elevated ICP on day 14 and another animal on day 21. The overall incidence of ICP elevation was 40% in SAH animals. On day 21, results of T-maze testing were significantly correlated with ICP values, i.e. animals with elevated ICP showed a lower number of alterations and a delayed decision. Histology yielded a significantly higher (3.59 fold increased) relative ventricle area in SAH animals with ICP elevation compared to SAH animals without ICP elevation. In conclusion, the current study shows that experimental SAH leads to chronic hydrocephalus, which is associated with ICP elevation, behavioral alterations and ventricular dilation in about 40% of SAH animals.

Lackner, Peter; Vahmjanin, Alexander; Hu, Qin; Krafft, Paul R.; Rolland, William; Zhang, John H.



Ventricular Arrhythmia Risk After Subarachnoid Hemorrhage  

PubMed Central

Introduction Cardiac morbidity and mortality after aneurysmal subarachnoid hemorrhage (SAH) are attributable to myocardial injury, decreased ventricular function, and ventricular arrhythmia (VA). Our objective was to test the relationships between QTc prolongation, VA, and survival after SAH. Methods In 200 subjects with acute aneurysmal SAH, electrocardiograms, echocardiograms, and telemetry were evaluated. Serum electrolytes and troponin were also evaluated. Results Initial QTc (mean 460 ± 45 ms) was prolonged (?470 ms) in 38% of subjects and decreased on follow-up (469 ± 49 initial vs. 435 ± 31 ms follow-up; N = 89; P < 0.0001). VA was present in 14% of subjects, 52% of subjects with VA had QTc ? 470 ms, and initial QTc trended toward longer duration in subjects with VA (474 ± 61 vs. 457 ± 42 ms; P = 0.084). Multivariate analysis demonstrated significant predictors of VA after SAH were increasing age (OR 1.3/5 years; P = 0.025), increasing stroke severity (OR 1.8; P = 0.009), decreasing heart rate (OR 0.5/10 beats/min; P= 0.006), and the absence of angiotensin converting enzyme inhibitor or angiotensin II receptor antagonist use at SAH onset (OR 0.10; P = 0.027). All-cause mortality was 19% (25/135) at 3 months and subjects with VA had significantly higher mortality than those without VA (37% vs. 16%; P = 0.027). Conclusions These data demonstrate that QTc prolongation and arrhythmias are frequently noted after SAH, but arrhythmias are often not associated with QTc prolongation. In addition, the presence of VA identified subjects at greater risk of mortality following their SAH.

Frangiskakis, J. Michael; Hravnak, Marilyn; Crago, Elizabeth A.; Tanabe, Masaki; Kip, Kevin E.; Gorcsan, John; Horowitz, Michael B.; Kassam, Amin B.; London, Barry



Endovascular treatment of massive retroperitoneal haemorrhage due to inferior adrenal artery injury. A case report.  


Massive retroperitoneal haemorrhage because of adrenal bleeding following blunt trauma is a rare entity. We describe a 23-year-old woman with massive retroperitoneal haemorrhage as a result of inferior adrenal artery (IAA) disruption following a car accident. Superselective transcatheter embolization of the IAA using polyvinyl alcohol particles was performed successfully to control haemorrhage. To our knowledge, this is the second report of massive retroperitoneal haemorrhage caused by IAA disruption successfully treated by transcatheter embolization. PMID:12100332

Dinc, H; Sim?ek, A; Ozyavuz, R; Ozgür, G K; Gümele, H R



Transcatheter arterial embolisation for haemorrhage from the inferior epigastric artery after acupuncture: a case report.  


We report a rare case of haemorrhage from the inferior epigastric artery, which was injured after acupuncture. The haemorrhage was successfully controlled by transcatheter arterial embolisation. To the best of our knowledge, this is the first report describing the use of transcatheter arterial embolisation for inferior epigastric artery haemorrhage following acupuncture. PMID:23462648

Moon, Sang Won; Kim, Ki Hoon



A gastrointestinal stromal tumour presenting incidentally with haemorrhage and perforation associated with a Meckel's diverticulum: a case report  

PubMed Central

Introduction This is the first reported case of perforation and haemorrhage of a Meckel's diverticulum leading to the incidental finding of a gastrointestinal stromal tumour within the diverticulum. Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract, however, when symptomatic, it is often misdiagnosed at presentation. Common complications presenting in adults include bleeding, obstruction, diverticulitis and perforation. Tumours within a Meckel's diverticulum are a rare but recognised complication. We discuss the management of a gastrointestinal tumour within the diverticulum. Case presentation A 59-year-old Caucasian man presented with acute right iliac fossa pain with localized peritonism. At surgery, he was found to have a perforated and haemorrhagic Meckel's diverticulum, associated with a gastrointestinal stromal tumour within the apex of the diverticulum. The absence of necrosis and a low mitotic rate indicated primary resection with subsequent computed tomography surveillance to be the most appropriate management strategy. Conclusion We report a unique triad of complications associated with the presentation of a Meckel's diverticulum. This article reviews this common congenital abnormality and discusses the management of a gastrointestinal tumour. Meckel's diverticulum will mimic other intra-abdominal pathologies in presentation and should therefore often be considered as a differential diagnosis.



Acute complications.  


Critically high or low blood sugar in a patient with diabetes is a medical emergency. You'll need to be able to quickly identify and know how to manage the acute complications of diabetes to help a patient avoid a tragic outcome. Here's how. PMID:12033003

Cypress, M



Neurological and neurobehavioral assessment of experimental subarachnoid hemorrhage  

Microsoft Academic Search

About 50% of humans with aneurysmal subarachnoid hemorrhage (SAH) die and many survivors have neurological and neurobehavioral dysfunction. Animal studies usually focused on cerebral vasospasm and sometimes neuronal injury. The difference in endpoints may contribute to lack of translation of treatments effective in animals to humans. We reviewed prior animal studies of SAH to determine what neurological and neurobehavioral endpoints

Hyojin Jeon; Jinglu Ai; Mohamed Sabri; Asma Tariq; Xueyuan Shang; Gang Chen; R Loch Macdonald



[Bilateral abducens nerve palsies in treated cases of subarachnoid hemorrhage].  


Isolated abducens nerve palsies associated with the rupture of intracranial aneurysms have rarely been reported. We report two cases of isolated bilateral abducens nerve palsies occurring after subarachnoid hemorrhage due to the rupture of an intracranial aneurysm. Case 1: A 49-year-old woman had bilateral abducens nerve palsies following subarachnoid hemorrhage due to the rupture of the left vertebral artery-posterior inferior cerebellar artery aneurysm. Case 2: A 55-year-old man had bilateral abducens nerve palsies following subarachnoid hemorrhage due to dissecting aneurysm of the right vertebral artery. Case 1 and 2 were treated with surgical clipping of the aneurysm and internal occlusion of the parent artery. In both cases, bilateral abducens nerve palsies achieved almost full recovery several months after treatment. It is speculated that the main causes of palsies are compression and stretching of the bilateral abducens nerves by a thick clot in the prepontine cistern. Although most of the abducens palsies may be reversible and have good prognosis, it is important that they are kept in mind as isolated symptoms of subarachnoid hemorrhage. PMID:22824578

Saito, Hisayasu; Nakayama, Naoki; Takikawa, Shugo; Ushikoshi, Satoshi; Shinbo, Daisuke; Kuroda, Satoshi; Houkin, Kiyohiro



Towards safer colonoscopy: a report on the complications of 5000 diagnostic or therapeutic colonoscopies  

Microsoft Academic Search

The diagnostic and therapeutic benefits of colonoscopy are well known but most large-scale surveys, especially those involving multiple centres, may underestimate the range and incidence of complications. The detailed records of 5000 colonoscopies in a specialist unit have been analysed and conclusions drawn which may help to make the procedure safer. The incidence of haemorrhage was 1% and bowel perforation

F A Macrae; K G Tan; C B Williams



A 4Year Consecutive Study of Post-Tonsillectomy Haemorrhage  

Microsoft Academic Search

Objective: To analyse consecutive material over a period of 4 years concerning the incidence and consequences of post-tonsillectomy haemorrhages (PTH). Design: Prospective study. Setting: University hospital. Participants: All non-oncological cases of tonsillectomy (TE) and adenotonsillectomy (TA) performed at the ENT department at the Karolinska University Hospital between March 2000 and April 2004. Main Outcome Measures: Rate, timing and classification of

Per Attner; Per-Olle Haraldsson; Claes Hemlin; Anne-Charlotte Hessén Söderman



Postpartum haemorrhage occurrence and recurrence: a population-based study  

Microsoft Academic Search

Objective: To determine the risk of occurrence and recurrence of postpartum haemorrhage (excessive bleeding after childbirth) among women having at least two consecutive pregnancies. Design and setting: Population-based study using longitudinally linked hospital discharge and birth records from New South Wales for the period 1 January 1994 to 31 December 2002. Participants: All 125 295 women having at least a

Jane B Ford; Christine L Roberts; Jane C Bell; Charles S Algert; Jonathan M Morris



Breathing-Impaired Speech after Brain Haemorrhage: A Case Study  

ERIC Educational Resources Information Center

|Results are presented from an auditory and acoustic analysis of the speech of an adult male with impaired prosody and articulation due to brain haemorrhage. They show marked effects on phonation, speech rate and articulator velocity, and a speech rhythm disrupted by "intrusive" stresses. These effects are discussed in relation to the speaker's…

Heselwood, Barry



Dengue Haemorrhagic Fever in Thailand: Current Incidence and Vector Management  

Microsoft Academic Search

\\u000a Dengue, dengue haemorrhagic fever and dengue shock syndrome are endemic throughout South East Asia where they present a serious\\u000a public health concern. The current status of these diseases in Thailand is described along with the challenges that confront\\u000a those who seek to control the spread of these diseases.

Apiwat Tawatsin; Usavadee Thavara


Visual performance after interface haemorrhage during laser in situ keratomileusis  

Microsoft Academic Search

Aim: To study the visual performance in eyes with interface haemorrhage during laser assisted in situ keratomileusis (LASIK).Methods: Case records of 20 patients, who had bleeding from the limbal vessels in one eye during LASIK (group 1) and uncomplicated surgery in the fellow eye (group 2) were studied. The parameters evaluated were uncorrected visual acuity (UCVA) best corrected visual acuity

R B Vajpayee; R Balasubramanya; A Rani; N Sharma; J S Titiyal; R M Pandey



Haemorrhagic diathesis in children associated with vitamin K deficiency  

Microsoft Academic Search

A haemorrhagic diathesis is described in infants; this is preceded and accompanied by constitutional symptoms such as fever, diarrhoea, vomiting, anorexia, and pallor. These children had a severe coagulation abnormality, due to deficiency of vitamin-K-dependent coagulation factors, and it was corrected by administration of vitamin K. No conclusion could be drawn as to the aetiology of this condition but some

Salman Taj-Eldin; Luay Al-Nouri; Omar Fakri



Medical Complications Drive Length of Stay After Brain Hemorrhage: A Cohort Study  

Microsoft Academic Search

Introduction  Longer length of stay (LOS) is associated with higher complications and costs in ICU patients, while hospital protocols may\\u000a decrease complications and LOS. We hypothesized that medical complications would increase LOS after spontaneous subarachnoid\\u000a (SAH) and intracerebral (ICH) hemorrhage after accounting for severity of neurologic injury in a cohort of consecutively admitted\\u000a patients.\\u000a \\u000a \\u000a \\u000a Methods  We prospectively recorded admission characteristics, hospital complications,

Andrew M. Naidech; Bernard R. Bendok; Paul Tamul; Sarice L. Bassin; Charles M. Watts; H. Hunt Batjer; Thomas P. Bleck



Haemorrhagic liver syndrome of broiler chickens fed diets containing rapeseed products.  


Haemorrhagic livers were observed in male white rock chicks of one to four weeks old, that were fed diets supplemented with 50 per cent rapeseed meal and 50 per cent rapeseed full-fat seeds. The haemorrhagic lesions were comparable to those of the laying hens except for the absence of fatty degeneration. There were no substantial fibrotic lesions. Multifocal or solitary hepatocytic necrosis was observed around the haemorrhagic lesions, although the necrotic foci did not always accompany the haemorrhage. The reticulum only of the necrotic and haemorrhagic lesions was not demonstrated with silver strain. Association of hepatocytic necrosis with liver haemorrhage and absence of argyrophilic fibres suggested that the hepatocytic necrosis was the primary contributory factor for the development of the hepatic haemorrhage. PMID:928982

Yamashiro, S; Umemura, T; Bhatnagar, M K; David, L; Sadiq, M; Slinger, S J



Tryptase Promotes Atherosclerotic Plaque Haemorrhage in ApoE-/- Mice  

PubMed Central

Tryptase, the most abundant mast cell (MC) granule protein, plays an important role in atherosclerosis plaque development. To test the hypothesis that tryptase participates directly in atherosclerosis plaque haemorrhage, the gene sequence and siRNA for tryptase were cloned into a lentivirus carrier and atherosclerosis plaque haemorrhage models in ApoE-/- mice were constructed. After a cuffing-cervical artery operation, the mice were randomly divided into 6 groups. Hematoxylin and eosin(HE) staining showed that the cervical artery plaque area was much larger in the tryptase overexpression group compared to the other groups, and there was greater artery stenosis. The artery stenosis from the cuff-side in all groups was more than 90%, except the siRNA group. Tryptase promotes plaque haemorrhage distinctively because 50% of the mice in the tryptase overexpression group had plaque haemorrhage, while only 10% in the siRNA group did. The immunohistochemistry of the cervical artery plaque showed that plasminogen activator inhibitor-1 (PAI-1) expression was the lowest while tissue plasminogen activator (tPA), CD31, CD34 and VEGF was the highest in the tryptase overexpression groups. This observation was completely contrary to what was observed in the siRNA group. Tryptase promoted bEnd.3 cell growth, migration and capillary-like tube formation, which suggests that tryptase can promote microvessel angiogenesis. PAI-1 expression was inhibited, while tPA expression was increased by tryptase in bEnd.3 cells. Our in vivo and in vitro studies suggest that trypase can promote atherosclerotic plaque haemorrhage by promoting angiogenesis and regulating the balance of PAI-1 and tPA. Thus, regulating tryptase expression in MCs may provide a potential target for atherosclerosis treatment.

Tian, Dai; Li, Xiaobo; Ning, Yanxia; Yin, Lianhua



Effect of rebleeding on the course and incidence of vasospasm after subarachnoid hemorrhage  

PubMed Central

Objective: Rebleeding of an aneurysm is a leading cause of morbidity and mortality after subarachnoid hemorrhage (SAH). Whereas numerous studies have demonstrated the risk factors associated with rebleeding, few data on complications of rebleeding, including its effect on the development of delayed cerebral ischemia (DCI), are available. Methods: A nested case-control study was performed on patients with rebleeding and control subjects matched for modified Fisher scale, Hunt-Hess grade, age, and sex previously entered into a prospective database. Rebleeding was defined as new hemorrhage apparent on repeat CT with or without new symptoms. Incidence and time course of DCI and hospital complications were compared. A secondary analysis of DCI and hospital complications was also performed on subjects surviving to postbleed day 7. Results: We identified 120 patients with rebleeding and 359 control subjects from 1996 to 2011. The rebleeding rate was 8.6%. In both the primary and secondary analyses, there was no difference in the incidence of DCI or its time course (29% vs 27%, p = 0.6; 7 ± 5 vs 7 ± 6 days, p = 0.9 for primary analysis; 39% vs 31%, p = 0.1, 7 ± 5 vs 7 ± 6 days, p = 0.6 for the secondary analysis). In a multivariate logistic regression model, rebleeding was associated with the complications of hyponatremia, respiratory failure, and hydrocephalus. Patients with rebleeding had higher rates of mortality, brain death, and poor outcomes. Conclusions: Rebleeding after SAH is associated with multiple medical and neurologic complications, resulting in higher morbidity and mortality, but is not associated with change of incidence or timing of DCI.

Lord, A.S.; Fernandez, L.; Schmidt, J.M.; Mayer, S.A.; Claassen, J.; Lee, K.; Connolly, E.S.



Complications observed during and after ovariohysterectomy of 142 bitches at a veterinary teaching hospital.  


The clinical, anaesthetic and surgical records of 142 bitches admitted into the primary care clinic at the Small Animal Hospital, University of Liverpool, between January 2002 and August 2004 for routine ovariohysterectomy by final-year students were analysed for complications during and after the surgery. The time taken to perform the surgical procedure was recorded, to allow assessment of the time involved in one-to-one surgical teaching during live-recovery surgeries of client-owned pets. The types of complications were similar to those reported in earlier studies: nine bitches suffered haemorrhage of the ovarian arteries during surgery, and there were four cases of haemorrhage after surgery, 12 cases of wound inflammation and four other types of complication. The rates of intraoperative, postoperative and total complications were 6.3, 14.1 and 20.6 per cent, respectively. PMID:16377787

Burrow, R; Batchelor, D; Cripps, P


[Dental and buccal complications of lip and tongue piercing].  


Oral and facial piercing with different kinds of body art are being observed more frequently in medical and dental practices. Principally, piercing is not a new form of body art and is traditional in different geographical areas. In this review, the possible risks and complications are described. Postprocedural complications are oedema, haemorrhage and infection. Other adverse outcomes include mucosal or gingival trauma, chipped or fractured teeth, increased salivary flow, calculus build-up, and interference with speech, mastication and swallowing. Dentists, and oral- and maxillofacial surgeons should be in the position to advise patients with orofocial piercings or those who plan to have this type of body art performed. PMID:18506959

De Moor, Roeland; De Witte, An; Delmé, Katleen; De Bruyne, Mieke; Hommez, Geert



Boxing sparring complicated by an acute subdural haematoma and brainstem haemorrhage.  


A professional boxer developed an acute subdural haematoma after boxing sparring. Despite timely surgical decompression, he had a poor overall outcome predominantly from a delayed brainstem haematoma. Magnetic resonance imaging (MRI) was used to elucidate the pathophysiology of the patients' injury and clinical condition. PMID:22380874

Hart, Michael G; Trivedi, Rikin A; Hutchinson, Peter J



A retrospective analysis and review of an institution's experience with the complications of cranioplasty.  


Abstract Introduction. Cranial reconstruction with a cranioplasty is performed to repair skull defects after decompressive craniectomies. Aims. To retrospectively review all cranioplasties performed in our institution over 10 years and analyse the complications and the factors that cause complications. Patient and methods. Two hundred and forty-three cranioplasties were performed from 2000 to 2010, with a follow-up of at least 1 year. Age, sex, comorbidities, material, site of skull defect, time between decompression and cranioplasty, and rate of complications were collected from our database. Fischer's T-test and direct logistical regression were performed to identify factors that contributed to the rate of complications. p < 0.05 was considered significant. Results. Post-cranioplasty seizures (14.81%), infection and exposed implant (9.05%), haemorrhage (1.65%) and others (0.82%) were identified complications. Total percentage of complications was 25.92%. Previous trauma (p = 0.034) and intracranial haemorrhage (p = 0.019) as well as pre-cranioplasty neurological deficit (p = 0.046) were related to seizures, while pre-cranioplasty neurological deficit (p = 0.036) and exposed implant extrusion (p = 0.048) contributed to infection of cranioplasties. Discussion. Most of the seizures may be post-traumatic seizures or scar epilepsy from intracranial haemorrhage. Implant extrusions were found to be associated with infection of the implant, and they should therefore be treated early. Patient selection is important as patients with neurological deficits were susceptible to seizures and infection. Intracranial haemorrhage was caused by persistant bleeding, trauma or shunt overdrainge. Conclusion. Cranioplasty has significant complications. A thorough understanding of factors that contribute to the different types of complications will benefit the management of cranioplasty patients. PMID:23879443

Lee, Lester; Ker, Justin; Quah, Boon Leong; Chou, Ning; Choy, David; Yeo, Tseng Tsai



EARLYDRAIN- outcome after early lumbar CSF-drainage in aneurysmal subarachnoid hemorrhage: study protocol for a randomized controlled trial  

PubMed Central

Background Aneurysmal subarachnoid hemorrhage (SAH) may be complicated by delayed cerebral ischemia, which is a major cause of unfavorable clinical outcome and death in SAH-patients. Delayed cerebral ischemia is presumably related to the development of vasospasm triggered by the presence of blood in the basal cisterns. To date, oral application of the calcium antagonist nimodipine is the only prophylactic treatment for vasospasm recognized under international guidelines. In retrospective trials lumbar drainage of cerebrospinal fluid has been shown to be a safe and feasible measure to remove the blood from the basal cisterns and decrease the incidence of delayed cerebral ischemia and vasospasm in the respective study populations. However, the efficacy of lumbar drainage has not been evaluated prospectively in a randomized controlled trial yet. Methods/Design This is a protocol for a 2-arm randomized controlled trial to compare an intervention group receiving early continuous lumbar CSF-drainage and standard neurointensive care to a control group receiving standard neurointensive care only. Adults suffering from a first aneurysmal subarachnoid hemorrhage whose aneurysm has been secured by means of coiling or clipping are eligible for trial participation. The effect of early CSF drainage (starting < 72 h after securing the aneurysm) will be measured in the following ways: the primary endpoint will be disability after 6 months, assessed by a blinded investigator during a personal visit or standardized telephone interview using the modified Rankin Scale. Secondary endpoints include mortality after 6 months, angiographic vasospasm, transcranial Doppler sonography (TCD) mean flow velocity in both middle cerebral arteries and rate of shunt insertion at 6 months after hospital discharge. Discussion Here, we present the study design of a multicenter prospective randomized controlled trial to investigate whether early application of a lumbar drainage improves clinical outcome after aneurysmal subarachnoid hemorrhage. Trial registration Identifier: NCT01258257



[Spinal subarachnoid hemorrhage due to neurinoma of the cauda equina].  


