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1

[The mechanism of cardiorespiratory arrest due to subarachnoid hemorrhage].  

PubMed

This report describes the clinical course of patients with sudden cardiorespiratory arrest (CRA) due to subarachnoid hemorrhage (SAH). We have seen fifteen patients of SAH that presented initially as CRA. All of them were diagnosed as SAH by CT scan. The patients were divided into two groups; one group (early DOA group) included 11 patients, who had been recognized as CRA within 60 minutes from the onset of SAH, the other group (late DOA group) consisted of 4 patients, who developed CRA more than 60 minutes after the initial onset. The major mechanism leading to delayed CRA in the late DOA group appeared to have been from brain stem herniation, but another mechanism appeared to be involved in sudden CRA in the early DOA group. Sixty percent of our patients with CRA due to SAH had a low serum potassium concentration, though hypokalemia was observed in only 4 out of 100 patients with CRA due to diseases other than SAH. These facts suggest that sympathetic hyperstimulation might result not only from stress but also from a disorder of the central autonomic nervous system. We speculate that the mechanism leading to early CRA after SAH appears to result from a disorder of the central autonomic nerve system. PMID:7637838

Kanemoto, Y; Kamada, K; Sasaoka, Y; Nishimura, A; Sakitani, H

1995-07-01

2

Endoscopic Third Ventriculostomy for Obstructive Hydrocephalus due to Intraventricular Hemorrhage.  

PubMed

Background?Although endoscopic third ventriculostomy (ETV) is the first-line treatment for obstructive hydrocephalus due to various pathologies, its role in hemorrhage-related obstructive hydrocephalus is poorly defined. We report our experience with ETV for hemorrhage-related obstructive hydrocephalus, demonstrate it feasibility, and discuss potential advantages over more conventional treatment modalities. Methods?We performed a retrospective analysis of 78 consecutive patients who underwent ETV in our institution between January 2003 and January 2011. We identified 17 consecutive patients who underwent ETV for obstructive hydrocephalus related to intraventricular hemorrhage (IVH). Results?ETV was performed in 9 men and 8 women (mean age: 58 years; range: 42-79). All patients had IVH (n?=?17), either alone (n?=?3) or with intracranial hemorrhage (n?=?4) or subarachnoid hemorrhage (SAH) (n?=?10). Endoscopic clot evacuation was performed in seven cases (41%). External ventricular drain (EVD) was avoided in two patients. 15 patients had external EVD, and EVD wean was performed on average 5 days post-ETV. Two patients died in the early postoperative period (< 1 month) from the initial cerebral insult. For the 15 surviving patients, the average modified Rankin Scale (mRS) at last follow-up (15 months; range: 1-48) was 2.4. Thus most surviving patients were independent (mRS?SAH (100%). Conclusion?ETV with or without endoscopic clot evacuation is feasible for patients with hemorrhage-related obstructive hydrocephalus. Potential advantages include avoiding or reducing duration of EVD placement and preventing ventriculoperitoneal shunt placement. Further large prospective randomized trials are needed to evaluate the safety and efficacy of ETV with or without clot evacuation for IVH-related obstructive hydrocephalus. PMID:25045859

Obaid, Sami; Weil, Alexander G; Rahme, Ralph; Bojanowski, Michel W

2014-07-21

3

Crohns disease with central nervous system vasculitis causing subarachnoid hemorrhage due to aneurysm and cerebral ischemic stroke.  

PubMed

Cerebral vasculitis secondary to Crohn's disease (CD) seems to be a very rare phenomenon. We report a 39-year-old male who presented with headache, vomiting, and left-sided weakness in the known case of CD. Cross-sectional imaging (computed tomography and magnetic resonance imaging,) showed right gangliocapsular acute infarct with supraclinoid cistern subarachnoid hemorrhage (SAH). Cerebral digital substraction angiography (DSA) showed dilatation and narrowing of right distal internal carotid artery (ICA). Left ICA was chronically occluded. His inflammatory markers were significantly raised. Imaging features are suggestive of cerebral vasculitis. Arterial and venous infarcts due to thrombosis are known in CD. Our case presented with acute subarachnoid hemorrhage in supraclinoid cistern due to rupture of tiny aneurysm of perforator arteries causing SAH and infarction in right basal ganglia. Patient was treated conservatively with immunosuppression along with medical management of SAH. PMID:25506170

Garge, Shaileshkumar S; Vyas, Pooja D; Modi, Pranav D; Ghatge, Sharad

2014-10-01

4

Two Cases of Subarachnoid Hemorrhage from Spontaneous Anterior Cerebral Artery Dissection : A Case of Simultaneous Hemorrhage and Ischemia Without Aneurysmal Formation and Another Case of Hemorrhage with Aneurysmal Formation  

PubMed Central

Spontaneous anterior cerebral artery (ACA) dissection, although extremely rare, is often associated with severe morbidity and mortality. It could lead to cerebral hemorrhage, ischemic stroke, or, rarely, combination of hemorrhage and ischemia due to hemodynamic changes. Prompt and accurate diagnosis is essential for determining the appropriate management. However, the optimal treatment for ACA dissection remains controversial. Herein, we report on two rare cases of subarachnoid hemorrhage (SAH) caused by ACA dissection; a case presenting with simultaneous SAH and infarction without aneurysmal formation and another case presenting with SAH with fusiform aneurysmal formation. A review of the related literature is provided, and optimal treatments for each type of dissection are suggested. PMID:25045652

Im, Tae-Seop; Suh, Sang-Jun; Lee, Jeong-Ho; Ryu, Kee-Young; Kang, Dong-Gee

2014-01-01

5

Radiculopathy due to spontaneous facetal cyst hemorrhage  

PubMed Central

Facetal cysts are usually encountered as incidental radiological findings in spinal imaging studies. Only rarely can neurological symptoms be attributed to them. These cysts are lined by vascularized synovial tissue. There are few reports in literature of hemorrhagic transformation in these cysts with sudden increase in size precipitating symptoms acutely. We report one such case where the existence of a hitherto undiagnosed cyst was unmasked by the haemorrhage. There is a need to be aware of this complication in patients with untreated or incidentally diagnosed cysts so that any sudden neurological deterioration can be dealt with promptly.

Krishnan, Prasad; Sanyal, Sugat; Das, Sayan

2014-01-01

6

[Bilateral adrenal hemorrhage due to adrenal metastasis of lung cancer].  

PubMed

A 58-year-old man presented with nausea and left flank pain. The patient was referred to our hospital based on clear detection of anemia and computed tomography findings of bilateral adrenal tumors with hemorrhage and a mass in the apex of the left lung. Right adrenal artery embolization had no effect on enlargement of the right adrenal hematoma or advanced anemia. Right adrenalectomy was then performed in an attempt to control hemorrhaging and make a definitive diagnosis, and the patient's anemia improved following the operation. Histopathological diagnosis suggested adrenal metastasis of lung adenocarcinoma, which was subsequently diagnosed given similarities in transbronchial biopsy findings to those in the right adrenal gland. Adrenal hemorrhage due to metastasis of lung cancer is an extremely rare condition; indeed, to our knowledge, the present case is only the 26th reported worldwide. However, prognosis for this mortal condition may be improved should patients receive adrenalectomy followed by an appropriate treatment regimen. PMID:23457929

Tamura, Keita; Furuse, Hiroshi; Sugiyama, Takayuki; Kato, Taiki; Suzuki, Takahisa; Kai, Fumitake; Nagata, Masao; Otsuka, Atsushi; Takayama, Tatsuya; Ishii, Yasuo; Mugiya, Soichi; Ozono, Seiichiro

2013-01-01

7

Cerebral venous thrombosis as a rare cause of subarachnoid hemorrhage: case report and literature review.  

PubMed

We report a 48-year-old woman presenting with subarachnoid hemorrhage (SAH) as the first manifestation of superior sagittal sinus thrombosis. In a literature review of 73 cases, SAH associated with cerebral venous thrombosis (CVT) was usually seen at the cerebral convexities. SAH was adjacent to thrombosed venous structures; therefore, the most possible explanation seems to be the rupture of cortical veins due to extension of thrombosis. Computed tomography (CT) was effective for diagnosis of CVT in only 32% of the cases. CVT should be considered when SAH is limited to cerebral convexities and magnetic resonance (MR) imaging with MR venography should be performed. PMID:24746346

Sahin, Neslin; Solak, Aynur; Genc, Berhan; Bilgic, Nalan

2014-01-01

8

Management of SAH with traditional Chinese medicine in China.  

PubMed

China lacks large scale authorized epidemiological study results in allusion to subarachnoid hemorrhage (SAH) within recent 15 years since MONICA (multinational monitoring of trends and determinants in cardiovascular disease) study revealed SAH situation in China in 2000. The main cause of SAH in China is aneurysm which takes up 30-50%, while over 90% aneurysm locates at Willis circle. Early surgery for SAH after aneurysm rupture is the dominant procedure to deal with SAH in China. Moreover, calcium antagonists rank the absolute leading position for cerebral vascular spasm (CVS) among medication-based treatment options. However, traditional Chinese medicine such as Salvia miltiorrhiza, Acanthopanax senticosus, Ginkgo biloba, Pueraria lobata, Liguisticum chuanxiong, cow bezoar, Diospyros kaki and Gynostemma pentaphyllum have been proven beneficial in CVS prevention and treatment, while Salvia miltiorrhiza and TCM soup have unique effects on bleeding absorption. In addition, aescine and some TCM soup might relieve strong headache after SAH. In general, TCM integrated with western medicine have shown unique advantages in the current treatment of SAH in China. However, it is a pity that China still lacks larger scale randomized controlled trials and research on SAH treatment focusing on TCM and the related mechanism of TCM on SAH still need to be investigated further. PMID:16759447

Wang, Chunxue; Zhao, Xingquan; Mao, Shujing; Wang, Yongjun; Cui, Xiangning; Pu, Yuehua

2006-06-01

9

Neurovascular events after subarachnoid hemorrhage: focusing on subcellular organelles.  

PubMed

Subarachnoid hemorrhage (SAH) is a devastating condition with high morbidity and mortality rates due to the lack of effective therapy. Early brain injury (EBI) and cerebral vasospasm (CVS) are the two most important pathophysiological mechanisms for brain injury and poor outcomes for patients with SAH. CVS has traditionally been considered the sole cause of delayed ischemic neurological deficits after SAH. However, the failure of antivasospastic therapy in patients with SAH supported changing the research target from CVS to other mechanisms. Currently, more attention has been focused on global brain injury within 3 days after ictus, designated as EBI. The dysfunction of subcellular organelles, such as endoplasmic reticulum stress, mitochondrial failure, and autophagy-lysosomal system activation, has developed during EBI and delayed brain injury after SAH. To our knowledge, there is a lack of review articles addressing the direction of organelle dysfunction after SAH. In this review, we discuss the roles of organelle dysfunction in the pathogenesis of SAH and present the opportunity to develop novel therapeutic strategies of SAH via modulating the functions of organelles. PMID:25366597

Chen, Sheng; Wu, Haijian; Tang, Jiping; Zhang, Jianmin; Zhang, John H

2015-01-01

10

Solitary ruptured aneurysm of the spinal artery of adamkiewicz with subarachnoid hemorrhage.  

PubMed

Spinal subarachnoid hemorrhage (SAH) due to solitary spinal aneurysm is extremely rare. A 45-year-old female patient visited the emergency department with severe headache and back pain. Imaging studies showed cerebral SAH in parietal lobe and spinal SAH in thoracolumbar level. Spinal angiography revealed a small pearl and string-like aneurysm of the Adamkiewicz artery at the T12 level. One month after onset, her back pain aggravated, and follow-up imaging study showed arachnoiditis. Two months after onset, her symptoms improved, and follow-up imaging study showed resolution of SAH. The present case of spinal SAH due to rupture of dissecting aneurysm of the Adamkiewicz artery underwent subsequent spontaneous resolution, indicating that the wait-and-see strategy may provide adequate treatment option. PMID:24044082

Son, Seong; Lee, Sang-Gu; Park, Cheol-Wan

2013-07-01

11

Long-term outcome and quality of life after nonaneurysmal subarachnoid hemorrhage  

Microsoft Academic Search

Purpose  Nonaneurysmal subarachnoid hemorrhage (SAH) is an uncommon form of SAH. As nonaneurysmal SAH is often concentrated around\\u000a the pons and midbrain, the term perimesencephalic SAH (pmSAH) is widely accepted to describe this entity, though there are\\u000a patients with a more widespread distribution of subarachnoid blood (non-pmSAH). The outcome of pmSAH is commonly regarded\\u000a as good, although often outcome is not

Kerim Beseoglu; Silke Pannes; Hans J. Steiger; Daniel Hänggi

2010-01-01

12

Unfractionated Heparin: Multitargeted Therapy for Delayed Neurological Deficits Induced by Subarachnoid Hemorrhage  

Microsoft Academic Search

Aneurysmal subarachnoid hemorrhage (SAH) is associated with numerous “delayed neurological deficits” (DNDs) that have been\\u000a attributed to multiple pathophysiological mechanisms, including ischemia, microthrombosis, free radical damage, inflammation,\\u000a and vascular remodeling. To date, effective prophylactic therapy for SAH-induced DNDs has been elusive, due perhaps to the\\u000a multiplicity of mechanisms involved that render typical, single-agent therapy seemingly futile. We hypothesized that heparin,

J. Marc SimardDavid Schreibman; David Schreibman; E. Francois Aldrich; Bernadette Stallmeyer; Brian Le; Robert F. James; Narlin Beaty

2010-01-01

13

Glibenclamide reduces inflammation, vasogenic edema, and caspase-3 activation after subarachnoid hemorrhage  

PubMed Central

Subarachnoid hemorrhage (SAH) causes secondary brain injury due to vasospasm and inflammation. Here, we studied a rat model of mild-to-moderate SAH intended to minimize ischemia/hypoxia to examine the role of sulfonylurea receptor 1 (SUR1) in the inflammatory response induced by SAH. mRNA for Abcc8, which encodes SUR1, and SUR1 protein were abundantly upregulated in cortex adjacent to SAH, where tumor-necrosis factor-? (TNF?) and nuclear factor (NF)?B signaling were prominent. In vitro experiments confirmed that Abcc8 transcription is stimulated by TNF?. To investigate the functional consequences of SUR1 expression after SAH, we studied the effect of the potent, selective SUR1 inhibitor, glibenclamide. We examined barrier permeability (immunoglobulin G, IgG extravasation), and its correlate, the localization of the tight junction protein, zona occludens 1 (ZO-1). SAH caused a large increase in barrier permeability and disrupted the normal junctional localization of ZO-1, with glibenclamide significantly reducing both effects. In addition, SAH caused large increases in markers of inflammation, including TNF? and NF?B, and markers of cell injury or cell death, including IgG endocytosis and caspase-3 activation, with glibenclamide significantly reducing these effects. We conclude that block of SUR1 by glibenclamide may ameliorate several pathologic effects associated with inflammation that lead to cortical dysfunction after SAH. PMID:18854840

Simard, J Marc; Geng, Zhihua; Woo, S Kyoon; Ivanova, Svetlana; Tosun, Cigdem; Melnichenko, Ludmila; Gerzanich, Volodymyr

2009-01-01

14

Brainstem Opioidergic System Is Involved in Early Response to Experimental SAH.  

PubMed

Subarachnoid hemorrhage (SAH) is a form of stroke with high rates of mortality and permanent disability for patients who survive the initial event. Previous research has focused on delayed cerebral vasospasm of large conduit arteries as the cause of poor long-term outcomes after SAH. New evidence suggests that acute failure to restore cerebral blood flow (CBF) after SAH may be setting the stage for delayed ischemic neurological deficits. Our lab previously demonstrated that the rostral ventromedial medulla (RVM), an autonomic and sensorimotor integration center, is important for maintaining CBF after experimental SAH. In this study, we have demonstrated that ablation of ?-opioid receptor containing cells with dermorphin conjugates in the RVM results in a high mortality rate after experimental SAH and, in survivors, causes a dramatic decrease in CBF. Further, locally blocking the ?-opioid receptor with the antagonist naltrexone attenuated the reduction in CBF secondary to experimental SAH. Saturating ?-opioid receptors with the agonist [D-Ala(2),NMe-Phe(4),Gly-ol(5)]-encephalin (DAMGO) had no effect. Taken together, these results suggest that SAH activates opioidergic signaling in the RVM with a resultant reduction in CBF. Further, cells in the RVM that contain ?-opioid receptors are important for survival after acute SAH. We propose that failure of the RVM ?-opioid receptor cells to initiate the compensatory CBF response sets the stage for acute and delayed ischemic injury following SAH. PMID:25417789

Cetas, Justin S; McFarlane, Robin; Kronfeld, Kassi; Smitasin, Phoebe; Liu, Jesse J; Raskin, Jeffrey S

2014-11-25

15

Diffuse Alveolar Hemorrhage due to Acute Mitral Valve Regurgitation  

PubMed Central

Diffuse alveolar hemorrhage (DAH) can be caused by several etiologies including vasculitis, drug exposure, anticoagulants, infections, mitral valve stenosis, and regurgitation. Chronic mitral valve regurgitation (MR) has been well documented as an etiological factor for DAH, but there have been only a few cases which have reported acute mitral valve regurgitation as an etiology of DAH. Acute mitral valve regurgitation can be a life-threatening condition and often requires urgent intervention. In rare cases, acute mitral regurgitation may result in a regurgitant jet which is directed towards the right upper pulmonary vein and may specifically cause right-sided pulmonary edema and right-sided DAH. Surgical repair of the mitral valve results in rapid resolution of DAH. Acute MR should be considered as a possible etiology in patients presenting with unilateral pulmonary edema, hemoptysis, and DAH. PMID:24383034

Marak, Creticus P.; Joy, Parijat S.; Gupta, Pragya; Guddati, Achuta K.

2013-01-01

16

The Importance of Early Brain Injury after Subarachnoid Hemorrhage  

PubMed Central

Aneurysmal subarachnoid hemorrhage (aSAH) is a medical emergency that accounts for 5% of all stroke cases. Individuals affected are typically in the prime of their lives (mean age 50 years). Approximately 12% of patients die before receiving medical attention, 33% within 48 hours and 50% within 30 days of aSAH. Of the survivors 50% suffer from permanent disability with an estimated lifetime cost more than double that of an ischemic stroke. Traditionally, spasm that develops in large cerebral arteries 3-7 days after aneurysm rupture is considered the most important determinant of brain injury and outcome after aSAH. However, recent studies show that prevention of delayed vasospasm does not improve outcome in aSAH patients. This finding has finally brought in focus the influence of early brain injury on outcome of aSAH. A substantial amount of evidence indicates that brain injury begins at the aneurysm rupture, evolves with time and plays an important role in patients’ outcome. In this manuscript we review early brain injury after aSAH. Due to the early nature, most of the information on this injury comes from animals and few only from autopsy of patients who died within days after aSAH. Consequently, we began with a review of animal models of early brain injury, next we review the mechanisms of brain injury according to the sequence of their temporal appearance and finally we discuss the failure of clinical translation of therapies successful in animal models of aSAH. PMID:22414893

Sehba, Fatima A.; Hou, Jack; Pluta, Ryszard M.; Zhang, John H.

2012-01-01

17

Activation of TRPV4 Channels Does Not Mediate Inversion of Neurovascular Coupling After SAH.  

PubMed

Neurovascular coupling (NVC) allows increased blood flow to metabolically active neurons and involves the Ca(2+)-dependent release of vasodilator influences by astrocyte endfeet that encase parenchymal arterioles. We previously reported inversion of NVC from dilation to constriction in brain slices from subarachnoid hemorrhage (SAH) model rats. Corresponding to NVC inversion, there was a marked increase in the amplitude of spontaneous Ca(2+) oscillations in astrocyte endfeet. Calcium-permeable transient receptor potential vanilloid (TRPV)-4 channels have been reported in astrocyte endfeet, and activators of these channels enhance Ca(2+) oscillations in healthy animals. Here, we examined the role of TRPV4 channels in the development of high-amplitude spontaneous Ca(2+) oscillations in astrocyte endfeet and the inversion of neurovascular coupling after SAH. Treatment of brain slices with the TRPV4 channel antagonist, HC-067047 (10 ?M), did not alter the amplitude of spontaneous Ca(2+) oscillations after SAH. In addition, HC-067047 did not inhibit or change SAH-induced inversion of neurovascular coupling. In summary, TRPV4 channels do not appear to be involved in the inversion of neurovascular coupling after SAH. Further studies examining the impact of SAH on additional Ca(2+) signaling pathways in astrocytes are likely to reveal valuable insights into new therapeutic strategies to advance SAH treatments. PMID:25366609

Koide, Masayo; Wellman, George C

2015-01-01

18

Multimodality Monitoring, Inflammation, and Neuroregeneration in Subarachnoid Hemorrhage  

PubMed Central

BACKGROUND: Stroke, including subarachnoid hemorrhage (SAH), is one of the leading causes of morbidity and mortality worldwide. The mortality rate of poor-grade SAH ranges from 34% to 52%. In an attempt to improve SAH outcomes, clinical research on multimodality monitoring has been performed, as has basic science research on inflammation and neuroregeneration (which can occur due to injury-induced neurogenesis). Nevertheless, the current literature does not focus on the integrated study of these fields. Multimodality monitoring corresponds to physiological data obtained during clinical management by both noninvasive and invasive methods. Regarding inflammation and neuroregeneration, evidence suggests that, in all types of stroke, a proinflammatory phase and an anti-inflammatory phase occur consecutively; these phases affect neurogenesis, which is also influenced by other pathophysiological features of stroke, such as ischemia, seizures, and spreading depression. OBJECTIVE: To assess whether injury-induced neurogenesis is a prognostic factor in poor-grade SAH that can be monitored and modulated. METHODS: We propose a protocol for multimodality monitoring-guided hypothermia in poor-grade SAH in which cellular and molecular markers of inflammation and neuroregeneration can be monitored in parallel with clinical and multimodal data. EXPECTED OUTCOMES: This study may reveal correlations between markers of inflammation and neurogenesis in blood and cerebrospinal fluid, based on clinical and multimodality monitoring parameters. DISCUSSION: This protocol has the potential to lead to new therapies for acute, diffuse, and severe brain diseases. ABBREVIATIONS: BBB, blood-brain barrier CPP, cerebral perfusion pressure EEG, electroencephalography ICP, intracranial pressure IL, interleukin MCA, middle cerebral artery SAH, subarachnoid hemorrhage SD, spreading depression SGZ, subgranular zone SVZ, subventricular zone TCD, transcranial Doppler PMID:25050583

Nogueira, Ariel B.; Esteves Veiga, José C.; Teixeira, Manoel J.

2014-01-01

19

Early Brain Injury, an Evolving Frontier in Subarachnoid Hemorrhage Research  

PubMed Central

Summary Subarachnoid hemorrhage (SAH), predominantly caused by a ruptured aneurysm, is a devastating neurological disease that has a morbidity and mortality rate higher than 50%. Most of the traditional in vivo research has focused on the pathophysiological or morphological changes of large-arteries after intracisternal blood injection. This was due to a widely held assumption that delayed vasospasm following SAH was the major cause of delayed cerebral ischemia and poor outcome. However, the results of the CONSCIOUS-1 trial implicated some other pathophysiological factors, independent of angiographic vasospasm, in contributing to the poor clinical outcome. The term early brain injury (EBI) has been coined and describes the immediate injury to the brain after SAH, before onset of delayed vasospasm. During the EBI period, a ruptured aneurysm brings on many physiological derangements such as increasing intracranial pressure (ICP), decreased cerebral blood flow (CBF), and global cerebral ischemia. These events initiate secondary injuries such as blood-brain barrier disruption, inflammation, and oxidative cascades that all ultimately lead to cell death. Given the fact that the reversal of vasospasm does not appear to improve patient outcome, it could be argued that the treatment of EBI may successfully attenuate some of the devastating secondary injuries and improve the outcome of patients with SAH. In this review, we provide an overview of the major advances in EBI after SAH research. PMID:23894255

Fujii, Mutsumi; Yan, Junhao; Rolland, William B.; Soejima, Yoshiteru; Caner, Basak; Zhang, John H.

2013-01-01

20

Early events after aneurysmal subarachnoid hemorrhage.  

PubMed

The first 72 h after aneurysmal subarachnoid hemorrhage (SAH) is a critical period for the patient. Most of the deaths in the SAH patient population occur during this time, and a number of key events activate and trigger mechanisms that not only contribute to early brain injury but evolve over time and participate in the delayed complications. This review highlights the contribution of key events to the early brain injury and to overall outcome after SAH. PMID:25366594

Sehba, Fatima A; Friedrich, Victor

2015-01-01

21

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

22

Unfractionated Heparin: Multitargeted Therapy for Delayed Neurological Deficits Induced by Subarachnoid Hemorrhage  

PubMed Central

Aneurysmal subarachnoid hemorrhage (SAH) is associated with numerous “delayed neurological deficits” (DNDs) that have been attributed to multiple pathophysiological mechanisms, including ischemia, microthrombosis, free radical damage, inflammation, and vascular remodeling. To date, effective prophylactic therapy for SAH-induced DNDs has been elusive, due perhaps to the multiplicity of mechanisms involved that render typical, single-agent therapy seemingly futile. We hypothesized that heparin, which has multiple underappreciated salutary effects, might be useful as a multitargeted prophylactic agent against SAH-induced DNDs. We performed a comprehensive review of the literature to evaluate the potential utility of heparin in targeting the multiple pathophysiological mechanisms that have been identified as contributing to SAH-induced DNDs. Our literature review revealed that unfractionated heparin can potentially antagonize essentially all of the pathophysiological mechanisms known to be activated following SAH. Heparin binds >100 proteins, including plasma proteins, proteins released from platelets, cytokines, and chemokines. Also, heparin complexes with oxyhemoglobin, blocks the activity of free radicals including reactive oxygen species, antagonizes endothelin-mediated vasoconstriction, smooth muscle depolarization, and inflammatory, growth and fibrogenic responses. Our review suggests that the use of prophylactic heparin following SAH may warrant formal study. PMID:20809188

Schreibman, David; Aldrich, E. Francois; Stallmeyer, Bernadette; Le, Brian; James, Robert F.; Beaty, Narlin

2010-01-01

23

Acute enlargement of subdural hygroma due to subdural hemorrhage in a victim of child abuse.  

PubMed

An 11-month-old female baby was found dead by her mother. Cranial postmortem CT prior to the forensic autopsy showed dilatation of bilateral extra-axial spaces and ventricles. The autopsy revealed a new linear fracture of the left parietal bone and occipital bone, and a healed linear fracture of the right parietal bone and occipital bone like a mirror image of the left one as well. Intracranially, 230ml of subdural fluid were collected, which was mixed with blood. There was a fresh hemorrhage around a bridging vein of the left parietal lobe and the dura mater. Moreover, the outer side of the cerebrum and the inner side of the dura mater were covered by a thin membrane, which mater might have been previously formed because of being positive for Fe-staining and anti-CD68 antibody. A subdural hematoma might have been developed when the right side of the skull was previously fractured, which was transformed into a subdural hygroma. Subsequently, it is likely that, after the left side fracture of the skull occurred, the subdural hygroma rapidly enlarged due to hemorrhaging from the bridging vein, which resulted in intracranial hypertension, because microbleeding was detected in the brain stem. Accordingly, we diagnosed the cause and manner of death as intracranial hypertension due to subdural hemorrhage in subdural hygroma, and homicide, including child abuse, respectively. PMID:25457269

Inoue, Hiromasa; Hyodoh, Hideki; Watanabe, Satoshi; Okazaki, Shunichiro; Mizuo, Keisuke

2014-10-22

24

Acute airway obstruction due to spontaneous intrathyroid hemorrhage precipitated by anticoagulation therapy  

PubMed Central

Acute airway compromise due to hemorrhage in of thyroid gland is a rare life-hreating condition. The increasing use of anticoagulants for various reasons is likely increased the occurrence of this this complication. We describe an elderly patient on anticoagulation for atrial fibrillation, which developed swelling on the right side of neck causing acute airway obstruction requiring emergency intubation for airway protection. Computed tomographic scan showed massive intrathyroid hemorrhage along with substernal extension. She had supratherapeutic INR which was appropriately corrected emergently. She underwent resection of the thyroid gland which showed multinodular goiter without any evidence of malignancy. Our case illustrates the rare but lethal bleeding complication of anticoagulants in critical anatomical area and we request physicians should be wary of similar conditions. PMID:25538419

Kokatnur, Laxmi; Rudrappa, Mohan; Mittadodla, Penchala

2014-01-01

25

Spontaneous resolution of an isolated cervical anterior spinal artery aneurysm after subarachnoid hemorrhage  

PubMed Central

Background: Isolated cervical anterior spinal artery aneurysms are extremely rare. Subarachnoid hemorrhage (SAH) secondary to such lesions have been described only in six cases to the best of our knowledge. Case Description: We describe an unusual clinical picture of SAH due to rupture of anterior spinal artery aneurysm in a patient with previous normal angiogram. Due to the location of the aneurysm and clinical status of the patient, conservative management was proposed, and she was discharged to further follow-up. Monthly routine angiograms revealed resolution of the aneurysm 90 days after bleeding, which was highly suggestive of vascular dissection. Conclusion: We highlight the need to consider these aneurysms in the differential diagnosis of SAH, especially when occurring in the posterior fossa and when angiography findings are inconclusive. PMID:25317354

Pahl, Felix Hendrik; de Oliveira, Matheus Fernandes; Rotta, Marcus Alexandre Cavalcanti; Dias, Guilherme Marcos Soares; Rezende, André Luiz; Rotta, José Marcus

2014-01-01

26

[A case of moyamoya disease with a subarachnoid hemorrhage treated with endovascular technique].  

PubMed

We report a case of a moyamoya disease presenting with subarachonoid hemorrhage (SAH) due to a ruptured aneurysm. A 40-year-old woman presented with sudden onset of headache and vomiting. Computed tomography (CT) showed diffuse thick SAH localized around basal cistern. 3D-CT Angiography (3D-CTA) and digital subtraction angiography (DSA) demonstrated a saccular aneurysm at the bifurcation of the left superior cerebellar artery and basilar artery. In addition, the both carotid arteries were occluded at the terminal portion and the territory of both middle cerebral arteries were perfused by abnormal moyamoya vessels. The aneurysm was completely embolized by endovascular embolization. The SAH due to a ruptured aneurysm associated with moyamoya disease is rare. We think endovascular therapy is safe and effective. However, a vasospasm of the catheter technique occurred during the operation. This fact is very important to consider when we treat diseases such as this in the future. PMID:25351798

Wada, Kentaro; Hattori, Kenichi; Araki, Yoshio; Noda, Tomoyuki; Maki, Hideki; Oyama, Hirofumi; Kito, Akira; Wakabayashi, Toshihiko

2014-11-01

27

Intracranial aneurysms and subarachnoid hemorrhage: Clinical studies on diagnosis and treatment.  

E-print Network

??abstractComputerized tomography angiography (CTA) can be performed quicker, safer and cheaper than digital subtraction angiography (DSA) in patients after aneurysmal subarachnoid hemorrhage (SAH). However, DSA… (more)

M. van der Jagt (Mathieu)

2006-01-01

28

Loss of long-term potentiation in the hippocampus after experimental subarachnoid hemorrhage in rats.  

PubMed

Survivors of aneurysmal subarachnoid hemorrhage (SAH) often suffer from cognitive impairment such as memory loss. However, the underlying mechanisms of these impairments are not known. Long-term potentiation (LTP) of synapses in the hippocampus is generally regarded as a molecular substrate of memory. The purpose of this study was to examine the effect of SAH on LTP in the hippocampal Schaffer collateral (CA3-CA1) pathway in a rat model of SAH. We found SAH caused significant vasospasm of the middle cerebral artery (MCA) compared to saline injected or sham controls (P<0.001). Basic neurotransmission quantified as excitatory post synaptic and spike response from animals with SAH were significantly decreased as compared to naive controls (P<0.05). However, sham operated and saline injected controls showed similar amplitude as naive controls. This suggests that reduction in basic neurotransmission is due to blood in the subarachnoid space. Similarly, analysis of LTP demonstrated that naive, sham and saline controls have a 92+/-16%, 69+/-27% and 71+/-14% increase over the baseline in the average spike amplitude following high frequency stimulation (HFS), respectively. This indicates the presence of LTP (P<0.05). In contrast, the spike amplitude in animals of SAH returned to baseline level within 60 min post HFS indicating the absence of LTP. We conclude that SAH caused vasospasm of the MCA that was associated with disrupted basic neurotransmission and plasticity at CA3-CA1 synapses. These changes might be accountable for the memory loss in humans with SAH. PMID:19854243

Tariq, A; Ai, J; Chen, G; Sabri, M; Jeon, H; Shang, X; Macdonald, R L

2010-01-20

29

Transjugular intrahepatic portosystemic shunt for variceal hemorrhage due to recurrent of hereditary hemorrhagic telangiectasia in a liver transplant.  

PubMed

Hepatic involvement in hereditary hemorrhagic telangiectasia (HHT) consists of vascular malformations associated with arteriovenous (AV), arterioportal, and/or portovenous shunting. Most patients with HHT have liver involvement. Symptoms, although rare, consist of cardiac failure, pulmonary hypertension, portal hypertension, portosystemic encephalopathy, cholangitis, and atypical cirrhosis. Reported treatments for symptomatic AV malformations have been associated with substantial morbidity and mortality. This report describes a case of hepatic HHT that required liver transplantation after hepatic artery embolization. Recurrent vascular malformations developed in the transplant, resulting in portal hypertension and life-threatening variceal hemorrhage that was controlled with transjugular intrahepatic portosystemic shunt creation. PMID:19926494

Cura, Marco A; Postoak, Darren; Speeg, Kermit V; Vasan, Rajiv

2010-01-01

30

Time trends in outcome of subarachnoid hemorrhage  

PubMed Central

Background: Treatment of aneurysmal subarachnoid hemorrhage (SAH) has changed substantially over the last 25 years but there is a lack of reliable population-based data on whether case-fatality or functional outcomes have improved. Methods: We determined changes in the standardized incidence and outcome of SAH in the same population between 1981 and 1986 (Oxford Community Stroke Project) and 2002 and 2008 (Oxford Vascular Study). In a meta-analysis with other population-based studies, we used linear regression to determine time trends in outcome. Results: There were no reductions in incidence of SAH (RR = 0.79, 95% confidence interval [CI] 0.48–1.29, p = 0.34) and in 30-day case-fatality (RR = 0.67, 95% CI 0.39–1.13, p = 0.14) in the Oxford Vascular Study vs Oxford Community Stroke Project, but there was a decrease in overall mortality (RR = 0.47, 0.23–0.97, p = 0.04). Following adjustment for age and baseline SAH severity, patients surviving to hospital had reduced risk of death or dependency (modified Rankin score > 3) at 12 months in the Oxford Vascular Study (RR = 0.51, 0.29–0.88, p = 0.01). Among 32 studies covering 39 study periods from 1980 to 2005, 7 studied time trends within single populations. Unadjusted case-fatality fell by 0.9% per annum (0.3–1.5, p = 0.007) in a meta-analysis of data from all studies, and by 0.9% per annum (0.2–1.6%, p = 0.01) within the 7 population studies. Conclusion: Mortality due to subarachnoid hemorrhage fell by about 50% in our study population over the last 2 decades, due mainly to improved outcomes in cases surviving to reach hospital. This improvement is consistent with a significant decrease in case-fatality over the last 25 years in our pooled analysis of other similar population-based studies. GLOSSARY CI = confidence interval; mRS = modified Rankin score; OCSP = Oxford Community Stroke Project; OXVASC = Oxford Vascular Study; SAH = subarachnoid hemorrhage; WFNS = World Federation of Neurosurgical Societies. PMID:20375310

Lovelock, C.E.; Rinkel, G.J.E.; Rothwell, P.M.

2010-01-01

31

The Role of Arterioles and the Microcirculation in the Development of Vasospasm after Aneurysmal SAH  

PubMed Central

Cerebral vasospasm of the major cerebral arteries, which is characterized by angiographic narrowing of those vessels, had been recognized as a main contributor to delayed cerebral ischemia (DCI) in subarachnoid hemorrhage (SAH) patients. However, the CONSCIOUS-1 trial revealed that clazosentan could not improve mortality or clinical outcome in spite of successful reduction of relative risk in angiographic vasospasm. This result indicates that the pathophysiology underlying DCI is multifactorial and that other pathophysiological factors, which are independent of angiographic vasospasm, can contribute to the outcome. Recent studies have focused on microcirculatory disturbance, such as microthrombosis and arteriolar constriction, as a factor affecting cerebral ischemia after SAH. Reports detecting microthrombosis and arteriolar constriction will be reviewed, and the role of the microcirculation on cerebral ischemia during vasospasm after SAH will be discussed. PMID:24900959

Asano, Kenichiro; Ohkuma, Hiroki

2014-01-01

32

Subarachnoid hemorrhage due to nonbranching aneurysm of the middle cerebral artery in a young adult with a history of Kawasaki disease  

PubMed Central

Background: The incidence of subarachnoid hemorrhage (SAH) in young adults is relatively rare. Kawasaki disease is a systemic vasculopathy that is known to cause coronary artery aneurysms; however, its effect on cerebral arteries remains largely unclear. Case Description: We report the case of a 20-year-old male with a history of Kawasaki disease who presented with SAH caused by the rupture of a nonbranching middle cerebral artery aneurysm. This is the third report of SAH associated with Kawasaki disease. Preoperative echocardiography of the patient rejected the presence of bacterial endocarditis and other heart abnormalities. An emergency craniotomy and clip occlusion of the aneurysm was successfully performed without obstructing the parent artery. Two weeks later, the patient was discharged without any apparent neurological deficit. We also performed a circumstantial pathological study on specimens obtained from the aneurysm wall. Our histological findings suggest that the elastic lamina and tunica intima were completely destroyed during the acute vasculitis phase of Kawasaki disease, which possibly led to the aneurysmal formation. Conclusions: Lack of active inflammatory changes and atherosclerotic lesions may explain the chronic feature of Kawasaki disease, not a typical aneurysmal formation. PMID:24575320

Ishida, Atsushi; Matsuo, Seigo; Kawamura, Shunji; Nishikawa, Toshio

2014-01-01

33

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. PMID:22347326

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

2011-01-01

34

Spectrophotometric Quantification of Bilirubin in Hemorrhagic Spinal Fluid using an Innovative Algorithm  

Microsoft Academic Search

Annually, approximately 30,000 people suffer from aneurysmal subarachnoid hemorrhage (SAH) in the United States. In an estimated 5% of these patients, the hemorrhage is difficult to diagnose using conventional methods. Clini- cians must rely upon a combination of clinical history, Computerized Tomography (CT) scan evidence and lumbar punc- ture results to diagnose and differentiate SAH from a traumatic spinal tap

Prashant R. Bhadri; Vasant A. Salgaonkar; Gail J. Pyne-Geithman; James J. Caffery Jr; Rakesh Shukla; Fred R. Beyette Jr; Joseph F. Clark

2007-01-01

35

[Acquired hemorrhagic coagulopathy due to contact with the rodenticide brodifacoum in the Nutcracker bait].  

PubMed

Rodenticide (RD) application is the most effective chemical procedure against rodents. RDs containing indirect-action anticoagulants have received currently wide acceptance. When the recommended standards for handling these agents and precautionary measures in their use are violated, there may be poisoning, the main manifestation of which is hemorrhagic coagulation. The paper provides a literature review on poisoning by RDs having anticoagulant properties. This communication gives a detailed description of a clinical case of poisoning with brodifacoum contained in the ready-to-use Nutcracker bait due to long-term exposure to the rat poison that has a cumulative effect. Careful history data collection and coagulogram analysis make it possible to establish a correct clinical diagnosis and to use appropriate therapy that leads to patient recovery. PMID:23038975

Vo?tsekhovski?, V V; Pivnik, A V; Bitiutskaia, L G; Protsko, T T

2012-01-01

36

Pneumatic displacement with intravitreal bevacizumab for massive submacular hemorrhage due to polypoidal choroidal vasculopathy  

PubMed Central

Background The purpose of this study was to compare the effectiveness of pneumatic displacement combined with intravitreal bevacizumab (IVB) with that of pneumatic displacement (PD) alone to treat massive submacular hemorrhage (SMH) secondary to polypoidal choroidal vasculopathy (PCV). Methods Thirty-two eyes of 32 patients with massive SMH secondary to PCV were studied. Twenty-two eyes were treated with a combination of PD and 1.25 mg of intravitreal bevacizumab (PD + IVB group), and ten eyes with pneumatic displacement alone (PD group). Results Pretreatment, the differences in best-corrected visual acuity and size of the SMH between the two groups were not significant (P=0.59 and P=0.72, respectively). Complete displacement of the hemorrhage from under the fovea was achieved in 19 of 22 eyes (86.4%) in the PD + IVB group and in five of ten eyes (50%) in the PD group. The best-corrected visual acuity in the PD + IVB group was significantly better than that in the PD group at one, 3, and 6 months after treatment (P<0.001, P<0.001, and P<0.001, respectively). Improvement in best-corrected visual acuity by >0.3 logMAR units was obtained in 18 eyes (81.8%) in the PD + IVB group and two eyes (20%) in the PD group (P<0.001). The number of eyes that required additional treatments was significantly fewer in the PD + IVB group than in the PD group (P=0.0001). Conclusion The combination of PD and IVB may be a better therapeutic procedure for eyes with massive SMH due to PCV in the short term because of the better visual outcome and less need for additional treatments. PMID:24623972

Kitahashi, Masayasu; Baba, Takayuki; Sakurai, Madoka; Yokouchi, Hirotaka; Kubota-Taniai, Mariko; Mitamura, Yoshinori; Yamamoto, Shuichi

2014-01-01

37

Prevalence and Determinants of Cognitive Complaints after Aneurysmal Subarachnoid Hemorrhage  

Microsoft Academic Search

Background: To investigate the prevalence of cognitive complaints after subarachnoid hemorrhage (SAH) and the relationships between cognitive complaints and cognitive impairments, disability and emotional problems. Methods: Cognitive complaints were assessed with the Checklist for Cognitive and Emotional Consequences following stroke (CLCE-24) in 111 persons who visited our outpatient clinic 3 months after SAH. Associations between cognitive complaints and cognitive functioning,

P. E. C. A. Passier; J. M. A. Visser-Meily; M. J. E. van Zandvoort; M. W. M. Post; G. J. E. Rinkel; C. van Heugten

2010-01-01

38

Anterior circulation model of subarachnoid hemorrhage in mice.  

PubMed

Subarachnoid hemorrhage (SAH) remains one of the most morbid subtypes of stroke around the world and has been the focus of hemorrhagic stroke research for longer than five decades. Animal models have been instrumental in shaping the progress and advancement of SAH research, particularly models that allow for transgenic manipulation. The anterior circulation mouse model provides the research community with a rodent model that depicts very similar clinical findings of SAH; from the location of the hemorrhages to the secondary complications that arise after the hemorrhagic insult. The model allows for the recreation of clinically relevant findings such as large vessel vasospasm, oxidative stress, microcirculatory spasm and microthrombosis, and delayed neuronal injury - all of which appear in human cases of SAH. The model is also not technically demanding, is highly reproducible, and allows for an array of transgenic manipulation, which is essential for mechanistic investigations of the pathogenesis of SAH. The anterior circulation mouse model of SAH is one of a few models that are currently used in mice, and provides the research community with a relatively easy, reliable, and clinically relevant model of SAH - one that could be effectively be used to test for early brain injury (EBI) and delayed neurological injury after SAH. PMID:25366643

Attia, Mohammed Sabri; Macdonald, R Loch

2015-01-01

39

Burden of disease and costs of aneurysmal subarachnoid haemorrhage (aSAH) in the United Kingdom  

PubMed Central

Background To estimate life years and quality-adjusted life years (QALYs) lost and the economic burden of aneurysmal subarachnoid haemorrhage (aSAH) in the United Kingdom including healthcare and non-healthcare costs from a societal perspective. Methods All UK residents in 2005 with aSAH (International Classification of Diseases 10th revision (ICD-10) code I60). Sex and age-specific abridged life tables were generated for a general population and aSAH cohorts. QALYs in each cohort were calculated adjusting the life tables with health-related quality of life (HRQL) data. Healthcare costs included hospital expenditure, cerebrovascular rehabilitation, primary care and community health and social services. Non-healthcare costs included informal care and productivity losses arising from morbidity and premature death. Results A total of 80,356 life years and 74,807 quality-adjusted life years were estimated to be lost due to aSAH in the UK in 2005. aSAH costs the National Health Service (NHS) £168.2 million annually with hospital inpatient admissions accounting for 59%, community health and social services for 18%, aSAH-related operations for 15% and cerebrovascular rehabilitation for 6% of the total NHS estimated costs. The average per patient cost for the NHS was estimated to be £23,294. The total economic burden (including informal care and using the human capital method to estimate production losses) of a SAH in the United Kingdom was estimated to be £510 million annually. Conclusion The economic and disease burden of aSAH in the United Kingdom is reported in this study. Decision-makers can use these results to complement other information when informing prevention policies in this field and to relate health care expenditures to disease categories. PMID:20423472

2010-01-01

40

An autopsy case of subarachnoid hemorrhage due to ruptured cerebral aneurysm associated with polycystic kidney disease caused by a novel PKD1 mutation.  

PubMed

Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common genetic disorders and is characterized by the development and progressive enlargement of cysts in the kidneys. ADPKD is caused by mutations of either PKD1 or PKD2. The prevalence of brain aneurysm in patients with ADPKD is increased, and subarachnoid hemorrhage (SAH) from a ruptured intracranial aneurysm is one of the frequent complications. We describe an autopsy case of death of a 31-year-old woman by aneurysmal SAH. ADPKD as an underlining disease was suggested by the autopsy findings. Sequence analysis of the PKD1 and PKD2 genes revealed deletion of a guanine at position 8019 in PKD1 (8019delG) in a heterozygous state resulting in a shift in the reading frame and generation of a premature termination codon at amino acid 2684 (G2673fs12X). This mutation is novel and highly suspected as the causal mutation of ADPKD of this case. PMID:25022697

Soejima, Mikiko; Sugita, Yasuo; Koda, Yoshiro

2014-09-01

41

A rabbit cisterna magna double-injection subarachnoid hemorrhage model.  

PubMed

In recent years, the shift of research interest in the pathological condition after subarachnoid hemorrhage (SAH) from delayed cerebral vasospasm to early brain injury and the development of molecular genetic approaches in animal experiments has resulted in a diversification of animal SAH models. The properties of each animal SAH model thus need to be validated and the purpose of using each animal model should be clarified. This study presents the settings and technical procedures for a rabbit cisterna magna double-injection SAH model and discusses the advantages and limitations of using this model. PMID:25366647

Kikkawa, Yuichiro

2015-01-01

42

Remote cerebellar hemorrhage due to ventriculoperitoneal shunt in an infant: a case report  

PubMed Central

Introduction Cerebellar hemorrhage remote from the operative site is an unpredictable and rare complication in neurosurgery, with reported rates of morbidity and mortality in the literature of 8.4% and 7.8%, respectively. The range of procedures associated with remote cerebellar hemorrhage is diverse and includes both supratentorial and spinal procedures that entail significant cerebral spinal fluid loss or resection of supratentorial content. We present here the first documented case of remote cerebellar hemorrhage after controlled supratentorial cerebral spinal fluid drainage by ventriculoperitoneal shunt, and discuss the proposed pathophysiology and treatment. Case presentation We present the case of a four-month-old Saudi Arabian male baby who presented with progressive symptoms and signs of congenital hydrocephalus. An uneventful ventriculoperitoneal shunting was performed with our patient recovering smoothly in the immediate postoperative period. On the next day, he had frequent episodes of vomiting and became lethargic. An urgent computed tomography scan of his brain revealed mild ventricular decompression and unexpected cerebellar hemorrhage. The infant was put under close observation, with marked spontaneous improvement over 48?hours and complete resolution of the hemorrhage on a follow-up computed tomography brain scan two weeks later. On regular outpatient visits at one, three and twelve months, he had no neurological deficit. Conclusion Remote cerebellar hemorrhage is a complication that remains enigmatic in terms of both the underlying mechanism and clinical behavior. Our case revealed that the risk factors identified in the literature are not sufficient in predicting patients at risk of developing remote cerebellar hemorrhage. Our report also adds to the growing body of evidence challenging the currently accepted hypothesis explaining the pathomechanism of remote cerebellar hemorrhage. It thereby remains an unpredictable hazard that requires further study and increased awareness, as many cases in the literature are incidental findings. PMID:22846583

2012-01-01

43

Uncoupling of endothelial nitric oxide synthase after experimental subarachnoid hemorrhage.  

PubMed

We studied whether endothelial nitric oxide synthase (eNOS) is upregulated and uncoupled in large cerebral arteries after subarachnoid hemorrhage (SAH) and also whether this causes cerebral vasospasm in a mouse model of anterior circulation SAH. Control animals underwent injection of saline instead of blood (n=16 SAH and n=16 controls). There was significant vasospasm of the middle cerebral artery 2 days after SAH (lumen radius/wall thickness ratio 4.3 ± 1.3 for SAH, 23.2 ± 2.1 for saline, P<0.001). Subarachnoid hemorrhage was associated with terminal deoxynucleotidyl transferase dUTP nick-end labeling, cleaved caspase-3, and Fluoro-Jade-positive neurons in the cortex and with CA1 and dentate regions in the hippocampus. There were multiple fibrinogen-positive microthromboemboli in the cortex and hippocampus after SAH. Transgenic mice expressing lacZ under control of the eNOS promoter had increased X-gal staining in large arteries after SAH, and this was confirmed by the increased eNOS protein on western blotting. Evidence that eNOS was uncoupled was found in that nitric oxide availability was decreased, and superoxide and peroxynitrite concentrations were increased in the brains of mice with SAH. This study suggests that artery constriction by SAH upregulates eNOS but that it is uncoupled and produces peroxynitrite that may generate microemboli that travel distally and contribute to brain injury. PMID:20517322

Sabri, Mohammed; Ai, Jinglu; Knight, Britta; Tariq, Asma; Jeon, Hyojin; Shang, Xueyuan; Marsden, Philip Anthony; Loch Macdonald, Robert

2011-01-01

44

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

45

Inflammation, Vasospasm, and Brain Injury after Subarachnoid Hemorrhage  

PubMed Central

Subarachnoid hemorrhage (SAH) can lead to devastating neurological outcomes, and there are few pharmacologic treatments available for treating this condition. Both animal and human studies provide evidence of inflammation being a driving force behind the pathology of SAH, leading to both direct brain injury and vasospasm, which in turn leads to ischemic brain injury. Several inflammatory mediators that are elevated after SAH have been studied in detail. While there is promising data indicating that blocking these factors might benefit patients after SAH, there has been little success in clinical trials. One of the key factors that complicates clinical trials of SAH is the variability of the initial injury and subsequent inflammatory response. It is likely that both genetic and environmental factors contribute to the variability of patients' post-SAH inflammatory response and that this confounds trials of anti-inflammatory therapies. Additionally, systemic inflammation from other conditions that affect patients with SAH could contribute to brain injury and vasospasm after SAH. Continuing work on biomarkers of inflammation after SAH may lead to development of patient-specific anti-inflammatory therapies to improve outcome after SAH. PMID:25105123

Miller, Brandon A.

2014-01-01

46

[Case report: Aneurysmatic subarachnoid hemorrhage - Complicated course due to coincidental manifestation of an inverted Tako-Tsubo-cardiomyopathy].  

PubMed

We report the case of a patient who suffered a serious subarachnoid hemorrhage with a cardialaffection and development of an inverted Tako-Tsubo-cardiomyopathy. To avoid apparent cerebral ischemia due to severe cerebral vasospasm after exhaustion of conservative therapeutic options a temporarily endovascular therapy with continuous intra-arterial application of Nimodipine was necessary. In the overall protracted and complicated course the special challenge were the therapeutic efforts to avoid apparent cerebral ischemia in context to the significant cardial affection. PMID:25137200

Zech, Nina; Kieninger, Martin; Seemann, Milena; Künzig, Holger; Bele, Sylvia; Dietl, Alexander

2014-07-01

47

A case of pulmonary hemorrhage due to drug-induced pneumonitis secondary to ticagrelor therapy.  

PubMed

We report a case of significant pulmonary hemorrhage developing shortly after commencing ticagrelor and aspirin therapy and requiring coronary artery bypass grafting to safely cease the antiplatelet therapy. Lung biopsy findings were consistent with drug-induced lung injury. Clinicians should be aware of this significant adverse event with this drug class. PMID:24590025

Whitmore, Timothy J; O'Shea, John P; Starac, Diana; Edwards, Mark G; Waterer, Grant W

2014-03-01

48

Neuroprotective Effect of Tea Polyphenols on Oxyhemoglobin Induced Subarachnoid Hemorrhage in Mice  

PubMed Central

Tea polyphenols are of great benefit to the treatment of several neurodegenerative diseases. In order to explore the neuroprotective effects of tea polyphenols and their potential mechanisms, an established in vivo subarachnoid hemorrhage (SAH) model was used and alterations of mitochondrial function, ATP content, and cytochrome c (cyt c) in cerebral cortex were detected. This study showed that the alteration of mitochondrial membrane potential was an early event in SAH progression. The trend of ATP production was similar to that of mitochondrial membrane potential, indicating that the lower the mitochondrial membrane potential, lesser the ATP produced. Due to mitochondrial dysfunction, more cyt c was released in the SAH group. Interestingly, the preadministration of tea polyphenols significantly rescued the mitochondrial membrane potential to basal level, as well as the ATP content and the cyt c level in the brain cortex 12?h after SAH. After pretreatment with tea polyphenols, the neurological outcome was also improved. The results provide strong evidence that tea polyphenols enhance neuroprotective effects by inhibiting polarization of mitochondrial membrane potential, increasing ATP content, and blocking cyt c release. PMID:23840920

Mo, Haizhen; Chen, Ying; Huang, Liyong; Zhang, Hao; Li, Juxiang; Zhou, Wenke

2013-01-01

49

Canine double hemorrhage model of experimental subarachnoid hemorrhage.  

PubMed

Several animal subarachnoid hemorrhage (SAH) models have been proposed for the investigation of cerebral vasospasm. We describe the experimental procedures of a canine double-SAH model and also examine the model based on the canine physiological parameters and occurrence of angiographic delayed cerebral vasospasm using magnetic resonance (MR) imaging and digital subtraction angiography. Autologous blood was injected twice on days 1 and 3 in 36 beagles. All animals showed delayed angiographic vasospasm in the vertebrobasilar arteries on day 7. The degree of vasospasm was 29-42 % of the arterial caliber. MR imaging did not show any ischemic change. This animal model can produce definite delayed vasospasm without detectable cerebral infarction on MR imaging. The canine SAH model is suitable for the quantitative and chronological study of delayed angiographic vasospasm, but not for investigating early brain injury and delayed cerebral ischemia. PMID:25366650

Mori, Kentaro; Fujii, Kazuya; Tomura, Satosi; Ueno, Hideaki; Wada, Kojiro; Otani, Naoki; Osada, Hideo; Tomiyama, Arata

2015-01-01

50

Subarachnoid hemorrhage  

MedlinePLUS

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

51

The rodent endovascular puncture model of subarachnoid hemorrhage: mechanisms of brain damage and therapeutic strategies  

PubMed Central

Subarachnoid hemorrhage (SAH) represents a considerable health problem. To date, limited therapeutic options are available. In order to develop effective therapeutic strategies for SAH, the mechanisms involved in SAH brain damage should be fully explored. Here we review the mechanisms of SAH brain damage induced by the experimental endovascular puncture model. We have included a description of similarities and distinctions between experimental SAH in animals and human SAH pathology. Moreover, several novel treatment options to diminish SAH brain damage are discussed. SAH is accompanied by cerebral inflammation as demonstrated by an influx of inflammatory cells into the cerebral parenchyma, upregulation of inflammatory transcriptional pathways and increased expression of cytokines and chemokines. Additionally, various cell death pathways including cerebral apoptosis, necrosis, necroptosis and autophagy are involved in neuronal damage caused by SAH. Treatment strategies aiming at inhibition of inflammatory or cell death pathways demonstrate the importance of these mechanisms for survival after experimental SAH. Moreover, neuroregenerative therapies using stem cells are discussed as a possible strategy to repair the brain after SAH since this therapy may extend the window of treatment considerably. We propose the endovascular puncture model as a suitable animal model which resembles the human pathology of SAH and which could be applied to investigate novel therapeutic therapies to combat this debilitating insult. PMID:24386932

2014-01-01

52

Evaluation of a Murine Single-Blood-Injection SAH Model  

PubMed Central

The molecular pathways underlying the pathogenesis after subarachnoid haemorrhage (SAH) are poorly understood and continue to be a matter of debate. A valid murine SAH injection model is not yet available but would be the prerequisite for further transgenic studies assessing the mechanisms following SAH. Using the murine single injection model, we examined the effects of SAH on regional cerebral blood flow (rCBF) in the somatosensory (S1) and cerebellar cortex, neuro-behavioural and morphological integrity and changes in quantitative electrocorticographic and electrocardiographic parameters. Micro CT imaging verified successful blood delivery into the cisterna magna. An acute impairment of rCBF was observed immediately after injection in the SAH and after 6, 12 and 24 hours in the S1 and 6 and 12 hours after SAH in the cerebellum. Injection of blood into the foramen magnum reduced telemetric recorded total ECoG power by an average of 65%. Spectral analysis of ECoGs revealed significantly increased absolute delta power, i.e., slowing, cortical depolarisations and changes in ripples and fast ripple oscillations 12 hours and 24 hours after SAH. Therefore, murine single-blood-injection SAH model is suitable for pathophysiological and further molecular analysis following SAH. PMID:25545775

Sommer, Clemens; Steiger, Hans-Jakob; Schneider, Toni; Hänggi, Daniel

2014-01-01

53

Simvastatin Reduces Vasospasm After Aneurysmal Subarachnoid Hemorrhage: Results of a Pilot Randomized Clinical Trial  

Microsoft Academic Search

Background and Purpose—Cerebral vasospasm remains a major source of morbidity after aneurysmal subarachnoid hemorrhage (SAH). We demonstrate that simvastatin reduces serum markers of brain injury and attenuates vasospasm after SAH. Methods—Patients with angiographically documented aneurysmal SAH were randomized within 48 hours of symptom onset to receive either simvastatin (80 mg daily; n19) or placebo (n20) for 14 days. Plasma alanine

John R. Lynch; Haichen Wang; Matthew J. McGirt; James Floyd; Allan H. Friedman; Alexander L. Coon; Robert Blessing; Michael J. Alexander; Carmelo Graffagnino; David S. Warner; Daniel T. Laskowitz

2005-01-01

54

Neuroprotection in Subarachnoid Hemorrhage  

PubMed Central

Despite advances in aneurysm ablation and the initial management of patients presenting with aneurysmal subarachnoid hemorrhage (aSAH), delayed cerebral ischemia remains a significant source of morbidity. Traditionally, delayed cerebral ischemia was felt to be a result of vasospasm of the proximal intracranial vessels, and clinical trials have relied largely on radiographic evidence of vasospasm as a surrogate for functional outcome. However, a number of trials have demonstrated a dissociation between angiographic vasospasm and outcome, and more recent data suggests that other mechanisms of injury, such as microvascular dysfunction and complex neuronal-glial interactions may influence the development of delayed ischemic deficit following aSAH. Our evolving understanding of the pathophysiology of delayed cerebral ischemia may offer the opportunity to test new therapeutic strategies in this area and improve clinical trial design. PMID:20876512

Laskowitz, Daniel T.; Kolls, Brad J.

