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Sample records for hemorrhage sah due

  1. A non-human primate model of aneurismal subarachnoid hemorrhage (SAH).

    PubMed

    Pluta, Ryszard M; Bacher, John; Skopets, Boris; Hoffmann, Victoria

    2014-12-01

    Aneurismal subarachnoid hemorrhage (SAH) is relatively rare form of hemorrhagic stroke, which produces significant social and medical challenges. As it affects people in their high productivity age and leaves 50 % of them dead and almost 70 % of survivors disabled, many of them severely, the reasons of such a dismal outcome have been intensively researched all over the world. Nevertheless, despite more than a half a century of clinical and scientific effort and dramatic improvement of surgical repair of aneurysms, the causes of poor outcome remain enigmatic. Introduction of numerous in vitro and in vivo models to study the unleashed by SAH mechanisms that injured the brain significantly advanced our understanding of biology of cerebral vessels, brain responses to intracranial pressure changes, and the presence of blood clot in subarachnoid space. One of the most important animal models that significantly contributed to those advances has been a non-human primate model introduced at the Bryce Weir laboratory in the University of Alberta, Canada, in 1984. Since then, this model, with some modifications, has been successfully used in several animal laboratories in the USA, Canada, and Japan. We present the model characteristics and describe in details medical, surgical, imagining techniques that we have used at the Surgical Neurology Branch of the National Institute of Neurological Disorders and Stroke from 1989. PMID:25216692

  2. Aneurysmal subarachnoid hemorrhage (aSAH) results in low prevalence of neuro-endocrine dysfunction and NOT deficiency.

    PubMed

    Lammert, Alexander; Bode, Hinrich; Hammes, Hans-Peter; Birck, Rainer; Fatar, Marc; Zohsel, Katrin; Schmieder, Kirsten; Schubert, Gerrit Alexander; Thom, Claudius; Seiz, Marcel

    2012-12-01

    Neuro-endocrine deficiencies have been argued to be common sequelae after aneurysmal subarachnoid hemorrhage (aSAH). As this, however, does not resemble our clinical experience, we studied the incidence of neuro-endocrine and neuropsychological deficits after aSAH. Twenty-six patients (20 females) were prospectively screened for neuro-endocrine and neuropsychological deficits 3, 6 and 12 months after aSAH. GH, IGF-1, prolactin, LH, FSH, estradiol, testosterone, ACTH as well as cortisol during ACTH-stimulation were assessed. Neuropsychological analysis covered verbal comprehension, short term and working memory, visuospatial construction, figural memory, psychomotor speed, attention, and concentration. During the study period 5 individuals demonstrated neuro-endocrine dysfunction. Hypogonadotrophic hypogonadism resolved spontaneously in 2 patients and central hypothyroidism in one of these patients during the study. After 12 months three patients presented low IGF-1 levels. 73.9% of our cohort was affected by neuropsychological deficits during follow-up. At 3, 6 and 12 months the prevalences were 56.5, 52.6 and 42.1%, respectively. Interestingly, all patients with neuro-endocrine dysfunction presented impaired clinical outcome with a GOS 4 at some time point of the study (GOS 4 vs. 5, 45.5% vs. 0, P = 0.007). We found a low prevalence of neuro-endocrine and a high prevalence of neuropsychological deficits in patients 3, 6 and 12 months after aSAH without significant interrelation. Spontaneous recovery of neuro-endocrine alterations most likely presents an adaption to or dysfunction after severe illness. This hypothesis is strengthened by the fact that only patients with inferior clinical outcome after aSAH as assessed by GOS demonstrated neuro-endocrine dysfunction. PMID:22038031

  3. Monotherapy with stenting in subarachnoid hemorrhage (SAH) after middle cerebral artery dissection.

    PubMed

    Puri, Ajit S; Gounis, Matthew J; Massari, Francesco; Howk, Mary; Weaver, John; Wakhloo, Ajay K

    2015-01-01

    Isolated middle cerebral artery dissection is a rare clinical entity, with descriptions limited to a few case reports and case series. Symptomatic dissection in the anterior circulation can present as an ischemic stroke in a young population; however, it is rarely associated with subarachnoid hemorrhage. We describe a young patient who presented with acute headache from a subarachnoid hemorrhage that was ultimately determined to be due to a vascular dissection in the middle cerebral artery. The initial angiogram showed vascular irregularities in this area with stenosis. Repeat imaging 4?days after presentation identified a pseudoaneurysm proximal to the stenosis. The patient was successfully treated with a self-expanding nitinol stent and followed up with serial angiography during postoperative recovery in the hospital; additional angiograms were performed approximately 1 and 6?months after treatment. Serial angiograms demonstrated incremental healing of the dissection. The patient was discharged and remains neurologically intact at the 6-month follow-up. PMID:25833904

  4. Monotherapy with stenting in subarachnoid hemorrhage (SAH) after middle cerebral artery dissection.

    PubMed

    Puri, Ajit S; Gounis, Matthew J; Massari, Francesco; Howk, Mary; Weaver, John; Wakhloo, Ajay K

    2016-04-01

    Isolated middle cerebral artery dissection is a rare clinical entity, with descriptions limited to a few case reports and case series. Symptomatic dissection in the anterior circulation can present as an ischemic stroke in a young population; however, it is rarely associated with subarachnoid hemorrhage. We describe a young patient who presented with acute headache from a subarachnoid hemorrhage that was ultimately determined to be due to a vascular dissection in the middle cerebral artery. The initial angiogram showed vascular irregularities in this area with stenosis. Repeat imaging 4 days after presentation identified a pseudoaneurysm proximal to the stenosis. The patient was successfully treated with a self-expanding nitinol stent and followed up with serial angiography during postoperative recovery in the hospital; additional angiograms were performed approximately 1 and 6 months after treatment. Serial angiograms demonstrated incremental healing of the dissection. The patient was discharged and remains neurologically intact at the 6-month follow-up. PMID:25854687

  5. Brain Iron Metabolism and early brain injury following subarachnoid hemorrhage: iCeFISH-pilot (CSF iron in SAH)

    PubMed Central

    Selim, Magdy; Cotleur, Anne; Hussain, M. Shazam; Toth, Gabor; Provencio, J. Javier

    2015-01-01

    Objectives To explore the relationship between levels of non-protein bound iron in cerebrospinal fluid and the development of early brain injury in patients with aneurysmal SAH. Design Prospective observational cohort pilot study. Setting Neurointensive care unit of an academic, tertiary medical center Patients Patients admitted with aneurysmal subarachnoid hemorrhage Hunt and Hess grades 2 to 4 requiring ventriculostomy insertion as part of their clinical management. Interventions None. Measurements and main results Samples of cerebrospinal fluid (CSF) were obtained on days 1, 3, and 5. A fluorometric assay that relies on an oxidation sensitive probe was used to measure unbound iron, and levels of iron-handling proteins were measured by means of enzyme-linked immunosorbent assays. We prospectively collected and recorded demographic, clinical, and radiological data. A total of 12 patients were included in this analysis. Median Hunt and Hess score on admission was 3.5 (IQR: 1) and median modified Fisher scale score was 4 (IQR: 1). Seven of 12 patients (58%) developed delayed cerebral ischemia (DCI). Day 5 non-transferrin bound iron (NTBI) (7.881 vs. 3.58 0.8, p= 0.02) and mean NTBI (7.39 0.4 vs. 3.340.4 p= 0.03) were significantly higher in patients who developed DCI. Mean and day 3 levels of redox-active iron correlated with development of angiographic vasospasm in logistic regression analysis (p= 0.02); while mean redox-active iron and lower levels of ceruloplasmin on days 3, 5 and peak were correlated with development of deep cerebral infarcts. Conclusions our preliminary data indicate a causal relationship between unbound iron and brain injury following SAH and suggest a possible protective role for ceruloplasmin in this setting, particularly in the prevention of cerebral ischemia. Further studies are needed to validate these findings and to probe their clinical significance. PMID:24710655

  6. Intracerebral hemorrhage due to developmental venous anomalies.

    PubMed

    Li, Xiaodi; Wang, Yuzhou; Chen, Wenming; Wang, Wensheng; Chen, Kaizhe; Liao, Huayin; Lu, Jianjun; Li, Zhigang

    2016-04-01

    Developmental venous anomalies (DVA) and cavernous malformations (CM) are a common form of mixed vascular malformation. The relationship between DVA, CM and hemorrhage is complicated. It is important to differentiate hemorrhagic CM and hemorrhagic DVA. A retrospective review of all patients with acute spontaneous intracerebral hemorrhages (ICH) between 1 May 2008 and 1 May 2013 was performed. ICH due to DVA or CM were identified and compared for demographic features, clinical symptoms, neurological deficits, and radiological findings. A total of 1706 patients with acute spontaneous ICH were admitted to our hospital during the study period. Among these, 10 (0.59%) were caused by DVA and 42 (2.47%) were caused by CM. No significant differences were found in age (p=0.252) or sex ratio (p=1.000) between the two groups. Compared with CM-induced ICH, DVA-induced ICH were characterized by cerebellar predominance (p=0.000) and less severe neurological deficits (p=0.008). Infratentorial hemorrhagic DVA are characterized by cerebellar predominance and benign clinical course. Infratentorial hemorrhagic CM are mainly located in the brainstem. DVA should be given suspected rather than CM when considering the etiology of a cerebellar hemorrhage, especially in young adults. PMID:26803466

  7. Premacular hemorrhage due to isotretinoin use.

    PubMed

    Onder, Halil Ibrahim; Turan, Hakan; Kilic, Ali Cagri; Kaya, Murat; Tunc, Murat

    2013-06-01

    Isotretinoin is a vitamin A derivative used for serious acne that is refractory to other modes of treatment. The most common side effects include dryness of the skin and mucous membranes. Itching as a result of neurological, hematological and ocular side effects has also been reported. Here, we present a 19-year-old female patient who developed premacular hemorrhage and consequent loss of vision in the left eye after oral use of isotretinoin. To the best of our knowledge, this is the first report of the development of premacular hemorrhage as a result of isotretinoin use. PMID:22510043

  8. Effective Use of Sertraline for Pathological Laughing after Severe Vasospasm Due to Aneurysmal Subarachnoid Hemorrhage: Case Report

    PubMed Central

    TAKEUCHI, Hayato; IWAMOTO, Kazuhide; MUKAI, Mao; FUJITA, Tomoaki; TSUJINO, Hitoshi; IWAMOTO, Yoshihiro

    2014-01-01

    Pathological laughing, one subgroup of psuedobulbar affect, is known as laughter inappropriate to the patient's external circumstances and unrelated to the patient's internal emotional state. The authors present the case of a 76-year-old woman with no significant medical history who experienced pathological laughing after subarachnoid hemorrhage (SAH) due to rupture of an aneurysm, which was successfully treated with craniotomy for aneurysm clipping. In the acute stage after the operation she suffered from severe vasospasm and resulting middle cerebral artery territory infarction and conscious disturbance. As she regained consciousness she was afflicted by pathological laughing 6 months after the onset of SAH. Her involuntary laughter was inappropriate to the situation and was incongruent with the emotional state, and she could not control by herself. Finally the diagnosis of pathological laughing was made and treatment with sertraline, a selective serotonin reuptake inhibitor (SSRI), effectively cured the symptoms. Her pathological laughing was estimated to be consequence of infarction in the right prefrontal cortex and/or corona radiata, resulting from vasospasm. To the authors' knowledge, this is the first report of pathological laughing after aneurysmal SAH. The authors offer insight into the pathophysiology of this rare phenomenon. Effectiveness of sertraline would widen the treatment modality against pathological laughing. PMID:24201096

  9. Effective use of sertraline for pathological laughing after severe vasospasm due to aneurysmal subarachnoid hemorrhage: case report.

    PubMed

    Takeuchi, Hayato; Iwamoto, Kazuhide; Mukai, Mao; Fujita, Tomoaki; Tsujino, Hitoshi; Iwamoto, Yoshihiro

    2014-01-01

    Pathological laughing, one subgroup of psuedobulbar affect, is known as laughter inappropriate to the patient's external circumstances and unrelated to the patient's internal emotional state. The authors present the case of a 76-year-old woman with no significant medical history who experienced pathological laughing after subarachnoid hemorrhage (SAH) due to rupture of an aneurysm, which was successfully treated with craniotomy for aneurysm clipping. In the acute stage after the operation she suffered from severe vasospasm and resulting middle cerebral artery territory infarction and conscious disturbance. As she regained consciousness she was afflicted by pathological laughing 6 months after the onset of SAH. Her involuntary laughter was inappropriate to the situation and was incongruent with the emotional state, and she could not control by herself. Finally the diagnosis of pathological laughing was made and treatment with sertraline, a selective serotonin reuptake inhibitor (SSRI), effectively cured the symptoms. Her pathological laughing was estimated to be consequence of infarction in the right prefrontal cortex and/or corona radiata, resulting from vasospasm. To the authors' knowledge, this is the first report of pathological laughing after aneurysmal SAH. The authors offer insight into the pathophysiology of this rare phenomenon. Effectiveness of sertraline would widen the treatment modality against pathological laughing. PMID:24201096

  10. Subarachnoid Hemorrhage-Triggered Acute Hypotension Is Associated with Left Ventricular Cardiomyocyte Apoptosis in a Rat Model.

    PubMed

    Fujii, Mutsumi; Sherchan, Prativa; Soejima, Yoshiteru; Doycheva, Desislava; Zhang, John H

    2016-01-01

    Whether hypotension that occurs due to neurogenic stunned myocardium after subarachnoid hemorrhage (SAH) is associated with cardiomyocyte apoptotic cell death remains unknown. In this study, 18 male rats were subjected to sham or the endovascular perforation model of SAH surgery. Based on the mean arterial pressure (MAP) after SAH, rats were separated into SAH with hypotension (SAH hypotension) or SAH with blood pressure preservation (SAH BP preservation) groups. All animals were euthanized 2 h after the surgical procedure. Hearts were removed and separated transversely into base and apex parts, then Western blot analyses and immunohistochemistry were performed only in the apex part. One rat died as a result of severe SAH and two rats with mild SAH were excluded. We analyzed data from 15 rats that were divided into three groups: sham, SAH hypotension, and SAH BP preservation (n?=?5, each). There was a significantly higher cleaved caspase-3/caspase-3 ratio in the SAH hypotension group compared with sham and the SAH BP preservation group. Cardiomyocyte apoptosis was demonstrated in the SAH rats. This is the first experimental report that describes SAH-induced neurogenic stunned myocardium with ensuing hypotension may result from the acute apoptotic cardiomyocyte cell death in the left ventricle. PMID:26463939

  11. Gastrointestinal Hemorrhage Due to Duodenal Erosion by a Biliary Wallstent

    SciTech Connect

    Roebuck, Derek J.; Stanley, Philip; Katz, Michael D.; Parry, Robert L.; Haight, Michael A.

    1998-01-15

    A self-expanding metallic stent (Wallstent) was used to relieve obstruction of the common bile duct in a young male with a desmoplastic small cell tumor of the abdomen. Two months after insertion and following a course of chemotherapy the lower end of the stent eroded the mucosa of the second part of the duodenum causing severe gastrointestinal hemorrhage which necessitated laparotomy and trimming of the stent. This complication may have been due to shrinking of the tumor as well as thrombocytopenia following chemotherapy.

  12. Turner syndrome with spinal hemorrhage due to vascular malformation

    PubMed Central

    Yu, Min Kyung; Jung, Mo Kyung; Kim, Ki Eun; Kwon, Ah Reum; Kim, Duk Hee; Kim, Ho-Seong

    2015-01-01

    Turner syndrome (TS) is a relatively common chromosomal disorder and is associated with a range of comorbidities involving the cardiovascular system. Vascular abnormalities, in particular, are a common finding in cases of TS. However, dissection involving the vertebral arteries is rare. Here, we report the case of a 9-year-old girl with TS who had been treated with growth hormone replacement therapy for the past 3 years. She presented with weakness of both lower legs, and was ultimately diagnosed with spinal hemorrhage due to vascular malformation. We treated her with intravenous high dose dexamethasone (0.6 mg/kg) and she could walk without assistance after 6 days of treatment. In conclusion, when a patient with TS shows sudden weakness of the lower limbs, we should consider the possibility of spinal vessel rupture and try to take spine magnetic resonance imaging as soon as possible. We suggest a direction how to make a proper diagnosis and management of sudden vertebral artery hemorrhage in patients with TS. PMID:26817012

  13. Signaling Pathway in Cerebral Vasospasm After Subarachnoid Hemorrhage: News Update.

    PubMed

    Wu, Lingyun; Chen, Gang

    2016-01-01

    Subarachnoid hemorrhage (SAH) caused by ruptured intracranial aneurysms is a serious threat to human health and life. Although advances in surgical and anesthetic techniques have improved the prognosis of patients with aneurysms, the rate of death and disability caused by SAH remains high, predominantly due to cerebral vasospasm (CVS) after SAH and early brain damage. In particular, CVS is a common complication after SAH. However, its pathogenesis has not yet been fully elucidated, and clinically effective prevention and treatment measures are still lacking. Spasm of blood vessels can decrease cerebral blood flow, leading to ischemia and hypoxia in brain tissues and ultimately severe neurological dysfunction. Currently, there is no comprehensive theory that can fully explain the mechanisms underlying SAH-caused CVS. However, studies on signal transduction, apoptosis, and glial cell-mediated mechanisms in recent years have shed new light on the treatment of CVS. PMID:26463942

  14. Subarachnoid Hemorrhage Presenting with Seizure due to Cerebrospinal Fluid Leakage after Spinal Surgery

    PubMed Central

    Yaman, Mesut Emre

    2016-01-01

    Cerebrospinal fluid leakage may commonly occur during spinal surgeries and it may cause dural tears. These tears may result in hemorrhage in the entire compartments of the brain. Most common site of such hemorrhages are the veins in the cerebellar region. We report a case of hemorrhage, mimicking aneurysmal subarachnoid hemorrhage due to a cerebrospinal fluid leakage following lumbar spinal surgery and discuss the possible mechanisms of action. PMID:26885288

  15. Secondary intracranial subarachnoid hemorrhage due to spinal missile injury.

    PubMed

    Smialek, J E; Chason, J L; Kshirsagar, V; Spitz, W U

    1981-04-01

    Fresh intracranial subarachnoid hemorrhage may occur secondary to blast-type injury of the spinal cord. This phenomenon is demonstrated in four cases of gunshot and shotgun wounds involving the spinal column. The significance of such a finding is that the subarachnoid hemorrhage should not be construed to represent an independent injury. Such an erroneous conclusion could jeopardize a theory of self-defense in a homicidal shooting. PMID:7264587

  16. Characteristics of Cerebrovascular Injury in the Hyperacute Phase After Induced Severe Subarachnoid Hemorrhage.

    PubMed

    Hasegawa, Yu; Suzuki, Hidenori; Uekawa, Ken; Kawano, Takayuki; Kim-Mitsuyama, Shokei

    2015-12-01

    Although there have been several investigations regarding acute brain injury after subarachnoid hemorrhage (SAH), the pathological conditions of severe SAH are unclear. In this study, we pursued the characteristics of cerebrovascular injury in the hyperacute phase after experimentally induced severe SAH. Twenty-three male Sprague-Dawley rats were subjected to sham or SAH operation using the endovascular perforation method and were evaluated for brain edema, blood-brain barrier (BBB) permeability, and arterial endothelial cell injury at 5 min after SAH (experiment 1). Next, animals were examined for functional and morphological changes of cerebral artery for 30 min after an acetazolamide injection administered 5 min after SAH (experiment 2). In experiment 1, while cerebral blood flow (CBF) was reduced, brain edema was not observed in SAH-operated rats. BBB permeability detected by immunoglobulin G extravasation was observed in the optic tract and was accompanied by the upregulation of phosphorylated extracellular signal-regulated kinase (ERK)-positive astrocytes. In addition, the number of phosphorylated ERK-positive endothelial cell in the distal middle cerebral artery (MCA) was significantly increased by SAH. In experiment 2, CBF in non-lethal SAH rats was reduced, and no response to acetazolamide was detected. Conversely, CBF in lethal SAH increased due to acetazolamide, although the value of CBF was low. Furthermore, there was significant narrowing of the MCA in SAH-operated rats. The findings suggest that the optic tract and the cerebral artery are the most vulnerable areas regarding cerebrovascular injury in a hyperacute phase after severe SAH and that they are associated with fatal outcomes. PMID:26358229

  17. Management of aneurysmal subarachnoid hemorrhage

    PubMed Central

    Diringer, Michael N.

    2010-01-01

    Objective Acute aneurysmal subarachnoid hemorrhage (SAH) is a complex multifaceted disorder that plays out over days to weeks. Many SAH patients are seriously ill and require a prolonged ICU stay. Cardiopulmonary complications are common. The management of SAH patients focuses on the anticipation, prevention and management of these secondary complications. Data Sources Source data were obtained from a PubMed search of the medical literature. Data Synthesis and Conclusion The rupture of an intracranial aneurysm is a sudden devastating event with immediate neurologic and cardiac consequences that require stabilization to allow for early diagnostic angiography. Early complications include rebleeding, hydrocephalus, and seizures. Early repair of the aneurysm (within 1-3 days) should take place by surgical or endovascular means. Over the first 1-2 weeks after hemorrhage, patients are at risk for delayed ischemic deficits due to vasospasm, autoregulatory failure and intravascular volume contraction. Delayed ischemia is treated with combinations of volume expansion, induced hypertension, augmentation of cardiac output, angioplasty and intra-arterial vasodilators. Subarachnoid hemorrhage is a complex disease with a prolonged course that can be particularly challenging and rewarding to the intensivist. PMID:19114880

  18. Acute Onset of Intracerebral Hemorrhage due to Autonomic Dysreflexia

    PubMed Central

    Yigitoglu, Pembe Hare; Ipekdal, H. Ilker; Tosun, Aliye

    2014-01-01

    Autonomic dysreflexia is a clinical emergency syndrome of uncontrolled sympathetic output that can occur in patients who have a history of spinal cord injury. Despite its frequency in spinal cord injury patients, central nervous system complications are very rare. We report a man with traumatic high level incomplete spinal cord injury who suffered hypertensive right thalamic hemorrhage secondary to an episode of autonomic dysreflexia. Prompt recognition and removal of the triggering factor, the suprapubic catheter obstruction which led to hypertensive attack, the patient had a favorable functional outcome after the resorption of the hematoma and effective rehabilitation programme. PMID:25132935

  19. A Case Report of Acute Acalculous Cholecystitis and Acute Hemorrhagic Cystitis due to Salmonella Typhi

    PubMed Central

    Beyazal Polat, Hatice; Beyazal Çeliker, Fatma

    2014-01-01

    Acute acalculous cholecystitis and acute hemorrhagic cystitis due to Salmonella Typhi are a rare condition. A 24-year-old female patient was admitted to our clinic with abdominal pain, nausea, fever, headache, urinary burning, and bloody urine. Based on clinical, laboratory, and radiological evaluations, the patient was diagnosed with acute acalculous cholecystitis and acute hemorrhagic cystitis due to Salmonella Typhi. The patient was treated with intravenous ceftriaxone for two weeks. After the treatment, the patient's clinical and laboratory findings improved. Acute acalculous cholecystitis due to Salmonella Typhi concomitant with acute hemorrhagic cystitis is very rare and might be difficult to diagnose. Infectious agents such as Salmonella Typhi should be considered when acute acalculous cholecystitis and acute hemorrhagic cystitis are detected in adult patients with no underlying diseases. PMID:25161668

  20. Hemoglobin induced NO/cGMP suppression Deteriorate Microcirculation via Pericyte Phenotype Transformation after Subarachnoid Hemorrhage in Rats.

    PubMed

    Li, Qiang; Chen, Yujie; Li, Bo; Luo, Chunxia; Zuo, Shilun; Liu, Xin; Zhang, John H; Ruan, Huaizhen; Feng, Hua

    2016-01-01

    Subarachnoid hemorrhage (SAH) usually results from ruptured aneurysm, but how leaked hemoglobin regulates the microcirculation in the pathophysiology of early brain injury after SAH is still unclear. In the present study, we sought to investigate the role and possible mechanism of hemoglobin induced pericyte phenotype transformation in the regulation of microcirculation after SAH. Endovascular perforation SAH rat model, brain slices and cultured pericytes were used, and intervened with endothelial nitric oxide synthase (eNOS) antagonist L-NNA and its agonist scutellarin, hemoglobin, DETA/NO (nitric oxide(NO) donor), PITO (NO scavenger), 8-Br-cGMP (cGMP analog). We found modulating eNOS regulated pericyte ?-SMA phenotype transformation, microcirculation, and neurological function in SAH rats. Modulating eNOS also affected eNOS expression, eNOS activity and NO availability after SAH. In addition, we showed hemoglobins penetrated into brain parenchyma after SAH. And hemoglobins significantly reduced the microvessel diameters at pericyte sites, due to the effects of hemoglobin inducing ?-SMA expressions in cultured pericytes and brain slices via inhibiting NO/cGMP pathway. In conclusion, pericyte ?-SMA phenotype mediates acute microvessel constriction after SAH possibly by hemoglobin suppressing NO/cGMP signaling pathway. Therefore, by targeting the eNOS and pericyte ?-SMA phenotype, our present data may shed new light on the management of SAH patients. PMID:26911739

  1. Hemoglobin induced NO/cGMP suppression Deteriorate Microcirculation via Pericyte Phenotype Transformation after Subarachnoid Hemorrhage in Rats

    PubMed Central

    Li, Qiang; Chen, Yujie; Li, Bo; Luo, Chunxia; Zuo, Shilun; Liu, Xin; Zhang, John H.; Ruan, Huaizhen; Feng, Hua

    2016-01-01

    Subarachnoid hemorrhage (SAH) usually results from ruptured aneurysm, but how leaked hemoglobin regulates the microcirculation in the pathophysiology of early brain injury after SAH is still unclear. In the present study, we sought to investigate the role and possible mechanism of hemoglobin induced pericyte phenotype transformation in the regulation of microcirculation after SAH. Endovascular perforation SAH rat model, brain slices and cultured pericytes were used, and intervened with endothelial nitric oxide synthase (eNOS) antagonist L-NNA and its agonist scutellarin, hemoglobin, DETA/NO (nitric oxide(NO) donor), PITO (NO scavenger), 8-Br-cGMP (cGMP analog). We found modulating eNOS regulated pericyte α-SMA phenotype transformation, microcirculation, and neurological function in SAH rats. Modulating eNOS also affected eNOS expression, eNOS activity and NO availability after SAH. In addition, we showed hemoglobins penetrated into brain parenchyma after SAH. And hemoglobins significantly reduced the microvessel diameters at pericyte sites, due to the effects of hemoglobin inducing α-SMA expressions in cultured pericytes and brain slices via inhibiting NO/cGMP pathway. In conclusion, pericyte α-SMA phenotype mediates acute microvessel constriction after SAH possibly by hemoglobin suppressing NO/cGMP signaling pathway. Therefore, by targeting the eNOS and pericyte α-SMA phenotype, our present data may shed new light on the management of SAH patients. PMID:26911739

  2. Acute subarachnoid hemorrhage

    PubMed Central

    Hassan, Ali; Ahmad, Bakhtiar; Ahmed, Zahoor; Al-Quliti, Khalid W.

    2015-01-01

    Ruptured cerebral aneurysm is the most common cause of spontaneous subarachnoid hemorrhage (SAH). Rarely cerebral venous sinus thrombosis (CVST) may present initially as acute SAH, and clinically mimics aneurysmal bleed. We report 2 cases of CVST who presented with severe headache associated with neck pain and focal seizures. Non-contrast brain CT showed SAH, involving the sulci of the convexity of hemisphere (cSAH) without involving the basal cisterns. Both patients received treatment with anticoagulants and improved. Awareness of this unusual presentation of CVST is important for early diagnosis and treatment. The purpose of this paper is to emphasize the inclusion of vascular neuroimaging like MRI with venography or CT venography in the diagnostic workup of SAH, especially in a patient with strong clinical suspicion of CVST or in a patient where neuroimaging showed cSAH. PMID:25630784

  3. Role of trauma and infection in childhood hemorrhagic stroke due to vascular lesions

    PubMed Central

    Singhal, Nilika Shah; Hills, Nancy K.; Sidney, Stephen

    2013-01-01

    Objective: Trauma and infection have been postulated as triggers for hemorrhage from underlying brain vascular lesions (arteriovenous malformations, cavernous malformations, and aneurysms) in pediatric hemorrhagic stroke. We decided to perform an association study examining these environmental risk factors. Methods: In this case-control study nested within the cohort of 2.3 million children enrolled in a Northern California integrated health plan (19932004), we identified childhood hemorrhagic stroke cases through electronic searches of diagnostic and radiology databases, confirmed through chart review. Three age- and facility-matched controls per case were randomly selected from the study population. Exposure variables were measured using medical records documented before stroke diagnosis. Main outcome measure was hemorrhagic stroke. Results: Of 132 childhood, non-neonatal hemorrhagic stroke cases, 65 had underlying vascular lesions: 34 arteriovenous malformations, 16 cavernous malformations, and 15 aneurysms. A documented exposure to head and neck trauma in the prior 12 weeks was present in 3 cases (4.6%) with underlying vascular lesions, compared with no controls (p < 0.015). However, all 3 vascular lesions were aneurysms, and traumatic pseudoaneurysms were possible. Recent minor infection (prior 4 weeks) was present in 5 cases (7.7%) and 9 controls (4.6%) (p = 0.34). Conclusions: Our observed association between trauma and hemorrhagic stroke with a vascular lesion may be explained by traumatic pseudoaneurysms. Neither recent head or neck trauma nor infection appeared to be a trigger for pediatric hemorrhagic stroke due to underlying vascular malformations. PMID:23825175

  4. Intracranial Vasospasm without Intracranial Hemorrhage due to Acute Spontaneous Spinal Subdural Hematoma

    PubMed Central

    Oh, Jung-Hwan; Jwa, Seung-Joo; Yang, Tae Ki; Lee, Chang Sub; Oh, Kyungmi

    2015-01-01

    Spontaneous spinal subdural hematoma (SDH) is very rare. Furthermore, intracranial vasospasm (ICVS) associated with spinal hemorrhage has been very rarely reported. We present an ICVS case without intracranial hemorrhage following SDH. A 41-year-old woman was admitted to our hospital with a complaint of severe headache. Multiple intracranial vasospasms were noted on a brain CT angiogram and transfemoral cerebral angiography. However, intracranial hemorrhage was not revealed by brain MRI or CT. On day 3 after admission, weakness of both legs and urinary incontinence developed. Spine MRI showed C7~T6 spinal cord compression due to hyperacute stage of SDH. After hematoma evacuation, her symptoms gradually improved. We suggest that spinal cord evaluation should be considered in patients with headache who have ICVS, although intracranial hemorrhage would not be visible in brain images. PMID:26713084

  5. Mediastinal hemorrhage due to ectopic parathyroid hyperplasia with long-term hemodialysis: report of a case.

    PubMed

    Matsutani, Noriyuki; Kawamura, Masafumi; Dejima, Hitoshi; Takahashi, Yusuke

    2015-12-01

    Secondary hyperparathyroidism can sometimes occur among long-term hemodialysis patients. We herein present the case of a 48-year-old female who underwent surgical resection to treat a mediastinal hemorrhage from an ectopic parathyroid. She had been receiving dialysis for the past 16years due to renal failure. She visited the hospital due to chest pain, and a CT scan revealed a tumorous lesion in the anterior mediastinum. An increase in size of the tumorous lesion, accompanied by bilateral pleural fluid, was observed. Emergency surgery was performed due to a diagnosis of a mediastinal hemorrhage from the tumorous lesion, accompanied by a decrease in the Hb value. The pathological findings of the hematoma revealed parathyroid hyperplasia. This is a rare case report of an ectopic parathyroid developing hyperplasia which caused a mediastinal hemorrhage due to secondary hyperparathyroidism. PMID:25663073

  6. Decorin alleviated chronic hydrocephalus via inhibiting TGF-?1/Smad/CTGF pathway after subarachnoid hemorrhage in rats.

    PubMed

    Yan, Hui; Chen, Yujie; Li, Lingyong; Jiang, Jiaode; Wu, Guangyong; Zuo, Yuchun; Zhang, John H; Feng, Hua; Yan, Xiaoxin; Liu, Fei

    2016-01-01

    Chronic hydrocephalus is one of the severe complications after subarachnoid hemorrhage (SAH). However, there is no efficient treatment for the prevention of chronic hydrocephalus, partially due to poor understanding of underlying pathogenesis, subarachnoid fibrosis. Transforming growth factor-?1(TGF-?1) is a potent fibrogenic factor implicated in wide range of fibrotic diseases. To investigate whether decorin, a natural antagonist for TGF-?1, protects against subarachnoid fibrosis and chronic hydrocephalus after SAH, two-hemorrhage-injection SAH model was conducted in 6-week-old rats. Recombinant human decorin(rhDecorin) (30ug/2ul) was administered before blood injection and on the 10th day after SAH. TGF-?1, p-Smad2/3, connective tissue growth factor (CTGF), collagen I and pro-collagen I c-terminal propeptide were assessed via western blotting, enzyme-linked immunosorbent assay, radioimmunoassay and immunofluorescence. And neurobehavioral tests and Morris water maze were employed to evaluate long-term neurological functions after SAH. We found that SAH induced heightened activation of TGF-?1/Smad/CTGF axis, presenting as a two peak response of TGF-?1 in cerebrospinal fluid, elevation of TGF-?1, p-Smad2/3, CTGF, collagen I in brain parenchyma and pro-collagen I c-terminal propeptide in cerebrospinal fluid, and increased lateral ventricle index. rhDecorin treatment effectively inhibited up-regulation of TGF-?1, p-Smad2/3, CTGF, collagen I and pro-collagen I c-terminal propeptide after SAH. Moreover, rhDecorin treatment significantly reduced lateral ventricular index and incidence of chronic hydrocephalus after SAH. Importantly, rhDecorin improved neurocognitive deficits after SAH. In conclusion, rhDecorin suppresses extracellular matrix accumulation and following subarachnoid fibrosis via inhibiting TGF-?1/Smad/CTGF pathway, preventing development of hydrocephalus and attenuating long-term neurocognitive defects after SAH. PMID:26556770

  7. An Online Health Community for Aneurysmal Subarachnoid Hemorrhage Patients: A Pilot Study

    PubMed Central

    van Nuenen-Platvoet, Willemijn; van den Abbeele, Leonie; Petersen, Harriette; Draskovic, Irena; de Vries, Joost; Westert, Gert; Grotenhuis, J Andre; Bartels, Ronald

    2014-01-01

    Background Aneurysmal subarachnoid hemorrhage (aSAH) is a condition affecting relatively young patients and has high rates of morbidity and mortality. Online health communities have emerged to fill the void for patient advocacy and information, allowing individuals with shared experiences and chronic disorders to connect. Objective We have developed an online health community for aSAH patients, and this pilot study was conducted to evaluate it from a patients perspective. Methods We implemented an online, members-only, health community (MijnSAB, translation: MySAH) in addition to the usual aSAH care at Radboudumc, Nijmegen, the Netherlands. A questionnaire that was sent to consecutive aSAH patients was used to evaluate the usability and utility of MySAH. Answers were provided using a 5-point Likert scale. There was also one open-ended question asking about what was missing from the MySAH tool. Results In total, 66 consecutive patients with aneurysmal subarachnoid hemorrhage were informed about the online health community. Of 64 potential MySAH users, 26 patients gained access to MySAH, 20 of whom were willing to participate in the evaluation. Those who used the community were younger (P=.03) and in a better condition at discharge (P=.03). The patients were positive about MySAHs contribution to the quality of their care, but not to their quality of life. Most patients (18/20, 90%) reported that they would recommend the community to others in their position. Open suggestions on how to improve the tool included more frequent blogs, including by a rehabilitation specialist. Conclusions This pilot study showed that the online health community, MySAH, has a beneficial effect on the aftercare of patients suffering from aSAH because it gives easy access to relevant information provided by peers or caregivers. Due to the variable clinical outcomes after aSAH, the tool will mainly be useful for a select group of patients (with a better clinical outcome). PMID:25405364

  8. Endovascular Perforation Murine Model of Subarachnoid Hemorrhage.

    PubMed

    Du, Guo Jia; Lu, Gang; Zheng, Zhi Yuan; Poon, Wai Sang; Wong, Kwok Chu George

    2016-01-01

    Subarachnoid hemorrhage (SAH) is a subtype of stroke with disastrous outcomes of high disability and mortality. A variety of endeavors have been developed to explore a SAH animal model for investigation of the disease. Among these models, the endovascular perforation SAH model was considered to be the most simulative to the clinical human SAH because it reproduces several pathophysiology procedures and presents some of the most important post-hemorrhage features. An applicable SAH animal model should have the characteristics of low mortality rate, limited surgical manipulation, and adaptation to many species, which permits reproducibility and standardization. An intensive discussion of how to improve the techniques and refine the procedure has taken place in the last decade. This report describes our experiences with a murine model of SAH. We aim to standardize and optimize the procedures to establish a relatively stable animal model for SAH research. PMID:26463927

  9. Fatal hemorrhagic pneumonia caused by infection due to Kytococcus sedentarius--a pathogen or passenger?

    PubMed

    Levenga, Henriëtte; Donnelly, Peter; Blijlevens, Nicole; Verweij, Paul; Shirango, Hebste; de Pauw, Ben

    2004-07-01

    A 55-year old man developed a hemorrhagic pneumonia, likely due to infection with Kytococcus sedentarius during neutropenia following induction chemotherapy for acute myeloid leukemia. Severe mucosal barrier injury and the selective pressure of broad-spectrum antibiotics probably made it possible for this normally harmless commensal to penetrate the gut, spread through the blood stream, and invade the lungs. PMID:14689234

  10. Activation of TRPV4 channels does not mediate inversion of neurovascular coupling after SAH

    PubMed Central

    Koide, Masayo; Wellman, George C.

    2015-01-01

    Summary Neurovascular coupling (NVC) allows increased blood flow to metabolically active neurons and involves the Ca2+-dependent release of vasodilator influences by astrocyte endfeet encasing parenchymal arterioles. We have 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 Ca2+ oscillations in astrocyte endfeet. Calcium-permeable transient receptor potential vanilloid 4 (TRPV4) channels have been reported in astrocyte endfeet and activators of these channels enhance Ca2+ oscillations in healthy animals. Here, we examined the role of TRPV4 channels in the development of high amplitude spontaneous Ca2+ oscillations in astrocyte endfeet and the inversion of neurovascular coupling after SAH. Treatment of brain slices with the TRPV4 channel antagonist, HC-067047 (10 μM), did not alter the amplitude of spontaneous Ca2+ 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 Ca2+ signaling pathways in astrocytes are likely to reveal valuable insights into new therapeutic strategies to advance SAH treatments. PMID:25366609

  11. Protocol Based Real-Time Continuous Electroencephalography for Detecting Vasospasm in Subarachnoid Hemorrhage

    PubMed Central

    Hong, Jeong-Ho; Bang, Jae Seung; Chung, Jin-Heon

    2016-01-01

    A continuous electroencephalography (cEEG) can be helpful in detecting vasospasm and delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage (SAH). We describe a patient with an aneurysmal SAH whose symptomatic vasospasm was detected promptly by using a real-time cEEG. Patient was immediately treated by intraarterial vasodilator therapy. A 50-year-old woman without any significant medical history presented with a severe bifrontal headache due to acute SAH with a ruptured aneurysm on the anterior communicating artery (Fisher grade 3). On bleed day 6, she developed a sudden onset of global aphasia and left hemiparesis preceded by cEEG changes consistent with vasospasm. A stat chemical dilator therapy was performed and she recovered without significant neurological deficits. A real-time and protocol-based cEEG can be utilized in order to avoid any delay in detection of vasospasm in aneurysmal SAH and thereby improve clinical outcomes. PMID:26962422

  12. The Importance of Early Brain Injury after Subarachnoid Hemorrhage

    PubMed Central

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

    2012-01-01

    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

  13. Successful application of extracorporeal membrane oxygenation due to pulmonary hemorrhage secondary to granulomatosis with polyangiitis

    PubMed Central

    Hohenforst-Schmidt, Wolfgang; Petermann, Arndt; Visouli, Aikaterini; Zarogoulidis, Paul; Darwiche, Kaid; Kougioumtzi, Ioanna; Tsakiridis, Kosmas; Machairiotis, Nikolaos; Ketteler, Markus; Zarogoulidis, Konstantinos; Brachmann, Johannes

    2013-01-01

    Extracorporeal membrane oxygenation (ECMO) is increasingly applied in adults with acute refractory respiratory failure that is deemed reversible. Bleeding is the most frequent complication during ECMO support. Severe pre-existing bleeding has been considered a contraindication to ECMO application. Nevertheless, there are cases of successful ECMO application in patients with multiple trauma and hemorrhagic shock or head trauma and intracranial hemorrhage. ECMO has proved to be life-saving in several cases of life-threatening respiratory failure associated with pulmonary hemorrhage of various causes, including granulomatosis with polyangiitis (Wegeners disease). We successfully applied ECMO in a 65-year-old woman with acute life-threatening respiratory failure due to diffuse massive pulmonary hemorrhage secondary to granulomatosis with polyangiitis, manifested as severe pulmonary-renal syndrome. ECMO sustained life and allowed disease control, together with plasmapheresis, cyclophosphamide, corticoids, and renal replacement therapy. The patient was successfully weaned from ECMO, extubated, and discharged home. She remains alive on dialysis at 17 months follow-up. PMID:23926421

  14. Melatonin attenuated early brain injury induced by subarachnoid hemorrhage via regulating NLRP3 inflammasome and apoptosis signaling.

    PubMed

    Dong, Yushu; Fan, Chongxi; Hu, Wei; Jiang, Shuai; Ma, Zhiqiang; Yan, Xiaolong; Deng, Chao; Di, Shouyin; Xin, Zhenlong; Wu, Guiling; Yang, Yang; Reiter, Russel J; Liang, Guobiao

    2016-04-01

    Subarachnoid hemorrhage (SAH) is a devastating condition with high morbidity and mortality rates due to the lack of effective therapy. Nucleotide-binding oligomerization domain-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome activation associated with the upregulation of apoptotic signaling pathway has been implicated in various inflammatory diseases including hemorrhagic insults. Melatonin is reported to possess substantial anti-inflammatory properties, which is beneficial for early brain injury (EBI) after SAH. However, the molecular mechanisms have not been clearly identified. This study was designed to investigate the protective effects of melatonin against EBI induced by SAH and to elucidate the potential mechanisms. The adult mice were subjected to SAH. Melatonin or vehicle was injected intraperitoneally 2 hr after SAH. Melatonin was neuroprotective, as shown by increased survival rate, as well as elevated neurological score, greater survival of neurons, preserved brain glutathione levels, and reduced brain edema, malondialdehyde concentrations, apoptotic ratio, and blood-brain barrier (BBB) disruption. Melatonin also attenuated the expressions of NLRP3, apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC), cleaved caspase-1, interleukin-1β (IL-1β), and interleukin-6 (IL-6); these changes were also associated with an increase in the anti-apoptotic factor (Bcl2) and reduction in the pro-apoptotic factor (Bim). In summary, our results demonstrate that melatonin treatment attenuates the EBI following SAH by inhibiting NLRP3 inflammasome-associated apoptosis. PMID:26639408

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

    PubMed

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

    2015-03-01

    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

  16. A case of metastatic testicular cancer complicated by pulmonary hemorrhage due to choriocarcinoma syndrome.

    PubMed

    Kandori, Shuya; Kawai, Koji; Fukuhara, Yoshiharu; Joraku, Akira; Miyanaga, Naoto; Shimazui, Toru; Akaza, Hideyuki

    2010-12-01

    A 40-year-old man was referred to our hospital for treatment of metastatic testicular cancer. Computerized tomography revealed multiple lung, liver, and retroperitoneal lymph node metastases. In addition, magnetic resonance imaging revealed multiple brain metastases. Induction chemotherapy with bleomycin, etoposide, and cisplatin was started the day after a high orchiectomy. The pathological diagnosis of the surgical specimen was yolk sac carcinoma. The serum human chorionic gonadotropin (hCG) was markedly increased to 630,000 mIU/ml, which suggested the presence of a choriocarcinoma element at metastatic sites. The patient subsequently suffered respiratory failure due to pulmonary hemorrhage. Intensive supportive care prevented a fatal outcome. Physicians who treat advanced testicular tumors should be aware of the potential complication of acute pulmonary hemorrhage, called choriocarcinoma syndrome, in cases with a high hCG level, which indicates a rapidly progressive and high-volume choriocarcinoma. PMID:20544252

  17. Aneurysmal subarachnoid hemorrhage: prognostic features and outcomes.

    PubMed

    Tamargo, R J; Walter, K A; Oshiro, E M

    1997-11-01

    The prognostic features and outcomes associated with aneurysmal subarachnoid hemorrhage (SAH) are reviewed. In the first section, the epidemiology of SAH is discussed with emphasis on prevalence, incidence, risk factors, heredity, activity, and seasonal variability. In the second section, the presentation, diagnosis, and treatment of patients with aneurysmal SAH is briefly reviewed. In the third section, the prognostic features associated with aneurysmal SAH are discussed with emphasis on neurologic condition and SAH grading scales, patient's age, aneurysm size and location, repeat hemorrhage, vasospasm, systemic disease, hypertensive response, computed tomograph features, hydrocephalus, timing of surgery, and expertise of the aneurysm center. Also in the third section, the prognostic features associated with unruptured aneurysms are discussed with emphasis on the actuarial risk of rupture, aneurysm size and location, and multiplicity of lesions. In the fourth and final section, the outcomes of aneurysmal SAH over the past 60 yrs are reviewed. PMID:9433989

  18. A Case of Recurrent Hemorrhages due to a Chronic Expanding Encapsulated Intracranial Hematoma.

    PubMed

    Marutani, Akiko; Nagata, Kiyoshi; Deguchi, Jun; Nikaido, Yuji; Kazuki, Syuji

    2015-01-01

    Few case reports of encapsulated intracranial hematoma (EIH) exist, and the mechanisms underlying the onset and enlargement of EIH remain unclear. Here, we report on a 39-year-old woman with an EIH that repeatedly hemorrhaged and swelled and was ultimately surgically removed. In June 2012, the patient visited her local doctor, complaining of headaches. A magnetic resonance imaging (MRI) scan identified a small hemorrhage of approximately 7 mm in her right basal ganglia, and a wait-and-see approach was adopted. Six months later, her headaches recurred. She was admitted to our department after MRI showed tumor lesions accompanying the intermittent hemorrhaging in the right basal ganglia. After admission, hemorrhaging was again observed, with symptoms progressing to left-sided hemiplegia and fluctuating consciousness; thus, a craniotomy was performed. No obvious abnormal blood vessels were observed on the preoperative cerebral angiography. We accessed the lesion using a transcortical approach via a right frontotemporal craniotomy and removed the subacute hematoma by extracting the encapsulated tumor as a single mass. Subsequent pathological examinations showed that the hematoma exhibited abnormal internal vascularization and was covered with a capsule formed from growing capillaries and accumulating collagen fibers, suggesting that it was an EIH. No lingering neurological symptoms were noted upon postoperative follow-up. This type of hematoma expands slowly and is asymptomatic, with reported cases consisting of patients that already have neurological deficits due to progressive hematoma growth. Our report is one of a few to provide a clinical picture of the initial stages that occur prior to hematoma encapsulation. PMID:26500543

  19. A Case of Recurrent Hemorrhages due to a Chronic Expanding Encapsulated Intracranial Hematoma

    PubMed Central

    Marutani, Akiko; Nagata, Kiyoshi; Deguchi, Jun; Nikaido, Yuji; Kazuki, Syuji

    2015-01-01

    Few case reports of encapsulated intracranial hematoma (EIH) exist, and the mechanisms underlying the onset and enlargement of EIH remain unclear. Here, we report on a 39-year-old woman with an EIH that repeatedly hemorrhaged and swelled and was ultimately surgically removed. In June 2012, the patient visited her local doctor, complaining of headaches. A magnetic resonance imaging (MRI) scan identified a small hemorrhage of approximately 7 mm in her right basal ganglia, and a wait-and-see approach was adopted. Six months later, her headaches recurred. She was admitted to our department after MRI showed tumor lesions accompanying the intermittent hemorrhaging in the right basal ganglia. After admission, hemorrhaging was again observed, with symptoms progressing to left-sided hemiplegia and fluctuating consciousness; thus, a craniotomy was performed. No obvious abnormal blood vessels were observed on the preoperative cerebral angiography. We accessed the lesion using a transcortical approach via a right frontotemporal craniotomy and removed the subacute hematoma by extracting the encapsulated tumor as a single mass. Subsequent pathological examinations showed that the hematoma exhibited abnormal internal vascularization and was covered with a capsule formed from growing capillaries and accumulating collagen fibers, suggesting that it was an EIH. No lingering neurological symptoms were noted upon postoperative follow-up. This type of hematoma expands slowly and is asymptomatic, with reported cases consisting of patients that already have neurological deficits due to progressive hematoma growth. Our report is one of a few to provide a clinical picture of the initial stages that occur prior to hematoma encapsulation. PMID:26500543

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

    PubMed Central

    Asano, Kenichiro; Ohkuma, Hiroki

    2014-01-01

    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

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

    PubMed Central

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

    2010-01-01

    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

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

    PubMed Central

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

    2014-01-01

    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

  3. Cerebral hemorrhage due to tuberculosis meningitis: a rare case report and literature review

    PubMed Central

    Zou, Hai; Pan, Ke-Hua; Pan, Hong-Ying; Huang, Dong-Sheng; Zheng, Ming-Hua

    2015-01-01

    Tuberculosis (TB) is a common disease to threaten human health. TB of the central nervous system (CNS) is rare but the most serious type of systemic TB because of its high mortality rate, serious neurological complications and sequelae. In this case report, we describe a woman who presented with walking instability, intracerebral hemorrhage and leptomeningeal enhancement due to tuberculosis meningitis. The patient had no significant medical history and the initial clinical symptoms were walking instability. On analysis, the cerebrospinal fluid was colorless and transparent, the pressure was more than 400 mm H2O, there was lymphocytic pleocytosis, increased protein, and decreased glucose levels present. No tuberculosis or other bacteria were detected. The patient's brain computed tomography image showed intra-cerebral hemorrhage (ICH) and contrast magnetic resonance imaging showed ICH in the right frontal lob, and leptomeningeal enhancement. CNS TB is rare but has a high mortality rate. As this disease has no unique characteristics at first presentation such as epidemiology and obvious clinical manifestation, a diagnosis of CNS TB remains difficult. PMID:26675758

  4. Practical Incidence and Risk Factors of Terson's Syndrome: A Retrospective Analysis in 322 Consecutive Patients with Aneurysmal Subarachnoid Hemorrhage

    PubMed Central

    Lee, Gun-Ill; Choi, Kyu-Sun; Han, Myung-Hoon; Byoun, Hyoung-Soo; Lee, Byung-Ro

    2015-01-01

    Objective Terson's syndrome, a complication of visual function, has occasionally been reported in patients with aneurysmal subarachnoid hemorrhage (SAH), however the factors responsible for Terson's syndrome in aneurysmal SAH patients have not yet been fully clarified. In this study, we report on potential risk factors for prediction and diagnosis of Terson's syndrome in the earlier stage of the disease course in patients with aneurysmal SAH. Materials and Methods The authors retrospectively analyzed the data of 322 consecutive patients who suffered from aneurysmal SAH in a single institution between Jan. 2007 and Dec. 2013. Medical records including demographics, neurologic examination, and radiologic images were collected to clarify the risk factors of Terson's syndrome. Patients with visual problem were consulted to the Department of Ophthalmology. Results Among 332 patients with aneurysmal SAH, 34 patients were diagnosed as Terson's syndrome. Four individual factors, including World Federation of Neurosurgical Societies (WFNS) grade at admission, aneurysm size, method of operation, and Glasgow outcome scale showed statistically significant association with occurrence of Terson's syndrome. Of these, WFNS grade at admission, aneurysm size, and method of operation showed strong association with Terson's syndrome in multivariate analysis. Terson's syndrome accompanied by papilledema due to increased intracranial pressure led to permanent visual complication. Conclusion In patients with aneurysmal SAH, the patients' WFNS grade at admission, the size of the aneurysms, particularly the diameter of the aneurysm dome, and the method of operation might influence development of Terson's syndrome. PMID:26526120

  5. Prospective randomized trial of sclerotherapy vs standard treatment for epistaxis due to hereditary hemorrhagic telangiectasia

    PubMed Central

    Boyer, Holly; Fernandes, Patricia; Le, Chap; Yueh, Bevan

    2016-01-01

    Background Our previous studies have demonstrated the tolerability and low side-effect profile of office-based sclerotherapy with sodium tetradecyl sulfate (STS) for treating recurrent epistaxis due to hereditary hemorrhagic telangiectasia (HHT). The objective of this study was to use a prospective randomized trial to determine the effectiveness of sclerotherapy with STS vs standard treatment. Methods This prospective randomized trial (conducted from November 1, 2011, through January 31, 2014) involved 17 patients with recurrent epistaxis due to HHT. We defined standard treatment as continuation of any treatment that the patient had previously undergone, such as moisturization, packing, and cautery. We used a crossover design, so study participants were randomized to either sclerotherapy or standard treatment during the first time period, and then to the other during the second period. The primary outcome measure was frequency and severity of epistaxis, as measured by the epistaxis severity score (ESS). The ESS is a 10-point scale, with higher scores corresponding to more bleeding. Results After controlling for treatment order, bleeding was substantially better controlled after sclerotherapy; the ESS after sclerotherapy was nearly one point lower than after standard treatment (?0.95, 1-sided p = 0.027). Treatment order, baseline ESS, the number of lesions, moisturization practices, and a history of previous blood transfusions did not significantly affect the results. Conclusion This trial demonstrated that sclerotherapy with STS (vs standard treatment) significantly reduced epistaxis due to HHT. PMID:25643928

  6. Foveal Damage Due to Subfoveal Hemorrhage Associated with Branch Retinal Vein Occlusion

    PubMed Central

    Muraoka, Yuki; Tsujikawa, Akitaka; Takahashi, Ayako; Iida, Yuto; Murakami, Tomoaki; Ooto, Sotaro; Suzuma, Kiyoshi; Uji, Akihito; Yoshimura, Nagahisa

    2015-01-01

    To investigate the functional and morphologic prognoses of eyes with subfoveal hemorrhage from acute branch retinal vein occlusion (BRVO), and to examine the effect of intravitreal ranibizumab injection (IVR) on these prognoses, we assessed 81 eyes with acute BRVO, of which 38 did not receive IVR [IVR(-) group], and 43 were treated with IVR [IVR(+) group] for macular edema. The foveal morphologic changes were examined via optical coherence tomography (OCT). At initial examination, 63 eyes exhibited subfoveal hemorrhage. At final examination, the defect lengths in the foveal external limiting membrane (ELM) and ellipsoid lines in these eyes were longer, and final VA was significantly poorer, compared with eyes without subfoveal hemorrhage. In comparisons between the final measurements in eyes with subfoveal hemorrhage in the IVR(-) and IVR(+) groups, while there were no differences in initial ocular conditions, final VA was significantly better in the IVR(+) group. The defects in the ELM and ellipsoid lines in the IVR(+) group were shorter than those of the IVR(-) group (p = 0.002 in both). Final VA was correlated with the defect lengths of foveal ELM and ellipsoid lines in both the IVR(-) and IVR(+) groups (both p < 0.001). In addition, the defect lengths of foveal ELM and ellipsoid lines were closely correlated with the duration of subfoveal hemorrhage (both p < 0.001). BRVO-associated subfoveal hemorrhage caused damage to the foveal photoreceptors, and visual dysfunction. However, IVR improved these prognoses, by accelerating the absorption of the subfoveal hemorrhage. PMID:26661582

  7. Diffuse Subarachnoid Hemorrhage Secondary to Cerebral Venous Sinus Thrombosis

    PubMed Central

    Anderson, Brian; Sabat, Shyamsunder; Agarwal, Amit; Thamburaj, Krishnamoorthy

    2015-01-01

    Summary Background Aneurysmal rupture accounts for the majority of nontraumatic subarachnoid hemorrhage (SAH). Increasingly recognized is the occurrence of nontraumatic convexity SAH unaccounted for by aneurysmal rupture. Case Report These presentations require consideration of rare but clinically significant sources of SAH. We report a patient presenting with prolonged mild headaches and acute onset of seizure like activity found to have diffuse subarachnoid hemorrhage and extensive dural venous sinus thrombosis involving the superior sagittal sinus and right transverse-sigmoid sinuses. Conclusions There are few reported cases of SAH secondary to dural sinus thrombosis; however most of these are convexity hemorrhage. Sinus thrombosis presenting as diffuse SAH is extremely rare, as is showcased in this report. PMID:26097524

  8. Large hemorrhage due to venipuncture in the elbow of a patient with severe hemophilia: A case report and literature review

    PubMed Central

    LYU, JINGTONG; WU, WENJIE; XIANG, ZHOU; HUANG, FUGUO

    2016-01-01

    Hemophilia A, which is the most common form of hemophilia, is caused by a deficiency of clotting factor VIII. The incidence of hemophilia A is 1:10,000 people worldwide. The most common complication associated with hemophilia A is bleeding into joints, predominantly the knees, ankles, and elbows, which may lead to destruction or osteoarthritis of the specific joint. Various degrees of disability may follow these initial or recurrent hemorrhages. Subsequent to improvements in medical management, patients with hemophilia A currently have a life expectancy similar to that of the normal population. However, the management of patients with hemophilia A remains a clinical challenge for various reasons, including the lack of reliable and cost-effective treatment, and the high risk of intra- or post-operative hemorrhages. Large hemorrhages due to the phlebotomizing of young patients are very rare. To the best of our knowledge, the present case is the first report regarding the occurrence of a large hemorrhage due to venipuncture in the elbow of a patient with hemophilia A, and discusses the pathogenesis, clinical manifestation, and the medico-chirurgical treatment of this patient. PMID:26998031

  9. Hormone replacement therapy and the risk of subarachnoid hemorrhage in postmenopausal women.

    PubMed

    Qureshi, Adnan I; Malik, Ahmed A; Saeed, Omar; Defillo, Archie; Sherr, Gregory T; Suri, M Fareed K

    2016-01-01

    OBJECT The incidence of subarachnoid hemorrhage (SAH) increases after menopause. Anecdotal data suggest that hormone replacement therapy (HRT) may reduce the rate of SAH and aneurysm formation in women. The goal of this study was to determine the effect of HRT on occurrence of SAH in a large prospective cohort of postmenopausal women. METHODS The data were analyzed for 93, 676 women 50-79 years of age who were enrolled in the observational arm of the Women's Health Initiative Study. The effect of HRT on risk of SAH was determined over a period of 12 1 years (mean SD) using Cox proportional hazards analysis after adjusting for potential confounders. Additional analysis was performed to identify the risk associated with "estrogen only" and "estrogen and progesterone" HRT among women. RESULTS Of the 93, 676 participants, 114 (0.1%) developed SAH during the follow-up period. The rate of SAH was higher among women on active HRT compared with those without HRT used (0.14% vs 0.11%, absolute difference 0.03%, p < 0.0001). In unadjusted analysis, participants who reported active use of HRT were 60% more likely to suffer an SAH (RR 1.6, 95% CI 1.1-2.3). Compared with women without HRT use, the risk of SAH continued to be higher among women reporting active use of HRT (RR 1.5, 95% CI 1.0-2.2) after adjusting for age, systolic blood pressure, cigarette smoking, alcohol consumption, body mass index, race/ethnicity, diabetes, and cardiovascular disease. The risk of SAH was nonsignificantly higher among women on "estrogen only" HRT (RR 1.4, 95% CI 0.91-2.0) than "estrogen and progesterone" HRT(RR 1.2, 95% CI 0.8-2.1) after adjusting for the above-mentioned confounders. CONCLUSIONS Postmenopausal women, particularly those at risk for SAH due to presence of unruptured aneurysms, family history, or cardiovascular risk factors, should be counseled against use of HRT. PMID:26162033

  10. Bilateral Spontaneous Perirenal Hemorrhage due to Initial Presentation of Polyarteritis Nodosa

    PubMed Central

    Choi, Hyung-Il; Kim, Yang-Gyun; Kim, Se-Yun; Jeong, Da Wun; Kim, Ki-Pyo; Jeong, Kyung-Hwan; Lee, Sang-Ho; Moon, Ju-Young

    2015-01-01

    Spontaneous perirenal hemorrhage (SPH) is uncommon but can be a life-threatening condition which is associated with flank or abdominal pain and hypovolemia. The etiologies of SPH include tumor, vascular disease, and infection. Among the vascular diseases, polyarteritis nodosa (PAN) is common cause of the SPH. However, patients with PAN usually complain of nonspecific symptoms and the incidence of PAN is relatively rare. So, diagnosis is difficult even though tissue biopsy and angiography help to confirm the PAN. Particularly bilateral perirenal hemorrhage is very rare complication in patients with PAN. We reported a case of bilateral perirenal hemorrhage in the patients with PAN who have continued to take exogenous sex hormone. PMID:26421017

  11. Static perfect fluids with Pant-Sah equations of state

    NASA Astrophysics Data System (ADS)

    Simon, Walter

    2008-12-01

    We analyze the 3-parameter family of exact, regular, static, spherically symmetric perfect fluid solutions of Einsteins equations (corresponding to a 2-parameter family of equations of state) due to Pant and Sah and rediscovered by Rosquist and by the present author. Except for the Buchdahl solutions which are contained as a limiting case, the fluids have finite radius and are physically realistic for suitable parameter ranges. The equations of state can be characterized geometrically by the property that the 3-metric on the static slices, rescaled conformally with the fourth power of any linear function of the norm of the static Killing vector, has constant scalar curvature. This local property does not require spherical symmetry; in fact it simplifies the proof of spherical symmetry of asymptotically flat solutions which we recall here for the Pant-Sah equations of state. We also consider a model in Newtonian theory with analogous geometric and physical properties, together with a proof of spherical symmetry of the asymptotically flat solutions.