A case of neurinoma of the cauda equina which showed spinal subarachnoid hemorrhage was reported. A 39-year-old man was admitted to our hospital because of left lumboischialgia, on August 7, 1987. Myelography disclosed a round mass at L2, and cerebrospinal fluid was slightly xanthochromic. MRI demonstrated a round isointensity mass by T1 weighted image, and slightly high intensity by T2 weighted image. On August 26, 1987, the patient developed sudden onset of headache, but his headache disappeared under medication. On August 27, 1987, laminectomy L1-3 and total removal of the tumor were carried out. At operation, marked subarachnoid hemorrhage was discovered. He was discharged with slight hypesthesia of the dermatome of left S2. PMID:2674761

Furuno, M; Nishiura, I; Koyama, T



Spinal vascular malformations in non-perimesencephalic subarachnoid hemorrhage  

Microsoft Academic Search

Objective\\u000a   In patients with non-traumatic subarachnoid hemorrhage (SAH) and no evidence for a cerebral aneurysm on angiography, a frequent\\u000a cause of the hemorrhage is perimesencephalic hemorrhage or other cerebral vascular pathology. In some patients no cause is\\u000a found. The exact incidence of a spinal vascular malformation (SVM) as the origin for the SAH is not known. We assessed the\\u000a occurrence

M. R. Germans; F. A. Pennings; M. E. S. Sprengers; W. P. Vandertop



Bevacizumab for glioblastoma multiforme after traumatic subarachnoid hemorrhage.  


We present a patient with a glioblastoma multiforme treated with bevacizumab who suffered a traumatic subarachnoid hemorrhage (SAH). Trascranial doppler revealed no evidence of vasoconstriction, which has been previously described in a bevacizumab-treated patient. Bevacizumab was resumed five weeks after the SAH without recurrence of bleeding or vasoconstriction. To our knowledge this is the first report of resumption of bevacizumab after SAH. PMID:22721885

Lukas, Rimas V; Goldenberg, Fernando; Nicholas, Martin K



“Triple-H” therapy for cerebral vasospasm following subarachnoid hemorrhage  

Microsoft Academic Search

The combination of induced hypertension, hypervolemia, and hemodilution (triple-H therapy) is often utilized to prevent and\\u000a treat cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH). Although this paradigm has gained widespread acceptance\\u000a over the past 20 years, the efficacy of triple-H therapy and its precise role in the management of the acute phase of SAH\\u000a remains uncertain. In addition, triple-H therapy

Kendall H. Lee; Timothy Lukovits; Jonathan A. Friedman



Mechanisms in neurogenic stress cardiomyopathy after aneurysmal subarachnoid hemorrhage  

Microsoft Academic Search

Cardiac dysfunction after aneurysmal subarachnoid hemorrhage (SAH) is often referred to as “neurogenic stunned myocardium,”\\u000a which does not accurately reflect the suspected pathophysiology. We propose an alternativeterminology,” neurogenic stress\\u000a cardiomyopathy,” as a more appropriate label based on our review of the current literature. This article will review the distinctive\\u000a characteristics of SAH-induced cardiac dysfunction, hypotheses to explain the pathophysiology, and

Vivien H. Lee; Jae K. Oh; Sharon L. Mulvagh; Eelco F. M. Wijdicks



Intracranial vertebral artery dissection with subarachnoid hemorrhage following child abuse.  


Child abuse is often suspected based on particular patterns of injury. We report a case of intracranial vertebral artery dissection with subarachnoid hemorrhage (SAH) in a 3-month-old boy following child abuse. The mechanisms of injury and the clinical and imaging findings are discussed. This particular pattern of injury has rarely been reported in association with child abuse. We hope to raise physician awareness of child abuse when faced with these imaging findings. PMID:17453187

Nguyen, Pamela H; Burrowes, Delilah M; Ali, Saad; Bowman, Robin M; Shaibani, Ali



Intracranial vertebral artery dissection with subarachnoid hemorrhage following child abuse  

Microsoft Academic Search

Child abuse is often suspected based on particular patterns of injury. We report a case of intracranial vertebral artery dissection\\u000a with subarachnoid hemorrhage (SAH) in a 3-month-old boy following child abuse. The mechanisms of injury and the clinical and\\u000a imaging findings are discussed. This particular pattern of injury has rarely been reported in association with child abuse.\\u000a We hope to

Pamela H. Nguyen; Delilah M. Burrowes; Saad Ali; Robin M. Bowman; Ali Shaibani




Microsoft Academic Search

A 67-year-old Korean woman attended our hospital complaining of a severe headache. A brain computed tomography scan showed conglomerated, high-density, calcified nodules in the left temporo-occipito-parietal area and high-density subarachnoid hemorrhage in the basal cisterns. Magnetic resonance imaging of the brain shows multiple conglomerated iso- or low-signal intensity round nodules with peripheral rim enhancement. She underwent craniotomies to clip the



Risk Factors for Aneurysmal Subarachnoid Hemorrhage in Aomori, Japan  

Microsoft Academic Search

Background and Purpose—Japan is known to have an incidence of aneurysmal subarachnoid hemorrhage (SAH) as high as that in Finland, where SAH is especially common. However, the risk factors for SAH in Japan are unknown. The purpose of this study was to identify the risk factors and then examine their possible roles in cases of SAH in Japan. Methods—Case-control data

Hiroki Ohkuma; Hidefumi Tabata; Shigeharu Suzuki; Shafiqul Islam



Cardiac troponin I predicts myocardial dysfunction in aneurysmal subarachnoid hemorrhage  

Microsoft Academic Search

OBJECTIVESWe studied the incidence of myocardial injury in aneurysmal subarachnoid hemorrhage (SAH) using the more sensitive cardiac troponin I (cTnI) assay, correlated changes in cTnI with creatine kinase, MB fraction (CK-MB), myoglobin, and catecholamine metabolite assays, and examined the predictive value of changes in cTnI for myocardial dysfunction.BACKGROUNDMyocardial injury in aneurysmal SAH as evidenced by elevated CK-MB fraction has been

Nilesh Parekh; Bala Venkatesh; David Cross; Anne Leditschke; John Atherton; William Miles; Adam Winning; Alan Clague; Claire Rickard



Myocardial Injury and Left Ventricular Performance After Subarachnoid Hemorrhage  

Microsoft Academic Search

Background and Purpose—Electrocardiographic abnormalities and elevations of the creatine kinase myocardial isoenzyme (CK-MB) occur frequently after subarachnoid hemorrhage. In some patients, a reversible and presumably neurogenic form of left ventricular dysfunction is demonstrated by echocardiography. It is not known whether cardiac injury of this type adversely affects cardiovascular hemodynamic performance. Methods—We retrospectively studied 72 patients admitted to our neuro-ICU for

Stephan A. Mayer; Julie Lin; Shunichi Homma; Robert A. Solomon; Laura Lennihan; David Sherman; Matthew E. Fink; Avis Beckford; Louise M. Klebanoff


[Odontoid fracture: Long-term subarachnoid hemorrhage after anterior screw fixation. Case report and literature review].  


Odontoid fractures have been classified by Anderson and D'Alonzo into three main categories. The most unstable injuries, type II fractures involve the base of the odontoid peg at the junction with the C2 body. Due to the proximity of vital neural structures, fracture of the odontoid process may result in instability and fatal neurological damage. Treatment aims to re-establish stability of the atlanto-axial complex by restoring the odontoid process. This may be achieved by conservative or surgical treatment. Anterior screw fixation of the odontoid peg is an interresting alternative surgical option but this technique has a significant complication rate. However, vascular injury is very rare with three case reported in the literature: one case of an intracranial vertebral artery (VA) injury, one case of a cervical internal carotid artery (ICA) injury and one case of anterior pseudoaneurysm of the spinal artery branch. We report a new case of long term vascular injury after screw fixation revealed by a subarachnoid hemorrhage. We discuss the incidence, the mechanisms of injury and the conditions necessary for the occurrence of this complication. PMID:22683208

Le Corre, M; Suleiman, N; Lonjon, N



Prevention of experimental haemorrhagic septicaemia with a live vaccine.  


Pasteurella multocida serotype B:3,4 isolated from a fallow deer in England was used as a vaccine to prevent haemorrhagic septicaemia. The deer strain was less virulent for calves than typical serotype B:2 of haemorrhagic septicaemia strains. It elicited antibodies in cattle that protected mice against serotype B:2 infection. The live deer vaccine containing 2 X 10(7) viable organisms per dose was used to immunise calves. Six months after vaccination, five of six calves were protected against serotype B:2 challenge. Two calves challenged nine months after vaccination survived the same challenge. The live vaccine was more efficacious than an alum precipitated vaccine in protecting calves against B:2 challenge. PMID:3111071

Myint, A; Carter, G R; Jones, T O



Elevated urinary catecholamines and adrenal haemorrhage mimicking phaeochromocytoma.  


A 51-year-old woman was admitted with left-sided flank pain initially thought to be renal colic. However, a CT urogram was normal. During the course of the admission the pain persisted and she developed severe sustained hypertension. A repeat CT scan of the abdomen revealed a 5×3 cm left adrenal abnormality consistent with haemorrhage, not seen on the original scan. Further assessment revealed elevated urine catecholamines and a short synacthen test showed a suboptimal cortisol response. The diagnosis was initially considered as a phaeochromocytoma, she received phenoxybenzamine with good resolution of hypertension and was referred for surgical opinion. However, serial urinary catecholamine concentrations returned to within the normal range and the diagnosis was revised to adrenal infarction and haemorrhage due to antiphospholipid syndrome. This case illustrates the importance of recognising adrenal infarction as a potential cause of 'pseudophaeochromocytoma'. PMID:22802465

Wordsworth, Simon; Thomas, Ben; Agarwal, Neera; Hoddell, Kate; Davies, Steve



An unusual cause of delayed postpartum haemorrhage following caesarean section.  


Although less common in the UK, postpartum haemorrhage (PPH)--defined as blood loss of 500 ml or more within the first 24 h of delivery--remains a significant cause of maternal death worldwide. Haemorrhage between 24 h and 6 weeks post partum is termed "delayed PPH". Common causes include retention of gestational products or endometritis. Bleeding can be sudden and profound, resulting in rapid cardiovascular collapse. A case of massive PPH 7 weeks after a caesarean section caused by a pseudoaneurysm of the uterine artery is reported. This case highlights diagnostic and therapeutic issues concerning this rare but potentially life-threatening condition and presents clinical features distinguishing it from other causes of PPH. Delay in diagnosis can result in repeated and catastrophic bleeding. PMID:19625573

Samad, S; Jonetzko, P; Hawkins, A P; Booth, J; Thorpe-Beeston, G; Marwood, R



Spontaneous intracerebral haemorrhage in adults: a literature overview  

Microsoft Academic Search

Summary  \\u000a Background. A large number of reports have analysed epidemiology, pathogenesis, symptomatology, diagnostics and options for medical and\\u000a surgical treatment of intracerebral haemorrhage. Nevertheless, management still remains controversial. The purpose of the\\u000a present review is to summarise the clinical data and derive a current updated management concept as a result.\\u000a \\u000a \\u000a Methods. The analysis was based on a Medline search to

D. Hänggi; H.-J. Steiger



Haemorrhagic diathesis in children associated with vitamin K deficiency  

PubMed Central

A haemorrhagic diathesis is described in infants; this is preceded and accompanied by constitutional symptoms such as fever, diarrhoea, vomiting, anorexia, and pallor. These children had a severe coagulation abnormality, due to deficiency of vitamin-K-dependent coagulation factors, and it was corrected by administration of vitamin K. No conclusion could be drawn as to the aetiology of this condition but some possible causes are discussed. Images

Taj-Eldin, Salman; Al-Nouri, Luay; Fakri, Omar



Surgical Trial in Lobar Intracerebral Haemorrhage (STICH II) Protocol  

PubMed Central

Background Within the spectrum of spontaneous intracerebral haemorrhage there are some patients with large or space occupying haemorrhage who require surgery for neurological deterioration and others with small haematomas who should be managed conservatively. There is equipoise about the management of patients between these two extremes. In particular there is some evidence that patients with lobar haematomas and no intraventricular haemorrhage might benefit from haematoma evacuation. The STICH II study will establish whether a policy of earlier surgical evacuation of the haematoma in selected patients will improve outcome compared to a policy of initial conservative treatment. Methods/Design an international multicentre randomised parallel group trial. Only patients for whom the treating neurosurgeon is in equipoise about the benefits of early craniotomy compared to initial conservative treatment are eligible. All patients must have a CT scan confirming spontaneous lobar intracerebral haemorrhage (?1 cm from the cortex surface of the brain and 10-100 ml in volume). Any clotting or coagulation problems must be corrected and randomisation must take place within 48 hours of ictus. With 600 patients, the study will be able to demonstrate a 12% benefit from surgery (2p < 0.05) with 80% power. Stratified randomisation is undertaken using a central 24 hour randomisation service accessed by telephone or web. Patients randomised to early surgery should have the operation within 12 hours. Information about the status (Glasgow Coma Score and focal signs) of all patients through the first five days of their trial progress is also collected in addition to another CT scan at about five days (+/- 2 days). Outcome is measured at six months via a postal questionnaire to the patient. Primary outcome is death or severe disability defined using a prognosis based 8 point Glasgow Outcome Scale. Secondary outcomes include: Mortality, Rankin, Barthel, EuroQol, and Survival. Trial Registration ISRCTN: ISRCTN22153967



Prevention of upper gastrointestinal haemorrhage: current controversies and clinical guidance.  


Acute upper gastrointestinal (GI) bleeding is a common medical emergency and associated with significant morbidly and mortality. The risk of bleeding from peptic ulceration and oesophagogastric varices can be reduced by appropriate primary and secondary preventative strategies. Helicobacter pylori eradication and risk stratification with appropriate gastroprotection strategies when used with antiplatelet drugs and nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in preventing peptic ulcer bleeding, whilst endoscopic screening and either nonselective beta blockade or endoscopic variceal ligation are effective at reducing the risk of variceal haemorrhage. For secondary prevention of variceal haemorrhage, the combination of beta blockade and endoscopic variceal ligation is more effective. Recent data on the possible interactions of aspirin and NSAIDs, clopidogrel and proton pump inhibitors (PPIs), and the increased risk of cardiovascular adverse events associated with all nonaspirin cyclo-oxygenase (COX) inhibitors have increased the complexity of choices for preventing peptic ulcer bleeding. Such choices should consider both the GI and cardiovascular risk profiles. In patients with a moderately increased risk of GI bleeding, a NSAID plus a PPI or a COX-2 selective agent alone appear equivalent but for those at highest risk of bleeding (especially those with previous ulcer or haemorrhage) the COX-2 inhibitor plus PPI combination is superior. However naproxen seems the safest NSAID for those at increased cardiovascular risk. Clopidogrel is associated with a significant risk of GI haemorrhage and the most recent data concerning the potential clinical interaction of clopidogrel and PPIs are reassuring. In clopidogrel-treated patients at highest risk of GI bleeding, some form of GI prevention is indicated. PMID:23997925

Brooks, Johanne; Warburton, Richard; Beales, Ian L P



Haemorrhage into juxta-facet cysts causing bilateral foot drop  

PubMed Central

An 89 year old gentleman awaiting surgery for carcinoma of caecum presented with sudden back pain and developed foot drop two weeks later. MRI revealed multiple spinal metastases with a cyst in the canal at L4/5 causing spinal canal stenosis. Surgery revealed a juxta articular synovial cyst with haemorrhage in it. We discuss the presentation and management of juxtarticular cysts with a review of the literature.

George, KJ; Roy, D; Shad, A



High incidence of cardiovascular complications in pheochromocytoma.  


Excess of catecholamines in pheochromocytoma is usually accompanied with classical symptoms and signs. In some cases, severe cardiovascular complications (e. g., heart failure, myocardial infarction) may occur. We performed a retrospective analysis focused on the incidence of cardiovascular complications (classified as follows: arrhythmias, myocardial involvement or ischemia and atherosclerosis, cerebrovascular impairment) before the establishment of diagnosis of pheochromocytoma among 145 subjects treated in our hospital. Cardiovascular complications occurred in 28 subjects, but these subjects did not differ significantly from subjects without complications in age, gender, body mass index, paroxysmal symptoms, symptom duration, tumor dimension, catecholamine secretory phenotype, and incidence of hypertension or diabetes mellitus. Arrhythmias occurred in 15 subjects (2 arrhythmia types in 2 subjects): atrial fibrillation in 9 subjects, supraventricular tachycardia in 3 cases, and ventricular tachycardia in 2 patients. Significant bradycardia was noted in 3 cases. Five subjects presented with heart failure with decreased systolic function (takotsubo-like cardiomyopathy found in 2 cases). One subject suffered from hypertrophic obstructive cardiomyopathy. Seven subjects presented with non-ST-segment elevation myocardial infarction, 2 patients with ST-segment myocardial infarction, and 1 subject underwent coronary artery bypass grafting. Two subjects suffered from significant peripheral atherosclerosis. Among cerebrovascular complications, transient ischemic attack was found in 3 cases, 2 subjects suffered from stroke, and subarachnoidal bleeding occurred in 1 patient. One subject suffered from diffuse neurological impairment due to multiple ischemic white matter lesions. These data show relatively high incidence of cardiovascular complications (19.3%) in subjects with pheochromocytoma. Early diagnosis is mandatory to prevent severe complications in pheochromocytoma. PMID:22517556

Zelinka, T; Petrák, O; Turková, H; Holaj, R; Strauch, B; Kršek, M; Vránková, A B; Musil, Z; Dušková, J; Kubinyi, J; Michalský, D; Novák, K; Widimský, J



The role of endoscopy in early postoperative haemorrhage.  


Diagnostic as well as therapeutic endoscopy has a decisive role in management of early postoperative haemorrhage. Endoscopy combines easy access to the upper and lower gastrointestinal tract and application of an array of interventional tools. In near future, even the small bowel will be accessible for diagnostic and therapeutic measures due to the advent of double-balloon enteroscopy. Thus, the endoscopist increasingly replaces the surgeon for diagnosis and therapy of postsurgical bleeding. Published data on frequency and aetiology of postoperative haemorrhage are scarce and mainly casuistic. Sources of gastrointestinal bleeding associated with surgery may be: anastomotic ulcers, mucosal ischaemia, 'stress' ulcers, reflux-induced lesions, coagulopathies (e.g. in sepsis or after organ transplantation) and aortoenteric fistula after bypass surgery. The endoscopist will frequently identify the culprit lesion and guide further management of the patient (e.g. endoscopic approach, repeated surgery, interventional radiology). All accessible lesions in postoperative haemorrhage should primarily be treated by endoscopic means, except aortoenteric fistulas. There is even a place for repeated endoscopy in recurrent bleeding. In the face of lacking controlled data, the endoscopist often has to rely on his personal experience in the selection of therapeutic options. PMID:15494279

Mayer, Gerhard; Lingenfelser, Thomas; Ell, Christian



Natural history of adrenal haemorrhage in the newborn  

PubMed Central

5 cases of unilateral and 3 cases of bilateral haemorrhage are described. Only 1 infant died, from venous thromboses elsewhere. Apart from this case, all had an above average birthweight. Probable predisposing causes apart from large size were fetal hypoxia, septicaemia, thrombocytopenia, coagulation defect, and disseminated thromboembolic disease. The condition must be distinguished from renal vein thrombosis. In the acute stage pyelography shows depression of the kidney on the affected side, with flattening of the upper calyces. Calcification develops rapidly round the periphery of the mass, then slowly contracts into an area of the size and shape of the original gland. Treatment is with antibiotics and blood transfusion, with intravenous corticosteroids in severely shocked or bilateral cases. Adrenal insufficiency is rarely found on follow-up even in bilateral cases, but renal hypertension should be looked for. No single cause for the haemorrhage could be discovered, but the preponderance of haemorrhage into the right adrenal gland is probably due to anatomical differences between the venous drainage of the two sides. ImagesFIG. 1FIG. 2FIG. 3FIG. 4FIG. 5

Black, John; Williams, David Innes



Arginine vasopressin: a promising rescue drug in the treatment of uncontrolled haemorrhagic shock.  


Haemorrhagic shock is one of the most frequent types of shock. If haemorrhage cannot be controlled and fluid resuscitation as well as catecholamines are insufficient to stabilize cardiovascular function, uncontrolled haemorrhagic shock occurs. Several approaches have been suggested as promising alternatives to volume resuscitation. The rationale for the use of arginine vasopressin (AVP) is the pharmacologic amplification of the neuroendocrine stress response. AVP-mediated vasoconstriction is the first physiologic step to haemostasis and shifts blood away from the bleeding site towards the heart, lungs and brain. Particularly, when uncontrolled haemorrhage is accompanied by traumatic brain injury this may help to reduce secondary neurological damage. Since AVP can prevent acute death only transiently, it must comprehensively be combined with rapid hospital admission, immediate control of haemorrhage followed by aggressive fluid resuscitation and blood transfusion. This review article summarizes current experimental and clinical evidence on the use of AVP in uncontrolled haemorrhagic shock. PMID:18683476

Wenzel, Volker; Raab, Helmut; Dünser, Martin W



Multiple non-branching dissecting aneurysms of the mid-basilar trunk presenting with sequential subarachnoid hemorrhages  

PubMed Central

Objective: We describe a rare case of a patient with subarachnoid hemorrhage (SAH) due to a ventral dissecting mid-basilar aneurysm that was treated surgically. One week after surgery, the patient experienced sudden deterioration due to a new SAH caused by the development of a new aneurysm of the basilar trunk distinct from the previously clipped aneurysm. Case Description: A 54-year-old woman with acute subarachnoid hemorrhage was found to have a small, broad-based aneurysm arising from the ventral aspect of the mid-basilar artery. This complicated lesion was treated with a microsurgical clipping via a translabyrinthine pre-sigmoidal sub-temporal approach. One week postoperatively, the patient suffered a new SAH and was found to have developed a distinct basilar artery aneurysm. The patient was returned to the Operating Room for microsurgical clipping via the previous craniotomy. After surgery, the patient made a slow, but steady, recovery. She underwent repeated angiographic imaging, demonstrating a stable appearance. Two years post surgery, the patient had returned to work and had no obvious neurological deficit, with the exception of unilateral iatrogenic hearing loss. Conclusion: We describe a rare case of multiple aneurysms originating in relation to a mid-basilar dissection, resulting in multiple episodes of SAH. These are difficult and dangerous lesions that can be treated with open microsurgical reconstruction or possibly via an endovascular approach. The intricate location of the lesions poses a particular challenge to neurosurgeons attempting to directly treat mid-basilar lesions.