2010-01-01

55

Recurrent secondary postpartum hemorrhages due to placental site vessel subinvolution and local uterine tissue coagulopathy  

PubMed Central

Background Postpartum hemorrhage (PPH) represents a serious problem for women and obstetricians. Because of its association with hemorrhagic shock and predisposition to disseminated coagulopathy, it is a leading cause of maternal deaths worldwide. Furthermore, the jeopardy of PPH is rising with the secondary form of PPH occurring between 24 hours and 6 weeks postpartum, when women are already discharged home. The causes of this pathology are severe inflammation (endometritis), inherited coagulation disorders, consumptive coagulopathy, and retained products of conceptions. Others are of rare occurrence, such as vessel subinvolution (VSI) of the placental implantation site, uterine artery pseudoaneurysm, or trauma. Case presentation We present a rare form of recurrent secondary postpartum hemorrhage in a woman after uncomplicated cesarean delivery, with review of the literature linked to the management of this situation originating in the rare local VSI in the placental implantation site, defective decidual homeostasis, and coagulopathy confined to the uterus. Conclusion The placental site VSI is one of the rare causes of secondary PPH, and this situation is frequently underdiagnosed by clinicians. The histological confirmation of dilated “clustered”-shaped myometrial arteries partially occluded by thrombi of variable “age” together with the presence of endovascular extravillous trophoblasts confirms the diagnosis. PMID:24558972

2014-01-01

56

Abdominal Compartment Syndrome Due to Spontaneous Retroperitoneal Hemorrhage in a Patient Undergoing Anticoagulation  

PubMed Central

Spontaneous retroperitoneal hemorrhage is one of the most serious and often lethal complications of anticoagulation therapy. The clinical symptoms vary from femoral neuropathy to abdominal compartment syndrome or fatal hypovolemic shock. Of these symptoms, abdominal compartment syndrome is the most serious of all, because it leads to anuria, worsening of renal failure, a decrease in cardiac output, respiratory failure, and intestinal ischemia. We report a case of a spontaneous retroperitoneal hemorrhage in a 48-year-old female who had been receiving warfarin and aspirin for her artificial aortic valve. She presented with a sudden onset of lower abdominal pain, dizziness and a palpable abdominal mass after prolonged straining to defecate. Computed tomography demonstrated a huge retroperitoneal hematoma and active bleeding from the right internal iliac artery. After achieving successful bleeding control with transcatheter arterial embolization, surgical decompression of the hematoma was performed for management of the femoral neuropathy and the abdominal compartment syndrome. She recovered without any complications. We suggest that initial hemostasis by transcatheter arterial embolization followed by surgical decompression of hematoma is a safe, effective treatment method for a spontaneous retroperitoneal hemorrhage complicated with intractable pain, femoral neuropathy, or abdominal compartment syndrome. PMID:21319359

Won, Dae-Yeon; Kim, Sang-Dong; Park, Sun-Chul; Moon, In-Sung

2011-01-01

57

Inhibition of Rho kinase by Hydroxyfasudil Attenuates Brain Edema after Subarachnoid Hemorrhage in Rats  

PubMed Central

The blood-brain barrier (BBB) disruption and brain edema are important pathophysiologies of early brain injury after subarachnoid hemorrhage (SAH). This study is to evaluate whether Rho kinase (Rock) enhances BBB permeability via disruption of tight junction proteins during early brain injury. Adult male rats were assigned to five groups; sham-operated, SAH treated with saline, a Rock inhibitor hydroxyfasudil (HF) (10mg/kg) treatment at 0.5 hours after SAH, HF treatment at 0.5 and 6 hours (10mg/kg, each) after SAH, and another Rock inhibitor Y27632 (10mg/kg) treatment at 0.5 hrs after SAH. The perforation model of SAH was performed and neurological score and brain water content were evaluated 24 and 72 hours after surgery. Evans blue extravasation, Rock activity assay, and Western blotting analyses were evaluated 24 hours after surgery. Treatment of HF significantly improved neurological scores 24 hours after SAH. Single treatment with HF and Y27632, and two treatments with HF reduced brain water content in the ipsilateral hemisphere. HF reduced Evans blue extravasation in the ipsilateral hemisphere after SAH. Rock activity increased 24 hours after SAH, and HF reversed the activity. SAH significantly decreased the levels of tight junction proteins, occludin and zonula occludens-1 (ZO-1), and HF preserved the levels of occluding and ZO-1 in ipsilateral hemisphere. In conclusion, HF attenuated BBB permeability after SAH, possibly by protection of tight junction proteins. PMID:22226843

Fujii, Mutsumi; Duris, Kamil; Altay, Orhan; Soejima, Yoshiteru; Sherchan, Prativa; Zhang, John H.

2012-01-01

58

Uterine Rupture with Massive Late Postpartum Hemorrhage due to Placenta Percreta Left Partially In Situ  

PubMed Central

Placental adhesive disorders involve the growth of placental tissue into or through the uterine wall. Among these disorders, placenta percreta is the rarest one. However, it may cause significant complications. This report aimed to report a neglected patient with placenta percreta who developed uterine rupture with life-threatening late postpartum intra-abdominal hemorrhage. On admission, the patient had acute abdomen with moderate abdominal distention and was subjected to emergency laparotomy. A full-thickness defect of the anterior uterine wall involving the hysterotomy site was seen. Placental tissues occupied both sides of the incision and posterior bladder wall was also invaded by placenta. Total abdominal hysterectomy with partial resection of the posterior bladder wall was performed. PMID:24392232

Salman, Mehmet Coskun; Calis, Pinar; Deren, Ozgur

2013-01-01

59

Endoscopic cryotherapy for the treatment of epistaxis due to hereditary hemorrhagic telangiectasia.  

PubMed

Hereditary hemorrhagic telangiectasia (HHT), an autosomal dominant vascular disease, involves mainly skin, mucocutaneous membranes, and viscera. Epistaxis is one of the most common symptoms of HHT, and chronic, frequently relapsing epistaxis can cause symptoms such as iron deficiency anemia, severe crusting, and nasal obstruction that can cause lower quality of life. Treatments for HHT range from medication and conservative management to more aggressive surgeries. None of the treatment options, however, have had satisfactory outcomes until now. We introduced cryotherapy for a patient with HHT and at least a 10-year history of frequent, severe epistaxis. This treatment strategy resulted in successful management of symptoms and no associated complications. We present herein a literature review and the clinical course and symptoms of an HHT patient who underwent cryotherapy. PMID:24469376

Kim, Joo Yeon; Oh, Jung Ho; Kim, Geun Tae; Kwon, Jae Hwan

2014-01-01

60

Update in Intracerebral Hemorrhage  

PubMed Central

Spontaneous, nontraumatic intracerebral hemorrhage (ICH) is defined as bleeding within the brain parenchyma. Intracranial hemorrhage includes bleeding within the cranial vault and encompasses ICH, subdural hematoma, epidural bleeds, and subarachnoid hemorrhage (SAH). This review will focus only on ICH. This stroke subtype accounts for about 10% of all strokes. The hematoma locations are deep or ganglionic, lobar, cerebellar, and brain stem in descending order of frequency. Intracerebral hemorrhage occurs twice as common as SAH and is equally as deadly. Risk factors for ICH include hypertension, cerebral amyloid angiopathy, advanced age, antithrombotic therapy and history of cerebrovascular disease. The clinical presentation is “stroke like” with sudden onset of focal neurological deficits. Noncontrast head computerized tomography (CT) scan is the standard diagnostic tool. However, newer neuroimaging techniques have improved the diagnostic yield in terms of underlying pathophysiology and may aid in prognosis. Intracerebral hemorrhage is a neurological emergency. Medical care begins with stabilization of airway, breathing function, and circulation (ABCs), followed by specific measures aimed to decrease secondary neurological damage and to prevent both medical and neurological complications. Reversal of coagulopathy when present is of the essence. Blood pressure management can be key and continues as an area of debate and ongoing research. Surgical evacuation of ICH is of unproven benefit though a subset of well-selected patients may have improved outcomes. Ventriculostomy and intracranial pressure (ICP) monitoring are interventions also used in this patient population. To date, hemostatic medications and neuroprotectants have failed to result in clinical improvement. A multidisciplinary approach is recommended, with participation of vascular neurology, vascular neurosurgery, critical care, and rehabilitation medicine as the main players. PMID:23983850

Aguilar, Maria I.; Brott, Thomas G.

2011-01-01

61

Long-Term Functional Consequences and Ongoing Cerebral Inflammation after Subarachnoid Hemorrhage in the Rat  

PubMed Central

Subarachnoid hemorrhage (SAH) represents a considerable health problem with an incidence of 6–7 per 100.000 individuals per year in Western society. We investigated the long-term consequences of SAH on behavior, neuroinflammation and gray- and white-matter damage using an endovascular puncture model in Wistar rats. Rats were divided into a mild or severe SAH group based on their acute neurological score at 24 h post-SAH. The degree of hemorrhage determined in post-mortem brains at 48 h strongly correlated with the acute neurological score. Severe SAH induced increased TNF-?, IL-1?, IL-10, MCP-1, MIP2, CINC-1 mRNA expression and cortical neutrophil influx at 48 h post-insult. Neuroinflammation after SAH was very long-lasting and still present at day 21 as determined by Iba-1 staining (microglia/macrophages) and GFAP (astrocytes). Long-term neuroinflammation was strongly associated with the degree of severity of SAH. Cerebral damage to gray- and white-matter was visualized by immunohistochemistry for MAP2 and MBP at 21 days after SAH. Severe SAH induced significant gray- and white-matter damage. MAP2 loss at day 21 correlated significantly with the acute neurological score determined at 24 h post-SAH. Sensorimotor behavior, determined by the adhesive removal task and von Frey test, was affected after severe SAH at day 21. In conclusion, we are the first to show that SAH induces ongoing cortical inflammation. Moreover, SAH induces mainly cortical long-term brain damage, which is associated with long-term sensorimotor damage. PMID:24603553

Kooijman, Elke; Nijboer, Cora H.; van Velthoven, Cindy T. J.; Mol, Wouter; Dijkhuizen, Rick M.; Kesecioglu, Jozef; Heijnen, Cobi J.

2014-01-01

62

The Subarachnoid Hemorrhage International Trialists (SAHIT) Repository: advancing clinical research in subarachnoid hemorrhage.  

PubMed

Researchers and other stakeholders continue to express concern about the failure of randomized clinical trials (RCT) in subarachnoid hemorrhage (SAH) to show efficacy of new treatments. Pooled data may be particularly useful to generate hypotheses about causes of poor outcomes and reasons for failure of RCT in SAH, and strategies to improve them. Investigators conducting SAH research collaborated to share data with the intent to develop a large repository of pooled individual patient data for exploratory analysis and testing of new hypotheses relevant to improved trial design and analysis in SAH. This repository currently contains information on 11,443 SAH patients from 14 clinical databases, of which 9 are datasets of recent RCTs and 5 are datasets of prospective observational studies and hospital registries. Most patients were managed in the last 15 years. Data validation and quality checks have been conducted and are satisfactory. Data is available on demographic, clinical, neuroimaging, and laboratory results and various outcome measures. We have compiled the largest known dataset of patients with SAH. The SAHIT repository may be an important resource for advancing clinical research in SAH and will benefit from contributions of additional datasets. PMID:24865271

Jaja, Blessing N R; Attalla, Daniel; Macdonald, R Loch; Schweizer, Tom A; Cusimano, Michael D; Etminan, Nima; Hanggi, Daniel; Hasan, David; Johnston, S Claiborne; Le Roux, Peter; Lo, Benjamin; Louffat-Olivares, Ada; Mayer, Stephan; Molyneux, Andrew; Noble, Adam; Quinn, Audrey; Schenk, Thomas; Spears, Julian; Singh, Jeffrey; Todd, Michael; Torner, James; Tseng, Ming; van den Bergh, William; Vergouwen, Mervyn D I; Wong, George K C

2014-12-01

63

The rat endovascular perforation model of subarachnoid hemorrhage.  

PubMed

The rat endovascular perforation model is considered the closest replica of human condition. Since its development, this model has been extensively used to study early brain injury after subarachnoid hemorrhage (SAH). However, like any other animal model, it has advantages and limitations. The following is a brief review of the rat endovascular perforation SAH model. One section is dedicated to technical considerations that can be used to overcome the model limitations. PMID:25366645

Sehba, Fatima A

2015-01-01

64

Hepatic hemorrhage, hemocoelom, and sudden death due to Haemoproteus infection in passerine birds: eleven cases.  

PubMed

Haemoproteus spp. are ancient apicomplexan hemoparasites that have undergone extensive coevolution with their natural hosts and are typically species specific, with inapparent or minimal pathogenicity. A promiscuous genotype of Haemoproteus capable of undergoing host switching on a familial level was identified. This protozoan caused severe disease with high mortality in 6 species of exotic passerine birds housed in California at the San Diego Zoo's Wild Animal Park: Surinam crested oropendola (Psarocolius decumanus decumanus), Guianan turquoise tanager (Tangara mexicana mexicana), blue-necked tanager (Tangara cyanicollis caeruleocephala, Guianan red-capped cardinal (Paroaria gularis gularis), magnificent bird of paradise (Diphyllodes magnificus hunsteini), and superb bird of paradise (Lophorina superba). The birds had few or no clinical signs. Necropsy findings consisted of hemocoelom and irregularly scattered areas of hemorrhage and hepatocellular necrosis. Affected areas of liver contained solitary protozoal megaloschizonts in varied states of degeneration and peripheral nonsuppurative inflammation. No other parasite life stages were found in parenchymal organs or blood smears. Polymerase chain reaction using consensus primers for an avian malarial mitochondrial cytochrome B gene segment was positive in all cases. Sequencing and BLAST analysis identified the protozoan as a Haemoproteus sp. related to Haemoproteus spp. found in asymptomatic passerine birds native to North America. In situ hybridization was performed in 3 animals with a mitochondrial cytochrome B probe and was positive only in megaloschizonts. These findings suggest the recognition of a genotype of Haemoproteus that exhibits high levels of host infidelity and causes severe disease in captive birds exotic to North America. PMID:18460616

Donovan, Taryn A; Schrenzel, Mark; Tucker, Tammy A; Pessier, Allan P; Stalis, Ilse H

2008-05-01

65

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

PubMed

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

Whetstone, Kirk E; Crane, Deborah A

2013-06-01

66

Ischemic optic neuropathy associated with subarachnoid hemorrhage after rupture of anterior communicating artery aneurysm.  

PubMed

Two clinical cases in which ischemic optic neuropathy (ION) occurred after subarachnoid hemorrhage (SAH) are reported. Hemorrhage in the proximity of the optic chiasm was confirmed in 2 cases following rupture of an anterior communicating artery aneurysm. Optic disk atrophy with excavation and permanent visual field defect (altitudinal superior hemianopia) occurred in both cases. ION seems to occur in association with the optic nerve coincidental with the hyperdensity side of SAH on head CT scan. The incidence of ION appears to be attributable to an insufficient blood supply to arteries distributed in the posterior part of the optic nerve as a result of SAH. PMID:12566879

Hara, Naoto; Mukuno, Kazuo; Ohtaka, Hironori; Shimizu, Kimiya

2003-01-01

67

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. PMID:23878760

Sehba, Fatima A.; Pluta, Ryszard M.

2013-01-01

68

Use of 31P Magnetic Resonance Spectroscopy to Study the Effect of Cortical Magnesium and Energy Metabolism after Subarachnoid Hemorrhage  

Microsoft Academic Search

Background: Flow metabolism coupling ensures adequate cerebral oxygenation. When subarachnoid hemorrhage (SAH) occurs, the flow metabolism coupling lost its balance and results in cerebral ischemia and infarction second to cortical magnesium and energy metabolism alternation. During chronic vasospasm, change in cortical energy metabolism is coupled with change in cerebral blood flow after SAH. Methods: What kind of noninvasive technique can

Heping Yang; Xiangqi Tang; Lihua Tan; Liuwang Zeng; Zhiping Hu

2008-01-01

69

Aneurysmal Subarachnoid Hemorrhage in Patients with Hunt and Hess Grade 4 or 5: Treatment Using the Guglielmi Detachable Coil System  

Microsoft Academic Search

BACKGROUND AND PURPOSE: Patients in poor clinical condition (Hunt and Hess grade 4 or 5) after subarachnoid hemorrhage (SAH) have historically fared poorly and many often were excluded from aggressive treatment. Early aggressive surgical treatment of SAH can produce good-quality survival for a higher percentage of patients than previously reported. We assessed the outcome of patients with Hunt and Hess

Raymond U. Weir; Mary L. Marcellus; Huy M. Do; Gary K. Steinberg; Michael P. Marks

70

The Role of Microclot Formation in an Acute Subarachnoid Hemorrhage Model in the Rabbit  

PubMed Central

Background. Microvascular dysfunction and microthrombi formation are believed to contribute to development of early brain injury (EBI) after aneurysmal subarachnoid hemorrhage (SAH). Objective. This study aimed to determine (i) extent of microthrombus formation and neuronal apoptosis in the brain parenchyma using a blood shunt SAH model in rabbits; (ii) correlation of structural changes in microvessels with EBI characteristics. Methods. Acute SAH was induced using a rabbit shunt cisterna magna model. Extent of microthrombosis was detected 24?h post-SAH (n = 8) by fibrinogen immunostaining, compared to controls (n = 4). We assessed apoptosis by terminal deoxynucleotidyl transferase nick end labeling (TUNEL) in cortex and hippocampus. Results. Our results showed significantly more TUNEL-positive cells (SAH: 115 ± 13; controls: 58 ± 10; P = 0.016) and fibrinogen-positive microthromboemboli (SAH: 9 ± 2; controls: 2 ± 1; P = 0.03) in the hippocampus after aneurysmal SAH. Conclusions. We found clear evidence of early microclot formation in a rabbit model of acute SAH. The extent of microthrombosis did not correlate with early apoptosis or CPP depletion after SAH; however, the total number of TUNEL positive cells in the cortex and the hippocampus significantly correlated with mean CPP reduction during the phase of maximum depletion after SAH induction. Both microthrombosis and neuronal apoptosis may contribute to EBI and subsequent DCI. PMID:25110658

Andereggen, Lukas; Neuschmelting, Volker; Widmer, Hans Rudolf; Fandino, Javier; Marbacher, Serge

2014-01-01

71

Haptoglobin phenotype predicts the development of focal and global cerebral vasospasm and may influence outcomes after aneurysmal subarachnoid hemorrhage.  

PubMed

Cerebral vasospasm (CV) and the resulting delayed cerebral ischemia (DCI) significantly contribute to poor outcomes following aneurysmal subarachnoid hemorrhage (aSAH). Free hemoglobin (Hb) within the subarachnoid space has been implicated in the pathogenesis of CV. Haptoglobin (Hp) binds free pro-oxidant Hb, thereby modulating its harmful effects. Humans can be of three Hp phenotypes: Hp1-1, Hp2-1, or Hp2-2. In several disease states, the Hp2-2 protein has been associated with reduced ability to protect against toxic free Hb. We hypothesized that individuals with the Hp2-2 phenotype would have more CV, DCI, mortality, and worse functional outcomes after aSAH. In a sample of 74 aSAH patients, Hp2-2 phenotype was significantly associated with increased focal moderate (P = 0.014) and severe (P = 0.008) CV and more global CV (P = 0.014) after controlling for covariates. Strong trends toward increased mortality (P = 0.079) and worse functional outcomes were seen for the Hp2-2 patients with modified Rankin scale at 6 wk (P = 0.076) and at 1 y (P = 0.051) and with Glasgow Outcome Scale Extended at discharge (P = 0.091) and at 1 y (P = 0.055). In conclusion, Hp2-2 phenotype is an independent risk factor for the development of both focal and global CV and also predicts poor functional outcomes and mortality after aSAH. Hp phenotyping may serve as a clinically useful tool in the critical care management of aSAH patients by allowing for early prediction of those patients who require increased vigilance due to their inherent genetic risk for the development of CV and resulting DCI and poor outcomes. PMID:25583472

Leclerc, Jenna L; Blackburn, Spiros; Neal, Dan; Mendez, Nicholas V; Wharton, Jeffrey A; Waters, Michael F; Doré, Sylvain

2015-01-27

72

The Biochemical Basis of Hydroxymethylglutaryl-CoA Reductase Inhibitors as Neuroprotective Agents in Aneurysmal Subarachnoid Hemorrhage  

PubMed Central

Aneurysmal subarachnoid hemorrhage (SAH) has the highest morbidity and mortality rates of all types of stroke. Many aneurysmal SAH patients continue to suffer from significant neurological morbidity and mortality directly related to delayed cerebral ischemia. Pilot clinical studies of the use of Hydroxymethylglutaryl-CoA Reductase Inhibitors (statins) in aneurysmal SAH patients have reported a reduction in delayed cerebral ischemia and better clinical outcomes. We review the biochemical effects of statins on endothelium vascular function, glutamate-mediated neurotoxicity, inflammatory changes, and oxidative injuries, with reference to their possible neuroprotective effects in aneurysmal SAH.

Wong, George Kwok Chu; Poon, Wai Sang

2010-01-01

73

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. PMID:24803729

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

2014-01-01

74

Natural history of premacular hemorrhage due to severe acute anemia: clinical and anatomical features in two untreated patients.  

PubMed

Premacular retrohyaloid hemorrhage is a rare complication of acute severe anemia. The authors report two cases of premacular hemorrhage in which no treatment other than clinical and spectral-domain optical coherence tomography observation was performed. The natural history of this condition reveals that complete clinical resolution is not accompanied by full anatomical restoration. [Ophthalmic Surg Lasers Imaging Retina. 2014;45:E5-E7.]. PMID:24496165

Turco, Claudia Del; La Spina, Carlo; Mantovani, Elena; Gagliardi, Marco; Lattanzio, Rosangela; Pierro, Luisa

2014-01-01

75

Subarachnoid Hemorrhage  

MedlinePLUS

... left with physical limitations or problems with their thinking. In those cases, long periods of rehabilitation are ... one dedicated to the care of patients with critical brain disease. Patients with SAH may need a ...

76

Blockage of mitochondrial calcium uniporter prevents iron accumulation in a model of experimental subarachnoid hemorrhage.  

PubMed

Previous studies have shown that iron accumulation is involved in the pathogenesis of brain injury following subarachnoid hemorrhage (SAH) and chelation of iron reduced mortality and oxidative DNA damage. We previously reported that blockage of mitochondrial calcium uniporter (MCU) provided benefit in the early brain injury after experimental SAH. This study was undertaken to identify whether blockage of MCU could ameliorate iron accumulation-associated brain injury following SAH. Therefore, we used two reagents ruthenium red (RR) and spermine (Sper) to inhibit MCU. Sprague-Dawley (SD) rats were randomly divided into four groups including sham, SAH, SAH+RR, and SAH+Sper. Biochemical analysis and histological assays were performed. The results confirmed the iron accumulation in temporal lobe after SAH. Interestingly, blockage of MCU dramatically reduced the iron accumulation in this area. The mechanism was revealed that inhibition of MCU reversed the down-regulation of iron regulatory protein (IRP) 1/2 and increase of ferritin. Iron-sulfur cluster dependent-aconitase activity was partially conserved when MCU was blocked. In consistence with this and previous report, ROS levels were notably reduced and ATP supply was rescued; levels of cleaved caspase-3 dropped; and integrity of neurons in temporal lobe was protected. Taken together, our results indicated that blockage of MCU could alleviate iron accumulation and the associated injury following SAH. These findings suggest that the alteration of calcium and iron homeostasis be coupled and MCU be considered to be a therapeutic target for patients suffering from SAH. PMID:25529443

Yan, Huiying; Hao, Shuangying; Sun, Xiaoyan; Zhang, Dingding; Gao, Xin; Yu, Zhuang; Li, Kuanyu; Hang, Chun-Hua

2015-01-24

77

SAH-Induced MMP Activation and K V Current Suppression is Mediated Via Both ROS-Dependent and ROS-Independent Mechanisms.  

PubMed

Voltage-gated potassium (K V) channels regulate cerebral artery tone and have been implicated in subarachnoid hemorrhage (SAH)-induced pathologies. Here, we examined whether matrix metalloprotease (MMP) activation contributes to SAH-induced K V current suppression and cerebral artery constriction via activation of epidermal growth factor receptors (EGFRs). Using patch clamp electrophysiology, we observed that K V currents were selectively decreased in cerebral artery myocytes isolated from SAH model rabbits. Consistent with involvement of enhanced MMP and EGFR activity in SAH-induced K V current suppression, we found that: (1) oxyhemoglobin (OxyHb) and/or the exogenous EGFR ligand, heparin-binding EGF-like growth factor (HB-EGF), failed to induce further K V current suppression after SAH and (2) gelatin zymography detected significantly higher MMP-2 activity after SAH. The removal of reactive oxygen species (ROS) by combined treatment with superoxide dismutase (SOD) and catalase partially inhibited OxyHb-induced K V current suppression. However, these agents had little effect on OxyHb-induced MMP-2 activation. Interestingly, in the presence of a broad-spectrum MMP inhibitor (GM6001), OxyHb failed to cause K V current suppression. These data suggest that OxyHb suppresses K V currents through both ROS-dependent and ROS-independent pathways involving MMP activation. The ROS-independent pathway involves activation of MMP-2, whereas the ROS-dependent pathway involves activation of a second unidentified MMP or ADAM (a disintegrin and metalloprotease domain). PMID:25366605

Koide, Masayo; Wellman, George C

2015-01-01

78

Splinter hemorrhages  

MedlinePLUS

Fingernail hemorrhage ... Splinter hemorrhages look like thin, red to reddish-brown lines of blood under the nails. They run in the direction of nail growth. They are named splinter hemorrhages because they look like a splinter under the ...

79

Life satisfaction and return to work after aneurysmal subarachnoid hemorrhage.  

PubMed

This study was conducted to investigate life satisfaction and employment status after aneurysmal subarachnoid hemorrhage (SAH) and to explain the associations between life satisfaction and demographic, disease-related, psychological, and personality characteristics. Subjects with SAH (n = 141) living at home 2-4 years after the SAH responded to a mailed questionnaire. Outcomes were life satisfaction, as measured with the Life Satisfaction Questionnaire 9 (LiSat-9), and employment status. Determinants in multiple regression analysis were demographic and SAH characteristics, subjective complaints (eg, mood disorder, fatigue, cognitive complaints), and personality characteristics (eg, neuroticism, passive coping style). Of the 141 subjects, 64 (46.7%) had a Glasgow Outcome Scale score of V (good outcome) at discharge. Mean subject age was 51.4 ± 12.3 years, and mean time after SAH was 36.1 ± 7.9 months. Of the 88 subjects who were working at the time of the SAH, 54 (61.4%) returned to work, but only 31 (35.2%) resumed their work completely. The subjects were least satisfied with their vocational situation (51.9% satisfied) and sexual life (51.7%) and were most satisfied with their relationships (75.2%-88.7%) and self-care ability (88.6%). Age (? value = 0.17), return to work after SAH (0.19), disability at hospital discharge (0.25), worsened mood (-0.37), and passive coping (-0.25) together accounted for 47.2% of the life satisfaction scores. Our data indicate that return to work is a major issue for individuals who survive an SAH. Not returning to work, disability, depression, and passive coping are associated with reduced life satisfaction. Thus, vocational reintegration after SAH merits more attention during rehabilitation. PMID:20656515

Passier, Patricia E C A; Visser-Meily, Johanna M A; Rinkel, Gabriel J E; Lindeman, Eline; Post, Marcel W M

2011-01-01

80

Application of lumbar drainage in vasospasm after spontaneous subarachnoid hemorrhage and prevention of late cerebral infarction.  

PubMed

Cerebral vasospasm, especially delayed cerebral ischemia following subarachnoid hemorrhage (SAH) is the most important complication that effects mortality and morbidity of patients with intracranial aneurysms. The presence of cerebral vasospasm has been correlated with an increase in mortality in the first 2 weeks after SAH. Despite clinical studies and research, the etiopathogenesis of cerebral vasospasm is not understood exactly and there is not yet an effective therapy. The aim of our study was to investigate the effect of application of lumber drainage on vasospasm and delayed cerebral infarction following SAH and to examine the incidence of complications. Patient groups were determined by retrospective screening of 70 patients who underwent a surgical operation at the Osmangazi University Medical Faculty Department of Neurosurgery between 2009 and 2013 after a diagnosis of ruptured aneurysmal SAH. After the application of lumbar drainage, the complications and mortality after aneurysm surgery was significantly decreased and correlated with the amount of hemorrhagic cerebrospinal fluid drainage. PMID:25366633

Aydin, Hasan Emre; Ozbek, Zühtü; Aydin, Nevin; Bolluk, Ozge; Vural, Murat; Arslantas, Ali; Atasoy, Metin Ant

2015-01-01

81

Recurrent Meningitis and Subarachnoid Hemorrhage Due to Salmonella in an HIV+ Patient: Case Report and Mini-Review of the Literature  

PubMed Central

Meningitis due to non-typhi salmonella is infrequent in HIV-positive adults. We report a case of a patient with >300 CD4+ cells/mm3 who presented with five episodes of recurrent meningitis, focal subarachnoid hemorrhage and cerebral vasculitis ultimately attributed to Salmonella choleraesuis infection. Even within the cART era invasive salmonellosis can occur in unusual ways in HIV-infected patients. PMID:21772932

Belloso, Waldo H; Romano, Marina; Greco, Graciela S; Davey, Richard T; Perelsztein, Ariel G; Sánchez, Marisa L; Ajzenszlos, Martín R; Otegui, Inés M

2011-01-01

82

Changes in trace elements of cerebrospinal fluid after subarachnoid hemorrhage, and effects of trace elements on vasospasm  

NASA Astrophysics Data System (ADS)

Various causal factors have been proposed for cerebral vasospasm after subarachnoid hemorrhage (SAH), such as serotonin, acetylcholine, angiotensin, thrombin and thromboxane A2. However, none of them explain the whole pathomechanism of vasospasm. To evaluate the role of trace elements on vasospasm, we have examined these sequential changes in the cerebrospinal fluid (CSF) after SAH by PIXE, and have investigated the relation between trace elements and vasospasm. We obtained the CSF samples from cisternal drainage in patients with SAH who underwent radical surgery within 48 h from the onset. The drainage was placed into basal cisterns at the end of the operation. Three sampling times (3-5, 7-9 and 12-14 days from the onset) has been scheduled because vasospasm is likely to occur from day 4 to day 14 after the onset. In this study, we focused on the levels of Mg, Ca, Mn, Al, Zn, P, Pb, Sr, Br, Co, Cu, Si, Ti, Mn,Co, Cu, Zn, Br, Sr, Mo and Pb, and we found a significantly lower level of Mg in the CSF of patients with vasospasm on days 7-9 after the onset. These results suggest that Mg in the CSF may ameliorate vasoconstriction due to Ca in the pathomechanism of vasospasm.

Sato, N.; Kuroda, K.; Suzuki, M.; Ogawa, A.; Sera, K.

1999-04-01

83

Risk of Recurrent Subarachnoid Hemorrhage After Complete Obliteration of Cerebral Aneurysms  

Microsoft Academic Search

Background and Purpose—The neck clipping of cerebral aneurysms is a well-established treatment for subarachnoid hemorrhage (SAH) caused by aneurysmal rupture. However, it is still unclear how great a risk of recurrence patients with a successfully treated aneurysm carry over a long-term period. Methods—Of 425 patients with SAH surgically treated in Aizu Chuou Hospital from 1976 to 1994, 220 cases meeting

K. Tsutsumi; K. Ueki; M. Usui; S. Kwak; T. Kirino

84

Gene Transfer of Calcitonin Gene-Related Peptide Prevents Vasoconstriction After Subarachnoid Hemorrhage  

Microsoft Academic Search

We sought to determine whether adenovirus-mediated gene transfer in vivo of calcitonin gene-related peptide (CGRP), a potent vasodilator, ameliorates cerebral vasoconstriction after experimental subarachnoid hemorrhage (SAH). Arterial blood was injected into the cisterna magna of rabbits to mimic SAH 5 days after injection of AdRSVCGRP (83108 pfu), AdRSVbgal (control virus), or vehicle. After injection of AdRSVCGRP, there was a 400-fold

Kazunori Toyoda; Frank M. Faraci; Yoshimasa Watanabe; Toshihiro Ueda; Jon J. Andresen; Yi Chu; Shoichiro Otake; Donald D. Heistad

85

Subarachnoid Hemorrhage Secondary to Forceful Sneeze  

PubMed Central

Subarachnoid hemorrhage (SAH) is a relatively less common but important neurological condition comprising 5% of all the cerebrovascular accidents. In most populations the reported incidence is 6-7 per 100,000 person-years and one-third of survivors become dependent. It is a serious but potentially treatable cause of neurological morbidity. Multiple authors have identified the most unusual novel associations and triggers of subarachnoid bleeds over the past decade. We herein report a rare case of subarachnoid hemorrhage leading to focal neurological deficit in a middle aged man secondary to forceful sneeze.

Nomani, Ali Zohair; Rajput, Haris Majid; Iqbal, Mansoor; Jan, Zakir; Irshad, Muhammad; Badshah, Mazhar; Khan, Rao Sohail Yasin

2015-01-01

86

Mouse genetic background is associated with variation in secondary complications after subarachnoid hemorrhage.  

PubMed

Spontaneous subarachnoid hemorrhage (SAH) is a form of hemorrhagic stroke that accounts for approximately 7 % of all strokes worldwide and is associated with mortality in approximately 35 % of cases and morbidity in many of the survivors. Studies have suggested that genetic variations may affect the pathophysiology of SAH. The goal of this study was to investigate the effect of mouse genetic background on brain injury and large artery vasospasm after SAH. SAH was induced in seven inbred strains of mice, and the degree of large artery vasospasm and brain injury was assessed. After 48 h, SAH mice showed a significant reduction in middle cerebral artery diameter and increased neuronal injury in the cerebral cortex compared with sham-operated controls. Mouse strains also demonstrated variable degrees of vasospasm and brain injury. This data suggests that different genetic factors influence how much brain injury and vasospasm occur after SAH. Future investigations may provide insight into the causes of these differences between strains and into which genetic contributors may be responsible for vasospasm and brain injury after SAH. PMID:25366595

D'Abbondanza, Josephine A; Lass, Elliot; Ai, Jinglu; Macdonald, R Loch

2015-01-01

87

Mouse model of subarachnoid hemorrhage: technical note on the filament perforation model.  

PubMed

Experiments using genetically engineered mice are regarded as indispensable to gaining a better understanding of the molecular pathophysiology in neuronal injury after subarachnoid hemorrhage (SAH). Therefore, mouse SAH models are becoming increasingly important. The circle of Willis perforation (cWp) model is the most frequently used mouse SAH model. We report and discuss the technical surgical approach, results, and difficulties associated with the cWp model, with reference to the existing literature. Our results largely confirmed previously published results. This model may be the first choice at present, because important pathologies can be reproduced in this model and most findings in the literature are based on it. PMID:25366644

Muroi, Carl; Fujioka, Masayuki; Marbacher, Serge; Fandino, Javier; Keller, Emanuela; Iwasaki, Katsunori; Mishima, Kenichi

2015-01-01

88

Copeptin as a Marker for Severity and Prognosis of Aneurysmal Subarachnoid Hemorrhage  

PubMed Central

Background Grading of patients with aneurysmal subarachnoid hemorrhage (aSAH) is often confounded by seizure, hydrocephalus or sedation and the prediction of prognosis remains difficult. Recently, copeptin has been identified as a serum marker for outcomes in acute ischemic stroke and intracerebral hemorrhage (ICH). We investigated whether copeptin might serve as a marker for severity and prognosis in aSAH. Methods Eighteen consecutive patients with aSAH had plasma copeptin levels measured with a validated chemiluminescence sandwich immunoassay. The primary endpoint was the association of copeptin levels at admission with the World Federation of Neurological Surgeons (WFNS) grade score after resuscitation. Levels of copeptin were compared across clinical and radiological scores as well as between patients with ICH, intraventricular hemorrhage, hydrocephalus, vasospasm and ischemia. Results Copeptin levels were significantly associated with the severity of aSAH measured by WFNS grade (P?=?0.006), the amount of subarachnoid blood (P?=?0.03) and the occurrence of ICH (P?=?0.02). There was also a trend between copeptin levels and functional clinical outcome at 6-months (P?=?0.054). No other clinical outcomes showed any statistically significant association. Conclusions Copeptin may indicate clinical severity of the initial bleeding and may therefore help in guiding treatment decisions in the setting of aSAH. These initial results show that copeptin might also have prognostic value for clinical outcome in aSAH. PMID:23326397

Fung, Christian; De Marchis, Gian Marco; Katan, Mira; Seiler, Marleen; Arnold, Marcel; Gralla, Jan; Raabe, Andreas; Beck, Jürgen

2013-01-01

89

Takotsubo cardiomyopathy secondary to intracranial hemorrhage  

PubMed Central

Patients suffering from aneurysmal subarachnoid hemorrhage often present with electrocardiogram (ECG) abnormalities that mimic cardiac ischemia, but documented left ventricular regional wall-motion dysfunction has rarely been reported. This report is intended to raise the awareness of possible ECG changes secondary to subarachnoid hemorrhage (SAH). We cared for a 55-year-old female with an acute aneurysmal subarachnoid hemorrhage, whose evaluation was delayed and complicated by the presence of Takotsubo cardiomyopathy (TCM). Aneurysmal subarachnoid hemorrhage may induce Takotsubo cardiomyopathy that can present as an acute ST-elevation myocardial infarction. Physicians need to be aware of this possibility since it can lead to significant delays and treatment options for the patient. PMID:25635193

2014-01-01

90

Inhibition of the Sur1-Trpm4 Channel Reduces Neuroinflammation and Cognitive Impairment in Subarachnoid Hemorrhage  

PubMed Central

Background and Purpose Subarachnoid hemorrhage (SAH) can leave patients with memory impairments that may not recover fully. Molecular mechanisms are poorly understood, and no treatment is available. The sulfonylurea receptor 1–transient receptor potential melastatin 4 (Sur1-Trpm4) channel plays an important role in acute central nervous system injury. We evaluated upregulation of Sur1-Trpm4 in humans with SAH and, in rat models of SAH, we examined Sur1- Trpm4 upregulation, its role in barrier dysfunction and neuroinflammation, and its consequences on spatial learning. Methods We used Förster resonance energy transfer to detect coassociated Sur1 and Trpm4 in human autopsy brains with SAH. We studied rat models of SAH involving filament puncture of the internal carotid artery or injection of blood into the subarachnoid space of the entorhinal cortex. In rats, we used Förster resonance energy transfer and coimmunoprecipitation to detect coassociated Sur1 and Trpm4, we measured immunoglobulin G extravasation and tumor necrosis ? overexpression as measures of barrier dysfunction and neuroinflammation, and we assessed spatial learning and memory on days 7 to 19. Results Sur1-Trpm4 channels were upregulated in humans and rats with SAH. In rats, inhibiting Sur1 using antisense or the selective Sur1 inhibitor glibenclamide reduced SAH-induced immunoglobulin G extravasation and tumor necrosis ? overexpression. In models with entorhinal SAH, rats treated with glibenclamide for 7 days after SAH exhibited better platform search strategies and better performance on incremental and rapid spatial learning than vehicle-treated controls. Conclusions Sur1-Trpm4 channels are upregulated in humans and rats with SAH. Channel inhibition with glibenclamide may reduce neuroinflammation and the severity of cognitive deficits after SAH. PMID:24114458

Tosun, Cigdem; Kurland, David B.; Mehta, Rupal; Castellani, Rudy J.; deJong, Joyce L.; Kwon, Min Seong; Woo, Seung Kyoon; Gerzanich, Volodymyr; Simard, J. Marc

2013-01-01

91

Alteration of Basilar Artery Rho-Kinase and Soluble Guanylyl Cyclase Protein Expression in a Rat Model of Cerebral Vasospasm following Subarachnoid Hemorrhage  

PubMed Central

Background and Purpose. The vasoconstrictor endothelin-1 (ET-1) has been implicated in the pathogenesis of cerebral vasospasm following subarachnoid hemorrhage (SAH). Previous results showed that CGS 26303, an endothelin converting enzyme (ECE) inhibitor, effectively prevented and reversed arterial narrowing in animal models of SAH. In the present study, we assessed the effect of CGS 26303 on neurological deficits in SAH rats. The involvement of vasoactive pathways downstream of ET-1 signaling in SAH was also investigated. Methods. Sprague-Dawley rats were divided into five groups (n = 6/group): (1) normal control, (2) SAH, (3) SAH+vehicle, (4) SAH+CGS 26303 (prevention), and (5) SAH+CGS 26303 (reversal). SAH was induced by injecting autologous blood into cisterna magna. CGS 26303 (10?mg/kg) was injected intravenously at 1 and 24?hr after the initiation of SAH in the prevention and reversal protocols, respectively. Behavioral changes were assessed at 48?hr after SAH. Protein expression was analyzed by Western blots. Results. Deficits in motor function were obvious in the SAH rats, and CGS 26303 significantly improved the rate of paraplegia. Expressions of rho-kinase-II and membrane-bound protein kinase C-? and rhoA were significantly increased, while those of soluble guanylyl cyclase ?1 and ?1 as well as protein kinase G were significantly decreased in the basilar artery of SAH rats. Treatment with CGS 26303 nearly normalized these effects. Conclusions. These results demonstrate that the rhoA/rho-kinase and sGC/cGMP/PKG pathways play pivotal roles in cerebral vasospasm after SAH. It also shows that ECE inhibition is an effective strategy for the treatment of this disease. PMID:24982890

Wang, Chih-Jen; Lee, Pei-Yu; Wu, Bin-Nan; Wu, Shu-Chuan; Loh, Joon-Khim; Tsai, Hung-Pei; Kassell, Neal F.; Kwan, Aij-Lie

2014-01-01

92

Tert-Butylhydroquinone Alleviates Early Brain Injury and Cognitive Dysfunction after Experimental Subarachnoid Hemorrhage: Role of Keap1/Nrf2/ARE Pathway  

PubMed Central

Tert-butylhydroquinone (tBHQ), an Nrf2 activator, has demonstrated neuroprotection against brain trauma and ischemic stroke in vivo. However, little work has been done with respect to its effect on early brain injury (EBI) after subarachnoid hemorrhage (SAH). At the same time, as an oral medication, it may have extensive clinical applications for the treatment of SAH-induced cognitive dysfunction. This study was undertaken to evaluate the influence of tBHQ on EBI, secondary deficits of learning and memory, and the Keap1/Nrf2/ARE pathway in a rat SAH model. SD rats were divided into four groups: (1) Control group (n?=?40); (2) SAH group (n?=?40); (3) SAH+vehicle group (n?=?40); and (4) SAH+tBHQ group (n?=?40). All SAH animals were subjected to injection of autologous blood into the prechiasmatic cistern once in 20 s. In SAH+tBHQ group, tBHQ was administered via oral gavage at a dose of 12.5 mg/kg at 2 h, 12 h, 24 h, and 36 h after SAH. In the first set of experiments, brain samples were extracted and evaluated 48 h after SAH. In the second set of experiments, changes in cognition and memory were investigated in a Morris water maze. Results shows that administration of tBHQ after SAH significantly ameliorated EBI-related problems, such as brain edema, blood-brain barrier (BBB) impairment, clinical behavior deficits, cortical apoptosis, and neurodegeneration. Learning deficits induced by SAH was markedly alleviated after tBHQ therapy. Treatment with tBHQ markedly up-regulated the expression of Keap1, Nrf2, HO-1, NQO1, and GST?1 after SAH. In conclusion, the administration of tBHQ abated the development of EBI and cognitive dysfunction in this SAH model. Its action was probably mediated by activation of the Keap1/Nrf2/ARE pathway. PMID:24848277

Wu, Lingyun; Qiu, Jiaoxue; Li, Qi; Shao, Zhong; Chen, Gang

2014-01-01

93

Blood Clot Placement Model of Subarachnoid Hemorrhage in Non-human Primates.  

PubMed

Despite ongoing extensive and promising research to prevent and treat cerebrovascular vasospasm and delayed ischemic neurological deficits (DIND) after aneurysmal subarachnoid hemorrhage (aSAH), clinical outcomes remain unsatisfying. Neuroprotective strategies developed in basic science research laboratories need to be translated from bench-to-bedside using appropriate animal models. While a primate model is widely accepted as the best animal model mimicking development of delayed cerebral vasospasm after aSAH, its worldwide usage has dramatically decreased because of ethical and financial limitations. However, the use of primate models of subarachnoid hemorrhage (SAH) remains a recommended bridge for translation of early preclinical studies in rodents to human clinical trials. This paper discusses the technical aspects as well as advantages and disadvantages of a blood clot placement model of subarachnoid hemorrhage in non-human primates. PMID:25366649

Fathi, Ali Reza; Bakhtian, Kamran D; Marbacher, Serge; Fandino, Javier; Pluta, Ryszard M

2015-01-01

94

Recombinant Osteopontin in Cerebral Vasospasm After Subarachnoid Hemorrhage  

PubMed Central

Objective Osteopontin (OPN), a pleiotropic extracellular matrix glycoprotein, has been reported to be protective against ischemic lesions, but effects of OPN on vascular functions have not been investigated. The aim of this study was to assess whether recombinant OPN (r-OPN) could prevent cerebral vasospasm after subarachnoid hemorrhage (SAH) in rats. Methods r-OPN was administered intraventricularly to rats undergoing SAH by the endovascular perforation, and its protective effects were evaluated by measuring the diameter of cerebral arteries and neurobehavioral testing. Western blotting and immunofluorescence were performed to explore the underlying mechanisms. An integrin receptor antagonist GRGDSP or mitogen-activated protein kinase (MAPK) phosphatase (MKP)-1 small interfering RNA (siRNA) was also administered to r-OPN-treated SAH rats, and those effects were evaluated. Results Pre-SAH administration of r-OPN prevented vasospasm and neurological impairments at 24–72 hours post-SAH. r-OPN enhanced an endogenous MAPK inhibitor, MKP-1, and suppressed the phosphorylation of MAPKs, caldesmon and heat shock protein 27 in the spastic cerebral arteries at 24 hours post-SAH. Immunofluorescence revealed that MKP-1 was induced in the arterial smooth muscle layer. GRGDSP prevented r-OPN-induced MKP-1 upregulation, and MKP-1 siRNA abolished both MAPK inactivation and anti-vasospastic effects by r-OPN. Post-SAH r-OPN treatment also prevented vasospasm. Interpretation r-OPN induced MKP-1 in the spastic cerebral arteries via binding to L-arginyl-glycyl-L-aspartate-dependent integrin receptors and prevented vasospasm after SAH. Therapeutic induction of MKP-1 may be a novel approach for the prevention and treatment of cerebral vasospasm. PMID:21031580

Suzuki, Hidenori; Hasegawa, Yu; Chen, Wanqiu; Kanamaru, Kenji; Zhang, John H.

2010-01-01

95

[Intracranial hemorrhage due to pulmonary thromboembolism in heparin therapy and therapeutic management of patients hospitalized with massive pulmonary embolism after discharge].  

PubMed

A patient with a history of intracranial hemorrhage who was hospitalized due to massive pulmonary thromboembolism (PTE) was presented. A 59-year-old female patient had an intracranial hemorrhage while under anticoagulant therapy due to PTE after a knee operation. Therefore, the anticoagulant therapy was discontinued. Forty-seven days after the cessation of the anticoagulant treatment, the patient was admitted to the emergency department with a complaint of acute dyspnea and presyncope. Transthoracic echocardiography showed signs of right ventricular overload. Contrast-enhanced thorax computed tomography showed saddle-like filling defects in the level of pulmonary trunk bifurcation to the extension of both the main pulmonary arteries. The patient was admitted with a massive PTE. Fibrinolytic treatment could not be given due to the history of hemorrhagic stroke while under heparin infusion therapy. The patient dyspnea did not resolve, so pulmonary angiography and thrombus aspiration was planned. The patient's clinical status had improved after the thrombus aspiration. After the thrombus aspiration, bemiparin treatment was given via effective anti-factor Xa level. Due to lower extremity Doppler ultrasonography showing subacute-chronic thrombosis on the right popliteal vein, inferior vena cava filter was inserted. When thrombolytic therapy cannot be given to patients with a high risk bleeding, the embolectomy and/or aspiration of pulmonary thrombus may be an appropriate treatment option. In such patients, for anticoagulant therapy, unfractioned heparin with close aPTT follow-up or low molecular weight heparin therapy with antifactor Xa follow-up can be used. PMID:23703559

Be?li, Feyzullah; Keçeba?, Mesut; Ali?ir, Mehmet Fethi; Güngören, Fatih

2013-04-01

96

Cerebral Venous Thrombosis with Subarachnoid Hemorrhage: A Case Report.  

PubMed

Cerebral venous thrombosis (CVT) presenting as subarachnoid hemorrhage (SAH) is infrequent. We present a man with CVT of right transverse sinus who presented a SAH in right parietal sinus. In the study we found a hyperhomocysteinemia in a heterozygous patient for the methylenetetrahydrofolate reductase C667T mutation. Our report highlights the value of an early diagnosis of CVT, the importance to identify possible causes that could be reversed with an appropriate treatment and the controversy about the moment of starting anticoagulant therapy in such cases. PMID:25380613

Arévalo-Lorido, José Carlos; Carretero-Gómez, Juana

2014-11-01

97

Successful percutaneous treatment for massive hemorrhage due to infectious pseudoaneurysm in the abdominal wall after percutaneous endoscopic gastrostomy: a case report  

PubMed Central

Background Percutaneous endoscopic gastrostomy (PEG) is often performed for alimentation and to prevent weight loss in patients with feeding problems due to central neurologic diseases such as cerebral infarction or intracranial hemorrhage. Although infection at the skin site after PEG placement is a typical late complication of PEG, a ruptured infectious pseudoaneurysm caused massive bleeding adjacent to the tract is rare. Prompt treatment is required to avoid the hemorrhage shock, however surgical ligation is difficult to obtain the arrest of bleeding in damaged skin due to the infection. Case presentation A 70-year-old male was bedridden due a cerebral infarction suffered 1 year previously. APEG was placed because of feeding problems, and a push-type, 20-Fr gastrostomy tube was inserted through the anterior abdominal wall. On day 16 after PEG placement, the patient had massive bleeding from the PEG site due to the rupture of infectious pseudoaneurysm and developed a decreased level of consciousness and hypotension. Treatment by percutaneous direct injection of a mixture of n-butyl-cyanoacrylate (NBCA)-lipiodol was performed and achieved good hemostasis is obtained. Conclusions A rare case of an infectious pseudoaneurysm that developed in the abdominal wall and caused massive bleeding at a PEG placement site was described. Percutaneous injection of a mixture of n-butyl-cyanoacrylate (NBCA)-lipiodol under ultrasound guidance is an effective treatment in this case. PMID:24915936

2014-01-01

98

Subconjunctival hemorrhage  

MedlinePLUS

Subconjunctival hemorrhage is a bright red patch appearing in the white of the eye. This condition is one of ... clear tissue called the bulbar conjunctiva . A subconjunctival hemorrhage occurs when a small blood vessel breaks open ...

99

Fatal Traumatic Subarachnoid Hemorrhage due to Acute Rebleeding of a Pseudoaneurysm Arising from the Distal Basilar Artery  

PubMed Central

Isolated traumatic pseudoaneurysms of the basilar artery are extremely rare but often fatal resulting in a mortality rate as high as 50%. A 51-year-old man presented with craniofacial injury after blunt trauma. A brain computed tomography (CT) scan showed thick basal subarachnoid hemorrhage associated with multiple craniofacial fractures, while CT angiography revealed contrast extravasation at the distal basilar artery with pseudoaneurysm formation. After this primary survey, the condition of the patient suddenly deteriorated. Conventional angiography confirmed the contrast extravasation resulted from pseudoaneurysm formation, which was successfully treated with endovascular coil embolization. Decompressive craniectomy and coma therapy with propofol were also performed. However, the patient died on the 7th hospital day because of the poor initial clinical condition. The current case is the first report of acute pseudoaneurysm rupture arising from the basilar artery within the first day after trauma. Our findings suggest the possibility that pseudoaneurysm rupture should be considered if brain CT shows thick traumatic subarachnoid hemorrhage on the basal cistern with a basal skull fracture.

Kim, Byung Chul; Lee, Jae Il; Cho, Won Ho

2014-01-01

100

Effects of nicardipine on the ex vivo release of eicosanoids after experimental subarachnoid hemorrhage.  

PubMed

The activation of lipid peroxidation and the enhancement of arachidonic acid metabolism have been demonstrated as indicators of brain damage after subarachnoid hemorrhage (SAH). Meanwhile, the final common pathway of neuronal damage seems to be related to the impaired homeostasis of Ca++. The present study evaluated the effect of the calcium-antagonist nicardipine on arachidonate metabolism after experimental induction of SAH. The ex vivo release of four eicosanoids (prostaglandin (PG)D2, PGE2, 6-keto-PGF1 alpha, and leukotriene (LT)C4) was measured at different intervals after SAH induction. Rats were separated into the following three groups: a sham-operated group, an SAH group (rats were injected with 0.3 ml autologous arterial blood), and an SAH-treated group (after SAH induction, rats were treated with nicardipine 1.2 mg/kg intraperitoneally). Nicardipine significantly decreased the ex vivo release of PGD2 at 48 hours after SAH (p less than 0.01). The release of PGE2 was significantly enhanced at 6 hours after SAH, while in the nicardipine-treated group PGE2 release is significantly reduced. Nicardipine also affects the lipoxygenase pathway, reducing the release of LTC4 at 1, 6, and 48 hours after SAH induction. The results of the present study show that nicardipine treatment exerts an inhibitory effect on both biochemical pathways of arachidonic acid metabolism; aside from vascular effects, nicardipine could exert a protective role against the release of arachidonate metabolites, which could play a significant role in the pathogenesis of brain damage after SAH. PMID:2585083

Rodriguez y Baena, R; Gaetani, P; Marzatico, F; Benzi, G; Pacchiarini, L; Paoletti, P

1989-12-01

101

Phosphodiesterase 5 Inhibition Attenuates Cerebral Vasospasm and Improves Functional Recovery after Experimental Subarachnoid Hemorrhage  

PubMed Central

Background Cerebral vasospasm is an independent predictor of poor outcome after subarachnoid hemorrhage (SAH). The nitric oxide-cyclic GMP (NO-cGMP) vasodilatory pathway is strongly implicated in its pathophysiology. Preliminary studies suggest that phosphodiesterase 5 (PDE5) – an enzyme that degrades cGMP – may play a role, as the PDE5 inhibitor sildenafil was found to reduce vasospasm after SAH. However, several questions that are critical when considering translational studies remain unanswered. Objective To elucidate the mechanism of action of sildenafil against vasospasm, and to assess whether sildenafil attenuates SAH-induced neuronal cell death, improves functional outcome after SAH, or causes significant physiological side effects when administered at therapeutically relevant doses. Methods SAH was induced via endovascular perforation in male C57BL6 mice. Beginning two hours later, mice received sildenafil citrate (0.7, 2 or 5mg/kg P.O. BID) or vehicle. Neurological outcome was assessed daily. Vasospasm was determined on post-SAH Day 3. Brain PDE5 expression and activity, cGMP content, neuronal cell death, arterial blood pressure (BP), and intracranial pressure (ICP) were examined. Results We found that PDE5 activity (but not expression) is increased after SAH, leading to decreased cGMP levels. Sildenafil attenuates this increase in PDE5 activity and restores cGMP levels after SAH. Post-SAH initiation of sildenafil was found to reduce vasospasm, decrease neuronal cell death, and markedly improve neurological outcome, without causing significant physiological side effects. Conclusion Sildenafil–an FDA-approved drug with a proven track record of safety in humans –is a promising new therapy for vasospasm and neurological deficits following SAH. PMID:21796010

Han, Byung Hee; Vellimana, Ananth Kesav; Zhou, Meng-Liang; Milner, Eric; Zipfel, Gregory Joseph

2014-01-01

102

Critical care of aneurysmal subarachnoid hemorrhage: state of the art.  

PubMed

Subarachnoid hemorrhage (SAH) from a ruptured aneurysm is a very complex disease. The brain can be injured from the immediate effects of the acute bleeding, but can also be threatened by secondary insults hours and days later. Early and delayed systemic complications are common and can be very serious. This brief paper summarizes key practical concepts regarding the neurocritical care of patients with aneurysmal SAH (aSAH). It proposes as a framework the division of the time course of the disease into a first phase (from aneurysm rupture to aneurysm treatment) of resuscitation and stabilization and a second phase (from aneurysm treatment to the end of the acute hospitalization) of prevention and treatment of secondary insults. The main mechanisms of cerebral injury and the principal systemic complications are discussed and diagnostic and therapeutic advice is provided based on a combination of available evidence and clinical experience. PMID:25366630

Rabinstein, Alejandro A

2015-01-01

103

A Case of Life-threatening Hemorrhagic Shock Due to Spontaneous Rupture of a Leg Varicose Vein  

PubMed Central

We report a case of massive, life-threatening from a varicose lesion of the right lower extremity. An 81-year-old lady was brought to the emergency room at our hospital because of massive bleeding from her right leg. She had had high ligation of the right saphenous vein at another hospital 2 years ago. After hemostat and transfusion, she recovered from hemorrhagic shock. Three-dimensional enhanced computed tomography angiography revealed a residual right great saphenous vein and recurrent varicose lesion. We performed high ligation of the great saphenous vein and closed all of the residual perforators. The patient was discharged hospital 10 days after the surgery and experienced no bleeding episodes within 8 months after the surgery. Certain high ligation and elimination of perforators of the great saphenous vein in surgery for varicose vein of leg is necessary to prevent lethal bleeding.

Shimada, Yasuyuki

2012-01-01

104

[Timing of helicopter transportation for patients presenting with subarachnoid hemorrhage on isolated islands].  

PubMed

Cerebral aneurysm re-rupture following subarachnoid hemorrhage(SAH)is a serious problem that is related with poor outcome. It is generally said that re-rupture occurs within 6 hours of the initial SAH;in the acute stage, strict management is needed even in the period before hospitalization. The aim of this study was to confirm whether patients on isolated islands should be transferred by helicopter > 6 hours after the initial SAH. Here we reviewed 125 cases of SAH in the isolated islands of Nagasaki prefecture between January 2007 and December 2012 who were transferred to Nagasaki Medical Center by helicopter as a result of consultation via TeleStroke(41 men, 84 women;mean age, 65.76 years). Re-rupture was observed in seven patients(5.6%), five of whom were diagnosed with re-rupture in a prior hospital on the isolated island. No patients demonstrated clinical deterioration during transport. Early helicopter transportation under adequate sedation and control of blood pressure within 6 hours is safe, and patients should be transferred as quickly as possible during the day. On the other hand, at night, flight safety must first be considered. Patients in stable clinical condition may be transferred the next day. We should pay special attention to patients with SAH and intracerebral hemorrhage, severe SAH, or vertebral artery dissecting aneurysm because their condition may gradually become more serious even if initially stable. PMID:24920741

Kawahara, Ichiro; Matsunaga, Yuki; Tsutsumi, Keisuke; Takahata, Hideaki; Ono, Tomonori; Toda, Keisuke; Baba, Hiroshi

2014-06-01

105

The Portuguese intra-industry tradeand the labor market adjustment costs: The SAH Again  

Microsoft Academic Search

This paper provides an empirical test of the SAH (Smooth Adjustment Hypothesis) using data from Portugal. According to SAH, intra-industry trade leads to relatively lower adjustment costs in comparison to inter-industry trade. The paper tests the SAH by using a dynamic panel data analysis that takes into account lagged effects of changes in the MIIT (Marginal Intra-Industry Trade) index. The

Horácio C. Faustino; Nuno Carlos Leitão

2010-01-01

106

CSF leukotriene C4 following subarachnoid hemorrhage.  