  12. A new grading system based on magnetic resonance imaging in a mouse model of subarachnoid hemorrhage

    PubMed Central

    Egashira, Yusuke; Shishido, Hajime; Hua, Ya; Keep, Richard F.; Xi, Guohua

    2014-01-01

    Background and Purpose A grading system for experimental subarachnoid hemorrhage (SAH) that does not require animal euthanasia is currently unavailable. We proposed a new grading system based on magnetic resonance imaging (MRI), and evaluated the feasibility of this method in a mouse model of SAH. Methods SAH was induced by endovascular perforation in adult male C57BL/6 mice. Mice underwent MRI 24 hours after SAH, and were categorized into the following five grades based on T2*-weighted imaging: Grade 0, no visible SAH or intraventricular hemorrhage (IVH); Grade 1, minimal/localized SAH without IVH; Grade 2, minimal/localized SAH with IVH; Grade 3, thick/diffuse SAH without IVH; Grade 4, thick/diffuse SAH with IVH. Neurological deficits were then assessed and the mice euthanized for conventional SAH grading. Results Among a total of 47 mice, 4% were scored as grade 0, 30% as grade 1, 11% as grade 2, 30% as grade 3, and 36% as grade 4. This MRI grading had excellent interobserver reliability (weighted κ value = 0.94), and there were strong correlations between the MRI grading and the conventional grading (r = 0.85; P < 0.001), or between MRI grade and neurological scores (r = −0.46; P < 0.01). Conclusions The new MRI grading correlated well with conventional grading, and enabled in-vivo evaluation of SAH severity. This grading system may offer advantages in future studies of experimental SAH. PMID:25550373

  13. Effects of Low-Dose Unfractionated Heparin Pretreatment on Early Brain Injury after Subarachnoid Hemorrhage in Mice.

    PubMed

    Altay, Orhan; Suzuki, Hidenori; Hasegawa, Yu; Sorar, Mehmet; Chen, Han; Tang, Jiping; Zhang, John H

    2016-01-01

    Heparin is a pleiotropic drug that antagonizes many pathophysiological mechanisms. In this study, we evaluated whether heparin prevents early brain injury (EBI) after subarachnoid hemorrhage (SAH) in mice. SAH was induced by endovascular perforation in mice randomly assigned to sham-operated (n?=?8), SAH?+?vehicle (n?=?12), SAH?+?10 U heparin pretreatment (n?=?11), and SAH?+?30 U heparin pretreatment (n?=?14) groups. At 24 h post-SAH, severity of SAH, neurological scores, and brain water content were evaluated. Low-dose heparin pretreatment improved neurobehavioral function, and decreased brain edema in the ipsilateral cerebral hemisphere to the perforation side. High-dose heparin had a tendency for increased SAH, which obscured the neuroprotective effects by heparin. Low-dose heparin pretreatment may decrease the development of post-SAH EBI. PMID:26463935

  14. Evaluation of a Murine Single-Blood-Injection SAH Model

    PubMed Central

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

    2014-01-01

    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

  15. Recurrent Hemorrhagic Pericardial Effusion and Tamponade due to Filariasis Successfully Treated with Ivermectin and Albendazole

    PubMed Central

    Sinha, Santosh Kumar; Goel, Amit; Sachan, Mohit; Saraf, Sameer; Verma, Chandra Mohan

    2015-01-01

    Filariasis presenting with pericardial effusion with tamponade is rare. We report a case of a 30-year-old female who was admitted with severe dyspnea and chest pain since 2 days. Echocardiogram showed massive pericardial effusion with tamponade. Pericardial fluid aspiration drained 1.2 L of hemorrhagic fluid. Cytology examination revealed microfilaria of Wuchereria bancrofti. She was treated with diethyl carbamazine and discharged. Six weeks later, she presented again with massive pericardial effusion with cardiac tamponade. Pericardiocentesis was done. Cytology examination revealed microfilaria of W. bancrofti. This time she was treated with ivermectin and albendazole and cured. Hemorrhagic effusion resolved completely. Though relatively uncommon, tropical diseases must always be considered in the etiological diagnosis of recurrent pericardial effusion. PMID:26240733

  16. Uncoupling of endothelial nitric oxide synthase after experimental subarachnoid hemorrhage

    PubMed Central

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

    2011-01-01

    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 4.31.3 for SAH, 23.22.1 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

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

    PubMed Central

    2014-01-01

    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

  18. The Harmful Effects of Subarachnoid Hemorrhage on Extracerebral Organs

    PubMed Central

    Chen, Sheng; Li, Qian; Wu, Haijian; Krafft, Paul R.; Wang, Zhen; Zhang, John H.

    2014-01-01

    Subarachnoid hemorrhage (SAH) is a devastating neurological disorder. Patients with aneurysmal SAH develop secondary complications that are important causes of morbidity and mortality. Aside from secondary neurological injuries, SAH has been associated with nonneurologic medical complications, such as neurocardiogenic injury, neurogenic pulmonary edema, hyperglycemia, and electrolyte imbalance, of which cardiac and pulmonary complications are most common. The related mechanisms include activation of the sympathetic nervous system, release of catecholamines and other hormones, and inflammatory responses. Extracerebral complications are directly related to the severity of SAH-induced brain injury and indicate the clinical outcome in patients. This review provides an overview of the extracerebral complications after SAH. We also aim to describe the manifestations, underlying mechanisms, and the effects of those extracerebral complications on outcome following SAH. PMID:25110700

  19. Subarachnoid hemorrhage with neurocardiogenic stunning.

    PubMed

    Rose, Jason J; Vanhecke, Thomas E; McCullough, Peter A

    2010-01-01

    A well-recognized complication of acute neurologic injury from intracranial bleeding is cardiotoxicity with electrocardiographic changes and transient left ventricular dysfunction. The phenomenon, called neurocardiogenic stunning (NCS), occurs in 20% to 30% cases of patients with acute subarachnoid hemorrhage (SAH). In this article, we describe a patient with acute SAH complicated by NCS and use this case to highlight the pathogenesis, diagnostic challenges, and management dilemmas that arise in such patients. We also review conventional surgical and medical treatment and present new therapeutic options for this problem. PMID:21389917

  20. Spinal axis imaging in non-aneurysmal subarachnoid hemorrhage: a prospective cohort study.

    PubMed

    Germans, Menno R; Coert, Bert A; Majoie, Charles B L M; van den Berg, Ren; Verbaan, Dagmar; Vandertop, W Peter

    2014-11-01

    In 15 % of all spontaneous subarachnoid hemorrhages (SAH), no intracranial vascular pathology is found. Those non-aneurysmal hemorrhages are categorized into perimesencephalic SAH (PMSAH) and non-perimesencephalic SAH (NPSAH). Searching for spinal pathology might reveal a cause for the hemorrhage in some patients. Our goal was to assess the yield of magnetic resonance (MR) imaging of the complete spinal axis in search for a spinal origin in non-aneurysmal SAH. In a prospective, observational study at a tertiary SAH referral center, we assessed clinical and radiological characteristics of patients who consecutively presented with spontaneous non-aneurysmal SAH, diagnosed by computed tomography (CT) or lumbar puncture, and negative CT angiography and digital subtraction angiography (DSA). Eligible patients were enrolled for investigation of the complete spinal axis by standard T1- and T2-weighted MR-imaging. Ninety-seven non-aneurysmal SAH patients were included in the study. Baseline characteristics were comparable between PMSAH and NPSAH patients. DSA and spinal MR-imaging were performed in 95 and 91 % of patients, respectively. This revealed one lumbar ependymoma in a 43-year-old male who was diagnosed by LP (yield 1 %). No spinal origin for the SAH was found in 51 PMSAH patients. The yield of MR-imaging of the complete spinal axis in spontaneous non-aneurysmal SAH patients is low. Routine radiological investigation of the spinal axis in non-aneurysmal SAH patients is therefore not recommended. PMID:25182702

  1. Seasonal and meteorological determinants of aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis.

    PubMed

    de Steenhuijsen Piters, W A A; Algra, A; van den Broek, M F M; Dorhout Mees, S M; Rinkel, G J E

    2013-02-01

    Many studies have assessed the relationships between seasonal or meteorological determinants and the occurrence of aneurysmal subarachnoid hemorrhage (SAH), but the data are conflicting. We systematically searched the literature and meta-analyzed data from all relevant articles when possible. We searched MEDLINE (1966-2011), EMBASE (1980-2011) and the Cochrane Library to identify all observational studies examining the relationship between seasonal and meteorological determinants (temperature, atmospheric pressure and relative humidity) and the occurrence of SAH. Two authors independently extracted data from articles that were included based on predefined criteria. We pooled relative risks (RR's) with corresponding 95 % confidence intervals (CI's) from the individual studies on season and month by means of the random effects method. We included 48 articles, totaling 72,694 patients. SAH occurred less often in summer than in winter (RR 0.89, 95 % CI 0.83-0.96), and was statistically significant more often in January than in the summer months of June-September. For atmospheric pressure seven of 17 studies found a significant association, six of 18 studies were significant for temperature, and three of 15 studies were significant for humidity, but the direction of these associations was conflicting and data on these determinants were too heterogeneous to pool. Seasons influence the occurrence of SAH, with SAH occurring less often in summer than in winter, and most often in January. The explanation for the seasonal differences remains uncertain, due to the lack of sound data on the influence of meteorological factors on SAH occurrence. PMID:23070464

  2. Controversies and Evolving New Mechanisms in Subarachnoid Hemorrhage

    PubMed Central

    Chen, Sheng; Feng, Hua; Sherchan, Prativa; Klebe, Damon; Zhao, Gang; Sun, Xiaochuan; Zhang, Jianmin; Tang, Jiping; Zhang, John H.

    2013-01-01

    Despite decades of study, subarachnoid hemorrhage (SAH) continues to be a serious and significant health problem in the United States and worldwide. The mechanisms contributing to brain injury after SAH remain unclear. Traditionally, most in vivo research has heavily emphasized the basic mechanisms of SAH over the pathophysiological or morphological changes of delayed cerebral vasospasm after SAH. Unfortunately, the results of clinical trials based on this premise have mostly been disappointing, implicating some other pathophysiological factors, independent of vasospasm, as contributors to poor clinical outcomes. Delayed cerebral vasospasm is no longer the only culprit. In this review, we summarize recent data from both experimental and clinical studies of SAH and discuss the vast array of physiological dysfunctions following SAH that ultimately lead to cell death. Based on the progress in neurobiological understanding of SAH, the terms “early brain injury” and “delayed brain injury” are used according to the temporal progression of SAH-induced brain injury. Additionally, a new concept of the vasculo-neuronal-glia triad model for SAH study is highlighted and presents the challenges and opportunities of this model for future SAH applications. PMID:24076160

  3. Inflammation, Vasospasm, and Brain Injury after Subarachnoid Hemorrhage

    PubMed Central

    Miller, Brandon A.

    2014-01-01

    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

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

    PubMed

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

    2014-01-01

    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

  5. Diffuse alveolar hemorrhage due to metastatic angiosarcoma of the lung: A case report

    PubMed Central

    PAN, ZHIJIE; AN, ZHOU; LI, YANYUAN; ZHOU, JIANYING

    2015-01-01

    Angiosarcoma is a rare, heterogeneous malignant tumor that derives from endothelial cells, and it has aggressive characteristics with a marked tendency for distant metastasis. Diffuse alveolar hemorrhage (DAH) is a catastrophic clinical syndrome, however, it is rare as the presentation of pulmonary angiosarcoma. To increase awareness with regard to angiosarcoma and DAH, the current study presents a case of angiosarcoma that originated from the subcutaneous soft tissue of the mastoid process, but was subject to a delayed diagnosis and rapid invasion into the brain and lung. The metastatic angiosarcoma of the lung presented with DAH as the initial manifestation. The pathological examination of a biopsy of the subcutaneous mass and pulmonary lesions confirmed the diagnosis of angiosarcoma. The patient succumbed to respiratory failure at 1 month post-diagnosis. PMID:26788222

  6. Pulmonary hemorrhage and edema due to inhalation of resins containing tri-mellitic anhydride.

    PubMed

    Herbert, F A; Orford, R

    1979-11-01

    Seven young men developed acute pulmonary hemorrhage and edema from the inhalation of powder or fumes of a bisphenol epoxy resin containing tri-mellitic anhydride (TMA) while working in a steel pipe-coating plant. The illness was characterized by cough, hemoptysis, dyspnea, fever, weakness and nausea or vomiting. Chest roentgenograms showed either a bilateral or unilateral pulmonary infiltrate. All patients had a normochromic type of anemia. Pulmonary function studies demonstrated a restrictive defect, hypoxemia, and increased A-a DO2 gradients. Light and electron microscopic studies of lung tissue revealed extensive bleeding into alveoli but no basement membrane deposits were seen and no antiglomerular basement membrane antibodies were detected. The patients improved quickly without treatment. Follow-up studies of six patients three weeks to one year after their illness revealed apparent recovery. A detailed medical survey carried out on all 29 workers currently employed in the plant revealed five additional men had experienced severe recurrent pulmonary problems. PMID:498827

  7. Vascular Endothelial Growth Factor in Brain Edema Formation After Subarachnoid Hemorrhage.

    PubMed

    Liu, Lei; Fujimoto, Masashi; Kawakita, Fumihiro; Ichikawa, Naoki; Suzuki, Hidenori

    2016-01-01

    Vascular endothelial growth factor (VEGF) has been implicated in the pathogenesis of brain edema formation after experimental subarachnoid hemorrhage (SAH). In this study, we evaluated the effect of anti-VEGF antibody neutralization on brain edema formation after experimental SAH in mice. Mice underwent sham operation or filament puncture SAH and were assigned to sham, SAH?+?vehicle, or SAH?+?anti-VEGF antibody groups. Vehicle or anti-VEGF antibody was administrated by an intracerebroventricular injection at 30 min post-SAH. After 24 h of SAH modeling, neurological score was recorded to evaluate neurobehavioral functions, brain water content was calculated to assess the level of brain edema, and immunohistochemistry of immunoglobulin (Ig) G was performed to evaluate the permeability of the blood-brain barrier (BBB). Anti-VEGF antibody significantly ameliorated neurological score and brain edema after SAH compared with the SAH?+?vehicle group. Immunohistochemistry showed that post-SAH IgG extravasation in brain tissue was suppressed by anti-VEGF antibody. This study suggests that VEGF is involved in brain edema formation after SAH, and that anti-VEGF antibody can decrease BBB permeability, suppress brain edema formation, and improve functional outcome after 24 h of SAH. PMID:26463944

  8. SAH-induced MMP activation and KV current suppression is mediated via both ROS-dependent and ROS-independent mechanisms

    PubMed Central

    Koide, Masayo; Wellman, George C.

    2015-01-01

    Summary Voltage-gated potassium (KV) 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 KV current suppression and cerebral artery constriction via activation of epidermal growth factor receptors (EGFRs). Using patch clamp electrophysiology, we observed that KV 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 KV current suppression, we found that: 1) OxyHb and/or the exogenous EGFR ligand, HB-EGF, failed to induce further KV 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 KV 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 KV current suppression. These data suggest OxyHb suppresses KV 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

  9. Memantine Attenuates Delayed Vasospasm after Experimental Subarachnoid Hemorrhage via Modulating Endothelial Nitric Oxide Synthase

    PubMed Central

    Huang, Chih-Yuan; Wang, Liang-Chao; Shan, Yan-Shen; Pan, Chia-Hsin; Tsai, Kuen-Jer

    2015-01-01

    Delayed cerebral vasospasm is an important pathological feature of subarachnoid hemorrhage (SAH). The cause of vasospasm is multifactorial. Impairs nitric oxide availability and endothelial nitric oxide synthase (eNOS) dysfunction has been reported to underlie vasospasm. Memantine, a low-affinity uncompetitive N-methyl-d-aspartate (NMDA) blocker has been proven to reduce early brain injury after SAH. This study investigated the effect of memantine on attenuation of vasospasm and restoring eNOS functionality. Male Sprague-Dawley rats weighing 350450 g were randomly divided into three weight-matched groups, sham surgery, SAH + vehicle, and SAH + memantine groups. The effects of memantine on SAH were evaluated by assessing the severity of vasospasm and the expression of eNOS. Memantine effectively ameliorated cerebral vasospasm by restoring eNOS functionality. Memantine can prevent vasospasm in experimental SAH. Treatment strategies may help combat SAH-induced vasospasm in the future. PMID:26110388

  10. Memantine Attenuates Delayed Vasospasm after Experimental Subarachnoid Hemorrhage via Modulating Endothelial Nitric Oxide Synthase.

    PubMed

    Huang, Chih-Yuan; Wang, Liang-Chao; Shan, Yan-Shen; Pan, Chia-Hsin; Tsai, Kuen-Jer

    2015-01-01

    Delayed cerebral vasospasm is an important pathological feature of subarachnoid hemorrhage (SAH). The cause of vasospasm is multifactorial. Impairs nitric oxide availability and endothelial nitric oxide synthase (eNOS) dysfunction has been reported to underlie vasospasm. Memantine, a low-affinity uncompetitive N-methyl-d-aspartate (NMDA) blocker has been proven to reduce early brain injury after SAH. This study investigated the effect of memantine on attenuation of vasospasm and restoring eNOS functionality. Male Sprague-Dawley rats weighing 350-450 g were randomly divided into three weight-matched groups, sham surgery, SAH + vehicle, and SAH + memantine groups. The effects of memantine on SAH were evaluated by assessing the severity of vasospasm and the expression of eNOS. Memantine effectively ameliorated cerebral vasospasm by restoring eNOS functionality. Memantine can prevent vasospasm in experimental SAH. Treatment strategies may help combat SAH-induced vasospasm in the future. PMID:26110388

  11. Endovascular perforation subarachnoid hemorrhage fails to cause Morris water maze deficits in the mouse

    PubMed Central

    Milner, Eric; Holtzman, Jacob C; Friess, Stuart; Hartman, Richard E; Brody, David L; Han, Byung H; Zipfel, Gregory J

    2014-01-01

    Cognitive dysfunction is the primary driver of poor long-term outcome in aneurysmal subarachnoid hemorrhage (SAH) survivors; modeling such deficits preclinically is thus key for mechanistic and translational investigation. Although rat SAH causes long-term deficits in learning and memory, it remains unknown whether similar deficits are seen in the mouse, a species particularly amenable to powerful, targeted genetic manipulation. We thus subjected mice to endovascular perforation SAH and assessed long-term cognitive outcome via the Morris water maze (MWM), the most commonly used metric for rodent neurocognition. No significant differences in MWM performance (by either of two protocols) were seen in SAH versus sham mice. Moreover, SAH caused negligible hippocampal CA1 injury. These results undercut the potential of commonly used methods (of SAH induction and assessment of long-term neurocognitive outcome) for use in targeted molecular studies of SAH-induced cognitive deficits in the mouse. PMID:24938403

  12. Multimodal MRI characterization of experimental subarachnoid hemorrhage.

    PubMed

    Sun, Y; Shen, Q; Watts, L T; Muir, E R; Huang, S; Yang, G-Y; Suarez, J I; Duong, T Q

    2016-03-01

    Subarachnoid hemorrhage (SAH) is associated with significant morbidity and mortality. We implemented an in-scanner rat model of mild SAH in which blood or vehicle was injected into the cistern magna, and applied multimodal MRI to study the brain prior to, immediately after (5min to 4h), and upto 7days after SAH. Vehicle injection did not change arterial lumen diameter, apparent diffusion coefficient (ADC), T2, venous signal, vascular reactivity to hypercapnia, or foot-fault scores, but mildly reduce cerebral blood flow (CBF) up to 4h, and open-field activity up to 7days post injection. By contrast, blood injection caused: (i) vasospasm 30min after SAH but not thereafter, (ii) venous abnormalities at 3h and 2days, delayed relative to vasospasm, (iii) reduced basal CBF and to hypercapnia 1-4h but not thereafter, (iv) reduced ADC immediately after SAH but no ADC and T2 changes on days 2 and 7, and (v) reduced open-field activities in both SAH and vehicle animals, but no significant differences in open-field activities and foot-fault tests between groups. Mild SAH exhibited transient and mild hemodynamic disturbances and diffusion changes, but did not show apparent ischemic brain injury nor functional deficits. PMID:26708744

  13. Pharmacologic Management of Subarachnoid Hemorrhage.

    PubMed

    Young, Adam M H; Karri, Surya K; Helmy, Adel; Budohoski, Karol P; Kirollos, Ramez W; Bulters, Diederik O; Kirkpatrick, Peter J; Ogilvy, Christopher S; Trivedi, Rikin A

    2015-07-01

    Subarachnoid hemorrhage (SAH) remains a condition with suboptimal functional outcomes, especially in the young population. Pharmacotherapy has an accepted role in several aspects of the disease and an emerging role in several others. No preventive pharmacologic interventions for SAH currently exist. Antiplatelet medications as well as anticoagulation have been used to prevent thromboembolic events after endovascular coiling. However, the main focus of pharmacologic treatment of SAH is the prevention of delayed cerebral ischemia (DCI). Currently the only evidence-based medical intervention is nimodipine. Other calcium channel blockers have been evaluated without convincing efficacy. Anti-inflammatory drugs such as statins have demonstrated early potential; however, they failed to provide significant evidence for the use in preventing DCI. Similar findings have been reported for magnesium, which showed potential in experimental studies and a phase 2 trial. Clazosentane, a potent endothelin receptor antagonist, did not translate to improve functional outcomes. Various other neuroprotective agents have been used to prevent DCI; however, the results have been, at best inconclusive. The prevention of DCI and improvement in functional outcome remain the goals of pharmacotherapy after the culprit lesion has been treated in aneurysmal SAH. Therefore, further research to elucidate the exact mechanisms by which DCI is propagated is clearly needed. In this article, we review the current pharmacologic approaches that have been evaluated in SAH and highlight the areas in which further research is needed. PMID:25701766

  14. Signaling Pathway in Early Brain Injury after Subarachnoid Hemorrhage: News Update.

    PubMed

    Ji, Chengyuan; Chen, Gang

    2016-01-01

    The annual incidence of subarachnoid hemorrhage (SAH) caused by intracranial aneurysm rupture is approximately 10.5/10 million people in China, making SAH the third most frequently occurring hemorrhage of the intracranial type after cerebral embolism and hypertensive intracerebral hemorrhage. SAH caused by ruptured aneurysm leads to a mortality rate as high as 67 %, and, because of the sudden onset of this disease, approximately 12-15 % of patients die before they can receive effective treatment. Early brain injury (EBI) is the brain damage occurring within the first 72 h after SAH. Two-thirds of mortality caused by SAH occurs within 48 h, mainly as a result of EBI. With the development of molecular biology and medicine microscopy techniques, various signaling pathways involved in EBI after SAH have been revealed. Understanding these signaling pathways may help clinicians treat EBI after SAH and improve long-term prognosis of SAH patients. This chapter summarizes several important signaling pathways implicated in EBI caused by SAH. PMID:26463934

  15. Monitoring in Neurointensive Care – The Challenge to Detect Delayed Cerebral Ischemia in High-Grade Aneurysmal SAH

    PubMed Central

    Sarrafzadeh, Asita S.; Vajkoczy, Peter; Bijlenga, Philippe; Schaller, Karl

    2014-01-01

    Delayed cerebral ischemia (DCI) is a feared and significant medical complication following aneurysmal subarachnoid hemorrhage (aSAH). It occurs in about 30% of patients surviving the initial hemorrhage, mostly between days 4 and 10 after aSAH. Clinical deterioration attributable to DCI is a diagnosis of exclusion and especially difficult to diagnose in patients who are comatose or sedated. The latter are typically patients with a high grade on the World Federation of Neurosurgical Societies scale (WFNS grade 4–5), who represent approximately 40–70% of the patient population with ruptured aneurysms. In this group of patients, the incidence of DCI is often underestimated and higher when compared to low WFNS grade patients. To overcome difficulties in diagnosing DCI, which is especially relevant in sedated and comatose patients, the article reports the most recent recommendation for definition of DCI and discusses their advantages and problematic issues in neurocritical care practice. Finally, appropriate neuromonitoring techniques and their clinical impact in high-grade SAH patients are summarized. PMID:25101052

  16. Serum lipid profile spectrum and delayed cerebral ischemia following subarachnoid hemorrhage: Is there a relation?

    PubMed Central

    Dhandapani, Sivashanmugam; Aggarwal, Ashish; Srinivasan, Anirudh; Meena, Rajesh; Gaudihalli, Sachin; Singh, Harnarayan; Dhandapani, Manju; Mukherjee, Kanchan K.; Gupta, Sunil K.

    2015-01-01

    Background: Serum lipid abnormalities are known to be important risk factors for vascular disorders. However, their role in delayed cerebral ischemia (DCI), the major cause of morbidity after subarachnoid hemorrhage (SAH) remains unclear. This study was an attempt to evaluate the spectrum of lipid profile changes in SAH compared to matched controls, and their relation with the occurrence of DCI. Methods: Admission serum lipid profile levels were measured in patients of SAH and prospectively studied in relation to various factors and clinical development of DCI. Results: Serum triglyceride (TG) levels were significantly lower among SAH patients compared to matched controls (mean [standard deviation (SD)] mg/dL: 117.3 [50.4] vs. 172.8 [89.1], P = 0.002), probably because of energy consumption due to hypermetabolic response. Patients who developed DCI had significantly higher TG levels compared to those who did not develop DCI (mean [SD] mg/dL: 142.1 [56] vs. 111.9 [54], P = 0.05). DCI was noted in 62% of patients with TG >150 mg/dL, compared to 22% among the rest (P = 0.01). Total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and lipoprotein (a) neither showed a significant difference between SAH and controls and nor any significant association with DCI. Multivariate analysis using binary logistic regression adjusting for the effects of age, sex, systemic disease, World Federation of Neurosurgical Societies grade, Fisher grade, and clipping/coiling, revealed higher TG levels to have significant independent association with DCI (P = 0.01). Conclusions: Higher serum TG levels appear to be significantly associated with DCI while other lipid parameters did not show any significant association. This may be due to their association with remnant cholesterol or free fatty acid-induced lipid peroxidation. PMID:26664869

  17. Basal Ganglia Damage in Experimental Subarachnoid Hemorrhage.

    PubMed

    Zhang, Haining; Okubo, Shuichi; Hua, Ya; Keep, Richard F; Xi, Guohua

    2016-01-01

    Research suggests that early brain injury following subarachnoid hemorrhage (SAH) is a primary therapeutic target, and early SAH-induced basal ganglia injury is not well studied. The present study examined basal ganglia injury in a rat model of SAH. Adult male Sprague-Dawley rats (n?=?78) weighing 275-300 g underwent endovascular perforation to mimic aneurysmal SAH. Sham rats (n?=?12) underwent the same procedure but without perforation. Magnetic resonance imaging (T2 MRI) was performed at 24 h after SAH to measure ventricle volumes and brain T2 lesion. Hydrocephalus in SAH rats was defined as a ventricular volume greater than three standard deviations above that in shams. Western blotting and immunochemistry were utilized to assess basal ganglia damage. Sixty rats survived the SAH and 40 % of those animals had T2 lesions in the basal ganglia. Twenty-six SAH rats had hydrocephalus. Rats with hydrocephalus had higher incidence of basal ganglia lesion (69 vs. 18 % in rats without hydrocephalus; p?SAH resulted in severe basal ganglia damage, which is associated with hydrocephalus development. PMID:26463938

  18. [Complete remission of consciousness disturbances and spasticity due to a severe subarachnoid hemorrhage after intrathecal baclofen therapy: a case report].

    PubMed

    Asahi, Takashi; Kashiwazaki, Daina; Koh, Masaki; Matsumura, Nobuhisa; Kuroda, Satoshi

    2015-03-01

    Typically, intrathecal baclofen therapy(ITB)for spasticity is continuously required because the spasticity can recur if the ITB is stopped. Thus, an infusion pump for the ITB is permanently implanted. Some sporadic cases exhibiting remarkable improvements in their spasticity and consciousness disturbances have been reported after implanting the ITB pump. We experienced a rare case involving removal of the ITB pump after the spasticity resolved and the consciousness disturbances markedly improved. A 15-year-old girl developed a subarachnoid hemorrhage due to rupture of an aneurysm in the right anterior cerebral artery. Her initial Glasgow Coma Scale score was 4(E1V1M2). Trapping of the aneurysm and decompression craniotomy were performed. Subsequently, she underwent a tracheotomy, and a percutaneous gastrostomy(PEG)tube was implanted because of persistent consciousness disturbances. Cranioplasty and lumbar-peritoneal shunt for normal pressure hydrocephalus were performed after 1 month. An ITB pump was implanted to improve the spasticity observed mainly in the lower extremities 61 days after hemorrhage onset. Right hemiparesis remained due to Kernohan's notch. After transfer to the rehabilitation hospital, her consciousness disturbances and spasticity remarkably improved(1.9 to 1.0 and 3.5 to 1.0 on the Ashworth scale for the upper and lower extremities, respectively). The tracheostomy and PEG tubes were removed, and the baclofen dose was gradually reduced. She was completely off baclofen after 7 months, and she was discharged with a short leg brace and a cane for walking. The baclofen pump was then removed. In this case, temporary ITB improved the spasticity and consciousness disturbances. PMID:25748812

  19. [Alveolar hemorrhage].

    PubMed

    Parrot, A; Fartoukh, M; Cadranel, J

    2015-04-01

    Alveolar hemorrhage occurs relatively rarely and is a therapeutic emergency because it can quickly lead to acute respiratory failure, which can be fatal. Hemoptysis associated with anemia and pulmonary infiltrates suggest the diagnosis of alveolar hemorrhage, but may be absent in one third of cases including patients in respiratory distress. The diagnosis of alveolar hemorrhage is based on the findings of a bronchoalveolar lavage. The causes are numerous. It is important to identify alveolar hemorrhage due to sepsis, then separate an autoimmune cause (vasculitis associated with antineutrophil cytoplasmic antibody, connective tissue disease and Goodpasture's syndrome) with the search for autoantibodies and biopsies from readily accessible organs, from a non-immune cause, performing echocardiography. Lung biopsy should be necessary only in exceptional cases. If the hemorrhage has an immune cause, treatment with steroids and cyclophosphamide may be started. The indications for treatment with rituximab are beginning to be established (forms that are not severe and refractory forms). The benefit of plasma exchange is unquestionable in Goodpasture's syndrome. In patients with an immune disease that can lead to an alveolar hemorrhage, removing any source of infection is the first priority. PMID:25891303

  20. Biomarkers as outcome predictors in subarachnoid hemorrhage – a systematic review

    PubMed Central

    Hong, Caron M.; Tosun, Cigdem; Kurland, David B.; Gerzanich, Volodymyr; Schreibman, David; Simard, J. Marc

    2015-01-01

    Context Subarachnoid hemorrhage (SAH) has a high fatality rate and many suffer from delayed neurological deficits. Biomarkers may aid in the identification of high-risk patients, guide treatment/management and improve outcome. Objective The aim of this review was to summarize biomarkers of SAH associated with outcome. Methods An electronic database query was completed, including an additional review of reference lists to include all potential human studies. Results A total of 298 articles were identified; 112 were reviewed; 55 studies were included. Conclusion This review details biomarkers of SAH that correlate with outcome. It provides the basis for research investigating their possible translation into the management of SAH patients. PMID:24499240

  1. Aneurysmal Subarachnoid Hemorrhage

    PubMed Central

    2015-01-01

    Aneurysmal subarachnoid hemorrhage (SAH) is a worldwide health burden with high fatality and permanent disability rates. The overall prognosis depends on the volume of the initial bleed, rebleeding, and degree of delayed cerebral ischemia (DCI). Cardiac manifestations and neurogenic pulmonary edema indicate the severity of SAH. The International Subarachnoid Aneurysm Trial (ISAT) reported a favorable neurological outcome with the endovascular coiling procedure compared with surgical clipping at the end of 1 year. The ISAT trial recruits were primarily neurologically good grade patients with smaller anterior circulation aneurysms, and therefore the results cannot be reliably extrapolated to larger aneurysms, posterior circulation aneurysms, patients presenting with complex aneurysm morphology, and poor neurological grades. The role of hypothermia is not proven to be neuroprotective according to a large randomized controlled trial, Intraoperative Hypothermia for Aneurysms Surgery Trial (IHAST II), which recruited patients with good neurological grades. Patients in this trial were subjected to slow cooling and inadequate cooling time and were rewarmed rapidly. This methodology would have reduced the beneficial effects of hypothermia. Adenosine is found to be beneficial for transient induced hypotension in 2 retrospective analyses, without increasing the risk for cardiac and neurological morbidity. The neurological benefit of pharmacological neuroprotection and neuromonitoring is not proven in patients undergoing clipping of aneurysms. DCI is an important cause of morbidity and mortality following SAH, and the pathophysiology is likely multifactorial and not yet understood. At present, oral nimodipine has an established role in the management of DCI, along with maintenance of euvolemia and induced hypertension. Following SAH, hypernatremia, although less common than hyponatremia, is a predictor of poor neurological outcome. PMID:25272066

  2. SAH-induced suppression of voltage-gated K+ (KV) channel currents in parenchymal arteriolar myocytes involves activation of the HB-EGF/EGFR pathway

    PubMed Central

    Koide, Masayo; Wellman, George C.

    2013-01-01

    Summary Potassium channels play an important role in the regulation of arterial tone and decreased activity of these ion channels has been linked to pial artery vasospasm after subarachnoid hemorrhage (SAH). Our previous work has shown that acute application of a blood component, oxyhemoglobin, caused suppression of voltage-gated K+ (KV) channels through heparin-binding epidermal growth factor-like growth factor (HB-EGF) mediated activation of epidermal growth factor receptor (EGFR). Using patch clamp electrophysiology, we have now examined whether this pathway of KV channel suppression is activated in parenchymal arteriolar myocytes following long-term in vivo exposure to subarachnoid blood. We have found that KV currents, but not large conductance Ca2+ activated or inwardly rectifying K+ channel currents, were decreased in parenchymal arteriolar myocytes freshly isolated from Day-5 SAH model rabbits. Interestingly, parenchymal arteriolar myocytes from control animals were more sensitive to exogenous HB-EGF (IC50: 0.2 ± 0.4 ng/mL) compared to pial arterial myocytes (IC50: 2.4 ±1.3 ng/mL). However, HB-EGF and oxyhemoglobin failed to decrease KV currents in parenchymal arteriolar myocytes from SAH animals, consistent with EGFR activation and KV current suppression by SAH. These data suggest that HB-EGF/EGFR pathway activation contributes to KV current suppression and enhanced parenchymal arteriolar constriction after SAH. PMID:22890666

  3. Myocarditis in patients with subarachnoid hemorrhage: A histopathologic study.

    PubMed

    van der Bilt, Ivo A C; Vendeville, Jean-Paul; van de Hoef, Tim P; Begieneman, Mark P V; Lagrand, Wim K; Kros, Johan M; Wilde, Arthur A M; Rinkel, Gabriel J E; Niessen, Hans W M

    2016-04-01

    Cardiac abnormalities after subarachnoid hemorrhage (SAH) such as electrocardiographic changes, echocardiographic wall motion abnormalities, and elevated troponin levels are independently associated with a poor prognosis. They are caused by catecholaminergic stress coinciding with influx of inflammatory cells into the heart. These abnormalities could be a sign of a myocarditis, potentially giving insight in pathophysiology and treatment options. These inflammatory cells are insufficiently characterized, and it is unknown whether myocarditis is associated with SAH. Myocardium of 25 patients who died of SAH and 18 controls was stained with antibodies identifying macrophages (CD68), lymphocytes (CD45), and neutrophil granulocytes (myeloperoxidase). Myocytolysis was visualized using complement staining (C3d). CD31 was used to identify putative thrombi. We used Mann-Whitney U testing for analysis. In the myocardium of SAH patients, the amount of myeloperoxidase-positive (P < .005), CD45-positive (P < .0005), and CD68-positive (P < .0005) cells was significantly higher compared to controls. Thrombi in intramyocardial arteries were found in 22 SAH patients and 1 control. Myocytolysis was found in 6 SAH patients but not in controls. Myocarditis, consisting of an influx of neutrophil granulocytes, lymphocytes, and macrophages, coinciding with myocytolysis and thrombi in intramyocardial arteries, occurs in patients with SAH but not in controls. These findings might explain the cardiac abnormalities after SAH and may have implications for treatment. PMID:26777746

  4. Aneurysmal Subarachnoid Hemorrhage Models: Do They Need a Fix?

    PubMed Central

    Sehba, Fatima A.; Pluta, Ryszard M.

    2013-01-01

    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

  5. Axonal pathology in subarachnoid and intracerebral hemorrhage.

    PubMed

    Petzold, A; Rejdak, K; Belli, A; Sen, J; Keir, G; Kitchen, N; Smith, M; Thompson, E J

    2005-03-01

    Electrically active axons degenerate in the presence of nitric oxide (NO) in vitro. High CSF NO concentrations have been observed in patients with hemorrhagic brain injury such as subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH). This study investigated the evidence for axonal injury in SAH and ICH and related this to CSF NO levels. In this study, neurofilament phosphoforms (NfH(SMI34), NfH(SMI35), NfH(SMI38), NfH(SMI310)), surrogate markers for axonal injury, and NO metabolites (nitrate, nitrite = NOx) were measured by ELISA in cerebrospinal fluid (CSF) from patients with SAH and ICH and from a group of controls. Injury severity was classified using the Glasgow Coma Scale, and survival was used as the outcome measure. Compared to the control group, a higher proportion of patients with SAH and ICH had elevated NfH(SMI34) levels from day 0 to day 6 (p < 0.001), elevated NfH(SMI35) levels from day 1 to 6 (p < 0.001), and elevated NfH(SMI310) levels at day 0, 1, 4, and 6 (p < 0.001). The NOx levels were higher in the SAH and ICH patients than in the controls (p < 0.05) and distinguished the non-survivors from the survivors (p < 0.05). No direct correlation was found for NOx with any of the NfH phosphoforms. This study provides evidence for primary and secondary axonal injury in patients with SAH and ICH, with non-survivors also having higher NOx levels. CSF NfH phosphoforms might emerge as a putative surrogate marker for monitoring the development for secondary axonal degeneration in neurocritical care and guiding targeted neuroprotective strategies. PMID:15785235

  6. Early Cerebral Infarction after Aneurysmal Subarachnoid Hemorrhage.

    PubMed

    Wong, George Kwok Chu; Leung, Joyce Hoi Ying; Yu, Janice Wong Li; Lam, Sandy Wai; Chan, Emily Kit Ying; Poon, Wai Sang; Abrigo, Jill; Siu, Deyond Yun Woon

    2016-01-01

    Aneurysmal subarachnoid hemorrhage (SAH) is a serious disease with high case fatality and morbidity. Early cerebral infarction has been suggested as a risk factor for poor outcome. We aimed to assess the pattern of early and delayed cerebral infarction after aneurysmal subarachnoid hemorrhage. We prospectively enrolled consecutive aneurysmal subarachnoid hemorrhage (SAH) patients presenting to an academic neurosurgical referral center (Prince of Wales Hospital, the Chinese University of Hong Kong) in Hong Kong. Cerebral infarction occurred in 24 (48 %) patients, in which 14 (28 %) had early cerebral infarction and 14 (28 %) had delayed cerebral infarction. Early anterior cerebral infarction occurred in a similar proportion of anterior and posterior circulation aneurysms (24 % vs. 21 %), whereas posterior circulation aneurysm patients had a higher proportion of early posterior cerebral infarction compared with anterior circulation aneurysm patients (18 % vs. 2 %). In conclusion, early cerebral infarction was common and different from delayed cerebral infarction. PMID:26463941

  7. [Antibiotic prophylaxis in patients with acute hemorrhage due to portal hypertension--personal experience].

    PubMed

    Husov, L; Senkyrk, M; Lata, J; Husa, P; Jurnkov, J; Dastych, M

    2003-10-01

    Acute bleeding from upper part of gastrointestinal tract is a frequent and serious complication affecting 20 to 60% of patients with liver cirrhosis and portal hypertension. It is associated with a high death rate of 30 to 50% and a frequent relapse of bleeding occurs in up to 40% of these patients. The most recent meta-analyses have shown that bacterial infection is an independent factor in the failure of blood hemostasis and significantly influenced mortality in these patients. The authors investigated 25 patients with acute bleeding from the upper part of gastrointestinal tract due to portal hypertension in patients with liver cirrhosis. Irrespective of the proved bacterial infection the patients were given antibiotic prophylaxis. In 13 patients the authors administered norfloxacin orally and 12 patients were treated intravenously with ampicilin/sulbactam. The prophylaxis of the bleeding cirrhotic patients by norfloxacin (orally) resulted in a statistically significant prevention of early relapse as compared with the therapy by ampicilin/sulbactam (intravenously). The death rate reached 40% in spite of the antibiotic prophylaxis. There was no significant difference in the death rate between the two groups with different treatments. PMID:14682154

  8. Lycopene attenuates early brain injury and inflammation following subarachnoid hemorrhage in rats

    PubMed Central

    Wu, An; Liu, Rongcai; Dai, Weimin; Jie, Yuanqing; Yu, Guofeng; Fan, Xiaofeng; Huang, Qiang

    2015-01-01

    Early brain injury (EBI), following subarachnoid hemorrhage (SAH), includes blood-brain barrier (BBB) disruption and consequent edema formation. This study aims to evaluate the effect of lycopene on early brain injury and inflammation in SAH. Neurological deficits, brain water content and Evans blue dye extravasation were evaluated after the treatment with lycopene. Besides neuronal apoptosis,some inflammatory cytokines were also detected. The results suggested that administration of lycopene following SAH significantly ameliorated EBI, including brain edema, blood-brain barrier (BBB) impairment, cortical apoptosis, and neurological deficits. In addition, it also ameliorated inflammation triggered by SAH. In conclusion, post-SAH lycopene administration may attenuate EBI in SAH, possibly through ameliorating neuronal apoptosis, maintaining BBB integrity and attenuating inflammation. PMID:26550416

  9. Melatonin mitigate cerebral vasospasm after experimental subarachnoid hemorrhage: a study of synchrotron radiation angiography

    NASA Astrophysics Data System (ADS)

    Cai, J.; He, C.; Chen, L.; Han, T.; Huang, S.; Huang, Y.; Bai, Y.; Bao, Y.; Zhang, H.; Ling, F.

    2013-06-01

    Cerebral vasospasm (CV) after subarachnoid hemorrhage (SAH) is a devastating and unsolved clinical issue. In this study, the rat models, which had been induced SAH by prechiasmatic cistern injection, were treated with melatonin. Synchrotron radiation angiography (SRA) was employed to detect and evaluate CV of animal models. Neurological scoring and histological examinations were used to assess the neurological deficits and CV as well. Using SRA techniques and histological analyses, the anterior cerebral artery diameters of SAH rats with melatonin administration were larger than those without melatonin treatment (p < 0.05). The neurological deficits of SAH rats treated with melatonin were less than those without melatonin treatment (p < 0.05). We concluded that SRA was a precise and in vivo tool to observe and evaluate CV of SAH rats; intraperitoneally administration of melatonin could mitigate CV after experimental SAH.

  10. Memantine alleviates brain injury and neurobehavioral deficits after experimental subarachnoid hemorrhage.

    PubMed

    Huang, Chih-Yuan; Wang, Liang-Chao; Wang, Hao-Kuang; Pan, Chia-Hsin; Cheng, Ya-Yun; Shan, Yan-Shen; Chio, Chung-Ching; Tsai, Kuen-Jer

    2015-06-01

    Subarachnoid hemorrhage (SAH) causes brain injury via glutamate excitotoxicity, which leads to an excessive Ca(2+) influx and this starts an apoptotic cascade. Memantine has been proven to reduce brain injury in several types of brain insults. This study investigated the neuro-protective potential of memantine after SAH and explored the underlying mechanisms. An endovascular perforation rat model of SAH was used and Sprague-Dawley rats were randomized into sham surgery, SAH?+?vehicle, and SAH?+?memantine groups. The effects of memantine on SAH were evaluated by assessing the neuro-behavioral functions, blood-brain barrier (BBB) permeability and neuronal cell preservation. The mechanisms of action of memantine, with its N-methyl-D-aspartate (NMDA) antagonistic characteristics on nitric oxide synthase (NOS) expression and peroxynitrite formation, were also investigated. The apoptotic cascade after SAH was suppressed by memantine. Neuronal NOS (nNOS) expression, peroxynitrite formation, and subsequent oxidative/nitrosative stress were also reduced. Memantine effectively preserved BBB integrity, rescued neuronal injury, and improved neurological outcome in experimental SAH. Memantine has neuro-protective potential in experimental SAH and may help combat SAH-induced brain damage in the future. PMID:24952609

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

    PubMed Central

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

    2014-01-01

    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

  12. The Early Endocrine Stress Response in Experimental Subarachnoid Hemorrhage

    PubMed Central

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

    2016-01-01

    Introduction In patients with severe illness, such as aneurysmal subarachnoid hemorrhage (SAH), a physiologic stress response is triggered. This includes activation of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system. The aim of this study was to investigate the very early responses of these systems. Methods A porcine animal model of aneurysmal SAH was used. In this model, blood is injected slowly to the basal cisterns above the anterior skull base until the cerebral perfusion pressure is 0 mm Hg. Sampling was done from blood and urine at -10, +15, +75 and +135 minutes from time of induction of SAH. Analyses of adrenocorticotropic hormone (ACTH), cortisol, aldosterone, catecholamines and chromogranin-A were performed. Results Plasma ACTH, serum cortisol and plasma aldosterone increased in the samples following induction of SAH, and started to decline after 75 minutes. Urine cortisol also increased after SAH. Urine catecholamines and their metabolites were found to increase after SAH. Many samples were however below detection level, not allowing for statistical analysis. Plasma chromogranin-A peaked at 15 minutes after SAH, and thereafter decreased. Conclusions The endocrine stress response after aneurysmal SAH was found to start within 15 minutes in the HPA axis with early peak values of ACTH, cortisol and aldosterone. The fact that the concentrations of the HPA axis hormones decreased 135 minutes after SAH may suggest that a similar pattern exists in SAH patients, thus making it difficult to catch these early peak values. There were also indications of early activation of the sympathetic nervous system, but the small number of valid samples made interpretation difficult. PMID:27007694

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

    PubMed Central

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

    2015-01-01

    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

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

    SciTech Connect

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

    2015-01-24

    Highlights: • Iron accumulation was involved in the acute phase following SAH. • Blockage of MCU could attenuate cellular iron accumulation following SAH. • Blockage of MCU could decrease ROS generation and improve cell energy supply following SAH. • Blockage of MCU could alleviate apoptosis and brain injury following SAH. - Abstract: 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.

  15. Early identification of secondary brain damage in subarachnoid hemorrhage: a role for glial fibrillary acidic protein.

    PubMed

    Petzold, Axel; Keir, Geoffrey; Kerr, Mary; Kay, Andrew; Kitchen, Neil; Smith, Martin; Thompson, Edward J

    2006-07-01

    Secondary ischaemic deficit adversely affects outcome in patients with subarachnoid hemorrhage (SAH). Astrocytes are vulnerable to ischemia, releasing glial fibrillary acidic protein (GFAP) when challenged. In this study, we followed nine patients with SAH who underwent extra-ventricular drainage for the management of secondary hydrocephalus. Cerebrospinal fluid (CSF) was collected daily for up to 14 days. CSF GFAP was quantified using a standard ELISA. In the patients, we found that the CSF GFAP values were pathologically elevated in 83/89 (93%) of the CSF samples. The levels were highest on day 1 (median = 47.64 ng/mL) and decreased to 11.19 ng/mL on day 3, leveling out at approximately 1 ng/mL after 10 days. In non-survivors, a secondary rise of GFAP levels became significant during the high-risk period for vasospasm, with median levels of 21.76 ng/mL compared to 2.62 ng/mL in the survivors (p = 0.037) on day 6. This study suggests that CSF GFAP levels are of prognostic value in SAH. Additionally, the difference in the slope of GFAP levels between survivors (rapid wash-out) and non-survivors (secondary peaks) may allow difierentiation between primary brain injury from secondary brain damage due to delayed cerebral ischaemia. PMID:16866629

  16. Role of levosimendan in the management of subarachnoid hemorrhage.

    PubMed

    Varvarousi, Giolanda; Xanthos, Theodoros; Sarafidou, Pavlina; Katsioula, Ellisavet; Georgiadou, Marianthi; Eforakopoulou, Maria; Pavlou, Hlias

    2016-02-01

    Aneurysmal subarachnoid hemorrhage (aSAH) is one of the leading causes of neurologic disability accounting for dismal long term survival rates. aSAH leads to a sudden increase in intracranial pressure and a massive sympathetic discharge. Excessive sympathetic stimulation leads to catecholamine mediated myocardial dysfunction and hemodynamic instability which may critically hamper brain perfusion and oxygenation. In the setting of acute aSAH, administration of vasoactive drugs aims at stabilizing impaired hemodynamics. However, studies have shown that conventional treatment with vasoactive drugs that lead to Ca(+2) overload and increase myocardial oxygen consumption, fail to restore hemodynamics and decrease cerebral blood flow. Levosimendan is a non-adrenergic inotropic Ca(+2) sensitizer with not only beneficial hemodynamic properties but also pleiotropic effects, contributing to its cardioprotective and neuroprotective role. Although there have been limited data available regarding the use of levosimendan in patients with aSAH, current evidence suggests that levosimendan may have a role in the setting of post-aSAH cardiomyopathy and decreased cerebral blood flow both in the emergency departments and in intensive care units. The purpose of this review is to provide an overview of studies of levosimendan therapy for aSAH, and describe current knowledge about the effects of levosimendan in the management of aSAH. PMID:26669277

  17. Acute abdomen and massive hemorrhage due to placenta percreta leading to spontaneous uterine rupture in the second trimester

    PubMed Central

    Ulkumen, Burcu A.; Pala, Halil G.; Baytur, Yesim

    2014-01-01

    Placental invasion anomalies are rare obstetrical complications. They cause severe third trimester hemorrhage, severe postpartum bleeding, and maternal morbidity and mortality unless they are diagnosed antenatally. We present a rare case with placenta percreta leading to spontaneous uterine rupture during the second trimester with an acute abdomen and hypovolemia. PMID:25228189

  18. Relationship between Postmenopausal Estrogen Deficiency and Aneurysmal Subarachnoid Hemorrhage

    PubMed Central

    Tabuchi, Sadaharu

    2015-01-01

    Aneurysmal subarachnoid hemorrhage (SAH) is one of the most severe forms of stroke, which results from the rupture of a cerebral aneurysm. SAH is the only type of stroke with a female predominance, suggesting that reproductive factors may play a significant role in the etiology. Estrogen has important effects on vascular physiology and pathophysiology of cerebral aneurysm and SAH and, thus, potential therapeutic implications. There have been growing bodies of epidemiological and experimental studies which support the hypothesis of a significant relationship between estrogen deficiency and cerebral aneurysm formation with subsequent SAH. This hypothesis is the focus of this review as well as possible pathology-based therapeutics with regard to aspects of molecular pathophysiology, especially related to women's health. PMID:26538819

  19. Brain interstitial fluid TNF-? after subarachnoid hemorrhage

    PubMed Central

    Hanafy, Khalid A.; Grobelny, Bartosz; Fernandez, Luis; Kurtz, Pedro; Connolly, ES; Mayer, Stephan A.; Schindler, Christian; Badjatia, Neeraj

    2010-01-01

    Objective: TNF-? is an inflammatory cytokine that plays a central role in promoting the cascade of events leading to an inflammatory response. Recent studies have suggested that TNF-? may play a key role in the formation and rupture of cerebral aneurysms, and that the underlying cerebral inflammatory response is a major determinate of outcome following subrarachnoid hemorrhage (SAH). Methods: We studied 14 comatose SAH patients who underwent multimodality neuromonitoring with intracranial pressure (ICP) and cerebral microdialysis as part of their clinical care. Continuous physiological variables were time-locked every 8 hours and recorded at the same point that brain interstitial fluid TNF-? was measured in brain microdialysis samples. Significant associations were determined using generalized estimation equations. Results: Each patient had a mean of 9 brain tissue TNF-? measurements obtained over an average of 72 hours of monitoring. TNF-? levels rose progressively over time. Predictors of elevated brain interstitial TNF-? included higher brain interstitial fluid glucose levels (?=0.066, P<0.02), intraventricular hemorrhage (?=0.085, P<0.021), and aneurysm size >6 mm (?=0.14, p<0.001). There was no relationship between TNF-? levels and the burden of cisternal SAH; concurrent measurements of serum glucose, or lactate-pyruvate ratio. Interpretation: Brain interstitial TNF-? levels are elevated after SAH, and are associated with large aneurysm size, the burden of intraventricular blood, and elevation brain interstitial glucose levels. PMID:20110094

  20. 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 ...

  1. Aneurysmal subarachnoid hemorrhage: relationship to solar activity in the United States, 1988-2010.

    PubMed

    Rosenbaum, Benjamin P; Weil, Robert J

    2014-07-01

    Aneurysmal subarachnoid hemorrhage (SAH) is a common condition treated by neurosurgeons. The inherent variability in the incidence and presentation of ruptured cerebral aneurysms has been investigated in association with seasonality, circadian rhythm, lunar cycle, and climate factors. We aimed to identify an association between solar activity (solar flux and sunspots) and the incidence of aneurysmal SAH, all of which appear to behave in periodic fashions over long time periods. The Nationwide Inpatient Sample (NIS) provided longitudinal, retrospective data on patients hospitalized with SAH in the United States, from 1988 to 2010, who underwent aneurysmal clipping or coiling. Solar activity and SAH incidence data were modeled with the cosinor methodology and a 10-year periodic cycle length. The NIS database contained 32,281 matching hospitalizations from 1988 to 2010. The acrophase (time point in the cycle of highest amplitude) for solar flux and for sunspots were coincident. The acrophase for aneurysmal SAH incidence was out of phase with solar activity determined by non-overlapping 95% confidence intervals (CIs). Aneurysmal SAH incidence peaks appear to be delayed behind solar activity peaks by 64 months (95% CI; 56-73 months) when using a modeled 10-year periodic cycle. Solar activity (solar flux and sunspots) appears to be associated with the incidence of aneurysmal SAH. As solar activity reaches a relative maximum, the incidence of aneurysmal SAH reaches a relative minimum. These observations may help identify future trends in aneurysmal SAH on a population basis. PMID:24979701

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

    PubMed

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

    2015-01-24

    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

  3. Protein expression levels in the medullary visceral zone of rats with subarachnoid hemorrhage.

    PubMed

    Sun, L H; Xing, L F; Zhang, G H; Pan, S Y

    2015-01-01

    We investigated protein expression in the medullary visceral zone (MVZ) of rats with multiple-organ dysfunction syndrome (MODS) caused by subarachnoid hemorrhage (SAH) to discuss the possible regulatory mechanism of the MVZ in the course of SAH-induced MODS. A SAH-induced MODS model was established in rats by injecting arterial blood into the Willis' circle. Protein expression in the MVZ was analyzed by immunohistochemistry assay. Protein expression in the MVZ peaked 24-36 h after SAH, and was significantly higher than in the control and sham operation groups. Organs at each time point exhibited inflammatory injuries to varying degrees after SAH, which reached a maximum at 24-36 h. Incidences of systemic inflammatory response syndrome and MODS were 100 and 71.67%, respectively, after SAH. There is a consistency between MVZ protein expression and inflammatory changes in each organ after SAH. This prompts the suggestion that the MVZ may be one of the direct regulative centers in SAH-induced MODS, and may be involved in the functional regulation of the surrounding organs after SAH. PMID:26345815

  4. Spontaneous intracranial hemorrhage in children: report of a hemophilia patient who survived due to a brain cyst

    PubMed Central

    Colleti Junior, Jos; Koga, Walter; de Carvalho, Werther Brunow

    2015-01-01

    We report the case of a 2-year-old child who survived an acute episode of severe spontaneous intracranial hemorrhage with clinical and radiological signs of intracranial hypertension and transtentorial herniation. The patient underwent emergency surgery to drain the hematoma, and a catheter was inserted to monitor intracranial pressure. In the initial computed tomography analysis performed prior to hematoma drainage, a brain cyst was evident contralateral to the hematoma, which, based on the analysis by the care team, possibly helped to avoid a worse outcome because the cyst accommodated the brain after the massive hemorrhage. After the investigation, the patient was determined to have previously undiagnosed hemophilia A. The patient underwent treatment in intensive care, which included the control of intracranial pressure, factor VIII replacement and discharge without signs of neurological impairment. PMID:26761482

  5. Ruptured internal carotid artery bifurcation aneurysm presenting with only intracerebral hemorrhage without subarachnoid hemorrhage--case report.

    PubMed

    Yamamoto, Naoki; Terakawa, Yuzo; Okada, Yumiko; Mitsuhashi, Yutaka; Nishio, Akimasa; Shimotake, Katsumi; Murata, Takaho

    2011-01-01

    A 55-year-old man presented with intracerebral hemorrhage (ICH) without subarachnoid hemorrhage (SAH) manifesting as acute onset of consciousness disturbance and right hemiparesis. Computed tomography showed ICH mainly localized in the left putamen, but no evidence of SAH. Magnetic resonance angiography demonstrated a cerebral aneurysm originating from the bifurcation of the left internal carotid artery, which was considered to be responsible for the ICH. The patient underwent emergent intravascular surgery for coil embolization of the aneurysm, and his neurological symptoms gradually recovered with rehabilitation after surgery. Although ICH without SAH is a rare presentation of cerebral aneurysm, ruptured cerebral aneurysm should be considered as a potential cause of ICH. The localization and extent of ICH may be suggestive of latent cerebral aneurysm in such cases. PMID:21358153

  6. Cannabinoid Receptor Type 2 Agonist Attenuates Acute Neurogenic Pulmonary Edema by Preventing Neutrophil Migration after Subarachnoid Hemorrhage in Rats.