Defillo, Archie; Nussbaum, Eric S.; Zelensky, Andrea; Nussbaum, Leslie



Predictors of in-hospital shunt-dependent hydrocephalus following rupture of cerebral aneurysms.  


The development of shunt-dependent hydrocephalus is a well-recognised complication after aneurysmal subarachnoid haemorrhage, and negatively impacts on outcomes among survivors. This study aimed to identify early predictors of shunt dependency in a large administrative dataset of aneurysmal subarachnoid haemorrhage patients. We reviewed the National Hospital Morbidity Database in Australia for the years 1998 to 2008 and investigated the incidence of ventricular shunt placement following aneurysmal subarachnoid haemorrhage admissions. Putative risk factors were evaluated with univariate and multivariate logistic regression analysis to identify independent predictors of outcome. The following variables were considered: poor admission neurological grade; aneurysm location; intracerebral haemorrhage; intraventricular haemorrhage; acute hydrocephalus requiring the insertion of an external ventricular drain; surgical clipping; endovascular coiling; meningitis; and prolonged period of external ventricular drainage. A total of 10807 patients hospitalised for aneurysmal subarachnoid haemorrhage were identified. Among them, 701 (6.5%) required a permanent cerebrospinal fluid diversion procedure during the same admission as the aneurysmal subarachnoid haemorrhage. On multivariate analysis, poor admission neurological grade, acute hydrocephalus, the presence of intraventricular haemorrhage, ruptured vertebral artery aneurysm, surgical clipping, endovascular coiling, meningitis, and a prolonged period of external ventricular drainage were significant predictors of shunt dependency. A patient with a ruptured middle cerebral artery aneurysm was unlikely to develop shunt dependency (odds ratio 0.58; 95% confidence interval 0.46-0.73; p < 0.001). PMID:23517672

Lai, Leon; Morgan, Michael K



Cisternal irrigation therapy with urokinase and ascorbic acid for prevention of vasospasm after aneurysmal subarachnoid hemorrhage  

Microsoft Academic Search

BACKGROUNDCisternal irrigation therapy with urokinase and ascorbic acid was introduced to prevent symptomatic vasospasm after aneurysmal subarachnoid hemorrhage (SAH). To dissolve and wash out the subarachnoid clot, cisternal irrigation with urokinase is used. Ascorbic acid is added to degenerate oxy-hemoglobin, one of the strongest spasmogenic substances, into verdohemelike products, which are nonspasmogenic. The efficacy and safety of this therapy were

Namio Kodama; Tatsuya Sasaki; Masahisa Kawakami; Masahiro Sato; Jun Asari



Acute Subarachnoid Hemorrhage and Cardiac Abnormalities: Takotsubo Cardiomyopathy or Neurogenic Stunned Myocardium? a case report  

Microsoft Academic Search

INTRODUCTION: Cardiac abnormalities can be seen with subarachnoid hemorrhage. To date, there have been isolated case reports of transient left ventricular apical ballooning cardiomyopathy, also known as Takotsubo cardiomyopathy in patients suffering from subarachnoid hemorrhage. CASE PRESENTATION: An adult female was brought to the emergency department with somnolence. A 3 × 3 mm ruptured basilar aneurysm was found and successfully

C Franco; B Khaled; L Afonso; M Raufi



Intra-Aortic Balloon Pump Counterpulsation in the Setting of Subarachnoid Hemorrhage, Cerebral Vasospasm, and Neurogenic Stress Cardiomyopathy. Case Report and Review of the Literature  

Microsoft Academic Search

Background  The management of symptomatic cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH) can be often complicated\\u000a by the presence of stunned myocardium and left ventricular failure. Vasopressors and inotropes are commonly used to optimize\\u000a mean arterial pressure (MAP) and cerebral perfusion pressure (CPP). Intra-aortic balloon counterpulsation pump (IABP) may\\u000a be indicated in the management of these patients.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  We report the case

Christos Lazaridis; Gustavo Pradilla; Paul A. Nyquist; Rafael J. Tamargo



Correlation of Transcranial Color Doppler to N20 Somatosensory Evoked Potential Detects Ischemic Penumbra in Subarachnoid Hemorrhage  

PubMed Central

Background: Normal subjects present interhemispheric symmetry of middle cerebral artery (MCA) mean flow velocity and N20 cortical somatosensory evoked potential (SSEP). Subarachnoid haemorrhage (SAH) can modify this pattern, since high regional brain vascular resistances increase blood flow velocity, and impaired regional brain perfusion reduces N20 amplitude. The aim of the study is to investigate the variability of MCA resistances and N20 amplitude between hemispheres in SAH. Methods: Measurements of MCA blood flow velocity (vMCA) by transcranial color-Doppler and median nerve SSEP were bilaterally performed in sixteen patients. MCA vascular changes on the compromised hemisphere were calculated as a ratio of the reciprocal of mean flow velocity (1/vMCA) to contralateral value and correlated to the simultaneous variations of interhemispheric ratio of N20 amplitude, within each subject. Data were analysed with respect to neuroimaging of MCA supplied areas. Results: Both interhemispheric ratios of 1/vMCA and N20 amplitude were detected >0.65 (p <0,01) in patients without neuroimages of injury. Both ratios became <0.65 (p <0.01) when patients showed unilateral images of ischemic penumbra and returned >0.65 if penumbra disappeared. The two ratios no longer correlated after structural lesion developed, as N20 detected in the damaged side remained pathological (ratio <0.65), whereas 1/vMCA reverted to symmetric interhemispheric state (ratio >0.65), suggesting a luxury perfusion. Conclusion: Variations of interhemispheric ratios of MCA resistance and cortical N20 amplitude correlate closely in SAH and allow identification of the reversible ischemic penumbra threshold, when both ratios become <0.65. The correlation is lost when structural damage develops.

Di Pasquale, Piero; Zanatta, Paolo; Morghen, Ilaria; Bosco, Enrico; Forini, Elena



Predictors Analysis of Symptomatic Cerebral Vasospasm After Subarachnoid Hemorrhage  

Microsoft Academic Search

\\u000a \\u000a Purpose: Symptomatic cerebral vasospasm (SCVS) is still lacking in reliable early warning methods and often diagnosed after clinical\\u000a deterioration of neurological function, making prevention and treatment extremely passive. This study investigates the risk\\u000a factors relevant to SCVS after subarachnoid hemorrhage (SAH) in order to provide useful information for clinical work.\\u000a \\u000a \\u000a \\u000a Materials and Methods: Clinical data of 211 patients with SAH

L. Yin; C. Y. Ma; Z. K. Li; D. D. Wang; C. M. Bai


Iatrogenic dural arteriovenous fistula and aneurysmal subarachnoid hemorrhage.  


The authors present the case of a patient who presented acutely with aneurysmal subarachnoid hemorrhage (SAH) and a contralateral iatrogenic dural arteriovenous fistula (DAVF). Diagnostic angiography was performed, revealing a right-sided middle cerebral artery (MCA) aneurysm and a left-sided DAVF immediately adjacent to the entry of the ventriculostomy and bur hole site. A craniotomy was performed for clipping of the ruptured MCA aneurysm, and the patient subsequently underwent endovascular obliteration of the DAVF 3 days later. The authors present their treatment of an iatrogenic DAVF in a patient with an aneurysmal SAH, considerations in management options, and a literature review on the development of iatrogenic DAVFs. PMID:22537118

Vadivelu, Sudhakar; Xin, Xin; Loven, Tina; Restrepo, Guillermo; Chalif, David J; Setton, Avi



Mechanism of functional residual capacity increase in haemorrhagic shock.  


Shock was elicited in anaesthetized dogs by maintaining a haemorrhagic hypotension of 4 kPa until 30 per cent spontaneous refusion, followed by total reinfusion. Functional residual capacity (FRC) and minute ventilation increased considerably similarly to our previous experiments. Lactate content in both the external intercostal and the biceps femoris muscles increased significantly in advanced shock. The expiratory external abdominal oblique muscle showed electromyographic signs of fatigue. At the height of the FRC changes tonic contraction of the external intercostal muscle could be demonstrated electron microscopically. This tonic contraction is the main factor in the large FRC rise in late shock forming the basis of a hitherto unknown vicious circle. PMID:6230849

Nagy, S; Hantos, Z; Deavers, S I; Tóth, I; Klebniczki, J; Adamicza, A



An unusual cause for an optic disc haemorrhage  

PubMed Central

A 51-year-old male on chemotherapy for myeloma presented initially with a unilateral optic disc haemorrhage and signs of optic neuropathy. This rapidly progressed to affect both eyes and within a few days he developed retinal features suggestive of progressive outer retinal necrosis. He was treated with intravenous acyclovir that was subsequently changed to ganciclovir when serological tests for cytomegalovirus were found to be positive for immunoglobulin M antibodies. His visual loss continued to deteriorate despite treatment, and he subsequently developed a retinal detachment in one eye. The causes of optic neuropathy in immunocompromised patients and the importance of eliminating an infective cause are discussed.

Baxter, Julia; Kailasanathan, Anusha; Chen, Hean



Aetiological examination of an outbreak of haemorrhagic syndrome in a broiler flock in Japan  

Microsoft Academic Search

The aetiology of an outbreak of haemorrhagic syndrome (HS) in a commercial broiler flock was examined. At a rearing farm, 596 of 6376 chicks (9.3%) in a flock were culled with depression and increased mortality from 12 to 26 days of age, with a peak at 16 to 19 days of age. Most of the affected chicks examined had haemorrhagic

N. Yuasa; K. Imai; K. Watanabe; F. Saito; M. Abe; K. Komi



Safety and efficacy of an inactivated Carbopol-adjuvanted goose haemorrhagic polyomavirus vaccine for domestic geese  

Microsoft Academic Search

Haemorrhagic nephritis enteritis of the goose (HNEG) is an epizootic viral disease in domestic geese. The causal agent is a polyomavirus, namely goose haemorrhagic polyomavirus. To help control the disease, an inactivated vaccine was developed, based on viral particles produced in goose kidney cells. Viral material was quantified using real-time quantitative polymerase chain reaction, inactivated with ?-propiolactone and adjuvanted with

Jacqueline Gelfi; Michael Pappalardo; Carine Claverys; Brigitte Peralta; Jean-Luc Guérin



Crimean-Congo haemorrhagic fever virus infection in the Western Province of Saudi Arabia  

Microsoft Academic Search

In 1990, an outbreak of suspected viral haemorrhagic fever involving 7 individuals occurred in Mecca in the Western Province of Saudi Arabia. Congo-Crimean haemorrhagic fever (CCHF), not previously known to be present in Saudi Arabia, was incriminated. A study of the epidemiology of this virus was therefore carried out in Mecca, and in nearby Jeddah and Taif in 1991–1993; 13

O. M. E. El-Azazy; E. M. Scrimgeour



The effect of acute haemorrhage in the dog and man on plasma-renin concentration  

PubMed Central

1. The effect of acute haemorrhage on the plasma renin concentration was studied in the dog and man. 2. Plasma-renin concentration was regularly increased after the larger bleeds; after the smaller haemorrhages plasma-renin concentration remained unchanged. 3. The results are discussed in relation to current hypotheses concerning the control of renin and aldosterone secretion.

Brown, J. J.; Davies, D. L.; Lever, A. F.; Robertson, J. I. S.; Verniory, A.



Are systemic levels of non steroidal anti inflammatory drugs relevant to acute upper gastrointestinal haemorrhage?  

Microsoft Academic Search

It is uncertain as to the extent which gastrointestinal (GI) haemorrhage related to NSAIDs is due to a local, topical effect or to an action related to systemic absorption. We hypothesised that, should systemic drug concentrations be of importance, plasma levels of NSAIDs might be higher in patients who had developed GI haemorrhage, from controls who had not.

H. A. Wynne; M. D. Rawlins



Recombinant subunit vaccine elicits protection against goose haemorrhagic nephritis and enteritis  

Microsoft Academic Search

Outbreaks of haemorrhagic nephritis and enteritis of geese (HNEG) have been reported in goose flocks in Hungary, Germany and France since 1969. HNEG is characterized by high morbidity and mortality rates in geese 3 to 10 weeks of age. The causative agent of HNEG is the goose haemorrhagic polyomavirus (GHPV), which has a circular double-stranded DNA genome encoding the structural

Tamás Mató; Zoltán Pénzes; Paloma Rueda; Carmen Vela; Veronika Kardi; Anna Zolnai; Ferenc Misák; Vilmos Palya



Haemorrhagic syndrome of cattle associated with the feeding of sweet vernal (Anthoxanthum odoratum) hay containing dicoumarol  

Microsoft Academic Search

An outbreak of a haemorrhagic diathesis in cattle fed home produced hay is described. A similar syndrome was reproduced experimentally in calves by feeding them the hay. The experimental disease was characterised by increased prothrombin and partial thromboplastin times while the leucocyte and erythrocyte counts remained normal until the terminal haemorrhage. The calves ate well and grew well until the

DG Pritchard; LM Markson; PJ Brush; JA Sawtell; PA Bloxham



Cerebral haemorrhage in arteriovenous malformation associated with Klippel-Trenaunay syndrome  

Microsoft Academic Search

The computed tomography, magnetic resonance imaging and angiographic findings are described in a patient with Klippel-Trenaunay syndrome, who also had a cerebral haemorrhage from an arteriovenous malformation. The resulting aphasia disappeared completely after resorption of the haemorrhage. In this syndrome, the occurrence of a cerebral angioma has not previously been mentioned in the literature.

H. Jaksch; H. Bewermeyer; H. A. Dreesbach; W.-D. Heiss



The collagen-binding protein of Streptococcus mutans is involved in haemorrhagic stroke  

Microsoft Academic Search

Although several risk factors for stroke have been identified, one-third remain unexplained. Here we show that infection with Streptococcus mutans expressing collagen-binding protein (CBP) is a potential risk factor for haemorrhagic stroke. Infection with serotype k S. mutans, but not a standard strain, aggravates cerebral haemorrhage in mice. Serotype k S. mutans accumulates in the damaged, but not the contralateral

Kazuhiko Nakano; Kazuya Hokamura; Naho Taniguchi; Koichiro Wada; Chiho Kudo; Ryota Nomura; Ayuchi Kojima; Shuhei Naka; Yoshinori Muranaka; Min Thura; Atsushi Nakajima; Katsuhiko Masuda; Ichiro Nakagawa; Pietro Speziale; Nobumitsu Shimada; Atsuo Amano; Yoshinori Kamisaki; Tokutaro Tanaka; Kazuo Umemura; Takashi Ooshima



Partly reversible central auditory dysfunction induced by cerebral vasospasm after subarachnoid hemorrhage.  


The authors describe a rare case of central auditory dysfunction induced by cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH). A 55-year-old woman who was admitted after aneurysmal SAH developed cerebral vasospasm on Day 3 affecting mainly the right middle cerebral artery (MCA) and partly the left MCA. The vasospasm became refractory to conventional therapy and was ultimately improved by intraarterial infusion of nimodipine in the right MCA and angioplasty. Severe auditory dysfunction was apparent from Day 10 as the patient was not reactive to speech or environmental sounds. Brain MRI on Day 17 demonstrated infarcted areas mainly in the right hippocampus, medial occipital lobe, and thalamus. The patient underwent further examination using audiometry, speech testing, auditory evoked potentials, functional MRI, and cerebral PET. The initial diagnosis was extended nonverbal agnosia and total pure word deafness. The central auditory dysfunction improved over 6 months, with persisting hyperacusis, tinnitus, and amusia. Central auditory dysfunction is a rare complication after SAH. While cortical deafness may be associated with bilateral lesions of the temporal cortex, partly reversible central auditory dysfunction was observed in this patient after prominently unilateral right temporal lesions. The role of the interthalamic connections can be discussed, as well as the possibility that a less severe vasospasm on the left MCA could have transiently impaired the left thalamocortical auditory pathways. PMID:23971951

Ponzetto, Ester; Vinetti, Marco; Grandin, Cécile; Duprez, Thierry; van Pesch, Vincent; Deggouj, Naïma; Lhommel, Renaud; Hantson, Philippe



Syringomyelia and arachnoid cysts associated with spinal arachnoiditis following subarachnoid hemorrhage.  


A 66-year-old woman with primary Sjogren syndrome developed syringomyelia following two episodes of subarachnoid hemorrhage (SAH) due to the rupture of basilar artery aneurysms. Gait disturbance and abnormal sensation with pain over the foot and abdomen appeared 3 years after the last SAH. Magnetic resonance (MR) imaging revealed a syringomyelia throughout the thoracic cord, from the T2 to T11 levels. In addition, the thoracic cord was compressed by multiple arachnoid cysts in the ventral side of spinal cord. Computed tomography myelography revealed complete block of cerebrospinal fluid (CSF) flow at the T7 level. Surgery for microlysis of the adhesions and restoration of the CSF flow pathway was performed. Postoperatively, leg motor function slowly improved and she could walk unaided. However, abdominal paresthesia was persisted. Postoperative MR imaging revealed diminished size of the syrinxes. We should recognize syringomyelia and arachnoid cysts due to adhesive arachnoiditis as a late complication of SAH. Microlysis of the adhesions focusing on the lesion thought to be the cause of the symptoms is one of the choices to treat massive syringomyelia and arachnoid cysts associated with arachnoiditis following SAH. PMID:23006888

Ishizaka, Shunsuke; Hayashi, Kentaro; Otsuka, Munehiro; Fukuda, Shuji; Tsunoda, Keishi; Ushijima, Ryujiro; Kitagawa, Naoki; Suyama, Kazuhiko; Nagata, Izumi



Rebleeding and Ischemia after Acute Endovascular Treatment of Ruptured Dissecting Subarachnoid Vertebral Artery Aneurysms  

PubMed Central

Summary Dissection aneurysms of the vertebral artery represent 3.2% of all cerebral aneurysms and 28% of intracranial dissection aneurysms. Dissection of the vertebral artery in its intracranial segment (V4) usually causes a subarachnoid hemorrhage (SAH) from subadventiatial extension of the vessel wall hematoma. Rarely (one case in seven), the symptomatology is characterized by brain stem ischemia from the vertebral artery and/or postero-inferior cerebellar artery occlusive dissection. The high rebleeding (18-33% with a 10+/-5 day interval between the first and the second bleeding) and mortality (>45%) rates 1,13 of this disease prompt emergency treatment usually consisting in endovascular coiling of the dissection aneurysm and/or the dissected segment of the parent vessel. Herein we report our experience in endovascular coiling of acutely ruptured dissecting aneurysms of the vertebral artery dissection in V4 segment. We focus the discussion on the risk of rebleeding and the ischemic complications that my occur after endovascular or surgical treatment

Mangiafico, S.; Padolecchia, R.; Cellerini, M.; Puglioli, M.; Villa, G.; Nistri, M.



CSF and Serum Biomarkers Focusing on Cerebral Vasospasm and Ischemia after Subarachnoid Hemorrhage  

PubMed Central

Delayed cerebral vasospasm (CVS) and delayed cerebral ischemia (DCI) remain severe complications after subarachnoid hemorrhage (SAH). Although focal changes in cerebral metabolism indicating ischemia are detectable by microdialysis, routinely used biomarkers are missing. We therefore sought to evaluate a panel of possible global markers in serum and cerebrospinal fluid (CSF) of patients after SAH. CSF and serum of SAH patients were analyzed retrospectively. In CSF, levels of inhibitory, excitatory, and structural amino acids were detected by high-performance liquid chromatography (HPLC). In serum, neuron-specific enolase (NSE) and S100B level were measured and examined in conjunction with CVS and DCI. CVS was detected by arteriography, and ischemic lesions were assessed by computed tomography (CT) scans. All CSF amino acids were altered after SAH. CSF glutamate, glutamine, glycine, and histidine were significantly correlated with arteriographic CVS. CSF glutamate and serum S100B were significantly correlated with ischemic events after SAH; however, NSE did not correlate neither with ischemia nor with vasospasm. Glutamate, glutamine, glycine, and histidine might be used in CSF as markers for CVS. Glutamate also indicates ischemia. Serum S100B, but not NSE, is a suitable marker for ischemia. These results need to be validated in larger prospective cohorts.

Jung, Carla S.; Lange, Bettina; Zimmermann, Michael; Seifert, Volker



Cerebrospinal fluid ferritin level, a sensitive diagnostic test in late-presenting subarachnoid hemorrhage.  