PubMed

Leukotrienes derive from arachidonic acid metabolism via the lipoxygenase pathway and modulate several cellular events. In the central nervous system, leukotrienes are mainly synthesized in the gray matter and in vascular tissues. Their production is enhanced in ischemic conditions and in experimental subarachnoid hemorrhage (SAH). Previous studies have indicated the ability of the leukotrienes C4 and D4 to constrict arterial vessels in vivo and in vitro and have suggested their involvement in the pathogenesis of cerebral arterial spasm. In the present study, the authors measured lumbar and cisternal cerebrospinal fluid (CSF) levels of leukotriene C4 in 48 patients who had suffered aneurysmal SAH. In 12 of the cases, symptomatic and radiological spasm was evident. The mean lumbar CSF level of immunoreactive-like activity of leukotriene C4 (i-LTC4) was significantly higher (p less than 0.005) than in control cases, while the cisternal CSF level was higher than the lumbar mean concentration (p less than 0.005). Patients presenting with vasospasm had significantly higher levels of i-LTC4 compared to patients without symptomatic vasospasm. This is the first report concerning monitoring of i-LTC4 levels in the CSF after SAH. The results of this study suggest that: 1) metabolism of arachidonic acid via the lipoxygenase pathway is enhanced after SAH; 2) the higher cisternal CSF levels of i-LTC4 may be part of the biological response in the perianeurysmal subarachnoid cisterns after the hemorrhage; and 3) the higher CSF levels of i-LTC4 in patients presenting with vasospasm suggest that a relationship exists between this compound and arterial spasm and/or reflect the development of cerebral ischemic damage. PMID:3418380

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

1988-10-01

107

Simvastatin Re-Couples Dysfunctional Endothelial Nitric Oxide Synthase in Experimental Subarachnoid Hemorrhage  

PubMed Central

Reduced endothelial nitric oxide synthase (eNOS) function has been linked to secondary complications of subarachnoid hemorrhage (SAH). We previously found that there is increased eNOS function after SAH but that it is uncoupled, leading to secondary complications such as vasospasm, microthromboembolism and neuronal apoptosis. Here we test the hypothesis that recoupling eNOS with simvastatin can prevent these complications. SAH was created in mice that were treated with vehicle or simvastatin starting 2 weeks before or 30 minutes after SAH. SAH increased phosphorylated eNOS which was prevented by pre- or post-treatment with simvastatin. Simvastatin pre-treatment also prevented the increase in eNOS monomer formation that was associated with SAH, decreased superoxide anion radical production and increased NO. These changes were associated with decreased vasospasm, microthromboemboli and neuronal injury. The data suggest that simvastatin re-couples eNOS after SAH, leading to decreased secondary complications such as vasospasm, microthromboemboli and neuronal injury. PMID:21373645

Sabri, Mohammed; Ai, Jinglu; Marsden, Philip A.; Macdonald, R. Loch

2011-01-01

108

Subarachnoid hemorrhage: tests of association with apolipoprotein E and elastin genes  

PubMed Central

Background Apolipoprotein E (APOE) and elastin (ELN) are plausible candidate genes involved in the pathogenesis of stroke. We tested for association of variants in APOE and ELN with subarachnoid hemorrhage (SAH) in a population-based study. We genotyped 12 single nucleotide polymorphisms (SNPs) on APOE and 10 SNPs on ELN in a sample of 309 Caucasian individuals, of whom 107 are SAH cases and 202 are age-, race-, and gender-matched controls from the Greater Cincinnati/Northern Kentucky region. Associations were tested at genotype, allele, and haplotype levels. A genomic control analysis was performed to check for spurious associations resulting from population substructure. Results At the APOE locus, no individual SNP was associated with SAH after correction for multiple comparisons. Haplotype analysis revealed significant association of the major haplotype (Hap1) in APOE with SAH (p = 0.001). The association stemmed from both the 5' promoter and the 3' region of the APOE gene. APOE ?2 and ? 4 were not significantly associated with SAH. No association was observed for ELN at genotype, allele, or haplotype level and our study failed to confirm previous reports of ELN association with aneurysmal SAH. Conclusion This study suggests a role of the APOE gene in the etiology of aneurysmal SAH. PMID:17672902

Kaushal, Ritesh; Woo, Daniel; Pal, Prodipto; Haverbusch, Mary; Xi, Huifeng; Moomaw, Charles; Sekar, Padmini; Kissela, Brett; Kleindorfer, Dawn; Flaherty, Matthew; Sauerbeck, Laura; Chakraborty, Ranajit; Broderick, Joseph; Deka, Ranjan

2007-01-01

109

Effect of 18?-glycyrrhetinic acid on cerebral vasospasm caused by asymmetric dimethylarginine after experimental subarachnoid hemorrhage in rats.  

PubMed

Objectives: Cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH) is characterized by the severe constriction of an artery, which often leads to unfavorable outcomes. CVS after SAH is closely associated with asymmetric dimethylarginine (ADMA) and connexin. The effect of 18?-glycyrrhetinic acid (18?-GA), an inhibitor of gap junction, on ADMA, connexin, and CVS after SAH were investigated. Methods: Sprague-Dawley rats (n ?=? 120), weighing 300-350 g, were divided into the control group, sham, SAH, and SAH + 18?-GA groups. In the SAH group, blood was injected into the prechiasmatic cistern of the rats, and 18?-GA (10 mg/kg) was intraperitoneally injected. The neurological score, basilar artery diameter, ADMA, and connexin protein contents (Cx40, Cx43, and Cx45) were measured using Kaoutzanis scoring system, pressure myograph, enzyme linked immunosorbent assay kit, and Western blot, respectively, 1, 3, 5, 7, and 14 days after SAH. Results: The neurological score significantly decreased 3, 5, 7, and 14 days after SAH. The basilar artery diameter significantly decreased, and the ADMA level in the cerebrospinal fluid (CSF) significantly increased at all time points. The level of Cx40 significantly decreased on days 3, 5, 7, and 14, and the level of Cx43 and Cx45 significantly increased at all time points. ADMA and Cx43 are positively correlated. However, the upregulated level of ADMA, Cx43, and Cx45 were attenuated. The neurology result significantly improved in the SAH + 18?-GA group. Conclusions: Treatment with 18?-GA in SAH rats decreases Cx43 and Cx45 in basilar artery and ADMA in CSF. ADMA is probably involved in the pathophysiological events of CVS after SAH by altering connexin proteins. The mechanism of connexin protein changes caused by ADMA needs to be further studied. PMID:25475507

Zhao, Dong; Liu, Qi; Ji, Yunxiang; Wang, Ganggang; He, Xuejun; Tian, Weidong; Xu, Hui; Lei, Ting; Wang, Yezhong

2014-12-01

110

Cannabinoid type 2 receptor stimulation attenuates brain edema by reducing cerebral leukocyte infiltration following subarachnoid hemorrhage in rats.  

PubMed

Early brain injury (EBI), following subarachnoid hemorrhage (SAH), comprises blood-brain barrier (BBB) disruption and consequent edema formation. Peripheral leukocytes can infiltrate the injured brain, thereby aggravating BBB leakage and neuroinflammation. Thus, anti-inflammatory pharmacotherapies may ameliorate EBI and provide neuroprotection after SAH. Cannabinoid type 2 receptor (CB2R) agonism has been shown to reduce neuroinflammation; however, the precise protective mechanisms remain to be elucidated. This study aimed to evaluate whether the selective CB2R agonist, JWH133 can ameliorate EBI by reducing brain-infiltrated leukocytes after SAH. Adult male Sprague-Dawley rats were randomly assigned to the following groups: sham-operated, SAH with vehicle, SAH with JWH133 (1.0mg/kg), or SAH with a co-administration of JWH133 and selective CB2R antagonist SR144528 (3.0mg/kg). SAH was induced by endovascular perforation, and JWH133 was administered 1h after surgery. Neurological deficits, brain water content, Evans blue dye extravasation, and Western blot assays were evaluated at 24h after surgery. JWH133 improved neurological scores and reduced brain water content; however, SR144528 reversed these treatment effects. JWH133 reduced Evans blue dye extravasation after SAH. Furthermore, JWH133 treatment significantly increased TGF-?1 expression and prevented an SAH-induced increase in E-selectin and myeloperoxidase. Lastly, SAH resulted in a decreased expression of the tight junction protein zonula occludens-1 (ZO-1); however, JWH133 treatment increased the ZO-1 expression. We suggest that CB2R stimulation attenuates neurological outcome and brain edema, by suppressing leukocyte infiltration into the brain through TGF-?1 up-regulation and E-selectin reduction, resulting in protection of the BBB after SAH. PMID:24819918

Fujii, Mutsumi; Sherchan, Prativa; Krafft, Paul R; Rolland, William B; Soejima, Yoshiteru; Zhang, John H

2014-07-15

111

Spreading depolarization: a possible new culprit in the delayed cerebral ischemia of subarachnoid hemorrhage.  

PubMed

Aneurysmal subarachnoid hemorrhage (SAH) is a devastating disease with a high mortality and morbidity rate. Gradual improvements have been made in the reduction of mortality rates associated with the disease during the last 30 years. However, delayed cerebral ischemia (DCI), the major delayed complication of SAH, remains a significant contributor to mortality and morbidity despite substantial research and clinical efforts. During the last several years, the predominant role of cerebral vasospasm, the long-accepted etiologic factor behind DCI, has been questioned. It is now becoming increasingly clear that the pathophysiology underlying DCI is multifactorial. Cortical spreading depression is emerging as a likely factor in this complex web of pathologic changes after SAH. Understanding its role after SAH and its relationship with the other pathologic processes such as vasospasm, microcirculatory dysfunction, and microemboli will be vital to the development of new therapeutic approaches to reduce DCI and improve the clinical outcome of the disease. PMID:20837823

Leng, Lewis Z; Fink, Matthew E; Iadecola, Costantino

2011-01-01

112

The Incidence of Aneurysmal Subarachnoid Hemorrhage in Youngdong District, Korea  

PubMed Central

Objective The purpose of this study is to investigate the incidence of aneurysmal subarachnoid hemorrhage (SAH) in Youngdong district for 10 years. Methods From Jan. 1997 to Dec. 2006, 732 patients (327 males, 405 females, mean age: 54.8±13.1 years) with spontaneous SAH were admitted to our hospital. We reviewed the medical records and radiological findings regarding to the ictus of SAH, location and size of the ruptured aneurysms, Hunt-Hess grade and Fisher grade on admission, personal details such as address, age, and sex, and previous history of medical diseases. Results In these 732 patients, 672 cases were confirmed as aneurysmal SAH. Among them, 611 patients (262 males, 349 females, mean age: 54.9±13.2 years) came from Youngdong district. The average crude annual incidence of aneurysmal SAH for men, women, and both sexes combined in Youngdong district was 7.8±1.7, 10.5±2.7, and 9.1±2.1 per 100,000 population, respectively. Because of the problems related to the observation period and geographical confinement, it was suspected that the representative incidence of aneurysmal SAH in Youngdong district should be made during the later eight years in six coastal regions. Therefore, the average age-adjusted annual incidence for men, women, and both sexes combined was 8.8±1.4, 11.2±1.3 and 10.0±1.0, respectively in the coastal regions of Youngdong district from 1999 to 2006. Conclusion In overall, our results on the incidence of aneurysmal SAH was not very different from previous observations from other studies. PMID:19096553

Lee, Hyoung Soo; Kim, Young June; Jang, Yeon Gyu; Rhee, Woo Tack; Lee, Sang Youl

2007-01-01

113

Everyday Memory in Microsurgically Treated Patients After Subarachnoid Hemorrhage  

PubMed Central

Background Memory declines measured by traditional tests in patients after subarachnoid hemorrhage (SAH) are well documented. Classic examinations of memory problems sometimes do not significantly correlate with memory functions in everyday life. The objective of the study was to assess the specific type of everyday memory loss in patients after microsurgical treatment of ruptured intracranial aneurysm causing SAH. Methods The prospective controlled, randomized study was conducted using the specific tests for everyday memory measure with high ecological validity. All patients were operated on by the same neurosurgeon (KD). Preoperatively, patients were in a good grade (Hunt-Hess I or II), with no neurological deficit and no hydrocephalus postoperatively. Patients were tested at two phases: 15 and 45 days after microsurgery with the Rivermead behavioral memory test (RBMT) and the cognitive failure questionnaire (CFQ). Results We compared the results of the tests administered in subjects that underwent microdiscectomy surgery for SAH to a control group that underwent surgery for lumbar disc herniation (DH). Conclusion Neuropsychological assessment of operated patients who sustained SAH showed a decline, compared to the DH group, in everyday memory function. Also, we found failures in perception and motor function in operated SAH patients with a trend of cognitive recovery as time progresses.

Koso, Maida; Dizdarevic, Kemal; Sose-Selimotic, Jasmina

2015-01-01

114

The Siva-1 putative amphipathic helical region (SAH) is sufficient to bind to BCL-XL and sensitize cells to UV radiation induced apoptosis.  

PubMed

The human Siva gene is localized to chromosome 14q32-33 and gives rise to the full-length predominant form, Siva-1 and a minor alternate form, Siva-2 that appears to lack the proapoptotic properties of Siva-1. Our recent work has shown that the missing region in Siva-2 encodes a unique twenty amino acid putative amphipathic helical region (SAH, residues 36-55 in Siva-1). Despite the fact that Siva-1 does not belong to the BCL-2 family, it specifically interacts with the anti-apoptotic protein BCL-XL and sensitizes MCF7 breast cancer cells expressing BCL-XL to UV radiation induced apoptosis. Deletion mutagenesis has mapped the necessary region to the SAH in Siva-1. In this paper we demonstrate that the SAH region in Siva-1 is sufficient to specifically interact with the anti-apoptotic members of the BCL2 family such as BCL-XL and BCL-2 but not its apoptotic member BAX. Using transient transfections and direct microinjection of synthetic SAH peptides, we also demonstrate that the SAH region is sufficient to inhibit the BCL-XL mediated cell survival and render MDA-MB-231 and MCF7 breast cancer cells expressing BCL-XL highly susceptible to UV radiation induced apoptosis. The underlying mechanism of action of SAH mediated inhibition of BCL-XL (and/or BCL2) cell survival appears to be due to loss of mitochondrial integrity as reflected in enhanced cytochrome c release leading to the activation of caspase 9 and finally caspase 3. PMID:14739602

Chu, F; Borthakur, A; Sun, X; Barkinge, J; Gudi, R; Hawkins, S; Prasad, K V S

2004-01-01

115

Multichannel near-infrared spectroscopy as a tool for assisting intra-arterial fasudil therapy for diffuse vasospasm after subarachnoid hemorrhage  

PubMed Central

Background: Diffuse cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH) refractory to medical management can be treated with intra-arterial administration of vasodilators, but valid bedside monitoring for the diagnosis and therapeutic assessment is poorly available. We demonstrate the successful application of regional cerebral oxygen saturation (rSO2) monitoring with multichannel near-infrared spectroscopy (NIRS) in assisting intra-arterial infusions of fasudil hydrochloride to a patient suffering from post-SAH vasospasm in the distal vascular territories. Case Description: A 63-year-old man presented with SAH and intracerebral hematoma due to ruptured right middle cerebral artery aneurysm developed aphasia and right-sided weakness on day 9 after SAH onset. Delayed cerebral ischemia attributable to diffuse vasospasm in the distal territories of the left anterior and middle cerebral arteries was suspected. Since the symptoms persisted despite maximal hyperdynamic therapy with dobutamine, intra-arterial fasudil treatment in the setting of rSO2 monitoring including the spasm-affected vascular territory with four-channel flexible NIRS sensors was subsequently performed. Decreased and fluctuating rSO2 in angiographically documented vasospastic territories increased immediately after intra-arterial fasudil infusion in accordance with relief of vasospasm that correlated with neurological improvement. The procedure was repeated on day 11 since the effect was transient and neurological deterioration and reduction of rSO2 recurred. The deficits resolved accompanied by uptake and maintenance of rSO 2 following the intra-arterial fasudil, resulting in favorable functional outcome. Conclusion: Continuous rSO2 monitoring with multichannel NIRS is a feasible strategy to assist intraarterial fasudil therapy for detecting and treating the focal ischemic area exposed to diffuse vasospasm. PMID:21697982

Mutoh, Tatsushi; Kobayashi, Shinya; Tamakawa, Noriyuki; Ishikawa, Tatsuya

2011-01-01

116

Identification of the copper chaperone SAH in Ovis aries: expression analysis and in vitro interaction of SAH with ATP7B  

Microsoft Academic Search

A clone encoding the putative copper chaperone protein Sheep Atx1 Homologue (SAH) was isolated from a sheep liver cDNA library. The 466-bp cDNA encoded a predicted protein of 68 amino acids, with 44 and 81% amino acid identity to the yeast Atx1 and human Atox1 copper chaperone proteins, respectively. The characteristic MTCxxC and KTGK motifs were conserved in SAH. Northern

Paul J. Lockhart; Julian F. B. Mercer

2000-01-01

117

Correlation between plasma total nitric oxide levels and cerebral vasospasm and clinical outcome in patients with aneurysmal subarachnoid hemorrhage in Indian population  

PubMed Central

Context: Cerebral vasospasm remains a major cause of morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (aSAH). Reduced bioavailability of nitric oxide has been associated with the development of cerebral vasospasm after aSAH. Such data is not available in Indian population. Aims: The objective of the study was to measure the plasma total nitric oxide (nitrite and nitrate-NOx) level in aSAH patients and healthy controls treated at a tertiary hospital in India and to investigate a possible association between plasma total nitric oxide level and cerebral vasospasm and clinical outcome following treatment in patients with aSAH. Settings and Design: A case-control study of aSAH patients was conducted. Plasma total NOx levels were estimated in aSAH patients with and without vasospasm and compared the results with NOx levels in healthy individuals. Materials and Methods: aSAH in patients was diagnosed on the basis of clinical and neuro-imaging findings. Plasma total NOx levels in different subject groups were determined by Griess assay. Results: Plasma total NOx level was found to be significantly decreased in patients with aSAH when compared to controls. Plasma total NOx level in the poor-grade SAH group was lower than that in the good-grade SAH group. Plasma total NOx level further reduced in patients with angiographic (P < 0.05) and clinical vasospasm. Conclusions: Reduced plasma NOx level is seen in aSAH patients as compared to normal individuals. In aSAH patients reduced levels are associated with increased incidence of cerebral vasospasm and poor outcome. Plasma total NOx level could be used as a candidate biomarker for predicting vasospasm and outcome for this pathology.

Ramesh, Shruthi Shimoga; Prasanthi, Aripirala; Bhat, Dhananjaya Ishwar; Devi, Bhagavatula Indira; Cristopher, Rita; Philip, Mariamma

2014-01-01

118

Early Brain Injury: A Common Mechanism in Subarachnoid Hemorrhage and Global Cerebral Ischemia  

PubMed Central

Early brain injury (EBI) has become an area of extreme interest in the recent years and seems to be a common denominator in the pathophysiology of global transient ischemia and subarachnoid hemorrhage (SAH). In this paper, we highlight the importance of cerebral hypoperfusion and other mechanisms that occur in tandem in both pathologies and underline their possible roles in triggering brain injury after hemorrhagic or ischemic strokes. PMID:23533958

Macdonald, R. Loch

2013-01-01

119

Subarachnoid hemorrhage in the rat: cerebral blood flow and glucose metabolism after selective lesions of the catecholamine systems in the brainstem  

SciTech Connect

A double-isotope autoradiographic technique was used to evaluate CBF and glucose metabolism 2 days after a subarachnoid hemorrhage (SAH) in rats with lesions in the lower brainstem. Lesioning in the mesencephalon of the ascending catecholamine pathways from locus ceruleus and from the A1 and A2 nuclei, or lesioning in the medulla oblongata of the ascending fibers from A1 and A2, prevents the development of the global changes in flow and metabolism seen in normal animals post SAH. Also the focal low-flow areas with markedly elevated deoxyglucose uptake, which can develop in normal animals 2 days post SAH, were not seen in the lesioned animals after the SAH. The findings indicate that the A1 and A2 nuclei, which project to the hypothalamus-pituitary, are essential for the flow and metabolic changes after an SAH. The lesions per se did not change baseline flow and metabolism as compared with sham-lesioned animals.

Delgado, T.J.; Diemer, N.H.; Svendgaard, N.A.

1986-10-01

120

Glycyrrhizic acid confers neuroprotection after subarachnoid hemorrhage via inhibition of high mobility group box-1 protein: a hypothesis for novel therapy of subarachnoid hemorrhage.  

PubMed

Subarachnoid hemorrhage usually results in poor clinical outcome and devastating neurological deficits. The early brain injury and delayed vasospasm after subarachnoid hemorrhage (SAH) are involved in the poor prognosis to the patients, while the mechanisms have not been well elucidated. Previous studies found an up-regulation of Toll-like receptor 4 (TLR4), inflammatory factors and high-mobility group box 1 (HMGB1) in the cortex after SAH. Increased inflammatory response contributes to the early brain injury and delayed vasospasm after SAH. Moreover, we found that the inflammatory response could be induced and amplified following recombinant HMGB1 (rHMGB1) addition in cultured neurons. Based on the latest researches in this field, we raised a hypothesis that HMGB1, a prototypical member of damage-associated molecular pattern (DAMP) family, could be passively released from the damaged neuroglia cells and hemotocyte lysis after SAH. Extracellular HMGB1 initiated the inflammation through its receptors. The inflammatory mediators then acted on the neurocytes to make them actively release HMGB1 continuously, manifesting an double phases. HMGB1 might be the key factor to induce sterile inflammation, and thus be one of the origin of early brain injury and delayed vasospasm after SAH. Inhibition of extracellular HMGB1 activities might be a novel therapeutic target for SAH to reduce the damaging inflammatory response. Glycyrrhizic acid (GA) which was extracted from liquorice and confirmed as a nature inhibitor of HMGB1 with little side-effects could inhibit extracellular HMGB1 cytokine activities and reduce the level of inflammatory response, thus alleviating early brain injury and cerebrovasospasm. GA might be a new novel therapy of SAH for better outcomes. PMID:23932051

Sun, Qing; Wang, Fan; Li, Wei; Li, Weide; Hu, Yang-chun; Li, Song; Zhu, Jian-hong; Zhou, Mengliang; Hang, Chun-hua

2013-10-01

121

Dengue hemorrhagic fever  

MedlinePLUS

Hemorrhagic dengue; Dengue shock syndrome; Philippine hemorrhagic fever; Thai hemorrhagic fever; Singapore hemorrhagic fever ... Yellow Fever, Dengue, Dengue Hemorrhagic Fever, Japanese ... Encephalitis, St. Louis Encephalitis, Tick-Borne Encephalitis). ...

122

Rescue Therapy for Refractory Vasospasm after Subarachnoid Hemorrhage  

PubMed Central

Vasospasm and delayed cerebral ischemia remain to be the common causes of increased morbidity and mortality after aneurysmal subarachnoid hemorrhage. The majority of clinical vasospasm responds to hemodynamic augmentation and direct vascular intervention; however, a percentage of patients continue to have symptoms and neurological decline. Despite suboptimal evidence, clinicians have several options in treating refractory vasospasm in aneurysmal subarachnoid hemorrhage (aSAH), including cerebral blood flow enhancement, intra-arterial manipulations, and intra-arterial and intrathecal infusions. This review addresses standard treatments as well as emerging novel therapies aimed at improving cerebral perfusion and ameliorating the neurologic deterioration associated with vasospasm and delayed cerebral ischemia. PMID:25501582

Durrant, Julia C.; Hinson, Holly E.

2014-01-01

123

Cyclosporin A ameliorates early brain injury after subarachnoid hemorrhage through inhibition of a Nur77 dependent apoptosis pathway.  

PubMed

Nur77 is a potent pro-apoptotic member of the orphan nuclear receptor superfamily. It has been demonstrated that can mediate apoptosis in many system cells in response to extracellular stimuli. Our previous study revealed Nur77-mediated apoptotic also involved in early brain injury (EBI) after experimental subarachnoid hemorrhage (SAH). CsA, a Nur77 inhibitor, can abolish DNA binding activity of Nur77, further inhibit the Nur77 dependent apoptosis pathway. CsA has the neuroprotective effects and has been demonstrated in ischemic stroke and traumatic brain injury. Hence, in this study was designed to explore the neuroprotective effects of CsA in EBI after SAH. Adult male SD rats were randomly assigned to four groups: (1) control group (n = 24); (2) SAH (n = 24); (3) SAH+DMSO group (n = 24); and (4) SAH+CsA (n = 24), 10 mg/kg of CsA or same volume of DMSO was administered by femoral vein injection at 15 min before SAH. CsA markedly decreased expressions of Nur77, p-Nur77, Bcl-2 and cyto C, and inhibited apoptosis.Improvement of neurological deficit, alleviation of brain edema and amelioration of EBI were obtained after prophylactic use of CsA. TUNEL-positive cells were reduced markedly in brain cortex by CsA. These findings suggest that neuroprotective effects of CsA during early peroid after SAH may be related to its inhibition of Nur77 dependent apoptosis pathway. PMID:24508908

Dai, Yuxiang; Sun, Qing; Zhang, Xing; Hu, Yangchun; Zhou, Mengliang; Shi, Jixin

2014-03-27

124

Imatinib preserves blood-brain barrier integrity following experimental subarachnoid hemorrhage in rats.  

PubMed

Blood-brain barrier (BBB) disruption and consequent edema formation contribute to the development of early brain injury following subarachnoid hemorrhage (SAH). Various cerebrovascular insults result in increased platelet-derived growth factor receptor (PDGFR)-? stimulation, which has been linked to BBB breakdown and edema formation. This study examines whether imatinib, a PDGFR inhibitor, can preserve BBB integrity in a rat endovascular perforation SAH model. Imatinib (40 or 120 mg/kg) or a vehicle was administered intraperitoneally at 1 hr after SAH induction. BBB leakage, brain edema, and neurological deficits were evaluated. Total and phosphorylated protein expressions of PDGFR-?, c-Src, c-Jun N-terminal kinase (JNK), and c-Jun were measured, and enzymatic activities of matrix metalloproteinase (MMP)-2 and MMP-9 were determined in the injured brain. Imatinib treatment significantly ameliorated BBB leakage and edema formation 24 hr after SAH, which was paralleled by improved neurological functions. Decreased brain expressions of phosphorylated PDGFR-?, c-Src, JNK, and c-Jun as well as reduced MMP-9 activities were found in treated animals. PDGFR-? inhibition preserved BBB integrity following experimental SAH; however, the protective mechanisms remain to be elucidated. Targeting PDGFR-? signaling might be advantageous to ameliorate early brain injury following SAH. © 2014 Wiley Periodicals, Inc. PMID:25196554

Zhan, Yan; Krafft, Paul R; Lekic, Tim; Ma, Qingyi; Souvenir, Rhonda; Zhang, John H; Tang, Jiping

2015-01-01

125

Insurance Status Is Associated with Treatment Allocation and Outcomes after Subarachnoid Hemorrhage  

PubMed Central

Objective Subarachnoid hemorrhage (SAH) is a particularly devastating type of stroke which is responsible for one third of all stroke-related years of potential life lost before age 65. Surgical treatment has been shown to decrease both morbidity and mortality after subarachnoid hemorrhage. We hypothesized that payer status other than private insurance is associated with lower allocation to surgical treatment for patients with SAH and worse outcomes. Design We examined the association between insurance type and surgical treatment allocation and outcomes for patients with SAH while adjusting for a wide range of patient and hospital factors. We analyzed the Nationwide Inpatient Sample hospital discharge database using survey procedures to produce weighted estimates representative of the United States population. Patients We studied 21047 discharges, representing a weighted estimate of 102595 patients age 18 and above with a discharge diagnosis of SAH between 2003 and 2008. Measurements Multivariable logistic and generalized linear regression analyses were used to assess for any associations between insurance status and surgery allocation and outcomes. Main Results Despite the benefits of surgery 66% of SAH patients did not undergo surgical treatment to prevent rebleeding. Mortality was more than twice as likely for patients with no surgical treatment compared to those who received surgery. Medicare patients were significantly less likely to receive surgical treatment. Conclusions Nearly two thirds of patients with SAH don't receive operative care, and Medicare patients were significantly less likely to receive surgical treatment than other patients. Bias against the elderly and those with chronic illness and disability may play a part in these findings. A system of regionalized care for patients presenting with SAH may reduce disparities and improve appropriate allocation to surgical care and deserves prospective study. PMID:25141303

Hobson, Charles; Dortch, John; Ozrazgat Baslanti, Tezcan; Layon, Daniel R.; Roche, Alina; Rioux, Alison; Harman, Jeffrey S.; Fahy, Brenda; Bihorac, Azra

2014-01-01

126

Cannabinoid receptor type 2 agonist attenuates apoptosis by activation of phosphorylated CREB-Bcl-2 pathway after subarachnoid hemorrhage in rats.  

PubMed

Early brain injury (EBI) which comprises of vasogenic edema and apoptotic cell death is an important component of subarachnoid hemorrhage (SAH) pathophysiology. This study evaluated whether cannabinoid receptor type 2 (CB2R) agonist, JWH133, attenuates EBI after SAH and whether CB2R stimulation reduces pro-apoptotic caspase-3 via up-regulation of cAMP response element-binding protein (CREB)-Bcl-2 signaling pathway. Male Sprague-Dawley rats (n=123) were subjected to SAH by endovascular perforation. Rats received vehicle or JWH133 at 1h after SAH. Neurological deficits and brain water content were evaluated at 24h after SAH. Western blot was performed to quantify phosphorylated CREB (pCREB), Bcl-2, and cleaved caspase-3 levels. Neuronal cell death was evaluated with terminal deoxynucleotidyl transferase-mediated uridine 5'-triphosphate-biotin nick end-labeling staining. Additionally, CREB siRNA was administered to manipulate the proposed pathway. JWH133 (1.0mg/kg) improved neurological deficits and reduced brain water content in left hemisphere 24h after SAH. JWH133 significantly increased activated CREB (pCREB) and Bcl-2 levels and significantly decreased cleaved caspase-3 levels in left hemisphere 24h after SAH. CREB siRNA reversed the effects of treatment. TUNEL positive neurons in the cortex were reduced with JWH133 treatment. Thus, CB2R stimulation attenuated EBI after SAH possibly through activation of pCREB-Bcl-2 pathway. PMID:25058046

Fujii, Mutsumi; Sherchan, Prativa; Soejima, Yoshiteru; Hasegawa, Yu; Flores, Jerry; Doycheva, Desislava; Zhang, John H

2014-11-01

127

Attenuation of early brain injury and learning deficits following experimental subarachnoid hemorrhage secondary to Cystatin C: possible involvement of the autophagy pathway.  

PubMed

Cystatin C (CysC) is a cysteine protease inhibitor and previous studies have demonstrated that increasing endogenous CysC expression has therapeutic implications on brain ischemia, Alzheimer's disease, and other neurodegenerative disorders. Our previous reports have demonstrated that the autophagy pathway was activated in the brain after experimental subarachnoid hemorrhage (SAH), and it may play a beneficial role in early brain injury (EBI). This study investigated the effects of exogenous CysC on EBI, cognitive dysfunction, and the autophagy pathway following experimental SAH. All SAH animals were subjected to injections of 0.3 ml fresh arterial, nonheparinized blood into the prechiasmatic cistern in 20 s. As a result, treatment with CysC with low and medial concentrations significantly ameliorated the degree of EBI when compared with vehicle-treated SAH rats. Microtubule-associated protein light chain-3 (LC3), a biomarker of autophagosomes, and beclin-1, a Bcl-2-interacting protein required for autophagy, were significantly increased in the cortex 48 h after SAH and were further up-regulated after CysC therapy. By ultrastructural observation, there was a marked increase in autophagosomes and autolysosomes in neurons of CysC-treated rats. Learning deficits induced by SAH were markedly alleviated after CysC treatment with medial doses. In conclusion, pre-SAH CysC administration may attenuate EBI and neurobehavioral dysfunction in this SAH model, possibly through activating autophagy pathway. PMID:24203677

Liu, Yizhi; Li, Jianke; Wang, Zhong; Yu, Zhengquan; Chen, Gang

2014-04-01

128

The Contribution of Chemoreceptor-Network Injury to the Development of Respiratory Arrest Following Subarachnoid Hemorrhage  

PubMed Central

Objective: Respiratory arrest following brainstem herniation has been attributed to injuries resulting from compression of the respiratory centers. While it is widely perceived that the chemoreceptor network, consisting of the glossopharyngeal nerve and carotid body (GPN-CB), is essential for the modulation of respiration, its contribution to the development of respiratory arrest has not been investigated. Therefore, the aim of this study was to investigate whether injury to the GPN-CB occurs in animals with respiratory arrest caused by experimentally-induced subarachnoid hemorrhage. Materials and Methods: Eighteen hybrid rabbits were used in this study. Four rabbits (n=4) were used to determine the normal structure of the GPN-CB. The remaining rabbits (n=14) received an autologous blood injection into the cisterna magna to produce a subarachnoid hemorrhage, after which they were observed for 20 days. The number of axons and the neuron density in the glossopharyngeal nerve and carotid body, respectively, were counted by stereological methods. The Mann-Whitney U test was used to analyze the results. Results: Six of 14 rabbits died within the first week, likely due to brain swelling and crushing injuries that were observed in the brain stem and related structures. In control rabbits, the average neuronal density of the carotid body was 4250 ±1250/mm3, while the axonal density in the glossopharyngeal nerve was 18000±5100 mm2. Conversely, in the dead rabbits, the degenerated neuron density of the carotid body was 2100±500/mm3, while the degenerated axon density in the glossopharyngeal nerve was 8500±2550 mm2. In addition, histopathological lesions were more severe in the dead rabbits in terms of their glossopharyngeal nerve and carotid body. Conclusion: There is an important relationship between neurodegeneration in the GPN-CB and mortality rates following experimentally-induced hemorrhage. This relationship suggests that injury to the GPN-CB network disrupts the breathing reflex and results in respiratory arrest following a subarachnoid hemorrhage (SAH).

Aydin, Mehmet Dumlu; Eroglu, Atilla; Turkyilmaz, Atila; Erdem, Ali Fuat; Al?c?, Hac? Ahmet; Aydin, Nazan; Altas, Sare; Unal, Bunyami

2010-01-01

129

Molecular alterations in the hippocampus after experimental subarachnoid hemorrhage  

PubMed Central

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

130

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

131

Prophylactic Intra-Arterial Injection of Vasodilator for Asymptomatic Vasospasm Converts the Patient to Symptomatic Vasospasm due to Severe Microcirculatory Imbalance  

PubMed Central

Object. The strategy to treat asymptomatic angiographic vasospasm following subarachnoid hemorrhage (SAH) is controversial. In this study we review our consecutive vasospasm series and discuss an adequate treatment strategy for asymptomatic vasospasm. Methods. From January 2007 to December 2012 we treated 281 aneurysmal SAH cases, with postoperative angiography performed 9?±?2 days after the onset of SAH. Four asymptomatic cases received intra-arterial (IA) injection of vasodilator due to angiographic vasospasm. All cases improved vasospasm immediately following intervention. But all cases turned symptomatic within 48 hours. We retrospectively analyzed the time-density angiography curve and calculated the time to peak (TTP), mean transit time (MTT), and relative blood flow (rBF). Relative blood flow was calculated as follows. The integration of the value of the time-density curve for the artery was divided by the same value for the internal carotid artery multiplied by the MTT. Results. The decrease in TTP and MTT for the etiologic artery was similar to that of the nonetiologic artery. But the improvement in rBF for the etiologic artery and nonetiologic artery was 10% and 17%, respectively. Blood supply to the spastic artery decreased due to iatrogenic steal. Conclusion. Prophylactic IA injection of vasodilator in cases of asymptomatic vasospasm can produce symptomatic vasospasm. PMID:24822199

Matsuda, Naoya; Kakuta, Kiyohide; Ohkuma, Hiroki

2014-01-01

132

Predictors and outcomes of shunt-dependent hydrocephalus in patients with aneurysmal sub-arachnoid hemorrhage  

PubMed Central

Background Hydrocephalus following spontaneous aneurysmal sub-arachnoid hemorrhage (SAH) is often associated with unfavorable outcome. This study aimed to determine the potential risk factors and outcomes of shunt-dependent hydrocephalus in aneurysmal SAH patients but without hydrocephalus upon arrival at the hospital. Methods One hundred and sixty-eight aneurysmal SAH patients were evaluated. Using functional scores, those without hydrocephalus upon arrival at the hospital were compared to those already with hydrocephalus on admission, those who developed it during hospitalization, and those who did not develop it throughout their hospital stay. The Glasgow Coma Score, modified Fisher SAH grade, and World Federation of Neurosurgical Societies grade were determined at the emergency room. Therapeutic outcomes immediately after discharge and 18?months after were assessed using the Glasgow Outcome Score. Results Hydrocephalus accounted for 61.9% (104/168) of all episodes, including 82 with initial hydrocephalus on admission and 22 with subsequent hydrocephalus. Both the presence of intra-ventricular hemorrhage on admission and post-operative intra-cerebral hemorrhage were independently associated with shunt-dependent hydrocephalus in patients without hydrocephalus on admission. After a minimum 1.5?years of follow-up, the mean Glasgow outcome score was 3.33?±?1.40 for patients with shunt-dependent hydrocephalus and 4.21?±?1.19 for those without. Conclusions The presence of intra-ventricular hemorrhage, lower mean Glasgow Coma Scale score, and higher mean scores of the modified Fisher SAH and World Federation of Neurosurgical grading on admission imply risk of shunt-dependent hydrocephalus in patients without initial hydrocephalus. These patients have worse short- and long-term outcomes and longer hospitalization. PMID:22765765

2012-01-01

133

Mechanisms of hemorrhagic cystitis  

PubMed Central

The vast majority of cases of infectious cystitis are easily treated, and most patients have no long-term complications. However, hemorrhagic cystitis is a potentially deadly complication associated with pelvic radiation therapy, chemotherapy, and stem-cell transplant therapy. The focus of current understanding, and hence therapy, is directed toward urothelial cell death. However, the primary functional ramification of inflammatory bladder disease is the loss of compliance due to muscular expansion. Recent studies on smooth muscle response in models of bladder inflammation demonstrate a process of pyroptotic cell death that potentiates further muscle hyperplasia. These findings may support alternative interventions for subjects with hemorrhagic cystitis refractive to current therapy. PMID:25374922

Haldar, Subhash; Dru, Christopher; Bhowmick, Neil A

2014-01-01

134

Targeted over-expression of endothelin-1 in astrocytes leads to more severe brain damage and vasospasm after subarachnoid hemorrhage  

PubMed Central

Background Endothelin-1 (ET-1) is a potent vasoconstrictor, and astrocytic ET-1 is reported to play a role in the pathogenesis of cerebral ischemic injury and cytotoxic edema. However, it is still unknown whether astrocytic ET-1 also contributes to vasogenic edema and vasospasm during subarachnoid hemorrhage (SAH). In the present study, transgenic mice with astrocytic endothelin-1 over-expression (GET-1 mice) were used to investigate the pathophysiological role of ET-1 in SAH pathogenesis. Results The GET-1 mice experienced a higher mortality rate and significantly more severe neurological deficits, blood–brain barrier breakdown and vasogenic edema compared to the non-transgenic (Ntg) mice following SAH. Oral administration of vasopressin V1a receptor antagonist, SR 49059, significantly reduced the cerebral water content in the GET-1 mice. Furthermore, the GET-1 mice showed significantly more pronounced middle cerebral arterial (MCA) constriction after SAH. Immunocytochemical analysis showed that the calcium-activated potassium channels and the phospho-eNOS were significantly downregulated, whereas PKC-? expression was significantly upregulated in the MCA of the GET-1 mice when compared to Ntg mice after SAH. Administration of ABT-627 (ETA receptor antagonist) significantly down-regulated PKC-? expression in the MCA of the GET-1 mice following SAH. Conclusions The present study suggests that astrocytic ET-1 involves in SAH-induced cerebral injury, edema and vasospasm, through ETA receptor and PKC-mediated potassium channel dysfunction. Administration of ABT-627 (ETA receptor antagonist) and SR 49059 (vasopressin V1a receptor antagonist) resulted in amelioration of edema and vasospasm in mice following SAH. These data provide a strong rationale to investigate SR 49059 and ABT-627 as therapeutic drugs for the treatment of SAH patients. PMID:24156724

2013-01-01

135

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

136

Non-aneurysmal non-traumatic subarachnoid hemorrhage: patient characteristics, clinical outcome and prognostic factors based on a single-center experience in 125 patients  

PubMed Central

Background Subarachnoid hemorrhage (SAH) is mainly caused by ruptured cerebral aneurysms but in up to 15% of patients with SAH no bleeding source could be identified. Our objective was to analyze patient characteristics, clinical outcome and prognostic factors in patients suffering from non-aneurysmal SAH. Methods From 1999 to 2009, data of 125 patients with non-aneurysmal SAH were prospectively entered into a database. All patients underwent repetitive cerebral angiography. Outcome was assessed according to the modified Rankin Scale (mRS) (mRS 0–2 favorable vs. 3–6 unfavorable). Also, patients were divided in two groups according to the distribution of blood in the CT scan (perimesencephalic and non-perimesencephalic SAH). Results 106 of the 125 patients were in good WFNS grade (I-III) at admission (85%). Overall, favorable outcome was achieved in 104 of 125 patients (83%). Favorable outcome was associated with younger age (P?SAH, most patients (90%) were in good grade at admission, and 64 achieved favorable outcome. 52 of the 125 patients suffered from non-perimesencephalic SAH and 40 were in good grade at admission. Also 40 patients achieved favorable outcome. Conclusions Patients suffering from non-aneurysmal SAH have better prognosis compared to aneurysm related SAH and poor admission status was the only independent predictor of unfavorable outcome in the multivariate analysis. Patients with a non-perimesencephalic SAH have an increased risk of a worse neurological outcome. These patients should be monitored attentively. PMID:24986457

2014-01-01

137

Demonstration of Traumatic Subarachnoid Hemorrhage from the Anterior Choroidal Artery  

PubMed Central

We present a case of angiographically confirmed transection of the cisternal segment of the anterior choroidal artery (AChA) associated with a severe head trauma in a 15-year old boy. The initial brain computed tomography scan revealed a diffuse subarachnoid hemorrhage (SAH) and pneumocephalus with multiple skull fractures. Subsequent cerebral angiography clearly demonstrated a complete transection of the AChA at its origin with a massive extravasation of contrast medium as a jet trajectory creating a plume. We speculate that severe blunt traumatic force stretched and tore the left AChA between the internal carotid artery and the optic tract. In a simulation of the patient's brain using a fresh-frozen male cadaver, the AChA is shown to be vulnerable to stretching injury as the ipsilateral optic tract is retracted. We conclude that the arterial injury like an AChA rupture should be considered in the differential diagnosis of severe traumatic SAH.

Sim, Ki-Bum; Choi, H. Alex; Kim, Daniel H.

2014-01-01

138

Baincalein alleviates early brain injury after experimental subarachnoid hemorrhage in rats: Possible involvement of TLR4/NF-?B-mediated inflammatory pathway.  

PubMed

Early brain injury (EBI) following subarachnoid hemorrhage (SAH) largely contributes to unfavorable outcomes. Hence, effective therapeutic strategies targeting on EBI have recently become a major goal in the treatment of SAH patients. Baicalein is a flavonoid that has been shown to offer neuroprotection in kinds of brain injury models. This study investigated the effects of baicalein on EBI in rats following SAH. SAH was inducted in male Sprauge-Dawley rats by injection of fresh non-heparinized arterial blood into the prechiasmatic cistern. Baicalein (30 or 100mg/kg) or vehicle were administrated 30min after injury. Neurological deficit, brain edema, blood-brain barrier (BBB) permeability and neural cell apoptosis were assessed. To explore the further mechanisms, the change of toll-like receptor 4 (TLR4) and nuclear factor-?B (NF-?B) signaling pathway and the levels of apoptosis associated proteins were also examined. Our study showed that treatment with baicalein (30mg/kg) significantly improved neurological function at 24h after SAH and reduced brain edema at both 24h and 72h after SAH. Baicalein also significantly reduced neural cell death, BBB permeability. These changes were associated with the remarkable reductions of TLR4 expression, I?B-? degradation, NF-?B translocation to nucleus, as well as the expressions of matrix metalloproteinase-9, tight junctions protein, interleukin-1? and tumor necrosis factor- ?. These findings suggest that baicalein may ameliorate EBI after SAH potentially via inhibition of inflammation-related pathway. PMID:25451085

Wang, Chun-Xi; Xie, Guang-Bin; Zhou, Chen-Hui; Zhang, Xiang-Sheng; Li, Tao; Xu, Jian-Guo; Li, Ning; Ding, Ke; Hang, Chun-Hua; Shi, Ji-Xin; Zhou, Meng-Liang

2015-01-12

139

Astaxanthin alleviates early brain injury following subarachnoid hemorrhage in rats: possible involvement of Akt/bad signaling.  

PubMed

Apoptosis has been proven to play a crucial role in early brain injury pathogenesis and to represent a target for the treatment of subarachnoid hemorrhage (SAH). Previously, we demonstrated that astaxanthin (ATX) administration markedly reduced neuronal apoptosis in the early period after SAH. However, the underlying molecular mechanisms remain obscure. In the present study, we tried to investigate whether ATX administration is associated with the phosphatidylinositol 3-kinase-Akt (PI3K/Akt) pathway, which can play an important role in the signaling of apoptosis. Our results showed that post-SAH treatment with ATX could cause a significant increase of phosphorylated Akt and Bad levels, along with a significant decrease of cleaved caspase-3 levels in the cortex after SAH. In addition to the reduced neuronal apoptosis, treatment with ATX could also significantly reduce secondary brain injury characterized by neurological dysfunction, cerebral edema and blood-brain barrier disruption. In contrast, the PI3K/Akt inhibitor, LY294002, could partially reverse the neuroprotection of ATX in the early period after SAH by downregulating ATX-induced activation of Akt/Bad and upregulating cleaved caspase-3 levels. These results provided the evidence that ATX could attenuate apoptosis in a rat SAH model, potentially, in part, through modulating the Akt/Bad pathway. PMID:25072152

Zhang, Xiang-Sheng; Zhang, Xin; Wu, Qi; Li, Wei; Zhang, Qing-Rong; Wang, Chun-Xi; Zhou, Xiao-Ming; Li, Hua; Shi, Ji-Xin; Zhou, Meng-Liang

2014-08-01

140

Intracranial vasospasm with subsequent stroke after traumatic subarachnoid hemorrhage in a 22-month-old child.  

PubMed

Clinical and radiographic evidence of subarachnoid hemorrhage (SAH)-related vasospasm is rare in children and has not been reported in infants. In this report the authors present the case of a 22-month-old child who developed clinically symptomatic, radiographically identifiable vasospasm after traumatic SAH. To the authors' knowledge, this is the first report of vasospasm associated with SAH in a child this young. This 22-month-old boy fell and had a dense SAH. He had a history of surgically corrected craniosynostosis and nonsymptomatic ventriculomegaly. The boy was evaluated for occult vascular lesions using imaging; none were found and normal vessel caliber was noted. Ten days later, the child developed left-sided weakness and a right middle cerebral artery infarct was identified. Evaluation disclosed significant intracranial vasospasm. This diagnosis was supported by findings on CT angiography, transcranial Doppler ultrasonography, MR imaging, and conventional angiography. The child was treated using intraarterial verapamil with a good result, as well as with conventional intensive care measures to reduce vasospasm. This report documents the first known case of intracranial vasospasm with stroke after SAH in a patient under the age of 2 years. This finding is important because it demonstrates that the entity of SAH-associated vasospasm can affect the very young, widening the spectrum of ages susceptible to this condition. This case is also important because it demonstrates that even very young children can respond to conventional therapeutic interventions such as intraarterial verapamil. Thus, clinicians need to be alert to the possibility of vasospasm as a potential diagnosis when evaluating young children with SAH. PMID:19338410

Nahed, Brian V; Ferreira, Manuel; Naunheim, Matthew R; Kahle, Kristopher T; Proctor, Mark R; Smith, Edward R

2009-04-01

141

Therapeutic Implications of Estrogen for Cerebral Vasospasm and Delayed Cerebral Ischemia Induced by Aneurysmal Subarachnoid Hemorrhage  

PubMed Central

Cerebral vasospasm (CV) remains the leading cause of delayed morbidity and mortality following aneurysmal subarachnoid hemorrhage (SAH). However, increasing evidence supports etiologies of delayed cerebral ischemia (DCI) other than CV. Estrogen, specifically 17?-estradiol (E2), has potential therapeutic implications for ameliorating the delayed neurological deterioration which follows aneurysmal SAH. We review the causes of CV and DCI and examine the evidence for E2-mediated vasodilation and neuroprotection. E2 potentiates vasodilation by activating endothelial nitric oxide synthase (eNOS), preventing increased inducible NOS (iNOS) activity caused by SAH, and decreasing endothelin-1 production. E2 provides neuroprotection by increasing thioredoxin expression, decreasing c-Jun N-terminal kinase activity, increasing neuroglobin levels, preventing SAH-induced suppression of the Akt signaling pathway, and upregulating the expression of adenosine A2a receptor. The net effect of E2 modulation of these various effectors is the promotion of neuronal survival, inhibition of apoptosis, and decreased oxidative damage and inflammation. E2 is a potentially potent therapeutic tool for improving outcomes related to post-SAH CV and DCI. However, clinical evidence supporting its benefits remains lacking. Given the promising preclinical data available, further studies utilizing E2 for the treatment of patients with ruptured intracranial aneurysms appear warranted. PMID:24724095

Starke, Robert M.; Dumont, Aaron S.; Owens, Gary K.; Hasan, David M.

2014-01-01

142

Subarachnoid hemorrhage with transient ischemic attack: another masquerader in cerebral venous thrombosis.  

PubMed

Cerebral venous thrombosis has a wide spectrum of clinical manifestations that may mimic many other neurological disorders and lead to frequent misdiagnoses or delay in diagnosis. The most frequent symptoms and signs are headache, seizures, focal deficits, and papilledema. A number of rare atypical manifestations have been described. Cerebral venous thrombosis may present with an isolated intracranial hypertension type picture, thunderclap headache, attacks of migraine with aura, isolated psychiatric disturbances, pulsatile tinnitus, isolated or multiple cranial nerve involvement, and occasionally as subarachnoid hemorrhage (SAH) or transient ischemic attack. Our patient presented with thunderclap headache and transient ischemic attack like episode with obvious SAH on CT scan. Acute SAH suggests the presence of a vascular lesion, such as ruptured aneurysm, and CVT is not generally considered in the diagnostic workup of SAH. The case emphasizes the importance of cerebral venous study in nonaneurysmal cases of SAH. It is important to have a high index of suspicion in such atypical cases to avoid delay in diagnosis. PMID:22466498

Sharma, Bhawna; Satija, Vipin; Dubey, Parul; Panagariya, Ashok

2010-02-01

143

The role of the microcirculation in delayed cerebral ischemia and chronic degenerative changes after subarachnoid hemorrhage  

PubMed Central

The mortality after aneurysmal subarachnoid hemorrhage (SAH) is 50%, and most survivors suffer severe functional and cognitive deficits. Half of SAH patients deteriorate 5 to 14 days after the initial bleeding, so-called delayed cerebral ischemia (DCI). Although often attributed to vasospasms, DCI may develop in the absence of angiographic vasospasms, and therapeutic reversal of angiographic vasospasms fails to improve patient outcome. The etiology of chronic neurodegenerative changes after SAH remains poorly understood. Brain oxygenation depends on both cerebral blood flow (CBF) and its microscopic distribution, the so-called capillary transit time heterogeneity (CTH). In theory, increased CTH can therefore lead to tissue hypoxia in the absence of severe CBF reductions, whereas reductions in CBF, paradoxically, improve brain oxygenation if CTH is critically elevated. We review potential sources of elevated CTH after SAH. Pericyte constrictions in relation to the initial ischemic episode and subsequent oxidative stress, nitric oxide depletion during the pericapillary clearance of oxyhemoglobin, vasogenic edema, leukocytosis, and astrocytic endfeet swelling are identified as potential sources of elevated CTH, and hence of metabolic derangement, after SAH. Irreversible changes in capillary morphology and function are predicted to contribute to long-term relative tissue hypoxia, inflammation, and neurodegeneration. We discuss diagnostic and therapeutic implications of these predictions. PMID:24064495

Østergaard, Leif; Aamand, Rasmus; Karabegovic, Sanja; Tietze, Anna; Blicher, Jakob Udby; Mikkelsen, Irene Klærke; Iversen, Nina Kerting; Secher, Niels; Engedal, Thorbjørn Søndergaard; Anzabi, Mariam; Jimenez, Eugenio Gutierrez; Cai, Changsi; Koch, Klaus Ulrik; Næss-Schmidt, Erhard Trillingsgaard; Obel, Annette; Juul, Niels; Rasmussen, Mads; Sørensen, Jens Christian Hedemann

2013-01-01

144

Changes in responsiveness of the canine basilar artery to endothelin-1 after subarachnoid hemorrhage  

SciTech Connect

The effect of endothelin-1 (ET-1) on the basilar arteries from control and subarachnoid hemorrhage (SAH) dogs were examined. The maximal contraction of the basilar artery in response to ET-1 was markedly decreased in the SAH group. Treatment with 10{sup {minus}8}M phorbol 12-myristate 13-acetate (PMA) reduced the contractile responses to ET-1 in the basilar arteries from control dogs. ET-1-induced contractions of the basilar arteries from control dogs were similar to those in strips from SAH dogs by the treatment with 10{sup {minus}8}M PMA. Ca{sup 2+}-induced contraction of the basilar arteries which were depolarized with isotonic K{sup +} were significantly attenuated in SAH dogs. Treatment with PMA also reduced the contractile responses to Ca{sup 2+} in the basilar arteries from control dogs. These results indicate that decreased contractile responses of the basilar arteries to ET-1 and Ca{sup 2+} in the SAH group may be related to changes in the activity of the protein kinase C in vascular smooth muscle.

Kamata, Katsuo; Nishiyama, Hiroshi; Kasuya, Yutaka (Taisho Pharmaceutical Co. Ltd., Saitama (Japan)); Miyata, Noriyuki (Hoshi Univ., Tokyo (Japan))

1991-01-01

145

SAHIT Investigators--on the outcome of some subarachnoid hemorrhage clinical trials.  

PubMed

Outcome of patients with aneurysmal subarachnoid hemorrhage (SAH) has improved over the last decades. Yet, case fatality remains nearly 40% and survivors often have permanent neurological, cognitive and/or behavioural sequelae. Other than nimodipine drug or clinical trials have not consistently improved outcome. We formed a collaboration of SAH investigators to create a resource for prognostic analysis and for studies aimed at optimizing the design and analysis of phase 3 trials in aneurysmal SAH. We identified investigators with data from randomized, clinical trials of patients with aneurysmal SAH or prospectively collected single- or multicentre databases of aneurysmal SAH patients. Data are being collected and proposals to use the data and to design future phase 3 clinical trials are being discussed. This paper reviews some issues discussed at the first meeting of the SAH international trialists (SAHIT) repository meeting. Investigators contributed or have agreed to contribute data from several phase 3 trials including the tirilazad trials, intraoperative hypothermia for aneurysmal SAH trial, nicardipine clinical trials, international subarachnoid aneurysm trial, intravenous magnesium sulphate for aneurysmal SAH, magnesium for aneurysmal SAH and from prospectively-collected data from four institutions. The number of patients should reach 15,000. Some industry investigators refused to provide data and others reported that their institutional research ethics boards would not permit even deidentified or anonymized data to be included. Others reported conflict of interest that prevented them from submitting data. The problems with merging data were related to lack of common definitions and coding of variables, differences in outcome scales used, and times of assessment. Some questions for investigation that arose are discussed. SAHIT demonstrates the possibility of SAH investigators to contribute data for collaborative research. The problems are similar to those already documented in other similar collaborative efforts such as in head injury research. We encourage clinical trial and registry investigators to contact us and participate in SAHIT. Key issues moving forward will be to use common definitions (common data elements), outcomes analysis, and to prioritize research questions, among others. PMID:24323299

Macdonald, R Loch; Jaja, Blessing; Cusimano, Michael D; Etminan, Nima; Hanggi, Daniel; Hasan, David; Ilodigwe, Don; 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; Singh, Jeff

2013-06-01

146

Possible role of Eptifibatide drip in-patient with aneurysmal subarachnoid hemorrhage in vasospasm prevention  

PubMed Central

Objective Approximately 18,000 patients suffer from a subarachnoid hemorrhage (SAH) in the United States annually. SAH is a form of stroke and comprises 1%–5% of all strokes. Nearly 50% of all SAH cases end in fatality within 30 days of presentation; one of eight patients die before reaching a hospital. Those who survive often have neurological or cognitive impairment. Methods This case report describes the course of two patients who presented to the emergency department with aneurismal subarachnoid hemorrhage and received external ventricular drainage and endovascular treatment of their aneurysm. Results Both patients required treatment with Eptifibatide drip after endovascular approach and their SAH in the basal cisterns resolved by day 5. Neither patient developed signs of clinical or subclinical vasospasm. Comments Eptifibatide drip facilitated resolution of the thick clot in the subarachnoid space early enough to eliminate the direct toxicity of oxyhemoglobin on the cerebral arteries and arachnoid granulations, thus preventing vasospasm and eliminating the necessity for a long-term shunt. PMID:25298852

Dababneh, Haitham; Guerrero, Waldo; Mehta, Siddhart; Moussavi, Mohammad; Kirmani, Jawad F

2014-01-01

147

Rat cisterna magna double-injection model of subarachnoid hemorrhage - background, advantages/limitations, technical considerations, modifications, and outcome measures.  

PubMed

The pathophysiological changes following aneurysmal subarachnoid hemorrhage (SAH) are commonly divided into early consequences (developing shortly after the bleeding) and delayed consequences of the bleeding. The development of delayed injury mechanisms, e.g., reduced cerebral blood flow (CBF) caused by cerebral vasospasm (CVS) or development of delayed ischemic neurological deficits (DIND), seem mainly to depend on the amount and duration of the subarachnoid blood clot. CVS may progress to cerebral ischemia and infarction, and therefore lead to delayed neurological deterioration. The rat double-hemorrhage model reproduces the time course of the delayed pathophysiological consequences of CVS, which imitates the clinical setting more precisely than other rodent models. Furthermore, this model is adjustable via various technical considerations or modifications. Therefore, the double-hemorrhage model is predisposed to be used to mimic the delayed effects of SAH and to investigate the use of drugs on morphological ischemic, functional, and vasospastic effects. PMID:25366646

Güresir, Erdem; Schuss, Patrick; Borger, Valeri; Vatter, Hartmut

2015-01-01

148

Blood–brain barrier disruption following subarchnoid hemorrhage may be faciliated through PUMA induction of endothelial cell apoptosis from the endoplasmic reticulum  

Microsoft Academic Search

The blood–brain barrier (BBB) plays a vital role as both a physiologic and physical barrier in regulating the movement of water from the vasculature to the brain. During a subarachnoid hemorrhage (SAH), the BBB is disrupted by a variety of mediators, one of which can result in endothelial cell death. As a result, in the present study, we investigated the

Junhao Yan; Li Li; Nikan H. Khatibi; Lei Yang; Ke Wang; Weiguang Zhang; Robert D. Martin; Jingyan Han; John Zhang; Changman Zhou

2011-01-01

149

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

150

Intracerebral hemorrhage (image)  

MedlinePLUS

Intracerebral hemorrhage may be caused by trauma (brain injury) or abnormalities of the blood vessels (aneurysm or angioma). When ... commonly associated with high blood pressure (hypertensive intracerebral hemorrhage).

