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1

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

2012-01-01

2

Antifibrinolytic agents in subarachnoid haemorrhage  

Microsoft Academic Search

For many years clinicians have used antifibrinolytic agents to try to reduce rebleeding after subarachnoid haemorrhage. Early studies of their effectiveness produced conflicting results. This paper re-evaluates the available trials and considers benefits in the light of potential complications. Present evidence conclusively demonstrates that epsilon-aminocaproic acid and tranexamic acid administered in standard dosage, reduce the risk of rebleeding but, as

K. W. Lindsay

1987-01-01

3

Management of aneurysmal subarachnoid haemorrhage.  

PubMed

Aneurysmal subarachnoid haemorrhage (aSAH) occurs as a result of rupture of an intracranial aneurysm and affects a younger population compared with ischaemic stroke or intracerebral haemorrhage. Although it makes up only about 5% of all cerebrovascular events, it accounts for over a quarter of the productive life-years lost to stroke. Its surgical and medical treatment represents a multidisciplinary effort. We herein provide an overview of current management options for aSAH. PMID:24782062

Schattlo, Bawarjan; Fathi, Ali-Reza; Fandino, Javier

2014-01-01

4

Takotsubo cardiomyopathy following subarachnoid haemorrhage.  

PubMed

A 67-year-old woman was admitted with aneurysmal subarachnoid haemorrhage and a 12-lead ECG showed ST segment elevation. Transthoracic echocardiography confirmed akinesis of the left ventricular mid-apical segment, with an ejection fraction of 26%, features characteristic of takotsubo cardiomyopathy. Five days later, we identified thrombus in the apex of the left ventricle. Sixteen days after onset, the thrombus had disappeared and wall motion improved (ejection fraction 58%) without evidence of cardioembolism. Takotsubo cardiomyopathy is a cause of cardiac dysfunction after stroke, including SAH. It is characterised by transiently depressed contractile function of the left mid and apical ventricle, without obstructive coronary artery disease. Clinicians should suspect takotsubo cardiomyopathy in patients with subarachnoid haemorrhage who have an ECG abnormality. Echocardiography is needed to detect the distinctive regional wall motion abnormality. Despite its severity in the acute phase, takotsubo cardiomyopathy is self-limiting and its management is conservative. PMID:24101552

Maekawa, Hidetsugu; Hadeishi, Hiromu

2014-08-01

5

Subarachnoid haemorrhage in children caused by cerebral tumour.  

PubMed Central

Subarachnoid haemorrhage in children is uncommon. In a review of 110 children with an intracranial tumour over a 20 year period there were four patients (3.6%) who presented with the typical features of a subarachnoid haemorrhage. During the same period of time there were 15 children who presented with subarachnoid haemorrhage of which 26% were secondary to a cerebral tumour. This study suggests that cerebral tumour is a common cause of subarachnoid haemorrhage in children.

Wong, G; Knuckey, N W; Gubbay, S S

1983-01-01

6

Isolated trochlear nerve palsy with perimesencephalic subarachnoid haemorrhage  

PubMed Central

Perimesencephalic subarachnoid haemorrhage is usually asymptomatic other than meningeal irritation sign. The authors report a case of subarachnoid haemorrhage at the quadrigeminal cistern showing ipsilateral trochlear nerve palsy and discuss the pathogenesis. A 71-year-old man with a history of diabetes mellitus and acute myocardial infarction presented with diplopia. He underwent CT, which revealed subarachnoid haemorrhage at the left quadrigeminal cistern. Neurological examination revealed left isolated trochlear nerve palsy, with results otherwise normal. The diagnosis of perimesencephalic subarachnoid haemorrhage was established on neuroimaging. The amount of haemorrhage is related to symptoms. A dense clot in the quadrigeminal cistern might have been the cause of trochlear nerve palsy.

Adachi, Koji; Hironaka, Kouhei; Suzuki, Hisaharu; Oharazawa, Hideaki

2012-01-01

7

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

PubMed

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

2012-01-01

8

Delayed neurological deterioration after subarachnoid haemorrhage.  

PubMed

Subarachnoid haemorrhage (SAH) causes early brain injury (EBI) that is mediated by effects of transient cerebral ischaemia during bleeding plus effects of the subarachnoid blood. Secondary effects of SAH include increased intracranial pressure, destruction of brain tissue by intracerebral haemorrhage, brain shift, and herniation, all of which contribute to pathology. Many patients survive these phenomena, but deteriorate days later from delayed cerebral ischaemia (DCI), which causes poor outcome or death in up to 30% of patients with SAH. DCI is thought to be caused by the combined effects of angiographic vasospasm, arteriolar constriction and thrombosis, cortical spreading ischaemia, and processes triggered by EBI. Treatment for DCI includes prophylactic administration of nimodipine, and current neurointensive care. Prompt recognition of DCI and immediate treatment by means of induced hypertension and balloon or pharmacological angioplasty are considered important by many physicians, although the evidence to support such approaches is limited. This Review summarizes the pathophysiology of DCI after SAH and discusses established treatments for this condition. Novel strategies--including drugs such as statins, sodium nitrite, albumin, dantrolene, cilostazol, and intracranial delivery of nimodipine or magnesium--are also discussed. PMID:24323051

Macdonald, R Loch

2014-01-01

9

Prognosis and treatment of acute hydrocephalus following aneurysmal subarachnoid haemorrhage  

Microsoft Academic Search

The aim of this study was to determine the rate of acute hydrocephalus in patients with aneurysmal subarachnoid haemorrhage (SAH) and evaluate its clinical prognosis and treatment options. We recruited 152 patients who had cerebral aneurysms between 2006 and 2010. Sequential CT scans were performed 24–72hours after haemorrhage to examine the development of acute hydrocephalus following aneurysmal SAH. If hydrocephalus

Jingjing Lu; Nan Ji; Zhonghua Yang; Xingquan Zhao

10

Cerebral blood velocity in subarachnoid haemorrhage: a transcranial Doppler study.  

PubMed Central

A study examining the utility of transcranial Doppler ultrasound for the determination of cerebral vasospasm following subarachnoid haemorrhage is reported. A control group of 21 patients and a second group of 20 patients suffering from subarachnoid haemorrhage or aneurysm and a group of 26 with other intracranial pathologies were studied. The Doppler flow velocity (DFV) was significantly higher when vasospasm was present. If it was higher than 100 cm/s, the patients were found to have vasospasm in 80% of cases. If Doppler flow velocity was below 100, less than 10% had spasm. Doppler flow velocity was not found to increase following craniotomy in patients not suffering from subarachnoid haemorrhage. In subarachnoid haemorrhage patients there was a trend to increased Doppler flow velocity especially in patients who developed neurological deficit. Doppler flow velocity and Initial Slope Index by xenon clearance (ISI) were not found to correlate with clinical grade. The ISI/DFV quotient (which can be shown mathematically to be related to vessel diameter) was found to correlate well with clinical grade. In this largely post-operative group, absolute levels, or rate of change of Doppler flow velocity could not be shown to be related to the onset or existence of neurological deficit.

Compton, J S; Redmond, S; Symon, L

1987-01-01

11

Beta-Cell Dysfunction and Insulin Resistance after Subarachnoid Haemorrhage  

Microsoft Academic Search

Background: Hyperglycaemia is a common finding and an independent risk factor for increased morbidity and mortality in aneurysmal subarachnoid haemorrhage (SAH). Although in these patients hyperglycaemia is commonly ascribed to insulin resistance, there is little understanding of underlying mechanisms. Aims: To prospectively study temporal disturbances of glucose metabolism after aneurysmal SAH in patients without known abnormalities of glucose metabolism and

N. D. Kruyt; A. Musters; G. J. Biessels; J. H. DeVries; B. A. Coert; M. D. I. Vergouwen; J. Horn; Y. B. Roos

2011-01-01

12

Can CT angiography rule out aneurysmal subarachnoid haemorrhage in CT scan-negative subarachnoid haemorrhage patients?  

PubMed

Current management guidelines for CT scan-negative subarachnoid haemorrhage (SAH) patients recommend cerebral digital subtraction angiography (DSA). We aimed to investigate the utility of CT angiography (CTA) as a substitute for DSA in these patients. We included patients who presented with SAH confirmed by spectrophotometric xanthochromia analysis of cerebrospinal fluid (CSF) whereby the CT scan was negative. Electronic records were reviewed to collect data on non-contrast CT scan, CTA and DSA results. Patients without DSA or with other explanations for CSF xanthochromia were excluded. Sixty-three patients with CT scan-negative SAH were included. The diagnosis of SAH was confirmed by CSF analysis. All 63 patients underwent both DSA and CTA. Using DSA as the benchmark, CTA demonstrated a negative predictive value, positive predictive value, sensitivity and specificity of 98%, 82%, 90% and 96%, respectively, for the detection of intracranial aneurysms. CTA correctly identified patients in whom there were no underlying aneurysms responsible for SAH, with one patient with suspected dissection referred for further evaluation using MRI and DSA. PMID:23954458

Lim, Lee Kai; Dowling, Richard J; Yan, Bernard; Mitchell, Peter J

2014-01-01

13

Prognosis and treatment of acute hydrocephalus following aneurysmal subarachnoid haemorrhage.  

PubMed

The aim of this study was to determine the rate of acute hydrocephalus in patients with aneurysmal subarachnoid haemorrhage (SAH) and evaluate its clinical prognosis and treatment options. We recruited 152 patients who had ruptured cerebral aneurysms between 2006 and 2010. Sequential CT scans were performed 24-72 hours after haemorrhage to examine the development of acute hydrocephalus following aneurysmal SAH. If hydrocephalus was present but the patient's condition was stable, the patient was closely monitored for 48 hours before undergoing a repeat CT scan to evaluate ventricular changes. To exclude aneurysm rebleeding, repeat CT scans were performed frequently in patients who continued to deteriorate clinically, and external ventricular drainage was performed if the deterioration was due to worsening hydrocephalus. In clinically stable patients with persistent hydrocephalus and patients with external ventricular drainage, lamina terminalis fenestration was performed during aneurysm clipping, and the procedure's therapeutic efficacy was evaluated at the postoperative follow-up. The overall incidence of acute hydrocephalus following aneurysmal SAH was 17.8% (27/152). Of these patients, 29.6% (eight of 27) recovered spontaneously within 48 hours of hydrocephalus development, 37.0% (10/27) required external ventricular drainage, and 33.3% (nine of 27) remained clinically stable with persistent hydrocephalus during the observational period. Hydrocephalus was significantly alleviated in eight of 11 patients who underwent lamina terminalis fenestration, and no related complications were observed during follow-up. Three patients, for whom intraoperative fenestration was ineffective, underwent shunt surgery. Our results showed approximately 30% of patients with acute hydrocephalus following aneurysmal SAH recover spontaneously. In the majority of patients with persistent hydrocephalus, lamina terminalis fenestration performed during aneurysm clipping is effective. Ventriculoperitoneal shunting can be considered in the remaining patients. PMID:22361252

Lu, Jingjing; Ji, Nan; Yang, Zhonghua; Zhao, Xingquan

2012-05-01

14

ECG abnormalities in predicting secondary cerebral ischemia after subarachnoid haemorrhage  

Microsoft Academic Search

Summary  \\u000a Background. Electrocardiographic (ECG) abnormalities frequently occur after subarachnoid haemorrhage (SAH), and have been linked with\\u000a poor outcome. The pathogenesis behind this relation is unclear. We hypothesized that cardiac dysfunction may contribute to\\u000a the development of delayed cerebral ischemia (DCI) and investigated if electrocardiographic repolarization abnormalities on\\u000a admission, representing this cardiac dysfunction, are related to DCI. We also assessed the

W. J. Schuiling; A. Algra; A. W. de Weerd; P. Leemans; G. J. E. Rinkel

2006-01-01

15

Basilar Vasospasm Following Spontaneous and Traumatic Subarachnoid Haemorrhage: Clinical Implications  

Microsoft Academic Search

Summary.\\u000a Summary.  \\u000a ?\\u000a \\u000a \\u000a \\u000a \\u000a Background:   Cerebral vasospasm has been commonly described following subarachnoid haemorrhage (SAH) though its impact on neurological\\u000a outcome, especially in head trauma, has not been yet elucidated. The purpose of this study was to monitor and correlate neurological\\u000a condition and flow velocities (FVs) in the arteries of the brain after SAH and more particularly to investigate the influence

J. F. Soustiel; V. Shik; M. Feinsod

2002-01-01

16

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

PubMed

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

2013-06-11

17

Bleeding in the subarachnoid space: a possible complication during laser therapy for equine progressive ethmoid haematoma.  

PubMed

A 10-year-old KWPN (Royal Warmblood Studbook of the Netherlands) gelding was euthanized after developing severe neurological symptoms preceded by severe epistaxis during laser treatment for progressive ethmoid haematoma (PEH) in the right nasal cavity. Postmortem examination of the head revealed a large amount of clotted blood between the right ventral and dorsal conchae in the nasal cavity and acute haemorrhage in the right subarachnoid space. Histologically, there was moderate, acute polioencephalomalacia in the neuropil adjacent to the haemorrhage. The haemorrhages were most likely caused by the laser treatment and therefore should be considered a possible complication that could lead to severe peracute neurological symptoms. PMID:24199337

Vreman, S; Wiemer, P; Keesler, R I

2013-10-01

18

Investigation of subarachnoid haemorrhage: Does the buck stop with CT?  

PubMed Central

Background and Aim: In patients suspected of having a subarachnoid haemorrhage (SAH), a normal CT should be followed by lumbar puncture (LP) to detect xanthochromia. We studied the practice of performing a LP following a normal CT in patients with a clinical suspicion of SAH in a District General Hospital. We aimed to assess whether patients were being fully investigated for SAH and whether standards were being met. Methods: This was a prospective study aiming to improve the patient's care by implementing the best practice. We initially recorded CT and LP results of patients with suspected SAH (phase 1) and presented the results to the referring clinicians. After a period of time, data was re–collected to study any change in practice (phase 2). Results: In phase 1, 36 of 61 patients (59.0%) with a normal CT had a subsequent LP compared to 67/104 (64.4%) in the second phase (p=0.51). In the first phase, xanthochromia was detected in 1 of 36 patients (2.8%) who had a LP following a normal CT, compared to 1 of 67 patients (1.5%) in the second phase (p=1.0). Conclusion: Approximately a third of patients with symptoms of SAH in both study periods did not undergo LP following a normal CT scan. This is an important finding, as it is known that a normal CT does not exclude the diagnosis of SAH and by not proceeding to LP, patients have not been fully investigated for a SAH.

Sookhoo, S; Kolla, S; Halbert, H; Lavell, K; England, S

2010-01-01

19

Possible interpretation of subjective complaints in patients with spontaneous subarachnoid haemorrhage  

Microsoft Academic Search

Objective: To analyse factors related to subjective non- cognitive and cognitive complaints in patients with sponta- neous subarachnoid haemorrhage. Subjects: Twenty-seven patients with subarachnoid haemor- rhage and 27 age-, sex- and education-matched healthy controls. Methods: A battery of cognitive tests measuring visuo-spatial abilities, verbal abilities, and fine-motor skill, Brief Social Support Questionnaire, and Life Orientation Scale were individually presented to

Aaro Toomela; Aleksander Pulver; Tiiu Tomberg; Anu Orasson; Arvo Tikk; Toomas Asser

2004-01-01

20

Magnesium for aneurysmal subarachnoid haemorrhage (MASH-2): a randomised placebo-controlled trial  

PubMed Central

Summary Background Magnesium sulphate is a neuroprotective agent that might improve outcome after aneurysmal subarachnoid haemorrhage by reducing the occurrence or improving the outcome of delayed cerebral ischaemia. We did a trial to test whether magnesium therapy improves outcome after aneurysmal subarachnoid haemorrhage. Methods We did this phase 3 randomised, placebo-controlled trial in eight centres in Europe and South America. We randomly assigned (with computer-generated random numbers, with permuted blocks of four, stratified by centre) patients aged 18 years or older with an aneurysmal pattern of subarachnoid haemorrhage on brain imaging who were admitted to hospital within 4 days of haemorrhage, to receive intravenous magnesium sulphate, 64 mmol/day, or placebo. We excluded patients with renal failure or bodyweight lower than 50 kg. Patients, treating physicians, and investigators assessing outcomes and analysing data were masked to the allocation. The primary outcome was poor outcome—defined as a score of 4–5 on the modified Rankin Scale—3 months after subarachnoid haemorrhage, or death. We analysed results by intention to treat. We also updated a previous meta-analysis of trials of magnesium treatment for aneurysmal subarachnoid haemorrhage. This study is registered with controlled-trials.com (ISRCTN 68742385) and the EU Clinical Trials Register (EudraCT 2006-003523-36). Findings 1204 patients were enrolled, one of whom had his treatment allocation lost. 606 patients were assigned to the magnesium group (two lost to follow-up), 597 to the placebo (one lost to follow-up). 158 patients (26·2%) had poor outcome in the magnesium group compared with 151 (25·3%) in the placebo group (risk ratio [RR] 1·03, 95% CI 0·85–1·25). Our updated meta-analysis of seven randomised trials involving 2047 patients shows that magnesium is not superior to placebo for reduction of poor outcome after aneurysmal subarachnoid haemorrhage (RR 0·96, 95% CI 0·86–1·08). Interpretation Intravenous magnesium sulphate does not improve clinical outcome after aneurysmal subarachnoid haemorrhage, therefore routine administration of magnesium cannot be recommended. Funding Netherlands Heart Foundation, UK Medical Research Council.

Mees, Sanne M Dorhout; Algra, Ale; Vandertop, W Peter; van Kooten, Fop; Kuijsten, Hans AJM; Boiten, Jelis; van Oostenbrugge, Robert J; Salman, Rustam Al-Shahi; Lavados, Pablo M; Rinkel, Gabriel JE; van den Bergh, Walter M

2012-01-01

21

Incidence and outcome of subarachnoid haemorrhage: a retrospective population based study  

PubMed Central

OBJECTIVES—The purpose was to define the incidence and case fatality rates of subarachnoid haemorrhage in the population of Devon and Cornwall.?METHODS—A retrospective population based design was employed with multiple overlapping methods of case ascertainment. A strict definition of subarachnoid haemorrhage was used. Age and sex specific incidence rates and relative risks for death at different time intervals are calculated.?RESULTS—Eight hundred cases of first ever subarachnoid haemorrhage were identified; 77% of cases were verified by CT, 22% by necropsy, and 1% by lumbar puncture. The incidence rates are higher than those previously reported in the United Kingdom. The age standardised incidence rate (/100 000 person-years) for females was 11.9 (95% confidence interval (95% CI) 9.5-15.0), for males 7.4 (5.4-10.0), and the total rate was 9.7 (7.5-12.6). The case fatality rates at 24 hours, 1 week, and 30 days were 21 (18-24)%, 37 (33-41)%, and 44 (40-49)% respectively. The relative risk for death at 30days for those over 60 years:under 60 years was 2.95 (2.18-3.97).?CONCLUSION—The incidence of subarachnoid haemorrhage in the United Kingdom is higher than previously reported. Three quarters of the mortality occurs within 3days.??

Pobereskin, L

2001-01-01

22

Observer variability in assessment of angiographic vasospasm after aneurysmal subarachnoid haemorrhage  

Microsoft Academic Search

Summary In clinical practice and in many reported studies about incidences and time courses of vasospasm the angiographic spasms are judged by eye without clear definition of vessel narrowings. To evaluate the reliability of this diagnostic method two experienced neuroradiologists and two experienced neurosurgeons independently in two sessions, examined 30 carotid angiograms performed after an aneurysmal subarachnoid haemorrhage. The intra-

V. Eskesen; A. Karle; A. Kruse; Chr Kruse-Larsen; J. Præstholm; K. Schmidt

1987-01-01

23

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. Catecholamines, released in massive quantities due to hypothalamic stress from subarachnoid haemorrhage (SAH), result in specific myocardial lesions and hydrostatic pressure injury to the pulmonary capillaries causing neurogenic pulmonary oedema (NPO). The acute, reversible cardiac injury ranges from hypokinesis with a normal

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

2002-01-01

24

Spontaneous subarachnoid haemorrhage with negative initial angiography: A review of 143 cases  

Microsoft Academic Search

The need for repeat angiography in patients with subarachnoid haemorrhage (SAH) who initially present with a negative angiogram is still debated. The aim of this study was to provide a management protocol for ‘angiogram-negative SAH’. From January 1986 to June 2004, 143 patients with SAH were admitted to our institution with negative initial angiograms. We classified the 143 patients into

Jin Young Jung; Yong Bae Kim; Jae Whan Lee; Seung Kon Huh; Kyu Chang Lee

2006-01-01

25

Endothelin and aneurysmal subarachnoid haemorrhage: a study of subarachnoid cisternal cerebrospinal fluid.  

PubMed Central

Endothelin (ET) is considered one of the most potent vasoconstrictor polypeptides; several experimental studies have suggested its possible role in the pathogenesis of arterial vasospasm after subarachnoid haemorrhage (SAH). Previously reported data on plasma and CSF levels of endothelin in patients with a diagnosis of SAH have been controversial. Cisternal endothelin CSF levels and the possibility that they could be related to vasospasm and other clinical patterns of SAH were investigated. CSF samples were obtained from 55 patients admitted after angiographic diagnosis of intracranial aneurysm. Levels of ET-1 and ET-3 were measured through radio-immunoassay technique. Twelve patients who had operations for unruptured aneurysms were considered control cases; 43 patients with SAH were classified according to: Hunt and Hess grading at admission, vasospasm grading, CT classification and timing of surgery. In all 55 patients ET-1 was measured, while positive levels of ET-3 were found only in 17 cases of 48. No linear correlation was found between cisternal CSF ET-1 levels when considering time of surgery, CT classification, Hunt and Hess grading at admission, and vasospasm grading. The results of ET-3 assay should be considered with great caution because of the low percentage of positive cases. Cisternal CSF levels of ET-1 and ET-3 are not directly related to the occurrence of arterial vasospasm after the aneurysm rupture, or to other major clinical patterns of SAH; however, ET-1 expression occurs either in paraphysiological (unruptured aneurysm) or in pathological conditions (SAH). It is suggested that ET may potentiate, or may be potentiated by, other factors playing a consistent pathophysiological role in the development of vasospasm.

Gaetani, P; Rodriguez y Baena, R; Grignani, G; Spanu, G; Pacchiarini, L; Paoletti, P

1994-01-01

26

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

2012-01-01

27

Digoxin-like immunoreactive substance in patients with aneurysmal subarachnoid haemorrhage.  

PubMed Central

Digoxin was measured by radioimmunoassay in the plasma of 25 patients with aneurysmal subarachnoid haemorrhage who had not received digoxin treatment. After heating the plasma an endogenous substance cross reacting with antibodies to digoxin was identified in 18 cases. The presence of this substance was significantly related to the total amount of blood and to the presence of blood in the frontal interhemispheric fissure and could not be explained by hypertension or intake of water and sodium. A negative sodium balance and volume depletion occurred more often in patients who were positive for digoxin, but this relation did not reach statistical significance. It is concluded that a digoxin-like natriuretic factor is released in response to a subarachnoid haemorrhage, probably as a result of hypothalamic damage. Images FIG. 2

Wijdicks, E F; Vermeulen, M; van Brummelen, P; den Boer, N C; van Gijn, J

1987-01-01

28

CT appearances of haematomas in the corpus callosum in patients with subarachnoid haemorrhage  

Microsoft Academic Search

Corpus callosum heamatoma is a rare feature in subarachnoid haemorrhage (SAH), which may result from aneurysms of the anterior communicating artery (ACoA) or pericallosal artery (PCA). In 348 patients with aneurysmal SAH, bleeding from ACoA aneurysms in 88 cases produced no abnormality on CT in 7. Blood in the cistern of the lamina terminalis was the most frequent abnormality (76\\/88);

A. Jackson; J. B. Fitzgerald; R. W. J. Hartley; A. Leonard; J. Yates

1993-01-01

29

The long-term consequences of subarachnoid haemorrhage. 2: Prevalence of instrumental ADL disabilities  

Microsoft Academic Search

A total of 244 long-term survivors of subarachnoid haemorrhage (SAH) were examined at a follow-up concerning change in instrumental activities of daily living (IADL). A decrease from previous independence prevailed for 51 % of the sample. As expected, home-maintenance activities were more common pre-SAH for women than for men, and for these activities post-SAH disabilities were most frequently recorded for

Margareta Lindberg; Axel R Fugl-Meyer

1996-01-01

30

Effect of oral nimodipine on cerebral infarction and outcome after subarachnoid haemorrhage: British aneurysm nimodipine trial  

Microsoft Academic Search

OBJECTIVE--To determine the efficacy of oral nimodipine in reducing cerebral infarction and poor outcomes (death and severe disability) after subarachnoid haemorrhage. DESIGN--Double blind, placebo controlled, randomised trial with three months of follow up and intention to treat analysis. To have an 80% chance with a significance level of 0.05 of detecting a 50% reduction in an incidence of cerebral infarction

J. D. Pickard; G. D. Murray; R. Illingworth; M. D. Shaw; G. M. Teasdale; P. M. Foy; P. R. Humphrey; D. A. Lang; R. Nelson; P. Richards

1989-01-01

31

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

PubMed

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

2013-11-01

32

The relationship of coping style with depression, burden, and life dissatisfaction in caregivers of patients with subarachnoid haemorrhage.  

PubMed

Objective: To assess the relationship of coping style with depression, burden and life satisfaction in caregivers of patients with subarachnoid haemorrhage. Design: Cross-sectional study. Participants: Forty-one primary caregivers of patients with subarachnoid haemorrhage. Methods: Caregivers completed several questionnaires within the first year after subarachnoid haemorrhage. Coping style was assessed using the Utrecht Coping List, depression with the Goldberg Depression Scale (GDS), burden with the Sense of Competence Questionnaire, and life satisfaction with the Life Satisfaction Questionnaire. Results: Caregivers had a mean burden score of 37.8 (standard deviation (SD)?=?7.4) and a life satisfaction score of 5.0 (SD?=?0.6). Nine caregivers (23%) had depressive symptoms (GDS ??2). A palliative coping style was positively associated with the presence of depressive symptoms (odds ratio (OR)?=?1.45, p?=?0.016). A passive coping style was positively related to burden (ß?=?1.61, p?=?0.024), adjusted for morbidity of the caregiver (ß?=?11.90, p?=?0.013), and inversely related to life satisfaction (ß?=?-0.10, p?=?0.025). Conclusion: In caregivers of patients with subarachnoid haemorrhage palliative or passive coping styles are related to depressive symptoms, higher burden and life dissatisfaction. This implies that rehabilitation programmes for patients with subarachnoid haemorrhage should also include caregiver support programmes that focus on coping style. PMID:24626873

Boerboom, Wendy; Jacobs, Esther A C; Khajeh, Ladbon; van Kooten, Fop; Ribbers, Gerard M; Heijenbrok-Kal, Majanka H

2014-03-31

33

To Look Beyond Vasospasm in Aneurysmal Subarachnoid Haemorrhage  

PubMed Central

Delayed cerebral vasospasm has classically been considered the most important and treatable cause of mortality and morbidity in patients with aneurysmal subarachnoid hemorrhage (aSAH). Secondary ischemia (or delayed ischemic neurological deficit, DIND) has been shown to be the leading determinant of poor clinical outcome in patients with aSAH surviving the early phase and cerebral vasospasm has been attributed to being primarily responsible. Recently, various clinical trials aimed at treating vasospasm have produced disappointing results. DIND seems to have a multifactorial etiology and vasospasm may simply represent one contributing factor and not the major determinant. Increasing evidence shows that a series of early secondary cerebral insults may occur following aneurysm rupture (the so-called early brain injury). This further aggravates the initial insult and actually determines the functional outcome. A better understanding of these mechanisms and their prevention in the very early phase is needed to improve the prognosis. The aim of this review is to summarize the existing literature on this topic and so to illustrate how the presence of cerebral vasospasm may not necessarily be a prerequisite for DIND development. The various factors determining DIND that worsen functional outcome and prognosis are then discussed.

Messerer, Mahmoud; Oddo, Mauro; Daniel, Roy Thomas

2014-01-01

34

Haemorrhagic breast infarction complicating anticoagulant therapy.  

PubMed

Haemorrhagic infarction of the breast induced by anticoagulant therapy is rare and has been infrequently reported in the literature. The following report illustrates such a case in which there was development of massive haemorrhagic infarction of the breast during treatment with nicoumalone for deep venous thrombosis after an operation for carcinoma of the colon. PMID:7088760

Banik, S; Brun, C

1982-01-01

35

Haemorrhagic breast infarction complicating anticoagulant therapy.  

PubMed Central

Haemorrhagic infarction of the breast induced by anticoagulant therapy is rare and has been infrequently reported in the literature. The following report illustrates such a case in which there was development of massive haemorrhagic infarction of the breast during treatment with nicoumalone for deep venous thrombosis after an operation for carcinoma of the colon. Images Fig. 1

Banik, S.; Brun, C.

1982-01-01

36

Acute Aneurismal Bilateral Subdural Haematoma without Subarachnoid Haemorrhage: A Case Report and Review of the Literature  

PubMed Central

Spontaneous pure acute bilateral subdural haematoma (ASDH) without intraparenchymal or subarachnoid haemorrhage caused by a ruptured cerebral aneurysm is extremely rare. It can follow rupture of different aneurysms specially located in anterior incisural space; the most frequently encountered location is the PcoA aneurysms as demonstrated in the present case. We present a case report of a PcoA aneurysm presenting as pure bilateral ASDH. A high level of suspicion for bleeding of arterial origin should be maintained in all cases of acute subdural haematoma without history of trauma. The neurological status on admission dictates the appropriate timing and methodology of the neuroradiological investigations.

Mansour, Ossama; Hassen, Tamer; Fathy, Sameh

2014-01-01

37

Haemopoietic stem cell transplants: the impact of haemorrhagic complications  

Microsoft Academic Search

Acute graft-versus-host disease (GVHD) is the most important complication of allogeneic haemopoietic stem cell transplantation (HSCT), increasing susceptibility to haemorrhage and risk of early mortality. We evaluated 807 allogeneic HSCT patients to assess both the association between bleeding and GVHD, and the influence of haemorrhagic complications on clinical outcome. Up to 55% of patients with grade III–IV GVHD experienced bleeding,

Andrea Bacigalupo

2003-01-01

38

Pituitary apoplexy can mimic acute meningoencephalitis or subarachnoid haemorrhage.  

PubMed

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

2011-01-01

39

Haemorrhagic complications of pancreatitis: presentation, diagnosis and management.  

PubMed Central

Massive haemorrhage is an uncommon complication in pancreatitis. Most affected patients suffer from chronic disease with associated pseudocyst. We present five patients (four male) with a mean age of 41 years (range 34-48 years). All patients had alcohol-induced pancreatitis complicated either by haematemesis (3), intraperitoneal haemorrhage (1) or both haematemesis and intraperitoneal haemorrhage (1). Source of bleeding was pseudocyst wall (2), splenic artery pseudoaneurysm (2) and splenic artery rupture (1). Distal pancreatectomy and splenectomy was performed in two patients, intracystic ligation and drainage in two, and packing with subsequent external drainage in one. Rebleeding occurred in two patients and required subsequent distal pancreatectomy and splenectomy in one; the other patient died of splenic rupture. No rebleeding and no mortality occurred after resection. Primary pancreatic resection is recommended whenever possible. Other management options include embolisation and ligation. Images Figure 1

Ammori, B. J.; Madan, M.; Alexander, D. J.

1998-01-01

40

Single photon emission computed tomography in patients with acute hydrocephalus or with cerebral ischaemia after subarachnoid haemorrhage  

Microsoft Academic Search

Using single photon emission computed tomography (SPECT), cerebral blood flow was studied in eight patients with gradual deterioration in the level of consciousness after subarachnoid haemorrhage. Four had cerebral ischaemia and four had acute hydrocephalus. In patients with cerebral ischaemia, single photon emission computed tomography scanning showed multiple regions with decreased uptake of technetium-99M labelled d,l-hexamethyl-propylene amine oxime (99mTcHM-PAO) mainly

D Hasan; J van Peski; I Loeve; E P Krenning; M Vermeulen

1991-01-01

41

An asymmetrical fenestration of the basilar artery coexisting with two aneurysms in a patient with subarachnoid haemorrhage: case report and review of the literature.  

PubMed

The vertebrobasilar system is a part of the cerebral arterial circle (circle of Willis), which forms the collateral circulation of the brain. A 75-year-old Caucasian female was admitted to hospital because of a strong headache radiating to the neck. On the basis of a neurological examination, the patient was classified into group III of the Hunt and Hess scale. Subarachnoid haemorrhage and 2 aneurysms of the cerebral arteries were diagnosed during multidetector 64-row computed tomography and angiography. An asymmetrical fenestration of the proximal part of the basilar artery was also observed. The bleeding aneurysm locating at anterior communicating artery was diagnosed and clipped surgically by right fronto-parietal craniotomy. The second aneurysm was located just after the junction of the vertebral arteries on the wall of the basilar artery. The presented case firstly illustrates the asymmetric fenestration of the proximal part of the basilar artery coexisting with subarachnoid haemorrhage and 2 aneurysms of brain arteries. Such observation should increase diagnostic attention in the detection of possible associated aneurysms and can help in preventing complications during all endovascular treatment procedures. PMID:24902104

Polguj, M; Majos, M; Topol, M; Majos, A

2014-05-01

42

A single subcutaneous bolus of erythropoietin normalizes cerebral blood flow autoregulation after subarachnoid haemorrhage in rats  

PubMed Central

Systemic administration of recombinant erythropoietin (EPO) has been demonstrated to mediate neuroprotection. This effect of EPO may in part rely on a beneficial effect on cerebrovascular dysfunction leading to ischaemic neuronal damage. We investigated the in vivo effects of subcutaneously administered recombinant EPO on impaired cerebral blood flow (CBF) autoregulation after experimental subarachnoid haemorrhage (SAH).Four groups of male Sprague-Dawley rats were studied: group A, sham operation plus vehicle; group B, sham operation plus EPO; group C, SAH plus vehicle; group D, SAH plus EPO. SAH was induced by injection of 0.07?ml of autologous blood into the cisterna magna. EPO (400?iu?kg?1 s.c.) or vehicle was given immediately after the subarachnoid injection of blood or saline. Forty-eight hours after the induction of SAH, CBF autoregulatory function was evaluated using the intracarotid 133Xe method.CBF autoregulation was preserved in both sham-operated groups (lower limits of mean arterial blood pressure: 91±3 and 98±3?mmHg in groups A and B, respectively). In the vehicle treated SAH-group, autoregulation was abolished and the relationship between CBF and blood pressure was best described by a single linear regression line. A subcutaneous injection of EPO given immediately after the induction of SAH normalized autoregulation of CBF (lower limit in group D: 93±4?mmHg, NS compared with groups A and B).Early activation of endothelial EPO receptors may represent a potential therapeutic strategy in the treatment of cerebrovascular perturbations after SAH.

Springborg, Jacob Bertram; Ma, XiaoDong; Rochat, Per; Knudsen, Gitte Moos; Amtorp, Ole; Paulson, Olaf B; Juhler, Marianne; Olsen, Niels Vidiendal

2002-01-01

43

Focal subarachnoid haemorrhage mimicking transient ischaemic attack - do we really need MRI in the acute stage?  

PubMed Central

Background Acute non-traumatic focal subarachnoid haemorrhage (fSAH) is a rare transient ischaemic attack (TIA)-mimic. MRI is considered to be indispensable by some authors in order to avoid misdiagnosis, and subsequent improper therapy. We therefore evaluated the role of CT and MRI in the diagnosis of fSAH patients by comparing our cases to those from the literature. Methods From 01/2010 to 12/2012 we retrospectively identified seven patients with transient neurological episodes due to fSAH, who had received unenhanced thin-sliced multiplanar CT and subsequent MRI within 3 days on a 1.5 T scanner. MRI protocol included at least fast-field-echo (FFE), diffusion-weighted imaging (DWI), T2-weighted fluid-attenuated inversion recovery (FLAIR) and time-of-flight (TOF) MRA sequences. By using MRI as gold-standard, we re-evaluated images and data from recent publications regarding the sensitivity to detect fSAH in unenhanced CT. Results fSAH was detected by CT and by FFE and FLAIR on MRI in all of our own cases. However, DWI and T2w-spin-echo sequences revealed fSAH in 3 of 7 and 4 of 6 cases respectively. Vascular imaging was negative in all cases. FFE-MRI revealed additional multiple microbleeds and superficial siderosis in 4 of 7 patients and 5 of 7 patients respectively. Including data from recently published literature CT scans delivered positive results for fSAH in 95 of 100 cases (95%), whereas MRI was positive for fSAH in 69 of 69 cases (100%). Conclusions Thin-sliced unenhanced CT is a valuable emergency diagnostic tool to rule out intracranial haemorrhage including fSAH in patients with acute transient neurological episodes if immediate MRI is not available. However, MRI work-up is crucial and mandatorily has to be completed within the next 24–72 hours.

2014-01-01

44

Incidence of subarachnoid haemorrhage: an Australian national hospital morbidity database analysis.  

PubMed

Incidences of subarachnoid haemorrhage (SAH) in Australia have been reported in regional studies with variable rates. We investigated the national SAH rate and evaluated the trend over the 10 years from 1998 to 2008. The crude SAH incidence, not related to trauma or arteriovenous malformation, was estimated at 10.3 cases per 100,000 person-years (95% confidence interval [CI]: 10.2-10.4). Females have a higher incidence of SAH (12.5 cases per 100,000; 95% CI: 12.3-12.8) compared to males (8.0 cases per 100,000; 95% CI: 7.8-8.3), with age-adjusted incidence increases with increasing age for both sexes. Less than 10% of SAH occurred in the first three decades of life. The peak age group for patients to experience SAH was between 45 years and 64 years, accounting for almost 45% of the overall annual SAH admissions. Aneurysms located in the anterior circulation were a more common source of rupture compared to those located in the posterior circulation (rate ratio 3.9; 95% CI: 3.6-4.2). Contrary to contemporary observations in the literature, we did not observe a decline in the incidence of SAH during this specified study period. PMID:22326203

Lai, Leon; Morgan, Michael Kerin

2012-05-01

45

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

1987-01-01

46

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 ClinicalTrials.gov 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

2013-01-01

47

Self-perceived health status following aneurysmal subarachnoid haemorrhage: a cohort study  

PubMed Central

Objective The objective of the study was to assess the long-term self-reported health status and quality of life (QoL) of patients following an aneurysmal subarachnoid haemorrhage (ASAH) using a self-completed questionnaire booklet. Design A two-cohort study. Setting A regional tertiary neurosurgical centre. Participants 2 cohorts of patients with ASAH treated between 1998 and 2008 and followed up at approximately 1?year. Interventions Routine care. Primary and secondary outcomes A range of standardised scales included: AKC Short Sentences Test, the Barthel Index, the Self-Report Dysexecutive Questionnaire, the Everyday Memory Questionnaire, Stroke Symptom Checklist, Wimbledon Self-Report Scale, Modified Rankin Score (MRS) and a new Stroke-QoL. The data from summated scales were fit to the Rasch measurement model to validate the summed score. Results 214 patients (48%) returned the questionnaires; the majority (76%) had a World Federation of Neurosurgeons grade of 1 or 2. The most frequent aneurysm type was that of the anterior communicating artery (28%) with approximately 90% of aneurysms of the anterior circulation. Of those previously in full or part-time employment, 48.9% were unemployed at follow-up. All summated scales satisfied the Rasch measurement model requirements, such that their summed scores were a sufficient statistic. Given this, one-third of patients were noted to have a significant mood disorder and 25% had significant dysexecutive function. Patients with an MRS of 3, 4 or 5 had significantly worse scores on most outcome measures, but a significant minority of those with a score of zero had failed to return to work and displayed significant mood disorder. Conclusions A range of self-reported cognitive and physical deficits have been highlighted in a cohort of patients with ASAH. While the MRS has been shown to provide a reasonable indication of outcome, in routine clinical follow-up it requires supplementation by instruments assessing dysexecutive function, memory and mood.

Quinn, Audrey C; Bhargava, Deepti; Al-Tamimi, Yahia Z; Clark, Matthew J; Ross, Stuart A; Tennant, Alan

2014-01-01

48

Incidence of subarachnoid haemorrhage: a systematic review with emphasis on region, age, gender and time trends  

PubMed Central

Background and aim To update our 1996 review on the incidence of subarachnoid haemorrhage (SAH) and assess the relation of incidence with region, age, gender and time period. Methods We searched for studies on the incidence of SAH published until October 2005. The overall incidences with corresponding 95% confidence intervals were calculated. We determined the relationship between the incidence of SAH and determinants by means of univariate Poisson regression. Results We included 51 studies (33 new), describing 58 study populations in 21 countries, observing 45?821?896 person?years. Incidences per 100?000 person?years were 22.7 (95% CI 21.9 to 23.5) in Japan, 19.7 (18.1 to 21.3) in Finland, 4.2 (3.1 to 5.7) in South and Central America, and 9.1 (8.8 to 9.5) in the other regions. With age category 45–55?years as the reference, incidence ratios increased from 0.10 (0.08 to 0.14) for age groups younger than 25?years to 1.61 (1.24 to 2.07) for age groups older than 85?years. The incidence in women was 1.24 (1.09 to 1.42) times higher than in men; this gender difference started at age 55?years and increased thereafter. Between 1950 and 2005, the incidence decreased by 0.6% (1.3% decrease to 0.1% increase) per year. Conclusions The overall incidence of SAH is approximately 9 per 100?000 person?years. Rates are higher in Japan and Finland and increase with age. The preponderance of women starts only in the sixth decade. The decline in incidence of SAH over the past 45?years is relatively moderate compared with that for stroke in general.

de Rooij, N K; Linn, F H H; van der Plas, J A; Algra, A; Rinkel, G J E

2007-01-01

49

The lumbar sedimentation sign: spinal MRI findings in patients with subarachnoid haemorrhage with no demonstrable intracranial aneurysm  

PubMed Central

We present a new MRI finding within the lumbar spine in a series of six patients admitted with CT proven subarachnoid haemorrhage (SAH) where cerebral angiography demonstrated no aneurysm and who had not had a lumbar puncture. A retrospective audit of 130 patients presenting to a regional neurosciences centre over a 13 month period with a suspected diagnosis of SAH was performed. Seven patients with proven SAH underwent MRI of the lumbar spine during the same admission. In six of these patients layering of haemorrhagic blood products was demonstrated within the lumbosacral spine. The process is analogous to the previously ubiquitous bedside erythrocyte sedimentation rate assay and has has been termed the “lumbar sedimentation” sign. This finding has not previously been reported in the literature in relation to SAH. While this is a small unselected group it may provide a useful adjunct in the diagnosis of SAH.

Crossley, R A; Raza, A; Adams, W M

2011-01-01

50

Acute pancreatitis and acute respiratory distress syndrome complicating dengue haemorrhagic fever  

PubMed Central

Dengue infection is now known to present with wide spectrum of complications. Isolated cases of acute pancreatitis complicating dengue haemorrhagic fever have been reported in literature. Here the authors report a case of dengue haemorrhagic fever that develops acute pancreatitis and presented with acute onset of breathlessness, which then progressed to full-blown acute respiratory distress syndrome. To our knowledge, this is the first reported case of dengue haemorrhagic fever complicated with acute pancreatitis and acute respiratory distress syndrome.

Agrawal, Avinash; Jain, Nirdesh; Gutch, Manish; Shankar, Amit

2011-01-01

51

Timing of surgery for supratentorial aneurysmal subarachnoid haemorrhage: report of a prospective study  

PubMed Central

Objectives: The debate on the timing of aneurysm surgery after subarachnoid haemorrhage (SAH) pivots on the balance of the temporal risk for fatal rebleeding versus the risk of surgical morbidity when operating early on an acutely injured brain. By following a strict management protocol for SAH, the hypothesis has been tested that in the modern arena of treatment for aneurysmal SAH the timing of surgery to secure supratentorial aneurysms does not affect surgical outcome. Methods: Over a 6 year period, patients admitted with a diagnosis of SAH to a regional neurosurgical unit have been prospectively studied. All have been on a management protocol in which early transfer and resuscitation has been followed regardless of age and clinical condition. Angiographic investigation and surgery have been pursued in those who have been able to at least flex to pain. A total of 1168 patients (60.7% female, mean age 54.3) with proved SAH were received on median day 1 (86.4% arrived within 3 days) of the ictus. Of these, 784 (67.1%) showed aneurysms on angiography and were prepared for surgery. Those who received surgery for a supratentorial aneurysm within 21 days of the ictus were included in the final analysis (n=550). Patients with an initial negative angiogram, with posterior circulation aneurysms, or aneurysms treated by endovascular means, with aneurysms requiring emergency surgery for space occupying haematomas, with aneurysms which re-bled before surgery, and those who received very late surgery (after 21 days from ictus) were excluded. Surgical outcomes at hospital discharge and after 6 months were assessed using the Glasgow outcome score (GOS). Discharge destination and duration of stay in a neurosurgical ward were also documented. The influence of the timing of surgery (early group day 1–3 postictus, intermediate group day 4–10, or late group day 11–21) was analysed prospectively. Results: 60.2% of cases fell into the early surgery group, 32.4% into the intermediate group, and 7.5% into the late operated group. Late surgery was due to delays in diagnosis, transfer, and logistic factors, but not clinical decision. The demographic characteristics, site of aneurysm, and clinical condition of the patients at the time of initial medical assessment were balanced in the three surgical timing groups. There was no significant difference in GOS between the surgical timing groups at 6 months (favourable GOS score 4 and 5: 83.2%, 80.5%, and 83.8% respectively; p=0.47, Kruskal-Wallis test). Outcome was favourable in 84% of patients under 65 years, and 70% in those over 65. The discharge destinations (home, referring hospital, nursing home, rehabilitation centre) showed no significant difference between surgical timing groups. There was no significant difference in mean time to discharge after admission to this hospital from the referring hospital (16.2, 16.2, and 14.6 days for early, intermediate, and late groups respectively; p=0.789, Analysis of variance (ANOVA)). As a result, there was reduction in the mean duration of total hospital inpatient stay in favour of the earliest operated patients (mean time 18.1, 22.0, and 28.3 days respectively; p=0.001. ANOVA showed that besides age, the only determinant of surgical outcome and duration of stay was presenting clinical grade (p<0.0005). Conclusion: The current management of patients presenting with SAH from anterior circulation aneurysms allows early surgery to be followed safely regardless of age. The only independent variables affecting outcome are age and clinical grade at presentation. The timing of surgery did not significantly affect surgical outcome, promoting a policy for early surgery that avoids the known risks of rebleeding and reduces inpatient stay.

Ross, N; Hutchinson, P; Seeley, H; Kirkpatrick, P

2002-01-01

52

Incidence, National Trend, and Outcome of Nontraumatic Subarachnoid Haemorrhage in Taiwan: Initial Lower Mortality, Poor Long-Term Outcome  

PubMed Central

To investigate the longitudinal trend of nontraumatic subarachnoid haemorrhage (SAH), we analyzed the annual population-based incidence and mortality rate of nontraumatic subarachnoid hemorrhage in Taiwan. Logistic regression was used to identify independent predictors of mortality. The average incidence rate (IR) of nontraumatic SAH was 6.25 ± 0.88 per 100,000 per year. The prevalence of female patients was higher than in the male population (54.5% versus 45.5%). The average age of these patients was 55.78 ± 17.09 and females were older than males (58.50 ± 15.9 versus 52.45 ± 18.50, P < 0.001). Of these patients, 97.6% (611/626) were treated with surgical intervention with clipping procedure and 2.9% (18/626) with coiling. Total mortality of these patients was 13.4% (84/626). In adjusted analysis, age (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.98-0.98; P < 0.001) and Charlson comorbidity index (OR, 0.709; 95% CI, 0.57–0.88; P = 0.002) remained independent predictors of the mortality. Patients with nontraumatic SAH had a much higher prevalence in older age groups and in females than in the general population. Patients with old age and more comorbidity have higher mortality. Aggressive management of patients might reduce the initial mortality; however, patient outcome still remains poor.