The workup of patients with suspected subarachnoid hemorrhage (SAH) presenting late is complicated by a loss of diagnostic sensitivity of computed tomography (CT) brain imaging and cerebrospinal fluid (CSF) bilirubin levels. In this prospective longitudinal study of CSF ferritin levels in SAH, serial CSF samples from 14 patients with aneurysmal SAH requiring extraventricular drainage (EVD) were collected. The control group comprised 44 patients presenting with headache suspicious of SAH. Nine patients underwent a traumatic spinal tap. CSF ferritin levels were significantly higher in the patients with SAH compared with controls (P < .0001). The upper reference range of CSF ferritin is 12 ng/mL, and there was no significant difference between the traumatic and normal spinal taps (mean, 9.0 ng/mL vs 3.9 ng/mL; P = .59). CSF ferritin levels increased after SAH, from an average of 65 ng/mL on day 1 to 1750 ng/mL on day 11 (P < .01). Both the Fisher and Columbia CT scores were significantly correlated with CSF ferritin level. The increase in CSF ferritin level after SAH and possibly may provide additional diagnostic information in patients with suspected SAH who present late to the clinic. PMID:20719531

Petzold, Axel; Worthington, Viki; Appleby, Ian; Kerr, Mary E; Kitchen, Neil; Smith, Martin



Evidence that a Panel of Neurodegeneration Biomarkers Predicts Vasospasm, Infarction, and Outcome in Aneurysmal Subarachnoid Hemorrhage  

PubMed Central

Biomarkers for neurodegeneration could be early prognostic measures of brain damage and dysfunction in aneurysmal subarachnoid hemorrhage (aSAH) with clinical and medical applications. Recently, we developed a new panel of neurodegeneration biomarkers, and report here on their relationships with pathophysiological complications and outcomes following severe aSAH. Fourteen patients provided serial cerebrospinal fluid samples for up to 10 days and were evaluated by ultrasonography, angiography, magnetic resonance imaging, and clinical examination. Functional outcomes were assessed at hospital discharge and 6–9 months thereafter. Eight biomarkers for acute brain damage were quantified: calpain-derived ?-spectrin N- and C-terminal fragments (CCSntf and CCSctf), hypophosphorylated neurofilament H, 14-3-3 ? and ?, ubiquitin C-terminal hydrolase L1, neuron-specific enolase, and S100?. All 8 biomarkers rose up to 100-fold in a subset of patients. Better than any single biomarker, a set of 6 correlated significantly with cerebral vasospasm, brain infarction, and poor outcome. Furthermore, CSF levels of 14-3-3?, CCSntf, and NSE were early predictors of subsequent moderate-to-severe vasospasm. These data provide evidence that a panel of neurodegeneration biomarkers may predict lasting brain dysfunction and the pathophysiological processes that lead to it following aSAH. The panel may be valuable as surrogate endpoints for controlled clinical evaluation of treatment interventions and for guiding aSAH patient care.

Siman, Robert; Giovannone, Nicholas; Toraskar, Nikhil; Frangos, Suzanne; Stein, Sherman C.; Levine, Joshua M.; Kumar, Monisha A.



Complications in resident-performed phacoemulsification cataract surgery at New Jersey Medical School  

PubMed Central

Aim To describe the complications related to cataract surgery performed by phacoemulsification technique by third?year ophthalmology residents at New Jersey Medical School, who are trained to perform phacoemulsification without any prior experience with extracapsular extraction. Design Retrospective, observational case series. Methods A retrospective chart review of 755 patients who underwent cataract surgery by third?year residents between July 2000 and June 2005 at the Institute of Ophthalmology and Visual Science was performed. Details of intraoperative complications (posterior capsular rupture, vitreous loss, subluxation of lens fragments into the vitreous, extracapsular cases converted to phacoemulsification, retinal detachment, vitreous haemorrhage and haemorrhagic choroidals) of the cases done by phacoemulsification technique were recorded. Results were analysed and compared with complication rates reported from other residency programmes and from experienced ophthalmologists. Results Of 755 cataract surgeries, 719 were performed using phacoemulsification technique. Posterior capsule disruption occurred in 48 (6.7%), vitreous loss in 39 (5.4%) and dislocated lenticular fragments in 7 (1.0%) of 719 cases that underwent phacoemulsification technique. Subsequent pars plana lensectomy was required in 5 (0.7%) cases; 1 case (0.1%) experienced retinal detachment and haemorrhagic choroidal detachment. Conclusion The residents can perform phacoemulsification well with a very low complication rate, without prior training with extracapsular cataract extraction technique.

Bhagat, Neelakshi; Nissirios, Nicholas; Potdevin, Lindsay; Chung, Jacob; Lama, Paul; Zarbin, Marco A; Fechtner, Robert; Guo, Suquin; Chu, David; Langer, Paul



Gastrointestinal complications of the Ehlers-Danlos syndrome  

PubMed Central

The gastrointestinal abnormalities encountered in 125 patients with the Ehlers-Danlos syndrome have been described. Spontaneous perforation of the intestine and massive gastrointestinal haemorrhage are uncommon but potentially lethal complications of the Ehlers-Danlos syndrome. Less dangerous abnormalities, such `as external hernia, hiatus hernia, eventration of the diaphragm, intestinal diverticula, and rectal prolapse were all encountered in patients in the series. Abdominal surgery in affected patients may be made difficult by fragility of tissues and a bleeding tendency. In the postoperative period, tearing out of sutures and wound dehiscence may occur.

Beighton, Peter H.; Murdoch, J. Lamont; Votteler, Theodore



Dental and oral complications of lip and tongue piercings.  


Piercing of the tongue and perioral regions is an increasingly popular expression of body art, with more patients coming in for a routine check-up with tongue and/or lip piercings. Several complications of oral piercing have been reported, some of which are life-threatening. In the present clinical survey the prevalence of both tongue and lip piercing complications in oral health was assessed in a group of 50 patients. The most common dental problem registered was chipping of the teeth, especially in association with tongue piercing. Gingival recession was seen as a result of lip piercing with studs. Post-procedural complications included oedema, haemorrhage and infection. Therefore, dentists and oral and maxillofacial surgeons should be given more authority to advise patients with oral and facial piercings or those who plan to acquire this type of body art. PMID:16244618

De Moor, R J G; De Witte, A M J C; Delmé, K I M; De Bruyne, M A A; Hommez, G M G; Goyvaerts, D



Cerebral Vasospasm with Ischemia following a Spontaneous Spinal Subarachnoid Hemorrhage  

PubMed Central

Cerebral vasospasm is a well-known consequence of aneurysmal subarachnoid hemorrhage (SAH) triggered by blood breakdown products. Here, we present the first case of cerebral vasospasm with ischemia following a spontaneous spinal SAH. A 67-year-old woman, who was on Coumadin for atrial fibrillation, presented with chest pain radiating to the back accompanied by headache and leg paresthesias. The international normalized ratio (INR) was 4.5. Ten hours after presentation, she developed loss of movement in both legs and lack of sensation below the umbilicus. Spine MRI showed intradural hemorrhage. Her coagulopathy was reversed, and she underwent T2 to T12 laminectomies. A large subarachnoid hematoma was evacuated. Given her complaint of headache preoperatively and the intraoperative finding of spinal SAH, a head CT was done postoperatively that displayed SAH in peripheral sulci. On postoperative day 5, she became obtunded. Brain MRI demonstrated focal restricted diffusion in the left frontoparietal area. Formal angiography revealed vasospasm in anterior cerebral arteries bilaterally and right middle cerebral artery. Vasospasm was treated, and she returned to baseline within 48 hours. Spontaneous spinal SAH can result in the same sequelae typically associated with aneurysmal SAH, and the clinician must have a degree of suspicion in such patients. The pathophysiological mechanisms underlying cerebral vasospasm may explain this unique case.

Shakur, Sophia F.; Farhat, Hamad I.



CSF pressure and velocity in obstructions of the subarachnoid spaces.  


According to some theories, obstruction of CSF flow produces a pressure drop in the subarachnoid space in accordance with the Bernoulli theorem that explains the development of syringomyelia below the obstruction. However, Bernoulli's principle applies to inviscid stationary flow unlike CSF flow. Therefore, we performed a series of computational experiments to investigate the relationship between pressure drop, flow velocities, and obstructions under physiologic conditions. We created geometric models with dimensions approximating the spinal subarachnoid space with varying degrees of obstruction. Pressures and velocities for constant and oscillatory flow of a viscid fluid were calculated with the Navier-Stokes equations. Pressure and velocity along the length of the models were also calculated by the Bernoulli equation and compared with the results from the Navier-Stokes equations. In the models, fluid velocities and pressure gradients were approximately inversely proportional to the percentage of the channel that remained open. Pressure gradients increased minimally with 35% obstruction and with factors 1.4, 2.2 and 5.0 respectively with 60, 75 and 85% obstruction. Bernoulli's law underestimated pressure changes by at least a factor 2 and predicted a pressure increase downstream of the obstruction, which does not occur. For oscillatory flow the phase difference between pressure maxima and velocity maxima changed with the degree of obstruction. Inertia and viscosity which are not factored into the Bernoulli equation affect CSF flow. Obstruction of CSF flow in the cervical spinal canal increases pressure gradients and velocities and decreases the phase lag between pressure and velocity. PMID:23859246

Støverud, K H; Langtangen, H P; Haughton, V; Mardal, K-A



Clinical review: Prevention and therapy of vasospasm in subarachnoid hemorrhage  

PubMed Central

Vasospasm is one of the leading causes of morbidity and mortality following aneurysmal subarachnoid hemorrhage (SAH). Radiographic vasospasm usually develops between 5 and 15 days after the initial hemorrhage, and is associated with clinically apparent delayed ischemic neurological deficits (DID) in one-third of patients. The pathophysiology of this reversible vasculopathy is not fully understood but appears to involve structural changes and biochemical alterations at the levels of the vascular endothelium and smooth muscle cells. Blood in the subarachnoid space is believed to trigger these changes. In addition, cerebral perfusion may be concurrently impaired by hypovolemia and impaired cerebral autoregulatory function. The combined effects of these processes can lead to reduction in cerebral blood flow so severe as to cause ischemia leading to infarction. Diagnosis is made by some combination of clinical, cerebral angiographic, and transcranial doppler ultrasonographic factors. Nimodipine, a calcium channel antagonist, is so far the only available therapy with proven benefit for reducing the impact of DID. Aggressive therapy combining hemodynamic augmentation, transluminal balloon angioplasty, and intra-arterial infusion of vasodilator drugs is, to varying degrees, usually implemented. A panoply of drugs, with different mechanisms of action, has been studied in SAH related vasospasm. Currently, the most promising are magnesium sulfate, 3-hydroxy-3-methylglutaryl-CoA reductase inhibitors, nitric oxide donors and endothelin-1 antagonists. This paper reviews established and emerging therapies for vasospasm.

Keyrouz, Salah G; Diringer, Michael N



Massive haemorrhagic necrosis of the liver after liver transplantation.  

PubMed Central

Six of the first 85 patients who received the first 100 liver transplantations carried out in Birmingham developed a syndrome of fulminant liver failure with distinctive clinical and pathological features. The typical clinical presentation was of an uneventual initial postoperative period, followed by a sudden deterioration in graft function, progressing rapidly to graft failure. All six patients died. The characteristic pathological changes were those of massive haemorrhage and hepatocyte necrosis with only mild inflammation and without occlusive lesions in large arteries or veins. These distinctive features differed from other recognised patterns of graft damage and seemed to comprise a specific post-transplant syndrome. The pathogenesis was not clear and in the absence of any definite aetiology it is suggested that the term "massive haemorrhagic necrosis" be used to describe these cases. Additional findings seen in five of the six cases were venoocclusive lesions (n = 4) and a combination of ductopenia and foam cell arteriopathy (n = 2). The presence of these associated lesions suggests that there may be an overlap with other types of graft damage. Images Fig 2 Fig 3 Fig 4 Fig 5 Fig 6 Fig 7

Hubscher, S G; Adams, D H; Buckels, J A; McMaster, P; Neuberger, J; Elias, E



Diffuse alveolar haemorrhage due to 5-nitroimidazole treatment.  


Diffuse alveolar haemorrhage (DAH) is indicated by the presence of red blood cells, fibrin and haemosiderin deposits in the lung parenchyma. We present a case of DAH in a 25-year-old male following 5-nitroimidazole treatment. The first episode of haemoptysis occurred following metronidazole treatment 10 months previously. The second episode of haemoptysis occurred following ornidazole treatment 10 days before admission. During his first admission, the patients haemoglobin concentration decreased to 40 g/L. The CXR was normal, whereas high resolution CT of the lungs revealed a diffuse acinonodular pattern. Serological tests for connective tissue diseases were negative. The haemorrhagic appearance of the BAL fluid obtained during fibreoptic bronchoscopy was consistent with DAH. Microbiological analysis of the BAL fluid showed no evidence for bacterial or mycobacterial infection. Haemosiderin laden macrophages were detected in BAL fluid and lung biopsy specimens. DAH due to use of 5-nitroimidazole was diagnosed on the basis of the patient's previous history and complete recovery following treatment with corticosteroid. This is the first reported case of DAH due to use of 5-nitroimidazole. Physicians should be aware of this side-effect when prescribing this group of drugs to patients. PMID:19645871

Uyar, Meral; Elbek, Osman; Bayram, Nazan; Ekiz, Sule; Bakir, Kemal; Dikensoy, Oner



'Fragile' liver and massive hepatic haemorrhage due to hereditary amyloidosis.  

PubMed Central

The first case of amyloidosis is reported in which spontaneous massive hepatic haemorrhage necessitated emergency liver transplantation. Liver transplantation, as a treatment for a failing liver due to amyloidosis has not been previously reported. At transplantation, the liver tissue was uncharacteristically friable, although the subsequent vascular and biliary anastomoses were uncomplicated. Histological examination of the liver showed a surprisingly modest amount of amyloid, which was shown immunohistochemically to be derived from lysozyme, and a striking absence of reticulin staining. Both the patient's father and paternal grandfather had died from spontaneous hepatic haemorrhage, and histological review of their liver tissue showed similarly modest deposition of lysozyme-derived amyloid associated with loss of reticulin staining. In each case the quantity of amyloid was far less than would be expected to interfere with the mechanical integrity of the liver. This is the only report of hepatic disintegration associated with absence of reticulin staining, and it is probable that the mechanism represents a novel secondary effect of the amyloid deposits in the livers of this family. Images Figure 1 Figure 2

Harrison, R F; Hawkins, P N; Roche, W R; MacMahon, R F; Hubscher, S G; Buckels, J A



Effect of peroral antacid treatment in patients with acute upper gastrointestinal haemorrhage: a randomized controlled trial.  


During recent years, it has been reported that antacids have a beneficial prophylactic effect in critically ill patients regarding upper gastrointestinal bleeding. In these trials rather complicated treatment schedules and high doses of antacids were used. The present study was designed to investigate the therapeutic efficacy of a more practical antacid treatment regimen in patients with haematemesis and/or melaena. Ninety patients, hospitalized for haematemesis and/or melaena within the past 24 hours, were included to double-blind treatment with antacids or placebo for 7 days. The dose, 20 ml liquid antacid (Balancid) with a neutralizing capacity of 105 mmol, was administered each second hour during waking hours. The groups were comparable regarding incidence of ulcer disease, age, sex, acid secretion, and usage of aspirin. Continuous bleeding or rebleeding was recorded in 15 of the 43 patients in the antacid group (34.9%), compared to 19 of the 47 patients in the placebo group (40.4%), the difference not being statistically significant. Furthermore, the requirement of blood transfusions was not significantly different in the two groups. In conclusion, the haemostatic effect of the antacid treatment regimen used in the present study was not significantly superior to placebo in patients with endoscopically verified acute upper gastrointestinal haemorrhage. PMID:6755651

Kittang, E; Aadland, E; Oyen, D; Holm, H A; Berstad, A; Pytte, R; Qvigstad, T; Tommelstad, T



Spontaneous Thrombosis of an Orbital Arteriovenous Malformation Revealing Hereditary Haemorrhagic Telangiectasia (Rendu-Osler-Weber Disease)  

PubMed Central

Summary Hereditary Haemorrhagic Telangiectasia (HHT) is a genetic disorder responsible for cutaneous or mucosal telangiectasia and arteriovenous malformations (AVMs). The most frequent locations are lung and brain. In contrast, orbital AVMs are very rare. We describe a case of symptomatic orbital arteriovenous malformation due to spontaneous thrombosis. A 65-year-old woman was referred for chronic right eye proptosis associated with dilation of conjunctival vessels with a jellyfish pattern. Right visual acuity was 20/40 and intraocular pressure was 40 mmHg. Personal and familial history of recurrent epistaxis, associated with multiple telangiectasia within lips and palate, led to the diagnosis of HHT. Magnetic resonance imaging (MRI) completed with cerebral angiography found a giant and occluded AVM within the right orbit. Other AVMs were also found in brain and chest, confirming the diagnosis. Antiglaucomatous eyedrops were added to reduce intraocular pressure and a steroid therapy was begun. Two months later, visual acuity decreased in the right eye, due to a central retinal vein thrombosis. In conclusion, Most brain or pulmonary AVM can be treated by embolization. By contrast, this treatment in case of orbital location can lead to central retinal artery and/or central retinal vein occlusion, which may also appear as a spontaneous complication of the orbital AVM. Therapeutic management of orbital AVM is thus not standardized, and the balance between spontaneous and iatrogenic risk of visual loss has to be taken into account.

Van Went, C.; Ozanne, A.; Saliou, G.; Dethorey, G.; De Monchy, I.; Krings, T.; Ducreux, D.; Labetoulle, M.



Bath-related thunderclap headache associated with subarachnoid and intracerebral hemorrhage.  


Purpose: Bath-related thunderclap headache (BRTH) is a rare and usually benign condition. We report a case of episodic explosive thunderclap headache (TH) provoked by showering water, with the complications of cortical subarachnoid hemorrhages (SAH) and delayed intracerebral hemorrhage (ICH). Case Report: A 56-year-old premenopausal woman, without chronic illness or headache history, suffered from 4 episodes of severe explosive TH within 11 days. Two of these attacks were provoked by hot water and 1 by cold water. A small acute SAH was found in the left high frontal cortex on brain computed tomography (CT) performed 7 days after the first attack (day 7). Brain magnetic resonance imaging (MRI) and angiography (MRA) on day 9 disclosed a new acute SAH in the right frontal cortex but with no apparent vasoconstriction. CT angiography (CTA) on day 12 first revealed vasoconstriction in the M2 segment of right middle cerebral artery (MCA), and found a new ICH in the right anterior frontal lobe. Conventional angiography on day 14 revealed partial remission of vasoconstriction with only mild short segmental narrowing at the proximal M1 segment of right MCA. The patient had no clinical neurological deficit. She was free of headache at day 11 when she started taking nimodipine. Conclusion: Reversible cerebral vasoconstriction syndrome (RCVS) presented with BRTH is rare and is not always that benign as was once thought. The delayed ICH and the short-period of vasoconstriction in this patient extended our knowledge that the time course of the complications and the duration of vasospasm in RCVS could vary widely among patients. Nimodipine is probably effective in both relieving symptoms and reversing vasoconstriction. PMID:24030092

Jhang, Kai-Ming; Lin, Chun-Hsiang; Lee, Kwo-Whei; Chen, Yen-Yu



[An infrared photocoagulative technic in the prevention of hemorrhagic complications in oral medicine].  


The infrared ray clotting technique has been successfully employed in numerous branches of medicine and surgery. Here its usefulness is demonstrated in dentistry, particularly in the treatment of haemorrhagic complications in oral and extractive surgery in patients suffering from clotting disturbances. The physical features of infrared radiation make it possible to perform a targeted, instantaneous tissue necrosis of depth proportional to exposure time. Its speed, simplicity and effectiveness make infrared ray clotting the haemostatic intervention of choice in every single event. PMID:2329978

Roggia, S; Albera, G; Curioni, L; Moniaci, D



[Hemoperitoneum caused by lesions to the appendix epiploica. An unusual complication of colonoscopy].  


A rare case of hemoperitoneum in a young man who performed a diagnostic colonoscopy is reported. The rupture of an epiploic appendix among rectum and colon sigma caused massive bleeding into the peritoneum cavity followed by haemorrhagic shock. Diagnostic and therapeutic colonoscopy has a low rate of morbility; perforation and bleeding are the most common events; hemoperitoneum following colonscopy is usually due to spleen rupture. Among other complications, ileal and cecal volvolus, incarceration of hernias and subcutaneous emphysema are reported. PMID:9082215

Sorrentino, M; Terrosu, G; Risaliti, A; Bulligan, M G; Petri, R; Donini, A; Soro, P; Bresadola, F



[Serious bleeding in systemic lupus erythematosus complicated by lupus anticoagulant-hypoprothrombinaemia syndrome].  


Severe hemorrhagic diathesis due to lupus anticoagulant complicated by hypoprothrombinaemia resulting from prothrombin autoantibodies is a rare disorder and is often associated with systemic lupus erythematosus (SLE). We report a case in which a 15-year-old girl with SLE developed marked haemorrhagic manifestations due to menorrhagia and nosebleeds. The acute bleeding episode was treated with SAGM, tranexamic acid and recombinant factor VIIa. Lupus anticoagulant, cardiolipin antibodies and antiprothrombin antibodies were successfully depressed within weeks after corticosteroid therapy was begun. PMID:16472441

Engelsen, Jytte; Nielsen, Susan M; Thorsen, Sixtus



Life-threatening haemorrhage after 750 Le Fort I osteotomies and 376 SARPE procedures.  


This study assessed the incidence, presenting symptoms, diagnosis, and management of patients with life-threatening postoperative haemorrhage after total Le Fort I osteotomy and surgically assisted rapid palatal expansion (SARPE). The medical records of 750 consecutive Le Fort I osteotomies and 376 consecutive SARPEs, both of which involved pterygomaxillary separation with a curved osteotome and a mallet, were analysed prospectively. Two cases of life-threatening haemorrhage were observed in the Le Fort I osteotomy group, both initiated on postoperative day 7. Anterior and posterior nasal packing were successful in one patient; the other required two embolizations for bleeding control (incidence of life-threatening postoperative haemorrhage: 2/750; confidence interval: 0.03-0.96%). In the SARPE group, one brisk epistaxis on the first postoperative day was controlled with anterior and posterior nasal packing under general anaesthesia. This haemorrhage was not considered life threatening (incidence of life-threatening postoperative haemorrhage: 0/376; confidence interval: 0-0.98%). In no case could the source of bleeding be established during re-explorative surgery or during diagnostic arteriography. The authors conclude that life-threatening haemorrhage is an exceptional finding after Le Fort I osteotomy; the observed incidence was 2/750, and life-threatening haemorrhage was not observed after SARPE in this series, despite the use of identical pterygomaxillary separation. PMID:22480877

Politis, C



Local haemorrhage induced by Bothrops jararaca venom: relationship to neurogenic inflammation.  