151

Acute management of poor condition subarachnoid hemorrhage patients  

PubMed Central

Poor condition subarachnoid hemorrhage (SAH) patients present a high mortality and morbidity. In this study, we reviewed the acute interventional (surgical and endovascular) management of 109 SAH-poor condition patients, who were treated as early as logistically possible after confirming stable circulation parameters. Patients over the age of 70 years, without clinical response to painful stimulation were excluded. We recognized at least 3 different postinterventional therapeutic approaches: (1) Norm- or hypovolemic, normotensive hemodilution in 30 patients with space-occupying intracranial hematomas as well as in 31 cases with acute cerebro-spinal-fluid obstruction. (2) Normovolemic, hypertensive hemodilution after unilateral decompressive craniotomy in 23 surgical- and 2 endovascular-treated patients with focalized space occupying lesions and reduced cerebral perfusion. (3) Hypovolemic, normo-, or hypertensive hemodilution after bilateral decompressive craniotomy in 23 cases with massive brain-swelling. We observed a reduced mortality (21%). The overall late outcome was favorable in 56% and unfavorable in 23%. Selective aggressive treatment adapted to increase the cerebral perfusion, seems to be an effective therapy to improve the survival and outcome of several poor condition SAH-patients. PMID:18200827

Eleftherios, Archavlis; Carvi y Nievas, Mario Nazareno

2007-01-01

152

Upregulation of Relaxin after Experimental Subarachnoid Hemorrhage in Rabbits  

PubMed Central

Background. Although relaxin causes vasodilatation in systemic arteries, little is known about its role in cerebral arteries. We investigated the expression and role of relaxin in basilar arteries after subarachnoid hemorrhage (SAH) in rabbits. Methods. Microarray analysis with rabbit basilar artery RNA was performed. Messenger RNA expression of relaxin-1 and relaxin/insulin-like family peptide receptor 1 (RXFP1) was investigated with quantitative RT-PCR. RXFP1 expression in the basilar artery was investigated with immunohistochemistry. Relaxin concentrations in cerebrospinal fluid (CSF) and serum were investigated with an enzyme-linked immunosorbent assay. Using human brain vascular smooth muscle cells (HBVSMC) preincubated with relaxin, myosin light chain phosphorylation (MLC) was investigated with immunoblotting after endothelin-1 stimulation. Results. After SAH, RXFP1 mRNA and protein were significantly downregulated on day 3, whereas relaxin-1 mRNA was significantly upregulated on day 7. The relaxin concentration in CSF was significantly elevated on days 5 and 7. Pretreatment with relaxin reduced sustained MLC phosphorylation induced by endothelin-1 in HBVSMC. Conclusion. Upregulation of relaxin and downregulation of RXFP1 after SAH may participate in development of cerebral vasospasm. Downregulation of RXFP1 may induce a functional decrease in relaxin activity during vasospasm. Understanding the role of relaxin may provide further insight into the mechanisms of cerebral vasospasm. PMID:25133183

Kikkawa, Yuichiro; Matsuo, Satoshi; Kurogi, Ryota; Nakamizo, Akira; Mizoguchi, Masahiro; Sasaki, Tomio

2014-01-01

153

Differential Regulation of Matrix-Metalloproteinases and Their Tissue Inhibitors in Patients with Aneurysmal Subarachnoid Hemorrhage  

PubMed Central

Background Matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) are involved in vascular remodeling, (neuro)inflammation, blood-brain barrier breakdown and neuronal apoptosis. Proinflammatory mechanisms are suggested to play an important role during early brain injury and cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH). This study aimed to analyze MMP-3, MMP-9, TIMP-1 and TIMP-3 in patients with SAH and their respective association with cerebral vasospasm (CVS). Methods Blood samples were collected in 20 SAH patients on days 1 to 7, 9, 11, 13 and 15 and 20 healthy age and gender matched volunteers. Serum MMPs and TIMPs were analyzed using enzyme-linked immunosorbent assay. Doppler sonographic CVS was defined as a mean blood flow velocity above 120 cm/sec in the middle cerebral artery. When discharged from hospital and at 6 month follow-up neurological outcome was evaluated using the Glasgow Outcome Score and the modified Rankin Scale. Results MMP-9 was higher in SAH patients compared to healthy controls (p<0.001). Patients with CVS (n?=?11) had elevated MMP-9 serum levels compared to patients without CVS (n?=?9, p<0.05). Higher MMP-9 was observed in the presence of cerebral ischemia associated with cerebral vasospasm (p<0.05). TIMP-1 was increased in patients with SAH on day 4 (p<0.05). There was an imbalance of the MMP-9/TIMP-1 ratio in favor of MMP-9 in SAH patients, in particular those with CVS (p<0.001). MMP-3 and TIMP-3 were significantly lower in SAH patients throughout day 4 and day 7, respectively (p<0.05). We did not find an association between MMP-, TIMP levels and neurological outcome after 6 months. Conclusions MMP-3 and -9 are differentially regulated in SAH patients with both enzymes showing peak levels correlating with the development of CVS. The inhibitors TIMP-1 and -3 were low during the acute phase after SAH and increased later on which might suggest a preponderance of pro-inflammatory mechanisms. PMID:23555845

Fischer, Marlene; Dietmann, Anelia; Beer, Ronny; Broessner, Gregor; Helbok, Raimund; Pfausler, Bettina; Schmutzhard, Erich; Lackner, Peter

2013-01-01

154

Pleiotropic effects of the rho-kinase inhibitor fasudil after subarachnoid hemorrhage: a review of preclinical and clinical studies.  

PubMed

There is growing evidence that Rho-kinase contributes to cardiovascular disease, which has made Rho-kinase a target for the treatment of human diseases. To date, the only Rho-kinase inhibitor employed clinically in humans is fasudil, which has been used for the prevention of cerebral vasospasm and subsequent ischemic injury after surgery for subarachnoid hemorrhage (SAH). A number of pathological processes, in particular hemodynamic dysfunctions and inflammatory reactions, are thought to be related in the pathogenesis of delayed cerebral vasospasm and subsequent ischemic injury after SAH. This review focuses on fasudil's pleiotropic therapeutic effects: amelioration of hemodynamic dysfunction and inflammation, and discusses in detail the clinical studies on fasudil administered after the occurrence of SAH. PMID:24923440

Satoh, Shin-ichi; Ikegaki, Ichiro; Kawasaki, Koh; Asano, Toshio; Shibuya, Masato

2014-01-01

155

Syringomyelia and spinal arachnoiditis resulting from aneurysmal subarachnoid hemorrhage: Report of two cases and review of the literature.  

PubMed

Syringomyelia resulting from arachnoiditis secondary to aneurysmal subarachnoid hemorrhage (SAH) is an extremely rare clinical entity with few cases reported in the literature. The presentation, management, and pathogenesis of syringomyelia in this setting is poorly understood. We describe the presentation, radiology, management, and outcomes in two patients with syringomyelia resulting from arachnoiditis secondary to aneurysmal SAH and review the literature on this rare condition. Case number 1 was treated successfully with syrinx-subarachnoid shunt after extensive lysis of adhesions. Case number 2 was treated with syringoperitoneal shunt. Both patients had radiographic decreased syrinx size postoperatively. These patients add to the small literature on syringomyelia occurring secondary to SAH-associated arachnoiditis. The radiographic outcomes demonstrate that in the appropriately selected patient, syrinx-subarachnoid or syringoperitoneal shunting are viable options. PMID:25013348

Abel, Taylor J; Howard, Matthew A; Menezes, Arnold

2014-01-01

156

Syringomyelia and spinal arachnoiditis resulting from aneurysmal subarachnoid hemorrhage: Report of two cases and review of the literature  

PubMed Central

Syringomyelia resulting from arachnoiditis secondary to aneurysmal subarachnoid hemorrhage (SAH) is an extremely rare clinical entity with few cases reported in the literature. The presentation, management, and pathogenesis of syringomyelia in this setting is poorly understood. We describe the presentation, radiology, management, and outcomes in two patients with syringomyelia resulting from arachnoiditis secondary to aneurysmal SAH and review the literature on this rare condition. Case number 1 was treated successfully with syrinx-subarachnoid shunt after extensive lysis of adhesions. Case number 2 was treated with syringoperitoneal shunt. Both patients had radiographic decreased syrinx size postoperatively. These patients add to the small literature on syringomyelia occurring secondary to SAH-associated arachnoiditis. The radiographic outcomes demonstrate that in the appropriately selected patient, syrinx-subarachnoid or syringoperitoneal shunting are viable options. PMID:25013348

Abel, Taylor J.; Howard, Matthew A.; Menezes, Arnold

2014-01-01

157

Recent progress in hemorrhagic moyamoya disease.  

PubMed

Moyamoya disease (MMD) is a chronic progressive cerebrovascular disease, which can be divided into three types: ischemic, hemorrhagic, and asymptomatic. Hemorrhagic MMD has attracted considerable attention due to its distinctive imaging features and the controversy over the treatment. This report presents a comprehensive review of the literature on hemorrhagic MMD, focusing on the epidemiological characteristics, etiology and pathogenesis, imaging features, predictors of hemorrhage, and treatment options and their efficacy of hemorrhagic MMD. Hemorrhagic MMD mainly occurs in adult patients in Asian countries, and many factors may contribute to the etiology and development of this disease. Hemorrhagic MMD has two major imaging features: the dilatation and abnormal branching of anterior choroidal artery or posterior communicating artery, and multiple microbleeds, which may predict subsequent hemorrhage. The treatment for hemorrhagic MMD is not standardized, and large sample prospective randomized clinical trials may help to determine which method is better. In hemorrhagic MMD patients, more attention should be paid to cognitive function and quality of life, and these assessments should be included in the evaluation of effectiveness of treatment modalities. PMID:25365664

Wan, Ming; Duan, Lian

2014-11-01

158

Endoplasmic reticulum stress is associated with neuroprotection against apoptosis via autophagy activation in a rat model of subarachnoid hemorrhage.  

PubMed

Endoplasmic reticulum (ER) stress might play an important role in a range of neurological diseases; however, this phenomenon's role in subarachnoid hemorrhage (SAH) remains unclear. In this study, we explored the potential role of endoplasmic reticulum stress in early brain injury following SAH.84 rats were used for an endovascular perforation-induced subarachnoid hemorrhage model. The rats were intraperitoneally pretreated with the ER stress inducer tunicamycin (Tm) or with the inhibitor tauroursodeoxycholic acid (TUDCA) before SAH onset. An intracerebral ventricular infusion of autophagy inhibitor 3-methyladenine (3-MA) was also used to determine the relation between autophagy and ER stress in early brain injury following SAH. At 24h, rats were neurologically evaluated, and their brains were extracted for molecular biological and histological studies. ER stress was activated in rats after 24h of SAH. Enhanced ER stress via Tm pretreatment significantly improved neurological deficits, attenuated the expression of pro-apoptotic molecules of caspase-3 and reduced the number of TUNEL-positive cells. In contrast, the ER stress inhibitor TUDCA aggravated neurological deficits and apoptotic cell death. Western blot analysis revealed that levels of the autophagic protein Beclin 1 and the ratio of LC3-II to LC3-I were both increased by Tm infusion and reduced by TUDCA administration. The suppression of autophagic activity with 3-MA attenuated Tm-induced anti-apoptotic effects. Our study indicates that ER stress alleviates early brain injury following SAH via inhibiting apoptosis. This neuroprotective effect is most likely exerted by autophagy activation. PMID:24513235

Yan, Feng; Li, Jianru; Chen, Jingyin; Hu, Qiang; Gu, Chi; Lin, Wang; Chen, Gao

2014-03-20

159

Comparison of cerebrospinal fluid biomarkers between idiopathic normal pressure hydrocephalus and subarachnoid hemorrhage-induced chronic hydrocephalus: A pilot study  

PubMed Central

Summary Background We examined the cerebrospinal fluid (CSF) markers of subarachnoid hemorrhage (SAH)-induced and idiopathic normal pressure hydrocephalus (INPH) to investigate the pathophysiology and mechanism of communicating hydrocephalus compared to obstructive hydrocephalus. Material/Methods We obtained CSF samples from 8 INPH, 10 SAH-induced hydrocephalus, and 6 unmatched patients with non-hemorrhagic obstructive hydrocephalus during their ventriculoperitoneal shunt operations. Transforming growth factor (TGF)-?1, tumor necrosis factor (TNF)-?, vascular endothelial growth factor (VEGF), and total tau in the CSF were analyzed via enzyme-linked immunosorbent assay. Results The mean VEGF levels in the CSF of patients with SAH-induced hydrocephalus, INPH, and obstructive hydrocephalus were 239±131, 239±75, and 163±122 pg/mL, respectively. The total tau concentrations in the CSF of the groups were 1139±1900, 325±325, and 1550±2886 pg/mL, respectively. TNF-? values were 114±34, 134±38, and 55±16 pg/mL, respectively. TGF-?1 values were 953±430, 869±447, and 136±63 pg/mL, respectively. A significant difference in TNF-? and TGF-?1 levels was observed only between SAH-induced and chronic obstructive hydrocephalus, and between INPH and chronic obstructive hydrocephalus (p<0.01). Conclusions No significant differences in the 4 CSF biomarker levels were observed between INPH and SAH-induced hydrocephalus, whereas CSF TNF-? and TGF-?1 levels were increased compared to those in patients with chronic obstructive hydrocephalus. Post-SAH hydrocephalus and INPH are probably more destructive to neural tissues, and then stimulate the inflammatory reaction and healing process, compared with obstructive hydrocephalus. PMID:23197244

Lee, Jeong-Hyun; Park, Dong-Hyuk; Back, Dong-Bin; Lee, Jea-Young; Lee, Chang-In; Park, Kyung-Jae; Kang, Shin-Hyuk; Cho, Tai-Hyoung; Chung, Yong-Gu

2012-01-01

160

Impairment of cardiac metabolism and sympathetic innervation after aneurysmal subarachnoid hemorrhage: a nuclear medicine imaging study  

PubMed Central

Introduction Although aneurysmal subarachnoid hemorrhage (SAH) is often complicated by myocardial injury, whether this neurogenic cardiomyopathy is associated with the modification of cardiac metabolism is unknown. This study sought to explore, by positron emission tomography/computed tomography, the presence of altered cardiac glucose metabolism after SAH. Methods During a 16-month period, 30 SAH acute phase patients underwent myocardial 18?F- fluorodesoxyglucose positron emission tomography (18F-FDGPET), 99mTc-tetrofosmin and 123I-meta-iodobenzylguanidine (123I-mIBG) scintigraphy, respectively, assessing glucose metabolism, cardiac perfusion, and sympathetic innervation. Patients with initial abnormalities were followed monthly for two months for 18F-FDG, and six months later for 123I-mIBG. Results In this SAH population, acute cardiac metabolic disturbance was observed in 83% of patients (n?=?25), and sympathetic innervation disturbance affected 90% (n?=?27). Myocardial perfusion was normal for all patients. The topography and extent of metabolic defects and innervation abnormalities largely overlapped. Follow-up showed rapid improvement of glucose metabolism in one or two months. Normalization of sympathetic innervation was slower; only 27% of patients (n?=?8) exhibited normal 123I-mIBG scintigraphy after six months. Presence of initial altered cardiac metabolism was not associated with more unfavorable cardiac or neurological outcomes. Conclusions These findings support the hypothesis of neurogenic myocardial stunning after SAH. In hemodynamically stable acute phase SAH patients, cardiomyopathy is characterized by diffuse and heterogeneous 18F-FDG and 123I-mIBG uptake defect. Trial registration Clinicaltrials.gov NCT01218191. Registered 6 October 2010. PMID:24964817

2014-01-01

161

Role of HCN channels in neuronal hyperexcitability after subarachnoid hemorrhage in rats.  

PubMed

Disruption of ionic homeostasis and neuronal hyperexcitability contribute to early brain injury after subarachnoid hemorrhage (SAH). The hyperpolarization-activated/cyclic nucleotide (HCN)-gated channels play critical role in the regulation of neuronal excitability in hippocampus CA1 region and neocortex, in which the abnormal neuronal activities are more readily provoked. This study was to investigate the interactions between HCN channels and hyperneuronal activity after experimental SAH. The present results from whole-cell recordings in rat brain slices indicated that (1) perfusion of hemoglobin (Hb)-containing artificial CSF produced neuronal hyperexcitability and inhibited HCN currents in CA1 pyramidal neurons, (2) nitric oxide/Spermine (NO/Sp), a controlled releaser of nitric oxide, attenuated neuronal excitability and enhanced HCN currents in CA1 pyramidal neurons, while L-nitroarginine (L-NNA), an inhibitor of nitric oxide synthase, reduced the HCN currents; and (3) the inhibitory action of Hb on HCN currents was reversed by application of NO/Sp, which also reduced neuronal hyperexcitability; conversely, L-NNA enhanced inhibitory action of Hb on HCN currents. Additionally, Hb perfusion scavenged the production of nitric oxide and decreased the expression of HCN1 subunits in CA1 region. In the rat SAH model, the expression of HCN1, both at mRNA and protein level, decreased in hippocampus CA1 region at 24 h and more pronounced at 72 h after SAH. These observations demonstrated a reduction of HCN channels expression after SAH and Hb reduced HCN currents in hippocampus CA1 pyramidal neurons. Inhibition of HCN channels by Hb may be a novel pathway for inducing the hyperneuronal excitability after SAH. PMID:22378889

Li, Bo; Luo, Chunxia; Tang, Weihua; Chen, Zhi; Li, Qiang; Hu, Bo; Lin, Jiangkai; Zhu, Gang; Zhang, John H; Feng, Hua

2012-02-29

162

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. PMID:24564759

2014-01-01

163

Astaxanthin Activates Nuclear Factor Erythroid-Related Factor 2 and the Antioxidant Responsive Element (Nrf2-ARE) Pathway in the Brain after Subarachnoid Hemorrhage in Rats and Attenuates Early Brain Injury.  

PubMed

Astaxanthin (ATX) has been proven to ameliorate early brain injury (EBI) after experimental subarachnoid hemorrhage (SAH) by modulating cerebral oxidative stress. This study was performed to assess the effect of ATX on the Nrf2-ARE pathway and to explore the underlying molecular mechanisms of antioxidant properties of ATX in EBI after SAH. A total of 96 male SD rats were randomly divided into four groups. Autologous blood was injected into the prechiasmatic cistern of the rat to induce an experimental SAH model. Rats in each group were sacrificed at 24 h after SAH. Expressions of Nrf2 and heme oxygenase-1 (HO-1) were measured by Western blot and immunohistochemistry analysis. The mRNA levels of HO-1, NAD (P) H: quinone oxidoreductase 1 (NQO-1), and glutathione S-transferase-?1 (GST-?1) were determined by real-time polymerase chain reaction (PCR). It was observed that administration of ATX post-SAH could up-regulate the cortical expression of these agents, mediated in the Nrf2-ARE pathway at both pretranscriptional and posttranscriptional levels. Meanwhile, oxidative damage was reduced. Furthermore, ATX treatment significantly attenuated brain edema, blood-brain barrier (BBB) disruption, cellular apoptosis, and neurological dysfunction in SAH models. This study demonstrated that ATX treatment alleviated EBI in SAH model, possibly through activating the Nrf2-ARE pathway by inducing antioxidant and detoxifying enzymes. PMID:25528957

Wu, Qi; Zhang, Xiang-Sheng; Wang, Han-Dong; Zhang, Xin; Yu, Qing; Li, Wei; Zhou, Meng-Liang; Wang, Xiao-Liang

2014-12-01

164

Astaxanthin Activates Nuclear Factor Erythroid-Related Factor 2 and the Antioxidant Responsive Element (Nrf2-ARE) Pathway in the Brain after Subarachnoid Hemorrhage in Rats and Attenuates Early Brain Injury  

PubMed Central

Astaxanthin (ATX) has been proven to ameliorate early brain injury (EBI) after experimental subarachnoid hemorrhage (SAH) by modulating cerebral oxidative stress. This study was performed to assess the effect of ATX on the Nrf2-ARE pathway and to explore the underlying molecular mechanisms of antioxidant properties of ATX in EBI after SAH. A total of 96 male SD rats were randomly divided into four groups. Autologous blood was injected into the prechiasmatic cistern of the rat to induce an experimental SAH model. Rats in each group were sacrificed at 24 h after SAH. Expressions of Nrf2 and heme oxygenase-1 (HO-1) were measured by Western blot and immunohistochemistry analysis. The mRNA levels of HO-1, NAD (P) H: quinone oxidoreductase 1 (NQO-1), and glutathione S-transferase-?1 (GST-?1) were determined by real-time polymerase chain reaction (PCR). It was observed that administration of ATX post-SAH could up-regulate the cortical expression of these agents, mediated in the Nrf2-ARE pathway at both pretranscriptional and posttranscriptional levels. Meanwhile, oxidative damage was reduced. Furthermore, ATX treatment significantly attenuated brain edema, blood–brain barrier (BBB) disruption, cellular apoptosis, and neurological dysfunction in SAH models. This study demonstrated that ATX treatment alleviated EBI in SAH model, possibly through activating the Nrf2-ARE pathway by inducing antioxidant and detoxifying enzymes. PMID:25528957

Wu, Qi; Zhang, Xiang-Sheng; Wang, Han-Dong; Zhang, Xin; Yu, Qing; Li, Wei; Zhou, Meng-Liang; Wang, Xiao-Liang

2014-01-01

165

Acute hypotension associated with intraoperative cell salvage using a leukocyte depletion filter during management of obstetric hemorrhage due to amniotic fluid embolism.  

PubMed

Amniotic fluid embolism (AFE) is a rare but catastrophic obstetric complication that can lead to profound coagulopathy and hemorrhage. The role of cell salvage and recombinant human Factor VIIa (rFVIIa) administration in such cases remains unclear. We present a case of AFE and describe our experience with the use of cell salvage and rFVIIa administration during the resuscitation. Cell salvage and transfusion through a leukocyte depletion filter was attempted after the diagnosis of AFE was made, but the attempted transfusion was immediately followed by hypotension and a worsening of hemodynamics. rFVIIa, on the contrary, was used with clinical improvement in coagulopathy and without apparent adverse thrombotic effect. PMID:23749444

Rogers, William Kirke; Wernimont, Sarah A; Kumar, Girish C; Bennett, Eliza; Chestnut, David H

2013-08-01

166

Effects of statins-use for patients with aneurysmal subarachnoid hemorrhage: a meta-analysis of randomized controlled trials.  

PubMed

Aneurysmal subarachnoid hemorrhage (aSAH)-induced cerebral vasospasm and delayed ischemic neurological deficit (DIND) are the major causes of morbidity and mortality in patients with aSAH. The effects of statins-use for patients with aSAH remain controversial. Here,a total of 249 patients from six randomized controlled trials(RCTs) were subjected to meta-analysis. No significant decrease was found in the incidence of vasospasm(RR, 0.80; 95% CI, 0.54-1.17), with substantial heterogeneity (I(2) = 49%, P = 0.08), which was verified by the further sensitivity analysis and subgroup meta-analysis. Furthermore, no significant difference was presented in the incidence of poor neurological outcome(RR, 0.94; 95% CI, 0.77-1.16), and potential side effects(RR, 2.49; 95% CI, 0.75-8.33). Nevertheless, significant difference was reported in the occurrence of DIND(RR, 0.58; 95% CI, 0.37-0.92) and mortality(RR, 0.30; 95% CI, 0.14-0.64). At present, although statins-use in the patients with aSAH should not be considered standard care at present, statins-use may have the potential effects in the prevention of mortality in patients with aSAH. PMID:24763190

Su, Shao-Hua; Xu, Wei; Hai, Jian; Wu, Yi-Fang; Yu, Fei

2014-01-01

167

Higher brain extracellular potassium is associated with brain metabolic distress and poor outcome after aneurysmal subarachnoid hemorrhage  

PubMed Central

Introduction Elevated brain potassium levels ([K+]) are associated with neuronal damage in experimental models. The role of brain extracellular [K+] in patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH) and its association with hemorrhage load, metabolic dysfunction and outcome has not been studied so far. Methods Cerebral microdialysis (CMD) samples from 28 poor grade aSAH patients were analyzed for CMD [K+] for 12 consecutive days after ictus, and time-matched to brain metabolic and hemodynamic parameters as well as corresponding plasma [K+]. Statistical analysis was performed using a generalized estimating equation with an autoregressive function to handle repeated observations of an individual patient. Results CMD [K+] did not correlate with plasma [K+] (Spearman’s ??=?0.114, P?=?0.109). Higher CMD [K+] was associated with the presence of intracerebral hematoma on admission head computed tomography, CMD lactate/pyruvate ratio >40 and CMD lactate >4 mmol/L (P?SAH patients. Further studies are needed to elucidate the relevance of brain interstitial K+ levels in the pathophysiology of secondary brain injury after aSAH. PMID:24920041

2014-01-01

168

Clinical review: Prevention and therapy of vasospasm in subarachnoid hemorrhage  

PubMed Central

Vasospasm is one of the leading causes of morbidity and mortality following aneurysmal subarachnoid hemorrhage (SAH). Radiographic vasospasm usually develops between 5 and 15 days after the initial hemorrhage, and is associated with clinically apparent delayed ischemic neurological deficits (DID) in one-third of patients. The pathophysiology of this reversible vasculopathy is not fully understood but appears to involve structural changes and biochemical alterations at the levels of the vascular endothelium and smooth muscle cells. Blood in the subarachnoid space is believed to trigger these changes. In addition, cerebral perfusion may be concurrently impaired by hypovolemia and impaired cerebral autoregulatory function. The combined effects of these processes can lead to reduction in cerebral blood flow so severe as to cause ischemia leading to infarction. Diagnosis is made by some combination of clinical, cerebral angiographic, and transcranial doppler ultrasonographic factors. Nimodipine, a calcium channel antagonist, is so far the only available therapy with proven benefit for reducing the impact of DID. Aggressive therapy combining hemodynamic augmentation, transluminal balloon angioplasty, and intra-arterial infusion of vasodilator drugs is, to varying degrees, usually implemented. A panoply of drugs, with different mechanisms of action, has been studied in SAH related vasospasm. Currently, the most promising are magnesium sulfate, 3-hydroxy-3-methylglutaryl-CoA reductase inhibitors, nitric oxide donors and endothelin-1 antagonists. This paper reviews established and emerging therapies for vasospasm. PMID:17705883

Keyrouz, Salah G; Diringer, Michael N

2007-01-01

169

Possible Role of Raf-1 Kinase in the Development of Cerebral Vasospasm and Early Brain Injury After Experimental Subarachnoid Hemorrhage in Rats.  

PubMed

This study aims to clarify the potential role of Raf-1 kinase in cerebral vasospasm (CVS) and early brain injury (EBI) after subarachnoid hemorrhage (SAH). Two experimental SAH models in rats, including cisterna magna double injection model for CVS study and prechiasmatic cistern single injection model for EBI study, were performed in this research. As a specific inhibitor of Raf-1, BAY 43-9006 was used in this study. In CVS study, time course study showed that the basilar artery exhibited vasospasm after SAH and became most severe at day 5, and the phosphorylation of Raf-1 had the same trends, while both vasospasm and the phosphorylation of Raf-1 induced by SAH were inhibited by BAY 43-9006 treatment. In addition, BAY 43-9006 treatment significantly reversed the phosphorylation of ERK1/2 and the activation of NF-?B induced by SAH and decreased the messenger RNA (mRNA) levels of IL-6 and IL-1?. In EBI study, BAY 43-9006 treatment significantly suppressed the brain injury induced by SAH. Besides, BAY 43-9006 inhibited the phosphorylation of Raf-1 and ERK1/2; decreased the protein levels of COX-2, VEGF, and MMP-9; and reversed the activation of NF-?B induced by SAH. These results demonstrate that Raf-1 kinase contributes to CVS and EBI after SAH by enhancing the activation of the Raf-1/ERK1/2 and Raf-1/NF-?B signaling pathways, and that the inhibition of these pathways might offer new treatment strategies for CVS and EBI. PMID:25367879

Zhang, Jian; Xu, Xiang; Zhou, Dai; Li, Haiying; You, Wanchun; Wang, Zhong; Chen, Gang

2014-11-01

170

Intrathecal Application of the Nimodipine Slow-Release Microparticle System EG-1962 for Prevention of Delayed Cerebral Ischemia and Improvement of Outcome After Aneurysmal Subarachnoid Hemorrhage.  

PubMed

The effective reduction of delayed cerebral ischemia (DCI), a main contributor for poor outcome following aneurysmal subarachnoid hemorrhage (SAH), remains challenging. Previous clinical trials on systemic pharmaceutical treatment of SAH mostly failed to improve outcome, probably because of insensitive pharmaceutical targets and outcome measures, small sample size, insufficient subarachnoid drug concentrations and also detrimental, systemic effects of the experimental treatment per se. Interestingly, in studies that are more recent, intrathecal administration of nicardipine pellets following surgical aneurysm repair was suggested to have a beneficial effect on DCI and neurological outcome. However, this positive effect remained restricted to patients who were treated surgically for a ruptured aneurysm. Because of the favorable results of the preclinical data on DCI and neurological outcome in the absence of neurotoxicity or systemic side effects, we are initiating clinical trials. The PROMISE (Prolonged Release nimOdipine MIcro particles after Subarachnoid hemorrhage) trial is designed as an unblinded, nonrandomized, single-center, single-dose, dose-escalation safety and tolerability phase 1 study in patients surgically treated for aSAH and will investigate the effect of intracisternal EG-1962 administration. The NEWTON (Nimodipine microparticles to Enhance recovery While reducing TOxicity after subarachNoid hemorrhage) trial is a phase 1/2a multicenter, controlled, randomized, open-label, dose-escalation, safety, tolerability, and pharmacokinetic study comparing EG-1962 and nimodipine in patients with aneurysmal SAH. PMID:25366637

Etminan, Nima; Macdonald, R Loch; Davis, Cara; Burton, Kevin; Steiger, Hans-Jakob; Hänggi, Daniel

2015-01-01

171

Effects of diltiazem on sympathetic activity in patients with aneurysmal subarachnoid hemorrhage.  

PubMed

This study evaluated the effect of diltiazem, a calcium antagonist, on sympathetic activity in patients with aneurysmal subarachnoid hemorrhage (SAH) during the hyperacute stage. Of patients with aneurysmal SAH who underwent aneurysm repair between August 2008 and June 2011, 119 consecutive patients were enrolled in this prospective study. On admission, patients were assigned to an antihypertensive treatment receiving continuous infusion of diltiazem (67 patients) or nicardipine (52 patients). Plasma levels of adrenaline (AD), noradrenaline (NA), and dopamine (DP) were repeatedly measured using high-performance liquid chromatography (HPLC). There were no significant differences in patient characteristics or aneurysm topography between the two groups. In all patients, acute surge of catecholamines was observed with mutual correlation. However, patients receiving diltiazem exhibited a significantly lower plasma concentration of DP than those receiving nicardipine, 3 and 6 h after admission. A similar trend was observed for NA, but the difference was not significant at 6 h. Conversely, the concentration of AD was similar between the two groups. Diltiazem may suppress sympathetic activity in the hyperacute stage of aneurysmal SAH. Further studies are needed to verify the beneficial effect of diltiazem in patients with SAH. PMID:25366598

Ogura, Takeshi; Takeda, Ririko; Ooigawa, Hidetoshi; Nakajima, Hiroyuki; Kurita, Hiroki

2015-01-01

172

Aneurismal subarachnoid hemorrhage in a Chilean population, with emphasis on risk factors  

PubMed Central

Background Subarachnoid Hemorrhage (SAH) is caused principally by the rupture of intracranial aneurisms. Important risk factors have been described such as age, sex, hypertension (HT) and season of the year, among others. The objective is to investigate the demographic characteristics and possible risk factors in a population of Chilean patients. Methods This retrospective study was based on the analysis of 244 clinical records of patients diagnosed with aneurismal SAH who were discharged from the Instituto de Neurocirugía ASENJO in Santiago, Chile. Results The mean age of patients was 49.85 years and the male:female ratio was 1:2.7. The signs and symptoms were not different between sexes; cephalea (85.7%) was predominant, followed by loss of consciousness, vomiting/nausea and meningeal signs. Risk factors included sex, age and HT. Concordant with other reports, the incidence of SAH was greatest in spring. Conclusions The demographic characteristics and risk factors observed in patients with aneurismal SAH treated in ASENJO were comparable to those of other populations. We were not able to conclude that tobacco and alcohol consumption were risk factors for this population. PMID:22035203

2011-01-01

173

Significance of apolipoprotein E in subarachnoid hemorrhage: neuronal injury, repair, and therapeutic perspectives--a review.  

PubMed

Subarachnoid hemorrhage (SAH) strikes individuals at a young age with devastating neurologic consequences. Classic formulations that correlate complications and outcome with clinical variables do not explain all the heterogeneity that is usually found in clinical practice. The role of genetic predisposition has recently been investigated. Particular attention has been paid to the apolipoprotein E (APOE) genotype that encodes for a polymorphic protein existing as 3 isoforms (apoE2, apoE3, apoE4), products of alleles E2, E3, and E4 at a single gene locus. ApoE is produced by astrocytes and exerts complex neuroprotective functions that make it a hub of the biochemical network of SAH. The neuroprotective effectiveness of the apoE4 isoform is reduced with respect to the others and this has made the E4 allele a risk factor candidate. Recently published observational studies and meta-analyses suggested that the APOE genotype may strongly improve the usual predictive model with the possibility of optimizing clinical decisions according to the individual's needs. Furthermore, the clinical results, together with new biological insights, suggest that SAH may be a possible candidate for the ongoing research on apoE-based neuroprotective therapy. This article reviews the clinical studies, analyzes their methodology, and surveys the biological links between the physiopathology of SAH and apoE and the possible prospects. PMID:19251187

Lanterna, Luigi A L; Biroli, F

2009-01-01

174

Relationship between angiographic vasospasm, cerebral blood flow, and cerebral infarction after subarachnoid hemorrhage.  

PubMed

Delayed cerebral ischemia (DCI) and cerebral infarction are major contributors to poor functional recovery after subarachnoid hemorrhage (SAH). Cerebral vasospasm, the narrowing of proximal intracranial arteries after SAH, has long been assumed to be the primary cause of DCI, and has therefore been the primary therapeutic target in attempts to diminish disability after SAH. However, emerging evidence has questioned the strength and causality of the relationship between vasospasm and DCI. To address this fundamental question, we performed two parallel studies assessing the relationship between the presence of vasospasm in a vascular territory and both regional reductions in cerebral blood flow (CBF) and development of cerebral infarction.In a cohort of SAH patients at high-risk for DCI, we identified regions of hypoperfusion using positron emission tomography (PET) and compared their distribution with territories exhibiting vasospasm on concurrent angiography. We found that regional hypoperfusion was common in the absence of proximal vasospasm and that some patients without any significant vasospasm still could have hypoperfused brain regions. Similarly, our parallel study demonstrated that both patients and brain territories without vasospasm could develop delayed cerebral infarction, and that such vasospasm-independent infarcts account for more than a quarter of the infarct burden from DCI. These findings suggest that other processes, perhaps at a microvascular level, contribute at least part of the burden of DCI and future interventions should also address these other pathophysiologic processes. PMID:25366617

Dhar, Rajat; Diringer, Michael N

2015-01-01

175

Impact of early-onset seizures on grading and outcome in patients with subarachnoid hemorrhage.  

PubMed

OBJECT After subarachnoid hemorrhage (SAH), seizure occurs in up to 26% of patients. The impact of seizure on outcome has been studied, yet its impact on grading is unknown. The authors evaluated the impact of early-onset seizures (EOS) on grading of spontaneous SAH and on outcome. METHODS This retrospective analysis included consecutive patients with SAH who were treated at the NeuroCenter, Inselspital, University Hospital Bern, Switzerland, between January 2005 and December 2010. Demographic data, clinical data, and reports of EOS were recorded. The EOS were defined as seizures occurring within 24 hours after ictus. Patients were graded according to the World Federation of Neurosurgical Societies (WFNS) scale pre- and postresuscitation and dichotomized into good (WFNS I-III) and poor (WFNS IV-V) grades. Outcome was assessed at 6 months by using the modified Rankin Scale (mRS); an mRS score of 0-3 was considered a good outcome and an mRS score of 4-6 was considered a poor outcome. RESULTS Forty-one of 425 patients with SAH had EOS. Twenty-seven of those 41 patients (65.9%) had a poor WFNS grade. Twenty-eight (68.3%) achieved a good outcome, 11 (26.8%) had a poor outcome, and 2 (4.9%) were lost to followup. Early-onset seizures were proven in 9 of 16 electroencephalograms. The EOS were associated with poor WFNS grade (OR 2.81, 97.5% CI 1.14-7.46; p = 0.03) and good outcome (OR 4.01, 97.5% CI 1.63-10.53; p = 0.03). Increasing age, hydrocephalus, intracerebral hemorrhage, and intraventricular hemorrhage were associated with poor WFNS grade, whereas only age, intracerebral hemorrhage (p < 0.001), and poor WFNS grade (p < 0.001) were associated with poor outcome. CONCLUSIONS Patients with EOS were classified significantly more often in a poor grade initially, but then they significantly more often achieved a good outcome. The authors conclude that EOS can negatively influence grading. This might influence decision making for the care of patients with SAH, so grading of patients with EOS should be interpreted with caution. PMID:25479126

Fung, Christian; Balmer, Mathias; Murek, Michael; Z'Graggen, Werner J; Abu-Isa, Janine; Ozdoba, Christoph; Haenggi, Matthias; Jakob, Stephan M; Raabe, Andreas; Beck, Jürgen

2015-02-01

176

Upper thoracic intradural-extramedullary cavernous malformation presenting as subarachnoid hemorrhage without spinal dysfunction: a case report and review of the literature.  

PubMed

A 45-year-old man had subarachnoid hemorrhage (SAH) which was confirmed by lumbar puncture, since it was negative on head computed tomography. The result of neurological examination was normal. Following pan-cerebral angiography and cranial magnetic resonance imaging (MRI) failed to find out the cause of bleeding. The whole spinal MRI revealed an intradural-extramedullary mass lesion at the upper thoracic level which was consistent with cavernous malformation after surgery. When patients presented with SAH of no spinal symptoms, the diagnosis of an intradural-extramedullary cavernous malformation is challenging. A whole spinal workup should be considered in a patient with spontaneous SAH when bleeding from intracranial origin is carefully excluded. PMID:24878074

Tao, Chuan-Yuan; He, Min; Zhang, Yue-Kang; You, Chao

2014-12-01

177

A Hypothesis: Hydrogen Sulfide Might Be Neuroprotective against Subarachnoid Hemorrhage Induced Brain Injury  

PubMed Central

Gases such as nitric oxide (NO) and carbon monoxide (CO) play important roles both in normal physiology and in disease. Recent studies have shown that hydrogen sulfide (H2S) protects neurons against oxidative stress and ischemia-reperfusion injury and attenuates lipopolysaccharides (LPS) induced neuroinflammation in microglia, exhibiting anti-inflammatory and antiapoptotic activities. The gas H2S is emerging as a novel regulator of important physiologic functions such as arterial diameter, blood flow, and leukocyte adhesion. It has been known that multiple factors, including oxidative stress, free radicals, and neuronal nitric oxide synthesis as well as abnormal inflammatory responses, are involved in the mechanism underlying the brain injury after subarachnoid hemorrhage (SAH). Based on the multiple physiologic functions of H2S, we speculate that it might be a promising, effective, and specific therapy for brain injury after SAH. PMID:24707204

Yu, Yong-Peng; Chi, Xiang-Lin; Liu, Li-Jun

2014-01-01

178

[Electrocardiographic and arterial pressure changes in the acute phase of subarachnoid hemorrhage].  

PubMed

A prospective study was made of 30 patients, admitted to the neurology ward with subarachnoidal hemorrhage (SAH), at its onset. The diagnosis was established on the basis of anamnesis, clinical examination, spinal puncture, anatomopathological examination. The patients with other cerebrovascular affections or with antecedents of ischaemic cardiac affections were excluded. ECG tracings, serum ionogram, AT and VA at the onset and in evolution, and their modifications were followed and assessed in all the patients. The conclusion is reached that SAH in acute phase is associated with transitory ECG and pressure anomalies which become elements of unfavourable prognosis when persistent and deeply altered. They are valuable, at hand, elements in the differential diagnosis, and in the opportune therapeutical intervention. PMID:2575277

Popescu, M; Nu??, G; Toma, D

1989-01-01

179

Compressive Cervicothoracic Adhesive Arachnoiditis following Aneurysmal Subarachnoid Hemorrhage: A Case Report and Literature Review.  

PubMed

We present the case of a 55-year-old woman with diffuse adhesive arachnoiditis in the posterior fossa and cervicothoracic spine following posterior inferior cerebellar artery aneurysmal subarachnoid hemorrhage (SAH). She underwent aneurysm clipping with subsequent gradual neurologic decline associated with sensory disturbances, gait ataxia, and spastic paraparesis. Magnetic resonance imaging revealed diffuse adhesive arachnoiditis in the posterior fossa and cervicothoracic spine, syringobulbia, and multiple arachnoid cysts in the cervicothoracic spine along with syringohydromyelia. Early surgical intervention with microlysis of the adhesions and duraplasty at the clinically relevant levels resulted in clinical improvement. Although adhesive arachnoiditis, secondary arachnoid cysts, and cerebrospinal fluid flow abnormalities resulting in syrinx are rare following aneurysmal SAH, early recognition and appropriate intervention lead to good clinical outcomes. PMID:25083391

Rahmathulla, Gazanfar; Kamian, Kambiz

2014-08-01

180

Compressive Cervicothoracic Adhesive Arachnoiditis following Aneurysmal Subarachnoid Hemorrhage: A Case Report and Literature Review  

PubMed Central

We present the case of a 55-year-old woman with diffuse adhesive arachnoiditis in the posterior fossa and cervicothoracic spine following posterior inferior cerebellar artery aneurysmal subarachnoid hemorrhage (SAH). She underwent aneurysm clipping with subsequent gradual neurologic decline associated with sensory disturbances, gait ataxia, and spastic paraparesis. Magnetic resonance imaging revealed diffuse adhesive arachnoiditis in the posterior fossa and cervicothoracic spine, syringobulbia, and multiple arachnoid cysts in the cervicothoracic spine along with syringohydromyelia. Early surgical intervention with microlysis of the adhesions and duraplasty at the clinically relevant levels resulted in clinical improvement. Although adhesive arachnoiditis, secondary arachnoid cysts, and cerebrospinal fluid flow abnormalities resulting in syrinx are rare following aneurysmal SAH, early recognition and appropriate intervention lead to good clinical outcomes. PMID:25083391

Rahmathulla, Gazanfar; Kamian, Kambiz

2014-01-01

181

ENDOTOXEMIA AND ADRENAL HEMORRHAGE  

PubMed Central

An experimental model that produces adrenal cortical hemorrhage with endotoxin has been described. When stimulated by thorotrast, endotoxin, or its tropic hormone (ACTH), the adrenal cortex is susceptible to the development of a hemorrhagic reaction during endotoxemia. The hemorrhagic reaction resembles that described in the Waterhouse-Friderichsen syndrome. A pathophysiologic mechanism for the occurrence of adrenal hemorrhage occurring during acute sepsis is presented. Increased metabolic activity associated with the production of corticosteroids seems to make the adrenal cortex susceptible to endotoxin-induced hemorrhage. Adrenal hemorrhage observed during sepsis, as in the Waterhouse-Friderichsen syndrome, may be attributable to endotoxemia occurring during or shortly after stimulation of the adrenal cortex by infection. Significant differences between adrenal cortical hemorrhage and the Shwartzman phenomenon are described. PMID:14264270

Levin, Jack; Cluff, Leighton E.

1965-01-01

182

Ginsenoside Rbeta1 reduces neurologic damage, is anti-apoptotic, and down-regulates p53 and BAX in subarachnoid hemorrhage.  

PubMed

Stroke is the second leading cause of death worldwide and the number one cause of adult disability in the United States and Europe. A subtype of stroke, subarachnoid hemorrhage (SAH), accounts for 7% of all strokes each year and claims one of the highest mortalities and morbidities. Many therapeutic interventions have been used to treat brain injury following SAH but none have reached the level of effectiveness needed to clinically reduce mortality. Ginsenoside Rb1 (GRb1), a major component of the Chinese traditional medicine Panax Ginseng, has been shown to reduce ischemic brain injury and myocardial injury via anti-apoptotic pathways. In the present study, we investigated the use of GRb1 on SAH induced brain injury in rats. Four groups were used: sham, vehicle (SAH), low dose treatment (SAH+ 5mg/kg GRb1), and high dose treatment (SAH+ 20mg/kg GRb1). Post assessment included wall thickness and mean cross-section area of basilar artery were measured for evaluating cerebral vasospasm, Evans blue extravasations to assess blood brain barrier (BBB) permeability, immunohistochemistry and Western Blot analysis looking for specific pro-apoptotic markers, and tunnel staining for cell death assessment. In addition, mortality, neurological function and brain edema were investigated. The results showed that high dose GRb1 treatment significantly enlarged mean cross-sectional area and decreased wall thickness of basilar artery, reduced neurological deficits, brain edema, BBB disruption, and TUNEL positive cell expression. Same time, we found that the proteins expression of P53, Bax and Caspase-3 were significantly reduced, whereas the expression of bcl-2 was up-regulated in Rb1 treatment. The results of this study suggest that GRb1 could relieve cerebral vasospasm and potentially provide neuroprotection in SAH victims. The underlying mechanisms may be partly related to inhibition of P53 and Bax dependent proapoptosis pathway. More studies will be needed to confirm these results and determine its potential as a long term agent. PMID:20353383

Li, Yingbo; Tang, Jiping; Khatibi, Nikan H; Zhu, Mei; Chen, Di; Zheng, Weiping; Wang, Shali

2010-05-01

183

Retinal hemorrhage after cardiopulmonary resuscitation with chest compressions.  

PubMed

Retinal hemorrhages in children in the absence of risk factors are regarded to be pathognomonic of shaken baby syndrome or other nonaccidental injuries. The physician must decide whether the retinal hemorrhages in children without risk factors are due to abuse or cardiopulmonary resuscitation with chest compression (CPR-CC). The objective of this study was to determine if CPR-CC can lead to retinal hemorrhages in children. Twenty-two patients who received in-hospital CPR-CC between February 15, 1990, and June 15, 1990, were enrolled. Pediatric ophthalmology fellows carried a code beeper and responded to calls for cardiopulmonary arrest situations. At the scene of CPR-CC, an indirect funduscopic examination was conducted for presence of retinal hemorrhages in the posterior pole. Follow-up examinations were performed at 24 and 72 hours. Of the 22 patients, 6 (27%) had retinal hemorrhages at the time of CPR-CC. Of these 6 patients, 5 had risk factors for retinal hemorrhages. The sixth patient had no risk factors and may have represented the only true case of retinal hemorrhages due to CPR-CC. Retinal hemorrhages are uncommon findings after CPR-CC. Retinal hemorrhages that are found after CPR-CC usually occur in the presence of other risk factors for hemorrhage with a mild hemorrhagic retinopathy in the posterior pole. PMID:23629401

Pham, Hang; Enzenauer, Robert W; Elder, James E; Levin, Alex V

2013-06-01

184

Metabolic Pattern of the Acute Phase of Subarachnoid Hemorrhage in a Novel Porcine Model: Studies with Cerebral Microdialysis with High Temporal Resolution  

PubMed Central

Background Aneurysmal subarachnoid hemorrhage (SAH) may produce cerebral ischemia and systemic responses including stress. To study immediate cerebral and systemic changes in response to aneurysm rupture, animal models are needed. Objective To study early cerebral energy changes in an animal model. Methods Experimental SAH was induced in 11 pigs by autologous blood injection to the anterior skull base, with simultaneous control of intracranial and cerebral perfusion pressures. Intracerebral microdialysis was used to monitor concentrations of glucose, pyruvate and lactate. Results In nine of the pigs, a pattern of transient ischemia was produced, with a dramatic reduction of cerebral perfusion pressure soon after blood injection, associated with a quick glucose and pyruvate decrease. This was followed by a lactate increase and a delayed pyruvate increase, producing a marked but short elevation of the lactate/pyruvate ratio. Glucose, pyruvate, lactate and lactate/pyruvate ratio thereafter returned toward baseline. The two remaining pigs had a more severe metabolic reaction with glucose and pyruvate rapidly decreasing to undetectable levels while lactate increased and remained elevated, suggesting persisting ischemia. Conclusion The animal model simulates the conditions of SAH not only by deposition of blood in the basal cisterns, but also creating the transient global ischemic impact of aneurysmal SAH. The metabolic cerebral changes suggest immediate transient substrate failure followed by hypermetabolism of glucose upon reperfusion. The model has features that resemble spontaneous bleeding, and is suitable for future research of the early cerebral and systemic responses to SAH that are difficult to study in humans. PMID:24940881

Nyberg, Christoffer; Karlsson, Torbjörn; Hillered, Lars; Engström, Elisabeth Ronne

2014-01-01

185

Subarachnoid Hemorrhage Mimicking Leakage of Contrast Media After Coronary Angiography  

PubMed Central

We report a patient who developed subarachnoid hemorrhage (SAH) just after coronary angiography (CAG) with non-ionic contrast media (CM) and minimal dose of heparin. The 55-year-old man had a history of acute ST elevation myocardial infarction that had been treated with primary percutaneous coronary intervention and was admitted for a follow-up CAG. The CAG was performed by the transradial approach, using 1000 U of unfractionated heparin for the luminal coating and 70 mL of iodixanol. At the end of CAG, he complained of nausea and rapidly became stuporous. Brain CT showed a diffusely increased Hounsfield unit (HU) in the cisternal space, similar to leakage of CM. The maximal HU was 65 in the cisternal space. No vascular malformations were detected on cerebral angiography. The patient partially recovered his mental status and motor weakness after 2 days. Two weeks later, subacute SAH was evident on magnetic resonance imaging. The patient was discharged after 28 days. PMID:22493615

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

2012-01-01

186

Migrating lumbar intrathecal catheter fragment associated with intracranial subarachnoid hemorrhage.  

PubMed

Intrathecal catheter placement into the lumbar cistern has varied indications, including drug delivery and CSF diversion. These Silastic catheters are elastic and durable; however, catheter-associated malfunctions are well reported in the literature. Fractured catheters are managed with some variability, but entirely intradural retained fragments are often managed conservatively with observation. The authors describe a case of a 70-year-old man with an implanted intrathecal morphine pump for failed back surgery syndrome who presented to an outside hospital with a history of headache, neck pain, nausea, and photophobia of 3 days' duration. He also described mild weakness and intermittent numbness of both legs. Unenhanced head CT demonstrated subarachnoid hemorrhage (SAH). A right C-5 hemilaminectomy was performed. This case is unique in that there was no indication that the lumbar intrathecal catheter had fractured prior to the patient's presentation with SAH. This case demonstrates that intrathecal catheter fragments are mobile and can precipitate intracranial morbidity. Extrication of known fragments is safe and should be attempted to prevent further neurosurgical morbidity. PMID:25360531

Hnenny, Luke; Sabry, Hatem A; Raskin, Jeffrey S; Liu, Jesse J; Roundy, Neil E; Dogan, Aclan

2015-01-01

187

Perioperative spontaneous bilateral suprachoroidal hemorrhage  

PubMed Central

Summary Suprachoroidal hemorrhage is a rare condition, occurring most commonly in the perioperative period, although cases of unilateral spontaneous hemorrhages have been reported. We report a case of bilateral spontaneous suprachoroidal hemorrhage and discuss the potential causative factors. PMID:23362387

Haridas, Anjana; Litwin, Andre S.; Coker, Timothy

2011-01-01

188

Early release of high-mobility group box 1 (HMGB1) from neurons in experimental subarachnoid hemorrhage in vivo and in vitro  

PubMed Central

Background Translocation of high-mobility group box 1 (HMGB1) from nucleus could trigger inflammation. Extracellular HMGB1 up-regulates inflammatory response in sepsis as a late mediator. However, little was known about its role in subarachnoid hemorrhage-inducible inflammation, especially in the early stage. This study aims to identify whether HMGB1 translocation occurred early after SAH and also to clarify the potential role of HMGB1 in brain injury following SAH. Methods Sprague-Dawley (SD) rats were randomly divided into sham group and SAH groups at 2 h, 12 h and on day 1, day 2. SAH groups suffered experimental subarachnoid hemorrhage by injection of 0.3 ml autoblood into the pre-chiasmatic cistern. Rats injected by recombinant HMGB1(rHMGB1) solution were divided into four groups according to different time points. Cultured neurons were assigned into control group and four hemoglobin (Hb) incubated groups. Mixed glial cells were cultured and stimulated in medium from neurons incubated by Hb. HMGB1 expression is measured by western blot analysis, real-time polymerase chain reaction (PCR), immunohistochemistry and immunofluorescence. Downstream nuclear factor kappa B (NF-?B) subunit P65 and inflammatory factor Interleukin 1? (IL-1?) were measured by western blot and real-time PCR, respectively. Brain injury was evaluated by cleaved caspase-3 staining. Results Our results demonstrated HMGB1 translocation occurred as early as 2 h after experimental SAH with mRNA and protein level increased. Immunohistochemistry and immunofluorescence results indicated cytosolic HMGB1 was mainly located in neurons while translocated HMGB1 could also be found in some microglia. After subarachnoid injection of rHMGB1, NF-?B, downstream inflammatory response and cleaved caspase-3 were up-regulated in the cortex compared to the saline control group. In-vitro, after Hb incubation, HMGB1 was also rapidly released from neurons to medium. Incubation with medium from neurons up-regulated IL-1? in mixed glial cells. This effect could be inhibited by HMGB1 specific inhibitor glycyrrhizic acid (GA) treatment. Conclusion HMGB1 was released from neurons early after SAH onset and might trigger inflammation as an upstream inflammatory mediator. Extracellular HMGB1 contributed to the brain injury after SAH. These results might have important implications during the administration of specific HMGB1 antagonists early in order to prevent or reduce inflammatory response following SAH. PMID:24924349

2014-01-01

189

Inverted (Reverse) Takotsubo Cardiomyopathy following Cerebellar Hemorrhage  

PubMed Central

Background. First described in 2005, inverted takotsubo is one of the four stress-induced cardiomyopathy patterns. It is rarely associated with subarachnoid hemorrhage but was not previously reported after intraparenchymal bleeding. Purpose. We reported a symptomatic case of inverted takotsubo pattern following a cerebellar hemorrhage. Case Report. A 26-year-old woman presented to the emergency department with sudden headache and hemorrhage of the posterior fossa was diagnosed, probably caused by a vascular malformation. Several hours later, she developed acute pulmonary edema due to acute heart failure. Echocardiography showed left ventricular dysfunction with hypokinetic basal segments and hyperkinetic apex corresponding to inverted takotsubo. Outcome was spontaneously favorable within a few days. Conclusion. Inverted takotsubo pattern is a stress-induced cardiomyopathy that could be encountered in patients with subarachnoid hemorrhage and is generally of good prognosis. We described the first case following a cerebellar hematoma. PMID:24826313

Piérard, Sophie; Vinetti, Marco

2014-01-01

190

Grains and gamma-ray observations NIC_XI_371 Stardust Material in the Meteorite SAH 97096  

E-print Network

Grains and gamma-ray observations NIC_XI_371 Stardust Material in the Meteorite SAH 97096 Bose M.1 system materials, such as meteorites, interplanetary dust particles, and comets. Carbonaceous and oxide of the meteoritic materials. Silicate stardust grains were discovered in the laboratory only recently when new

191

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

192

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 PMID:23680226

2013-01-01

193

Ethyl pyruvate improves survival in awake hemorrhage  

PubMed Central

Classical experimental models of hemorrhage are characterized by the use of anesthetics that may interfere with the typical immune responses and pathology of hemorrhage/resuscitation. Thus, therapeutic strategies successful in anesthetized animals might not be beneficial in clinical trials. In this study, we analyzed whether ethyl pyruvate could provide therapeutic benefits during resuscitation in awake (unanesthetized) hemorrhage. Our results indicate that hemorrhage in unanesthetized animals required approximately 25% higher blood withdrawal than anesthetized animals to achieve the same targeted mean arterial blood pressure. Resuscitation with Hextend reestablished circulatory volume and improved survival during resuscitation of awake rodents. Yet, over 75% of the animals resuscitated with Hextend died within the first hours after hemorrhage. Resuscitation with Hextend containing 50 mM ethyl pyruvate protected over 87% of the animals. This survival benefit did not correlate with significant changes in the metabolic markers but with an anti-inflammatory potential during resuscitation. Unlike classical hemorrhage in anesthetized animals, ethyl pyruvate reestablished mean arterial blood pressure significantly earlier than Hextend in unanesthetized rodents. Unanesthetized animals showed twofold higher serum tumor necrosis factor (TNF)-? than anesthetized animals subjected to the same blood pressure. This process was not due to the response of a single organ, but affected all the analyzed organs including the lung, heart, spleen, and liver. Although resuscitation with Hextend failed to attenuate systemic TNF-? levels, it inhibited TNF-? levels in the lung, heart, and liver but not in the spleen. Unlike Hextend, resuscitation with ethyl pyruvate prevented high serum TNF-? levels and blunted TNF-? responses in all the organs including the spleen. These studies indicate that the inflammatory responses in anesthetized animals differ from that in unanesthetized animals and that awake hemorrhage can provide advantages in the study of anti-inflammatory strategies during resuscitation. Ethyl pyruvate may attenuate systemic inflammatory responses during resuscitation and improve survival in experimental models of awake hemorrhage. PMID:19172241

Cai, Bolin; Brunner, Michael; Wang, Haichao; Wang, Ping; Deitch, Edwin A.