Lin, Hsing-Lin; Soo, Kwan-Ming; Chen, Chao-Wen; Lin, Yen-Ko; Lin, Tsung-Ying; Kuo, Liang-Chi; Lee, Wei-Che; Huang, Shiuh-Lin

2014-01-01

53

Up-regulation of proteinase-activated receptor 1 and increased contractile responses to thrombin after subarachnoid haemorrhage  

PubMed Central

Background and purpose: The mechanism for the development of post-haemorrhagic cerebral vasospasm after subarachnoid haemorrhage (SAH) still remains unknown. Experimental approach: We investigated the role of thrombin and its receptor PAR1 in the development of hyper-contractility of the basilar artery in a rabbit double haemorrhage model, which received two injections of autologous blood into the cisterna magna. Key results: In the basilar artery isolated from the control rabbits, thrombin, only at 10?units?ml?1, induced a transient endothelium-dependent relaxation and a slight smooth muscle contraction. In SAH, the contractile response to thrombin was markedly enhanced, while the endothelium-dependent relaxant effect of thrombin remained unchanged. The enhancement of the contractile responses was also observed in the absence of endothelium and thrombin induced an enhanced contraction at concentrations higher than 0.3?units?ml?1. The contractile response to PAR1-activating peptide was also enhanced after SAH. However, the contractile responses to high K+ and endothelin-1, and the myofilament Ca2+-sensitivity remained unchanged after SAH. An immunoblot analysis suggested the up-regulation of PAR1 in the smooth muscle of the basilar artery. The heparinization of blood before injection prevented the enhancement of the contractile responses to thrombin and PAR1-activating peptide. Conclusions and implications: The present study demonstrated, for the first time, that the contractile response of the basilar artery to thrombin was markedly enhanced after SAH. Mechanistically, our findings suggested that the activation of thrombin following hemorrhage up-regulated the expression of PAR1, thereby inducing the hyper-responsiveness to thrombin.

Maeda, Y; Hirano, K; Kai, Y; Hirano, M; Suzuki, S O; Sasaki, T; Kanaide, H

2007-01-01

54

Melatonin ameliorates cerebral vasospasm after experimental subarachnoidal haemorrhage correcting imbalance of nitric oxide levels in rats.  

PubMed

In the present study, we investigated the in vivo effects of melatonin on SAH-induced cerebral vasospasm and oxidative stress, resulting from SAH in an experimental rat model. Twenty-eight rats (225-250 g) were divided into four groups equally: group 1; control, group 2; SAH, group 3; SAH plus placebo, and group 4; SAH plus melatonin. We used double haemorrhage method for SAH groups. Beginning 6 h after SAH, 20 mg/kg melatonin or equal volume of 0.9% saline was administered intraperitoneally twice daily for 5 days to groups 3 and 4, respectively. Melatonin or 0.9% saline injections were continued up to fifth day after SAH and rats were sacrificed at the end of this period. Brain sections at the level of the pons were examined by light microscopy. The lumen diameter and the vessel wall thickness of basilar artery were measured using a micrometer. The serum levels of cerebral vasodilator nitric oxide (NO), the brain levels of an intrinsic antioxidant superoxide dismutase (SOD) and a NO regulator arginase activities were measured. The brain levels of inducible nitric oxide (iNOS) and nitrotyrosine, a nitrosative stress parameter immunohistochemiacally determined. In conclusion, melatonin administration ameliorated cerebral vasospasm by increasing serum NO level and decreasing the brain the levels of arginase and oxidative stress. It is therefore possible that increased brain arginase activity after SAH may also have a significant role in the pathogenesis of vasospasm by limiting the availability of arginine for NO production. PMID:19415488

Aladag, M A; Turkoz, Y; Parlakpinar, H; Ozen, H; Egri, M; Unal, S C

2009-11-01

55

Combined argatroban and anti-oxidative agents prevents increased vascular contractility to thrombin and other ligands after subarachnoid haemorrhage  

PubMed Central

BACKGROUND AND PURPOSE Increased vascular contractility plays a fundamental role in cerebral vasospasm in subarachnoid haemorrhage (SAH). We investigated the role of thrombin and its receptor, proteinase-activated receptor 1 (PAR1), and other G protein-coupled receptors in the increased contractility, and examined the preventive effects of the thrombin inhibitor, argatroban, and anti-oxidative agents, vitamin C and tempol. EXPERIMENTAL APPROACH A rabbit model of SAH was utilized. Contractile responses of the isolated basilar artery and the level of oxidative stress of brain tissues were evaluated. KEY RESULTS Contractile responses to thrombin and PAR1-activating peptide (PAR1-AP) were enhanced and prolonged after SAH. The thrombin-induced contraction persisted even after terminating thrombin stimulation. When sequentially stimulated with PAR1-AP, the second response was maintained in SAH, while it was substantially attenuated in the control. Only a combination of argatroban with vitamin C or tempol prevented both the enhancement and prolongation of the contractile response to PAR1-AP and restored the reversibility of the thrombin-induced contraction. The responses to angiotensin II, vasopressin and PGF2? were enhanced and prolonged after SAH to varying degrees, and responded differently to the treatment. The response to vasopressin exhibited a similar phenomenon to that seen with PAR1-AP. Oxidative stress was increased in SAH, and normalized by the treatment with argatroban, vitamin C or their combination. CONCLUSIONS AND IMPLICATIONS Increased vascular reactivity to agonists in SAH was attributable to the enhancement and prolongation of the contractile response. A combination of argatroban and anti-oxidative agents was required to prevent both the enhancement and prolongation of the contractile response. LINKED ARTICLE This article is commented on by Hollenberg, pp. 103–105 of this issue. To view this commentary visit http://dx.doi.org/10.1111/j.1476-5381.2011.01564.x

Kameda, Katsuharu; Kikkawa, Yuichiro; Hirano, Mayumi; Matsuo, Satoshi; Sasaki, Tomio; Hirano, Katsuya

2012-01-01

56

Evaluation of the calcium-antagonist nimodipine for the prevention of vasospasm after aneurysmal subarachnoid haemorrhage. A prospective transcranial Doppler ultrasound study.  

PubMed

70 consecutive patients admitted within four days after the first aneurysmal subarachnoid haemorrhage (SAH) were evaluated by daily transcranial Doppler ultrasound (TCD) measurement of the blood flow velocities (BFVs) of both middle cerebral arteries (MCAs) and by daily recordings of their clinical grade (Hunt and Hess). Patients with no or only little subarachnoid blood in the first CT after admission were classified as low-risk for the development of symptomatic vasospasm (VSP), and patients with big subarachnoid clots or thick layers of subarachnoid blood were graded as high-risk patients for symptomatic VSP. The first series of 33 patients received no nimodipine whereas the second series of 37 patients were treated with nimodipine 2 mg/h intravenously, starting within 24 hours after the SAH in the majority of patients. 7-14 days postoperatively, the intravenous dose was changed to oral nimodipine 60 mg/q4h for one week and then discontinued. A mean BFV curve of the side with the higher flow velocities correlated with the mean clinical status (Hunt and Hess) was calculated by computer analysis for the patients treated without nimodipine and for those receiving nimodipine in each risk group. The mean BFV curves of the same risk groups were compared in order to evaluate the effect of nimodipine for the prevention of vasospasm following SAH. The delayed neurological deficits (DIND) and the functional outcome six months after the SAH were recorded in each group and compared. Nimodipine given within four days after the SAH did not prevent vasospasm evaluated by TCD, but it significantly reduced the severity of the vasoconstriction, especially in high-risk patients. It reduced significantly the incidence of DIND in high-risk patients and improved their functional outcome. Although nimodipine may have a reduced efficacy in preventing vasospasm after early operation of high-risk patients, it probably protects the brain by increasing its tolerance to focal ischaemia. PMID:2955675

Seiler, R W; Grolimund, P; Zurbruegg, H R

1987-01-01

57

Survival after profound hypocalcaemia with tetany complicating severe haemorrhagic acute pancreatitis.  

PubMed Central

A patient is reported who developed severe haemorrhagic pancreatitis, without hyperamylasemia, which was complicated by gross hypocalcaemia presenting as tetany. Tetany is very uncommon in acute pancreatitis and is a grave prognostic indicator, recovery being exceptionally rare. The mechanisms responsible for disordered calcium homeostasis associated with acute pancreatitis are reviewed. CT scanning was an important feature of this patient's management and its role in severe pancreatitis is discussed. Images Figure 1

Jones, P. A.

1985-01-01

58

Extensive haemorrhagic necrosis of liver is an unpredictable fatal complication in dengue infection: a postmortem study  

PubMed Central

Background Dengue infection carries a potential risk of death despite stringent management of plasma leak and haemorrhage. It appears that the extent of liver dysfunction determines the outcome. Methods We present a postmortem study of five patients, died of dengue shock syndrome who had markedly elevated liver enzymes and irreparable circulatory failure. Results All were females with a median age of 46 years (range 20–50 years). All had positive NS1 and IgM. Clinically, one patient developed severe degree of hepatic encephalopathy whilst three patients developed uncontrollable bleeding manifestations. Dengue virus was detected in three liver specimens by reverse transcription PCR. Histology of the liver revealed massive necrosis with haemorrhages in these patients with evidence of micro and macrovesicular steatosis with significant periportal inflammatory infiltrate. No significant ischaemic changes or necrosis was observed in the other organs. Conclusions Severe haemorrhagic necrosis of the liver was the cause of death in these patients probably due to direct viral infection. Predilection for severe liver disease remains unknown. Therefore, it is prudent to think beyond plasma leak as the main pathology of dengue infection and attempts should be made to develop other treatment modalities to prevent and manage unforeseen fatal complications of dengue infection.

2014-01-01

59

Spontaneous dissection of the extracranial vertebral artery with spinal subarachnoid haemorrhage in a patient with Behçet's disease  

Microsoft Academic Search

A 40-year-old man with known definite Behçet's disease (BD) was admitted with confusional state which had started 4 days before admission with an acute headache and vomiting. Neurological examination revealed confusion, stiff neck, right facial weakness, left hemiparesis, dysartria and truncal ataxia. CSF was haemorrhagic and xanthochromic. Cranial CT scans were negative, but MRI showed a right pontine hyperintense lesion

S. Bahar; O. Çoban; I. H. Gürvit; G. Akman-Demir; A. Gökyigit

1993-01-01

60

Tonic-Clonic Activity at Subarachnoid Hemorrhage Onset: Impact on Complications and Outcome  

PubMed Central

Objective Tonic-clonic activity (TCA) at onset complicates 3% to 21% of cases of subarachnoid hemorrhage (SAH). The impact of onset TCA on in-hospital complications, including seizures, remains unclear. One study associated onset TCA with poor clinical outcome at 6 weeks after SAH, but to our knowledge no other studies have confirmed this relationship. This study aims to assess the impact of onset TCA on in-hospital complications, poor functional outcome, mortality, and epilepsy at 3 months. Methods Analysis of a prospective study cohort of 1479 SAH patients admitted to Columbia University Medical Center between 1996 and 2012. TCA within 6 hours of hemorrhage onset was identified based on accounts of emergency care providers or family witnesses. Results TCA at onset was described in 170 patients (11%). Patients with onset TCA were younger (P?=?0.002), presented more often with poor clinical grade (55% vs. 26%, P<0.001) and had larger amounts of cisternal, intraventricular, and intracerebral blood than those without onset TCA (all, P<0.001). After adjusting for known confounders, onset TCA was significantly associated with in-hospital seizures (OR 3.80, 95%-CI: 2.43–5.96, P<0.001), in-hospital pneumonia (OR 1.56, 95%-CI: 1.06–2.31, p?=?0.02), and delayed cerebral ischemia (OR 1.77, 95%-CI: 1.21–2.58, P?=?0.003). At 3 months, however, onset TCA was not associated with poor functional outcome, mortality, and epilepsy after adjusting for age, admission clinical grade, and cisternal blood volume. Conclusions Onset TCA is not a rare event as it complicates 11% of cases of SAH. New and clinically relevant findings are the association of onset TCA with in-hospital seizures, pneumonia and delayed cerebral ischemia. Despite the increased risk of in-hospital complications, onset TCA is not associated with disability, mortality, and epilepsy at 3 months.

De Marchis, Gian Marco; Pugin, Deborah; Lantigua, Hector; Zammit, Christopher; Tadi, Prasanna; Schmidt, J. Michael; Falo, M. Cristina; Agarwal, Sachin; Mayer, Stephan A.; Claassen, Jan

2013-01-01

61

Effects of continuous prostacyclin infusion on regional blood flow and cerebral vasospasm following subarachnoid haemorrhage: statistical analysis plan for a randomized controlled trial  

PubMed Central

Background One of the main causes of mortality and morbidity following subarachnoid hemorrhage (SAH) is the development of cerebral vasospasm, a frequent complication arising in the weeks after the initial bleeding. Despite extensive research, no effective treatment of vasospasm exists to date. Prostacyclin is a potent vasodilator and inhibitor of platelet aggregation. In vitro models have shown a relaxing effect of prostacyclin after induced contraction in cerebral arteries, and a recent pilot trial showed a positive effect on cerebral vasospasm in a clinical setting. No randomized clinical trials have investigated the possible pharmacodynamic effects of prostacyclin on the human brain following SAH. Methods/Design This trial is a single centre, randomized, placebo-controlled, parallel group, double blinded, clinical pilot trial. A total of 90 patients with SAH will be randomized to one of three intervention arms: epoprostenol at 1 ng/kg/min, epoprostenol at 2 ng/kg/min, or placebo in addition to the standard treatment. Trial medication will start on Day 5 after SAH and continue to Day 10. The primary outcome measure is changes in cerebral blood flow measured by a computed tomography (CT) perfusion scan. The secondary outcomes are vasospasm measured by a CT angiography, regional blood flow, clinical symptoms of cerebral ischemia, and outcome at three months (Glasgow Outcome Scale). Discussion The primary outcome has been altered slightly since the publication of our study protocol. Global cerebral blood flow is now primary outcome, whereas regional blood flow is a secondary outcome. Trial registration Clinicaltrials.gov NCT01447095. Registration date: 11 October 2011.

2014-01-01

62

Genetic elimination of Nrf2 aggravates secondary complications except for vasospasm after experimental subarachnoid hemorrhage in mice.  

PubMed

Nuclear factor erythroid 2-related factor 2 (Nrf2) is a key endogenous protective regulator in the body. This study aimed to explore the role of Nrf2 in subarachnoid hemorrhage (SAH)-induced secondary complications. Wild type (WT) and Nrf2 knockout (KO) mice were subjected to experimental SAH by injecting fresh autologous blood into pre-chiasmatic cistern. The absence of Nrf2 function in mice resulted in exacerbated brain injury with increased brain edema, blood-brain barrier (BBB) disruption, neural apoptosis, and severe neurological deficits at 24h after SAH. Moreover, cerebral vasospasm was severe at 24h after SAH, but not significantly different between WT and Nrf2 KO mice after SAH. Meanwhile, Molondialdehyde (MDA) was increased and GSH/GSSG ratio was decreased in Nrf2 KO mice after SAH. Furthermore, higher expression of TNF-? and IL-1? was also found after SAH in Nrf2 KO mice. In conclusion, our results revealed that Nrf2 plays an important role in attenuating SAH-induced secondary complications by regulating excessive oxidative stress and inflammatory response. PMID:24576487

Li, Tao; Wang, Handong; Ding, Yu; Zhou, Mengliang; Zhou, Xiaoming; Zhang, Xiangshen; Ding, Ke; He, Jin; Lu, Xinyu; Xu, Jianguo; Wei, Wuting

2014-04-16

63

High-volume hemofiltration and prone ventilation in subarachnoid hemorrhage complicated by severe acute respiratory distress syndrome and refractory septic shock  

PubMed Central

We report the successful treatment of two patients with aneurismal subarachnoid hemorrhage complicated by severe respiratory failure and refractory septic shock using simultaneous prone position ventilation and high-volume hemofiltration. These rescue therapies allowed the patients to overcome the critical situation without associated complications and with no detrimental effects on the intracranial and cerebral perfusion pressures. Prone position ventilation is now an accepted therapy for severe acute respiratory distress syndrome, and high-volume hemofiltration is a non-conventional hemodynamic support that has several potential mechanisms for improving septic shock. In this manuscript, we briefly review these therapies and the related evidence. When other conventional treatments are insufficient for providing safe limits of oxygenation and perfusion as part of basic neuroprotective care in subarachnoid hemorrhage patients, these rescue therapies should be considered on a case-by-case basis by an experienced critical care team.

Cornejo, Rodrigo; Romero, Carlos; Ugalde, Diego; Bustos, Patricio; Diaz, Gonzalo; Galvez, Ricardo; Llanos, Osvaldo; Tobar, Eduardo

2014-01-01

64

Complications of Uterine Fibroids and Their Management, Surgical Management of Fibroids, Laparoscopy and Hysteroscopy versus Hysterectomy, Haemorrhage, Adhesions, and Complications  

PubMed Central

A critical analysis of the surgical treatment of fibroids compares all available techniques of myomectomy. Different statistical analyses reveal the advantages of the laparoscopic and hysteroscopic approach. Complications can arise from the location of the fibroids. They range from intermittent bleedings to continuous bleedings over several weeks, from single pain episodes to severe pain, from dysuria and constipation to chronic bladder and bowel spasms. Very seldom does peritonitis occur. Infertility may result from continuous metro and menorrhagia. The difficulty of the laparoscopic and hysteroscopic myomectomy lies in achieving satisfactory haemostasis using the appropriate sutures. The hysteroscopic myomectomy requires an operative hysteroscope and a well-experienced gynaecologic surgeon.

Mettler, Liselotte; Schollmeyer, Thoralf; Tinelli, Andrea; Malvasi, Antonio; Alkatout, Ibrahim

2012-01-01

65

Subarachnoid hemorrhage  

MedlinePLUS

... injury leading to subarachnoid hemorrhage is motor vehicle crashes. Risks include: Aneurysm in other blood vessels Fibromuscular ... lumbar puncture ( spinal tap ) must be done. Other tests that may be done include: Cerebral angiography of ...

66

Spontaneous haemorrhagic perforation of gallbladder in acute cholecystitis as a complication of antiplatelet, immunosuppressant and corticosteroid therapy  

PubMed Central

An older lady presented 1 week after being discharged from hospital with acute cholecystitis. She suffered a sudden onset lower abdominal pain and was in hypovolaemic shock upon arrival. It was noted that she had been on antiplatelet therapy after suffering a recent myocardial infarction, an immunosuppressor and steroids for rheumatoid arthritis. Her admission bloods revealed a platelet count of 83 with normal clotting factors. After resuscitation, a CT scan confirmed fluid in the abdomen possibly arising from the right subhepatic space. During laparotomy, bleeding was noted from a perforated and ischaemic-looking gallbladder, with an intact cystic artery and duct and no biliary calculi evident. The gallbladder was removed and the patient was transferred to intensive therapy unit. She recovered well within the subsequent 8 days and was discharged. Her histology described ‘haemorrhage within the gallbladder wall along with oedema, fibrosis and patchy inflammation and no signs of malignancy or gangrene’.

Vijendren, Ananth; Cattle, Kirsty; Obichere, Marion

2012-01-01

67

Spontaneous haemorrhagic perforation of gallbladder in acute cholecystitis as a complication of antiplatelet, immunosuppressant and corticosteroid therapy.  

PubMed

An older lady presented 1 week after being discharged from hospital with acute cholecystitis. She suffered a sudden onset lower abdominal pain and was in hypovolaemic shock upon arrival. It was noted that she had been on antiplatelet therapy after suffering a recent myocardial infarction, an immunosuppressor and steroids for rheumatoid arthritis. Her admission bloods revealed a platelet count of 83 with normal clotting factors. After resuscitation, a CT scan confirmed fluid in the abdomen possibly arising from the right subhepatic space. During laparotomy, bleeding was noted from a perforated and ischaemic-looking gallbladder, with an intact cystic artery and duct and no biliary calculi evident. The gallbladder was removed and the patient was transferred to intensive therapy unit. She recovered well within the subsequent 8 days and was discharged. Her histology described 'haemorrhage within the gallbladder wall along with oedema, fibrosis and patchy inflammation and no signs of malignancy or gangrene'. PMID:22778467

Vijendren, Ananth; Cattle, Kirsty; Obichere, Marion

2012-01-01

68

Anticoagulation-related intracranial extracerebral haemorrhage.  

PubMed Central

From January 1981 to June 1986 116 patients with anticoagulation-related intracranial haemorrhage were referred to hospital. Seventy six of these haemorrhages were extracerebral, 69 were in the subdural and seven in the subarachnoid space. No epidural haemorrhages were identified. Compared with non-anticoagulation-related haematomas, the risk of haemorrhage was calculated to be increased fourfold in men and thirteenfold in women. An acute subdural haematoma, mostly due to contusion, was more frequently accompanied by an additional intracerebral haematoma than a chronic subdural haematoma. Trauma was a more important factor in acute subdural haematomas than in chronic. Almost half of the patients (48%) had a history of hypertension, more than a third (35%) had heart disease and about one fifth (18%) were diabetic. Headache was the most frequent initial symptom. Later decreased level of consciousness and focal neurological signs exceeded the frequency of headache. Three patients with subarachnoid haemorrhage and nine patients with acute subdural haematomas died, while those with chronic subdural haematomas all survived and had at the most mild, non-disabling sequelae. Myocardial infarction (22%), pulmonary embolism (20%), and arterial disease (20%) were the most frequent reasons for anticoagulant treatment. Critical review based on established criteria for anticoagulation treatment suggests there was no medical reason to treat a third of these patients. The single most useful measure that could be taken to reduce the risk of anticoagulation-induced intracranial haemorrhage would be to identify patients who are being unnecessarily treated and to discontinue anticoagulants.

Mattle, H; Kohler, S; Huber, P; Rohner, M; Steinsiepe, K F

1989-01-01

69

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

2011-01-01

70

Postpartum haemorrhage after induced and spontaneous labour.  

PubMed Central

The labour records of 1000 consecutive deliveries were studied to compare the incidence of postpartum haemorrhage after induced labour with that after spontaneous labour. The discovery of an increased incidence of postpartum haemorrhage in the induced group prompted further analysis of the incidence of haemorrhage among 3674 normal deliveries. This analysis confirmed that the incidence of postpartum haemorrhage was increased after induction of labour; among primiparous patients the increased incidence after induced labours was nearly twice that after spontaneous labours, even when only normal deliveries were considered. These findings indicate that postpartum haemorrhage is another complication of induction that needs to be taken into account when induction is being considered.

Brinsden, P R; Clark, A D

1978-01-01

71

Unreported neurological complications of Gemella bergeriae infective endocarditis.  

PubMed

We report the first case of native aortic and mitral valve endocarditis due to Gemella bergeriae from the Middle East in a young patient with rheumatic heart disease. Our case illustrates a fulminant course of infection with G. bergeriae endocarditis that was complicated by embolic stroke, as well as intracerebral and subarachnoid haemorrhage secondary to rupture of a mycotic aneurysm in the right middle cerebral artery. This case highlights the dire, unreported neurological complications of infective endocarditis due to a rare causative organism-G. bergeriae. PMID:24899013

Hussain, Kosar; Abubaker, Jawed; Omar Al Deesi, Zulfa; Ahmed, Raees

2014-01-01

72

Complications associated with cerebral venous thrombosis.  

PubMed

Although CVT is associated with a good outcome in the majority of cases, it may be complicated by numerous unique and sometimes rare complications. The purpose of this review is to discuss the acute and chronic complications of CVT in greater detail. Awareness may lead to a more aggressive approach in those in which these complications are anticipated and perhaps avoided. The complications of CVT may be temporally divided into those unique to the acute stage and those that are associated with the chronic stage of CVT. They are venous infarction and haemorrhage, subarachnoid haemorrhage, a rapid progression and pulmonary embolism. In the chronic stages of CVT, one may encounter dural AV--fistula, progressive psychiatric disease, residual epilepsy and recurrence. Cerebral venous sinus thrombosis is associated with unique acute and chronic complications, some of them may be avoidable, e.g. pulmonary embolism. The chronic complications are rare but are potentially treatable, e.g. dural AVFistula nidus obliteration with intervention. PMID:17183989

Siddiqui, Fazeel Mukhtar; Kamal, Ayeesha K

2006-11-01

73

Spinal subarachnoid hemorrhage accompanied with intraventricular hemorrhage.  

PubMed

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. PMID:23961296

Fatehi, Farzad; Basiri, Keivan; Ghorbani, Askar

2013-03-01

74

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

2013-01-01

75

Spinal syringomyelia following subarachnoid hemorrhage.  

PubMed

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

2012-04-01

76

Supratentorial Intraparenchymal Haemorrhages during Spine Surgery.  

PubMed

Intracranial haemorrhages are rare but potentially life-threatening complications of spine surgery. Most reported cases involved subdural or cerebellar haemorrhages; supratentorial parenchymal bleeding is very uncommon. We report a 28-year-old woman who underwent resection of a thoracic Ewing's sarcoma, and developed fatal haemorrhages around her cerebral metastases during surgery. The clinical presentations, possible pathogenesis and potential preventive measures are discussed. Patients with disseminated metastases within the neural axis are at risks of intracranial complications during spine surgery. The presence of intracranial mass lesions should be considered as a relative contraindication to intradural spine surgery. PMID:24653806

Leung, Gilberto Ka Kit; Chan, Johnny Ping Hon

2014-02-01

77

Significance of placental pathology in transplacental haemorrhage  

PubMed Central

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. When there were no maternal antibodies transplacental haemorrhages occurred occasionally in the absence of such placental lesions but more frequently when these lesions were present. Moreover, the greater the number of lesions in a placenta the greater the size of the transplacental haemorrhage. In Rh-negative women with antibodies the observed incidence of transplacental haemorrhage was significantly less despite an appreciable increase in placental lesions. Images

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

1968-01-01

78

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.

1978-01-01

79

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

2000-01-01

80

Complications  

MedlinePLUS

... Eye Complications Neuropathy Foot Complications DKA (Ketoacidosis) & Ketones Kidney Disease (Nephropathy) Gastroparesis Mental Health Treatment & Care Blood Glucose Testing Medication Doctors, Nurses & More ...

81

Magnesium in subarachnoid hemorrhage  

Microsoft Academic Search

The main objective of this thesis was to determine the role of serum magnesium\\u000ain the pathophysiology after subarachnoid hemorrhage (SAH) and to assess \\u000athe effect of magnesium treatment in reducing cerebral ischemia in experimental \\u000aSAH and in improving clinical outcome in patients with aneurysmal SAH. \\u000aIn Chapter 2 we reviewed the potentials of magnesium treatment in subarachnoid \\u000ahemorrhage by

W. M. van den Bergh

2004-01-01

82

Pars plana vitrectomy in vitreous haemorrhage due to Eales' disease.  

PubMed

Repeated vitreous haemorrhage is a common occurrence in Eales disease. 25 eyes of unresolving vitreous haemorrhage were subjected to pars plana vitrectomy. 18 eyes improved to 1/60 or better. Vitreous rebleed was the commonest problem encountered. We discuss our experience, complications and limitations. PMID:1452278

Gadkari, S S; Kamdar, P A; Jehangir, R P; Shah, N A; Adrianwala, S D

1992-01-01

83

Late epilepsy following open surgery for aneurysmal subarachnoid haemorrhage  

PubMed Central

Design: Subgroup analysis of the East Anglian regional audit of SAH (1994–2000; n = 872) with 12 month follow up. Prophylactic anticonvulsants were not routinely prescribed unless there was a perioperative seizure. Subjects: 472 patients with aneurysmal SAH undergoing surgical clipping of the aneurysm were studied. Patients presenting in WFNS grade V, with space occupying haematomas requiring emergency surgery, or with posterior circulation aneurysms, rebleeds, and surgery after 21 days were excluded. Results: Late epilepsy occurred in 23 patients (4.9%). There was a correlation between the incidence of late epilepsy and both the presenting WFNS grade (p<0.05) (grade 1, 1.4%; grade 2, 3.8%; grade 3, 9.6%; grade 4, 12.5%) and the Glasgow outcome score at discharge (p<0.01) (good recovery, 2.2%; moderate disability, 5.0%; severe disability, 15.5%). There was no relation between the incidence of late epilepsy and sex or the site of the aneurysm. Conclusions: The low incidence of late epilepsy following open surgery for aneurysmal SAH supports the withholding of prophylactic anticonvulsants. Patients with poor WFNS grade and poor recovery after surgery are at increased risk and should be closely monitored.

Buczacki, S; Kirkpatrick, P; Seeley, H; Hutchinson, P

2004-01-01

84

[Haemorrhage delivery. About 65 cases].  

PubMed

The delivery haemorrhage is actually a problem of public health. It is responsible of 31.5 % of the maternal death in Tunisia. The goal of this work is to study the frequency of this complication, its gravity, its risk factors, its etiologists and its methods of treatment. It is a retrospective study. of 65 cases of delivery haemorrhage recorded to the obstetric gynaecology service "C" of the centre of motherhood and neonatology of Tunis during 4 years. The frequency of the delivery haemorrhage in our study is 1.19%. The middle age of the patient is of 31 years. Their middle parity is 2.4. Factors of risk taking out again our set are: gestational toxemia (35.4%), primiparity (33.8%), advanced maternal age (30.7%), pre-existent anaemia (24.6%). the uterine surdistension (21.3%), an abnormal middle length of labour (69.6%). use of oxytocin during labour (34%), induction (21.5%). Etiologists in our set are: atone in 63% of cases, retained placenta in 31.2% des cases, coagulopathie (9.2%), placenta previa (1.5%), uterine inversion (1.5%). The hold must be in charge multidisciplinary, systematized, precocious and dynamic. PMID:16915778

Ben Hmid, Rim; El Houssaini, Sonia; Mahjoub, Sami; Mourali, Mecheal; Zeghal, Dorra; Zouari, Faouzia; El Kamel, Moez; Bouchnek, Mourad; Maghrebi, Hayen

2006-05-01

85

Angiostrongylus meningitis associated with intraparenchymal cerebral haemorrhage.  

PubMed

Angiostrongylus cantonensis (A. cantonensis) is a nematode parasite found in Southeast Asia, Australia and the Pacific that is the most common cause of eosinophilic meningitis. We report a case of intraparenchymal cerebral haemorrhage associated with A. cantonensis meningitis. This complication has not previously been reported in the literature. PMID:24316997

Lilic, Nikola; Addison, Ben

2013-11-22

86

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

2007-01-01

87

CT-findings in haemorrhages from aneurysms of the anterior communicating artery: Correlation with angiography and clinical course  

Microsoft Academic Search

Summary CT findings, angiography and clinical course were analyzed in a series of 31 patients with a recent subarachnoid haemorrhage (SAH) from an aneurysm of the anterior communicating artery (ACoAA). It is shown that 3 types of bleedings can be distinguished according to the CT findings. In thefirst group (52%), suffering a mild or moderate bleeding into the basal cisterns

P. Stoeter; H.-J. Reulen; U. Groeger

1987-01-01

88

Managing Major Postpartum Haemorrhage following Acute Uterine Inversion with Rusch Balloon Catheter  

PubMed Central

Acute postpartum uterine inversion is a relatively rare complication. The uterus inverts and the uterine fundus prolapses to or through the dilated cervix. It is associated with major postpartum haemorrhage with or without shock. Shock is sometimes out of proportion to the haemorrhage. Minimal maternal morbidity and mortality can be achieved when uterine inversion is promptly and aggressively managed. We present this report of three cases of acute uterine inversion complicated with major postpartum haemorrhage and managed with Rusch balloon. The paper highlights the importance of early recognition and the safety of the use of intrauterine balloon to manage major postpartum haemorrhage in these cases.

Keriakos, Remon; Chaudhuri, Smriti Ray

2011-01-01

89

Timing of surgery for aneurysmal subarachnoid hemorrhage.  

PubMed

Despite the many studies about timing for surgery in subarachnoid hemorrhage (SAH), the optimum time is still unclear. The aim of this study was to determine the results of early and late surgery for aneurysmal subarachnoid hemorrhage. In this cross-sectional study we evaluated the results of 70 consecutive surgery for aneurysmal subarachnoid hemorrhage in in Firuzgar hospital from 2005 to 2008. Surgery was performed in 50 cases (71.4%) in early period after SAH (first 4 days) and in 20 cases (28.6%) in at least 7 days after SAH. Statitical analysis was done by SPSS software, using Chi-square and t-test. Mean age of patients was 48.54 ± 13.4 years. 41.4% of patients were male and 58.6% were female. Most (77.2%) of patients had clinical grade I or II. 92.9% of aneurysms were single. Hypertension was the most common associated disease (34.3%). The most common site of aneurysms was anterior communicating artery (41.4%), followed by middle cerebral artery (35.7%). The outcome of surgery was favorable in 70% and unfavorable in 30%. Mortality rate was 24.3%. Outcome was favorable in 66% of early surgeries and 80% of late surgeries. There was no statistically significant difference between early and late surgery in terms of complications and outcome. Mean hospital stay of patients in the early surgery group was significantly lower than late group (16.46 ± 9.36 vs. 22.5 ± 7.97 days; P=0.01). The results of early and late surgery for aneurysmal subarachnoid hemorrhage is similar and decision making for timing of surgery should be based on each patient individual clinical conditions, age, size and site of aneurysm. PMID:21960072

Hashemi, Seyed Mahmoud Ramak; Golchin, Navid; Nejad, Enayatollah Abbas; Noormohamadi, Shabnam

2011-01-01

90

Acute fatal haemorrhage during percutaneous dilatational tracheostomy.  

PubMed

Percutaneous dilatational tracheostomy (PDT) is associated with a number of life-threatening complications. We present a case of massive and fatal arterial haemorrhage that occurred in the intensive care unit during an elective PDT on an 86-year-old woman following earlier evacuation of a traumatic subdural haematoma. An avulsed right subclavian artery was found at post mortem. Previous thyroid surgery and aberrant arterial anatomy contributed to the fatal outcome. PMID:12644430

Shlugman, D; Satya-Krishna, R; Loh, L

2003-04-01

91

Antithrombotic medicines following intracerebral haemorrhage: where's the evidence?  

PubMed Central

The use of antithrombotic medicines in patients who have a history of intracerebral haemorrhage is widely perceived as being contraindicated. However, many patients with intracerebral haemorrhage may suffer from conditions for which antithrombotic medicines are indicated. Such scenarios represent a therapeutic dilemma whereby treating infers an increased risk of recurrent intracerebral haemorrhage, but not treating infers an increase of thrombotic complications. Despite the importance of this dilemma, there is very little guidance for prescribers. This perspective review considered previous systematic reviews that addressed this issue, together with recently published research findings from the Tayside Stroke Cohort. Systematic reviews of experimental and observational studies have concluded that there is a marked lack of data on which to judge the safety of oral anticoagulant agents following intracerebral haemorrhage. In addition, the limited data available regarding the use of antiplatelet medicines following intracerebral haemorrhage provide no evidence that they are harmful, and again further data are required. In the absence of such data, a decision analysis approach has been proposed. This considers the findings of other studies to infer the likely impact of using antithrombotic agents in patients with intracerebral haemorrhage. The success of this approach is contingent on the availability of reliable data that describe the rate of recurrent intracerebral haemorrhage; however, published data on this varies widely. There are a number of factors that conspire against researchers addressing this issue. The current paucity of evidence to guide prescribers faced with this therapeutic dilemma seems likely to remain for some time.

Doney, Alexander

2011-01-01

92

Haemorrhagic shock, therapeutic management.  

PubMed

The management of a patient in post-traumatic haemorrhagic shock will meet different logics that will apply from the prehospital setting. This implies that the patient has beneficiated from a "Play and Run" prehospital strategy and was sent to a centre adapted to his clinical condition capable of treating all haemorrhagic lesions. The therapeutic goals will be to control the bleeding by early use of tourniquet, pelvic girdle, haemostatic dressing, and after admission to the hospital, the implementation of surgical and/or radiological techniques, but also to address all the factors that will exacerbate bleeding. These factors include hypothermia, acidosis and coagulopathy. The treatment of these contributing factors will be associated to concepts of low-volume resuscitation and permissive hypotension into a strategy called "Damage Control Resuscitation". Thus, the objective in situation of haemorrhagic shock will be to not exceed a systolic blood pressure of 90 mmHg (in the absence of severe head trauma) until haemostasis is achieved. PMID:23896213

David, J-S; Spann, C; Marcotte, G; Reynaud, B; Fontaine, O; Lefèvre, M; Piriou, V

2013-01-01

93

Percutaneous treatment of subarachnoid-pleural fistula with Onyx.  

PubMed

Subarachnoid-pleural fistula is a well-described complication after anterior surgery for thoracic disc herniation, but is difficult to treat by means of traditional chest and lumbar drains due to interference by positive ventilation pressures that may keep the fistula open and prevent proper closure. Current treatment strategies include surgical repair, which is technically challenging, and noninvasive positive pressure ventilation, which can take several weeks to be effective. In this report, the authors describe a novel treatment for subarachnoid-pleural fistula using percutaneous obliteration with Onyx. Surgery for removal of a T7-8 disc herniation associated with ossification of the posterior longitudinal ligament was performed in a 56-year-old woman via an anterior transthoracic transpleural approach. Ten days after surgery, she presented with diplopia due to a subarachnoid-pleural fistula that was confirmed by CT myelography. Percutaneous injection of Onyx was performed under local anesthesia. Postprocedure CT showed complete obliteration of the fistula with no adverse events. A CT scan obtained 1 month later showed complete resolution of the pleural effusion. Neurological examination at 3 months postsurgery was normal. Clinical and radiological follow-up at 1 year showed complete recovery and no sign of fistula recurrence. Percutaneous treatment for subarachnoid-pleural fistula is an easy, safe, and effective strategy and can therefore be proposed as a first-line option for this challenging complication. PMID:23432323

Knafo, Steven; Parker, Fabrice; Herbrecht, Anne; Court, Charles; Saliou, Guillaume

2013-04-01

94

Clarithromycin-induced haemorrhagic colitis.  

PubMed

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

2013-01-01

95

Haemostasis. Part 1: The management of post-extraction haemorrhage.  

PubMed

The management of bleeding complications following a dental extraction is an essential skill for the dental practitioner. Extractions are often carried out on patients with complex medical histories and a long list of medications. This paper aims to help the clinician manage post-extraction haemorrhage. A review of the management of patients on anti-thrombotic medications will be covered in a subsequent paper. Clinical Relevance: This article reviews the management of haemorrhage following tooth extraction; from the risk assessment of any underlying medical conditions and medications, to the clinical techniques used to control bleeding following an extraction. PMID:24930250

McCormick, Neal J; Moore, Undrell J; Meechan, John G

2014-05-01

96

[Embolization procedures in acute haemorrhage from upper gastrointestinal tract].  

PubMed

Perioperative mortality in the pa tients with acute haemorrhage from upper gastrointestinal tract undergo ng unsuccessful routine endoscopic procedures is relatively high. The study evaluates the effective ness of upper gastrointestinal tract arterial vessels embolization as the alternative procedure to surgery. The analyses was conducted in 48 patients who underwent unsuccessful endoscopic procedures. All patients were subjected to diagnostic angiogra phy, which allowed to localize or con firm the haemorrhage site in 37 (77%) cases. Twenty eight (58%) out of 48 analyzed patients underwent embolizaion and hemorrhage was successfully controlled in 19 (68%) of these cases There were no complications in the analyzed group related to the perfor med intravascular procedures. Intravascular embolization of upper gastrointestinal tract is the alternative to surgical operations and effective method to be used in the treatment of acute haemorrhages from upper ga strointestinal tract in the patients who underwent unsuccessful endoscopic procedures. PMID:23944102

Popiela, Tadeusz J; Brzegowy, Pawe?; Paciorek, Anna

2013-01-01

97

Radiation–Induced Haemorrhagic Cystitis  

Microsoft Academic Search

Objectives: In this article we review the literature concerning the frequency and management of severe haemorrhagic radiation–induced cystitis.Methods: A Medline search was performed from 1966 to 1999 for articles in English. A total of 309 references were found. Abstracts and complete articles were reviewed.Results: Severe haemorrhagic cystitis following radiotherapy remains a relatively rare event. However, the fact that it is

Jeremy P. Crew; Catherine R. Jephcott; John M. Reynard

2001-01-01

98

Intracranial haemorrhage and child abuse.  

PubMed

Intracranial haemorrhage is a major cause of severe morbidity and mortality in child abuse cases in developed countries. However, similar data are not available in most developing countries. This study therefore aimed to determine the incidence of intracranial haemorrhage amongst all cases of child physical abuse, the nature of the injuries incurred, and the morbidity and mortality resulting therefrom. Among 369 cases of physical abuse seen over a 4-year period, 41 (11.4%) had intracranial haemorrhage, of whom 37 (90%) were 2 years old or less. A history of trauma was present in only eight (20%), of which only two were compatible with the injuries incurred. Subdural haemorrhages accounted for 80% of the cases, with skull fractures present in only nine cases. Fifty-four per cent of the 37 children aged 2 years of age or less had no external signs of trauma, but 11 of them had retinal haemorrhages. This is in contrast to the children older than 2 years of age who all had external signs of trauma. The overall prognosis was dismal with an early mortality of almost 30% (13 cases) and at least seven cases with severe neurological sequelae. These findings are comparable with studies from developed countries which have established that non-accidental injury must be considered as a cause of intracranial haemorrhage in any young child, despite the absence of external signs of trauma. PMID:7880096

Cheah, I G; Kasim, M S; Shafie, H M; Khoo, T H

1994-01-01

99

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.

2011-01-01

100

Maxillary tuberosity fracture: a life-threatening haemorrhage following simple exodontia.  

PubMed

Maxillary tuberosity fracture is a potential complication of routine exodontia of posterior maxillary teeth. On rare occasions, such a complication can result in torrential haemorrhage due to the close proximity of significant vessels to the area. We present a case of life-threatening haemorrhage complicating a tuberosity fracture during simple extraction of a maxillary posterior tooth. The local anatomy of the region is discussed and we provide guidelines for general dental practitioners for the management of the complication of a tuberosity fracture during routine exodontia. PMID:21623815

Bertram, A R; Rao, A C A; Akbiyik, K M; Haddad, S; Zoud, K

2011-06-01

101

Subarachnoid hemorrhage and cerebral vasospasm - literature review.  

PubMed

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. PMID:23904869

Ciurea, A V; Palade, C; Voinescu, D; Nica, D A

2013-06-15

102

Extracerebral organ dysfunction in the acute stage after aneurysmal subarachnoid hemorrhage  

Microsoft Academic Search

In patients with aneurysmal subarachnoid hemorrhage (SAH), secondary complications are an important cause of morbidity and\\u000a case fatality. Delayed cerebral ischemia and hydrocephalus are important intracranial secondary complications. Potentially\\u000a treatable extracranial complications are also frequently observed, and some are related to the occurrence of delayed cerebral\\u000a ischemia and outcome. In addition to the occurrence of an inflammatory response and metabolic

Wouter J. Schuiling; Paul J. W. Dennesen; Gabriël J. E. Rinkel

2005-01-01

103

Posterior-Fossa Haemorrhage After Supratentorial Surgery – Report of Three Cases and Review of the Literature  

Microsoft Academic Search

Summary  ?We present clinical details of three patients with posterior fossa haemorrhage after supratentorial surgery and discuss possible\\u000a pathomechanisms of this rare complication. All patients were males of advanced age. Two patients presented with a history\\u000a of hypertension. In all patients the occurence of haemorrhage was associated with loss\\/removal of large amounts of cerebrospinal\\u000a fluid (CSF) either intra-operatively (one patient undergoing

M. Koller; M. Ortler; J. Langmayr; K. Twerdy

1999-01-01

104

Spontaneous adrenal haemorrhage in pregnancy  

PubMed Central

The authors present a case of spontaneous adrenal haemorrhage, in a 28-year-old woman at 36 weeks of a twin pregnancy. Initial symptom was sudden onset chest pain which soon migrated to abdomen, accompanied by hypovolaemic shock and fetal bradycardia. Subsequent caesarean section for suspected placental abruption and resuscitation with nine units of blood, 10 of cryoprecipitate, four of fresh frozen plasma and two of platelets, in order to treat anaemia of Hgb of 3.6 g/dl and disseminated intravascular coagulation, failed to stabilise the woman. A CT scan of abdomen and pelvis then revealed a 15×17×17 cm retroperitoneal haematoma, secondary to right adrenal haemorrhage. Management was with laparotomy drainage and packing of the retroperitoneal haematoma along with the use of activated factor VII. Adrenal haemorrhage in pregnancy is an extremely rare, acute, life-threatening condition, presenting with non-specific symptoms.

A, Anagnostopoulos; S, Sharma

2011-01-01

105

[A case of Churg-Strauss syndrome with subarachnoid hemorrhage].  

PubMed

Churg-Strauss syndrome (CSS) is a vasculitis syndromes and is only rarely complicated by subarachnoid hemorrhage. In the current report, we describe a case of CSS with subarachnoid hemorrhage, which showed a favorable outcome following conservative treatment. A 68-year-old man with CSS on maintenance steroid therapy underwent MRI/A during tinnitus aggravation, and showed dilation of the left middle cerebral artery and stenosis of the peripheral area of the right vertebral artery. After 2 months, he presented sudden pain in the occipitocervical area, and CT revealed subarachnoid hemorrhage. Intracranial 3D CT-A and MRI/A showed the development of a protrusion at the base of the left anterior cerebral artery. Although both findings suggested cerebral artery dissection, the source of hemorrhage could not be identified. The 2009 Japanese Guidelines for the Management of Stroke recommends early diagnosis and treatment of hemorrhagic cerebral artery dissection because of the high risk of re-bleeding. However, considering the risks of vasculitis aggravation, development of systemic complications, and recurrence, conservative treatment was selected. In addition, owing to the risk of complications associated with the frequent use of iodinated contrast agents and angiography procedures, patient was followed up using MRI. His course was favorable, and he was discharged despite mild right abducens paralysis. When patients with hemorrhagic cerebral artery dissection have a history of allergic diseases, CCS should be considered; conservative treatment consisting of rest, strict blood pressure control, and steroid therapy may be the most appropriate option for certain patients. PMID:24607952

Ito, Miiko; Kato, Naoki; Su, Ching-Chan; Kayama, Takamasa

2014-03-01

106

Dengue/dengue haemorrhagic fever  

NSDL National Science Digital Library

A World Health Organization page devoted to the control of dengue. Many excellent informative PDF files are available from this page dealing with vector control, as well as recognition of symptoms, and treatment of dengue haemorrhagic fever. Estimated numbers of at risk people are staggering. A powerful resource for teaching the importance of vector borne diseases.

0002-11-30

107

Specific TNF-alpha inhibition in cerebral aneurysm formation and subarachnoid hemorrhage.  

PubMed

The signal transduction of tumor necrosis factor-alpha (TNF-alpha) is complex and regulated via a vast number of interconnecting pathways. The TNF-alpha signaling pathway plays a major role in the pathogenesis of subarachnoid hemorrhage (SAH). The advent of molecular mimicry has provided a number of opportunities to tackle disease with improved specificity. Here we review the mechanisms of their action and the potential for TNF-alpha inhibitors as a treatment for subarachnoid hemorrhage. Searches were performed using PubMed with the search terms "subarachnoid haemorrhage", "TNF alpha", "novel drugs" TNF alpha inhibition", "management", "cerebral aneurysm", and "vasospasm" from 1970 to February, 2012. Articles were also identified through searches of the Cochrane library and searches of the authors' own files. Only papers published in English were reviewed. In conclusion, there is considerable theoretical evidence for the potential of TNF-alpha inhibitors to impact on the pathogenesis of aneurismal SAH. Such indications demonstrate the potential for specific targeting of molecular signaling pathways to prevent the growth and rupture of cerebral aneurysm. PMID:22950379

Young, Adam M H; Karri, Surya K; You, Wanchun; Ogilvy, Christopher S

2012-07-01

108

Surgical management of aneurysmal subarachnoid hemorrhage.  