We investigated morphological alterations induced by s.c. injection of 2.5 microg of Bothrops jararaca venom in rats. Intense disorganisation of collagen fibres was observed 1 min after the venom injection, particularly at regions near vessels and nerves. Mast cells were degranulated, and erythrocytes were seen leaving venules throughout the endothelial junctions. At this time, damaged endothelial cells were not observed. In rats envenomed as above, but immediately after cardiorespiratory failure induced by deep ether anaesthesia, alterations in the connective tissue structures, as previously described, were not observed. The mediation of this haemorrhage was investigated by injecting the venom into the foot pad of mice and compared to the mediation of oedema. Local haemorrhage was significantly reduced in mice pre-treated with capsaicin or guanethidine or submitted to a surgical section of sciatic and saphenous nerves. In these animals, oedema was not affected. Groups treated with methysergide or morphine showed both haemorrhage and oedema significantly reduced. Indomethacin or dexamethasone pre-treatments significantly reduced the oedema, but not the haemorrhage. Moreover, in animals treated with promethazine or mepyramine, oedema and haemorrhage were not affected. These data suggest that local haemorrhage induced by Bothrops jararaca venom is partially controlled by serotonin and neurohumoral mediators. Furthermore, results indicate that haemorrhage and oedema are mediated by different pharmacological systems. PMID:10958383

Gonçalves, L R; Mariano, M



Sequential Changes of Vascular Ultrastructure in Cerebral Vasospasm: Myonecrosis of Subarachnoid Arteries.  

National Technical Information Service (NTIS)

Cerebral vasospasm following subarachnoid hemorrhage may contribute to morbidity and mortality. The inconsistent therapeutic responses to sympatholytic agents described in the literature raise doubts as to the purely functional nature of the vasoconstrict...

J. M. Fein W. J. Flor L. J. Parkhurst J. L. Parker



Use of portal pressure studies in the management of variceal haemorrhage.  


Portal hypertension occurs as a complication of liver cirrhosis and complications such as variceal bleeding lead to significant demands on resources. Endoscopy is the gold standard method for screening cirrhotic patients however universal endoscopic screening may mean a lot of unnecessary procedures as the presence of oesophageal varices is variable hence a large time and cost burden on endoscopy units to carry out both screening and subsequent follow up of variceal bleeds. A less invasive method to identify those at high risk of bleeding would allow earlier prophylactic measures to be applied. Hepatic venous pressure gradient (HVPG) is an acceptable indirect measurement of portal hypertension and predictor of the complications of portal hypertension in adult cirrhotics. Varices develop at a HVPG of 10-12 mmHg with the appearance of other complications with HPVG > 12 mmHg. Variceal bleeding does not occur in pressures under 12 mmHg. HPVG > 20 mmHg measured early after admission is a significant prognostic indicator of failure to control bleeding varices, indeed early transjugular intrahepatic portosystemic shunt (TIPS) in such circumstances reduces mortality significantly. HVPG can be used to identify responders to medical therapy. Patients who do not achieve the suggested reduction targets in HVPG have a high risk of rebleeding despite endoscopic ligation and may not derive significant overall mortality benefit from endoscopic intervention alone, ultimately requiring TIPS or liver transplantation. Early HVPG measurements following a variceal bleed can help to identify those at risk of treatment failure who may benefit from early intervention with TIPS. Therefore, we suggest using HVPG measurement as the investigation of choice in those with confirmed cirrhosis in place of endoscopy for intitial variceal screening and, where indicated, a trial of B-blockade, either intravenously during the initial pressure study with assessment of response or oral therapy with repeat HVPG six weeks later. In those with elevated pressures, primary medical prophylaxis could be commenced with subsequent close monitoring of HVPG thus negating the need for endoscopy at this point. All patients presenting with variceal haemorrhage should undergo HVPG measurement and those with a gradient greater than 20 mmHg should be considered for early TIPS. By introducing portal pressure studies into a management algorithm for variceal bleeding, the number of endoscopies required for further intervention and follow up can be reduced leading to significant savings in terms of cost and demand on resources. PMID:22816007

Addley, Jennifer; Tham, Tony Ck; Cash, William Jonathan



An unusual presentation of bee sting: subarachnoid hemorrhagia.  


A person consists of a variety of immune reactions as a result of bee stings, depending on his/her immunologic structure. A 49-year-old male patient was brought to the emergency department because of generalized tonic clonic seizure and loss of consciousness after an hour of wild bee bite from the anterior abdomen in a rural area. After cardiopulmonary resuscitation, he was admitted to intensive care unit. Although cranial computed tomography taken in the emergency department was normal, control cranial computed tomography at the 36th hour after admission was consisted with subarachnoid hemorrhagia (SAH). The patient was diagnosed as SAH due to exposure to bee stings. The patient was treated for a month in an intensive care unit and discharged in a vegetative state. We present and discuss the case that had epileptic seizures and SAH after a bee bite, with the review of the literature. PMID:22100477

Dikici, Suber; Aydin, Leyla Yilmaz; Saritas, Ayhan; Kudas, Ozlem; Kandis, Hayati



Subarachnoid hemorrhage in a 13-year-old girl.  


At 5:20 pm, a local flight team was activated to respond for an interfacility transfer of a 13-year-old girl with a subarachnoid hemorrhage. In the history obtained, the patient's parents noted that she had not been feeling well for the past several days. She had been complaining of intermittent dizziness and a persistent headache. Until the onset of these prodromal events, she had been active with no medical history. That afternoon, the child was playing with her friends at the school playground. As the group was walking home, they noticed that the patient was not with them. They subsequently returned and found her lying face-down in the bushes, unresponsive, with agonal respirations. PMID:20826349

Tilney, Peter


A Case of Cerebral Aneurysmal Subarachnoid Hemorrhage in Fabry's Disease.  


We report an unusual case of cerebral aneurysmal subarachnoid hemorrage (SAH) with Fabry's disease. A 42-year-old woman presented with aneurysmal SAH originated from a saccular aneurysm of the right posterior communicating artery. The patient was treated by an endovascular coil embolization of aneurysm. Postoperatively the patient recovered favorably without any neurological deficit. During her admission, the patient had a sign of proteinuria in urine analysis. The pathologic findings of kidney needle biopsy implied nephrosialidosis (mucolipidosis of lysosomal stroage disease), which is consistent with a Fabry's disease. It is uncommon that Fabry's disease is presented with aneurysmal SAH, especially in middle-aged patients, but could be a clinical concern. Further investigations are needed to reveal risk factors, vascular anatomy, and causative mechanisms of Fabry's disease with aneurysmal SAH. PMID:23634271

Chang, Youn Hyuk; Hwang, Sung-Kyun



[The Factors which Affect the Neurological Condition in Subarachnoid Hemorrhage].  


The factors which were related to the neurological condition were analyzed in 233 cases of subarachnoid hemorrhage. Bivariate analysis and multiple(binomial)logistic regression analysis were performed as for Hunt & Kosnik grade, modified Rankin Scale at discharge and modified Rankin Scale in the out-patient department to detect the factors which were related to the neurological condition. Hematoma-filled intraventricular hemorrhage, intracerebral hemorrhage with midline shift, acute subdural hematoma and aneurysm of the vertebrobasilar system were the representative factors which caused poor neurological condition. Hunt & Kosnik grade was poor when rebleeding occurred or hematoma was formed in the sylvian fissure. Hunt & Kosnik grade and modified Rankin Scale at discharge tended to be poor in the cases with acute hydrocephalus. The elevation of intracranial pressure was the major factor in neurological deterioration. PMID:24091459

Oyama, Hirofumi; Wada, Kentaro; Kito, Akira; Maki, Hideki; Noda, Tomoyuki



Subarachnoid Hemorrhage Mimicking Leakage of Contrast Media After Coronary Angiography  

PubMed Central

We report a patient who developed subarachnoid hemorrhage (SAH) just after coronary angiography (CAG) with non-ionic contrast media (CM) and minimal dose of heparin. The 55-year-old man had a history of acute ST elevation myocardial infarction that had been treated with primary percutaneous coronary intervention and was admitted for a follow-up CAG. The CAG was performed by the transradial approach, using 1000 U of unfractionated heparin for the luminal coating and 70 mL of iodixanol. At the end of CAG, he complained of nausea and rapidly became stuporous. Brain CT showed a diffusely increased Hounsfield unit (HU) in the cisternal space, similar to leakage of CM. The maximal HU was 65 in the cisternal space. No vascular malformations were detected on cerebral angiography. The patient partially recovered his mental status and motor weakness after 2 days. Two weeks later, subacute SAH was evident on magnetic resonance imaging. The patient was discharged after 28 days.

Oh, Min Seok; Kwon, Jee Eun; Kim, Kyung Jun; Jo, Joon Hwan; Min, Yun Ju; Byun, Jun Soo; Kim, Kyung Tae; Kim, Sang Wook



Musical murmurs in human cerebral arteries after subarachnoid hemorrhage.  


A transcranial ultrasonic method for the recording of murmurs from cerebral vessels is described. Using the new approach the authors have observed musical murmurs of pure tone quality in 15 patients with increased flow velocities in the cerebral arteries after spontaneous subarachnoid hemorrhage (SAH). The frequency range of the pure tones was from 140 to 820 Hz, corresponding to flow velocities between 73 and 215 cm/sec. The musical murmurs occurred as a transitional state between silent flow and the well known phenomenon of bruit. They were observed between the 4th and the 20th day after SAH. The most likely cause of the musical murmur is a periodic shedding of vortices in the cerebral arteries, commonly referred to as "a von Kármán vortex street." Clinically the presence of musical murmurs indicated that pathologically increased blood velocities were present in the artery under investigation. This probably reflected the degree of spasm. PMID:6689725

Aaslid, R; Nornes, H



Acute Microvascular Changes after Subarachnoid Hemorrhage and Transient Global Cerebral Ischemia  

PubMed Central

Subarachnoid hemorrhage and transient global cerebral ischemia result in similar pathophysiological changes in the cerebral microcirculation. These changes include microvascular constriction, increased leukocyte-endothelial interactions, blood brain barrier disruption, and microthrombus formation. This paper will look at various animal and preclinical studies that investigate these various microvascular changes, perhaps providing insight in how these microvessels can be a therapeutic target in both subarachnoid hemorrhage and transient global cerebral ischemia.

Tso, Michael K.; Macdonald, R. Loch



Syringo-subarachnoid shunt for syringomyelia associated with Chiari malformation (type 1)  

Microsoft Academic Search

Summary The authors report the surgical results of 28 patients with syringomyelia associated with Chiari malformation (type 1). 28 patients underwent 34 operative procedures. Syringo-subarachnoid shunt was performed in 28 patients, foramen magnum decompression with syringo-subarachnoid shunt in three, ventriculo-peritoneal shunt in one, terminal syringostomy in one, and foramen magnum decompression with terminal syringostomy in one. In an average postoperative

T. Isu; Y. Iwasaki; M. Akino; H. Abe



Traumatic subarachnoid hemorrhage and the COL3A1 gene: emergence of a potential causal link  

Microsoft Academic Search

We describe two previously unreported associations in four cases. The first two cases demonstrate an association between segmental\\u000a mediolytic arteriopathy and vascular Ehlers-Danlos syndrome. The second two cases illustrate an association between vascular\\u000a Ehlers-Danlos syndrome and traumatic subarachnoid hemorrhage. In case 1, there was acute subarachnoid hemorrhage and mesenteric\\u000a artery dissection. In case 2, there was an acute mesenteric artery

Michael J. Pickup; Michael S. Pollanen



[Vertebral artery dissection without subarachnoid hemorrhage studied by serial angiography].  


We presented six cases we have encountered of vertebral artery dissection without subarachnoid hemorrhage followed by serial angiography. All six patients suffered from severe headache and/or nuchal pain at onset. Pain was acute at onset, with severe intensity and sharp quality and was located unilaterally on the dissection side. Only two patients showed neurological deficits. CT scan disclosed no abnormalities in any of the cases and angiography performed at the acute stage showed varied findings. The so-called pearl and string sign, which has been considered the most common finding of this disorder, was observed in only two cases. The definite diagnosis was able to be finally made by serial angiography. During the first few months after onset, dynamic changes of angiographical findings were demonstrated in all cases. During these periods, although transient deterioration of the angiographical findings was shown in four cases, spontaneous healing or improvement was finally recognized in all cases except one which progressed to total occlusion. In contrast to this, in the chronic stage, no changes of angiographical findings occurred in any of the cases. All six patients were treated non-surgically. All showed almost total recovery from symptoms and returned to their previous life styles. There were no cases of recurrent deterioration of symptoms in spite of the changes indicated by the angiographical findings. Our experience with these patients suggests that the actual incidence of vertebral artery dissection without subarachnoid hemorrhage may be much higher than is usually thought, and that the natural course of this disorder seems to be usually favorable. However, longer follow-up study and an analysis of a larger number of cases are required to identify the true incidence and the natural course of this disorder. In addition, we would like to emphasize that accurate diagnosis is most important. If it is clinically suspected, careful investigations including serial angiography should be carried out for the diagnosis of this disorder. PMID:8692370

Akiyama, Y; Itoh, T; Kumai, J; Iwamuro, Y; Miyake, H; Nishikawa, M



Immunity provided by haemorrhagic septicaemia-subunit vaccine in ruminants.  


A subunit vaccine against haemorrhagic septicaemia (HS), the principal killer disease in ruminants, especially cattle and carabao, in the Philippines, has been developed. Using capsules of Pasteurella multocida Group B as an active component of the vaccine, it gave solid protection against challenge with live organism in mice. An active calf protection test showed that in 24 hours, animals vaccinated with plain saline died after challenge compared to those given the subunit vaccine which survive the challenge dose. Using 104 cattle from a farm, the field trial of the HS subunit vaccine showed that the antibody titre was high for up to 14 months. A high titer is an indication of protection. PMID:9554285

Maslog, F S



Rodent control programmes in areas affected by Bolivian haemorrhagic fever.  


Bolivian haemorrhagic fever (BHF) caused by Machupo virus is acquired by contact with the excretions and secretions of Calomys callosus, an indigenous cricetine rodent which is preadapted to peridomestic habitats. It competes successfully with Mus musculus, but not with Rattus rattus. A successful disease control programme has functioned in Beni Department since 1964. It is based on trapping surveys and the detection of splenomegaly in Calomys rodents as an index of chronic virus infection. Mass trapping and poisoning are used initially, and regular trapping is employed to control Calomys populations in towns where disease has occurred. More than 1000 cases of BHF were recorded from 1960-1964, but less than 200 in the past 10 years. The cost of this programme is approximately $30 000 annually. PMID:182405

Mercado, R



Massive colonic haemorrhage--the case for right hemicolectomy.  

PubMed Central

A total of 14 patients had operations for massive colonic haemorrhage. Of the seven who had a right hemicolectomy, four had the bleeding site localised, and three had only 'equivocal' indications of a right-sided source. One of these rebled 11 months later, but all survived and are well. Of the remaining patients, two had left-sided resection, one requiring an immediate second operation for rebleeding, and five, subtotal colectomy, of whom two died. A literature review confirms the suggestion that if the bleeding site has not been identified but, nevertheless, there are clues suggesting it to be right-sided, the best results will be obtained by right hemicolectomy. Left-sided resection should be used only when there is proof of left-sided bleeding, otherwise there will be an unacceptably high mortality. No clues, 'equivocal' indications of a left-sided source, or the presence of bilateral disease, should lead the operator to perform subtotal colectomy.

Milewski, P. J.; Schofield, P. F.



[Fruit of the emergence of an enterovirus: acute haemorrhagic conjunctivitis].  


First seen in Ghana and Indonesia in the early 70's, acute haemorrhagic conjunctivitis or "Apollo 11" disease is an eye infection caused by Enterovirus type 70 (EV70). The disease appeared to be a highly contagious conjunctivitis which spread rapidly all over the world. EV70 has been considered as an emerging virus and was classified as a new Enterovirus. No human or animal virus genetically similar to EV70 was known before the sudden outcome of the disease in Ghana, West Africa. EV70 appeared as a pretty demonstrative example of virus emergence and virus spreading. Studies of virus genetic mutations emphasized the variations of RNA virus within a short time period. The current review presents the EV70 infection and the genetic profile of the virus from its emergence to nowadays. PMID:18957336

Sane, F; Sauter, P; Fronval, S; Goffard, A; Dewilde, A; Hober, D


The surgical management of post-partum haemorrhage.  


Life-threatening post-partum haemorrhage (PPH) occurs with a frequency of 1 per 1000 deliveries in the developed world. In the 1994-1996 Triennial Confidential Enquiry into Maternal Deaths in the United Kingdom primary PPH was responsible for five deaths. In this chapter we discuss briefly the assessment and initial medical management of the patient with primary PPH but concentrate on the surgical management where medical treatment has failed. The surgical management discussed includes both traditional or long-established management strategies together with newer, less radical surgical options, such as embolization techniques, uterine compression sutures and methods involving uterine tamponade, which are less hazardous to perform and have the advantage of preserving reproductive function. The recommendations of the reports from the Confidential Enquiries into Maternal Deaths in the UK are summarized at the end of the chapter. PMID:11866499

Tamizian, Onnig; Arulkumaran, S



Haemorrhage and coagulopathy in the Defence Medical Services.  


Over the past 12 years, the United Kingdom Defence Medical Services have evolved an integrated 'damage control resuscitation - damage control surgery' sequence for the management of patients sustaining complex injuries. During 2009, over 3200 units of blood products were administered as massive transfusions to severely injured UK personnel. An important part of the approach to traumatic bleeding is the early, empirical use of predefined ratios of blood and clotting products. As soon as control of bleeding is achieved, current practice is to switch towards a tailored transfusion, based on clinical and laboratory assessments, including point-of-care coagulation testing. A key goal is to provide resuscitation seamlessly throughout surgery, so that patients leave the operating room with their normal physiology restored. This article outlines the current management of haemorrhage and coagulation employed in Afghanistan from the point of wounding to transfer back to the National Health Service. PMID:23210556

Mercer, S J; Tarmey, N T; Woolley, T; Wood, P; Mahoney, P F



A risk scoring system for prediction of haemorrhagic stroke.  


The present pair-matched case control study was carried out at Government Medical College Hospital, Nagpur, India, a tertiary care hospital with the objective to devise and validate a risk scoring system for prediction of hemorrhagic stroke. The study consisted of 166 hospitalized CT scan proved cases of hemorrhagic stroke (ICD 9, 431-432), and a age and sex matched control per case. The controls were selected from patients who attended the study hospital for conditions other than stroke. On conditional multiple logistic regression five risk factors- hypertension (OR = 1.9. 95% Cl = 1.5-2.5). raised scrum total cholesterol (OR = 2.3, 95% Cl = 1.1-4.9). use of anticoagulants and antiplatelet agents (OR = 3.4, 95% Cl =1.1-10.4). past history of transient ischaemic attack (OR = 8.4, 95% Cl = 2.1- 33.6) and alcohol intake (OR = 2.1, 95% Cl = 1.3-3.6) were significant. These factors were ascribed statistical weights (based on regression coefficients) of 6, 8, 12, 21 and 8 respectively. The nonsignificant factors (diabetes mellitus, physical inactivity, obesity, smoking, type A personality, history of claudication, family history of stroke, history of cardiac diseases and oral contraceptive use in females) were not included in the development of scoring system. ROC curve suggested a total score of 21 to be the best cut-off for predicting haemorrhag stroke. At this cut-off the sensitivity, specificity, positive predictivity and Cohen's kappa were 0.74, 0.74, 0.74 and 0.48 respectively. The overall predictive accuracy of this additive risk scoring system (area under ROC curve by Wilcoxon statistic) was 0.79 (95% Cl = 0.73-0.84). Thus to conclude, if substantiated by further validation, this scorincy system can be used to predict haemorrhagic stroke, thereby helping to devise effective risk factor intervention strategy. PMID:16479901

Zodpey, S P; Tiwari, R R


Theoretical calculation of optimal depth in the percutaneous native kidney biopsy to drastically reduce bleeding complications and sample inadequacy for histopathological diagnosis  

Microsoft Academic Search

Background. In recent years percutaneous native kidney biopsy (PNKB) has become of very common use and safe enough for the patient if performed by skilled physicians; nevertheless, haemorrhagic compli- cations or inadequate tissue sample for the diagnosis may occur. We report here the type and the adequacy rate of specimens for diagnosis and complication rate associated with PNKB performed in

Antonio Pasquariello; Maurizio Innocenti; Valentina Batini; Giovanna Pasquariello; Sara Beati; Stefano Rindi; Sabrina Paoletti; Vincenzo Panichi


[Forensic medical assessment of the role of the injury and pathology in the development of basal subarachnoidal hemorrhage].  


The comparative analysis of clinical and pathomorphological forensic medical literature and the original investigations of basal subarachnoidal hemorrhage carried out by the author during 25 years provided a basis for morphological diagnostics of traumatic and non-traumatic subarachnoidal hemorrhage with special reference to variants of forensic medical assessment of the role of injuries and pathologies in the development of basal subarachnoidal hemorrhage. PMID:23888498

Popov, V L


Contrecoup haemorrhage in a patient with left pubic fracture but right obturator artery bleeding.  