2011-01-01

194

Impact of Admission Month on Outcomes in Spontaneous Subarachnoid Hemorrhage: Evidence Against the March Effect  

PubMed Central

Objective We attempted to identify the presence of a so called 'March effect (or phenomenon)' (which had long been known as a 'July effect' in western countries), a transient increase in adverse outcomes during an unskilled period for new interns and residents in a teaching hospital, among a cohort of patients with spontaneous subarachnoid hemorrhage (sSAH). Methods A total of 455 consecutive patients with sSAH from our department database from 2008 to 2010 were enrolled retrospectively and the admission month, patient demographics and clinical characteristics, treatment modalities and discharge outcomes were analyzed. Multivariate regression analysis was used to determine whether unfavorable discharge and in-hospital mortality showed a significant increase during the unskilled months for new interns and residents (from March to May) in a pattern suggestive of a "March effect". Results Among 455 patients with sSAH, 113 patients were treated during the unskilled period (from March to May) and the remaining 342 patients were treated during the skilled period (from June until February of the next year). No statistically significant difference in demographics and clinical characteristics was observed between patients treated during these periods. In addition, the mortality and unfavorable discharge rates of the un-skilled period were 16.8% and 29.7% and those of the skilled period were 15.5% and 27.2%, respectively. However, no statistically significant difference was observed between them. Conclusions Findings of our study suggest that there was no 'March effect' on the mortality rate and unfavorable discharge rate among patients with sSAH in our hospital during the study period. PMID:23844350

Kim, Hyun Su; Yoo, Chan Jong; Kim, Eun Young; Kim, Young Bo; Kim, Woo Kyung

2013-01-01

195

Cortisol dynamics are associated with electrocardiographic abnormalities following the aneurysmal subarachnoid hemorrhage  

PubMed Central

Context: Electrocardiographic (ECG) abnormalities are common following subarachnoid hemorrhage (SAH). It probably represents cardiovascular stress after SAH. Aims: The purpose of this study was to assess cortisol dynamics in relation to the ECG abnormality and disease course of SAH. Settings and Design: The study follows a consecutive cohort of aneurysmal SAH patients, who underwent surgery within 72 hours of onset, and they were followed up for 10 days. Materials and Methods: Serum cortisols, cortisol-binding globulin (CGB), adenocorticotropic hormone were measured (between 08.00-09.00 hours) preoperatively and then on postoperative days (PODs) 2, 4, 7, and 10. Electrocardiographs (ECG) were recorded on initial assessment and after surgery on daily basis in ICU. ECG abnormalities will be followed up by measurement of cardiac troponin T to quantify the myocyte necrosis. Statistical Analysis Used: Logistic regression analysis using commercial available software STATA 9. Results: A total of 44 patients (20 M and 24 F) were eligible for the cohort analysis. Average patient age is 52.02 years (52.02 ± 11.23), and 86% (6/44) arrived with World Federation of Neurosurgical Society Scale grade 3 or better. The ECG abnormality was found in 10 cases (22.7%), but the abnormal TnT (>1 ?g/l) were found in eight cases, and two cases contribute to the mortality. The ECG abnormalities are significantly associated with total cortisol on day 4 (P < 0.05) and free cortisol on day 2 (P = 0.0065). Conclusions: Elevated levels of morning cortisol within the first four days after surgery are associated with the ECG abnormality. PMID:23233777

July, Julius; As’ad, Suryani; Suhadi, F. X. Budhianto; Islam, Andi A.

2012-01-01

196

Progressive Manifestations of Reversible Cerebral Vasoconstriction Syndrome Presenting with Subarachnoid Hemorrhage, Intracerebral Hemorrhage, and Cerebral Infarction  

PubMed Central

Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by sudden-onset headache with focal neurologic deficit and prolonged but reversible multifocal narrowing of the distal cerebral arteries. Stroke, either hemorrhagic or ischemic, is a relatively frequent presentation in RCVS, but progressive manifestations of subarachnoid hemorrhage, intracerebral hemorrhage, cerebral infarction in a patient is seldom described. We report a rare case of a 56-year-old woman with reversible cerebral vasoconstriction syndrome consecutively presenting as cortical subarachnoid hemorrhage, intracerebral hemorrhage, and cerebral infarction. When she complained of severe headache with subtle cortical subarachnoid hemorrhage, her angiography was non-specific. But, computed tomographic angiography showed typical angiographic features of this syndrome after four days. Day 12, she suffered mental deterioration and hemiplegia due to contralateral intracerebral hematoma, and she was surgically treated. For recurrent attacks of headache, medical management with calcium channel blockers has been instituted. Normalized angiographic features were documented after 8 weeks. Reversible cerebral vasoconstriction syndrome should be considered as differential diagnosis of non-aneurysmal subarachnoid hemorrhage, and repeated angiography is recommended for the diagnosis of this under-recognized syndrome.

Choi, Kyu-Sun

2014-01-01

197

Simian hemorrhagic fever virus  

Technology Transfer Automated Retrieval System (TEKTRAN)

This book chapter describes the taxonomic classification of Simian hemorrhagic fever virus (SHFV). Included are: host, genome, classification, morphology, physicochemical and physical properties, nucleic acid, proteins, lipids, carbohydrates, geographic range, phylogenetic properties, biological pro...

198

Microwave hemorrhagic stroke detector  

DOEpatents

The microwave hemorrhagic stroke detector includes a low power pulsed microwave transmitter with a broad-band antenna for producing a directional beam of microwaves, an index of refraction matching cap placed over the patients head, and an array of broad-band microwave receivers with collection antennae. The system of microwave transmitter and receivers are scanned around, and can also be positioned up and down the axis of the patients head. The microwave hemorrhagic stroke detector is a completely non-invasive device designed to detect and localize blood pooling and clots or to measure blood flow within the head or body. The device is based on low power pulsed microwave technology combined with specialized antennas and tomographic methods. The system can be used for rapid, non-invasive detection of blood pooling such as occurs with hemorrhagic stroke in human or animal patients as well as for the detection of hemorrhage within a patient's body.

Haddad, Waleed S. (Dublin, CA); Trebes, James E. (Livermore, CA)

2002-01-01

199

Microwave hemorrhagic stroke detector  

DOEpatents

The microwave hemorrhagic stroke detector includes a low power pulsed microwave transmitter with a broad-band antenna for producing a directional beam of microwaves, an index of refraction matching cap placed over the patients head, and an array of broad-band microwave receivers with collection antennae. The system of microwave transmitter and receivers are scanned around, and can also be positioned up and down the axis of the patients head. The microwave hemorrhagic stroke detector is a completely non-invasive device designed to detect and localize blood pooling and clots or to measure blood flow within the head or body. The device is based on low power pulsed microwave technology combined with specialized antennas and tomographic methods. The system can be used for rapid, non-invasive detection of blood pooling such as occurs with hemorrhagic stoke in human or animal patients as well as for the detection of hemorrhage within a patient's body.

Haddad, Waleed S. (Dublin, CA); Trebes, James E. (Livermore, CA)

2007-06-05

200

Superficial Siderosis of the Central Nervous System Induced by a Single-Episode of Traumatic Subarachnoid Hemorrhage: A Study Using MRI-Enhanced Gradient Echo T2 Star-Weighted Angiography  

PubMed Central

The purpose of this study was to examine whether a single episode of traumatic subarachnoid hemorrhage (tSAH) could cause superficial siderosis of the central nervous system (SS-CNS).This study was approved by the local ethics committee. Thirty-two patients with a history of a single episode of tSAH were enrolled in the study. An episode of tSAH was confirmed in patients based on a CT scan or a lumbar puncture, and a follow-up examination was conducted at least six weeks after the brain trauma. A follow-up MRI examination was performed, using enhanced gradient echo T2 star-weighted angiography (ESWAN) to detect hemosiderin deposition on the cortical surface. The extent to which hemosiderin deposition was associated with several clinical factors was investigated. Various degrees of hemosiderin deposition were detected in 31 of 32 (96.9%) single-episode tSAH patients. Analysis of contingency tables revealed an association between the regions of subarachnoid bleeding based on CT images and the regions of hemosiderin deposition based on ESWAN images (?2 = 17.73, P<0.05). SS-CNS was determined to be a common consequence after a single episode of tSAH. The extent of hemosiderin deposition is closely correlated with the initial bleeding sites and bleeding volume. PMID:25647424

Zhao, Hongwei; Wang, Jin; Lu, Zhonglie; Wu, Qingjie; Lv, Haijuan; Liu, Hu; Gong, Xiangyang

2015-01-01

201

Superficial Siderosis of the Central Nervous System Induced by a Single-Episode of Traumatic Subarachnoid Hemorrhage: A Study Using MRI-Enhanced Gradient Echo T2 Star-Weighted Angiography.  

PubMed

The purpose of this study was to examine whether a single episode of traumatic subarachnoid hemorrhage (tSAH) could cause superficial siderosis of the central nervous system (SS-CNS).This study was approved by the local ethics committee. Thirty-two patients with a history of a single episode of tSAH were enrolled in the study. An episode of tSAH was confirmed in patients based on a CT scan or a lumbar puncture, and a follow-up examination was conducted at least six weeks after the brain trauma. A follow-up MRI examination was performed, using enhanced gradient echo T2 star-weighted angiography (ESWAN) to detect hemosiderin deposition on the cortical surface. The extent to which hemosiderin deposition was associated with several clinical factors was investigated. Various degrees of hemosiderin deposition were detected in 31 of 32 (96.9%) single-episode tSAH patients. Analysis of contingency tables revealed an association between the regions of subarachnoid bleeding based on CT images and the regions of hemosiderin deposition based on ESWAN images (?2 = 17.73, P<0.05). SS-CNS was determined to be a common consequence after a single episode of tSAH. The extent of hemosiderin deposition is closely correlated with the initial bleeding sites and bleeding volume. PMID:25647424

Zhao, Hongwei; Wang, Jin; Lu, Zhonglie; Wu, Qingjie; Lv, Haijuan; Liu, Hu; Gong, Xiangyang

2015-01-01

202

Risk Factors for DVT/PE in Patients with Stroke and Intracranial Hemorrhage  

PubMed Central

Objective: Deep venous thrombosis (DVT) and pulmonary embolus (PE) are serious problems for patients admitted to the hospital with stroke, subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH) and transient ischemic attack (TIA). The purpose of this paper is to further understand the factors that place certain patients at increased risk of DVT/PE. Methods: At a 600 bed hospital, a retrospective analysis of data from 2613 patients admitted with a diagnosis of stroke, SAH, ICH or TIA in the time range 1/2008 through 3/2012 was carried out. The data was taken from the hospital’s Get with the Guidelines database and included 28 variables. These included initial NIH stroke scale, length of stay, heart failure, ambulatory by day 2 after admission, altered mental status,and renal failure among others. Multiple analyses were carried out to determine whether there were univariable or multivariable effects of any of the factors on the risk for DVT/PE. Results: The risk of DVT/PE was highest in patients with SAH and ICH and smallest with TIA. Multivariable analyses were performed and revealed only altered level of consciousness or heart failure as significant risks for DVT/PE. With the limited available data, administration of subcutaneous heparin or other chemoprophylaxis did not reduce the risk of DVT/PE. Conclusion: Although many of the variables used to describe the stroke patient are correlated, in multivariable analyses only heart failure and altered level of consciousness were important risk factors for DVT/PE. The risk of DVT/PE was 7 fold greater in patients in patients with both of these risk factors. PMID:24847389

Stecker, Mark; Michel, Kathleen; Antaky, Karin; Cherian, Sarah; Koyfmann, Feliks

2014-01-01

203

Administration of a PTEN inhibitor BPV(pic) attenuates early brain injury via modulating AMPA receptor subunits after subarachnoid hemorrhage in rats.  

PubMed

The aim of this study was to investigate whether the phosphatase and tensin homolog deleted on chromosome ten (PTEN) inhibitor dipotassium bisperoxo(pyridine-2-carboxyl) oxovanadate (BPV(pic)) attenuates early brain injury by modulating ?-amino-3-hydroxy-5-methyl-4-isoxa-zolep-propionate (AMPA) receptor subunits after subarachnoid hemorrhage (SAH). A standard intravascular perforation model was used to produce the experimental SAH in Sprague-Dawley rats. BPV(pic) treatment (0.2mg/kg) was evaluated for effects on neurological score, brain water content, Evans blue extravasation, hippocampal neuronal death and AMPA receptor subunits alterations after SAH. We found that BPV(pic) is effective in attenuating BBB disruption, lowering edema, reducing hippocampal neural death and improving neurological outcomes. In addition, the AMPA receptor subunit GluR1 protein expression at cytomembrane was downregulated, whereas the expression of GluR2 and GluR3 was upregulated after BPV(pic) treatment. Our results suggest that PTEN inhibited by BPV(pic) plays a neuroprotective role in SAH pathophysiology, possibly by alterations in glutamate AMPA receptor subunits. PMID:25575796

Chen, Yujie; Luo, Chunxia; Zhao, Mingyue; Li, Qiang; Hu, Rong; Zhang, John H; Liu, Zhi; Feng, Hua

2015-02-19

204

[Spontaneous subarachnoid hemorrhage].  

PubMed

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

Steinmetz, H

2012-06-01

205

Microcatheter embolization of hemorrhages  

SciTech Connect

Purpose. To evaluate the efficacy of embolotherapy using microcatheters in patients with hemorrhage from various locations. Methods. Among 29 patients there were 13 with severe epistaxis, 7 with gastrointestinal bleeding, 4 with hemorrhage in the kidney, 4 with bleeding in pelvic organs and 1 with bleeding in the shoulder region. In all cases, a Tracker-18 or Tracker-10 microcatheter was advanced coaxially through a 4.1 Fr guiding catheter in order to reach the bleeding site as distally as possible. Polyvinyl alcohol microparticles and/or platinum microcoils were used as embolic material. Results. The bleeding was stopped in 90% (26 of 29) of cases. In 66% of cases the treatment was curative, in 7% preoperative, and in 17% palliative. There were 3 clinical failures. Conclusion. Microcatheter embolization is an effective and safe means of managing different kinds of hemorrhage of various causes from a variety of sites.

Seppaenen, Seppo K.; Leppaenen, Martti J.; Pimenoff, Georg; Seppaenen, Janne M. [Tampere University Hospital, Department of Radiology (Finland)

1997-05-15

206

Cerebral Cavernous Malformation and Hemorrhage  

MedlinePLUS

... hemorrhage remains poorly understood. While there are various theories regarding CCM hemorrhagic behavior, none have been unequivocally ... symptoms is both confusing and frightening. Many patients demand answers that are not yet available based upon ...

207

Marburg Hemorrhagic Fever (Marburg HF)  

MedlinePLUS

... chronological list of known cases and outbreaks. Marburg hemorrhagic fever (Marburg HF) Topics Transmission How do people get Marburg hemorrhagic fever? Signs and Symptoms What are the signs and ...

208

Ebola hemorrhagic Fever.  

PubMed

Ebola hemorrhagic fever is an often-fatal disease caused by a virus of the Filoviridae family, genus Ebolavirus. Initial signs and symptoms of the disease are nonspe-cific, often progressing on to a severe hemorrhagic illness. Special Operations Forces Medical Providers should be aware of this disease, which occurs in sporadic outbreaks throughout Africa. Treatment at the present time is mainly supportive. Special care should be taken to prevent contact with bodily fluids of those infected, which can transmit the virus to caregivers. PMID:25344714

Burnett, Mark W

2014-01-01

209

Vasospasm following aneurysmal subarachnoid hemorrhage: Thrombocytopenia a marker  

PubMed Central

Background: Symptomatic vasospasm (SV) is often seen after aneurysmal subarachnoid hemorrhage (aSAH). The pathophysiology suggests that platelets initiate the process and are consumed. This is likely to result in thrombocytopenia. The objective of this study was to find out if thrombocytopenia preceded or followed SV and to analyze the relationship between the two. Materials and Methods: The platelet counts of 74 patients were studied on day 1, 3, 5, 7, 9, 11, and 14 following aSAH. Clinical symptoms and raised velocities on transcranial Doppler were studied on the same days to determine SV. The relationship of platelet counts and SV were analyzed. Results: Thirty-nine (52.7%) patients developed SV. Platelet counts dropped on postictal day (PID) 3-7 and SV was commonly seen on PID 5-9. The median platelet counts were significantly lower in patients with SV when compared to those without SV. Platelet count <150,000/mm3 on PID 1 and 7 had statistically significant association (P < 0.001) with SV. The odds ratio was 5.1, 6.9, and 5.1 on PID 5, 7, and 9, respectively, for patients with relative thrombocytopenia (P < 0.001). Conclusions: There is a strong correlation between thrombocytopenia and SV. A platelet count < 150,000/mm3 on PID 1 and 7 predicts presence of SV. The relative risk of developing SV is >5 times for a patient with relative thrombocytopenia especially on PID 5-9. Additionally, it appears that thrombocytopenia precedes vasospasm and may be an independent predictor. However, this requires further studies for validation. PMID:24250155

Aggarwal, Ashish; Salunke, Pravin; Singh, Harnarayan; Gupta, Sunil Kumar; Chhabra, Rajesh; Singla, Navneet; Sachdeva, Ashwani Kumar

2013-01-01

210

Clot-clearance rate in the sylvian cistern is associated with the severity of cerebral vasospasm after subarachnoid hemorrhage.  

PubMed

Rapid clot removal and clearance has been proposed as an effective tool for preventing cerebral vasospasm after subarachnoid hemorrhage (SAH). We examined the relationship between clot-clearance rate and the severity of cerebral vasospasm in 110 consecutive patients with aneurysmal SAH. We measured clot-clearance rates per day in the basal and Sylvian cisterns, and evaluated the presence of symptomatic vasospasm based on changes in clinical symptoms and the appearance of a new low-density area on a computed tomography (CT) scan. The severity of symptomatic cerebral vasospasm was associated with age and the SAH grade on admission; however, we observed no significant difference between these variables in patients with urokinase irrigation or fasudil hydrochloride treatment. The mean clot-clearance rates per day for patients with asymptomatic and permanent delayed ischemic neurological deficit were 41.9 and 41.5 %, respectively, in the basal cistern (P?=?0.7358) and 37.7 and 23.9 %, respectively, in the Sylvian cistern (P?=?0.0021). The reduced clot-clearance rate in the Sylvian cistern increased the risk of vasospasm-related infarction (P?=?0.0093) and markedly reduced unfavorable outcomes (P?=?0.0115). PMID:25366636

Toyoda, Tomikatsu; Yonekura, Ichiro; Iijima, Akira; Shinozaki, Munehisa; Tanishima, Takeo

2015-01-01

211

Cerebrospinal Fluid Catecholamine Levels as Predictors of Outcome in Subarachnoid Hemorrhage  

PubMed Central

Objective Subarachnoid hemorrhage (SAH) is associated with marked sympathetic activation at the time of ictus. The purpose of this study is to determine whether early central catecholamine levels measured from cerebrospinal fluid (CSF) relate to outcome in patients with SAH. Methods Observational study of consecutive SAH grade 3–5 patients who underwent ventriculostomy placement, but did not undergo open craniotomy for aneurysm obliteration. CSF samples were obtained during the first 48 h following symptom onset and assayed for catecholamine levels. Statistical analyses were performed to determine whether the levels predicted mortality by day 15 or mortality/disability by day 30. Results For the 102 patients included, mean age was 58, and 73% were female ? 21% experienced day-15 mortality, and 32% experienced mortality/disability by day 30. Early mortality was related to Hunt-Hess (H/H) grade (p < 0.001), neurogenic cardiomyopathy (NC) (p = 0.003), cerebral infarction (p = 0.001), elevated intracranial pressure (ICP) (p = 0.029), epinephrine (EPI) level (p = 0.002) and norepinephrine/3,4-dihydroxyphenylglycol (NE/DHPG) ratio (p = 0.003). Mortality/disability was related to H/H grade (p < 0.001), NC (p = 0.018), infarction (p < 0.001), elevated ICP (p = 0.002), EPI (p = 0.004) and NE/DHPG (p = 0.014). Logistic regression identified age [OR 1.09 (95% CI 1.01–1.17)], H/H grade [9.52 (1.19–77)], infarction [10.87 (1.22–100)], ICP elevation [32.26 (2–500)], EPI [1.06 (1.01–1.10)], and (inversely) DHPG [0.99 (0.99–1.00)] as independent predictors of early mortality. For mortality/disability, H/H grade [OR 21.74 (95% CI 5.62?83)], ICP elevation [18.52 (1.93–166)], and EPI [1.05 (1.02–1.09)] emerged as independent predictors. Proportional-hazards analysis revealed age [HR 1.041 (95% CI 1.003–1.08)], H/H grade [6.9 (1.54–31.25)], NC [4.31 (1.5–12.35)], and EPI [1.032 (1.009–1.054)] independently predicted early mortality. Conclusions CSF catecholamine levels are elevated in SAH patients who experience early mortality or disability. EPI may potentially serve as useful index of outcome in this population of patients with SAH. PMID:22222551

Moussouttas, Michael; Huynh, Thanh T.; Khoury, John; Lai, Edwin W.; Dombrowski, Keith; Pello, Scott; Pacak, Karel

2012-01-01

212

THE ALBUMIN IN SUBARACHNOID HEMORRHAGE (ALISAH) MULTICENTER PILOT CLINICAL TRIAL: SAFETY AND NEUROLOGIC OUTCOMES  

PubMed Central

Background and Purpose Human albumin has been shown to exert neuroprotective effects in animal models of cerebral ischemia and humans with various intracranial pathologies. We investigated the safety and tolerability of 25% human albumin (ALB) in patients with subarachnoid hemorrhage (SAH). Methods The ALISAH (Albumin in Subarachnoid Hemorrhage) Pilot Clinical Trial was an open-label, dose-escalation study. We intended to study 4 different dosages of ALB of increasing magnitude (0.625 g/kg: tier 1; 1.25 g/kg: tier 2; 1.875 g/kg: tier 3; and 2.5 g/kg: tier 4). Each dosage was to be given to 20 adult patients. Treatment was administered daily for 7 days. We investigated the maximum tolerated dose of ALB based on the rate of severe-to-life-threatening heart failure and anaphylactic reaction, and functional outcome at 3 months. Results We treated 47 adult subjects: 20 in tier 1; 20 in tier 2; and 7 in tier 3. We found that doses ranging up to 1.25 g/kg/day × 7 days were tolerated by patients without major dose-limiting complications. We also found that outcomes trended towards better responses in those subjects enrolled in tier 2 compared to tier 1 (OR: 3.0513; CI: 0.6586 – 14.1367) and to the International Intra-operative Hypothermia for Aneurysm Surgery Trial cohort (OR: 3.1462; CI: 0.9158 – 10.8089). Conclusions ALB in doses ranging up to 1.25 g/Kg/day × 7 days was tolerated by patients with SAH without major complications and may be neuroprotective. Based on these results, planning of the ALISAH II, a Phase III, randomized, placebo-controlled trial to test the efficacy of ALB is underway. Clinical Trial Registration Information: NCT00283400 (clinicaltrials.gov) http://clinicaltrials.gov/ct2/show/NCT00283400?term=subarachnoid+hemorrhage+houston&rank=1 PMID:22267829

Suarez, Jose I; Martin, Renee H.; Calvillo, Eusebia; Dillon, Catherine; Bershad, Eric M; MacDonald, R Loch; Wong, John; Harbaugh, Robert

2012-01-01

213

Alpha7 nicotinic acetylcholine receptor agonist PNU-282987 attenuates early brain injury in a perforation model of subarachnoid hemorrhage in rats  

PubMed Central

Background and purpose Early brain injury is an important pathological process following subarachnoid hemorrhage (SAH). The goal of this study was to evaluate whether the Alpha7 nicotinic acetylcholine receptor (?7nAChR) agonist PNU-282987 attenuates early brain injury after SAH and whether ?7nAChR stimulation is associated with down regulation of caspase activity via PI3K-Akt signaling. Methods The perforation model of SAH was performed and neurological score, body-weight loss and brain water content were evaluated 24 and 72 hours after surgery. Western blot and immunohistochemistry were used for quantification and localization of phosphorylated Akt (p-Akt) and Cleaved Caspase-3 (CC3). Neuronal cell death was quantified with TUNEL staining. ?7nAChR antagonist Methylcaconitine and PI3K inhibitor Wortmannin were used to manipulate the proposed pathway and results were quantified with western blot. Results PNU-282987 improved neurological deficits both 24 and 72 hours after surgery and reduced brain water content in left hemispheres 24 hours after surgery. PNU-282987 significantly increased p-Akt levels and significantly decreased CC3 levels in ipsilateral hemispheres after SAH. Methylcaconitine and Wortmannin reversed effects of treatment. P-Akt and CC3 were co-localized to neurons in the ipsilateral basal cortex. P-Akt was mainly localized in TUNEL negative cells. PNU-282987 significantly reduced neuronal cell death in ipsilateral basal cortex. Conclusion ?7nAChR stimulation decreased neuronal cell death, brain edema and improved neurological status in a rat perforation model of SAH. ?7nAChR stimulation is associated with increasing phosphorylation of Akt and decreasing cleaved caspase-3 levels in neurons. PMID:21960575

Duris, Kamil; Manaenko, Anatol; Suzuki, Hidenori; Rolland, William B.; Krafft, Paul R.; Zhang, John H.

2011-01-01

214

Decompressive Surgery in Patients with Poor-grade Aneurysmal Subarachnoid Hemorrhage: Clipping with Simultaneous Decompression Versus Coil Embolization Followed by Decompression  

PubMed Central

Objective In addition to obliterating the aneurysm using clipping or coiling, decompressive surgery for control of rising intracranial pressure (ICP) is thought to be crucial to prevention of adverse outcomes in patients with poor grade aneurysmal subarachnoid hemorrhage (aSAH). We evaluated the clinical characteristics of patients with poor-grade aSAH, and compared outcomes of aneurysmal clipping with simultaneous decompressive surgery to those of coil embolization followed by decompression. Materials and Methods In 591 patients with aSAH, 70 patients with H-H grade IV and V underwent decompressive surgery including craniectomy, lobectomy, and hematoma removal. We divided the patients into two groups according to clipping vs. coil embolization (clip group vs. coil group), and analyzed outcomes and mortality. Results Aneurysmal clipping was performed in 40 patients and coil embolization was performed in 30 patients. No significant differences in demographics were observed between the two groups. Middle cerebral artery and posterior circulation aneurysms were more frequent in the clip group. Among 70 patients, mortality occurred in 29 patients (41.4%) and 61 patients (87.1%) had a poor score on the Glasgow outcome scale (scores I-III). No significant difference in mortality was observed between the two groups, but a favorable outcome was more frequent in the coil group (p < 0.05). Conclusion In this study, despite aggressive surgical and endovascular management for elevated ICP, there were high rates of adverse outcomes and mortality in poor-grade aSAH. Despite poor outcomes overall, early coil embolization followed by decompression surgery could lead to more favorable outcomes in patients with poor-grade aSAH. PMID:25340028

Hwang, Ui Seung; Lee, Seung Hwan; Koh, Jun Seok

2014-01-01

215

Mean hemoglobin concentration after acute subarachnoid hemorrhage and the relation to outcome, mortality, vasospasm, and brain infarction.  

PubMed

Lower mean hemoglobin (HGB) levels are associated with unfavorable outcome after spontaneous subarachnoid hemorrhage (SAH). Currently, there is no cutoff level for mean HGB levels associated with unfavorable outcome. This study was conducted to evaluate a threshold for mean HGB concentrations after SAH, and to observe the relation to outcome. The medical records of 702 patients with spontaneous SAH were reviewed. Predictors of outcome were proved by univariate analysis. Predictors with p<0.1 were included in a multivariate binary logistic regression model. Cutoff points for mean HGB levels were calculated by receiver operating characteristic curve analysis. Mean HGB was 11.9g/dl (±standard deviation [SD] 1.7g/dl) in patients with favorable outcome compared to 10.8g/dl (±SD 1.1g/dl) in patients with unfavorable outcome (p<0.001). The highest Youden's index value was found for a HGB cutoff at 11.1g/dl. In a binary logistic regression model, predictors of unfavorable outcome were identified as an initially high Hunt-Hess grade (odds ratio [OR]: 7.7; 95% confidence interval [CI]: 4.4-13.4; p<0.001), cerebral infarction on a CT scan during hospital stay (OR: 3.8; 95% CI: 2.0-7.3; p<0.001), rebleeding during the hospital stay (OR: 3.5; 95% CI: 1.6-8.0; p=0.002), mean HGB concentration <11.1g/dl (OR: 3.3; 95% CI: 2.0-5.3; p<0.001), and hydrocephalus (OR: 2.3; 95% CI: 1.4-3.7; p=0.001). In conclusion, a mean HGB concentration <11.1g/dl during the hospital stay was associated with unfavorable outcome after acute SAH. PMID:25533213

Stein, Marco; Brokmeier, Lisa; Herrmann, Johannes; Scharbrodt, Wolfram; Schreiber, Vanessa; Bender, Michael; Oertel, Matthias F

2015-03-01

216

Colonic diverticula and hemorrhage  

Microsoft Academic Search

Summary  Approximately 17 per cent of 500 patients with diverticular disease had colonic hemorrhage. In most cases the bleeding was\\u000a mild, but it is potentially a lethal complication. In this series the associated mortality was 3.6 per cent. If the bleeding\\u000a site is readily identifiable it is reasonable to resect the involved area; if not, total abdominal colectomy with ileorectal\\u000a anastomosis

ANTHONY R.. GENNARO; George P. Rosemond

1973-01-01

217

Grading scales used in the management of aneurysmal subarachnoid hemorrhage: a critical review.  

PubMed

The use of grading scales to predict clinical outcomes following aneurysmal subarachnoid hemorrhage (aSAH) is commonplace. In recent times management of aSAH patients has developed such that surgical intervention is taking place earlier in the course of the illness. Given the complex and multifactoral clinical picture of these patients, there is an increased impetus to examine and reevaluate the relative merits and predictive characteristics of grading scales. The measurement characteristics and predictive power of the following instruments were reviewed: Fisher Scale (FS), Glasgow Coma Scale (GCS), Glasgow Outcome Score (GOS), Hunt and Hess (HH) Scale, Karnovsky Performance Scale (KPS), and the World Federation of Neurological Surgeons (WFNS) Scale. No uniformly conclusive findings were found when the HH Scale, GCS, and WFNS Scale were used to predict clinical outcomes. No instrument consistently outperformed any other across age or severity. Contradictory findings were reported. Difficulties were encountered in comparing instruments because of administration, scoring schemes, timing of assessments, and psychometric properties, such as interrater reliability. Reports on newly developed instruments often lacked the replication data necessary to effectively compare measures currently in use. The timing of measurements and the use of serial measures emerged as important factors in the prediction of clinical outcomes. Assessments taken close to the time of surgical intervention were found to have superior predictive abilities. PMID:12506811

Cavanagh, Stephen J; Gordon, Vickie L

2002-12-01

218

Intravenous Flat-Detector Computed Tomography Angiography for Symptomatic Cerebral Vasospasm following Aneurysmal Subarachnoid Hemorrhage  

PubMed Central

The study evaluated the diagnostic accuracy of intravenous flat-detector computed tomography (IV FDCT) angiography in assessing hemodynamically significant cerebral vasospasm in patients with subarachnoid hemorrhage (SAH) with digital subtraction angiography (DSA) as the reference. DSA and IV FDCT were conducted concurrently in patients suspected of having symptomatic cerebral vasospasm postoperatively. The presence and severity of vasospasm were estimated according to location (proximal versus distal). Vasospasm >50% was defined as having hemodynamic significance. Vasospasms <30% were excluded from this analysis to avoid spectrum bias. Twenty-nine patients (311 vessel segments) were measured. The intra- and interobserver agreements were excellent for depicting vasospasm (k = 0.84 and 0.74, resp.). IV FDCT showed a sensitivity of 95.7%, specificity of 92.3%, positive predictive value of 93.6%, and negative predictive value of 94.7% for detecting vasospasm (>50%) with DSA as the reference. Bland-Altman plots revealed good agreement of assessing vasospasm between the two tests. The discrepancy of vasospasm severity was more noted in the distal location with high-severity. However, it was not statistically significant (Spearman's rank test; r = 0.15, P = 0.35). Therefore, IV FDCT could be a feasible noninvasive test to evaluate suspected significant vasospasm in SAH. PMID:25383367

Jeon, Jin Pyeong; Sheen, Seung Hun; Cho, Yong-Jun

2014-01-01

219

Subarachnoid hemorrhage and death following coingestion of MDMA with other drugs.  

PubMed

Ecstasy, the popular name for 3,4-methylenedioxymethamphetamine (MDMA), is a synthetic amphetamine derivative. It stimulates the sympathetic nervous system, producing serious adverse effects on the cardiovascular system. We present a 20-year-old female patient, who developed subarachnoid hemorrhage (SAH) and death following MDMA and coingestion with other drugs. She suffered from severe headache followed by vomiting, and conscious change 5 hours after an intake of 1 tablet MDMA and other drugs at a dance club. Her blood pressure was 226/164 mmHg, pulse rate 164/min, respiratory rate 30/min on arrival at our emergency department. Diffuse rales were heard over both lung fields. Both pupils' sizes were 4 mm, with sluggish reaction to light. A 12 lead electrocardiograph showed sinus tachycardia, ST depression in the inferior leads and V4 to V6 precordial leads. Laboratory findings revealed normal except a slightly raised white cell count and glucose. Arterial blood gas analysis showed pH was 7.333, with PaCO2 24.6 mmHg, PaO2 151.7 mmHg and HCO3 12.8 mmol/L. Chest x-ray revealed acute pulmonary edema. Urgent computerized tomography scanning of the head demonstrated SAH. Her condition continued to deteriorate, and went to deep coma and shock status. She expired on the second day although we treated aggressively. PMID:15779490

Ho, Min-Po; Tsai, Jen-Lieu; Wong, Yin-Kin

2004-12-01

220

Impact of clipping versus coiling on postoperative hemodynamics and pulmonary edema after subarachnoid hemorrhage.  

PubMed

Volume management is critical for assessment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH). This multicenter prospective cohort study compared the impact of surgical clipping versus endovascular coiling on postoperative hemodynamics and pulmonary edema in patients with SAH. Hemodynamic parameters were measured for 14 days using a transpulmonary thermodilution system. The study included 202 patients, including 160 who underwent clipping and 42 who underwent coiling. There were no differences in global ejection fraction (GEF), cardiac index, systemic vascular resistance index, or global end-diastolic volume index between the clipping and coiling groups in the early period. However, extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) were significantly higher in the clipping group in the vasospasm period. Postoperative C-reactive protein (CRP) level was higher in the clipping group and was significantly correlated with postoperative brain natriuretic peptide level. Multivariate analysis found that PVPI and GEF were independently associated with high EVLWI in the early period, suggesting cardiogenic edema, and that CRP and PVPI, but not GEF, were independently associated with high EVLWI in the vasospasm period, suggesting noncardiogenic edema. In conclusion, clipping affects postoperative CRP level and may thereby increase noncardiogenic pulmonary edema in the vasospasm period. His trial is registered with University Hospital Medical Information Network UMIN000003794. PMID:24818154

Horie, Nobutaka; Iwaasa, Mitsutoshi; Isotani, Eiji; Ishizaka, Shunsuke; Inoue, Tooru; Nagata, Izumi

2014-01-01

221

Hemorrhagic adrenal cyst.  

PubMed

The authors present a case of a hemorrhagic adrenal cyst, one of the tumors known in literature as incidentalomas, emphasizing the clinical characteristics, since adrenal cysts or pseudocysts are generally rare and observed by chance during imaging procedures. Traditionally they are classified as pseudocysts, endothelial, epithelial or parasitic cysts. Laparoscopic adrenalectomy has been considered the treatment of choice for benign, functioning or non-functioning adrenal lesions. Small cystic adrenal tumors can be managed conservatively by laparoscopic decortication or marsupialization, but larger cysts should be treated by total or partial adrenalectomy. PMID:23045835

da Silva, Elsa Cristina Fontes Pires; Viamontez, Francisco; Silva, Vasco Sabino; Andrade, Artur; Júlio Neto, Gonçalo; Gomes, Constança de Palma; Neto, Sérgio; Quitembo, Mateus; Dimbany, Higino; Van-Dunem, Joaquim Carlos Vicente Dias; de Miranda, Sandra Maria da Rocha Neto; Bastos, Fernando; Cordeiro, Lemuel Bornelli; Guilherme, Mateus

2012-01-01

222

Thalamic hemorrhage imitating hyperventilation.  

PubMed

A 52-year-old woman developed subjective right hemiparesthesias over a two-day period. Because of a paucity of physical findings, apparent anxiety with tachypnea, and a respiratory alkalosis with hypocapnia, a diagnosis of hyperventilation syndrome was considered. However, because of the unilateral symptoms, a computed tomography scan was performed, demonstrating a left posterior thalamic infarct. Most reports of thalamic infarct indicate altered mental status, vertical gaze palsies, or sensorimotor hemiparesis with sensory involvement predominant. The case of a patient with thalamic hemorrhage who presented with only hemiparesthesia is reported to heighten clinicians' awareness of this diagnosis. PMID:2389866

Scialdone, A M

1990-07-01

223

Treatment of subarachnoid hemorrhage.  

PubMed

Nontraumatic subarachnoid hemorrhage from intracranial aneurysm rupture presents with sudden severe headache. Initial treatment focuses on airway management, blood pressure control, and extraventricular drain for hydrocephalus. After identifying the aneurysm, they may be clipped surgically or endovascularly coiled. Nimodipine is administered to maintain a euvolemic state and prevent delayed cerebral ischemia (DCI). Patients may receive anticonvulsants. Monitoring includes serial neurologic assessments, transcranial Doppler ultrasonography, computed tomography perfusion, and angiographic studies. Treatment includes augmentation of blood pressure and cardiac output, cerebral angioplasty, and intra-arterial infusions of vasodilators. Although early mortality is high, about one half of survivors recover with little disability. PMID:25257737

Raya, Amanda K; Diringer, Michael N

2014-10-01

224

B-type natriuretic peptide release and left ventricular filling pressure assessed by echocardiographic study after subarachnoid hemorrhage: a prospective study in non-cardiac patients  

Microsoft Academic Search

Introduction  Serum B-type natriuretic peptide (BNP) is frequently elevated after subarachnoid hemorrhage (SAH), but whether this high BNP\\u000a level is related to transient elevation of left ventricular filling pressure (LVFP) is unknown. However, in patients with\\u000a preexistent cardiac pathologies, it is impossible to differentiate between BNP elevation caused by chronic cardiac abnormalities\\u000a and BNP related to acute neurocardiac injury.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  All adult

Eric Meaudre; Christophe Jego; Nadia Kenane; Ambroise Montcriol; Henry Boret; Philippe Goutorbe; Gilbert Habib; Bruno Palmier

2009-01-01

225

Angiogenesis and Hereditary Hemorrhagic Telangiectasia  

Microsoft Academic Search

To date much of the recent work on pathological angiogenesis has focused on inflammatory diseases, diabetes and cancer in particular. Hereditary hemorrhagic telangiectasia or Rendu-Osler-Weber disease provides an example of the genetic disorder of angiogenesis in which a multisystemic angiodysplasia is responsible for severe hemorrhage. The disease pathogenesis is partially explained by a defect in the TGF-? signaling system, although

Carlo Sabbà; Anna Cirulli; Rita Rizzi; Giovanna Pasculli; Mauro Gallitelli; Giorgina Specchia; Vincenzo Liso

2001-01-01

226

Argentine hemorrhagic fever vaccines.  

PubMed

Argentine hemorrhagic fever (AHF), an acute disease caused by Junin virus (JUNV, Arenaviridae), has been an important issue to public health in Argentina since the early 1950s. The field rodent Calomys musculinus is JUNV natural reservoir and human disease is a consequence of contact with infected rodents. A steady extention of AHF endemic area is being observed since the first reports of the disease. Important achievements have been made in: (a) improvement of methods for the etiological diagnosis; (b) implementation and validation of therapeutical measures; (c) development of vaccines to protect against AHF. Reference is made to different research strategies used to obtain anti-AHF vaccines in the past and anti-arenaviral diseases in the present. Information is updated on features and field performance of Candid #1 vaccine, a live attenuted vaccine currently used to prevent AHF. This vaccine was developed through a joint international effort that envisioned it as an orphan drug. With transferred technology, Argentine government was committed to be Candid #1 manufacturer and to register this vaccine as a novel medical product under the Argentine regulatory authority. Candid #1 vaccine is the first one used to control an arenaviral hemorrhagic fever, the first live viral vaccine to be manufactured and registered in Argentina, reaching its target population through governmental effort. PMID:21451263

Ambrosio, Ana; Saavedra, Maria; Mariani, Mauricio; Gamboa, Graciela; Maiza, Andrea

2011-06-01

227

Incidence, predisposing factors, management and survival following cardiac arrest due to subarachnoid haemorrhage: a review of the literature  

PubMed Central

Introduction The prevalence of cardiac arrest among patients with subarachnoid haemorrhage [SAH], and the prevalence of SAH as the cause following out-of-hospital cardiac arrest [OHCA] or in-hospital cardiac arrest [IHCA] is unknown. In addition it is unclear whether cardiopulmonary resuscitation [CPR] and post-resuscitation care management differs, and to what extent this will lead to meaningful survival following cardiac arrest [CA] due to SAH. Aim We reviewed the literature in order to describe; 1.The prevalence and predisposing factors of CA among patients with SAH 2.The prevalence of SAH as the cause of OHCA or IHCA and factors characterising CPR 3.The survival and management of SAH patients with CA. Material and methods The following sources, PubMed, CinAHL and The Cochrane DataBase were searched using the following Medical Subheadings [MeSH]; 1. OHCA, IHCA, heart arrest and 2. subarachnoid haemorrhage. Articles containing relevant data based on the abstract were reviewed in order to find results relevant to the proposed research questions. Manuscripts in other languages than English, animal studies, reviews and case reports were excluded. Results A total of 119 publications were screened for relevance and 13 papers were included. The prevalence of cardiac or respiratory arrest among all patients with SAH is between 3-11%, these patients commonly have a severe SAH with coma, large bleeds and evidence of raised intracerebral pressure on computed tomography scans compared to those who did not experience a CA. The prevalence of patients with SAH as the cause of the arrest among OHCA cases vary between 4 to 8% among those who die before hospital admission, and between 4 to 18% among those who are admitted. The prevalence of SAH as the cause following IHCA is low, around 0.5% according to one recent study. In patients with OHCA survival to hospital discharge is poor with 0 to 2% surviving. The initial rhythm is commonly asystole or pulseless electrical tachycardia. In IHCA the survival rate is variable with 0-27% surviving. All survivors experience brief cardiac arrests with short latencies to ROSC. Conclusion Cardiac arrest is a fairly common complication following severe SAH and these patients are encountered both in the pre-hospital and in-hospital setting. Survival is possible if the arrest occurs in the hospital and the latency to ROSC is short. In OHCA the outcome seems to be uniformly poor despite initially successful resuscitation. PMID:23151345

2012-01-01

228

Isolated arterioportal fistula presenting with variceal hemorrhage  

PubMed Central

We report a case of life-threatening hematemesis due to portal hypertension caused by an isolated arterioportal fistula (APF). Intrahepatic APFs are extremely rare and are a cause of presinusoidal portal hypertension. Etiologies for APFs are comprised of precipitating trauma, malignancy, and hereditary hemorrhagic telangiectasia, but these were not the case in our patient. Idiopathic APFs are usually due to congenital vascular abnormalities and thus usually present in the pediatric setting. This is one of the first cases of adult-onset isolated APF who presented with portal hypertension and was successfully managed through endoscopic hemostasis and subsequent interventional radiological embolization. PMID:23674881

Nookala, Anupama; Saberi, Behnam; Ter-Oganesyan, Ramon; Kanel, Gary; Duong, Phillip; Saito, Takeshi

2013-01-01

229

Perioperative measures to improve outcome after subarachnoid hemorrhage-revisiting the concept of secondary brain injury.  

PubMed

Progress in the management of aneurysmal subarachnoid hemorrhage (SAH) is reflected most clearly in a continuously decreasing case fatality rate over the last decades. The purpose of the present review is to identify the relevant factors responsible for this progress and to outline future possibilities of improvement. Although data on intracerebral hemorrhage and ischemic stroke are less homogeneous, the respective data suggest that reduction of case fatalities could also be achieved with these types of stroke. Therefore, advances of general neurocritical care may be the common denominator responsible for the decreasing case fatality rates. Additionally, a change in practice with regard to treatment of elderly patients that is more active may also be a factor. Regarding SAH, the majority of unfavorable outcomes is still related to early or delayed cerebral injury. Therefore, efforts to pharmacologically prevent secondary neuronal damage are likely to play a certain role in achieving improvement in overall outcome. However, the data from previous randomized clinical trials conducted during the last three decades does not strongly support this. A clear benefit has only been proven for oral nimodipine, whereas other calcium antagonists and the rho-kinase inhibitors were not conclusively shown to have a significant effect on functional outcome, and all other tested substances disappointed in clinical trials. Regarding ischemic stroke and traumatic brain injury, intensive clinical research has also been conducted during the last 30 years to improve outcome and to minimize secondary neuronal injury. For ischemic stroke, treatment focusing on reversal of the primary pathomechanism, such as thrombolysis, proved effective, but none of the pharmacological neuroprotective concepts resulted in any benefit. To date, decompressive hemicraniectomy has been the only effective effort focused at reducing secondary damage that resulted in a clear reduction of mortality. In the case of traumatic brain injury, none of the pharmacological or other efforts to limit secondary damage met our hopes. In summary, although limited, pharmacotherapy to limit delayed neuronal injury is more effective for SAH than for ischemic stroke and traumatic brain injury. The disappointing results of most trials addressing secondary damage force one to question the general concept of mechanisms of secondary damage that do not also have a positive side in the natural course of the disease. For example, in the case of SAH, the data from the Cooperative Study from the 1960s showed that vasospasm to some degree protects against rerupture of unsecured aneurysms. Thus, one could argue from an evolutionary standpoint that the purpose of vasospasm was not exclusively a detrimental or suicide pathomechanism, but an attempt to protect against life-threating aneurysm rerupture. Because of the above-discussed arguments, SAH may indeed differ from ischemic stroke and traumatic brain injury with regard to the usefulness of blocking secondary mechanisms pharmacologically. Further efforts to limit vasospasm should therefore be made, and the most promising drugs, calcium antagonists, deserve further development. Because, with various drugs, systemic side effects counteracted the local beneficial effect, future efforts should focus on topical administration of drugs instead of systemic administration. Furthermore, efforts for a better understanding of the variations of the calcium channels and the interplay between the different types of calcium channels should be made. PMID:25366626

Steiger, Hans-Jakob; Beez, Thomas; Beseoglu, Kerim; Hänggi, Daniel; Kamp, Marcel A

2015-01-01

230

A schizophrenic patient with cerebral infarctions after hemorrhagic shock  

PubMed Central

We herein report the fourth case of cerebral infarction, concomitant with hemorrhagic shock, in English literature. A 33-year-old male, who had been diagnosed with schizophrenia and given a prescription for Olanzapine, was discovered with multiple self-inflicted bleeding cuts on his wrist. On arrival, he was in hemorrhagic shock without verbal responsiveness, but his vital signs were normalized following infusion of Lactate Ringer's solution. The neuroradiological studies revealed multiple cerebral ischemic lesions without any vascular abnormality. He was diagnosed with speech apraxia, motor aphasia, and dysgraphia, due to multiple cerebral infarctions. As there was no obvious causative factor with regard to the occurrence of cerebral infarction in the patient, the hypoperfusion due to hemorrhagic shock, and the thromboembolic tendency due to Olanzapine, might have acted together to lead to the patient's cerebral ischemia. PMID:23493336

Yanagawa, Youichi; Ohara, Keiichiro; Tanaka, Yasutaka; Tanaka, Ryota

2013-01-01

231

Hemorrhagic shock: The “physiology approach”  

PubMed Central

A shift of approach from ‘clinics trying to fit physiology’ to the one of ‘physiology to clinics’, with interpretation of the clinical phenomena from their physiological bases to the tip of the clinical iceberg, and a management exclusively based on modulation of physiology, is finally surging as the safest and most efficacious philosophy in hemorrhagic shock. ATLS® classification and recommendations on hemorrhagic shock are not helpful because antiphysiological and potentially misleading. Hemorrhagic shock needs to be reclassified in the direction of usefulness and timing of intervention: in particular its assessment and management need to be tailored to physiology. PMID:23248495

Bonanno, Fabrizio Giuseppe

2012-01-01

232

Volume replacement following severe postpartum hemorrhage.  

PubMed

Severe postpartum hemorrhage (PPH) can be defined as a blood loss of more than 1500 mL to 2500 mL. While rare, severe PPH is a significant contributor to maternal mortality and morbidity in the United States and throughout the world. Due to the maternal hematologic adaptation to pregnancy, the hypovolemia resulting from hemorrhage can be asymptomatic until a large amount of blood is lost. Rapid replacement of lost fluids can mitigate effects of severe hemorrhage. Current evidence on postpartum volume replacement suggests that crystalloid fluids should be used only until the amount of blood loss becomes severe. Once a woman displays signs of hypovolemia, blood products including packed red blood cells, fresh frozen plasma, platelets, and recombinant factor VIIa should be used for volume replacement. Overuse of crystalloid fluids increases the risk for acute coagulopathy and third spacing of fluids. A massive transfusion protocol is one mechanism to provide a rapid, consistent, and evidence-based team response to this life-threatening condition. PMID:24751109

Schorn, Mavis N; Phillippi, Julia C

2014-01-01

233

Spontaneous Absorption of Extensive Subinternal Limiting Membrane Hemorrhage in Shaken Baby Syndrome  

PubMed Central

The Shaken Baby Syndrome (SBS) is characterized by subdural hematomas (SH), retinal hemorrhages (RH), and multiple fractures of long bones without external evidence of head trauma. Subinternal limiting membrane (ILM) hemorrhage, also known as macular schisis, is a characteristic finding of this entity. There is no guideline on the right time to indicate surgical treatment. This report describes an abused child with massive sub-ILM hemorrhage, which showed spontaneous absorption after less than two months of follow-up. Due to the possible spontaneous resolution, we suggest an initial conservative treatment in cases of sub-ILM hemorrhage related to SBS.

Azzi, Tatiana Tarules; Zacharias, Leandro Cabral; Pimentel, Sérgio Luis Gianotti

2014-01-01

234

Hemorrhagic fever with renal syndrome and Crimean-Congo hemorrhagic fever as causes of acute undifferentiated febrile illness in Bulgaria.  

PubMed

Hemorrhagic fever with renal syndrome (HFRS) and Crimean-Congo hemorrhagic fever (CCHF) are the 2 widespread viral hemorrhagic fevers occurring in Europe. HFRS is distributed throughout Europe, and CCHF has been reported mainly on the Balkan Peninsula and Russia. Both hemorrhagic fevers are endemic in Bulgaria. We investigated to what extent acute undifferentiated febrile illness in Bulgaria could be due to hantaviruses or to CCHF virus. Using enzyme-linked immunosorbent assays (ELISAs), we tested serum samples from 527 patients with acute febrile illness for antibodies against hantaviruses and CCHF virus. Immunoglobulin M (IgM) antibodies against hantaviruses were detected in 15 (2.8%) of the patients. Of the 15 hantavirus-positive patients, 8 (1.5%) were positive for Dobrava virus (DOBV), 5 (0.9%) were positive for Puumala virus (PUUV), and the remaining 2 were positive for both hantaviruses. A plaque reduction neutralization test (PRNT) confirmed 4 of the 10 DOBV-positive samples. PRNT was negative for all PUUV-positive samples. Serologic evidence of recent CCHF virus infection was found in 13 (2.5%) of the patients. Interestingly, HFRS and CCHF were not only detected in well-known endemic areas of Bulgaria but also in nonendemic regions. Our results suggested that in endemic countries, CCHF and/or HFRS might appear as a nonspecific febrile illness in a certain proportion of patients. Physicians must be aware of possible viral hemorrhagic fever cases, even if hemorrhages or renal impairment are not manifested. PMID:23421884

Christova, Iva; Younan, Rasha; Taseva, Evgenia; Gladnishka, Teodora; Trifonova, Iva; Ivanova, Vladislava; Spik, Kristin; Schmaljohn, Connie; Mohareb, Emad

2013-03-01

235

Catastrophic sepsis and hemorrhage following transrectal ultrasound guided prostate biopsies.  

PubMed

We report 2 cases of catastrophic complications following routine transrectal ultrasound guided prostate biopsy. The first patient incurred near-fatal septic shock due to multi-resistant Escherichia coli. Due to the severity of his shock, he developed bilateral leg gangrene requiring amputations. The second patient incurred significant hemorrhage eventually requiring an emergent general anesthesia and surgical management to control hemorrhage after other measures failed. While rare events, these reports emphasize the caution needed for physicians who routinely order prostate biopsies. PMID:20174484

Toren, Paul; Razik, Roshan; Trachtenberg, John

2010-02-01

236

Travelers' Health: Viral Hemorrhagic Fevers  

MedlinePLUS

... flaviviruses (dengue, yellow fever, Omsk hemorrhagic fever, Kyasanur Forest disease, and Alkhurma viruses); see the Dengue and ... mosquito (RVF virus) or tick (CCHF, Omsk, Kyasanur Forest disease, Alkhurma viruses) bites or by crushing infected ...

237

[Endoscopic surgery of hemorrhagic stroke.  

PubMed

Objectives. Demonstration and analysis of possibilities of video-endoscopy in the surgical treatment of hypertensive hemorrhages Materials and methods. We analyzed the results of surgical treatment of 35 patients with hypertensive intracranial hematomas which were removed using endoscopic method. Twenty-eight patients had putamen, 3 thalamic, 3 cerebellar and 1 subcortical hematoma; the volume of hematomas ranged from 14 to 84 cm3. Results. Neurological lesions completely disappeared in 7 patients, 6 patients had moderate and 17 severe disability. Five (14%) patients died. Outcome of treatment was significantly (p<0.05) correlated with the level of consciousness before surgery, localization of the hemorrhage, presence and degree of transverse brain dislocation, repeated hemorrhages. Risk factors for poor outcome were depressed consciousness, recurrent hemorrhages, the transverse dislocation >6 mm and deep intracranial hematoma. Conclusions. The efficacy of endoscopic aspiration of hematomas is comparable to open surgical interventions but less traumatic. PMID:24781235

Dash'ian, V G; Korshikova, A N; Godkov, I M; Krylov, V V

2014-01-01

238

Crimean–Congo hemorrhagic fever  

Microsoft Academic Search

Crimean–Congo hemorrhagic fever (CCHF) is a tick-borne disease caused by the arbovirus Crimean–Congo hemorrhagic fever virus (CCHFV), which is a member of the Nairovirus genus (family Bunyaviridae). CCHF was first recognized during a large outbreak among agricultural workers in the mid-1940s in the Crimean peninsula. The disease now occurs sporadically throughout much of Africa, Asia, and Europe and results in

Chris A. Whitehouse

2004-01-01

239

Monitoring of Cerebral Blood Flow and Metabolism Bedside in Patients with Subarachnoid Hemorrhage – A Xenon-CT and Microdialysis Study  

PubMed Central

Cerebral ischemia is the leading cause of morbidity and mortality following aneurysmal subarachnoid hemorrhage (SAH). Although 70% of the patients show angiographic vasospasm only 30% develop symptomatic vasospasm defined as delayed cerebral ischemia (DCI). Early detection and management of reversible ischemia is of critical importance in patients with SAH. Using a bedside Xenon enhanced computerized tomography (Xenon-CT) scanner makes it possible to measure quantitative regional Cerebral blood flow (CBF) bedside in the neurointensive care setting and intracerebral microdialysis (MD) is a method that offers the possibility to monitor the metabolic state of the brain continuously. Here, we present results from nine SAH patients with both MD monitoring and bedside Xenon-CT measurements. CBF measurements were performed within the first 72?h following bleeding. Six out of nine patients developed DCI at a later stage. Five out of six patients who developed DCI had initial global CBF below 26?ml/100?g/min whereas one had 53?ml/100?g/min. The three patients who did not develop clinical vasospasm all had initial global CBF above 27?ml/100?g/min. High lactate/pyruvate (L/P) ratio was associated with lower CBF values in the area surrounding the catheter. Five out of nine patients had L/P ratio ?25 and four of these patients had CBF???22?ml/100?g/min. These preliminary results suggest that patients with initially low global CBF on Xenon-CT may be more likely to develop DCI. Initially low global CBF was accompanied with metabolic disturbances determined by the MD. Most importantly, pathological findings on the Xenon-CT and MD could be observed before any clinical signs of DCI. Combining bedside Xenon-CT and MD was found to be useful and feasible. Further studies are needed to evaluate if DCI can be detected before any other signs of DCI to prevent progress to infarction. PMID:24917850

Rostami, Elham; Engquist, Henrik; Johnson, Ulf; Howells, Timothy; Ronne-Engström, Elisabeth; Nilsson, Pelle; Hillered, Lars; Lewén, Anders; Enblad, Per

2014-01-01

240

Neonatal venous cerebral hemorrhage. Report of two cases.  

PubMed

Intracranial pathological changes can occur as a result of impaired craniocervical venous return. Thrombosis of central venous access catheters was demonstrated in two neonates born at 38 and 27 weeks' gestation. Neither infant developed hemorrhage of prematurity as confirmed on cranial ultrasonography. Clinical evidence of vena cava thrombosis and associated spontaneous intraventricular hemorrhage developed on Day 24 and 36, respectively, and these findings were confirmed on imaging studies. In one infant the hemorrhage was accompanied by communicating hydrocephalus. The cause of the intracranial disease was attributable to the retrograde cerebral venous congestion. This, together with the primitive venous bed developing in the periventricular region, was associated with the spontaneous hemorrhage in the region of the foramen of Monro. To the authors' knowledge, this is the first report in the English-language literature of spontaneous neonatal intracerebral hemorrhage, due to thrombosis of the superior or inferior vena cava. The natural history of this condition is resolution without sequelae after appropriate therapeutic intervention for the vena cava thrombosis. PMID:15344898

Misra, Sanjay N; Misra, Ashish K

2003-10-15

241

Traumatic Injury Causing Intraperitoneal Hemorrhage of an Occult Pheochromocytoma  

PubMed Central

Pheochromocytoma is a rare catecholamine-secreting tumor derived from chromaffin cells. The diagnosis is usually suggested by classic history in a symptomatic patient, presence of a strong family history in a patient, or discovery of an incidental mass on imaging in an asymptomatic patient. Traumatic hemorrhage into an occult pheochromocytoma presenting as hypovolemic shock is a rare presentation of pheochromocytoma. We report a case of a 48-year-old female, who presented in hypovolemic shock due to unilateral adrenal hemorrhage secondary to a fall from horse. Computed tomographic imaging revealed that the source of the hypovolemic shock was hemorrhagic right adrenal mass with active extravasation. The patient underwent emergent selective arterial embolization of right superior adrenal artery and a small adrenal branch from the right renal artery to control the hemorrhage. The patient subsequently progressed to sepsis and MODS, needing multiple surgical procedures and a protracted recovery in the ICU. In the ICU, the patient suffered from rapid cyclic fluctuation of her systolic blood pressure and was subsequently diagnosed with pheochromocytoma secondary to traumatic hemorrhage. We discuss this rare case along with the presentation and diagnostic workup of this critically ill patient with a previously undiagnosed pheochromocytoma. PMID:24826336

Amin, Arpit; Biswas, Saptarshi; Baccay, Francis

2012-01-01

242

Genetics Home Reference: Hereditary hemorrhagic telangiectasia  

MedlinePLUS

... to hereditary hemorrhagic telangiectasia? Mutations in the ACVRL1 , ENG , and SMAD4 genes cause hereditary hemorrhagic telangiectasia. Hereditary ... 1 is caused by mutations in the gene ENG . Type 2 is caused by mutations in the ...

243

Crimean-Congo Hemorrhagic Fever (CCHF)  

MedlinePLUS

... Middle East, and the Indian subcontinent. Crimean-Congo Hemorrhagic Fever (CCHF) Topics Transmission How do people get Crimean-Congo hemorrhagic fever? Signs and Symptoms What are the signs and ...

244

[Sheehan's syndrome after obstetric hemorrhage].  