    PubMed

    Fujii, Mutsumi; Sherchan, Prativa; Soejima, Yoshiteru; Doycheva, Desislava; Zhao, Diana; Zhang, John H

    2016-01-01

    We evaluated whether JWH133, a selective cannabinoid type 2 receptor (CB2R) agonist, prevented neurogenic pulmonary edema (NPE) after subarachnoid hemorrhage (SAH) by attenuating inflammation. Adult male rats were assigned to six groups: sham-operated, SAH with vehicle, SAH with JWH133 (0.3, 1.0, or 3.0 mg/kg) treatment 1 h after surgery, and SAH with JWH133 (1.0 mg/kg) at 1 h with a selective CB2R antagonist, SR144528 (3.0 mg/kg). The perforation model of SAH was performed and pulmonary wet-to-dry weight ratio was evaluated 24 and 72 h after surgery. Western blot analyses and immunohistochemistry were evaluated 24 h after surgery. JWH133 (1.0 mg/kg) significantly and most strongly improved lung edema 24 h after SAH. SR144528 administration significantly reversed the effects of JWH133 (1.0 mg/kg). SAH-induced increasing levels of myeloperoxidase (MPO) and decreasing levels of a tight junction (TJ) protein, junctional adhesion molecule (JAM)-A, were ameliorated by JWH133 (1.0 mg/kg) administration 24 h after SAH. Immunohistochemical assessment also confirmed substantial leukocyte infiltration in the outside of vessels in SAH, which were attenuated by JWH133 (1.0 mg/kg) injection. CB2R agonist ameliorated lung permeability by inhibiting leukocyte trafficking and protecting tight junction proteins in the lung of NPE after SAH. PMID:26463937

  7. The Effect of Gender on Acute Hydrocephalus after Experimental Subarachnoid Hemorrhage.

    PubMed

    Shishido, Hajime; Zhang, Haining; Okubo, Shuichi; Hua, Ya; Keep, Richard F; Xi, Guohua

    2016-01-01

    Acute hydrocephalus is a common complication of subarachnoid hemorrhage (SAH). We investigated the effect of gender on acute hydrocephalus development in a rat SAH model. SAH was induced in adult male and female Sprague-Dawley rats using endovascular perforation. Sham rats underwent the same procedure without perforation. Magnetic resonance imaging (MRI) was performed 24 h after SAH to determine ventricular volume. Hydrocephalus was defined as a ventricular volume that was more than 3 standard deviations from the mean value in sham-operated animals. After MRI, animals were euthanized and the extent of SAH was assessed using a modified grading system. No sham animals died. Mortality rates after SAH induction in male and female animals were 27 and 22 %, respectively. SAH induced significant ventricular enlargement compared with sham-operated rats (p < 0.01). The T2* hypointensity volume in the ventricle (used to assess intraventricular blood) was correlated with ventricular volume after SAH (r = 0.33, p < 0.05). The incidence of acute hydrocephalus 24 h after SAH was greater in female (75 %) than in male animals (47 %, p < 0.05) and the relative changes in ventricular volume were significantly larger in female than in male rats (292 ± 150 % vs 216 ± 127 % of sham-operated animals, respectively, p < 0.05). The increased hydrocephalus occurred even though SAH severity grade and ventricular T2* hypointensity volumes were not significantly different between male and female animals. Our data demonstrate that gender influences acute hydrocephalus development in a rat SAH model. Future studies should determine the role of estrogen in SAH-induced hydrocephalus. PMID:26463971

  8. Life satisfaction and return to work after aneurysmal subarachnoid hemorrhage.

    PubMed

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

    2011-01-01

    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

  9. Subarachnoid Hemorrhage Secondary to Forceful Sneeze

    PubMed Central

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

    2015-01-01

    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. PMID:25685569

  10. Intraoperative idiopathic subarachnoid hemorrhage during carotid artery stenting: A case report and literature review.

    PubMed

    Okamura, Akitake; Nakaoka, Mitsuo; Ohbayashi, Naohiko; Yahara, Kaita; Nabika, Shinya

    2015-10-01

    Carotid artery stenting (CAS) has a fatal complication of intracranial hemorrhage (ICH) associated with cerebral hyperperfusion syndrome (CHS), i.e. brain hemorrhage and subarachnoid hemorrhage (SAH). Although SAH accounts for a small percentage of these patients, it is difficult to make a differential diagnosis of this syndrome from CHS without ICH because the clinical presentations resemble each other. Furthermore, not only does the cause of SAH following CAS remain unclear but also the role of controlling postoperative blood pressure is not detected in preventing ICH after CAS. Herein, we report a case of SAH following CAS and review previous literature to discuss the mechanism and the management of this fatal complication. A 78-year-old woman with a history of arteriosclerotic obliteration and myocardial infarction was referred to our department for intervention to asymptomatic severe stenosis of the right internal carotid artery. We performed CAS under local anesthesia. Although her blood pressure was controlled to normotension during the procedure, the patient complained of headache following predilation. Postoperative emergent non-contrast computed tomography revealed SAH with leakage of contrast medium occupying the right sylvian fissure. We continued strict blood pressure control, and the patient was discharged without any neurological deficit. A well-opened lumen of the stent was recognized three months later at the outpatient visit. Strict control of intraoperative and postoperative blood pressure may improve the outcome of SAH following CAS though the role in preventing ICH after CAS is unclear. PMID:26184053

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

    PubMed Central

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

    2013-01-01

    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

  12. Sex Differences in the Formation of Intracranial Aneurysms and Incidence and Outcome of Subarachnoid Hemorrhage: Review of Experimental and Human Studies.

    PubMed

    Turan, Nefize; Heider, Robert Allen-James; Zaharieva, Dobromira; Ahmad, Faiz U; Barrow, Daniel L; Pradilla, Gustavo

    2016-02-01

    Intracranial aneurysms are defined as pathological dilatations of cerebral arteries and rupture of intracranial aneurysms leads to subarachnoid hemorrhage (SAH). The goal of this review was to outline the sex differences in the formation and progression of intracranial aneurysms as well as sex-related differences in incidence and outcome of SAH. The literature review was performed using PubMed with a combination of these search terms: "subarachnoid hemorrhage," "incidence," "outcome," "sex," "gender," "male," "female," "experimental," "mice," and "rats." Studies written in English were used. Female sex is thought to be a risk factor for aneurysm formation, especially in postmenopausal age populations, suggesting the potential protective involvement of sex steroids. Female sex is also considered a risk factor for SAH occurrence. Although incidence and mortality are confirmed to be higher in females in most studies, they elucidated no clear differences in the functional outcome among SAH survivors. The effect of gender on the pathophysiology of SAH is not very well understood; nevertheless, the majority of pre-clinical studies suggest a beneficial effect of sex steroids in experimental SAH. Moreover, conflicting results exist on the role and effect of hormone replacement therapies and oral contraceptive pills on the incidence and outcome of human SAH. Sex differences exist in the formation of aneurysms as well as the incidence and mortality of SAH. Potential therapeutic effects of sex steroids have been replicated in many animal studies, but their potential use in the treatment of acute SAH in human populations needs more future study. PMID:26573918

  13. Whole Blood Gene Expression Profiles of Patients with a Past Aneurysmal Subarachnoid Hemorrhage

    PubMed Central

    van ’t Hof, Femke N. G.; Ruigrok, Ynte M.; Medic, Jelena; Sanjabi, Bahram; van der Vlies, Pieter; Rinkel, Gabriel J. E.; Veldink, Jan H.

    2015-01-01

    Background The pathogenesis of development and rupture of intracranial aneurysms (IA) is largely unknown. Also, screening for IA to prevent aneurysmal subarachnoid hemorrhage (aSAH) is inefficient, as disease markers are lacking. We investigated gene expression profiles in blood of previous aSAH patients, who are still at risk for future IA, aiming to gain insight into the pathogenesis of IA and aSAH, and to make a first step towards improvement of aSAH risk prediction. Methods and Results We collected peripheral blood of 119 patients with aSAH at least two years prior, and 118 controls. We determined gene expression profiles using Illumina HumanHT-12v4 BeadChips. After quality control, we divided the dataset in a discovery (2/3) and replication set (1/3), identified differentially expressed genes, and applied (co-)differential co-expression to identify disease-related gene networks. No genes with a significant (false-discovery rate <5%) differential expression were observed. We detected one gene network with significant differential co-expression, but did not find biologically meaningful gene networks related to a history of aSAH. Next, we applied prediction analysis of microarrays to find a gene set that optimally predicts absence or presence of a history of aSAH. We found no gene sets with a correct disease state prediction higher than 40%. Conclusions No gene expression differences were present in blood of previous aSAH patients compared to controls, besides one differentially co-expressed gene network without a clear relevant biological function. Our findings suggest that gene expression profiles, as detected in blood of previous aSAH patients, do not reveal the pathogenesis of IA and aSAH, and cannot be used for aSAH risk prediction. PMID:26439625

  14. Hemorrhagic stomatitis in a natural hybrid of Vipera ammodytes × Vipera berus due to inappropriate substrate in terrarium

    PubMed Central

    CZIRJÁK, Gábor Árpád; KÖBÖLKUTI, Lóránd Béla; TENK, Miklós; SZAKÁCS, Attila; KELEMEN, Attila; SPÎNU, Marina

    2015-01-01

    A natural hybrid of Vipera ammodytes × Vipera berus was presented having low body weight, seizures and generalized swelling of the cephalic region. Based on the history of the case and clinical examination, hemorrhagic stomatitis of traumatic origin was diagnosed. The snake was kept in a terrarium with wood chips as a substrate, and the material had induced trauma in the oral mucosa which was further complicated with Salmonella Arizonae and Morganella morganii co-infection, abscessation and osteomyelitis. To the best of the authors’ knowledge, this is the first reported case of bacterial infection in European snake hybrids and one of a few case reports in European snakes. Although wood chips are an inexpensive substrate, based on our findings, they should be avoided when keeping and breeding European vipers. PMID:25715871

  15. Hemorrhagic stomatitis in a natural hybrid of Vipera ammodytes Vipera berus due to inappropriate substrate in terrarium.

    PubMed

    Czirjk, Gbor rpd; Kblkuti, Lrnd Bla; Tenk, Mikls; Szakcs, Attila; Kelemen, Attila; Spnu, Marina

    2015-06-01

    A natural hybrid of Vipera ammodytes Vipera berus was presented having low body weight, seizures and generalized swelling of the cephalic region. Based on the history of the case and clinical examination, hemorrhagic stomatitis of traumatic origin was diagnosed. The snake was kept in a terrarium with wood chips as a substrate, and the material had induced trauma in the oral mucosa which was further complicated with Salmonella Arizonae and Morganella morganii co-infection, abscessation and osteomyelitis. To the best of the authors' knowledge, this is the first reported case of bacterial infection in European snake hybrids and one of a few case reports in European snakes. Although wood chips are an inexpensive substrate, based on our findings, they should be avoided when keeping and breeding European vipers. PMID:25715871

  16. Blood clot placement model of subarachnoid hemorrhage in non-human primates.

    PubMed

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

    2015-01-01

    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

  17. [The relationship between aneurysmal subarachnoid hemorrhage and meteorological parameters based on a series of 236 French patients].

    PubMed

    Rué, M; Camiade, E; Jecko, V; Bauduer, F; Vignes, J-R

    2014-10-01

    Subarachnoid hemorrhage (SAH) is a sudden and potentially severe event with mortality rates ranging between 24 and 30 % depending on the initial clinical condition. Studies have attempted to assess the possible influence of meteorological parameters on the occurrence of SAH. However, this idea remains very controversial and the results vary widely from one study to another. Our study is the second largest French series, and first performed in a homogeneous series of patients. The aim of our study was to attempt to establish a relationship between the weather (i.e.) temperature variations and daily variations of atmospheric pressure in the days before the onset of SAH and the same day and the occurrence of non-traumatic SAH in a homogeneous population of 236 patients from a single center, over a period of 7 years (2002 to 2008). This retrospective study does not suggest any relationship between the occurrence of SAH and meteorological data studied. Moreover, no relationship was observed between mean changes in temperature or pressure and the occurrence of SAH, that the day of the bleeding or the days preceding the SAH. However, a female predominance was observed and a relatively high mortality rate of 18.3 %. The distribution of the occurrence of an SAH was random. As it seems impossible to provide logistics and organization of care for non-traumatic SAH, the care system must remain vigilant throughout the year. PMID:24856315

  18. 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 ...

  19. Changes in the metabolism of sphingolipids after subarachnoid hemorrhage.

    PubMed

    Testai, Fernando D; Xu, Hao-Liang; Kilkus, John; Suryadevara, Vidyani; Gorshkova, Irina; Berdyshev, Evgeny; Pelligrino, Dale A; Dawson, Glyn

    2015-05-01

    We previously described how ceramide (Cer), a mediator of cell death, increases in the cerebrospinal fluid (CSF) of subarachnoid hemorrhage (SAH) patients. This study investigates the alterations of biochemical pathways involved in Cer homeostasis in SAH. Cer, dihydroceramide (DHC), sphingosine-1-phosphate (S1P), and the activities of acid sphingomyelinase (ASMase), neutral sphingomyelinase (NSMase), sphingomyelinase synthase (SMS), S1P-lyase, and glucosylceramide synthase (GCS) were determined in the CSF of SAH subjects and in brain homogenate of SAH rats. Compared with controls (n?=?8), SAH patients (n?=?26) had higher ASMase activity (10.0??3.5 IF/l min vs. 15.0??4.6 IF/l min; P?=?0.009) and elevated levels of Cer (11.4??8.8 pmol/ml vs. 33.3??48.3 pmol/ml; P?=?0.001) and DHC (1.3??1.1 pmol/ml vs. 3.8??3.4 pmol/ml; P?=?0.001) in the CSF. The activities of GCS, NSMase, and SMS in the CSF were undetectable. Brain homogenates from SAH animals had increased ASMase activity (control: 9.7??1.2 IF/g min; SAH: 16.8??1.6 IF/g min; P?SAH: 7,073??2,467 fmol/nmol of total lipid P; P?SAH was associated with a reduction of 60% in S1P levels, a 40% increase in S1P-lyase activity, and a twofold increase in the activity of GCS. In comparison, NSMase and SMS activities were similar to controls and SMS activities similar to controls. In conclusion, our results show an activation of ASMase, S1P-lyase, and GCS resulting in a shift in the production of protective (S1P) in favor of deleterious (Cer) sphingolipids after SAH. Additional studies are needed to determine the effect of modulators of the pathways described here in SAH. PMID:25597763

  20. Prevalence of thoracic aortopathy in patients with juvenile Polyposis Syndrome-Hereditary Hemorrhagic Telangiectasia due to SMAD4.

    PubMed

    Heald, Brandie; Rigelsky, Christina; Moran, Rocio; LaGuardia, Lisa; O'Malley, Margaret; Burke, Carol A; Zahka, Kenneth

    2015-08-01

    Hereditary hemorrhagic telangiectasia (HHT) is characterized by abnormal vascular structures that may present as epistaxis, telangiectasias, and/or arteriovenous malformations. The genes associated with HHT (ACVRL1, ENG, and SMAD4) are members of the TGF? pathway. Other syndromes associated with abnormalities in TGF? signaling include Marfan syndrome, Loeys-Dietz syndrome and related disorders. These disorders have aortic disease as a prominent finding. While there are case reports of patients with HHT and aortopathy (dilatation/aneurysm, dissection, and rupture), this has not been systematically investigated. We conducted a retrospective chart review to determine the prevalence of aortopathy in an HHT cohort. Patients from a single institution were identified who met the Curacao Criteria for a clinical diagnosis of HHT and/or had a mutation in ACVRL1, ENG, or SMAD4 and underwent echocardiogram. Two-dimensional echocardiograms were reviewed by a single pediatric cardiologist, and data were collected on demographics, genotype, HHT features, aortic root measurements, past medical history, and family history. Z scores and nomograms were utilized to identify abnormal results. Twenty-six patients from 15 families (one ACVRL1, four ENG, eight SMAD4, and two clinical diagnoses) were included in the analysis. Aortopathy was found in 6/26 (23%) patients; all had SMAD4 mutations. In our cohort, 6/16 (38%) SMAD4 mutation carriers had evidence of aortopathy. These data suggest that aortopathy could be part of the spectrum of SMAD4-induced HHT manifestations. Routine aortic imaging, including measurements of the aorta, should be considered in patients with SMAD4 mutations to allow for appropriate medical and surgical recommendations. PMID:25931195

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

    PubMed

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

    2004-01-01

    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

  2. Transcranial Doppler sonography within 12 hours after subarachnoid hemorrhage.

    PubMed

    Romner, B; Ljunggren, B; Brandt, L; Sveland, H

    1989-05-01

    Twenty-one patients were subjected to repeated assessment of cerebral blood flow velocities by means of transcranial Doppler sonography (TCDS) during the first 12 hours after subarachnoid hemorrhage (SAH). In 19 patients the study was performed following the first SAH, and in two after early rebleeds. Flow velocities did not indicate an early phase of arterial narrowing in any case. Following the first TCDS assessment, flows were evaluated repeatedly in the 19 survivors. Increased flow velocities suggesting arterial narrowing or vasospasm occurred only after a delay of at least 4 days. The results of this study favor the restoration of normal velocity patterns in surviving patients and do not indicate that an acute phase of vasospasm exists either immediately after or in the first 12 hours after SAH. PMID:2651585

  3. Subarachnoid hemorrhage and the distribution of drugs delivered into the cerebrospinal fluid

    PubMed Central

    Pluta, Ryszard M.; Butman, John A.; Schatlo, Bawarjan; Johnson, Dennis L.; Oldfield, Edward H.

    2016-01-01

    Object Investigators in experimental and clinical studies have used the intrathecal route to deliver drugs to prevent or treat vasospasm. However, a clot near an artery or arteries after subarachnoid hemorrhage (SAH) may hamper distribution and limit the effects of intrathecally delivered compounds. In a primate model of right middle cerebral artery (MCA) SAH, the authors examined the distribution of Isovue-M 300 and 3% Evans blue after infusion into the cisterna magna CSF. Methods Ten cynomolgus monkeys were assigned to SAH and sham SAH surgery groups (5 in each group). Monkeys received CSF injections as long as 28 days after SAH and were killed 3 hours after the contrast/Evans blue injection. The authors assessed the distribution of contrast material on serial CT within 2 hours after contrast injection and during autopsy within 3 hours after Evans blue staining. Results Computed tomography cisternographies showed no contrast in the vicinity of the right MCA (p < 0.05 compared with left); the distribution of contrast surrounding the entire right cerebral hemisphere was substantially reduced. Postmortem analysis demonstrated much less Evans blue staining of the right hemisphere surface compared with the left. Furthermore, the Evans blue dye did not penetrate into the right sylvian fissure, which occurred surrounding the left MCA. The authors observed the same pattern of changes and differences in contrast distribution between SAH and sham SAH animals and between the right and the left hemispheres on Days 1, 3, 7, 14, 21, and 28 after SAH. Conclusions Intrathecal drug distribution is substantially limited by SAH. Thus, when using intrathecal drug delivery after SAH, vasoactive drugs are unlikely to reach the arteries that are at the highest risk of delayed cerebral vasospasm. PMID:19374502

  4. Elevated relative risk of aneurysmal subarachnoid hemorrhage with colder weather in the mid-Atlantic region.

    PubMed

    Rivera-Lara, Lucia; Kowalski, Robert G; Schneider, Eric B; Tamargo, Rafael J; Nyquist, Paul

    2015-10-01

    We have previously reported an increase of 0.6% in the relative risk of aneurysmal subarachnoid hemorrhage (aSAH) in response to every 1F decrease in the maximum daily temperature (Tmax) in colder seasons from patients presenting to our regional tertiary care center. We hypothesized that this relationship would also be observed in the warmer summer months with ambient temperatures greater than 70F. From prospectively collected incidence data for aSAH patients, we investigated absolute Tmax, average daily temperatures, intraday temperature ranges, and the variation of daily Tmax relative to 70F to assess associations with aSAH incidence for patients admitted to our institution between 1991 and 2009 during the hottest months and days on which Tmax>70F. For all days treated as a group, the mean Tmax ( standard deviation) was lower when aSAH occurred than when it did not (64.418.2F versus 65.818.3F; p=0.016). During summer months, the odds ratio (OR) of aSAH incidence increased with lower mean Tmax (OR 1.019; 95% confidence interval 1.001-1.037; p=0.043). The proportion of days with aSAH admissions was lower on hotter days than the proportion of days with no aSAH (96% versus 98%; p=0.006). aSAH were more likely to occur during the summer and on days with a temperature fluctuation less than 10F (8% versus 4%; p=0.002). During the hottest months of the year in the mid-Atlantic region, colder maximum daily temperatures, a smaller heat burden above 70F, and smaller intraday temperature fluctuations are associated with increased aSAH admissions in a similar manner to colder months. These findings support the hypothesis that aSAH incidence is more likely with drops in temperature, even in the warmer months. PMID:26149403

  5. Expression of Cytoplasmic Gelsolin in Rat Brain After Experimental Subarachnoid Hemorrhage.

    PubMed

    Xie, Guang-Bin; Wang, Chun-Xi; Zhou, Chen-Hui; Li, Hua; Zhang, Xiang-Sheng; Zhou, Xiao-Ming; Zhang, Li; Hang, Chun-Hua; Zhou, Meng-Liang; Shi, Ji-Xin

    2015-07-01

    Convincing evidence indicates that apoptosis contributes to the unfavorable prognosis of subarachnoid hemorrhage (SAH), a significant cause of morbidity and case fatality throughout the world. Gelsolin (GSN) is a Ca(2+)-dependent actin filament severing, capping, and nucleating protein, as well as multifunctional regulator of cell structure and metabolism, including apoptosis. In the present study, we intended to investigate the expression pattern and cell distribution of GSN in rat brain after experimental SAH. GSN expression was examined in sham group and at 3, 6, 12 h, day 1 (1 day), 2, 3, 5, and 7 days after SAH by Western blot analysis as well as real-time polymerase chain reaction. Immunohistochemistry and immunofluorescence were performed to detect the localization of GSN. The level of GSN protein expression was significantly decreased in SAH group and reached a bottoming point on 1 day after SAH. GSN mRNA level was significantly decreased in SAH groups in comparison with the sham group, and reached a minimum value at 12 h after SAH. Immunohistochemistry showed that GSN was constitutively and obviously expressed in the cortex of the normal rat brain and significantly decreased in the rat cortex after SAH. In addition, immunofluorescence results revealed that GSN expression could be found in both neurons and microglias, as well as in glialfibrillary acidic protein-positive astrocytes. The decreased expression of GSN could mainly be found in neurons and astrocytes as well, and GSN-positive microglias showed different cell morphological characteristics. Interestingly, the protein and gene levels of GSN seemed to be constant in the rat hippocampus of sham and SAH groups. These findings suggested a potential role of GSN in the pathophysiology of the brain at the early stage of SAH. PMID:25744577

  6. Acute and delayed vasoconstriction after subarachnoid hemorrhage: local cerebral blood flow, histopathology, and morphology in the rat basilar artery.

    PubMed

    Alkan, T; Tureyen, K; Ulutas, M; Kahveci, N; Goren, B; Korfali, E; Ozluk, K

    2001-04-01

    The decreased local cerebral blood flow (LCBF) and cerebral ischemia that occur after subarachnoid hemorrhage (SAH) may be caused by acute and/or delayed vasospasm. In 36 Sprague-Dawley (350-450 g) rats SAH was induced by transclival puncture of the basilar artery. Mean arterial blood pressure (MABP), LCBF, intracranial pressure (ICP), and cerebral perfusion pressure (CPP) were measured in all rats for 30 min before and 60 min after SAH was induced. One set of control (n : 7) and experimental animals (n : 7) was sacrificed after the 60 min of initial post-hemorrhage measurements were recorded. Four days after SAH induction, LCBF and MABP were measured again for 60 min in subgroups of surviving experimental rats (n : 7) and control rats (n : 7). Histopathologic and morphologic examinations of the basilar artery were performed in each subgroup. There was a sharp drop in LCBF just after SAH was induced (55.50 +/- 11.46 mlLD/min/100 g and 16.1 +/- 3.6 mlLD/min/100 g for baseline and post-SAH, respectively; p < 0.001). The flow then gradually increased but had not returned to pre-SAH values by 60 min (p < 0.05). At 4 days after SAH induction, although LCBF was lower than that observed in the control group and pre-SAH values, it was not significantly different from either of these flow rates (p > 0.05). ICP (baseline 7.05 +/- 0.4 mmHg) increased acutely to 75.2 +/- 7.1 mmHg, but returned to normal levels by 60 min after SAH. CPP (baseline 84.5 +/- 6.3 mmHg) dropped accordingly (to 18.6 +/- 3.1 mmHg), and then increased, reaching 72.2 +/- 4.9 mmHg at 60 min after SAH (p > 0.05). Examinations of the arteries revealed decreased inner luminal diameter and distortion of the elastica layer in the early stage. LCBF in nonsurviver rats (n : 8) was lower than that in the animals that survived (p < 0.01). At 4 days post-hemorrhage, the rats' basilar arteries showed marked vasculopathy. The findings showed that acute SAH alters LCBF, ICP, and CPP, and that decreased LCBF affects mortality rate. Subsequent vasculopathy occurs in delayed fashion, and this was observed at 4 days after the hemorrhage event. PMID:11780775

  7. Effect of subarachnoid hemorrhage on contractile responses and noradrenaline release evoked in cat cerebral arteries by histamine

    SciTech Connect

    Lobato, R.D.; Marin, J.; Salaices, M.; Rico, M.L.; Sanchez, C.F.

    1981-10-01

    This study analyzes the changes induced by subarachnoid hemorrhage (SAH) on the contractile responses and the noradrenaline release evoked in cat cerebral arteries by histamine. The dose-dependent vasoconstriction induced by histamine on the cerebral arteries of normal cats was significantly reduced by diphenhydramine and phentolamine. When SAH was produced 3 and 7 days before the experiment, the histamine-induced vasoconstriction also decreased. Thereafter, a tendency to normalization in the contractile vascular responses was observed such that in 15 days after the hemorrhage it was not significantly different from that found in controls animals. The decrease in the contractile responses to histamine provoked by SAH was similar to that seen after pretreatment with intracisternal injections of 6-hydroxydopamine. The amount of radioactivity released by histamine following preincubation with /sup 3/H-noradrenaline from the cerebral arteries of cats exposed to SAH 3, 7, and 15 days before the experiment was significantly reduced when compared with controls. Moreover, the basal level of tritium release and the radioactivity retained at the end of the experiment were also decreased after SAH. Results indicate histamine releases noradrenaline from cat cerebral arteries, and SAH produce a transient denervation of the perivascular adrenergic nerve endings, which explained by the impairment of the indirect adrenergic mechanism involved in the overall contractile response elicited by this amine in cerebral arteries. Histamine does not seem to play a significant role in the production of the cerebral vasospasm occurring after SAH.

  8. Cerebral vasospasm following traumatic subarachnoid hemorrhage

    PubMed Central

    Aminmansour, Bahram; Ghorbani, Abbas; Sharifi, Davood; Shemshaki, Hamidreza; Ahmadi, Amin

    2009-01-01

    Background: Cerebral vasospasm is a preventable cause of death and disability in patients who experience aneurysmal subarachnoid hemorrhage (SAH). The aim of this study is to investigate the incidence of cerebral vasospasm following traumatic SAH and its relationship with different brain injuries and severity of trauma. Methods: This cross-sectional study was conducted from October 2006 to March 2007 in department of Neurosurgery in Al-Zahra Hospital. Consecutive head-injured patients who had SAH on the basis of an admission CT scan were prospectively evaluated. The severity of the trauma was evaluated by determining Glasgow Coma Scale (GCS) score on admission. Transcranial Doppler ultrasonography evaluations were performed at least 48 hours after admission and one week thereafter. Vasospasm in the MCA and ACA was defined by mean flow velocity (FV) of more than 120 cm/sec with a Lindegaard index (MVA/ICA FV ratio) higher than 3. Basilar artery vasospasm was defined by FV higher than 85 cm/sec. Results: Seventy seven patients with tSAH were enrolled from whom 13 were excluded. The remaining were 52 (81.2%) men and 12 (18.7%) women, with a mean age of 37.89 years. Trauma was severe in 11 (17.2%), moderate in 13 (20.3%), and mild in 40 (62.5%) patients. From all, 27 patients (42.1%) experienced at least one vasospasm during the study period and MCA vasospasm was the most common in the first and second weeks (55.5%). Conclusions: Traumatic SAH is associated with a high incidence of cerebral vasospasm with a higher probability in patients with severe TBI. PMID:21772907

  9. Functional response of cerebral blood flow induced by somatosensory stimulation in rats with subarachnoid hemorrhage.

    PubMed

    Li, Zhiguo; Huang, Qin; Liu, Peng; Li, Pengcheng; Ma, Lianting; Lu, Jinling

    2015-09-01

    Subarachnoid hemorrhage (SAH) is often accompanied by cerebral vasospasm (CVS), which is the phenomenon of narrowing of large cerebral arteries, and then can produce delayed ischemic neurological deficit (DIND) such as lateralized sensory dysfunction. CVS was regarded as a major contributor to DIND in patients with SAH. However, therapy for preventing vasospasm after SAH to improve the outcomes may not work all the time. It is important to find answers to the relationship between CVS and DIND after SAH. How local cerebral blood flow (CBF) is regulated during functional activation after SAH still remains poorly understood, whereas, the regulation of CBF may play an important role in weakening the impact of CVS on cortex function. Therefore, it is worthwhile to evaluate the functional response of CBF in the activated cortex in an SAH animal model. Most evaluation of the effect of SAH is presently carried out by neurological behavioral scales. The functional imaging of cortical activation during sensory stimulation may help to reflect the function of the somatosensory cortex more locally than the behavioral scales do. We investigated the functional response of CBF in the somatosensory cortex induced by an electrical stimulation to contralateral forepaw via laser speckle imaging in a rat SAH model. Nineteen Sprague-Dawley rats from two groups (control group, n=10 and SAH group, n=9) were studied. SAH was induced in rats by double injection of autologous blood into the cisterna magna after CSF aspiration. The same surgical procedure was applied in the control group without CSF aspiration or blood injection. Significant CVS was found in the SAH group. Meanwhile, we observed a delayed peak of CBF response in rats with SAH compared with those in the control group, whereas no significant difference was found in magnitude, duration, and areas under curve of relative CBF changes between the two groups. The results suggest that the regulation function of local CBF during functional activation induced by somatosensory stimulation might not be seriously impaired in the somatosensory cortex of rats with SAH. Therefore, our findings might help to understand the clinical phenomenon that DIND might not occur even when CVS was found in SAH patients. PMID:26358821

  10. Functional response of cerebral blood flow induced by somatosensory stimulation in rats with subarachnoid hemorrhage

    NASA Astrophysics Data System (ADS)

    Li, Zhiguo; Huang, Qin; Liu, Peng; Li, Pengcheng; Ma, Lianting; Lu, Jinling

    2015-09-01

    Subarachnoid hemorrhage (SAH) is often accompanied by cerebral vasospasm (CVS), which is the phenomenon of narrowing of large cerebral arteries, and then can produce delayed ischemic neurological deficit (DIND) such as lateralized sensory dysfunction. CVS was regarded as a major contributor to DIND in patients with SAH. However, therapy for preventing vasospasm after SAH to improve the outcomes may not work all the time. It is important to find answers to the relationship between CVS and DIND after SAH. How local cerebral blood flow (CBF) is regulated during functional activation after SAH still remains poorly understood, whereas, the regulation of CBF may play an important role in weakening the impact of CVS on cortex function. Therefore, it is worthwhile to evaluate the functional response of CBF in the activated cortex in an SAH animal model. Most evaluation of the effect of SAH is presently carried out by neurological behavioral scales. The functional imaging of cortical activation during sensory stimulation may help to reflect the function of the somatosensory cortex more locally than the behavioral scales do. We investigated the functional response of CBF in the somatosensory cortex induced by an electrical stimulation to contralateral forepaw via laser speckle imaging in a rat SAH model. Nineteen Sprague-Dawley rats from two groups (control group, n=10 and SAH group, n=9) were studied. SAH was induced in rats by double injection of autologous blood into the cisterna magna after CSF aspiration. The same surgical procedure was applied in the control group without CSF aspiration or blood injection. Significant CVS was found in the SAH group. Meanwhile, we observed a delayed peak of CBF response in rats with SAH compared with those in the control group, whereas no significant difference was found in magnitude, duration, and areas under curve of relative CBF changes between the two groups. The results suggest that the regulation function of local CBF during functional activation induced by somatosensory stimulation might not be seriously impaired in the somatosensory cortex of rats with SAH. Therefore, our findings might help to understand the clinical phenomenon that DIND might not occur even when CVS was found in SAH patients.

  11. Tenascin-C causes neuronal apoptosis after subarachnoid hemorrhage in rats.

    PubMed

    Shiba, Masato; Fujimoto, Masashi; Imanaka-Yoshida, Kyoko; Yoshida, Toshimichi; Taki, Waro; Suzuki, Hidenori

    2014-04-01

    The role of tenascin-C (TNC), a matricellular protein, in brain injury is unknown. The aim of this study was to examine if TNC causes neuronal apoptosis after subarachnoid hemorrhage (SAH), a deadly cerebrovascular disorder, using imatinib mesylate (a selective inhibitor of platelet-derived growth factor receptor [PDGFR] that is reported to suppress TNC induction) and recombinant TNC. SAH by endovascular perforation caused caspase-dependent neuronal apoptosis in the cerebral cortex irrespective of cerebral vasospasm development at 24 and 72 h post-SAH, associated with PDGFR activation, mitogen-activated protein kinases (MAPKs) activation, and TNC induction in rats. PDGFR inactivation by an intraperitoneal injection of imatinib mesylate prevented neuronal apoptosis, as well as MAPKs activation and TNC induction in the cerebral cortex at 24 h. A cisternal injection of recombinant TNC reactivated MAPKs and abolished anti-apoptotic effects of imatinib mesylate. The TNC injection also induced TNC itself in SAH brain, which may internally augment neuronal apoptosis after SAH. These findings suggest that TNC upregulation by PDGFR activation causes neuronal apoptosis via MAPK activation, and that the positive feedback mechanisms may exist to augment neuronal apoptosis after SAH. TNC-induced neuronal apoptosis would be a new target to improve outcome after SAH. PMID:24481545

  12. Meteorological Influences on the Incidence of Aneurysmal Subarachnoid Hemorrhage A Single Center Study of 511 Patients

    PubMed Central

    Neidert, Marian Christoph; Sprenger, Michael; Wernli, Heini; Burkhardt, Jan-Karl; Krayenbhl, Niklaus; Bozinov, Oliver; Regli, Luca; Woernle, Christoph Michael

    2013-01-01

    Objective To assess the potential meteorological influence on the incidence of aneurysmal subarachnoid hemorrhage (SAH). Previous studies used inhomogeneous patient groups, insufficient study periods or inappropriate statistics. Patients and Methods We analyzed 511 SAH admissions between 2004 and 2012 for which aneurysmal rupture occurred within the Zurich region. The hourly meteorological parameters considered are: surface pressure, 2-m temperature, relative humidity and wind gusts, sunshine, and precipitation. For all parameters we investigate three complementary statistical measures: i) the time evolution from 5 days before to 5 days after the SAH occurrence; ii) the deviation from the 10-year monthly mean; and iii) the change relative to the parameter's value two days before SAH occurrence. The statistical significance of the results is determined using a Monte Carlo simulation combined with a re-sampling technique (1000). Results Regarding the meteorological parameters considered, no statistically significant signal could be found. The distributions of deviations relative to the climatology and of the changes during the two days prior to SAH events agree with the distributions for the randomly chosen days. The analysis was repeated separately for winter and summer to exclude compensating effects between the seasons. Conclusion By using high-quality meteorological data analyzed with a sophisticated and robust statistical method no clearly identifiable meteorological influence for the SAH events considered can be found. Further studies on the influence of the investigated parameters on SAH incidence seem redundant. PMID:24312565

  13. Mesenchymal Stem Cells Improved the Ultrastructural Morphology of Cerebral Tissues after Subarachnoid Hemorrhage in Rats

    PubMed Central

    Khalili, Mohammad Ali; Fesahat, Farzaneh; Mir-Esmaeili, Seyed Mohsen; Anvari, Morteza; Hekmati-moghadam, Seyed Hossain

    2014-01-01

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

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

    PubMed Central

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

    2011-01-01

    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

  15. The role of rhynchophylline in alleviating early brain injury following subarachnoid hemorrhage in rats.

    PubMed

    Zhang, Yan; Sun, Juan; Zhu, Shijie; Xu, Ting; Lu, Jianfei; Han, Hongbin; Zhou, Changman; Yan, Junhao

    2016-01-15

    Rhynchophylline (Rhy) has been demonstrated protective effects on some neurological diseases. However, the roles of Rhy in the subarachnoid hemorrhage (SAH) are still to be cleared. In the present study, the effects of Rhy on attenuation of early brain injury (EBI) after SAH have been evaluated. The adult male Sprague-Dawley rats (280-300g) were used to establish the SAH models using endovascular perforation method. Rhy was administered by intraperitoneal injection immediately following SAH. Brain edema was assessed by magnetic resonance imaging (MRI) at 24h after SAH. Neurological deficits, brain water content, malondialdehyde (MDA) concentration, myeloperoxidase (MPO) activity and reactive oxygen species (ROS) content in hippocampus were also evaluated. Immunofluorescence and western blot were used to explore the underlying protective mechanism of Rhy. The results showed that, following 10mg/kg Rhy treatment, the brain edema and neurological deficits, and blood-brain barrier (BBB) disruption were significantly attenuated at 24h after SAH. Additionally, in hippocampus, MDA concentration, MPO activity and ROS content were markedly decreased. Meanwhile, the levels of nuclear factor erythroid 2-related factor 2 (Nrf2), heme oxygenase-1 (HO-1) and NAD(P)H quinone oxidoreductase (NQO-1) were increased, while the expressions of p-p53, cleaved-caspase-3 and tumor necrosis factor-? (TNF-?) were significantly decreased. Our results indicated that Rhy could attenuate early brain injury by reducing inflammation and apoptosis in hippocampus after SAH. PMID:26631843

  16. Role of P2X Purinoceptor 7 in Neurogenic Pulmonary Edema after Subarachnoid Hemorrhage in Rats

    PubMed Central

    Chen, Sheng; Zhu, Zhigang; Klebe, Damon; Bian, Hetao; Krafft, Paul R.; Tang, Jiping; Zhang, Jianmin; Zhang, John H.

    2014-01-01

    Introduction Neurogenic pulmonary edema (NPE) is an acute and serious complication after subarachnoid hemorrhage (SAH) with high mortality. The present study aimed to test the therapeutic potential of brilliant blue G (BBG), a selective P2X purinoceptor 7 (P2X7R) antagonist, on NPE in a rat SAH model. Methods SAH was induced by endovascular perforation. 86 Sprague-Dawley rats were randomly divided into sham, vehicle-, or BBG-treatment groups. Mortality, body weight, SAH grading, neurological deficits, NPE clinical symptoms, and pulmonary index were measured at 24 hours following SAH. Western blot, gelatin zymography, lung histopathology, and immunofluorescence staining were performed in the left lung lobe to explore the underlying mechanisms at 24 hours post-surgery. Results The incidence of clinical symptoms was correlated with pulmonary index. P2X7R and the marker of alveolar type I epithelial cells (the mucin-type glycoprotein T1-?) immunoreactivities were generally co-localized. BBG administration decreased mature interleukin-1?, myeloperoxidase, and matrix metallopeptidase-9 activation, but increased tight junction proteins, such as ZO-1 and occludin, which ameliorated pulmonary edema via anti-inflammation and improved neurological deficits. Conclusion P2X7R inhibition prevented NPE after SAH by attenuating inflammation. Thus, BBG is a potential therapeutic application for NPE after SAH and warrants further research. PMID:24533168

  17. Lipocalin 2 and Blood-Brain Barrier Disruption in White Matter after Experimental Subarachnoid Hemorrhage.

    PubMed

    Egashira, Yusuke; Hua, Ya; Keep, Richard F; Iwama, Toru; Xi, Guohua

    2016-01-01

    We reported previously that subarachnoid hemorrhage (SAH) causes acute white matter injury in mice. In this study, we investigated lipocalin 2 (LCN2) mediated blood-brain barrier (BBB) disruption in white matter, which may lead to subsequent injury. SAH was induced by endovascular perforation in wild-type (WT) and LCN2-knockout (LCN2(-/-)) mice. Sham mice underwent the same procedure without perforation. Mice underwent magnetic resonance imaging (MRI) 24 h after SAH to confirm the development of T2-hyperintensity in white matter. Western blotting and immunohistochemistry were performed to elucidate the mechanisms of LCN2-mediated white matter injury and BBB disruption. It was confirmed that LCN2 expression was significantly increased in white matter of WT mice after SAH by Western blotting (versus sham; p?SAH, albumin leakage along the white matter was prominently observed and was consistent with T2-hyperintensity on MRI. As with our previous report, LCN2(-/-) mice scarcely developed T2-hyperintensity on MRI or albumin leakage in white matter. Our results suggest that BBB leakage occurs in white matter after SAH and that LCN2 contributes to SAH-induced BBB disruption. PMID:26463936

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

    PubMed

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

    2014-07-15

    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

  19. Biomarkers of vasospasm development and outcome in aneurysmal subarachnoid hemorrhage.

    PubMed

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

    2014-06-15

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

  20. Subarachnoid Hemorrhage, Spreading Depolarizations and Impaired Neurovascular Coupling

    PubMed Central

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

    2013-01-01

    Aneurysmal subarachnoid hemorrhage (SAH) has devastating consequences on brain function including profound effects on communication between neurons and the vasculature leading to cerebral ischemia. Physiologically, neurovascular coupling represents a focal increase in cerebral blood flow to meet increased metabolic demand of neurons within active regions of the brain. Neurovascular coupling is an ongoing process involving coordinated activity of the neurovascular unit—neurons, astrocytes, and parenchymal arterioles. Neuronal activity can also influence cerebral blood flow on a larger scale. Spreading depolarizations (SD) are self-propagating waves of neuronal depolarization and are observed during migraine, traumatic brain injury, and stroke. Typically, SD is associated with increased cerebral blood flow. Emerging evidence indicates that SAH causes inversion of neurovascular communication on both the local and global level. In contrast to other events causing SD, SAH-induced SD decreases rather than increases cerebral blood flow. Further, at the level of the neurovascular unit, SAH causes an inversion of neurovascular coupling from vasodilation to vasoconstriction. Global ischemia can also adversely affect the neurovascular response. Here, we summarize current knowledge regarding the impact of SAH and global ischemia on neurovascular communication. A mechanistic understanding of these events should provide novel strategies to treat these neurovascular disorders. PMID:23577279

  1. Impact of Subarachnoid Hemorrhage on Parenchymal Arteriolar Function

    PubMed Central

    Wellman, George C.; Koide, Masayo

    2013-01-01

    Summary Intracerebral or parenchymal arterioles play an important role in the regulation of both global and regional blood flow within the brain. Brain cortex lacks significant collateral sources of blood and are thus at risk if blood flow through parenchymal arterioles is restricted. Increasingly, evidence is accumulating that abnormal parenchymal arteriolar constriction contributes to the development of neurological deficits caused by subarachnoid hemorrhage (SAH). For example, parenchymal arterioles isolated from SAH model rats exhibit enhanced constriction in response to increased intravascular pressure. This increased pressure-dependent constriction or myogenic tone would result in a shift in the cerebral autoregulatory response and decreased cerebral perfusion. Here, we summarize our current knowledge regarding cellular mechanisms contributing to enhanced contractility of parenchymal arteriolar myocytes following SAH. Our studies demonstrate SAH-induced membrane potential depolarization involving altered K+ homeostasis leads to enhanced voltage-dependent Ca2+ channel activity, increased smooth muscle cytosolic Ca2+ and parenchymal arteriolar constriction. In summary, emerging evidence demonstrates that SAH can profoundly affect parenchymal arteriolar tone promoting decreased cortical blood flow and compromised neuronal viability. PMID:22890665

  2. Using quantitative CT perfusion for evaluation of delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage

    PubMed Central

    Sanelli, Pina C.; Ugorec, Igor; Johnson, Carl E.; Tan, Jessica; Segal, Alan Z.; Fink, Matthew; Heier, Linda A.; Tsiouris, Apostolos J.; Comunale, Joseph P.; John, Majnu; Stieg, Philip E.; Zimmerman, Robert D.; Mushlin, Alvin I.

    2011-01-01

    Background and Purpose To prospectively evaluate the diagnostic accuracy of CT perfusion (CTP) and determine a quantitative threshold for delayed cerebral ischemia (DCI) in aneurysmal subarachnoid hemorrhage (SAH). Methods SAH patients were prospectively enrolled in an IRB approved protocol. CTP was performed during the typical time-period for DCI, between days 6–8 following SAH. Quantitative cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) values were obtained using standard region-of-interest placement sampling gray matter. The reference standard for DCI is controversial and consisted of clinical and imaging criteria in this study. In a subanalysis of vasospasm, digital subtraction angiography was used as the reference standard. Receiver operating characteristic curves determined diagnostic accuracy using area under the curve. Optimal threshold values were calculated using patient population utility method. Results Ninety-seven patients were included; 41% (40/97) had DCI. Overall diagnostic accuracy was 93% CBF, 88% MTT and 72% CBV. Optimal threshold values were 35mL/100gm/min (90% sensitivity,68% specificity) for CBF and 5.5sec (73% sensitivity,79% specificity) for MTT. In the subanalysis (n=57), 63% (36/57) had vasospasm. Overall diagnostic accuracy was 94% CBF, 85% MTT and 72% CBV. Optimal threshold values were 36.5 mL/100gm/min (95% sensitivity,70% specificity) for CBF and 5.4 sec (78% sensitivity,70% specificity) for MTT. Conclusion CBF and MTT have the highest overall diagnostic accuracy. Threshold values of 35mL/100gm/min CBF and 5.5sec MTT are suggested for DCI based on patient population utility method. Absolute threshold values may not be generalizable due to differences in scanner equipment and post-processing methods. PMID:21960495

  3. Sensitivity of a Clinical Decision Rule and Early Computed Tomography in Aneurysmal Subarachnoid Hemorrhage

    PubMed Central

    Mark, Dustin G.; Kene, Mamata V.; Udaltsova, Natalia; Vinson, David R.; Ballard, Dustin W.

    2015-01-01

    Introduction Application of a clinical decision rule for subarachnoid hemorrhage, in combination with cranial computed tomography (CT) performed within six hours of ictus (early cranial CT), may be able to reasonably exclude a diagnosis of aneurysmal subarachnoid hemorrhage (aSAH). This studys objective was to examine the sensitivity of both early cranial CT and a previously validated clinical decision rule among emergency department (ED) patients with aSAH and a normal mental status. Methods Patients were evaluated in the 21 EDs of an integrated health delivery system between January 2007 and June 2013. We identified by chart review a retrospective cohort of patients diagnosed with aSAH in the setting of a normal mental status and performance of early cranial CT. Variables comprising the SAH clinical decision rule (age ?40, presence of neck pain or stiffness, headache onset with exertion, loss of consciousness at headache onset) were abstracted from the chart and assessed for inter-rater reliability. Results One hundred fifty-five patients with aSAH met study inclusion criteria. The sensitivity of early cranial CT was 95.5% (95% CI [90.998.2]). The sensitivity of the SAH clinical decision rule was also 95.5% (95% CI [90.998.2]). Since all false negative cases for each diagnostic modality were mutually independent, the combined use of both early cranial CT and the clinical decision rule improved sensitivity to 100% (95% CI [97.6100.0]). Conclusion Neither early cranial CT nor the SAH clinical decision rule demonstrated ideal sensitivity for aSAH in this retrospective cohort. However, the combination of both strategies might optimize sensitivity for this life-threatening disease. PMID:26587089

  4. Changes in the Coagulation and Fibrinolytic System of Patients with Subarachnoid Hemorrhage

    PubMed Central

    JI, Yong; MENG, Qin-Hu; WANG, Zhi-Gang

    2014-01-01

    The aim of this study was to investigate the dynamic changes in the coagulation and fibrinolytic system with subarachnoid hemorrhage. The blood coagulation enzyme-AT complex (TAT), anticoagulant enzyme (AT), tissue plasminogen activator (tPA), plasminogen activin inhibitor (PAI-1), and mean blood flow velocity were measured. The TAT level was significantly higher 6 h after subarachnoid hemorrhage (SAH), whereas AT was significantly lower. These changes were maintained at 12 h to 1 d after SAH, returned to normal at 3 d, significantly changed again at 7 d to 14 d. The tPA level gradually increased after SAH and peaked at 14 d, and then returned to normal at 21 d. The PAI-1 levels were significantly lower than those in the control group 1 d after SAH gradually increased, and returned to normal at 21 d. In the cerebral vasospasm (CVS) groups, the levels of TAT, and AT significantly changed compared to the non-CVS groups after SAH. The PAI-1 levels were higher at 7 d and 14 d, but the changes were not significant. In groups Fisher III and IV as well as Hunt III to V, the TAT, AT, tPA, and PAI-1 levels were significantly higher than those in both Fisher and Hunt I and II 6 h, 12 h, 1 d, 7 d, and 14 d after SAH. The changes in the coagulation and fibrinolytic system of patients with SAH are correlated with the progress and symptoms of SAH as well as the blood content and CVS. PMID:24305025

  5. Phosphorylation of Akt by SC79 Prevents Iron Accumulation and Ameliorates Early Brain Injury in a Model of Experimental Subarachnoid Hemorrhage.

    PubMed

    Hao, Shuangying; Song, Chuanhui; Shang, Longcheng; Yu, Jiang; Qiao, Tong; Li, Kuanyu

    2016-01-01

    Previous studies have demonstrated that activation of Akt may alleviate early brain injury (EBI) following subarachnoid hemorrhage (SAH). This study is undertaken to determine whether iron metabolism is involved in the beneficial effect of Akt activation after SAH. Therefore, we used a novel molecule, SC79, to activate Akt in an experimental Sprague-Dawley rat model of SAH. Rats were randomly divided into four groups as follows: sham, SAH, SAH + vehicle, SAH + SC79. The results confirmed that SC79 effectively enhanced the defense against oxidative stress and alleviated EBI in the temporal lobe after SAH. Interestingly, we found that phosphorylation of Akt by SC79 reduced cell surface transferrin receptor-mediated iron uptake and promoted ferroportin-mediated iron transport after SAH. As a result, SC79 administration diminished the iron content in the brain tissue. Moreover, the impaired Fe-S cluster biogenesis was recovered and loss of the activities of the Fe-S cluster-containing enzymes were regained, indicating that injured mitochondrial functions are restored to healthy levels. These findings suggest that disrupted iron homeostasis could contribute to EBI and Akt activation may regulate iron metabolism to relieve iron toxicity, further protecting neurons from EBI after SAH. PMID:26978329

  6. [Subarachnoid hemorrhage in young patients].

    PubMed

    Naggara, Olivier; Nataf, Franois

    2013-09-01

    Subarachnoid hemorrhage (SAH) accounts for 5 % of strokes with a high rate of death and morbidity. It occurs in young patients, often hypertensive and smoking. Patients usually present with sudden headache. Initial clinical evaluation uses a prognosis grading scale including level of consciousness and motor deficit on admission (WFNS scale). Unenhanced CT brain imaging demonstrates the SHA together with evaluation of the initial blood amount, predictive of the occurrence of cerebral vasospasm that may lead to delayed cerebral ischemia. After referral to a multidisciplinary center with neurovascular expertise, MR, CT and/or catheter angiography detects the ruptured aneurysm, the cause of SAH in 85 % of cases. Since rebleeding is an imminent danger, occlusion of the aneurysm should be performed, as soon as possible and within the first 72 heures, either by an endovascular or microsurgical approach. Medical management includes early detection of hydrocephalus and cerebral vasospasm is a devastating complication inducing death and functional impairment. Prevention strategies remain limited and include maintenance of normovolemia and calcium antagonists such as nimodipine. Treatment of cerebral vasospasm associates maintenance of cerebral perfusion and more invasive techniques such as chemical or mechanical angioplasty. PMID:24167898

  7. Multiple Intestinal Erosions as a Result of Hemorrhage due to Parasites: Case Reports and Review of the Literature

    PubMed Central

    Pitanga Lukashok, Hannah; Robles-Jara, Carlos; Robles-Medranda, Carlos

    2011-01-01

    Obscure gastrointestinal bleeding appears to be uncommon in patients with parasites. In spite of that some reports had described this relationship in patients evaluated during capsule endoscopy procedures; the characteristic of the bleeding lesions remains unclear. This paper describes two patients with a massive obscure gastrointestinal bleeding due to ascariasis, using the new capsule endoscopy technology MiroCam, describing the characteristic of the lesions found in our patients (observed in a better image quality), and reviewing the literature. PMID:21747648

  8. A review of current and future medical therapies for cerebral vasospasm following aneurysmal subarachnoid hemorrhage.

    PubMed

    Mocco, J; Zacharia, Brad E; Komotar, Ricardo J; Connolly, E Sander

    2006-01-01

    In an effort to help clarify the current state of medical therapy for cerebral vasospasm, the authors reviewed the relevant literature on the established medical therapies used for cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH), and they discuss burgeoning areas of investigation. Despite advances in the treatment of aneurysmal SAH, cerebral vasospasm remains a common complication and has been correlated with a 1.5- to threefold increase in death during the first 2 weeks after hemorrhage. A number of medical, pharmacological, and surgical therapies are currently in use or being investigated in an attempt to reverse cerebral vasospasm, but only a few have proven to be useful. Although much has been elucidated regarding its pathophysiology, the treatment of cerebral vasospasm remains a dilemma. Although a poor understanding of SAH-induced cerebral vasospasm pathophysiology has, to date, hampered the development of therapeutic interventions, current research efforts promise the eventual production of new medical therapies. PMID:17029348

  9. A Glutamate Receptor Antagonist, S-4-Carboxyphenylglycine (S-4-CPG), Inhibits Vasospasm After Subarachnoid Hemorrhage in Haptoglobin 2-2 Mice

    PubMed Central

    Garzon-Muvdi, Tomas; Pradilla, Gustavo; Ruzevick, Jacob J.; Bender, Matthew; Edwards, Lindsay; Grossman, Rachel; Zhao, Ming; Rudek, Michelle A.; Riggins, Gregory; M.D., Andrew Levy; Tamargo, Rafael J.

    2015-01-01

    Background Vasospasm contributes to delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage (aSAH). Glutamate concentrations increase after aSAH and correlate with vasospasm in experimental SAH. The Hp2-2 genotype is associated with higher risk of vasospasm after SAH. We tested the efficacy of S-4-CPG, a metabotropic glutamate receptor inhibitor, for treatment of vasospasm after SAH in Hp2-2 and Hp1-1 mice. Objective To evaluate the effect on vasospasm and neurobehavioral scores after SAH of systemic S-4-CPG, as well as its toxicity, and phosphorylation of vasodilator-stimulated phosphoprotein (VASP) in Hp 2-2 mice. Methods Western blot was used to assess changes in VASP phosphorylation in response to glutamate with and without S-4-CPG. A pharmacokinetics study was done to evaluate S-4-CPG penetration through the blood brain barrier (BBB) in vivo. Toxicity was assessed by administering escalating S-4-CPG doses. Efficacy of S-4-CPG assessed the effect of S-4-CPG on lumen patency of the basilar artery and animal behavior after SAH in Hp 1-1 and Hp 2-2 mice. Immunohistochemistry was used to evaluate the presence of neutrophils surrounding the basilar artery after SAH. Results Exposure of human brain microvascular endothelial cells to glutamate decreased phosphorylation of VASP (p-VASP), but glutamate treatment in the presence of S-4-CPG maintains p-VASP. S-4-CPG crosses the BBB and was not toxic to mice. S-4-CPG treatment significantly prevents vasospasm after SAH. S-4-CPG administered after SAH resulted in a trend towards improvement of animal behavior. Conclusions S-4-CPG prevents vasospasm after experimental SAH in Hp2-2 mice. S-4-CPG was not toxic and is a potential therapeutic agent for vasospasm after SAH. PMID:23842553

  10. Subarachnoid hemorrhage.

    PubMed

    Manno, Edward M

    2004-05-01

    The medical and surgical management of aneurysmal SAH has changed dramatically in the past few decades. Surgical management emphasizes early triage and repair of the responsible aneurysm. Medical management focuses on maintenance of adequate volume, monitoring cerebral vasospasm, and initiation of medical maneuvers or interventional procedures designed to improve vessel patency and CBF. The results of these techniques have not been studied in randomized controlled trials; however, several large retrospective analyses reveal a significant decrease in mortality and morbidity with the institution of these measures. Future improvements will continue to develop with increased understanding of cerebral vasospasm and in neurologic monitoring. PMID:15062516

  11. Increased ICP promotes CaMKII-mediated phosphorylation of neuronal NOS at Ser??? in the hippocampus immediately after subarachnoid hemorrhage.

    PubMed

    Makino, Kazushige; Osuka, Koji; Watanabe, Yasuo; Usuda, Nobuteru; Hara, Masahito; Aoyama, Masahiro; Takayasu, Masakazu; Wakabayashi, Toshihiko

    2015-08-01

    Early brain injury has recently been identified as an indicator of poor prognosis after subarachnoid hemorrhage (SAH). Calmodulin-dependent protein kinase II? (CaMKII?) has been shown to phosphorylate neuronal NOS (nNOS) at Ser(847), resulting in a reduction in nNOS activity. In this study, we revealed chronological changes in the phosphorylation of nNOS at Ser(847) in the hippocampus and cortex immediately after SAH. In a rat single-hemorrhage model of SAH, the hippocampus and adjacent cortex were collected up to 24h after SAH. Samples from rats that were not injected with blood were used as controls. NOS was partially purified from the crude samples using ADP-agarose affinity chromatography. Western blot analysis revealed that nNOS phosphorylated (p-nNOS) at Ser(847) was significantly increased in the hippocampus, but not in the cortex, at 1h after SAH compared with that resulting from the control treatment. Immunoreactivity of p-nNOS at Ser(847) was observed in interneurons of the hippocampus at 1h after SAH. Injection of saline instead of blood also significantly induced p-nNOS at Ser(847) levels in the hippocampus at 1h after injection. The colocalization of CaMKII? and nNOS was transiently increased in the hippocampus at 0.5h after SAH. Our data suggest that immediately after SAH, an increase in intracranial pressure might induce transient cerebral ischemia, potentially promoting the phosphorylation of nNOS at Ser(847) by CaMKII? in the hippocampus. The activation of p-nNOS at Ser(847) in the hippocampus may alleviate ischemic insults immediately after SAH to exert a neuroprotective effect against early brain injury. PMID:25940762

  12. Cerebral amyloid angiopathy-related atraumatic convexal subarachnoid hemorrhage: an ARIA before the tsunami.

    PubMed

    Martnez-Lizana, Eva; Carmona-Iragui, Mara; Alcolea, Daniel; Gmez-Choco, Manuel; Vilaplana, Eduard; Snchez-Saudins, Mara B; Clarimn, Jordi; Hernndez-Guillamon, Mar; Munuera, Josep; Gelpi, Ellen; Gmez-Anson, Beatriz; de Juan-Delago, Manel; Delgado-Mederos, Raquel; Montaner, Joan; Ois, Angel; Amaro, Sergi; Blesa, Rafael; Mart-Fbregas, Joan; Lle, Alberto; Fortea, Juan

    2015-05-01

    Atraumatic convexal subarachnoid hemorrhage (cSAH) in elderly patients is a rare entity that has been associated with cerebral amyloid angiopathy (CAA) and intracerebral hematomas (ICH). To characterize this entity and to study these associations, 22 patients over 60 with cSAH were included in a multicenter ambispective cohort study. Clinical data, magnetic resonance imaging (MRI) studies, APOE genotyping, and cerebrospinal fluid (CSF) biomarkers were evaluated. Results were compared with data from healthy controls (HC), non-cSAH CAA patients (CAAo), and Alzheimer disease patients. Convexal subarachnoid hemorrhage presented with transient sensory or motor symptoms. At follow-up (median 30.7 months), 5 patients had died, 6 survivors showed functional disability (modified Rankins Scale (mRS)>2), and 12 cognitive impairment. Four patients had prior ICH and six had an ICH during follow-up. CSF-A40 and A42 levels were lower in cSAH and CAAo compared with HC. Convexal subarachnoid hemorrhage presented an APOE-?2 overrepresentation and CAAo had an APOE-?4 overrepresentation. On MRI, all patients fulfilled CAA-modified Boston criteria and 9 showed cortical ischemia in the surrounding cortex or the vicinity of superficial siderosis. The neuropathologic study, available in one patient, showed severe CAA and advanced Alzheimer-type pathology. Convexal subarachnoid hemorrhage in the elderly is associated with cognitive impairment and lobar ICH occurrence. Our findings support the existence of an underlying CAA pathology. PMID:25735919

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

    SciTech Connect

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

    1986-10-01

    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.