PubMed

Aneurysmal subarachnoid hemorrhage (aSAH) is a common and often devastating condition that requires prompt neurosurgical evaluation and intervention. Modern management of aSAH involves a multidisciplinary team of subspecialists, including vascular neurosurgeons, neurocritical care specialists and, frequently, neurointerventional radiologists. This team is responsible for stabilizing the patient on presentation, diagnosing the offending ruptured aneurysm, securing the aneurysm, and managing the patient through a typically prolonged and complicated hospital course. Surgical intervention has remained a definitive treatment for ruptured cerebral aneurysms since the early 1900s. Over the subsequent decades, many innovations in microsurgical technique, adjuvant maneuvers, and intraoperative and perioperative medical therapies have advanced the care of patients with aSAH. This report focuses on the modern surgical management of patients with aSAH. Following a brief historical perspective on the origin of aneurysm surgery, the topics discussed include the timing of surgical intervention after aSAH, commonly used surgical approaches and craniotomies, fenestration of the lamina terminalis, intraoperative neurophysiological monitoring, intraoperative digital subtraction and fluorescent angiography, temporary clipping, deep hypothermic cardiopulmonary bypass, management of acute hydrocephalus, cerebral revascularization, and novel clip configurations and microsurgical techniques. Many of the topics highlighted in this report represent some of the more debated techniques in vascular neurosurgery. The popularity of such techniques is constantly evolving as new studies are performed and data about their utility become available. PMID:20380967

Colby, Geoffrey P; Coon, Alexander L; Tamargo, Rafael J

2010-04-01

109

Anemia and transfusion after subarachnoid hemorrhage.  

PubMed

Delayed cerebral ischemia after subarachnoid hemorrhage (SAH) may be affected by a number of factors, including cerebral blood flow and oxygen delivery. Anemia affects about half of patients with SAH and is associated with worse outcome. Anemia also may contribute to the development of or exacerbate delayed cerebral ischemia. This review was designed to examine the prevalence and impact of anemia in patients with SAH and to evaluate the effects of transfusion. A literature search was made to identify original research on anemia and transfusion in SAH patients. A total of 27 articles were identified that addressed the effects of red blood cell transfusion (RBCT) on brain physiology, anemia in SAH, and clinical management with RBCT or erythropoietin. Most studies provided retrospectively analyzed data of very low-quality according to the GRADE criteria. While RBCT can have beneficial effects on brain physiology, RBCT may be associated with medical complications, infection, vasospasm, and poor outcome after SAH. The effects may vary with disease severity or the presence of vasospasm, but it remains unclear whether RBCTs are a marker of disease severity or a cause of worse outcome. Erythropoietin data are limited. The literature review further suggests that the results of the Transfusion Requirements in Critical Care Trial and subsequent observational studies on RBCT in general critical care do not apply to SAH patients and that randomized trials to address the role of RBCT in SAH are required. PMID:21769459

Le Roux, Peter D

2011-09-01

110

Systemic hypovolemia after subarachnoid hemorrhage.  

PubMed

Two patients who had suffered subrachnoid hemorrhage were subjected to intensive monitoring of parameters of circulating blood flow, cardiovascular dynamics, and fluid and electrolyte balance. Among the parameters studied were red cell volume, plasma volume, and total blood volume, cardiac output, and central venous and pulmonary capillary wedge pressures. Both patients experienced acute neurological deterioration during the study. Red cell volume fell in a premonitory fashion prior to neurological deterioration in both, and in one patient plasma volume and total blood volume decreased by almost 50% in the 5 days prior to neurological deterioration. Central venous and pulmonary capillary wedge pressures fell initially but did not predict the deterioration. Systemic vascular resistance fell prior to clinical deterioration in one patient following ventriculoperitoneal shunting, and in the other following craniotomy and subarachnoid drainage. The falls in systemic vascular resistance may have caused shunting of cardiac output away from the compromised cerebral circulation, thereby triggering neurological deterioration. PMID:15815316

Brazenor, G A; Chamberlain, M J; Gelb, A W

1990-03-01

111

Acute cholecystitis presenting with massive intra-abdominal haemorrhage  

PubMed Central

Haemorrhagic cholecystitis is a known rare life-threatening complication of acute cholecystitis. In this case report, we describe clinical presentation and radiological findings of acute cholecystitis presenting with massive intra-abdominal haemorrhage. We present a case of a 57-year-old male presenting to the emergency department with clinical symptoms of acute cholecystitis. Initially, the patient was haemodynamically stable. Gallbladder could not be visualized by ultrasound. Computed tomography with IV contrast showed a large haematoma in the gallbladder fossa, with active extravasation of IV contrast. On angiography the bleeding was localized to a branch of the cystic artery, which was embolized using gelfoam material. The patient was taken to the operating room for an urgent laparotomy and cholecystectomy.

Aljiffry, Murad M.; Almulhim, Amna N.; Jamal, Mohammad H.; Hassanain, Mazen M.

2014-01-01

112

Acute cholecystitis presenting with massive intra-abdominal haemorrhage.  

PubMed

Haemorrhagic cholecystitis is a known rare life-threatening complication of acute cholecystitis. In this case report, we describe clinical presentation and radiological findings of acute cholecystitis presenting with massive intra-abdominal haemorrhage. We present a case of a 57-year-old male presenting to the emergency department with clinical symptoms of acute cholecystitis. Initially, the patient was haemodynamically stable. Gallbladder could not be visualized by ultrasound. Computed tomography with IV contrast showed a large haematoma in the gallbladder fossa, with active extravasation of IV contrast. On angiography the bleeding was localized to a branch of the cystic artery, which was embolized using gelfoam material. The patient was taken to the operating room for an urgent laparotomy and cholecystectomy. PMID:24876458

Aljiffry, Murad M; Almulhim, Amna N; Jamal, Mohammad H; Hassanain, Mazen M

2014-01-01

113

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

1975-01-01

114

Outcome following intracerebral hemorrhage and subarachnoid hemorrhage.  

PubMed

Intracerebral hemorrhage and subarachnoid hemorrhage account for almost 20% of all stroke cases. Both forms of stroke are associated with a high morbidity and mortality rate. The incidence of intracerebral hemorrhage increases with the age and certain ethnical groups are more affected. Subarachnoid hemorrhage tends to occur in a much younger population than other types of strokes. Outcome predictors for intracerebral and subarachnoid hemorrhage have been extensively discussed in the literature. Based on the current literature, we review the morbidity and mortality rates and predictors of outcome for these two life-threatening diseases. Initial Glasgow Coma Scale (GCS) score, hematoma volume, and presence of ventricular blood are the most prominent predictors of outcome following intracerebral hemorrhage. Age and initial severity of neurologic deficits on presentation, measured by GCS, Hunt and Hess Scale or the World Federation of Neurological Surgeons Scale, are the most important predictors of outcome following subarachnoid hemorrhage. PMID:12074438

Hanel, Ricardo A; Xavier, Andrew R; Mohammad, Yousef; Kirmani, Jawad F; Yahia, Abutaher M; Qureshi, Adnan I

2002-01-01

115

Dural arteriovenous fistula causing primary intraventricular haemorrhage  

Microsoft Academic Search

Primary intraventricular haemorrhage is a rare presentation of a dural arteriovenous fistula. We describe the case of a 52-year-old woman with a past history of idiopathic intracranial hypertension who presented with sudden-onset severe headache. The CT scan on admission showed primary intraventricular haemorrhage with no associated haemorrhage in the brain parenchyma or the extra-axial compartment. The cerebral angiogram demonstrated a

R PADMANABHAN; R STACEY; S WIMALARATNA; W KUKER

2008-01-01

116

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

1976-01-01

117

[Targets and prevention of complications in nursing of subarachnoid hemorrhage].  

PubMed

A qualified nursing care is mandatory in patients after SAH. Clinical and instrumental monitoring are basilar to assure the rapid control of dangerous ICP or CPP changes and of epileptic crisis. Prophylaxis of infections is greatly minimized when coherent treatments are applied to any invasive devices, patient body, patient bed and UTI area. Many drugs can be useful to avoid ICP increases by tracheal suctioning and other sensorial stimulations. Having a trained staff, patient outcome can be improved. PMID:9773670

De Bellis, P; Traverso, F; Zattoni, P L

1998-05-01

118

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.

2012-01-01

119

Haemorrhage associated with silastic dural substitute.  

PubMed Central

Three cases of haemorrhage after the use of a silastic dural substitute are presented. In all cases the implant was removed and further haemorrhage has not occurred. Published work is reviewed and the implications for the continued use of silastic are discussed. Images

Thompson, D; Taylor, W; Hayward, R

1994-01-01

120

Quality of life after perimesencephalic haemorrhage  

Microsoft Academic Search

Quality of life was measured by means of the sickness impact profile (SIP) questionnaire in a prospectively collected, consecutive series of 25 patients with perimesencephalic haemorrhage. A mean of two years and four months (range six months to six years) after the perimesencephalic haemorrhage, quality of life scores of the (former) patients were comparable with those of a random sample

Eva H Brilstra; Jeanette W Hop; Gabriel J E Rinkel

1997-01-01

121

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.

1993-01-01

122

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

2005-01-01

123

Anti-shock garment in postpartum haemorrhage.  

PubMed

The non-pneumatic anti-shock garment (NASG) is a first-aid device that reverses hypovolaemic shock and decreases obstetric haemorrhage. It consists of articulated neoprene segments that close tightly with Velcro, shunting blood from the lower body to the core organs, elevating blood pressure and increasing preload and cardiac output. This chapter describes the controversial history of the predecessors of NASG, pneumatic anti-shock garments (PASGs), relates case studies of PASG for obstetric haemorrhage, compares pneumatic and non-pneumatic devices and posits why the NASG is more appropriate for low-resource settings. This chapter discusses the only evidence available about NASGs for obstetric haemorrhage - two pre-post pilot trials and three case series - and describes recently initiated randomized cluster trials in Africa. Instructions and an algorithm for ASGs in haemorrhage and shock management are included. Much remains unknown about the NASG, a promising intervention for obstetric haemorrhage management. PMID:18805742

Miller, Suellen; Martin, Hilarie B; Morris, Jessica L

2008-12-01

124

Take care when taking care of fever after aneurysmal subarachnoid hemorrhage  

PubMed Central

Fever is prevalent in the majority of patients after aneurysmal subarachnoid hemorrhage and is associated with worse outcome. Treatment of fever is highly recommended, but with low-grade evidence in current guidelines. The analysis by Schiefecker and colleagues reveals that the situation may be more complicated than at first glance and careless treatment may introduce further harm. The importance of this study lies in analyzing real-world multimodal neuromonitoring data, showing a pitfall in incautiously applied treatment paradigms.

2013-01-01

125

Treatment and outcome of neonatal haemorrhagic brain injury  

Microsoft Academic Search

Treatment and outcome of neonatal haemorrhagic brain injury In this thesis we have described the treatment and outcome of preterm infants with a severe intraventricular haemorrhage (IVH) who subsequently developed post haemorrhagic ventricular dilatation (PHVD). In addition we described the treatment and outcome of term infants who suffered from an intracranial haemorrhage (ICH). There are considerable differences in the diagnostic

A. J. Brouwer

2011-01-01

126

Review of the literature regarding the relationship of rebleeding and external ventricular drainage in patients with subarachnoid hemorrhage of aneurysmal origin  

Microsoft Academic Search

Acute hydrocephalus is a well-documented complication of subarachnoid hemorrhage. The insertion of external ventricular drainage (EVD) has been the standard of care in the management of this complication, aiming primarily at immediate improvement of the clinical condition of these patients, making them more suitable candidates for surgical or endovascular intervention. In our current communication, we review the pertinent literature regarding

K. N. Fountas; E. Z. Kapsalaki; T. Machinis; I. Karampelas; H. F. Smisson; J. S. Robinson

2006-01-01

127

Adrenal haemorrhage due to heparin-induced thrombocytopenia.  

PubMed

Adrenal haemorrhage (AH) is a rare but potentially devastating complication of heparin-induced thrombocytopenia (HIT). Neither the prevalence nor the natural history of AH due to HIT are known. The objectives of this study were to identify the spectrum of AH causes, to characterise the frequency of AH due to HIT and determine the natural history of HIT-associated AH. All patients with incident adrenal haemorrhage from January 2002 through June 2012 seen at the Mayo Clinic were identified. Over this time frame, there were a total of 115 patients with AH of which 11 cases (10%; mean age 67 ± 8 years; 73% female) were associated with HIT. Of these, all but one occurred in the postoperative setting and involved both adrenal glands (89%) with acute adrenal insufficiency at the time of diagnosis. Cases were found incidentally during an evaluation for fever, shock, abdominal pain or mental status changes. All HIT patients experienced venous thrombosis at other locations including deep venous thromboses (n=14), pulmonary emboli (n= 4) and arterial thrombosis (n=2). Four patients undergoing total knee arthroplasty had "spontaneous HIT" with AH in the absence of identifiable heparin exposure. Other causes of AH included trauma (29%), sepsis (15%), antiphospholipid antibody syndrome (10%), and metastatic disease (12%). In conclusion, AH is an important but seldom recognised presumed thrombotic complication of HIT, which usually occurs in the postoperative period, especially after orthopaedic procedures. This syndrome can occur in the apparent absence of heparin exposure, especially following major joint replacement surgery. PMID:23389301

Ketha, Siva; Smithedajkul, Patrick; Vella, Adrian; Pruthi, Rajiv; Wysokinski, Waldemar; McBane, Robert

2013-04-01

128

Retinal haemorrhage in abusive head trauma.  

PubMed

Paediatric abusive head injury may have grave consequences, especially when characterized by repetitive acceleration-deceleration forces (shaken baby syndrome). Death occurs in approximately 30% and permanent neurologic damage in up to 80% of the victims. Retinal haemorrhages are a cardinal sign seen in approximately 85% of cases. In most cases haemorrhages are preretinal, intraretinal and subretinal, too numerous to count, and involving the entire retinal surface extending to the ora serrata. Traumatic macular retinoschisis is a lesion with important diagnostic significance. Vitreoretinal traction appears to be the mechanism of haemorrhage and schisis formation along with a possible role of orbital tissue trauma from repetitive acceleration-deceleration forces. Ophthalmologists must carefully document ocular findings. Appropriate autopsy examination should include ocular and orbital tissue removal. Although there is a wide differential diagnosis for retinal haemorrhages, clinical appearance, when considered in the context of systemic and laboratory findings, usually leads to the correct diagnosis. PMID:20584025

Morad, Yair; Wygnansky-Jaffe, Tamara; Levin, Alex V

2010-07-01

129

Ultrasonically detectable cerebellar haemorrhage in preterm infants  

Microsoft Academic Search

ObjectiveTo determine the frequency and pattern of cerebellar haemorrhage (CBH) on routine cranial ultrasound (cUS) imaging in infants of ?32 weeks gestation, and to investigate how extremely preterm infants with CBH differ from those with severe intraventricular haemorrhage (IVH).Methods672 infants of ?32 weeks gestation were prospectively examined for CBH on serial cUS imaging. In a separate case–control analysis, the clinical

L K McCarthy; V Donoghue; J F A Murphy

2011-01-01

130

Nasal and intrapulmonary haemorrhage in sudden infant death syndrome  

PubMed Central

BACKGROUND—Fresh intrapulmonary and oronasal haemorrhages in cases of sudden infant death syndrome (SIDS) might be markers for accidental or intentional smothering inappropriately diagnosed as SIDS.?AIM—To compare the incidence, epidemiological association, and inter-relation of nasal haemorrhage, intrapulmonary haemorrhage, and intrathoracic petechiae in infant deaths certified as SIDS.?METHODS—In SIDS cases from a large nationwide case-control study, a wide range of variables were compared in cases with and without reported nasal haemorrhage and, in a subgroup of cases, in those with and without pathologically significant intrapulmonary haemorrhage.?RESULTS—Nasal haemorrhage was reported in 60 of 385 cases (15%) whose parents were interviewed. Pathologically significant intra-alveolar pulmonary haemorrhage was found in 47% of 115 cases studied, but was severe in only 7%. Infants with nasal haemorrhage had more haemorrhage into alveoli and air passages than age matched cases without nasal haemorrhage. In multivariate analysis, nasal haemorrhage was associated with younger infant age, bed sharing, and the infant being placed non-prone to sleep. Intrapulmonary haemorrhage was associated with the same three factors in univariate analysis, but in multivariate analysis only younger infant age remained statistically significant. There was no significant association between nasal or intra-alveolar haemorrhages and intrathoracic petechiae.?CONCLUSIONS—Nasal and intrapulmonary haemorrhages have common associations not shared with intrathoracic petechiae. Smothering is a possible common factor, although is unlikely to be the cause in most cases presenting as SIDS.??

Becroft, D; Thompson, J; Mitchell, E

2001-01-01

131

An emerging pulmonary haemorrhagic syndrome in dogs: similar to the human leptospiral pulmonary haemorrhagic syndrome?  

PubMed

Severe pulmonary haemorrhage is a rare necropsy finding in dogs but the leptospiral pulmonary haemorrhagic syndrome (LPHS) is a well recognized disease in humans. Here we report a pulmonary haemorrhagic syndrome in dogs that closely resembles the human disease. All 15 dogs had massive, pulmonary haemorrhage affecting all lung lobes while haemorrhage in other organs was minimal. Histologically, pulmonary lesions were characterized by acute, alveolar haemorrhage without identifiable vascular lesions. Seven dogs had mild alveolar wall necrosis with hyaline membranes and minimal intraalveolar fibrin. In addition, eight dogs had acute renal tubular necrosis. Six dogs had a clinical diagnosis of leptospirosis based on renal and hepatic failure, positive microscopic agglutination test (MAT) and/or positive blood/urine Leptospira-specific PCR. Leptospira could not be cultured post mortem from the lungs or kidneys. However, Leptospira-specific PCR was positive in lung, liver or kidneys of three dogs. In summary, a novel pulmonary haemorrhagic syndrome was identified in dogs but the mechanism of the massive pulmonary erythrocyte extravasation remains elusive. The lack of a consistent post mortem identification of Leptospira spp. in dogs with pulmonary haemorrhage raise questions as to whether additional factors besides Leptospira may cause this as yet unrecognized entity in dogs. PMID:21274452

Klopfleisch, R; Kohn, B; Plog, S; Weingart, C; Nöckler, K; Mayer-Scholl, A; Gruber, A D

2010-01-01

132

An Emerging Pulmonary Haemorrhagic Syndrome in Dogs: Similar to the Human Leptospiral Pulmonary Haemorrhagic Syndrome?  

PubMed Central

Severe pulmonary haemorrhage is a rare necropsy finding in dogs but the leptospiral pulmonary haemorrhagic syndrome (LPHS) is a well recognized disease in humans. Here we report a pulmonary haemorrhagic syndrome in dogs that closely resembles the human disease. All 15 dogs had massive, pulmonary haemorrhage affecting all lung lobes while haemorrhage in other organs was minimal. Histologically, pulmonary lesions were characterized by acute, alveolar haemorrhage without identifiable vascular lesions. Seven dogs had mild alveolar wall necrosis with hyaline membranes and minimal intraalveolar fibrin. In addition, eight dogs had acute renal tubular necrosis. Six dogs had a clinical diagnosis of leptospirosis based on renal and hepatic failure, positive microscopic agglutination test (MAT) and/or positive blood/urine Leptospira-specific PCR. Leptospira could not be cultured post mortem from the lungs or kidneys. However, Leptospira-specific PCR was positive in lung, liver or kidneys of three dogs. In summary, a novel pulmonary haemorrhagic syndrome was identified in dogs but the mechanism of the massive pulmonary erythrocyte extravasation remains elusive. The lack of a consistent post mortem identification of Leptospira spp. in dogs with pulmonary haemorrhage raise questions as to whether additional factors besides Leptospira may cause this as yet unrecognized entity in dogs.

Klopfleisch, R.; Kohn, B.; Plog, S.; Weingart, C.; Nockler, K.; Mayer-Scholl, A.; Gruber, A. D.

2010-01-01

133

Triggers for aggressive interventions in subarachnoid hemorrhage.  

PubMed

Ischemia is a common cause of secondary neuronal injury after aneurysmal subarachnoid hemorrhage. An electronic literature search was conducted to identify clinical signs and laboratory data that could serve as predictors for delayed cerebral ischemia and define triggers for additional diagnostic testing or more aggressive intervention. Fifteen articles describing original research that included some discussion of triggers were identified and reviewed. Quality of evidence was considered very low to moderate for included studies. Using data from these studies and expert opinion, a variety of clinical signs and monitoring data were identified as potentially useful triggers for additional tests or aggressive treatments. These data were used to develop a sequence that might be employed in the clinical management of subarachnoid hemorrhage to determine which patients need additional attention, testing, or interventions to reduce/prevent ischemia caused by vasospasm. PMID:21748498

Stocchetti, Nino

2011-09-01

134

Magnesium Sulfate Administration in Subarachnoid Hemorrhage  

Microsoft Academic Search

Magnesium offers theoretic vascular and neuroprotective benefits for patients with subarachnoid hemorrhage. An electronic\\u000a literature search was conducted to identify original research studies describing intravenous magnesium treatment in patients\\u000a with SAH published in English between January 1990 and October 2010. Seventeen articles were identified and reviewed, including\\u000a one phase III randomized-controlled clinical trial and six phase II randomized-controlled trials. Study

Jose I. Suarez; Daryl Gress; J. Claude Hemphill; Brian Hoh; Giuseppe Lanzino; David Menon; Alejandro Rabinstein; Lori Shutter; Nino Stocchetti; Mervyn Vergouwen; Paul Vespa; Gregory J. Zipfel

135

Triggers for Aggressive Interventions in Subarachnoid Hemorrhage  

Microsoft Academic Search

Ischemia is a common cause of secondary neuronal injury after aneurysmal subarachnoid hemorrhage. An electronic literature\\u000a search was conducted to identify clinical signs and laboratory data that could serve as predictors for delayed cerebral ischemia\\u000a and define triggers for additional diagnostic testing or more aggressive intervention. Fifteen articles describing original\\u000a research that included some discussion of triggers were identified and

Nino Stocchetti; Daryl Gress; J. Claude Hemphill; Brian Hoh; Giuseppe Lanzino; David Menon; Alejandro Rabinstein; Lori Shutter; Jose Suarez; Mervyn Vergouwen; Paul Vespa; Gregory J. Zipfel; Neuroscience ICU

136

Subdural haemorrhages in infants: population based study  

PubMed Central

Objectives To identify the incidence, clinical outcome, and associated factors of subdural haemorrhage in children under 2 years of age, and to determine how such cases were investigated and how many were due to child abuse. Design Population based case series. Setting South Wales and south west England. Subjects Children under 2 years of age who had a subdural haemorrhage. We excluded neonates who developed subdural haemorrhage during their stay on a neonatal unit and infants who developed a subdural haemorrhage after infection or neurosurgical intervention. Main outcome measures Incidence and clinical outcome of subdural haemorrhage in infants, the number of cases caused by child abuse, the investigations such children received, and associated risk factors. Results Thirty three children (23 boys and 10 girls) were identified with subdural haemorrhage. The incidence was 12.8/100?000 children/year (95% confidence interval 5.4 to 20.2). Twenty eight cases (85%) were under 1 year of age. The incidence of subdural haemorrhage in children under 1 year of age was 21.0/100?000 children/year and was therefore higher than in the older children. The clinical outcome was poor: nine infants died and 15 had profound disability. Only 22 infants had the basic investigations of a full blood count, coagulation screen, computed tomography or magnetic resonance imaging, skeletal survey or bone scan, and ophthalmological examination. In retrospect, 27 cases (82%) were highly suggestive of abuse. Conclusion Subdural haemorrhage is common in infancy and carries a poor prognosis; three quarters of such infants die or have profound disability. Most cases are due to child abuse, but in a few the cause is unknown. Some children with subdural haemorrhage do not undergo appropriate investigations. We believe the clinical investigation of such children should include a full multidisciplinary social assessment, an ophthalmic examination, a skeletal survey supplemented with a bone scan or a skeletal survey repeated at around 10 days, a coagulation screen, and computed tomography or magentic resonance imaging. Previous physical abuse in an infant is a significant risk factor for subdural haemorrhage and must be taken seriously by child protection agencies. Key messagesSubdural haemorrhage in children under 2 years of age is a relatively common occurrence. The majority are due to child abuseThe mortality and morbidity of this condition are both high and seriousThe high probability of child abuse in cases is still not being recognised, and cases are not being investigated fullyThe clinical investigation of subdural haemorrhage must include a full series of basic investigationsPrevious child abuse in an infant is a strong risk factor for subdural haemorrhage, and social services must be aware of this in the future care plans for that child and family

Jayawant, S; Rawlinson, A; Gibbon, F; Price, J; Schulte, J; Sharples, P; Sibert, J R; Kemp, A M

1998-01-01

137

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

2010-01-01

138

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

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

2012-04-01

139

Nonaneurysmal subarachnoid hemorrhage and cerebral infarction associated with moyamoya disease.  

PubMed

Moyamoya disease patients with subarachnoid hemorrhage and cerebral infarction are rare, especially when the subarachnoid hemorrhage is nonaneurysmal. Here, we present one 48-year-old male patient with moyamoya disease identified with digital subtraction angiography. His initial symptoms are associated with increased intracranial pressure. Subsequent computed tomography demonstrated subarachnoid hemorrhage and cerebral infarction. Digital subtraction angiography showed no obvious aneurysms. We assume that subarachnoid hemorrhage is associated with the rupture of the moyamoya vessels and transdural anastomotic vessels. The cerebral infarction can be also explained by hemodynamic mechanisms. We should pay more attention to the recurrent hemorrhagic stroke. PMID:25006946

Wu, Hui; Song, Shaoli; Zhang, Xiaohua; Jin, Yichao

2014-07-01

140

Simultaneous presentation of sarcoidosis and acute myeloid leukaemia: predisposition to pulmonary haemorrhage.  

PubMed Central

A case of coexistent acute myeloid leukaemia and sarcoidosis is reported. This was complicated by recurrent pulmonary haemorrhage during reinduction and consolidation chemotherapy. A review of published papers on malignancy and sarcoidosis, in particular acute leukaemia is given. The outcome of most cases of acute leukaemia and sarcoidosis is poor with respiratory complications a frequent cause of death in this group. It is proposed that modifications to treatment to avoid pulmonary toxicity and maintenance of platelet counts above 40 x 10(9)/l are warranted to reduce the risk of this complication. Images

Williams, B; Francis, A; Durrant, S

1994-01-01

141

Fatal subarachnoid hemorrhage after endoscopic third ventriculostomy. Case report.  

PubMed

In recent years, endoscopic third ventriculostomy has become a well-established procedure for the treatment of various forms of noncommunicating hydrocephalus. Endoscopic third ventriculostomy is considered to be an easy and safe procedure. Complications have rarely been reported in the literature. The authors present a case in which the patient suffered a fatal subarachnoid hemorrhage (SAH) after endoscopic third ventriculostomy. This 63-year-old man presented with confusion and drowsiness and was admitted in to the hospital in poor general condition. Computerized tomography scanning revealed an obstructive hydrocephalus caused by a tumor located in the cerebellopontine angle. An endoscopic third ventriculostomy was performed with the aid of a Fogarty balloon catheter. Some hours postoperatively, the patient became comatose. Computerized tomography scanning revealed a severe perimesencephalic-peripontine SAH and progressive hydrocephalus. Despite emergency external ventricular drainage, the patient died a few hours later. Although endoscopic third ventriculostomy is considered to be a simple and safe procedure, one should be aware that severe and sometimes fatal complications may occur. To avoid vascular injury, perforation of the floor of the third ventricle should be performed in the midline, halfway between the infundibular recess and the mammillary bodies, just behind the dorsum sellae. PMID:10413171

Schroeder, H W; Warzok, R W; Assaf, J A; Gaab, M R

1999-01-01

142

Spontaneous perirenal haemorrhage in polyarteritis nodosa.  

PubMed

Patients presenting with flank pain are likely to have urological pathology but when features of hypotension are present high index of suspicion is needed to reach the cause such as perirenal haemorrhage. Spontaneous perirenal haemorrhage (SPH) is an uncommon presentation of vasculitis, autoimmune disease or malignancy. It is common in males in the age group between 30 and 60 years. Polyarteritis nodosa (PAN) is one of the commonest vascular diseases associated with SPH. Angiography adds valuable information to the diagnosis and management and can prevent unnecessary nephrectomy. We report a case of SPH that was successfully managed with angioembolization. PMID:23763812

Nandwani, Ghulam Mustafa; Musker, Mathew Paul; Chaplin, Brian John; El Madhoun, Ihab; Akbani, Habib

2013-06-01

143

Recurrent oculomotor palsy due to haemorrhage in pituitary adenoma.  

PubMed Central

Haemorrhage in pituitary adenoma is an unusual cause of recurrent oculomotor palsy. Three episodes of right oculomotor palsy are reported from a patient having haemorrhage in pituitary adenoma. Early operation and decompression of haemorrhagic pituitary adenoma should be performed so that vision may be preserved and recovery of oculomotor palsy be assured. Images Fig. 1 Fig. 2 Fig. 3

Mohanty, S.

1980-01-01

144

Neuroprotection in a rabbit model of intraventricular haemorrhage by cyclooxygenase-2, prostanoid receptor-1 or tumour necrosis factor-alpha inhibition  

PubMed Central

Intraventricular haemorrhage is a major complication of prematurity that results in neurological dysfunctions, including cerebral palsy and cognitive deficits. No therapeutic options are currently available to limit the catastrophic brain damage initiated by the development of intraventricular haemorrhage. As intraventricular haemorrhage leads to an inflammatory response, we asked whether cyclooxygenase-2, its derivative prostaglandin E2, prostanoid receptors and pro-inflammatory cytokines were elevated in intraventricular haemorrhage; whether their suppression would confer neuroprotection; and determined how cyclooxygenase-2 and cytokines were mechanistically-linked. To this end, we used our rabbit model of intraventricular haemorrhage where premature pups, delivered by Caesarian section, were treated with intraperitoneal glycerol at 2 h of age to induce haemorrhage. Intraventricular haemorrhage was diagnosed by head ultrasound at 6 h of age. The pups with intraventricular haemorrhage were treated with inhibitors of cyclooxygenase-2, prostanoid receptor-1 or tumour necrosis factor-?; and cell-infiltration, cell-death and gliosis were compared between treated-pups and vehicle-treated controls during the first 3 days of life. Neurobehavioural performance, myelination and gliosis were assessed in pups treated with cyclooxygenase-2 inhibitor compared to controls at Day 14. We found that both protein and messenger RNA expression of cyclooxygenase-2, prostaglandin E2, prostanoid receptor-1, tumour necrosis factor-? and interleukin-1? were consistently higher in the forebrain of pups with intraventricular haemorrhage relative to pups without intraventricular haemorrhage. However, cyclooxygenase-1 and prostanoid receptor 2–4 levels were comparable in pups with and without intraventricular haemorrhage. Cyclooxygenase-2, prostanoid receptor-1 or tumour necrosis factor-? inhibition reduced inflammatory cell infiltration, apoptosis, neuronal degeneration and gliosis around the ventricles of pups with intraventricular haemorrhage. Importantly, cyclooxygenase-2 inhibition alleviated neurological impairment, improved myelination and reduced gliosis at 2 weeks of age. Cyclooxygenase-2 or prostanoid receptor-1 inhibition reduced tumour necrosis factor-? level, but not interleukin-1?. Conversely, tumour necrosis factor-? antagonism did not affect cyclooxygenase-2 expression. Hence, prostanoid receptor-1 and tumour necrosis factor-? are downstream to cyclooxygenase-2 in the inflammatory cascade induced by intraventricular haemorrhage, and cyclooxygenase-2-inhibition or suppression of downstream molecules—prostanoid receptor-1 or tumour necrosis factor-?—might be a viable neuroprotective strategy for minimizing brain damage in premature infants with intraventricular haemorrhage.

Vinukonda, Govindaiah; Csiszar, Anna; Hu, Furong; Dummula, Krishna; Pandey, Nishi Kant; Zia, Muhammad T.; Ferreri, Nicholas R.; Ungvari, Zoltan; LaGamma, Edmund F.

2010-01-01

145

Management of agitation following aneurysmal subarachnoid hemorrhage: is there a role for Beta-blockers?  

PubMed

Introduction. Stroke is a leading cause of mortality and morbidity in the United States. About 20% of the stroke is hemorrhagic and about 50% of these is due to aneurysmal subarachnoid hemorrhage. A troublesome neuropsychiatric complication of subarachnoid hemorrhage is agitation/aggression. Case Presentation. A 45-year-old man with no prior psychiatric history, sustained subarachnoid hemorrhage. After initial stabilization for 2 days, he underwent craniotomy and clipping of anterior cerebral communicating artery aneurysm. Treatment was continued with labetalol, nimodipine, and levetiracetam. Beginning postoperative day 4, patient developed episodes of confusion and agitation/aggression. Switching of Levetiracetam to valproate did not show any improvement. Psychiatry team tried to manage him with intense nursing intervention and different medications like olanzapine, valproate, lorazepam, and haloperidol. However, patient continued to be agitated and aggressive. Switching from labetalol to metoprolol resulted in dramatic improvement within 3 days. Discussion. Antipsychotics and benzodiazepines are often not sufficiently effective in the control of agitation/aggression in patients with traumatic brain injury and similar conditions. Our case report and the literature review including a cochrane review suggests that beta-blockers may be helpful in this situation. PMID:22937415

Ibrahim, Fayaz; Viswanathan, Ramaswamy

2012-01-01

146

[Haemorrhagic exanthema due to dengue virus induced by acetylsalicylic acid].  

PubMed

Dengue fever, a viral infectious disease characteristic of tropical climates, is considered to be a re-emergent pathology responsible for several serious outbreaks in the last decade. Some factors have been involved in the spread of the virus and its vectorial mosquito carrier: human alteration of the ecosystems, improvement and speed in the transit of goods and people and climate changes. As a reflection of this, an increase in imported cases is probable, especially in tourists coming from endemic areas, considering its short period of incubation (7-10 days). The recognition of personal antecedents of journeys, the main symptoms of the disease and the potential presence of complications (haemorrhagic dengue) should be included in the examination of fever of unknown origin or feverish exanthema. The case of a patient is presented whose clinical picture of classic dengue fever was worsened by self-treatment with acetylsalicylic acid. PMID:17224945

Valerio, L; de Balanzó, X; Jiménez, O; Pedro-Bolet, M L

2006-01-01

147

Post-traumatic subarachnoid pneumocephalus. A case report.  

PubMed

We present a case of subarachnoid pneumocephalus fed through a basal bony breach and confined to the cysterns of the Willis circle in a traumatized patient. The peculiar configuration of the pneumocephalus is attributed to the partial obliteration of the subarachnoid space due to the increased intracranial pressure. PMID:2092553

Turtas, S; Orunesu, G

1990-01-01

148

Successful use of recombinant activated factor VII for postoperative associated haemorrhage: a case report  

PubMed Central

Background Coagulopathy is a major contributing factor to bleeding related mortality even after achieving adequate surgical control of the haemorrhage in trauma and surgical patients. Case presentation A 65 years old Greek man was admitted in our ICU with critical haemorrhage following renal biopsy. Despite surgical exploration the patient continued to bleed resulting in a vicious cycle of transfusion, coagulopathy and re-bleeding. After all standard management options were exhausted, the patient was given rFVIIa (total dose 4,8 mg). Clinical improvement was noted without adverse thrombotic complications. One month later the same patient was operated on for a suspected retroperitoneal infected collection that it was assumed to be the cause of persistent pyrexia. After abdominal washout, he suffered haemorrhagic shock with postoperative coagulopathy. Standard transfusion therapy was again unsuccessful. The patient was given rFVIIa again resulting in an immediate reduction in coagulopathic haemorrhage accompanied by a significant improvement in laboratory measurements and reduction in blood products requirements. Conclusion Published clinical experiences for the use of rFVIIa in trauma patients are limited to small series and case reports. However, in trauma patients, administration of rFVIIa appears to be effective in addition to prompt surgical intervention as an adjunctive haemostatic measure to control life threatening bleeding in appropriately selected patients.

Vlachos, Konstantinos; Archontovasilis, Fotis; Papadima, Artemisia; Maragiannis, Dimitrios; Aloizos, Stavros; Lagoudianakis, Emmanuel; Dalianoudis, Ioannis G; Koronakis, Nikolaos; Chrysikos, John; Zaravinos, Spyros; Manouras, Andreas

2008-01-01

149

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.

2004-01-01

150

Intracranial haemorrhage associated with ingestion of 'ecstasy'.  

PubMed Central

A case of a patient with intracranial haemorrhage thought to have been associated with ingestion of 'Ecstasy' [3-4 methylenedioxymethamphetamine (MDMA)] is presented. The case illustrates the importance of drug analysis in cases involving illicit drug use. Images Fig. 1

Hughes, J C; McCabe, M; Evans, R J

1993-01-01

151

Haemorrhage through the ampulla of Vater.  

PubMed Central

A patient with chronic pancreatitis presented with a series of massive upper gastrointestinal haemorrhages due to bleeding into the pancreatic duct. This report emphasizes the value of intensive investigation before surgery, since it may be impossible to identify the site of bleeding at laparotomy. Images Figure 1 Figure 2 Figure 3 Figure 4

Ribbans, W. J.; Pounder, R. E.; Lindsay, I.

1985-01-01

152

Haemorrhage through the ampulla of Vater.  

PubMed

A patient with chronic pancreatitis presented with a series of massive upper gastrointestinal haemorrhages due to bleeding into the pancreatic duct. This report emphasizes the value of intensive investigation before surgery, since it may be impossible to identify the site of bleeding at laparotomy. PMID:3892520

Ribbans, W J; Pounder, R E; Lindsay, I

1985-06-01

153

Brain monitoring after subarachnoid hemorrhage: lessons learned.  

PubMed

Aneurysmal subarachnoid hemorrhage is a serious condition with a high morbidity and mortality rate despite advances in neurocritical care. Intraparenchymal monitors providing continuous bedside physiological data have been introduced into the care of the neurocritically ill and are the focus of clinical research. We review the available technology for bedside brain monitoring and the knowledge that has been gathered and its clinical utility by organizing it into 3 main areas: detecting vasospasm early, establishing end points to resuscitation in the management of cerebral vasospasm, and developing insights into the pathophysiology of the disease. Finally, we discuss its implications for the field and future directions. PMID:21508881

Spiotta, Alejandro M; Provencio, J Javier; Rasmussen, Peter A; Manno, Edward

2011-10-01

154

Treatment of Intracranial Vasospasm Following Subarachnoid Hemorrhage  

PubMed Central

Vasospasm has been a long known source of delayed morbidity and mortality in aneurysmal subarachnoid hemorrhage patients. Delayed ischemic neurologic deficits associated with vasospasm may account for as high as 50% of the deaths in patients who survive the initial period after aneurysm rupture and its treatment. The diagnosis and treatment of vasospasm has still been met with some controversy. It is clear that subarachnoid hemorrhage is best cared for in tertiary care centers with modern resources and access to cerebral angiography. Ultimately, a high degree of suspicion for vasospasm must be kept during ICU care, and any signs or symptoms must be investigated and treated immediately to avoid permanent stroke and neurologic deficit. Treatment for vasospasm can occur through both ICU intervention and endovascular administration of intra-arterial vasodilators and balloon angioplasty. The best outcomes are often attained when these methods are used in conjunction. The following article reviews the literature on cerebral vasospasm and its treatment and provides the authors’ approach to treatment of these patients.

Bauer, Andrew M.; Rasmussen, Peter A.

2014-01-01

155

Subarachnoid Hemorrhage International Trialists data repository (SAHIT).  

PubMed

The outcome of patients with aneurysmal subarachnoid hemorrhage (SAH) has improved slowly over the past 25 years. This improvement may be due to early aneurysm repair by endovascular or open means, use of nimodipine, and better critical care management. Despite this improvement, mortality remains at about 40%, and many survivors have permanent neurologic, cognitive, and neuropsychologic deficits. Randomized clinical trials have tested pharmacologic therapies, but few have been successful. There are numerous explanations for the failure of these trials, including ineffective interventions, inadequate sample size, treatment side effects, and insensitive or inappropriate outcome measures. Outcome often is evaluated on a good-bad dichotomous scale that was developed for traumatic brain injury 40 years ago. To address these issues, we established the Subarachnoid Hemorrhage International Trialists (SAHIT) data repository. The primary aim of the SAHIT data repository is to provide a unique resource for prognostic analysis and for studies aimed at optimizing the design and analysis of phase III trials in aneurysmal SAH. With this aim in mind, we convened a multinational investigator meeting to explore merging individual patient data from multiple clinical trials and observational databases of patients with SAH and to create an agreement under which such a group of investigators could submit data and collaborate. We welcome collaboration with other investigators. PMID:23295631

Macdonald, R Loch; Cusimano, Michael D; Etminan, Nima; Hanggi, Daniel; Hasan, David; Ilodigwe, Don; Jaja, Blessing; Lantigua, Hector; Le Roux, Peter; Lo, Benjamin; Louffat-Olivares, Ada; Mayer, Stephan; Molyneux, Andrew; Quinn, Audrey; Schweizer, Tom A; Schenk, Thomas; Spears, Julian; Todd, Michael; Torner, James; Vergouwen, Mervyn D I; Wong, George K C

2013-01-01

156

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))

1989-09-01

157

Effect of Aneurysmal Subarachnoid Hemorrhage on Word Generation  

PubMed Central

Background. Aneurysmal subarachnoid hemorrhage (aSAH) survivors commonly exhibit impairment on phonemic and semantic fluency tests; however, it is unclear which of the contributing cognitive processes are compromised in aSAH patients. One method of disentangling these processes is to compare initial word production, which is a rapid, semiautomatic, frontal-executive process, and late phase word production, which is dependent on more effortful retrieval and lexical size and requires a more distributed neural network. Methods. Seventy-two individuals with aSAH and twenty-five control subjects were tested on a cognitive battery including the phonemic and semantic fluency task. Demographic and clinical information was also collected. Results. Compared to control subjects, patients with aSAH were treated by clipping and those with multiple aneurysms were impaired across the duration of the phonemic test. Among patients treated by coiling, those with anterior communicating artery aneurysms or a neurological complication (intraventricular hemorrhage, vasospasm, and edema) showed worse output only in the last 45 seconds of the phonemic test. Patients performed comparably to control subjects on the semantic test. Conclusions. These results support a “diffuse damage” hypothesis of aSAH, indicated by late phase phonemic fluency impairment. Overall, the phonemic and semantic tests represent a viable, rapid clinical screening tool in the postoperative assessment of patients with aSAH.

Ladowski, Daniella; Qian, Winnie; Kapadia, Anish N.; Macdonald, R. Loch; Schweizer, Tom A.

2014-01-01

158

Aneurysmal Subarachnoid Hemorrhage Models: Do They Need a Fix?  

PubMed Central

The discovery of tissue plasminogen activator to treat acute stroke is a success story of research on preventing brain injury following transient cerebral ischemia (TGI). That this discovery depended upon development of embolic animal model reiterates that proper stroke modeling is the key to develop new treatments. In contrast to TGI, despite extensive research, prevention or treatment of brain injury following aneurysmal subarachnoid hemorrhage (aSAH) has not been achieved. A lack of adequate aSAH disease model may have contributed to this failure. TGI is an important component of aSAH and shares mechanism of injury with it. We hypothesized that modifying aSAH model using experience acquired from TGI modeling may facilitate development of treatment for aSAH and its complications. This review focuses on similarities and dissimilarities between TGI and aSAH, discusses the existing TGI and aSAH animal models, and presents a modified aSAH model which effectively mimics the disease and has a potential of becoming a better resource for studying the brain injury mechanisms and developing a treatment.

Sehba, Fatima A.; Pluta, Ryszard M.

2013-01-01

159

Haemorrhage control in extremity stab injury  

PubMed Central

The Foley catheter is described in the emergency treatment of penetrating cardiac injuries, and its intra-operative use to control bleeding while definitive measures for intravascular embolization are being made. We present the first reported case of the use of a urinary catheter to control haemorrhage in an extremity stab injury to obtain haemodynamic stability while awaiting definitive surgical treatment. This quick, easy and useful technique can be used for junctional vascular injuries and wounds with a narrow neck, and can be easily removed once in the operating theatre. This life-saving, simple and cost-effective technique ‘internalises’ the externally applied pressure to control massive haemorrhage while awaiting definitive operative intervention. The catheter can be sutured in place if the patient is to be transferred to another department or hospital.

Singh, R. A.; Asprou, F.; Patel, Amit; Trickett, R. W.

2013-01-01

160

High-grade intracranial chondrosarcoma presenting with haemorrhage.  

PubMed

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 24 hours. 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

2013-10-01

161

Magnesium sulfate administration in subarachnoid hemorrhage.  

PubMed

Magnesium offers theoretic vascular and neuroprotective benefits for patients with subarachnoid hemorrhage. An electronic literature search was conducted to identify original research studies describing intravenous magnesium treatment in patients with SAH published in English between January 1990 and October 2010. Seventeen articles were identified and reviewed, including one phase III randomized-controlled clinical trial and six phase II randomized-controlled trials. Study quality was low for most of the included studies, with the phase III trial considered to be of moderate quality. Due to inconsistently reported benefits and the occurrence of side effects, phase II data suggested that intravenous magnesium for SAH provided either no overall net benefit or uncertain trade-offs. Benefit was likewise not supported in the single phase III clinical trial. PMID:21748496

Suarez, Jose I

2011-09-01

162

[Subarachnoidal hemorrhage and multiple vascular cerebral abnormalities in ?-thalassemia major].  

PubMed

?-thalassemia is a genetic hemoglobinopathy, which can cause hypercoagulability, vessel wall damages and thromboembolic events. Spontaneous subarachnoidal hemorrhages are not commonly described in this affection. We report subarachnoidal hemorrhage, observed during the post-partum period in a 27-year-old woman suffering from ?-thalassemia major. Brain MRI revealed complex vascular abnormalities: intracranial carotid occlusion, carotid micro-aneurisms, abnormally developed deep perforators and cortical arteries. PMID:23394851

Svahn, J; Cho, T-H; Derex, L; Mechtouff, L; Nighoghossian, N

2013-03-01

163

Non-Aneurysm Subarachnoid Hemorrhage in Young Adults  

Microsoft Academic Search

\\u000a \\u000a Objective: The incidence of subarachnoid hemorrhage (SAH) in the young is increasing recently. Among the young patients, some of them\\u000a do not have detectable aneurysms, so the cause of the disease may be non-aneurysmal. In this study, we analyzed some clinical\\u000a cases of subarachnoid hemorrhage in young adults and discussed the possible causes other than present aneurysm and arteriovenous\\u000a malformation

Tianzhu Wang; John H. Zhang; Xinyue Qin

164

Simultaneous hypertensive intracerebral haemorrhages: what are the odds?  

PubMed

The simultaneous development of two (or more) spontaneous, hypertensive, non-traumatic intraparenchymal cerebral haemorrhages is rare and constitutes less than 5.6% of all hypertensive cerebral haemorrhages. In addition to having a high early mortality, these haemorrhages carry a considerable morbidity figure in patients who survive the event. We report a 68-year-old hypertensive and diabetic woman who presented with a sudden onset of headache, vomiting, and dense right-sided weakness. In less than an hour, she became obtunded. An urgent non-contrast CT brain scan revealed two left-sided supratentorial hemispheric haemorrhages; putamenal and thalamic. PMID:23345495

Amin, Osama S M

2013-01-01

165

Foam sclerotherapy for spouting haemorrhage in patients with varicose veins.  