PubMed

Sheehan's syndrome is described as panhypopituitarism secondary to a pituitary hypoperfusion during or just after obstetric hemorrhage. Advances in obstetric care make this syndrome quite unusual, but some cases are reported in underdeveloped countries. Clinical presentation may change depending on the severity of the hormone deficiencies. The diagnosis is clinical, but abnormalities are observed in the magnetic resonance in up to 70% of patients. We present a case of a woman with hypotension, hypothermia and edemas in relation to a previous massive postpartum hemorrhage. Failure in lactation was the clue to the diagnosis. A review of its main features, its diagnosis and treatment in the current literature is also presented. PMID:24636598

Ramos-López, L; Pons-Canosa, V; Juncal-Díaz, J L; Núñez-Centeno, M B

2014-12-01

245

Parenteral diclofenac infusion significantly decreases brain-tissue oxygen tension in patients with poor-grade aneurysmal subarachnoid hemorrhage  

PubMed Central

Introduction Diclofenac, a nonsteroidal antiinflammatory drug, is commonly used as antipyretic therapy in intensive care. The purpose of this study was to investigate the effects of parenteral diclofenac infusion on brain homeostasis, including brain-tissue oxygen tension (PbtO2) and brain metabolism after aneurysmal subarachnoid hemorrhage (aSAH). Methods We conducted a prospective, observational study with retrospective analysis of 21 consecutive aSAH patients with multimodal neuromonitoring. Cerebral perfusion pressure (CPP), mean arterial pressure (MAP), intracranial pressure (ICP), body temperature, and PbtO2 were analyzed after parenteral diclofenac infusion administered over a 34-minute period (20 to 45 IQR). Data are given as mean ± standard error of mean and median with interquartile range (IQR), as appropriate. Time-series data were analyzed by using a general linear model extended by generalized estimation equations (GEEs). Results One-hundred twenty-three interventions were analyzed. Body temperature decreased from 38.3°C ± 0.05°C by 0.8°C ± 0.06°C (P < 0.001). A 10% decrease in MAP and CPP (P < 0.001) necessitated an increase of vasopressors in 26% (n = 32), colloids in 33% (n = 41), and crystalloids in 5% (n = 7) of interventions. PbtO2 decreased by 13% from a baseline value of 28.1 ± 2.2 mm Hg, resulting in brain-tissue hypoxia (PbtO2 <20 mm Hg) in 38% (n = 8) of patients and 35% (n = 43) of interventions. PbtO2 <30 mm Hg before intervention was associated with brain-tissue hypoxia after parenteral diclofenac infusion (likelihood ratio, 40; AUC, 93%; 95% confidence interval (CI), 87% to 99%; P < 0.001). Cerebral metabolism showed no significant changes after parenteral diclofenac infusion. Conclusions Parenteral diclofenac infusion after aSAH effectively reduces body temperature, but may lead to CPP decrease and brain-tissue hypoxia, which were both associated with poor outcome after aSAH. PMID:23663770

2013-01-01

246

SD-OCT to differentiate traumatic submacular hemorrhage types using automatic three-dimensional segmentation analysis.  

PubMed

Traumatic submacular hemorrhage may present with significant decrease in vision and may have varying outcomes. Following injury, the hemorrhage can collect either between the neurosensory retina and retinal pigment epithelium (RPE) or below the RPE. This differentiation may be important to prognosticate and to guide treatment. In two patients with post-traumatic submacular hemorrhage, Cirrius spectral domain high-definition optical coherence tomography (OCT) (Carl Zeiss Meditec, Dublin, CA) was used to differentiate traumatic submacular hemorrhage types using automation three-dimensional segmentation analysis. Based on the OCT findings, the patient with sub-RPE bleed was subjected to pneumatic displacement. En face C-scan imaging just below the RPE allowed for the diagnosis of the exact location of choroidal rupture that was masked due to hemorrhage. PMID:21366180

Sampangi, Raju; Chandrakumar, H V; Somashekar, Sandhya E; Joshi, Gauri R; Ganesh, Sri

2011-01-01

247

Assessing preventability for obstetric hemorrhage.  

PubMed

We sought to determine preventability for cases of obstetric hemorrhage, identify preventable factors, and compare differences between levels of hospital. We retrospectively reviewed a 1-year cohort of severe and near-miss obstetric hemorrhage in an urban perinatal network. An expert panel, using a validated preventability model, reviewed all cases. Preventability and distribution of preventability factors were compared between levels of hospital care. Sixty-three severe and near-miss obstetric hemorrhage cases were identified from 11 hospitals; 54% were deemed potentially preventable. Overall preventability was not statistically different by level of hospital, and 88% were provider related. The only treatment-related preventability factors were significantly different between levels of hospital and significantly less common in level III hospitals (p?hemorrhage was preventable. The most common potentially preventable factor was provider treatment error, and this was significantly more common in level II hospitals. New interventions should be focused on decreasing providers' treatment errors. PMID:21698554

Della Torre, Micaela; Kilpatrick, Sarah J; Hibbard, Judith U; Simonson, Louise; Scott, Shirley; Koch, Abby; Schy, Deborah; Geller, Stacie E

2011-12-01

248

Subdural Hemorrhage Mimicking Peripheral Neuropathy  

PubMed Central

Subdural hemorrhage (SDH) can manifest various neurologic symptoms. However, SDH presenting with only hand weakness has rarely been reported. We report two SDH cases with only hand weakness mimicking peripheral neuropathy. Since SDH can present with hand weakness only, we suggest the clinicians to do a careful history taking and recommend a CT scan in the elderly patients. PMID:25328658

Kim, Hye Ihn; Oh, Yeo Jin; Cho, Yu Na

2014-01-01

249

Effects of Comprehensive Stroke Care Capabilities on In-Hospital Mortality of Patients with Ischemic and Hemorrhagic Stroke: J-ASPECT Study  

PubMed Central

Background The effectiveness of comprehensive stroke center (CSC) capabilities on stroke mortality remains uncertain. We performed a nationwide study to examine whether CSC capabilities influenced in-hospital mortality of patients with ischemic and hemorrhagic stroke. Methods and Results Of the 1,369 certified training institutions in Japan, 749 hospitals responded to a questionnaire survey regarding CSC capabilities that queried the availability of personnel, diagnostic techniques, specific expertise, infrastructure, and educational components recommended for CSCs. Among the institutions that responded, data on patients hospitalized for stroke between April 1, 2010 and March 31, 2011 were obtained from the Japanese Diagnosis Procedure Combination database. In-hospital mortality was analyzed using hierarchical logistic regression analysis adjusted for age, sex, level of consciousness on admission, comorbidities, and the number of fulfilled CSC items in each component and in total. Data from 265 institutions and 53,170 emergency-hospitalized patients were analyzed. Mortality rates were 7.8% for patients with ischemic stroke, 16.8% for patients with intracerebral hemorrhage (ICH), and 28.1% for patients with subarachnoid hemorrhage (SAH). Mortality adjusted for age, sex, and level of consciousness was significantly correlated with personnel, infrastructural, educational, and total CSC scores in patients with ischemic stroke. Mortality was significantly correlated with diagnostic, educational, and total CSC scores in patients with ICH and with specific expertise, infrastructural, educational, and total CSC scores in patients with SAH. Conclusions CSC capabilities were associated with reduced in-hospital mortality rates, and relevant aspects of care were found to be dependent on stroke type. PMID:24828409

Iihara, Koji; Nishimura, Kunihiro; Kada, Akiko; Nakagawara, Jyoji; Ogasawara, Kuniaki; Ono, Junichi; Shiokawa, Yoshiaki; Aruga, Toru; Miyachi, Shigeru; Nagata, Izumi; Toyoda, Kazunori; Matsuda, Shinya; Miyamoto, Yoshihiro; Suzuki, Akifumi; Ishikawa, Koichi B.; Kataoka, Hiroharu; Nakamura, Fumiaki; Kamitani, Satoru

2014-01-01

250

Malignant paraganglioma presenting with hemorrhagic stroke in a child.  

PubMed

Sympathetic paragangliomas are rare catecholamine-secreting tumors of extra-adrenal origin, and their diagnosis in children is even more infrequent. They usually manifest as hypertension, palpitations, headache, sweating, and pallor. Malignant paragangliomas are identified by the presence of metastasis. Hemorrhagic stroke in the pediatric population is a life-threatening condition with several etiologies. We report here the case of a 12-year-old boy with malignant sympathetic paraganglioma presenting with hemorrhagic stroke. Severe hypertension was found and the patient evolved into a coma. Brain computed tomography scan showed right thalamus hemorrhage with intraventricular extension. After clinical improvement, further investigation revealed elevated catecholamine and metanephrine levels, and 2 abdominal tumors were identified by computed tomography. Resection of both lesions was performed, and histologic findings were consistent with paraganglioma. Multiple metastatic involvement of bones and soft tissues appeared several years later. Genetic testing identified a mutation in succinate dehydrogenase subunit B gene, with paternal transmission. 131I-metaiodobenzylguanidine therapy was performed 3 times with no tumoral response. Our patient is alive, with adequate quality of life, 25 years after initial diagnosis. To our knowledge, this is the first pediatric case of paraganglioma presenting with hemorrhagic stroke. Intracerebral hemorrhage was probably caused by severe hypertension due to paraganglioma. Therefore, we expand the recognized clinical spectrum of the disease. Physicians evaluating children with hemorrhagic stroke, particularly if hypertension is a main symptom, should consider the possibility of catecholamine-secreting tumors. Metastatic disease is associated with succinate dehydrogenase subunit B mutations and, although some patients have poor prognosis, progression can be indolent. PMID:24276837

Luiz, Henrique V; da Silva, Tiago N; Pereira, Bernardo D; Santos, Joaquim G; Gonçalves, Diogo; Manita, Isabel; Portugal, Jorge

2013-12-01

251

Putative Role of Prostaglandin Receptor in Intracerebral Hemorrhage  

PubMed Central

Each year, approximately 795,000 people experience a new or recurrent stroke. Of all strokes, 84% are ischemic, 13% are intracerebral hemorrhage (ICH) strokes, and 3% are subarachnoid hemorrhage strokes. Despite the decreased incidence of ischemic stroke, there has been no change in the incidence of hemorrhagic stroke in the last decade. ICH is a devastating disease 37–38% of patients between the ages of 45 and 64 die within 30?days. In an effort to prevent ischemic and hemorrhagic strokes we and others have been studying the role of prostaglandins and their receptors. Prostaglandins are bioactive lipids derived from the metabolism of arachidonic acid. They sustain homeostatic functions and mediate pathogenic mechanisms, including the inflammatory response. Most prostaglandins are produced from specific enzymes and act upon cells via distinct G-protein coupled receptors. The presence of multiple prostaglandin receptors cross-reactivity and coupling to different signal transduction pathways allow differentiated cells to respond to prostaglandins in a unique manner. Due to the number of prostaglandin receptors, prostaglandin-dependent signaling can function either to promote neuronal survival or injury following acute excitotoxicity, hypoxia, and stress induced by ICH. To better understand the mechanisms of neuronal survival and neurotoxicity mediated by prostaglandin receptors, it is essential to understand downstream signaling. Several groups including ours have discovered unique roles for prostaglandin receptors in rodent models of ischemic stroke, excitotoxicity, and Alzheimer disease, highlighting the emerging role of prostaglandin receptor signaling in hemorrhagic stroke with a focus on cyclic-adenosine monophosphate and calcium (Ca2+) signaling. We review current ICH data and discuss future directions notably on prostaglandin receptors, which may lead to the development of unique therapeutic targets against hemorrhagic stroke and brain injuries alike. PMID:23097645

Mohan, Shekher; Ahmad, Abdullah S.; Glushakov, Alexander V.; Chambers, Chase; Doré, Sylvain

2012-01-01

252

Synergistically acting PLA?: peptide hemorrhagic complex from Daboia russelii venom.  

PubMed

Snake venoms are complex mixture of enzymatic and non-enzymatic proteins. Non-covalent protein-protein interaction leads to protein complexes, which bring about enhanced pharmacological injuries by their synergistic action. Here we report identification and characterization of a new Daboia russelii hemorrhagic complex I (DR-HC-I) containing phospholipase A? (PLA?) and non-enzymatic peptide. DR-HC-I was isolated from the venom of D. russelii by CM-Shepadex-C25 and gel permeation chromatography. Individual components were purified and identified by RP-HPL chromatography, mass spectrometry and N-terminal amino acid sequencing. DR-HC-I complex was lethal to mice with the LD?? dose of 0.7 mg/kg body weight with hemorrhagic and neurotoxic properties. DR-HC-I complex consists of non-hemorrhagic PLA? and neurotoxic non-enzymatic peptide. The non-enzymatic peptide quenched the intrinsic fluorescence of PLA? in a dose dependent manner, signifying the synergistic interaction between two proteins. PLA? and peptide toxin in a 5:2 M ratio induced skin hemorrhage in mice with MHD 20 ?g. However, addition of ANS (1-Anilino-8-naphthalene sulfonate) to DR-HC-I complex inhibited skin hemorrhagic effect and also synergic interaction. But there was no impact on PLA? due to this synergistic interaction, and indirect hemolytic or plasma re-calcification activity. However, the synergistic interaction of PLA? and non-enzymatic peptide contributes to the enhanced venom-induced hemorrhage and toxicity of Daboia russellii venom. PMID:23872188

Venkatesh, Madhukumar; Gowda, Veerabasappa

2013-10-01

253

Familial perimesencephalic subarachnoid hemorrhage: two case reports  

PubMed Central

Introduction Non-aneurysmal spontaneous subarachnoid hemorrhage is characterized by an accumulation of a limited amount of subarachnoid hemorrhage, predominantly around the midbrain, and a lack of blood in the brain parenchyma or ventricular system. It represents 5% of all spontaneous subarachnoid hemorrhage cases. In spite of extensive investigation, understanding of the mechanisms leading to perimesencephalic non-aneurysmal subarachnoid hemorrhage remains incompletely defined. A growing body of evidence has supported a familial predisposition for non-aneurysmal spontaneous subarachnoid hemorrhage. Case presentation A 39-year-old Caucasian man presented with sudden onset headache associated with diplopia. His computed tomography scan revealed perimesencephalic subarachnoid hemorrhage. A cerebral angiogram showed no apparent source of bleeding. He was treated conservatively and discharged after 1 week without any neurological deficits. The older brother of the first case, a 44-year-old Caucasian man, presented 1.5 years later with acute onset of headache and his computed tomography scan also showed perimesencephalic non-aneurysmal subarachnoid hemorrhage. He was discharged home with normal neurological examination 1 week later. Follow-up angiograms did not reveal any source of bleeding in either patient. Conclusions We report the cases of two siblings with perimesencephalic non-aneurysmal subarachnoid hemorrhage, which may further suggest a familial predisposition of non-aneurysmal spontaneous subarachnoid hemorrhage and may also point out the possible higher risk of perimesencephalic non-aneurysmal subarachnoid hemorrhage in the first-degree relatives of patients with perimesencephalic non-aneurysmal subarachnoid hemorrhage. PMID:25416614

2014-01-01

254

Recurrent vitreous hemorrhage associated with regressed retinopathy of prematurity in a 47-year-old patient: a case report  

PubMed Central

Introduction Vitreous hemorrhage associated with retinopathy of prematurity is often seen in childhood, but adult onset without retinal break is rare. We describe a case of recurrent vitreous hemorrhage associated with regressed retinopathy of prematurity in a 47-year-old patient. Case presentation A 47-year-old Japanese woman with a history of retinopathy of prematurity presented with a visual disturbance in her left eye due to vitreous hemorrhage. Because the vitreous hemorrhage was recurrent and refractory, we performed pars plana vitrectomy combined with lens extraction by phacoemulsification and intraocular lens implantation. No retinal break or retinal detachment was found. No vitreous hemorrhage or other complication occurred in the first six months after surgery. Conclusions Vitrectomy, potentially in combination with lens extraction, should be considered in adult-onset recurrent vitreous hemorrhage associated with retinopathy of prematurity. PMID:24916359

2014-01-01

255

“Post partum hemorrhage: causes and management”  

PubMed Central

Background Post partum hemorrhage is defined as blood loss of 500 ml or above. It is the most common cause of pre-mature mortality of women world wide. Our objective was to evaluate the most common etiology and method of management of Post partum Hemorrhage in a tertiary care hospital of Karachi. Findings It was a cross sectional study conducted at Liaquat National Hospital Karachi, during the period of July 2011 to May 2012. Review include mode of delivery, possible cause of postpartum hemorrhage, supportive, medical and surgical interventions. All the women admitted with post partum hemorrhage or develop PPH in hospital after delivery were included in our study. Bleeding disorder and use of anticoagulants were set as exclusion criteria. Diagnosis was made on the basis of blood loss assessment which was made via subjective and objective evaluation. During the targeted months, out of total 1493 deliveries (26/1493?=?1.741%) 26 cases of post partum hemorrhage were reported with a mean age of 26.153?±?7.37. No deaths were reported and all cases were referred and unbooked cases. All Patients were conscious, tachycardiac and hypotensive. Most of the women were suffering from hemorrhage during or after the birth of their 1st child. Primary post partum hemorrhage emerge as the most common type of post partum hemorrhage and uterine atony was detected as the most common cause of primary post partum hemorrhage. Retained products of conception was the most common cause of secondary post partum hemorrhage and hysterectomy was found to be the most frequent method of management of post partum hemorrhage. Conclusion This study highlights the existing variable practices for the management of postpartum hemorrhage. Hemorrhage associated morbidity and mortality can be prevented by critical judgment, early referral and resuscitation by attendants. Introduction of an evidence-based management model can potentially reduce the practice variability and improve the quality of care. PMID:23773785

2013-01-01

256

Pulmonary hemorrhage in pediatric lupus anticoagulant hypoprothrombinemia syndrome  

PubMed Central

Lupus anticoagulant-hypoprothrombinemia syndrome (LAHPS), a very rare disease that is caused by the presence of antifactor II antibodies, is usually counterbalanced by the prothrombotic effect of lupus anticoagulant (LAC). Patients with LAHPS are treated using fresh frozen plasma, steroids, immunosuppressive agents, and immunoglobulins for managing the disease and controlling hemorrhages. Notably, steroids are the important treatment for treating hypoprothrombinemia and controlling the bleeding. However, some patients suffer from severe, life-threatening hemorrhages, when factor II levels remain very low in spite of treatment with steroids. Here, we report a case of LAHPS in a 15-year-old girl who experienced pulmonary hemorrhage with rapid progression. She was referred to our hospital owing to easy bruising and prolonged bleeding. She was diagnosed with LAHPS that presented with pancytopenia, positive antinuclear antibody, proloned prothrombin time, activated partial thromboplastin time, positive LAC antibody, and factor II deficiency. Her treatment included massive blood transfusion, high-dose methylprednisolone, vitamin K, and immunoglobulin. However, she died due to uncontrolled pulmonary hemorrhage. PMID:24868219

Kim, Ji Soo; Kim, Min Jae; Bae, E Young

2014-01-01

257

Spontaneous Intracerebral Hemorrhage Image Analysis Methods: A Survey  

NASA Astrophysics Data System (ADS)

Spontaneous intracerebral hemorrhages (ICH) account for 10-30% of all strokes and are a result of acute bleeding into the brain due to ruptures of small penetrating arteries. Despite major advancements in the management of ischemic strokes and other causes of hemorrhagic strokes, such as ruptured aneurysm, arteriovenous malformations (AVMs), or cavernous angioma, during the past several decades, limited progress has been made in the treatment of ICH, and the prognosis for patients who suffer them remains poor. The societal impact of these hemorrhagic strokes is magnified by the fact that affected patients typically are a decade younger than those afflicted with ischemic strokes. The ICH continues to kill or disable most of their victims. Some studies show that those who suffer ICH have a 30-day mortality rate of 35-44% and a 6-month mortality rate approaching 50%. Approximately 700,000 new strokes occur in the United States annually and approximately 15% are hem-orrhagic strokes related to ICH. The poor outcome associated with ICH is related to the extent of brain damage. ICH produces direct destruction and compression of surrounding brain tissue. Direct compression causes poor perfusion and venous drainage to surrounding penumbra at risk, resulting in ischemia to the tissues that most need perfusion [16].

Pérez, Noel; Valdés, Jose; Guevara, Miguel; Silva, Augusto

258

Clinical Features and Patient Management of Lujo Hemorrhagic Fever  

PubMed Central

Background In 2008 a nosocomial outbreak of five cases of viral hemorrhagic fever due to a novel arenavirus, Lujo virus, occurred in Johannesburg, South Africa. Lujo virus is only the second pathogenic arenavirus, after Lassa virus, to be recognized in Africa and the first in over 40 years. Because of the remote, resource-poor, and often politically unstable regions where Lassa fever and other viral hemorrhagic fevers typically occur, there have been few opportunities to undertake in-depth study of their clinical manifestations, transmission dynamics, pathogenesis, or response to treatment options typically available in industrialized countries. Methods and Findings We describe the clinical features of five cases of Lujo hemorrhagic fever and summarize their clinical management, as well as providing additional epidemiologic detail regarding the 2008 outbreak. Illness typically began with the abrupt onset of fever, malaise, headache, and myalgias followed successively by sore throat, chest pain, gastrointestinal symptoms, rash, minor hemorrhage, subconjunctival injection, and neck and facial swelling over the first week of illness. No major hemorrhage was noted. Neurological signs were sometimes seen in the late stages. Shock and multi-organ system failure, often with evidence of disseminated intravascular coagulopathy, ensued in the second week, with death in four of the five cases. Distinctive treatment components of the one surviving patient included rapid commencement of the antiviral drug ribavirin and administration of HMG-CoA reductase inhibitors (statins), N-acetylcysteine, and recombinant factor VIIa. Conclusions Lujo virus causes a clinical syndrome remarkably similar to Lassa fever. Considering the high case-fatality and significant logistical impediments to controlled treatment efficacy trials for viral hemorrhagic fever, it is both logical and ethical to explore the use of the various compounds used in the treatment of the surviving case reported here in future outbreaks. Clinical observations should be systematically recorded to facilitate objective evaluation of treatment efficacy. Due to the risk of secondary transmission, viral hemorrhagic fever precautions should be implemented for all cases of Lujo virus infection, with specialized precautions to protect against aerosols when performing enhanced-risk procedures such as endotracheal intubation. PMID:25393244

Sewlall, Nivesh H.; Richards, Guy; Duse, Adriano; Swanepoel, Robert; Paweska, Janusz; Blumberg, Lucille; Dinh, Thu Ha; Bausch, Daniel

2014-01-01

259

?2-adrenergic regulation of stress hyperglycemia following hemorrhage in the obese Zucker rat.  

PubMed

Stress hyperglycemia following trauma has been shown to potentiate morbidity and mortality. Glucose control in obese patients can be challenging due to insulin resistance. Thus, understanding the mechanisms for glucose generation following hemorrhage may provide important insights into alternative options for glycemic control in obesity. Obesity is characterized by elevated glycogen and increased hepatic ?2-adrenergic activity, which play major roles in glucose production after hemorrhage. We hypothesized that, in obesity, hepatic glycogenolysis is enhanced during stress hyperglycemia due to increased hepatic ?2-adrenoceptor activation. Hemorrhage was performed in conscious lean Zucker (LZ) and obese Zucker rats (OZ) by withdrawing 35% total blood volume over 10 min. Liver glycogen content and plasma levels of glucose, insulin, and glucagon were measured before and 1 h after hemorrhage. The hyperglycemic response was greater in OZ as compared to LZ, but glycogen content was similarly reduced in both groups. Subsequently, OZ had a greater fall in insulin compared to LZ. Glucagon levels were significantly increased 1 h after hemorrhage in LZ but not in OZ. To test the direct adrenergic effects on the liver after hemorrhage, we treated animals before hemorrhage with a selective ?2-adrenoceptor antagonist, ICI-118,551 (ICI; 2 mg/kg/h, i.v.). After hemorrhage, ICI significantly reduced hyperglycemia in both LZ and OZ, independent of hormonal changes, but there was a significantly decreased hepatic glycogenolysis in OZ. These results suggest that the hemorrhage-induced hepatic glycogenolysis is likely glucagon-dependent in LZ, whereas the ?2-adrenoceptor plays a greater role in OZ. PMID:25472607

Clemmer, John S; Xiang, Lusha; Lu, Silu; Mittwede, Peter N; Hester, Robert L

2014-12-01

260

Hemorrhagic Varicella in Chronic Liver Disease  

PubMed Central

Hemorrhagic varicella is a serious complication of a relatively benign disorder and usually occurs in immunocompromised persons and those on immunosuppressive therapy. To the best of our knowledge, this is the first case report of hemorrhagic varicella associated with chronic liver disease in Indian literature. Our encounter with this case highlights that rare hemorrhagic varicella can also present in cases of chronic liver disease. Prompt diagnosis and treatment with acyclovir leads to complete recovery. PMID:24741231

Sharma, Chandra Madhur; Sharma, Deepti; Agrawal, Ravi Prakash

2014-01-01

261

Shock Wave Lithotripsy and Renal Hemorrhage  

PubMed Central

Although shock wave lithotripsy is a safe and efficacious treatment for nephrolithiasis, the most common acute complication is renal hemorrhage. Shock wave-induced renal hemorrhage is a potentially devastating injury if not promptly recognized and treated appropriately. The authors report a large perirenal hematoma occurring after shock wave lithotripsy and review the causes, prevention, and treatment of shock wave-induced renal hemorrhage. PMID:18836562

Silberstein, Jonathan; Lakin, Charles M; Kellogg Parsons, J

2008-01-01

262

Impaired hemorrhage tolerance in the obese Zucker rat model of metabolic syndrome.  

PubMed

As obese Zucker rats (OZR) manifesting the metabolic syndrome exhibit enhanced vascular adrenergic constriction and potentially an enhanced adrenergic activity vs. lean Zucker rats (LZR), this study tested the hypothesis that OZR exhibit an improved tolerance to progressive hemorrhage. Preliminary experiments indicated that, corrected for body mass, total blood volume was reduced in OZR vs. LZR. Anesthetized LZR and OZR had a cremaster muscle prepared for in situ videomicroscopy and had renal, splanchnic, hindlimb, and skeletal muscle perfusion monitored with flow probes. Arterial pressure, arteriolar reactivity to norepinephrine, and tissue/organ perfusion were monitored after either infusion of phentolamine or successive withdrawals of 10% total blood volume. Phentolamine infusion indicated that regional adrenergic tone under control conditions differs substantially between LZR and OZR, whereas with hemorrhage OZR exhibit decompensation in arterial pressure before LZR. Renal, distal hindlimb, and skeletal muscle perfusion decreased more rapidly and to a greater extent in OZR vs. LZR after hemorrhage. In contrast, hemorrhage-induced reductions in splanchnic perfusion in OZR lagged behind those in LZR, although a similar maximum reduction was ultimately attained. With increasing hemorrhage, cremasteric arteriolar tone increased more in OZR than LZR, and this increase in active tone was entirely due to an elevated adrenergic contribution. Norepinephrine-induced arteriolar constriction was greater in OZR vs. LZR under control conditions and during hemorrhage, with arterioles from OZR demonstrating early closure vs. LZR. These results suggest that a combination of reduced blood volume and elevated peripheral adrenergic constriction contribute to impaired hemorrhage tolerance in OZR. PMID:16223976

Frisbee, Jefferson C

2006-02-01

263

[Hereditary hemorrhagic telangiectasia: Report of a pediatric case].  

PubMed

Hereditary hemorrhagic telangiectasia, or Rendu-Osler-Weber syndrome, is an autosomal dominant multiorgan disorder. This multisystemic vascular dysplasia is determined by a mutation of one of two main genes, endoglin (ENG) or HHT1, or ACVRL1 or HHT2. These mutations induce vascular disorders that cause recurrent epistaxis and eventually multiple telangiectasia and arteriovenous visceral malformations. We report the case of a 7-year-old girl who developed severe hypoxemia due to multiple pulmonary arteriovenous malformations. PMID:24935454

Maaloul, I; Aloulou, H; Fourati, H; Sfaihi, L; Chabchoub, I; Kamoun, T; Mnif, Z; Hachicha, M

2014-07-01

264

Hemorrhagic Stroke in Term and Late Preterm Neonates  

PubMed Central

Objective Few data regarding causes and outcome of hemorrhagic stroke (HS) in term neonates are available. We characterized risk factors, mechanism, and short-term outcomes in term and late preterm neonates with acute HS. Design Prospective cohort. Setting Single-center tertiary care stroke registry. Subjects Term and late preterm neonates (?34 weeks gestation) born 2004-2010 with acute HS ?28 days of life were identified, and clinical information was abstracted. Short-term outcomes were assessed via standardized neurological exam and rated using the Pediatric Stroke Outcome Measure (PSOM). Results Among 42 subjects, median gestational age was 39.7 weeks [interquartile range (IQR) 38-40.7 weeks]. Diagnosis occurred at a median of 1 day (IQR 0-7 days) after delivery. Twenty-seven (64%) had both intraparenchymal and intraventricular hemorrhage. Mechanism was hemorrhagic transformation of venous or arterial infarction in 22 (53%). Major risk factors included congenital heart disease (CHD), fetal distress, and hemostatic abnormalities. Common presentations included seizure, apnea, and poor feeding or vomiting. Acute hydrocephalus was common. Mortality was 12%. Follow-up occurred in 36/37 survivors at a median of 1 year (IQR 0.5-2.0). Among 17/36 survivors evaluated in stroke clinic, 47% demonstrated neurologic deficits. Deficits were mild (PSOM 0.5-1.5) in 9/36 (25%), and moderate-to-severe (PSOM ? 2.0) in 8/36 (22%). Conclusions In our cohort with acute HS, most presented with seizures, apnea, and/or poor feeding. Fetal distress and CHD were common. Nearly two-thirds had intraparenchymal with intraventricular hemorrhage. Over half were due to hemorrhagic transformation of infarction. Short-term neurologic deficits were present in 47% of survivors. PMID:23995383

Bruno, Christie J; Beslow, Lauren A; Witmer, Char M; Vossough, Arastoo; Jordan, Lori C; Zelonis, Sarah; Licht, Daniel J; Ichord, Rebecca N; Smith, Sabrina E

2013-01-01

265

(-)-Deprenyl inhibits vascular hyperpermeability after hemorrhagic shock.  

PubMed

Recent studies from our laboratory demonstrated the involvement of endothelial cell reactive oxygen species (ROS) formation and activation of apoptotic signaling in vascular hyperpermeability after hemorrhagic shock (HS). The objective of this study was to determine if (-)-deprenyl, an antioxidant with antiapoptotic properties, would attenuate HS-induced vascular hyperpermeability. In rats, HS was induced by withdrawing blood to reduce the MAP to 40 mmHg for 60 min followed by resuscitation for 60 min. To study hyperpermeability, we injected the rats with fluorescein isothiocyanate--albumin (50 mg/kg), and the changes in integrated optical intensity of the mesenteric postcapillary venules were obtained intravascularly and extravascularly using intravital microscopy. Mitochondrial ROS formation and mitochondrial transmembrane potential (DeltaPsim) were studied using dihydrorhodamine 123 and JC-1, respectively. Mitochondrial release of cytochrome c was determined using enzyme-linked immunosorbent assay and caspase-3 activity by a fluorometric assay. Parallel studies were performed in rat lung microvascular endothelial cells using proapoptotic BAK as inducer of hyperpermeability. Hemorrhagic shock induced vascular hyperpermeability, mitochondrial ROS formation, DeltaPsim decrease, cytochrome c release, and caspase-3 activation (P G 0.05). (-)-Deprenyl (0.15 mg/kg) attenuated all these effects (P < 0.05). Similarly in rat lung microvascular endothelial cells, (-)-deprenyl attenuated BAK peptide-induced monolayer hyperpermeability (P < 0.05), ROS formation, DeltaPsim decrease, cytochrome c release (P<0.05), and caspase-3 activation (P < 0.05). The protective effects of (-)-deprenyl on vascular barrier functions may be due to its protective effects on DeltaPsim, thereby preventing mitochondrial release of cytochrome c and caspase-3--mediated disruption of endothelial adherens junctions. PMID:19373132

Tharakan, Binu; Whaley, J Greg; Hunter, Felicia A; Smythe, W Roy; Childs, Ed W

2010-01-01

266

Multiple Spontaneous Simultaneous Intracerebral Hemorrhages  

PubMed Central

Simultaneous occurrence of intracerebral hemorrhage (ICH) in different arterial territories is an uncommon event. We report on two cases of multiple spontaneous simultaneous ICH for which we could find no specific cause. A 73-year-old man, with no related medical history, was admitted to the hospital with simultaneous bithalamic ICH, and subsequently died of recurrent pneumonia. Second patient was a 60-year-old man who presented with simultaneous ICH in the pons and thalamus; he died of recurrent bleeding. We review the possible pathological mechanisms, clinical and radiologic features of simultaneous multiple ICH. PMID:25045650

Seo, Jin-Suk; Nam, Taek-Kyun; Kwon, Jeong-Taik

2014-01-01

267

Optimal management of hereditary hemorrhagic telangiectasia.  

PubMed

Hereditary hemorrhagic telangiectasia (HHT), also known by the eponym Osler-Weber-Rendu syndrome, is a group of related disorders inherited in an autosomal dominant fashion and characterized by the development of arteriovenous malformations (AVM) in the skin, mucous membranes, and/or internal organs such as brain, lungs, and liver. Its prevalence is currently estimated at one in 5,000 to 8,000. Most cases are due to mutations in the endoglin (HHT1) or ACVRLK1 (HHT2) genes. Telangiectasias in nasal and gastrointestinal mucosa generally present with recurrent/chronic bleeding and iron deficiency anemia. Larger AVMs occur in lungs (~40%-60% of affected individuals), liver (~40%-70%), brain (~10%), and spine (~1%). Due to the devastating and potentially fatal complications of some of these lesions (for example, strokes and brain abscesses with pulmonary AVMs), presymptomatic screening and treatment are of utmost importance. However, due to the rarity of this condition, many providers lack an appreciation for the whole gamut of its manifestations and complications, age-dependent penetrance, and marked intrafamilial variation. As a result, HHT remains frequently underdiagnosed and many families do not receive the appropriate screening and treatments. This article provides an overview of the clinical features of HHT, discusses the clinical and genetic diagnostic strategies, and presents an up-to-date review of literature and detailed considerations regarding screening for visceral AVMs, preventive modalities, and treatment options. PMID:25342923

Garg, Neetika; Khunger, Monica; Gupta, Arjun; Kumar, Nilay

2014-01-01

268

Epizootic hemorrhagic disease in a yak  

PubMed Central

Epizootic hemorrhagic disease virus (EHDV) infection was diagnosed in a 3-year-old yak. The yak had signs of intermittent tremors, dysphagia, oral ulcerative lesions, hemorrhagic enteritis, tachypnea, and thrombocytopenia. Postmortem diagnostics confirmed EHDV (serotype 2) using reverse-transcriptase polymerase chain reaction (RT-PCR). Gross and histopathological results were consistent with EHDV reported in other species. PMID:24688138

Raabis, Sarah M.; Byers, Stacey R.; Han, Sushan; Callan, Robert J.

2014-01-01

269

Upper gastrointestinal hemorrhage caused by superwarfarin poisoning.  

PubMed

Superwarfarins are a class of rodenticides. Gastrointestinal hemorrhage is a fatal complication of superwarfarin poisoning, requiring immediate treatment. Here, we report a 55-year-old woman with tardive upper gastrointestinal hemorrhage caused by superwarfarin poisoning after endoscopic cold mucosal biopsy. PMID:20355251

Zhao, Shu Lei; Li, Peng; Ji, Ming; Zong, Ye; Zhang, Shu Tian

2010-04-01

270

Upper gastrointestinal hemorrhage caused by superwarfarin poisoning  

PubMed Central

Superwarfarins are a class of rodenticides. Gastrointestinal hemorrhage is a fatal complication of superwarfarin poisoning, requiring immediate treatment. Here, we report a 55-year-old woman with tardive upper gastrointestinal hemorrhage caused by superwarfarin poisoning after endoscopic cold mucosal biopsy. PMID:20355251

Zhao, Shu-Lei; Li, Peng; Ji, Ming; Zong, Ye; Zhang, Shu-Tian

2010-01-01

271

Reperfusion Hemorrhage Following Superior Mesenteric Artery Stenting  

Microsoft Academic Search

Percutaneous transluminal angioplasty and stent placement is now an established treatment option for chronic mesenteric ischemia and is associated with low mortality and morbidity rates. We present a case of reperfusion hemorrhage complicating endovascular repair of superior mesenteric artery stenosis. Although a recognized complication following repair of carotid stenosis, hemorrhage has not previously been reported following mesenteric endovascular reperfusion. We

Michael Moore; Sean McSweeney; Gregory Fulton; John Buckley; Michael Maher; Michael Guiney

2008-01-01

272

Spontaneous Retroperitoneal Hemorrhage from Adrenal Artery Aneurysm  

SciTech Connect

Spontaneous adrenal hemorrhage is a very rare but serious disorder of the adrenal gland that can require emergent treatment. We report on a 42-year-old man who underwent selective angiography for diagnosis and treatment of retroperitoneal hemorrhage from small adrenal artery aneurysm. This case gives further details about the value of transluminal artery embolization in the management of visceral aneurysm rupture.

Gonzalez Valverde, F.M., E-mail: migova@terra.es; Balsalobre, M.; Torregrosa, N.; Molto, M. [Hospital General Vega Baja, Department of Surgery (Spain); Gomez Ramos, M.J. [Hospital General Vega Baja, Intensive Care Unit (Spain); Vazquez Rojas, J.L. [Hospital General Vega Baja, Department of Surgery (Spain)

2007-04-15

273

Hemorrhagic Disease in Bighorn Sheep in Arizona  

Microsoft Academic Search

Two bighorn sheep from Arizona (USA) were submitted for necropsy. One was a Rocky Mountain bighorn (Ovis canadensis can- adensis) and the other was a desert bighorn (Ovis canadensis mexicana). Both had lesions consistent with those of hemorrhagic disease (HD). Epizootic hemorrhagic disease virus (EHDV) type-2 and bluetongue virus (BTV) type-17, respectively, were isolated from the sheep tissues. To our

Ted H. Noon; Shannon Lynn Wesche; Dave Cagle; Daniel G. Mead; Edward J. Bicknell

274

[Hemorrhagic fever with renal syndrome].  

PubMed

Puumala hantavirus is the most common hantavirus infection in Western Europe. The causative agent, Puumala virus, is a member of the Hantavirus genus in the Bunyaviridae family. The natural hosts of hantaviruses are chronically, but asymptomatic infected rodents, which transmit the virus to human in their excretions. Puumala virus is carried by the bank vole, clethrionomys glareolus. Hemorrhagic fever with renal syndrome (HFRS) caused by Puumala virus in France or Belgium is very similar to the previously described Nephropathia epidemica in Scandinavia. In most severe cases, the disease is clinically characterized by high fever of abrupt onset, headache, loin or abdominal pains, nausea and vomiting, and occasionally acute and transient myopia. Renal involvement results in transient proteinuria and hematuria and acute renal failure. Except for interstitial hemorrhage in the outer medulla, the renal histopathologic findings are unspecific and include prominent changes in the interstitium with interstitial oedema and inflammatory infiltrates. Thrombocytopenia, mild elevation of liver enzymes, and leukocytosis are typical laboratory findings. Spontaneous complete recovery is the rule. Laboratory diagnosis is primarily based on serology such as indirect immunofluorescence or capture enzyme--linked immunosorbent assays which detect IgM antibodies and an increased level of IgG antibodies against Puumala virus. Viral antigen may be demonstrated in the cytoplasm of renal tubular epithelial cells. PMID:11715607

Vanhille, P; Binaut, R; Kyndt, X; Launay, D; Thomas, C; Fleury, D

2001-01-01

275

Intracranial Hemorrhage in Patient Treated with Rivaroxaban  

PubMed Central

Rivaroxaban is an oral factor Xa inhibitor used for stroke prevention in atrial fibrillation. There are currently no evidence-based guidelines for the treatment of hemorrhagic side effects of factor Xa inhibitors. We report a case of a thalamic hemorrhage in an 84 year-old right-handed female on rivaroxaban for treatment of atrial fibrillation. The patient had fallen down steps and became unresponsive. She was found to have diffuse scattered acute subarachnoid hemorrhage as well as intraventricular hemorrhage. Neurosurgical intervention was not required in this case, but controversy over decision making to pursue pro-coagulant therapy in the setting of worsening hemorrhage requiring emergent surgery is discussed. PMID:24711920

Molina, Michelle; Hillard, Virany H.; Fekete, Robert

2014-01-01

276

Thrombo-hemorrhagic deaths in acute promyelocytic leukemia.  

PubMed

Acute promyelocytic leukemia (APL) has become the most curable form of acute myeloid leukemia after the advent of all-trans retinoic acid (ATRA). However, early deaths (ED) mostly due to the disease-associated coagulopathy remain the major cause of treatment failure. In particular, hemorrhagic events account for 40-65% of ED and several prognostic factors have been identified for such hemorrhagic deaths, including poor performance status, high white blood cell (WBC) count and coagulopathy. Occurrence of thrombosis during treatment with ATRA may be associated with differentiation syndrome (DS) or represent an isolated event. Some prognostic factors have been reported to be associated with thrombosis, including increased WBC or aberrant immunophenotype of leukemic promyelocytes. Aim of this review is to report the incidence, severity, possible pathogenesis and clinical manifestations of thrombo-haemorrhagic deaths in APL. PMID:24862130

Breccia, Massimo; Lo Coco, Francesco

2014-05-01

277

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. PMID:24729958

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

2013-01-01

278

Artifact quantification and tractography from 3T MRI after placement of aneurysm clips in subarachnoid hemorrhage patients  

PubMed Central

Background The application of advanced 3T MRI imaging techniques to study recovery after subarachnoid hemorrhage (SAH) is complicated by the presence of image artifacts produced by implanted aneurysm clips. To characterize the effect of these artifacts on image quality, we sought to: 1) quantify extent of image artifact in SAH patients with implanted aneurysm clips across a range of MR sequences typically used in studies of volumetry, blood oxygen level dependent signal change (BOLD-fMRI), and diffusion-weighted imaging (DW-MRI) and 2) to explore the ability to reconstruct white matter pathways in these patients. Methods T1- and T2-weighted structural, BOLD-fMRI, and DW-MRI scans were acquired at 3T in two patients with titanium alloy clips in ACOM and left ACA respectively. Intensity-based planimetric contouring was performed on aligned image volumes to define each artifact. Artifact volumes were quantified by artifact/clip length and artifact/brain volume ratios and analyzed by two-way (scan-by-rater) ANOVAs. Tractography pathways were reconstructed from DW-MRI at varying distances from the artifacts using deterministic methods. Results Artifact volume varied by MR sequence for length (p = 0.007) and volume (p < 0.001) ratios: it was smallest for structural images, larger for DW-MRI acquisitions, and largest on fMRI images. Inter-rater reliability was high (r = 0.9626, p < 0.0001), and reconstruction of white matter connectivity characteristics increased with distance from the artifact border. In both patients, reconstructed white matter pathways of the uncinate fasciculus and inferior fronto-occipital fasciculus were clearly visible within 2 mm of the artifact border. Conclusions Advanced 3T MR can successfully image brain tissue around implanted titanium aneurysm clips at different spatial ranges depending on sequence type. White matter pathways near clip artifacts can be reconstructed and visualized. These findings provide a reference for designing functional and structural neuroimaging studies of recovery in aSAH patients after clip placement. PMID:21970560

2011-01-01

279

Relationship between the occurrence of spontaneous intracerebral hemorrhage and holidays and traditionally unlucky days in Fukuyama City, Hiroshima Prefecture, Japan.  

PubMed

To investigate whether calendrical information influences the occurrence of spontaneous intracerebral hemorrhage, we statistically compared the incidence of intracerebral hemorrhage for inpatients at Teraoka Memorial Hospital (164 patients), against various calendrical factors such as the day of the week, national holidays, and RokuYo (a recurring six-day series of lucky and unlucky days in the Japanese traditional calendar) over the period from January 1, 2001 to December 31, 2003. On Japanese national holidays the relative risk of intracerebral hemorrhage is significantly higher than on other days, certainly due to much more alcohol consumption on holidays. During RokuYo, the relative risk of intracerebral hemorrhage is extremely low on the traditionally unlucky days of ButsuMetsu and TomoBiki, as many Japanese people restrain their activities on these days. Certain days of the year and certain times of the Japanese supplemental calendars correlate significantly with the incidence of intracerebral hemorrhage. PMID:17845915

Nakaguchi, Hiroshi; Teraoka, Akira

2007-01-01

280

[Management of major postpartum hemorrhage].  

PubMed

Postpartum hemorrhage (PPH) is defined by loss of greater than 500 mL of blood following vaginal delivery or 1,000 mL of blood following cesarean section, in the first 24 hours postpartum. Its incidence is up to 5% and the severe forms represent 1% of births. PPH is the first cause of obstetrical maternal mortality in France and 90% of these deaths are considered as preventable. Its management is multidisciplinary (obstetricians, anesthetists, midwives, biologists and interventional radiologists), based on treatment protocols where time is a major prognosis factor. In case of failure of the initial measures (oxytocin, manual placenta removal, uterus and birth canal examination), the management of severe forms includes active resuscitation (intravenous fluids, blood transfusion, vasoactive drugs), haemostatic interventions (sulprostone, tamponnade and haemostatic suture, surgical procedures and arterial embolization) and the correction of any potential coagulopathy (administration of blood products and haemostatic agents). PMID:24373716

Nebout, Sophie; Merbai, Nadia; Faitot, Valentina; Keita, Hawa

2014-02-01

281

Imaging of Hereditary Hemorrhagic Telangiectasia  

SciTech Connect

This pictorial review is based on our experience of the follow-up of 120 patients at our multidisciplinary center for hereditary hemorrhagic telangiectasia (HHT). Rendu-Osler-Weber disease or HHT is a multiorgan autosomal dominant disorder with high penetrance, characterized by epistaxis, mucocutaneous telangiectasis, and visceral arteriovenous malformations (AVMs). The research on gene mutations is fundamental and family screening by clinical examination, chest X-ray, research of pulmonary shunting, and abdominal color Doppler sonography is absolutely necessary. The angioarchitecture of pulmonary AVMs can be studied by unenhanced multidetector computed tomography; however, all other explorations of liver, digestive bowels, or brain require administration of contrast media. Magnetic resonance angiography is helpful for central nervous system screening, in particular for the spinal cord, but also for pulmonary, hepatic, and pelvic AVMs. Knowledge of the multiorgan involvement of HHT, mechanism of complications, and radiologic findings is fundamental for the correct management of these patients.

Carette, Marie-France, E-mail: marie-france.carette@tnn.aphp.fr; Nedelcu, Cosmina; Tassart, Marc [AP-HP Tenon Hospital, Radiology Department (France); Grange, Jean-Didier; Wislez, Marie [Centre d'Accueil de la Maladie de Rendu Osler de Tenon (CAMROT) (France); Khalil, Antoine, E-mail: antoine_khalil@yahoo.f [AP-HP Tenon Hospital, Radiology Department (France)

2009-07-15

282

Crimean-Congo Hemorrhagic Fever in Bulgaria  

PubMed Central

We report the epidemiologic characteristics of Crimean-Congo hemorrhagic fever in Bulgaria, as well as the first genetic characterization of the virus strains circulating in the country in 2002 to 2003 that caused disease in humans. PMID:15496250

Christova, Iva; Papadimitriou, Evangelia; Antoniadis, Antonis

2004-01-01

283

Gastrointestinal hemorrhage in aluminum phosphide poisoning.  

PubMed

Poisoning, both accidental and intentional, is a significant contributor to the mortality and morbidity throughout the world. The commonest pesticide poisoning is organophosphates followed by phosphides. Ingestion of phosphides can induce severe gastrointestinal irritation leading to hemorrhage and ulcerations. Gastrointestinal hemorrhages and ulcerations beyond the duodenum have not been reported in the literature. Here, we report a case of severe hemorrhages and ulcerations in stomach, duodenum, jejunum, and ileum observed in a 45-year-old male who had consumed five tablets of Celphos(®) (each 3 g with 56% aluminum phosphide and 44% Ammonium carbonate) to commit suicide. He started vomiting after consumption, and the vomitus was blood-tinged. Once the treatment was instituted, he was stable for a day and thereafter his condition gradually deteriorated. He died on the 4th day of hospitalization, and autopsy revealed features of multiorgan failure and extensive gastrointestinal hemorrhages. PMID:25098904

Hugar, Basappa S; Praveen, Shivaramareddy; Hosahally, Jayanth S; Kainoor, Sunilkumar; Shetty, Akshith Raj S

2015-01-01

284

Reperfusion Hemorrhage Following Superior Mesenteric Artery Stenting  

Microsoft Academic Search

Percutaneous transluminal angioplasty and stent placement is now an established treatment option for chronic mesenteric ischemia\\u000a and is associated with low mortality and morbidity rates. We present a case of reperfusion hemorrhage complicating endovascular\\u000a repair of superior mesenteric artery stenosis. Although a recognized complication following repair of carotid stenosis, hemorrhage\\u000a has not previously been reported following mesenteric endovascular reperfusion. We

Michael Moore; Sean McSweeney; Gregory Fulton; John Buckley; Michael Maher; Michael Guiney

2008-01-01

285

[Primary intraventricular hemorrhage in the adult].  

PubMed

Forty two instances of primary intraventricular hemorrhage (PIVH) out of overall 592 cases of intracerebral hemorrhages diagnosed by CT in 1980-1989, to evaluate the general prognosis attributable to PIVH and its factors. The mortality rate was 23.8%, and persistent residual disability was small or absent in 59.5% of patients. The prognosis was influenced by the clinical status at admission and the magnitude of ventricular bleeding. We conclude that PIVH is comparatively benign. PMID:1863453

Ara, J R; Martín, J; Errea, J M; Bertol, V; Pina, M A; Oliveros, A

1991-01-01

286

Subconjunctival hemorrhage: risk factors and potential indicators  

PubMed Central

Subconjunctival hemorrhage is a benign disorder that is a common cause of acute ocular redness. The major risk factors include trauma and contact lens usage in younger patients, whereas among the elderly, systemic vascular diseases such as hypertension, diabetes, and arteriosclerosis are more common. In patients in whom subconjunctival hemorrhage is recurrent or persistent, further evaluation, including workup for systemic hypertension, bleeding disorders, systemic and ocular malignancies, and drug side effects, is warranted. PMID:23843690

Tarlan, Bercin; Kiratli, Hayyam

2013-01-01

287

Reperfusion Hemorrhage Following Superior Mesenteric Artery Stenting  

SciTech Connect

Percutaneous transluminal angioplasty and stent placement is now an established treatment option for chronic mesenteric ischemia and is associated with low mortality and morbidity rates. We present a case of reperfusion hemorrhage complicating endovascular repair of superior mesenteric artery stenosis. Although a recognized complication following repair of carotid stenosis, hemorrhage has not previously been reported following mesenteric endovascular reperfusion. We describe both spontaneous cessation of bleeding and treatment with coil embolization.

Moore, Michael; McSweeney, Sean [Cork University Hospital, Department of Radiology (Ireland); Fulton, Gregory [Cork University Hospital, Department of Vascular Surgery (Ireland); Buckley, John; Maher, Michael, E-mail: m.maher@ucc.ie; Guiney, Michael [Cork University Hospital, Department of Radiology (Ireland)

2008-07-15

288

Hypothermia-induced coagulopathy during hemorrhagic shock.  

PubMed

A porcine model of hemorrhagic shock was used to study the effect of hypothermia on hemodynamic, metabolic, and coagulation parameters. The model was designed to simulate the events of severe blunt injury with hemorrhage occurring initially, to a systolic blood pressure of 30 mm Hg, followed by simultaneous hemorrhage and crystalloid volume replacement, followed by cessation of hemorrhage and blood replacement. Half of the animals were rendered hypothermic by external application of ice, and half remained normothermic. There was seven pigs in each group. Two deaths occurred in each during the hemorrhage phase. The hypothermic pigs demonstrated larger reduction in cardiac output than normothermic pigs. Volume replacement in the normothermic group restored cardiac output to baseline values. In the hypothermic group, cardiac output remained depressed despite volume replacement. Prothrombin times and partial thromboplastin times showed significantly more prolongation in the hypothermic group. Furthermore, this was not corrected by replacement of shed blood in the hypothermic group, as was seen in the normothermic group. We conclude that when shock and hypothermia occur together, their deleterious effect on hemodynamic and coagulation parameters are additive. The effects of hypothermia persist despite the arrest of hemorrhage and volume replacement. Thus, it is necessary to aggressively address both shock and hypothermia when they occur simultaneously. PMID:10776871

Krause, K R; Howells, G A; Buhs, C L; Hernandez, D A; Bair, H; Schuster, M; Bendick, P J

2000-04-01

289

Spontaneous Intratumoral Hemorrhage into Hepatocellular Carcinoma During Transcatheter Arterial Embolization: A Case Report  

PubMed Central

Spontaneous extrahepatic rupture of hepatocellular carcinoma (HCC) is a rare but serious complication that occurs with an incidence of between 5 and 15% of patients with HCC. It is thought to be preceded by rapid expansion due to intratumoral bleed-ing. Extrahepatic rupture of HCC has been reported as a rare complication of tran-scatheter arterial embolization (TAE). Although there have been reports of extrahepatic rupture of HCC after TAE, but there is no report regarding intratumoral hemor-rhage into HCC during TAE. We report a unique case of intratumoral hemorrhage into HCC during TAE presumably triggered by TAE. Although a rare complication, intratumoral hemorrhage into HCC after TAE should be considered in any patient with TAE due to HCC. PMID:15608405

Choi, Jae Ho; Won, Jong-Ho; Kim, Yun Soo; Goo, Dong Erk; Choi, Deuk Lin

2004-01-01

290

Improving ascertainment and communication of prognosis in intracerebral hemorrhage  

PubMed Central

Prognostication after intracerebral hemorrhage remains a significant challenge for the field of neurocritical care. Despite several available tools that can predict mortality and, to some degree, functional outcomes, deciding which prediction score to use and how best to translate the resultant population-based value to the individual level is not always clear. As more and more scores are published, we need to give due attention to the qualitative aspect of prognostication and explore how best to move this critical aspect of our field forward. PMID:24321182

2013-01-01

291

Supernova hemorrhage: obliterative hemorrhage of brain arteriovenous malformations following ? knife radiosurgery.  

PubMed

Hemorrhage represents the most feared complication of cerebral arteriovenous malformations (AVMs) in both untreated patients and those treated with gamma knife radiosurgery. Radiosurgery does not immediately lead to obliteration of the malformation, which often does not occur until years following treatment. Post-obliteration hemorrhage is rare, occurring months to years after radiosurgery, and has been associated with residual or recurrent AVM despite prior apparent nidus elimination. Three cases are reported of delayed intracranial hemorrhage in patients with cerebral AVMs treated with radiosurgery in which no residual AVM was found on catheter angiography at the time of delayed post-treatment hemorrhage. That the pathophysiology of these hemorrhages involves progressive venous outflow occlusion is speculated and the possible mechanistic link to subsequent vascular rupture is discussed. PMID:21990534

Alexander, Matthew D; Hetts, Steven W; Young, William L; Halbach, Van V; Dowd, Christopher F; Higashida, Randall T; English, Joey D

2012-09-01

292

Treatment of hemorrhagic gastritis by antacid.  

PubMed Central

A simple and safe method of nonsurgical treatment for the control of massive acute gastric mucosal hemorrhage is described. The procedure was developed from experimental and clinical observations that the presence of gastric hydrocloric acid played an important part in the development and perpetuation of the entity. The treatment consists of complete neutralization of gastric acid with antacid to a pH of 7. The antacid is intermittently added and aspirate at 7. In a retrospective analysis, the hemorrhage was controlled in 44 of 49 patients (89%). Five patients who continued to bleed underwent surgery (10%). Three patients had vagotomy and pyloroplasty and their bleeding ceased without recurrence. Two patients underwent partial gastrectomy, but they developed recurrent bleeding and died. One patient whose bleeding has been controlled by vagotomy and pyloroplasty died without hemorrhage 10 days after operation. Of the 44 patients whose bleeding had been controlled by antacid, 11 patients died without hemorrhage one or more weeks later. These results of 89% control of hemorrhage compare favorably with those in the literature. PMID:13746

Simonian, S J; Curtis, L E

1976-01-01

293

A case of anaphylactoid purpura nephritis accompanied by pulmonary hemorrhage and review of the literature  

PubMed Central

Cases of Henoch-Schönlein purpura and purpura nephritis accompanied by pulmonary hemorrhage are rare. Mild cases are easily ignored due to a lack of evident bleeding, and severe cases may be fatal. We have only treated one patient with Henoch-Schönlein nephritis (HSPN), a female child. The clinical manifestations were not evident, however, the imaging manifestations were clear. Finally, the patient was definitively diagnosed with HSPN accompanied by pulmonary hemorrhage. Following treatment with antiinflammatory and steroidal agents, tripterygium glycosides and traditional Chinese medicine, the patient recovered. In the present study, we report the diagnosis and treatment of this disease, with a review of the literature. PMID:23737885

REN, XIANQING; ZHANG, WENJUAN; DANG, WEILI; ZHAI, WENSHENG; GUO, QINGYIN; DING, YIN; YANG, XIAOQING

2013-01-01

294

Management of airway compromise following thyroid cyst hemorrhage after thrombolytic therapy.  

PubMed

The risk of hemorrhage after therapeutic administration of tissue plasminogen activator (tPA) is well known. Cases of postadministration hemorrhage have been reported within many organ systems. We present a case of a 62-year-old female with undiagnosed thyroid goiter who received tPA for acute ischemic stroke and developed acute airway compromise. The surgical airway response team was called due to inability to ventilate or intubate. An incision into the mass during attempted tracheotomy released colloid and blood, decompressing the airway and facilitating ventilation and intubation. Hemithyroidectomy for mass removal was delayed for 3 days to allow normalization of post-tPA coagulopathy. Laryngoscope, 2014. PMID:25043767

Gallant, Sara C; Fritz, Mark A; Paul, Benjamin C; Costantino, Peter D

2014-07-14

295

Life or Death? A Physiogenomic Approach to Understand Individual Variation in Responses to Hemorrhagic Shock  

PubMed Central

Severe hemorrhage due to trauma is a major cause of death throughout the world. It has often been observed that some victims are able to withstand hemorrhage better than others. For decades investigators have attempted to identify physiological mechanisms that distinguish survivors from nonsurvivors for the purpose of providing more informed therapies. As an alternative approach to address this issue, we have initiated a research program to identify genes and genetic mechanisms that contribute to this phenotype of survival time after controlled hemorrhage. From physiogenomic studies using inbred rat strains, we have demonstrated that this phenotype is a heritable quantitative trait, and is therefore a complex trait regulated by multiple genes. Our work continues to identify quantitative trait loci as well as potential epigenetic mechanisms that might influence survival time after severe hemorrhage. Our ultimate goal is to improve survival to traumatic hemorrhage and attendant shock via regulation of genetic mechanisms and to provide knowledge that will lead to genetically-informed personalized treatments. PMID:22379396

Klemcke, Harold G; Joe, Bina; Rose, Rajiv; Ryan, Kathy L

2011-01-01

296

Low ADAMTS-13 activity during hemorrhagic events with disseminated intravascular coagulation.  