  14. Prolonged Paroxysmal Sympathetic Storming Associated with Spontaneous Subarachnoid Hemorrhage

    PubMed Central

    Liu, Yan; Jolly, Suneil; Pokala, Krishna

    2013-01-01

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

  15. Rescue Therapy for Refractory Vasospasm after Subarachnoid Hemorrhage

    PubMed Central

    Durrant, Julia C.; Hinson, Holly E.

    2014-01-01

    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

  16. Subarachnoid hemorrhage

    MedlinePLUS

    ... and may need more imaging tests. Treatment for coma or decreased alertness includes: Draining tube placed in ... subarachnoid hemorrhage may become worse and lead to coma or death. Other complications include: Complications of surgery ...

  17. Subarachnoid Hemorrhage

    MedlinePLUS

    ... Sign-Up Contact Us Understanding Brain Aneurysm Basics Warning Signs/Symptoms Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History Early Detection and Screening Unruptured Brain Aneurysms Subarachnoid Hemorrhage ...

  18. Toll-like receptor 4 (TLR4) is correlated with delayed cerebral ischemia (DCI) and poor prognosis in aneurysmal subarachnoid hemorrhage.

    PubMed

    Ma, Chunxiao; Zhou, Wei; Yan, Zhaoyue; Qu, Mingqi; Bu, Xingyao

    2015-12-15

    Toll-like receptor 4 (TLR4) is one of key players in regulation of inflammation. Animal experiments have suggested an important role of TLR4 in the pathophysiology of subarachnoid hemorrhage (SAH). In present study, TLR4 is investigated in clinical SAH patients to explore its clinical significance. 30 patients with aneurysmal subarachnoid hemorrhage (aSAH) and 20 healthy control patients (HC) were enrolled in this prospective study. Blood samples were collected on days 1, 3 and 7 after admission. TLR4 expression level on cell surface of peripheral blood mononuclear cells (PBMCs) was determined by flow cytometry and presented as mean fluorescence intensity (MFI). Patients were clinically assessed every day after admission to monitor the occurrence of delayed cerebral ischemia (DCI). Participants were followed up until completion of 3months after SAH. Functional outcome was defined by modified Rankin score (mRs). Results show that SAH patients presented a significantly higher TLR4 levels on days 1 and 3 post SAH compared to HC; TLR4 levels in SAH patients on day 1 was highest compared with that on days 3 and 7 and in HC. TLR4 of SAH patients on day 7 declined to the level showing no significant difference with that of HC. In patients with Hunt-Hess grades I-III lower TLR4 levels were observed. Patients with DCI showed significantly higher TLR4 levels than those without DCI. High TLR4 levels were statistically significantly associated with poor functional outcome after 3months. Logistic regression analysis showed that TLR4 level on day 1 was independent predictor for DCI and 3-month poor neurological outcome of aneurysmal SAH patients. In summary, admission TLR4 level on PBMCs (day 1) is an independent risk factor to predict the occurrence of DCI and 3-month poor neurological outcome in aneurysmal SAH patients. PMID:26671088

  19. Intravenous magnesium sulfate after aneurysmal subarachnoid hemorrhage: a prospective randomized pilot study.

    PubMed

    Wong, George K C; Chan, Matthew T V; Boet, Ronald; Poon, Wai S; Gin, Tony

    2006-04-01

    We performed a randomized, double-blind, pilot study on magnesium sulfate (MgSO4) infusion for aneurysmal subarachnoid hemorrhage (SAH).Sixty patients with SAH were randomly allocated to receive either MgSO4 80 mmol/day or saline infusion for 14 days. Patients also received intravenous nimodipine. Episodes of vasospasm were treated with hypertensive and hypervolemic therapy. Neurologic status was assessed 6 months after hemorrhage using the Barthel index and Glasgow Outcome Scale. Incidences of cardiac and pulmonary complications were also recorded. Patient characteristics, severity of SAH, and surgical treatment did not differ between groups. The incidence of symptomatic vasospasm decreased from 43% in the saline group to 23% in patients receiving MgSO4 infusion, but it did not reach statistical significance, P=0.06. For patients who had transcranial Doppler-detected vasospasm, defined as mean flow velocity >120 cm/s and a Lindegaard index >3, the duration was shorter in the magnesium group compared with controls (P<0.01). There was, however, no difference between groups in functional recovery or Glasgow Outcome Scale score. The incidence of adverse events such as brain swelling, hydrocephalus, and nosocomial infection was also similar in patients receiving MgSO4 or saline. In this small pilot study, MgSO4 infusion for aneurysmal SAH is feasible. On the basis of the preliminary data, a larger study recruiting approximately 800 patients is required to test for a possible neuroprotective effect of magnesium after SAH. PMID:16628069

  20. Posterior reversible encephalopathy syndrome following hemodynamic treatment of aneurysmal subarachnoid hemorrhage-induced vasospasm.

    PubMed

    Awori, Jonathan; Rajajee, Venkatakrishna; Gemmete, Joseph J; Chaudhary, Neeraj; Thompson, B Gregory; Pandey, Aditya S

    2016-04-01

    Posterior reversible encephalopathy syndrome (PRES) is an uncommon but significant complication of hemodynamic therapy after aneurysmal subarachnoid hemorrhage (aSAH)-induced vasospasm. We performed a PubMed literature search for the period January 1999 to January 2015 using the search terms "posterior reversible encephalopathy syndrome", "subarachnoid hemorrhage", "vasospasm", and "hypertensive encephalopathy", and identified nine cases of PRES after aSAH-induced vasospasm in the literature. We also present a 63-year-old man with aSAH complicated by vasospasm treated with hemodynamic augmentation who subsequently developed PRES. Imaging following development of PRES symptoms shows vasogenic edema in the white matter of the parietal and occipital lobes. Age, sex, history of hypertension, and baseline blood pressure were variable among patients in the literature review. In all cases, patients improved both from a radiological and clinical perspective following blood pressure reduction. To summarize, PRES is a rare complication of hemodynamic therapy for vasospasm following aSAH. The literature at the time of writing demonstrates no common pattern with regard to patient demographics, medical history, or mode of treatment for symptomatic vasospasm. Given its sporadic and unpredictable nature, considering PRES in the differential diagnosis is important when addressing neurological decline following hemodynamic treatment of vasospasm related to aSAH. PMID:26755456

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

    PubMed

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

    2015-01-01

    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. PMID:25196554

  2. Altered Resting-State Connectivity within Executive Networks after Aneurysmal Subarachnoid Hemorrhage

    PubMed Central

    Maher, Monica; Churchill, Nathan W.; de Oliveira Manoel, Airton Leonardo; Graham, Simon J.; Macdonald, R. Loch; Schweizer, Tom A.

    2015-01-01

    Aneurysmal subarachnoid hemorrhage (aSAH) is associated with significant mortality rates, and most survivors experience significant cognitive deficits across multiple domains, including executive function. It is critical to determine the neural basis for executive deficits in aSAH, in order to better understand and improve patient outcomes. This study is the first examination of resting-state functional Magnetic Resonance Imaging in a group of aSAH patients, used to characterize changes in functional connectivity of the frontoparietal network. We scanned 14 aSAH patients and 14 healthy controls, and divided patients into “impaired” and “unimpaired” groups based on a composite executive function score. Impaired patients exhibited significantly lower quality of life and neuropsychological impairment relative to controls, across multiple domains. Seed-based functional connectivity analysis demonstrated that unimpaired patients were not significantly different from controls, but impaired patients had increased frontoparietal connectivity. Patients evidenced increased frontoparietal connectivity as a function of decreased executive function and decreased mood (i.e. quality of life). In addition, T1 morphometric analysis demonstrated that these changes are not attributable to local cortical atrophy among aSAH patients. These results establish significant, reliable changes in the endogenous brain dynamics of aSAH patients, that are related to cognitive and mood outcomes. PMID:26172281

  3. Reduced Ca2+ spark activity after subarachnoid hemorrhage disables BK channel control of cerebral artery tone

    PubMed Central

    Koide, Masayo; Nystoriak, Matthew A; Krishnamoorthy, Gayathri; O'Connor, Kevin P; Bonev, Adrian D; Nelson, Mark T; Wellman, George C

    2011-01-01

    Intracellular Ca2+ release events (Ca2+ sparks') and transient activation of large-conductance Ca2+-activated potassium (BK) channels represent an important vasodilator pathway in the cerebral vasculature. Considering the frequent occurrence of cerebral artery constriction after subarachnoid hemorrhage (SAH), our objective was to determine whether Ca2+ spark and BK channel activity were reduced in cerebral artery myocytes from SAH model rabbits. Using laser scanning confocal microscopy, we observed ?50% reduction in Ca2+ spark activity, reflecting a decrease in the number of functional Ca2+ spark discharge sites. Patch-clamp electrophysiology showed a similar reduction in Ca2+ spark-induced transient BK currents, without change in BK channel density or single-channel properties. Consistent with a reduction in active Ca2+ spark sites, quantitative real-time PCR and western blotting revealed decreased expression of ryanodine receptor type 2 (RyR-2) and increased expression of the RyR-2-stabilizing protein, FKBP12.6, in the cerebral arteries from SAH animals. Furthermore, inhibitors of Ca2+ sparks (ryanodine) or BK channels (paxilline) constricted arteries from control, but not from SAH animals. This study shows that SAH-induced decreased subcellular Ca2+ signaling events disable BK channel activity, leading to cerebral artery constriction. This phenomenon may contribute to decreased cerebral blood flow and poor outcome after aneurysmal SAH. PMID:20736958

  4. Subarachnoid Hemorrhage Induces Gliosis and Increased Expression of the Pro-inflammatory Cytokine High Mobility Group Box 1 Protein

    PubMed Central

    Murakami, Kentaro; Koide, Masayo; Dumont, Travis M.; Russell, Sheila R.; Tranmer, Bruce I.

    2011-01-01

    Subarachnoid hemorrhage (SAH) following cerebral aneurysm rupture is associated with high rates of morbidity and mortality. Surviving SAH patients often suffer from neurological impairment, yet little is currently known regarding the influence of subarachnoid blood on brain parenchyma. The objective of the present study was to examine the impact of subarachnoid blood on glial cells using a rabbit SAH model. The astrocyte-specific proteins, glial fibrillary acidic protein (GFAP) and S100B, were up-regulated in brainstem from SAH model rabbits, consistent with the development of reactive astrogliosis. In addition to reactive astrogliosis, cytosolic expression of the pro-inflammatory cytokine, high-mobility group box 1 protein (HMGB1) was increased in brain from SAH animals. We found that greater than 90% of cells expressing cytosolic HMGB1 immunostained positively for Iba1, a specific marker for microglia and macrophages. Further, the number of Iba1-positive cells was similar in brain from control and SAH animals, suggesting the majority of these cells were likely resident microglial cells rather than infiltrating macrophages. These observations demonstrate SAH impacts brain parenchyma by activating astrocytes and microglia, triggering up-regulation of the pro-inflammatory cytokine HMGB1. PMID:21479116

  5. Protective effects of perfluorooctyl-bromide nanoparticles on early brain injuries following subarachnoid hemorrhage in rats

    PubMed Central

    Zhang, Huan; Xu, Rui; Xie, Fei; Xu, Wei; Zeng, Meng-Fei; Wang, Xin; Zhu, Ji

    2015-01-01

    To investigate the protective effects of perfluorooctyl-bromide (PFOB) nanoparticles on early brain injury (EBI) following subarachnoid hemorrhage (SAH), a total of 120 rats were randomly assigned to the following groups: Sham operation group (n = 40), SAH group (n = 40), and SAH + PFOB group (n = 40). Endovascular perforation was performed to induce subarachnoid hemorrhage. Brain water content was measured 24 h after surgery. Meanwhile, morphological changes in the rat hippocampal CA1 region were examined using light and transmission electron microscopy. The rate of neuronal apoptosis in rat hippocampal CA1 region was determined using TUNEL assay. Protein and mRNA expression levels of Caspase-3, Bax, and Bcl-2 were measured using western blot and RT-PCR assays 12, 24, 48, and 72 h after surgery. Compared to the SAH group, the SAH + PFOB group had significantly lower brain water content (P<0.01), with alleviated morphological abnormalities in HE-stained neurons and significantly decreased neurons with karyopyknosis and hyperchromatism in the hippocampal CA1 region. Electron microscopy revealed reduction of neuronal apoptosis, alleviation of glial cell swelling, and mitigation of perivascular edema in the hippocampal region. Immunohistochemical analysis showed that the expression of apoptosis-related factors Caspase-3 and Bax was significantly reduced, while that of the anti-apoptotic factor Bcl-2 was significantly increased. TUNEL staining showed that neuronal apoptosis was significantly reduced in the hippocampal CA1 region (P<0.01). RT-PCR and Western-blot data indicated that expressions of Caspase-3 and Bax were both significantly reduced, while bcl-2 expression was increased significantly at 12, 24, 48, and 72 h after SAH (P<0.01). Together, our data support that PFOB nanoparticles with high oxygen content could counteract ischemia and hypoxia, block neuronal apoptotic pathways, reduce neuronal apoptosis, and therefore, achieve neuroprotective effects in EBI following SAH. PMID:26396671

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

    PubMed Central

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

    2009-01-01

    Objective Although prophylactic antiepileptic drug (AED) use in patients with aneurysmal subarachnoid hemorrhage (SAH) is a common practice, lack of uniform definitions and guidelines for seizures and AEDs rendered this prescription more habitual instead of evidence-based manner. We herein evaluated the incidence and predictive factors of seizure and complications about AED use. Methods From July 1999 to June 2007, data of a total of 547 patients with aneurysmal SAH who underwent operative treatments were reviewed. For these, the incidence and risk factors of seizures and epilepsy were assessed, in addition to complications of AEDs. Results Eighty-three patients (15.2%) had at least one seizure following SAH. Forty-three patients (7.9%) had onset seizures, 34 (6.2%) had perioperative seizures, and 17 (3.1%) had late epilepsy. Younger age (< 40 years), poor clinical grade, thick hemorrhage, acute hydrocephalus, and rebleeding were related to the occurrence of onset seizures. Cortical infarction and thick hemorrhage were independent risk factors for the occurrence of late epilepsy. Onset seizures were not predictive of late epilepsy. Moreover, adverse drug effects were identified in 128 patients (23.4%) with AEDs. Conclusion Perioperative seizures are not significant predictors for late epilepsy. Instead, initial amount of SAH and surgery-induced cortical damage should be seriously considered as risk factors for late epilepsy. Because AEDs can not prevent early postoperative seizures (< 1 week) and potentially cause unexpected side effects, long-term use should be readjusted in high-risk patients. PMID:19763209

  7. Mechanisms of hemorrhagic cystitis

    PubMed Central

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

    2014-01-01

    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

  8. SUBPERITONEAL HEMORRHAGE

    PubMed Central

    Cushman, Glenn F.

    1953-01-01

    Clinical diagnosis of subperitoneal hemorrhage can be made in a substantial percentage of cases by recognition of a quite constant syndrome—provided the possibility of bleeding is considered. Progressive anemia, as indicated by repeated counts of erythrocytes in the blood or by hematocrit determinations, is confirmation of the diagnosis. The majority of patients recover spontaneously under conservative management. Surgical intervention is indicated if repeated episodes of hemorrhage occur or if the volume of circulating blood cannot be maintained by repeated transfusions of whole blood. PMID:13009511

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

    PubMed Central

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

    2010-01-01

    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 180005100 mm2. Conversely, in the dead rabbits, the degenerated neuron density of the carotid body was 2100500/mm3, while the degenerated axon density in the glossopharyngeal nerve was 85002550 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). PMID:25610122

  10. Puerperal Extracranial Vertebral Artery Dissection and Nonaneurysmal Subarachnoid Hemorrhage.

    PubMed

    Garrard, James W; Simm, Renata F; Bor-Seng-Shu, Edson; Nogueira, Ricardo C

    2016-02-01

    Previously reported only a few times before, we present a case of extracranial vertebral dissection and spontaneous frontoparietal subarachnoid hemorrhage (SAH) in the puerperium, discussing possible mechanisms and difficulties in management. A 35-year-old woman presented 10 days postcaesarean section with neck pain and vertigo with normal initial investigations. Following recurrent vertigo, headache, and ataxia, imaging revealed a frontoparietal SAH and vertebral artery dissection. The patient was consequently treated with aspirin, and then following a return of symptoms 3 weeks later, warfarin therapy was continued for 6 months. The possible underlying mechanisms for this case are discussed, including reversible cervical vasoconstriction syndrome and posterior reversible encephalopathy syndrome, although neither was identified. The small SAH alongside recurrent posterior circulation symptoms resulted in the initiation of antithrombotic therapy. This report supports studies demonstrating higher incidence of cervicocephalic arterial dissection in the puerperium. Moreover, the heterogeneous presentation and manifestations of such cases require individualized treatment, and warrant studies into underlying mechanisms behind extracranial dissection and nonaneurysmal SAH. PMID:26696611

  11. Molecular alterations in the hippocampus after experimental subarachnoid hemorrhage.

    PubMed

    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

    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

  12. Health-Related Quality-of-Life Outcomes: Comparing Patients With Aneurysmal and Nonaneurysmal Subarachnoid Hemorrhage.

    PubMed

    McIntosh, Arthur P; Thomas, Ajith

    2015-10-01

    Subarachnoid hemorrhage (SAH) is divided into two major types (aneurysmal [ASAH] and nonaneurysmal [NASAH]) because, in approximately 15% of the patients who experience SAH, no source of hemorrhage can be identified. Anecdotal evidence and contradictory research suggest that patients with NASAH experience some of the same health-related quality of life (HRQOL) issues as patients with ASAH. This quantitative survey design study compared 1-3 years after hemorrhage the HRQOL in patients who had experienced an NASAH with those who had experienced an ASAH. This is the first U.S. study to specifically investigate HRQOL in NASAH and the second to compare HRQOL outcomes between patients with ASAH and NASAH. These study results corroborate those of the first-that the two groups are much more similar than different. It confirms that the impact on employment for both hemorrhage groups is significant, and it also finds an even greater inability to return to work for the patients with NASAH. Physical symptom complaints were more common in the group with NASAH, whereas the group with ASAH experienced more emotional symptoms. Both groups had low levels of posttraumatic stress disorder (PTSD), with those levels not differing significantly between groups. However, PTSD and social support were shown to impact HRQOL for both groups. The authors recommend that clinicians assess all patients with SAH for PTSD and institute treatment early. This may include offering psychological services or social work early in the hospital course. Further research and policy changes are needed to assist in interventions that improve vocational reintegration after SAH. Patients with NASAH should no longer be described as having experienced a "benign hemorrhage." They have had a life-changing hemorrhage that may forever change their lives and impact their HRQOL. PMID:26348436

  13. Fatal spotted fever group rickettsiosis due to Rickettsia conorii conorii mimicking a hemorrhagic viral fever in a South African traveler in Brazil.

    PubMed

    de Almeida, Daniele N; Favacho, Alexsandra R; Rozental, Tatiana; Barcaui, Halime; Guterres, Alexandro; Gomes, Raphael; Levis, Silvana; Coelho, Janice; Chebabo, Alberto; Costa, Ligia C; Andrea, Salete; Barroso, Paulo F; de Lemos, Elba R S

    2010-09-01

    The authors present a fatal case of spotted fever group rickettsiosis (SFGR) caused by Rickettsia conorii conorii mimicking a hemorrhagic viral fever in a South African male on a business trip in Brazil. SFGR was confirmed by molecular and immunohistochemical analyses. PMID:21771523

  14. CSF 20-HETE is associated with delayed cerebral ischemia and poor outcomes after aneurysmal subarachnoid hemorrhage

    PubMed Central

    Crago, Elizabeth A.; Thampatty, Bhavani P.; Sherwood, Paula R.; Kuo, Chie-Wen J.; Bender, Catherine; Balzer, Jeffrey; Horowitz, Michael; Poloyac, Samuel M.

    2011-01-01

    Background and Purpose Delayed cerebral ischemia (DCI) is a major complication after aneurysmal subarachnoid hemorrhage (aSAH) that is manifested by changes in cerebral blood flow (CBF) accompanied by neurological decline and results in long-term functional and neuropsychological (NP) impairment. Preclinical evidence has demonstrated that the arachidonic acid metabolite, 20-hydroxyeicosatetraenoic acid (20-HETE), affects cerebral microvascular tone and CBF after aSAH. The purpose of this study was to determine if CSF 20-HETE levels were associated with DCI and long term NP outcomes in aSAH patients. Methods CSF samples collected twice daily through 14 days after hemorrhage on 108 acute, adult aSAH patients. Samples were analyzed for 20-HETE via HPLC MSQ single quadrupole mass spectrometry. DCI was defined as the presence of impaired CBF (angiographic vasospasm, elevated transcranial Dopplers, abnormal CT or MR perfusion scans) accompanied by neurological deterioration. Outcomes including death and neuropsychological testing were completed at 3 months after hemorrhage. Results and Conclusions Detectible 20-HETE levels were observed in 31% of patient samples and were associated with severity of hemorrhage (Hunt&Hess p=0.04; Fisher p=0.05). Detection of 20-HETE was not associated with angiographic vasospasm (p=0.34), however, detectible 20-HETE was significantly associated with DCI (p=0.016). Our data also suggests that detectable 20-HETE was associated with decreased performance in 5 NP domains. These results provide the first clinical evidence that CSF 20-HETE concentrations are associated with DCI and poor outcomes and provide impetus for future studies to elucidate the clinical utility of inhibiting 20-HETE formation as a novel therapeutic intervention in patients with aSAH. PMID:21617146

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

    PubMed Central

    2013-01-01

    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-α 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-α 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

  16. Perioperative critical care management for patients with aneurysmal subarachnoid hemorrhage

    PubMed Central

    Choi, H. Alex; Edwards, Nancy; Chang, Tiffany; Sladen, Robert N.

    2014-01-01

    Despite significant regional and risk factor-related variations, the overall mortality rate in patients suffering from aneurysmal subarachnoid hemorrhage (SAH) remains high. Compared to ischemic stroke, which is typically irreversible, hemorrhagic stroke tends to carry a higher mortality, but patients who do survive have less disability. Technologies to monitor and treat complications of SAH have advanced considerably in recent years, but good long-term functional outcome still depends on prompt diagnosis, early aggressive management, and avoidance of premature withdrawal of support. Endovascular procedures and open craniotomy to secure a ruptured aneurysm represent some of the numerous critical steps required to achieve the best possible result. In this review, we have attempted to provide a contemporary, evidence-based outline of the perioperative critical care management of patients with SAH. This is a challenging and potentially fatal disease with a wide spectrum of severity and complications and an often protracted course. The dynamic nature of this illness, especially in its most severe forms, requires considerable flexibility in clinician management, especially given the panoply of available treatment modalities. Judicious hemodynamic monitoring and adaptive therapy are essential to respond to the fluctuating nature of cerebral vasospasm and the varying oxygen demands of the injured brain that may readily induce acute or delayed cerebral ischemia. PMID:25237442

  17. Carotid rete mirabile associated with subarachnoid hemorrhage from intracranial aneurysm: A case report and systematic review.

    PubMed

    Paschoal, Eric Homero Albuquerque; Yamaki, Vitor Nagai; Jnior, Fernando Mendes Paschoal; Piske, Ronie Leo; Teixeira, Manoel Jacobsen; Bor-Seng-Shu, Edson

    2015-02-01

    Carotid rete mirabile (CRM) is a rare physiological vascular network in humans that is most often found in Eastern populations. This paper describes a CRM associated with an aneurysmal subarachnoid hemorrhage (aSAH) and discusses the details of the patient's treatment. A 28-year-old woman was admitted to our service with clinical signs and symptoms of a spontaneous aSAH. Computed tomography revealed a diffuse and extensive SAH (Fisher group IV), while an angiogram showed an abnormal collateral network in the right carotid system and a hypoplastic aspect to the internal carotid artery (ICA) on the same side. In addition, a saccular aneurysm with a diameter of 9.5?mm was present in the ophthalmic segment of the left ICA. This case is extremely uncommon. To avoid rebleeding in the patient, we successfully treated the patient by clipping the aneurysmal lesion. No procedure was performed for the CRM. PMID:25934776

  18. Alterations in the expression of protease-activated receptor 1 and tumor necrosis factor-α in the basilar artery of rats following a subarachnoid hemorrhage

    PubMed Central

    LI, GANG; WANG, QING-SONG; LIN, TING-TING

    2016-01-01

    The present study aimed to investigate the expression of protease-activated receptor 1 (PAR1) and tumor necrosis factor (TNF)-α in a rat model of subarachnoid hemorrhage (SAH)-induced cerebral vasospasm (CVS). The rat models were established by twice injecting blood into the cisterna magna, after which the following experimental groups were established: The normal group, the SAH3d group, the SAH5d group and the SAH7d group. The rats were perfused and the basilar artery was removed for histological examination. The cross-sectional area of the basilar artery lumen was measured using computer software; and the protein expression of PAR1 and TNF-α was detected by immunohistochemistry. The cross-sectional area of the basilar artery of the rats in the SAH model groups was significantly decreased in a time-dependent manner, as compared with the normal group. The protein expression of PAR1 and TNF-α in the SAH3d, SAH5d and SAH7d groups was significantly increased over time (P<0.05), as compared with the normal group. CVS was detected in the basilar artery, and was associated with wall thickening and significant narrowing of the lumen, thus suggesting that the present model may be used for investigating cerebrovascular disease following SAH. The immunohistochemical analyses demonstrated that the protein expression of PAR1 and TNF-α was significantly increased in the basilar artery of the SAH model rats, and were positively correlated with the degree of CVS. PMID:26997984

  19. Demonstration of traumatic subarachnoid hemorrhage from the anterior choroidal artery.

    PubMed

    Sim, Ki-Bum; Park, Sukh Que; Choi, H Alex; Kim, Daniel H

    2014-12-01

    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. PMID:25628818

  20. The AGTR1 gene A1166C polymorphism as a risk factor and outcome predictor of primary intracerebral and aneurysmal subarachnoid hemorrhages.

    PubMed

    Adamski, Mateusz G; Golenia, Aleksandra; Turaj, Wojciech; Baird, Alison E; Moskala, Marek; Dziedzic, Tomasz; Szczudlik, Andrzej; Slowik, Agnieszka; Pera, Joanna

    2014-01-01

    Associations between the angiotensin II type 1 receptor (AGTR1) gene A1166C polymorphism and hypertension, aortic abdominal aneurysms (as a risk factor) as well as cardiovascular disorders (as a risk factor and an outcome predictor) have been demonstrated. We aimed to investigate the role of this polymorphism as risk factors and outcome predictors in primary intracerebral hemorrhage (PICH) and aneurysmal subarachnoid hemorrhage (aSAH). We have prospectively recruited 1078 Polish participants to the study: 261 PICH patients, 392 aSAH patients, and 425 unrelated control subjects. The A1166C AGTR1 gene polymorphism was studied using the tetra-primer ARMS-PCR method. Allele and genotype frequencies were compared with other ethnically different populations. The A1166C polymorphism was not associated with the risk of PICH or aSAH. Among the aSAH patients the AA genotype was associated with a good outcome, defined by a Glasgow Outcome Scale of 4 or 5 (p<0.02). The distribution of A1166C genotypes in our cohort did not differ from other white or other populations of European descent. In conclusion, we found an association between the A1166C AGTR1 polymorphism and outcome of aSAH patients, but not with the risk of PICH or aSAH. PMID:25168322

  1. Substantial radiation exposure for patients with subarachnoid hemorrhage.

    PubMed

    Gelfand, Amy A; Josephson, S Andrew

    2011-01-01

    Increasing attention is being paid to the cancer risk conferred by imaging modalities such as computed tomography (CT). Patients with subarachnoid hemorrhage (SAH) often are critically ill and require numerous imaging studies. A nonradiating diagnostic modality, transcranial Doppler (TCD), effectively screens for cerebral vasospasm. But when TCD is not available, CT angiography or conventional angiography may be ordered, increasing a patient's total radiation dose. This study investigated the total amount of radiation to which patients with SAH are exposed, and whether that amount was decreased by the availability of TCD. Patients with nontraumatic SAH who were admitted to an intensive care unit within 48 hours of symptom onset and who survived and remained hospitalized for at least 7 days were eligible. TCD was available for one group (TCD group) but not for the other group (no-TCD group). The total radiation dose for each patient was tallied. There were no differences in demographic variables or significant difference in radiation exposure between the 2 groups. Average total radiation exposure was 82.03 mSv in the TCD group and 89.79 mSv in the no-TCD group (P=.60). Head imaging accounted for 97.2% of the total radiation exposure in the TCD group and 90% of that in the no-TCD group. Patients with SAH are exposed to a substantial amount of radiation, almost all of which is centered on the head. Using Biological Effects of Ionizing Radiation VII cancer risk estimates, the average lifetime attributable risk from SAH management was approximately 1 in 125. Methods for decreasing radiation exposure are needed. PMID:20621510

  2. NONCONVULSIVE SEIZURES IN SUBARACHNOID HEMORRHAGE LINK INFLAMMATION AND OUTCOME

    PubMed Central

    Claassen, Jan; Albers, David; Schmidt, J. Michael; De Marchis, Gian Marco; Pugin, Deborah; Falo, Christina Maria; Mayer, Stephan A.; Cremers, Serge; Agarwal, Sachin; Elkind, Mitchell SV; Connolly, E. Sander; Dukic, Vanja; Hripcsak, George; Badjatia, Neeraj

    2014-01-01

    Objective Nonconvulsive seizures (NCSz) are frequent following acute brain injury and have been implicated as a cause of secondary brain injury but mechanisms that cause NCSz are controversial. Pro-inflammatory states are common after many brain injuries and inflammatory mediated changes in blood-brain-barrier permeability have experimentally been linked to seizures. Methods In this prospective observational study of aneurysmal subarachnoid hemorrhage (SAH) patients we explored the link between the inflammatory response following SAH and in-hospital NCSz studying clinical (systemic inflammatory response syndrome,SIRS) and laboratory markers of inflammation (tumor necrosis factor receptor 1,TNF-R1; high sensitivity C-reactive protein,hsCRP). Logistic regression, cox proportional hazards regression, and mediation analyses were performed to investigate temporal and causal relationships. Results Among 479 SAH patients, 53(11%) had in-hospital NCSz. Patients with in-hospital NCSz had a more pronounced SIRS response (OR1.9 per point increase in SIRS; 95%-CI1.3-2.9), inflammatory surges were more likely immediately preceding NCSz onset, and the negative impact of SIRS on functional outcome at 3 months was mediated in part through in-hospital NCSz. In a subset with inflammatory serum biomarkers we confirmed these findings linking higher serum TNF-R1 and hsCRP to in-hospital NCSz (OR1.2 per 20 point hsCRP increase [95%-CI1.1-1.4]; OR2.5 per 100 point TNF-R1 increase [95%-CI2.1-2.9]). The association of inflammatory biomarkers with poor outcome was mediated in part through NCSz. Interpretation In-hospital NCSz were independently associated with a pro-inflammatory state following SAH reflected in clinical symptoms and serum biomarkers of inflammation. Our findings suggest that inflammation following SAH is associated with poor outcome and this effect is at least in part mediated through in-hospital NCSz. PMID:24771589

  3. Causes of 30-day readmission after aneurysmal subarachnoid hemorrhage.

    PubMed

    Greenberg, Jacob K; Washington, Chad W; Guniganti, Ridhima; Dacey, Ralph G; Derdeyn, Colin P; Zipfel, Gregory J

    2016-03-01

    OBJECT Hospital readmission is a common but controversial quality measure increasingly used to influence hospital compensation in the US. The objective of this study was to evaluate the causes for 30-day hospital readmission following aneurysmal subarachnoid hemorrhage (SAH) to determine the appropriateness of this performance metric and to identify potential avenues for improved patient care. METHODS The authors retrospectively reviewed the medical records of all patients who received surgical orendovas-cular treatment for aneurysmal SAH at Barnes-Jewish Hospital between 2003 and 2013. Two senior faculty identified by consensus the primary medical/surgical diagnosis associated with readmission as well as the underlying causes of rehospitalization. RESULTS Among 778 patients treated for aneurysmal SAH, 89 experienced a total of 97 readmission events, yielding a readmission rate of 11.4%. The median time from discharge to readmission was 9 days (interquartile range 3-17.5 days). Actual hydrocephalus or potential concern for hydrocephalus (e.g., headache) was the most frequent diagnosis (26/97, 26.8%), followed by infections (e.g., wound infection [5/97, 5.2%], urinary tract infection [3/97, 3.1%], and pneumonia [3/97, 3.1%]) and thromboembolic events (8/97, 8.2%). In most cases (75/97, 77.3%), we did not identify any treatment lapses contributing to readmission. The most common underlying causes for readmission were unavoidable development of SAH-related pathology (e.g., hydrocephalus; 36/97, 37.1%) and complications related to neurological impairment and immobility (e.g., thromboembolic event despite high-dose chemoprophylaxis; 21/97, 21.6%). The authors determined that 22/97 (22.7%) of the readmissions were likely preventable with alternative management. In these cases, insufficient outpatient medical care (for example, for hyponatremia; 16/97, 16.5%) was the most common shortcoming. CONCLUSIONS Most readmissions after aneurysmal SAH relate to late consequences of hemorrhage, such as hydrocephalus, or medical complications secondary to severe neurological injury. Although a minority of readmissions may potentially be avoided with closer medical follow-up in the transitional care environment, readmission after SAH is an insensitive and likely inappropriate hospital performance metric. PMID:26361278

  4. Protocol for the induction of subarachnoid hemorrhage in mice by perforation of the Circle of Willis with an endovascular filament.

    PubMed

    Bhler, Dominik; Schller, Kathrin; Plesnila, Nikolaus

    2014-12-01

    Genetically engineered mice are a valuable tool to investigate the molecular and cellular mechanisms leading to brain damage following subarachnoid hemorrhage (SAH). Therefore, several murine SAH models were developed during the last 15years. Among those models, the perforation of the Circle of Willis by an endovascular filament or "filament model" turned out to become the most popular one, since it is believed to reproduce some of the most prominent pathophysiological features observed after human SAH. Despite the importance of the endovascular filament model for SAH research, relatively few studies were published using this technique during the past years and a number of laboratories reported problems establishing the technique. This triggered discussions about the standardization, reproducibility, and the reliability of the model. In order to improve this situation, the current paper aims to provide a comprehensive hands-on protocol of the murine endovascular filament model. The protocol proved to result in induction of SAH in mice with high intrapersonal and interpersonal reproducibility and is based on our experience with this technique for more than 10years. By sharing our experience with this valuable model, we aim to initiate a constantly ongoing discussion process on the improvement of standards and techniques in the field of experimental SAH research. PMID:25123204

  5. Microglia regulate blood clearance in subarachnoid hemorrhage by heme oxygenase-1.

    PubMed

    Schallner, Nils; Pandit, Rambhau; LeBlanc, Robert; Thomas, Ajith J; Ogilvy, Christopher S; Zuckerbraun, Brian S; Gallo, David; Otterbein, Leo E; Hanafy, Khalid A

    2015-07-01

    Subarachnoid hemorrhage (SAH) carries a 50% mortality rate. The extravasated erythrocytes that surround the brain contain heme, which, when released from damaged red blood cells, functions as a potent danger molecule that induces sterile tissue injury and organ dysfunction. Free heme is metabolized by heme oxygenase (HO), resulting in the generation of carbon monoxide (CO), a bioactive gas with potent immunomodulatory capabilities. Here, using a murine model of SAH, we demonstrated that expression of the inducible HO isoform (HO-1, encoded by Hmox1) in microglia is necessary to attenuate neuronal cell death, vasospasm, impaired cognitive function, and clearance of cerebral blood burden. Initiation of CO inhalation after SAH rescued the absence of microglial HO-1 and reduced injury by enhancing erythrophagocytosis. Evaluation of correlative human data revealed that patients with SAH have markedly higher HO-1 activity in cerebrospinal fluid (CSF) compared with that in patients with unruptured cerebral aneurysms. Furthermore, cisternal hematoma volume correlated with HO-1 activity and cytokine expression in the CSF of these patients. Collectively, we found that microglial HO-1 and the generation of CO are essential for effective elimination of blood and heme after SAH that otherwise leads to neuronal injury and cognitive dysfunction. Administration of CO may have potential as a therapeutic modality in patients with ruptured cerebral aneurysms. PMID:26011640

  6. Microglia regulate blood clearance in subarachnoid hemorrhage by heme oxygenase-1

    PubMed Central

    Schallner, Nils; Pandit, Rambhau; LeBlanc, Robert; Thomas, Ajith J.; Ogilvy, Christopher S.; Zuckerbraun, Brian S.; Gallo, David; Otterbein, Leo E.; Hanafy, Khalid A.

    2015-01-01

    Subarachnoid hemorrhage (SAH) carries a 50% mortality rate. The extravasated erythrocytes that surround the brain contain heme, which, when released from damaged red blood cells, functions as a potent danger molecule that induces sterile tissue injury and organ dysfunction. Free heme is metabolized by heme oxygenase (HO), resulting in the generation of carbon monoxide (CO), a bioactive gas with potent immunomodulatory capabilities. Here, using a murine model of SAH, we demonstrated that expression of the inducible HO isoform (HO-1, encoded by Hmox1) in microglia is necessary to attenuate neuronal cell death, vasospasm, impaired cognitive function, and clearance of cerebral blood burden. Initiation of CO inhalation after SAH rescued the absence of microglial HO-1 and reduced injury by enhancing erythrophagocytosis. Evaluation of correlative human data revealed that patients with SAH have markedly higher HO-1 activity in cerebrospinal fluid (CSF) compared with that in patients with unruptured cerebral aneurysms. Furthermore, cisternal hematoma volume correlated with HO-1 activity and cytokine expression in the CSF of these patients. Collectively, we found that microglial HO-1 and the generation of CO are essential for effective elimination of blood and heme after SAH that otherwise leads to neuronal injury and cognitive dysfunction. Administration of CO may have potential as a therapeutic modality in patients with ruptured cerebral aneurysms. PMID:26011640

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

    PubMed Central

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

    2013-01-01

    Delayed cerebral vasospasm (CVS) and delayed cerebral ischemia (DCI) remain severe complications after subarachnoid hemorrhage (SAH). Although focal changes in cerebral metabolism indicating ischemia are detectable by microdialysis, routinely used biomarkers are missing. We therefore sought to evaluate a panel of possible global markers in serum and cerebrospinal fluid (CSF) of patients after SAH. CSF and serum of SAH patients were analyzed retrospectively. In CSF, levels of inhibitory, excitatory, and structural amino acids were detected by high-performance liquid chromatography (HPLC). In serum, neuron-specific enolase (NSE) and S100B level were measured and examined in conjunction with CVS and DCI. CVS was detected by arteriography, and ischemic lesions were assessed by computed tomography (CT) scans. All CSF amino acids were altered after SAH. CSF glutamate, glutamine, glycine, and histidine were significantly correlated with arteriographic CVS. CSF glutamate and serum S100B were significantly correlated with ischemic events after SAH; however, NSE did not correlate neither with ischemia nor with vasospasm. Glutamate, glutamine, glycine, and histidine might be used in CSF as markers for CVS. Glutamate also indicates ischemia. Serum S100B, but not NSE, is a suitable marker for ischemia. These results need to be validated in larger prospective cohorts. PMID:23509668

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

    SciTech Connect

    Kamata, Katsuo; Nishiyama, Hiroshi; Kasuya, Yutaka ); Miyata, Noriyuki )

    1991-01-01

    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.

  9. Assessment of the Correlations Between Brain Weight and Brain Edema in Experimental Subarachnoid Hemorrhage.

    PubMed

    Hasegawa, Yu; Suzuki, Hidenori; Nakagawa, Takashi; Uekawa, Ken; Koibuchi, Nobutaka; Kawano, Takayuki; Kim-Mitsuyama, Shokei

    2016-01-01

    Because brain edema is correlated with poor outcome in clinical subarachnoid hemorrhage (SAH), appropriate evaluation methods for brain edema are important in experimental SAH studies. Although brain water content (BWC) is widely used to evaluate brain edema in stroke research, the usefulness of brain weight is undetermined. In this study, we examined the role of brain weight in the evaluation of brain edema in experimental SAH. The endovascular perforation model of SAH was used, and rats were assessed by neurological scoring (NS). The brains were quickly removed at 24 h after the operation, and the weights of wet cerebrum (WWC) and dry cerebrum (WDC) were measured to determine the brain water content (BWC). The correlations of those values with each other and to body weight (BW) were then examined to reveal the significance of brain weight. The rats were assigned to sham-operated (n = 8) and SAH (n = 16) groups. There were no significant differences in WWC between the groups (p = 0.61). WWC was correlated with BWC but not with NS in all rats. In addition, WWC was clearly correlated with BW and WDC, which is thought to substitute for the original brain weight. From these results, we suggest that the measurement of brain weight as an evaluation of brain edema is limited and that BW and original brain volume can be confounding factors in evaluation. PMID:26463928

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

    PubMed Central

    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

    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

  11. Dysfunction of nitric oxide synthases as a cause and therapeutic target in delayed cerebral vasospasm after SAH

    PubMed Central

    Pluta, Ryszard M.

    2016-01-01

    Nitric oxide (NO), also known as endothelium-derived relaxing factor, is produced by endothelial nitric oxide synthase (eNOS) in the intima and by neuronal nitric oxide synthase (nNOS) in the adventitia of cerebral vessels. It dilates the arteries in response to shear stress, metabolic demands, pterygopalatine ganglion stimulation and chemoregulation. Subarachnoid hemorrhage (SAH) interrupts this regulation of cerebral blood flow. Hemoglobin, gradually released from erythrocytes in the subarachnoid space, destroys nNOS-containing neurons in the conductive arteries. This deprives the arteries of NO, leading to initiation of delayed vasospasm. But such vessel narrowing increases shear stress, which stimulates eNOS. This mechanism normally would lead to increased production of NO and dilation of arteries. However, a transient eNOS dysfunction evoked by an increase in the endogenous competitive NOS inhibitor, asymmetric dimethylarginine (ADMA), prevents this vasodilation. eNOS dysfunction has been recently shown to be evoked by increased levels of ADMA in cerebrospinal fluid (CSF) in response to the presence of bilirubin-oxidized fragments (BOXes). A direct cause of the increased ADMA CSF level is most likely decreased ADMA elimination owing to disappearance of ADMA-hydrolyzing enzyme [dimethylarginine dimethylaminohydrolase II (DDAH II)] immunoreactivity in the arteries in spasm. This eNOS dysfunction sustains vasospasm. CSF ADMA levels are closely associated with the degree and time course of vasospasm; when CSF ADMA levels decrease, vasospasm resolves. Thus, exogenous delivery of NO, inhibiting the L-arginine-methylating enzyme or stimulating DDAH II, may provide new therapeutic modalities to prevent and treat vasospasm. This paper will present results of pre-clinical studies supporting the NO-based hypothesis of delayed cerebral vasospasm development and its prevention by increased NO availability. PMID:18456999

  12. Impact of electrolyte imbalances on the outcome of aneurysmal subarachnoid hemorrhage: A prospective study

    PubMed Central

    Alimohamadi, Maysam; Saghafinia, Masoud; Alikhani, Fariba; Danial, Zohreh; Shirani, Mohamad; Amirjamshidi, Abbas

    2016-01-01

    Background: Electrolyte disturbances are frequently observed during the acute and subacute period after subarachnoid hemorrhage (SAH) and may potentially worsen therapeutic outcome. This study was conducted to determine the pattern of electrolyte disturbance in the acute and subacute phase after SAH and their effect on the long-term outcome of the patients. Materials and Methods: Fifty-three patients were prospectively enrolled. The standards of care for all patients were uniformly performed. The serum levels of electrolytes (sodium, potassium and magnesium) were determined with measurements obtained on admission, 3–5 and 7–10 days after SAH. Radiographic intensity of hemorrhage (Fisher's scale), and the clinical grading (World Federation of Neurosurgical Societies grade) were documented in the first visit. The outcomes were evaluated using Glasgow outcome scale at 3 months after discharge. Results: Hyponatremia was the most common electrolyte imbalance among the patients but did not worsen the outcome. Although less common, hypernatremia in the subacute phase was significantly associated with poor outcome. Both hypokalemia and hypomagnesemia were predictive of poor outcomes. Conclusions: Because electrolyte abnormalities can adversely affect the outcome, the serum levels of electrolytes should be closely monitored with serial measurements and treated properly in patients with aneurysmal SAH. PMID:26889275

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

    PubMed Central

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

    2014-01-01

    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

  14. Postpartum hemorrhage.

    PubMed

    Su, Cindy W

    2012-03-01

    Postpartum hemorrhage (PPH) is a very common obstetric emergency with high morbidity and mortality rates worldwide. Understanding its etiology is fundamental to effectively managing PPH in an acute setting. Active management of the third stage of labor is also a key component in its prevention. Management strategies include conservative measures (medications, uterine tamponade, and arterial embolization) as well as surgical interventions (arterial ligations, compression sutures, and hysterectomy). Creating a standardized PPH protocol and running simulation-based drills with a multidisciplinary team may also help decrease maternal morbidity and improve perinatal outcomes, although further studies are needed. PMID:22309588

  15. High altitude subhyaloid hemorrhage

    PubMed Central

    Hanifudin, Abdul; Lim, Lik Thai; Ah-Kee, Elliott Yann; El-Khashab, Tarek

    2015-01-01

    Subhyaloid hemorrhages can occur as a result of exposure to high altitude. We hereby report a clinical picture of subhyaloid hemorrhage associated with high altitude. The case demonstrates optical coherence tomography findings that aid diagnosis of subhyaloid hemorrhage.

  16. Viral Hemorrhagic Fevers

    MedlinePLUS

    ... Renal Syndrome Hendra Virus Disease Kyasanur Forest Disease Lassa Fever Lymphocytic Choriomeningitis (LCM) Marburg Hemorrhagic Fever Nipah Virus ... infection in outbreaks of Ebola hemorrhagic fever and Lassa fever. What are the symptoms of viral hemorrhagic fever ...

  17. Intracranial hemorrhage following allogeneic hematopoietic stem cell transplantation.

    PubMed

    Najima, Yuho; Ohashi, Kazuteru; Miyazawa, Maho; Nakano, Mikako; Kobayashi, Takeshi; Yamashita, Takuya; Akiyama, Hideki; Sakamaki, Hisashi

    2009-05-01

    Charts and radiographs of 622 allogeneic hematopoietic stem cell transplant (HSCT) recipients, over a 20-year period, were retrospectively reviewed for intracranial hemorrhage (ICH) following transplant. A total of 21 cases of ICH were identified (3.4%) including 15 cases of intraparenchymal hemorrhage (IPH), two cases of subarachnoid hemorrhage (SAH), and four cases of subdural hematoma (SDH). The median time from transplantation to the onset of ICH was 63 days (range, 6-3,488 days). The clinical features of post-transplant ICH patients were similar and included hypertension, diabetes mellitus, chronic graft-versus-host disease (GVHD), systemic infection, and veno occlusive disease (VOD), recently referred to as sinusoidal obstruction syndrome, in addition to severe thrombocytopenia. Mortality rate was especially high (89%) after IPH with a median survival of 2 days (range, 0-148 days). In contrast, all patients with SAH or SDH following HSCT survived. The cause of post-transplant ICH appears to be multifactorial, including thrombocytopenia, hypertension, acute GVHD, VOD, and radiation therapy. Most patients in our series displayed severe thrombocytopenia at the onset of ICH, even though adequate prophylactic platelet transfusions were given. By univariate analysis, cord blood transplantation, acute GVHD, systemic infection, and VOD were related to the incidence of ICH, whereas prior CNS episodes and radiation therapy did not reach statistical significance. A multivariate analysis with logistic regression identified acute GVHD as the only factor that significantly influenced ICH occurrence. PMID:19338041

  18. Description of the Vasospasm Phenomena following Perimesencephalic Nonaneurysmal Subarachnoid Hemorrhage

    PubMed Central

    Goren, Oded; Bruk, Bela; Bakon, Mati; Hadani, Moshe; Harnof, Sagi

    2013-01-01

    Background. Perimesencephalic nonaneurysmal subarachnoid hemorrhage (PM-NASAH) is characterized by a benign course compared with aneurysmal SAH. While vasospasm (VS) after aneurysmal SAH is considered responsible for serious complications, VS post-PM-NASAH is not well documented. Our purpose was to characterize the incidence and course of VS among 63 patientsone of the largest databases of PM-NASAH patients with documented blood flow velocities in the literature. Methods. Data from 63 patients that were admitted with PM-NASAH from 2000 to 2012 and underwent transcranial Doppler tests to assess cranial vessel flow velocity was analyzed. Results. On average, the maximal flow velocity was measured on the 7th day after hemorrhage. Higher risk for VS was associated with younger age, female sex, and higher Hunt and Hess scores, a lower risk for patients treated with statins (P < 0.05). Using velocity thresholds for diagnosis of VS, 49.2% showed evidence of VS. This is the first description of blood flow velocities in PM-NASAH. VS average onset was on the 4th day, average cessation on day 15 after hemorrhage. No patients showed clinical manifestation of VS. Conclusions. VS post-PM-NASAH is not as rare as previously believed. However, its lack of clinical significance raises questions regarding the need for diagnosis and may suggest a less intensive treatment protocol. PMID:24455690

  19. Angiographic dimple of profound significance in cases of aneurysmal subarachnoid hemorrhage: report of 2 cases.

    PubMed

    Park, Jaechan

    2015-12-01

    The occurrence of an angiographic dimple or irregularity due to indentation of the contrast column by an intraluminal thrombus at the dome of a ruptured aneurysm is not uncommon and does not draw much clinical attention. However, an angiographic dimple at the base of the ruptured aneurysm or division of the parent artery can signify a rupture point close to the dimple and an intraluminal thrombus, which has utmost clinical significance as it is close to the parent artery and necessitates a different treatment strategy from rupture of the aneurysm dome. The author reports on 2 cases of an angiographic dimple following subarachnoid hemorrhage (SAH) and subsequent surgical exploration. In the first patient, a 57-year-old-woman, angiography revealed a basal dimple in a superiorly directed anterior communicating artery aneurysm. A pterional craniotomy was performed, which revealed a bilobed aneurysm harboring a superiorly directed unruptured lobule and inferiorly directed ruptured lobule. An intraluminal thrombus in the inferiorly directed lobule apparently obscured the lobule and caused the appearance of the basal dimple on the angiograms. In the second patient, a 40-year-old man who had been transferred to the author's institution because of an angiographic evaluation that did not show any aneurysm despite SAH in the basal cisterns, initial angiography revealed a subtle dimple on the superior wall of the anterior communicating artery (ACoA). On follow-up angiography, a very small aneurysm was seen at the site of the dimple. A craniotomy then revealed a very small ruptured and thrombosed aneurysm on the superior wall of the ACoA. PMID:26053688

  20. Hemorrhagic tonsillitis.

    PubMed

    Levy, S; Brodsky, L; Stanievich, J

    1989-01-01

    Eleven patients with acute and/or chronic tonsillitis, who presented with a spontaneous tonsillar hemorrhage are reported and discussed. Two patterns of hemorrhage were noted: 1. diffuse, parenchymal bleeding and 2. localized bleeding from dilated surface vessels. Pharyngeal culture for group A beta-hemolytic Streptococcus was positive in six patients (55%). Monospot, heterophile antibodies, complete blood cell count, prothombin time, partial thromboplastin time, and viral studies did not consistently demonstrate any abnormality. Two patients, however, did have an elevation in liver enzymes. In five patients, the bleeding stopped spontaneously; in five patients the bleeding was controlled with local chemical cautery. In two patients, Avitene was used for hemostasis. One other patient's bleeding was controlled by electrocautery while the patient was under anesthesia for endoscopic evaluation of hemoptysis. Two patients required blood transfusions; one of these patients had a history of factor IX deficiency. Four case histories are discussed in detail to illustrate the varied clinical presentation and some pitfalls in diagnosing and managing this rarely reported complication of tonsillitis. Possible mechanisms for the pathophysiology include increased tonsillar blood flow, necrosis of tonsillar surface cells, and trauma to dilated surface vessels. No common bacterial or viral etiology could be determined in this rare, but potentially serious, complication of tonsillitis. PMID:2909817

  1. Intracerebral hemorrhage (image)

    MedlinePLUS

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

  2. Comparison of Incidence and Risk Factors for Shunt-dependent Hydrocephalus in Aneurysmal Subarachnoid Hemorrhage Patients

    PubMed Central

    Bae, In-Seok; Choi, Kyu-Sun; Chun, Hyoung-Joon

    2014-01-01

    Objective The objective of this study was to compare the incidence of ventricular shunt placement for shunt-dependent hydrocephalus (SDHC) after clipping versus coiling of ruptured aneurysms. Materials and Methods A retrospective review was conducted in 215 patients with aneurysmal subarachnoid hemorrhage (SAH) who underwent surgical clipping or endovascular coiling during the period from May 2008 to December 2011. Relevant clinical and radiographic data were analyzed with regard to the incidence of hydrocephalus and ventriculo-peritoneal shunt (VPS). Patients treated with clipping were assigned to Group A, while those treated with coiling were assigned to Group B. Results Of 215 patients (157 clipping, 58 coiling), no significant difference in the incidence of final VPS was observed between treatment modalities (15.3% vs. 10.3%) (p = 0.35). Independent risk factors for VPS for treatment of chronic hydrocephalus were as follows: (1) older than 65 years, (2) poorer Hunt-Hess grade IV and V, (3) Fisher grade III and IV, and (4) particularly initial presence of an intraventricular hemorrhage. Conclusion In this study comparing two modalities for treatment of aneurysm, there was no difference in the incidence of chronic hydrocephalus requiring VPS. A significantly higher rate of shunt dependency was observed for age older than 65 years, poor initial neurological status, and thick SAH with presence of initial intraventricular hemorrhage. By understanding these factors related to development of SDHC and results, it is expected that management of aneurysmal SAH will result in a better prognosis. PMID:25045646

  3. Hydrocephalus in 389 patients with aneurysm-associated subarachnoid hemorrhage.

    PubMed

    Woernle, Christoph M; Winkler, Kerstin M L; Burkhardt, Jan-Karl; Haile, Sarah R; Bellut, David; Neidert, Marian C; Bozinov, Oliver; Krayenbhl, Niklaus; Bernays, Ren-Ludwig

    2013-06-01

    Subarachnoid hemorrhage (SAH) often leads to hydrocephalus, which is commonly treated by placement of a ventriculoperitoneal (VP) shunt. There is controversy over which factors affect the need for such treatment. In this study, data were prospectively collected from 389 consecutive patients who presented with an aneurysm-associated SAH at a single center. External ventricular drainage placement was performed as part of the treatment for acute hydrocephalus, and VP shunts were placed in patients with chronic hydrocephalus. The data were retrospectively analyzed using two-sample t-tests, Fisher's exact test and logistic regression analysis. Overall, shunt dependency occurred in 91 of the 389 patients (23.4%). Using logistic regression analysis, two factors were found to be significantly associated with VP shunt placement: an initial Glasgow Coma Scale (GCS) score of 8-14 (8-14 versus 3-7, p = 0.016; 15 versus 3-7, p = 0.55); and aneurysm coiling (p = 0.017). Patients with an initial GCS score of 8-14 after aneurysm-associated SAH had a 2.5-fold higher risk of receiving a VP shunt than those with a GCS score of 3-7. Those with a GCS of 15 had a 50% lower risk of becoming shunt dependent than did the subgroup with a GCS score of 8-14. To clarify and strengthen these observations, prospective, randomized trials are needed. PMID:23562295

  4. Brain Volume Determination in Subarachnoid Hemorrhage Using Rats.

    PubMed

    Lekic, Tim; Hardy, Maurice; Fujii, Mutsumi; McBride, Devin W; Zhang, John H

    2016-01-01

    Brain edema is routinely measured using the wet-dry method. Volume, however, is the sum total of all cerebral tissues, including water. Therefore, volumetric change following injury may not be adequately quantified using percentage of edema. We thus tested the hypothesis that dried brains can be reconstituted with water and then re-measured to determine the actual volume. Subarachnoid hemorrhage (SAH) was induced by endovascular perforation in adult male Sprague-Dawley rats (n?=?30). Animals were euthanized at 24 and 72 h after evaluation of neurobehavior for determination of brain water content. Dried brains were thereafter reconstituted with equal parts of water (lost from brain edema) and centrifuged to remove air bubbles. The total volume was quantified using hydrostatic (underwater) physics principles that 1 ml water (mass)?=?1 cm(3) (volume). The amount of additional water needed to reach a preset level marked on 2-ml test tubes was added to that lost from brain edema, and from the brain itself, to determine the final volume. SAH significantly increased both brain water and volume while worsening neurological function in affected rats. Volumetric measurements demonstrated significant brain swelling after SAH, in addition to the brain edema approach. This modification of the "wet-dry" method permits brain volume determination using valuable post hoc dried brain tissue. PMID:26463930

  5. Severe microvascular injury induced by lysosomal releasates of human polymorphonuclear leukocytes. Increase in vasopermeability, hemorrhage, and microthrombosis due to degradation of subendothelial and perivascular matrices.

    PubMed Central

    Movat, H. Z.; Wasi, S.