Contrecoup injury following head trauma is well known. It is caused by the acceleration-deceleration mechanism that can be fully explained by Newton's first law of motion. We report on a victim of a motor vehicle accident with non-displacement left pubis fracture but haemorrhage from the right obturator artery. Contrecoup haemorrhage should be excluded first in unstable patients without evidence of significant trauma but with a minor pelvic fracture. PMID:17652697

Huang, Ying C; Liu, Peter; Su, Jenn-Shyan; Lin, Yi-Lii



Non-accidental subdural haemorrhage in Hong Kong: incidence, clinical features, management and outcome  

Microsoft Academic Search

Objective  We aim to identify the incidence and the characteristics of non-accidental subdural haemorrhage in Hong Kong in children under the age of 5 years.Method  Eighteen children aged below 5 years presented with subdural haemorrhage without a history of significant trauma were studied. Clinical features and the work-up process for probable child abuse were analysed.Results  Sixteen combined case conferences were held, and eleven cases were

David T. F. Sun; X. L. Zhu; W. S. Poon



Massive post-partum haemorrhage and management of disseminated intravascular coagulation  

Microsoft Academic Search

Death from haemorrhage fell in the last triennial report from 5.5 to 3.3 per million maternities in the UK. Although the Confidential Report into Maternal Deaths in the UK 1997–1999 continues to make recommendations in relation to the management of obstetric haemorrhage in an attempt to improve the overall level of care, it is disappointing that care was considered to

Sheila Macphail; Kate Talks



Single versus bilateral external ventricular drainage for intraventricular fibrinolysis in severe ventricular haemorrhage  

Microsoft Academic Search

Background:Intraventricular fibrinolysis (IVF) through bilateral external ventricular drains (EVD) may provide better access of the thrombolytic agent to the intraventricular clot, potentially influencing clot clearance and outcome.Methods:Patients with spontaneous ganglionic intracerebral haemorrhage (ICH)<40 cm3 and intraventricular haemorrhage (IVH) with acute hydrocephalus have been treated with IVF. The decision for placement of one or two EVDs has been left to the

D Staykov; H B Huttner; J Lunkenheimer; B Volbers; T Struffert; A Doerfler; O Ganslandt; E Juettler; S Schwab; J Bardutzky



Association of early post-procedure hemodynamic management with the outcomes of subarachnoid hemorrhage patients.  


Post-procedure hemodynamic management for aneurysmal subarachnoid hemorrhage is controversial because of the paucity of studied patients. Using a Japanese administrative database, we tested whether increased albumin, catecholamine, and volumes of fluid administered between the procedure and the 4th post-procedure day would be associated with outcomes of mortality, consciousness deterioration at discharge and re-intubation between the 5th and 14th post-procedure days. Across 550 hospitals, 5,400 patients were identified who received clipping, wrapping and endovascular coiling within 48 h after admission in 2010. Patient characteristics and the administration of albumin, catecholamine, and volume of fluid normalized by body weight were analyzed among the groups and categorized according to the presence of albumin and catecholamine administered between the procedure and the 4th post-procedure day. The association of early hemodynamic management with outcomes was measured using logistic regression models, through controlling for the preference of early administration of albumin and catecholamine. For the patients, 9.3 % received albumin only, 14.4 % catecholamine only, and 4.9 % both between the procedure and the 4th post-procedure day, while 16.5 % received albumin or catecholamine on other days. Variation in albumin and catecholamine administration was observed. Higher normalized fluid volume, commenced before the 4th post-procedure day, was associated with increased mortality and re-intubation (although with decreased complications), and vice versa between the 4th and 14th post-procedure days. Catecholamine administration was associated with worsened outcomes. Hypervolemic and hypertensive therapies commenced before the 4th post-procedure day require further research to determine whether their associations with outcomes in this administrative data base are causal or not. PMID:23096067

Kuwabara, Kazuaki; Fushimi, Kiyohide; Matsuda, Shinya; Ishikawa, Koichi B; Horiguchi, Hiromasa; Fujimori, Kenji



Relationship between Angiographic Vasospasm and Regional Hypoperfusion In Aneurysmal Subarachnoid Hemorrhage  

PubMed Central

Background Angiographic vasospasm frequently complicates subarachnoid hemorrhage (SAH) and has been implicated in the development of delayed cerebral ischemia. Whether large-vessel narrowing adequately accounts for the critical reductions in regional cerebral blood flow (CBF) underlying ischemia is unclear. We sought to clarify the relationship between angiographic vasospasm and regional hypoperfusion. Methods 25 patients with aneurysmal SAH underwent cerebral catheter angiography and 15O-PET imaging within 1 day of each other (median of 7 days after SAH). Severity of vasospasm was assessed in each intracranial artery while cerebral blood flow (CBF) and oxygen extraction fraction (OEF) were measured in 28 brain regions distributed across these vascular territories. We analyzed the association between vasospasm and perfusion and compared frequency of hypoperfusion (CBF < 25 ml/100g/min) and oligemia (low oxygen delivery with OEF ? 0.5) in territories with vs. without significant vasospasm. Results 24% of 652 brain regions were supplied by vessels with significant vasospasm. CBF was lower in such regions (38.6±12 vs. 48.7±16 ml/100g/min) while OEF was higher (0.48±0.19 vs. 0.37±0.14, both p<0.001). Hypoperfusion was seen in 46 regions (7%) but 66% of these were supplied by vessels with no significant vasospasm; 24% occurred in patients without angiographic vasospasm. Similarly, oligemia occurred more frequently outside territories with vasospasm. Conclusions Angiographic vasospasm is associated with reductions in cerebral perfusion. However, regional hypoperfusion and oligemia frequently occurred in territories and patients without vasospasm. Other factors in addition to large-vessel narrowing must contribute to critical reductions in perfusion.

Dhar, Rajat; Scalfani, Michael T; Blackburn, Spiros; Zazulia, Allyson R; Videen, Tom; Diringer, Michael



Predictors of Subarachnoid Hemorrhage in Acute Ischemic Stroke with Endovascular Therapy  

PubMed Central

Background and Purpose Subarachnoid hemorrhage (SAH) is a potential hemorrhagic complication after endovascular intracranial recanalization. The purpose of this study was to describe the frequency and predictors of SAH in acute ischemic stroke patients treated endovascularly, and its impact on clinical outcome. Methods Acute ischemic stroke (AIS) patients treated with primary mechanical thrombectomy, intra-arterial thrombolysis (IAT), or both were analyzed. Post-procedural CT and MR images were reviewed to identify the presence of SAH. We assessed any decline in the National Institutes of Health Stroke Scale (NIHSS) score 3 hours post-intervention and outcomes at discharge. Results One hundred twenty-eight patients were treated by primary thrombectomy with Merci Retriever devices, while 31 were treated by primary IAT. Twenty patients experienced SAH- eight with pure SAH, and twelve with co-existing parenchymal hemorrhages. SAH was numerically more frequent with primary thrombectomy than IAT groups (14.1% versus 6.5%, p=0.37). On multivariate analysis, independent predictors of SAH were hypertension (OR 5.39; p=0.035), distal middle cerebral artery (MCA) occlusion (OR 3.53; p=0.027), use of rescue angioplasty after thrombectomy (OR 12.49; p=0.004), and procedure-related vessel perforation (OR 30.72; p<0.001). Patients with extensive SAH or co-existing parenchymal hematomas tended to have more neurologic deterioration at 3 hours (28.6% versus 0%; p=0.11), to be less independent at discharge (modified Rankin Scale ? 2, 0% versus 15.4%; p=0.5); and to more often die during hospitalization (42.9% versus 15.4%; p=0.29). Conclusions Procedure-related vessel perforation, rescue angioplasty after thrombectomy with Merci devices, distal MCA occlusion, and hypertension were independent predictors of SAH following endovascular therapy for AIS. Only extensive SAH or SAH accompanied by severe parenchymal hematomas may worsen clinical outcome at discharge.

Shi, Zhong-Song; Liebeskind, David S; Loh, Yince; Saver, Jeffrey L; Starkman, Sidney; Vespa, Paul M; Gonzalez, Nestor R.; Tateshima, Satoshi; Jahan, Reza; Feng, Lei; Miller, Chad; Ali, Latisha K; Ovbiagele, Bruce; Kim, Doojin; Duckwiler, Gary R; Vinuela, Fernando



CSF 20-HETE is associated with delayed cerebral ischemia and poor outcomes after aneurysmal subarachnoid hemorrhage  

PubMed Central

Background and Purpose Delayed cerebral ischemia (DCI) is a major complication after aneurysmal subarachnoid hemorrhage (aSAH) that is manifested by changes in cerebral blood flow (CBF) accompanied by neurological decline and results in long-term functional and neuropsychological (NP) impairment. Preclinical evidence has demonstrated that the arachidonic acid metabolite, 20-hydroxyeicosatetraenoic acid (20-HETE), affects cerebral microvascular tone and CBF after aSAH. The purpose of this study was to determine if CSF 20-HETE levels were associated with DCI and long term NP outcomes in aSAH patients. Methods CSF samples collected twice daily through 14 days after hemorrhage on 108 acute, adult aSAH patients. Samples were analyzed for 20-HETE via HPLC MSQ single quadrupole mass spectrometry. DCI was defined as the presence of impaired CBF (angiographic vasospasm, elevated transcranial Dopplers, abnormal CT or MR perfusion scans) accompanied by neurological deterioration. Outcomes including death and neuropsychological testing were completed at 3 months after hemorrhage. Results and Conclusions Detectible 20-HETE levels were observed in 31% of patient samples and were associated with severity of hemorrhage (Hunt&Hess p=0.04; Fisher p=0.05). Detection of 20-HETE was not associated with angiographic vasospasm (p=0.34), however, detectible 20-HETE was significantly associated with DCI (p=0.016). Our data also suggests that detectable 20-HETE was associated with decreased performance in 5 NP domains. These results provide the first clinical evidence that CSF 20-HETE concentrations are associated with DCI and poor outcomes and provide impetus for future studies to elucidate the clinical utility of inhibiting 20-HETE formation as a novel therapeutic intervention in patients with aSAH.

Crago, Elizabeth A.; Thampatty, Bhavani P.; Sherwood, Paula R.; Kuo, Chie-Wen J.; Bender, Catherine; Balzer, Jeffrey; Horowitz, Michael; Poloyac, Samuel M.



Urea for treatment of acute SIADH in patients with subarachnoid hemorrhage: a single-center experience  

PubMed Central

Background Hyponatremia occurring as a result of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) or cerebral salt wasting syndrome is a common complication in patients with subarachnoid hemorrhage (SAH). The efficacy and safety of urea as treatment for SIADH-induced hyponatremia has not been reported in this population. Methods This is a retrospective analysis of all patients admitted to our department for nontraumatic SAH between January 2003 and December 2008 (n?=?368). All patients with SIADH-induced hyponatremia (plasma sodium??20 mEq/L, and osmolality?>?200 mOsm/kg; absence of overt dehydration or hypovolemia; no peripheral edema or renal failure; no history of adrenal or thyroid disease) routinely received urea per os when hyponatremia was associated with clinical deterioration or remained less than 130 mEq/L despite saline solution administration. Results Forty-two patients developed SIADH and were treated with urea. Urea was started after a median of 7 (IQR, 5–10) days and given orally at doses of 15–30 g tid or qid for a median of 5 (IQR, 3–7) days. The median plasma sodium increase over the first day of treatment was 3 (IQR, 1–6) mEq/L. Hyponatremia was corrected in all patients, with median times to Na+ >130 and >135 mEq/L of 1 (IQR, 1–2) and 3 (IQR, 2–4) days, respectively. Urea was well tolerated, and no adverse effects were reported. Conclusions Oral urea is an effective and well-tolerated treatment for SIADH-induced hyponatremia in SAH patients.



Chickenpox (Varicella) Complications  


... Patients who have had transplants, and People on chemotherapy, immunosuppressive medications, or long-term use of steroids. For more information, see People at High Risk for Varicella Complications . Serious complications from chickenpox include dehydration pneumonia bleeding ...


Complications of wrist arthroplasty.  


Total wrist arthroplasty is an alternative for patients with severe wrist arthritis who have specific requirements or desires to preserve motion. However, wrist replacement has its own unique risks and potential complications, and is not appropriate for patients with high physical demands. This article discusses these risks and complications and provides strategies to minimize risks and manage complications. PMID:20494747

Adams, Brian D



Late Complications of Tracheostomy  

Microsoft Academic Search

Tracheostomy may be associated with numerous acute, perioperative complications, some of which continue to be relevant well after the placement of the tracheostomy. A number of clinically important unique late complications have been recognized as well, including the formation of granulation tissue, tracheal stenosis, tracheomalacia, tracheoinnominate-artery fistula, tracheo- esophageal fistula, ventilator-associated pneumonia, and aspiration. The clinical relevance of these complications

Scott K Epstein


Complications of Tumor Ablation  

Microsoft Academic Search

Percutaneous and surgical ablation procedures are flourishing, in large part because of the relative paucity and the acceptability\\u000a of complications. However, serious and fatal complications have occurred, albeit rarely, with ablation. This chapter identifies\\u000a those complications, describes their underlying cause, and, when possible, discusses strategies to avoid them.

Lawrence Cheung; Tito Livraghi; Luigi Solbiati; Gerald D. Dodd; Eric vanSonnenberg


Dengue fever and dengue haemorrhagic fever in adolescents and adults  

PubMed Central

Dengue fever (DF) is endemic in tropical and subtropical zones and the prevalence is increasing across South-east Asia, Africa, the Western Pacific and the Americas. In recent years, the spread of unplanned urbanisation, with associated substandard housing, overcrowding and deterioration in water, sewage and waste management systems, has created ideal conditions for increased transmission of the dengue virus in tropical urban centres. While dengue infection has traditionally been considered a paediatric disease, the age distribution of dengue has been rising and more cases have been observed in adolescents and adults. Furthermore, the development of tourism in the tropics has led to an increase in the number of tourists who become infected, most of whom are adults. Symptoms and risk factors for dengue haemorrhagic fever (DHF) and severe dengue differ between children and adults, with co-morbidities and incidence in more elderly patients associated with greater risk of mortality. Treatment options for DF and DHF in adults, as for children, centre round fluid replacement (either orally or intravenously, depending on severity) and antipyretics. Further data are needed on the optimal treatment of adult patients.

Tantawichien, Terapong



Misoprostol for the prevention and treatment of postpartum haemorrhage.  


Postpartum haemorrhage (PPH) causes preventable maternal deaths, mainly in low-income countries. Misoprostol has powerful uterotonic effects and, because it is well absorbed orally and sublingually, has the potential to be used more widely than would be possible with injectable uterotonics alone. Misoprostol is clearly less effective than oxytocin. Placebo-controlled studies have had variable results, although two recent trials in low-income communities have shown promising results. The main recognized side effects have been dose-related pyrexia and shivering, including occasional hyperpyrexia. In the randomized trials reported to date, there has been a trend to more deaths with misoprostol than with the control groups. The dose that has been most commonly used in clinical trials for preventing PPH is 600 microg orally. Meta-analysis of direct and adjusted indirect comparisons between 600 and 400 microg showed very similar effectiveness. To date, there is very limited evidence for the effectiveness of misoprostol, the lowest effective dose and the magnitude of adverse effects, both direct and indirect. The need for further research is a matter of great urgency. PMID:18786863

Hofmeyr, G Justus; Gülmezoglu, A Metin



External diathermy treatment of proliferative diabetic retinopathy with vitreous haemorrhage.  

PubMed Central

Sixty-six cases of advanced proliferative diabetic retinopathy were treated by external diathermy. The eyes had extensive fibrovascular proliferations growing into the vitreous. All had some blood, recent and old, in the vitreous. The vitreous was extremely degenerated and retracted. All the patients had inadequate diabetic control. More than half were hypertensive, with reasonable medical control, while a few had some degree of renal failure, with lower limb oedema. None of the cases were suitable for photocoagulation. Thirty-two control eyes were followed up together with the treated eyes for one to eight years. Of 53 eyes of patients with maturity onset diabetes 28 improved, 12 remained unchanged, and 13 deteriorated. Only two eyes developed neovascular glaucoma, while eight of 13 eyes of patients with juvenile diabetes improved. Of the control eyes, one regressed spontaneously, six remained unchanged, and 25 deteriorated. Of these 25 eyes eight developed traction detachment, 10 suffered relentless attacks of vitreous haemorrhage, and seven developed neovascular glaucoma. External diathermy appears to be a logical approach to cases which could not be treated by either photocoagulation or vitrectomy.

Siam, A L



Syringo-Subarachnoid-Peritoneal Shunt Using T-Tube for Treatment of Post-Traumatic Syringomyelia  

PubMed Central

Various surgical procedures for the treatment of post-traumatic syringomyelia have been introduced recently, but most surgical strategies have been unreliable. We introduce the concept and technique of a new shunting procedure, syringo-subarachnoid-peritoneal shunt. A 54-year-old patient presented to our hospital with a progressive impairment of motion and position sense on the right side. Sixteen years before this admission, he had been treated by decompressive laminectomy for a burst fracture of L1. On his recent admission, magnetic resonance (MR) imaging studies of the whole spine revealed the presence of a huge syrinx extending from the medulla to the L1 vertebral level. We performed a syringo-subarachnoid-peritoneal shunt, including insertion of a T-tube into the syrinx, subarachnoid space and peritoneal cavity. Clinical manifestations and radiological findings improved after the operation. The syringo-subarachnoid-peritoneal shunt has several advantages. First, fluid can communicate freely between the syrinx, the subarachnoid space, and the peritoneal cavity. Secondly, we can prevent shunt catheter from migrating because dural anchoring of the T-tube is easy. Finally, we can perform shunt revision easily, because only one arm of the T-tube is inserted into the intraspinal syringx cavity. We think that this procedure is the most beneficial method among the various shunting procedures.

Kim, Seon-Hwan; Youm, Jin-Young; Kwon, Hyon-Jo



[Two cases of spinal arteriovenous malformation presenting with subarachnoid hemorrhage].  


Two cases of spinal arteriovenous malformation (AVM) with subarachnoid hemorrhage (SAH) are reported. The first case is that of a 14-year-old boy who was transferred to our hospital with a sudden onset of headache. Neurological examination revealed no motosensory deficit, but a brain CT showed a slight diffuse SAH. A left vertebral angiogram demonstrated intramedullary AVM in the cervical region of the spinal cord. This AVM was therefore occluded using a solid embolization material. The patient was then discharged without neurological deficit. The second case is that of a 67-year-old man who visited our hospital with a sudden onset of headache. Neurological examination revealed no motor or sensory deficit, but a brain CT showed SAH, which was dominant in the posterior fossa. Initial cerebral angiography demonstrated no abnormality such as cerebral aneurysm or AVM except for laterality of the C1 radiculo-meningeal artery. A second angiogram on day 11 demonstrated spinal arteriovenous fistula (AVF), which was fed by the left radiculo-meningeal artery and drained to the posterior spinal vein. Embolization for the AVF was performed using liquid material. He was then discharged without neurological deficit. These two cases revealed non-specific SAH symptoms and were indistinguishable from other ruptured aneurysms. Although the brain CT can show a slight SAH or posterior fossa dominant SAH, repeated angiography may be necessary to verify and conclude the diagnosis of spinal AVM. PMID:15352630

Hayashi, Kentaro; Takahata, Hideaki; Nakamura, Minoru



Subarachnoid anesthesia in a patient with type I Gaucher disease.  


Gaucher's disease is a rare genetic disorder characterized by lack or functional insufficiency of glucocerebrosidase, an enzyme accountable for intracellular hydrolysis of glucosyl ceramide and other glycosphingolipids, which results in macrophage storage in the mononuclear-macrophage system. The severity of Gaucher's disease is correlated with the extent to which the central nervous system is involved. It is associated with the so-called Gaucher's cells in the bone marrow, but is specifically diagnosed by showing enzyme acid beta-glucosidase activity in a sample of blood leukocyte or cultured macrophages from skin biopsy. In the last 10 years, an enzyme replacement therapy (alglucerase) for the disease has been available, which has significantly changed approaches to its treatment. Here we report the case of a 56-year-old female patient with type I Gaucher's disease who underwent surgery for subcapital hip fracture with subarachnoid anesthesia. Type I Gaucher's disease clinical and pathophysiologic aspects relevant to anesthetic management are discussed. As very few similar cases have been reported in the anesthesiology literature, it is our belief that the present case may help to elucidate some controversial issues relating to the perioperative anesthetic management of patients with type I Gaucher's disease. PMID:12492809

García Collada, J C; Pereda Marín, R M; Martínez, A I Garrote; Miralles Serrano, E M; Pacheco López, J F



Subarachnoid versus General Anesthesia in Penile Prosthetic Implantation: Outcomes Analyses  

PubMed Central

The leading patient complaint during the perioperative period for penile prosthesis implantation is postoperative pain, while emesis and urticaria also affect the procedure's perceived success. In analyzing surgical outcomes, assessment of the anesthetic for postoperative pain and side effects should be included. This paper retrospectively reviews 90 consecutive, primary inflatable penile prosthetic operations performed by a single surgeon at one private medical center. Fifty-seven patients were included in final analysis. Patients who had more than one procedure that day or who used chronic pain medication were excluded. The type and amount of each drug used for each respective side effect (within the first 24 hours after procedure) were compared to determine relative benefit. Twenty patients received general anesthesia (denoted herein as “GA”) and 37 received spinal (or also known as subarachnoid) anesthesia (denoted herein as “SA”). Patients receiving GA had significantly greater (P < 0.0001) occurrence and amount of intravenous pain treatment than those receiving SA. Patients with SA required less intravenous pain medication and less treatment for nausea/emesis.

Henry, Gerard D.; Sacca, Antonino; Eisenhart, Elizabeth; Cleves, Mario A.; Kramer, Andrew C.



Recent advances in diagnostic approaches for sub-arachnoid hemorrhage  

PubMed Central

Sub-arachnoid hemorrhage (SAH) has been easily one of the most debilitating neurosurgical entities as far as stroke related case mortality and morbidity rates are concerned. To date, it has case fatality rates ranging from 32-67%. Advances in the diagnostic accuracy of the available imaging methods have contributed significantly in reducing morbidity associated with this deadly disease. We currently have computed tomography angiography (CTA), magnetic resonance angiography (MRA) and the digital subtraction angiography (DSA) including three dimensional DSA as the mainstay diagnostic techniques. The non-invasive angiography in the form of CTA and MRA has evolved in the last decade as rapid, easily available, and economical means of diagnosing the cause of SAH. The role of three dimensional computed tomography angiography (3D-CTA) in management of aneurysms has been fairly acknowledged in the past. There have been numerous articles in the literature regarding its potential threat to the conventional “gold standard” DSA. The most recent addition has been the introduction of the fourth dimension to the established 3D-CT angiography (4D-CTA). At many centers, DSA is still treated as the first choice of investigation. Although, CT angiography still has some limitations, it can provide an unmatched multi-directional view of the aneurysmal morphology and its surroundings including relations with the skull base and blood vessels. We study the recent advances in the diagnostic approaches to SAH with special emphasis on 3D-CTA and 4D-CTA as the upcoming technologies.