PubMed

The bleeding from various veins can be intense and may be mistaken for arterial haemorrhage. Several fatal cases are reported due to delay of treatment and inappropriate first aid. We describe five cases of haemorrhage from varicose veins that were treated with foam sclerotherapy. Polidocanol foam was injected in the various veins using ultrasound guidance. There was no recurrence of haemorrhage in any patient during the 17.4 months follow-up period. Foam sclerotherapy can be performed easily in an out-patient clinic setting. This method is an ideal therapy for haemorrhage from varicose veins because it mitigates problematic varicose veins. PMID:21420881

Hamahata, A; Yamaki, T; Osada, A; Fujisawa, D; Sakurai, H

2011-06-01

166

Cerebral haemorrhage in a French prospective population study.  

PubMed Central

The incidence of cerebral haemorrhage was studied from a population-based stroke registry. The incidence was 12.3 per 100,000 per year in women and 13.9 per 100,000 per year in men, with a peak in the eighth decade and a male preponderance. Haemorrhages were deep seated and mostly due to hypertension. Recognised clinical characteristics of haemorrhage are acute onset, convulsion, vomiting, and disturbed consciousness. This study showed that cerebral haemorrhage may present with pure motor deficit or transient deficit preceding the stroke. The mortality was 51% in the first month, and 61% by two years.

Giroud, M; Gras, P; Chadan, N; Beuriat, P; Milan, C; Arveux, P; Dumas, R

1991-01-01

167

A new manifestation of thrombocytopenia: myocardial haemorrhage with symptomatic arrhythmia  

PubMed Central

We describe a patient with thrombocytopenia who developed episodes of dyspnoea due to recurrent cardiac arrhythmia. Necropsy revealed that the apparent mechanism was extensive myocardial haemorrhage. Images

Wyld, PJ; Beck, S; Slater, DN

1982-01-01

168

[Cavernous sinus dural arteriovenous shunt presenting with subarachnoid hemorrhage and acute subdural hematoma: a case report].  

PubMed

Cavernous sinus dural arteriovenous shunt (CdAVS) usually presents with exophthalmos, conjunctival chemosis, ophthalmoplegia, headache, bruit, or pulsatile tinnitus. Intracranial hemorrhage associated with CdAVS is rare. We describe a patient with CdAVS presenting with subarachnoid hemorrhage and acute subdural hematoma. A 65-year-old woman presented headache and temporary loss of consciousness and was transferred to our hospital. On admission, the patient was alert and complained of a left-sided temporal headache. There were no ocular symptoms. A CT scan revealed subarachnoid hemorrhage and left acute subdural hematoma. When we prepared for cerebral angiography, the patient presented loss of consciousness following sudden onset of severe headache. Urgent angiography revealed left CdAVS, which was fed by both the internal carotid artery and the external carotid artery and drained only into ipsilateral (left) vein of the sylvian fissure. Aneurysmal dilatation of the draining veins and leptomeningeal drainage were present. No cerebral aneurysms were detected. After the angiography, a CT scan showed enlarged subdural hematoma, so left fronto-temporo-parietal craniotomy was immediately performed. On opening the dura mater, arterial bleeding from Sylvian fissure appeared and was uncontrollable. Unfortunately, the patient died 3 days after the operation. We concluded that subarachnoid hemorrhage and subdural hematoma were due to the rupture of engorged cortical veins. Our case report suggests that CdAVS with angiographic findings such as aneurysmal dilatation of the draining veins and leptomeningeal drainage should be treated urgently because of the high risk of the life-threatening complications resulting from a surgically uncontrollable hemorrhage. PMID:11449719

Kagawa, K; Nishimura, S; Seki, K

2001-05-01

169

Alveolar haemorrhage in eosinophilic granulomatosis and polyangiitis (Churg-Strauss).  

PubMed

We describe two patients of alveolar haemorrhage in patients with eosinophilic granulomatosis with polyangiitis (eGPA). This report adds to the evidence that pulmonary haemorrhage is a rare but severe manifestation of eGPA. It may not be associated with positive ANCA antibodies and requires aggressive treatment. PMID:24464436

Jagadeesh, L Yalakki; Sangle, S R; Verma, H; D'Cruz, D

2014-08-01

170

Unilateral parenchymal haemorrhagic infarction in the preterm infant  

Microsoft Academic Search

A unilateral parenchymal haemorrhage associated with a germinal matrix–intraventricular haemorrhage (GMH–IVH) is still an important problem in the preterm infant and especially in those who are very immature. This type of lesion is now considered mainly to be caused by impaired drainage of the veins in the periventricular white matter and is often referred to as a venous infarction. The

Linda S de Vries; Ariadne M Roelants-van Rijn; Karin J Rademaker; Ingrid C van Haastert; Frederik JA Beek; Floris Groenendaal

2001-01-01

171

Targeted obstetric haemorrhage programme improves incoming resident confidence and knowledge.  

PubMed

Postpartum haemorrhage is an infrequent but potentially life-threatening obstetrical emergency amenable to simulation. An educational programme consisting of a lecture and high-fidelity simulation exercise was given to incoming obstetrics and gynaecology (OB) and family medicine (FM) residents. Residents reported pre- and post-intervention confidence scores on a 1-5 Likert scale and a subset completed a postpartum haemorrhage knowledge assessment. Residents reported significant improvements in confidence in parameters involved in diagnosis and management of postpartum haemorrhage. The postpartum haemorrhage test mean scores significantly increased (57.4 ± 9.6% vs 77.1 ± 7.9%, p < 0.01) and were significantly correlated to confidence scores (Spearman's coefficient of 0.651, p < 0.001). In conclusion, an education programme that incorporates high-fidelity simulation of postpartum haemorrhage improves the confidence and knowledge of incoming residents and appears to be an effective educational approach. PMID:24219716

Straub, H L; Morgan, G; Ochoa, P; Grable, I; Wang, E; Kharasch, M; Plunkett, B A

2013-11-01

172

Convulsions and retinal haemorrhage: should we look further?  

PubMed Central

Background and Aims: The prevalence of retinal haemorrhages after convulsions is not well established. As these haemorrhages are considered characteristic of child abuse, we investigated their occurrence after convulsive episodes to see whether the finding of haemorrhage should prompt further investigation. Methods: Prospective study of 153 children (aged 2 months to 2 years), seen in the emergency department after a convulsive episode. After a thorough history and physical examination, a retinal examination was performed by an ophthalmologist. If findings were positive, further investigation was undertaken to rule out systemic disorder or child abuse. Results: One child was found with unilateral retinal haemorrhages following an episode of a simple febrile convulsion. A thorough investigation uncovered no other reason for this finding. Conclusion: Retinal haemorrhages following a convulsive episode are rare. Such a finding should trigger an extensive search for other reasons, including child abuse.

Mei-Zahav, M; Uziel, Y; Raz, J; Ginot, N; Wolach, B; Fainmesser, P

2002-01-01

173

Cell death starts early after subarachnoid hemorrhage  

PubMed Central

Brain injury begins early after aneurysmal subarachnoid hemorrhage (SAH). Although cell death via apoptosis and necrosis is known to be present in brain 24 hours after SAH, it is not known how soon after SAH cell death begins. We have previously described structural changes in rat brain microvessels 10 minutes after induction of SAH by endovascular puncture. This study examined brain for evidence of cell death beginning 10 minutes after induction of SAH. Cleaved caspase-3 (cl-caspase-3) staining was evident in vascular and parenchymal cells at 10 minutes after SAH and was significantly greater than in time-matched, sham-operated controls. The number of cl-caspase-3 positive cells was increased further at 24 hour after SAH. TUNEL assay revealed apoptotic cells present at 10 minutes, with substantially more at 24 hours after SAH. Scattered Fluoro-Jade positive neurons appeared at 1 hour after SAH and their number increased with time. At 1 hour Fluoro-Jade positive neurons were present in cortical and subcortical regions but not in hippocampus; at 24 hours they were also present in hippocampus and were significantly greater in the hemisphere ipsilateral to the vascular puncture. No Fluoro-Jade staining was present in shams. These data demonstrate an early activation of endothelial and parenchymal cells apoptosis and neuronal necrosis after SAH and identifies endpoints that can be targeted to reduce early brain injury after SAH.

Friedrich, Victor; Flores, Rowena; Sehba, Fatima A.

2012-01-01

174

Brain microbleeds as a potential risk factor for antiplatelet-related intracerebral haemorrhage: hospital-based, case–control study  

Microsoft Academic Search

BackgroundIntracerebral haemorrhage (ICH) is an uncommon but devastating complication of regular antiplatelet use: identifying high-risk patients before treatment could potentially reduce this hazard. Brain microbleeds on gradient-recalled echo (GRE) T2*-weighted MRI are considered a biomarker for bleeding-prone small-vessel diseases. The authors hypothesised that microbleeds are a risk factor for antiplatelet-related ICH, and investigated this in a hospital-based matched case–control study.MethodsCases

S. M. Gregoire; H. R. Jager; T. A. Yousry; C. Kallis; M. M. Brown; D. J. Werring

2010-01-01

175

Deep vein thrombosis induced by thalidomide to control epistaxis secondary to hereditary haemorrhagic telangiectasia.  

PubMed

Thalidomide was recently reported to reduce the severity and frequency of epistaxes in patients with hereditary haemorrhagic telangiectasia (HHT). We here describe the case of a patient with HHT and severe epistaxes refractory to medical and local surgical treatments who developed an extensive deep vein thrombosis shortly after initiation of treatment with thalidomide. This is the first report of venous thromboembolic complication induced by thalidomide prescribed in this setting. Although thalidomide was recently found to provide an alternative therapeutic strategy in patients with HHT and refractory epistaxes, this agent should be used with great caution in this indication, given its thrombogenicity and difficulties to manage systemic anticoagulation in patients with HHT. PMID:21885956

Penaloza, Andrea; Vekemans, Marie-Christiane; Lambert, Catherine; Hermans, Cedric

2011-10-01

176

Risk Factors for Rebleeding of Aneurysmal Subarachnoid Hemorrhage: A Meta-Analysis  

PubMed Central

Background Rebleeding is a serious complication of aneurysmal subarachnoid hemorrhaging. To date, there are conflicting data regarding the factors contributing to rebleeding and their significance. Methods A systematic review of PubMed and Embase databases was conducted for studies pertaining to aneurysmal subarachnoid hemorrhage (aSAH) and rebleeding in order to assess the associated risk factors. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated from fourteen studies comprised of a total of 5693 patients that met the inclusion criteria. Results Higher rebleeding rates were observed < 6 h after the initial aSAH (OR ?=?3.22, 95% CI ?=?1.46–7.12), and were associated with high systolic blood pressure (OR ?=?1.93, 95% CI ?=?1.31–2.83), poor Hunt-Hess grade (III–IV) (OR ?=?3.43, 95% CI ?=?2.33–5.05), intracerebral or intraventricular hematomas (OR ?=?1.65, 95% CI ?=?1.33–2.05), posterior circulation aneurysms (OR ?=?2.15, 95% CI ?=?1.32–3.49), and aneurysms >10 mm in size (OR ?=?1.70, 95% CI ?=?1.35–2.14). Conclusions Aneurysmal rebleeding occurs more frequently within the first 6 hours after the initial aSAH. Risk factors associated with rebleeding include high systolic pressure, the presence of an intracerebral or intraventricular hematoma, poor Hunt-Hess grade (III-IV), aneurysms in the posterior circulation, and an aneurysm >10 mm in size.

Tang, Chao; Zhang, Tian-Song; Zhou, Liang-Fu

2014-01-01

177

The Relationship between Localized Subarachnoid Inflammation and Parenchymal Pathophysiology after Spinal Cord Injury  

PubMed Central

Abstract 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.

Austin, James W.; Afshar, Mehdi

2012-01-01

178

An analysis of 88 patients with diffuse and "benign" perimesencephalic subarachnoid hemorrhage.  

PubMed

Background and Study Aims?Perimesencephalic subarachnoid hemorrhage (PMSAH) was previously defined as a variant of subarachnoid hemorrhage (SAH) associated with a relatively benign clinical presentation and better outcomes than aneurysmal SAH. However, several prior studies have shown complications associated with PMSAH including vasospasm and hydrocephalus, and the need for follow-up imaging. We therefore reviewed our experience to further characterize the clinical consequences of PMSAH. Materials and Methods?Eighty-eight consecutive patients who sustained spontaneous intracranial SAH and whose cerebral angiograms did not show any obvious source for SAH were retrospectively studied to characterize their prognosis and outcome based on SAH pattern. Glasgow Coma Scale and Hunt-Hess scores on admission, the incidence of vasospasm or hydrocephalus, the need for an external ventricular drain, and shunt dependence, along with Glasgow outcome score (GOS) at discharge and follow-up, were used to draw comparisons between perimesencephalic and diffuse SAH patient populations. Results?Patients with perimesencephalic SAH differed statistically (p?

Patel, Neal B; Patel, Amrita D; Wilkinson, Jared; Gianaris, Nicholas G; Payner, Troy D; Leipzig, Thomas J; Ansari, Shaheryar; Cohen-Gadol, Aaron A

2014-07-01

179

[Aneurysm of the anterior communicating artery as a possible late complication of internal carotid artery ligation].  

PubMed

A case of a 55-year-old woman with anterior communicating artery aneurysm has been described. The aneurysm led to subarachnoid haemorrhage 8 years after ligation of the right internal carotid artery in order to turn off an aneurysm of this artery. Angiography showed the existence of collateral circulation through the arterial circle of the brain with haemodynamic disturbances, confirmed by Doppler ultrasonography. According to the views found in the literature these disturbances are considered the probable factor of initiation of the described aneurysm. PMID:7870268

Ladzi?ski, P; Majchrzak, H; Machowski, J; Lech, A

1994-01-01

180

Subarachnoid dissemination of pineal germinoma 9 years after radiation therapy without local relapse--case report.  

PubMed

A 22-year-old female developed intracranial and spinal subarachnoid metastases 9 years after radiation therapy for a pineal germinoma. Computed tomographic scans showed no evidence of local recurrence. Cerebrospinal axis irradiation achieved total remission. Delayed subarachnoid dissemination may be caused by germinoma cells remaining dormant in the subarachnoid space, outside the radiation field. PMID:1723161

Tokoro, K; Chiba, Y; Murase, S; Yagishita, S; Kyuma, Y

1991-11-01

181

Pseudo-Subarachnoid Hemorrhage: A Potential Imaging Pitfall Associated with Diffuse Cerebral Edema  

Microsoft Academic Search

Summary: We report CT findings in seven patients with diffuse cerebral edema and increased attenuation in the basilar cisterns resembling subarachnoid hemorrhage. On the basis of autopsy (three cases) and lumbar puncture (four cases) findings, true subarachnoid hemorrhage was reasonably excluded. Pathophysiologic changes that occur with diffuse cerebral edema are explored, with proposed explanations for the appearance of a pseudo-subarachnoid

Curtis A. Given II; Jonathan H. Burdette; Allen D. Elster; Daniel W. Williams

182

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.

2013-01-01

183

Comprehensive assessment of isolated traumatic subarachnoid hemorrhage.  

PubMed

Abstract Recent studies have shown that isolated traumatic subarachnoid hemorrhage (tSAH) in the setting of a high Glasgow Coma Scale (GCS) score (13-15) is a relatively less severe finding not likely to require operative neurosurgical intervention. This study sought to provide a more comprehensive assessment of isolated tSAH among patients with any GCS score, and to expand the analysis to examine the potential need for aggressive medical, endovascular, or open surgical interventions in these patients. By undertaking a retrospective review of all patients admitted to our trauma center from 2003-2012, we identified 661 patients with isolated tSAH. Only four patients (0.61%) underwent any sort of aggressive neurosurgical, medical, or endovascular intervention, regardless of GCS score. Most tSAH patients without additional systemic injury were discharged home (68%), including 53% of patients with a GCS score of 3-8. However, older patients were more likely to be discharged to a rehabilitation facility (p<0.01). There were six (1.7%) in-hospital deaths, and five patients of these patients were older than 80 years old. We conclude that isolated tSAH, regardless of admission GCS score, is a less severe intracranial injury that is highly unlikely to require aggressive operative, medical, or endovascular intervention, and is unlikely to be associated with major neurologic morbidity or mortality, except perhaps in elderly patients. Based upon our findings, we argue that impaired consciousness in the setting of isolated tSAH should strongly compel a consideration of non-traumatic factors in the etiology of the altered neurological status. PMID:24224706

Lee, Jonathan J; Segar, David J; Asaad, Wael F

2014-04-01

184

Gastrointestinal complications of gastrocystoplasty.  

PubMed Central

The cases are reported of five children with chronic renal failure who underwent gastrocystoplasty for a variety of urological disorders. Gastrocystoplasty comprises the transplantation of a vascularised segment of stomach to the bladder to form an augmented neobladder. The patients had gastrointestinal complications after the operation, including considerable weight loss in all five patients, accompanied by marked failure to thrive in four of the five patients, and food aversion, feeding intolerance, dumping syndrome, delayed gastric emptying, and oesophagitis in two patients. Three of the five patients developed severe abdominal pain and haemorrhagic cystitis secondary to gastric acid secretion in the neobladder from the transplanted gastric pedicle. Nutritional and pharmacological interventions were used to manage the gastrointestinal problems. Explanations are offered for the pathophysiology of the observed complications of gastrocystoplasty. It is believed that the use of this procedure in infants and children, particularly those with chronic renal failure and uraemia, warrants caution until successful long term follow up and experience with this procedure have been reported.

Gold, B D; Bhoopalam, P S; Reifen, R M; Harvey, E; Marcon, M A

1992-01-01

185

Concurrent arterial aneurysms in brain arteriovenous malformations with haemorrhagic presentation  

PubMed Central

Objective: To assess the effect of concurrent arterial aneurysms on the risk of incident haemorrhage from brain arteriovenous malformations (AVMs). Methods: In a cross sectional study, 463 consecutive, prospectively enrolled patients from the Columbia AVM Databank were analysed. Concurrent arterial aneurysms on brain angiography were classified as feeding artery aneurysms, intranidal aneurysms, and aneurysms unrelated to blood flow to the AVM. Clinical presentation (diagnostic event) was categorised as intracranial haemorrhage proved by imaging or non-haemorrhagic presentation. Univariate and multivariate statistical models were applied to test the effect of age, sex, AVM size, venous drainage pattern, and the three types of aneurysms on the risk of AVM haemorrhage at initial presentation. Results: Arterial aneurysms were found in 117 (25%) patients with AVM (54 had feeding artery aneurysms, 21 had intranidal aneurysms, 18 had unrelated aneurysms, and 24 had more than one aneurysm type). Intracranial haemorrhage was the presenting symptom in 204 (44%) patients with AVM. In the univariate model, the relative risk for haemorrhagic AVM presentation was 2.28 (95% confidence interval (CI) 1.12 to 4.64) for patients with intranidal aneurysms and 1.88 (95% CI 1.14 to 3.08) for those with feeding artery aneurysms. In the multivariate model an independent effect of feeding artery aneurysms (odds ratio 2.11, 95% CI 1.18 to 3.78) on haemorrhagic AVM presentation was found. No significant effect was seen for intranidal and unrelated aneurysms. The attributable risk of feeding artery aneurysms for incident haemorrhage in patients with AVM was 6% (95% CI 1% to 11%). Conclusions: The findings suggest that feeding artery aneurysms are an independent determinant for increased risk of incident AVM haemorrhage.

Stapf, C; Mohr, J; Pile-Spellman, J; Sciacca, R; Hartmann, A; Schumacher, H; Mast, H

2002-01-01

186

Spontaneous adrenal haemorrhage in early pregnancy.  

PubMed

A 32-year-old primigravida presented at our emergency room at 6 weeks of gestation with acute severe right upper quadrant abdominal pain, radiating to the right flank. Vital signs were stable. Abdominal ultrasound showed a round inhomogeneous mass of 10 cm diameter behind the right kidney, suspected for adrenal haemorrhage. The patient was admitted for observation. An MRI showed some right-sided pleural effusion and a round mass in the adrenal region with no recognisable adrenal gland, therefore most likely originating from the right adrenal. After 10 days the patient was discharged with no change in size of the haematoma. MRI was carried out every 2 months which showed a decrease in size of the haematoma, with no other abnormalities. Based on stable MRI and the patient's preference, a vaginal delivery mode was chosen. At 37 weeks of gestation labour was induced, followed by an uncomplicated delivery. PMID:23955977

Keizer, Alieke L; Peters, Louisette W; de Vries, Cees; Smets, Yves F C; de Wit, Laurens Th; van Pampus, Mariëlle G

2013-01-01

187

[Crimean-Congo haemorrhagic fever: an enemy at the gates].  

PubMed

Crimea-Congo haemorrhagic fever is a tick-borne viral zoonosis with the potential of human-to-human transmission. The disease occurs in extensive areas in Asia, South-eastern Europe and Africa. Haemorrhagic manifestations constitute a prominent symptom of the late disease stage, with case fatality rates from 9 to 50%. The recent increase in the number of cases in Eastern Europe and the potential for nosocomial outbreaks indicate the advisability of diagnosis in every patient hospitalized in Italy with haemorrhagic fever. PMID:19838084

Pittalis, Silvia; Meschi, Silvia; Castilletti, Maria Concetta; Di Caro, Antonino; Puro, Vicenzo

2009-09-01

188

Corticosteroid-responsive prolonged thrombocytopenia following dengue haemorrhagic fever.  

PubMed

A case of prolonged thrombocytopenia following dengue haemorrhagic fever in a 15 year old boy is reported. The mechanism was presumed to be immunological and he responded dramatically to oral prednisolone. PMID:8183156

Leong, K W; Srinivas, P

1993-09-01

189

Cisternal Puncture Complications--Treatment of Coccidioidal Meningitis with Amphotericin B  

PubMed Central

Of two patients who had acute neurologic damage from cisternal punctures, one died 17 hours following a tap which produced major subarachnoid hemorrhage, the other patient recovered from probable brain stem infarction associated with cisterna magna amphotericin injection. Subarachnoid hemorrhage is the commonest major complication of cisternal puncture, with at least 30 reported fatalities. Other serious complications result from direct puncture of brain substance. Cisternal puncture is not an appropriate alternative to a difficult lumbar puncture, and indications for its use are limited. The occasional required cisternal tap should be performed only by persons carefully trained in the technique, preferably utilizing fluoroscopic guidance, and only where neurosurgical assistance is readily available. Post-puncture subarachnoid hemorrhage accompanied by progressive obtundation requires emergency evaluation and consideration of posterior fossa decompression. ImagesFigure 1.Figure 2.Figure 3.

Keane, James R.

1973-01-01

190

Early complications of interventional balloon catheterisation in infants and children.  

PubMed Central

Interventional balloon catheterisation is now the recommended procedure for several congenital heart defects. The overall complication rate in the first 160 children (median age 3 years) to undergo balloon intervention (excluding balloon atrial septostomy) at the Brompton Hospital was 24% (14% excluding haemorrhage and including three deaths (1.9%]. Most complications were related to vascular problems at the site of cardiac catheterisation. Complications were more common in the younger patient, especially neonates, and also in procedures that were ultimately unsuccessful. Most complications were transient and usually had no long term effects. Improvements in equipment design and technical expertise may reduce morbidity from these procedures.

Booth, P; Redington, A N; Shinebourne, E A; Rigby, M L

1991-01-01

191

Haemorrhage control in severely injured patients.  

PubMed

Most surgeons have adopted damage control surgery for severely injured patients, in which the initial operation is abbreviated after control of bleeding and contamination to allow ongoing resuscitation in the intensive-care unit. Developments in early resuscitation that emphasise rapid control of bleeding, restrictive volume replacement, and prevention or early management of coagulopathy are making definitive surgery during the first operation possible for many patients. Improved topical haemostatic agents and interventional radiology are becoming increasingly useful adjuncts to surgical control of bleeding. Better understanding of trauma-induced coagulopathy is paving the way for the replacement of blind, unguided protocols for blood component therapy with systemic treatments targeting specific deficiencies in coagulation. Similarly, treatments targeting dysregulated inflammatory responses to severe injury are under investigation. As point-of-care diagnostics become more suited to emergency environments, timely targeted intervention for haemorrhage control will result in better patient outcomes and reduced demand for blood products. Our Series paper describes how our understanding of the roles of the microcirculation, inflammation, and coagulation has shaped new and emerging treatment strategies. PMID:22998719

Gruen, Russell L; Brohi, Karim; Schreiber, Martin; Balogh, Zsolt J; Pitt, Veronica; Narayan, Mayur; Maier, Ronald V

2012-09-22

192

Observations on haemorrhagic septicaemia in Pakistan livestock.  

PubMed

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

1996-07-01

193

Ebola haemorrhagic fever in Zaire, 1976  

PubMed Central

Between 1 September and 24 October 1976, 318 cases of acute viral haemorrhagic fever occurred in northern Zaire. The outbreak was centred in the Bumba Zone of the Equateur Region and most of the cases were recorded within a radius of 70 km of Yambuku, although a few patients sought medical attention in Bumba, Abumombazi, and the capital city of Kinshasa, where individual secondary and tertiary cases occurred. There were 280 deaths, and only 38 serologically confirmed survivors. The index case in this outbreak had onset of symptoms on 1 September 1976, five days after receiving an injection of chloroquine for presumptive malaria at the outpatient clinic at Yambuku Mission Hospital (YMH). He had a clinical remission of his malaria symptoms. Within one week several other persons who had received injections at YMH also suffered from Ebola haemorrhagic fever, and almost all subsequent cases had either received injections at the hospital or had had close contact with another case. Most of these occurred during the first four weeks of the epidemic, after which time the hospital was closed, 11 of the 17 staff members having died of the disease. All ages and both sexes were affected, but women 15-29 years of age had the highest incidence of disease, a phenomenon strongly related to attendance at prenatal and outpatient clinics at the hospital where they received injections. The overall secondary attack rate was about 5%, although it ranged to 20% among close relatives such as spouses, parent or child, and brother or sister. Active surveillance disclosed that cases occurred in 55 of some 550 villages which were examined house-by-house. The disease was hitherto unknown to the people of the affected region. Intensive search for cases in the area of north-eastern Zaire between the Bumba Zone and the Sudan frontier near Nzara and Maridi failed to detect definite evidence of a link between an epidemic of the disease in that country and the outbreak near Bumba. Nevertheless it was established that people can and do make the trip between Nzara and Bumba in not more than four days: thus it was regarded as quite possible that an infected person had travelled from Sudan to Yambuku and transferred the virus to a needle of the hospital while receiving an injection at the outpatient clinic. Both the incubation period, and the duration of the clinical disease averaged about one week. After 3-4 days of non-specific symptoms and signs, patients typically experienced progressively severe sore throat, developed a maculopapular rash, had intractable abdominal pain, and began to bleed from multiple sites, principally the gastrointestinal tract. Although laboratory determinations were limited and not conclusive, it was concluded that pathogenesis of the disease included non-icteric hepatitis and possibly acute pancreatitis as well as disseminated intravascular coagulation. This syndrome was caused by a virus morphologically similar to Marburg virus, but immunologically distinct. It was named Ebola virus. The agent was isolated from the blood of 8 of 10 suspected cases using Vero cell cultures. Titrations of serial specimens obtained from one patient disclosed persistent viraemia of 106.5-104.5 infectious units from the third day of illness until death on the eighth day. Ebola virus particles were found in formalin-

1978-01-01

194

No association between obesity and post-tonsillectomy haemorrhage.  

PubMed

Background: The prevalence of overweight and obesity is increasing worldwide. The impact of overweight on post-tonsillectomy haemorrhage rates in children and adults is unclear. Methods: Body mass index and post-tonsillectomy haemorrhage were evaluated in all patients treated with tonsillectomy within one year in a tertiary referral centre. Bleeding episodes were categorised according to the Austrian Tonsil Study. Results: Between June 2011 and June 2012, 300 adults and children underwent tonsillectomy. Post-tonsillectomy haemorrhage occurred in 55 patients. Of those, 29 were type A (history of blood in saliva only, no active bleeding), 15 were type B (active bleeding, treatment under local anaesthesia) and 11 were type C (active bleeding, treatment under general anaesthesia). The return to operating theatre rate was 3.7 per cent. Post-tonsillectomy haemorrhage was more frequent in adolescents and adults than in children. Overweight or obesity was positively correlated with age. Post-tonsillectomy bleeding was recorded in 11.1 per cent of underweight patients, 18.9 per cent of normal weight patients and 18.7 per cent of overweight patients (p = 0.7). Data stratification (according to age and weight) did not alter the post-tonsillectomy bleeding risk (p = 0.8). Conclusion: Overweight or obesity did not increase the risk of post-tonsillectomy haemorrhage in either children or adults. PMID:24849331

Riechelmann, H; Blassnigg, E C; Profanter, C; Greier, K; Kral, F; Bender, B

2014-05-01

195

Communicating Hydrocephalus Accompanied by Arachnoid Cyst in Aneurismal Subarachnoid Hemorrhage  

PubMed Central

The authors describe a case of communicating hydrocephalus accompanied by an arachnoid cyst in an aneurismal subarachnoid hemorrhage. A 69-year-old female was referred to our clinic due to the sudden onset of a headache. A head computed tomography scan demonstrated an arachnoid cyst in the right middle fossa with a mass effect and diffuse subarachnoid hemorrhage. Digital subtraction angiography then revealed a left internal carotid-posterior communicating artery aneurysm. The neck of the aneurysm was clipped successfully and the post-operative period was uneventful. However, two months after discharge, the patient reported that her mental status had declined over previous weeks. A cranial computed tomography scan revealed an interval increase in the size of the ventricle and arachnoid cyst causing a midline shift. Simultaneous navigation guided ventriculoperitoneal shunt and cystoperitoneal shunt placement resulted in remarkable radiological and clinical improvements.

Choi, Jae Young; Cha, Seung Heon; Cho, Won Ho

2013-01-01

196

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

PubMed

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. PMID:23814588

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

2012-12-01

197

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

2012-01-01

198

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

2008-01-01

199

CHRONIC CEREBRAL PARAGONIMIASIS COMBINED WITH ANEURYSMAL SUBARACHNOID HEMORRHAGE  

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

JUK-DONG CHOO; BUMN-SUK SUH; HYUN-SUNG LEE; JONG-SOO LEE; CHANG-JUNE SONG; DAE-WHAN SHIN; YOUNG-HA LEE

200

Intravenous Magnesium Sulfate After Aneurysmal Subarachnoid Hemorrhage: Current Status  

Microsoft Academic Search

\\u000a Delayed ischemic neurological deficit or clinical vasospasm remained a major cause for delayed neurological morbidity and\\u000a mortality for patients with aneurysmal subarachnoid hemorrhage (SAH). Magnesium is a cerebral vasodilator. In experimental\\u000a model of drug or SAH-induced vasospasm, magnesium blocks voltage-dependent calcium channels and reverses cerebral vasoconstriction.\\u000a Furthermore, its antagonistic action on N-methyl-D-aspartate receptor in the brain prevents glutamate stimulation and

George Kwok Chu Wong; Matthew Tai Vai Chan; Tony Gin; Wai Sang Poon

201

Disorders of Sleep and Wake in Patients After Subarachnoid Hemorrhage  

Microsoft Academic Search

Background and Purpose—To determine the frequency and severity of disorders of sleep and wake and their relation to the quality of life (QoL) in patients who have survived an episode of subarachnoid hemorrhage (SAH). Methods—In a prospectively collected, consecutive series of 89 patients, 83 patients completed validated and frequently used questionnaires for the assessment of disorders of sleep and wake

Wouter J. Schuiling; Gabriel J. E. Rinkel; Rob Walchenbach; Al W. de Weerd

2010-01-01

202

Subarachnoid hemorrhage and vasospastic stroke after self-enucleation.  

PubMed

A 31-year-old intoxicated woman self-enucleated her left eye during an acute psychotic episode. CT revealed avulsion of the intracranial optic nerve, chiasmal edema, and adjacent subarachnoid hemorrhage. Exploration via transconjunctival orbitotomy was performed, and the globe and 4.8 cm of contiguous optic nerve were removed. The patient developed postoperative contralateral visual loss followed by middle cerebral artery vasospasm and bilateral cortical infarcts. PMID:17882004

Kotlus, Brett S; Lo, Mikel W

2007-01-01

203

Subarachnoid hemorrhage caused by a ruptured anterior spinal artery aneurysm.  

PubMed

A 51-year-old man presented with an extremely rare case of intracranial subarachnoid hemorrhage caused by rupture of an anterior spinal artery aneurysm manifesting as disturbance of consciousness following sudden onset of neck pain and numbness of the extremities. Cranial computed tomography revealed subarachnoid hemorrhage, mainly in the posterior fossa. Cerebral angiography studies on admission and on the 4th day demonstrated no definite abnormality as a bleeding source. A ventricular catheter was inserted to treat the acute hydrocephalus, and conservative management was continued during the acute period. Third angiography on the 18th day demonstrated an anterior spinal artery aneurysm at the C1 level which was considered to be the bleeding site. After conservative treatment, the patient was discharged without neurological deficits. Fourth angiography on the 108 th day disclosed spontaneous disappearance of the aneurysm, which was confirmed by the fifth angiography on the 269 th day. If subarachnoid hemorrhage of unknown etiology is encountered, spinal artery aneurysm should be considered as the bleeding source. Despite the controversy concerning the treatment strategy, ruptured spinal artery aneurysms can be treated conservatively because of the possibility of spontaneous regression. Follow-up angiography is required to evaluate the natural course of the lesion. PMID:21123989

Karakama, Jun; Nakagawa, Kazuhiko; Maehara, Taketoshi; Ohno, Kikuo

2010-01-01

204

[Subarachnoid anesthesia with Sprotte 24-G needle in ambulatory surgery].  

PubMed

In order to evaluate the possibility of using a selective subarachnoid anesthesia in ambulatory surgery we studied its feasibility with a Sprotte needle 24 G in 103 patients (range 15-67 years) undergoing a knee joint arthroscopy. The subarachnoid anesthesia was achieved with Sprotte needle 24 G with introducer with patient on lateral decubitus. Hyperbaric bupivacaine 1% (0.05 mg/cm height) was used in order to obtain a selective homolateral metameric anesthesia between L1 and S3. The numbers of attempts were 1.29 (range 1-4). We involved the homolateral determatomeres in 94% of our attempts, adding a weak anesthetic action on contralateral ones. In the remaining 6% of the patients the anesthesia was bilateral and extending in an overlying manner. Anesthesia was adequate for the time needed to perform all the surgical procedures. Nevertheless in 3 patients the tourniquet was painful. We registered systemic hypotension only in 2% of the patients (a reduced systolic pressure value > 30%). No cases of postdural puncture headache were registered. Non postural atypical headache was seem in 3.9% of the patients. Urinary retention necessitating catheterization was noted only in 3 cases. A weak backache was revealed in 8.8%. When interviewed after surgery, 98% of our patients fulfilled the technique. In spite of technical difficulties that the use of the Sprotte needle may present, the selective subarachnoid anesthesia may be a safe alternative to the other anesthetic procedures for ambulatory surgery of the legs. PMID:8355863

Toffoletto, F; Pittoni, G; Marazza, D; Davià, G; Lamarca, L

1993-05-01

205

[Erythrocytes and microvascular tone during acute traumatic haemorrhagic shock].  

PubMed

Haemorrhagic shock remains a leading cause of death in trauma patients. The concept of haematologic damage control is gradually taking place in the management of traumatic haemorrhagic shock. It is based primarily on the early implementation of a quality blood transfusion involving erythrocytes, plasmas and platelets transfusion. Red blood cell transfusion is mainly supported by the oxygen carrier properties of erythrocytes. However, it appears that erythrocytes ability to modulate the bioavailability of nitric oxide (NO) plays a major role in capillary opening and perfusion. Erythrocytes are also actively involved in the processes of hemostasis and coagulation. In this context, it seems difficult to define a threshold of hemoglobin concentration to determine the implementation of a blood transfusion in traumatic haemorrhagic shock. PMID:23611789

Morel, N; Biais, M; Delaunay, F; Dubuisson, V; Cassone, O; Siméon, F; Morel, O; Janvier, G

2013-05-01

206

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 www.clinicaltrials.gov Identifier: NCT01258257

2011-01-01

207

Blood transfusion and the anaesthetist: management of massive haemorrhage  

PubMed Central

Hospitals must have a major haemorrhage protocol in place and this should include clinical, laboratory and logistic responses. Immediate control of obvious bleeding is of paramount importance (pressure, tourniquet, haemostatic dressings). The major haemorrhage protocol must be mobilised immediately when a massive haemorrhage situation is declared. A fibrinogen < 1 g.l?1 or a prothrombin time (PT) and activated partial thromboplastin time (aPTT) of > 1.5 times normal represents established haemostatic failure and is predictive of microvascular bleeding. Early infusion of fresh frozen plasma (FFP; 15 ml.kg?1) should be used to prevent this occurring if a senior clinician anticipates a massive haemorrhage. Established coagulopathy will require more than 15 ml.kg?1 of FFP to correct. The most effective way to achieve fibrinogen replacement rapidly is by giving fibrinogen concentrate or cryoprecipitate if fibrinogen is unavailable. 1:1:1 red cell:FFP:platelet regimens, as used by the military, are reserved for the most severely traumatised patients. A minimum target platelet count of 75 × 109.l?1 is appropriate in this clinical situation. Group-specific blood can be issued without performing an antibody screen because patients will have minimal circulating antibodies. O negative blood should only be used if blood is needed immediately. In hospitals where the need to treat massive haemorrhage is frequent, the use of locally developed shock packs may be helpful. Standard venous thromboprophylaxis should be commenced as soon as possible after haemostasis has been secured as patients develop a prothrombotic state following massive haemorrhage.

Thomas, D; Wee, M; Clyburn, P; Walker, I; Brohi, K; Collins, P; Doughty, H; Isaac, J; Mahoney, PF; Shewry, L

2010-01-01

208

Neonatal posterior fossa haemorrhage associated with vacuum extractor.  

PubMed

We report one case of posterior fossa intracranial haemorrhage in a full-term Malay baby boy following vacuum assisted delivery. The patient, a term baby boy was delivered by a vacuum extraction and later developed signs of increased intracranial pressure 72 hours after birth. Computed tomography (CT) of the brain showed a posterior fossa intracranial haemorrhage with acute obstructive hydrocephalus. He was initially treated with isolated ventricular shunting which later caused an upward cerebellar herniation. An immediate suboccipital craniectomy for evacuation of cerebellar haematoma was performed which resulted in a gradual recovery. PMID:16708744

Ghani, A R I; Prakash, R G; Abdullah, J

2006-03-01

209

Seizures and Epilepsy following Aneurysmal Subarachnoid Hemorrhage : Incidence and Risk Factors  

PubMed Central

Objective Although prophylactic antiepileptic drug (AED) use in patients with aneurysmal subarachnoid hemorrhage (SAH) is a common practice, lack of uniform definitions and guidelines for seizures and AEDs rendered this prescription more habitual instead of evidence-based manner. We herein evaluated the incidence and predictive factors of seizure and complications about AED use. Methods From July 1999 to June 2007, data of a total of 547 patients with aneurysmal SAH who underwent operative treatments were reviewed. For these, the incidence and risk factors of seizures and epilepsy were assessed, in addition to complications of AEDs. Results Eighty-three patients (15.2%) had at least one seizure following SAH. Forty-three patients (7.9%) had onset seizures, 34 (6.2%) had perioperative seizures, and 17 (3.1%) had late epilepsy. Younger age (< 40 years), poor clinical grade, thick hemorrhage, acute hydrocephalus, and rebleeding were related to the occurrence of onset seizures. Cortical infarction and thick hemorrhage were independent risk factors for the occurrence of late epilepsy. Onset seizures were not predictive of late epilepsy. Moreover, adverse drug effects were identified in 128 patients (23.4%) with AEDs. Conclusion Perioperative seizures are not significant predictors for late epilepsy. Instead, initial amount of SAH and surgery-induced cortical damage should be seriously considered as risk factors for late epilepsy. Because AEDs can not prevent early postoperative seizures (< 1 week) and potentially cause unexpected side effects, long-term use should be readjusted in high-risk patients.

Choi, Kyu-Sun; Chun, Hyoung-Joon; Ko, Yong; Kim, Young-Soo; Kim, Jae-Min

2009-01-01

210

Massive haemorrhage into acoustic neurinoma related to rapid growth of the tumour.  

PubMed

Massive haemorrhage into a acoustic neurinoma is very rare. A large size, mixed Antoni type and secondary vascular changes are thought to be causative factors. We describe a patient with a rapidly growing acoustic neurinoma which led to a massive haemorrhage. Rapid growth of the tumour seems to be another risk factor for haemorrhage. PMID:10070453

Ohta, S; Yokoyama, T; Nishizawa, S

1998-10-01

211

Acute haemorrhagic and hypoxic-ischaemic brain damage in the neonate  

Microsoft Academic Search

Haemorrhage and hypoxic-ischaemic lesions are relatively frequent post-mortem findings in neonates, particularly in the context of low birth weight and prematurity. The most common of the acute abnormalities is germinal matrix haemorrhage, which is often accompanied by haemorrhage into the ventricles. Resolution of haematomas in the germinal matrix and brain parenchyma leaves gliotic cysts. The more severe grades of ventricular

Seth Love

2004-01-01

212

Management of bleeding disorders in traumatic-haemorrhagic shock states with deep frozen fresh plasma  

Microsoft Academic Search

Coagulation disorders in traumatic-haemorrhagic shock need not represent a simple coagulation problem. They may also occur as a complex of local and disseminated intravascular consumption, dilution, extravascular loss and depressed synthesis of coagulation factors. In the severely bleeding patient with a haemorrhagic diathesis heparin is contraindicated because it does not normalize coagulability immediately. Therefore, it fails to stop haemorrhage and

H. J. Helme; D. Nyman; H. Burri; G. Wolff

1976-01-01

213

Factors related to the incidence of secondary haemorrhage in 462 patients with traumatic hyphaema  

Microsoft Academic Search

In a retrospective study of 462 in-patients with traumatic hyphaema, secondary haemorrhage occurred in 8.7% of patients. A multivariate analysis demonstrated that the size of hyphaema on presentation and the presence of retinal damage did not affect the probability of secondary haemorrhage. The incidence of secondary haemorrhage was found to decrease by approximately half with the use of topical steroid

C S Ng; N P Strong; J M Sparrow; A R Rosenthal

1992-01-01

214

Reducing Haemorrhagic Transformation after Thrombolysis for Stroke: A Strategy Utilising Minocycline  

PubMed Central

Haemorrhagic transformation (HT) of recently ischaemic brain is a feared complication of thrombolytic therapy that may be caused or compounded by ischaemia-induced activation of matrix metalloproteinases (MMPs). The tetracycline antibiotic minocycline inhibits matrix MMPs and reduces macroscopic HT in rodents with stroke treated with tissue plasminogen activator (tPA). The West Australian Intravenous Minocycline and TPA Stroke Study (WAIMATSS) aims to determine the safety and efficacy of adding minocycline to tPA in acute ischaemic stroke. The WAIMATSS is a multicentre, prospective, and randomised pilot study of intravenous minocycline, 200?mg 12 hourly for 5 doses, compared with standard care, in patients with ischaemic stroke treated with intravenous tPA. The primary endpoint is HT diagnosed by brain CT and MRI. Secondary endpoints include clinical outcome measures. Some illustrative cases from the early recruitment phase of this study will be presented, and future perspectives will be discussed.

Blacker, David J.; Prentice, David; Alvaro, Anthony; Bates, Timothy R.; Bynevelt, Michael; Kelly, Andrew; Kho, Lay Kun; Kohler, Edith; Hankey, Graeme J.; Thompson, Andrew; Major, Taryn

2013-01-01

215

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

2011-01-01

216

Arterial pressure maintenance after haemorrhage in the pregnant rabbit.  

PubMed Central

The changes in arterial blood pressure and cardiac output following rapid removal of 10% of the blood volume have been compared in non-pregnant and pregnant anaesthetized rabbits close to term (28 or 29 days gestation). Immediately after the end of haemorrhage the fall in arterial pressure was greater in the pregnant group (27.7 vs. 17.8 mmHg), but as recovery proceeded the difference diminished and by the tenth minute the reduction from pre-haemorrhage levels was similar in pregnant and non-pregnant rabbits. Cardiac output fell by about 30% in both groups and increased only very slightly during the ensuing 10 min. 1 h after section of the carotid sinus and aortic nerves the haemorrhage was repeated. The fall in arterial pressure in the non-pregnant rabbits was now more than doubled (47.2 vs. 17.8 mmHg). By contrast it was little changed in the pregnant rabbits (32.0 vs. 27.7 mmHg). It is concluded that pregnancy diminishes the role of the baroreceptor reflexes in the response of the rabbit to haemorrhage. Other mechanisms, such as an increased compliance of the resistance vessels and/or a more effective chemically mediated vasoconstriction, probably become of more importance to the maintenance of arterial pressure.

Humphreys, P W; Joels, N

1985-01-01

217

Crimean Congo hemorrhagic fever and diffuse alveolar haemorrhage.  

PubMed

Although the pathology of Crimean Congo haemorrhagic fever (CCHF) is mainly related to a haemorrhagic process with secondary cytokine storm, there have been no published reports of this fatal disease being a cause of diffuse alveolar haemorrhage (DAH). There are many aetiological factors emphasizing the direct role of endothelial injury on DAH. We present the case of a young adult Turkish man with diffuse bilateral alveolar haemorrhage without an episode of gross haemoptysis caused by the CCHF virus. Successful clinical results and a rapid clinical and radiological clearance were obtained within few days after starting daily oral ribavirin treatment. This fatal infection should be considered to exist in any patient presenting with DAH, and should rapidly be treated with ribavirin. Another very important factor which should always be borne in mind is the contagious character of the CCHF virus. It is one of the most dangerous microorganisms transmitted from person to person. Even the bronchoscopes contaminated with patient blood carry a high risk for nosocomial spread to medical staff and other patients. PMID:18820205

Doganci, Levent; Ceyhan, Meltem; Tasdeler, Nuriye Fisgin; Sarikayalar, Hanife; Tulek, Necla

2008-10-01

218

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

2009-01-01

219

Sudden death from primary intraventricular haemorrhage in childhood  

Microsoft Academic Search

We report on two girls, 10 and 13 years old, who died suddenly from ruptured vascular malformations of the choroid plexus. Both presented with headache, vomiting, loss of conciousness and coma. The rare cause of massive primary intraventricular haemorrhage and malignant, rapidly increasing brain pressure was not recognized. The communication highlights the urgency of an early accurate diagnosis with prompt

Erich Reusche; Christian Gaebel; Katharina Gloeckner; Parviz Mehraein; Abolghassem Sepehrnia

1999-01-01

220

Haemophagocytosis in dengue haemorrhagic fever: a case report.  

PubMed

Virus associated haemophagocytic syndrome (VAHS), a distinct clinico-pathologic entity, is characterised by systemic proliferation of non-neoplastic histotiocytes showing haemophagocytosis resulting in blood cytopaenia. It has been described in relation to several viruses earlier. Here we describe a young girl who developed this reactive process during the course of dengue haemorrhagic fever (DHF). PMID:1803975

Ramanathan, M; Duraisamy, G

1991-11-01

221

Haemorrhagic gastroenteritis in the dog associated with Clostridium welchii.  