    1985-01-01

    The purpose of this study was to assess the nature of the lesions in the microcirculation of the dermis of rabbits induced with lysosomal releasates of human polymorphonuclear leukocytes (PMNs). No attempt was made in the studies presented in this publication to deal with the offending agent in the releasate. Four parameters of microvascular injury were quantitated: increase in vascular permeability with 125I-labeled serum albumin, hemorrhage with 59Fe-labeled erythrocytes, accumulation (aggregation) of platelets with 111In-labeled platelets. In one experiment accumulation of 51Cr-PMNs was investigated. The lysosomal releasate induced a rapid increase in vasopermeability, but both hemorrhage and exudate formation peaked 1 hour after intradermal injection. Platelet accumulation was also demonstrable in these lesions, and microthrombosis was a very prominent feature. The microvascular injury, including microthrombosis, could be elicited also in animals rendered leukopenic with nitrogen mustard. Simultaneous injection of prostaglandin E2 with the releasate enhanced the microvascular injury. The morphologic changes in the microcirculation of the rabbit's dermis were assessed in lesions 5 minutes to 5 hours old. Several changes were encountered, primarily in the wall of venules and small veins and to a lesser degree in small arteries and capillaries. Ultrastructurally very early lesions (up to 15 minutes) had gaps or spaces in the endothelium, resembling those induced by mediators such as histamine or bradykinin. Older lesions were different, quite characteristic, and represent the hallmark of these lesions. Lysis and disappearance of vascular basement membrane, of perivascular collagen, and of the internal elastic lamina were a frequent finding, best demonstrable when microthrombi did not abut on vessel walls. Cellular components of vessels (endothelium, pericytes, smooth muscle) showed fragmentation, leading to complete disappearance of cellular elements. These lesions were usually walled off by platelet aggregates and fibrin. At times microthrombi occluded an entire vessel. These changes were interpreted as hemostasis. The mild accumulation of PMNs at the site of injury did not contribute significantly to the microvascular injury. The findings indicate that the unique changes in the microcirculation, not described before, may occur quite frequently, when the microvascular injury is elicited primarily by release of lysosomal constituents by phagocytic or nonphagocytic stimuli. One can conclude that the hallmark of this type of injury is disappearance of basement membrane followed secondarily by disintegration of the vascular wall, followed in turn by hemo Images Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 PMID:3907363

  6. Relevance of bleeding pattern on clinical appearance and outcome in patients with hemorrhagic brain arteriovenous malformations.

    PubMed

    Sturiale, Carmelo Lucio; Puca, Alfredo; Calandrelli, Rosalinda; D'Arrigo, Sonia; Albanese, Alessio; Marchese, Enrico; Alexandre, Andrea; Colosimo, Cesare; Maira, Giulio

    2013-01-15

    Although several descriptions of the angioarchitectural features of brain arteriovenous malformations (AVMs) associated with higher hemorrhagic risk have been reported, the prognostic value of the different bleeding patterns still needs to be elucidated. This study evaluated the influence on clinical appearance and outcome of the parenchymal and non-parenchymal (subarachnoid hemorrhage-SAH-and intraventricular hemorrhage-IVH) bleedings associated with ruptured AVMs. Clinical records and neuroradiological examinations of 30 patients with hemorrhagic AVMs were reviewed in order to identify their angioarchitectural features and the associated bleeding pattern. These data along with demographic characteristics and treatment modality were dichotomized and their relationship with clinical status at admission and follow-up was tested. IVH as well as parenchymal hematomas larger than 20 cm(3) appeared associated with a severe clinical status at admission, whereas SAH involving basal cisterns was significantly associated with unfavorable outcome. Age, sex and angioarchitectural features did not show significant association with the severity of the prognosis. However, none of these bleeding patterns appeared as an independent risk factor of poor outcome at multivariate analysis. In conclusion, our data emphasized the possibility that non-parenchymal bleeding may worsen the outcome of patients with hemorrhagic AVMs. PMID:23146614

  7. Prognostic Value of Serum S100 Protein by Elecsys S100 Immunoassay in Patients with Spontaneous Subarachnoid and Intracerebral Hemorrhages

    PubMed Central

    Choi, Young-Jin; Kim, Hwi-Jun; Shim, Jai-Joon; Bae, Hack-Gun; Yun, Il-Gyu

    2008-01-01

    Objective The serum S100 protein has been known to reflect the severity of neuronal damage. The purpose of this study was to assess the prognostic value of the serum S100 protein by Elecsys S100 immunoassay in patients with subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH) and to establish reference value for this new method. Methods Serum S100 protein value was measured at admission, day 3 and 7 after bleeding in 42 consecutive patients (SAH : 20, ICH : 22) and 74 healthy controls, prospectively. Admission Glasgow coma scale (GCS) score, Hunt & Hess grade and Fisher grade for SAH, presence of intraventricular hemorrhage, ICH volume, and outcome at discharge were evaluated. Degrees of serum S100 elevation and their effect on outcomes were compared between two groups. Results Median S100 levels in SAH and ICH groups were elevated at admission (0.092 versus 0.283 µg/L) and at day 3 (0.110 versus 0.099 µg/L) compared to healthy controls (0.05 µg/L; p<0001). At day 7, however, these levels were normalized in both groups. Time course of S100 level in SAH patient was relatively steady at least during the first 3 days, whereas in ICH patient it showed abrupt S100 surge on admission and then decreased rapidly during the next 7 days, suggesting severe brain damage at the time of bleeding. In ICH patient, S100 level on admission correlated well with GCS score (r=-0.859; p=0.0001) and ICH volume (r=0.663; p=0.001). A baseline S100 level more than 0.199 µg/L predicted poor outcome with 92% sensitivity and 90% specificity. Logistic regression analyses showed Ln (S100) on admission as the only independent predictor of poor outcome (odd ratio 36.1; 95% CI, 1.98 to 656.3). Conclusion Brain damage in ICH patient seems to develop immediately after bleeding, whereas in SAH patients it seems to be sustained for few days. Degree of brain damage is more severe in ICH compared to SAH group based on the S100 level. S100 level is considered an independent predictor of poor outcome in patient with spontaneous ICH, but not in SAH. Further study with large population is required to confirm this result. PMID:19119467

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

    PubMed Central

    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

    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)-β1, tumor necrosis factor (TNF)-α, 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-α values were 114±34, 134±38, and 55±16 pg/mL, respectively. TGF-β1 values were 953±430, 869±447, and 136±63 pg/mL, respectively. A significant difference in TNF-α and TGF-β1 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-α and TGF-β1 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

  9. Heart Rate Variability for Preclinical Detection of Secondary Complications after Subarachnoid Hemorrhage

    PubMed Central

    Schmidt, J. Michael; Sow, Daby; Crimmins, Michael; Albers, David; Agarwal, Sachin; Claassen, Jan; Connolly, E. Sander; Elkind, Mitchell S. V.; Hripcsak, George; Mayer, Stephan A.

    2015-01-01

    Introduction We sought to determine if monitoring heart rate variability (HRV) would enable preclinical detection of secondary complications after subarachnoid hemorrhage (SAH). Methods We studied 236 SAH patients admitted within the first 48 hours of bleed onset, discharged after SAH day 5, and had continuous electrocardiogram records available. The diagnosis and date of onset of infections and DCI events were prospectively adjudicated and documented by the clinical team. Continuous ECG was collected at 240 Hz using a high-resolution data acquisition system. The Tompkins Hamilton algorithm was used to identify R-R intervals excluding ectopic and abnormal beats. Time, frequency, and regularity domain calculations of HRV were generated over the first 48 hours of ICU admission and 24 hours prior to the onset of each patient's first complication, or SAH day 6 for control patients. Clinical prediction rules to identify infection and DCI events were developed using bootstrap aggregation and cost sensitive meta-classifiers. Results The combined infection and DCI model predicted events 24 hours prior to clinical onset with high sensitivity (87%) and moderate specificity (66%), and was more sensitive than models that predicted either infection or DCI. Models including clinical and HRV variables together substantially improved diagnostic accuracy (AUC 0.83) compared to models with only HRV variables (AUC 0.61). Conclusions Changes in HRV after SAH reflect both delayed ischemic and infectious complications. Incorporation of concurrent disease severity measures substantially improves prediction compared to using HRV alone. Further research is needed to refine and prospectively evaluate real-time bedside HRV monitoring after SAH. PMID:24610353

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

    PubMed Central

    2014-01-01

    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

  11. Ischemia modified albumin increase indicating cardiac damage after experimental subarachnoid hemorrhage

    PubMed Central

    2014-01-01

    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

  12. Coffee Consumption and Incidence of Subarachnoid Hemorrhage: The Jichi Medical School Cohort Study

    PubMed Central

    Sakamaki, Tsuyako; Hara, Motohiko; Kayaba, Kazunori; Kotani, Kazuhiko; Ishikawa, Shizukiyo

    2016-01-01

    Background Previous studies on the association between coffee consumption and subarachnoid hemorrhage (SAH) have provided inconsistent results. We examine the risk of SAH from coffee consumption in a Japanese population. Methods Our analyses were based on the Jichi Medical School Cohort Study, a large-scale population-based prospective cohort study. A total of 9941 participants (3868 men and 6073 women; mean age 55 years) with no history of cardiovascular disease or carcinoma were examined. Participants were asked to choose one of five options to indicate their daily coffee consumption: none, less than 1 cup a day, 1–2 cups a day, 3–4 cups a day, or 5 or more cups a day. The incidence of SAH was assessed independently by a diagnostic committee. Cox proportional hazards models were used to calculate hazard ratios (HRs) and their 95% confidence intervals (CI) after adjustment for age and sex (HR1) and for additional potential confounders (HR2). Results During 10.7 years of follow-up, SAH occurred in 47 participants. When compared with the participants who consumed less than 1 cup of coffee a day, the HR of SAH was significantly higher in the group who consumed 5 or more cups a day in both models (HR1 4.49; 95% CI, 1.44–14.00; HR2 3.79; 95% CI, 1.19–12.05). Conclusions The present community-based cohort study showed that heavy coffee consumption was associated with an increased incidence of SAH after adjusting for age, sex, and multiple potential cardiovascular confounders. PMID:26460383

  13. Impaired Cerebral Autoregulation Is Associated With Vasospasm and Delayed Cerebral Ischemia in Subarachnoid Hemorrhage

    PubMed Central

    Otite, Fadar; Mink, Susanne; Tan, Can Ozan; Puri, Ajit; Zamani, Amir A.; Mehregan, Aujan; Chou, Sherry; Orzell, Susannah; Purkayastha, Sushmita; Du, Rose; Sorond, Farzaneh A.

    2015-01-01

    Background and Purpose Cerebral autoregulation may be impaired in the early days after subarachnoid hemorrhage (SAH). The purpose of this study was to examine the relationship between cerebral autoregulation and angiographic vasospasm (aVSP) and radiographic delayed cerebral ischemia (DCI) in patients with SAH. Methods Sixty-eight patients (5413 years) with a diagnosis of nontraumatic SAH were studied. Dynamic cerebral autoregulation was assessed using transfer function analysis (phase and gain) of the spontaneous blood pressure and blood flow velocity oscillations on days 2 to 4 post-SAH. aVSP was diagnosed using a 4-vessel conventional angiogram. DCI was diagnosed from CT. Decision tree models were used to identify optimal cut-off points for clinical and physiological predictors of aVSP and DCI. Multivariate logistic regression models were used to develop and validate a risk scoring tool for each outcome. Results Sixty-two percent of patients developed aVSP, and 19% developed DCI. Patients with aVSP had higher transfer function gain (1.060.33 versus 0.890.30; P=0.04) and patients with DCI had lower transfer function phase (17.539.6 versus 38.318.2; P=0.03) compared with those who did not develop either. Multivariable scoring tools using transfer function gain >0.98 and phase <12.5 were strongly predictive of aVSP (92% positive predictive value; 77% negative predictive value; area under the receiver operating characteristic curve, 0.92) and DCI (80% positive predictive value; 91% negative predictive value; area under the curve, 0.94), respectively. Conclusions Dynamic cerebral autoregulation is impaired in the early days after SAH. Including autoregulation as part of the initial clinical and radiographic assessment may enhance our ability to identify patients at a high risk for developing secondary complications after SAH. PMID:24425120

  14. Correlation Between ED Symptoms and Clinical Outcomes in the Patient with Aneurysmal Subarachnoid Hemorrhage

    PubMed Central

    Adkins, Kristin; Crago, Elizabeth; Kuo, Chien-Wen J.; Horowitz, Michael; Sherwood, Paula

    2012-01-01

    Introduction Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating neurologic insult often presenting to the emergency department as a headache. Recognition and prompt treatment are important to good outcomes. The purpose of this analysis was to examine the presentation of aSAH patients to the emergency department and determine whether presentation predicts length of stay or death. Methods This is a retrospective review of data gathered from 2 existing studies. Data from patients diagnosed with acute aSAH were reviewed for symptoms, clinical presentation, history, demographics, and laboratory results. Statistical analysis was completed by use of ?2 and regression analysis. Results This sample of 193 adult aSAH patients confirmed headache as well as meningeal signs as the most frequent symptom on presentation to the emergency department, and this was cited as the most common reason for seeking medical treatment. Symptom presentation did not appear to affect length of stay; however, survival analysis showed that patients who presented with a Hunt and Hess grade greater than 3 along with bradycardia were 15.6 times more likely to die within the first month of aSAH. Discussion Although aSAH presentation remains the same, this analysis did find a correlation between poor clinical grade and bradycardia to be a significant predictor of death at 30 days. Additional study may help to determine whether any intervention could lessen this effect. Although patient diagnosis and referral from the community emergency department to a tertiary center were relatively quick, there was a wide window of time between patient recognition of symptoms and seeking medical treatment. PMID:22578393

  15. Role of L-type Ca(2+) channels, sarcoplasmic reticulum and Rho kinase in rat basilar artery contractile properties in a new model of subarachnoid hemorrhage.

    PubMed

    Egea-Guerrero, Juan Jos; Murillo-Cabezas, Francisco; Muoz-Snchez, Mara ngeles; Vilches-Arenas, Angel; Porras-Gonzlez, Cristina; Castellano, Antonio; Urea, Juan; Gonzlez-Montelongo, Mara del Carmen

    2015-09-01

    We have previously described that L-type Ca(2+) channels' (LTCCs) activation and metabotropic Ca(2+) release from the sarcoplasmic reticulum (SR) regulate RhoA/Rho kinase (ROCK) activity and sustained arterial contraction. We have investigated whether this signaling pathway can be altered in a new experimental model of subarachnoid hemorrhage (SAH). For this purpose, arterial reactivity was evaluated on days 1 to 5 after surgery. A significant increase of basal tone, measured 4 and 60min after normalization, was observed on day 5 after SAH and at 60min on days 2 and 3 after SAH. This phenomenon was suppressed with LTCCs and ROCK inhibitors. We have also studied arterial rings vasoreactivity in response to high K(+) solutions. Interestingly, there were no significant differences in the phasic component of the high K(+)-induced contraction between sham and SAH groups, whereas a significant increase in the sustained contraction was observed on day 5 after SAH. This latter component was sensitive to fasudil, and selectively reduced by low nifedipine concentration, and phospholipase C and SR-ATPase inhibitors. Therefore, our data suggest that the metabotropic function of LTCCs is potentiated in SAH. Our results could provide a new strategy to optimize the pharmacological treatment of this pathological process. PMID:25937251

  16. Arctigenin, a Potent Ingredient of Arctium lappa L., Induces Endothelial Nitric Oxide Synthase and Attenuates Subarachnoid Hemorrhage-Induced Vasospasm through PI3K/Akt Pathway in a Rat Model

    PubMed Central

    Chang, Chih-Zen; Wu, Shu-Chuan; Chang, Chia-Mao; Lin, Chih-Lung; Kwan, Aij-Lie

    2015-01-01

    Upregulation of protein kinase B (PKB, also known as Akt) is observed within the cerebral arteries of subarachnoid hemorrhage (SAH) animals. This study is of interest to examine Arctigenin, a potent antioxidant, on endothelial nitric oxide synthase (eNOS) and Akt pathways in a SAH in vitro study. Basilar arteries (BAs) were obtained to examine phosphatidylinositol-3-kinase (PI3K), phospho-PI3K, Akt, phospho-Akt (Western blot) and morphological examination. Endothelins (ETs) and eNOS evaluation (Western blot and immunostaining) were also determined. Arctigenin treatment significantly alleviates disrupted endothelial cells and tortured internal elastic layer observed in the SAH groups (p < 0.01). The reduced eNOS protein and phospho-Akt expression in the SAH groups were relieved by the treatment of Arctigenin (p < 0.01). This result confirmed that Arctigenin might exert dural effects in preventing SAH-induced vasospasm through upregulating eNOS expression via the PI3K/Akt signaling pathway and attenuate endothelins after SAH. Arctigenin shows therapeutic promise in the treatment of cerebral vasospasm following SAH. PMID:26539501

  17. Arctigenin, a Potent Ingredient of Arctium lappa L., Induces Endothelial Nitric Oxide Synthase and Attenuates Subarachnoid Hemorrhage-Induced Vasospasm through PI3K/Akt Pathway in a Rat Model.

    PubMed

    Chang, Chih-Zen; Wu, Shu-Chuan; Chang, Chia-Mao; Lin, Chih-Lung; Kwan, Aij-Lie

    2015-01-01

    Upregulation of protein kinase B (PKB, also known as Akt) is observed within the cerebral arteries of subarachnoid hemorrhage (SAH) animals. This study is of interest to examine Arctigenin, a potent antioxidant, on endothelial nitric oxide synthase (eNOS) and Akt pathways in a SAH in vitro study. Basilar arteries (BAs) were obtained to examine phosphatidylinositol-3-kinase (PI3K), phospho-PI3K, Akt, phospho-Akt (Western blot) and morphological examination. Endothelins (ETs) and eNOS evaluation (Western blot and immunostaining) were also determined. Arctigenin treatment significantly alleviates disrupted endothelial cells and tortured internal elastic layer observed in the SAH groups (p < 0.01). The reduced eNOS protein and phospho-Akt expression in the SAH groups were relieved by the treatment of Arctigenin (p < 0.01). This result confirmed that Arctigenin might exert dural effects in preventing SAH-induced vasospasm through upregulating eNOS expression via the PI3K/Akt signaling pathway and attenuate endothelins after SAH. Arctigenin shows therapeutic promise in the treatment of cerebral vasospasm following SAH. PMID:26539501

  18. Comprehensive Stroke Centers May Be Associated With Improved Survival in Hemorrhagic Stroke

    PubMed Central

    McKinney, James S; Cheng, Jerry Q; Rybinnik, Igor; Kostis, John B

    2015-01-01

    Background Comprehensive stroke centers (CSCs) provide a full spectrum of neurological and neurosurgical services to treat complex stroke patients. CSCs have been shown to improve clinical outcomes and mitigate disparities in ischemic stroke patients. It is believed that CSCs also improve outcomes in hemorrhagic stroke. Methods and Results We used the Myocardial Infarction Data Acquisition System (MIDAS) database, which includes data on patients discharged with a primary diagnosis of intracerebral hemorrhage (ICH; International Classification of Diseases, Ninth Revision [ICD-9] 431) and subarachnoid hemorrhage (SAH; ICD-9 430) from all nonfederal acute care hospitals in New Jersey (NJ) between 1996 and 2012. Out-of-hospital deaths were assessed by matching MIDAS records with NJ death registration files. The primary outcome variable was 90-day all-cause mortality. The primary independent variable was CSC versus primary stroke center (PSC) and nonstroke center (NSC) admission. Multivariate logistic models were used to measure the effects of available covariates. Overall, 36 981 patients were admitted with a primary diagnosis of ICH or SAH during the study period, of which 40% were admitted to a CSC. Patients admitted to CSCs were more likely to have neurosurgical or endovascular interventions than those admitted to a PSC/NSC (18.9% vs. 4.7%; P<0.0001). CSC admission was associated with lower adjusted 90-day mortality (35.0% vs. 40.3%; odds ratio, 0.93; 95% confidence interval, 0.89 to 0.97) for hemorrhagic stroke. This was particularly true for those admitted with SAH. Conclusions Hemorrhagic stroke patients admitted to CSCs are more likely to receive neurosurgical and endovascular treatments and be alive at 90 days than patients admitted to other hospitals. PMID:25950185

  19. Matched Cohort Analysis of the Effects of Limb Remote Ischemic Conditioning in Patients with Aneurysmal Subarachnoid Hemorrhage.

    PubMed

    Laiwalla, Azim N; Ooi, Yinn Cher; Liou, Raymond; Gonzalez, Nestor R

    2016-02-01

    Remote ischemic conditioning (RIC) is a powerful innate response to transient subcritical ischemia that protects against severe ischemic insults at distant sites. We have previously shown the safety and feasibility of limb RIC in aneurysmal subarachnoid hemorrhage (aSAH) patients, along with changes in neurovascular and cerebral metabolism. In this study, we aim to detect the potential effect of an established lower-limb conditioning protocol on clinical outcomes of aSAH patients. Neurologic outcome (modified Rankin Scale (mRS)) of patients enrolled in a prospective trial (RIPC-SAH) was measured. A matching algorithm was applied to identify control patients with aSAH from an institutional departmental database. RIC patients underwent four lower-limb conditioning sessions, consisting of four 5-min cycles per session over nonconsecutive days. Good functional outcome was defined as mRS of 0 to 2. The study population consisted of 21 RIC patients and 61 matched controls. There was no significant intergroup difference in age, gender, aneurysm location, clipping vs coiling, Fisher grades, Hunt and Hess grades, or vasospasm. RIC was independently associated with good outcome (OR 5.17; 95% confidence interval (CI) 1.21-25.02). RIC also showed a trend toward lower incidence of stroke (28.6 vs. 47.5%) and death (4.8 vs. 19.7%). Lower-limb RIC following aSAH appears to have a positive effect in the functional outcomes of patients with aSAH. While this effect is consistent with prior preclinical studies, future trials are necessary to conclusively evaluate the effects of RIC for aSAH. PMID:26630942

  20. Statins and Anti-Inflammatory Therapies for Subarachnoid Hemorrhage

    PubMed Central

    Dhar, Rajat; Diringer, Michael

    2013-01-01

    Opinion Statement Aneurysmal subarachnoid hemorrhage induces a potent inflammatory cascade that contributes to endothelial dysfunction, imbalance of vasoactive substances (excess endothelin, depletion of nitric oxide) and arterial vasospasm. This process results in delayed cerebral ischemia, a major cause of neurological disability in those surviving the initial hemorrhage. The only therapy shown to be effective in improving neurologic outcomes after SAH is the calcium-channel antagonist, nimodipine (although it achieved this without reducing vasospasm). A number of novel therapies have been explored to inhibit the development of vasospasm and reduce the burden of ischemia and cerebral infarction. Statins are promising candidates, as they block multiple aspects of the inflammatory pathway that contributes to ischemic brain injury. Early clinical trials, however, have produced conflicting results and adoption of their use in clinical practice should await the results of larger more definitive studies. While endothelin-receptor antagonists showed promise in significantly reducing vasospasm in preliminary trials, their failure to improve clinical outcomes in phase III studies has been disappointing, highlighting the complex link between vasospasm and ischemia. Future directions in the quest to improve outcomes of patients with SAH may need to approach ischemia as a multifactorial process with inflammatory, vasoactive, and ionic/metabolic components. PMID:22249788

  1. Grading of Intracerebral Hemorrhage in Ruptured Middle Cerebral Artery Aneurysms

    PubMed Central

    Shim, Yu Shik; Chun, Young Il; Koh, Young Cho

    2012-01-01

    Objective To propose grading of intracerebral hemorrhage (ICH) in ruptured middle cerebral artery (MCA) aneurysms, which helps to predict the prognosis more accurately. Methods From August 2005 to December 2010, 27 cases of emergent hematoma evacuation and aneurysm clipping for MCA aneurysms were done in the author's clinic. Three variables were considered in grading the ICH, which were 1) hematoma volume, 2) diffuse subarachnoid hemorrhage (SAH) that extends to the contralateral sylvian cistern, and 3) the presence of midline shifting from computed tomography findings. For hematoma volume of greater than 25 mL, we assigned 2 points whereas 1 point for less than 25 cc. We also assigned 1 point for the presence of diffuse SAH whereas 0 point for the absence of it. Then, 1 point was assigned for midline shifting of greater than 5 mm whereas 0 point for less than 5 mm. Results According to the grading system, the numbers of patients from grade 1 to 4 were 4, 6, 8 and 9 respectively and 5, 7, 8, 4 and 3 patients belonged to Glasgow Outcome Scale (GOS) 5 to 1 respectively. It was found that the patients with higher GOS had lower ICH grade which were confirmed to be statistically significant (p<0.01). Preoperative Hunt and Hess grade and absence of midline shifting were the factors to predict favorable outcome. Conclusion The ICH grading system composed of above three variables was helpful in predicting the patient's outcome more accurately. PMID:22792422

  2. Toll-like Receptor 4 (TLR4) is Associated with Cerebral Vasospasm and Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage

    PubMed Central

    MA, Chunxiao; ZHOU, Wei; YAN, Zhaoyue; QU, Mingqi; BU, Xingyao

    2015-01-01

    In the present prospective study, the Toll-like receptor 4 (TLR4) levels on peripheral blood mononuclear cells (PBMCs) were investigated in 30 patients with aneurysmal subarachnoid hemorrhage (aSAH) and in 20 healthy controls (HCs). The relationship between TLR4 levels and the occurrence of cerebral vasospasm (CVS) was also analyzed. TLR4 expression level on cell surface of PBMCs on days 1, 3, and 7 after admission was determined by flow cytometry. Results showed that patients with aSAH presented a significantly higher TLR4 levels. For patients with Hunt-Hess grades IV–V, higher TLR4 levels were also observed; higher TLR4 levels have already been seen in patients developing CVS and/or delayed cerebral ischemia (DCI). Higher TLR4 levels were also associated with modified Fisher score, occurrence of dCVS, DCI, cerebral infarction (CT), and poor neurological functional recovery. Binary logistic regression analysis indicated that high TLR4 expression on blood monocytes was an independent predictive factor of the occurrence of dCVS, DCI, and poor neurological functional recovery. Taken together, TLR4 levels on PBMCs is significantly altered in the early stage of aSAH, especially in those patients experiencing CVS and DCI. Furthermore, higher TLR4 levels in the early stage of aSAH is also associated with the neurological function outcome. As far as we know, this is the first clinical study about TLR4's significance for patients with aSAH. PMID:26437797

  3. The Relationship between Clinical Outcome in Subarachnoidal Hemorrhage Patients with Emergency Medical Service Usage and Interhospital Transfer.

    PubMed

    Lee, Sang Hwa; Song, Kyoung Jun; Shin, Sang Do; Ro, Young Sun; Kim, Min Jung; Holmes, James F

    2015-12-01

    Prompt diagnosis and appropriate transport of patients with subarachnoid hemorrhage (SAH) is critical. We aimed to study differences in clinical outcomes by emergency medical services (EMS) usage and interhospital transfer in patients with SAH. We analyzed the CAVAS (CArdioVAscular disease Surveillance) database which is an emergency department-based, national cohort of cardiovascular disease in Korea. Eligible patients were adults with non-traumatic SAH diagnosed between January 2007 and December 2012. We excluded those whose EMS use and intershopital transfer data was unknown. The primary and secondary outcomes were mortality and neurologic status at discharge respectively. We compared the outcomes between each group using multivariable logistic regressions, adjusting for sex, age, underlying disease, visit time and social history. Of 5,461 patients with SAH, a total of 2,645 were enrolled. Among those, 258 used EMS and were transferred from another hospital, 686 used EMS only, 1,244 were transferred only, and 457 did not use EMS nor were transferred. In the regression analysis, mortality was higher in patients who used EMS and were transferred (OR 1.40, 95% CI 1.02-1.92), but neurologic disability was not meaningfully different by EMS usage and interhospital transfer. In Korea, SAH patients' mortality is higher in the case of EMS use or receiving interhospital transfer. PMID:26713067

  4. Carnosine attenuates early brain injury through its antioxidative and anti-apoptotic effects in a rat experimental subarachnoid hemorrhage model.

    PubMed

    Zhang, Zong-yong; Sun, Bao-liang; Yang, Ming-feng; Li, Da-wei; Fang, Jie; Zhang, Shuai

    2015-03-01

    Carnosine (β-alanyl-L-histidine) has been demonstrated to provide antioxidative and anti-apoptotic roles in the animal of ischemic brain injuries and neurodegenerative diseases. The aim of this study was to examine whether carnosine prevents subarachnoid hemorrhage (SAH)-induced early brain injury (EBI) in rats. We found that intraperitoneal administration of carnosine improved neurobehavioral deficits, attenuated brain edema and blood-brain barrier permeability, and decreased reactive oxygen species level at 48 h following SAH in rat models. Carnosine treatment increased tissue copper/zinc superoxide dismutase (CuZn-SOD) and glutathione peroxidase (GSH-Px) enzymatic activities, and reduced post-SAH elevated lactate dehydrogenase (LDH) activity, the concentration of malondialdehyde (MDA), 3-nitrotyrosine (3-NT), 8-hydroxydeoxyguanosine (8-OHDG), interleukin (IL)-1β, IL-6, and tumor necrosis factor-α (TNF-α) in rats. Furthermore, carnosine treatment attenuated SAH-induced microglia activation and cortical neuron apoptosis. These results indicated that administration of carnosine may provide neuroprotection in EBI following SAH in rat models. PMID:25179154

  5. The Relationship between Clinical Outcome in Subarachnoidal Hemorrhage Patients with Emergency Medical Service Usage and Interhospital Transfer

    PubMed Central

    2015-01-01

    Prompt diagnosis and appropriate transport of patients with subarachnoid hemorrhage (SAH) is critical. We aimed to study differences in clinical outcomes by emergency medical services (EMS) usage and interhospital transfer in patients with SAH. We analyzed the CAVAS (CArdioVAscular disease Surveillance) database which is an emergency department-based, national cohort of cardiovascular disease in Korea. Eligible patients were adults with non-traumatic SAH diagnosed between January 2007 and December 2012. We excluded those whose EMS use and intershopital transfer data was unknown. The primary and secondary outcomes were mortality and neurologic status at discharge respectively. We compared the outcomes between each group using multivariable logistic regressions, adjusting for sex, age, underlying disease, visit time and social history. Of 5,461 patients with SAH, a total of 2,645 were enrolled. Among those, 258 used EMS and were transferred from another hospital, 686 used EMS only, 1,244 were transferred only, and 457 did not use EMS nor were transferred. In the regression analysis, mortality was higher in patients who used EMS and were transferred (OR 1.40, 95% CI 1.02-1.92), but neurologic disability was not meaningfully different by EMS usage and interhospital transfer. In Korea, SAH patients' mortality is higher in the case of EMS use or receiving interhospital transfer. PMID:26713067

  6. Detection of CT occult aneurismal subarachnoid hemorrhage using a novel spectrophotometric analysis of cerebral spinal fluid

    NASA Astrophysics Data System (ADS)

    Salgaonkar, Vasant A.; Bhadri, Prashant R.; Huang, Jian; Kumar, Alla S.; Pyne, Gail J.; Caffery, James, Jr.; Clark, Joseph F.; Shukla, Rakesh; Beyette, Fred R., Jr.

    2005-04-01

    In North America, approximately 30,000 people annually suffer an aneurismal subarachnoid hemorrhage (SAH). Using computerized tomography (CT), the blood is generally not visible after 12 hours. Currently lumbar puncture (LP) results are equivocal for diagnosing SAH largely because of technical limitations in performing a quick and objective evaluation. Having ruptured once, an aneurysm is statistically more likely to rupture again. Therefore, for those individuals with a sentinel (or warning) hemorrhage, detection within the first 12 hours is paramount. We present a diagnostic technology based on visible spectroscopy to quickly and objectively assess low-blood volume SAH from a diagnostic spinal tap. This technology provides clinicians, with the resources necessary for assessing patients with suspected aneurismal SAH beyond the current 12-hour limitation imposed by CT scans. This aids in the improvement of patient care and results in rapid and appropriate treatment of the patient. To perform this diagnosis, we quantify bilirubin and hemoglobin in human CSF over a range of concentrations. Because the bilirubin and hemoglobin spectra overlap quantification is problematic. To solve this problem, two algorithmic approaches are presented: a statistical or a random stochastic component known as Partial Least Square (PLS) and a control theory based mathematical model. These algorithms account for the noise and distortion from blood in CSF leading to the quantification of bilirubin and methemoglobin spectroscopically. The configurations for a hardware platform is introduced, that is portable and user-friendly composed of specific components designed to have the sensitivity and specificity required. This aids in measuring bilirubin in CSF, hemorrhagic-CSF and CSF-like solutions. The prototype uses purpose built algorithms contained within the platform, such that physicians can use it in the hospital and lab as a point of care diagnostic test.

  7. Plasma Estrogen Levels Are Associated With Severity of Injury and Outcomes After Aneurysmal Subarachnoid Hemorrhage

    PubMed Central

    Crago, Elizabeth A.; Sherwood, Paula R.; Bender, Catherine; Balzer, Jeffrey; Ren, Dianxu; Poloyac, Samuel M.

    2015-01-01

    Background Biochemical mediators alter cerebral perfusion and have been implicated in delayed cerebral ischemia (DCI) and poor outcomes after aneurysmal subarachnoid hemorrhage (aSAH). Estrogens (estrone [E1] and estradiol [E2]) are mediators with neuroprotective properties that could play a role in DCI. This study explored associations between plasma estrogen levels and outcomes following aSAH. Methods Plasma samples from 14, 46, and 710 days after hemorrhage from 99 adult aSAH patients were analyzed for estrogen levels using liquid chromatography tandem mass spectrometry. DCI was operationalized as radiographic/ultrasonic evidence of impaired cerebral blood flow accompanied by neurological deterioration. Outcomes were assessed using the Modified Rankin Scale at 3 and 12 months after hemorrhage. Statistical analysis included correlation, regression, and group-based trajectory. Results Higher E1 and E2 levels were associated with higher Hunt and Hess grade (E1, p = .01; E2, p = .03), the presence of DCI (E1, p = .02; E2, p = .02), and poor 3-month outcomes (E1, p = .002; E2, p = .002). Trajectory analysis identified distinct populations over time for E1 (61 % E1 high) and E2 {68% E2 high). Patients in higher trajectory groups had higher Fisher grades (E1, p = .008; E2, p = .01), more frequent DCI (E1, p = .04; E2, p = .08), and worse 3-month outcomes (E1, p = .01; E2, p = .004) than low groups. Conclusions These results provide the first clinical evidence that plasma El and E2 concentrations are associated with severity of injury and outcomes after aSAH. PMID:25548393

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

    PubMed Central

    2014-01-01

    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+] (Spearmans ??=?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 >4mmol/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

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

    PubMed

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

    2015-12-01

    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

  10. Voltage-dependent anion channels (VDACs) promote mitophagy to protect neuron from death in an early brain injury following a subarachnoid hemorrhage in rats.

    PubMed

    Li, Jian; Lu, Jianfei; Mi, Yongjie; Shi, Zhao; Chen, Chunhua; Riley, John; Zhou, Changman

    2014-07-21

    The term mitophagy is coined to describe the selective removal of mitochondria by autophagy but the process itself is still contentious, especially in the early period following subarachnoid hemorrhage (SAH). In the present study, we investigated the role of mitophagy following 48h after SAH injury in rats. Specifically evaluating whether mitophagy, through voltage dependant anion channels (VDACs) interacting with microtubule-associated protein 1 light chain 3, could orchestrate the induction of apoptotic and necrotic cell death in neurons, a VDAC1siRNA and an activitor Rapamycian (RAPA), were engaged. One hundred and twelve male Sprague-Dawley rats were randomly divided into 4 groups: Sham, SAH, SAH+VDAC1siRNA, and SAH+RAPA. Outcomes measured included mortality rate, brain edema, BBB disruption, and neurobehavioral testing. We also used western blotting techniques to analyze the expressions of key mitophagic/autophagic proteins and pro-apoptotic protein such as ROS, VDAC1, LC-3II and Caspase-3. Rapamycin treatment significantly improved the mortality rate, cerebral edema, and neurobehavioral deficits; apoptotic and necrotic cell death in neurons were reduced by Rapamycin following SAH injury. However, VDAC1siRNA worsened the brain injury following SAH. Immunohistochemical staining and western blot analysis demonstrated a decreased expression of VDAC1, LC3II, and an increase of ROS and Caspase-3 followed by VDAC1siRNA administration. In conclusion, mitophagy induced by VDAC1 following SAH injury may in fact play a significant role in neuroprotection, the mechanism which may be through the attenuation of the apoptosic and necrosic molecular pathways. This translates a preservation of functional integrity and an improvement in mortality. PMID:24880016

  11. The Neuroprotection of Lysosomotropic Agents in Experimental Subarachnoid Hemorrhage Probably Involving the Apoptosis Pathway Triggering by Cathepsins via Chelating Intralysosomal Iron.

    PubMed

    Wang, Yang; Gao, Anju; Xu, Xiang; Dang, Baoqi; You, Wanchun; Li, Haiying; Yu, Zhengquan; Chen, Gang

    2015-08-01

    ?-Lipoic acid-plus (LAP), an amine derivative of ?-lipoic acid (LA), could protect cells against oxidant challenges via chelating intralysosomal iron. However, the application of LAP in experimental subarachnoid hemorrhage (SAH) is still not well known. This study was designed to evaluate the potential neuroprotection of LAP on the early brain injury (EBI) and the underlying mechanisms in a rat model of SAH. The SAH models were induced in Sprague-Dawley rats. LA and LAP were oral administration and lasted for 72 h once a day. The brain tissue samples were obtained for assay at 72 h after SAH. In experiment 1, we found that lysosome amounts in neurons decreased significantly in SAH group, and LAP (100 mg/kg) could stabilize lysosomal membrane markedly based on lysosomal-associated membrane protein-1 (LAMP-1) expression in neurons by immunofluorescence. Hence, the LAP dosages of 100 and 150 mg/kg were applied in experiment 2. Firstly, Western blot analysis showed that the protein levels of cathepsin B/D, caspase-3, Bax, ferritin, and heme-oxygenase-1 (HO-1) markedly increased after SAH, which were further confirmed by double immunofluorescence staining and reversed by LA and LAP treatments. In addition, LA and LAP also reduced oxidative stress and iron deposition in brain tissue. Furthermore, LA and LAP significantly ameliorated brain edema, blood-brain barrier injury, cortical apoptosis, and neurological behavior impairment induced by SAH. Finally, it is noteworthy that LAP exerted more significant effects than LA on these parameters as described above. LAP probably exerted neuroprotective effects via targeting lysosomes and chelating intralysosomal iron in EBI post-SAH in rats. PMID:25112680

  12. Bromo-deaza-SAH: a potent and selective DOT1L inhibitor

    PubMed Central

    Tempel, Wolfram; Fedorov, Oleg; Nguyen, Kong T.; Bolshan, Yuri; Al-Awar, Rima; Knapp, Stefan; Arrowsmith, Cheryl H.; Vedadi, Masoud; Brown, Peter J.; Schapira, Matthieu

    2016-01-01

    Chemical inhibition of proteins involved in chromatin-mediated signaling is an emerging strategy to control chromatin compaction with the aim to reprogram expression networks to alter disease states. Protein methyltransferases constitute one of the protein families that participate in epigenetic control of gene expression, and represent a novel therapeutic target class. Recruitment of the protein lysine methyltransferase DOT1L at aberrant loci is a frequent mechanism driving acute lymphoid and myeloid leukemias, particularly in infants, and pharmacological inhibition of DOT1L extends survival in a mouse model of mixed lineage leukemia. A better understanding of the structural chemistry of DOT1L inhibition would accelerate the development of improved compounds. Here, we report that the addition of a single halogen atom at a critical position in the cofactor product S-adenosylhomocysteine (SAH, an inhibitor of SAM-dependent methyltransferases) results in an 8-fold increase in potency against DOT1L, and reduced activities against other protein and non-protein methyltransferases. We solved the crystal structure of DOT1L in complex with Bromo-deaza-SAH and rationalized the observed effects. This discovery reveals a simple strategy to engineer selectivity and potency towards DOT1L into the adenosine scaffold of the cofactor shared by all methyltransferases, and can be exploited towards the development of clinical candidates against mixed lineage leukemia. PMID:23433670

  13. Dengue hemorrhagic fever

    MedlinePLUS

    ... into dengue hemorrhagic fever. Most infections in the United States are brought in from other countries. Risk factors for dengue hemorrhagic fever include having antibodies to dengue virus from an earlier infection.

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

    PubMed Central

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

    2011-01-01

    Biomarkers for neurodegeneration could be early prognostic measures of brain damage and dysfunction in aneurysmal subarachnoid hemorrhage (aSAH) with clinical and medical applications. Recently, we developed a new panel of neurodegeneration biomarkers, and report here on their relationships with pathophysiological complications and outcomes following severe aSAH. Fourteen patients provided serial cerebrospinal fluid samples for up to 10 days and were evaluated by ultrasonography, angiography, magnetic resonance imaging, and clinical examination. Functional outcomes were assessed at hospital discharge and 6–9 months thereafter. Eight biomarkers for acute brain damage were quantified: calpain-derived α-spectrin N- and C-terminal fragments (CCSntf and CCSctf), hypophosphorylated neurofilament H, 14-3-3 β and ζ, ubiquitin C-terminal hydrolase L1, neuron-specific enolase, and S100β. All 8 biomarkers rose up to 100-fold in a subset of patients. Better than any single biomarker, a set of 6 correlated significantly with cerebral vasospasm, brain infarction, and poor outcome. Furthermore, CSF levels of 14-3-3β, CCSntf, and NSE were early predictors of subsequent moderate-to-severe vasospasm. These data provide evidence that a panel of neurodegeneration biomarkers may predict lasting brain dysfunction and the pathophysiological processes that lead to it following aSAH. The panel may be valuable as surrogate endpoints for controlled clinical evaluation of treatment interventions and for guiding aSAH patient care. PMID:22174930

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

    PubMed Central

    2011-01-01

    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 Neurociruga 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

  16. Cerebrospinal fluid nitrite/nitrate correlated with oxyhemoglobin and outcome in patients with subarachnoid hemorrhage.

    PubMed

    Rejdak, Konrad; Petzold, Axel; Sharpe, Martyn A; Kay, Andrew D; Kerr, Mary; Keir, Geoff; Thompson, Edward J; Giovannoni, Gavin

    2004-04-15

    The findings of various studies reporting temporal changes in CSF total nitrite/nitrate (NOx) levels after subarachnoid hemorrhage (SAH) vary considerably. The study group comprised 10 patients with SAH and 10 control subjects. Total nitrite/nitrate concentration was measured by a vanadium-based assay with the colorimetric Griess reaction. CSF oxyhemoglobin level was assessed by spectrophotometry. After an initial peak (22.6+/-10.1 microM) within first 24 h after SAH, CSF NOx decreased gradually during the period of observation. There was a significant correlation between CSF concentrations of NOx and OxyHb in the entire observation period (R=0.87, p<0.001). When the impact of bleeding into CSF was considered, patients with very good outcome [Glasgow Outcome Scale (GOS)=5] had significantly lower CSF NOx (11.1+/-1.3 microM) than those with worse outcome (GOS<5) (21.8+/-11.2 microM, p<0.01). In conclusion, this study demonstrates that after aneurysm rupture CSF NOx levels correlate with OxyHb. We suggest this as a novel interpretation of other variable findings in relation to NO metabolites in the central nervous system (CNS) post SAH, and hence it could usefully be incorporated into the planning of future studies, correlating NOx with clinical outcome. PMID:15050440

  17. The predictive value of serum myeloperoxidase for vasospasm in patients with aneurysmal subarachnoid hemorrhage.

    PubMed

    Lim, Michael; Bower, Regina S; Wang, Ying; Sims, Leroy; Bower, Mark R; Camara-Quintana, Joaquin; Li, Gordon; Cheshier, Samuel; Harsh, Griffith R; Steinberg, Gary K; Guccione, Samira

    2012-07-01

    Vasospasm is a major contributor to morbidity and mortality in aneurysmal subarachnoid hemorrhage (SAH), with inflammation playing a key role in its pathophysiology. Myeloperoxidase (MPO), an inflammatory marker, was examined as a potential marker of vasospasm in patients with SAH. Daily serum samples from patients with aneurysmal SAH were assayed for MPO, and transcranial Doppler (TCDs) and neurological exams were assessed to determine vasospasm. Suspected vasospasm was confirmed by angiography. Peak MPO levels were then compared with timing of onset of vasospasm, based on clinical exams, TCDs and cerebral angiography. Patients with vasospasm had a mean MPO level of 115.5ng/ml, compared to 59.4ng/ml in those without vasospasm, 42.0ng/ml in those with unruptured aneurysms, and 4.3ng/ml in normal controls. In patients who experienced vasospasm, MPO was elevated above the threshold on the day of, or at any point prior to, vasospasm in 10 of 15 events (66.7%), and on the day of, or within 2days prior to, vasospasm in 8 of 15 events (53.3%). Elevated serum MPO correlates with clinically evident vasospasm following aneurysmal SAH. The potential utility of MPO as a marker of vasospasm is discussed. PMID:22370810

  18. Management of submacular hemorrhage.

    PubMed

    Tennant, Matthew T S; Borrillo, Jesus L; Regillo, Carl D

    2002-12-01

    Submacular hemorrhage is a vision-threatening complication of choroidal and retinal disease. Visual outcome after submacular hemorrhage is dependent on the underlying disease process, amount of subretinal hemorrhage, and duration before treatment. Treatment options include observation, surgical evacuation with or without tissue plasminogen activator (tPA), or pneumatic displacement with or without tPA. The preoperative amount of subretinal hemorrhage may help dictate what treatment modality is chosen. PMID:12515076

  19. Genetic determinants of cerebral vasospasm, delayed cerebral ischemia, and outcome after aneurysmal subarachnoid hemorrhage

    PubMed Central

    Ducruet, Andrew F; Gigante, Paul R; Hickman, Zachary L; Zacharia, Brad E; Arias, Eric J; Grobelny, Bartosz T; Gorski, Justin W; Mayer, Stephan A; Connolly, E Sander

    2010-01-01

    Despite extensive effort to elucidate the cellular and molecular bases for delayed cerebral injury after aneurysmal subarachnoid hemorrhage (aSAH), the pathophysiology of these events remains poorly understood. Recently, much work has focused on evaluating the genetic underpinnings of various diseases in an effort to delineate the contribution of specific molecular pathways as well as to uncover novel mechanisms. The majority of subarachnoid hemorrhage genetic research has focused on gene expression and linkage studies of these markers as they relate to the development of intracranial aneurysms and their subsequent rupture. Far less work has centered on the genetic determinants of cerebral vasospasm, the predisposition to delayed cerebral injury, and the determinants of ensuing functional outcome after aSAH. The suspected genes are diverse and encompass multiple functional systems including fibrinolysis, inflammation, vascular reactivity, and neuronal repair. To this end, we present a systematic review of 21 studies suggesting a genetic basis for clinical outcome after aSAH, with a special emphasis on the pathogenesis of cerebral vasospasm and delayed cerebral ischemia. In addition, we highlight potential pitfalls in the interpretation of genetic association studies, and call for uniformity of design of larger multicenter studies in the future. PMID:20068580

  20. Subarachnoid hemorrhage from a thoracic radicular artery pseudoaneurysm after methamphetamine and synthetic cannabinoid abuse: case report.

    PubMed

    Ray, Wilson Z; Krisht, Khaled M; Schabel, Alex; Schmidt, Richard H

    2013-06-01

    Background Context?Isolated spinal artery aneurysms not associated with vascular malformations are exceedingly rare. Purpose?To present a rare case of subarachnoid hemorrhage after thoracic radiculomedullary artery pseudoaneurysm rupture in a patient who abused synthetic cannabinoids and methamphetamines. Study Design?Case report. Methods?A 41-year-old man with a history of polysubstance abuse presented with acute-onset headache, back pain, and transient bilateral lower-extremity numbness. He reported daily use of the synthetic cannabinoid "Spice." He denied use of other illegal drugs, but laboratory testing was positive for methamphetamines. Magnetic resonance imaging showed a focal hematoma at T2-3, and spinal angiography was negative for vascular abnormalities; however, a follow-up angiogram 6 days later revealed interval development of an irregular dilation of the left T3 radiculomedullary artery originating from the left supreme intercostal artery. Results?Surgical trapping and resection of the lesion yielded a good clinical outcome. Conclusions?Although two previous case reports have described patients with thoracic radiculomedullary pseudoaneurysm causing spinal subarachnoid hemorrhage (SAH), this is the first reported case associated with synthetic cannabinoids and methamphetamine abuse. Although this diagnosis is exceptionally rare, clinical presentation of SAH with associated back pain and lower-extremity symptoms warrants an aggressive imaging workup. Even in the setting of negative angiography, repeat cerebral and spinal angiograms may be necessary to identify a potentially treatable cause of spinal SAH. PMID:24436861

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

    PubMed Central

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

    2014-01-01

    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

  2. INTRACRANIAL AND BLOOD PRESSURE VARIABILITY AND LONG-TERM OUTCOME AFTER ANEURYSMAL SUBARACHNOID HEMORRHAGE

    PubMed Central

    Kirkness, Catherine J.; Burr, Robert L.; Mitchell, Pamela H.

    2009-01-01

    Background Care of individuals in the intensive care unit (ICU) with brain injury traditionally focuses on maintaining ABP and ICP within prescribed ranges. However research suggests that the dynamic variability of these pressure signals provides additional information about physiologic functioning and may reflect adaptive capacity. Objectives The purpose of this study was to examine the ability to predict long-term outcome from arterial blood pressure (ABP) and intracranial pressure (ICP) variability in patients with aneurysmal subarachnoid hemorrhage (SAH). Methods ABP and ICP were monitored continuously for four days in 90 patients (74% female; mean age 53 years) in an ICU following SAH. Variability of ABP and ICP signals was calculated at four time scales (24-hour, hourly, 5-minute, and difference of sequential 5second averages). Long-term functional outcome was assessed 6 months post-SAH using the Extended Glasgow Outcome Scale. Results Pressure (ABP, ICP) variability indices were better predictors of 6-month functional outcome than mean pressure levels. Indices reflecting faster variability (particularly 5-second) were positively associated with better long-term outcome (typical p<0.001), while greater 24-hour variability was related to poorer outcomes (typical p <0.001), controlling for initial neurologic condition. Conclusions Beyond the measurement of ABP and ICP levels in acutely ill patients with SAH, simple measures of variability of these signals provide prognostic information regarding long-term functional outcome. The relationship between outcome and ICP and ABP variability in SAH 2 variability was dependent on the time scale at which the variability was measured. Given its positive association with better outcome, greater faster variability may reflect better physiologic adaptive capacity. PMID:19411584

  3. Intracerebral hemorrhage associated with cocaine abuse.

    PubMed

    Nolte, K B; Gelman, B B

    1989-07-01

    With the current epidemic of cocaine abuse, there have been many clinical reports of cocaine toxicity, including stroke. Autopsy findings were reported in only one case of intracerebral hemorrhage associated with cocaine abuse. We describe the autopsy toxicological findings in a case of sudden death in a young person due to intracerebral hemorrhage associated with cocaine abuse. In view of the present epidemic of cocaine abuse, cocaine toxicity should be considered in the differential diagnosis of intracerebral hemorrhage. We suggest that the pharmacodynamic effects of cocaine on the cerebral vasculature is the most likely cause. PMID:2742464

  4. Pharmacologically Augmented S-Nitrosylated Hemoglobin Improves Recovery From Murine Subarachnoid Hemorrhage

    PubMed Central

    Sheng, Huaxin; Reynolds, James D.; Auten, Richard L.; Demchenko, Ivan T.; Piantadosi, Claude A.; Stamler, Jonathan S.; Warner, David S.

    2013-01-01

    Background and Purpose S-nitrosylated hemoglobin (S-nitrosohemoglobin) has been implicated in the delivery of O2 to tissues through the regulation of microvascular blood flow. This study tested the hypothesis that enhancement of S-nitrosylated hemoglobin by ethyl nitrite inhalation improves outcome after experimental subarachnoid hemorrhage (SAH). Methods A preliminary dosing study identified 20 ppm ethyl nitrite as a concentration that produced a 4-fold increase in S-nitrosylated hemoglobin concentration with no increase in methemoglobin. Mice were subjected to endovascular perforation of the right anterior cerebral artery and were treated with 20 ppm ethyl nitrite in air, or air alone for 72 hours, after which neurologic function, cerebral vessel diameter, brain water content, cortical tissue PO2, and parenchymal red blood cell flow velocity were measured. Results At 72 hours after hemorrhage, air- and ethyl nitrite exposed mice had similarly sized blood clots. Ethyl nitrite improved neurologic score and rotarod performance; abated SAH-induced constrictions in the ipsilateral anterior, middle cerebral, and internal carotid arteries; and prevented an increase in ipsilateral brain water content. Ethyl nitrite inhalation increased red blood cell flow velocity and cortical tissue PO2 in the ipsilateral cortex with no effect on systemic blood pressure. Conclusions Targeted S-nitrosylation of hemoglobin improved outcome parameters, including vessel diameter, tissue blood flow, cortical tissue PO2, and neurologic function in a murine SAH model. Augmenting endogenous PO2-dependent delivery of NO bioactivity to selectively dilate the compromised cerebral vasculature has significant clinical potential in the treatment of SAH. PMID:21193749

  5. Vasospasm Risk in Surgical ICU Patients With Grade I Subarachnoid Hemorrhage

    PubMed Central

    Lessen, Samantha; Keene, Adam

    2016-01-01

    Aneurysmal subarachnoid hemorrhage (SAH) is associated with high mortality. The initial hemorrhage causes death in approximately 25% of patients, with most subsequent mortality being attributable to delayed cerebral ischemia (DCI). Delayed cerebral ischemia generally occurs on post-bleed days 4 through 20, with the incidence peaking at day 8. Because of the risks of DCI, patients with SAH are usually monitored in an intensive care unit (ICU) for 14 to 21 days. Unfortunately, prolonged ICU admissions are expensive and are associated with well-documented risks to patients. We hypothesized that a subset of patients who are at low risk of DCI should be safe to transfer out of the ICU early. All patients admitted to Montefiore Medical Center from 2008 to 2013 with grade I SAH who had their aneurysms successfully protected, had an uncomplicated postoperative course, and had no clinical or ultrasonographic evidence of DCI after day 8 were retrospectively studied. The primary outcome was clinical or ultrasonographic evidence of the development of DCI after day 8. Secondary outcomes included length of ICU and hospital stay and hospital mortality. Forty patients who met the above-mentioned criteria were identified. Of these, only 1 (2.5%) developed ultrasonographic evidence of DCI after day 8 but required no intervention. The mean length of stay in the ICU was until post-bleed day 13, and the mean hospital length of stay was until post-bleed day 14. The in-hospital mortality was 0 of 40. Thus, we identified a low-risk subset of patients with grade I SAH who may be candidates for early transfer out of the ICU. PMID:26740854

  6. Alterations of Voltage-Dependent Calcium Channel Currents in Basilar Artery Smooth Muscle Cells at Early Stage of Subarachnoid Hemorrhage in a Rabbit Model

    PubMed Central

    Shi, Xianqing; Fu, Yongjian; Liao, Daqing; Chen, Yanfang; Liu, Jin

    2014-01-01

    Objective To investigate the changes in the currents of voltage-dependent calcium channels (VDCCs) in smooth muscle cells of basilar artery in a rabbit model of subarachnoid hemorrhage (SAH). Methods New Zealand white rabbits were randomly divided into five groups: sham (C), normal (N), 24 hours (S1), 48 hours (S2) and 72 hours (S3) after SAH. Non-heparinized autologous arterial blood (1ml/kg) was injected into the cisterna magna to create SAH after intravenous anesthesia, and 1 ml/kg of saline was injected into cisterna magna in the sham group. Rabbits in group N received no injections. Basilar artery in S1, S2, S3 group were isolated at 24, 48, 72 hours after SAH. Basilar artery in group C was isolated at 72 hours after physiological saline injection. Basilar artery smooth muscle cells were isolated for all groups. Whole-cell patch-clamp technique was utilized to record cell membrane capacitance and VDCCs currents. The VDCCs antagonist nifedipine was added to the bath solution to block the Ca++ channels currents. Results There were no significant differences in the number of cells isolated, the cell size and membrane capacitance among all the five groups. VDCC currents in the S1S3 groups had higher amplitudes than those in control and sham groups. The significant change of current amplitude was observed at 72 hours after SAH, which was higher than those of 24 and 48 hours. The VDCCs were shown to expression in human artery smooth muscle cells. Conclusions The changes of activation characteristics and voltage-current relationship at 72 hours after SAH might be an important event which leads to a series of molecular events in the microenvironment of the basilar artery smooth muscle cells. This may be the key time point for potential therapeutic intervention against subarachnoid hemorrhage. PMID:24392110

  7. Retinal hemorrhage after cardiopulmonary resuscitation with chest compressions.

    PubMed

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

    2013-06-01

    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

  8. Reversal of cerebral vasospasm via intravenous sodium nitrite after subarachnoid hemorrhage in primates

    PubMed Central

    Fathi, Ali Reza; Pluta, Ryszard M.; Bakhtian, Kamran D.; Qi, Meng; Lonser, Russell R.

    2016-01-01

    Object Subarachnoid hemorrhage (SAH)-induced vasospasm is a significant underlying cause of aneurysm rupture-related morbidity and death. While long-term intravenous infusion of sodium nitrite (NaNO2) can prevent cerebral vasospasm after SAH, it is not known if the intravenous administration of this compound can reverse established SAH-induced vasospasm. To determine if the intravenous infusion of NaNO2 can reverse established vasospasm, the authors infused primates with the compound after SAH-induced vasospasm was established. Methods Subarachnoid hemorrhageinduced vasospasm was created in 14 cynomolgus macaques via subarachnoid implantation of a 5-ml blood clot. On Day 7 after clot implantation, animals were randomized to either control (saline infusion, 5 monkeys) or treatment groups (intravenous NaNO2 infusion at 300 ?g/kg/hr for 3 hours [7 monkeys] or 8 hours [2 monkeys]). Arteriographic vessel diameter was blindly analyzed to determine the degree of vasospasm before, during, and after treatment. Nitric oxide metabolites (nitrite, nitrate, and S-nitrosothiols) were measured in whole blood and CSF. Results Moderate-to-severe vasospasm was present in all animals before treatment (control, 36.2% 8.8% [mean SD]; treatment, 45.5% 12.5%; p = 0.9). While saline infusion did not reduce vasospasm, NaNO2 infusion significantly reduced the degree of vasospasm (26.9% 7.6%; p = 0.008). Reversal of the vasospasm lasted more than 2 hours after cessation of the infusion and could be maintained with a prolonged infusion. Nitrite (peak value, 3.7 2.1 ?mol/L), nitrate (18.2 5.3 ?mol/L), and S-nitrosothiols (33.4 11.4 nmol/L) increased significantly in whole blood, and nitrite increased significantly in CSF. Conclusions These findings indicate that the intravenous infusion of NaNO2 can reverse SAH-induced vasospasm in primates. Further, these findings indicate that a similar treatment paradigm could be useful in reversing cerebral vasospasm after aneurysmal SAH. PMID:21888479

  9. Hemorrhagic Stroke in Children

    PubMed Central

    Hillis M.D., Argye E.

    2007-01-01

    Hemorrhagic stroke accounts for approximately half of stroke in childhood. Unlike arterial ischemic stroke, there are no consensus guidelines to assist in the evaluation and treatment of these children. We review the literature on the evaluation, treatment, etiology and neurologic outcome of hemorrhagic stroke in children. Important differences between pediatric and adult hemorrhage are highlighted, as treatment guidelines for adults may not be applicable in all cases. Needed future research and potential therapies are also discussed. PMID:17275656

  10. Fisetin alleviates early brain injury following experimental subarachnoid hemorrhage in rats possibly by suppressing TLR 4/NF-?B signaling pathway.