Kumar, Ashish; Kato, Yoko; Hayakawa, Motoharu; Junpei, ODA; Watabe, Takeya; Imizu, Shuei; Oguri, Daikichi; Hirose, Yuichi



Dynamic alterations of cerebral pial microcirculation during experimental subarachnoid hemorrhage.  


The study aimed to investigate the involvement of cerebral microcirculation turbulence after subarachnoid hemorrhage (SAH). Wistar rats were divided into non-SAH and SAH groups. Autologous arterial hemolysate was injected into rat's cisterna magna to induce SAH. Changes of pial microcirculation within 2 h were observed. It was found that there were no obvious changes of the diameters, flow velocity, and fluid state of microvessels in non-SAH group. With the exception of rare linear-granular flow in A4 arteriole, linear flow was observed in most of the arterioles. There was no blood agglutination in any of the arterioles. After SAH, abnormal cerebral pial microcirculation was found. Spasm of microvessels, decreased blood flow, and agglutination of red blood cells occurred. Five minutes following the induction of SAH, the diameters of the arterioles and venules significantly decreased. The decreased diameters persisted for 2 h after cisternal injection. Decreased flow velocity of venules was found from 5 to 90 min after induction of SAH. Spasm of the basilar artery and increased brain malondialdehyde were also found after SAH. We concluded that cerebral microcirculation turbulence plays an important role in the development of secondary cerebral ischemia following SAH. PMID:18821009

Sun, Bao-Liang; Zheng, Cheng-Bi; Yang, Ming-Feng; Yuan, Hui; Zhang, Su-Ming; Wang, Le-Xin



Zinc protoporphyrin aggravates cerebral ischemic injury following experimental subarachnoid hemorrhage.  


This study was aimed to evaluate the influence of an antagonist of heme oxygenase, zinc protoporphyrin IX (ZnPPIX), on the production of endogenous carbon monoxide (CO) and the secondary cerebral injury after subarachnoid hemorrhage (SAH). Wistar rats were divided into non-SAH, SAH, and ZnPPIX groups. Autologus arterial hemolysate was injected into rat cisterna magna to induce SAH. CO and cyclic guanosine monophosphate (cGMP) levels in the brain, and lactate dehydrogenase (LDH) activity in serum were determined 24 hours and 72 hours after cisternal injection. It was found that 24 hours and 72 hours after SAH, the CO contents in SAH group were increased by 20.76% and 37.36%, respectively. CO content in ZnPPIX group was statistically lower than that in SAH group. No obvious change of cGMP content in SAH group was found. However, cGMP content in ZnPPIX group was lower than that in SAH group. Serum LDH activity increased significantly after induction of SAH. LDH activity in ZnPPIX group increased to a greater extent. It was concluded that ZnPPIX aggravates the cerebral injury secondary to experimental SAH by inhibiting the production of endogenous CO. The activation of HO/CO pathway is an intrinsic protective mechanism against cerebral ischemic injury after SAH. PMID:16543643

Sun, Bao-Liang; An, Wei; Xia, Zuo-Li; Zheng, Cheng-Bi; Li, Wen-Xia; Yang, Ming-Feng; Zhao, Tong; Ye, Wen-Jing



New insights into the structural elements involved in the skin haemorrhage induced by snake venom metalloproteinases.  


Haemorrhage induced by snake venom metalloproteinases (SVMPs) is a complex phenomenon resulting in capillary disruption and extravasation. This study analysed structural elements important for the interaction of four Bothrops jararaca SVMPs of different domain organisation and glycosylation levels with plasma and extracellular matrix proteins: HF3 (P-III class) is highly glycosylated and ~80 times more haemorrhagic than bothropasin (P-III class), which has a minor carbohydrate moiety; BJ-PI (P-I class) is not haemorrhagic and the DC protein is composed of disintegrin-like/cysteine-rich domains of bothropasin. HF3, bothropasin and BJ-PI showed different degradation profiles of fibrinogen, fibronectin, vitronectin, von Willebrand factor, collagens IV and VI, laminin and Matrigel; however, only bothropasin degraded collagen I. In solid-phase binding assays HF3 and bothropasin interacted with fibrinogen, fibronectin, laminin, collagens I and VI; the DC protein bound only to collagens I and VI; however, no binding of BJ-PI to these proteins was detected. N-deglycosylation caused loss of structural stability of bothropasin and BJ-PI but HF3 remained intact, although its haemorrhagic and fibrinogenolytic activities were partially impaired. Nevertheless, N-deglycosylated HF3 bound with higher affinity to collagens I and VI, although its proteolytic activity upon these collagens was not enhanced. This study demonstrates that features of carbohydrate moieties of haemorrhagic SVMPs may play a role in their interaction with substrates of the extracellular matrix, and the ability of SVMPs to degrade proteins in vitro does not correlate to their ability to cause haemorrhage, suggesting that novel, systemic approaches are necessary for understanding the mechanism of haemorrhage generation by SVMPs. PMID:20664911

Oliveira, Ana K; Paes Leme, Adriana F; Asega, Amanda F; Camargo, Antonio C M; Fox, Jay W; Serrano, Solange M T



Intra-alveolar haemorrhage in sudden infant death syndrome: a cause for concern?  

PubMed Central

BACKGROUND: The "Back to Sleep" campaign in 1991 resulted in a dramatic decrease in the incidence of sudden infant death syndrome (SIDS). The proportion of presumed SIDS deaths being actually suspicious deaths from airway obstruction is likely to have become relatively greater. There is usually little pathological evidence to suggest smothering, but intra-alveolar haemorrhage appears to be more prominent in cases where interference with the airway is suspected. AIM: To attempt to quantify intra-alveolar haemorrhage to see whether it could be used as a marker to distinguish between smothering/overlaying and SIDS. METHODS: Intra-alveolar haemorrhage was quantified using digital image analysis on haematoxylin/eosin stained sections taken from the lungs of 62 consecutive infants who had died suddenly and unexpectedly. Cases were initially classified according to the original cause of death. After quantitation, the case histories were critically reviewed. Three pathologists independently made microscopic assessments of the degree of intra-alveolar haemorrhage in the first 24 cases to see whether these accurately reflected the quantitative results. RESULTS: 73% of those infants with a history suggesting possible involuntary overlaying and 45% of those with a history suspicious of smothering had significant intra-alveolar haemorrhage (> 5% of total lung surface area assessed). From the history, the cause of death in 11 cases initially classified as SIDS would better have been given as "Unascertained." Simple microscopic assessments underestimated the true extent of the haemorrhage in 33% (8/24). CONCLUSIONS: If a moderate degree (at least 5%) of pulmonary parenchymal haemorrhage is observed, this may be an indicator of airway obstruction for a significant period, either from overlaying or possibly smothering. The diagnosis of SIDS may be being used inappropriately in such cases. Images

Yukawa, N; Carter, N; Rutty, G; Green, M A



A Severe Vicious Cycle in Uncontrolled Subarachnoid Hemorrhage: the Effects on Cerebral Blood Flow and Hemodynamic Responses upon Intracranial Hypertension  

Microsoft Academic Search

In subarachnoid hemorrhage (SAH), Cushing postulated that the increase in systemic arterial pressure (SAP) in response to elevation of intracranial pressure (ICP) was beneficial to cerebral perfusion. However, in uncontrolled SAH, the increased SAP may cause more bleeding into the subarachnoid space and further increase the ICP. We created an animal model to simulate SAH by connecting a femoral arterial

Chain-Fa Su; Yi-Ling Yang; Ming-Che Lee; Hsing I Chen


A long diagnostic delay in patients with Hereditary Haemorrhagic Telangiectasia: a questionnaire-based retrospective study  

PubMed Central

Background The difficulty in establishing a timely correct diagnosis is a relevant matter of concern for several rare diseases. Many rare-disease-affected patients suffer from considerable diagnostic delay, mainly due to their poor knowledge among healthcare professionals, insufficient disease awareness among patients’ families, and lack of promptly available diagnostic tools. Hereditary Haemorrhagic Telangiectasia (HHT) is an autosomal-dominantly inherited vascular dysplasia, affecting 1:5,000-10,000 patients. HHT is characterized by high variability of clinical manifestations, which show remarkable overlapping with several common diseases. Aim To perform a detailed analysis concerning the diagnostic time lag occurring in patients with HHT, defined as the time period spanning from the first clinical manifestation to the attainment of a definite, correct diagnosis. Methods A questionnaire was administered to the HHT patients previously recruited from 2000 and 2009. Clinical onset, first referral to a physician for disease manifestations, and first correct diagnosis of definite HHT were collected. Eventual misdiagnosis at first referral and serious complications occurring throughout the time elapsing between disease onset and definite diagnosis were also addressed. Results In the 233 respondents, the clinical onset of disease occurred at an age of 14.1 yrs, while the age of first referral and the age of first definite diagnosis of HHT were 29.2 yrs and 40.1 yrs, respectively. Only 88/233 patients received a correct diagnosis at first counseling. Thus, the diagnostic time lag, represented by the time elapsing from disease onset and first definite diagnosis of HHT, proved to be 25.7 yrs. Twenty-two patients suffered from severe complications during this time interval. The diagnostic delay was significantly longer (p?



Local and diffuse spread of juvenile cerebellar astrocytomas in subarachnoid space. Light and electron microscopic study.  


Based on 5 cases of juvenile astrocytomas the unusual behaviour of this type of tumor is described. It is expressed by local and/or diffuse spread of the neoplasms in the subarachnoid space of the brain hemispheres, cerebellum and spinal cord. The light and electron microscopic examinations have revealed the morphological features of well differentiated tumors of astrocytic origin and of fibrillary type which in a great number of cases have a favourable prognosis. The cause of break through into the subarachnoid space, despite its morphology which indicates on a high degree of differentiation of the tumors, is not known. The relation of primary to secondary infiltration of the subarachnoid space or of the leptomeninges is discussed. PMID:1845479

Ka?uza, J; Sidor, B; Danielewicz, A; Lesz, A; Gruszka, E



Gastro-intestinal haemorrhage risks of selective serotonin receptor antagonist therapy: a new look  

PubMed Central

AIMS (i) To determine the effects of selective serotonin reuptake inhibitors (SSRI) and other classes of antidepressants on upper gastro-intestinal (GI) haemorrhage and (ii) to assess the drug–drug interaction effects of antidepressants and warfarin or clopidogrel on the risk of GI haemorrhage. METHODS This was a population-based case control study in the General Practice Research Database (GPRD). Cases with a first episode of upper GI haemorrhage between 2000 and 2005 were matched with up to 10 controls. Exposure to the study drugs was defined by a prescription issued in the 90 days before the index date. Rate ratios were estimated using conditional logistic regression. RESULTS Four thousand and twenty-eight cases of GI haemorrhage and 40 171 controls were identified. The excess risk of GI haemorrhage with SSRI use was small (Rate Ratio [RR]: 1.3; 95% confidence interval [CI]: 1.1, 1.6) and null with exposure to tricyclic antidepressants (TCAs) (RR 1.0; 95% CI: 0.8, 1.3). The risk of GI haemorrhage was highest with venlafaxine use (RR: 1.9; 95% CI: 1.3, 2.6). There was no drug–drug interaction between warfarin anticoagulation and antidepressant use. CONCLUSIONS This study supports a small increased risk of upper GI haemorrhage with the use of SSRI antidepressants compared with the older TCA drugs, but to a lesser extent than previously reported due to confounding by alcohol use. The small elevation in risk of GI haemorrhage with SSRI and venlafaxine should be weighed against the therapeutic benefit of their use. WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT The known biological effects of selective serotonin reuptake inhibitors (SSRI) on platelets are consistent with an increased risk of gastrointestinal haemorrhage in patients on SSRI therapy.Previous research supports this increased risk among SSRI users with a large increase in bleeding risk observed. WHAT THIS STUDY ADDS This large study was able to compare the effects of different classes of antidepressant as well as to test for drug–drug interactions with warfarin.The discovery of alcohol abuse as a strong confounder may partially explain the very high risks of bleed seen in previous studies that did not adjust for this confounder.

Opatrny, Lucie; Delaney, J A 'Chris'; Suissa, Samy



[Perforation and haemorrhage duodenal bulbar ulcers in a child: a case report].  


A perforation rarely reveals a primary duodenal ulcer. The occurring of digestive haemorrhage in post operative followings evokes spontaneously a stress ulcer. We report an observation of a child who presented on fourth day delay after operation an ulcer of the anterior duodenal bulbar face and a haemorrhage of the posterior bulbar face. A 7-year-old girl with no particular pathological antecedent was admitted for abdominal pain, bile vomiting and constipation evolving since 6 days. Clinical examination revealed a general state thickening, an infectious syndrome, a meteoric and general abdominal sensitivity. The abdominal radiography without preparation showed a pneumoperitoneum. The surgical exploration discovered a perforated ulcer on the bulbar anterior face. A simple closure associated with omental patch was performed. Four days after operation, she presented an abundant digestive haemorrhage with shock. The resuscitation did not improve the patient's general state. The upper digestive endoscopy revealed a haemorrhage of the posterior bulbar face. An adrenalin injection stopped the bleeding. The treatment by neutron pump inhibitors and an eradicating treatment of Helicobacter pylori permitted the healing of the ulcers. The occurring of digestive haemorrhage in the followings of surgical intervention for perforated ulcer involves an upper digestive endoscopy. This examination can reveal misdiagnosed ulcer during the surgical exploration and permits to perform a haemostatic act. PMID:19102114

Ngom, G; Diouf, M L; Fall, M; Konaté, I; Sankalé, A A; Diop, M; Fall, I; Ndoye, M



Complication Analysis of 469 Brain Arteriovenous Malformations Treated with N-Butyl Cyanoacrylate  

PubMed Central

Summary We independently assessed the frequency, severity and determinants of neurological deficits after endovascular embolization with NBCA of brain arteriovenous malformations (BAVMs) to have a better basis for making treatment decisions. All the charts of 469 BAVMs patients who underwent embolization with NBCA were reviewed. We analyzed the complications and their relation to angiographic features. The 469 patients were treated with 1108 endovascular procedures. Each met one to eight times, average 2.3 times. Eleven patients showed treatment-related complications, including four haemorrhagic and seven ischemic complications. Of these 11 cases, two died, two had persistent disabling deficits, and another seven suffered transient neurological deficits. Our finding suggests a low rate of disabling treatment complications for embolization of brain AVMs with NBCA in this center. The management of AVM patients who have high risk of embolization therapy should be treated by special strategy.

Li, T.L.; Fang, B.; He, X.Y.; Duan, C.Z.; Wang, Q.J.; Zhao, Q.P.; Yi Fm Huan, Q.



Subarachnoid and Intracerebral Hemorrhage in Patients with Churg-Strauss Syndrome: Two Case Reports  

PubMed Central

Churg-Strauss syndrome (CSS) is a systemic necrotizing vasculitis of the small and medium vessels, associated with extravascular eosinophilic granulomas, peripheral eosinophilia, and asthma. The exact etiology of CSS is unknown. This syndrome commonly affects the lungs, peripheral nerves, skin, heart, and gastrointestinal tract, but rarely the central nervous system. Subarachnoid and intracerebral hemorrhage in CSS patients is extremely rare; however, clinicians should consider that CSS may be a cause of intracranial hemorrhage and its high rate of mortality and morbidity. The authors report on two cases of subarachnoid and intracerebral hemorrhage with CSS and discuss a brief review of CSS.

Go, Myeong Hoon; Park, Jeong Un; Kang, Jae Gyu



Clinical audit: a useful tool for reducing severe postpartum haemorrhages?  

PubMed Central

Objective Reducing the rate of severe postpartum haemorrhage (PPH) is a major challenge in obstetrics today. One potentially effective tool for improving the quality of care is the clinical audit, that is, peer evaluation and comparison of actual practices against explicit criteria. Our objective was to assess the impact of regular criteria-based audits on the prevalence of severe PPH. Design Quasi-experimental before-and-after survey Setting Two French maternity units in the Rhône-Alpes region, with different organisation of care. Participants All staff of both units. Intervention Quarterly clinical audit meetings at which a team of reviewers analysed all cases of severe PPH and provided feedback on quality of care and where all staff actively participated. Main outcome measures The primary outcome was the prevalence of severe PPH. Secondary outcomes included the global quality of care for women with severe PPH, including the performance rate for each recommended procedure. Differences in these variables between 2005 and 2008 were tested. Results The prevalence of severe PPH declined significantly in both units, from 1.52% to 0.96% of deliveries in the level III hospital (p=0.048) and from 2.08% to 0.57% in the level II hospital (p<0.001). From 2005 to 2008, the proportion of deliveries with severe PPH that were managed consistently with the guidelines increased for all of its main components, in both units. Conclusion Regular clinical audits of cases severe PPH were associated with a persistent reduction in the prevalence of severe PPH.

Dupont, Corinne; Deneux-Tharaux, Catherine; Touzet, Sandrine; Colin, Cyrille; Bouvier-Colle, Marie-Helene; Lansac, Jacques; Thevenet, Simone; Boberie-Moyrand, Claire; Piccin, Gaelle; Fernandez, Marie-Pierre; Rudigoz, Rene-Charles



Periventricular haemorrhage in very low birth weight Malaysian neonates.  


A prospective study was carried out to determine the incidence, clinical presentation, early outcome, and risk factors associated with periventricular haemorrhage (PVH) in 88 (84 per cent) of the 105 consecutive very low birth weight (VLBW) (< 1500 g) Malaysian neonates born in the Maternity Hospital, Kuala Lumpur. Based on the cranial ultrasound findings, PVH was detected in 86 of the 88 neonates (98 per cent, 95 per cent confidence intervals: 95 to 101). Seventeen (20 per cent) of them had grade I, 52 (61 per cent) had grade II, 7 (8 per cent) had grade III and 10 (12 per cent) had grade IV PVH. PVH was detected in all the affected neonates by the fifth day of life. Sixty-four neonates (74 per cent) were symptomatic when PVH was first detected. Shock (P < 0.01), pallor (P = 0.028), low haematocrit of less than 40 per cent (P < 0.01), convulsion (P < 0.001), and bulging of anterior fontanelle (P = 0.019) were significantly more common in the neonates with severe PVH (grades III or IV). Death occurred in 43/86 (50 per cent, 95 per cent confidence interval: 39-61 per cent) of the neonates with PVH before their first discharge from the hospital. Ventriculomegaly developed in 29/43 (67 per cent, 95 per cent confidence intervals: 54.4-81.4) of the survivors with PVH. Our study suggests that PVH is a common problem in the Malaysian VLBW neonates. To reduce the incidence and severity of this condition, prevention of preterm delivery and improvement in the basic facilities for neonatal care would help. PMID:8411316

Boo, N Y; Ong, L C; Lye, M S; Wong, K P; Mastura, M



Complications of nephrotic syndrome.  


Nephrotic syndrome (NS) is one of the most common glomerular diseases that affect children. Renal histology reveals the presence of minimal change nephrotic syndrome (MCNS) in more than 80% of these patients. Most patients with MCNS have favorable outcomes without complications. However, a few of these children have lesions of focal segmental glomerulosclerosis, suffer from severe and prolonged proteinuria, and are at high risk for complications. Complications of NS are divided into two categories: disease-associated and drug-related complications. Disease-associated complications include infections (e.g., peritonitis, sepsis, cellulitis, and chicken pox), thromboembolism (e.g., venous thromboembolism and pulmonary embolism), hypovolemic crisis (e.g., abdominal pain, tachycardia, and hypotension), cardiovascular problems (e.g., hyperlipidemia), acute renal failure, anemia, and others (e.g., hypothyroidism, hypocalcemia, bone disease, and intussusception). The main pathomechanism of disease-associated complications originates from the large loss of plasma proteins in the urine of nephrotic children. The majority of children with MCNS who respond to treatment with corticosteroids or cytotoxic agents have smaller and milder complications than those with steroid-resistant NS. Corticosteroids, alkylating agents, cyclosporin A, and mycophenolate mofetil have often been used to treat NS, and these drugs have treatment-related complications. Early detection and appropriate treatment of these complications will improve outcomes for patients with NS. PMID:22087198

Park, Se Jin; Shin, Jae Il



Complications of Colles' fractures.  


Patients with Colles' fractures have serious complications more frequently than is generally appreciated. A study of 565 fractures revealed 177 (31 per cent) with such complications as persistent neuropathies of the median, ulnar, or radial nerves (forty-five cases), radiocarpal or radio-ulnar arthrosis (thirty-seven cases), and malposition-malunion (thirty cases). Other complications included tendon ruptures (seven), unrecognized associated injuries (twelve), Volkmann's ischemia (four cases), finger stiffness (nine cases), and shoulder-hand syndrome (twenty cases). In many patients, incomplete restoration of radial length or secondary loss of the reduction position caused the complications. PMID:6155380

Cooney, W P; Dobyns, J H; Linscheid, R L



Gastrointestinal Complications (PDQ)  


... Fecal impaction. Bowel obstruction . Diarrhea . Radiation enteritis . This summary is about GI complications in adults with cancer. Treatment of ... Other Versions: Mobile | Español U.S. Department of ...


[Complications of mechanical ventilation].  