PubMed

Two cases of peracute haemorrhagic enteritis in the dog are reported. Gram-positive bacilli, which were shown in one case to be Clostridium welchii were found adhering to the necrotic epithelial surfaces in parts of the gastrointestinal tract in both cases. Large numbers of C welchii were recovered from the intestines of both dogs. PMID:211699

Prescott, J F; Johnson, J A; Patterson, J M; Bulmer, W S

1978-08-01

222

Spontaneous intracerebral haemorrhage in patients suspected of multiple sclerosis  

Microsoft Academic Search

Two cases of spontaneous intracerebral haemorrhage in adolescent girls suspected of having multiple sclerosis are reported. Surgical evacuation of haematomas in the left thalamus and left side of the pons, respectively, was performed with excellent recovery in both cases. Some clinical and pathological aspects of small arteriovenous malformations are discussed and the pertinent literature reviewed.

I. F. Abroms; L. Yessayan; J. Shillito; C. F. Barlow

1971-01-01

223

Tuberculous pancreatitis complicated by ruptured splenic artery pseudoaneurysm.  

PubMed

Tuberculosis involving the pancreas is rare. We report a patient with pancreatic tuberculosis complicated by haemorrhage from a splenic artery pseudoaneurysm. As far as we are aware, the development of a splenic artery pseudoaneurysm in association with a large caseating mass of tuberculous pancreatic lymph nodes has not been reported previously. We review the literature and discuss the varied presentations of tuberculosis involving the pancreas or the pancreatic bed and its draining lymph nodes. PMID:24761532

Irfan, M; Thiavalappil, F; Nagaraj, J; Brown, T H; Roberts, D; McKnight, L; Harrison, N K

2013-01-01

224

Intravenous magnesium sulfate administration in a patient with refractory vasospasm following subarachnoid hemorrhage  

Microsoft Academic Search

Objective Magnesium sulfate is being investigated for the prevention or treatment of vasospasm following subarachnoid hemorrhage. Patient A 45-year-old woman suffered subarachnoid hemorrhage and developed after 8 days symptomatic vasospasm in the left middle cerebral artery (MCA) while she was receiving nimodipine prophylactically. Methods and results Transcranial Doppler monitoring was performed. Cerebral autoregulation was abolished in the left MCA. Despite this

Maria Barile; Françoise van de Wyngaert; Jean-Jacques Essama Mbia; Mijael Jativa; Cécile Grandin; Herbert Rooijakkers; Philippe Hantson

2003-01-01

225

17-? Estradiol Can Reduce Secondary Ischemic Damage and Mortality of Subarachnoid Hemorrhage  

Microsoft Academic Search

Subarachnoid hemorrhage (SAH) is a unique disorder commonly occurring when an aneurysm ruptures, leading to bleeding and clot formation, with a higher incidence in females. To evaluate the influence of 17-? estradiol (E2) in the outcome of subarachnoid hemorrhage, SAH was induced by endovascular puncture of the intracranial segment of internal carotid artery in 15 intact females (INT), 19 ovariectomized

Shao-Hua Yang; Zhen He; Samuel S. Wu; Yun-Ju He; Jason Cutright; William J. Millard; Arthur L. Day; James W. Simpkins

2001-01-01

226

The cardiovascular effects of vasopressin after haemorrhage in anaesthetized rats.  

PubMed Central

The cardiovascular effects of an acute haemorrhage (2% of the body weight) were studied over a 60 min period in three groups of rats: (a) Brattleboro rats with hereditary hypothalamic diabetes insipidus (b.d.i.) lacking circulating vasopressin, (b) control rats of the parent Long Evans (l.e.) strain, and (c) l.e. rats treated with an antagonist of the vascular action of vasopressin. Prior to the haemorrhage there were no significant differences between the three groups of rats with respect to mean arterial blood pressure, cardiac output, stroke volume or total peripheral resistance. Following the haemorrhage cardiac output and stroke volume were severely reduced in all three groups of rats. Total peripheral resistance was relatively unaffected in antagonist-treated l.e. rats and b.d.i. rats, but rose substantially in response to the loss of blood in the control l.e. group. Both total peripheral resistance and mean arterial blood pressure were markedly greater in the untreated l.e. control rats than in the other two groups of animals during the first 20 min after haemorrhage. The mean heart rate measured in Brattleboro rats was elevated compared with that of control l.e. rats throughout the experiment and, in addition, significantly greater than that of antagonist-treated l.e. rats during the first 40 min after the haemorrhage. Survival rate for the b.d.i. rats following the 2% haemorrhage was lower than that for l.e. control rats and antagonist-treated l.e. rats. The results indicate that the recovery of the blood pressure following an acute arterial haemorrhage is significantly influenced by vasopressin, particularly during the first 20 min, and that the predominant effect of the hormone is to increase the total peripheral resistance. The higher mortality associated with volume depletion in the b.d.i. rats is unlikely to be directly related to the absence of the vascular action of vasopressin, since administration of the vasopressin antagonist to normal l.e. rats does not reduce their survival rate.

Chapman, J T; Hreash, F; Laycock, J F; Walter, S J

1986-01-01

227

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

2013-01-01

228

Plasma gelsolin levels and outcomes after aneurysmal subarachnoid hemorrhage  

PubMed Central

Introduction Lower gelsolin levels have been associated with the severity and poor outcome of critical illness. Nevertheless, their link with clinical outcomes of aneurysmal subarachnoid hemorrhage is unknown. Therefore, we aimed to investigate the relationship between plasma gelsolin levels and clinical outcomes in patients with aneurysmal subarachnoid hemorrhage. Methods A total of 262 consecutive patients and 150 healthy subjects were included. Plasma gelsolin levels were measured by enzyme-linked immunosorbent assay. Mortality and poor long-term outcome (Glasgow Outcome Scale score of 1-3) at 6 months were recorded. Results Plasma gelsolin levels on admission were substantially lower in patients than in healthy controls (66.9 (26.4) mg/L vs. 126.4 (35.4) mg/L, P < 0.001), and negatively associated with World Federation of Neurological Surgeons score (r = -0.554, P < 0.001) and Fisher score (r = -0.538, P < 0.001), and identified as an independent predictor of poor functional outcome (odds ratio, 0.957; 95% confidence interval (CI), 0.933-0.983; P = 0.001) and death (odds ratio, 0.953; 95% CI, 0.917-0.990; P = 0.003) after 6 months. The areas under the ROC curve of gelsolin for functional outcome and mortality were similar to those of World Federation of Neurological Surgeons score and Fisher score (all P > 0.05). Gelsolin improved the predictive values of World Federation of Neurological Surgeons score and Fisher score for functional outcome (both P < 0.05), but not for mortality (both P > 0.05). Conclusions Gelsolin levels are a useful, complementary tool to predict functional outcome and mortality 6 months after aneurysmal subarachnoid hemorrhage.

2013-01-01

229

Severe hypokalemia in a patient with subarachnoid hemorrhage.  

PubMed

Hypokalemia is a common electrolyte disorder in the intensive care unit. Its cause often is complex, involving both potassium losses from the body and shifts of potassium into cells. We present a case of severe hypokalemia of sudden onset in a patient being treated for subarachnoid hemorrhage in the surgical intensive care unit in order to illustrate the diagnosis and management of severe hypokalemia of unclear cause. Our patient received agents that promote renal potassium losses and treatments associated with a shift of potassium into cells. We outline the steps in diagnosis and management, focusing on the factors regulating the transcellular distribution of potassium in the body. PMID:23972266

Ybanez, Neil; Agrawal, Varun; Tranmer, Bruce I; Gennari, F John

2014-03-01

230

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

1983-01-01

231

Optimal treatment determination on the basis of haematoma volume and intra-cerebral haemorrhage score in patients with hypertensive putaminal haemorrhages: a retrospective analysis of 310 patients  

PubMed Central

Background Hypertensive putaminal haemorrhage comprises major part of intra-cerebral haemorrhages, with particularly high morbidity and mortality. However, the optimal treatments for these individuals remain controversial. Methods From June 2010 to August 2013, patients with hypertensive putaminal haemorrhages were treated in the Department of Neurosurgery, West China Hospital. Information regarding the age, signs of cerebral herniation, haematoma volume, intra-ventricular haemorrhage, intra-cerebral haemorrhage score and the treatments of each patient were analyzed retrospectively. The outcome was evaluated by the 30-day mortality rate. Results The 30-day mortality rate of the patients with haematomas volume greater than or equal to 30 ml and intra-cerebral haemorrhage scores of 1 or 2 was decreased in the surgical group compared with those in the conservative group (1.92% VS. 21.40%, OR?=?0.072, p?=?0.028; 15.40% VS. 33.3%, OR?=?0.365, p?=?0.248, respectively). The mortality rate of the patients with signs of cerebral herniation was not significantly different between the surgical and conservative groups (83.30% VS. 100%; p?=?0.529). The intra-cerebral haemorrhage score was significantly associated with the 30-day mortality rate of patients with intra-cerebral haemorrhages (r?=?-0.798, p?haemorrhage scores of 1 or 2 could benefit from the surgical removal of haematomas. The intra-cerebral haemorrhage score can accurately predict the 30-day mortality rate of patients with hypertensive putaminal haemorrhages.

2014-01-01

232

Spontaneous Anterior Cerebral Artery Dissection Presenting with Simultaneous Subarachnoid Hemorrhage and Cerebral Infarction in a Patient with Multiple Extracranial Arterial Dissections  

PubMed Central

Simultaneous subarachnoid hemorrhage and infarction is a quite rare presentation in a patient with a spontaneous dissecting aneurysm of the anterior cerebral artery. Identifying relevant radiographic features and serial angiographic surveillance as well as mode of clinical manifestation, either hemorrhage or infarction, could sufficiently determine appropriate treatment. Enlargement of ruptured aneurysm and progressing arterial stenosis around the aneurysm indicates impending risk of subsequent stroke. In this setting, prompt treatment with stent-assisted endovascular embolization can be a reliable alternative to direct surgery. When multiple arterial dissections are coexistent, management strategy often became complicated. However, satisfactory clinical results can be obtained by acknowledging responsible arterial site with careful radiographic inspection and antiplatelet medication.

Park, Yung Ki; Lee, Young Jun; Kim, Young-Seo

2013-01-01

233

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

2011-01-01

234

Biomarkers of vasospasm development and outcome in aneurysmal subarachnoid hemorrhage.  

PubMed

Aneurysmal subarachnoid hemorrhage (SAH) is a neurologic emergency caused by a brain aneurysm burst, resulting in a bleeding into the subarachnoid space. Its incidence is estimated between 4 and 28/10,000 inhabitants and it is the main cause of sudden death from stroke. The prognosis of patients with SAH is directly related to neurological status on admission, to the magnitude of the initial bleeding, as well as to the development of cerebral vasospasm (CVS). Numerous researchers have studied the role of different biomarkers in CVS development. These biomarkers form part of the metabolic cascade that is triggered as a result of the SAH. Hence, among these metabolites we found biomarkers of oxidative stress, inflammation biomarkers, indicators of brain damage, and markers of vascular pathology. However, to the author knowledge, none of these biomarkers has been demonstrated as a useful tool for predicting neither CVS development nor outcome after SAH. In order to reach success on future researches, firstly it should be stated which pathophysiological process is mainly responsible for CVS development. Once this process has been determined, the temporal course of this pathophysiologic cascade should be characterized, and then, perform further studies on biomarkers already analyzed, as well as on new biomarkers not yet studied in the SAH pathology, focusing attention on the temporal course of the diverse metabolites and the sampling time for its quantification. PMID:24811975

Rodríguez-Rodríguez, Ana; Egea-Guerrero, Juan José; Ruiz de Azúa-López, Zaida; Murillo-Cabezas, Francisco

2014-06-15

235

Molecular alterations in the hippocampus after experimental subarachnoid hemorrhage.  

PubMed

Patients with aneurysmal subarachnoid hemorrhage (SAH) frequently have deficits in learning and memory that may or may not be associated with detectable brain lesions. We examined mediators of long-term potentiation after SAH in rats to determine what processes might be involved. There was a reduction in synapses in the dendritic layer of the CA1 region on transmission electron microscopy as well as reduced colocalization of microtubule-associated protein 2 (MAP2) and synaptophysin. Immunohistochemistry showed reduced staining for GluR1 and calmodulin kinase 2 and increased staining for GluR2. Myelin basic protein staining was decreased as well. There was no detectable neuronal injury by Fluoro-Jade B, TUNEL, or activated caspase-3 staining. Vasospasm of the large arteries of the circle of Willis was mild to moderate in severity. Nitric oxide was increased and superoxide anion radical was decreased in hippocampal tissue. Cerebral blood flow, measured by magnetic resonance imaging, and cerebral glucose metabolism, measured by positron emission tomography, were no different in SAH compared with control groups. The results suggest that the etiology of loss of LTP after SAH is not cerebral ischemia but may be mediated by effects of subarachnoid blood such as oxidative stress and inflammation. PMID:24064494

Han, Sang Myung; Wan, Hoyee; Kudo, Gen; Foltz, Warren D; Vines, Douglass C; Green, David E; Zoerle, Tommaso; Tariq, Asma; Brathwaite, Shakira; D'Abbondanza, Josephine; Ai, Jinglu; Macdonald, R Loch

2014-01-01

236

Prolonged paroxysmal sympathetic storming associated with spontaneous subarachnoid hemorrhage.  

PubMed

Paroxysmal sympathetic storming (PSS) is a rare disorder characterized by acute onset of nonstimulated tachycardia, hypertension, tachypnea, hyperthermia, external posturing, and diaphoresis. It is most frequently associated with severe traumatic brain injuries and has been reported in intracranial tumors, hydrocephalous, severe hypoxic brain injury, and intracerebral hemorrhage. Although excessive release of catecholamine and therefore increased sympathetic activities have been reported in subarachnoid hemorrhage (SAH), there is no descriptive report of PSS primarily caused by spontaneous SAH up to date. Here, we report a case of prolonged PSS in a patient with spontaneous subarachnoid hemorrhage and consequent vasospasm. The sympathetic storming started shortly after patient was rewarmed from hypothermia protocol and symptoms responded to Labetalol, but intermittent recurrence did not resolve until 3 weeks later with treatment involving Midazolam, Fentanyl, Dexmedetomidine, Propofol, Bromocriptine, and minimizing frequency of neurological and vital checks. In conclusion, prolonged sympathetic storming can also be caused by spontaneous SAH. In this case, vasospasm might be a precipitating factor. Paralytics and hypothermia could mask the manifestations of PSS. The treatment of the refractory case will need both timely adjustment of medications and minimization of exogenous stressors or stimuli. PMID:23476663

Liu, Yan; Jolly, Suneil; Pokala, Krishna

2013-01-01

237

CSF pressure and velocity in obstructions of the subarachnoid spaces.  

PubMed

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

2013-04-01

238

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

PubMed

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

2012-10-01

239

Pulmonary Complications  

Microsoft Academic Search

\\u000a After hematopoietic stem cell transplant (HSCT), up to 60% of patients develop pulmonary complications. In spite of antibacterial,\\u000a antiviral, and antifungal prophylaxis, reduced host defenses render the HSCT patient vulnerable to pulmonary and other infections\\u000a in the early weeks and even months post-transplantation. This chapter will suggest an integrative approach followed by a description\\u000a of the most common pulmonary syndromes

Tarek Eid; Alan F. Barker

240

Gastrointestinal Complications  

Microsoft Academic Search

\\u000a Gastrointestinal and hepatic complications are common in the hematopoietic stem cell transplant (HSCT) patient. The agents\\u000a used in the conditioning regimen induce direct disruption of the intestinal barrier as well as indirect damage from cytokine\\u000a release and generalized inflammatory state. These events lead to permeation of bacteria and endotoxins through the bowel wall,\\u000a with subsequent organ damage and increased risk

Eneida Nemecek

241

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

PubMed

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

2013-11-01

242

Mesenchymal stem cells improved the ultrastructural morphology of cerebral tissues after subarachnoid hemorrhage in rats.  

PubMed

Subarachnoid hemorrhage (SAH) causes widespread disruption in the cerebral architecture.The process of SAH is complicated and many people lose their lives or become disabled after injury. Mesenchymal stem cells (MSCs) are considered as good candidate for repair of cerebral damage. The aim was to assess the ultrastructural changes in the rat cerebral tissue after intravenous transplantation of MSCs. Female Wistar rats (8 per group) weighing 275~300 g were assigned to control (SAH+PBS) and experimental groups (SAH+MSCs).The samples from middle cerebral arterial wall and parietal cerebral tissue were prepared for transmission electron microscopy (TEM) according to standard protocol. Fine architectures of the vessel wall, including the contraction of the inner layer, smooth muscle layer,as well as neural cells were observed after SAH. Cerebral arterial wall and cortex, including neuronal and glial cells were injured post SAH. But, administration of MSCs improved the structural integrity of cerebral tissues. Changes were much more balanced with their relative improvement in some areas. The role of MSCs for repairing the injured cerebral tissues post experimental SAH was approved by electron microscopy. PMID:24737942

Khalili, Mohammad Ali; Sadeghian-Nodoushan, Fatemeh; Fesahat, Farzaneh; Mir-Esmaeili, Seyed Mohsen; Anvari, Morteza; Hekmati-Moghadam, Seyed Hossain

2014-03-01

243

Hydrocephalus Onset after Microsurgical or Endovascular Treatment for Acute Subarachnoid Hemorrhage. Retrospective Italian Multicenter Study  

PubMed Central

Background Chronic shunt-dependent hydrocephalus is a complication of aneurysmal subarachnoid hemorrhage (aSAH). Its incidence and risk factors have been described while the hydrocephalus onset in terms of days after treatment (microsurgical or endovascular) has not been yet analyzed. Materials and Methods 45 patients, treated for aSAH in 4 Italian Neurosurgical Departments, were retrospectively analyzed. It was calculated the time that elapses between treatment and hydrocephalus onset in 36 patients. Results Of the 45 shunted patients, 15 (33.3%) were included in the microsurgical group (group A) and 30 (66.6%) were in the endovascular one (group B). There was no difference of the hydrocephalus onset between the two groups (24,1 days, group A vs. 27,7 days, group B). The presence of intracerebral hematoma (ICH) caused a delay in the hydrocephalus onset after endovascular treatment in terms of 11,5 days compared to microsurgical group as well the absence of vasospasm determined a delay of 13,7 days (not statistically significant). Conclusion No difference in terms of hydrocephalus onset after microsurgical or endovascular treatment has been demonstrated. Only the presence of ICH or the absence of vasospasm can cause a slight delay in the time of hydrocephalus onset in the endovascular series (not statistically significant). Long-term follow-up studies involving higher numbers of subjects are needed to better demonstrate this issue.

Gangemi, Michelangelo; Cavallo, Luigi Maria; Di Somma, Alberto; Mazzucco, Grazia Marina; Bono, Paolo Sebastiano; Ghetti, Giovanni; Zambon, Giampaolo

2014-01-01

244

Metamorphosis of Subarachnoid Hemorrhage Research: from Delayed Vasospasm to Early Brain Injury  

PubMed Central

Delayed vasospasm that develops 3–7 days after aneurysmal subarachnoid hemorrhage (SAH) has traditionally been considered the most important determinant of delayed ischemic injury and poor outcome. Consequently, most therapies against delayed ischemic injury are directed towards reducing the incidence of vasospasm. The clinical trials based on this strategy, however, have so far claimed limited success; the incidence of vasospasm is reduced without reduction in delayed ischemic injury or improvement in the long-term outcome. This fact has shifted research interest to the early brain injury (first 72 h) evoked by SAH. In recent years, several pathological mechanisms that activate within minutes after the initial bleed and lead to early brain injury are identified. In addition, it is found that many of these mechanisms evolve with time and participate in the pathogenesis of delayed ischemic injury and poor outcome. Therefore, a therapy or therapies focused on these early mechanisms may not only prevent the early brain injury but may also help reduce the intensity of later developing neurological complications. This manuscript reviews the pathological mechanisms of early brain injury after SAH and summarizes the status of current therapies.

Pluta, Ryszard M.; Zhang, John H.

2010-01-01

245

Effect of Cisternal Drainage on the Shunt Dependency Following Aneurysmal Subarachnoid Hemorrhage  

PubMed Central

Objective Shunt-dependent chronic hydrocephalus (SDCH) is known to be a major complication associated with aneurysmal subarachnoid hemorrhage (aSAH). Old age is known to be one of numerous factors related to the development of SDCH. This study investigated whether postoperative cisternal drainage affects the incidence of SDCH and clinical outcome in elderly patients with aSAH. Methods Fifty-nine patients participated in this study. All patients underwent aneurysmal clipping with cisternal cerebrospinal fluid (CSF) drainage. Clinical variables relevant to the study included age, sex, location of ruptured aneurysm, CT finding and clinical state on admission, clinical outcome, and CSF drainage. We first divided patients into two groups according to age (<70 years of age and ?70 years of age) and compared the two groups. Secondly, we analyzed variables to find factors associated with SDCH in both groups (<70 years of age and ?70 years of age). Results Of 59 patients, SDCH was observed in 20 patients (33.9 %), who underwent shunt placement for treatment of hydrocephalus. Forty seven percent of cases of acute hydrocephalus developed SDCH. In the elderly group (?70 years of age), the duration and amount of CSF drainage did not affect the development of chronic hydrocephalus. Conclusion In elderly patients, although the incidence of SDCH was significantly higher, clinical outcome was acceptable. The duration and the amount of cisternal drainage did not seem to be related to subsequent development of chronic hydrocephalus within elderly patients aged 70 or older.

Kim, Sung Hun; Chung, Pil-Wook; Kwon, Young Joon; Shin, Hyun Chul; Choi, Chun Sik

2012-01-01

246

Intracranial Hypotension with Multiple Complications: An Unusual Case Report  

PubMed Central

Background. Undiagnosed intracranial hypotension can result in several complications including subdural hematoma (SDH), subarachnoid hemorrhage (SAH), dural venous sinuses thrombosis (CVT), cranial nerve palsies, and stupor resulting from sagging of the brain. It is rare to see all the complications in one patient. Furthermore, imaging of the brain vasculature may reveal incidental asymptomatic small aneurysms. Given the combination of these imaging findings and a severe headache, the patients are often confused to have a primary subarachnoid hemorrhage. Case Report. We present a patient with spontaneous intracranial hypotension (SIH) who had an incidental ophthalmic artery aneurysm on MR imaging, and this presentation led to coiling of the aneurysm. The key aspect in the history “postural headaches” was missed, and this led to life threatening complications and unnecessary interventions. Revisiting the history and significant improvement in symptoms following an epidural blood patch resulted in the diagnosis of SIH. Conclusion. We strongly emphasize that appropriate history taking is the key in the diagnosis of SIH and providing timely treatment with an epidural blood patch could prevent potentially life threatening complications.

Moonis, Majaz

2013-01-01

247

Elevated urinary catecholamines and adrenal haemorrhage mimicking phaeochromocytoma.  

PubMed

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

2010-01-01

248

Intracerebral haemorrhage: mechanisms of injury and therapeutic targets  

PubMed Central

Intracerebral haemorrhage (ICH) accounts for about 10–15% of all strokes. ICH is associated with high mortality and morbidity and there has been no successful Phase III clinical trial for this condition. The last six years has seen a great increase in the number of pre-clinical and clinical studies focused on ICH. There have been significant advances in the animal models available to study ICH and in our understanding of the mechanisms underlying brain injury following haemorrhage. This has led to the identification of several therapeutic targets that are now being pursued into clinical trials. These advances are described in this review in addition to information on past and current clinical trials. Many of the former were based on very limited pre-clinical data and possible guidelines on the nature of pre-clinical results that justify proceeding to the clinic are discussed.

Keep, Richard F.; Hua, Ya; Xi, Guohua

2013-01-01

249

Prevention of postpartum haemorrhage with the oxytocin analogue carbetocin  

Microsoft Academic Search

Postpartum haemorrhage is the leading cause of maternal mortality worldwide: 67–80% of cases are caused by uterine atony. Preventive measures include prophylactic drug use to aid uterine contraction after delivery, thus avoiding severe blood loss and reducing maternal morbidity and mortality. Carbetocin is a synthetic analogue of oxytocin with a half-life approximately 4–10 times longer than that reported for oxytocin.

Werner Rath

2009-01-01

250

Prevention of upper gastrointestinal haemorrhage: current controversies and clinical guidance  

PubMed Central

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.

Brooks, Johanne; Warburton, Richard

2013-01-01

251

Spontaneous spinal epidural haemorrhage: good results after early treatment.  

PubMed Central

Extravasation of blood in the spinal epidural space is an uncommon but often disastrous problem. Severe trauma, anticoagulants, bleeding diatheses, and intraspinal vascular malformations have been associated with such haemorrhage, but occasionally it occurs without apparent cause. It may then be confused with transverse myelopathy or vascular occlusion. Early diagnosis by myelography and treatment by surgery can result in good recovery, as illustrated by two cases.

Grollmus, J; Hoff, J

1975-01-01

252

Spontaneous spinal epidural haemorrhage: good results after early treatment.  

PubMed

Extravasation of blood in the spinal epidural space is an uncommon but often disastrous problem. Severe trauma, anticoagulants, bleeding diatheses, and intraspinal vascular malformations have been associated with such haemorrhage, but occasionally it occurs without apparent cause. It may then be confused with transverse myelopathy or vascular occlusion. Early diagnosis by myelography and treatment by surgery can result in good recovery, as illustrated by two cases. PMID:1117304

Grollmus, J; Hoff, J

1975-01-01

253

The surgical management of post-partum haemorrhage  

Microsoft Academic Search

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

Onnig Tamizian; S. Arulkumaran

2002-01-01

254

Effects of fibrinolytic inhibitors on mortality from upper gastrointestinal haemorrhage  

Microsoft Academic Search

OBJECTIVE--To see whether fibrinolytic inhibitors are of value when given to patients with upper gastrointestinal haemorrhage. DESIGN--Meta-analysis of six randomised double blind placebo controlled trials. Two methods used for obtaining an overall estimate of effect, including a random effects model incorporating any heterogeneity of outcome in the estimate of the overall treatment effect. SETTING--Inpatient care in hospitals in the United

D. A. Henry; D. L. OConnell

1989-01-01

255

Resolution of neurological deficits secondary to spontaneous intracranial haemorrhage and posterior reversible encephalopathy syndrome (PRES) in a patient with hepatitis C-associated cryoglobulinaemia: a role for plasmapheresis.  

PubMed

Essential mixed cryoglobulinaemia or type II cryoglobulinaemia is an important extrahepatic manifestation of chronic hepatitis C. Cryoglobulinaemia results in the deposition of immune complexes in small or medium-sized blood vessels leading to palpable purpura, arthralgia, renal disease and peripheral neuropathy. Posterior reversible encephalopathy syndrome (PRES) is a distinct phenomenon characterised by vasogenic oedema in the posterior circulation of brain. Cryoglobulinaemic vasculitis leading to spontaneous intracranial haemorrhage and PRES syndrome is rarely reported in the medical literature. In this report, we present an unusual case of spontaneous intracranial haemorrhage and PRES secondary to hepatitis C-associated cryoglobulinaemia presenting as right dense hemiplegia. Prompt institution of plasmapheresis resulted in successful resolution of symptoms in our patient, followed by full neurological recovery. To the best of our knowledge, this case describes the first successful use of plasmapheresis in alleviating neurological complications resulting from cryoglobulinaemic vasculitis and PRES secondary to chronic hepatitis C. PMID:24445850

Ahmad, Delshad; Ilias Basha, Haseeb; Towfiq, Basim; Bachuwa, Ghassan

2014-01-01

256

Pathogenesis of classical swine fever: renal haemorrhages and erythrodiapedesis.  

PubMed

Thirty pigs were inoculated with a virulent isolate (Quillota strain) of classical swine fever (hog cholera) virus to establish the chronological occurrence of lesions in the kidney and to determine the mechanism responsible for renal haemorrhages. The study included the use of histopathological, ultrastructural, immunohistochemical (detection of viral antigen gp55, MAC387, lambda chains, CD3 and C1q) and morphometrical techniques (vascular area). Renal interstitial oedema and haemorrhages were detected from 7 days post-inoculation (dpi), associated with a slight interstitial mononuclear infiltrate and evidence of viral infection in macrophages and fibroblasts, and in a small proportion of lymphocytes. Viral infection was not detected in capillary endothelial cells. An intense mononuclear infiltrate, with B cells, T cells and small numbers of macrophages, was detected from 10 dpi. In the final phase of the experiment (14 dpi), slight proliferation and degranulation of mast cells were observed. Increased expression of the C1q component of complement was also detected. A significant increase in vascular area was observed from 7 dpi. These results suggest that haemorrhages observed in the kidneys of pigs inoculated with the Quillota strain resulted from erythrodiapedesis and increased vascular permeability, probably aggravated by mast cell degranulation in the final stage of the experiment. The results suggested that mast cell degranulation was linked to activation of the complement system. PMID:10906255

Gómez-Villamandos, J C; Ruiz-Villamor, E; Bautista, M J; Quezada, M; Sánchez, C P; Salguero, F J; Sierra, M A

2000-07-01

257

Infectious Complications  

Microsoft Academic Search

\\u000a Infections are the most frequently occurring complications of hematopoietic stem cell transplantation (HSCT). Myelosuppressive\\u000a medications, the conditioning regimen (chemotherapy, radiation therapy), mucosal damage, type of transplant, immune-suppressive\\u000a therapy, and graft-versus-host disease (GvHD) all predispose the HSCT patient to life-threatening infections. Abnormal B-\\u000a and T-lymphocyte function results in impaired cellular and humoral immune function. Infections that can occur in the setting

Lynne Strasfeld

258

High incidence of post-tonsillectomy secondary haemorrhage following coblation tonsillectomy.  

PubMed

To examine the incidence of haemorrhage following tonsillectomy, to explore the usefulness of antibiotic in preventing postoperative haemorrhage and to examine if the haemorrhage depended on the level of expertise of the surgeon. A retrospective review analysing tonsillectomy method, the rate secondary haemorrhage, the grade of operating surgeon. A ?(2) analysis was used to determine the statistical difference between the haemorrhage rates of different tonsillectomy methods. One thousand three hundred and thirty-six tonsillectomies were performed during this period by four different methods: 615 by cold steel dissection, 582 by Coblation, 32 by bipolar dissection and 107 by Helica thermal coagulation. 621 tonsillectomies were performed by Consultant grade and middle grades performed 693 operations. 124 patients (9.3 %) were readmitted with haemorrhage. The secondary haemorrhage requiring surgery for controlling bleeding for cold steel dissection method was 1.5 % compared to 6.7 % for coblation method (P < 0.01 %), 6.3 % for bipolar dissection and 1.9 % for Helica thermal coagulation method. Overall consultants had a post tonsillectomy haemorrhage rate of 5.5 % and middle grades had a rate of 3.7 %. 86.5 % of the patients were already on routine prophylactic oral antibiotics at the time of presentation with haemorrhage needing surgical arrest and 13.5 % were not on antibiotics (P < 0.05 %). There was statistically significant difference in secondary haemorrhage rate between coblation and cold steel dissection methods. Coblation tonsillectomies had an increased need for operative intervention to control secondary haemorrhage. Routine use of antibiotic and expertise of operating surgeon had no bearing on secondary haemorrhage rate. PMID:24381914

Praveen, C V; Parthiban, Subashini; Terry, R M

2013-01-01

259

Assessment of fetal-maternal haemorrhage in mothers with hereditary persistence of fetal haemoglobin  

Microsoft Academic Search

Kleihauer examination of peripheral blood cannot be used reliably to detect transplacental fetal-maternal haemorrhage in mothers with hereditary persistence of fetal haemoglobin (HPFH). In Rh(D) negative pregnancies diagnostic confusion with a large fetal-maternal haemorrhage could result in the administration of inappropriately excessive amounts of anti-D immunoglobulin, and the inability to diagnose and quantify transplacental haemorrhage in maternal HPFH by current

W N Patton; G S Nicholson; A H Sawers; I M Franklin; F A Ala; A W Simpson

1990-01-01

260

Fertility and pregnancy outcomes following hypogastric artery ligation for severe post-partum haemorrhage  

Microsoft Academic Search

BACKGROUND: Hypogastric artery ligation is a therapeutic option for severe post-partum haemorrhage. Little is known about the outcomes of subsequent fertility and pregnancy. We studied these parameters in women who required hypogastric artery ligation for severe post-partum haemorrhage in our institution over a 13-year period. METHODS: All patients who required hypogastric artery ligation for severe intractable post-partum haemorrhage from January,

J. Nizard; L. Barrinque; R. Frydman; H. Fernandez

2003-01-01

261

Neurologic Complications of Cancer and its Treatment  

PubMed Central

The central nervous system (CNS) and peripheral nervous system (PNS) are very susceptible to cancer and its treatment. The most direct involvement of the nervous system manifests in the development of primary brain and spinal cord tumors. Many cancers exhibit a propensity toward spread to the CNS, and brain metastases are common problems seen in malignancies such as lung, breast, and melanoma. Such spread may involve the brain or spine parenchyma or the subarachnoid space. In the PNS, spread is usually through direct infiltration of nerve roots, plexi, or muscle by neighboring malignancies. In some cases, cancer has sudden, devastating effects on the nervous system: epidural spinal cord compression or cord transection from pathologic fractures of vertebra involved by cancer; increased intracranial pressure from intracranial mass lesion growth and edema; and uncontrolled seizure activity as a result of intracranial tumors (status epilepticus), which are neuro-oncologic emergencies. The best known indirect or remote effects of cancer on the nervous system are the neurologic paraneoplastic syndromes. Cancer can also result in a hypercoagulable state causing cerebrovascular complications. Treatment of cancer can have neurologic complications. The commonest of these complications are radiation-induced injury to the brain, spine, and peripheral nerves and chemotherapy-induced peripheral neuropathy. The suppressant effect of cancer and its treatment on the body’s immune system can result in infectious complications within the nervous system.

Giglio, Pierre

2013-01-01

262

Severe hemorrhagic complications in pancreatitis.  

PubMed

Severe bleeding may complicate the course of either acute or chronic pancreatitis, the latter being more frequently involved. Pseudocysts, severe inflammation, regional necrosis and infection may cause major vessel erosion with or without pseudoaneurysm formation which eventually may result in severe bleeding into the gastrointestinal tract, retroperitoneum and peritoneal cavity. The AA report their experience on 8 cases and analyze the data of a comprehensive review of 389 cases of massive bleeding reported in the literature during the last 100 years until December 1993. Mortality rate seems to be related to the etiology of the bleeding along with its localization and the underlying anatomo-pathologic findings. In patients with chronic pancreatitis it is 22% while in patients with acute pancreatitis or chronic pancreatitis with acute exacerbation it is 60.4% and 57.1% respectively. Splenic, gastroduodenal and superior pancreaticoduodenal arteries are the most commonly involved vessels being associated respectively with a mortality rate of 20.5%, 27.9% and 46.1%. Massive haemorrhage complicating infected necrosis or abscesses implies a worse prognosis when compared to severe bleeding associated with pseudocyst with or without pseudoaneurysm. The increasing use of diagnostic and interventional radiology appears to be the way forward to improve survival rates. Awareness of high risk predisposing condition, activism in achieving an early identification of the bleeding sources, and eventually its angiographic control are essential guidelines for successful approach to the most unpredictable complication of pancreatitis. When embolization fails or is followed by recurrence of hemorrhage, definitive surgical procedures should be immediately instituted. PMID:7668500

Flati, G; Salvatori, F; Porowska, B; Talarico, C; Flati, D; Proposito, D; Talarico, E; Carboni, M

1995-01-01

263

[Case of pineocytoma causing repetitive subarachnoid hemorrhage for 43 years].  

PubMed

A 61-year-old woman had suffered from severe headache and nausea over 20 times during the last 43 years. An subarachnoid hemorrhage (SAH) was detected by spinal puncture in some other hospitals, but the source of hemorrhage remained unknown in spite of repeated angiography. At the age of 61, she was diagnosed as having normal pressure hydrocephalus, and received a ventriculo-peritoneal shunt. She suffered from sudden headache 12 days after surgery. A CT scan showed a SAH and enlargement of the pineal mass. The tumor was totally removed via the occipital interhemispheric transtentorial approach and was diagnosed histologically as a pineocytoma. She has been free from SAH for three years since removal of the tumor. Pineal apoplexy should be considered as a cause of SAH. PMID:18341015

Ogiwara, Toshihiro; Kakizawa, Yukinari; Yomo, Shoji; Wada, Naomichi; Goto, Tetsuya; Tanaka, Yuichiro; Hongo, Kazuhiro; Kaneko, Tomoki

2008-03-01

264

Interference of apoptosis in the pathophysiology of subarachnoid hemorrhage  

PubMed Central

Programmed cell death is crucial for the correct development of the organism and the clearance of harmful cells like tumor cells or autoreactive immune cells. Apoptosis is initiated by the activation of cell death receptors and in most cases it is associated with the activation of the cysteine proteases, which lead to apoptotic cell death. Cells shrink, chromatin clumps and forms a large, sharply demarcated, crescent-shaped or round mass; the nucleus condenses, apoptotic bodies are formed and eventually dead cells are engulfed by a neighboring cell or cleared by phagocytosis. The authors have summarized the most important data concerning apoptosis in subarachnoid hemorrhage that have been issued in the medical literature in the last 20 years.

Palade, C.; Ciurea, Alexandru V.; Nica, D. A.; Savu, R.; Moisa, Horatiu Alexandru

2013-01-01

265

Interference of apoptosis in the pathophysiology of subarachnoid hemorrhage.  

PubMed

Programmed cell death is crucial for the correct development of the organism and the clearance of harmful cells like tumor cells or autoreactive immune cells. Apoptosis is initiated by the activation of cell death receptors and in most cases it is associated with the activation of the cysteine proteases, which lead to apoptotic cell death. Cells shrink, chromatin clumps and forms a large, sharply demarcated, crescent-shaped or round mass; the nucleus condenses, apoptotic bodies are formed and eventually dead cells are engulfed by a neighboring cell or cleared by phagocytosis. The authors have summarized the most important data concerning apoptosis in subarachnoid hemorrhage that have been issued in the medical literature in the last 20 years. PMID:24049554

Palade, C; Ciurea, Alexandru V; Nica, D A; Savu, R; Moisa, Horatiu Alexandru

2013-04-01

266

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

PubMed Central

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.

Chang, Youn Hyuk

2013-01-01

267

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

PubMed

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

2013-03-01

268

Delayed rebleeding of a spontaneously thrombosed aneurysm after subarachnoid hemorrhage  

PubMed Central

Background: This report provides a rare documentation of spontaneous thrombosis of a ruptured aneurysm followed by delayed recanalization and subsequent rerupture. Case Description: A 47-year-old female presented with spontaneous subarachnoid hemorrhage (SAH). Four aneurysms were identified on CT angiogram including a basilar apex aneurysm, considered source of bleeding. Cerebral angiogram on postbleed day (PBD) #1 showed spontaneous thrombosis of basilar apex aneurysm. The patient was discharged to a nursing home on PBD #18 after two subsequent studies showed no recanalization of the basilar aneurysm. The patient returned on PBD #26 with a second episode of spontaneous SAH. The previously thrombosed basilar aneurysm had recanalized and reruptured, which was now treated with coil embolization. Conclusion: We are not aware of a previous report of saccular cerebral aneurysm documenting spontaneous thrombosis after SAH and recanalization with second hemorrhage. This occurrence presents a dilemma regarding the timing and frequency of subsequent cerebrovascular imaging and treatment.

Chohan, Muhammad Omar; Westhout, Franklin D.; Taylor, Christopher L.

2014-01-01

269

[Chemotherapy for experimental subarachnoid dissemination model of brain tumor].  

PubMed

Chemotherapy was applied for experimental subarachnoid dissemination model of brain tumor which was established in male Wister-SPF (SLC) rats inoculated intracisternally with 2 X 10(5) C6 rat glioma cells. Nontreated animals died about 24 days after inoculation. Autopsy findings of the animals showed localized or multifocal invasion of the tumor on leptomeninges in cisterna magna, and partially infiltration into the parenchyma of the cerebellum and medulla oblongata. Three days after inoculation, the tumor deposition and proliferation already occurred. Several tumor cell layers were found in the subarachnoid space over the cerebellomedullary surface. Tumor bearing animals were at first treated by single agent. These are ACNU administered intraperitoneally, methotrexate administered intracisternally, and OK-432 administered intraperitoneally. In the next stage, combination of these drugs was applied. ACNU, 3 mg/kg i. p., on Day 3, was effective in elongation of median survival time by 23.6%, statistically significant (P less than 0.02). Methotrexate, 0.25 mg/kg i.th., on Day 3, was also effective in elongation of median survival time by 8.4%, statistically significant (P less than 0.05). OK-432, 0.1 KE/kg i. p., daily, 14 times, from Day 3 to Day 16, was ineffective in elongation of median survival time. Combination of ACNU, methotrexate and OK-432, in the same schedule as described above, produced the longest median survival time of 42.4%, statistically significant (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:6585681

Yamashita, T; Shinonaga, M; Ishiwata, Y; Nishimura, S; Murai, M; Kyuma, Y; Kuwabara, T

1984-01-01

270

Arachnoid cell involvement in the mechanism of coagulation-initiated inflammation in the subarachnoid space after subarachnoid hemorrhage*  

PubMed Central

Objective: To assess if arachnoid cells have the capability to present antigen and activate T-lymphocytes after stimulation by bloody cerebrospinal fluid (CSF), and to illuminate the mechanism of coagulation-initiated inflammation in the subarachnoid space after subarachnoid hemorrhage (SAH). Methods: Arachnoid cells were cultured, characterized, and examined by immunofluorescence for the basal expression of human leukocyte antigen-DR (HLA-DR). Expression of HLA-DR, after co-culturing arachnoid cells in vitro with bloody CSF, was investigated by immunofluorescence and flow cytometry (FCM). The variation of arachnoid cells’ ultrastructure was observed by transmission electron microscope (TEM). Arachnoid cells were co-cultured with peripheral blood mononuclear cells (PBMCs). The content of soluble interleukin-2 receptor (sIL-2r) in culture medium was detected by enzyme-linked immunosorbent assay (ELISA). Results: (1) Arachnoid cells were successfully cultured for many passages. The immunofluorescent staining was positive for HLA-DR in over 95% of the human arachnoid cells. The punctate HLA-DR was distributed in cytoplasm and not in the karyon. (2) After co-culturing arachnoid cells in vitro with bloody CSF, numerous particles with strong fluorescence appeared in the cytoplasm on Day 6. On Day 8, the quantity of particles and fluorescent intensity were maximal. FCM showed that the percentage of HLA-DR expressing cells was (2.5±0.4)% at the first 5 d, increasing to (60.8±3.6)% on Day 7. (3) After co-culturing arachnoid cells in vitro with bloody CSF, many lysosome and secondary lysosome particles were present in the cytoplasm. Hyperplasia of rough endoplasmic reticulum and enlarged cysts were observed, with numerous phagocytizing vesicles also observed at the edge of the arachnoid cells. (4) Arachnoid cells stimulated by bloody CSF were co-cultured in vitro with PBMCs. The content of sIL-2r in the culture medium, having been maintained at around 1.30 ng/ml during the first 3 d, had increased by Day 4. The content of sIL-2r peaked 7.53 ng/ml on Day 7 and then reduced gradually. Conclusions: (1) Basic HLA-DR expression is present in arachnoid cells. (2) After stimulation by bloody CSF, arachnoid cells have the potential to serve as antigen presenting cells (APCs) and the ability to activate T-lymphocytes, indicating that arachnoid cells are involved in the mechanism of coagulation-initiated inflammation in the subarachnoid space after SAH.

Xin, Zhao-liang; Wu, Xiao-kang; Xu, Jian-rong; Li, Xi

2010-01-01

271

Pre-Eclampsia Increases the Risk of Postpartum Haemorrhage: A Nationwide Cohort Study in The Netherlands  

PubMed Central

Background Postpartum haemorrhage is a leading cause of maternal morbidity and mortality worldwide. Identifying risk indicators for postpartum haemorrhage is crucial to predict this life threatening condition. Another major contributor to maternal morbidity and mortality is pre-eclampsia. Previous studies show conflicting results in the association between pre-eclampsia and postpartum haemorrhage. The primary objective of this study was to investigate the association between pre-eclampsia and postpartum haemorrhage. Our secondary objective was to identify other risk indicators for postpartum haemorrhage in the Netherlands. Methods A nationwide cohort was used, containing prospectively collected data of women giving birth after 19 completed weeks of gestation from January 2000 until January 2008 (n?=? 1 457 576). Data were extracted from the Netherlands Perinatal Registry, covering 96% of all deliveries in the Netherlands. The main outcome measure, postpartum haemorrhage, was defined as blood loss of ?1000 ml in the 24 hours following delivery. The association between pre-eclampsia and postpartum haemorrhage was investigated with uni- and multivariable logistic regression analyses. Results Overall prevalence of postpartum haemorrhage was 4.3% and of pre-eclampsia 2.2%. From the 31 560 women with pre-eclampsia 2 347 (7.4%) developed postpartum haemorrhage, compared to 60 517 (4.2%) from the 1 426 016 women without pre-eclampsia (odds ratio 1.81; 95% CI 1.74 to 1.89). Risk of postpartum haemorrhage in women with pre-eclampsia remained increased after adjusting for confounders (adjusted odds ratio 1.53; 95% CI 1.46 to 1.60). Conclusion Women with pre-eclampsia have a 1.53 fold increased risk for postpartum haemorrhage. Clinicians should be aware of this and use this knowledge in the management of pre-eclampsia and the third stage of labour in order to reach the fifth Millenium Developmental Goal of reducing maternal mortality ratios with 75% by 2015.

von Schmidt auf Altenstadt, Joost F.; Hukkelhoven, Chantal W. P. M.; van Roosmalen, Jos; Bloemenkamp, Kitty W. M.

2013-01-01

272

Dengue Fever/Dengue Haemorrhagic Fever in Filipino Children: Clinical Experience During the 1983-1984 Epidemic.  

National Technical Information Service (NTIS)

Although more than thirty years have lapsed since the first cases of dengue haemorrhagic fever, then known as Philippine haemorrhagic fever, were reported, studies on the various aspects of this disease were handicapped by the lack of valuable laboratory ...

R. S. Songco C. G. Hayes C. D. Leus C. O. Manaloto

1987-01-01

273

Prevention of postpartum haemorrhage with the oxytocin analogue carbetocin.  

PubMed

Postpartum haemorrhage is the leading cause of maternal mortality worldwide: 67-80% of cases are caused by uterine atony. Preventive measures include prophylactic drug use to aid uterine contraction after delivery, thus avoiding severe blood loss and reducing maternal morbidity and mortality. Carbetocin is a synthetic analogue of oxytocin with a half-life approximately 4-10 times longer than that reported for oxytocin. It combines the safety and tolerability profile of oxytocin with the sustained uterotonic activity of injectable ergot alkaloids. Furthermore, carbetocin can be administered as a single dose injection either intravenously or intramuscularly rather than as an infusion over several hours as is the case with oxytocin. Carbetocin is currently indicated for prevention of uterine atony after delivery by caesarean section in spinal or epidural anaesthesia. Data from three randomised controlled trials in caesarean delivery and a meta-analysis indicate that carbetocin significantly reduces the need for additional uterotonic agents or uterine massage to prevent excessive bleeding compared with placebo or oxytocin. The risk of headache, tremor, hypotension, flushing, nausea, abdominal pain, pruritus and feeling of warmth was similar in women who received carbetocin or oxytocin. The findings from two more recent double-blind randomised trials and one retrospective study suggest that carbetocin may also represent a good alternative to conventional uterotonic agents for prevention of postpartum haemorrhage after vaginal deliveries. A reduced need for additional uterotonics was observed with carbetocin vs. oxytocin in high-risk women and carbetocin was at least as effective as syntometrine in low-risk women. In these studies of vaginal deliveries, carbetocin was associated with a low incidence of adverse effects and demonstrated a better tolerability profile than syntometrine. Carbetocin had a long duration of action compared with intravenous oxytocin alone and a better cardiovascular side effect profile compared with syntometrine. In addition to being an effective treatment for the prevention of postpartum haemorrhage following caesarean delivery, carbetocin may also become the drug of choice for postpartum haemorrhage prevention after vaginal delivery in high-risk women and those who suffer from hypertensive disorders in pregnancy. Preeclampsia is still a contraindication to the administration of carbetocin in the EU, and further studies would be required to assess the cardiovascular effects of carbetocin before it can be advocated for routine use in preeclamptic patients. Further research is required to assess whether prophylactic carbetocin is superior to conventional uterotonic agents following vaginal delivery in low-risk women. PMID:19616358

Rath, Werner

2009-11-01

274

Adrenocortical Carcinoma Presenting as A Rupture and Extensive Retroperitoneal Haemorrhage  

PubMed Central

Adrenocortical carcinoma (ACC) is an extremely rare tumour. We are reporting a 45-year-male patient who had a history of sudden severe worsening epigastric pain and fullness in abdomen, with giddiness. The radiological investigations showed a large right suprarenal mass with extensive destruction and retroperitoneal haemorrhage, with extra capsular, periportal and liver metastases. Exploratory laparotomy was done for excisions of mass and surrounding tissue. On histopathological examination, diagnosis was given as Adreno Cortical Carcinoma with capsular, vascular, and soft tissue nodular involvement.