    PubMed

    Zhou, Chen-Hui; Wang, Chun-Xi; Xie, Guang-Bin; Wu, Ling-Yun; Wei, Yong-Xiang; Wang, Qiang; Zhang, Hua-Sheng; Hang, Chun-Hua; Zhou, Meng-Liang; Shi, Ji-Xin

    2015-12-10

    Early brain injury (EBI) determines the unfavorable outcomes after subarachnoid hemorrhage (SAH). Fisetin, a natural flavonoid, has anti-inflammatory and neuroprotection properties in several brain injury models, but the role of fisetin on EBI following SAH remains unknown. Our study aimed to explore the effects of fisetin on EBI after SAH in rats. Adult male Sprague-Dawley rats were randomly divided into the sham and SAH groups, fisetin (25mg/kg or 50mg/kg) or equal volume of vehicle was given at 30min after SAH. Neurological scores and brain edema were assayed. The protein expression of toll-like receptor 4 (TLR 4), p65, ZO-1 and bcl-2 was examined by Western blot. TLR 4 and p65 were also assessed by immunohistochemistry (IHC). Enzyme-linked immunosorbent assay (ELISA) was performed to detect the production of pro-inflammatory cytokines. Terminal deoxynucleotidyl transferase-mediated uridine 5'-triphosphate-biotin nick end-labeling (TUNEL) was perform to assess neural cell apoptosis. High-dose (50mg/kg) fisetin significantly improved neurological function and reduced brain edema at both 24h and 72h after SAH. Remarkable reductions of TLR 4 expression and nuclear factor ?B (NF-?B) translocation to nucleus were detected after fisetin treatment. In addition, fisetin significantly reduced the productions of pro-inflammatory cytokines, decreased neural cell apoptosis and increased the protein expression of ZO-1 and bcl-2. Our data provides the evidence for the first time that fisetin plays a protective role in EBI following SAH possibly by suppressing TLR 4/NF-?B mediated inflammatory pathway. PMID:26475978

  11. Cocaine use as an independent predictor of seizures after aneurysmal subarachnoid hemorrhage.

    PubMed

    Chang, Tiffany R; Kowalski, Robert G; Carhuapoma, J Ricardo; Tamargo, Rafael J; Naval, Neeraj S

    2016-03-01

    OBJECT Seizures are relatively common after aneurysmal subarachnoid hemorrhage (aSAH). Seizure prophylaxis is controversial and is often based on risk stratification; middle cerebral artery (MCA) aneurysms, associated intracerebral hemorrhage (ICH), poor neurological grade, increased clot thickness, and cerebral infarction are considered highest risk for seizures. The purpose of this study was to evaluate the impact of recent cocaine use on seizure incidence following aSAH. METHODS Prospectively collected data from aSAH patients admitted to 2 institutional neuroscience critical care units between 1991 and 2009 were reviewed. The authors analyzed factors that potentially affected the incidence of seizures, including patient demographic characteristics, poor clinical grade (Hunt and Hess Grade IV or V), medical comorbidities, associated ICH, intraventricular hemorrhage (IVH), hydrocephalus, aneurysm location, surgical clipping and cocaine use. They further studied the impact of these factors on "early" and "late" seizures (defined, respectively, as occurring before and after clipping/coiling). RESULTS Of 1134 aSAH patients studied, 182 (16%) had seizures; 81 patients (7.1%) had early and 127 (11.2%) late seizures, with 26 having both. The seizure rate was significantly higher in cocaine users (37 [26%] of 142 patients) than in non-cocaine users (151 [15.2%] of 992 patients, p = 0.001). Eighteen cocaine-positive patients (12.7%) had early seizures compared with 6.6% of cocaine-negative patients (p = 0.003); 27 cocaine users (19%) had late seizures compared with 10.5% non-cocaine users (p = 0.001). Factors that showed a significant association with increased risk for seizure (early or late) on univariate analysis included younger age (< 40 years) (p = 0.009), poor clinical grade (p = 0.029), associated ICH (p = 0.007), and MCA aneurysm location (p < 0.001); surgical clipping was associated with late seizures (p = 0.004). Following multivariate analysis, age < 40 years (OR 2.04, 95% CI 1.355-3.058, p = 0.001), poor clinical grade (OR 1.62, 95% CI 1.124-2.336, p = 0.01), ICH (OR 1.95, 95% CI 1.164-3.273, p = 0.011), MCA aneurysm location (OR 3.3, 95% CI 2.237-4.854, p < 0.001), and cocaine use (OR 2.06, 95% CI 1.330-3.175, p = 0.001) independently predicted seizures. CONCLUSIONS Cocaine use confers a higher seizure risk following aSAH and should be considered during risk stratification for seizure prophylaxis and close neuromonitoring. PMID:26315001

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

    PubMed Central

    Nyberg, Christoffer; Karlsson, Torbjrn; Hillered, Lars; Engstrm, Elisabeth Ronne

    2014-01-01

    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

  13. Circulating microRNA 132-3p and 324-3p Profiles in Patients after Acute Aneurysmal Subarachnoid Hemorrhage

    PubMed Central

    Su, Xian Wei; Chan, Anna Ho Yin; Lu, Gang; Lin, Marie; Sze, Johnny; Zhou, Jing Ye; Poon, Wai Sang; Liu, Qiang; Zheng, Vera Zhi Yuan; Wong, George Kwok Chu

    2015-01-01

    Background Aneurysmal subarachnoid hemorrhage (SAH) is a highly morbid and fatal condition with high rate of cognitive impairment and negative impact in quality of life among survivors. Delayed cerebral infarction (DCI) is one the major factors for these negative outcomes. In this study we compared the circulating microRNA profiles of SAH patients and healthy individuals, and the circulating microRNA profiles of SAH patients with and without DCI. Methods Peripheral blood samples on Day 7 after the onset of SAH were subjected to microarray analysis with Affymetrix miRNA 3.0 array and quantitative PCR analysis. SAH patients with (N = 20) and without DCI (N = 20) and Healthy controls (N = 20) were included for analyses. Results We demonstrated that 99 miRNAs were found to be dysregulated in the SAH patient group with DCI. 81 miRNAs were upregulated and 18 were downregulated. Findings from KEGG pathway analysis showed that miRNAs and target genes for axon guidance and TGF-beta signaling were involved, implying that the resulted differential miRNA expression pattern reflect the results of SAH instead of etiology of the disease. miR-132-3p and miR-324-3p showed distinctive upregulations in qPCR [miR-132: 9.5 fold (95%CI: 2.3 to 16.7) in DCI group and 3.4 fold (95%CI: 1.0 to 5.8) in Non-DCI group; miR-324: 4924 fold (95%CI: 2620 to 7228) in DCI group and 4545 fold (95%CI: 2408 to 6683) in non-DCI group]. However, there were no significant differences in fold changes between SAH patients with and without DCI [fold change ratios (mean+/-SD): 2.7+/-4.2 and 1.1+/-1.1 for miRNA-132 and miRNA-324]. Conclusion Our study demonstrated that as compared to healthy control, miR-132 and miR-324 showed a upregulation in both SAH DCI and Non-DCI groups. However, the differences between the SAH DCI and non-DCI groups were not statistically significant. PMID:26675167

  14. Intraventricular hemorrhage of the newborn

    MedlinePLUS

    ... Grade 1 is also referred to as germinal matrix hemorrhage (GMH). Grades 3 and 4 involve more ... 2015:chap 60. Volpe JJ. Intracranial hemorrhage: germinal matrix-intraventricular hemorrhage. In Volpe JJ, ed. Neurology of ...

  15. Recurrent cerebral aneurysm formation and rupture within a short period due to invasive aspergillosis of the nasal sinus; pathological analysis of the catastrophic clinical course

    PubMed Central

    Shinya, Yuki; Miyawaki, Satoru; Nakatomi, Hirofumi; Okano, Atsushi; Imai, Hideaki; Shin, Masahiro; Sato, Kazuya; Tsuchida, Takeyuki; Hayashi, Toshihiro; Terao, Yasuo; Numakura, Satoe; Morikawa, Teppei; Shibahara, Junji; Kikuta, Shu; Kondo, Kenji; Tatsuno, Keita; Mori, Harushi; Kunimatsu, Akira; Tsuji, Shoji; Saito, Nobuhito

    2015-01-01

    Destructive infiltration of invasive fungal sinusitis can easily occur into the central nervous system (CNS). Cerebral aneurysms associated with fungal infection are highly vulnerable to rupture, and can frequently and rapidly take a serious clinical course. We experienced a patient who twice developed cerebral aneurysm followed by rupture due to invasive fugal sinusitis. This 77-year-old man was admitted for progressive bilateral visual disturbance, which was initially treated as idiopathic hypertrophic pachymeningitis. The patient subsequently suffered subarachnoid hemorrhage (SAH) twice in only 12 days. Both SAH originated from different newly formed cerebral aneurysms. Trapping was performed for both ruptured aneurysms. Pathological examination of the resected aneurysms indicated the presence of fungi determined to be Aspergillus. This Aspergillus infection was also discovered inside the frontal sinus by endoscopic biopsy, so a regimen of antifungal agents was instituted. Prolonged antifungal therapy caused renal impairment, which ultimately led to the patient’s death. Autopsy detected no mycotic infiltration of the major cerebral arteries, except for the 2 ruptured cerebral aneurysms. However, prolonged mycosis of the CNS, such as in the deep part in the falx cerebri and in the small veins proximal to the tentorium cerebelli, was observed, indicating that mycosis invading the cranium is refractory even to long-term administration of antifungal agents. The present case strongly suggests that urgent and proactive definitive diagnosis is essential to successfully treat invasive paranasal sinus aspergillosis. If infiltration of the CNS is suspected, early surgical resection and antifungal therapy must be initiated immediately. PMID:26722566

  16. The dilemma of complicated shunt valves: How to identify patients with posthemorrhagic hydrocephalus after aneurysmatic subarachnoid hemorrhage who will benefit from a simple valve?

    PubMed Central

    von der Brelie, Christian; Meier, Ullrich; Grwe, Alexander; Lemcke, Johannes

    2016-01-01

    Background: Sophisticated shunt valves provide the possibility of pressure adjustment and antisiphon control but have a higher probability of valve dysfunction especially in a posthemorrhagic setting. The aim of the present study is to analyze the clinical outcome of patients with shunt dependent posthemorrhagic hydrocephalus after aneurysmatic subarachnoid hemorrhage (SAH) in order to identify patients who would benefit from a simple differential pressure valve. Methods: From 2000 to 2013, 547 patients with aneurysmatic SAH were treated at our institution, 114 underwent ventricular shunt placement (21.1%). 47 patients with available pre- and post-operative computed tomography scans, and an available follow-up of minimum 6 months were included. In order to measure the survival time which a nonprogrammable differential pressure valve would have had in an individual patient we defined the initial equalized shunt survival time (IESS). IESS is the time until surgical revisions of fixed differential pressure or flow-regulated valves for the treatment of over- or under-drainage as well as re-programming of adjustable valves due to over- or under-drainage. Results: Twenty patients were treated with fixed differential pressure valves, 15 patients were treated with flow-regulated valves, and 12 underwent ventriculoperitoneal (VP) shunt placement with differential pressure valves assisted by a gravitational unit. Patients who reacted with remarkable changes of the ventricular width after the insertion of external ventricular drainage (EVD), before shunt placement, showed a significantly longer IESS. Conclusions: Decline of the ventricular width after EVD placement was a predictor for successful VP shunt therapy in the later course of disease. Possibly, this could allow identifying patients who benefit from a simple differential pressure valve or a flow-regulated valve, and thus could possibly avoid valve-associated complications of a programmable valve in the later course of disease. PMID:26933344

  17. Intraventricular Injection of Noncellular Cerebrospinal Fluid from Subarachnoid Hemorrhage Patient into Rat Ventricles Leads to Ventricular Enlargement and Periventricular Injury.

    PubMed

    Li, Peiliang; Chaudhary, Neeraj; Gemmete, Joseph J; Thompson, B Gregory; Hua, Ya; Xi, Guohua; Pandey, Aditya S

    2016-01-01

    Early brain injury and hydrocephalus (HCP) are important mediators of poor outcome in subarachnoid hemorrhage (SAH) patients. We aim to understand the development of HCP and subependymal cellular injury after intraventricular injection of noncellular human SAH cerebrospinal fluid (CSF) into rat ventricles. Two-hundred microliters of noncellular CSF from SAH patients or normal controls were injected into the right lateral ventricle of seven adult male Sprague-Dawley rats. Propidium iodide (PI) was simultaneously injected to detect necrotic cellular death. Rats were then sacrificed 24 h after surgery and the brain specimens were cut and stained for heme oxygenase 1 (HO-1), an oxidative stress marker. We found that the ventricular area at the bregma level in the CSF injection group was significantly larger than that in the control group (p < 0.05). The periventricular tissue in the CSF injection group had significantly more necrotic cell death as well as HO-1 expression as compared with the control group (p < 0.05). In conclusion, injection of SAH patients' CSF into the rat ventricle leads to HCP as well as subependymal injury compared with injection of control CSF. PMID:26463970

  18. Cerebral Infarction After Aneurysmal Subarachnoid Hemorrhage.

    PubMed

    Kanamaru, Kenji; Suzuki, Hidenori; Taki, Waro

    2016-01-01

    Predictors for cerebral infarction, an important cause of poor outcome after aneurysmal subarachnoid hemorrhage (SAH), were examined. This study used data from the Prospective Registry of Subarachnoid Aneurysms Treatment (PRESAT) cohort, which included 579 patients whose ruptured aneurysms were treated with either clipping or coiling within 12 days of onset. Patient, clinical, radiographic, and treatment variables associated with cerebral infarction were determined. Ruptured aneurysms were clipped in 282 patients and coiled in 297 patients. Cerebral infarction occurred in 162 patients (28.0 %): 101 patients by cerebral vasospasm, 34 patients by clipping, and 33 patients by coiling. Univariate analyses showed that significant factors associated with cerebral infarction development were Fisher computed tomography (CT) group 3 on admission, premature aneurysm rupture during clipping procedure, cerebrospinal fluid drainage, symptomatic vasospasm, endovascular treatment for vasospasm, and shunt-dependent hydrocephalus. Multivariable logistic regression analyses showed that cerebral infarction was significantly associated with Fisher CT group 3 on admission, larger aneurysm dome size, ruptured posterior circulation aneurysms, premature aneurysm rupture during clipping procedure, symptomatic vasospasm, and infection, while endovascular treatment for vasospasm significantly decreased the development of cerebral infarction. The most important potentially treatable factor associated with cerebral infarction was symptomatic vasospasm. PMID:26463943

  19. Impaired Fracture Healing after Hemorrhagic Shock

    PubMed Central

    Kobbe, Philipp; Pfeifer, Roman; Campbell, Graeme C.; Tohidnezhad, Mersedeh; Bergmann, Christian; Kadyrov, Mamed; Fischer, Horst; Gler, Christian C.; Pape, Hans-Christoph; Pufe, Thomas

    2015-01-01

    Impaired fracture healing can occur in severely injured patients with hemorrhagic shock due to decreased soft tissue perfusion after trauma. We investigated the effects of fracture healing in a standardized pressure controlled hemorrhagic shock model in mice, to test the hypothesis that bleeding is relevant in the bone healing response. Male C57/BL6 mice were subjected to a closed femoral shaft fracture stabilized by intramedullary nailing. One group was additionally subjected to pressure controlled hemorrhagic shock (HS, mean arterial pressure (MAP) of 35?mmHg for 90 minutes). Serum cytokines (IL-6, KC, MCP-1, and TNF-?) were analyzed 6 hours after shock. Fracture healing was assessed 21 days after fracture. Hemorrhagic shock is associated with a significant increase in serum inflammatory cytokines in the early phase. Histologic analysis demonstrated a significantly decreased number of osteoclasts, a decrease in bone quality, and more cartilage islands after hemorrhagic shock. ?CT analysis showed a trend towards decreased bone tissue mineral density in the HS group. Mechanical testing revealed no difference in tensile failure. Our results suggest a delay in fracture healing after hemorrhagic shock. This may be due to significantly diminished osteoclast recruitment. The exact mechanisms should be studied further, particularly during earlier stages of fracture healing. PMID:26106256

  20. Geographical Analysis of Aneurysmal Subarachnoid Hemorrhage in Japan Utilizing Publically-Accessible DPC Database

    PubMed Central

    Fukuhara, Toru

    2015-01-01

    Since the launch of the novel medical reimbursement system Diagnosis Procedure Combination (DPC) in 2003 in Japan, inpatient data has been accumulated over time as part of a Japanese governmental nationwide database. This is partially accessible by the public, and this study examined the adequacy of this database as epidemiological research material by extracting the data relating to aneurysmal subarachnoid hemorrhage (aSAH) with special attention given to the limitations that this involves. Datasets after 2010 are considered suitable for analysis because of the numbers of participating hospitals and the analysis term. Extracting the data by prefecture, those with a continuously high aSAH incidence were Aomori, Iwate, Akita, Yamagata, Kochi and Kumamoto Prefectures, and those with low aSAH incidence were Kanagawa, Shiga, Kyoto, Shimane and Ehime Prefectures. Although these obtained results are informative, a publically-accessible DPC database has several limitations. Some limitations have been resolved: the analyzed term each year is now 12-months and the number of participating hospitals seems to have stabilized around 1700. However, other limitations such as masking the numbers in each hospital reporting less than 10 patients still exist, so careful and critical interpretation is necessary in utilizing a publically-accessible DPC database. Considering the potential of this database as material for epidemiological research, future analysis of the entire DPC database by qualified researchers is desirable. PMID:25811480

  1. Plasma Catecholamine Profile of Subarachnoid Hemorrhage Patients with Neurogenic Cardiomyopathy

    PubMed Central

    Moussouttas, Michael; Mearns, Elizabeth; Walters, Arthur; DeCaro, Matthew

    2015-01-01

    Purpose To investigate the connection between sympathetic function and neurogenic cardiomyopathy (NC), and to determine whether NC is mediated primarily by circulating adrenal epinephrine (EPI) or neuronally transmitted norepinephrine (NE), following subarachnoid hemorrhage (SAH). Methods This is a prospective observational investigation of consecutive severe-grade SAH patients. All participants had transthoracic echocardiography and serological assays for catecholamine levels – dopamine (DA), NE and EPI – within 48 h of hemorrhage onset. Clinical and serological independent predictors of NC were determined using multivariate logistic regression analyses, and the accuracy of predictors was assessed by receiver operating characteristic (ROC) curves. Multivariate linear regression analyses were used to evaluate correlations among the catecholamines. Results The investigation included a total of 94 subjects: the mean age was 55 years, 81% were female and 57% were Caucasian. NC was identified in approximately 10% (9/94) of cases. Univariate analyses revealed associations between NC and worse clinical severity (p = 0.019), plasma DA (p = 0.018) and NE levels (p = 0.024). Plasma NE correlated with DA levels (ρ = 0.206, p = 0.046) and EPI levels (ρ = 0.392, p < 0.001), but was predicted only by plasma EPI in bivariate [parameter estimate (PE) = 1.95, p < 0.001] and multivariate (PE = 1.89, p < 0.001) linear regression models. Multivariate logistic regression analyses consistently demonstrated the predictive value of clinical grade for NC (p < 0.05 for all analyses) except in models incorporating plasma NE, where NC was independently predicted by NE level (OR 1.25, 95% CI 1.01-1.55) over clinical grade (OR 4.19, 95% CI 0.874-20.1). ROC curves similarly revealed the greater accuracy of plasma NE [area under the curve (AUC) 0.727, 95% CI 0.56-0.90, p = 0.02] over clinical grade (AUC 0.704, 95% CI 0.55-0.86, p = 0.05) for identifying the presence or absence of NC. Conclusions Following SAH, the development of NC is primarily related to elevated plasma NE levels. Findings implicate a predominantly neurogenic process mediated by neuronal NE (and not adrenal EPI), but cannot exclude synergy between the catecholamines. PMID:26120322

  2. 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...

  3. Microwave hemorrhagic stroke detector

    DOEpatents

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

    2002-01-01

    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.

  4. Microwave hemorrhagic stroke detector

    DOEpatents

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

    2007-06-05

    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.

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

    PubMed Central

    Choi, Kyu-Sun

    2014-01-01

    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. PMID:25535520

  6. Optimal Contrast of Cerebral Dual-Energy Computed Tomography Angiography in Patients With Spontaneous Subarachnoid Hemorrhage

    PubMed Central

    Wang, Dan; Zhang, Qiaowei; Hu, Hongjie; Zhang, Wenming; Chen, Renbiao; Zee, Chi S.; Yu, Risheng

    2016-01-01

    Objective The aim of this study was to investigate the image quality of cerebral dual-energy computed tomography (CT) angiography using a nonlinear image blending technique as compared with the conventional linear blending method in patients with spontaneous subarachnoid hemorrhage (SAH). Methods A retrospective review of 30 consecutive spontaneous SAH patients who underwent a dual-source, dual-energy (80 kV and Sn140 kV mode) cerebral CT angiography was performed with permission from hospital ethical committee. Optimized images using nonlinear blending method were generated and compared with the 0.6 linear blending images by evaluating cerebral artery enhancement, attenuation of SAH, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR), respectively. Two neuroradiologists independently assessed subjective vessel visualization per segment using a 5-point scale. Results The nonlinear blending images showed higher cerebral artery enhancement (307.24 58.04 Hounsfield unit [HU]), lower attenuation of SAH (67.07 6.79 HU), and image noise (7.18 1.20 HU), thus achieving better SNR (43.92 11.14) and CNR (34.34 10.25), compared with those of linear blending images (235.47 46.45 HU for cerebral artery enhancement, 70.00 6.41 HU for attenuation of SAH, 8.39 1.25 HU for image noise, 28.86 8.43 for SNR, and 20.37 7.74 for CNR) (all P < 0.01). The segmental scorings of the nonlinear blending image (31.6% segments with a score of 5, 57.4% segments with a score of 4, 11% segments with a score of 3) ranged significantly higher than those of linear blending images (11.5% segments with a score of 5, 77.5% segments with a score of 4, 11% segments with a score of 3) (P < 0.01). The interobserver agreement was good (? = 0.762), and intraobserver agreement was excellent for both observers (? = 0.844 and 0.858, respectively). Conclusions The nonlinear image blending technique improved vessel visualization of cerebral dual-energy CT angiography by optimizing contrast enhancement in spontaneous SAH patients. PMID:26571057

  7. Pramipexole-Induced Hypothermia Reduces Early Brain Injury via PI3K/AKT/GSK3β pathway in Subarachnoid Hemorrhage rats.

    PubMed

    Ma, Junwei; Wang, Zhong; Liu, Chenglin; Shen, Haitao; Chen, Zhouqing; Yin, Jia; Zuo, Gang; Duan, Xiaochun; Li, Haiying; Chen, Gang

    2016-01-01

    Previous studies have shown neuroprotective effects of hypothermia. However, its effects on subarachnoid hemorrhage (SAH)-induced early brain injury (EBI) remain unclear. In this study, a SAH rat model was employed to study the effects and mechanisms of pramipexole-induced hypothermia on EBI after SAH. Dose-response experiments were performed to select the appropriate pramipexole concentration and frequency of administration for induction of mild hypothermia (33-36 °C). Western blot, neurobehavioral evaluation, Terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) and Fluoro-Jade B (FJB) staining were used to detect the effects of pramipexole-induced hypothermia on SAH-induced EBI, as well as to study whether controlled rewarming could attenuate these effects. Inhibitors targeting the PI3K/AKT/GSK3β pathway were administered to determine whether the neuroprotective effect of pramipexole-induced hypothermia was mediated by PI3K/AKT/GSK3β signaling pathway. The results showed that intraperitoneal injection of pramipexole at 0.25 mg/kg body weight once per 8 hours was found to successfully and safely maintain rats at mild hypothermia. Pramipexole-induced hypothermia ameliorated SAH-induced brain cell death, blood-brain barrier damage and neurobehavioral deficits in a PI3K/AKT/GSK3β signaling-dependent manner. Therefore, we may conclude that pramipexole-induced hypothermia could effectively inhibit EBI after SAH in rats via PI3K/AKT/GSK3β signaling pathway. PMID:27026509

  8. Hemorrhage after pancreatoduodenectomy.

    PubMed Central

    Rumstadt, B; Schwab, M; Korth, P; Samman, M; Trede, M

    1998-01-01

    OBJECTIVE: The authors reviewed the hemorrhagic complications of patients who underwent pancreatoduodenectomies between 1972 and 1996. SUMMARY BACKGROUND DATA: Although recent studies have demonstrated a reduction in the mortality of pancreatic resection, morbidity is still high. Bleeding is a close second to anastomotic dehiscence in the list of dangerous postoperative complications. METHODS: The medical records from a prospective data bank of 559 patients who underwent pancreatic resection at the Surgical Clinic of Mannheim (Heidelberg University) were analyzed in regard to postoperative hemorrhagic complications. Differences were evaluated with the Fisher exact test. RESULTS: The overall mortality rate was 2.7%. Postoperative bleeding occurred in 42 patients (7.5%), with 6 episodes ending fatally (14.3%). Erosive bleeding after pancreatic leak was noted in 11 patients (26.2%), 4 of whom died. Gastrointestinal hemorrhage occurred in 22 patients, and operative field hemorrhage was present in 20 cases. Relaparotomy was necessary in 29 patients. An angiography with interventional embolization for recurrent bleeding was performed in three patients. Seven hemorrhages (4.6%) occurred after pancreatectomy for chronic pancreatitis and 35 episodes of bleeding (8.6%) were encountered after pancreatectomy for malignant disease. Obstructive jaundice was present in 359 patients (63.9%). In this group of patients, 32 (8.9%) postoperative hemorrhages occurred. Preoperative biliary drainage did not influence the type and mortality rate of postoperative hemorrhage in jaundiced patients. CONCLUSION: The prevention of these bleeding complications depends in the first place on meticulous hemostatic technique. Preoperative biliary drainage does not lower postoperative bleeding complications in jaundiced patients. Continuous, close observation of the patient in the postoperative period, so as to detect complications in time, and expeditious hemostasis are paramount. Images Figure 1. Figure 2. PMID:9488522

  9. Molsidomine for the prevention of vasospasm-related delayed ischemic neurological deficits and delayed brain infarction and the improvement of clinical outcome after subarachnoid hemorrhage: a single-center clinical observational study.

    PubMed

    Ehlert, Angelika; Schmidt, Christoph; Wlfer, Johannes; Manthei, Gerd; Jacobs, Andreas H; Brning, Roland; Heindel, Walter; Ringelstein, E Bernd; Stummer, Walter; Pluta, Ryszard M; Hesselmann, Volker

    2016-01-01

    OBJECT Delayed ischemic neurological deficits (DINDs) and cerebral vasospasm (CVS) are responsible fora poor outcome in patients with aneurysmal subarachnoid hemorrhage (SAH), most likely because of a decreased availability of nitric oxide (NO) in the cerebral microcirculation. In this study, the authors examined the effects of treatment with the NO donor molsidomine with regard to decreasing the incidence of spasm-related delayed brain infarctions and improving clinical outcome in patients with SAH. METHODS Seventy-four patients with spontaneous aneurysmal SAH were included in this post hoc analysis. Twenty-nine patients with SAH and proven CVS received molsidomine in addition to oral or intravenous nimodipine. Control groups consisted of 25 SAH patients with proven vasospasm and 20 SAH patients without. These patients received nimodipine therapy alone. Cranial computed tomography (CCT) before and after treatment was analyzed for CVS-related infarcts. A modified National Institutes of Health Stroke Scale (mNIHSS) and the modified Rankin Scale (mRS) were used to assess outcomes at a 3-month clinical follow-up. RESULTS Four of the 29 (13.8%) patients receiving molsidomine plus nimodipine and 22 of the 45 (48%) patients receiving nimodipine therapy alone developed vasospasm-associated brain infarcts (p < 0.01). Follow-up revealed a median mNIHSS score of 3.0 and a median mRS score of 2.5 in the molsidomine group compared with scores of 11.5 and 5.0, respectively, in the nimodipine group with CVS (p < 0.001). One patient in the molsidomine treatment group died, and 12 patients in the standard care group died (p < 0.01). CONCLUSIONS In this post hoc analysis, patients with CVS who were treated with intravenous molsidomine had a significant improvement in clinical outcome and less cerebral infarction. Molsidomine offers a promising therapeutic option in patients with severe SAH and CVS and should be assessed in a prospective study. PMID:26162034

  10. Subpial Hematoma and Extravasation in the Interhemispheric Fissure with Subarachnoid Hemorrhage.

    PubMed

    Suzuki, Kazufumi; Matsuoka, Go; Abe, Kayoko; Okada, Yoshikazu; Sakai, Shuji

    2015-06-01

    A recent report on computed tomography (CT) findings of contrast extravasation in subarachnoid hemorrhage (SAH) with Sylvian hematoma suggests that the occurrence of the hematoma is secondary to bleeding in the subpial space. Our patient was in his sixties and was admitted to the hospital because of loss of consciousness (Glasgow Coma Scale E4V1M4). SAH was diagnosed in plain head CT, and growing hematomas were observed in the Sylvian and interhemispheric fissures following a subarachnoid hemorrhage. CT angiography (CTA) using a dual-phase scan protocol revealed contrast extravasation in both the fissures in the latter phase, and hematoma in the interhemispheric fissure contained multiple bleeding points. This case indicates that the occurrence of subpial hematoma such as Sylvian hematoma can be a secondary event following subpial bleeding from damaged small vessels elsewhere in the cranium. Instead of four-dimensional (4D) CT, the dual-phase CTA technique may help detect minor extravasations with usual helical CT scanner. PMID:25963159

  11. Microcatheter embolization of hemorrhages

    SciTech Connect

    Seppaenen, Seppo K.; Leppaenen, Martti J.; Pimenoff, Georg; Seppaenen, Janne M.

    1997-05-15

    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.

  12. 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 ...

  13. Let's Talk about Hemorrhagic Stroke

    MedlinePLUS

    ... part of the brain. Intracerebral hemorrhages (most common type of hemorrhagic stroke): Occur when a blood vessel bleeds or ruptures ... to reduce the brain swelling that follows a stroke. Surgery may be needed depending on the cause and type of the hemorrhage. Surgery is often recommended to ...

  14. Cerebral amyloid angiopathy with atypical imagingfindings of subarachnoid hemorrhage

    PubMed Central

    Tempaku, Akira; Ikeda, Hidetoshi; Nitta, Kazumi

    2015-01-01

    Cerebral amyloid angiopathy (CAA) is observed in most cases of nonhypertensive subcortical hemorrhage involving elderly patients. We herein describe the case of a female in whom a convexal subarachnoid hemorrhage was observed at 55 years of age. The cerebral hemorrhage occurred repeatedly; however, no obvious vascular lesions were observed on a cerebral angiography, and no signs of microbleeding or lesions in the deep white matter were identified on magnetic resonance imaging (MRI). Partial excision of the right frontal cortex and hematoma evacuation were performed, and histopathological examination showed deposition of an acidophilic substance with positive staining for Direct Fast Scarlet (DFS) in the cerebral vascular wall. Finally, brain hemorrhage due to CAA was diagnosed. This case suggests that CAA is an important differential diagnosis in patients with localized non-aneurysmal subarachnoid hemorrhage in the convexity sulcus. PMID:26705433

  15. [Hemorrhagic cystitis due to adenovirus in a renal transplant recipient: the first reported case in black Africa in a setting of a very beginning of a kidney transplantation program and review of the literature].

    PubMed

    Ackoundou-N'Guessan, Clment; Coulibaly, Nol; Guei, Cyr Monley; Aye, Denis; N'guessan, Francis Yapi; N'Dah, Justin Kouame; Lagou, Delphine Amlie; Tia, Mlanie Weu; Coulibaly, Pessa Albert; Nzoue, Sita; Konan, Serges; Gnionsahe, Daze Apollinaire

    2015-04-01

    Viral infections are an important complication of transplantation. Polyomavirus are the commonest viruses that infect the renal allograft. Herpes virus nephropathy has also been described. In the past 15 years, adenovirus nephritis has emerged as a potentially life-threatening disease in renal transplant patients in developed countries. Most of the papers devoted to adenovirus nephritis are reported cases. The fate of such patients in resources-limited countries is not known. Herein, we describe the clinical, biological and prognostic findings of a black African transplanted patient with adenoviral hemorrhagic cystitis. This case is the very first of its kind reported in black Africa in a setting of a start of a renal transplantation pilot project. The patient is a 54-year-old man admitted at the nephrology service for gross haematuria and fever occurred 1 month after kidney transplantation. The diagnosis of adenoviral hemorrhagic cystitis has been suspected because the patient has displayed recurrent conjunctivitis and gastroenteritis well before transplantation, which was then confirmed by the real-time polymerase chain reaction performed on the blood. Conservatory measures associated with immunosuppression reduction have permitted the discontinuation of haematuria. This case has been discussed in regard of the epidemiology, the diagnosis, the treatment, the evolution and the prognosis of the adenoviral infection in the renal transplant patient. A review of the literature has been performed subsequently. PMID:25684056

  16. Incidence and risk factors associated with in-hospital venous thromboembolism after aneurysmal subarachnoid hemorrhage.

    PubMed

    Kshettry, Varun R; Rosenbaum, Benjamin P; Seicean, Andreea; Kelly, Michael L; Schiltz, Nicholas K; Weil, Robert J

    2014-02-01

    Our purpose was to determine the incidence and risk factors associated with in-hospital venous thromboembolism (VTE) in patients with aneurysmal subarachnoid hemorrhage (aSAH). The Nationwide Inpatient Sample database was queried from 2002 to 2010 for hospital admissions for subarachnoid hemorrhage or intracerebral hemorrhage and either aneurysm clipping or coiling. Exclusion criteria were age <18, arteriovenous malformation/fistula diagnosis or repair, or radiosurgery. Primary outcome was VTE (deep vein thrombosis [DVT] or pulmonary embolus [PE]). Multivariate logistic regression was used to assess association between risk factors and VTE. Secondary outcomes were in-hospital mortality, discharge disposition, length of stay and hospital charges. A total of 15,968 hospital admissions were included. Overall rates of VTE (DVT or PE), DVT, and PE were 4.4%, 3.5%, and 1.2%, respectively. On multivariate analysis, the following factors were associated with increased VTE risk: increasing age, black race, male sex, teaching hospital, congestive heart failure, coagulopathy, neurologic disorders, paralysis, fluid and electrolyte disorders, obesity, and weight loss. Patients that underwent clipping versus coiling had similar VTE rates. VTE was associated with pulmonary/cardiac complication (odds ratio [OR] 2.8), infectious complication (OR 2.8), ventriculostomy (OR 1.8), and vasospasm (OR 1.3). Patients with VTE experienced increased non-routine discharge (OR 3.3), and had nearly double the mean length of stay (p<0.001) and total inflation-adjusted hospital charges (p<0.001). To our knowledge, this is the largest study evaluating the incidence and risk factors associated with the development of VTE after aSAH. The presence of one or more of these factors may necessitate more aggressive VTE prophylaxis. PMID:24128773

  17. Hereditary Hemorrhagic Telangiectasia

    PubMed Central

    Kamath, Nagesh; Bhatia, Sumit; Singh, Harneet; Shetty, Anurag; Shetty, Shiran

    2015-01-01

    Background: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disorder, which affects various internal organs and has a tendency for bleeding. It has a classic triad of mucocutaneous telangiectasias, recurrent hemorrhages and positive familial history of first-degree relative. Epistaxis or gastrointestinal telangiectasia can be fatal in a small number of cases. Case Report: A 44-year-old woman came with complaints of recurrent episodes of hematemesis and epistaxis. Patient had a family history of similar complaints. Patient underwent esophagogastroduodenoscopy (EGD), which revealed telangiectasia in the stomach. Imaging of the abdomen showed features suggestive of arteriovenous shunting. Conclusion: HHT can remain undiagnosed for a long time, and is rarely being reported in the literature with management needing a multidisciplinary approach with early inputs from a gastroenterologist. PMID:25839006

  18. Management of gastrointestinal hemorrhage.

    PubMed Central

    Hilsden, R. J.; Shaffer, E. A.

    1995-01-01

    Acute gastrointestinal hemorrhage is a common problem that requires prompt recognition and management to prevent serious morbidity and mortality. Management goals are stabilization of the patient with vigorous fluid resuscitation followed by investigation and definitive treatment of the bleeding source. Endoscopy is often the initial diagnostic test and allows therapeutic measures to be performed at the same time. Images Figure 1 Figure 2 PMID:8563510

  19. [Rectal hemorrhage in adults].

    PubMed

    Sirakov, P

    1983-01-01

    Two hundred thirty two patients, aged over 50, were examined, that were consulted with a view to rectal hemorrhage. After the analysis of the results obtained the author established that the causes of the rectal hemorrhage were: Tumours of colon--in 40,5 per cent, 64 per cent of them with cancer of colon. Diseases of sphincter region--in 44,9 per cent (anal fissure in 12,5 per cent; erosive and ulcerous sphincteritis--in 16,9 per cent; internal and external hemorrhoids--in 15,5 per cent). Ulcerous and erosive colitis--in 10,6 per cent, etc. The group of the sixth decade was underlined to be most affected--in 48,5 per cent. The localization of the tumours from the anorectal line up to 30 cm--is in 84 per cent and over 30 cm--in 16%. It is stressed that the presence of blood in feces, demands, without delay, the elucidation of the etiology of the hemorrhage. PMID:6608829

  20. Elevated Baseline C-Reactive Protein as a Predictor of Outcome After Aneurysmal Subarachnoid Hemorrhage: Data From the Simvastatin in Aneurysmal Subarachnoid Hemorrhage (STASH) Trial

    PubMed Central

    Budohoski, Karol; Smith, Christopher; Hutchinson, Peter J.; Kirkpatrick, Peter J.

    2015-01-01

    BACKGROUND: There remains a proportion of patients with unfavorable outcomes after aneurysmal subarachnoid hemorrhage, of particular relevance in those who present with a good clinical grade. A forewarning of those at risk provides an opportunity towards more intensive monitoring, investigation, and prophylactic treatment prior to the clinical manifestation of advancing cerebral injury. OBJECTIVE: To assess whether biochemical markers sampled in the first days after the initial hemorrhage can predict poor outcome. METHODS: All patients recruited to the multicenter Simvastatin in Aneurysmal Hemorrhage Trial (STASH) were included. Baseline biochemical profiles were taken between time of ictus and day 4 post ictus. The t-test compared outcomes, and a backwards stepwise binary logistic regression was used to determine the factors providing independent prediction of an unfavorable outcome. RESULTS: Baseline biochemical data were obtained in approximately 91% of cases from 803 patients. On admission, 73% of patients were good grade (World Federation of Neurological Surgeons grades 1 or 2); however, 84% had a Fisher grade 3 or 4 on computed tomographic scan. For patients presenting with good grade on admission, higher levels of C-reactive protein, glucose, and white blood cells and lower levels of hematocrit, albumin, and hemoglobin were associated with poor outcome at discharge. C-reactive protein was found to be an independent predictor of outcome for patients presenting in good grade. CONCLUSION: Early recording of C-reactive protein may prove useful in detecting those good grade patients who are at greater risk of clinical deterioration and poor outcome. ABBREVIATIONS: ALP, alkaline phosphatase ALT, alanine aminotransferase CK, creatine kinase CRP, C-reactive protein EVD, external ventricular drainage ICH GCP, International Conference on Harmonisation guidelines for good clinical practice mRS, modified Rankin Scale SAH, subarachnoid hemorrhage STASH, Simvastatin in Aneurysmal Subarachnoid Hemorrhage Trial WBC, white blood cells WFNS, World Federation of Neurological Surgeons PMID:26280117

  1. Incidence of delayed seizures, delayed cerebral ischemia and poor outcome with the use of levetiracetam versus phenytoin after aneurysmal subarachnoid hemorrhage.

    PubMed

    Karamchandani, Rahul Ramesh; Fletcher, Jeffrey James; Pandey, Aditya Swarup; Rajajee, Venkatakrishna

    2014-09-01

    Current guidelines recommend against the use of phenytoin following aneurysmal subarachnoid hemorrhage (aSAH) but consider other anticonvulsants, such as levetiracetam, acceptable. Our objective was to evaluate the risk of poor functional outcomes, delayed cerebral ischemia (DCI) and delayed seizures in aSAH patients treated with levetiracetam versus phenytoin. Medical records of patients with aSAH admitted between 2005-2012 receiving anticonvulsant prophylaxis with phenytoin or levetiracetam for >72 hours were reviewed. The primary outcome measure was poor functional outcome, defined as modified Rankin Scale (mRS) score >3 at first recorded follow-up. Secondary outcomes measures included DCI and the incidence of delayed seizures. The association between the use of levetiracetam and phenytoin and the outcomes of interest was studied using logistic regression. Medical records of 564 aSAH patients were reviewed and 259 included in the analysis after application of inclusion/exclusion criteria. Phenytoin was used exclusively in 43 (17%), levetiracetam exclusively in 132 (51%) while 84 (32%) patients were switched from phenytoin to levetiracetam. Six (2%) patients had delayed seizures, 94 (36%) developed DCI and 63 (24%) had mRS score >3 at follow-up. On multivariate analysis, only modified Fisher grade and seizure before anticonvulsant administration were associated with DCI while age, Hunt-Hess grade and presence of intraparenchymal hematoma were associated with mRS score >3. Choice of anticonvulsant was not associated with any of the outcomes of interest. There was no difference in the rate of delayed seizures, DCI or poor functional outcome in patients receiving phenytoin versus levetiracetam after aSAH. The high rate of crossover from phenytoin suggests that levetiracetam may be better tolerated. PMID:24919470

  2. Spontaneous Spinal Subdural Hematoma with Simultaneous Cranial Subarachnoid Hemorrhage

    PubMed Central

    Jung, Hwan-Su; Kim, Sang Woo

    2015-01-01

    Spontaneous spinal subdural hematoma is reported at a rare level of incidence, and is frequently associated with underlying coagulopathy or those receiving anticoagulant or antiplatelet agents; some cases accompany concomitant intracranial hemorrhage. The spontaneous development of spinal subdural hemorrhage (SDH) is a neurological emergency; therefore, early diagnosis, the discontinuation of anticoagulant, and urgent surgical decompression are required to enable neurological recovery. In this report, we present a simultaneous spinal subdural hematoma and cranial subarachnoid hemorrhage, which mimicked an aneurysmal origin in a female patient who had been taking warfarin due to aortic valve replacement surgery. PMID:26113966

  3. Effects of interrupted and uninterrupted occlusion of the basilar artery on cerebral blood flow, and on neurological and histological outcome in rats with subarachnoid hemorrhage.

    PubMed

    Alkan, T; Kahveci, N; Goren, B; Korfali, E; Ozluk, K

    2001-04-01

    Most neurosurgeons consider temporary vessel occlusion for aneurysmal clipping an effective technique that facilitates dissection between the aneurysm and the parent vessel. It is generally believed that repeated short periods of cerebral ischemia are safer for the brain than a single long episode. The aim of this study was to identify whether interrupted and uninterrupted vessel occlusion differs with regard to changes in brain tissue and cerebral hemodynamics after subarachnoid hemorrhage (SAH). Fifty Spraque Dawley rats (300-350 g) were placed under general anaesthesia and ventilated. The basilar artery was exposed through a transclival approach. Baseline local cerebral blood flow (LCBF) values was measured, and then the basilar artery was punctured, causing subarachnoid hemorrhage (SAH). Group I (n = 24) was subjected to 60 min of interrupted basilar artery occlusion, defined as 5 min of reperfusion after every 10 min of occlusion, group II (n = 26) 60 min of uninterrupted artery occlusion. Three days after completion of the experiment, each rat was neurologically evaluated and decapitated. Coronal brain slices were obtained and stained to assess infarct volume. Immediately after SAH, LCBF fell by 58% in group I, and by 52% in group II. In group I, each ischemic insult brought a similar reduction in LCBF, and after each release of the occlusion there was a rapid rise in flow. In group II, the LCBF values dropped initially and remained at low levels until the end of the study. The 2,3,5 triphenyltetrazolium chloride stained sections showed similar volumes of brainstem infarction in both groups (38.3 +/- 9.2 mm3 vs. 34.3 +/- 8.7 mm3, respectively; p > 0.05). The results suggest that there is no neuroprotective advantage to either interrupted or uninterrupted temporary blockage of blood flow during neurovascular procedures after SAH in the basilar artery region. PMID:11780776

  4. Effects of ischemic phrenic nerve root ganglion injury on respiratory disturbances in subarachnoid hemorrhage: an experimental study

    PubMed Central

    Demir, Recep; Aygl, Recep; Kotan, Dilcan; alik, Muhammet

    2013-01-01

    Introduction Phrenic nerves have important roles on the management of respiration rhythm. Diaphragm paralysis is possible in phrenic nerve roots ischemia in subarachnoid hemorrhage (SAH). We examined whether there is a relationship between phrenic nerve root ischemia and respiratory disturbances in SAH. Material and methods This study was conducted on 5 healthy control and 14 rabbits with experimentally induced SAH by injecting autologous blood into their cisterna magna. Animals were followed up via monitors for detecting the heart and respiration rhythms for 20 days and then decapitaed by humanely. Normal and degenerated neuron densities of phrenic nerve root at the level of C4 dorsal root ganglia (C4DRG) were estimated by Stereological methods. Between the mean numerical density of degenerated neurons of C4DRG and respiratory rate/minute of groups were compared statistically. Results Phrenic nerve roots, artery and diaphragm muscles degeneration was detected in respiratory arrest developed animals. The mean neuronal density of C4DRG was 13272 1201/mm3 with a mean respiration rate of 23 4/min in the control group. The mean degenerated neuron density was 2.240 450/mm3 and respiration rhythm was 31 6/min in survivors. But, the mean degenerated neuron density was 5850 650/mm3 and mean respiration rhythm was 34 7/min in respiratory arrest developed animals (n = 7). A linear relationship was noticed between the degenerated neuron density of C4DRG and respiraton rate (r = 0.758; p < 0.001). Conclusions Phrenic nerve root ischemia may be an important factor in respiration rhythms deteriorations in SAH which has not been mentioned in the literature. PMID:24482661

  5. Ischemic brain injury caused by interrupted versus uninterrupted occlusion in hypotensive rats with subarachnoid hemorrhage: neuroprotective effects of citicoline.

    PubMed

    Alkan, T; Kahveci, N; Goren, B; Korfali, E; Ozluk, K

    2001-04-01

    This study investigated the neuroprotection provided by cytidine 5'-diphosphocholine (citicoline) during interrupted and uninterrupted occlusion of the basilar artery after subarachnoid hemorrhage (SAH) in 121 hypotensive rats. Animals were anesthetized and the basilar artery was exposed through a transclival approach. Baseline local cerebral blood flow (LCBF) values were recorded, and then the basilar artery was punctured, causing SAH. Blood was drawn to induce hypotension [60-70 mmHg mean arterial blood pressure (MABP)]. Control rats received intraperitoneal (i.p.) injections of 0.5 ml saline immediately after SAH before hypotension induction and after 60 min of occlusion. Experimental rats received 400-mg/kg citicoline i.p. at the same time points. Control group I and treatment group III were subjected to 60 min of interrupted occlusion (5 min of reperfusion after each 10 min of occlusion). Control group II and treatment group IV were subjected to 60 min of uninterrupted occlusion. MABP and LCBF were recorded every 5 minutes. Brain edema was evaluated in seven rats from each group at 24 hours after ischemic injury. At 3 days after occlusion, another set of 28 rats was killed and coronal brain slices were stained to assess infarct volume. The groups' physiological and edema findings were similar. In all groups, LCBF fell immediately after SAH and remained below baseline throughout the experiment. In the citicoline-treated rats, arterial pressure increased significantly after 30-40 min of occlusion, and brain slices showed significantly smaller infarct volumes compared to control slices (p < 0.05). Mortality was significantly lower in the citicoline-treated animals (p < 0.001). The results suggest that citicoline provides significant neuroprotection during cerebral ischemia, and that it significantly reduces mortality. Part of the neuroprotective effect may be mediated by recovery of arterial pressure. PMID:11780777

  6. Symptomatic intracystic hemorrhage in pineal cysts. Report of 3 cases.

    PubMed

    Sarikaya-Seiwert, Sevgi; Turowski, Bernd; Hnggi, Daniel; Janssen, Giesela; Steiger, Hans-Jakob; Stummer, Walter

    2009-08-01

    Pineal cysts are benign and often asymptomatic intracranial entities. Occasionally they can lead to neurological symptoms through growth or due to intracystic hemorrhage. The purpose of the current report is to describe their clinical characteristics and treatment options. In the current study, the authors illustrate the course of disease in 3 patients who developed neurological symptoms due to hemorrhage into a pineal cyst. Two of their patients had additional cerebral disease, and regular MR imaging examinations were conducted. This circumstance allowed documentation of growth and intracystic hemorrhage. After the occurrence of new neurological symptoms with severe headache, MR images showed a fluid-fluid interface due to intracystic hemorrhage. The third patient presented with acute triventricular hydrocephalus and papilledema due to aqueductal stenosis caused by intracystic hemorrhage. In all 3 cases, excision of the pineal cysts via an infratentorial/supracerebellar approach was performed. Histological examination revealed the characteristic structure of pineal cyst in all cases, with hemorrhagic residues in the form of hemosiderin deposits. All patients recovered fully after surgical removal of the cysts. Furthermore, resolution of occlusive hydrocephalus could be demonstrated in those cases with ventricular enlargement. Pineal cysts without neurological symptoms are often discovered as incidental findings on cranial MR images. In contrast, neurological symptoms such as severe headache, diplopia, or Parinaud syndrome, may occur as a result of pineal apoplexy due to intracystic hemorrhage. The authors' cases confirm that MR imaging can identify intracystic hemorrhage by a characteristic fluid-fluid interface. Their experience suggests that microsurgical resection of cysts may be an effective and curative treatment option. PMID:19645546

  7. Postpartum hemorrhage: a continuing challenge.

    PubMed

    Lockhart, Evelyn

    2015-12-01

    Obstetric hemorrhage remains a leading cause of maternal morbidity and mortality worldwide. Many postpartum hemorrhages (PPHs) do not have identifiable risk factors; maternity units should therefore have obstetric hemorrhageprotocols in place for all parturients as every pregnancy has the potential to be complicated by hemorrhage. This review will examine the epidemiology of PPH as well as current recommendations for key elements in obstetric hemorrhage protocols. Recent advances in hematologic management of PPH will be also be reviewed, including: (1) recognition of hypofibrinogenemia as a risk factor for severe PPH, (2) use of antifibrinolytic therapy, and (3) strategies for fibrinogen replacement therapy. PMID:26637712

  8. A Phase I proof-of-concept and safety trial of sildenafil to treat cerebral vasospasm following subarachnoid hemorrhage.

    PubMed

    Washington, Chad W; Derdeyn, Colin P; Dhar, Rajat; Arias, Eric J; Chicoine, Michael R; Cross, DeWitte T; Dacey, Ralph G; Han, Byung Hee; Moran, Christopher J; Rich, Keith M; Vellimana, Ananth K; Zipfel, Gregory J

    2016-02-01

    OBJECT Studies show that phosphodiesterase-V (PDE-V) inhibition reduces cerebral vasospasm (CVS) and improves outcomes after experimental subarachnoid hemorrhage (SAH). This study was performed to investigate the safety and effect of sildenafil (an FDA-approved PDE-V inhibitor) on angiographic CVS in SAH patients. METHODS A2-phase, prospective, nonrandomized, human trial was implemented. Subarachnoid hemorrhage patients underwent angiography on Day 7 to assess for CVS. Those with CVS were given 10 mg of intravenous sildenafil in the first phase of the study and 30 mg in the second phase. In both, angiography was repeated 30 minutes after infusion. Safety was assessed by monitoring neurological examination findings and vital signs and for the development of adverse reactions. For angiographic assessment, in a blinded fashion, pre- and post-sildenafil images were graded as "improvement" or "no improvement" in CVS. Unblinded measurements were made between pre- and post-sildenafil angiograms. RESULTS Twelve patients received sildenafil; 5 patients received 10 mg and 7 received 30 mg. There were no adverse reactions. There was no adverse effect on heart rate or intracranial pressure. Sildenafil resulted in a transient decline in mean arterial pressure, an average of 17% with a return to baseline in an average of 18 minutes. Eight patients (67%) were found to have a positive angiographic response to sildenafil, 3 (60%) in the low-dose group and 5 (71%) in the high-dose group. The largest degree of vessel dilation was an average of 0.8 mm (range 0-2.1 mm). This corresponded to an average percentage increase in vessel diameter of 62% (range 0%-200%). CONCLUSIONS The results from this Phase I safety and proof-of-concept trial assessing the use of intravenous sildenafil in patients with CVS show that sildenafil is safe and well tolerated in the setting of SAH. Furthermore, the angiographic data suggest that sildenafil has a positive impact on human CVS. PMID:26314998

  9. Aneurysm location and clipping versus coiling for development of secondary normal-pressure hydrocephalus after aneurysmal subarachnoid hemorrhage: Japanese Stroke DataBank.

    PubMed

    Yamada, Shigeki; Ishikawa, Masatsune; Yamamoto, Kazuo; Ino, Tadashi; Kimura, Toru; Kobayashi, Shotai

    2015-12-01

    OBJECT The present study aimed to investigate aneurysm locations and treatments for ruptured cerebral aneurysms associated with secondary normal-pressure hydrocephalus (sNPH) after subarachnoid hemorrhage (SAH) by using comprehensive data from the Japanese Stroke DataBank. METHODS Among 101,165 patients with acute stroke registered between 2000 and 2013, 4693 patients (1482 men, 3211 women) were registered as having had an SAH caused by a ruptured saccular aneurysm. Of them, 1448 patients (438 men and 1010 women; mean age 61.9 13.4 years) who were confirmed to have or not have coexisting acute hydrocephalus and sNPH were included for statistical analyses. Locations of the ruptured aneurysms were subcategorized into 1 of the following 4 groups: middle cerebral artery (MCA; n = 354), anterior communicating artery and anterior cerebral artery (ACA; n = 496), internal carotid artery (ICA; n = 402), and posterior circulation (n = 130). Locations of 66 of the ruptured aneurysms were unknown/unrecorded. Treatments included craniotomy and clipping alone in 1073 patients, endovascular coil embolization alone in 285 patients, and a combination of coiling and clipping in 17 patients. The age-adjusted and multivariate odds ratios from logistic regression analyses were calculated after stratification using the Fisher CT scale to investigate the effects of the hematoma volume of SAH. RESULTS Acute hydrocephalus was confirmed in 593 patients, and 521 patients developed sNPH. Patients with a ruptured ACA aneurysm had twice the risk for sNPH over those with a ruptured MCA aneurysm. Those with an ACA aneurysm with Fisher Grade 3 SAH had a 9-fold-higher risk for sNPH than those with an MCA aneurysm with Fisher Grade 1 or 2 SAH. Patients with a ruptured posterior circulation aneurysm did not have any significant risk for sNPH. Clipping of the ruptured aneurysm resulted in twice the risk for sNPH over coil embolization alone. CONCLUSIONS Patients with low-grade SAH caused by a ruptured MCA aneurysm had a low risk for the development of sNPH. In contrast, patients with high-grade SAH caused by a ruptured ACA aneurysm had a higher risk for sNPH. Endovascular coiling might confer a lower risk of developing sNPH than microsurgical clipping. PMID:26230474

  10. Retinal hemorrhagic lesions from femtosecond visible laser pulses

    NASA Astrophysics Data System (ADS)

    Stein, Cindy D.; Toth, Cynthia A.; Cain, Clarence P.; Noojin, Gary D.; Stolarski, David J.; Rockwell, Benjamin A.; Roach, William P.

    1994-08-01

    We present our clinical evaluation of hemorrhagic and non-hemorrhagic 90 fs single pulses in rabbits and primates. The rabbit and primate eye present unique in vivo models for evaluation of retinal and choroidal laser induced hemorrhages with distinct differences in their retinal anatomy. We found two different hemorrhagic events to occur in the posterior pole with delivery of 90 fs pulses. First, in the Dutch Belted rabbit, we found large amounts of energy per pulse (from 20 to 60 times ED50) were required for formation of subretinal hemorrhages. Second, in the Rhesus monkey, we found significant numbers of small intraretinal hemorrhages from relatively low energy 90 fs pulses. Both the Dutch Belted rabbit and the Rhesus monkey failed to consistently show subretinal hemorrhagic lesions form very high pulse energies. Our findings suggest more energy absorption at the level of the retinal circulation than the choroidal circulation with our pulse parameters. The effects of the laser on the retinal circulation may be due to the use of a wavelength of 580 nm. At this wavelength the oxyhemoglobin to melanin absorption ratio is nearly at its peak (approximately 0.40), perhaps allowing improved absorption in the retinal vasculature. One precaution with this finding, however, are the distinct differences between primate and non-primate ocular systems. Further studies are required to resolve the differences in damage at the level of the RPE and choroid between rabbits and primates.

  11. Early cerebral infarction following aneurysmal subarachnoid hemorrhage: frequency, risk factors, patterns, and prognosis.

    PubMed

    Fu, Chao; Yu, Weidong; Sun, Libo; Li, Dongyuan; Zhao, Conghai

    2013-11-01

    Early cerebral infarction (ECI) following aneurysmal subarachnoid hemorrhage (aSAH) remains poorly understood. This study aims to determine the frequency and risk factors of this special episode, as well as to assess the relationship between its patterns and outcome. We retrospectively enrolled 243 patients who underwent aneurysm treatment within 60 hours of SAH. ECI was defined as one or more new hypodense abnormalities on computed tomography within 3 days after SAH, rather than lesions attributable to edema, retraction effect, and ventricular drain placement. Risk factors were tested by multivariate analysis. The infarct was classified by an established grading system (single or multiple, cortical or deep or combined). Poor outcome was defined as the Glasgow Outcome Score of severe disability or worse. Sixty-five patients (26.7%) had early infarction. Acute hydrocephalus (odds ratio [OR] 6.67; 95% confidence interval [CI] 1.59-27.95), admission plasma glucose level (OR 1.42 per mmol/L; 95% CI 1.16-1.73), and treatment modality (OR 16.27; 95% CI 4.05-65.28) were independent predictors of ECI. The pattern was single cortical in 19 patients (29.2%), single deep in 9 (13.8%), multiple cortical in 8 (12.3%), multiple deep in 14 (21.5%), and multiple combined in 15 (23.1%). ECI was associated with delayed cerebral infarction (DCI) (P = 0.002) and poor outcome (P < 0.001). Multiple combined infarction was related to poor outcome (P = 0.001). In summary, the occurrence of ECI, which is associated with surgical treatment, acute hydrocephalus and high admission plasma glucose, may potentially predict DCI and unfavorable outcome. Further studies are warranted to reveal the underlying mechanisms of this event and thereby minimize it. PMID:24016219

  12. Transcranial Doppler monitoring and clinical decision-making after subarachnoid hemorrhage.

    PubMed

    McGirt, Matthew J; Blessing, Robert P; Goldstein, Larry B

    2003-01-01

    Our objective was to examine the impact of transcranial Doppler ultrasound (TCD) vasospasm monitoring on clinical decision-making following subarachnoid hemorrhage (SAH). The records of 50 randomly selected patients undergoing serial TCD monitoring following SAH were reviewed. Dates and results of TCDs and cerebral angiograms, the use of hypertensive hemodilution (HH) therapy, and the development of new neurological deficits were recorded. The independent effects of TCD-defined vasospasm and new neurological deficits on patient management were determined with multiple logistical regression. Results were validated in a second randomly selected, 50 patient cohort. Mild or moderate TCD-defined vasospasm developed in 76% of patients 5.8 +/- 0.5 days after SAH; 38% developed severe TCD-defined vasospasm after 7.9 +/- 0.7 days. Focal neurological deficits occurred in 50% after 5.7 +/- 0.6 days with TCD abnormalities preceding the deficit by 2.5 +/- 0.7 days in 64%. TCD-defined vasospasm or a new neurological deficit explained 60% of the variance in the use of HH therapy (P = .005). New neurological deficits increased the odds of HH therapy 33-fold (P = .004) whereas there was no independent effect of TCD-defined vasospasm. These variables explained 64% of the variance in the performance of angiography (P = .0002). An abnormal TCD did not increase the odds of angiography whereas its use increased 28-fold (P = .01) after a neurological deficit developed. These results were confirmed in an independent cohort. We concluded that TCD-defined vasospasm did not independently influence the use of HH therapy or angiography with both decisions associated with the development of new neurological deficits. As TCD-defined vasospasm preceded the neurological deficit in 64%, earlier intervention might reduce the incidence of vasospasm-related stroke in institutions with similar practice patterns. PMID:17903910

  13. Reconsidering the logic of World Federation of Neurosurgical Societies grading in patients with severe subarachnoid hemorrhage.