PubMed

Disseminated intravascular coagulation (DIC) is a life-threatening complication, and its control is essential for therapeutic success. Recombinant human soluble thrombomodulin alfa (rTM) is a novel therapeutic agent for DIC. The efficacy of rTM in the treatment of DIC is reportedly superior to that of conventional anti-DIC treatments, such as unfractionated heparin or low molecular weight heparin, but hemorrhagic events occasionally interfere with the therapeutic benefits of rTM. We assessed the clinical features of 20 consecutive patients who were given rTM for DIC associated with various hematologic disorders. Eight patients achieved remission of both primary disease and DIC, eight died due to progression of the primary disease, and four died of various hemorrhagic complications. Assessment of 16 biomarkers for coagulation showed that the four patients who died of hemorrhagic complications despite remission of their primary disease showed lower ADAMTS-13 (a disintegrin and metalloproteinase with a thrombospondin Type 1 motif, member 13) plasma activity than other patients (P = 0.016). The optimal cut-off level of ADAMTS-13 for predicting risk of hemorrhagic complications was 42 % (P = 0.007). Plasma ADAMTS-13 activity determined at diagnosis of DIC may help predict the risk of hemorrhagic events during and/or following DIC treatment with hematologic disorders. PMID:23494361

Chinen, Yoshiaki; Kuroda, Junya; Ohshiro, Muneo; Shimura, Yuji; Mizutani, Shinsuke; Nagoshi, Hisao; Sasaki, Nana; Nakayama, Ryuko; Kiyota, Miki; Yamamoto-Sugitani, Mio; Kobayashi, Tsutomu; Matsumoto, Yosuke; Horiike, Shigeo; Taniwaki, Masafumi

2013-04-01

297

Acute Abdominal Pain after Intercourse: Adrenal Hemorrhage as the First Sign of Metastatic Lung Cancer  

PubMed Central

Although the adrenal glands are a common site of cancer metastases, they are often asymptomatic and discovered incidentally on CT scan or autopsy. Spontaneous adrenal hemorrhage associated with metastatic lung cancer is an exceedingly rare phenomenon, and diagnosis can be difficult due to its nonspecific symptoms and ability to mimic other intra-abdominal pathologies. We report a case of a 65-year-old man with a history of right upper lobectomy seven months earlier for stage IB non-small cell lung cancer who presented with acute abdominal pain after intercourse. CT scan revealed a new right adrenal mass with surrounding hemorrhage, and subsequent FDG-PET scan confirmed new metabolic adrenal metastases. The patient's presentation of abdominal pain and adrenal hemorrhage immediately after sexual intercourse suggests that exertion, straining, or increased intra-abdominal pressure might be risk factors for precipitation of hemorrhage in patients with adrenal metastases. Management includes pain control and supportive treatment in mild cases, with arterial embolization or adrenalectomy being reserved for cases of severe hemorrhage. PMID:25126096

Packer, Clifford D.

2014-01-01

298

A Mild Chest Trauma in an Infant who Developed Severe Pulmonary Hemorrhage  

PubMed Central

Chest trauma, an important cause of morbidity and mortality, is the second most common cause of death in children under four years of age. Due to the different anatomy and physiology of the respiratory system in childhood, the injuries and consequences of chest trauma are also dissimilar. A seven-month-old male infant presented to the emergency clinic with cyanosis and respiratory distress. His medical history revealed that he had been found trapped behind his bed in a cyanotic state two hours earlier. Although physical examination revealed no signs of trauma, respiratory distress and hemorrhagic secretions indicated pulmonary hemorrhage or contusion. This preliminary diagnosis was confirmed by thoracic tomography. There was complete recovery following 48-hour oxygen and medical treatment. Even after mild injuries, the fact that severe pulmonary hemorrhages and contusions may develop without a trace of trauma should be kept in mind.

Yazgan, Hamza; Demirdoven, Mehmet; Korkmaz, Askin Ali; Mahmutyazicioglu, Kamran; Toraman, Ahmet Ruhi

2011-01-01

299

A case of acute bilateral retrocochlear hearing loss as an initial symptom of unilateral thalamic hemorrhage.  

PubMed

A speech discrimination test is a test using a list of 25 phonetically balanced monosyllables. It is often overlooked but significant enough for pure tone audiometry. Many physicians have performed pure tone audiometry but without a speech discrimination test. A 73-year-old woman visited our clinic complaining of sudden bilateral hearing loss. Pure tone audiometry showed only bilateral high frequency loss. However, speech discrimination had decreased markedly. We decided to follow-up after 1 week of Ginexin-F® (ginkgo leaf extract) and Nafril® (nafronyl oxalate). She felt a gait disturbance within 2 days. Magnetic resonance imaging revealed a left thalamic hemorrhage. After a 1 month hospitalization, the hematoma subsided, and speech discrimination recovered 3 months later. Acute hearing loss due to thalamic hemorrhage that recovered has never been reported. We report the first case of retrocochlear hearing loss that occurred with a thalamic hemorrhage in a patient who recovered. PMID:25279230

Park, Min-Joon; Yoon, Sung-Won; Kim, Kang-Hyeon; Kim, Young-Jin

2014-09-01

300

Radiation-Induced Spinal Cord Hemorrhage (Hematomyelia)  

PubMed Central

Intraspinal hemorrhage is very rare and intramedullary hemorrhage, also called hematomyelia, is the rarest form of intraspinal hemorrhage, usually related to trauma. Spinal vascular malformations such intradural arteriovenous malformations are the most common cause of atraumatic hematomyelia. Other considerations include warfarin or heparin anticoagulation, bleeding disorders, spinal cord tumors. Radiation-induced hematomyelia of the cord is exceedingly rare with only one case in literature to date. We report the case of an 8 year old girl with Ewing’s sarcoma of the thoracic vertebra, under radiation therapy, presenting with hematomyelia. We describe the clinical course, the findings on imaging studies and the available information in the literature. Recognition of the clinical pattern of spinal cord injury should lead clinicians to perform imaging studies to evaluate for compressive etiologies. PMID:25568739

Agarwal, Amit; Kanekar, Sangam; Thamburaj, Krishnamurthy; Vijay, Kanupriya

2014-01-01

301

Resuscitative strategies in traumatic hemorrhagic shock  

PubMed Central

Managing trauma patients with hemorrhagic shock is complex and difficult. Despite our knowledge of the pathophysiology of hemorrhagic shock in trauma patients that we have accumulated during recent decades, the mortality rate of these patients remains high. In the acute phase of hemorrhage, the therapeutic priority is to stop the bleeding as quickly as possible. As long as this bleeding is uncontrolled, the physician must maintain oxygen delivery to limit tissue hypoxia, inflammation, and organ dysfunction. This process involves fluid resuscitation, the use of vasopressors, and blood transfusion to prevent or correct acute coagulopathy of trauma. The optimal resuscitative strategy is controversial. To move forward, we need to establish optimal therapeutic approaches with clear objectives for fluid resuscitation, blood pressure, and hemoglobin levels to guide resuscitation and limit the risk of fluid overload and transfusion. PMID:23311726

2013-01-01

302

Sudden death due to undiagnosed acute promyelocytic leukemia: a case report.  

PubMed

Acute promyelocytic leukemia (APL) is associated with severe hemorrhagic coagulopathy induced by the release of procoagulant, plasminogen, and protease from leukemic cells. The case described in this report is of a 15-year-old male who unexpectedly died due to a cerebral hemorrhage caused by underlying APL within 12 h after presentation. This case suggests that underlying APL should be considered as a differential diagnosis when sudden death occurs with a fatal spontaneous hemorrhage, although it is rare. PMID:16741743

Sakai, Kentaro; Takatsu, Akihiro; Shigeta, Akio; Abe, Shuntaro; Ikegami, Masahiro; Takagi, Keizo

2007-07-01

303

Early Physiological Responses to Hemorrhagic Hypotension  

PubMed Central

The identification of early indicators of hemorrhagic hypotension (HH) severity may support early therapeutic approaches and bring insights into possible mechanistic implications. However, there are few systematic investigations of physiological variables during early stages of hemorrhage. We hypothesized that, in certain subjects, early physiological responses to blood loss are associated with the ability to survive hemorrhage levels that are lethal to subjects that do not present the same responses. Therefore, we examine the relevance of specific systemic changes during and after the bleeding phase of HH. Stepwise hemorrhage, representing pre-hospital situations, was performed in 44 rats and measurements were made after each step. Heart and respiratory rates, arterial and venous blood pressures, gases, acid-base status, glucose, lactate, electrolytes, hemoglobin, O2 saturation, tidal volume and minute volume were measured before, during and after bleeding 40% of the total blood volume. Fifty percent of rats survived ? 100 min (survivors, S); others were considered nonsurvivors (NS). Our findings were: 1) S and NS subjected to a similar hemorrhage challenge showed significantly different responses during non-lethal levels of bleeding; 2) survivors showed higher blood pressure and ventilation than NS; 3) while pH was lower in NS at later stages, changes in bicarbonate and base excess occurred already during the hemorrhage phase and were higher in NS; 4) plasma K+ levels and glucose extraction were higher in NS. We conclude that cardio-respiratory and metabolic responses, essential for the survival at HH, can differentiate between S and NS even before a lethal bleeding was reached. PMID:20129488

Torres Filho, Ivo P.; Torres, Luciana N.; Pittman, Roland N.

2009-01-01

304

Redefining secondary injury after subarachnoid hemorrhage in light of multimodal advanced neuroimaging, intracranial and transcranial neuromonitoring: beyond vasospasm.  

PubMed

The classic idea that arterial narrowing, called vasospasm (VSP), represents the hallmark of secondary injury after subarachnoid hemorrhage, has been challenged. The more complex and pleiotropic pathophysiological repercussions from the irruption of arterial blood into the subarachnoid layers go beyond the ascribed VSP. Putting adjectives in front of this term, such as "symptomatic," "microdialytic," or "angiographic" VSP, is misleading. Delayed cerebral ischemia (DCI) is a better term but remains restrictive to severe hypoperfusive injury and neglects oligemia, edema, and metabolic nonischemic injuries. In recognition of these issues, the international conference on VSP integrated "neurovascular events" into its name ( www.vasospasm2013.com ) and a multidisciplinary research group was formed in 2010 to study subgroups of DCI/VSP and their respective significance.In three parts, this tiered article provides a broader definitional envelope for DCI and secondary neurovascular insults after SAH, with a rubric for each subtype of delayed neuronal dysfunction. First, it pinpoints the need for nosologic precision and covers current terminological inconsistency. Then, it highlights the input of neuroimaging and neuromonitoring in defining secondary injurious processes. Finally, a new categorization of deteriorating patients is proposed, going beyond a hierarchical or dichotomized definition of VSP/DCI, and common data elements are suggested for future trials. PMID:25366634

Kapinos, Gregory

2015-01-01

305

Differential Diagnosis of Nontraumatic Intracerebral Hemorrhage  

Microsoft Academic Search

\\u000a Abstract\\u000a   A wide variety of nontraumatic pathologies can result in intracerebral hemorrhage (ICH). Primary causes such as arterial hypertension\\u000a or cerebral amyloid angiopathy can be differentiated from secondary pathologies, such as neoplasms, arterio-venous malformations,\\u000a coagulopathies, hemorrhagic ischemic strokes, and cerebral venous and sinus thrombosis.\\u000a \\u000a Here, the authors first provide some general information on epidemiology, clinical presentation, and imaging appearance of

Jennifer Linn; Hartmut Brückmann

2009-01-01

306

Hemorrhage-Adjusted Iron Requirements, Hematinics and Hepcidin Define Hereditary Hemorrhagic Telangiectasia as a Model of Hemorrhagic Iron Deficiency  

PubMed Central

Background Iron deficiency anemia remains a major global health problem. Higher iron demands provide the potential for a targeted preventative approach before anemia develops. The primary study objective was to develop and validate a metric that stratifies recommended dietary iron intake to compensate for patient-specific non-menstrual hemorrhagic losses. The secondary objective was to examine whether iron deficiency can be attributed to under-replacement of epistaxis (nosebleed) hemorrhagic iron losses in hereditary hemorrhagic telangiectasia (HHT). Methodology/Principal Findings The hemorrhage adjusted iron requirement (HAIR) sums the recommended dietary allowance, and iron required to replace additional quantified hemorrhagic losses, based on the pre-menopausal increment to compensate for menstrual losses (formula provided). In a study population of 50 HHT patients completing concurrent dietary and nosebleed questionnaires, 43/50 (86%) met their recommended dietary allowance, but only 10/50 (20%) met their HAIR. Higher HAIR was a powerful predictor of lower hemoglobin (p?=?0.009), lower mean corpuscular hemoglobin content (p<0.001), lower log-transformed serum iron (p?=?0.009), and higher log-transformed red cell distribution width (p<0.001). There was no evidence of generalised abnormalities in iron handling Ferritin and ferritin2 explained 60% of the hepcidin variance (p<0.001), and the mean hepcidinferritin ratio was similar to reported controls. Iron supplement use increased the proportion of individuals meeting their HAIR, and blunted associations between HAIR and hematinic indices. Once adjusted for supplement use however, reciprocal relationships between HAIR and hemoglobin/serum iron persisted. Of 568 individuals using iron tablets, most reported problems completing the course. For patients with hereditary hemorrhagic telangiectasia, persistent anemia was reported three-times more frequently if iron tablets caused diarrhea or needed to be stopped. Conclusions/significance HAIR values, providing an indication of individuals’ iron requirements, may be a useful tool in prevention, assessment and management of iron deficiency. Iron deficiency in HHT can be explained by under-replacement of nosebleed hemorrhagic iron losses. PMID:24146883

Finnamore, Helen; Le Couteur, James; Hickson, Mary; Busbridge, Mark; Whelan, Kevin; Shovlin, Claire L.

2013-01-01

307

Intracranial Hemorrhage in Term Newborns: Management and Outcomes  

Microsoft Academic Search

Child neurology is frequently a late player in the man- agement of the term newborn with intracranial hemor- rhage in the first neonatal week. It is crucial, however, that the child neurologist undertake a comprehensive evaluation by investigating etiology and management of the hemorrhage. Intracranial hemorrhage is usually associated with premature newborns. The literature on intracranial hemorrhage in term newborns

Surya N. Gupta; Amer M. Kechli; Uday S. Kanamalla

308

Spontaneous hemorrhage into a lumbar synovial cyst  

Microsoft Academic Search

Lumbar synovial cysts frequently present with back pain, chronic radiculopathy and\\/or progressive symptoms of spinal canal\\u000a compromise. These cysts generally appear in the context of degenerative lumbar spinal disease. Few cases of spontaneous hemorrhage\\u000a into synovial cysts have been reported in the literature.

Marta CicuendezJose; Jose F. Alen; Ana Ramos; Ramiro D. Lobato; Alfonso Lagares

2010-01-01

309

Fahr's Disease Presenting with Aneurysmal Subarachnoid Hemorrhage.  

PubMed

Fahr's disease is a rare disorder of slowly progressive cognitive, psychiatric, and motor decline associated with idiopathic basal ganglia calcification (IBGC) and widespread calcification in the brain and cerebellum. Acute presentation of IBGC is most often as a seizure disorder; however, we present a case of an acute IBCG presentation in which the cause of the deterioration was an aneurysmal subarachnoid hemorrhage. PMID:22754741

Al-Jehani, Hosam; Ajlan, Abdulrazag; Sinclair, David

2012-01-01

310

Fahr's Disease Presenting with Aneurysmal Subarachnoid Hemorrhage  

PubMed Central

Fahr's disease is a rare disorder of slowly progressive cognitive, psychiatric, and motor decline associated with idiopathic basal ganglia calcification (IBGC) and widespread calcification in the brain and cerebellum. Acute presentation of IBGC is most often as a seizure disorder; however, we present a case of an acute IBCG presentation in which the cause of the deterioration was an aneurysmal subarachnoid hemorrhage. PMID:22754741

Al-Jehani, Hosam; Ajlan, Abdulrazag; Sinclair, David

2012-01-01

311

Epizootic hemorrhagic disease in alberta, Canada.  

PubMed

Epizootic hemorrhagic disease (EHD) virus serotype 2 was identified by reverse-transcription (RT)-PCR in a white-tailed deer (Odocoileus virginianus) found dead in southern Alberta in September 2013. Field observations indicate at least 50 deer, primarily white-tailed deer, and three pronghorn antelope (Antilocapra americana) died during a suspected localized EHD outbreak. PMID:24807363

Pybus, Margo J; Ravi, Madhu; Pollock, Colleen

2014-07-01

312

Viral hemorrhagic septicemia virus in North America  

Microsoft Academic Search

The first detections of viral hemorrhagic septicemia virus (VHSV) in North America were in Washington State from adult coho (Oncorhynchus kisutch) and chinook (O. tshawytscha) salmon in 1988. Subsequently, VHSV was isolated from adult coho salmon returning to hatcheries in the Pacific Northwest in 1989, 1991 and 1994. These isolates represented a strain of VHSV that was genetically different from

Theodore R. Meyers; James R. Winton

1995-01-01

313

Comparative Pathogenesis of Crimean-Congo Hemorrhagic Fever and Ebola Hemorrhagic Fever  

Microsoft Academic Search

Crimean-Congo hemorrhagic fever (CCHF) virus has been called “the Asian Ebola virus” – an epithet that recognizes the close\\u000a clinical resemblance of CCHF and Ebola hemorrhagic fever (EHF), and also suggests that the two illnesses share similar underlying\\u000a mechanisms [38]. CCHF and EHF both present difficult challenges to pathophysiology research, because they occur principally\\u000a in regions lacking a modern medical

Mike Bray

314

Embolization of Rectal Arteries: An Alternative Treatment for Hemorrhagic Shock Induced by Traumatic Intrarectal Hemorrhage  

SciTech Connect

Rectal injuries caused by foreign bodies or iatrogenic insertions may lead to severe complications whose therapeutic management remains controversial. At times, both the rapid identification and treatment of subsequent active rectal bleeding may be challenging, especially when endoscopy fails to locate and control the arterial hemorrhage. We present the first two successful cases of middle rectal artery embolization in patients presenting with sustained bleeding and hemorrhagic shock.

Pichon, Nicolas, E-mail: nicolas.pichon@unilim.fr, E-mail: nicolas.pichon@chu-limoges.fr; Francois, Bruno [Dupuytren University Hospital, Intensive Care Unit (France); Pichon-Lefievre, Florence [Dupuytren University Hospital, Department of Radiology (France); Mathonnet, Murielle [Dupuytren University Hospital, Department of Surgery (France); Maubon, Antoine [Dupuytren University Hospital, Department of Radiology (France); Vignon, Philippe [Dupuytren University Hospital, Intensive Care Unit (France)

2005-05-15

315

Miniature electrical stimulator for hemorrhage control.  

PubMed

Noncompressible hemorrhage is currently the most common cause of preventable death in battlefield and in civilian trauma injuries. Tourniquets, specialized wound dressings, and hemorrhage-inhibiting biomaterials are not sufficiently effective in arrest of noncompressible hemorrhage and often cause collateral tissue damage. An effective, easy-to-use, portable device is needed to reduce blood loss in trauma patients immediately following injury and to maintain hemorrhage control up to several hours-until the injured is evacuated to a medical facility. We developed a miniature electrical stimulator to induce vascular constriction and, thereby, reduce hemorrhage. Vasoconstriction of the rat femoral arteries and veins was studied with pulse durations in the range of 1 ?s to 10 ms and repetition rate of 10 Hz. Pulse amplitude of 20 V, duration of 1 ms, and repetition rate of 10 Hz were found sufficient to induce rapid constriction down to 31 ± 2% of the initial diameter, which could be maintained throughout a two-hour treatment. Within one minute following treatment termination the artery dilated back to 88 ± 3% of the initial diameter, providing rapid restoration of blood perfusion. Histology indicated no damage to the vessel wall and endothelium seven days after stimulation. The same treatment reduced the blood loss following complete femoral artery resection by 68 ± 11%, compared to untreated vessels. Very low power consumption during stimulation (<10 mW per 1.6 mm electrode) allows miniaturization of the stimulator for portable battery-powered operation in the field to control the blood loss following vascular trauma. PMID:24845287

Brinton, Mark R; Mandel, Yossi; Dalal, Roopa; Palanker, Daniel

2014-06-01

316

Delayed subarachnoid hemorrhage following failed odontoid screw fixation.  

PubMed

Iatrogenic vascular injury is a rare but potentially devastating complication of cervical spine instrumentation. The authors report on a patient who developed an anterior spinal artery pseudoaneurysm associated with delayed subarachnoid hemorrhage after undergoing odontoid screw placement 14 months earlier. This 86-year-old man presented with spontaneous subarachnoid hemorrhage (Fisher Grade 4) and full motor strength on neurological examination. Imaging demonstrated pseudarthrosis of the odontoid process, extension of the odontoid screw beyond the posterior cortex of the dens, and a pseudoaneurysm arising from an adjacent branch of the anterior spinal artery. Due to the aneurysm's location and lack of active extravasation, endovascular treatment was not attempted. Posterior C1-2 fusion was performed to treat radiographic and clinical instability of the C1-2 joint. Postoperatively, the patient's motor function remained intact. Almost all cases of vascular injury related to cervical spine instrumentation are recognized at surgery. To the authors' knowledge, this is the first report of delayed vascular injury following an uncomplicated cervical fixation. This case further suggests that the risk of this phenomenon may be elevated in cases of failed fusion. PMID:21395399

Wilson, David A; Fusco, David J; Theodore, Nicholas

2011-06-01

317

[Pontine hemorrhage presenting with Foville syndrome and transient contralateral hyperhidrosis].  

PubMed

This report concerns a 88-year-old diabetic and hypertensive woman with pontine hemorrhage who presented with Foville syndrome and contralateral hyperhidrosis. She was admitted to our hospital for sudden onset of headaches and disturbed consciousness. Neurologic examination revealed bilateral miosis, Foville syndrome and superficial hemianesthesia on the right side of the face and body. No associated Horner syndrome and other autonomic dysfunction were observed. Laboratory data were normal except for diabetic findings. Brain CT and MRI revealed a hematoma in the left side at the lower pons. One month after the onset, hemihyperhidrosis on the face, arm and upper trunk contralateral side of the lesion appeared abruptly, and gradually disappeared a week later. Sweating on the ipsilateral side was normal and no new lesion was seen on the brain CT then. Only a few cases of contralateral hyperhidrosis due to pontine lesion have been reported. We suggest that the contralateral inhibitory sweating pathway was disrupted though the ipsilateral excitatory one was intact. Contralateral hyperhidrosis attributed to imbalance of the perspiratory control can be observed in the subacute or late phase after pontine hemorrhage. PMID:10885341

Sato, K; Nitta, E

2000-03-01

318

Intravascular Ultrasound of Symptomatic Intracranial Stenosis Demonstrates Atherosclerotic Plaque with Intraplaque Hemorrhage: A Case Report  

PubMed Central

BACKGROUND Intracranial artery stenosis is assumed to represent atherosclerotic plaque. Catheter cerebral arteriography shows that intracranial stenosis may progress, regress, or remain unchanged. It is counterintuitive that atherosclerotic plaque should spontaneously regress, raising questions about the composition of intracranial stenoses. Little is known about this disease entity in vivo. We provide the first demonstration of in vivo atherosclerotic plaque with intraplaque hemorrhage using intravascular ultrasound (IVUS). CASE DESCRIPTION A 35-year-old man with multiple vascular risk factors presented with recurrent stroke failing medical therapy. Imaging demonstrated left internal carotid artery occlusion, severe intracranial right internal carotid artery stenosis, and cerebral perfusion failure. Cerebral arteriography with IVUS confirmed 85% stenosis of the petrous right carotid artery due to atherosclerotic plaque with intraplaque hemorrhage. Intracranial stent-supported angioplasty was performed with IRB approval. The patient recovered without complication. CONCLUSIONS This case supports the premise that symptomatic intracranial stenosis can be caused by atherosclerotic plaque complicated by intraplaque hemorrhage similar to coronary artery plaque. IVUS provides additional characteristics that define intracranial atherosclerosis and high-risk features. To our knowledge, this is the first report of stroke due to unstable atherosclerotic plaque with intraplaque hemorrhage in vivo. PMID:19021843

Meyers, Philip M.; Schumacher, H. Christian; Gray, William A.; Fifi, Johanna; Gaudet, John G.; Heyer, Eric J.; Chong, Ji Y.

2009-01-01

319

Survival and Inflammatory Responses in Experimental Models of Hemorrhage  

PubMed Central

Background Alternative experimental models of hemorrhage mimic particular conditions of clinical settings and provide advantages to analyze novel resuscitation treatments. Here, we compared alternative models of hemorrhage and analyzed the effects of resuscitation with Hextend. Methods Adult male Sprague-Dawley rats underwent alternative models of hemorrhage: anesthetized without trauma, anesthetized with trauma, or conscious (unanesthetized) hemorrhage. Each model of hemorrhage includes three experimental groups: (C) control without hemorrhage or resuscitation treatment; (NR) animals with hemorrhage but without resuscitation; and (HX) animals with hemorrhage and resuscitation treatment with Hextend. Results Conscious animals required the highest hemorrhagic volume, whereas hemorrhage with trauma required the lowest blood volume withdrawal to achieve the same arterial pressure. Conscious hemorrhage exhibited the fastest mortality, but anesthetized animals with or without trauma had similar mortality kinetic. These survival rates did not correlate with blood chemistry, hemodynamic responses, or serum TNF and HMGB1 levels. Hemorrhage in conscious animals or anesthetized animals with trauma increased serum TNF levels by approximately 2-fold compared with hemorrhage in anesthetized animals without trauma. Animals in conscious hemorrhage had similar TNF increases in all the organs, but trauma induced a specific TNF overproduction in the spleen. Resuscitation with Hextend improved survival in all the experimental models, yet its survival benefits were statistically greater in anesthetized animals with trauma. The only two markers similar to the survival benefits of Hextend were the TNF levels in the lung and liver. Hextend significantly improved survival and inhibited pulmonary and hepatic TNF levels in all the experimental models. Conclusions The survival benefits of resuscitation with Hextend depended on the experimental models and did not correlate with blood chemistry, hemodynamic, or serum cytokine levels. However, resuscitation with Hextend inhibited TNF levels in the lung and the liver with a pattern that resembled the survival benefits. PMID:20189589

Cai, Bolin; Dong, Weihong; Sharpe, Susan; Deitch, Edwin A.; Ulloa, Luis

2011-01-01

320

Bilateral adrenal hemorrhage: The unrecognized cause of hemodynamic collapse associated with heparin-induced thrombocytopenia  

PubMed Central

Objective Heparin-induced thrombocytopenia is a common adverse effect of treatment with heparin resulting in paradoxical thromboses. An immunoglobulin G class “heparin-induced thrombocytopenia antibody” attaches to a heparin—platelet factor 4 protein complex. The antibody then binds to the Fc?IIa receptor on the surface of a platelet, resulting in activation, consumption, and thrombocytopenia in the clinical syndrome of heparin-induced thrombocytopenia. In contradistinction to other drug-induced thrombocytopenias that lead to a risk of hemorrhage, the state of thrombocytopenia in heparin-induced thrombocytopenia leads to an acquired hypercoagulability syndrome. Bilateral adrenal hemorrhage associated with heparin-induced thrombocytopenia has become an increasingly documented association. The adrenal gland has a vascular construction that lends itself to venous thrombus in the setting of heparin-induced thrombocytopenia and subsequent arterial hemorrhage. A literature search revealed 17 reported cases of bilateral adrenal hemorrhage in the setting of heparin-induced thrombocytopenia uniformly presenting with complete hemodynamic collapse. Data Sources An Ovid MEDLINE search of the English-language medical literature was conducted, identifying articles describing cases of bilateral adrenal hemorrhage in the setting of heparin-induced thrombocytopenia. Study Selection All cases with this association were included in the review. Data Extraction and Data Synthesis A total of 14 articles were identified, describing 17 individual case reports of bilateral adrenal hemorrhage associated with heparin-induced thrombocytopenia. All cases confirmed known characteristics of heparin-induced thrombocytopenia and uniformly revealed hypotension due to adrenal insufficiency. There were five deaths, resulting in an overall mortality rate of 27.8%, and 100% mortality in the three cases where adrenal insufficiency went unrecognized. Conclusions The secondary complication of adrenal vein thrombosis leading to bilateral adrenal hemorrhage remains insufficiently recognized and undertreated. The nonspecific presentation of adrenal hemorrhage and insufficiency as a complication of heparin-induced thrombocytopenia, coupled with the catastrophic clinical course of untreated adrenal collapse, requires a high index of suspicion to achieve rapid diagnosis and provide life-saving therapy. PMID:21242799

Rosenberger, Laura H.; Smith, Philip W.; Sawyer, Robert G.; Hanks, John B.; Adams, Reid B.; Hedrick, Traci L.

2011-01-01

321

An Update on Crimean Congo Hemorrhagic Fever  

PubMed Central

Crimean Congo hemorrhagic fever (CCHF) is one of the deadly hemorrhagic fevers that are endemic in Africa, Asia, Eastern Europe, and the Middle East. It is a tick-borne zoonotic viral disease caused by CCHF virus of genus Nairovirus (family Bunyaviridae). CCHF not only forms an important public health threat but has a significant effect on the healthcare personnel, especially in resource-poor countries. India was always a potentially endemic area until an outbreak hit parts of Gujarat, taking four lives including the treating medical team. The current review is an attempt to summarize the updated knowledge on the disease particularly in modern era, with special emphasis on nosocomial infections. The knowledge about the disease may help answer certain questions regarding entry of virus in India and future threat to community. PMID:21887063

Appannanavar, Suma B; Mishra, Baijayantimala

2011-01-01

322

Crimean-Congo hemorrhagic fever in Tajikistan.  

PubMed

Crimean-Congo hemorrhagic fever (CCHF) is a pathogenic tick-borne disease caused by a single-stranded negative-sense RNA virus classified within the Nairovirus genus of the family Bunyaviridae. Cases of CCHF have been registered in Tajikistan since the disease was first brought to medical attention in 1944. However, historical Tajik manuscripts describe the features of hemorrhagic fever associated with ticks, indicating that the disease might have been known in this region for many years before it was officially characterized. Here we review the historical context of CCHF in Tajikistan, much of which has been described over several decades in the Russian literature, and include reports of recent outbreaks in Tajikistan. PMID:22217164

Tishkova, Farida H; Belobrova, Evgeniya A; Valikhodzhaeva, Matlyuba; Atkinson, Barry; Hewson, Roger; Mullojonova, Manija

2012-09-01

323

[Hemorrhagic stress lesions in the gastroduodenal mucosa. Incidence and therapy].  

PubMed

We have observed 428 patients with hemorrhages of the upper gastrointestinal tract; 7% of patients with stress lesions of the gastroduodenal mucosa being the cause of hemorrhages (4.9% were erosional stress hemorrhages and 2.1% were stress ulcera). Surgery is the most common cause of stress hemorrhages of the stomach and duodenum. They occur during the first 5 days after the surgery, whereas 70.59% (n = 12) occur during the first 72 hours. The localization of erosional hemorrhages of the stomach mucosa is mostly diffuse and that is why they are numerous (78.6% of the third degree) and hemorrhages are mostly heavy (the case with stress hemorrhages). Chronic peptic ulcera, especially duodenal (62.5% duodenal ulcera and 37.5% stomach ulcera) present an expressed risk factor for the occurrence of hemorrhagic erosions under the influence of the stress factor. The most common localization of the stress hemorrhagic ulcus is duodenum (66.7%) which is a potential danger for occurrence of the heaviest arterial hemorrhages. After major surgeries and during postoperative periods patients must be preventively protected by "antiulcus therapy" (especially patients with ulcera). PMID:7565340

Radovanovi?, D; Stojanovi?, D; Kalaba, J

1995-01-01

324

Nicotine reverses hemorrhagic shock in rats  

Microsoft Academic Search

Cholinergic mechanisms are currently thought to play an essential role in blood pressure homeostasis. Here we show that, in urethane-anaesthetized rats bled to severe hemorrhagic shock, the i. v. administration of nicotine 0.2–50 µg\\/kg causes a prompt, sustained and dose-dependent improvement in cardiovascular and respiratory functions, the animals' survival rate being significantly higher than that of animals treated with saline.

Salvatore Guarini; Simonetta Tagliavini; Carla Bazzani; Alfio Bertolini; William Ferrari

1991-01-01

325

Epidemiology of Crimean-Congo Hemorrhagic Fever  

Microsoft Academic Search

Viral hemorajik ate? (VHA), insanlarda farkli viruslar tarafindan olu?turulan, ate? ve kanama ile karakterli bir klinik sendromdur. Günümüzde modern yo?un bakim tekniklerine ra?men VHA önemli oranda ölümle sonuçlanmaktadir. Kirim- Kongo hemorajik ate? (KKHA) hastali?inin etkeni olan Crimean- Congo hemorrhagic fever virus (CCHFV), Bunyaviridae ailesinin Nairovirus gurubuna mensup bir RNA virusudur. Bu virusun neden oldu?u hemorajik ate? hastali?i ilk kez 1944

Nazif ELALDI

326

Subperiosteal Orbital Hemorrhage Complicating Cardiac Surgery  

SciTech Connect

Subperiosteal orbital hemorrhage (SPOH) following cardiac surgery has not been previously reported. We present a patient who developed diplopia and right eye proptosis immediately after cardiac surgery for a mitral valve repair and coronary artery bypass graft. A computed tomography (CT) study demonstrated a right superior SPOH. The diplopia and proptosis resolved spontaneously within 4 weeks. Follow-up CT showed complete resolution of the SPOH.

Peden, Marc C.; Bhatti, M. Tariq [University of Florida College of Medicine, Department of Ophthalmology (United States)], E-mail: tbhatti@eyel.eye.ufl.edu

2004-09-15

327

Acute hemorrhage and blood transfusions in horses.  

PubMed

Treatment of acute hemorrhage in the horse involves targeted medical management and also may involve surgical stabilization. This article provides an approach to the initial stabilization and information on available topical hemostats. The practice of blood collection and transfusion is also described, with attention to new information on viability of transfused equine blood, potential negative effects of blood transfusion, and methods of cell salvage. PMID:25016500

Mudge, Margaret C

2014-08-01

328

Vaccines for viral hemorrhagic fevers--progress and shortcomings.  

PubMed

With a few exceptions, vaccines for viruses that cause hemorrhagic fever remain unavailable or lack well-documented efficacy. In the past decade this has not been due to a lack of the ability to develop vaccine platforms against highly pathogenic viruses, but rather the lack of will/interest to invest in platforms that have the potential to become successful vaccines. The two exceptions to this are vaccines against Dengue virus (DENV) and Rift Valley fever virus (RVFV), which recently have seen significant progress in putting forward new and improved vaccines, respectively. Experimental vaccines for filoviruses and Lassa virus (LASV) do exist but are hindered by a lack of financial interest and only partially or ill-defined correlates/mechanisms of protection that could be assessed in clinical trials. PMID:23773330

Falzarano, Darryl; Feldmann, Heinz

2013-06-01

329

Management of Macular Pre-Retinal Subhyaloid hemorrhage by Nd:Yag laser hyaloidotomy  

PubMed Central

Objective: To evaluate the efficacy, visual outcome and complication following Nd:Yag laser hyaloidtomy for subhyaloid hemorrhage. Methods: This interventional case series was managed at LRBT, Free Base Eye Hospital Karachi from January 2010 to December 2010. It included 30 eyes of 30 patients with subhyaloid hemorrhage due to different causes which underwent Nd: Yag laser sublyaloidotomy Results: Out of thirty patients, eighteen (60%) were male and twelve (40%) were females. Mean age was 32.57 years. Males pre-dominated the study. Pre laser visual acuity was between counting finger at one meter in 22 patients (73.33%) and between counting finger one meter to hand movement in 8 patients (26.66%). Vision improved to 6/6 in 10 patients (33%), 6/9 – 6/12 in 17 patients (56.66%) and between 6/24 – 6/60 in 3 patients (9.99%) at the end of follow up. Complications were persistent vitreous hemorrhage in one (3.33%) patient, failed drainage in one (3.33%) patient and metamorphopsia in one (3.33%) patient. Conclusion: Nd: Yag laser hyloidotomy is an excellent technique for management of Subhyaloid hemorrhage with early visual recovery provided there is no macular pathology. PMID:24772139

Murtaza, Faisal; Rizvi, Syed Fawad; Bokhari, Syeda Aisha; Kamil, Zeeshan

2014-01-01

330

Catastrophic Antiphospholipid Syndrome with Severe Acute Thrombotic Microangiopathy and Hemorrhagic Complications  

PubMed Central

The catastrophic antiphospholipid syndrome (CAPS) is a rare life-threatening form of the antiphospholipid syndrome characterized by disseminated vascular thrombosis resulting in multiorgan failure. On an exceedingly rare occasion, CAPS can be associated with severe hemorrhagic manifestations. We report a young woman with a history of several spontaneous miscarriages who presented with menorrhagia and hemoptysis. The patient developed respiratory failure due to diffuse alveolar hemorrhage. Laboratory tests demonstrated severe hemolytic anemia, profound thrombocytopenia, markedly elevated fibrin degradation products, and renal failure. Blood films revealed numerous schistocytes. Serologic tests disclosed hypocomplementemia and autoantibodies directed against several nuclear antigens. Coagulation studies revealed lupus anticoagulant. Echocardiography demonstrated reduced ejection fraction and moderate to severe mitral and tricuspid regurgitation. The patient was diagnosed with CAPS with hemorrhagic manifestations in the setting of new-onset SLE. The patient was treated with hemodialysis, high-dose glucocorticoids, plasma exchange, intravenous cyclophosphamide, and rituximab. Over the ensuing four weeks, the combination therapy led to hematological, cardiopulmonary, and renal recovery. This exceedingly rare case emphasizes that hemorrhagic manifestations, severe microangiopathic hemolytic anemia, and profound thrombocytopenia can dominate the clinical picture in CAPS. PMID:24382968

Vieregge, Gerardo B.; Harrington, Thomas J.; Andrews, David M.; Carpintero, Maria F.; Green, Dollie F.; Nayer, Ali

2013-01-01

331

Excessive vascular sprouting underlies cerebral hemorrhage in mice lacking ?V?8-TGF? signaling in the brain.  

PubMed

Vascular development of the central nervous system and blood-brain barrier (BBB) induction are closely linked processes. The role of factors that promote endothelial sprouting and vascular leak, such as vascular endothelial growth factor A, are well described, but the factors that suppress angiogenic sprouting and their impact on the BBB are poorly understood. Here, we show that integrin ?V?8 activates angiosuppressive TGF? gradients in the brain, which inhibit endothelial cell sprouting. Loss of ?V?8 in the brain or downstream TGF?1-TGFBR2-ALK5-Smad3 signaling in endothelial cells increases vascular sprouting, branching and proliferation, leading to vascular dysplasia and hemorrhage. Importantly, BBB function in Itgb8 mutants is intact during early stages of vascular dysgenesis before hemorrhage. By contrast, Pdgfb(ret/ret) mice, which exhibit severe BBB disruption and vascular leak due to pericyte deficiency, have comparatively normal vascular morphogenesis and do not exhibit brain hemorrhage. Our data therefore suggest that abnormal vascular sprouting and patterning, not BBB dysfunction, underlie developmental cerebral hemorrhage. PMID:25406396

Arnold, Thomas D; Niaudet, Colin; Pang, Mei-Fong; Siegenthaler, Julie; Gaengel, Konstantin; Jung, Bongnam; Ferrero, Gina M; Mukouyama, Yoh-suke; Fuxe, Jonas; Akhurst, Rosemary; Betsholtz, Christer; Sheppard, Dean; Reichardt, Louis F

2014-12-01

332

Histological characterization of hemorrhages in muscles of broiler chickens.  

PubMed

Hemorrhages in meat of broiler chickens are major quality defects. The objective of our study was to characterize the various types of hemorrhages in thigh and breast muscles with respect to their morphological appearance, location, and origin. Chickens were stunned using a water-bath stunner and were either exsanguinated and fixed or perfused with fixative. The morphological appearance of the hemorrhages was determined by the type of tissue in which they were found and by the amount of extravasating blood. Origins of hemorrhages were found only at sites of rupture of venous structures, such as postcapillary venules and small collecting veins. The absence of significant leukocyte infiltration strongly indicated that muscle tissue damage and hemorrhage occurred within the 24 h preceding stunning and slaughter. The locations and types of hemorrhages indicate different underlying mechanisms. PMID:10685898

Kranen, R W; Lambooy, E; Veerkamp, C H; Van Kuppevelt, T H; Veerkamp, J H

2000-01-01

333

Risk factors for hemorrhage in severe dengue infections  

Microsoft Academic Search

The purpose of this study was to identify the early indicators of hemorrhage in severe dengue infections in 114 patients; 24 patients had severe hemorrhage and 92 had no hemorrhage. The platelet counts were not predictive of bleeding. The duration of shock (OR, 2.11; 95% CI, 1.13 to 3.92; P = .019) and low-normal hematocrit at the time of shock

Lucy Chai See Lum; Adrian Yu Teik Goh; Patrick Wai Keong Chan; Abdel-Latif Mohd El-Amin; Sai Kit Lam

2002-01-01

334

Holmes' Tremor Associated with Bilateral Hypertrophic Olivary Degeneration Following Brain Stem Hemorrhage: A Case Report  

PubMed Central

Holmes' tremor is a condition characterized by a mixture of postural, rest, and action tremors due to midbrain lesions in the vicinity of the red nucleus. Hypertrophic olivary degeneration (HOD) is a rare type of neuronal degeneration involving the dento-rubro-olivary pathway and may present clinically as Holmes tremor. We report on a 59-year-old female patient who developed Holmes tremor in association with bilateral HOD, following brain stem hemorrhage. PMID:25340035

Kim, Min Kyu; Park, Se-Hyuck; Yoon, Dae Young

2014-01-01

335

Neuroimaging of white matter injury, intraventricular and cerebellar hemorrhage.  

PubMed

White matter injury and hemorrhage are common findings in extremely preterm infants. Large hemorrhages and extensive cystic lesions are identified with cranial ultrasound. MRI, which is more sensitive, is especially useful in the identification of small intraventricular hemorrhage; cerebellar hemorrhage; punctate lesion in the white matter and cerebellum; and diffuse, noncystic white matter injury. Imaging sequences such as diffusion-weighted, diffusion tensor, and susceptibility weighted imaging may improve recognition and prediction of outcome. These techniques improve understanding of the underlying pathophysiology of white matter injury and its effects on brain development and neurodevelopmental outcome. PMID:24524447

Benders, Manon J N L; Kersbergen, Karina J; de Vries, Linda S

2014-03-01

336

Cerebral venous sinus thrombosis with cerebral hemorrhage during early pregnancy.  

PubMed

Cerebral venous sinus thrombosis (CVST) rarely induces cerebral hemorrhage, and CVST with cerebral hemorrhage during early pregnancy is extremely rare. Upon literature review, we are able to find only one case of CVST with cerebral hemorrhage in early pregnancy. In this paper, we report another case of a 27-year-old patient who developed CVST with cerebral hemorrhage in her fifth week of pregnancy. Although the optimal treatment for this infrequent condition remains controversial, we adopted anticoagulation as the first choice of treatment and obtained favorable results. PMID:25630781

Nie, Quanmin; Guo, Pin; Ge, Jianwei; Qiu, Yongming

2015-01-01

337

Outcomes of TIPS for Treatment of Gastroesophageal Variceal Hemorrhage.  

PubMed

Variceal hemorrhage is a life-threatening complication of cirrhosis that requires a multidisciplinary approach to management. The transjugular intrahepatic portosystemic shunt (TIPS) procedure is a minimally invasive image-guided intervention used for secondary prevention of bleeding and as salvage therapy in acute hemorrhage. This review focuses on the role of TIPS in the setting of variceal hemorrhage, with emphasis on the pathophysiology and conventional management of variceal hemorrhage, current and emerging indications for TIPS creation, TIPS clinical outcomes, and the role of adjuvant embolotherapy. PMID:25177086

Parvinian, Ahmad; Gaba, Ron C

2014-09-01

338

Centrally injected histamine increases posterior hypothalamic acetylcholine release in hemorrhage-hypotensive rats.  

PubMed

Histamine, acting centrally as a neurotransmitter, evokes a reversal of hemorrhagic hypotension in rats due to the activation of the sympathetic and the renin-angiotensin systems as well as the release of arginine vasopressin and proopiomelanocortin-derived peptides. We demonstrated previously that central nicotinic cholinergic receptors are involved in the pressor effect of histamine. The aim of the present study was to examine influences of centrally administrated histamine on acetylcholine (ACh) release at the posterior hypothalamus-a region characterized by location of histaminergic and cholinergic neurons involved in the regulation of the sympathetic activity in the cardiovascular system-in hemorrhage-hypotensive anesthetized rats. Hemodynamic and microdialysis studies were carried out in Sprague-Dawley rats. Hemorrhagic hypotension was induced by withdrawal of a volume of 1.5ml blood/100g body weight over a period of 10min. Acute hemorrhage led to a severe and long-lasting decrease in mean arterial pressure (MAP), heart rate (HR), and an increase in extracellular posterior hypothalamic ACh and choline (Ch) levels by 56% and 59%, respectively. Intracerebroventricularly (i.c.v.) administered histamine (50, 100, and 200nmol) dose- and time-dependently increased MAP and HR and caused an additional rise in extracellular posterior hypothalamic ACh and Ch levels at the most by 102%, as compared to the control saline-treated group. Histamine H1 receptor antagonist chlorpheniramine (50nmol; i.c.v.) completely blocked histamine-evoked hemodynamic and extracellular posterior hypothalamic ACh and Ch changes, whereas H2 and H3/H4 receptor blockers ranitidine (50nmol; i.c.v.) and thioperamide (50nmol; i.c.v.) had no effect. In conclusion, centrally administered histamine, acting via H1 receptors, increases ACh release at the posterior hypothalamus and causes a pressor and tachycardic response in hemorrhage-hypotensive anesthetized rats. PMID:25468497

Altinbas, Burcin; Yilmaz, Mustafa S; Savci, Vahide; Jochem, Jerzy; Yalcin, Murat

2015-01-01

339

Orbital hemorrhage and compressive optic neuropathy in patients with midfacial fractures receiving low-molecular weight heparin therapy.  

PubMed

While the implementation of deep vein thrombosis (DVT) prophylaxis in the hospital setting is a major concern, the use of antithrombotic agents is fraught with a variety of hemorrhagic complications. Due to increasing reports of adverse reactions to unfractionated heparin (UFH), several manufacturers have initiated product recalls. As a result, the use of low-molecular weight heparins (LMWHs) such as enoxaparin has risen substantially. In this paper, 2 orbital hemorrhagic complications in patients receiving enoxaparin therapy will be presented. The incidence of DVT in the OMS patient, recent prophylactic strategies, and their effectiveness will be reviewed. PMID:19531411

Jamal, Basem T; Diecidue, Robert J; Taub, Daniel; Champion, Allen; Bilyk, Jurij R

2009-07-01

340

Hemorrhagic Transformation (HT) and Symptomatic Intracerebral Hemorrhage (sICH) Risk Prediction Models for Postthrombolytic Hemorrhage in the Stroke Belt  

PubMed Central

Background Symptomatic intracerebral hemorrhage (sICH) remains the most feared complication of intravenous tissue plasminogen activator (IV tPA) treatment. We aimed to investigate how previously validated scoring methodologies would perform in treated patients in two US Stroke Belt states. Methods and Results We retrospectively reviewed consecutive patients from two centers in two Stroke Belt states who received IV tPA (2008–2011). We assessed the ability of three models to predict sICH. sICH was defined as a type 2 parenchymal hemorrhage with deterioration in National Institutes of Health Stroke Scale (NIHSS) score of ?4 points or death. Among 457 IV tPA-treated patients, 19 (4.2%) had sICH (mean age 68, 26.3% Black, 63.2% female). The Cucchiara model was most predictive of sICH in the entire cohort (AUC: 0.6528) and most predictive of sICH among Blacks (OR = 6.03, 95% CI 1.07–34.1, P = 0.0422) when patients were dichotomized by score. Conclusions In our small sample from the racially heterogeneous US Stroke Belt, the Cucchiara model outperformed the other models at predicting sICH. While predictive models should not be used to justify nontreatment with thrombolytics, those interested in understanding contributors to sICH may choose to use the Cucchiara model until a Stroke Belt model is developed for this region. PMID:24504047

Siegler, James E.; Alvi, Muhammad; Boehme, Amelia K.; Lyerly, Michael J.; Albright, Karen C.; Shahripour, Reza Bavarsad; Rawal, Pawan V.; Kapoor, Niren; Sisson, April; Houston, J. Thomas; Alexandrov, Anne W.; Martin-Schild, Sheryl; Alexandrov, Andrei V.

2014-01-01

341

Hemorrhage Near Fetal Rat Bone: Preliminary Results  

NASA Astrophysics Data System (ADS)

High-intensity ultrasound has shown potential in treating many ailments requiring noninvasive tissue necrosis. However, little work has been done on using ultrasound to ablate pathologies on or near the developing fetus. For example, Congenital Cystic Adenomatoid Malformation (cyst on lungs), Sacrococcygeal Teratoma (benign tumor on tail bone), and Twin-Twin Transfusion Syndrome (one twin pumps blood to other twin) are selected problems that will potentially benefit from noninvasive ultrasound treatments. Before these applications can be explored, potential ultrasound-induced bioeffects should be understood. Specifically, ultrasound-induced hemorrhage near the fetal rat skull was investigated. An f/1 spherically focused transducer (5.1-cm focal length) was used to expose the skull of 18- to 19-day-gestation exteriorized rat fetuses. The ultrasound pulse had a center frequency of 0.92 MHz and pulse duration of 9.6 ?s. The fetuses were exposed to 1 of 4 exposure conditions (denoted A, B, C, and D) in addition to a sham exposure. Three of the exposures consisted of a peak compressional pressure of 10 MPa, a peak rarefactional pressure of 6.7 MPa, and pulse repetition frequencies of 100 Hz (A), 250 Hz (B), and 500 Hz (C), corresponding to time-average intensities of 1.9 W/cm2, 4.7 W/cm2, and 9.4 W/cm2, respectively. Exposure D consisted of a peak compressional pressure of 6.7 MPa, a peak rarefactional pressure of 5.0 MPa, and a PRF of 500 Hz corresponding to a time-average intensity of 4.6 W/cm2. Hemorrhage occurrence increased slightly with increasing time-average intensity (i.e., 11% for A, 28% for B, 31% for C, and 19% for D with a 9% occurrence when the fetuses were not exposed). The low overall occurrence of hemorrhaging may be attributed to fetal motion (observed in over half of the fetuses from the backscattered echo during the exposure). The mean hemorrhage sizes were 3.1 mm2 for A, 2.5 mm2 for B, 2.7 mm2 for C, and 5.1 mm2 for D. The larger lesions at D may be related to these fetuses moving less as only 40% of the fetuses were observed moving for this exposure condition.

Bigelow, Timothy A.; Miller, Rita J.; Blue, James P.; O'Brien, William D.

2006-05-01

342

Diagnosis and Treatment of Hemorrhagic Pituitary Adenomas  

Microsoft Academic Search

\\u000a We retrospectively analyzed the clinical manifestations, imaging results, and surgical treatment conditions of 72 patients\\u000a who were diagnosed with hemorrhagic pituitary adenoma between January 2006 and May 2009 at our Department of Neurosurgery.\\u000a We reached the conclusion that the CT-positive rate was 55.17% and the MRI-positive rate was 94.44%. Sixty-six patients underwent\\u000a transsphenoidal operations; 6 patients, transfrontal operations; 52, total

Gang Huo; Qing-Lin Feng; Mao-Yuan Tang; Dong Li

343

CT of extracranial hemorrhage and hematomas  

SciTech Connect

Computed tomography was used to examine 100 patients with extracranial hemorrhage. Of these patients, 29 had serial scans that allowed for the study of evolutionary changes. Operation, anticoagulation, and trauma were the prime etiological factors. The most frequent sites included the retroperitoneum (27%), body wall or extremities (24%), peritoneal cavity (19%), and subcapsular (16%) and intraparenchymal (7%) locations. The computed tomographic features were carefully studied and documented. Age-related features included contrast-material extravasation, inhomogeneity, hematocrit effect, attenuation changes, lucent halo, pseudocapsule development, decreased size with time, peripheral calcification, and fascial plane thickening. This report discussed all these findings and their usefulness in diagnosis and patient care.

Swensen, S.J.; McLeod, R.A.; Stephens, D.H.

1984-10-01

344

Aortoesophageal fistula due to esophageal ulcer.  

PubMed

Aortoesophageal fistula is a rare but fatal disease. Many such fistulas are caused by an aortic aneurysm, a previous operation, or esophageal disease. We report a case of aortoesophageal fistula due to an esophageal ulcer. A 66-year-old man suffered massive hematemesis; he was diagnosed as having an aortoesophageal fistula due to an esophageal ulcer after examination by upper endoscopy, computed tomography, and angiography. He had no aortic aneurysm, nor was there a history of a previous operation. An emergency operation was performed, but we could only accomplish closure because clamping of the aorta was impossible, and the source of the bleeding could not be established. He died 4 days later after sudden hemorrhage. Surgical outcome depends on early surgical intervention before massive hemorrhage occurs. PMID:19440823

Takano, Shinji; Katsuhara, Kazuhiro; Nobuhara, Kenji; Ueda, Shigeharu; Imura, Masato; Hohjo, Yoshihisa

2009-05-01

345

Influence of Lamina Terminalis Fenestration on the Occurrence of the Shunt-Dependent Hydrocephalus in Anterior Communicating Artery Aneurysmal Subarachnoid Hemorrhage  

PubMed Central

Recently, it was reported that fenestration of the lamina terminalis (LT) may reduce the incidence of shunt-dependent hydrocephalus in aneurysmal subarachnoid hemorrhage (SAH). The authors investigated the efficacy of the LT opening on the incidence of shunt-dependent hydrocephalus in the ruptured anterior communicating artery (ACoA) aneurysms. The data of 71-ruptured ACoA aneurysm patients who underwent aneurysmal clipping in acute stage were reviewed retrospectively. Group I (n=36) included the patients with microsurgical fenestration of LT during surgery, Group II (n=35) consisted of patients in whom fenestration of LT was not feasible. The rate of shunt-dependent hydrocephalus was compared between two groups by logistic regression to control for confounding factors. Ventriculo-peritoneal shunts were performed after aneurysmal obliteration in 18 patients (25.4%). The conversion rates from acute hydrocephalus on admission to chronic hydrocephalus in each group were 29.6% (Group I) and 58.8% (Group II), respectively. However, there was no significant correlation between the microsurgical fenestration and the rate of occurrence of shunt-dependent hydrocephalus (p>0.05). Surgeons should carefully decide the concomitant use of LT fenestration during surgery for the ruptured ACoA aneurysms because of the microsurgical fenestration of LT can play a negative role in reducing the incidence of chronic hydrocephalus. PMID:16479076

Jeon, Ji Young; Kim, Jae Hoon; Cheong, Jin Hwan; Bak, Koang Hum; Kim, Choong Hyun; Yi, Hyeong Joong; Kim, Kwang Myung

2006-01-01

346

Cerebral Vasospasm in Critically III Patients with Aneurysmal Subarachnoid Hemorrhage: Does the Evidence Support the Ever-Growing List of Potential Pharmacotherapy Interventions?  

PubMed

The occurrence of cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH) is a significant event resulting in decreased cerebral blood flow and oxygen delivery. Prevention and treatment of cerebral vasospasm is vital to avert neurological damage and reduced functional outcomes. A variety of pharmacotherapy interventions for the prevention and treatment of cerebral vasospasm have been evaluated. Unfortunately, very few large randomized trials exist to date, making it difficult to make clear recommendations regarding the efficacy and safety of most pharmacologic interventions. Considerable debate exists regarding the efficacy and safety of hypervolemia, hemodilution, and hypertension (triple-H therapy), and the implementation of each component varies substantially amongst institutions. There is a new focus on euvolemic-induced hypertension as a potentially preferred mechanism of hemodynamic augmentation. Nimodipine is the one pharmacologic intervention that has demonstrated favorable effects on patient outcomes and should be routinely administered unless contraindications are present. Intravenous nicardipine may offer an alternative to oral nimodipine. The addition of high-dose magnesium or statin therapy has shown promise, but results of ongoing large prospective studies are needed before they can be routinely recommended. Tirilazad and clazosentan offer new pharmacologic mechanisms, but clinical outcome results from prospective randomized studies have largely been unfavorable. Locally administered pharmacotherapy provides a targeted approach to the treatment of cerebral vasospasm. However, the paucity of data makes it challenging to determine the most appropriate therapy and implementation strategy. Further studies are needed for most pharmacologic therapies to determine whether meaningful efficacy exists. PMID:25477565

Kiser, Tyree H

2014-11-01

347

Recombinant Activated Factor VII for Acute Intracerebral Hemorrhage  

Microsoft Academic Search

background Intracerebral hemorrhage is the least treatable form of stroke and is associated with high mortality. Among patients who undergo computed tomography (CT) within three hours after the onset of intracerebral hemorrhage, one third have an increase in the vol- ume of the hematoma related to subsequent bleeding. We sought to determine wheth- er recombinant activated factor VII (rFVIIa) can

Stephan A. Mayer; Nikolai C. Brun; Kamilla Begtrup; Joseph Broderick; Stephen Davis; Michael N. Diringer; Brett E. Skolnick; Thorsten Steiner

2005-01-01

348

Intelligent brain hemorrhage diagnosis using artificial neural networks  

Microsoft Academic Search

Brain hemorrhage is a type of stroke which is caused by an artery in the brain bursting and causing bleeding in the surrounded tissues. Diagnosing brain hemorrhage, which is mainly through the examination of a CT scan enables the accurate prediction of disease and the extraction of reliable and robust measurement for patients in order to describe the morphological changes

Ushani Balasooriya

2012-01-01

349

Hemorrhagic enteritis in captive American kestrels (Falco sparverius)  

USGS Publications Warehouse

Hemorrhagic enteritis and hepatitis of suspected adenovirus etiology were the apparent cause of death of nine captive American kestrels. Cloacal hemorrhage was the only prominent gross lesion: disseminated hepatocellular necrosis, and intranuclear inclusion bodies were evident microscopically. Electron microscopy revealed numerous adenovirus-like particles associated with the hepatic lesions. Attempts to serologically identify the agent were unsuccessful.

Sileo, L.; Franson, J.C.; Graham, D.L.; Domermuth, C.H.; Rattner, B.A.; Pattee, O.H.

1983-01-01

350

Xanthogranulomatous cholecystitis: a rare cause of digestive hemorrhage.  

PubMed

Xanthogranulomatous cholecystitis is a rare affection with non-specific symptoms. It is essential to differentiate it from gall bladder adenocarcinoma. Presentation signs include hemorrhage or fistula. This report concerns a patient with pseudotumoral xanthogranulomatous cholecystitis who presented with gastrointestinal hemorrhage. PMID:24411821

Scheiwe, C; Muller, A; Rocas, D; Cotte, E

2014-02-01

351

Endovascular Therapies for Primary Postpartum Hemorrhage: Techniques and Outcomes  

PubMed Central

Interventional radiologists are often consulted for acute management of hemorrhagic complications in obstetric and gynecologic patients. The aim of this article is to review the common indications for vascular embolization in obstetric and gynecologic emergencies, specifically in the setting of primary postpartum hemorrhage, and to discuss the technique and outcomes of endovascular treatment. PMID:24436559

Gipson, Matthew G.; Smith, Mitchell T.

2013-01-01

352

[A case and pedigree report of hereditary hemorrhagic telangiectasia].  

PubMed

A case of hereditary hemorrhagic telangiectasia was reported. Repeated hemorrhage in nasal and digestive system are main clinical manifestation. Capillary expanded on tongue and finger is the main physical sign. Main clinical manifestation and typical physical signs, combined with family history, can help to establish a diagnosis. PMID:24826466

Lin, Jiafeng; Chen, Jianqiu; Wang, Baodong

2014-02-01

353

Ebola and Marburg Hemorrhagic Fevers: Neglected Tropical Diseases?  