Jagtap, Sunil Vitthalrao; Desai, Sushama; Halder, Sandeepan; Jagtap, Swati S.; Badwe, Anuya Shrikant

2014-01-01

275

Early and late complications after endoscopic sphincterotomy for biliary lithiasis with and without the gall bladder 'in situ'  

Microsoft Academic Search

Endoscopic sphincterotomy has gained wide acceptance in the treatment of biliary lithiasis. We attempted endoscopic sphincterotomy in 443 patients and were successful in 407 (92%). Sphincterotomy was carried out with the gall bladder in situ in 234 cases (57%) of advanced age or high surgical risk. Immediate complications occurred in 7%, of which haemorrhage was the most frequent. The mortality

J Escourrou; J A Cordova; F Lazorthes; J Frexinos; A Ribet

1984-01-01

276

Fibrinolysis of experimental subretinal haemorrhage without removal using tissue plasminogen activator.  

PubMed Central

AIMS/BACKGROUND: Human recombinant tissue plasminogen activator (rt-PA) fibrinolysis of subretinal haemorrhage with concomitant removal has been shown to reverse the natural history of photoreceptor degeneration in experimental subretinal haemorrhages if evacuated within 7 days. The aim of the study was to determine whether fibrinolysis of subretinal haemorrhage without concomitant removal would offer a simpler approach with similar photoreceptor sparing. METHODS: A neodymium YAG laser was used to create experimental subretinal haemorrhages beneath the holangiotic retina of the cat. Tissue plasminogen activator (10 micrograms/ml) was injected into 4 day old subretinal haemorrhages to evaluate its effect on altering the natural history of retinal degeneration. Light and electron microscopy were used to study the histopathological effect. RESULTS: The injection of rt-PA into large 4 day old subretinal haemorrhages without concomitant removal did not alter the natural history of retinal degeneration. In fact, a second focus of retinal degeneration occurred at a gravity dependent inferior site where the subretinal haemorrhages had migrated. CONCLUSIONS: There was no therapeutic benefit from the injection of rt-PA into subretinal haemorrhages without con-comitant removal in this cat model. Images

Morse, L. S.; Benner, J. D.; Hjelmeland, L. M.; Landers, M. B.

1996-01-01

277

Endoplasmic Reticulum Quality Control Is Involved in the Mechanism of Endoglin-Mediated Hereditary Haemorrhagic Telangiectasia  

Microsoft Academic Search

Hereditary haemorrhagic telangiectasia (HHT) is an autosomal dominant genetic condition affecting the vascular system and is characterised by epistaxis, arteriovenous malformations and mucocutaneous and gastrointestinal telangiectases. This disorder affects approximately 1 in 8,000 people worldwide. Significant morbidity is associated with this condition in affected individuals, and anaemia can be a consequence of repeated haemorrhages from telangiectasia in the gut and

Bassam R. Ali; Imen Ben-Rebeh; Anne John; Nadia A. Akawi; Reham M. Milhem; Nouf A. Al-Shehhi; Mouza M. Al-Ameri; Shamma A. Al-Shamisi; Lihadh Al-Gazali; David Holowka

2011-01-01

278

Tissue plasminogen activator (tPA) to facilitate removal of post-traumatic submacular haemorrhage.  

PubMed

A case report is presented of a 20-year-old man, who had posttraumatic choroidal rupture and thick submacular haemorrhage. The haemorrhage was successfully removed with vitrectomy and intraoperative fibrinolysis with subretinal tissue plasminogen activator. Six months postoperatively the visual acuity was 0.7 (6/9). PMID:8646587

Laatikainen, L; Mattila, J

1995-08-01

279

The incidence of fetomaternal haemorrhage following elective termination of first-trimester pregnancy.  

PubMed

Alphafetoprotein (AFP) levels were determined in 62 patients undergoing termination of first-trimester pregnancy in order to ascertain the incidence of fetomaternal haemorrhage. The apparent frequency of this phenomenon (58%) was higher than that previously reported. There was no evidence of fetomaternal haemorrhage associated with simple bimanual examination. PMID:2454850

Naik, K; Kitau, M; Setchell, M E; Chard, T

1988-04-01

280

Subarachnoid hemorrhage in Kashmir: Causes, risk factors, and outcome  

PubMed Central

Context: Kashmir, a snow bound and mountain locked valley, is populated by about 7 million ethnic and non-migratory Kashmiris who have specific dietary and social habits than rest of the world. The neurological disorders are common in Kashmiri population. Aims: To study the prevalence and outcome of spontaneous intracranial subarachnoid hemorrhage (SAH) in Kashmir compared withother parts of the world. Settings and Design: A retrospective and hospital based study from 1982 to 2010 in the single and only Neurosurgical Centre of the State of Jammu and Kashmir. Materials and Methods: A hospital based study, in which, information concerning all Kashmiri patients was collected from the case sheets, patient files, discharge certificates, death certificates, and telephonic conversations with the help of Medical Records Department and Central Admission Register of Sher–i-Kashmir Institute of Medical Sciences, Kashmir India. Statistical Analysis: Analysis of variance and students T-test were used at occasions. Results: Incidence of SAH in Kashmiris is about 13/100,000 persons per year. SAH comprises 31.02% of total strokes and aneurysmal ruptures are cause of 54.35% SAHs. The female suffers 1.78 times more than the male. Total mortality of 36.60% was recorded against a good recovery of 14.99%. The familial SAHs and multiple aneurysms were also common. Intra-operative finding of larger aneurysmal size than recorded on pre-operative computed tomography (CT) angiogram of same patients was noteworthy. In 493 patients of SAH, the angiography revealed 705 aneurysms. Conclusion: Spontaneous intracranial subarachnoid hemorrhage, due to aneurysmal rupture, is common in Kashmir, with worst outcome. Food habits like “salt-tea twice a day”, group-smoking of wet tobacco like “Jejeer”, winter season, female gender, hypertension, and inhalation of “Kangri” smoke are special risk factorsof SAH, in Kashmiris. The plain CT brain and CT angiography are best diagnostic tools. The preventive measures for aneurysmal formation and rupture seems most promising management of future. The detachable endovascular aneurysmal occupying video assisted micro-camera capsules or plugs may be future treatment.

Bhat, Abdul Rashid; AfzalWani, Mohammed; Kirmani, Altaf R.

2011-01-01

281

Significance of C-Reactive Protein and Transcranial Doppler in Cerebral Vasospasm Following Aneurysmal Subarachnoid Hemorrhage  

PubMed Central

Objective Cerebral vasospasm is a common and potentially devastating complication of aneurysmal subarachnoid hemorrhage (aSAH). Inflammatory processes seem to play a major role in the pathogenesis of vasospasm. C-reactive protein (CRP) constitutes a highly sensitive inflammatory marker. Elevation of serum CRP levels has been demonstrated in patients with aSAH. The purpose of the current study was to evaluate the possible relationship between CRP levels in the serum and transcranial Doppler (TCD) and the development of vasospasm in patients with aSAH. Methods A total of 61 adult patients in whom aSAH was diagnosed were included in the study from November 2008 to May 2011. The patients' demographics, Hunt and Hess grade, Fisher grade, CT scans, digital subtraction angiography studies, and daily neurological examinations were recorded. Serial serum CRP measurements were obtained on days 1, 3, 5, 7, 9, 11 and 13 and TCD was measured on days 3, 5, 7, 9, 11 and 13. All patients underwent either surgical or endovascular treatment within 24 hours of their hemorrhagic attacks. Results Serum CRP levels peaked on the 3rd postoperative day. There were significant differences between the vasospasm group and the non-vasospasm group on the 1st, 3rd and 5th day. There were significant differences between the vasospasm group and the non-vasospasm group on the 3rd day in the mean middle cerebral artery velocities on TCD. Conclusion Patients with high levels of CRP on the 1st postoperative day and high velocity of mean TCD on the 3rd postoperative day may require closer observation to monitor for the development of vasospasm.

Hwang, Sung-Hwan; Kwon, Jeong-Taik; Nam, Taek-Kyun; Hwang, Sung-Nam; Kang, Hyun

2013-01-01

282

A Multicenter prospective study of poor-grade aneurysmal subarachnoid hemorrhage (AMPAS): observational registry study  

PubMed Central

Background Poor-grade aneurysmal subarachnoid hemorrhage (aSAH) is associated with very high mortality and morbidity. Our limited knowledge on predictors of long-term outcome in poor-grade patients with aSAH definitively managed comes from retrospective and prospective studies of small case series of patients in single center. The purpose of the AMPAS is to determine the long-term outcomes in poor-grade patients with different managements within different time after aSAH, and identify the independent predictors of the outcome that help guide the decision on definitive management. Methods/design The AMPAS study is a prospective, multicenter, observational registry of consecutive hospitalized patients with poor grade aSAH (WFNS grade IV and V). The aim is to enroll at least 226 poor-grade patients in 11 high-volume medical centers (eg, >150 aSAH cases per year) affiliated to different universities in China. This study will describe poor grade patients and aneurysm characteristics, treatment strategies (modality and time of definitive management), hospitalization complications and outcomes evolve over time. The definitive management is ruptured aneurysm treatment. Outcomes at 3, 6, 12 months after the management were measured using the Glasgow Outcome Scale and the Modified Rankin Scale. Discussion The AMPAS is the first prospective, multicenter, observational registry of poor grade aSAH with any management. This study will contribute to a better understanding of significant predictors of outcome in poor grade patients and help guide future treatment of the worst patients after aSAH. Trial registration Chinese Clinical Trial Registry: ChiCTR-TNRC-10001041.

2014-01-01

283

Clevidipine for acute hypertension in patients with subarachnoid hemorrhage: a pilot study.  

PubMed

Purpose: Clevidipine is a novel, ultra-short acting dihydropyridine. We hypothesized that clevidipine would rapidly control elevated blood pressure (BP) in patients with aneurysmal subarachnoid hemorrhage (SAH). Materials and Methods: This prospective open-label pilot study evaluated the efficacy and safety of clevidipine in reducing blood pressure (BP) to a pre-specified range and within 30 min before or after clipping or coiling of the aneurysm. Results: We enrolled five patients who received eight clevidipine infusions, including 1587 systolic or diastolic BP data points. The mean SBP upper and lower goals were set at 154 and 122 mmHg. The primary end point of achieving SBP control within <30 min was reached in all patients within 14.2 ± 6.4 min at an infusion rate of 10.8 ± 9.1 mg/h. The mean pre-infusion, during infusion and post-infusion SBP measurements were 165.5 ± 2.55, 146.4 ± 2.48 and 159.3 ± 11.5 mmHg (?p < 0.05 for pre- vs infusion comparison), respectively. After reaching the primary end point and during the clevidipine infusion, 17.5% and 11.8% of SBP readings were above the upper and below the lower goals, respectively. No patients re-bled. In one patient, the infusion had to be stopped temporarily three times due to SBP decrease below the lower goal. Conclusion: Clevidipine controlled SBP in all patients with aneurysmal SAH in <22 min and kept it within the elective range 70% of the time without major complications. PMID:24007334

Varelas, Panayiotis N; Abdelhak, Tamer; Corry, Jesse J; James, Elysia; Rehman, Mohammed F; Schultz, Lonni; Mays-Wilson, Kathleen; Mitsias, Panayiotis

2014-03-01

284

A prospective observational study of skin to subarachnoid space depth in the Indian population  

PubMed Central

Background and Aims: A pre-puncture estimate of skin to subarachnoid space depth (SSD) may guide spinal needle placement and reduce complications associated with lumbar puncture. Our aim was to determine (1) The SSD in Indian males, females, parturients and the overall population; (2) To derive formulae for predicting SSD and (3) To determine which previously suggested formula best suited our population. Methods: In this prospective, observational study, 800 adult Indian patients undergoing surgery under spinal anaesthesia were divided into three groups: Males (Group M), females (Group F) and parturients (Group PF). SSD was measured after lumbar puncture. The relationship between SSD and patient characteristics was studied and statistical models were used to derive formula for predicting SSD. Statistical analysis included One-way ANOVA with post hoc analysis, forward stepwise multivariate regression analysis and paired t-tests. Results: Mean SSD was 4.71 ± 0.70 cm in the overall population. SSD in adult males (4.81 ± 0.68 cm) was significantly longer than that observed in females (4.55 ± 0.66 cm) but was comparable with SSD in parturients (4.73 ± 0.73 cm). Formula for predicting SSD in the overall population was 2.71 + 0.09 × Body Mass Index (BMI). Stocker's formula when applied correlated best with the observed SSD. Formulae were derived for the three groups. Conclusions: We found gender-based differences in SSD, with SSD in males being significantly greater than that observed in the female population. SSD correlated with BMI in the parturient and the overall population. Amongst the previously proposed formulae, Stocker's formula was most accurate in predicting SSD in our population.

Prakash, Smita; Mullick, Parul; Chopra, Pooja; Kumar, Santosh; Singh, Rajvir; Gogia, Anoop R

2014-01-01

285

Early events triggering delayed vasoconstrictor receptor upregulation and cerebral ischemia after subarachnoid hemorrhage  

PubMed Central

Background Upregulation of vasoconstrictor receptors in cerebral arteries, including endothelin B (ETB) and 5-hydroxytryptamine 1B (5-HT1B) receptors, has been suggested to contribute to delayed cerebral ischemia, a feared complication after subarachnoid hemorrhage (SAH). This receptor upregulation has been shown to be mediated by intracellular signalling via the mitogen activated protein kinase kinase (MEK1/2) - extracellular regulated kinase 1/2 (ERK1/2) pathway. However, it is not known what event(s) that trigger MEK-ERK1/2 activation and vasoconstrictor receptor upregulation after SAH. We hypothesise that the drop in cerebral blood flow (CBF) and wall tension experienced by cerebral arteries in acute SAH is a key triggering event. We here investigate the importance of the duration of this acute CBF drop in a rat SAH model in which a fixed amount of blood is injected into the prechiasmatic cistern either at a high rate resulting in a short acute CBF drop or at a slower rate resulting in a prolonged acute CBF drop. Results We demonstrate that the duration of the acute CBF drop is determining for a) degree of early ERK1/2 activation in cerebral arteries, b) delayed upregulation of vasoconstrictor receptors in cerebral arteries and c) delayed CBF reduction, neurological deficits and mortality. Moreover, treatment with an inhibitor of MEK-ERK1/2 signalling during an early time window from 6 to 24 h after SAH was sufficient to completely prevent delayed vasoconstrictor receptor upregulation and improve neurological outcome several days after the SAH. Conclusions Our findings suggest a series of events where 1) the acute CBF drop triggers early MEK-ERK1/2 activation, which 2) triggers the transcriptional upregulation of vasoconstrictor receptors in cerebral arteries during the following days, where 3) the resulting enhanced cerebrovascular contractility contribute to delayed cerebral ischemia.

2013-01-01

286

Platelet-derived growth factor-? expression in rabbit models of cerebral vasospasm following subarachnoid hemorrhage.  

PubMed

Subarachnoid hemorrhage (SAH), one of the serious types of stroke incurred by bleeding into the space surrounding the brain, occurs when brains are deprived of oxygen by various factors, particularly an interruption to the blood supply or a ruptured aneurysm. Cerebral vasospasm (CVS) is one of the most common complications of SAH. It has been proposed that platelet?derived growth factor (PDGF) is involved in CVS. The aim of the present study was to analyze expression of PDGF in rabbit models of CVS. Post-SAH CVS rabbit models were created using endovascular puncture and employed to analyze the expression patterns of PDGF by enzyme-linked immunosorbent assay and immunohistochemistry. The results indicated that the creation of the rabbit model of CVS induced using endovascular puncture was successful and demonstrated the double phase changes observed in human CVS. The acute stage started at 12 h post-SAH with narrowing of the vascular lumen diameter. This narrowing appeared again on the seventh day in delayed CVS alongside increased thickness of vessel walls. PDGF-? expression was observed in vascular smooth muscle cells of the rabbit models. PDGF-? was expressed as early as 3 h post-SAH, it was evident after 1 day and reached a peak in 7 days, suggesting that PDGF-? is involved in the early stages of CVS. In the current study, it was confirmed that PDGF-? expression was present in the rabbit models of CVS, which may aid the elucidation of the pathogenesis of CVS, and also provide useful information for diagnosis and treatment of CVS. PMID:24969827

Cui, Hong-Kai; Yan, Rui-Fang; Ding, Xiao-Li; Zhao, Peng; Wu, Qing-Wu; Wang, Hong-Po; Qin, Hai-Xia; Tu, Jian-Fei; Yang, Rui-Min

2014-09-01

287

Ischemia modified albumin increase indicating cardiac damage after experimental subarachnoid hemorrhage  

PubMed Central

Background Cardiac complications are often developed after subarachnoid hemorrhage (SAH) and may cause sudden death of the patient. There are reports in the literature addressing ischemia modified albumin (IMA) as an early and useful marker in the diagnosis of ischemic heart events. The aim of this study is to evaluate serum IMA by using the albumin cobalt binding (ACB) test in the first, second, and seventh days of experimental SAH in rats. Twenty-eight Wistar albino rats were divided into four groups each consisting of seven animals. These were classified as control group, 1st, 2nd and 7th day SAH groups. SAH was done by transclival basilar artery puncture. Blood samples were collected under anesthesia from the left ventricles of the heart using the cardiac puncture method for IMA measurement. Histopathological examinations were performed on the heart and lung tissues. Albumin with by colorimetric, creatine kinase (CK), aspartate aminotransferase (AST), lactate dehydrogenase (LDH) were determined on an automatic analyser using the enzymatic method. IMA using by ACB test was detected with spectrophotometer. Results Serum IMA (p?=?0.044) in seventh day of SAH were higher compared to the control group. Total injury scores of heart and lung tissue, also myocytolysis at day 7 were significantly higher than control group (p?=?0.001, p?=?0.001, p?=?0.001), day 1 (p?=?0.001, p?=?0.001, p?=?0.001) and day 2 (p?=?0.001, p?=?0.007, p?=?0.001). A positive correlation between IMA - myocytolysis (r?=?0.48, p?=?0.008), and between IMA – heart tissue total injury score (r?=?0.41, p?=?0.029) was found. Conclusion The results revealed that increased serum IMA may be related to myocardial stress after SAH.

2014-01-01

288

A rare cause of gastrointestinal haemorrhage: gastric invasion by hepatocellular carcinoma  

PubMed Central

Patients with hepatocellular carcinoma (HCC) are predisposed to upper gastrointestinal (GI) haemorrhage with bleeding gastro-oesophageal varices and peptic ulcers being the common aetiologies. On rare occasions, HCC with direct invasion into the upper GI tract can lead to haemorrhage. Recognizing the possibility of invasive HCC causing upper GI haemorrhage is of paramount importance as acute management differs from the usual aetiologies. We describe a 76-year-old lady with long-standing liver cirrhosis who presented with upper GI haemorrhage due to an HCC invading into the greater curvature of the stomach. Trans-arterial embolization was performed which led to successful cessation of bleeding. Direct invasion of the GI tract by HCC causing haemorrhage is an extremely rare condition. Compared with endoscopic therapy, trans-arterial embolization offers the best chance of successful haemostasis and should be considered first-line therapy in these patients.

Tan, Winson Jianhong; Chia, Claramae Shulyn; Ong, Hock Soo

2013-01-01

289

Pregnancy Complications: Gonorrhea  

MedlinePLUS

... in the community. Home > Pregnancy > Pregnancy Complications > Gonorrhea Pregnancy complications Pregnancy complications may need special medical care. ... the United States. Can gonorrhea cause complications during pregnancy and for your baby? Yes. Gonorrhea can lead ...

290

Fatal brain stem event complicating acute pancreatitis.  

PubMed

Acute pancreatitis, developing in a patient with chronic renal failure, was complicated by a fatal neurological illness during which MRI showed pontine and extrapontine changes consistent with pontine and extrapontine myelinolysis. At post mortem, acute pancreatitis was confirmed but the neuropathological findings were more in keeping with an unusual presentation of acute haemorrhagic leucoencephalitis, perhaps even representing a form of 'pancreatic encephalopathy'. Although the development of CT and MRI scanning has greatly increased the resolution of neuroimaging and facilitated diagnosis during life, the value of autopsy examination is confirmed in cases such as this. Sometimes the findings may raise more questions than may have been answered - this too is an important function! PMID:12763345

Chan, C; Fryer, J; Herkes, G; Prelog, K; Harrington, T

2003-05-01

291

An outbreak of acute haemorrhagic conjunctivitis in Kaduna, Nigeria.  

PubMed

Clinical studies were carried out on two groups of patients with acute haemorrhagic conjunctivitis (AHC) during an epidemic in 1985 in Northern Nigeria. Group 1 consisted of 99 students attending a girls' boarding school, group 2 of 200 patients selected randomly from 1000 examined at the local clinic. Moderate to severe hyperaemia and papillary responses were present in the palpebral conjunctiva of all patients, and 234 (66%) had subconjunctival haemorrhages. Transient superficial punctate keratitis was noted in over 60% of patients. A transient flare suggestive of a low grade iritis was seen in five patients. No neurological disorders were noted. Serological studies were carried out on patients from group 2. Fifteen paired and 20 single serum samples were titrated against adenovirus type 4 (Ad-4) and enterovirus type 70 (EV-70). Two pairs of sera showed a 4-fold rise in antibody levels to EV-70, whereas the antibody titres to EV-70 in the rest of the sera ranged from 1:20 (no antibody) to 1:160. None of the paired serum samples showed a 4-fold rise in antibody levels to adenovirus. The results of clinical studies and serological findings support EV-70 as a probable cause of AHC in Nigeria. PMID:2155654

Babalola, O E; Amoni, S S; Samaila, E; Thaker, U; Darougar, S

1990-02-01

292

Ultrasound confirmation of ovulation in mares: a normal corpus luteum or a haemorrhagic anovulatory follicle?  

PubMed

The most common pathological anovulatory condition that occurs spontaneously during the breeding season in the mare is the haemorrhagic anovulatory follicle (HAF). A relatively high proportion of mares, soon after ovulation, develop a corpus haemorrhagicum (CH) with a central lacuna. This type of corpora lutea may resemble an HAF, which may complicate the accurate diagnosis of ovulation. The main objective of this study was to compare the ultrasound data of mares examined frequently with HAFs and CHs to elucidate whether it is possible to distinguish them from each other. A total of 135 ovulating mares were classified according to the morphology of the corpus luteum (CL) in mares with: a solid CL, a CH with small or with large central cavities. Ultrasound characteristics of the development of 11 HAF and 13 CHs with a large central cavity were compared. The pre-ovulatory follicular diameter of ovulatory mares was significantly correlated with the diameter of CH with large central cavities. The percentage of mares with post-ovulatory areas eligible to be mistaken with a CH was <25%. Although a predictive diagnosis of an HAF/CH can be made on the basis of several ultrasonographic endpoints, the only parameter that allows a definitive diagnosis is the thickness of the luteal border. This is <3 mm in HAFs in contrast to >5 mm in CHs. However, this only applies when the unidentified structure has non-organized contents. PMID:22594445

Cuervo-Arango, J; Newcombe, J R

2013-02-01

293

Statins and Anti-Inflammatory Therapies for Subarachnoid Hemorrhage  

PubMed Central

Opinion Statement Aneurysmal subarachnoid hemorrhage induces a potent inflammatory cascade that contributes to endothelial dysfunction, imbalance of vasoactive substances (excess endothelin, depletion of nitric oxide) and arterial vasospasm. This process results in delayed cerebral ischemia, a major cause of neurological disability in those surviving the initial hemorrhage. The only therapy shown to be effective in improving neurologic outcomes after SAH is the calcium-channel antagonist, nimodipine (although it achieved this without reducing vasospasm). A number of novel therapies have been explored to inhibit the development of vasospasm and reduce the burden of ischemia and cerebral infarction. Statins are promising candidates, as they block multiple aspects of the inflammatory pathway that contributes to ischemic brain injury. Early clinical trials, however, have produced conflicting results and adoption of their use in clinical practice should await the results of larger more definitive studies. While endothelin-receptor antagonists showed promise in significantly reducing vasospasm in preliminary trials, their failure to improve clinical outcomes in phase III studies has been disappointing, highlighting the complex link between vasospasm and ischemia. Future directions in the quest to improve outcomes of patients with SAH may need to approach ischemia as a multifactorial process with inflammatory, vasoactive, and ionic/metabolic components.

Dhar, Rajat; Diringer, Michael

2013-01-01

294

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.

2012-01-01

295

Long-term consequences of subarachnoid hemorrhage: examining working memory.  

PubMed

Working memory impairments are prevalent among survivors of aneurysmal subarachnoid hemorrhage (SAH), but few studies have examined specifically these impairments. Such an examination is important because working memory processes are vital for daily cognitive functioning. In the current study, patients with SAH and healthy control participants were administered the word-span and alpha-span test - experimental tests of working memory. In the word-span test, participants recalled increasingly longer word-lists, requiring the maintenance of information in mind. In the alpha-span test, participants recalled the word-lists in alphabetical order, requiring both the maintenance and manipulation of information. Patients with SAH were no different from healthy controls on a battery of standard neuropsychological measures or on the word-span test. They were, however, significantly impaired on the alpha-span test, suggesting a deficit in the manipulation components of working memory. That is, impairment resulting from SAH is present when a working memory task requires additional executive processing demands. This deficit in patients with SAH does not appear to be influenced by aneurysm location, suggesting that some of the effects of SAH on cognition are from diffuse rather than focal pathology; however, a larger sample size is needed to reinforce this claim. PMID:23871092

Sheldon, Signy; Macdonald, R Loch; Cusimano, Michael; Spears, Julian; Schweizer, Tom A

2013-09-15

296

Escape of intraluminal platelets into brain parenchyma after subarachnoid hemorrhage  

PubMed Central

Platelet aggregates are present in parenchymal vessels as early as 10 minutes after experimental subarachnoid hemorrhage (SAH). Structural injury to parenchymal vessel walls and depletion of collagen-IV (the major protein of basal lamina) occur in a similar time frame. Since platelets upon activation release enzymes which can digest collagen-IV, we investigated the topographical relationship between platelet aggregates, endothelium, and basal lamina after SAH produced by endovascular perforation, using triple immunofluorescence and confocal microscopy with deconvolution. The location of platelet aggregates in relation to zymography-detected active collagenase was also examined. As reported previously, most cerebral vessels profiles contained platelets aggregates at 10 minutes after SAH. High-resolution three-dimensional image analysis placed many platelets at the ab-luminal (basal) side of endothelium at 10 minutes, and others either within the vascular basal lamina or in nearby parenchyma. By 24 hours post-hemorrhage, large numbers of platelets had entered the brain parenchyma. The vascular sites of platelet movement were devoid of endothelium and collagen IV. Collagenase activity colocalized with vascular platelet aggregates. Our data demonstrate that parenchymal entry of platelets into brain parenchyma begins within minutes after hemorrhage. Three-dimensional analysis suggests that platelet aggregates initiate or stimulate local disruption of endothelium and destruction of adjacent basal lamina after SAH.

Friedrich, Victor; Flores, Rowena; Muller, Artur; Sehba, Fatima A.

2009-01-01

297

APOE genotype and functional outcome following aneurysmal subarachnoid hemorrhage.  

PubMed

Apolipoprotein E (apoE), the major apolipoprotein in the central nervous system, has been shown to influence neurologic disease progression and response to neurologic injury in a gene-specific manner. Presence of the APOE4 allele is associated with poorer response to traumatic brain injury and ischemic stroke, but the association between APOE genotype and outcome following aneurysmal subarachnoid hemorrhage (SAH) remains unclear. The purpose of this project was to investigate the association between APOE genotype and outcome after SAH. We also explored the association of APOE4 genotype and cerebral vasospasm (CV) presence in a subsample of our population with available angiographic data. A sample of 206 aneurysmal SAH participants had APOE genotyping performed, Glasgow outcome scores (GOS) and modified Rankin scores (MRS) collected at 3 and 6 months after aneurysm rupture. No significant association was found between the presence of the APOE4 genotype and functional outcomes controlling for age, race, size of hemorrhage (Fisher grade), and severity of injury (Hunt & Hess grade). However when controlling for CV and the covariates listed above, individuals with the APOE4 allele had worse functional outcomes at both time points. The presence of the APOE2 allele was not associated with functional outcomes even when considering presence of CV. There was no difference in mortality associated with APOE4 presence, APOE2 presence, or presence of CV. These findings suggest APOE4 allele is associated with poor outcome after aneurysmal SAH. PMID:19017669

Gallek, Matthew J; Conley, Yvette P; Sherwood, Paula R; Horowitz, Michael B; Kassam, Amin; Alexander, Sheila A

2009-01-01

298

Plasticity of cerebrovascular smooth muscle cells after subarachnoid hemorrhage.  

PubMed

Subarachnoid hemorrhage (SAH) is most often followed by a delayed phase of cerebral ischemia which is associated with high morbidity and mortality rates. The causes underlying this delayed phase are still unsettled, but are believed to include cerebral vasospasm, cortical spreading depression, inflammatory reactions, and microthrombosis. Additionally, a large body of evidence indicates that vascular plasticity plays an important role in SAH pathophysiology, and this review aims to summarize our current knowledge on the phenotypic changes of vascular smooth muscle cells of the cerebral vasculature following SAH. In light of the emerging view that the whole cerebral vasculature and the cells of the brain parenchyma should be viewed as one integrated neurovascular network, phenotypical changes are discussed both for the cerebral arteries and the microvasculature. Furthermore, the intracellular signaling involved in the vascular plasticity is discussed with a focus on the Raf-MEK1/2-ERK1/2 pathway which seems to play a crucial role in SAH pathology. PMID:24449486

Edvinsson, Lars; Larsen, Stine Schmidt; Maddahi, Aida; Nielsen, Janne

2014-06-01

299

Subarachnoid Hemorrhage, Spreading Depolarizations and Impaired Neurovascular Coupling  

PubMed Central

Aneurysmal subarachnoid hemorrhage (SAH) has devastating consequences on brain function including profound effects on communication between neurons and the vasculature leading to cerebral ischemia. Physiologically, neurovascular coupling represents a focal increase in cerebral blood flow to meet increased metabolic demand of neurons within active regions of the brain. Neurovascular coupling is an ongoing process involving coordinated activity of the neurovascular unit—neurons, astrocytes, and parenchymal arterioles. Neuronal activity can also influence cerebral blood flow on a larger scale. Spreading depolarizations (SD) are self-propagating waves of neuronal depolarization and are observed during migraine, traumatic brain injury, and stroke. Typically, SD is associated with increased cerebral blood flow. Emerging evidence indicates that SAH causes inversion of neurovascular communication on both the local and global level. In contrast to other events causing SD, SAH-induced SD decreases rather than increases cerebral blood flow. Further, at the level of the neurovascular unit, SAH causes an inversion of neurovascular coupling from vasodilation to vasoconstriction. Global ischemia can also adversely affect the neurovascular response. Here, we summarize current knowledge regarding the impact of SAH and global ischemia on neurovascular communication. A mechanistic understanding of these events should provide novel strategies to treat these neurovascular disorders.

Koide, Masayo; Sukhotinsky, Inna; Ayata, Cenk; Wellman, George C.

2013-01-01

300

Original surgical treatment of thoracolumbar subarachnoid cysts in six chondrodystrophic dogs  

PubMed Central

Background Subarachnoid cysts are rare conditions in veterinary medicine, associated with spinal cord dysfunction. Most of the 100 cases of subarachnoid cysts described since the first report in 1968 were apparently not true cysts. Reported cysts are usually situated in the cervical area and occur in predisposed breeds such as the Rottweiler. The purpose of this retrospective study, from May 2003 to April 2012, was to describe the distinctive features of thoracolumbar spinal subarachnoid cysts, together with their surgical treatment and outcome in 6 chondrodystrophic dogs. Results Five Pugs and 1 French Bulldog were examined. Images suggestive of a subarachnoid cyst were obtained by myelography (2/6) and computed tomography myelography (4/6), and associated disc herniation was observed in 3/6 dogs. A hemilaminectomy was performed. The protruding disc eventually found in 5/6 dogs was treated by lateral corpectomy. The ventral leptomeningeal adhesions observed in all dogs after durotomy were dissected. No or only mild post-operative neurological degradation was observed. Follow-up studies (7 months to 4 years) indicated good outcome and no recurrence. Conclusions All the thoracolumbar subarachnoid cysts described in these 6 chondrodystrophic dogs were associated with leptomeningeal adhesions. Good results seemed to be obtained by dissecting and removing these adhesions. A protruding disc, found here in 5/6 dogs, needs to be ruled out and can be treated by lateral corpectomy.

2014-01-01

301

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

2012-01-01

302

Gastric volvulus following diagnostic upper gastrointestinal endoscopy: a rare complication.  

PubMed

Esophagogastroduodenoscopy (EGD) is a commonly used, safe diagnostic modality for evaluation of epigastric pain and rarely its major complications include perforation, haemorrhage, dysrhythmias and death. Gastric volvulus has been reported to complicate percutaneous endoscopic gastrostomy but its occurrence after diagnostic EGD has not yet been reported in literature. The successful management relies on prompt diagnosis and gastric untwisting, decompression and gastropexy or gastrectomy in full thickness necrosis of the stomach wall. A 38-year-old woman presented with epigastric pain and EGD showed pangastritis. Immediately after EGD she developed increased severity of pain, vomiting and abdominal distension. Emergency laparotomy carried out for peritoneal signs revealed eventration of left hemidiaphragm with the stomach twisted anticlockwise in the longitudinal axis. After gastric decompression and untwisting of volvulus, anterior gastropexy and gastrostomy was carried out. Hence, we report this rare complication of diagnostic endoscopy and review the existing literature on the management. PMID:24515235

Karthikeyan, Vilvapathy Senguttuvan; Sistla, Sarath Chandra; Ram, Duvuru; Rajkumar, Nagarajan

2014-01-01

303

[Diverticulosis of the colon: complications of surgical interest].  

PubMed

Diverticular disease is prevalently only of medical interest. Repeated episodes of diverticulitis, particularly in younger patients, and serious complications such as perforation, stenosis, fistula and haemorrhage demand surgical treatment. The timing and type of surgical operation are conditioned by the pathological picture and by the patient's general condition and age. The authors present a series of 586 patients admitted for diverticular disease, 84 of whom presented complicated diverticulosis. Nineteen cases (22.6%) underwent elective surgery in the form of an anterior rectal resection, while 65 of them underwent urgent surgery for complicated diverticulosis variously consisting in total colectomy, a Hartman's resection, a simple rectal resection or a left or right hemicolectomy. PMID:12192936

Celi, Diego; Biasiato, Renzo; D'Amico, Carmelo; Danek, Ruggero; Casolino, Vincenzo; Battaglino, Domenico; Ferraro, Stefania; Errante, Donatello; Cadrobbi, Roberto

2002-01-01

304

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

PubMed Central

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.

Goncalves, L R; Mariano, M

2000-01-01

305

Hereditary cerebral haemorrhage with amyloidosis, Dutch type (HCHWA-D): clinicopathological studies.  

PubMed Central

Clinical and neuropathological findings are reported in 63 patients with hereditary cerebral haemorrhage with amyloid angiopathy. Patients had mostly recurrent strokes, and at least 80% of these were haemorrhages. Almost a third of the patients died within a year of their first and only recorded haemorrhage, half of them within two weeks. This angiopathy was restricted to the cerebral and cerebellar cortex and its covering leptomeninges. As the most important consequence, haemorrhagic infarcts and haemorrhages occurred in the subcortical white matter--that is, the region most vulnerable to impaired cortical circulation. Further development of these subcortical lesions gives rise to the fatal haemorrhages seen at necropsy. In so far as dementia occurs this is likely to result from multiple microinfarcts or haemorrhages. In most cases preamyloid lesions or diffuse plaques and early plaques were seen. No other type of plaque or neurofibrillary degeneration was found. The plaques occur in conjunction with the angiopathy, but may not occur even when the angiopathy is severe. In one patient plaques were totally absent. Angiopathy and plaques may be the result of the same mutation, the expression of which is governed by tissue factors or phenotypic differences between individual subjects. Images

Wattendorff, A R; Frangione, B; Luyendijk, W; Bots, G T

1995-01-01

306

Dexamethasone and haemorrhage risk in paediatric tonsillectomy: a systematic review and meta-analysis.  

PubMed

Summary In children undergoing tonsillectomy, dexamethasone is recommended to reduce the risk of postoperative nausea and vomiting while non-steroidal anti-inflammatory drugs (NSAIDs) are used for pain relief. We aimed to determine whether children who receive dexamethasone or dexamethasone with NSAID are more likely to experience haemorrhage post-tonsillectomy. Randomized and non-randomized studies in which children undergoing tonsillectomy received dexamethasone or dexamethasone and NSAID were sought within bibliographic databases and selected tertiary sources. The risk of bias assessment and evaluation of haemorrhage rate data collection and reporting were assessed using the Cochrane Risk of Bias Tool and McHarm tool. Synthesis methods comprised pooled estimate of the effect of dexamethasone on the risk of haemorrhage rate using the Peto odds ratio (OR) method. The pooled estimate for haemorrhage rate in children who received dexamethasone was 6.2%, OR 1.41 (95% confidence interval 0.89-2.25, P=0.15). There was risk of bias and inconsistent data collection and reporting rates of haemorrhage in many of the included studies. Clinical heterogeneity was observed between studies. The pooled analysis did not demonstrate a statistically significant increase in the risk of post-tonsillectomy haemorrhage with dexamethasone with/without NSAID use in children. However, the majority of the included studies were not designed to investigate this endpoint, and thus large studies which are specifically designed to collect data on haemorrhage rate are needed. PMID:24942713

Bellis, J R; Pirmohamed, M; Nunn, A J; Loke, Y K; De, S; Golder, S; Kirkham, J J

2014-07-01

307

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

PubMed

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

2012-06-01

308

Return to theatre in secondary post-tonsillectomy haemorrhage: a comparison of coblation and dissection techniques.  

PubMed

The aim of this study is to examine the incidence of return to theatre (RTT) for post-operative haemorrhage following coblation and dissection tonsillectomy and to investigate those that required RTT more than 10 days post-surgery. Retrospective review of post-tonsillectomy haemorrhages requiring RTT from April 2005 to March 2009 was conducted. Of 2,541 tonsillectomies performed, 81% were by coblation and 19% by dissection methods. The overall RTT rate was 1.7%. No difference was found in the overall RTT rates for primary and secondary haemorrhage between the two techniques. However, the overall RTT rates for primary and secondary haemorrhage were higher in adults than children (P = 0.0456 and P = 0.0215, respectively). RTT for secondary haemorrhage during the first ten post-operative days occurred in both coblation and dissection tonsillectomy with no significant difference. After the first post-operative week, late secondary bleeding requiring RTT occurred only in the coblation group (P = 0.0676). Four patients required blood transfusion; all were in the coblation group, three of which were required during RTT in the late secondary haemorrhage (after 10 days). The post-operative RTT rates for coblation tonsillectomy did not reveal a change of trend over the 4-year study period. Our RTT rate for secondary haemorrhage is higher than earlier published results. A learning curve could not be identified in RTT for coblation tonsillectomy haemorrhage. Late secondary haemorrhages requiring surgical intervention have only been identified in cases performed by coblation and could potentially be life threatening as 33% (3/9) required blood transfusion. This phenomenon may be explained by a particular physiological healing process associated with coblation. PMID:21706319

Amir, Ida; Belloso, Antonio; Broomfield, Stephen J; Morar, Pradeep

2012-02-01

309

Exploring the use of estrogen & progesterone replacement therapy in subarachnoid hemorrhage.  

PubMed

The hypothesis that alterations in hormone levels can impact on subarachnoid hemorrhage (SAH) is rapidly gaining momentum. Specifically, the concept that post-menopausal women are more susceptible to the condition has convinced many of the protective roles of estrogen and progesterone. Here we review the mechanisms of their actions and the potential for estrogen and progesterone replacement therapy in subarachnoid hemorrhage. Searches were performed using PubMed with the search terms "subarachnoid hemorrhage", "estrogen", "progesterone "treatment", "management", "cerebral aneurysm", and "vasospasm" from 1970 to February, 2012. Articles were also identified through searches of the Cochrane library and searches of the authors' own files. Only papers published in English were reviewed. In conclusion, there is significant theoretical evidence for the potential role of estrogen and progesterone use in altering the pathogenesis of SAH. Nevertheless, this has received mixed reviews in both case controlled studies and cohort analysis within the literature. PMID:22950381

Young, Adam M H; Karri, Surya K; Ogilvy, Christopher S

2012-07-01

310

Haemorrhage, hyponatraemia and more than just a hack.  

PubMed

A 43-year-old previously healthy solicitor presented with a 9-day history of cough productive of yellow sputum with a prodrome of sore throat and myalgia. The cough was paroxysmal in nature and severe enough to cause extensive bilateral subconjunctival haemorrhages and cough syncopes multiple times a day, with one bout of associated haematemesis on the day of admission. He was isolated, treated for a presumed atypical chest infection with tazocin and clarithromycin, and monitored carefully until the hyponatraemia on presentation was resolved. Atypical screen and blood cultures were sent off, though unexciting at first, eventually confirmed the unlikely; Bordetella pertussis, much to the surprise of many who had Legionella as the top differential. PMID:24943139

Shah, Mitsu; Kandil, Hala

2014-01-01

311

A rare case of Weil's disease with alveolar haemorrhage  

PubMed Central

Leptospirosis, a disease of protean manifestations occurs sporadically throughout the year with a peak seasonal incidence during the rainy season mimicking other febrile viral illness. In the rare case, the disease leads to renal and hepatic involvement with hemorrhage which may be associated with multisystem organ dysfunction in form of pulmonary, cardiac and central nervous system, when it is known as Weil's disease. Rarely haemorrhagic manifestations are assosciated. Early diagnosis is important as sometimes the disease may be life threatening. Proper antibiotics results in dramatic improvement. We hereby presented a case that had clinical features of Weil's disease with cough, dyspnoea and haemoptysis. Leptospirosis was detected on ELISA testing. Patient was cured rapidly with antibiotics.

Chakrabarti, Abhiram; Nandy, Manab; Pal, Dipankar; Mallik, Sudesna

2014-01-01

312

Haemorrhage and coagulopathy in the Defence Medical Services.  

PubMed

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

2013-01-01

313

Critical care in emergency department: massive haemorrhage in trauma.  

PubMed

Inadequate resuscitation of major haemorrhage is an important cause of avoidable death in severely injured patients. Early recognition of blood loss, control of bleeding and restoration of circulating volume are critical to the management of trauma shock, and transfusion of blood components is a key intervention. Vital signs may be inadequate to determine the need for transfusion, and resuscitation regimens targeting vital signs may be harmful in the context of uncontrolled bleeding. This article addresses current concepts in haemostatic resuscitation. Recent guidelines on the diagnosis and treatment of coagulopathy in major trauma, and the role of component and adjuvant therapies, are considered. Finally, the potential role of thromboelastography and rotational thromboelastometry are discussed. PMID:22328635

Mahambrey, Tushar; Pendry, Katherine; Nee, Alexandra; Bonney, Samantha; Nee, Patrick A

2013-01-01

314

Clinical events relating to intraventricular haemorrhage in the newborn.  

PubMed Central

Continuous measurements of arterial pressures, heart rates, respiratory movements, and respiratory rates were made from birth in 44 infants at risk from intraventricular haemorrhage (IVH). 17 babies died with IVH, in 10 of whom the event was timed objectively. Events in these babies were compared with survivors of similar birthweights, gestational ages, severity of birth asphyxia, and severity of hyaline membrane disease (HMD). IVH followed severe HMD and was associated with cessation of the babies' own respiratory efforts while on a ventilator and also with characteristic cardiorespiratory events. The minimum arterial pressure before IVH was lower than in comparable babies who survived. It is suggested that fluctuations of systemic blood pressure from initial low levels may be important in the pathogenesis of IVH. It is possible that changes in cerebral blood flow are of even greater significance.

Fujimura, M; Salisbury, D M; Robinson, R O; Howat, P; Emerson, P M; Keeling, J W; Tizard, J P

1979-01-01

315

Autopsy findings in fatal dengue haemorrhagic fever - 06 Cases  

PubMed Central

Background During recent outbreak of dengue fever in Delhi, there has been a significant increase in dengue-associated admission in hospitals. To better understand the pathology of dengue haemorrhagic fever, we conducted autopsies of dengue infections deaths within our hospital. Method This was an autopsy study of dengue-associated deaths at a large tertiary care hospital. Results From Sep 2009 to Dec 2010, a total of 1032 patients with serological evidence of dengue infection were admitted to our hospital. There were twelve deaths and autopsies were conducted in six. Adult respiratory distress syndrome, bleeding diathesis, hypotension, hepatic failure and acute renal failure were the common causes of death despite early hospitalization, intravenous fluid, and blood-product support. Conclusion Dengue is associated with severe disease, and deaths do occur despite current supportive management. Early predictors of disease severity and better clinical interventions are needed.

Rathi, K.R.; Arora, M.M.; Sahai, K.; Tripathi, S.; Singh, S.P.; Raman, D.K.; Anand, K.B.

2012-01-01

316

Haemorrhage after home birth: audit of decision making and referral.  

PubMed

In the Netherlands, 20 per cent of women give birth at home. In 0.7 per cent, referral to secondary care because of postpartum haemorrhage (PPH) is indicated. Midwives are regularly trained in managing obstetric emergencies. A postgraduate training programme developed for Dutch community-based midwives called 'CAVE' (pre-hospital obstetric emergency course) focuses on the identification and management of obstetric emergencies, including timely and adequate referral to hospital. This descriptive study aims to identify substandard care (SSC) in PPH after home birth in the Netherlands. Sixty seven cases of PPH reported by community-based midwives were collected. After applying selection criteria, seven cases were submitted to audit. The audit panel consisted of 12 midwives (of which seven contributed a case), 10 obstetricians, an educational expert and an ambulance paramedic. First, an individual assessment was performed by all members. Subsequently, at a plenary audit meeting, SSC factors were determined and assigned incidental, minor and major substandard care. PMID:24371910

Smit, Marrit; Dijkman, Anneke; Rijnders, Marlies; Bustraan, Jacqueline; van Dillen, Jeroen; Middeldorp, Johanna; Havenith, Barbara; van Roosmalen, Jos

2013-11-01

317

Factors influencing return to work after aneurysmal subarachnoid hemorrhage.  