Mechanical ventilation of the lungs, as an important therapeutic measure, cannot be avoided in critically ill patients. However, when machines take over some of vital functions there is always a risk of complications and accidents. Complications associated with mechanical ventilation can be divided into:1) airway-associated complications; 2) complications in the response of patients to mechanical ventilation; and 3) complications related to the patient's response to the device for mechanical ventilation. Complications of artificial airway may be related to intubation and extubation or the endotracheal tube. Complications of mechanical ventilation, which arise because of the patient's response to mechanical ventilation, may primarily cause significant side effects to the lungs. During the last two decades it was concluded that mechanical ventilation can worsen or cause acute lung injury. Mechanical ventilation may increase the alveolar/capillary permeability by overdistension of the lungs (volutrauma), it can exacerbate lung damage due to the recruitment/derecruitment of collapsed alveoli (atelectrauma) and may cause subtle damages due to the activation of inflammatory processes (biotrauma). Complications caused by mechanical ventilation, beside those involving the lungs, can also have significant effects on other organs and organic systems, and can be a significant factor contributing to the increase of morbidity and mortality in critically ill of mechanically ventilated patients. Complications are fortunately rare and do not occur in every patient, but due to their seriousness and severity they require extensive knowledge, experience and responsibility by healthcare workers. PMID:22070009

Draškovi?, Biljana; Raki?, Goran


Complications of nephrotic syndrome  

PubMed Central

Nephrotic syndrome (NS) is one of the most common glomerular diseases that affect children. Renal histology reveals the presence of minimal change nephrotic syndrome (MCNS) in more than 80% of these patients. Most patients with MCNS have favorable outcomes without complications. However, a few of these children have lesions of focal segmental glomerulosclerosis, suffer from severe and prolonged proteinuria, and are at high risk for complications. Complications of NS are divided into two categories: disease-associated and drug-related complications. Disease-associated complications include infections (e.g., peritonitis, sepsis, cellulitis, and chicken pox), thromboembolism (e.g., venous thromboembolism and pulmonary embolism), hypovolemic crisis (e.g., abdominal pain, tachycardia, and hypotension), cardiovascular problems (e.g., hyperlipidemia), acute renal failure, anemia, and others (e.g., hypothyroidism, hypocalcemia, bone disease, and intussusception). The main pathomechanism of disease-associated complications originates from the large loss of plasma proteins in the urine of nephrotic children. The majority of children with MCNS who respond to treatment with corticosteroids or cytotoxic agents have smaller and milder complications than those with steroid-resistant NS. Corticosteroids, alkylating agents, cyclosporin A, and mycophenolate mofetil have often been used to treat NS, and these drugs have treatment-related complications. Early detection and appropriate treatment of these complications will improve outcomes for patients with NS.

Park, Se Jin



Tattoo-associated complications.  


Tattoo rates in the United States have been rising in recent years, with an expected concomitant rise in tattoo-associated complications. Tattoo complications range from cutaneous localized and generalized inflammatory eruptions, to local bacterial or viral infections, and finally to infectious endocarditis and hepatitis. Many complications may be avoided with proper counseling prior to tattoo placement, especially in high risk individuals. It is important for physicians to be able to recognize and diagnose complications from tattoos to avoid morbidity and possible mortality. PMID:23287600

Juhas, Elizabeth; English, Joseph C



Recent advances in diagnostic approaches for sub-arachnoid hemorrhage.  


Sub-arachnoid hemorrhage (SAH) has been easily one of the most debilitating neurosurgical entities as far as stroke related case mortality and morbidity rates are concerned. To date, it has case fatality rates ranging from 32-67%. Advances in the diagnostic accuracy of the available imaging methods have contributed significantly in reducing morbidity associated with this deadly disease. We currently have computed tomography angiography (CTA), magnetic resonance angiography (MRA) and the digital subtraction angiography (DSA) including three dimensional DSA as the mainstay diagnostic techniques. The non-invasive angiography in the form of CTA and MRA has evolved in the last decade as rapid, easily available, and economical means of diagnosing the cause of SAH. The role of three dimensional computed tomography angiography (3D-CTA) in management of aneurysms has been fairly acknowledged in the past. There have been numerous articles in the literature regarding its potential threat to the conventional "gold standard" DSA. The most recent addition has been the introduction of the fourth dimension to the established 3D-CT angiography (4D-CTA). At many centers, DSA is still treated as the first choice of investigation. Although, CT angiography still has some limitations, it can provide an unmatched multi-directional view of the aneurysmal morphology and its surroundings including relations with the skull base and blood vessels. We study the recent advances in the diagnostic approaches to SAH with special emphasis on 3D-CTA and 4D-CTA as the upcoming technologies. PMID:22347331

Kumar, Ashish; Kato, Yoko; Hayakawa, Motoharu; Junpei, Oda; Watabe, Takeya; Imizu, Shuei; Oguri, Daikichi; Hirose, Yuichi



Low-dosage Ancrod for Prevention of Thrombotic Complications after Surgery for Fractured Neck of Femur  

PubMed Central

The effect of a low-dosage regimen of ancrod in the prevention of postoperative deep vein thrombosis was assessed in 24 patients having surgical repair of fractured neck femur and compared with 25 control patients who did not receive therapy. The objective of the therapy was to lower the preoperative fibrinogen level and produce a low concentration of fibrin degradation products yet avoid the haemorrhagic complications of total defibrination. Ancrod therapy proved feasible to carry out, was not associated with haemorrhagic complications, and produced sustained, predictable reductions in fibrinogen concentration. There were seven thromboembolic complications in the control patients compared to one such complication in the ancrod-treated patients. Five deaths occurred in the control group and one in the treated group. Though the incidence of deep vein thrombosis was not apparently affected by ancrod it appeared on venography that the thrombi in the treated patients were less extensive than those in the control patients. Finally, some discrepancies in the diagnosis of deep vein thrombosis by the three techniques of clinical examination, 125I-fibrinogen scanning, and ascending venography were identified. ImagesFIG. 3

Barrie, W. W.; Wood, E. H.; Crumlish, P.; Forbes, C. D.; Prentice, C. R. M.



[Anesthesia in the pleuropulmonary complications surgery of tuberculosis: a 79 cases study].  


Reported is a retrospective study carried out from Aristide Le Dantec Hospital in patients who underwent pleuropulmonary surgery after tuberculosis complication, from June 1995 to June 1999. The aim of this study was to evaluate the anaesthesiology procedures and outcomes of tuberculosis pleuropulmonary complications surgery. Seventy nine patients were studied. Their mean age was 34.63 years, and the sex ratio was 3.14. They all underwent general anaesthesia procedures with barbituric, morphinics et myorelaxants drugs. The peroperative complications noted were distributed as follow: 50 cases of haemorrhage needing transfusion, 18 cases of hypotension associated to the anaesthesia. In the intensive care period, we have noticed 30 atelectasia cases associated to a spastic bronchopathy, 3 cases of pulmonary oedema and 1 case of pulmonary infarctus. In the postoperative period, 8 cases of hemodynamic instability occurred, including 5 cases of cardiovascular collapsus treated by filling, and 2 septic shocks cases. An infectious bronchopneumopathy was noticed on 11 patients with two cases of septicaemia. The mortality rate was 6.3% (5 cases of death). The pleuropulmonary surgery in tuberculosis complication is very haemorrhagic, and therefore require an adequate preoperative preparation. PMID:15776622

Kane, O; Diouf, E; Beye, M D; Diarra, O; Ndoye Diop, M; Diouf, M; Ndiaye, M; Ka Sall, B



A modified double injection model of cisterna magna for the study of delayed cerebral vasospasm following subarachnoid hemorrhage in rats  

PubMed Central

Delayed cerebral vasospasm following subarachnoid hemorrhage (SAH) is a serious medical complication, characterized by constriction of cerebral arteries leading to varying degrees of cerebral ischemia. Numerous clinical and experimental studies have been performed in the last decades; however, the pathophysiologic mechanism of cerebral vasospasm after SAH still remains unclear. Among a variety of experimental SAH models, the double hemorrhage rat model involving direct injection of autologous arterial blood into the cisterna magna has been used most frequently for the study of delayed cerebral vasospasm following SAH in last years. Despite the simplicity of the technique, the second blood injection into the cisterna magna may result in brainstem injury leading to high mortality. Therefore, a modified double hemorrhage model of cisterna magna has been developed in rat recently. We describe here step by step the surgical technique to induce double SAH and compare the degree of vasospasm with other cisterna magna rat models using histological assessment of the diameter and cross-sectional area of the basilar artery.



The value of perfusion computed tomography in predicting clinically relevant vasospasm in patients with aneurysmal subarachnoid hemorrhage.  


Delayed cerebral ischemia remains a severe potential complication of aneurysmal subarachnoid hemorrhage (SAH) possibly leading to death and disability. We evaluated a semiquantitative and visual analysis of perfusion computed tomography (PCT) as a predictor of clinically relevant vasospasm (CRV) in patients with aneurysmal SAH. Thirty-eight patients with aneurysmal SAH were analyzed yielding 145 PCT scans. PCT, clinical examination, and transcranial Doppler ultrasound (TCD) were performed on days 3, 7, 10, and 14 after hemorrhage. Cerebral blood flow, cerebral blood volume, and time to peak (TTP) were analyzed semiquantitatively using six regions of interest, and visually for signs of cerebral hypoperfusion. CRV was defined as secondary cerebral infarction (CI) seen on cranial computed tomography scans and/or delayed neurological deterioration (DND). CI occurred in 13 (34.2 %) and DND in 11 patients (28.9 %). With TCD as pretest, TTP had a sensitivity of 90 % and a specificity of 72 % (cutoff value, 0.963) as predictor for CI. TTP's sensitivity as predictor for DND was 90 % with a specificity of 61.1 % (cutoff value, 0.983). Visual analysis of TTP showed a negative predictive value of 100 % with a positive predictive value of 52 %. TTP is a sensitive and specific perfusion parameter in predicting CI in patients with SAH. Its use in the clinical setting may optimize the early treatment of patients at risk for vasospasm before the onset of clinical deterioration, especially when applying TCD as pretest. Further investigation in a larger patient population is required. PMID:23104502

Hickmann, Anne-Katrin; Langner, Sönke; Kirsch, Michael; Baldauf, Jörg; Müller, Cornelia; Khaw, Alexander; Schroeder, Henry W S



Subarachnoid Hemorrhage in Type 1 Diabetes: A prospective cohort study of 4,083 patients with diabetes.  


OBJECTIVE To estimate for the first time the incidence of subarachnoid hemorrhage (SAH) in type 1 diabetes. RESEARCH DESIGN AND METHODS Using the nationwide Finnish Diabetic Nephropathy (FinnDiane) Study cohort of 4,083 patients with type 1 diabetes (mean age of 37.4 ± 11.8 years at enrollment), we analyzed the incidence of first-ever SAH events. RESULTS During the follow-up time of 36,680 person-years (median 9.4 years), 15 patients with type 1 diabetes experienced an aneurysmal or nonaneurysmal SAH, and thus the crude incidence of SAH was 40.9 (95% CI 22.9-67.4) per 100,000 person-years. One patient had a verified aneurysmal SAH, and four patients died suddenly of an SAH, which was most likely caused by an aneurysm. SAHs in 10 out of 15 patients were classified as nonaneurysmal SAH, and thus the crude incidence of nonaneurysmal SAH was 27.3 (13.1-50.1) per 100,000 person-years. None of the nonaneurysmal SAHs were fatal. In univariate analysis, current smokers had a hazard ratio of 4.82 (95% CI 1.31-17.81) for nonaneurysmal SAH. CONCLUSIONS The incidence of nonaneurysmal SAH is high among patients with type 1 diabetes. Our findings suggest that nonaneurysmal SAH is a distinct new microvascular complication in type 1 diabetes. PMID:23877984

Korja, Miikka; Thorn, Lena M; Hägg, Stefanie; Putaala, Jukka; Liebkind, Ron; Harjutsalo, Valma; Forsblom, Carol M; Gordin, Daniel; Tatlisumak, Turgut; Groop, Per-Henrik



Shunt-dependent hydrocephalus following subarachnoid hemorrhage correlates with increased S100B levels in cerebrospinal fluid and serum.  


Posthemorrhagic hydrocephalus requiring permanent ventriculoperitoneal shunt placement is a major complication of aneurysmal subarachnoid hemorrhage (SAH). High S100B serum and cerebrospinal fluid (CSF) levels are considered to reflect the severity of brain injury. We prospectively assessed whether S100B levels in serum and CSF were predictive parameters for permanent shunt requirement following aneurysmal SAH. In patients suffering from aneurysmal SAH and treated with an external ventricular drain (EVD), S100B levels in serum and CSF were measured daily as long as the EVD was in place. S100B levels of patients who passed their EVD challenge were compared with those patients who required a permanent ventriculoperitoneal shunt placement. Out of 68 patients included in the study, 43 patients (63.2%) passed the EVD challenge and in 25 patients (36.8%) permanent ventriculoperitoneal shunting was performed. Group comparison revealed that in patients who required shunt placement, S100B was significantly higher in CSF (p < 0.05 at days 2, 4, 6, 10; p < 0.005 at days 1, 3, 5, 7, 8, 9) and serum (p < 0.05 at days 4-7) compared with patients who could be weaned from the EVD. Assessment of S100B levels in CSF and serum may be useful as a predictive parameter for shunt dependency in patients with posthemorrhagic hydrocephalus following aneurysmal SAH. PMID:22327696

Brandner, S; Xu, Y; Schmidt, C; Emtmann, Irene; Buchfelder, Michael; Kleindienst, Andrea



Haemorrhagic nephritis and enteritis of geese: pathomorphological investigations and proposed pathogenesis.  


Haemorrhagic nephritis and enteritis of geese as a new disease was first described in Hungary in 1969. The authors identified the causative agent of the outbreaks occurring in 1969 as a polyomavirus by PCR in 2001. In order to study the pathogenesis of the virus, one-day-old goslings were infected with tissue homogenate that tested positive for polyomavirus by PCR. Morphological, light and transmission electron microscopic (TEM) examinations have revealed that goose haemorrhagic polyomavirus replicates in the endothelial cells of the blood vessels and capillaries of diseased birds. Infection causes damage and necrosis of the endothelial cells. The virus was not observed in the parenchymal cells. Oedema and haemorrhages found throughout the body may be due to the dysfunction or functional deficiency of endothelial cells damaged by the virus. PMID:15959979

Dobos-Kovács, M; Horváth, E; Farsang, A; Nagy, Edith; Kovács, Andrea; Szalai, F; Bernáth, S



Field evidence for mechanical transmission of rabbit haemorrhagic disease virus (RHDV) by flies (Diptera: Calliphoridae) among wild rabbits in Australia  

Microsoft Academic Search

Field collected flies were screened for the presence of rabbit haemorrhagic disease virus (RHDV) by applying reverse transcriptase PCR (RT-PCR) in which primers specific to the capsid protein of the virus were used. The virus was detected in flies from locations where rabbit haemorrhagic disease (RHD) was reported and also soon after the release of RHDV in a `clean' area.

Sassan Asgari; Jonathan R. E Hardy; Ron G Sinclair; Brian D Cooke



2012 outbreak of acute haemorrhagic conjunctivitis in Indian Ocean Islands: identification of Coxsackievirus A24 in a returned traveller.  


In May 2012, a Coxsackievirus A24 haemorrhagic conjunctivitis was diagnosed in Marseille, France, in a traveller returning from the Comoros Islands. This case allowed identification of the cause of an ongoing outbreak of haemorrhagic conjunctivitis in Indian Ocean Islands, illustrating that returning travellers may serve as sentinels for infectious diseases outbreaks in tropical areas where laboratory investigation is limited. PMID:22687914

Aubry, C; Gautret, P; Nougairede, A; Dussouil, A S; Botelho-Nevers, E; Zandotti, C; De Lamballerie, X; Brouqui, P; Parola, P



Effect of recombinant tissue plasminogen activator on clot lysis and ventricular dilatation in the treatment of severe intraventricular haemorrhage  

Microsoft Academic Search

Summary Twelve patients with severe intraventricular haemorrhage (IVH) underwent intraventricular thrombolysis with recombinant tissue plasminogen activator (rtPA). External ventricular drainage was performed in all patients within 24 hours of haemorrhage. Fibrinolytic therapy was started within 24 hours from the onset of symptoms in ten cases, and in two further cases after 48 hours and 5 days, respectively. Two to 5

L. Mayfrank; B. Lippitz; M. Groth; H. Bertalanffy; J. M. Gilsbach



Early complications following haematopoietic SCT in children.  


Early complications can be defined as those occurring within 100 days after transplant. Both epithelial and endothelial damage represent the pathogenetic basis for the onset of the most frequent complications. Clinical features related to endothelial damage depend on the involved district or on the grade and type of general distribution. Veno-occlusive disease (VOD) most often occurs within the first 20 days of haematopoietic SCT (HSCT) and is characterized by the obstruction of small intrahepatic venules and is caused by an initial injury of the sinusoid endothelial cells. The incidence in children ranges between 27 and 40%, and symptoms include hepatomegaly, portal hypertension and ascites. Early intervention with defibrotide (DF) proved to be effective for the treatment; however, overall mortality ranges between 20 and 50%. Thrombotic microangiopathy (TAM) incidence is 4-13%. It is often associated with the use of CYA or tacrolimus, and symptoms include haemolytic anaemia, thrombocytopenia and renal and/or central nervous system impairment. Treatment includes plasmapheresis and supportive care. The promising role of DF needs to be confirmed. The onset of engraftment syndrome may occur 1 or 2 days before the neutrophil count in peripheral blood increases. Clinical symptoms include fever not related to infection, respiratory involvement with pulmonary infiltrates or hypoxia and skin rash. Treatment consists of steroid administration for a few days. Haemorrhagic cystitis (HC) may occur early or later following transplant. Early-onset HC is related to mucosal damage caused by the catabolites of chemotherapy drugs, and late-onset HC is mostly caused by viral infections. The incidence ranges between 1 and 25%. Clinical symptoms include haematuria and dysuria without infections. Treatment includes hyperhydration and platelet support. In case of vescical clots, bladder irrigation is indicated. In advanced cases, hyperbaric oxygen administration or surgery may be useful. The use of cidofovir for BK virus-related HC seems encouraging, but further studies are needed to confirm its real efficacy. PMID:18545243

Miano, M; Faraci, M; Dini, G; Bordigoni, P



Acute upper gastrointestinal haemorrhage in west of Scotland: case ascertainment study.  

PubMed Central

OBJECTIVES: To determine the incidence and case fatality of acute upper gastrointestinal haemorrhage in the west of Scotland and to identify associated factors. DESIGN: Case ascertainment study. SETTING: All hospitals treating adults with acute upper gastrointestinal haemorrhage in the west of Scotland. SUBJECTS: 1882 patients aged 15 years and over treated in hospitals for acute upper gastrointestinal haemorrhage during a six month period. MAIN OUTCOME MEASURES: Incidence of acute upper gastrointestinal haemorrhage per 100,000 population per year, and case fatality. RESULTS: The annual incidence was 172 per 100,000 people aged 15 and over. The annual population mortality was 14.0 per 100,000. Both were higher among elderly people, men, and patients resident in areas of greater social deprivation. Overall case fatality was 8.2%. This was higher among those who bled as inpatients after admission for other reasons (42%) and those admitted as tertiary referrals (16%). Factors associated with increased case fatality were age, uraemia, pre-existing malignancy, hepatic failure, hypotension, cardiac failure, and frank haematemesis or a history of syncope at presentation. Social deprivation, sex, and anaemia were not associated with increased case fatality after adjustment for other factors. CONCLUSIONS: The incidence of acute upper gastrointestinal haemorrhage was 67% greater than the highest previously reported incidence in the United Kingdom, which may be partially attributable to the greater social deprivation in the west of Scotland and may be related to the increased prevalence of Helicobacter pylori. Fatality after acute upper gastrointestinal haemorrhage was associated with age, comorbidity, hypotension, and raised blood urea concentrations on admission. Although deprivation was associated with increased incidence, it was not related to the risk of fatality.

Blatchford, O.; Davidson, L. A.; Murray, W. R.; Blatchford, M.; Pell, J.



Anastomotic Complications after Esophagectomy  

Microsoft Academic Search

Anastomotic complications after esophagectomy continue to be a burden jeopardizing the quality of life and of swallowing. However, incidence, mortality and morbidity of anastomotic complications have substantially decreased in recent years. It seems that this is not so much related to the use of a particular conduit, approach or route for reconstruction, but rather related to refinement in anastomotic techniques

T. Lerut; W. Coosemans; G. Decker; P. De Leyn; P. Nafteux; D. Van Raemdonck



Complications of endoscopic neurosurgery  

Microsoft Academic Search

Neuroendoscopy is rapidly becoming an essential part of the neurosurgeon's repertoire. Currently, very few studies have identified the complications of this new technique, yet many have warned of the steep learning curve associated with its practice. We have reviewed the last 173 neuroendoscopic procedures performed by one surgeon and identified two distinct groups of complications: those that have clinically significant

Charles Teo; Salim Rahman; Frederick A. Boop; Bruce Cherny



Complications of enteral nutrition.  

PubMed Central

Complications may arise during enteral feeding that are usually related to the diameter and rigidity of the tube or the delivery, composition, and sterility of the feed uses. By using a soft, fine bore tube to deliver a sterile feed of known composition, by continuous infusion rather than as a bolus, most of these complications can be avoided.

Bastow, M D



Technetium labelled red blood cell scintigraphy in the diagnosis of intestinal haemorrhage.  

PubMed Central

99m-Technetium labelled red blood cell scintigraphy was used in the investigation of 15 adult patients with suspected small or large bowel bleeding requiring at least five units of blood (mean 14.3 units) and one neonate with rectal bleeding. Scintigraphy was found to be an accurate method of detecting the site of haemorrhage and was superior to angiography. This technique may be of particular value in patients with profuse colonic haemorrhage when the view at colonoscopy is poor. Images Fig. 1 Fig. 2 Fig. 3

Harvey, M. H.; Neoptolemos, J. P.; Watkin, E. M.; Cosgriff, P.; Barrie, W. W.