Microsoft Academic Search

Ebola hemorrhagic fever (EHF) and Marburg hemorrhagic fever (MHF) are rare viral diseases, endemic to central Africa. The overall burden of EHF and MHF is small in comparison to the more common protozoan, helminth, and bacterial diseases typically referred to as neglected tropical diseases (NTDs). However, EHF and MHF outbreaks typically occur in resource-limited settings, and many aspects of these

Adam MacNeil; Pierre E. Rollin

2012-01-01

354

Proposal Due: _________________________ Senior Project Due: _________________________  

E-print Network

Proposal Due: _________________________ HURCA & Senior Project Due: _________________________ Priorities: Senior Project Guide #12;2 The Honors College Senior Project Guide Why Research? Research the communication and critical thinking skills necessary for graduate school and professional employment. Honors

Huang, Haiying

355

A CAD System for Hemorrhagic Stroke.  

PubMed

Computer-aided detection/diagnosis (CAD) is a key component of routine clinical practice, increasingly used for detection, interpretation, quantification and decision support. Despite a critical need, there is no clinically accepted CAD system for stroke yet. Here we introduce a CAD system for hemorrhagic stroke. This CAD system segments, quantifies, and displays hematoma in 2D/3D, and supports evacuation of hemorrhage by thrombolytic treatment monitoring progression and quantifying clot removal. It supports seven-step workflow: select patient, add a new study, process patient's scans, show segmentation results, plot hematoma volumes, show 3D synchronized time series hematomas, and generate report. The system architecture contains four components: library, tools, application with user interface, and hematoma segmentation algorithm. The tools include a contour editor, 3D surface modeler, 3D volume measure, histogramming, hematoma volume plot, and 3D synchronized time-series hematoma display. The CAD system has been designed and implemented in C++. It has also been employed in the CLEAR and MISTIE phase-III, multicenter clinical trials. This stroke CAD system is potentially useful in research and clinical applications, particularly for clinical trials. PMID:25196612

Nowinski, Wieslaw L; Qian, Guoyu; Hanley, Daniel F

2014-09-01

356

[Therapeutic modalities in upper gastrointestinal tract hemorrhage].  

PubMed

During the observed 5 year period 428 patients were hospitalized because of upper digestive tract hemorrhages. The commonest cause of hemorrhage was the peptic ulcer (46.5%). The bleeding duodenal ulcer occurs more often than the stomach ulcer (55.2% to 44.8%). These patients are usually of older age (more than 50% of men and 46% women in whom duodenal ulcer bleeding occurs are older than 60 years of age). In about half of ulcers (40%) acute bleeding occurs during the urgent endoscopic procedure. Oozing type of bleeding occurs most frequently (82.5%), while the most serious type of bleeding, aortic pulse, is much less frequent (7%). Fibrinous coagulum recidives in bleeding in about one fifth of cases. Active pulse bleeding is the cause of surgery in 66.7% as well as two thirds (75%) of recidivant bleedings. More than 80% of patients in whom gastroduodenal bleeding occurs are being conservatively treated and this percentage may be taken as an adequate choice of the therapy modality. PMID:8657065

Radovanovi?, D; Kalaba, J; Stojanovi?, D

1995-01-01

357

Thrombolytic Evacuation of Intracerebral and Intraventricular Hemorrhage  

PubMed Central

Intracranial hemorrhage (ICH) accounts for 10–15% of all strokes, however it causes 30–50% of stroke related mortality, disability and cost. The prevalence increases with age with only 2 cases/100,000/year for age less than 40 years to almost 350 cases/100,000/year for age more than 80 years. Several trials of open surgical evacuation of ICH have failed to show clear benefit over medical management. But, some small trials of minimal invasive hematoma evacuation in combination with thrombolytics have shown encouraging results. Based on these findings larger clinical trials are being undertaken to optimize and define therapeutic benefit of minimally invasive surgery in combination with thrombolytic clearance of hematoma. In this article we will review some of the background of minimally invasive surgery and the use of thrombolytics in the setting of ICH and intraventricular hemorrhage (IVH) and will highlight the early findings of MISTIE and CLEAR trials for these two entities respectively. PMID:22945285

Dey, Mahua; Stadnik, Agnieszka; Awad, Issam A.

2012-01-01

358

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. PMID:24904517

Bauer, Andrew M.; Rasmussen, Peter A.

2014-01-01

359

Hemorrhagic Transformation of Scrub Typhus Encephalitis: A Rare Entity.  

PubMed

Central nervous system (CNS) involvement of scrub typhus infection is well known. Most CNS involvement of scrub typhus infection present as meningitis or encephalitis. We report on a patient suffering from hemorrhagic transformation of intracranial lesions caused by Orientia tsutsugamushi. A 53-year-old female farmer who was infected by scrub typhus was treated with doxycycline and recovered from the systemic illness. However, headache persisted. Brain radiologic studies revealed acute intracranial hemorrhage and enhancing lesion, which implied a CNS involvement. Hemorrhagic transformation of encephalitis by scrub typhus is very rare complication and to our best knowledge, this is the first report of hemorrhagic transformation of scrub typhus encephalitis. Clinician should consider the possibility of hemorrhagic transformation of encephalitis in cases of scrub typhus infection. PMID:25373351

Kim, H-C; Yoon, K-W; Yoo, D-S; Cho, C-S

2014-11-01

360

Underlying effect of age on outcome differences in arteriovenous malformation-associated intracerebral hemorrhage.  

PubMed

Brain arteriovenous malformations (AVM) are the most common cause of intracerebral hemorrhage (ICH) in young adults. Although previous studies have found that the mortality and morbidity of ICH due to AVM (AVM-ICH) is lower than in spontaneous ICH, it is unclear whether the more favorable prognosis is directly related to the presence of the vascular malformation. We included 34 patients with AVM-ICH and 187 with spontaneous intracerebral hemorrhage (sICH) due to either hypertension or cerebral amyloid angiopathy. Patient data were obtained from the prospective Intracerebral Hemorrhage Outcomes Project, which enrolls ICH patients admitted to Columbia University Medical Center. Using ICH etiology (AVM-ICH or sICH) and previously verified predictors of ICH outcome, two multivariate analyses were performed with and without age to compare the odds of death at 3months and the functional outcome. Although mortality in AVM-ICH group was lower than the sICH group (20.6% versus 43.3%, respectively), this value was only significant when age was excluded (p=0.017) and lost its significance when we controlled for age (p=0.157). There was an analogous loss of significance with functional outcome using the modified Rankin Scale. In conclusion, our data suggests that the previously observed lower case fatality rate and more favorable functional outcomes in the AVM-ICH group compared to the sICH group may largely be the result of age. PMID:25510539

Taylor, Blake; Appelboom, Geoffrey; Yang, Annie; Bruce, Eliza; LoPresti, Melissa; Bruce, Samuel; Christophe, Brandon; Claassen, Jan; Sander Connolly, E

2015-03-01

361

A case of solitary fibrous tumor in the pelvis presenting massive hemorrhage during surgery.  

PubMed

Solitary fibrous tumors (SFTs) are unique soft-tissue tumors of submesothelial origin. These tumors are mainly located in the pleural space but they can be originated within a variety of sites, including the abdomen, the pelvis, the soft tissues and the retroperitoneum. SFTs from all sites are usually benign, and the surgical resection is curative in almost all cases. According to the review of literatures, during the surgical resection, massive hemorrhage could occur due to the hypervascular nature of SFTs. This is a case report on SFT in the pelvis presenting great vessel injury, which resulted in life threatening hemorrhage during the resection of tumor. We wish this paper alerts gynecologists about the risk of massive bleeding during the resection of tumor located at adjacent to great vessels in the pelvis. PMID:25629023

Kim, Mi Young; Jeon, Seob; Choi, Seung Do; Nam, Kye Hyun; Sunwoo, Jae Gun; Lee, Ji-Hye

2015-01-01

362

A case of solitary fibrous tumor in the pelvis presenting massive hemorrhage during surgery  

PubMed Central

Solitary fibrous tumors (SFTs) are unique soft-tissue tumors of submesothelial origin. These tumors are mainly located in the pleural space but they can be originated within a variety of sites, including the abdomen, the pelvis, the soft tissues and the retroperitoneum. SFTs from all sites are usually benign, and the surgical resection is curative in almost all cases. According to the review of literatures, during the surgical resection, massive hemorrhage could occur due to the hypervascular nature of SFTs. This is a case report on SFT in the pelvis presenting great vessel injury, which resulted in life threatening hemorrhage during the resection of tumor. We wish this paper alerts gynecologists about the risk of massive bleeding during the resection of tumor located at adjacent to great vessels in the pelvis. PMID:25629023

Kim, Mi Young; Choi, Seung Do; Nam, Kye Hyun; Sunwoo, Jae Gun; Lee, Ji-Hye

2015-01-01

363

Interferon-? Therapy Prolongs Survival in Rhesus Macaque Models of Ebola and Marburg Hemorrhagic Fever  

PubMed Central

There is a clear need for novel, effective therapeutic approaches to hemorrhagic fever due to filoviruses. Ebola virus hemorrhagic fever is associated with robust interferon (IFN)–? production, with plasma concentrations of IFN-? that greatly (60- to 100-fold) exceed those seen in other viral infections, but little IFN-? production. While all of the type I IFNs signal through the same receptor complex, both quantitative and qualitative differences in biological activity are observed after stimulation of the receptor complex with different type I IFNs. Taken together, this suggested potential for IFN-? therapy in filovirus infection. Here we show that early postexposure treatment with IFN-? significantly increased survival time of rhesus macaques infected with a lethal dose of Ebola virus, although it failed to alter mortality. Early treatment with IFN-? also significantly increased survival time after Marburg virus infection. IFN-? may have promise as an adjunctive postexposure therapy in filovirus infection. PMID:23255566

Smith, Lauren M.; Hensley, Lisa E.; Geisbert, Thomas W.; Johnson, Joshua; Stossel, Andrea; Honko, Anna; Yen, Judy Y.; Geisbert, Joan; Paragas, Jason; Fritz, Elizabeth; Olinger, Gene; Young, Howard A.; Rubins, Kathleen H.; Karp, Christopher L.

2013-01-01

364

Valproic acid-associated low fibrinogen and delayed intracranial hemorrhage: case report and mini literature review  

PubMed Central

A 41-year-old male had suffered from gradual hearing loss in his right ear for 2 years. Head computed tomography and magnetic resonance imaging scans showed a neoplasm in the cerebellopontine angle region, which was confirmed by the diagnosis of acoustic neurilemmoma by pathological findings after surgery. Following surgery, he routinely received valproic acid (VPA) to prevent seizures. However, the patient presented with hypofibrinogenemia and cerebral hemorrhage after taking VPA for 12 days. The hypofibrinogenemia recurred when VPA was re-administered. After withdrawal of VPA, his fibrinogen concentration rose to normal within several days. As far as we are aware, this is the first case of cerebral hemorrhage due to VPA to have been reported. Herein, as well as reporting on this case, a mini review of the relevant literature is also presented. PMID:23976844

Chen, Hai-Fei; Xu, Li-Ping; Luo, Zhi-Yong; Yu, Zi-Qiang; Li, Zheng-Yang; Cui, Qing-Ya; Qin, Long-Mei; Ren, Yong-Ya; Shen, Hong-Shi; Tang, Jie-Qing; Jin, Ling-Juan; Zhu, Jing-Jing; Wang, Jing; Wang, Ke-Yuan; Wu, Tian-Qin; Wang, Zhao-Yue

2013-01-01

365

Endovascular Embolization of Spontaneous Retroperitoneal Hemorrhage Secondary to Anticoagulant Treatment  

SciTech Connect

The purpose of this study was to report a single hospital's experience of endovascular treatment of patients with retroperitoneal hemorrhage (RPH) secondary to anticoagulant treatment. Ten consecutive patients treated in an intensive care unit and needing blood transfusions due to RPH secondary to anticoagulation were referred for digital subtraction angiography (DSA) to detect the bleeding site(s) and to evaluate the possibilities of treating them by transcatheter embolization. DSA revealed bleeding site(s) in all 10 patients: 1 lumbar artery in 4 patients, 1 branch of internal iliac artery in 3 patients and multiple bleeding sites in 3 patients. Embolization could be performed in 9 of them. Coils, gelatin and/or polyvinyl alcohol were used as embolic agents. Bleeding stopped or markedly decreased after embolization in 8 of the 9 (89%) patients. Four patients were operated on prior to embolization, but surgery failed to control the bleeding in any of these cases. Abdominal compartment syndrome requiring surgical or radiological intervention after embolization developed in 5 patients. One patient died, and 2 had sequelae due to RPH. All 7 patients whose bleeding stopped after embolization had a good clinical outcome. Embolization seems to be an effective and safe method to control the bleeding in patients with RPH secondary to anticoagulant treatment when conservative treatment is insufficient.

Isokangas, Juha-Matti, E-mail: matti.isokangas@ppshp.fi; Peraelae, Jukka M. [Department of Diagnostic and Interventional Radiology, Oulu University Hospital (Finland)

2004-11-15

366

Transient lupus anticoagulants associated with hemorrhage rather than thrombosis: the hemorrhagic lupus anticoagulant syndrome.  

PubMed

Lupus anticoagulants (LAs) represent a diverse group of antibodies directed against phospholipids. Patients with LAs may be free of symptoms but can have thrombotic complications including stroke, placental infarction, and fetal loss. Rarely hemorrhagic symptoms have been reported. We describe six previously healthy children who were first seen with clinical bleeding and prolonged activated partial thromboplastin time. Laboratory evaluation revealed positive results on mixing studies and evidence of phospholipid dependence of the anticoagulant, suggesting LAs. Four of six patients had anticardiolipin antibodies, and all four who were tested had reduced factor II activity levels. In all patients, bleeding symptoms resolved spontaneously within 3 months, and laboratory findings returned to normal within 6 months. The hemorrhagic LA syndrome should be considered in previously healthy children with new-onset bleeding and prolonged activated partial thromboplastin time. This clinical entity probably represents pathogenic mechanism distinct from thrombotic LA syndromes. PMID:9202627

Becton, D L; Stine, K C

1997-06-01

367

A Case of Intracranial Hemorrhage Caused by Combined Dabrafenib and Trametinib Therapy for Metastatic Melanoma  

PubMed Central

Patient: Male, 50 Final Diagnosis: Intracranial hemorrhage Symptoms: — Medication: — Clinical Procedure: Craniotomy Specialty: Oncology Objective: Adverse events of drug therapy Background: Combination therapy with BRAF V600E inhibitor dabrafenib and MEK inhibitor trametinib significantly improves progression-free survival of patients with BRAF V600-positive metastatic melanoma, but their use can be associated with life-threatening toxicities. We report the case of a patient receiving dabrafenib and trametinib for metastatic melanoma who developed intracranial hemorrhage while on therapy. Combination therapy with dabrafenib and trametinib improves progression-free survival of patients with BRAF V600-positive metastatic melanoma. Nevertheless, it is associated with an increased incidence and severity of any hemorrhagic event. To the best of our knowledge, this is the first report of intracranial hemorrhage with pathological confirmation. Case Report: We present the case of a 48-year-old man with metastatic melanoma of unknown primary site. He had metastases to the right clavicle, brain, liver, adrenal gland, and the right lower quadrant of the abdomen. He progressed on treatment with alpha-interferon. He was found to have a 4.5-cm mass in the left frontotemporal lobe and underwent gross total resection followed by adjuvant CyberKnife stereotactic irradiation. He was subsequently started on ipilimumab. Treatment was stopped due to kidney injury. He was then placed on dabrafenib and trametinib. He returned for follow-up complaining of severe headache and developed an episode of seizure. MRI showed a large area of edema at the left frontal lobe with midline shift. Emergency craniotomy was performed. Intracranial hemorrhage was found intra-operatively. Pathology from surgery did not find tumor cells, reported as organizing hemorrhage and necrosis with surrounding gliosis; immunohistochemistry for S100 and HMB45 were negative. Conclusions: This case demonstrates the life-threatening adverse effects that can be seen with the newer targeted biological therapies. It is therefore crucial to maintain a high index of suspicion when patients on this combination therapy present with new neurologic symptoms. PMID:25305754

Lee, Le Min; Feun, Lynn; Tan, Yaohong

2014-01-01

368

New avenues for treatment of intracranial hemorrhage  

PubMed Central

Opinion statement The mortality and morbidity from intracerebral hemorrhage (ICH) remain high despite advances in medical, neurological, and surgical care during the past decade. The lessons learned from previous therapeutic trials in ICH, improved understanding of the pathophysiology of neuronal injury after ICH, and advances in imaging and pre-hospital assessment technologies provide optimism that more effective therapies for ICH are likely to emerge in the coming years. The potential new avenues for the treatment of ICH include a combination of increased utilization of minimally invasive surgical techniques with or without thrombolytic usage to evacuate or reduce the size of the hematoma; utilization of advanced imaging to improve selection of patients who are likely to benefit from reversal of coagulopathy or hemostatic therapy; ultra-early diagnosis and initiation of therapy in the ambulance; and the use of novel drugs to target the secondary injury mechanisms, including the inflammatory cascade, perihematomal edema reduction, and hemoglobin degradation products-mediated toxicity. PMID:24366522

Sonni, Shruti; Lioutas, Vasileios-Arsenios; Selim, Magdy H.

2014-01-01

369

Radionuclide localization of lower gastrointestinal hemorrhage  

SciTech Connect

The authors prospectively evaluated the usefulness of abdominal radionuclide scintigraphy using /sup 99m/Tc-labeled red cells as a means of monitoring for intermittent gastrointestinal bleeding over a 24-hour period in both control and actively bleeding populations. Of 32 patients with documented hemorrhage, 29 had positive scintiscans (sensitivity, 91%; 9% false negatives). Of 18 nonbleeding patients, 17 had negative scintiscans (specificity, 95%; 5% false positives). 12 of 29 patients bled from 6 to 24 hours after the study was begun. Scintiscans were positive in patient with transfusion requirements of greater than or equal to 500 ml/24 hr. The authors conclude that abdominal scintigraphy with /sup 99m/Tc-labeled red cells is an effective method of detecting gastrointestinal bleeding.

Winzelberg, G.G.; Froelich, J.W.; McKusick, K.A.; Waltman, A.C.; Greenfield, A.J.; Athanasoulis, C.A.; Strauss, H.W.

1981-05-01

370

Epidemiology and pathogenesis of Bolivian hemorrhagic fever.  

PubMed

The etiologic agent of Bolivian hemorrhagic fever (BHF), Machupo virus (MACV) is reported to have a mortality rate of 25-35%. First identified in 1959, BHF was the cause of a localized outbreak in San Joaquin until rodent population controls were implemented in 1964. The rodent Calomys collosus was identified as the primary vector and reservoir for the virus. Multiple animal models were considered during the 1970s with the most human-like disease identified in Rhesus macaques but minimal characterization of the pathogenesis has been published since. A reemergence of reported BHF cases has been reported in recent years, which necessitates the further study and development of a vaccine to prevent future outbreaks. PMID:24636947

Patterson, Michael; Grant, Ashley; Paessler, Slobodan

2014-04-01

371

Isolated non-hemorrhagic cecal varices  

PubMed Central

Ectopic varices (those outside of the gastro-esophageal region) are occasionally found on endoscopy in patients with portal hypertension; however they account for a small minority of all variceal bleeds. Cases of isolated cecal varices are quite rare and, when described, often present with acute hemorrhage or evidence of occult bleeding. We present the case of a 29-year-old male with a history of idiopathic portal vein thrombosis and known esophageal varices, who presented for evaluation of abdominal pain. Cecal varices were found on endoscopy, without evidence of bleeding and without varices in the remainder of the colon or rectum. Endoscopic ultrasound and computed tomography were useful in confirming the diagnosis and natural history of these unusual varices. PMID:24855312

Haddad, James D.; Lacey, Brent W.

2014-01-01

372

Targeting heme oxygenase after intracerebral hemorrhage  

PubMed Central

Intracerebral hemorrhage (ICH) is the primary event in approximately 10% of strokes, and has higher rates of morbidity and mortality than ischemic stroke. Experimental evidence suggests that the toxicity of hemoglobin and its degradation products contributes to secondary injury that may be amenable to therapeutic intervention. Hemin, the oxidized form of heme, accumulates in intracranial hematomas to cytotoxic levels. The rate limiting step of its breakdown is catalyzed by the heme oxygenase (HO) enzymes, which consist of inducible HO-1 and constitutively-expressed HO-2. The effect of these enzymes on perihematomal injury and neurological outcome has been investigated in ICH models using both genetic and pharmacological approaches to alter their expression, with variable results reported. These findings are summarized and reconciled in this review; therapeutic strategies that may optimize HO expression and activity after ICH are described. PMID:25642455

Chen-Roetling, Jing; Lu, Xiangping; Regan, Raymond F.

2015-01-01

373

How a Cerebral Hemorrhage Altered My Art  

PubMed Central

“How a Cerebral Hemorrhage Altered My Art” examines how a massive stroke affected my art practice. The paralysis that ensued forced me to switch hands and become a left-handed painter. It was postulated by several neuroscientists that the “interpreter” in my brain was severely damaged during my CVA. This has had a profoundly liberating effect on my work. Whereas my pre-stroke period had the tendency to be over-intellectualized and forced, my post-stroke art is less self-conscious, more urgent and expressive. The primary subject matter of both periods is the brain. In my practice as an artist, my stroke is a challenge and an opportunity rather than a loss. PMID:22493572

Sherwood, Katherine

2012-01-01

374

Principles of neuroanesthesia in aneurysmal subarachnoid hemorrhage  

PubMed Central

Aneurysmal subarachnoid hemorrhage is associated with high mortality. Understanding of the underlying pathophysiology is important as early intervention can improve outcome. Increasing age, altered sensorium and poor Hunt and Hess grade are independent predictors of adverse outcome. Early operative interventions imposes an onus on anesthesiologists to provide brain relaxation. Coiling and clipping are the two treatment options with increasing trends toward coiling. Intraoperatively, tight control of blood pressure and adequate brain relaxation is desirable, so that accidental aneurysm rupture can be averted. Patients with poor grades tolerate higher blood pressures, but are prone to ischemia whereas patients with lower grades tolerate lower blood pressure, but are prone to aneurysm rupture if blood pressure increases. Patients with Hunt and Hess Grade I or II with uneventful intraoperative course are extubated in operation theater, whereas, higher grades are kept electively ventilated. Postoperative management includes attention toward fluid status and early management of vasospasm. PMID:25190938

Kundra, Sandeep; Mahendru, Vidhi; Gupta, Vishnu; Choudhary, Ashwani Kumar

2014-01-01

375

Adrenal dysfunction in portal hypertensive rats with acute hemorrhage.  

PubMed

Nitric oxide (NO) participates in shock and poorer portal hypotensive effect to vasoconstrictors in portal hypertension with hemorrhage, the so-called splanchnic hyposensitivity. Relative adrenal insufficiency accompanies hemorrhagic shock and is found in liver disease, the 'hepatoadrenal syndrome', but the relevant interactions remain unsettled. Portal hypertensive rats were induced by partial portal vein ligation (PVL). Experiments were performed on the 14th day post PVL: (I) ACTH stimulation test for rats without or with hemorrhage; (II) Glypressin response (mean arterial pressure, MAP; portal pressure, PP) in rats (a) without hemorrhage or with hemorrhage, injected with (b) distilled water (DW), (c) dexamethasone 3 mg/kg; (III) To survey the dose-dependent effects of glucocorticoid without being confounded by endogenous adrenal hormone, glypressin response was surveyed in PVL rats with adrenalectomy: (a) without hemorrhage or with hemorrhage, injected with (b) DW; (c) dexamethasone 3 mg/kg; (d) dexamethasone 5 mg/kg. Plasma tumor necrosis factor-? (TNF-?) concentrations and abdominal aorta (AA), superior mesenteric artery (SMA) NO synthases (NOS) mRNA expressions were determined. The results showed that ACTH induced corticosterone release similarly in PVL rats with or without hemorrhage. In bleeding PVL rats, dexamethasone (1) down-regulated AA NOS and enhanced glypressin-induced MAP elevation; (2) did not influence glypressin-induced PP reduction; (3) reduced TNF-?. In bleeding PVL and adrenalectomized rats, high-dose dexamethasone (1) down-regulated AA/SMA NOS; (2) enhanced glypressin-induced MAP elevation and PP reduction; (3) reduced TNF-?. In conclusion, bleeding portal hypertensive rats failed to enhance corticosterone release, suggesting a relative adrenal insufficiency. High-dose dexamethasone reversed systemic hypotension and splanchnic hyporesponsiveness to glypressin in adrenalectomized PVL rats accompanied by TNF-? and NOS down-regulation, suggesting the importance of adequate adrenocorticoid supplement in portal hypertension with hemorrhage and adrenal dysfunction. PMID:24633079

Lee, Fa-Yauh; Wang, Sun-Sang; Tsai, Ming-Hung; Huang, Hui-Chun; Lin, Han-Chieh; Lee, Shou-Dong

2014-01-01

376

Adrenal Dysfunction in Portal Hypertensive Rats with Acute Hemorrhage  

PubMed Central

Nitric oxide (NO) participates in shock and poorer portal hypotensive effect to vasoconstrictors in portal hypertension with hemorrhage, the so-called splanchnic hyposensitivity. Relative adrenal insufficiency accompanies hemorrhagic shock and is found in liver disease, the ‘hepatoadrenal syndrome’, but the relevant interactions remain unsettled. Portal hypertensive rats were induced by partial portal vein ligation (PVL). Experiments were performed on the 14th day post PVL: (I) ACTH stimulation test for rats without or with hemorrhage; (II) Glypressin response (mean arterial pressure, MAP; portal pressure, PP) in rats (a) without hemorrhage or with hemorrhage, injected with (b) distilled water (DW), (c) dexamethasone 3 mg/kg; (III) To survey the dose-dependent effects of glucocorticoid without being confounded by endogenous adrenal hormone, glypressin response was surveyed in PVL rats with adrenalectomy: (a) without hemorrhage or with hemorrhage, injected with (b) DW; (c) dexamethasone 3 mg/kg; (d) dexamethasone 5 mg/kg. Plasma tumor necrosis factor-? (TNF-?) concentrations and abdominal aorta (AA), superior mesenteric artery (SMA) NO synthases (NOS) mRNA expressions were determined. The results showed that ACTH induced corticosterone release similarly in PVL rats with or without hemorrhage. In bleeding PVL rats, dexamethasone (1) down-regulated AA NOS and enhanced glypressin-induced MAP elevation; (2) did not influence glypressin-induced PP reduction; (3) reduced TNF-?. In bleeding PVL and adrenalectomized rats, high-dose dexamethasone (1) down-regulated AA/SMA NOS; (2) enhanced glypressin-induced MAP elevation and PP reduction; (3) reduced TNF-?. In conclusion, bleeding portal hypertensive rats failed to enhance corticosterone release, suggesting a relative adrenal insufficiency. High-dose dexamethasone reversed systemic hypotension and splanchnic hyporesponsiveness to glypressin in adrenalectomized PVL rats accompanied by TNF-? and NOS down-regulation, suggesting the importance of adequate adrenocorticoid supplement in portal hypertension with hemorrhage and adrenal dysfunction. PMID:24633079

Lee, Fa-Yauh; Wang, Sun-Sang; Lin, Han-Chieh; Lee, Shou-Dong

2014-01-01

377

[Intra-alveolar hemorrhage associated with dengue and leptospirosis].  

PubMed

The intra-alveolar hemorrhage syndrome is defined by the presence of red cells in the alveolar lumen and can lead to acute respiratory failure. Among the infectious etiologies of this syndrome, leptospirosis is a common cause, whereas in dengue, the intra-alveolar hemorrhage is exceptional. We report a patient aged 46 years, with no particular history, who presented a clinical picture involving acute respiratory failure, hemoptysis, bilateral alveolar images and anemia. The intra-alveolar hemorrhage has been authenticated by bronchoalveolar lavage. The etiological showed infection by both dengue and leptospirosis. PMID:22884169

Cadélis, G

2012-10-01

378

Aneurysmal subarachnoid hemorrhage with concomitant posterior communicating artery fenestration.  

PubMed

Fenestrations of the posterior communicating artery (PCoA) are extremely rare. Associated aneurysms have only been documented three times in the literature, and none associated with a subarachnoid hemorrhage. We describe a 52-year-old female who presented with a subarachnoid hemorrhage secondary to a ruptured saccular aneurysm at the proximal limb of a fenestrated right PCoA. The patient was also found to have bilateral middle cerebral artery (MCA) aneurysms. Surgical management included surmising the etiology of the subarachnoid hemorrhage with subsequent clipping of both the right PCoA and MCA aneurysm. The potential embryological mechanisms leading to a PCoA fenestration are discussed. PMID:24761761

Weiner, Gregory M; Grandhi, Ramesh; Zwagerman, Nathan T; Agarwal, Nitin; Friedlander, Robert M

2015-02-01

379

Hemorrhagic necrosis of pheochromocytoma associated with phentolamine administration.  

PubMed Central

A case of ruptured pheochromocytoma is presented, the pathophysiology discussed, and the literature reviewed. Evidence is presented that the use of alpha-adrenergic blockade in general, and phentolamine in particular, may predispose to this complication. Twelve cases of massive hemorrhagic necrosis with or without rupture were found in the literature, including the present case. Six had no operation; one survived. Six had immediate operation; 4 survived. An additional case of hemorrhage into a small pheochromocytoma following phentolamine is presented. This tumor was neither ruptured nor massively necrotic, but the case supports the hypothesis that alpha-adrenergic blockade may cause hemorrhage within the pheochromocytoma. Images Fig. 2. Fig. 3. PMID:938114

Van Way, C W; Faraci, R P; Cleveland, H C; Foster, J F; Scott, H W

1976-01-01

380

Experimental and clinical observations on massive suprachoroidal hemorrhage.  

PubMed Central

We have been able to create a reproducible experimental model of nonexpulsive massive suprachoroidal hemorrhage in a rabbit eye. Massive suprachoroidal hemorrhage was demonstrated on echography and confirmed on histopathologic examination in all eyes. The natural course of the disease suggests that there is very little change in the size of the choroidal detachment in the first 7 days. Maximum liquefaction of the suprachoroidal hemorrhage clot was seen to occur between 7 and 14 days. However, increased retinal and ciliary body atrophy was also noted at 14 days. Therefore, the optimum time to drain massive suprachoroidal hemorrhage appears to be between 7 and 14 days. Immediate sclerotomy during the acute formation of massive suprachoroidal hemorrhage resulted in further increase in the suprachoroidal hemorrhage, with marked extension of the hemorrhage into the retina and vitreous. Therefore, in our opinion, immediate sclerotomy during massive suprachoroidal hemorrhage is detrimental to the eye. Our clinical data have shown that eyes with massive suprachoroidal hemorrhage can be treated successfully by secondary surgery, and the majority of the eyes can be salvaged with good visual results. No serious complications of this surgery were encountered in our cases. We advocate early surgical intervention between 7 and 14 days. Aggressive anterior and posterior segment reconstruction by anterior and posterior vitrectomy after sclerotomy drainage of the suprachoroidal hemorrhage is essential for better anatomic and visual results. Our animal data and clinical experience suggest that the optimum time of drainage of massive suprachoroidal hemorrhage is between 7 and 14 days. The results of our animal experiments in relation to human clinical application should be taken with caution. Furthermore, we had a small number of animals to study the various groups. In addition, longer follow-up may be needed for comparing controls with the treatment groups. Our animal model may help in such future studies on massive suprachoroidal hemorrhage. Images FIGURE 1 FIGURE 2 FIGURE 3 FIGURE 4 FIGURE 5 FIGURE 6 FIGURE 7 FIGURE 8 FIGURE 9 FIGURE 10 FIGURE 11 FIGURE 12 FIGURE 13 FIGURE 14 FIGURE 15 FIGURE 16 FIGURE 17 FIGURE 18 FIGURE 19 FIGURE 20 FIGURE 21 FIGURE 22 FIGURE 23 FIGURE 24 FIGURE 25 FIGURE 26 FIGURE 27 FIGURE 28 FIGURE 29 FIGURE 30 FIGURE 31 FIGURE 32 FIGURE 33 FIGURE 34 FIGURE 35 FIGURE 36 FIGURE 37 FIGURE 38 FIGURE 39 FIGURE 40 FIGURE 41 FIGURE 42 FIGURE 43 FIGURE 44 FIGURE 45 FIGURE 46 FIGURE 47 FIGURE 48 FIGURE 49 FIGURE 51 figure 52 FIGURE 53 FIGURE 54 FIGURE 55 FIGURE 56 FIGURE 57 FIGURE 58 FIGURE 59 FIGURE 60 FIGURE 61 FIGURE 62 FIGURE 63 FIGURE 64 FIGURE 65 FIGURE 66 FIGURE 67 FIGURE 68 FIGURE 69 PMID:8140705

Lakhanpal, V

1993-01-01

381

A rare cause of embolic stroke in hereditary hemorrhagic telangiectasia.  

PubMed

A 57-year-old male patient with hereditary hemorrhagic telangiectasia presented with an acute right middle cerebral artery ischemic stroke. Investigations revealed a right middle cerebral artery M2 occlusion, hypoxemia, and a large pulmonary arteriovenous malformation and right lower limb deep venous thrombosis. Closure of the pulmonary arteriovenous malformation was successfully performed with an Amplatzer device. Catheter closure of pulmonary arteriovenous malformations in patients with hereditary hemorrhagic telangiectasia is a recognized treatment modality to prevent recurrent ischemic stroke and other embolic and hemorrhagic complications. PMID:24045083

Yassi, Nawaf; Yan, Bernard; Dowling, Richard; Mitchell, Peter J

2014-01-01

382

Hemorrhage in mouse tumors induced by dodecaborate cluster lipids intended for boron neutron capture therapy  

PubMed Central

The potential of boron-containing lipids with three different structures, which were intended for use in boron neutron capture therapy, was investigated. All three types of boron lipids contained the anionic dodecaborate cluster as the headgroup. Their effects on two different tumor models in mice following intravenous injection were tested; for this, liposomes with boron lipid, distearoyl phosphatidylcholine, and cholesterol as helper lipids, and containing a polyethylene glycol lipid for steric protection, were administered intravenously into tumor-bearing mice (C3H mice for SCCVII squamous cell carcinoma and BALB/c mice for CT26/WT colon carcinoma). With the exception of one lipid (B-THF-14), the lipids were well tolerated, and no other animal was lost due to systemic toxicity. The lipid which led to death was not found to be much more toxic in cell culture than the other boron lipids. All of the lipids that were well tolerated showed hemorrhage in both tumor models within a few hours after administration. The hemorrhage could be seen by in vivo magnetic resonance and histology, and was found to occur within a few hours. The degree of hemorrhage depended on the amount of boron administered and on the tumor model. The observed unwanted effect of the lipids precludes their use in boron neutron capture therapy. PMID:25114527

Schaffran, Tanja; Jiang, Nan; Bergmann, Markus; Küstermann, Ekkehard; Süss, Regine; Schubert, Rolf; Wagner, Franz M; Awad, Doaa; Gabel, Detlef

2014-01-01

383

A Reversible Aptamer Improves Outcome and Safety in Murine Models of Stroke and Hemorrhage  

PubMed Central

Treatment of acute ischemic stroke with intravenous tissue-type plasminogen activator is underutilized partly due to the risk of life-threatening hemorrhage. In response to the clinical need for safer stroke therapy, we explored using an aptamer-based therapeutic strategy to promote cerebral reperfusion in a murine model of ischemic stroke. Aptamers are nucleic acid ligands that bind to their targets with high affinity and specificity, and can be rapidly reversed with an antidote. Here we show that a Factor IXa aptamer administered intravenously after 60 minutes of cerebral ischemia and reperfusion improved neurological function and was associated with reduced thrombin generation and decreased inflammation. Moreover, when the aptamer was administered in the setting of intracranial hemorrhage, treatment with its specific antidote reduced hematoma volume and improved survival. The ability to rapidly reverse a pharmacologic agent that improves neurological function after ischemic stroke should intracranial hemorrhage arise indicates that aptamer–antidote pairs may represent a novel, safer approach to treatment of stroke. PMID:21142878

Blake, Charlene M.; Wang, Haichen; Laskowitz, Daniel T.

2011-01-01

384

Fibrinogenolytic and procoagulant activities in the hemorrhagic syndrome caused by Lonomia obliqua caterpillars.  

PubMed

The hemorrhagic syndrome caused by accidents with caterpillars of the genus Lonomia has been the focus of several clinical and biochemical studies, since its venom is composed of many active principles that interfere with the hemostatic system. Whereas a fibrinolytic agent has been characterized in the venom of Lonomia achelous, in Lonomia obliqua, only a prothrombin activator activity has been reported so far, even though both species cause similar bleeding disorders, characterized by hemorrhage, disseminated intravascular coagulation (DIC), and acute renal failure. Considering the possibility that the hemorrhagic syndrome resulting from envenoming by L. obliqua may be due to fibrinolytic and procoagulant activities acting together, we decided to investigate the effects of bristle extract (BE) of this species upon blood coagulation and fibrin(ogen)olysis. This study shows that besides a procoagulant activity related to the activation of prothrombin, the venom contains at least one fibrin(ogen)olytic activity, as shown by fibrinolysis in a fibrin (F) plate assay, by interference in thrombin-catalyzed fibrinocoagulation, and by polyacrylamide gel electrophoresis profile of fibrin and fibrinogen (Fg) degradation. Considering that a recombinant prothrombin activator from L. obliqua has been suggested in other studies to be used as an anti-thrombotic agent, it is important in the first place to better characterize the different active principles of this venom. PMID:14644086

Veiga, Ana Beatriz G; Pinto, Antônio F M; Guimarães, Jorge A

2003-01-01

385

Fatal intratumoral hemorrhage in tectal plate glioblastoma multiforme following ventriculoperitoneal shunt  

PubMed Central

Ventriculo-peritoneal (V-P) shunting is an accepted procedure before a direct approach to large tumors producing obstructive hydrocephalus. However, it has been associated with some complications. Intratumoral hemorrhage is an uncommon but fatal complication of V-P shunt insertion. The exact mechanism of this complication is unknown, but several mechanisms have been proposed including rapid lowering of intracranial pressure following V-P shunt placement or cerebrospinal fluid (CSF) drainage and sudden decrease in CSF volume and pressure after V-P shunting. We report an 8-year-old girl who presented with severe headache, double vision, and bilateral papilledema. Brain magnetic resonance imaging with and without gadolinium administration revealed a large tectal plate tumor compressing the aqueduct which caused hydrocephalus. Due to progressive decline in consciousness level, an emergency CSF diversion was planned and she underwent left side posterior parietal V-P shunt placement. Eight hours after V-P shunt insertion, she suddenly developed tonic-clonic seizures and collapsed into deep coma with dilated pupils and stopped breathing and died 1-day later. Histological examination of the autopsy specimen showed the tumor was a glioblastoma multiforme with massive intratumoral hemorrhage. The possible pathophysiological mechanisms of this fatal complication are discussed here and the pertinent literature is reviewed. It seems that endoscopic third ventriculostomy is the procedure of choice for CSF diversion in patients with tectal plate gliomas and decreases the occurrence of intratumoral hemorrhage. PMID:25250086

Khalatbari, Mahmoud Reza; Khalatbari, Sepehrdad; Moharamzad, Yashar

2014-01-01

386

Fatal intratumoral hemorrhage in tectal plate glioblastoma multiforme following ventriculoperitoneal shunt.  

PubMed

Ventriculo-peritoneal (V-P) shunting is an accepted procedure before a direct approach to large tumors producing obstructive hydrocephalus. However, it has been associated with some complications. Intratumoral hemorrhage is an uncommon but fatal complication of V-P shunt insertion. The exact mechanism of this complication is unknown, but several mechanisms have been proposed including rapid lowering of intracranial pressure following V-P shunt placement or cerebrospinal fluid (CSF) drainage and sudden decrease in CSF volume and pressure after V-P shunting. We report an 8-year-old girl who presented with severe headache, double vision, and bilateral papilledema. Brain magnetic resonance imaging with and without gadolinium administration revealed a large tectal plate tumor compressing the aqueduct which caused hydrocephalus. Due to progressive decline in consciousness level, an emergency CSF diversion was planned and she underwent left side posterior parietal V-P shunt placement. Eight hours after V-P shunt insertion, she suddenly developed tonic-clonic seizures and collapsed into deep coma with dilated pupils and stopped breathing and died 1-day later. Histological examination of the autopsy specimen showed the tumor was a glioblastoma multiforme with massive intratumoral hemorrhage. The possible pathophysiological mechanisms of this fatal complication are discussed here and the pertinent literature is reviewed. It seems that endoscopic third ventriculostomy is the procedure of choice for CSF diversion in patients with tectal plate gliomas and decreases the occurrence of intratumoral hemorrhage. PMID:25250086

Khalatbari, Mahmoud Reza; Khalatbari, Sepehrdad; Moharamzad, Yashar

2014-05-01

387

Hemorrhage in mouse tumors induced by dodecaborate cluster lipids intended for boron neutron capture therapy.  

PubMed

The potential of boron-containing lipids with three different structures, which were intended for use in boron neutron capture therapy, was investigated. All three types of boron lipids contained the anionic dodecaborate cluster as the headgroup. Their effects on two different tumor models in mice following intravenous injection were tested; for this, liposomes with boron lipid, distearoyl phosphatidylcholine, and cholesterol as helper lipids, and containing a polyethylene glycol lipid for steric protection, were administered intravenously into tumor-bearing mice (C3H mice for SCCVII squamous cell carcinoma and BALB/c mice for CT26/WT colon carcinoma). With the exception of one lipid (B-THF-14), the lipids were well tolerated, and no other animal was lost due to systemic toxicity. The lipid which led to death was not found to be much more toxic in cell culture than the other boron lipids. All of the lipids that were well tolerated showed hemorrhage in both tumor models within a few hours after administration. The hemorrhage could be seen by in vivo magnetic resonance and histology, and was found to occur within a few hours. The degree of hemorrhage depended on the amount of boron administered and on the tumor model. The observed unwanted effect of the lipids precludes their use in boron neutron capture therapy. PMID:25114527

Schaffran, Tanja; Jiang, Nan; Bergmann, Markus; Küstermann, Ekkehard; Süss, Regine; Schubert, Rolf; Wagner, Franz M; Awad, Doaa; Gabel, Detlef

2014-01-01

388

Your Dues  

NASA Astrophysics Data System (ADS)

Your AGU dues, at $20, are truly a bargain and have been so for 40 years. It would be difficult to point to the primary driver for the extraordinary growth in AGU membership during the past 40 years, but surely the low and stable dues have been a major contributor. The low entry fee brings a diverse, worldwide community of scientists into our network. It is also consistent with AGU's commitment to the public good, which is the basis for the tax-exempt status the Union enjoys in the United States.

Spilhaus, Fred

2009-01-01

389

Predictors of outcome in childhood intracerebral hemorrhage: a prospective consecutive cohort study  

PubMed Central

Background and Purpose To describe features of children with intracerebral hemorrhage (ICH) and to determine predictors of short-term outcome in a single-center prospective cohort study. Methods Single-center prospective consecutive cohort study of spontaneous ICH in children age 1-18 years from January 2006 to June 2008. Exclusion criteria were inciting trauma; intracranial tumor; isolated epidural, subdural, intraventricular, or subarachnoid hemorrhage; hemorrhagic transformation of ischemic stroke; and cerebral sinovenous thrombosis. Hospitalization records were abstracted. Follow-up assessments included outcome scores using the Pediatric Stroke Outcome Measure (PSOM) and King's Outcome Scale for Childhood Head Injury (KOSCHI). ICH volumes and total brain volumes (TBV) were measured by manual tracing. Results Twenty-two patients, median age of 10.3 years (range 4.2-16.6 years), had presenting symptoms of headache in 77%, focal deficits 50%, altered mental status 50%, and seizures 41%. Vascular malformations caused hemorrhage in 91%. Surgical treatment (hematoma evacuation, lesion embolization or excision) was performed during acute hospitalization in 50%. One patient died acutely. At median follow-up of 3.5 months (range 0.3-7.5 months), 71% of survivors had neurological deficits; 55% had clinically significant disability. Outcome based on PSOM and KOSCHI scores was worse in patients with ICH volume >2% of TBV (p=0.023) and altered mental status at presentation (p = 0.005). Conclusions Spontaneous childhood ICH was due mostly to vascular malformations. Acute surgical intervention was commonly performed. Although death was rare, 71% of survivors had persisting neurological deficits. Larger ICH volume and altered mental status predicted clinically significant disability. PMID:20019325

Beslow, Lauren A; Licht, Daniel J; Smith, Sabrina E; Storm, Phillip B; Heuer, Gregory G; Zimmerman, Robert A; Feiler, Alana M; Kasner, Scott E; Ichord, Rebecca N; Jordan, Lori C

2010-01-01

390

Vasculitis and stroke due to Lyme neuroborreliosis - a review.  

PubMed

Abstract Lyme neuroborreliosis (LNB) is a rare cause of vasculitis and stroke. It may manifest as subarachnoid hemorrhage, intracerebral hemorrhage, and most often ischemic stroke due to cerebral vasculitis. The vast majority of reported cases have been described by European authors. A high index of suspicion is required in patients who live or have traveled to areas with high prevalence of tick-borne diseases, and in the case of stroke-like symptoms of unknown cause in patients without cardiovascular risk factors. In this review, we also present four illustrative cases of vasculitis and stroke-like manifestations of LNB. PMID:25342573

Zajkowska, Joanna; Garkowski, Adam; Moniuszko, Anna; Czupryna, Piotr; Ptaszy?ska-Sarosiek, Iwona; Tarasów, Eugeniusz; Ustymowicz, Andrzej; ?ebkowski, Wojciech; Pancewicz, S?awomir

2015-01-01

391

Laser-assisted treatment of patients with hemorrhagic diathesis  

NASA Astrophysics Data System (ADS)

Today more and more patients with bleeding disorder come to our office for treatment. The number of patients with therapeutic anticoagulation is growing steadily. Discontinuation of this therapy can often be crucial. On the other hand are oralsurgical procedures extremely sensitive to bleeding due to the constant presents of saliva with its high fibrinolytic activity. The aim of this study was to evaluate the use of a surgical diode (wavelength 810 nm) laser as accessory tool in the treatment of patients with hemorrhagic diathesis. Enclosed in the study were 123 patients with: (1) Coumarintherapy, a Quick test ratio of 15 - 25%; (2) More than 300 mg of ASS/die; (3) Hemophilia, a factor activity under 35%; (4) Morbus Werlhof with less than 30000 thrombocytes. 179 Surgical procedures: (1) Tooth extraction 86%; (2) Apexectomy 3%; (3) Tumorexcision 9%; (4) Curettage and flapsurgery 1%; (5) Gingivectomy 1%. All procedures were laser-assisted with a diode laser emitting 810 nm. The glass fibers used were depending on the procedures either 200, 400, or 600 micron. No coagulating agents or tissue adhesives were used in addition. The postoperative outcome and complication rates were compared to substitution therapy and tissue adhesives. Laser-assisted treatment of these patients shows a high predictability and success rate leaving out side effects of drugs and human cryoprecipitates. Postoperative impairment is diminished.

Neckel, Claus P.

2000-03-01

392

Extracorporeal membrane oxygenation in the management of diffuse alveolar hemorrhage.  

PubMed

Extracorporeal membrane oxygenation (ECMO) may be used to support patients with severe hypoxemic respiratory failure refractory to conventional mechanical ventilation. However, because systemic anticoagulation is generally required to maintain circuit patency, severe bleeding is often seen as a contraindication to ECMO. We describe our center's experience with 4 patients who received ECMO for refractory hypoxemic respiratory failure due to diffuse alveolar hemorrhage (DAH), a condition for which anticoagulation is typically contraindicated, and provide a review of the literature. The mean age was 35.8?±?16.4. The mean pre-ECMO PaO2 to FIO2 ratio was 52.3?±?9.4. All patients were treated with continuous infusions of heparin with a goal activated partial thromboplastin time between 40 and 60 seconds (mean 47.4?±?11.6 seconds). All 4 subjects (100%) survived to decannulation, and three subjects (75%) survived to discharge. The results from this case series, along with previously published data, suggest that ECMO is a reasonable management option for patients with DAH-associated severe, refractory hypoxemic respiratory failure. This is especially true in the era of modern ECMO technology where lower levels of anticoagulation are able to maintain circuit patency while minimizing bleeding risk. PMID:25485559

Abrams, Darryl; Agerstrand, Cara L; Biscotti, Mauer; Burkart, Kristin M; Bacchetta, Matthew; Brodie, Daniel

2014-12-01

393

Intracerebral hemorrhage in patients receiving oral anticoagulation therapy.  

PubMed

Intracerebral hemorrhage (ICH) in patients with oral anticoagulation therapy is an increasingly prevalent problem in large part due to the aging population and the increased use of anticoagulants for patients at high risk of thrombosis. Warfarin has been virtually the only outpatient anticoagulant choice until fairly recently. The development of subcutaneously injected heparinoids, and more recently, of direct thrombin inhibitors, has made the treatment and prognostication of ICH in anticoagulated patients more difficult. In this review, we will review the current state of diagnosis, prognostication, and treatment for patients with this often-devastating type of bleeding. We will focus on warfarin therapy, because the preponderance of evidence comes from studies of warfarin treatment. Where there is evidence, we will contrast warfarin with some of the newer treatment modalities. We review the evidence of the 4 major reversal agents for warfarin, vitamin K, prothrombin complex concentrates, activated factor VII, and fresh frozen plasma as well as rational treatment choices. We offer possible treatments for the newer anticoagulants based on the limited evidence available. Finally, we review recommendations from the major societies and studies that support early and aggressive therapies in intensive care units with dedicated neurological specialists. PMID:23753250

da Silva, Ivan Rocha Ferreira; Provencio, J Javier

2015-02-01

394

Postpartum hemorrhage--update on problems of definitions and diagnosis.  

PubMed

Maternal mortality due to postpartum hemorrhage (PPH) continues to be one of the most important causes of maternal death worldwide. PPH is a significantly underestimated obstetric problem, primarily because a lack of definition and diagnosis. The 'traditional' definition of primary PPH based on quantification of blood loss has several limitations. Notoriously, blood loss is not measured or is significantly underestimated by visual estimation and there are no generally accepted cut-offs limits for estimated blood loss. A definition based on hematocrit change is not clinically useful in an emergency such as PPH, as a fall in hematocrit postpartum shows poor correlation with acute blood loss. The need for erythrocyte transfusion alone to define PPH is also of limited value, as the practice of blood transfusion varies widely. Definitions based on symptoms of hemodynamic instability are problematic, as they are late signs of depleted blood volume and commencing failure of compensatory mechanisms threatening the mother's life. There is thus currently no single, satisfactory definition of primary PPH. Proper and timely diagnosis of PPH should above all include accurate estimation of blood loss before vital signs change. Estimation of blood loss by calibrated bags has been shown to be significantly more accurate than visual estimation at vaginal delivery. Careful monitoring of the mother's vital signs, laboratory tests, in particular coagulation testing, and immediate diagnosis of the cause of PPH are important key factors to reduce maternal morbidity and mortality. PMID:21332452

Rath, Werner H

2011-05-01

395

Remote Cerebral and Cerebellar Hemorrhage after Massive Cerebrospinal Fluid Leakage  

PubMed Central

Dural tears can occur during spinal surgery and may lead to cerebrospinal fluid (CSF) leakage which is rarely involved in remote cerebellar hemorrhage. Only a few of cases of simultaneous cerebral and cerebellar hemorrhage have been reported in the English literature. We experienced a case of multiple remote cerebral and cerebellar hemorrhages in a 63-year-old man who exhibited no significant neurologic deficits after spinal surgery. Magnetic resonance imaging (MRI) performed 4 days after the surgery showed a large amount of CSF leakage in the lumbosacral space. The patient underwent the second surgery for primary repair of the dural defect, but complained of headache after dural repair surgery. Brain MRI taken 6 days after the dural repair surgery revealed multifocal remote intracerebral and cerebellar hemorrhages in the right temporal lobe and both cerebellar hemispheres. We recommend diagnostic imaging to secure early identification and treatment of this complication in order to prevent serious neurologic deficits. PMID:22737308

You, Sung-Hye; Lee, Nam Joon; Suh, Jung-Keun

2012-01-01

396

CLINICAL ASPECTS OF EBOLA HEMORRHAGIC FEVER: A REVIEW  

E-print Network

Ebola hemorrhagic fever is a viral disease marked by fever, systemic hemorrhage, and high mortality; it affects humans and monkeys and has appeared in epidemic form in Africa and Germany. The cause is one of the three subtypes of viruses in the Filoviridae family that is distinguished by long thread like strands of RNA. The animal or insect host (reservoir) has not been identified, limiting study of the disease. The three filoviruses known to cause disease in humans are the Marburg virus, Zaire virus, and Sudan virus. The fourth subtype, the Reston virus, is fatal to monkeys, but did not produce disease in infected. In the present article, we have concentrated on clinical features, diagnosis, transmission, prevention and treatment of Ebola hemorrhagic fever. The aim of present article is to provide in depth knowledge about the clinical aspects of Ebola hemorrhagic fever.

Satyanand Tyagi; Sachin Kumar; Mohit Singla

2010-01-01

397

Data Hemorrhages in the Health-Care Sector  

NASA Astrophysics Data System (ADS)

Confidential data hemorrhaging from health-care providers pose financial risks to firms and medical risks to patients. We examine the consequences of data hemorrhages including privacy violations, medical fraud, financial identity theft, and medical identity theft. We also examine the types and sources of data hemorrhages, focusing on inadvertent disclosures. Through an analysis of leaked files, we examine data hemorrhages stemming from inadvertent disclosures on internet-based file sharing networks. We characterize the security risk for a group of health-care organizations using a direct analysis of leaked files. These files contained highly sensitive medical and personal information that could be maliciously exploited by criminals seeking to commit medical and financial identity theft. We also present evidence of the threat by examining user-issued searches. Our analysis demonstrates both the substantial threat and vulnerability for the health-care sector and the unique complexity exhibited by the US health-care system.

Johnson, M. Eric

398

Dengue Viral Infection of Endothelial Cells and Dengue Hemorrhagic Fever.  

E-print Network

??Dengue virus (DENV) is the etiological agent responsible for the severe and potentially fatal illnesses known as dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS). Microvascular plasma… (more)

Arevalo, Maria Teresa; Jin, Xia

2011-01-01

399

Effects of Ubiquinol with Fluid Resuscitation following Hemorrhagic Shock  

E-print Network

Abstract Hemorrhagic shock (HS) and fluid resuscitation triggers ischemia-reperfusion injury in cells and increases the production of reactive oxygen species (ROS) which are known to activate the intrinsic pathway of ...

Bennetts, Paul S.

2013-08-31

400

Post-hemorrhagic hydrocephalus and diabetes insipidus in preterm infants.  

PubMed

We present two cases of transient central diabetes insipidus in preterm neonates with post-hemorrhagic hydrocephalus. Although the association between intraventricular hemorrhage and diabetes insipidus has been described in preterm infants, the association between diabetes insipidus and hydrocephalus, and the fact that such central diabetes insipidus could be reversible with the reduction of ventricular size, either because of spontaneous resolution or the placement of ventriculo-peritoneal shunt is first described here in neonates. PMID:25006753

Borenstein-Levin, Liron; Koren, Ilana; Kugelman, Amir; Bader, David; Toropine, Arina; Riskin, Arieh

2014-11-01

401

TIMP-2 Gene Polymorphism Is Associated with Intracerebral Hemorrhage  

Microsoft Academic Search

Background: Both ischemic stroke and intracerebral hemorrhage are associated with altered expression and activation of matrix metalloproteinases (MMPs). Particularly relevant are MMP-2 and MMP-9. This proteolytic effect is dampened by tissue inhibitors of metalloproteinases (TIMPs). TIMP-2 is an important endogenous inhibitor of MMP-2. Alterations in the TIMP-2 gene expression may contribute to the incidence of ischemic stroke and intracerebral hemorrhage.

Bjoern Reuter; Peter Bugert; Mark Stroick; Simone Bukow; Martin Griebe; Michael G. Hennerici; Marc Fatar

2009-01-01

402

[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

403

[Uterine artery pseudoaneurysm: an unusual cause of postpartum hemorrhage].  

PubMed

Uterine artery pseudoaneurysm is a rare complication of cesarean section. It can lead to severe postpartum hemorrhage. We report three cases of pseudoaneurysm diagnosed late after cesarean delivery, one followed by hemorrhagic shock. Ultrasound may point to the diagnosis, but arteriography of uterine arteries is decisive for the diagnosis. Selective artery embolization is recommended for treatment. Main advantages are complete occlusion of the pseudoaneurysm and fertility preservation. PMID:24656739

Delesalle, C; Dolley, P; Beucher, G; Dreyfus, M; Benoist, G

2015-01-01

404

Simian hemorrhagic fever virus: Recent advances.  

PubMed

The simian hemorrhagic fever virus (SHFV) genome differs from those of other members of the family Arteriviridae in encoding three papain-like one proteases (PLP1?, PLP1? and PLP1?) at the 5' end and two adjacent sets of four minor structural proteins at the 3' end. The catalytic Cys and His residues and cleavage sites for each of the SHFV PLP1s were predicted and their functionality was tested in in vitro transcription/translation reactions done with wildtype or mutant polyprotein constructs. Mass spectrometry analyses of selected autoproteolytic products confirmed cleavage site locations. The catalytic Cys of PLP1? is unusual in being adjacent to an Ala instead of a Typ. PLP1? cleaves at both downstream and upstream sites. Intermediate precursor and alternative cleavage products were detected in the in vitro transcription/translation reactions but only the three mature nsp1 proteins were detected in SHFV-infected MA104 cell lysates with SHFV nsp1 protein-specific antibodies. The duplicated sets of SHFV minor structural proteins were predicted to be functionally redundant. A stable, full-length, infectious SHFV-LVR cDNA clone was constructed and a set of mutant infectious clones was generated each with the start codon of one of the minor structural proteins mutated. All eight of the minor structural proteins were found to be required for production of infectious extracellular virus. SHFV causes a fatal hemorrhagic fever in macaques but asymptomatic, persistent infections in natural hosts such as baboons. SHFV infections were compared in macrophages and myeloid dendritic cells from baboons and macaques. Virus yields were higher from macaque cells than from baboon cells. Macrophage cultures from the two types of animals differed dramatically in the percentage of cells infected. In contrast, similar percentages of myeloid dendritic cells were infected but virus replication was efficient in the macaque cells but inefficient in the baboon cells. SHFV infection induced the production of pro-inflammatory cytokines, including IL-1?, IL-6, IL-12/23(p40), TNF-? and MIP-1?, in macaque cells but not baboon cells. PMID:25455336

Brinton, Margo A; Di, Han; Vatter, Heather A

2014-11-29

405

Risk Factors of Germinal Matrix Intraventricular Hemorrhage in Premature Infants  

PubMed Central

Abstract Objective To determine whether some clinical parameters can be used to predict the hemorrhage and whether the relationship between these clinical variables and the grades of hemorrhage is linear. Methods A total of 230 premature infants, born at a gestational age less than 34 weeks were retrospectively reviewed. Germinal matrix-intraventricular hemorrhage (GM-IVH), the grade of the hemorrhage, and clinical data were assessed with a checklist. Variables were analyzed by using Mann Whitney U and Fisher’s exact tests and then multiple logistic regression analysis was used to evaluate the independent risk factors. Findings Resuscitation, gestational age, hypotension, multiple birth, and birth weight were found to be independent risk factors. We determined non-linear relationship between the grades of hemorrhage and the clinical parameters. But when we classified hemorrhages as grade 1, grade 2-3 and grade 4, the relationships were found linear. Conclusion Premature infants who had resuscitation, low gestational age, hypotension, multiple birth, and low birth weight are more likely to have GM-IVH. The relationship between the clinical variables and the grades of GM-IVH does