PubMed

Background: Aneurysmal subarachnoid hemorrhage (aSAH) is a type of stroke that affects women and men with a mean age of 50 years. Return to work (RTW) has been cited as a strategic goal of patients after injury; however, success rates are low in multiple studies. Therefore, the purpose of this study was to investigate factors influencing RTW after aSAH. The study design was a cross-sectional design at 1-2 years after injury to assess work status in 134 patients who were treated for aSAH. Participants were recruited at one hospital setting via mailed invitations. They were interviewed over the telephone after consent was obtained for chart review and to participate in the study. Eligible participants were asked to complete the Brief Illness Perception Questionnaire and the Functional Status Questionnaire. Data analysis was performed using univariate analysis and logistic regression with Statistical Package for the Social Sciences software. Results: There was a moderate negative correlation between illness perception and RTW. Illness perception was found to significantly predict failure to RTW, whereas marital status improved the prediction model to significantly predict successful RTW. Conclusions: This study addressed a gap in the literature regarding work status after aSAH and has provided direction for further investigation. Addressing issues surrounding patients' perception of illness may serve as an important conduit to remove barriers to RTW. Recognition of these barriers to RTW in assessing a person's illness perception may be the key to the development of interventions in the recovery process. PMID:24992146

Harris, Catherine

2014-08-01

318

Hyponatremia after aneurysmal subarachnoid hemorrhage: Implications and outcomes  

PubMed Central

Background: Hyponatremia is the most common electrolyte abnormality seen in patients with aneurysmal SAH. Clinically significant hyponatremia (Serum Sodium <131 mEq/L) which needs treatment, has been redefined recently and there is a paucity of outcome studies based on this. This study aims to identify the mean Serum Sodium (S.Na+) level and its duration among inpatients with SAH and to identify the relationship between hyponatremia and the outcome status of patients undergoing surgery for SAH. Materials and Methods: This outcome study is undertaken in the department of neurosurgery, The Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala. Medical records of all patients with SAH from 1st January to 31st July 2010 were reviewed. Preoperative status was assessed using World Federation of Neurosurgical Societies (WFNS) grading system. Discharge status was calculated using the Glasgow outcome score scale. Results: Fifty nine patients were included in the study and 53 (89.8%) of them have undergone surgical treatment. Hyponatremia was observed in 22 of 59 patients (37%). The mean Sodium level of hyponatremic patients was 126.97 mEq/L for a median duration of two days. Glasgow outcome score was good in 89.8% of patients. We lost two patients, one of whom had hyponatremia and vasospasm. Conclusion: Hyponatremia is significantly associated with poor outcome in patients with SAH. Anticipate hyponatremia in patients with aneurysmal subarachnoid hemorrhage, timely detect and appropriately treat it to improve outcome. It is more common in patients who are more than 50 years old and whose aneurysm is in the anterior communicating artery. Our comprehensive monitoring ensured early detection and efficient surgical and nursing management reduced morbidity and mortality.

Saramma, PP; Menon, R Girish; Srivastava, Adesh; Sarma, P Sankara

2013-01-01

319

Risk Factors Associated with Cerebral Vasospasm following Aneurysmal Subarachnoid Hemorrhage.  

PubMed

We studied the risk factors associated with cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH). The subjects were 370 patients with ruptured aneurysms who fulfilled all of the following criteria: admission by day 2 after onset, operation performed by day 3 by the same surgeon (T.I.), Hunt-Hess grade I-IV, availability of bilateral carotid angiograms acquired by day 2 and repeated between days 7 and 9. The demographic, clinical, radiographic, surgical, laboratory, and electrocardiographic data were analyzed for angiographic vasospasm (AV), symptomatic vasospasm (SV), and cerebral infarction on computed tomography (CT) scan. Both CT-evident SAH and AV were graded as 0-IV. Among the 370 patients, AV grade III-IV, SV, and cerebral infarction occurred in 26%, 24%, and 20%, respectively. Univariate analysis showed that Hunt-Hess grade III-IV, SAH grade III-IV, intracerebral or/and intraventricular hemorrhage, rebleeding, cigarette smoking, hypertension, alcohol intake, leukocytosis, hyperglycemia, and electrocardiographic QTc prolongation, left ventricular hypertrophy (LVH), and ST depression were significantly related to at least one of AV grade III-IV, SV, or cerebral infarction. Multivariate analysis showed that SAH grade III-IV was the most important risk factor for vasospasm followed by LVH on electrocardiogram, cigarette smoking, and hypertension. AV grade III-IV, SV, and cerebral infarction occurred in 57%, 54%, and 39% of the 46 smokers with LVH, and in 43%, 49%, and 35% of the 68 patients who had both LVH and hypertension, respectively. CT-evident SAH, LVH, cigarette smoking, and hypertension are associated with vasospasm. In smokers or hypertensive patients, premorbid LVH appears to predict much more severe vasospasm. PMID:24670311

Inagawa, Tetsuji; Yahara, Kaita; Ohbayashi, Naohiko

2014-06-17

320

Evaluation of angiographic findings in spontaneous aneurysmal subarachnoid hemorrhage patients.  

PubMed

This paper describes the angiographic findings of spontaneous aneurysmal subarachnoid hemorrhage (SAH) patients, including frequency, anatomic location and multiplicity of cerebral aneurysms. We retrospectively reviewed the records of 796 SAH patients at our university affiliated hospital. After confirming SAH by lumbar puncture or CT scan, all patients underwent digital subtraction angiography to find the definite anatomic location. The male to Female ratio in SAH patients was 9:10. The mean (SD) age of all patients with SAH was 47.9±14.7 years. The mean (SD) age of men with SAH was 46.6 ±15.6 years and women with SAH was 49.3±13.5 years (P=0.015). 357 (44.8%) patients had aneurysms. The mean (SD) age of aneurysmal patients was 49.8±14.3 years. The mean (SD) age of men with aneurysm was 47.8 ±15.9 years and women with aneurysm was 51.3±12.9 years (P= 0.03). The male to female ratio in aneurysms was 0.72:1. The most common aneurysm location was in the anterior communicating artery (N=166, 39%). The second most common anatomic location was the middle cerebral artery bifurcation (66 left, 60 right). The total number of patients with single aneurysms was 303 (84.9%) while 54 (15.1%) patients had multiple aneurysms. Among these patients, 49 had two aneurysms, three had three aneurysms and two had four aneurysms. In all, 418 aneurysms were detected. Of 357 patients with aneurysms 150 (42%) had vasospasm during angiography. In conclusion, the most common aneurysm location was the anterior communicating artery and the rate of multiplicity was also higher in our patients. PMID:24148598

Firouznia, K; Ghanaati, H; Rahmat Sadeghi, S; Shakiba, M; Jalali, A H

2010-06-01

321

The Effect of Phosphodiesterase Inhibitor Tadalafil on Vasospasm Following Subarachnoid Hemorrhage in an Experimental Rabbit Model  

Microsoft Academic Search

\\u000a \\u000a Background: Despite the years of study on it, cerebral vasospasm following subarachnoid hemorrhage is still an important cause of mortality\\u000a and morbidity. The presented study was undertaken to show whether phosphodiesterase inhibitor tadalafil can attenuate the\\u000a vasospasm process following subarachnoid bleeding.\\u000a \\u000a \\u000a \\u000a Method: In this study, 20 male New Zealand White rabbits weighing 2,500–3,000 g were randomly assigned to four groups.

Firat Narin; Burcak Bilginer; Ahmet Ilkay Isikay; Mehmet Bülent Onal; Figen Soylemezoglu; Nejat Akalan

322

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

2012-01-01

323

Pregnancy Complications: Placenta Previa  

MedlinePLUS

... the community. Home > Pregnancy > Pregnancy Complications > Placenta previa Pregnancy complications Pregnancy complications may need special medical care. ... to get pregnant again. Are gallstones common during pregnancy? Not common, but they do happen. Elevated hormones ...

324

Pregnancy Complications: HELLP Syndrome  

MedlinePLUS

... the community. Home > Pregnancy > Pregnancy Complications > HELLP syndrome Pregnancy complications Pregnancy complications may need special medical care. ... to get pregnant again. Are gallstones common during pregnancy? Not common, but they do happen. Elevated hormones ...

325

Pregnancy Complications: Chlamydia  

MedlinePLUS

... in the community. Home > Pregnancy > Pregnancy Complications > Chlamydia Pregnancy complications Pregnancy complications may need special medical care. ... younger than 25. Can chlamydia cause problems during pregnancy? Yes. If you get it before or during ...

326

Pregnancy Complications: Genital Herpes  

MedlinePLUS

... the community. Home > Pregnancy > Pregnancy Complications > Genital herpes Pregnancy complications Pregnancy complications may need special medical care. ... to get pregnant again. Are gallstones common during pregnancy? Not common, but they do happen. Elevated hormones ...

327

Recurrent vitreous haemorrhage and epidural haematoma in a child with hypofibrinogenaemia.  

PubMed

A 14-month-old male infant was brought by parents for redness of the right eye of 18 days duration. Exam and B-scan ultrasonography revealed total hyphema, dense vitreous haemorrhage and lens subluxation in the right eye while CT disclosed right small epidural haematoma. The left eye had neither retinal haemorrhage nor disc oedema. There was no sign of shaken baby syndrome. Fibrinogen level in the blood was very low. The parents are first-degree cousins with two family members having hypofibrinogenaemia. Vitreous haemorrhage recurred after surgical intervention resulting in phthisis and loss of vision. Hypofibrinogenaemia needs to be included in the differential diagnosis of ocular haemorrhage and vision loss. PMID:22778479

Mansour, Ahmad M; Jaroudi, Mahmoud O

2012-01-01

328

Recurrent hypertensive intracerebral haemorrhages: what should we do when a new hemispheric ischaemic event strikes?  

PubMed

Hypertensive intracerebral haemorrhage is usually a once in a lifetime event and recurrences are rare. Most recurrences usually develop within 2 years of the first event and the majority usually target the basal ganglia and thalami. Failure of blood pressure control is the most important, potentially preventable, culprit behind the development of primary intracerebral haemorrhages. However, the occurrence of a recurrent bleed in patients with optimally controlled hypertension should always prompt the physician to think of a new co-operating factor. We report on a 60-year-old hypertensive woman who developed right-sided thalamic haemorrhage 5 days after sustaining a lacunar infarct of the left thalamus for which she had been prescribed a dual antiplatelet therapy: aspirin and clopidrogrel. She had a history of two bilateral sequential hypertensive deep cerebellar haemorrhages which were developed 2 years ago. PMID:23264163

Amin, Osama S M

2012-01-01

329

Effect of dexamethasone on plasma catecholamine levels of conscious dogs in haemorrhagic shock.  

PubMed

After 15 mg/kg dexamethasone pretreatment, conscious dogs in haemorrhagic shock demonstrated an augmented plasma noradrenaline increase. Increasing early compensatory adrenergic neuroeffector response could be one of the mechanisms of the protective effect of steroids in shock. PMID:6650192

Nagy, S; Tárnoky, K; Adamicza, A

1983-01-01

330

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

PubMed Central

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 0.1%. All the major haemorrhages occurred during polypectomies over 2 cm in size. Secondary haemorrhage was an unpredictable occurrence, one to 14 days later. Three deaths followed colonoscopy: one cardiorespiratory death was related to oversedation; a second was due to mismanaged ischaemic colitis developing two days after traumatic instrumentation, and the third was due to peritonitis. Minor complications included thrombophlebitis, abdominal distension, and vasovagal episodes. Because of experience during the first half of the series and also due to improvements in instrumentation, the complication rate of the later part of the series was halved. Recommendations include the avoidance of oversedation, review of previous barium enema films so as to be aware of large polyps which are more likely to bleed, and the recognition of situations where perforation or septicaemia is likely to occur.

Macrae, F A; Tan, K G; Williams, C B

1983-01-01

331

Ventricular trigeminy in a patient with serologically confirmed dengue haemorrhagic fever  

PubMed Central

Background Cardiac arrhythmias occur during the acute stage of Dengue Haemorrhagic Fever. Dengue myocarditis is the most likely cause of the arrhythmias. Case presentation We report a 55-year-old patient with Dengue Haemorrhagic Fever presenting with transient ventricular trigeminy which has not been reported before. Conclusion Among many other known cardiac arrhythmia seen in DHF, ventricular trigeminy is also a possibility. Clinicians should be aware of this cardiac rhythm abnormality that can occur in dengue patients.

2014-01-01

332

Return to theatre in secondary post-tonsillectomy haemorrhage: a comparison of coblation and dissection techniques  

Microsoft Academic Search

The aim of this study is to examine the incidence of return to theatre (RTT) for post-operative haemorrhage following coblation\\u000a and dissection tonsillectomy and to investigate those that required RTT more than 10 days post-surgery. Retrospective review\\u000a of post-tonsillectomy haemorrhages requiring RTT from April 2005 to March 2009 was conducted. Of 2,541 tonsillectomies performed,\\u000a 81% were by coblation and 19% by

Ida Amir; Antonio Belloso; Stephen J. Broomfield; Pradeep Morar

333

Results of intravitreal tissue plasminogen activator and expansile gas injection for submacular haemorrhage in Thais  

Microsoft Academic Search

PurposeTo study the results of intravitreal tissue plasminogen activator (tPA) and expansile gas injection for submacular haemorrhage in Thai patients.MethodsThe medical records of Thai patients who presented with submacular haemorrhage between January 1998 and December 2002 were reviewed. The inclusion criteria were acute onset of bleeding (<1 month), treatment with intravitreal injection of tPA solution (50–100 ?g in 0.1 ml)

M Ratanasukon; A Kittantong

2005-01-01

334

Haemorrhagic Pleural Effusion in an HIV infected patient with Salmonella typhimurium  

Microsoft Academic Search

Non-typhoidal salmonellosis is rarely encountered in immunodeficient individuals, including HIV\\/AIDS, where pleural effusion is an unlikely manifestation as well. Tuberculosis and Pneumocystis carinii pneumonia are the two leading causes of pleural effusion, which are mainly non-haemorrhagic. We report a rare case of haemorrhagic pleural effusion in an HIV-positive patient with Salmonella typhimurium as the only opportunistic infection. It was diagnosed

MUKHOPADHYAY C; RAO P S; VIDYASAGAR S

2007-01-01

335

Quantitative analysis of particles, genomes and infectious particles in supernatants of haemorrhagic fever virus cell cultures  

Microsoft Academic Search

Information on the replication of viral haemorrhagic fever viruses is not readily available and has never been analysed in\\u000a a comparative approach. Here, we compared the cell culture growth characteristics of haemorrhagic fever viruses (HFV), of\\u000a the Arenaviridae, Filoviridae, Bunyaviridae, and Flavivridae virus families by performing quantitative analysis of cell culture supernatants by (i) electron microscopy for the quantification\\u000a of

Manfred Weidmann; Amadou A Sall; Jean-Claude Manuguerra; Lamine Koivogui; Aime Adjami; Faye Fatou Traoré; Kjell-Olof Hedlund; Gunnel Lindegren; Ali Mirazimi

2011-01-01

336

Retinal haemorrhage and fatal stroke in an infant with fibromuscular dysplasia  

PubMed Central

Non-accidental injury should be suspected and excluded in any infant found to have intracranial and retinal haemorrhage of unknown aetiology. This can be a sensitive issue for both medical staff and parents. We present a case in which the underlying cause of intracranial and retinal haemorrhage was fibromuscular dysplasia. It was a diagnosis made only at postmortem examination and it illustrates the diagnostic difficulty such cases may present.??

Currie, A; Bentley, C; Bloom, P

2001-01-01

337

Historical overview and review of current day treatment in the management of acute variceal haemorrhage  

PubMed Central

Variceal haemorrhage is one of the most devastating consequences of portal hypertension, with a 1-year mortality of 40%. With the passage of time, acute management strategies have developed with improved survival. The major historical treatment landmarks in the management of variceal haemorrhage can be divided into surgical, medical, endoscopic and radiological breakthroughs. We sought to provide a historical overview of the management of variceal haemorrhage and how treatment modalities over time have impacted on clinical outcomes. A PubMed search of the following terms: portal hypertension, variceal haemorrhage, gastric varices, oesophageal varices, transjugular intrahepatic portosystemic shunt was performed. To complement this, Google™ was searched with the aforementioned terms. Other relevant references were identified after review of the reference lists of articles. The review of therapeutic advances was conducted divided into pre-1970s, 1970/80s, 1990s, 2000-2010 and post-2010. Also, a summary and review on the pathophysiology of portal hypertension and clinical outcomes in variceal haemorrhage was performed. Aided by the development of endoscopic therapies, medication and improved radiological interventions; the management of variceal haemorrhage has changed over recent decades with improved survival from an often-terminating event in recent past.

Rajoriya, Neil; Tripathi, Dhiraj

2014-01-01

338

Reporting postpartum haemorrhage with transfusion: a comparison of NSW birth and hospital data.  

PubMed

Aim: Postpartum haemorrhage rates have been increasing in NSW and internationally, and blood transfusion is required in severe cases. Using routinely collected administrative data provides a convenient method with which to monitor trends in both postpartum haemorrhage and associated transfusion use. In order for this to be feasible however, the reliability of reporting of the conditions needs to be assessed. Methods: This study used linked data to compare the reporting of postpartum haemorrhage with transfusion as reported in the NSW Admitted Patient Data Collection (hospital data), with the same information obtained from the Perinatal Data Collection (birth data), for births in NSW from 2007 to 2010. Results: The rate of postpartum haemorrhage requiring blood transfusion was 1.0% based on the hospital data and 1.1% based on the birth data, with a rate of 1.7% if identifying cases from either source. Agreement between the two sources improved from fair to moderate over the time period. Conclusion: Postpartum haemorrhage requiring transfusion recorded in the birth data shows only moderate agreement with hospital data, so caution is recommended when using this variable for analysis. Linkage of both datasets is recommended to identify birth information from birth data and postpartum haemorrhage with transfusion from hospital data until further validation work has been undertaken. PMID:24939224

Patterson, Jillian A; Roberts, Christine L; Taylor, Lee K; Ford, Jane B

2014-06-01

339

Ultra-early tranexamic acid after subarachnoid hemorrhage (ULTRA): study protocol for a randomized controlled trial  

PubMed Central

Background A frequent complication in patients with subarachnoid hemorrhage (SAH) is recurrent bleeding from the aneurysm. The risk is highest within the first 6 hours after the initial hemorrhage. Securing the aneurysm within this timeframe is difficult owing to logistical delays. The rate of recurrent bleeding can also be reduced by ultra-early administration of antifibrinolytics, which probably improves functional outcome. The aim of this study is to investigate whether ultra-early and short-term administration of the antifibrinolytic agent tranexamic acid (TXA), as add-on to standard SAH management, leads to better functional outcome. Methods/Design This is a multicenter, prospective, randomized, open-label trial with blinded endpoint (PROBE) assessment. Adult patients with the diagnosis of non-traumatic SAH, as proven by computed tomography (CT) within 24 hours after the onset of headache, will be randomly assigned to the treatment group or the control group. Patients in the treatment group will receive standard treatment with the addition of a bolus of TXA (1 g intravenously) immediately after randomization, followed by continuous infusion of 1 g per 8 hours until the start of aneurysm treatment, or a maximum of 24 hours after the start of medication. Patients in the control group will receive standard treatment without TXA. The primary outcome measure is favorable functional outcome, defined as a score of 0 to 3 on the modified Rankin Scale (mRS), at 6 months after SAH. Primary outcome will be determined by a trial nurse blinded for treatment allocation. We aim to include 950 patients in 3 years. Discussion The strengths of this study are: 1. the ultra-early and short-term administration of TXA, resulting in a lower dose as compared to previous studies, which should reduce the risk for delayed cerebral ischemia (DCI), an important risk factor in the long-term treatment with antifibrinolytics; 2. the power calculation is based on functional outcome and calculated with use of recent study results of our own population, supported by data from prominent studies; and 3. the participation of several specialized SAH centers, and their referring hospitals, in the Netherlands with comparative treatment protocols. Trial registration Nederlands Trial Register (Dutch Trial Registry) number NTR3272

2013-01-01

340

Cerebrospinal Fluid Adrenomedullin Concentration Correlates with Hyponatremia and Delayed Ischemic Neurological Deficits after Subarachnoid Hemorrhage  

Microsoft Academic Search

Background: Adrenomedullin (AM), a vasorelaxant peptide, is secreted into the cerebrospinal fluid (CSF) from the choroid plexus and can exert natriuretic effects in the kidney. CSF AM concentration is elevated 7–10 days after the onset of aneurysmal subarachnoid hemorrhage (SAH). The aim of the present study was to determine whether CSF AM concentrations correlate with hyponatremia and delayed ischemic neurological

Yoshitaka Kubo; Kuniaki Ogasawara; Shunsuke Kakino; Hiroshi Kashimura; Kenji Yoshida; Akira Ogawa

2008-01-01

341

Predicting the Outcome of Patients With Subarachnoid Hemorrhage Using Machine Learning Techniques  

Microsoft Academic Search

Background: Outcome prediction for subarachnoid hemorrhage (SAH) helps guide care and compare global management strategies. Logistic regression models for outcome prediction may be cumbersome to apply in clinical practice. Objective: To use machine learning techniques to build a model of outcome prediction that makes the knowledge discovered from the data explicit and communicable to domain experts. Material and methods: A

Paula de Toledo; Pablo M. Rios; Agapito Ledezma; Araceli Sanchís; Jose F. Alen; Alfonso Lagares

2009-01-01

342

Cerebellar contusions as a possible cause of traumatic basal subarachnoid hemorrhage: A case report  

Microsoft Academic Search

Traumatic basal subarachnoid hemorrhage (TBSAH) is infrequent but of forensic neuropathological importance because of its high mortality and complex causal mechanisms. The source of the hemorrhage is most frequently identified in the vertebro-basilar arteries but often cannot be identified in these arteries. We present a case of TBSAH possibly originating from hemorrhagic cerebellar contusions due to fist blows to the

Jian-Hua Chen; Takaki Ishikawa; Tomomi Michiue; Hitoshi Maeda

2010-01-01

343

Clinical Importance of Expanded Subarachnoid Spaces Detected by CT in Early Infancy.  

National Technical Information Service (NTIS)

It depends on the clinical course and on follow-up CT findings whether expansions of the subarachnoid space should be considered as pathological changes or as normal. There is no direct correlation between the degree of severity of the clinical symptoms o...

S. Krusche

1982-01-01

344

Vertebrobasilar dissection with subarachnoid hemorrhage: a retrospective study of 29 patients  

Microsoft Academic Search

We have reviewed initial diagnostic features, treatment, and outcome in 29 patients with acute subarachnoid hemorrhage due to non-traumatic vertebrobasilar artery dissection diagnosed in our hospital between 1993 and 2003. The dissections occurred in the vertebral artery in 19 patients, the posterior inferior cerebellar artery (PICA) in two patients, the basilar artery in four patients, and in the vertebral artery

B Ramgren; M Cronqvist; B Romner; L Brandt; S Holtås; E-M Larsson

2005-01-01

345

Brainstem control of cerebral blood flow and application to acute vasospasm following experimental subarachnoid hemorrhage  

PubMed Central

Symptomatic ischemia following aneurysmal subarachnoid hemorrhage is common but poorly understood and inadequately treated. Severe constriction of the major arteries at the base of the brain, termed vasospasm, traditionally has been thought to be a proximal event underlying these ischemias, although microvascular changes also have been described. The vast majority of studies aimed at understanding the pathogenesis of ischemic deficits and vasospasm have focused on the interaction of the “spasmogen” of the extravasated blood with the smooth muscle and endothelium of the arteries. This has led to a comparative neglect of the contribution of the central nervous system to the maintenance of cerebral perfusion. In the present study, we focused on the role of the rostral ventromedial medulla (RVM) in modulating cerebral perfusion at rest and following an experimental subarachnoid hemorrhage in the rat. Changes in cerebral blood flow (CBF) were measured using laser-Doppler flowmetry and three-dimensional optical microangiography. Focal application of a GABAA receptor agonist and antagonist were used to respectively inactivate and activate the RVM. We show here that the RVM modulates cerebral blood flow under resting conditions, and further, contributes to restoration of cerebral perfusion following a high-grade subarachnoid hemorrhage. Failure of this brainstem compensatory mechanism could be significant for acute perfusion deficits seen in patients following subarachnoid hemorrhage.

Cetas, Justin S.; Lee, Delaina R.; Alkayed, Nabil J.; Wang, Ruikang; Iliff, Jeffrey J.; Heinricher, Mary M.

2009-01-01

346

Giant intrasellar aneurysm presenting with panhypopituitarism and subarachnoid hemorrhage: case report and literature review  

Microsoft Academic Search

A 52-year-old woman was admitted to our hospital presenting with subarachnoid hemorrhage, left ophthalmoplegia, and right hemiparesis. Previous symptoms and signs suggested the presence of panhypopituitarism. A giant intracranial aneurysm of the internal carotid artery, diagnosed by magnetic resonance imaging, showed the characteristic flow void phenomenon with black appearance. Analysis of endocrine function disclosed panhypopituitarism and hyperprolactinemia. After proximal balloon

J. M. Fernandez-Real; M. Fernández-Castañer; C. Villabona; E. Sagarra; J. M. Gómez-Sáez; J. Soler

1994-01-01

347

Accumulation of intimal platelets in cerebral arteries following experimental subarachnoid hemorrhage in cats  

SciTech Connect

From 2 hours to 23 days following experimental subarachnoid hemorrhage, the accumulation of indium-111-labeled platelets on the intimal surface of the middle cerebral artery was studied in 23 cats. Subarachnoid hemorrhage was produced by transorbital rupture of the right middle cerebral artery. Of the 23 cats, 17 exhibited right middle cerebral artery/left middle cerebral artery radioactivity ratios of greater than 1.25. When these results were compared with those of 12 control cats, 0.001 less than p less than 0.005 (chi2 test). Thus, the results from the control and experimental groups are significantly different and indicate early (after 2 hours) preferential accumulation of intimal platelets in the ruptured right middle cerebral artery compared with the unruptured left middle cerebral artery and new platelet deposition continuing for up to 23 days. However, the experimental group did not reveal a clear pattern for platelet accumulation following subarachnoid hemorrhage. There was no simple correlation between the magnitude of the radioactivity ratios and the time after hemorrhage when the cats were killed although the ratios for 2 hours to 7 days seemed greater than those for 8 to 23 days. Assuming the pivotal role of platelets in the angiopathy of subarachnoid hemorrhage, the administration of antiplatelet agents as soon as possible following its occurrence may be of value.

Haining, J.L.; Clower, B.R.; Honma, Y.; Smith, R.R.

1988-07-01

348

Subarachnoid hematoma of the craniocervical junction and upper cervical spine after traumatic cerebral contusion: case report.  

PubMed

Spinal subarachnoid hematoma (SSH) is a rare condition, more commonly occurring after lumbar puncture for diagnostic or anesthesiological procedures. It has also been observed after traumatic events, in patients under anticoagulation therapy or in case of arteriovenous malformation rupture. In a very small number of cases no causative agent can be identified and a diagnosis of spontaneous SSH is established. The lumbar and thoracic spine are the most frequently involved segments and only seven cases of cervical spine SSH have been described until now. Differential diagnosis between subdural and subarachnoid hematoma is complex because the common neuroradiological investigations, including a magnetic resonance imaging (MRI), are not enough sensitive to exactly define clot location. Actually, confirmation of the subarachnoid location of bleeding is obtained at surgery, which is necessary to resolve the fast and sometimes dramatic evolution of clinical symptoms. Nonetheless, there are occasional reports on successful conservative treatment of these lesions. We present a peculiar case of subarachnoid hematoma of the craniocervical junction, developing after the rupture of a right temporal lobe contusion within the adjacent arachnoidal spaces and the following clot migration along the right lateral aspect of the foramen magnum and the upper cervical spine, causing severe neurological impairment. After surgical removal of the hematoma, significant symptom improvement was observed. PMID:24067775

Di Rienzo, Alessandro; Iacoangeli, Maurizio; Alvaro, Lorenzo; Colasanti, Roberto; Moriconi, Elisa; Gladi, Maurizio; Nocchi, Niccolò; Scerrati, Massimo

2013-01-01

349

The Role of Bone Subtraction Computed Tomographic Angiography in Determining Intracranial Aneurysms in Non-Traumatic Subarachnoid Hemorrhage  

PubMed Central

Background: The presence of blood in the subarachnoid space is an acute pathology with a serious risk of death and complications. The most common etiology (approximately 80%) is intracranial aneurysm. Objectives: The aim of this study was to assess the role of bone subtracted computed tomographic angiography (BSCTA), a novel and noninvasive method for determining and characterizing intracranial aneurysms. Patients and Methods: Sixty consecutive patients with clinically suspected non-traumatic subarachnoid hemorrhage (SAH) were considered to enter the study. The subtraction quality was inadequate in ten patients; thus, they were excluded, leaving 50 patients (84.4%) in the study. Bone subtracted and non-subtracted 3D images were obtained from the BSCTA raw data sets. All images obtained by digital subtraction angiography (DSA), BSCTA, and computed tomographic angiography (CTA) were evaluated for the presence or absence of an aneurysm and the location, minimal sac diameter, and neck size ratio of the aneurysm. DSA was considered as the gold standard during the evaluation of the data. Results: Of the 50 patients who participated in this study, 11 had no aneurysms as determined by both CTA and DSA. Examination of the remaining 39 patients revealed the presence of 51 aneurysms. While 3D-CTA could not detect six aneurysms that were located in the base of the skull, 3D-BSCTA easily detected them. Moreover, five aneurysms were only partially detected by 3D-CTA. According to this data, the sensitivity of 3D-BSCTA and 3D-CTA was calculated as 98% and 86.3%, respectively; the specificity was calculated as 100% and 90.9%, respectively, per aneurysm; and the sensitivity of 100% for 3D-BSCTA and 98% for 3D-CTA was achieved by using combined images with multi-planar reconstruction (MPR) and maximum intensity projection (MIP). BSCTA detected and characterized the aneurysms as well as DSA, and BSCTA and DSA gave concordant results in detecting aneurysms. Conclusions: BSCTA is easily accessible, less time consuming, and most importantly, a non-invasive technique for detecting intracranial aneurysms. It is also suitable for patients who have been referred to emergency services. Therefore, it can be used in emergency conditions and as a first-line diagnostic method in patients with non-traumatic SAH.

Kayhan, Aysegul; Koc, Osman; Keskin, Suat; Keskin, Fatih

2014-01-01

350

Chemical- and radiation-induced haemorrhagic cystitis: current treatments and challenges.  

PubMed

• To review the published data on predisposing risk factors for cancer treatment-induced haemorrhagic cystitis (HC) and the evidence for the different preventive and therapeutic measures that have been used in order to help clinicians optimally define and manage this potentially serious condition. • Despite recognition that HC can be a significant complication of cancer treatment, there is currently a lack of UK-led guidelines available on how it should optimally be defined and managed. • A systematic literature review was undertaken to evaluate the evidence for preventative measures and treatment options in the management of cancer treatment-induced HC. • There is a wide range of reported incidence due to several factors including variability in study design and quality, the type of causal agent, the grading of bleeding, and discrepancies in definition criteria. • The most frequently reported causal factors are radiotherapy to the pelvic area, where HC has been reported in up to 20% of patients, and treatment with cyclophosphamide and bacillus Calmette-Guérin, where the incidence has been reported as up to 30%. • Mesna (2-mercaptoethane sodium sulphonate), hyperhydration and bladder irrigation have been the most frequently used prophylactic measures to prevent treatment-related cystitis, but are not always effective. • Cranberry juice is widely cited as a preventative measure and sodium pentosanpolysulphate as a treatment, although the evidence for both is very limited. • The best evidence exists for intravesical hyaluronic acid as an effective preventative and active treatment, and for hyperbaric oxygen as an equally effective treatment option. • The lack of robust data and variability in treatment strategies used highlights the need for further research, as well as best practice guidance and consensus on the management of HC. PMID:24000900

Payne, Heather; Adamson, Andrew; Bahl, Amit; Borwell, Jonathan; Dodds, David; Heath, Catherine; Huddart, Robert; McMenemin, Rhona; Patel, Prashant; Peters, John L; Thompson, Andrew

2013-11-01

351

Clinical and epidemiological patterns of Argentine haemorrhagic fever  

PubMed Central

The epidemiology of Argentine haemorrhagic fever (AHF) is closely related to cricetine rodents acting as natural hosts of Junin virus. The endemo-epidemic area, which has increased 5 times since the disease was first recognized 15-20 years ago, is located in a densely populated region of Argentina. It has been shown that the virus of LCM is active in humans and rodents of the AHF endemic area; this demonstrates the simultaneous presence of two arenaviruses pathogenic for man in a given geographic location. The disease is characterized by haematological, renal, neurological and cardiovascular changes. Electron microscopy and immunohistochemical studies have shown cytopathic changes, characteristic intracellular virus-like particles, and antigenic determinants of Junin virus in different organs from 9 cases of AHF. No deposits of immunoglobulins or C3 were found in the kidneys; in addition, an absence of fibrinogen and C3 in the hepatocytes and of immunoglobulins in the spleen was observed. These findings suggest a direct viral pathogenic action in the human disease. Ultrastructural and immunofluorescence studies in tissues of guinea-pigs inoculated with two strains of Junin virus revealed the presence of the same types of virus-like particles and antigenic determinants of Junin virus as were encountered in the human subjects with AHF. ImagesFig. 2Fig. 3

Maiztegui, J. I.

1975-01-01

352

Delayed Anticoagulation-Related Intracranial Haemorrhage after Minor Head Injury  

PubMed Central

Treatment with anticoagulants and antiplatelet agents are well-known risk factors for an unfavourable outcome after traumatic brain injury (TBI). Guidelines for decision making in patients who sustained mild head injury do not apply to anticoagulated patients and therefore, in these cases diagnostic and therapeutic procedures have to be tailored patient-specific. A 69-year-old patient was referred to our hospital after sustaining mild head injury. Due to anticoagulation therapy, a cranial computed tomography was carried out and was without pathologic findings. After negative workup for TBI, the patient was admitted to the ward solely because of intermittent cardiac arrhythmia. The next day, the patient developed a hemiparesis and repeated brain imaging showed a large posttraumatic intracranial haematoma which had to be evacuated surgically. In the further clinical course, the patient recovered completely and a cardiac pacemaker was implanted. Emergency physicians have to be highly alert with anticoagulated patients after head injury, even if the trauma was mild and initial diagnostic procedures demonstrate no acute pathology. Delayed traumatic intracranial haemorrhage may have fatal consequences for patients and while the threshold for admission to a hospital ward should be low, adequate observation at home has to be ensured if patients are discharged.

Beynon, Christopher; Orakcioglu, Berk; Winkler, Harald; Geis, Nicolas A.; Unterberg, Andreas W.; Sakowitz, Oliver W.

2013-01-01

353

National mutation study among Danish patients with hereditary haemorrhagic telangiectasia.  

PubMed

Hereditary haemorrhagic telangiectasia (HHT) is an autosomal dominantly inherited vascular disease characterized by the presence of mucocutaneous telangiectasia and visceral arteriovenous malformations (AVM). The clinical diagnosis of HHT is based on the Curaçao criteria. About 85% of HHT patients carry mutations in the ENG, ACVRL1 or SMAD4 genes. Here, we report on the genetic heterogeneity in the Danish national HHT population and address the prevalence of pulmonary arteriovenous malformations (PAVM). Probands of 107 apparently unrelated families received genetic testing, including sequencing and multiplex ligation-dependent probe amplification (MLPA) analyses of ENG, ACVRL1 and SMAD4. These 107 families included 320 patients confirmed to have HHT either clinically or genetically. In 89% of the probands (n?=?95), a mutation was identified. We detected 64 unique mutations of which 27 (41%) were novel. Large deletions were identified in ENG and ACVRL1. The prevalence of PAVM was 52.3% in patients with an ENG mutation and 12.9% in the ACVRL1 mutation carriers. We diagnosed 80% of the patients clinically, fulfilling the Curaçao criteria, and those remaining were diagnosed by genetic testing. It is discussed when to assign pathogenicity to missense and splice site mutations. The adding of an extra criterion to the Curaçao criteria is suggested. PMID:24001356

Tørring, P M; Brusgaard, K; Ousager, L B; Andersen, P E; Kjeldsen, A D

2014-08-01

354

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

2012-01-01

355

Place of embolization of the uterine arteries in the management of post-partum haemorrhage: a study of 12 cases  

Microsoft Academic Search

Objective: To assess the current place of embolization of the uterine arteries in the treatment of severe post-partum haemorrhages. Materials and methods: A retrospective study of 13,160 deliveries in a level III maternity unit between January 1996 and December 2001. Five hundred and forty-nine post-partum haemorrhages were diagnosed. Seventeen (0.13%) patients had a haemorrhage which did not respond to treatment

Gaudérique Tourné; Frédérique Collet; Pierre Seffert; Charles Veyret

2003-01-01

356

Microbleeds on gradient-echo T2 * -weighted MR images from patients with multiple simultaneous intracerebral haemorrhages  

Microsoft Academic Search

Summary  \\u000a Background. Multiple simultaneous intracerebral haemorrhages (ICH) occur rarely and the mechanism remains unknown. In this report, we\\u000a compare several clinical factors of multiple haemorrhages, including microbleeds, with single intracerebral haemorrhages and\\u000a discuss a potential explanation for their occurrence.\\u000a \\u000a \\u000a Methods. One hundred and ninety consecutive patients with intracerebral haemorrhage who were admitted within 24 hours after onset\\u000a from January 2003

T. Sorimachi; Y. Ito; K. Morita; Y. Fujii

2007-01-01

357

New insights into the structural elements involved in the skin haemorrhage induced by snake venom metalloproteinases.  

PubMed

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

2010-09-01

358

The peripheral course of the axons innervating the medial rectus muscle within the subarachnoid portion of the oculomotor nerve.  

PubMed Central

There is clinical evidence of topographic localisation of fibres within the oculomotor nerve. It is generally accepted that the pupillomotor fibres have a localised course within the dorsomedial periphery of the subarachnoid portion. However, the precise course of the individual groups of axons innervating each muscle has not been examined in detail. In this study the course of the axons innervating the medial rectus muscle was investigated in the subarachnoid portion of the oculomotor nerve of the rat. The medial rectus muscle was injected with horseradish peroxidase until it was fully infiltrated. The subarachnoid portion of the oculomotor nerve was removed and sectioned longitudinally in the sagittal plane. Sections were reacted with tetramethylbenzidine as a chromogen. Labelled axons were found to be localised in the ventral part of the subarachnoid portion of the nerve. Images Fig. 1 Fig. 2 Fig. 3

Atasever, A; Durgun, B; Kansu, T; Cumhur, M

1992-01-01

359

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

2008-01-01

360

Trends in preterm survival and incidence of cerebral haemorrhage 1980-9.  

PubMed Central

The annual survival rates and incidence of cerebral haemorrhage in 2618 preterm infants of 34 weeks' gestation or less were examined in one referral centre over a 10 year period from January 1980 to December 1989. Survival was independently related to weight, gestation, sex, and inborn delivery. When these variables had been taken into account, survival was 56% greater at the end of the decade compared with 1980. The incidence of cerebral haemorrhage (diagnosed by cranial ultrasound scanning) was related to birth weight, gestation, sex, inborn delivery, and caesarean section, but there was no significant trend in the incidence with time. Rates of caesarean section in this group increased from 31% in 1980 to over 50% more recently. Haemorrhage affecting the brain parenchyma was related to gestation and inborn delivery, and showed a small but significant decline over time. The lack of association between changes in survival rates and rates of cerebral haemorrhage may indicate that factors associated with both neonatal mortality and the incidence of cerebral haemorrhage may not be causally related as previously assumed.

Cooke, R W

1991-01-01

361

Haemorrhagic disease of the newborn in the British Isles: two year prospective study.  

PubMed Central

OBJECTIVE--To determine the incidence of haemorrhagic disease of the newborn in the British Isles, study risk factors, and examine the effect of vitamin K prophylaxis. DESIGN--Prospective survey of all possible cases of haemorrhagic disease of the newborn as reported by consultant paediatricians using the monthly notification cards of the British Paediatric Surveillance Unit and a follow up questionnaire for each case to validate the diagnosis and accrue further data. SETTING--Britain (England, Scotland, and Wales) and Ireland (Northern Ireland and the Irish Republic) during December 1987 to March 1990. PATIENTS--27 infants classified as having confirmed (n = 25) or probable (n = 2) haemorrhagic disease of the newborn. RESULTS--24 of the 27 infants were solely breast fed. 10 suffered intracranial haemorrhage; two of these died and there was clinical concern about the remainder. 20 infants had received no vitamin K prophylaxis, and seven had received oral prophylaxis. Relative risk ratios for these groups compared with babies who had received intramuscular vitamin K were 81:1 and 13:1 respectively. Six infants had hepatitis (alpha 1 antitrypsin deficiency in four), unsuspected until presentation with haemorrhagic disease of the newborn, of whom four had received oral prophylaxis. One other baby had prolonged jaundice. One mother had taken phenytoin during pregnancy. CONCLUSIONS--All newborn infants should receive vitamin K prophylaxis. Intramuscular vitamin K is more effective than oral prophylactic regimens currently used in the British Isles.

McNinch, A W; Tripp, J H

1991-01-01

362

Haemorrhagic fever with renal syndrome: Memorandum from a WHO Meeting*  

PubMed Central

Haemorrhagic fever with renal syndrome (HFRS) is a public health problem throughout most of the European and Asian land mass. Although predominantly associated with rural areas, it is now being recognized as an urban problem in some countries, and also presents a particular hazard to laboratory staff who use rodents for biomedical research. In wild rodents (rats, mice and voles) the infection is asymptomatic. Human infection with the HFRS agent(s) is sporadic, but under special circumstances epidemics occur; the infection may be completely silent, or associated with mild or severe disease. Severe cases are usually seen in the Far East. The epidemiological features of the disease vary from country to country and depend upon a variety of factors, the elucidation of which requires a multidisciplinary approach. The recently discovered Hantaan virus is the etiologic agent of HFRS in Asia. It is now possible to detect Hantaan virus antigen by immunofluorescence using either infected mouse lung or infected human cells as substrate. Prevention measures to date have concentrated on rodent control; the role played by the ectoparasites of rodents, if any, has still to be elucidated. Antigens have been detected in rodents captured in HFRS-endemic areas in China, Finland, Japan, Sweden, and the Soviet Union. None of these have been cultured as yet, but preliminary results with the Puumala agent detected in Finland indicate a relationship with the Hantaan virus. Sera collected from Scandinavian patients react to a high titre with both Puumala and Hantaan agents, whereas sera collected from patients in East Asia have much higher titres against the homologous antigen. Surveillance is very important and further research on the virus is needed, especially to identify the virus in the West and to determine strain differences.

1983-01-01

363

Intraplaque haemorrhages as the trigger of plaque vulnerability  

PubMed Central

Atherothrombosis remains one of the main causes of morbidity and mortality in the western countries. Human atherothrombotic disease begins early in life in relation to circulating lipid retention in the inner vascular wall. Risk factors enhance the progression towards clinical expression: dyslipidaemia, diabetes, smoking, hypertension, ageing, etc. The evolution from the initial lipid retention in the arterial wall to clinical events is a continuum of increasingly complex biological processes. Current strategies to fight the consequences of atherothrombosis are orientated either towards the promotion of a healthy life style1 and preventive treatment of risk factors, or towards late interventional strategies.2 Despite this therapeutic arsenal, the incidence of clinical events remains dramatically high,3 dependent, at least in part, on the increasing frequency of type 2 diabetes and ageing. But some medical treatments, focusing only on prevention of the metabolic risk, have failed to reduce cardiovascular mortality, thus illustrating that our understanding of the pathophysiology of human atherothrombosis leading to clinical events remain incomplete. New paradigms are now emerging which may give rise to novel experimental strategies to improve therapeutic efficacy and prediction of disease progression. Recent studies strengthen the concept that the intraplaque neovascularization and bleeding (Figure 1, upper panel) are events that could play a major role in plaque progression and leucocyte infiltration, and may also serve as a measure of risk for the development of future events. The recent advances in our understanding of IntraPlaque Hemorrhage as a critical event in triggering acute clinical events have important implications for clinical research and possibly future clinical practice. Figure 1Macroscopic view and schematic representation of the detrimental consequences of intraplaque haemorrhages on plaque biology and stability.

Michel, Jean-Baptiste; Virmani, Renu; Arbustini, Eloisa; Pasterkamp, Gerard

2011-01-01

364

A Novel Intravital Method to Evaluate Cerebral Vasospasm in Rat Models of Subarachnoid Hemorrhage: A Study with Synchrotron Radiation Angiography  

PubMed Central

Precise in vivo evaluation of cerebral vasospasm caused by subarachnoid hemorrhage has remained a critical but unsolved issue in experimental small animal models. In this study, we used synchrotron radiation angiography to study the vasospasm of anterior circulation arteries in two subarachnoid hemorrhage models in rats. Synchrotron radiation angiography, laser Doppler flowmetry-cerebral blood flow measurement, [125I]N-isopropyl-p-iodoamphetamine cerebral blood flow measurement and terminal examinations were applied to evaluate the changes of anterior circulation arteries in two subarachnoid hemorrhage models made by blood injection into cisterna magna and prechiasmatic cistern. Using synchrotron radiation angiography technique, we detected cerebral vasospasm in subarachnoid hemorrhage rats compared to the controls (p<0.05). We also identified two interesting findings: 1) both middle cerebral artery and anterior cerebral artery shrunk the most at day 3 after subarachnoid hemorrhage; 2) the diameter of anterior cerebral artery in the prechiasmatic cistern injection group was smaller than that in the cisterna magna injection group (p<0.05), but not for middle cerebral artery. We concluded that synchrotron radiation angiography provided a novel technique, which could directly evaluate cerebral vasospasm in small animal experimental subarachnoid hemorrhage models. The courses of vasospasm in these two injection models are similar; however, the model produced by prechiasmatic cistern injection is more suitable for study of anterior circulation vasospasm.

Yuan, Falei; Chen, Lujia; He, Chuan; Bao, Yuhai; Chen, Zuoquan; Lou, Meiqing; Xia, Weiliang; Yang, Guo-Yuan; Ling, Feng

2012-01-01

365

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

366

Atrial flutter in a patient with glioblastoma multiforme: problems in treating thromboembolic complications  

PubMed Central

A 55-year-old gentleman with a left-sided glioblastoma multiforme (GBM) presented with palpitations which were shown to be atrial flutter (AFL) on ECG. Approximately 6 h later, he developed ataxia and expressive dysphasia. A brain CT scan showed no acute haemorrhage and no progression of the brain tumour. Ischaemic stroke was the top differential diagnosis. However, the authors could not perform thrombolysis due to the risk of intratumour haemorrhage. The AFL reverted to sinus rhythm with metoprolol and digoxin after 3 days. His neurological signs resolved within 24 h, and a diagnosis of transient ischaemic attack secondary to AFL was made. This case highlights the challenge of managing thrombo-embolic complications of arrhythmias in cancer patients.

Liu, Alexander; Pusalkar, Pawan

2011-01-01

367

Complications in shoulder arthroscopy.  

PubMed

Shoulder arthroscopy is generally a safe and effective method for treating a wide variety of shoulder pathology. Fortunately, complications following shoulder arthroscopy are rare, with reported rates between 4.6% and 10.6%.¹?? These rates may be underestimated, as underreporting of complications and varying definitions of the term complication are likely. During shoulder arthroscopy, complications may occur at numerous points. The surgeon must be aware of potential problems and take necessary measures to prevent them. This article describes common complications after arthroscopic shoulder surgery. Although failure of treatment and postoperative stiffness are undesirable outcomes, they are not described. PMID:20608603

Marecek, Geoffrey S; Saltzman, Matthew D

2010-07-01

368

Non-steroidal anti-inflammatory drugs used as a treatment modality in subarachnoid hemorrhage.  