    PubMed

    Fung, Christian; Inglin, Fabienne; Murek, Michael; Balmer, Mathias; Abu-Isa, Janine; Z'Graggen, Werner J; Ozdoba, Christoph; Gralla, Jan; Jakob, Stephan M; Takala, Jukka; Beck, Jrgen; Raabe, Andreas

    2016-02-01

    OBJECT Current data show a favorable outcome in up to 50% of patients with World Federation of Neurosurgical Societies (WFNS) Grade V subarachnoid hemorrhage (SAH) and a rather poor prediction of worst cases. Thus, the usefulness of the current WFNS grading system for identifying the worst scenarios for clinical studies and for making treatment decisions is limited. One reason for this lack of differentiation is the use of "negative" or "silent" diagnostic signs as part of the WFNS Grade V definition. The authors therefore reevaluated the WFNS scale by using "positive" clinical signs and the logic of the Glasgow Coma Scale as a progressive herniation score. METHODS The authors performed a retrospective analysis of 182 patients with SAH who had poor grades on the WFNS scale. Patients were graded according to the original WFNS scale and additionally according to a modified classification, the WFNS herniation (hWFNS) scale (Grade IV, no clinical signs of herniation; Grade V, clinical signs of herniation). The prediction of poor outcome was compared between these two grading systems. RESULTS The positive predictive values of Grade V for poor outcome were 74.3% (OR 3.79, 95% CI 1.94-7.54) for WFNS Grade V and 85.7% (OR 8.27, 95% CI 3.78-19.47) for hWFNS Grade V. With respect to mortality, the positive predictive values were 68.3% (OR 3.9, 95% CI 2.01-7.69) for WFNS Grade V and 77.9% (OR 6.22, 95% CI 3.07-13.14) for hWFNS Grade V. CONCLUSIONS Limiting WFNS Grade V to the positive clinical signs of the Glasgow Coma Scale such as flexion, extension, and pupillary abnormalities instead of including "no motor response" increases the prediction of mortality and poor outcome in patients with severe SAH. PMID:26381248

  14. [APPLICATIONS ENDOVASCULAR HEMOSTASIS TREATMENT OF PULMONARY HEMORRHAGE].

    PubMed

    Severgin, V E; Shipulin, P P; Agrahari, A; Tronina, E Yu; Kyrylyuk, A A; Polyak, S D; Kozyar, N

    2015-06-01

    Rentgenoendovascular embolization of bronchial arteries was performed in 222 patients about pulmonary hemorrhage (PH) of different nature. Resistant hemostasis was achieved in 198 (89.9%) patients. The possibility of endovascular hemostasis in patients in advanced lung cancer complicated by PH. Hemostasis was ineffective in 24 (10.8%) patients. Died 5 (2.2%) patients due to unresectable lung cancer. The reasons for ineffective hemostasis were analysed. PMID:26521468

  15. Hemorrhagic Fever with Renal Syndrome (HFRS)

    MedlinePLUS

    ... this page: About CDC.gov . Hantavirus Share Compartir Hemorrhagic Fever with Renal Syndrome (HFRS) On this Page What ... How is HFRS prevented? Suggested Reading What is hemorrhagic fever with renal syndrome? Hemorrhagic fever with renal syndrome ( ...

  16. Analysis of subconjunctival hemorrhage

    PubMed Central

    Sahinoglu-Keskek, Nedime; Cevher, Selim; Ergin, Ahmet

    2013-01-01

    Objective: To determine associated conditions, gender distribution and location of subconjunctival hemorrhage (SCH). Methodology: This retrospective, observational and non-interventional study involved total of 50 patients with SCH aged 0.16-88 years. The conjunctiva was divided into 4 equal areas. The data about the subjects with SCH that includes age, gender, medical history, ocular history and location of hemorrhage were noted for all patients. Results: The patients with SCH consisted of 21 (42%) women and 29 (58%) men, with a mean age of 29.56 years. Of the 50 patients, 34 (68%) had traumatic and 16 (32%) had spontaneous SCH. Of traumatic SCH group 24 (70.6%) were men and 10 (29.4%) were women. SCH was more common in the temporal areas than other areas (40.5%). Conclusion: The most associated condition in spontaneous SCH was hypertension. SCH was found to be predominant in the temporal areas among all patients. In traumatic SCH, temporal areas were affected more, whereas in spontaneous SCH, nasal and temporal areas were affected equally. Traumatic etiology was more likely seen in men than women. PMID:24353524

  17. [Thalamic hypertensive hemorrhage].

    PubMed

    Vereshchagin, N V; Peresedov, V V; Shirshov, A V; Kugoev, A I

    1997-01-01

    We performed statistic analysis of the results of both conservative and surgical (by means of laying on the external ventricle drain--EVD) treatment of 23 patients with thalamic (medial) hypertensive hemorrhage (THH) admitted to the hospital in the first two days of the stroke's beginning. We also investigated clinical tomographic factors which had influence either on the choice of the treatment or on the prognosis of the disease. The frequency of the lethal cases in EVD-group (6 observations) was about twice lower than in analogous group of patients treated conservatively (17 cases). In conservative treatment prognostically unfavourable factors in acute period of the stroke were the following: the awakening level lower than 10 points according to Glasgow Scale, development of acute obstructive hydrocephalus, dislocation of brain stem, break of blood into cerebral ventricles (of II-IV degree), the volume of hemorrhage more than 10 ml for thalamic and thalamo-capsular location and more than 5 ml for thalamo-mesencephalic location. Monitoring of intracranial pressure in patients with THH which had factors mentioned above revealed the development of steadfast intracranial hypertension by days 5-7 maximally. The laying on EVD was indicated in patients with unfavourable signs of THH by means of ventricle drainage. The controlled decrease of intracranial pressure increased the level of awakening, meanwhile it decreased the degree of hydrochephalus and dislocation of brain stem. PMID:11517469

  18. Intraventricular hemorrhage: emphasis on prevention.

    PubMed

    Hill, A

    1998-09-01

    Germinal matrix/intraventricular hemorrhage is a common type of cerebral injury in premature newborns. Based on the improved understanding of underlying pathogenetic mechanisms, numerous interventional strategies for prevention have been proposed. This article summarizes and evaluates the efficacy and safety of major interventions that are currently under consideration for the prevention of germinal matrix/intraventricular hemorrhage. PMID:9777674

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

    PubMed Central

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

    2014-01-01

    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

  20. Craniopharyngiomas Presenting with Nonobstructive Hydrocephalus: Underlying Influence of Subarachnoidal Hemorrhage. Two Case Reports.

    PubMed

    Kawaguchi, Tomohiro; Ogawa, Yoshikazu; Watanabe, Mika; Tominaga, Teiji

    2015-09-01

    Nonobstructive hydrocephalus in craniopharyngioma patients is rare, and the etiology is not known. We report two cases of patients with craniopharyngioma who presented with nonobstructive hydrocephalus. Repeated subarachnoidal hemorrhage (SAH) was considered as the underlying mechanism of hydrocephalus development. The first case was a 67-year-old woman presenting with deteriorated consciousness. Head computed tomography (CT) and magnetic resonance (MR) imaging demonstrated a solid suprasellar tumor with subarachnoidal and intraventricular hematoma with ventricle dilatation but no cerebrospinal fluid (CSF) obstruction. The extended transsphenoidal approach achieved gross total removal. Because of persistent ventricle dilatation, ventriculoperitoneal shunt was required. The second case was a 35-year-old woman presenting with persistent headache. Head CT and MR imaging demonstrated a solid suprasellar tumor with ventricular dilatation but no CSF obstruction. The extended transsphenoidal approach achieved gross total removal. The postoperative course was uneventful, and a ventriculoperitoneal shunt was not required. In both cases, histologic examination of the tumors revealed squamous-papillary type craniopharyngioma with remarkable inflammatory cell infiltrations in the perivascular space. CSF cytology revealed hemosiderin-laden phagocytes, indicative of previous SAH causing CSF malabsorption. These cases suggested that surgery should be indicated for patients with craniopharyngiomas with nonobstructive hydrocephalus, even if the tumors are not associated with neurologic and/or endocrinologic deficits. PMID:25072315

  1. Lethal Hemorrhage Caused by Aortoenteric Fistula Following Endovascular Stent Implantation

    SciTech Connect

    Kahlke, Volker; Brossmann, Joachim; Klomp, Hans-Juergen

    2002-06-15

    A 55-year-old women developed an aortointestinal fistula between the bifurcation of the aorta and the distal ileum following implantation of multiple endovascular stents into both common iliac arteries for treatment of aortoiliac occlusive disease. Ten months before the acute onset of the gastrointestinal hemorrhage two balloon-expandable steel stents had been implanted into both common iliac arteries. Due to restenosis and recurrent intermittent claudication, three balloon-expandable covered stents were implanted 4 months later on reintervention. The patient presented with abdominal pain and melena, and fell into hemorrhagic shock with signs of upper gastrointestinal bleeding. After transfer to our hospital, she again developed hemorrhagic shock with massive upper and lower gastrointestinal bleeding and died during emergency laparotomy. The development of aortoenteric fistulas following endovascular surgery/stent implantation is very rare and has to be considered in cases of acute gastrointestinal hemorrhage.

  2. Glioma mimicking a hypertensive intracerebral hemorrhage.

    PubMed

    Choi, Go; Park, Dong-Hyuk; Kang, Shin-Hyuk; Chung, Yong-Gu

    2013-08-01

    Here, we report a rare case of an anaplastic astrocytoma masquerading as a hypertensive basal ganglia hemorrhage. A 69-year-old woman who had been under medical management for hypertension during the past 3 years suddenly developed right hemiparesis with dysarthria. Brain computed tomography (CT) scans with contrast and CT angiograms revealed an intracerebral hemorrhage (ICH) in the left basal ganglia, without an underlying lesion. She was treated conservatively, but underwent a ventriculoperitoneal shunt operation 3 months after the initial attack due to deteriorated mental status and chronic hydrocephalus. Three months later, her mental status deteriorated further. Magnetic resonance imaging (MRI) with gadolinium demonstrated an irregular enhanced mass in which the previous hemorrhage occurred. The final histological diagnosis which made by stereotactic biopsy was an anaplastic astrocytoma. In the present case, the diagnosis of a high grade glioma was delayed due to tumor bleeding mimicking hypertensive ICH. Thus, a careful review of neuroradiological images including MRI with a suspicion of tumor bleeding is needed even in the patients with past medical history of hypertension. PMID:24175027

  3. Nimodipine in the treatment of subarachnoid hemorrhage.

    PubMed

    Yasuda, S U; Tietze, K J

    1989-06-01

    Nimodipine, a calcium-channel antagonist with a relatively selective vasodilatory effect on cerebral blood vessels, has recently been approved for improvement of neurologic deficits due to spasm following subarachnoid hemorrhage. Nimodipine has low oral bioavailability (2.7-27.9 percent), a short half-life (2 h), is highly protein bound (98-99 percent), and is hepatically metabolized. Clinical studies have evaluated topical, intravenous, and oral administration of nimodipine for the treatment of cerebral artery spasm associated with subarachnoid hemorrhage. These studies document some benefit of the drug in reducing the occurrence of severe neurologic deficit, although this effect is not universal. Few adverse effects have been noted. Further studies are necessary to evaluate the pharmacologic and pharmacokinetic characteristics, the appropriate dose and route of administration, adverse effects, drug interactions, and the therapeutic efficacy of nimodipine before routine use can be recommended. PMID:2662635

  4. Neuroinflammation after intracerebral hemorrhage

    PubMed Central

    Mracsko, Eva; Veltkamp, Roland

    2014-01-01

    Spontaneous intracerebral hemorrhage (ICH) is a particularly severe type of stroke for which no specific treatment has been established yet. Although preclinical models of ICH have substantial methodological limitations, important insight into the pathophysiology has been gained. Mounting evidence suggests an important contribution of inflammatory mechanisms to brain damage and potential repair. Neuroinflammation evoked by intracerebral blood involves the activation of resident microglia, the infiltration of systemic immune cells and the production of cytokines, chemokines, extracellular proteases and reactive oxygen species (ROS). Previous studies focused on innate immunity including microglia, monocytes and granulocytes. More recently, the role of adaptive immune cells has received increasing attention. Little is currently known about the interactions among different immune cell populations in the setting of ICH. Nevertheless, immunomodulatory strategies are already being explored in ICH. To improve the chances of translation from preclinical models to patients, a better characterization of the neuroinflammation in patients is desirable. PMID:25477782

  5. [Traumatic basal subarachnoid hemorrhage].

    PubMed

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

    2003-04-28

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

  6. Viral Hemorrhagic Fever Diagnostics.

    PubMed

    Racsa, Lori D; Kraft, Colleen S; Olinger, Gene G; Hensley, Lisa E

    2016-01-15

    There are 4 families of viruses that cause viral hemorrhagic fever (VHF), including Filoviridae. Ebola virus is one virus within the family Filoviridae and the cause of the current outbreak of VHF in West Africa. VHF-endemic areas are found throughout the world, yet traditional diagnosis of VHF has been performed in large reference laboratories centered in Europe and the United States. The large amount of capital needed, as well as highly trained and skilled personnel, has limited the availability of diagnostics in endemic areas except in conjunction with governmental and nongovernmental entities. However, rapid diagnosis of VHF is essential to efforts that will limit outbreaks. In addition, increased global travel suggests VHF diagnoses may be made outside of the endemic areas. Thus, understanding how to diagnose VHF is imperative for laboratories worldwide. This article reviews traditional and current diagnostic modalities for VHF. PMID:26354968

  7. Embolization for gastrointestinal hemorrhages.

    PubMed

    Krmer, S C; Grich, J; Rilinger, N; Siech, M; Aschoff, A J; Vogel, J; Brambs, H J

    2000-01-01

    Retrospective evaluation of interventional embolization therapy in the treatment of gastrointestinal hemorrhage over a long-term observation period from 1989 to 1997. Included in the study were 35 patients (age range 18-89 years) with gastrointestinal bleeding (GI) referred for radiological intervention either primarily or following unsuccessful endoscopy or surgery. Sources of GI bleeding included gastric and duodenal ulcers (n = 7), diverticula (n = 3), erosion of the intestinal wall secondary to malignancy (n = 6), vascular malformations (n = 4), and hemorrhoids (n = 2), as well as from postoperative (n = 6), posttraumatic (n = 2), postinflammatory (n = 4) or unknown (n = 1) causes. Ethibloc (12 cases) or metal coils (14 cases) were predominantly used as embolisates. In addition, combinations of tissue adhesive and gelfoam particles and of coils and Ethibloc were used (six cases). Finally, polyvinyl alcohol particles, a coated stent, and an arterial wire dissection were utilized in one case each. Bleeding was stopped completely in 29 of 35 cases (83%). In one case (3%) the source of bleeding was recognized but the corresponding vessel could not be catheterized. In five other cases (14%) there was partial success with reduced, though still persistent, bleeding. The rate of complications was 14%, including four instances of intestinal ischemia with fatal outcome in the first years, and, later, one partial infarction of the spleen without serious consequences. Gastrointestinal hemorrhage can be controlled in a high percentage of patients, including the seriously ill and those who had previously undergone surgery, with the use of minimally invasive interventional techniques. The availability of minicoils instead of fluid embolization agents has reduced the risk of serious complications. PMID:10823636

  8. Fatal case of hemolytic-uremic syndrome in an adult due to a rare serogroup O91 Entero hemorrhagic Escherichia coli associated with a Clostridium difficile infection. More than meets the eye.

    PubMed

    Guillard, Thomas; Limelette, Anne; Le Magrex-Debar, Elisabeth; Wynckel, Alain; Gouali, Malika; Mariani-Kurkdjian, Patricia; Guyot-Colosio, Charlotte; de Champs, Christophe

    2015-08-01

    Hemolytic-uremic syndrome due to enterohemorrhagic Escherichia coli, belonging to serogroup O91 has rarely been described. We report here a case of post-diarrheal HUS due to EHEC O91 in an elderly patient for whom diagnosis was delayed given a previously diagnosed C. difficile infection. This case highlights the usefulness of Shiga-toxin detection. PMID:26135847

  9. Prognosis Predicting Score for Endovascular Treatment of Aneurysmal Subarachnoid Hemorrhage: A Risk Modeling Study for Individual Elderly Patients.

    PubMed

    Duan, Guoli; Yang, Pengfei; Li, Qiang; Zuo, Qiao; Zhang, Lei; Hong, Bo; Xu, Yi; Zhao, Wenyuan; Liu, Jianmin; Huang, Qinghai

    2016-02-01

    The elderly patients with aneurysmal subarachnoid hemorrhage (aSAH) have a greater risk of poor clinical outcome after endovascular treatment (EVT) than younger patients do. Hence, it is necessary to explore which factors are associated with poor outcome and develop a predictive score specifically for elderly patients with aSAH receiving EVT.The aim of this study was to develop and validate a predictive score for 1-year outcomes in individual elderly patients with aSAH underwent EVT.In this 10-year prospective study, 520 consecutive aSAH elderly (age ? 60 years) patients underwent EVT in a single center were included. The risk factors, periprocedural, and 1-year follow-up data of all patients were entered in a specific prospective database.The modified Rankin scale was used for evaluating clinical outcome. To optimize the model's predictive capacity, the original matrix was randomly divided in 2 submatrices (learning and testing). The predictive score was developed using Arabic numerals for all variables based on the variable coefficients (?) of multivariable logistic regression analysis in the learning set and the predictive performance evaluation was assessed in the testing set. The risk classes were constructed using classification criteria based on sensitivity and specificity.The poor outcome rate at 1 year was 26.15%. Six risk factors, including age, hypertension, Hunt-Hess scale, Fisher scale, aneurysm location, and periprocedural complications, were independently associated with poor outcome and assembled the Changhai score. The discriminative power analysis with the area under the receiver operating characteristic curve (AUC) of the Changhai score was statistically significant (0.864, 0.824-0.904, P?SAH patients underwent EVT. In combination with these risk factors, the Changhai score can be a useful tool in the prediction of clinical outcome but needs to be validated in various centers before it can be recommended for application. PMID:26886607

  10. Impact of Comorbidity on Early Outcome of Patients with Subarachnoid Hemorrhage Caused by Cerebral Aneurysm Rupture

    PubMed Central

    Avdagic, Selma Sijercic; Brkic, Harun; Avdagic, Harun; Smajic, Jasmina; Hodzic, Samir

    2015-01-01

    Background: One of the complications aneurysms subarachnoid hemorrhage is the development of vasospasm, which is the leading cause of disability and death from ruptured cerebral aneurysm. Aim: To evaluate the significance of previous comorbidities on early outcome of patients with subarachnoid hemorrhage caused by rupture of a cerebral aneurysm in the prevention of vasospasm. Patients and methods: The study had prospective character in which included 50 patients, whose diagnosed with SAH caused by the rupture of a brain aneurysm in the period from 2011to 2013. Two groups of patients were formed. Group I: patients in addition to the standard initial treatment and “3H therapy” administered nimodipine at a dose of 15-30 mg / kg bw / h (3-10 ml) for the duration of the initial treatment. Group II: patients in addition to the standard initial treatment and “3H therapy” administered with MgSO4 at a dose of 12 grams in 500 ml of 0.9% NaCl / 24 h during the initial treatment. Results: Two-thirds of the patients (68%) from both groups had a good outcome measured with values according to GOS scales, GOS IV and V. The poorer outcome, GOS III had 20% patients, the GOS II was at 2% and GOS I within 10% of patients. If we analyze the impact of comorbidity on the outcome, it shows that there is a significant relationship between the presence of comorbidity and outcomes. The patients without comorbidity (83.30%) had a good outcome (GOS IV and V), the same outcome was observed (59.4%) with comorbidities, which has a statistically significant difference (p = 0.04). Patients without diabetes (32%) had a good outcome (GOS IV and V), while the percentage of patients with diabetes less frequent (2%) with a good outcome, a statistically significant difference (p = 0.009). Conclusion: The outcome of treatment 30 days after the subarachnoid hemorrhage analyzed values WFNS and GOS, is not dependent on the method of prevention and treatment of vasospasm. Most concomitant diseases in patients with SAH which, requiring additional treatment measures are arterial hypertension and diabetes mellitus. The best predictors in the initial treatment of patients with subarachnoid hemorrhage caused by rupture of a cerebral aneurysm has the presence of comorbidity, which has statistical significance. PMID:26622076

  11. Fatal subarachnoid hemorrhage associated with internal carotid artery dissection resulting from whiplash trauma.

    PubMed

    Uhrenholt, Lars; Freeman, Michael D; Webb, Alexandra L; Pedersen, Michael; Boel, Lene Warner Thorup

    2015-12-01

    Spinal injury following inertial loading of the head and neck (whiplash) is a common sequel of low speed traffic crashes. A variety of non-musculoskeletal injuries have been described in association with injury to the spine following whiplash trauma, including traumatic brain injury, vestibular derangement, and cranial nerve injury, among others. Vascular injuries in the head and neck have, however, only rarely been described. We present the case of a middle-aged male who sustained an ultimately fatal injury that resulted from injury to the internal carotid artery (ICA) and intracerebral vascular structures following a hard braking maneuver, with no direct head- or neck contact with the vehicular interior. Based on this unusual mechanism of injury we reviewed hospital data from the United States nationwide inpatient database (NIS) to assess the frequency of similar injuries reportedly resulting from traffic crashes. The post-mortem examination revealed a left internal carotid artery dissection associated with subarachnoid hemorrhage (SAH). Based on the close temporal association, the absent prior history, and the plausibility of the injury mechanism, the injury was attributed to the braking maneuver. An analysis of NIS data demonstrated that the prevalence of subarachnoid hemorrhage is significantly higher when there is a traumatic etiology, and higher yet when the trauma is a traffic crash (odds ratio 3.3 and 4.3, respectively). The presented case, together with the hospital inpatient data analysis, indicate that although SAH in combination with ICA dissection is relatively rare, it is substantially more probable following a traffic crash. In a clinical or forensic setting the inference that magnitude of a trauma was low should not serve as a basis for either excluding a cervical artery dissection from a differential diagnosis, or for excluding the trauma as a cause of a diagnosed dissection. This case report illustrates a rare fatal outcome of inertial load to the head and neck induced by a sudden braking event in a commonly experienced non-collision traffic incident. The likely mechanism of injury resulted from interaction between the occupant and the 3-point seat belt. These findings indicate that ICA dissections are substantially more likely to be associated with SAH following head and neck trauma, regardless of the magnitude of the traumatic event or whether an impact was involved. PMID:26499790

  12. Control of Traumatic Extremity Hemorrhage.

    PubMed

    Day, Michael W

    2016-02-01

    Although most extremity hemorrhage from trauma can be controlled with direct pressure and/or pressure dressings, the occasional uncontrolled hemorrhage can be life threatening. Tools that may be able to control such life-threatening extremity hemorrhage include hemostatic dressings, tourniquets, and several new devices that have recently become available. Hemostatic dressings, a relatively new concept, incorporate materials that increase coagulation into a dressing that is applied directly to the wound. Although the use of tourniquets has a long history, recent military conflicts have provided numerous studies that supported and refined their use. The novel extremity hemorrhage control devices effectively control bleeding in one of several ways: direct compression, arterial compression above the level of injury, and sealing the wounds' edges, creating a hematoma. PMID:26830179

  13. Cerebral Cavernous Malformation and Hemorrhage

    MedlinePLUS

    ... absorption, unmasking the lesion's boundary relative to healthy brain tissue; however, if surgery is contemplated, it should not be delayed so long after a bleed that the lesion begins to shrink, making extraction more difficult. Hemorrhage Rates What is ...

  14. Hemorrhagic Aspects of Gaucher Disease

    PubMed Central

    Rosenbaum, Hanna

    2014-01-01

    Gaucher disease (GD) is an inherited lysosomal disorder, originating from deficient activity of the lysosomal enzyme glucocerebrosidase (GCase). Normally, GCase hydrolyzes glucocerebroside (GC) to glucose and ceramide; however, impaired activity of this enzyme leads to the accumulation of GC in macrophages, termed Gaucher cells. Gaucher disease is associated with hepatosplenomegaly, cytopenias, skeletal complications and in some forms involves the central nervous system. Coagulation abnormalities are common among GD patients due to impaired production and chronic consumption of coagulation factors. Bleeding phenomena are variable (as are other symptoms of GD) and include mucosal and surgical hemorrhages. Four main etiological factors account for the hemostatic defect in GD: thrombocytopenia, abnormal platelet function, reduced production of coagulation factors, and activation of fibrinolysis. Thrombocytopenia relates not only to hypersplenism and decreased megakaryopoiesis by the infiltrated bone marrow but also to immune thrombocytopenia. Autoimmunity, especially the induction of platelet antibody production, might cause persistent thrombocytopenia. Enzyme replacement therapy reverses only part of the impaired coagulation system in Gaucher disease. Other therapeutic and supportive measures should be considered to prevent and/or treat bleeding in GD. Gaucher patients should be evaluated routinely for coagulation abnormalities especially prior to surgery and dental and obstetric procedures. PMID:25386355

  15. Angiographic diagnosis at gastrointestinal hemorrhage.

    PubMed

    Myllyl, V; Pivnsalo, M; Leinonen, A

    1984-01-01

    The position of angiography in the diagnosis of gastrointestinal hemorrhage is discussed on the basis of a series of 37 patients. In this series, there were angiographic signs of bleeding in 13 cases (35%). The largest group consisted of angiodysplasias. In 24 cases, angiography revealed no signs of bleeding. The cause of symptoms was discovered later in 17 of these cases. Hemorrhagic gastritis and ventricular ulcer were the main causes of bleeding in the latter group. PMID:6610524

  16. Hemorrhagic complications in dermatologic surgery

    PubMed Central

    Bunick, Christopher G.; Aasi, Sumaira Z.

    2014-01-01

    The ability to recognize, manage, and, most importantly, prevent hemorrhagic complications is critical to performing dermatologic procedures that have safe and high quality outcomes. This article reviews the preoperative, intraoperative, and postoperative factors and patient dynamics that are central to preventing such an adverse outcome. Specifically, the role that anticoagulants and antiplatelet agents, hypertension, and other medical conditions play in the development of postoperative hemorrhage are discussed. In addition, this article provides practical guidelines on managing bleeding during and after surgery. PMID:22515669

  17. Serial angiographic appearance of segmental arterial mediolysis manifesting as vertebral, internal mammary and intra-abdominal visceral artery aneurysms in a patient presenting with subarachnoid hemorrhage and review of the literature.

    PubMed

    Cooke, Daniel L; Meisel, Karl M; Kim, Warren T; Stout, Charles E; Halbach, Van V; Dowd, Christopher F; Higashida, Randall T

    2013-09-01

    Segmental arterial mediolysis (SAM) is a rare, non-inflammatory, non-atherosclerotic vasculopathy typically affecting the abdominal arteries although it may also affect the great vessels and cerebral vasculature. Diseased vessels manifest with aneurysms and/or dissections, often presenting clinically with catastrophic thromboembolic injury and less frequently with subarachnoid hemorrhage (SAH). The etiology of SAM remains indeterminate although there is evidence it may be an endogenous pathological response to vasospasm. The SAM literature is reviewed and a case of SAH related to a ruptured dissecting-type vertebral artery aneurysm is described. In addition to furthering awareness of SAM, this unique case offers insight into the acute phase of the disease and the potential role of vasospastic induction. PMID:22693248

  18. Dengue and Dengue Hemorrhagic Fever

    PubMed Central

    Gubler, Duane J.

    1998-01-01

    Dengue fever, a very old disease, has reemerged in the past 20 years with an expanded geographic distribution of both the viruses and the mosquito vectors, increased epidemic activity, the development of hyperendemicity (the cocirculation of multiple serotypes), and the emergence of dengue hemorrhagic fever in new geographic regions. In 1998 this mosquito-borne disease is the most important tropical infectious disease after malaria, with an estimated 100 million cases of dengue fever, 500,000 cases of dengue hemorrhagic fever, and 25,000 deaths annually. The reasons for this resurgence and emergence of dengue hemorrhagic fever in the waning years of the 20th century are complex and not fully understood, but demographic, societal, and public health infrastructure changes in the past 30 years have contributed greatly. This paper reviews the changing epidemiology of dengue and dengue hemorrhagic fever by geographic region, the natural history and transmission cycles, clinical diagnosis of both dengue fever and dengue hemorrhagic fever, serologic and virologic laboratory diagnoses, pathogenesis, surveillance, prevention, and control. A major challenge for public health officials in all tropical areas of the world is to devleop and implement sustainable prevention and control programs that will reverse the trend of emergent dengue hemorrhagic fever. PMID:9665979

  19. High-Dose Simvastatin Is Effective in Preventing Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage: A Prospective Cohort Study in Korean Patients

    PubMed Central

    Woo, Sung Woong; Kang, Hee In; Kim, Deok Ryeong; Moon, Byung Gwan; Kim, Joo Seung

    2015-01-01

    Objective The goal of this study was to assess the effect of high-dose simvastatin on cerebral vasospasm and its clinical outcome after aneurysmal subarachnoid hemorrhage (SAH) in Korean patients. Methods This study was designed as a prospective observational cohort study. Its subjects were aneurysmal SAH patients who had undergone aneurysm clipping or coiling. They were assigned to 1 of 3 groups : the 20 mg, 40 mg, and 80 mg simvastatin groups. The primary end-point was the occurrence of symptomatic vasospasm. The clinical outcome was assessed with the modified Rankin Scale (mRS) score after 1 month and 3 months. The risk factors of the development of vasospasm were assessed by logistic regression analysis. Results Ninety nine patients with aneurysmal SAH were treated and screened. They were sequentially assigned to the 20 mg (n=22), 40 mg (n=34), and 80 mg (n=31) simvastatin groups. Symptomatic vasospasm occurred in 36.4% of the 20 mg group, 8.8% of the 40 mg group, and 3.2% of the 80 mg group (p=0.003). The multiple logistic regression analysis showed that poor Hunt-Hess grades (OR=5.4 and 95% CI=1.09-26.62) and high-dose (80 mg) simvastatin (OR=0.09 and 95% CI=0.1-0.85) were independent factors of symptomatic vasospasm. The clinical outcomes did not show a significant difference among the three groups. Conclusion This study demonstrated that 80 mg simvastatin treatment was effective in preventing cerebral vasospasm after aneurysmal SAH, but did not improve the clinical outcome in Korean patients. PMID:26587185

  20. Internal iliac artery: embolization to control hemorrhage from pelvic neoplasms.

    PubMed

    Pisco, J M; Martins, J M; Correia, M G

    1989-08-01

    The control of the massive and often fatal hemorrhage from pelvic neoplasms is a major therapeutic problem. Transcatheter embolization of the internal iliac arteries was performed in 108 patients with uncontrollable hemorrhage due to pelvic neoplasms (urinary bladder in 50, uterus in 39, ovary in 16, and prostate in three). Complete control of the hemorrhage was achieved in 74 patients, partial control in 23, and no control in 11. Seventy patients experienced postembolization syndrome (nausea, vomiting, gluteal pain, and fever due to tissue necrosis), and three had transient acute tubular necrosis caused by the contrast medium. It is important for success that the embolization be bilateral and that the embolic agent used be a permanent one. PMID:2748811

  1. A case of hypertensive intraventricular hemorrhage bled from the hippocampus.

    PubMed

    Furuse, Motomasa; Kuroda, Kenji; Miyashita, Minoru; Saura, Ryuichi; Kuroiwa, Toshihiko

    2012-04-01

    The hippocampus is not a usual origin of bleeding due to hypertension. A 66-year-old male suffered from headache and abnormal behavior. Computed tomographic images showed an intraventricular hemorrhage predominantly located in the right lateral ventricle. His arterial blood pressure was 198/92 mmHg on admission. No apparent vascular anomaly was demonstrated on a digital subtraction angiogram. Two months after the onset, his mini-mental status examination showed full recovery from the score of 19 at onset, and most of his memory disturbances were improved except for visual memory disturbance. A follow-up magnetic resonance image revealed that the hemosiderin was stained in the atrophic right hippocampus, and the final diagnosis was hypertensive intraventricular hemorrhage bled from the right hippocampus. It is difficult to diagnose hippocampal hemorrhage immediately when it is combined with intraventricular hemorrhage, because the hippocampus is covered with hematoma in the inferior horn. Moreover, with regard to neurologic examination, the patients do not show any focal sign such as hemiparesis or aphasia. In elderly patients with compensatory ventricular dilatation, one must also be attentive to a misdiagnosis of obstructive hydrocephalus due to intraventricular hemorrhage. PMID:21850426

  2. Obstetric hemorrhage: A global review.

    PubMed

    Goffman, Dena; Nathan, Lisa; Chazotte, Cynthia

    2016-03-01

    Postpartum hemorrhage remains the number one cause of maternal death globally despite the fact that it is largely a preventable and most often a treatable condition. While the global problem is appreciated, some may not realize that in the United States postpartum hemorrhage is a leading cause of mortality and unfortunately, the incidence is on the rise. In New York, obstetric hemorrhage is the second leading cause of maternal mortality in the state. National data suggests that hemorrhage is disproportionally overrepresented as a contributor to severe maternal morbidity and we suspect as we explore further this will be true in New York State as well. Given the persistent and significant contribution to maternal mortality, it may be useful to analyze the persistence of this largely preventable cause of death within the framework of the historic "Three Delays" model of maternal mortality. The ongoing national and statewide problem with postpartum hemorrhage will be reviewed in this context of delays in an effort to inform potential solutions. PMID:26742599

  3. Prolonged Cerebral Circulation Time Is the Best Parameter for Predicting Vasospasm during Initial CT Perfusion in Subarachnoid Hemorrhagic Patients

    PubMed Central

    Lin, Chun Fu; Hsu, Sanford P. C.; Lin, Chung Jung; Guo, Wan Yuo; Liao, Chih Hsiang; Chu, Wei Fa; Hung, Sheng Che; Shih, Yang Shin; Lin, Yen Tzu

    2016-01-01

    Purpose We sought to imitate angiographic cerebral circulation time (CCT) and create a similar index from baseline CT perfusion (CTP) to better predict vasospasm in patients with subarachnoid hemorrhage (SAH). Methods Forty-one SAH patients with available DSA and CTP were retrospectively included. The vasospasm group was comprised of patients with deterioration in conscious functioning and newly developed luminal narrowing; remaining cases were classified as the control group. The angiography CCT (XA-CCT) was defined as the difference in TTP (time to peak) between the selected arterial ROIs and the superior sagittal sinus (SSS). Four arterial ROIs were selected to generate four corresponding XA-CCTs: the right and left anterior cerebral arteries (XA-CCTRA2 and XA-CCTLA2) and right- and left-middle cerebral arteries (XA-CCTRM2 and XA-CCTLM2). The CCTs from CTP (CT-CCT) were defined as the differences in TTP from the corresponding arterial ROIs and the SSS. Correlations of the different CCTs were calculated and diagnostic accuracy in predicting vasospasm was evaluated. Results Intra-class correlations ranged from 0.96 to 0.98. The correlations of XA-CCTRA2, XA-CCTRM2, XA-CCTLA2, and XA-CCTLM2 with the corresponding CT-CCTs were 0.64, 0.65, 0.53, and 0.68, respectively. All CCTs were significantly prolonged in the vasospasm group (5.8–6.4 s) except for XA-CCTLA2. CT-CCTA2 of 5.62 was the optimal cut-off value for detecting vasospasm with a sensitivity of 84.2% and specificity 82.4% Conclusion CT-CCTs can be used to interpret cerebral flow without deconvolution algorithms, and outperform both MTT and TTP in predicting vasospasm risk. This finding may help facilitate management of patients with SAH. PMID:26986626

  4. Effects of a single dose of dantrolene in patients with cerebral vasospasm after subarachnoid hemorrhage a prospective pilot study

    PubMed Central

    Muehlschlegel, Susanne; Rordorf, Guy; Sims, John

    2011-01-01

    Background and Purpose New therapies for cerebral vasospasm (CVSP) after subarachnoid hemorrhage (SAH) are needed because of its high morbidity and mortality. We investigated the feasibility and safety of a single dose of intravenous (IV) dantrolene and its effect on transcranial Doppler (TCD) in CVSP after SAH. Methods In a prospective open label single dose ascending safety trial, five patients received IV-dantrolene 1.25mg/kg and the next five patients 2.5mg/kg over 60 minutes. All other infusions were kept steady and hemodynamic parameters were recorded. TCDs were performed at t0, t45min, t90min and t135min relative to infusion start. Basic chemistries, serum osmolality, arterial blood gas and liver enzymes were measured before and after. Results Laboratory values and hemodynamic parameters remained unchanged except for a decrease in the systolic blood pressure in the low dose group (-8 mmHg; 95% CI [-26 to 10 mmHg]; p=0.027). After correcting for this decrease in blood pressure, peak systolic TCD velocities (PSV) decreased significantly (-26 cm/s; 95% CI [-47 to -5 cm/s]; p=0.02), with a borderline change in mean velocities in the low dose (-16 cm/s; 95% CI [-36 to 4 cm/s]; p=0.07), and PSV in the high dose group (-26 cm/s; 95% CI [-56 to 5 cm/s]; p=0.05). Conclusions In this pilot study, a single dose of IV-dantrolene in CVSP after SAH appears feasible while inhibiting vasoconstriction in the low dose group, but it may lower blood pressure. Our study provides useful data for the design of larger future studies. PMID:21454813

  5. Exsanguination due to gastric ulceration in a foal.

    PubMed

    Traub-Dagartz, J; Bayly, W; Riggs, M; Thomas, N; Pankowski, R

    1985-02-01

    An Arabian foal with a congenital heart disease died due to hemorrhage secondary to a large gastric ulcer. Previously, death of foals with gastric ulcers has been due to diffuse peritonitis resulting from gastric ulcer perforation. The foal in this case report died due to hemorrhage secondary to a large gastric ulcer. PMID:3972690

  6. Pharmacologic management of subarachnoid hemorrhage.

    PubMed

    Quandt, C M; de los Reyes, R A; Diaz, F G; Ausman, J I

    1982-12-01

    Subarachnoid hemorrhage, following rupture of an intracranial aneurysm, affects about 25 000 people in the U.S. each year. Less than half the patients who survive until hospital admission have an overall favorable outcome. This high morbidity and mortality rate is a result of serious complications following the initial subarachnoid hemorrhage, the most significant of these being rebleeding and cerebral ischemia secondary to vasospasm. While surgical clipping of the aneurysm is the most definitive therapy, this procedure may be postponed for a week or two after the initial hemorrhage, depending on the patient's clinical condition. Pharmacological therapy is a critical part of the preoperative care of these patients and of the postoperative management of complications. This article discusses the syndromes of rebleeding and vasospasm and reviews the current pharmacologic therapy for each. PMID:6129959

  7. Pathogenic role of B-cells in the development of diffuse alveolar hemorrhage induced by pristane

    PubMed Central

    Barker, Tolga; Lee, Pui Y.; Kelly-Scumpia, Kindra; Weinstein, Jason; Nacionales, Dina C.; Kumagai, Yutaro; Akira, Shizuo; Croker, Byron P.; Sobel, Eric S.; Reeves, Westley H.; Satoh, Minoru

    2011-01-01

    Diffuse alveolar hemorrhage is an uncommon yet often fatal complication of systemic lupus erythematosus (SLE). Advances in the treatment of alveolar hemorrhage have been hampered due to the heterogeneity of clinical findings and the lack of suitable animal models. A single intraperitoneal injection of pristane induces a lupus-like syndrome characterized by lupus-related autoantibodies and glomerulonephritis in non-autoimmune prone strains of mice. In addition, C57BL/6 (B6) mice frequently develop alveolar hemorrhage within a few weeks of pristane injection. Immunopathogenesis of pristane-induced alveolar hemorrhage was investigated in the present study. Early (2-4 weeks after injection) mortality due to hemorrhage was unique to C57BL/6 and C57BL/10 strains of mice. Recruitment of the macrophages and neutrophils preceded the hemorrhage by several days and hemorrhage started 3-7 days after pristane injection in some mice, peaked at 2 weeks (84% in B6) and then resolved by 4 weeks in a majority of mice. Alveolar hemorrhage was independent of MyD88-, or TLR7 pathways, in contrast to autoantibody production and glomerulonephritis, and also was independent of FcγR or Fas. Rag1-/- mice had a reduced prevalence of alveolar hemorrhage compared to B6 (P = 0.01) congenics. However, T-cell receptor deficient mice developed alveolar hemorrhage at a rate comparable to wild type controls, while B6 Igμ-/- mice surprisingly had a strikingly reduced prevalence (7% vs 84% in B6, P < 0.0001). Reconstitution of B6 Igμ-/- mice with wild type B cells increased the prevalence to 50% (P = 0.028). Pristane-induced alveolar hemorrhage is a useful model to study the pathogenesis and develop new therapy for this underappreciated and often life-threatening complication of SLE. PMID:21808234

  8. [Suspected azodicarbonamide poisoning in a patient with acute hemorrhaging pancreatitis].

    PubMed

    Zawadzki, Marcin; Maksymowicz, Krzysztof

    2007-01-01

    The report describes the case of death of a 22-year old man due to acute hemorrhaging pancreatitis. Azodicarbonamide poisoning was suspected in this patient. Autopsy results, data from the literature and the knowledge about mechanisms of azodicarbonamide toxicity allowed for excluding poisoning with this substance as the cause of death. PMID:18432145

  9. BK virus associated pronounced hemorrhagic cystoureteritis after bone marrow transplantation.

    PubMed

    Haab, Alexander C; Keller, Isabelle S; Padevit, Christian; John, Hubert

    2015-10-01

    Ureteral stenosis due to reactivation of the BK virus (BKV) in a state of immunodeficiency is very rare. More common is the appearance of a hemorrhagic cystitis. This report not only shows bilateral ureteral stenosis after bone marrow transplantation, but also presents severe complications as chronic pelvic pain and impaired kidney function as well as irreparable damage to the whole urinary tract leading to nephroureterectomy, subtrigonal cystectomy and orthotopic ileal neobladder. Finally renal transplantation was required. To our knowledge this is the first case in the literature where such a severe course of BKV associated hemorrhagic cystoureteritis is described. PMID:26432975

  10. An Unusual Reason for Gastric Variceal Hemorrhage: Wandering Spleen.

    PubMed

    Kseo?lu, Hseyin; Atalay, Roni; Byka??k, Naciye ?emnur; Canyi?it, Murat; zer, Mehmet; Solako?lu, Tevfik; Ak?n, Fatma Ebru; Bolat, Aylin Demirezer; Yrekli, yk Tayfur; Ersoy, Osman

    2015-12-01

    Wandering spleen is the displacement of the spleen due to the loss or weakening of the ligaments of the spleen and is seen very rarely with an incidence of less than 0.5%. It can cause portal hypertension, but gastric variceal hemorrhage is a quite rare condition within the spectrum of this uncommon disease. We report a 22-year-old woman with wandering spleen presenting with life-threatening gastric variceal hemorrhage. Her diagnosis was made by computerized tomography. Endoscopic therapy was not adequate to stop the bleeding, and urgent splenectomy was performed. After surgery she has been well with no symptoms until now. PMID:26730110

  11. Growing Hemorrhagic Choroidal Fissure Cyst

    PubMed Central

    Gelal, Fazıl; Gurkan, Gokhan; Feran, Hamit

    2016-01-01

    Choroidal fissure cysts are often incidentally discovered. They are usually asymptomatic. The authors report a case of growing and hemorrhagic choroidal fissure cyst which was treated surgically. A 22-year-old female presented with headache. Cranial MRI showed a left-sided choroidal fissure cyst. Follow-up MRI showed that the size of the cyst had increased gradually. Twenty months later, the patient was admitted to our emergency department with severe headache. MRI and CT showed an intracystic hematoma. Although such cysts usually have a benign course without symptoms and progression, they may rarely present with intracystic hemorrhage, enlargement of the cyst and increasing symptomatology. PMID:26962426

  12. 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 ...

  13. The Effectiveness of Lumbar Cerebrospinal Fluid Drainage to Reduce the Cerebral Vasospasm after Surgical Clipping for Aneurysmal Subarachnoid Hemorrhage

    PubMed Central

    Park, Soojeong; Yang, Narae

    2015-01-01

    Objective Removal of blood from subarachnoid space with a lumbar drainage (LD) may decrease development of cerebral vasospasm. We evaluated the effectiveness of a LD for a clinical vasospasm and outcomes after clipping of aneurysmal subarachnoid hemorrhage (SAH). Methods Between July 2008 and July 2013, 234 patients were included in this study. The LD group consisted of 126 patients, 108 patients in the non LD group. We investigated outcomes as follow : 1) clinical vasospasm, 2) angioplasty, 3) cerebral infarction, 4) Glasgow outcome scale (GOS) score at discharge, 5) GOS score at 6-month follow-up, and 6) mortality. Results Clinical vasospasm occurred in 19% of the LD group and 42% of the non LD group (p<0.001). Angioplasty was performed in 17% of the LD group and 38% of the non LD group (p=0.001). Cerebral infarctions were detected in 29% and 54% of each group respectively (p<0.001). The proportion of GOS score 5 at 6 month follow-up in the LD group was 69%, and it was 58% in the non LD group (p=0.001). Mortality rate showed 5% and 10% in each group respectively. But, there was no difference in shunt between the two groups. Conclusion LD after aneurysmal SAH shows marked reduction of clinical vasospasm and need for angioplasty. With this technique we have shown favorable GOS score at 6 month follow-up. PMID:25810855

  14. Symptomatic Tarlov Cyst Following Spontaneous Subarachnoid Hemorrhage

    PubMed Central

    Kong, Woo Keun; Hong, Seung-Koan

    2011-01-01

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

  15. Symptomatic tarlov cyst following spontaneous subarachnoid hemorrhage.

    PubMed

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

    2011-08-01

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

  16. Heterologous Expression of sahH Reveals That Biofilm Formation Is Autoinducer-2-independent in Streptococcus sanguinis but Is Associated with an Intact Activated Methionine Cycle*

    PubMed Central

    Redanz, Sylvio; Standar, Kerstin; Podbielski, Andreas; Kreikemeyer, Bernd

    2012-01-01

    Numerous studies have claimed deleterious effects of LuxS mutation on many bacterial phenotypes, including bacterial biofilm formation. Genetic complementation mostly restored the observed mutant phenotypes to WT levels, leading to the postulation that quorum sensing via a family of molecules generically termed autoinducer-2 (AI-2) is essential for many phenotypes. Because LuxS mutation has dual effects, this hypothesis needs to be investigated into the details for each bacterial species. In this study we used S. sanguinis SK36 as a model biofilm bacterium and employed physiological characterization and transcriptome approaches on WT and luxS-deficient strains, in combination with chemical, luxS, and sahH complementation experiments. SahH enables a direct conversion of SAH to homocysteine and thereby restores the activated methionine cycle in a luxS-negative background without formation of the AI-2 precursor 4,5-dihydroxy-2,3-pentanedione. With this strategy we were able to dissect the individual contribution of LuxS and AI-2 activity in detail. Our data revealed that S. sanguinis biofilm formation is independent from AI-2 substance pools and is rather supported by an intact activated methyl cycle. Of 216 differentially transcribed genes in the luxS mutant, 209 were restored by complementation with a gene encoding the S-adenosylhomocysteine hydrolase. Only nine genes, mainly involved in natural competence, were directly affected by the AI-2 quorum-sensing substance pool. Cumulatively, this suggested that biofilm formation in S. sanguinis is not under control of AI-2. Our study suggests that previously evaluated LuxS mutants in other species need to be revisited to resolve the precise contribution of AI-2 substance pools and the methionine pathways. PMID:22942290

  17. CT demonstration of bilateral adrenal hemorrhage

    SciTech Connect

    Ling, D.; Korobkin, M.; Silverman, P.M.; Dunnick, N.R.

    1983-08-01

    Bilateral adrenal hemorrhage with subsequent adrenal insufficiency is a recognized complication of anticoagulant therapy. Because the clinical manifestations are often nonspecific, the antemortem diagnosis of adrenal hemorrhage has been a difficult clinical problem. Computed tomography (CT) provides detailed images of the adrenal glands that are not possible with conventional imaging methods. The CT findings of bilateral adrenal hemorrhage in an anticoagulated patient are reported.

  18. Treatment targets in intracerebral hemorrhage.

    PubMed

    Sangha, Navdeep; Gonzales, Nicole R

    2011-07-01

    Intracerebral hemorrhage (ICH) imparts a higher mortality and morbidity than ischemic stroke. The therapeutic interventions that are currently available focus mainly on supportive care and secondary prevention. There is a paucity of evidence to support any one acute intervention that improves functional outcome. This chapter highlights current treatment targets for ICH based on the pathophysiology of the disease. PMID:21732225

  19. Electrocardiograph abnormalities in intracerebral hemorrhage.

    PubMed

    Takeuchi, Satoru; Nagatani, Kimihiro; Otani, Naoki; Wada, Kojiro; Mori, Kentaro

    2015-12-01

    This study investigated the prevalence and type of electrocardiography (ECG) abnormalities, and their possible association with the clinical/radiological findings in 118 consecutive patients with non-traumatic, non-neoplastic intracerebral hemorrhage (ICH). ECG frequently demonstrates abnormalities in patients with ischemic stroke and subarachnoid hemorrhage, but little is known of ECG changes in ICH patients. Clinical and radiological information was retrospectively reviewed. ECG recordings that were obtained within 24hours of the initial hemorrhage were analyzed. Sixty-six patients (56%) had one or more ECG abnormalities. The most frequent was ST depression (24%), followed by left ventricular hypertrophy (20%), corrected QT interval (QTc) prolongation (19%), and T wave inversion (19%). The logistic regression analysis demonstrated the following: insular involvement was an independent predictive factor of ST depression (p<0.001; odds ratio OR 10.18; 95% confidence interval [CI] 2.84-36.57); insular involvement (p<0.001; OR 23.98; 95% CI 4.91-117.11) and presence of intraventricular hemorrhage (p<0.001; OR 8.72; 95% CI 2.69-28.29) were independent predictive factors of QTc prolongation; deep hematoma location (p<0.001; OR 19.12; 95% CI 3.82-95.81) and hematoma volume >30ml (p=0.001; OR 6.58; 95% CI 2.11-20.46) were independent predictive factors of T wave inversion. We demonstrate associations between ECG abnormalities and detailed characteristics of ICH. PMID:26365482

  20. Pathogenic role of B cells in the development of diffuse alveolar hemorrhage induced by pristane.

    PubMed

    Barker, Tolga T; Lee, Pui Y; Kelly-Scumpia, Kindra M; Weinstein, Jason S; Nacionales, Dina C; Kumagai, Yutaro; Akira, Shizuo; Croker, Byron P; Sobel, Eric S; Reeves, Westley H; Satoh, Minoru

    2011-10-01

    Diffuse alveolar hemorrhage is an uncommon, yet often fatal, complication of systemic lupus erythematosus (SLE). Advances in the treatment of alveolar hemorrhage have been hampered because of the heterogeneity of clinical findings and the lack of suitable animal models. A single intraperitoneal injection of pristane induces a lupus-like syndrome characterized by lupus-related autoantibodies and glomerulonephritis in non-autoimmune-prone strains of mice. In addition, C57BL/6 (B6) mice frequently develop alveolar hemorrhage within a few weeks of pristane injection. Immunopathogenesis of pristane-induced alveolar hemorrhage was investigated in the present study. Early (2-4 weeks after injection) mortality due to hemorrhage was unique to C57BL/6 and C57BL/10 strains of mice. Recruitment of the macrophages and neutrophils preceded the hemorrhage by several days, and hemorrhage started 3-7 days after pristane injection in some mice, peaked at 2 weeks (84% in B6) and then resolved by 4 weeks in a majority of mice. Alveolar hemorrhage was independent of MyD88 (myeloid differentiation factor 88), or TLR7 pathways, in contrast to autoantibody production and glomerulonephritis, and was also independent of Fc?R or Fas. Rag1(-/-) mice had a reduced prevalence of alveolar hemorrhage compared with B6 (P=0.01) congenics. However, T-cell receptor-deficient mice developed alveolar hemorrhage at a rate comparable to wild-type controls, whereas B6 Ig?(-/-) mice surprisingly had a strikingly reduced prevalence (7% vs 84% in B6, P<0.0001). Reconstitution of B6 Ig?(-/-) mice with wild-type B cells increased the prevalence to 50% (P=0.028). Pristane-induced alveolar hemorrhage is a useful model to study the pathogenesis and develop new therapy for this underappreciated and often life-threatening complication of SLE. PMID:21808234

  1. Preventive effect of continuous cisternal irrigation with magnesium sulfate solution on angiographic cerebral vasospasms associated with aneurysmal subarachnoid hemorrhages: a randomized controlled trial.

    PubMed

    Yamamoto, Takuji; Mori, Kentaro; Esaki, Takanori; Nakao, Yasuaki; Tokugawa, Joji; Watanabe, Mitsuya

    2016-01-01

    OBJECT Although cerebral vasospasm (CV) is one of the most important predictors for the outcome in patients with subarachnoid hemorrhage (SAH), no treatment has yet been established for this condition. This study investigated the efficacy of continuous direct infusion of magnesium sulfate (MgSO4) solution into the intrathecal cistern in patients with an aneurysmal SAH. METHODS An SAH caused by a ruptured aneurysm was identified on CT scans within 72 hours after SAH onset. All patients were treated by surgical clipping and randomized into 2 groups: a control group of patients undergoing a standard treatment and a magnesium (Mg) group of patients additionally undergoing continuous infusion of 5 mmol/L MgSO4 solution for 14 days. The Mg(2+) concentrations in serum and CSF were recorded daily. Neurological examinations were performed by intensive care clinicians. Delayed cerebral ischemia was monitored by CT or MRI. To assess the effect of the Mg treatment on CV, the CVs were graded on the basis of the relative degree of constriction visible on cerebral angiograms taken on Day 10 after the SAH, and transcranial Doppler ultrasonography was performed daily to measure blood flow velocity in the middle cerebral artery (MCA). Neurological outcomes and mortality rates were evaluated with the Glasgow Outcome Scale and modified Rankin Scale at 3 months after SAH onset. RESULTS Seventy-three patients admitted during the period of April 2008 to March 2013 were eligible and enrolled in this study. Three patients were excluded because of violation of protocol requirements. The 2 groups did not significantly differ in age, sex, World Federation of Neurosurgical Societies grade, or Fisher grade. In the Mg group, the Mg(2+) concentration in CSF gradually increased from Day 4 after initiation of the continuous MgSO4 intrathecal administration. No such increase was observed in the control group. No significant changes in the serum Mg(2+) levels were observed for 14 days, and no cardiovascular complications such as bradycardia or hypotension were observed in any of the patients. However, bradypnea was noted among patients in the Mg group. The Mg group had a significantly better CV grade than the control group (p < 0.05). Compared with the patients in the Mg group, those in the control group had a significantly elevated blood flow velocity in the MCA. Both groups were similar in the incidences of cerebral infarction, and the 2 groups also did not significantly differ in clinical outcomes. CONCLUSIONS Continuous cisternal irrigation with MgSO4 solution starting on Day 4 and continuing to Day 14 significantly inhibited CV in patients with aneurysmal SAH without severe cardiovascular complications. However, this improvement in CV neither reduced the incidence of delayed cerebral ischemia nor improved the functional outcomes in patients with SAH. PMID:26230471

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

    PubMed Central

    2013-01-01

    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 38.3C 0.05C by 0.8C 0.06C (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

  3. Eosinophilic Gastroenteritis Due to Rhus Ingestion Presenting with Gastrointestinal Hemorrhage

    PubMed Central

    Choi, Wonsuk; Choi, Chan; Cho, Kyuman; Park, Chang-Hwan; Kim, Hyun-Soo; Choi, Sung-Kyu; Rew, Jong-Sun

    2015-01-01

    Rhus-related illnesses in Korea are mostly caused by ingestion of parts of the Rhus tree. Contact dermatitis occurrence after ingestion of Rhus-related food is very common in Korea. However, Rhus-related gastrointestinal disease is very rare. Herein, we present a case of eosinophilic gastroenteritis caused by Rhus ingestion. A 75-year-old woman was admitted with hematemesis and hematochezia after Rhus extract ingestion. Routine laboratory tests revealed leukocytosis without eosinophilia. Endoscopy showed friable and granular mucosal changes with touch bleeding in the second portion of the duodenum. Abdominal computed tomography revealed edematous wall thickening of the duodenum and proximal jejunal loops. Patch testing with Rhus extracts showed a strong positive reaction, suggesting Rhus as the allergen. Her symptoms improved after avoidance of the allergen. PMID:25844348

  4. Prognosis of patients in coma after acute subdural hematoma due to ruptured intracranial aneurysm.

    PubMed

    Torné, Ramon; Rodríguez-Hernández, Ana; Romero-Chala, Fabián; Arikan, Fuat; Vilalta, Jordi; Sahuquillo, Juan

    2016-04-01

    Acute subdural hematomas (aSDH) secondary to intracranial aneurysm rupture are rare. Most patients present with coma and their functional prognosis has been classically considered to be very poor. Previous studies mixed good-grade and poor-grade patients and reported variable outcomes. We reviewed our experience by focusing on patients in coma only and hypothesized that aSDH might worsen initial mortality but not long-term functional outcome. Between 2005 and 2013, 440 subarachnoid hemorrhage (SAH) patients were admitted to our center. Nineteen (4.3%) were found to have an associated aSDH and 13 (2.9%) of these presented with coma. Their prospectively collected clinical and outcome data were reviewed and compared with that of 104 SAH patients without aSDH who presented with coma during the same period. Median aSDH thickness was 10mm. Four patients presented with an associated aneurysmal cortical laceration and only one had good recovery. Overall, we observed good long-term outcomes in both SAH patients in coma with aSDH and those without aSDH (38.5% versus 26.4%). Associated aSDH does not appear to indicate a poorer long-term functional prognosis in SAH patients presenting with coma. Anisocoria and brain herniation are observed in patients with aSDH thicknesses that are smaller than those observed in trauma patients. Despite a high initial mortality, early surgery to remove the aSDH results in a good outcome in over 60% of survivors. Aneurysmal cortical laceration appears to be an independent entity which shows a poorer prognosis than other types of aneurysmal aSDH. PMID:26755452

  5. Putative Role of Prostaglandin Receptor in Intracerebral Hemorrhage

    PubMed Central

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

    2012-01-01

    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

  6. Malignant paraganglioma presenting with hemorrhagic stroke in a child.

    PubMed

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

    2013-12-01

    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

  7. Postpancreatectomy Hemorrhage: Diagnosis and Treatment

    PubMed Central

    Yekebas, Emre F.; Wolfram, Lars; Cataldegirmen, Guellue; Habermann, Christian R.; Bogoevski, Dean; Koenig, Alexandra M.; Kaifi, Jussuf; Schurr, Paulus G.; Bubenheim, Michael; Nolte-Ernsting, Claus; Adam, Gerhard; Izbicki, Jakob R.