PubMed

Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most frequently prescribed therapies worldwide. Meta-analysis data indicate the potential for myocardial infarction, cerebrovascular incident, heart failure, renal failure and arterial hypertension. Here we review the mechanisms of their actions and the potential for therapeutic use in subarachnoid hemorrhage. Searches were performed using PubMed with the search terms "subarachnoid hemorrhage", "NSAID", "treatment", "management", "cerebral aneurysm", and "vasospasm" from 1970 to February, 2012. Articles were also identified through searches of the Cochrane library and searches of the authors' own files. Only papers published in English were reviewed.There are considerably mixed views on the potential impact of NSAIDs on the treatment and prevention of SAH. Whilst theoretically, the potential for positive intervention in the condition is huge, little effect appears to be measurable in clinical practice. PMID:22950380

Young, Adam M H; Karri, Surya K; Ogilvy, Christopher S

2012-07-01

369

Cerebral aneurysm exclusion by CT angiography based on subarachnoid hemorrhage pattern: a retrospective study  

PubMed Central

Background To identify patients with spontaneous subarachnoid hemorrhage for whom CT angiography alone can exclude ruptured aneurysms. Methods An observational retrospective review was carried out of all consecutive patients with non-traumatic subarachnoid hemorrhage who underwent both CT angiography and catheter angiography to exclude an aneurysm. CT angiography negative cases (no aneurysm) were classified according to their CT hemorrhage pattern as "aneurismal", "perimesencephalic" or as "no-hemorrhage." Results Two hundred and forty-one patients were included. A CT angiography aneurysm detection sensitivity and specificity of 96.4% and 96.0% were observed. All 35 cases of perimesencephalic or no-hemorrhage out of 78 CT angiography negatives also had negative angiography findings. Conclusions CT angiography is self-reliant to exclude ruptured aneurysms when either a perimesencephalic hemorrhage or no-hemorrhage pattern is identified on the CT within a week of symptom onset.

2011-01-01

370

Cerebellar contusions as a possible cause of traumatic basal subarachnoid hemorrhage: a case report.  

PubMed

Traumatic basal subarachnoid hemorrhage (TBSAH) is infrequent but of forensic neuropathological importance because of its high mortality and complex causal mechanisms. The source of the hemorrhage is most frequently identified in the vertebro-basilar arteries but often cannot be identified in these arteries. We present a case of TBSAH possibly originating from hemorrhagic cerebellar contusions due to fist blows to the neck. A 35-year-old woman, who was punched on the right side of the neck, became unconscious about 20 min later and died. Autopsy demonstrated a massive subarachnoid hemorrhage at the base of the brain, with blood clots attached to the right lower surface of the cerebellum. No tear was detected in the vertebro-basilar vessels, but there were hemorrhagic cerebellar contusions beneath the blood clots as a possible source of TBSAH. The site of impact to the neck suggested the cerebellar contusions to be a coup injury due to hard blows. PMID:20122864

Chen, Jian-Hua; Ishikawa, Takaki; Michiue, Tomomi; Maeda, Hitoshi

2010-03-01

371

Traumatic basal subarachnoid hemorrhage suspected to have been caused by contrecoup cerebellar contusions: a case report.  

PubMed

Traumatic cerebellar hemorrhagic contusions are infrequent, and the pathogenic mechanism involves a coup injury that is associated with motor vehicle accidents in most cases. Traumatic basal subarachnoid hemorrhage (TBSAH) is commonly reported after blunt trauma to the neck or unrestricted movement of the head, and the source of the hemorrhage is most frequently identified in the vertebrobasilar arteries. A 55-year-old woman who was addicted to alcohol was found dead in her bed. She had a bruise on the left side of her posterior parietal region, and autopsy revealed massive subarachnoid hemorrhage at the base of the brain; the hematoma was strongly attached to the right lower surface of the cerebellar hemisphere. No ruptured cerebral aneurysms, arteriovenous malformations or vertebrobasilar artery leakage were detected. Hemorrhagic cerebellar contusions were regarded as the source of the TBSAH. This is the first report of TBSAH suspected to have been caused by contrecoup cerebellar contusions. PMID:24411402

Sato, Takako; Tsuboi, Kento; Nomura, Masakatsu; Iwata, Misa; Abe, Shuntaro; Tamura, Akiyoshi; Tsuchihashi, Hitoshi; Nishio, Hajime; Suzuki, Koichi

2014-03-01

372

Diffuse alveolar haemorrhage secondary to warfarin therapy for atrial fibrillation: a case report and literature review  

PubMed Central

Alveolar haemorrhage is a rare and serious medical emergency with many causes. Diffuse alveolar haemorrhage due to warfarin therapy has been rarely reported in the literature. In this paper, we describe the case of 62-year-old woman with a history of chronic atrial fibrillation treated with warfarin, who was admitted to our institution with haemoptysis and dyspnoea. Alveolar haemorrhage was suspected clinically and subsequently confirmed by bronchoscopy. The patient required aggressive treatment with fresh frozen plasma, vitamin K and mechanical ventilation with a successful outcome. We emphasise the need for early diagnosis and fast therapeutic intervention, especially with over-anticoagulation (INR >9), in patients with this rare and potentially lethal condition.

Waness, Abdelkarim; Aldabbagh, Tarek; Harakati, Mohammed

2009-01-01

373

Role of Autophagy in Early Brain Injury after Experimental Subarachnoid Hemorrhage  

Microsoft Academic Search

Autophagy is a self-degradative process and it plays a housekeeping role in removing misfolded or aggregated proteins, clearing\\u000a damaged organelles, and eliminating intracellular pathogens. Previous studies have demonstrated that autophagy pathway was\\u000a activated in brain after experimental subarachnoid hemorrhage (SAH); however, the role of autophagy in the pathogenesis of\\u000a early brain injury (EBI) following SAH remains unknown. Experiment 1 aimed to

Zhong Wang; Xiao-Yong Shi; Jia Yin; Gang Zuo; Jian Zhang; Gang Chen

374

[Subarachnoid hemorrhage due to autonomic dysreflexia: rare consequence of sexual stimulation in a paraplegic].  

PubMed

Nearly all men with spinal cord injury suffer from neurogenic sexual dysfunction which is often treated with phosphodiesterase-5 (PDE5) inhibitors. We describe a case of subarachnoid hemorrhage due to autonomic dysreflexia (AD) caused by sexual stimulation. Nitrates are frequently used for acute treatment of AD; however, the use of these drugs in combination with PDE5 inhibitors is contraindicated. Therefore, meticulous information from patients and relatives on the risk of AD and possible drug interactions is of vital importance. PMID:23784679

Galiart, E; Baumberger, M; Pannek, J

2013-11-01

375

Predictors of left ventricular regional wall motion abnormalities after subarachnoid hemorrhage  

Microsoft Academic Search

Introduction  Cardiac abnormalities that have been reported after subarachnoid hemorrhage (SAH) include the release of cardiac biomarkers,\\u000a electrocardiographic changes, and left ventricular (LV) systolic dysfunction. The mechanisms of cardiac dysfunction after\\u000a SAH remain controversial. The aim of this study was to determine the prevalence of LV regional wall motion abnormalities (RWMA)\\u000a after SAH and to quantify the independent effects of specific

Avinash Kothavale; Nader M. Banki; Alexander Kopelnik; Sirisha Yarlagadda; Michael T. Lawton; Nerissa Ko; Wade S. Smith; Barbara Drew; Elyse Foster; Jonathan G. Zaroff

2006-01-01

376

Spontaneous intradural disc herniation with focal distension of the subarachnoid space in a dog.  

PubMed

Myelo-computed tomography of a paraparetic 14-year-old dog revealed subarachnoid distension with an intradural filling defect above the T13-L1 disc space. T12-L1 hemilaminectomy followed by durotomy allowed removal of a large piece of degenerated disc material that compressed the spinal parenchyma. Full return to function was achieved 10 days post-surgery. The distension was likely secondary to the intradural herniation, and is a rare and distinct finding. PMID:23633713

Barnoon, Itai; Chai, Orit; Srugo, Itai; Peeri, Dana; Konstantin, Lilach; Brenner, Ori; Shamir, Merav H

2012-11-01

377

Role of p38 Mitogen-Activated Protein Kinase on Cerebral Vasospasm After Subarachnoid Hemorrhage  

Microsoft Academic Search

Background and Purpose—Inflammatory cytokines are involved in the pathogenesis of cerebral vasospasm after subarachnoid hemorrhage (SAH). This study was conducted to examine the role of p38 mitogen-activated protein kinase (MAPK) in the development of vasospasm and cytokine production. Methods—We measured the expression levels of genes and proteins related to inflammation in human vascular smooth muscle cells (hVSMCs) treated with hemolysate

Toshiyuki Sasaki; Hidetoshi Kasuya; Hideaki Onda; Atsushi Sasahara; Shin Goto; Tomokatsu Hori; Ituro Inoue

2010-01-01

378

Reduced ADAMTS13 activity in delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage  

Microsoft Academic Search

The pathogenesis of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (SAH) remains unknown. Besides vasospasm, microthrombosis might have an important function. As in patients with thrombotic thrombocytopenic purpura an A Disintegrin And Metalloprotease with ThromboSpondin repeats-13 (ADAMTS13) deficiency leads to higher concentrations of large von Willebrand factor (vWF) multimers resulting in microthrombosis, our purpose was to compare ADAMTS13 and

Mervyn DI Vergouwen; Kamran Bakhtiari; Nan van Geloven; Marinus Vermeulen; Yvo BWEM Roos; Joost CM Meijers; MDI Vergouwen

2009-01-01

379

Alpha Lipoic Acid Alleviates Oxidative Stress and Preserves Blood Brain Permeability in Rats with Subarachnoid Hemorrhage  

Microsoft Academic Search

The neuroprotective effect of alpha lipoic acid (ALA; 100 mg\\/kg, po), a dithiol antioxidant, on experimentally induced subarachnoid\\u000a hemorrhage (SAH) was assessed in Wistar albino rats. Neurological examination scores recorded at the 48th h of SAH induction\\u000a were increased in SAH groups, which were accompanied with significant increases in the formation of reactive oxygen species,\\u000a DNA fragmentation ratios, malondialdehyde levels and myeloperoxidase

Mehmet ErsahinHale; Hale Z. Toklu; ?ule Çetinel; Meral Yüksel; Can Erzik; M. Zafer Berkman; Berrak Ç. Ye?en; Göksel ?ener

2010-01-01

380

Metamorphosis of Subarachnoid Hemorrhage Research: from Delayed Vasospasm to Early Brain Injury  

Microsoft Academic Search

Delayed vasospasm that develops 3–7 days after aneurysmal subarachnoid hemorrhage (SAH) has traditionally been considered\\u000a the most important determinant of delayed ischemic injury and poor outcome. Consequently, most therapies against delayed ischemic\\u000a injury are directed towards reducing the incidence of vasospasm. The clinical trials based on this strategy, however, have\\u000a so far claimed limited success; the incidence of vasospasm is reduced

Fatima A. Sehba; Ryszard M. Pluta; John H. Zhang

2011-01-01

381

Serum magnesium levels as related to symptomatic vasospasm and outcome following aneurysmal subarachnoid hemorrhage  

Microsoft Academic Search

Introduction: Recent evidence suggests that magnesium may be neuroprotective in the setting of cerebral ischemia, and therapeutic magnesium\\u000a infusion has been proposed for prophylaxis and treatment of delayed ischemic neurological deficit (DIND) resulting from vasospasm\\u000a in patients with aneurysmal subarachnoid hemorrhage (SAH). We studied the association between serum magnesium levels, the\\u000a development of DIND, and the outcomes of patients with

Frederic P. Collignon; Jonathan A. Friedman; David G. Piepgras; Mark A. Pichelmann; Jon I. McIver; L. Gerard Toussaint III; Robyn L. McClelland

2004-01-01

382

Intravenous magnesium sulphate for aneurysmal subarachnoid hemorrhage: an updated systemic review and meta-analysis  

Microsoft Academic Search

INTRODUCTION: Previous meta-analyses of magnesium sulphate infusion in the treatment of aneurysmal subarachnoid hemorrhage (SAH) have become outdated due to recently published clinical trials. Our aim was thus to perform an up-to-date systemic review and meta-analysis of published data on the use of magnesium sulphate infusion in aneurysmal SAH patients. METHODS: A systemic review and meta-analysis of the literature was

George KC Wong; Ronald Boet; Wai S Poon; Matthew TV Chan; Tony Gin; Benny CY Zee

2011-01-01

383

Heme-oxygenase-1 induction in glia throughout rat brain following experimental subarachnoid hemorrhage  

Microsoft Academic Search

The heme released following subarachnoid hemorrhage is metabolized by heme-oxygenase (HO) to biliverdin and carbon monoxide (CO) with the release of iron. The HO reaction is important since heme may contribute to vasospasm and increase oxidative stress in cells. HO is comprised of at least two isozymes, HO-2 and HO-1. HO-1, also known as heat shock protein HSP32, is inducible

Paul Matz; Christopher Turner; Philip R. Weinstein; Stephen M. Massa; S. Scott Panter; Frank R. Sharp

1996-01-01

384

Decompression of the spinal subarachnoid space as a solution for syringomyelia without Chiari malformation  

Microsoft Academic Search

Study design: Review and analysis of seven cases of syringomyelia treated surgically.Objective: To demonstrate the beneficial role of decompressive surgery for the altered cerebrospinal fluid (CSF) flow dynamics in syringomyelia not associated with Chiari I malformation. A comparison between the pre- and post-operative syrinx size and CSF flow in the subarachnoid space was made using cine-mode magnetic resonance imaging (cine-MRI)

J-H Lee; C-K Chung; HJ Kim

2002-01-01

385

Effect of anatomical fine structure on the flow of cerebrospinal fluid in the spinal subarachnoid space.  

SciTech Connect

The lattice Boltzmann method is used to model oscillatory flow in the spinal subarachnoid space. The effect of obstacles such as trabeculae, nerve bundles, and ligaments on fluid velocity profiles appears to be small, when the flow is averaged over the length of a vertebra. Averaged fluid flow in complex models is little different from flow in corresponding elliptical annular cavities. However, the obstacles stir the flow locally and may be more significant in studies of tracer dispersion.

Stockman, Harlan Wheelock

2005-01-01

386

Importance of hypovolaemic shock and endoscopic signs in predicting recurrent haemorrhage from peptic ulceration: a prospective evaluation  

Microsoft Academic Search

The incidence of rebleeding was studied prospectively in 177 patients with acute gastrointestinal haemorrhage from peptic ulceration with reference to the degree of haemodynamic insult on admission and the presence of endoscopic signs of recent haemorrhage on initial endoscopy. Rebleeding occurred in two (2%) of 114 patients without shock, in seven (18%) of 38 with tachycardia (pulse rate greater than

P C Bornman; N A Theodorou; R D Shuttleworth; H P Essel; I N Marks

1985-01-01

387

2012 outbreak of acute haemorrhagic conjunctivitis in Indian Ocean Islands: identification of Coxsackievirus A24 in a returned traveller.  

PubMed

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

2012-01-01

388

The Response of Cerebral Cortex to Haemorrhagic Damage: Experimental Evidence from a Penetrating Injury Model  

PubMed Central

Understanding the response of the brain to haemorrhagic damage is important in haemorrhagic stroke and increasingly in the understanding the cerebral degeneration and dementia that follow head trauma and head-impact sports. In addition, there is growing evidence that haemorrhage from small cerebral vessels is important in the pathogenesis of age-related dementia (Alzheimer’s disease). In a penetration injury model of rat cerebral cortex, we have examined the neuropathology induced by a needlestick injury, with emphasis on features prominent in the ageing and dementing human brain, particularly plaque-like depositions and the expression of related proteins. Needlestick lesions were made in neo- and hippocampal cortex in Sprague Dawley rats aged 3–5 months. Brains were examined after 1–30 d survival, for haemorrhage, for the expression of hyperphosphorylated tau, A?, amyloid precursor protein (APP), for gliosis and for neuronal death. Temporal cortex from humans diagnosed with Alzheimer’s disease was examined with the same techniques. Needlestick injury induced long-lasting changes–haem deposition, cell death, plaque-like deposits and glial invasion–along the needle track. Around the track, the lesion induced more transient changes, particularly upregulation of A?, APP and hyperphosporylated tau in neurons and astrocytes. Reactions were similar in hippocampus and neocortex, except that neuronal death was more widespread in the hippocampus. In summary, experimental haemorrhagic injury to rat cerebral cortex induced both permanent and transient changes. The more permanent changes reproduced features of human senile plaques, including the formation of extracellular deposits in which haem and A?-related proteins co-localised, neuronal loss and gliosis. The transient changes, observed in tissue around the direct lesion, included the upregulation of A?, APP and hyperphosphorylated tau, not associated with cell death. The findings support the possibility that haemorrhagic damage to the brain can lead to plaque-like pathology.

Purushothuman, Sivaraman; Marotte, Lauren; Stowe, Sally; Johnstone, Daniel M.; Stone, Jonathan

2013-01-01

389

[Massive haemorrhage after bivalirudin anticoagulation in two heart transplant patients].  

PubMed

Heparin-induced thrombopenia is a common autoimmune complication. It is a prothrombotic state due to the formation of antibodies against heparin/platelet factor 4 complexes. In this situation drugs other than heparin must be used for anticoagulation during extracorporeal circulation (bypass) surgery. Two cases of heart transplantation are presented in whom bivalirudin was used as an anticoagulant during the cardiopulmonary bypass. Severe bleeding complications were observed in both patients. The diagnosis of heparin-induced thrombopenia needs to be improved, as well as the development of protocols for using new drugs other than heparin. For this reason, we have reviewed current protocols and alternative therapies to heparin. PMID:22784649

Tauron, M; Paniagua, P; Muñoz-Guijosa, C; Mirabet, S; Padró, J M

2013-01-01

390

Clinical Outcome Prediction in Aneurysmal Subarachnoid Hemorrhage Using Bayesian Neural Networks with Fuzzy Logic Inferences  

PubMed Central

Objective. The novel clinical prediction approach of Bayesian neural networks with fuzzy logic inferences is created and applied to derive prognostic decision rules in cerebral aneurysmal subarachnoid hemorrhage (aSAH). Methods. The approach of Bayesian neural networks with fuzzy logic inferences was applied to data from five trials of Tirilazad for aneurysmal subarachnoid hemorrhage (3551 patients). Results. Bayesian meta-analyses of observational studies on aSAH prognostic factors gave generalizable posterior distributions of population mean log odd ratios (ORs). Similar trends were noted in Bayesian and linear regression ORs. Significant outcome predictors include normal motor response, cerebral infarction, history of myocardial infarction, cerebral edema, history of diabetes mellitus, fever on day 8, prior subarachnoid hemorrhage, admission angiographic vasospasm, neurological grade, intraventricular hemorrhage, ruptured aneurysm size, history of hypertension, vasospasm day, age and mean arterial pressure. Heteroscedasticity was present in the nontransformed dataset. Artificial neural networks found nonlinear relationships with 11 hidden variables in 1 layer, using the multilayer perceptron model. Fuzzy logic decision rules (centroid defuzzification technique) denoted cut-off points for poor prognosis at greater than 2.5 clusters. Discussion. This aSAH prognostic system makes use of existing knowledge, recognizes unknown areas, incorporates one's clinical reasoning, and compensates for uncertainty in prognostication.

Lo, Benjamin W. Y.; Macdonald, R. Loch; Baker, Andrew; Levine, Mitchell A. H.

2013-01-01

391

Cerebral vasospasm evaluated by transcranial ultrasound correlated with clinical grade and CT-visualized subarachnoid hemorrhage.  

PubMed

In 39 patients with a proven subarachnoid hemorrhage (SAH), the clinical status, the amount of subarachnoid blood on a computerized tomography scan obtained within 5 days after SAH, and the flow velocities (FV's) in both middle cerebral arteries (MCA's) measured by transcranial Doppler sonography were recorded daily and correlated. All patients had pathological FV's over 80 cm/sec between Day 4 and Day 10 after SAH. The side of the ruptured aneurysm showed higher FV's than did the unaffected side in cases of laterally localized aneurysms. Increase in FV preceded clinical manifestation of ischemia. A step early increase of FV's portended severe ischemia and impending infarction. Maximum FV's in the range of 120 to 140 cm/sec were not critical and in no case led to brain infarction. Maximum FV's over 200 cm/sec were associated with a tendency for ischemia, but the patients may remain clinically asymptomatic. In cases of no or only a little blood in the basal cisterns, mean FV's in both MCA's increased only moderately whereas, with thick clots of subarachnoid blood, there was a steeper and higher increase of mean FV's. PMID:3512799

Seiler, R W; Grolimund, P; Aaslid, R; Huber, P; Nornes, H

1986-04-01

392

Theoretical foundations for non-invasive measurement of variations in the width of the subarachnoid space  

NASA Astrophysics Data System (ADS)

Numerical modeling was used for the theoretical analysis of the propagation of optical radiation in the tissues of the human head, generated by a single source placed on the surface of the scalp. Of special interest and importance is the propagation of radiation within the layer of cerebrospinal fluid contained in the subarachnoid space (SAS), which is the only low absorption/high transmittance medium whose width can vary rapidly. Qualitative and quantitative assessment of changes in propagation of radiation within the SAS could become a source of information on changes in the geometry of this anatomical compartment playing a crucial role in cranio-spinal physiology and pathology. Essential for the idea of the possible noninvasive assessment of changes in width of the SAS by an optical method is the dependence of intensity of radiation reaching a photodetector located at a certain distance from the source on changes in the width of this fluid layer, which acts like a biological optical waveguide. Monte Carlo modeling and numerical analysis confirmed the feasibility of assessing changes in the width of the subarachnoid space optically. Presented here are details of the Monte Carlo simulation of light propagation in the tissues of human head and the results of such simulation as a function of the width of the subarachnoid space, calculated for different distances between the source and detector and for a few selected values of bone thickness. Results of numerical modeling were then compared with those of experiments on a mechanical-optical model.

Plucinski, Jerzy; Frydrychowski, Andrzej F.; Kaczmarek, Jacek; Juzwa, Witold

2000-07-01

393

Intracranial hypotension in the setting of concurrent perineural cyst rupture and subarachnoid hemorrhage.  

PubMed

Although most patients with intracranial hypotension typically present with headaches, the rest of the clinical spectrum is characteristically non-specific and often quite variable. In a patient with concurrent pathologies that can produce a similar clinical picture, a high index of suspicion must be maintained to achieve the correct diagnosis. The authors report a patient with intracranial hypotension in the setting of concurrent perineural cyst rupture and subarachnoid hemorrhage. A 63-year-old woman with a family history of ruptured intracranial aneurysms presented after a sudden thunderclap headache and was found to have diffuse subarachnoid hemorrhage. Imaging revealed anterior communicating and superior hypophyseal artery aneurysms. Following the uneventful clipping of both aneurysms, the patient experienced a delayed return to her neurological baseline. After it was noted that the patient had an improved neurological examination when she was placed supine, further investigation confirmed intracranial hypotension from perineural cyst rupture. The patient improved and returned to her neurological baseline after undergoing a high-volume blood patch and remained neurologically intact at postoperative follow-up. Although intracranial hypotension is known to be commonly associated with cerebrospinal fluid leak, its causal and temporal relationship with subarachnoid hemorrhage has yet to be elucidated. PMID:24314847

Sivakumar, Walavan; Ravindra, Vijay M; Cutler, Aaron; Couldwell, William T

2014-06-01

394

Theoretical foundations for noninvasive measurement of variations in the width of the subarachnoid space.  

PubMed

Numerical modeling was used for the theoretical analysis of the propagation of optical radiation in the tissues of the human head, generated by a single source placed on the surface of the scalp. Of special interest and importance is the propagation of radiation within the layer of cerebrospinal fluid contained in the subarachnoid space (SAS), which is the only low absorption/high transmittance medium whose width can vary rapidly. Qualitative and quantitative assessment of changes in propagation of radiation within the SAS could become a source of information on changes in the geometry of this anatomical compartment playing a crucial role in cranio-spinal physiology and pathology. Essential for the idea of the possible noninvasive assessment of changes in width of the SAS by an optical method is the dependence of intensity of radiation reaching a photodetector located at a certain distance from the source on changes in the width of this fluid layer, which acts like a biological optical waveguide. Monte Carlo modeling and numerical analysis confirmed the feasibility of assessing changes in the width of the subarachnoid space optically. Presented here are details of the Monte Carlo simulation of light propagation in the tissues of human head and the results of such simulation as a function of the width of the subarachnoid space, calculated for different distances between the source and detector and for a few selected values of bone thickness. Results of numerical modeling were then compared with those of experiments on a mechanical-optical model. PMID:10958615

Pluci?ski, J; Frydrychowski, A F; Kaczmarek, J; Juzwa, W

2000-07-01

395

Factor XIII deficiency as a potential cause of supratentorial haemorrhage after posterior fossa surgery  

Microsoft Academic Search

Background  Postoperative intracranial haemorrhage can be a dramatic event, carrying significant morbidity and mortality. Bleeding at\\u000a sites remote from the operation area represents a small percentage of haemorrhages whose aetiology remains unclear (Harders\\u000a et al. Acta Neurochir (Wien) 74(1-2):57–60, 1985).\\u000a \\u000a \\u000a \\u000a \\u000a Aim  We present the case of a 60-year-old patient who underwent posterior fossa craniotomy for the removal of a space-occupying\\u000a lesion and

Charikleia Spyridon Vrettou; Lampis C. Stavrinou; Spyridon Halikias; Magdalini Kyriakopoulou; Spyridon Kollias; George Stranjalis; Antonia Koutsoukou

2010-01-01

396

Internal iliac artery embolisation for the control of severe bladder and prostate haemorrhage.  

PubMed

Embolisation of the internal iliac artery was preformed under local anaesthesia in eight patients with severe bladder haemorrhage and in two with severe bleeding from the prostatic bed after prostatectomy. Good and effective control of the bleeding was achieved in six of the patients with bladder haemorrhage, with a partial response in the other two. Both patients with post-prostatectomy bleeding responded well to embolisation, with prompt cessation of the bleeding. This technique is recommended for the control of severe bleeding from the bladder or prostate in the seriously ill patient. PMID:3342300

Appleton, D S; Sibley, G N; Doyle, P T

1988-01-01

397

Association between elevated plasma norepinephrine levels and cardiac wall motion abnormality in poor-grade subarachnoid hemorrhage patients.  

PubMed

Patients with aneurysmal subarachnoid hemorrhage (SAH) are frequently complicated by acute cardiac dysfunctions, including cardiac wall motion abnormality (WMA). Massive release of catecholamine into the systemic circulation after aneurysmal rupture is believed to result in WMA, and poor-grade SAH seems to be the most important risk factor. However, plasma catecholamine levels have rarely been measured in SAH patients with WMA, and previous studies indicated that the elevated levels might not necessarily predict WMA. The objective of this study is (1) to evaluate relationship between WMA and plasma catecholamine levels in poor-grade SAH patients in the acute phase and (2) to clarify clinical characteristics of SAH patients with WMA. Among 142 poor-grade (World Federation of Neurosurgical Societies grades IV and V) SAH patients, 48 underwent both transthoracic ultrasound and measurement of plasma catecholamine levels within 24 h of SAH onset. They were divided into WMA+ (n?=?23) and WMA- (n?=?25) groups, and intergroup comparison was made on demographics, plasma catecholamine levels, and outcomes. Plasma norepinephrine levels were significantly higher in WMA+ group than in WMA- group (2,098.4?±?1,773.4 vs. 962.9?±?838.9 pg/mL, p?=?0.02), and the former showed significantly worse outcomes 90 days after admission. There were no intergroup differences in the plasma levels of epinephrine. Plasma norepinephrine levels were inversely correlated with left ventricular ejection fraction. Multivariate logistic regression analysis revealed that increased plasma norepinephrine levels were predictive of WMA, although age, female sex, and grade V SAH were not. This retrospective study highlights the role of norepinephrine in pathogenesis of SAH-induced WMA. PMID:22936520

Sugimoto, Keiko; Inamasu, Joji; Kato, Yoko; Yamada, Yasuhiro; Ganaha, Tsukasa; Oheda, Motoki; Hattori, Natsuki; Watanabe, Eiichi; Ozaki, Yukio; Hirose, Yuichi

2013-04-01

398

What is the optimal timing for surgery in infective endocarditis with cerebrovascular complications?  

PubMed Central

Neurologic dysfunction complicates the course of 10–40% of left-side infective endocarditis (IE). In right-sided IE, instead, when systemic emboli occur, paradoxical embolism should be considered. The spectrum of neurologic events includes embolic cerebrovascular complication (CVC), intracranial haemorrhage, ruptured mycotic aneurysm, transient ischaemic attack (TIA), meningitis, encephalopathy and brain abscess. Cardiopulmonary bypass might exacerbate neurological deficits due to: heparinization and secondary cerebral haemorrhage; hypotension and cerebral oedema in areas of the disrupted blood brain barrier. A best evidence topic was written according to a structured protocol. The question addressed was, whether there is an optimal timing for surgery in IE with CVCs. One hundred papers were found using the reported search criteria, and out of these 20 papers, provided the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results were tabulated. We found that evidence is conflicting because of lack of controlled studies. The optimal timing for the valve replacement depends on the type of neurological complication and the urgency of the operation. The new 2009 Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (IE) recommend a multidisciplinary approach and to wait for 1–2 weeks of antibiotics treatment before performing cardiac surgery. However, early surgery is indicated in: heart failure (class 1 B), uncontrolled infection (class 1 B) and prevention of embolic events (class 1B/C). After a stroke, surgery should not be delayed as long as coma is absent and cerebral haemorrhage has been excluded by cranial CT (class IIa level B). After a TIA or a silent cerebral embolism, surgery is recommended without delay (class 1 level B). In intracranial haemorrhage (ICH), surgery must be postponed for at least 1 month (class 1 level C). Surgery for prosthetic valve endocarditis (PVE) follows the general principles outlined for native valve IE. Every patient should have a repeated head CT scan immediately before the operation to rule out a preoperative haemorrhagic transformation of a brain infarction. The presence of a haematoma warrants neurosurgical consultation and consideration of cerebral angiography to rule out a mycotic aneurysm.

Rossi, Michele; Gallo, Alina; Joseph De Silva, Ravi; Sayeed, Rana

2012-01-01

399

Neurological Complications of Lyme Disease  

MedlinePLUS

NINDS Neurological Complications of Lyme Disease Information Page Synonym(s): Lyme Disease - Neurological Complications Table of Contents (click to jump to sections) What are Neurological Complications of ...

400

Complications of hip arthroscopy.  

PubMed

Complications associated with hip arthroscopy occur between 1.6% and 5%. Fortunately, with the greater understanding of the causes and advancements in techniques and equipment, the incidence is declining. Most of the complications were transient neuropraxias and fluid extravasations resulting in no permanent damage. Severe scuffing of two femoral heads and one case of avascular necrosis were considered serious and permanent, thereby resulting in a 0.5% rate in our series for significant complications. PMID:11675890

Sampson, T G

2001-10-01

401

Nonimmune complications after transplantation.  

PubMed

As posttransplant longevity has increased, nonimmune complications related to the transplant and posttransplant course have emerged as important factors in defining long-term outcomes. The incidence of, and risk factors for these complications may vary by transplanted organ based on immunosuppressive protocols and preexisting risk factors. This article discusses the relevant nonimmune complications associated with posttransplant care, with a focus on risk factors and management strategies. PMID:20371049

Choquette, Monique; Goebel, Jens W; Campbell, Kathleen M

2010-04-01

402

PSYCHIATRIC COMPLICATIONS OF CHLOROQUINE  

PubMed Central

Sixty patients with chloroquine induced psychiatric complications are reported in the present series. Psychosis was the most common complication followed by anxiety state and seizures. The maximum number of patients were between the ages of 6 and 10 years and females (70.0%) outnumbered the males (30.0%). Headache and sleeplessness were found to be more common amongpatients developing psychiatric complications of chloroquine. The symptoms disappeared within 2 to 21 days after the discontinuation of chloroquine.

Bhatia, M.S.; Malik, S.C.

1994-01-01

403

Cerebral microbleeds and the risk of intracerebral haemorrhage after thrombolysis for acute ischaemic stroke: systematic review and meta-analysis  

PubMed Central

Background Intracerebral haemorrhage (ICH) remains the most devastating yet unpredictable complication of intravenous thrombolysis for acute ischaemic stroke. We performed a systematic review and meta-analysis, to assess whether the presence of cerebral microbleeds (CMBs) on prethrombolysis MRI scans is associated with an increased risk of ICH. Methods We searched PubMed for studies assessing ICH risk in patients with acute ischaemic stroke treated with thrombolysis, in relation to the presence of pre-treatment CMBs. Results We identified five studies including 790 patients and pooled data in a meta-analysis. The CMB (+) versus CMB (?) groups were not significantly different in age, gender or stroke severity. The overall prevalence of CMBs was 135/790 (17.1%). Amongst patients with CMBs, 10/135 (7.4%) experienced a symptomatic ICH after thrombolysis, compared to 29/655 (4.4%) patients without CMBs. The pooled relative risk of ICH was 1.90 (95% CI 0.92 to 3.93; p=0.082). Conclusions The available evidence does not demonstrate a statistically significant increased risk of symptomatic ICH after thrombolysis for ischaemic stroke in patients with CMBs. However, in view of the methodological limitations of the studies included, the clinical relevance of any potential hazard associated with CMBs remains uncertain. Further studies are warranted to evaluate whether the risk of ICH might outweigh the benefit of thrombolysis, especially in patients with multiple lobar CMBs suggestive of cerebral amyloid angiopathy.

Charidimou, Andreas; Kakar, Puneet; Fox, Zoe; Werring, David J

2013-01-01

404

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

2011-01-01

405

[Complications of body piercing].  

PubMed

The trend of body piercing has grown in popularity in the past decade within the general population and especially among young adults. Complications of body piercing include local inflammation and infections, but severe complications are also possible and largely underestimated. People are usually not aware of the risks before making a piercing, and their medical history, medication and comorbidities are largely neglected by the people who realise the piercing. This article presents a review of the complications that a primary care physician may observe, for a patient who wishes to make a piercing, or presents complications due to the implementation of such a device. PMID:24734366

Friedrich, L; Madrid, C; Odman-Jaques, M; Yersin, B; Carnon, P N

2014-03-19

406

Fetal intracranial haemorrhages caused by fetal and neonatal alloimmune thrombocytopenia: an observational cohort study of 43 cases from an international multicentre registry  

PubMed Central

Objective To characterise pregnancies where the fetus or neonate was diagnosed with fetal and neonatal alloimmune thrombocytopenia (FNAIT) and suffered from intracranial haemorrhage (ICH), with special focus on time of bleeding onset. Design Observational cohort study of all recorded cases of ICH caused by FNAIT from the international No IntraCranial Haemorrhage (NOICH) registry during the period 2001–2010. Setting 13 tertiary referral centres from nine countries across the world. Participants 37 mothers and 43 children of FNAIT pregnancies complicated by fetal or neonatal ICH identified from the NOICH registry was included if FNAIT diagnosis and ICH was confirmed. Primary and secondary outcome measures Gestational age at onset of ICH, type of ICH and clinical outcome of ICH were the primary outcome measures. General maternal and neonatal characteristics of pregnancies complicated by fetal/neonatal ICH were secondary outcome measures. Results From a total of 592 FNAIT cases in the registry, 43 confirmed cases of ICH due to FNAIT were included in the study. The majority of bleedings (23/43, 54%) occurred before 28 gestational weeks and often affected the first born child (27/43, 63%). One-third (35%) of the children died within 4?days after delivery. 23 (53%) children survived with severe neurological disabilities and only 5 (12%) were alive and well at time of discharge. Antenatal treatment was not given in most (91%) cases of fetal/neonatal ICH. Conclusions ICH caused by FNAIT often occurs during second trimester and the clinical outcome is poor. In order to prevent ICH caused by FNAIT, at-risk pregnancies must be identified and prevention and/or interventions should start early in the second trimester.

Tiller, Heidi; Kamphuis, Marije M; Flodmark, Olof; Papadogiannakis, Nikos; David, Anna L; Sainio, Susanna; Koskinen, Sinikka; Javela, Kaija; Wikman, Agneta Taune; Kekomaki, Riitta; Kanhai, Humphrey H H; Oepkes, Dick; Husebekk, Anne; Westgren, Magnus

2013-01-01

407

Antenatal complications in adolescent mothers aged below 14 years.  

PubMed

Antenatal complications in 340 booked and 710 unbooked adolescent mothers aged 12-14 years were evaluated over a 2-year period at the Specialist Hospital, Yola, Adamawa State, Nigeria. Emesis gravidarum was observed in 290 (85.3%) and 612 (86.2%) booked and unbooked mothers, respectively. While 112 (32.9%) booked mothers had malaria, this ailment was observed in 508 (71.5%) of unbooked mothers. Forty-six (13.5%) booked mothers suffered from anaemia as against 483 (68.0%) unbooked patients. It was observed that preeclampsia manifested in 62 (18.2%) booked and 158 (22.2%) unbooked mothers, while eclampsia occurred in 18 (5.3%) and 66 (9.3%) booked and unbooked mothers, respectively. The rates of premature deliveries were 16.20% in booked mothers and 22.82% in the unbooked group. Other notable complications observed in both groups include premature rupture of fetal membranes (PROM), preterm contractions, antepartum haemorrhage, and urinary tract infections. There were slightly higher frequencies of the above complications in 12-year-olds, and these decreased slightly towards the age of 14 years. Nine of the 10 above observed complications occurred more in the lower socioeconomic classes [3-4] than in the upper social economic classes [1-2] in significant proportions. PMID:10456165

Obed, J Y; Zarma, A; Mamman, L

1997-01-01

408

[Orthotopic liver transplant in rats. Surgical technique, complications and treatment].  

PubMed

The orthotopic rat liver transplant model is a widely used technique in transplantation research. It has many advantages over other animal transplant models because of its availability and low cost. However, it must be emphasized that success with the rat model requires thorough training. The aim of this paper is to describe the microsurgical technique involved in 60 rat liver transplants and to discuss the complications and their treatments. Forty-nine liver transplants were performed at the Experimental Laboratory of the University Hospital, Ontario, Canada (ELUH) and 11 were performed at the Laboratorio de Trasplante de Organos de la Facultad de Ciencias Médicas de La Plata, Buenos Aires. Argentina (LTO). Among the transplants performed at the ELUH, the observed complications were haemorrhage (n = 4), pneumothorax (n = 1), anastomotic failure (n = 15), bile leak (n = 3), and bile duct necrosis (n = 9). The remaining 17 rats at the ELUH were healthy at day 7 after surgery. Animal survival immediately postop, at 24 hours postop and at 7 days postop was achieved with the 9th, 20th and 21st transplants respectively. At the LTO, 3 rats died as a result of anaesthetic complications. Seven-day animal survival was achieved with the 11th transplant. We beleive that the description of the orthotopic rat liver transplantation technique, as well as the discussion regarding complications and their management, can be useful for researchers interested in performing liver transplantation in rats. PMID:12553156

Lausada, Natalia R; Gondolesi, G E; Ortiz, E; Dreizzen, E; Raimondi, J C

2002-01-01

409

Computational Intelligence Method for Early Diagnosis Dengue Haemorrhagic Fever Using Fuzzy on Mobile Device  

NASA Astrophysics Data System (ADS)

Mortality from Dengue Haemorrhagic Fever (DHF) is still increasing in Indonesia particularly in Jakarta. Diagnosis of the dengue shall be made as early as possible so that first aid can be given in expectation of decreasing death risk. The Study will be conducted by developing expert system based on Computational Intelligence Method. On the first year, study will use the Fuzzy Inference System (FIS) Method to diagnose Dengue Haemorrhagic Fever particularly in Mobile Device consist of smart phone. Expert system application which particularly using fuzzy system can be applied in mobile device and it is useful to make early diagnosis of Dengue Haemorrhagic Fever that produce outcome faster than laboratory test. The evaluation of this application is conducted by performing accuracy test before and after validation using data of patient who has the Dengue Haemorrhagic Fever. This expert system application is easy, convenient, and practical to use, also capable of making the early diagnosis of Dengue Haemorraghic to avoid mortality in the first stage.

Salman, Afan; Lina, Yen; Simon, Christian

2014-03-01

410

Cytokine patterns in a comparative model of arenavirus haemorrhagic fever in guinea pigs  

Microsoft Academic Search

Arenaviruses such as Lassa virus cause a spectrum of disease in humans ranging from mild febrile illness to lethal haemorrhagic fever. The contributions of innate immunity to protection or pathogenicity are unknown. We compared patterns of expression of cytokines of innate immunity in mild versus severe arenavirus disease using an established guinea pig model based on the macrophage-tropic arenavirus Pichinde

Erin P. Scott; Judith F. Aronson

2008-01-01

411

Acute gastrointestinal haemorrhage in anticoagulated patients: diagnoses and response to endoscopic treatment  

Microsoft Academic Search

The underlying diagnosis and clinical course of 52 patients who presented with severe acute gastrointestinal haemorrhage while taking the anticoagulant warfarin is reviewed. A bleeding site was identified in 83% of cases, only slightly fewer than the 92% found in a control of group of 710 patients not taking warfarin who presented in the same four year period. The degree

C P Choudari; C Rajgopal; K R Palmer

1994-01-01

412

Molecular Variability among Strains of Pasteurella multocida Isolated from an Outbreak of Haemorrhagic Septicaemia in India  

Microsoft Academic Search

The applicability of conventional and molecular methods for rapid detection and differentiation ofPasteurella multocida serogroup B isolates involved in an outbreak of haemorrhagic septicaemia affecting Indian buffaloes was studied. Five isolates were obtained and were subjected to phenotypic and genotypic characterization. None of the five isolates could be differentiated on the basis of cultural, biochemical, pathogenicity and antimicrobial sensitivity patterns.

A. Biswas; S. B. Shivachandra; M. K. Saxena; A. A. Kumar; V. P. Singh; S. K. Srivastava

2004-01-01

413

Vasopressin secretion in response to haemorrhage: Mathematical modelling of the factors involved  

Microsoft Academic Search

The secretion of vasopressin (estimated in terms of its plasma concentration — AVP) in response to haemorrhage was analysed as a function of blood volume (expressed in terms of % removed plasma — PV) and of mean arterial blood pressure (MABP). Blood was removed from lightly anaesthetized dogs in a carefully controlled, graded manner, so as to ensure a very

M. Rocha e Silva; W. Celso de Lima; Elizabeth M. Castro de Souza

1978-01-01

414

Detection of human antibodies to Crimean-Congo haemorrhagic fever virus using expressed viral nucleocapsid protein  

Microsoft Academic Search

Diagnosis of Crimean-Congo haemorrhagic fever (CCHF) virus infections is hampered by the problems of handling this human pathogen, which requires the highest levels of biological containment. Recombinant antigens were examined for their potential as non- hazardous diagnostic reagents. The nucleocapsid (N) gene of the Greek AP92 isolate of CCHF virus was sequenced from cloned PCR products and the open reading

Anthony C. Marriott; Thalia Polyzoni; Antony Antoniadis; Patricia A. Nuttall

1994-01-01

415

Risk of gastrointestinal haemorrhage with calcium antagonists in hypertensive persons over 67 years old  

Microsoft Academic Search

SummaryBackground Calcium antagonists are used frequently in management of hypertension. In addition to their cardiovascular effects, these drugs inhibit platelet aggregation. Therefore we examined whether the use of calcium antagonists was associated with an increased risk of gastrointestinal haemorrhage (GIH).Methods A prospective cohort study was conducted from 1985 through 1992 on 1636 hypertensive persons aged ?68 years living in three

M Pahor; P Carbonin; J. M Guralnik; R. J Havlik; C. D Furberg

1996-01-01

416

Bilateral subhyaloid haemorrhage in a conscious patient: a new spectrum of ocular involvement by Plasmodium falciparum.  

PubMed

A 24-year-old woman presented with a history of high-grade fever with rigours since 3?days and bilateral sudden loss of vision since 6?h. She was conscious, oriented and her vitals were stable. She had a temperature of 101°F, anaemia, thrombocytopaenia, normal white cell count and moderate splenomegaly. On testing visual activity, she could only perceive hand movements although her pupils were bilaterally equal, and normal in size and reaction. On indirect ophthalmoscopy, optic discs were normal bilaterally; however, fovea of both eyes was masked by subhyaloid haemorrhage. Peripheral smear showed gametocytes of Plasmodium falciparum. The patient was started on arteminsinin-combined therapy and advised to be in propped-up position to help resolution of the haemorrhage. The patient was afebrile in 4?days and follow-up fundus examination showed gradual resolution of the haemorrhage. After two months, the patient regained normal visual acuity in both eyes; however, it took nearly 3?months for complete resolution of the haemorrhage. PMID:24862605

Abdali, Nasar; Malik, Azharuddin Mohammed; Shamim, Md Dilawez; Rizvi, Syed Wajahat Ali

2014-01-01

417

Role of endotoxin in the pathogenesis of haemorrhagic septicaemia in the buffalo  

Microsoft Academic Search

The pathogenesis of haemorrhagic septicaemia in buffalo infected with Pasteurella multocida is poorly understood. However, the characteristic of sudden onset leading to the rapid death of infected animals is similar to that seen in other clinical conditions known to involve endotoxic shock. The objectives of the work were to assess the contribution of endotoxaemia to the disease's pathogenesis and to

N. U. Horadagoda; J. C. Hodgson; G. M. Moon; T. G. Wijewardana; P. D. Eckersall

2001-01-01

418

Blood pressure, heart rate, and skin temperature in preterm infants: associations with periventricular haemorrhage  

Microsoft Academic Search

The mean arterial blood pressure (MABP), heart rate, and skin temperature were monitored every 15 minutes in the first 10 days after birth in 34 preterm infants, gestational age 24 to 33 weeks. Ultrasound brain scans carried out daily showed that a periventricular haemorrhage (PVH) occurred in a subgroup of infants (n = 15) of lower birthweight and gestational age.

S. W. DSouza; H. Janakova; D. Minors; R. Suri; J. Waterhouse; G. Appleton; C. Ramesh; D. G. Sims; M. L. Chiswick

1995-01-01

419

Mountain sickness, retinal haemorrhages, and acclimatisation on Mount Everest in 1975  

Microsoft Academic Search

During the 1975 British Everest Expedition, which made the first ascent of the south-west face, observations were made in relation to mountain sickness and the appearance of retinal changes. Two Sherpas with cerebral oedema and one Briton with pulmonary oedema were treated. Retinal haemorrhages occurred in four out of six Britons who were newcomers to altitudes over 6000 m (19

C Clarke; J Duff

1976-01-01

420

Feasibility of electrical impedance tomography in haemorrhagic stroke treatment using adaptive mesh  

NASA Astrophysics Data System (ADS)

EIT has been proposed for acute stroke differentiation, specifically to determine the type of stroke, either ischaemia (clot) or haemorrhage (bleed) to allow the rapid use of clot-busting drugs in the former (Romsauerova et al 2006) . This addresses an important medical need, although there is little treatment offered in the case of haemorrhage. Also the demands on EIT are high with usually no availability to take a 'before' measurement, ruling out time difference imaging. Recently a new treatment option for haemorrhage has been proposed and is being studied in international randomised controlled trial: the early reduction of elevated blood pressure to attenuate the haematoma. This has been shown via CT to reduce bleeds by up to 1mL by Anderson et al 2008. The use of EIT as a continuous measure is desirable here to monitor the effect of blood pressure reduction. A 1mL increase of haemorrhagic lesion located near scalp on the right side of head caused a boundary voltage change of less than 0.05% at 50 kHz. This could be visually observed in a time difference 3D reconstruction with no change in electrode positions, mesh, background conductivity or drift when baseline noise was less than 0.005% but not when noise was increased to 0.01%. This useful result informs us that the EIT system must have noise of less than 0.005% at 50 kHz including instrumentation, physiological and other bias