    2007-01-01

    Background: To analyze clinical courses and outcome of postpancreatectomy hemorrhage (PPH) after major pancreatic surgery. Summary Background Data: Although PPH is the most life-threatening complication following pancreatic surgery, standardized rules for its management do not exist. Methods: Between 1992 and 2006, 1524 patients operated on for pancreatic diseases were included in a prospective database. A risk stratification of PPH according to the following parameters was performed: severity of PPH classified as mild (drop of hemoglobin concentration <3 g/dL) or severe (>3 g/dL), time of PPH occurrence (early, first to fifth postoperative day; late, after sixth day), coincident pancreatic fistula, intraluminal or extraluminal bleeding manifestation, and presence of complex vascular pathologies (erosions, pseudoaneurysms). Success rates of interventional endoscopy and angiography in preventing relaparotomy were analyzed as well as PPH-related overall outcome. Results: Prevalence of PPH was 5.7% (n = 87) distributed almost equally among patients suffering from malignancies, borderline tumors, and focal pancreatitis (n = 47) and from chronic pancreatitis (n = 40). PPH-related overall mortality of 16% (n = 14) was closely associated with 1) the occurrence of pancreatic fistula (13 of 14); 2) vascular pathologies, ie, erosions and pseudoaneurysms (12 of 14); 3) delayed PPH occurrence (14 of 14); and 4) underlying disease with lethal PPH found only in patients with soft texture of the pancreatic remnant, while no patient with chronic pancreatitis died. Conversely, primary severity of PPH (mild vs. severe) and the kind of index operation (Whipple resection, pylorus-preserving partial pancreaticoduodenectomy, organ-preserving procedures) had no influence on outcome of PPH. Endoscopy was successful in 3 from 15 patients (20%), who had intraluminal PPH within the first or second postoperative day. True, early extraluminal PPH had uniformly to be treated by relaparotomy. Seventeen patients had false, early extraluminal PPH due to primarily intraluminal bleeding site from the pancreaticoenteric anastomosis with secondary disruption of the anastomosis. From 43 patients subjected to angiography, 25 underwent interventional coiling with a success rate of 80% (n = 20). Overall, relaparotomy was performed in 60 patients among whom 33 underwent surgery as first-line treatment, while 27 were relaparotomied as rescue treatment after failure of interventional endoscopy or radiology. Conclusion: Prognosis of PPH depends mainly on the presence of preceding pancreatic fistula. Decision making as to the indication for nonsurgical interventions should consider time of onset, presence of pancreatic fistula, vascular pathologies, and the underlying disease. PMID:17667506

  8. Death from obstetrical hemorrhage.

    PubMed

    Hammond, H

    1972-08-01

    Twelve hundred nineteen maternal deaths occurring from 1957 through 1966 in the State of California have been reviewed by the Maternal Mortality Committee of the California Medical Association and the Bureau of Maternal and Child Welfare of the State of California. In 56 of these deaths the underlying causes were due to disorders of placental separation and placental bed hemostasis. Each of these 56 cases has been analyzed. Profiles of characteristics of patients dying from placenta previa, placenta abruptio, and uterine atony are given. The expected causes of death due to delay in giving adequate amounts of blood and fibrinogen occurred in this series but the most striking results of this study were the findings of (1) a large number of cases of placenta acreta in patients with repeat cesarean sections and (2) the lack of manual exploration of the uterus in many patients dying from uterine atony. PMID:4538203

  9. Death from Obstetrical Hemorrhage

    PubMed Central

    Hammond, Howard

    1972-01-01

    Twelve hundred nineteen maternal deaths occurring from 1957 through 1966 in the State of California have been reviewed by the Maternal Mortality Committee of the California Medical Association and the Bureau of Maternal and Child Welfare of the State of California. In 56 of these deaths the underlying causes were due to disorders of placental separation and placental bed hemostasis. Each of these 56 cases has been analyzed. Profiles of characteristics of patients dying from placenta previa, placenta abruptio, and uterine atony are given. The expected causes of death due to delay in giving adequate amounts of blood and fibrinogen occurred in this series but the most striking results of this study were the findings of (1) a large number of cases of placenta acreta in patients with repeat cesarean sections and (2) the lack of manual exploration of the uterus in many patients dying from uterine atony. PMID:4538203

  10. Intracerebral Hemorrhage in the Oldest Old: A Population-Based Study (Vantaa 85+)

    PubMed Central

    Tanskanen, Maarit; Mkel, Mira; Myllykangas, Liisa; Rastas, Sari; Sulkava, Raimo; Paetau, Anders

    2012-01-01

    Aims: Very elderly subjects represent the fastest growing population in the world. Most of the recent studies on intracerebral hemorrhage (ICH) have been carried out on younger patients and/or preferably using novel radiological techniques. We investigated the prevalence, risk factors, and histopathological characteristics of the ICH in the oldest old. Materials and methods: The brains of 300 autopsied individuals (248 females, 52 males, mean age at death 92.4??3.7?years) were investigated as part of the prospective population-based Vantaa 85+ study. After macroscopic investigation, the presence and extent of microscopic brain hemorrhages (MH) were analyzed by counting the number of iron containing macrophages (siderophages) by Prussian blue staining. Deposits with >5 siderophages were defined as MH+, forming a subgroup of MH. Genotyping of apolipoprotein E (APOE) and the analysis of microscopic (MI) or larger infarctions and cerebral amyloid angiopathy (CAA) were performed using standardized methods. Regression analysis was used to predict the presence of ICH, with and without co-localized CAA, and was adjusted for age at death and gender. Results: The prevalence of macroscopic ICH was 2.3% in total; consisting of 1% large lobar hemorrhage (LH), 1% deep hemorrhage (DH), and 0.3% of subarachnoid hemorrhage (SAH). 62% had MH and 15.3% MH+. All MH+ lesions were found to be >2?mm wide. 55.9% of subjects with MH and 81.2% of those with MH+ showed MH/MH+ and CAA in the same brain region (MHCAA and MH+CAA, respectively). MH was associated with none of the neuropathological or clinical conditions, nor with the APOE carrier status. The subjects with MH+, MHCAA or MH+CAA carried the APOE ?4 allele more frequently than controls (OR 3.681, 3.291, 7.522, respectively). Siderophages in MH+CAA co-localized with CAA and with two-thirds of the MI in the tissue sections. Conclusion: Macroscopic ICH was rare in the very elderly. MH was frequent and clinically insignificant. MH+ was rare but closely related with the APOE ?4 genotype and the presence of severe CAA and infarction. PMID:23015796

  11. Acute Hemorrhagic Edema of Infancy.

    PubMed

    Serra E Moura Garcia, C; Sokolova, A; Torre, M L; Amaro, C

    2016-01-01

    Acute Hemorrhagic Edema of Infancy is a small vessel leucocytoclastic vasculitis affecting young infants. It is characterized by large, target-like, macular to purpuric plaques predominantly affecting the face, ear lobes and extremities. Non-pitting edema of the distal extremities and low-grade fever may also be present. Extra-cutaneous involvement is very rare. Although the lesions have a dramatic onset in a twenty-four to forty-eight hour period, usually the child has a non-toxic appearance. In most cases there are no changes in laboratory parameters. The cutaneous biopsy reveals an inflammatory perivascular infiltrate. It is a benign and auto-limited disease, with complete resolution within two to three weeks leaving no sequelae in the majority of cases. No recurrences are described. We report a case of a 42-day old girl admitted at our hospital with Acute Hemorrhagic Edema of Infancy. PMID:26808448

  12. Imaging of adrenal and renal hemorrhage.

    PubMed

    Hammond, Nancy A; Lostumbo, Antonella; Adam, Sharon Z; Remer, Erick M; Nikolaidis, Paul; Yaghmai, Vahid; Berggruen, Senta M; Miller, Frank H

    2015-10-01

    Hemorrhage of the kidneys and adrenal glands has many etiologies. In the adrenal glands, trauma, anticoagulation, stress, sepsis, surgery, and neoplasms are common causes of hemorrhage. In the kidneys, reasons for hemorrhage include trauma, bleeding diathesis, vascular diseases, infection, infarction, hemorrhagic cyst rupture, the Antopol-Goldman lesion, and neoplasms. Angiomyolipoma and renal cell carcinoma are the neoplasms most commonly associated with hemorrhage in the kidneys and adrenal cortical carcinoma, metastases, and pheochromocytoma are associated with hemorrhage in the adrenal glands. Understanding the computed tomography and magnetic resonance imaging features, and causes of hemorrhage in the kidneys and adrenal glands is critical. It is also important to keep in mind that mimickers of hemorrhage exist, including lymphoma in both the kidneys and adrenal glands, and melanoma metastases in the adrenal glands. Appropriate imaging follow-up of renal and adrenal hemorrhage should occur to exclude an underlying malignancy as the cause. If there is suspicion for malignancy that cannot be definitively diagnosed on imaging, surgery or biopsy may be warranted. Angiography may be indicated when there is a suspected underlying vascular disease. Unnecessary intervention, such as nephrectomy, may be avoided in patients with benign causes or no underlying disease. Appropriate management is dependent on accurate diagnosis of the cause of renal or adrenal hemorrhage and it is incumbent upon the radiologist to determine the etiology. PMID:26036792

  13. Simple risk predictions for arteriovenous malformation hemorrhage.

    PubMed

    Kondziolka, D; McLaughlin, M R; Kestle, J R

    1995-11-01

    We present a simple risk prediction formula for arteriovenous malformation hemorrhage. Natural history studies have shown an annual risk of hemorrhage of 2 to 4% for patients with brain arteriovenous malformations. Although decision analysis programs and biostatistical models are available to predict long-term risks of hemorrhage, we hypothesized that there was varying knowledge regarding the use of such programs within the general neurosurgical community. To obtain information on the current use of risk data, we performed a survey of neurosurgeons at national meetings in 1988 and 1994. Neurosurgeons were asked to define the risk for arteriovenous malformation hemorrhage in the young adult patient over a 20- to 30-year period, given a 3 or 4% annual risk of hemorrhage. A wide range of answers was obtained (1-100% risk), and many different methods of calculation were used. The use of the multiplicative law of probability formula requires only knowledge of patient age and annual hemorrhage risk. Risk of hemorrhage = 1 - (risk of no hemorrhage) expected years of remaining life. The assumptions pertaining to this multiplicative formula include a constant yearly risk of hemorrhage and the independent behavior of all years of observation. We calculated the predictions of risk of hemorrhage across all age groups, as modified by published survival data. We think the use of this formula is justified by published natural history data across different ages and populations and that it is a simple and reasonable alternative to other methods of calculation. PMID:8559331

  14. Dabigatran-Associated Intracranial Hemorrhage

    PubMed Central

    Szarlej, Dorota K.; Rincon, Fred

    2015-01-01

    Dabigatran etexilate is an oral direct thrombin inhibitor approved for prevention of stroke and systemic embolization in patients with nonvalvular atrial fibrillation and for the treatment of venous thromboembolism. Although dabigatran has a favorable safety profile, predictable pharmacokinetics, fewer drug interactions than warfarin, and does not require monitoring, clinical data regarding dabigatran reversal are limited. In addition, currently available laboratory assays allow measurement of the presence, but not extent, of dabigatran-associated anticoagulation. Patient age, renal function, weight, concurrent drug therapy, adherence, and concomitant disease states can affect dabigatrans efficacy and safety. Management of dabigatran-related intracranial hemorrhage must be approached on a case-by-case basis and include assessment of degree of anticoagulation, severity of hemorrhage, renal function, timing of last dabigatran dose, and risk of thromboembolic events. Initial management includes dabigatran discontinuation and general supportive measures. Oral activated charcoal should be administered in those who ingested dabigatran within 2 hours. Four-factor prothrombin complex concentrates (4PCCs), activated PCC, or recombinant activated factor VII use may be reasonable but is not evidence based. Reserve fresh frozen plasma for patients with dilutional coagulopathy. If readily available, hemodialysis should be considered, particularly in patients with advanced kidney injury or excessive risk of thromboembolic events. More clinical studies are needed to determine a standardized approach to treating dabigatran-associated intracranial hemorrhage. Institutional protocol development will facilitate safe, efficacious, and timely use of the limited management options. PMID:26425251

  15. [Use of Bakri Balloon in postpartum hemorrhage].

    PubMed

    Poreba, Ryszard; Nowosielski, Krzysztof; Belowska, Anna; Poreba, Aneta

    2010-03-01

    Postpartum hemorrhage (PPH) is one of the leading causes of maternal death and one of the major causes of mortality in women in developing countries. According to the Central Statistical Office, in 2006, in Poland 540 maternal peripartum deaths were noted, 34.7% of which due to PPH. Therefore, active postpartum management should be the main goal in contemporary obstetrics. Some PPH management algorithms have been proposed by the World Health Organization, the American College of Obstetricians and Gynecologists and Polish Gynecological Society. In the event of unsuccessful conventional management of PPH (uterotonics, curettage, etc.) a new technique, intrauterine Bakri balloon tamponade, has been recently proposed. The current paper presents two case reports where this method has been successfully applied. PMID:20486546

  16. Role of external ventricular drainage in the management of intraventricular hemorrhage; its complications and management

    PubMed Central

    Kirmani, Altaf Rehman; Sarmast, Arif Hussain; Bhat, Abdul Rashid

    2015-01-01

    Background: External ventricular drainage (EVD) is the procedure of choice for the treatment of acute hydrocephalus and increased intracranial pressure in patients of subarachnoid hemorrhage (SAH) and intracerebral hemorrhage with hydrocephalus and its sequelae. We evaluated the use of EVD in patients of SAHs (spontaneous/posttraumatic with/without hydrocephalus), hypertensive intracerebral bleeds with interventricular extensions, along with evaluation of the frequency of occurrence of complications of the procedure, infectious and noninfectious, and their management. Methods: During the period of 2 years, between September 2012 and February 2015, 130 patients were subjected to external drainage procedure and were prospectively enrolled in this study. Information was collected on each patient regarding age, sex, diagnosis, underlying illness, secondary complications, other coexisting infections, use of systemic steroids, antibiotic treatment (systemic and intraventricular), and whether any other neurosurgical procedures were performed within 2 weeks of EVD insertion or any time the duration of ventriculostomy. Results: The study population of 130 patients underwent a total of 193 ventriculostomies. Thirty-six patients had ventriculostomy infection (27.6%). Evaluation of the use of EVD was done by comparing preoperative and postoperative grading scores. Forty-nine patients survived and improved their score from Grade 35 to Grade 24. Twenty-nine patients were moderately disable, 16 were severely disable, and 5 were left in the vegetative state. Evaluation of outcome of patients revealed that there was an overall mortality of 61 (46.9%) patients both in the acute phase and later. 33 of the 39 patients having Glasgow Coma Score (GCS) 35 at the time of EVD insertion expired, as against 20 of the 51 patients in GCS 68. Patients in GCS 912 had an even better outcome, with 8 of the 35 patients in this group expiring. Conclusions: The use of EVD should be undertaken only in situation where it is absolutely necessary and ventriculostomy should be kept only for the duration required, and this should be monitored on a daily basis, given the exponential increase in infection after 5 days. PMID:26759733

  17. Cerebellar hemorrhage provoked by combined use of nattokinase and aspirin in a patient with cerebral microbleeds.

    PubMed

    Chang, Yung-Yee; Liu, Jia-Shou; Lai, Shung-Lon; Wu, Hsiu-Shan; Lan, Min-Yu

    2008-01-01

    Nattokinase is used as a health-promoting medicine for preventing thrombosis due to its fibrinolytic activity. Cerebral microbleed is remnant of blood extravasations from the damaged vessels related to cerebral microangiopathies. We report a patient, having used aspirin for secondary stroke prevention, who had an acute cerebellar hemorrhage after taking nattokinase 400 mg daily for 7 consecutive days. In addition to the hemorrhagic lesion, multiple microbleeds were demonstrated on brain MR images. We suggest that nattokinase may increase risk of intracerebral hemorrhage in patients who have bleeding-prone cerebral microangiopathy and are receiving other antithrombotic agent at the same time. PMID:18310985

  18. A Long-Term Follow-up of Pontine Hemorrhage With Hearing Loss

    PubMed Central

    Kim, Seung Ki; Kim, Ae Ryoung; Kim, Joon Yeop

    2015-01-01

    A pontine intracranial hemorrhage (ICH) evokes several neurological symptoms, due to the various nuclei and nerve fibers; however, hearing loss from a pontine ICH is rare. We have experienced a non-traumatic pontine ICH patient, with hearing loss. A 43-year-old male patient had a massive pontine hemorrhage; his brain magnetic resonance imaging revealed the hemorrhage on the bilateral dorsal pons, with the involvement of the trapezoid body. Also, profound hearing loss on the pure-tone audiogram and abnormal brainstem auditory evoked potential were noticed. Fifty-two months of long-term follow-up did not reveal any definite improvement on the patient's hearing ability. PMID:26361602

  19. Spontaneous Intracerebral Hemorrhage Image Analysis Methods: A Survey

    NASA Astrophysics Data System (ADS)

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

    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].

  20. Clinical Features and Patient Management of Lujo Hemorrhagic Fever

    PubMed Central

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

    2014-01-01

    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

  1. Pathogenesis of the viral hemorrhagic fevers.

    PubMed

    Paessler, Slobodan; Walker, David H

    2013-01-24

    Four families of enveloped RNA viruses, filoviruses, flaviviruses, arenaviruses, and bunyaviruses, cause hemorrhagic fevers. These viruses are maintained in specific natural cycles involving nonhuman primates, bats, rodents, domestic ruminants, humans, mosquitoes, and ticks. Vascular instability varies from mild to fatal shock, and hemorrhage ranges from none to life threatening. The pathogenic mechanisms are extremely diverse and include deficiency of hepatic synthesis of coagulation factors owing to hepatocellular necrosis, cytokine storm, increased permeability by vascular endothelial growth factor, complement activation, and disseminated intravascular coagulation in one or more hemorrhagic fevers. The severity of disease caused by these agents varies tremendously; there are extremely high fatality rates in Ebola and Marburg hemorrhagic fevers, and asymptomatic infection predominates in yellow fever and dengue viral infections. Although ineffective immunity and high viral loads are characteristic of several viral hemorrhagic fevers, severe plasma leakage occurs at the time of viral clearance and defervescence in dengue hemorrhagic fever. PMID:23121052

  2. Shock Wave Lithotripsy and Renal Hemorrhage

    PubMed Central

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

    2008-01-01

    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

  3. Outcomes in Children With Hemorrhagic Stroke

    PubMed Central

    Lo, Warren D.; Hajek, Christine; Pappa, Christopher; Wang, Wei; Zumberge, Nicholas

    2013-01-01

    Objectives To determine if a specific intracerebral hemorrhage ratio predicts poor outcome; whether predictors of outcome in adults, specifically hemorrhage location, ventricular involvement, or initial Glasgow Coma Scale score, predict outcome in childhood hemorrhagic stroke; and whether the cause of hemorrhagic stroke predicts outcome. Design Retrospective case study. Setting A single tertiary care pediatric hospital. Participants Fifty-nine cases who had nontraumatic hemorrhages. Main Outcome Measures We examined whether hemorrhage volume, location, initial Glasgow Coma Scale score, or associated diagnoses predicted outcomes. We contacted survivors and parents and assessed outcomes using measures of neurological function, quality of life, and caregiver stress. Results Twenty died of the hemorrhage or associated illnesses, and we obtained follow-up on 19 survivors. Most survivors had mild to moderate neurological deficits, but many reported impaired school or physical functioning. Increasing hemorrhage volume predicted poorer neurological outcomes and poorer quality-of-life ratings among survivors. Subjects who had intracranial vascular anomalies had the best outcomes of the group. Associated diagnoses strongly predicted scores on the parent- and child-rated quality-of-life measures. In contrast to what has been reported in adult studies, initial Glasgow Coma Scale score, primary location of the hemorrhage, and ventricular hemorrhage did not significantly predict outcomes, although ventricular hemorrhage was associated with trends toward poorer outcomes. Conclusions The mortality of hemorrhagic stroke in children is lower than that in adults. Childhood survivors tend to have mild to moderate physical deficits, but they may have significant impairment in other domains such as school functioning. PMID:23108798

  4. ?2?adrenergic regulation of stress hyperglycemia following hemorrhage in the obese Zucker rat

    PubMed Central

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

    2014-01-01

    Abstract 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

  5. Management of atypical eclampsia with intraventricular hemorrhage: A rare experience and learning!

    PubMed Central

    Gupta, Kewal Krishan; Goyal, Lajya Devi

    2015-01-01

    Cerebrovascular accident during hypertensive disorder of pregnancy is a rare entity, but carries high risk of mortality and morbidity due to its unpredictable onset and late diagnosis. Here, we report an unusual case of 20-year-old primigravida with 34 weeks gestation having no risk factor, which developed sudden atypical eclampsia and intracranial hemorrhage within few hours. She was successfully managed by multidisciplinary approach including emergency cesarean section and conservative neurological treatment for intraventricular hemorrhage. PMID:26417139

  6. Chondromyxoid fibroma invasion of the transverse-sigmoid sinus junction causing posterior fossa hemorrhage.

    PubMed

    Hersh, David S; Firempong, Alexander O; Chesler, David; Castellani, Rudolph J; Woodworth, Graeme F

    2016-02-01

    We report a 50-year-old woman with a chondromyxoid fibroma of the occipital bone, who presented with a cerebellar hemorrhage due to invasion of the adjacent sinus. Chondromyxoid fibromas are benign cartilaginous tumors. However, this case represents the first example, to our knowledge, of a chondromyxoid fibroma invading the transverse-sigmoid junction, resulting in intracranial hemorrhage. Our report highlights that the location of an intracranial chondromyxoid fibroma is an important factor in guiding surgical management. PMID:26481053

  7. Dopamine D2-Receptor-Mediated Increase in Vascular and Endothelial NOS Activity Ameliorates Cerebral Vasospasm After Subarachnoid Hemorrhage In Vitro

    PubMed Central

    Caudell, Danielle N.; Cooper, Matthew; Clark, Joseph F.; Shutter, Lori A.

    2008-01-01

    Introduction Cerebral vasospasm after subarachnoid hemorrhage (SAH) is a serious complication resulting in delayed neurological deficit, increased morbidity, mortality, longer hospital stays, and rehabilitation time. It afflicts approximately 35 per 100,000 Americans per year, and there is currently no effective therapy. We present in vitro data suggesting that increasing intrinsic nitric oxide relaxation pathways in vascular smooth muscle via dopaminergic agonism ameliorates cerebral vasospasm after SAH. Methods Cerebrospinal fluid (CSF) from patients with cerebral vasospasm after SAH (CSFV) was used to induce vasospasm in porcine carotid artery in vitro. Dopamine was added to test its ability to reverse spasm, and specific dopamine receptor antagonists were used to determine which receptor mediated the protection. Immunohistochemical techniques confirmed the presence of dopamine receptor subtypes and the involvement of NOS in the mechanism of dopamine protection. Results Dopamine receptor 1, 2, and 3 subtypes are all present in porcine carotid artery. Dopamine significantly reversed spasm in vitro (67% relaxation), and this relaxation was prevented by Haloperidol, a D2R antagonist (10% relaxation, P < 0.05), but not by D1 or D3-receptor antagonism. Both eNOS and iNOS expression were increased significantly in response to CSFV alone, and this was significantly enhanced by addition of dopamine, and blocked by Haloperidol. Conclusion Cerebral vasospasm is significantly reversed in a functional measure of vasospasm in vitro by dopamine, via a D2R-mediated pathway. The increase in NOS protein seen in both the endothelium and vascular smooth muscle in response to CSFV is enhanced by dopamine, also in a D2R-dependent mechanism. PMID:18807216

  8. Femoral compressive neuropathy from iliopsoas haematoma complicating dengue hemorrhagic fever.

    PubMed

    Ganu, Sneha; Mehta, Yesha

    2013-05-13

    Dengue fever is a debilitating mosquito-borne disease caused by dengue virus. We reported a case of femoral compression neuropathy due to iliopsoas hematoma complicating dengue hemorrhagic fever. Iliopsoas muscle hematoma can cause femoral neuropathy with resultant pain and paralysis. Such manifestations are not well documented in the literature. The pathogenesis of hematoma and compressive neuropathy with its appropriate management is discussed. PMID:23608387

  9. Optimal management of hereditary hemorrhagic telangiectasia

    PubMed Central

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

    2014-01-01

    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

  10. Bullous hemorrhagic dermatosis induced by enoxaparin.

    PubMed

    Gouveia, Ana Isabel; Lopes, Leonor; Soares-Almeida, Luis; Filipe, Paulo

    2016-06-01

    The bullous hemorrhagic dermatosis induced by enoxaparin is a rare adverse reaction, which may be under-reported given its favorable evolution. We report a 71-year-old man who developed hemorrhagic bullae at sites distant from subcutaneous enoxaparin injections. It is important that clinicians be aware of the different adverse reactions of these widely used drugs. PMID:25942690

  11. Genetics Home Reference: Hereditary hemorrhagic telangiectasia

    MedlinePLUS

    ... Registry: Osler hemorrhagic telangiectasia syndrome MedlinePlus Encyclopedia: Osler-Weber-Rendu syndrome You might also find information on ... hemorrhagic telangiectasia syndrome Osler-Rendu Disease Osler-Rendu-Weber disease Osler's disease Rendu-Osler-Weber Weber-Osler ...

  12. Diffuse Alveolar Hemorrhage Associated with Warfarin Therapy

    PubMed Central

    Kaya, Bülent; Yildiz, Ibrahim; Baha, Reshat Mehmet; Zeytun, Neslihan Ebru Eryaşar; Yetisgen, Azize

    2015-01-01

    Diffuse alveolar hemorrhage (DAH) is a life-threatening clinical pathologic syndrome caused by a variety of diseases. We report a case of DAH related to therapy of warfarin use. In this case report, we present the diffuse alveolar hemorrhage case as a rare and life-threatening complication of warfarin. PMID:26347781

  13. Epizootic hemorrhagic disease in a yak

    PubMed Central

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

    2014-01-01

    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

  14. Spontaneous Retroperitoneal Hemorrhage from Adrenal Artery Aneurysm

    SciTech Connect

    Gonzalez Valverde, F.M. Balsalobre, M.; Torregrosa, N.; Molto, M.; Gomez Ramos, M.J.; Vazquez Rojas, J.L.

    2007-04-15

    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.

  15. Influence of Fever and Hospital-Acquired Infection on the Incidence of Delayed Neurological Deficit and Poor Outcome after Aneurysmal Subarachnoid Hemorrhage

    PubMed Central

    Douds, G. Logan; Tadzong, Bi; Agarwal, Akash D.; Krishnamurthy, Satish; Lehman, Erik B.; Cockroft, Kevin M.

    2012-01-01

    Although fever and infection have been implicated in the causation of delayed neurological deficits (DND) and poor outcome after aneurysmal subarachnoid hemorrhage (SAH), the relationship between these two often related events has not been extensively studied. We reviewed these events through of our retrospective database of patients with SAH. Multivariate logistic regression was used to determine independent predictors of DND and poor outcome. A total of 186 patients were analyzed. DND was noted in 76 patients (45%). Fever was recorded in 102 patients (55%); infection was noted in 87 patients (47%). A patient with one infection was more likely to experience DND compared to a patient with no infections (adjusted OR 3.73, 95% CI 1.62, 8.59). For those with more than two infections the likelihood of DND was even greater (adjusted OR 4.24, 95% CI 1.55, 11.56). Patients with 1-2 days of fever were less likely to have a favorable outcome when compared to their counterparts with no fever (adjusted OR 0.19, 95% CI 0.06, 0.62). This trend worsened as the number of days febrile increased. These data suggest that the presence of infection is associated with DND, but that fever may have a stronger independent association with overall outcome. PMID:23091718

  16. Postadenoidectomy hemorrhage: how we do it?

    PubMed Central

    Demirbilek, Nevzat; Evren, Cenk; Altun, Uzay

    2015-01-01

    Aims: Conventionally, adenoidectomy has been performed using blind curettage. Postoperative hemorrhage is the most common complication of surgery. There is no specific management algorithm in the literature. In this study, we described an endoscopic approach in the management of postadenoidectomy hemorrhage. Material and methods: Between 1995 and 2014, 7946 patients undergoing adenoidectomy under general anesthesia in our clinic were retrospectively analyzed. All patients had a rest adenoid tissue located in the choanae. Endoscopic excision of the tissue was performed without using a post-nasal pack. Results: All patients (100%) had a rest adenoid tissue located in the choanae. Hemorrhage was completely discontinued with endoscopic excision of the hemorrhagic tissue. Conclusion: Based on our study findings, we conclude that an endoscopic approach should be applied in all postoperative patients with hemorrhage who are unresponsive to conservative treatment modalities. PMID:25932238

  17. Sonographic Diagnosis of Fetal Adrenal Hemorrhage Complicating a Vein of Galen Aneurysmal Malformation

    PubMed Central

    Kütük, Mehmet Serdar; Doğanay, Selim; Özdemir, Ahmet; Görkem, Süreyya Burcu; Öztürk, Adnan

    2016-01-01

    Background: The vein of Galen aneurysmal malformation (VGAM) is a rare intracranial vascular malformation which causes end-organ ischemia or venous congestion due to heart failure. Adrenal hemorrhage associated with VGAM has not been reported in the literature. We present the imaging findings of a fetal VGAM with adrenal hemorrhage. Case Report: A 26 year-old primigravida woman whose fetus with VGAM and mild cardiomegaly was scanned in the 34th week. On fetal ultrasound, a hyperechoic, well-circumscribed mass in the left suprarenal region was shown. Fetal and postnatal magnetic resonance imaging confirmed the diagnosis of adrenal hemorrhage. The baby died after delivery. Conclusion: Adrenal hemorrhage can complicate VGAM in fetuses with severe heart failure. Evaluation of the adrenal gland in affected cases may contribute to the prenatal counseling, and postnatal management.

  18. Successfully Treated Isolated Posterior Spinal Artery Aneurysm Causing Intracranial Subarachnoid Hemorrhage: Case Report.

    PubMed

    Horio, Yoshinobu; Katsuta, Toshiro; Samura, Kazuhiro; Wakuta, Naoki; Fukuda, Kenji; Higashi, Toshio; Inoue, Tooru

    2015-12-15

    There are very few published reports of rupture of an isolated posterior spinal artery (PSA) aneurysm, and consequently the optimal therapeutic strategy is debatable. An 84-year-old man presented with sudden onset of restlessness and disorientation. Neuroradiological imaging showed an intracranial subarachnoid hemorrhage (SAH) with no visible intracranial vascular lesion. Spinal magnetic resonance imaging (MRI) detected a localized subarachnoid hematoma at Th10-11. Both contrast-enhanced spinal computed tomography and enhanced MRI and magnetic resonance angiography revealed an area of enhancement within the hematoma. Superselective angiography of the left Th12 intercostal artery demonstrated a faintly enhanced spot in the venous phase. Thirteen days after the onset of symptoms, a small fusiform aneurysm situated on the radiculopial artery was resected. The patient's postoperative course was uneventful and he was eventually discharged in an ambulatory condition. To our knowledge, this 84-year-old man is the oldest reported case of surgical management of a ruptured isolated PSA aneurysm. This case illustrates both the validity and efficacy of this therapeutic approach. PMID:26522607

  19. Successfully Treated Isolated Posterior Spinal Artery Aneurysm Causing Intracranial Subarachnoid Hemorrhage: Case Report

    PubMed Central

    HORIO, Yoshinobu; KATSUTA, Toshiro; SAMURA, Kazuhiro; WAKUTA, Naoki; FUKUDA, Kenji; HIGASHI, Toshio; INOUE, Tooru

    2015-01-01

    There are very few published reports of rupture of an isolated posterior spinal artery (PSA) aneurysm, and consequently the optimal therapeutic strategy is debatable. An 84-year-old man presented with sudden onset of restlessness and disorientation. Neuroradiological imaging showed an intracranial subarachnoid hemorrhage (SAH) with no visible intracranial vascular lesion. Spinal magnetic resonance imaging (MRI) detected a localized subarachnoid hematoma at Th10–11. Both contrast-enhanced spinal computed tomography and enhanced MRI and magnetic resonance angiography revealed an area of enhancement within the hematoma. Superselective angiography of the left Th12 intercostal artery demonstrated a faintly enhanced spot in the venous phase. Thirteen days after the onset of symptoms, a small fusiform aneurysm situated on the radiculopial artery was resected. The patient's postoperative course was uneventful and he was eventually discharged in an ambulatory condition. To our knowledge, this 84-year-old man is the oldest reported case of surgical management of a ruptured isolated PSA aneurysm. This case illustrates both the validity and efficacy of this therapeutic approach. PMID:26522607

  20. Massive hemoptysis due to welding fumes

    PubMed Central

    Uzun, O?uz; ?nce, Ozgur; Bakalov, Veli; Tuna, Tibel

    2012-01-01

    Many pulmonary problems such as lung cancer, occupational asthma, and pneumoconiosis have been described due to welding in the literature until now. This is the first case report of alveolar hemorrhage due to welding fumes presented with massive hemoptysis. We report a rare case of massive hemopthisis associated with welders lung, with a discussion based on a review of the literature. Established facts Many pulmonary diseases such as lung cancer, occupational asthma, and pneumoconiosis have been attributed welding fumes in the literature. Alveolar hemorrhage due to welding fumes has never defined before. Novel insights We herein report a case of alveolar hemorrhage presented with massive hemoptysis due to welding fumes. Clinicians should be aware of such rare but serious clinical picture which can occur in welding workers. Palliative measures and bronchoscopic Ankaferd Blood Stopper application may help to stop bleeding. PMID:26029581

  1. [Severe hemorrhagic form of Rift Valley Fever in Mauritania].

    PubMed

    Boushab, M B; Savadogo, M; Sow, M S; Fall-Malick, F Z; Seydi, M

    2015-03-01

    We report three severe cases of hemorrhagic form of Rift Valley Fever which have been observed in the Hospital of Aoun (two cases) and in the regional hospital of Tidjikdja (one case). The disease manifested itself by an infectious syndrome, an early infectious syndrome (on the second day) with onset of hemorrhagic complications and disorder of consciousness ranging from an agitation to deep coma. The biological examinations showed a severe anemia. Multiple organ failures were also observed. Of the three patients treated one died. Therefore, the management of both suspected and confirmed cases must be initiated as soon as possible in order to control organ damages and prevent fatality. There is no specific treatment. The importance of the epidemiological survey must be emphasized to avoid outbreaks and control any epidemic due to this virus. PMID:25925806

  2. Recent advances in research on Crimean-Congo hemorrhagic fever

    PubMed Central

    Papa, Anna; Mirazimi, Ali; Köksal, Iftihar; Estrada-Pena, Augustin; Feldmann, Heinz

    2014-01-01

    Crimean-Congo hemorrhagic fever (CCHF) is an expanding tick-borne hemorrhagic disease with increasing human and animal health impact. Immense knowledge was gained over the past 10 years mainly due to advances in molecular biology, but also driven by an increased global interest in CCHFV as an emerging/re-emerging zoonotic pathogen. In the present article we discuss the advances in research with focus on CCHF ecology, epidemiology, pathogenesis, diagnostics, prophylaxis and treatment. Despite tremendous achievements, future activities have to concentrate on the development of vaccines and antivirals/therapeutics to combat CCHF. Vector studies need to continue for better public and animal health preparedness and response. We conclude with a roadmap for future research priorities. PMID:25453328

  3. Recent advances in research on Crimean-Congo hemorrhagic fever.

    PubMed

    Papa, Anna; Mirazimi, Ali; Kksal, Iftihar; Estrada-Pena, Augustin; Feldmann, Heinz

    2015-03-01

    Crimean-Congo hemorrhagic fever (CCHF) is an expanding tick-borne hemorrhagic disease with increasing human and animal health impact. Immense knowledge was gained over the past 10 years mainly due to advances in molecular biology, but also driven by an increased global interest in CCHFV as an emerging/re-emerging zoonotic pathogen. In the present article, we discuss the advances in research with focus on CCHF ecology, epidemiology, pathogenesis, diagnostics, prophylaxis and treatment. Despite tremendous achievements, future activities have to concentrate on the development of vaccines and antivirals/therapeutics to combat CCHF. Vector studies need to continue for better public and animal health preparedness and response. We conclude with a roadmap for future research priorities. PMID:25453328

  4. Thrombo-hemorrhagic deaths in acute promyelocytic leukemia.

    PubMed

    Breccia, Massimo; Lo Coco, Francesco

    2014-05-01

    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

  5. Imaging of Hereditary Hemorrhagic Telangiectasia

    SciTech Connect

    Carette, Marie-France Nedelcu, Cosmina; Tassart, Marc; Grange, Jean-Didier; Wislez, Marie; Khalil, Antoine

    2009-07-15

    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.

  6. [Bacterial infection and its relation to the genesis and course of varicose hemorrhage].

    PubMed

    Husov, L; Jurnkov, J; Lata, J; Senkyrk, M; Prbramsk, V; Dastych, M; Kroupa, R; Krlov, D

    2007-12-01

    Acute hemorrhage from esophageal varices due to portal hypertension is a frequent and serious complication of liver cirrhosis. Bacterial infection may be one of the factors influencing such hemorrhage. Endotoxins may increase portal tension and at the same time result in primary hemostasis disorder, thus becoming one of the causes of hemorrhage. The authors of the paper compared the incidence of bacterial infection in 53 patients with varicose hemorrhage due to portal hypertension with 62 patients with liver cirrhosis and portal hypertension without varicose hemorrhage. At least one pathogen was found in considerable 61.1% of the total of patients in the liver cirrhosis group, while the difference between the two groups was but insignificant. No statistically significant difference was found between the group of patients with hemorrhage and those without hemorrhage in terms of presence of bacterial infection in hemoculture, urine, throat, faeces and ascites, nor was there a difference in the etiology of the G+ bacteria, G- bacteria or fungi and yeast infectious agents in the hemoculture, urine, throat, faeces and ascites in either of the groups. No statistically significant difference was found in comparing the patients with a recurrence of hemorrhage (or with mortality) and with infection with those without recurrence of hemorrhage. Bacterial infection was more often found in patients with a recurrence of hemorrhage (75%) as compared with those without any recurrence (52%), and also in patients who died bacterial infection was proven more often than in those who survived (61.9% vs. 58.1%, respectively). There was no difference in morbidity or recurrence of hemorrhage between the patients treated with norfloxacin and ampicilin/sulbactam. No statistically significant difference was recorded between the 1st and 5th day in terms of decrease in bacterial infection. A significant difference was found in the urine etiological agent, where a significant increase in the share of fungal and yeast urine infection (p = 0.011) was recorded after the application of the therapy, as well as a drop in urine infection caused by the G- bacterial agent (p = 0.057). PMID:18357859

  7. The Development of Neuroendocrine Disturbances over Time: Longitudinal Findings in Patients after Traumatic Brain Injury and Subarachnoid Hemorrhage

    PubMed Central

    Kopczak, Anna; Krewer, Carmen; Schneider, Manfred; Kreitschmann-Andermahr, Ilonka; Schneider, Harald Jrn; Stalla, Gnter Karl

    2015-01-01

    Previous reports suggest that neuroendocrine disturbances in patients with traumatic brain injury (TBI) or aneurysmal subarachnoid hemorrhage (SAH) may still develop or resolve months or even years after the trauma. We investigated a cohort of n = 168 patients (81 patients after TBI and 87 patients after SAH) in whom hormone levels had been determined at various time points to assess the course and pattern of hormonal insufficiencies. Data were analyzed using three different criteria: (1) patients with lowered basal laboratory values; (2) patients with lowered basal laboratory values or the need for hormone replacement therapy; (3) diagnosis of the treating physician. The first hormonal assessment after a median time of three months after the injury showed lowered hormone laboratory test results in 35% of cases. Lowered testosterone (23.1% of male patients), lowered estradiol (14.3% of female patients) and lowered insulin-like growth factor I (IGF-I) values (12.1%) were most common. Using Criterion 2, a higher prevalence rate of 55.6% of cases was determined, which correlated well with the prevalence rate of 54% of cases using the physicians diagnosis as the criterion. Intraindividual changes (new onset insufficiency or recovery) were predominantly observed for the somatotropic axis (12.5%), the gonadotropic axis in women (11.1%) and the corticotropic axis (10.6%). Patients after TBI showed more often lowered IGF-I values at first testing, but normal values at follow-up (p < 0.0004). In general, most patients remained stable. Stable hormone results at follow-up were obtained in 78% (free thyroxine (fT4) values) to 94.6% (prolactin values). PMID:26703585

  8. The Development of Neuroendocrine Disturbances over Time: Longitudinal Findings in Patients after Traumatic Brain Injury and Subarachnoid Hemorrhage.

    PubMed

    Kopczak, Anna; Krewer, Carmen; Schneider, Manfred; Kreitschmann-Andermahr, Ilonka; Schneider, Harald Jrn; Stalla, Gnter Karl

    2015-01-01

    Previous reports suggest that neuroendocrine disturbances in patients with traumatic brain injury (TBI) or aneurysmal subarachnoid hemorrhage (SAH) may still develop or resolve months or even years after the trauma. We investigated a cohort of n = 168 patients (81 patients after TBI and 87 patients after SAH) in whom hormone levels had been determined at various time points to assess the course and pattern of hormonal insufficiencies. Data were analyzed using three different criteria: (1) patients with lowered basal laboratory values; (2) patients with lowered basal laboratory values or the need for hormone replacement therapy; (3) diagnosis of the treating physician. The first hormonal assessment after a median time of three months after the injury showed lowered hormone laboratory test results in 35% of cases. Lowered testosterone (23.1% of male patients), lowered estradiol (14.3% of female patients) and lowered insulin-like growth factor I (IGF-I) values (12.1%) were most common. Using Criterion 2, a higher prevalence rate of 55.6% of cases was determined, which correlated well with the prevalence rate of 54% of cases using the physicians' diagnosis as the criterion. Intraindividual changes (new onset insufficiency or recovery) were predominantly observed for the somatotropic axis (12.5%), the gonadotropic axis in women (11.1%) and the corticotropic axis (10.6%). Patients after TBI showed more often lowered IGF-I values at first testing, but normal values at follow-up (p < 0.0004). In general, most patients remained stable. Stable hormone results at follow-up were obtained in 78% (free thyroxine (fT4) values) to 94.6% (prolactin values). PMID:26703585

  9. Massive pulmonary hemorrhage in neonatal infection.

    PubMed Central

    Yeung, C. Y.

    1976-01-01

    Of 35 newborn infants who died from an infection 19 had postmortem evidence of massive pulmonary hemorrhage. All but 1 of the 19 had evidence of antimortem formation of intravascular fibrin clots in lung tissue. Seventeen infants had low platelet counts. Of the 11 infants in whom coagulation studies were done, 8 had evidence of disseminated intravascular coagulation (DIC) during life. Vasculitis in the lungs, associated with fibrin clots and hemorrhages, was detected in two infants. It is postulated that sepsis is an important cause of hemorrhage in the newborn, probably as a result of the development of DIC. Images FIG. 1 FIG. 2 PMID:766937

  10. [Massive bilateral adrenal hemorrhage: role of imaging].

    PubMed

    Kably, M I; Zamiati, W; Benkirane, H; Kadiri, R

    2004-05-01

    Bilateral adrenal hemorrhage is a rare and potentially life threatening situation in adults. The clinical presentation is non-specific, and the diagnosis is based on imaging. The purpose of this report is to provide an illustrative case of spontaneous bilateral adrenal hemorrhage that occurred during pregnancy. The sonographic and computed tomographic findings included large bilateral adrenal hematomas with no evidence of underlying malignancy. Since bilateral adrenal hemorrhage is a rare but potentially life threatening situation, prompt laboratory and imaging evaluation are essential and may reduce both morbidity and mortality. PMID:15205660

  11. [Rare causes of acute gastric hemorrhage].

    PubMed

    Petrova, N N

    1975-06-01

    According to the author's findings rare causes of acute gastric hemorrhages (the Mallory-Weiss syndrome, cancerous lesions of the gastrointestinal organs, excluding the stomach, esophageal and duodenal diverticulum, prolapse of gastric mucosa into the duodenum, necrosis of the gastric wall, its traumatic rupture, the Rendu-Osler disease, rupture of the renal artery aneurysm) made 3.2% of other causes. Profuse hemorrhage was noted in 12 of 32 patients under consideration. In 8 of 32 patients (25%) the diagnosis was established only at autopsy. In other more frequent causes of acute gastric hemorrhage the diagnosis proved to be feasible in 90-95% of cases. PMID:1080309

  12. Massive pulmonary hemorrhage before living donor liver transplantation in infants.

    PubMed

    Matsuura, Toshiharu; Yoshimaru, Koichiro; Yanagi, Yusuke; Esumi, Genshiro; Hayashida, Makoto; Taguchi, Tomoaki

    2016-02-01

    A massive pulmonary hemorrhage in patients with liver cirrhosis is a life-threatening complication that may result in a contraindication of a liver transplantation because of its high mortality rate. Herein, we present two infant biliary atresia cases that successfully underwent an LDLT that was followed by intensive respiratory care for the pretransplant massive pulmonary hemorrhage. Both cases exhibited severe respiratory failure (minimum PaO2 /FiO2 ; 46 mmHg and 39 mmHg, respectively). To arrest the bleeding, we applied a very high positive pressure ventilation treatment (maximum PIP/PEEP; 38/14 cmH2 O and 55/15 cmH2 O, respectively), plasma exchange, several FFP transfusions, and recombinant factor VIIa via intrapulmonary administration. In addition, we used CHDF treatment, applied HFOV transiently, and treated the patient with inhalation of nitric oxide. Although we prepared ECMO for intra-operative use, both cases were successfully managed with conventional mechanical ventilation without using ECMO, which may have worsened the pulmonary hemorrhage due to the use of an anticoagulant. Use of an excessive positive pressure management, although it poses a risk for barotrauma, could be acceptable to arrest the pulmonary bleeding in selected cases of liver failure patients who have no time remaining before LDLT. PMID:26691206

  13. Clinical aspects of Marburg hemorrhagic fever

    PubMed Central

    Mehedi, Masfique; Groseth, Allison; Feldmann, Heinz; Ebihara, Hideki

    2011-01-01

    Marburg virus belongs to the genus Marburgvirus in the family Filoviridae and causes a severe hemorrhagic fever, known as Marburg hemorrhagic fever (MHF), in both humans and nonhuman primates. Similar to the more widely known Ebola hemorrhagic fever, MHF is characterized by systemic viral replication, immunosuppression and abnormal inflammatory responses. These pathological features of the disease contribute to a number of systemic dysfunctions including hemorrhages, edema, coagulation abnormalities and, ultimately, multiorgan failure and shock, often resulting in death. A detailed understanding of the pathological processes that lead to this devastating disease remains elusive, a fact that contributes to the lack of licensed vaccines or effective therapeutics. This article will review the clinical aspects of MHF and discuss the pathogenesis and possible options for diagnosis, treatment and prevention. PMID:22046196

  14. Curbing Inflammation in hemorrhagic trauma: a review.

    PubMed

    Godinho, Mauricio; Padim, Pedro; Evora, Paulo Roberto B; Scarpelini, Sandro

    2015-08-01

    Trauma is one of the world's leading causes of death within the first 40 years of life and thus a significant health problem. Trauma accounts for nearly a third of the lost years of productive life before 65 years of age and is associated with infection, hemorrhagic shock, reperfusion syndrome, and inflammation. The control of hemorrhage, coagulopathy, optimal use of blood products, balancing hypo and hyperperfusion, and hemostatic resuscitation improve survival in cases of trauma with massive hemorrhage. This review discusses inflammation in the context of trauma-associated hemorrhagic shock. When one considers the known immunomodulatory effects of traumatic injury, allogeneic blood transfusion, and the overlap between patient populations, it is surprising that so few studies have assessed their combined effects on immune function. We also discuss the relative benefits of curbing inflammation rather than attempting to prevent it. PMID:26517804

  15. Genetics Home Reference: Hereditary hemorrhagic telangiectasia

    MedlinePLUS

    ... at high pressure into the thinner walled, less elastic veins. The extra pressure tends to strain and ... autosomal ; autosomal dominant ; capillaries ; cell ; chromosome ; compression ; deficiency ; elastic ; gastrointestinal ; gene ; hemorrhage ; hereditary ; incidence ; inherited ; juvenile ; oxygen ; ...

  16. Retinal hemorrhage in abusive head trauma.

    PubMed

    Levin, Alex V

    2010-11-01

    Retinal hemorrhage is a cardinal manifestation of abusive head trauma. Over the 30 years since the recognition of this association, multiple streams of research, including clinical, postmortem, animal, mechanical, and finite element studies, have created a robust understanding of the clinical features, diagnostic importance, differential diagnosis, and pathophysiology of this finding. The importance of describing the hemorrhages adequately is paramount in ensuring accurate and complete differential diagnosis. Challenges remain in developing models that adequately replicate the forces required to cause retinal hemorrhage in children. Although questions, such as the effect of increased intracranial pressure, hypoxia, and impact, are still raised (particularly in court), clinicians can confidently rely on a large and solid evidence base when assessing the implications of retinal hemorrhage in children with concern of possible child abuse. PMID:20921069

  17. Peribulbar anesthesia causing bilateral orbital hemorrhage

    PubMed Central

    Garft, Kyla; Burt, Peter; Burt, Benjamin

    2016-01-01

    We report a case of bilateral orbital hemorrhage as a complication of peribulbar anesthesia in a 78 year old man. Initially, unilateral orbital hemorrhage occurred but quickly spread to the contralateral side. Neuroophthalmological assessment revealed a proptosed tense globe with normal retinovascular findings. Visual acuity was adversely affected and this was conservatively managed with no lasting ophthalmic sequela. This patient’s case was reported as it illustrates an unusual complication of bilateral spread of orbital hemorrhage secondary to peribulbar anesthesia. It highlights how early ophthalmic assessment can ensure a good visual outcome in the setting of appropriate ophthalmic monitoring. The mechanisms of orbital hemorrhage spread and appropriate management options are discussed. PMID:27013899

  18. Trisomy 13 and Massive Fetomaternal Hemorrhage

    PubMed Central

    Matsui, Ryoko; Suzuki, Shunji; Ito, Marie; Terada, Yusuke; Kumasaka, Sakae

    2015-01-01

    This is the first case report of trisomy 13 complicated by massive fetomaternal hemorrhage (FMH). A pale male infant weighing 2,950 g was delivered with low Apgar scores by emergency cesarean section due to non-reassuring fetal status. The umbilical arterial pH and hemoglobin level were 6.815 and 6.9 g/dL (normal: 13 - 22 g/dL), respectively. The maternal hemoglobin-F and serum alpha-fetoprotein levels were 6.0% (normal: < 1.0%) and 1,150 ng/mL (4.1 multiple of median), respectively. The neonate was diagnosed as having trisomy 13 by a subsequent chromosome examination. In the placenta, massive intervillous thrombosis was observed microscopically. This placental finding has been reported to be associated with both preeclampsia and massive FMH. In addition, the incidence of preeclampsia in pregnancies complicated by trisomy 13 has been reported to be significantly higher than normal karyotype populations. Therefore, the current finding may support the association between trisomy 13 and the incidence of massive FMH. PMID:26015824

  19. Reperfusion-Related Intracerebral Hemorrhage.

    PubMed

    Hayakawa, Mikito

    2015-11-01

    The efficacy of intravenous thrombolysis (IVT) for acute ischemic stroke patients has been well established worldwide, with endovascular therapy performed in patients who have failed or are ineligible for IVT and who have major vessel occlusion. The most feared complication of acute stroke reperfusion therapy is intracerebral hemorrhage (ICH), as these patients have a poor clinical outcome and high mortality. The fundamental mechanisms responsible for reperfusion-related ICH include increased permeability and disruption of the blood-brain barrier. Recombinant tissue plasminogen activator may exacerbate the blood-brain barrier disruption through its pharmacological action during IVT. Furthermore, interactions between the device and the vessel walls and contrast intoxication may also be related to ICH, which includes the occurrence of subarachnoid hemorrhage after endovascular therapy. Numerous factors have been reported to be associated with or to be able to predict ICH, and several scoring systems have been developed for predicting symptomatic ICH (sICH) after IVT. However, a scoring system with enough power to detect an unacceptably high risk of sICH or to provide information on when to withdraw IVT has yet to be definitively established. In current clinical practice, acute stroke patients without contraindications for IVT who have been identified by conventional computed tomography scans normally undergo IVT, irrespective of any clinical predictors of ICH after IVT. Strategies that have been suggested for preventing reperfusion-related ICH in high-risk patients include intensive blood pressure control, tight glycemic control, and the avoidance of early aggressive antithrombotic therapy. If sICH, and especially massive parenchymal hematoma, does occur, hematoma expansion needs to be prevented through the use of tight blood pressure control and other methods. Although evidence of efficacy has yet to be established, surgical removal is performed not only for the purpose of saving lives but also for improving the functional outcome. In order to develop therapeutic strategies for reperfusion-related ICH that will lead to an improved stroke prognosis, further studies are warranted. PMID:26587772

  20. Reperfusion Hemorrhage Following Superior Mesenteric Artery Stenting

    SciTech Connect

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

    2008-07-15

    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.

  1. Spontaneous Splenic Hemorrhage in the Newborn

    PubMed Central

    Tiboni, Sonia; Abdulmajid, Umar; Pooboni, Suneel; Wighton, Christopher; Eradi, Balgopal; Dagash, Haitham

    2015-01-01

    Spontaneous splenic hemorrhage in the newborn is a rare entity. The presentation is usually with a triad of bleeding, abdominal distension, and hemoperitoneum. Rapid diagnosis is essential as left untreated, death is inevitable. We present a case with an unusual initial presentation of a scrotal hematocele and ultrasonography suggesting an adrenal hemorrhage. At laparotomy, splenic preservation was unsuccessful, and therefore, splenectomy was performed. The child recovered well from the procedure. PMID:26788451

  2. Subconjunctival hemorrhage: risk factors and potential indicators

    PubMed Central

    Tarlan, Bercin; Kiratli, Hayyam

    2013-01-01

    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

  3. Predicting Hemorrhagic Transformation of Acute Ischemic Stroke

    PubMed Central

    Marsh, Elisabeth B.; Llinas, Rafael H.; Schneider, Andrea L.C.; Hillis, Argye E.; Lawrence, Erin; Dziedzic, Peter; Gottesman, Rebecca F.

    2016-01-01

    Abstract Hemorrhagic transformation (HT) increases the morbidity and mortality of ischemic stroke. Anticoagulation is often indicated in patients with atrial fibrillation, low ejection fraction, or mechanical valves who are hospitalized with acute stroke, but increases the risk of HT. Risk quantification would be useful. Prior studies have investigated risk of systemic hemorrhage in anticoagulated patients, but none looked specifically at HT. In our previously published work, age, infarct volume, and estimated glomerular filtration rate (eGFR) significantly predicted HT. We created the hemorrhage risk stratification (HeRS) score based on regression coefficients in multivariable modeling and now determine its validity in a prospectively followed inpatient cohort. A total of 241 consecutive patients presenting to 2 academic stroke centers with acute ischemic stroke and an indication for anticoagulation over a 2.75-year period were included. Neuroimaging was evaluated for infarct volume and HT. Hemorrhages were classified as symptomatic versus asymptomatic, and by severity. HeRS scores were calculated for each patient and compared to actual hemorrhage status using receiver operating curve analysis. Area under the curve (AUC) comparing predicted odds of hemorrhage (HeRS score) to actual hemorrhage status was 0.701. Serum glucose (P?hemorrhages were more likely to be symptomatic and more severe. The HeRS score is a valid predictor of HT in patients with ischemic stroke and indication for anticoagulation. PMID:26765425

  4. Cerebral Blood-Flow Regulation During Hemorrhage.

    PubMed

    Rickards, Caroline A

    2015-10-01

    Massive uncontrolled blood loss can occur under a variety of conditions including trauma, as a complication of childbirth or surgery, ruptured ulcers, clotting disorders, and hemorrhagic fevers. Across the continuum of hemorrhage, loss of blood volume is a significant challenge to the maintenance of cerebral perfusion. During the initial stages of hemorrhage, reflex mechanisms are activated to protect cerebral perfusion, but persistent blood loss will eventually reduce global cerebral blood flow and the delivery of metabolic substrates, leading to generalized cerebral ischemia, hypoxia, and ultimately, neuronal cell death. Cerebral blood flow is controlled by various regulatory mechanisms, including prevailing arterial pressure, intracranial pressure, arterial blood gases, neural activity, and metabolic demand. Hemorrhage represents a unique physiological stress to the brain, as it influences each of these regulatory mechanisms, resulting in complex interplay that ultimately challenges the ability of the brain to maintain adequate perfusion. Early studies of actual hemorrhage in humans employed blood loss protocols up to 1000 mL, but did not include any measurements of cerebral blood flow. As ethical considerations necessarily constrain the use of human volunteers for massive blood loss studies that induce irreversible shock, most of what is known about cerebral blood-flow responses to hemorrhage has been determined from animal models. Limitations of species differences regarding regulatory mechanisms, anatomy, and the effect of anesthesia, however, must be considered. Advances in monitoring technologies, and a recent renewed interest in understanding cerebral blood-flow regulation in humans, however, is rapidly accelerating knowledge in this field. PMID:26426461

  5. Occult hemorrhage in children with severe ITP.

    PubMed

    Flores, Adolfo; Buchanan, George R

    2016-03-01

    Little is known about the frequency and significance of clinically unapparent or occult hemorrhage in ITP. Therefore, we prospectively explored the sites and frequency of occult bleeding in children with severe ITP at diagnosis or upon symptomatic relapse in a prospective, single-institution cohort study of patients???18 years of age and a platelet count???10,000/mm(3) . Data collected included bleeding severity assessment, urinalysis, fecal occult blood testing, and non-contrast brain MRI. Stool and urine samples were tested within 7 days of diagnosis or symptomatic relapse. Three months after diagnosis or relapse a noncontrast brain MRI evaluated hemosiderin deposits resulting from prior localized hemorrhage. Fifty-two ITP patients were enrolled with a mean platelet count of 4,000/mm(3) . A significant occurrence of occult hemorrhage was identified in the urine (27%) compared with clinically overt hematuria (0.91%, P?hemorrhage and bleeding manifestations on physical examination. Occult hemorrhage was not a harbinger of subsequent bleeding. Our findings suggest that occult hemorrhage occurs with greater frequency than overt bleeding in children with severe ITP. CNS microbleeding is a potential risk in this patient population. Assessment of brain microbleeds and microscopic hematuria in this patient population require additional study. Am. J. Hematol. 91:287-290, 2016. 2015 Wiley Periodicals, Inc. PMID:26661930

  6. Idiopathic Bilateral Adrenal Hemorrhage in a 63-Year-Old Male: A Case Report and Review of the Literature

    PubMed Central

    Bodukam, Vijay Kumar; Thakur, Kshitij; Singh, Amandeep; Jenkins, Donald; Bahl, Jaya

    2015-01-01

    Adrenal hemorrhage is a largely uncommon condition typically caused by a number of factors including infection, MI, CHF, anticoagulants, trauma, surgery, and antiphospholipid syndrome. Yet, idiopathic bilateral hemorrhage is rare. The authors present a case of a 63-year-old male who presented with abdominal pain that was eventually diagnosed as bilateral adrenal hemorrhages due to an unknown origin. Abdominal CT revealed normal adrenal glands without enlargement, but an MRI displayed enlargement due to hemorrhage in both adrenals. There was no known cause; the patient had not suffered from an acute infection and was not on anticoagulants, and the patient's history did not reveal any of the other known causative factors. The case underscores the importance of keeping bilateral adrenal hemorrhages on the list of differentials even when a cause is not immediately clear. It also raises the question of whether CT is the most sensitive test in the diagnosis of adrenal hemorrhage and whether the diagnostic approach should place greater weight on MRI. The case highlights the need for prompt therapy with steroids once bilateral hemorrhage is suspected to avert the development or progression of adrenal insufficiency. PMID:25973281

  7. Spontaneous intracerebral hemorrhage in CADASIL

    PubMed Central

    2013-01-01

    Background Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a rare hereditary small vascular disease and its mainly clinical manifestations are ischemic events. Spontaneous intracerebral hemorrhage (ICH) involvement in patients with CADASIL is extremely uncommon. Case report A 46-year-old normotensive Chinese man developed a large hematoma in the left basal ganglia after he was diagnosed with CADASIL 2months ago, the patient did not take any antithrombotics. Susceptibility weighted imaging at pre-ICH showed multiple cerebral microbleeds (CMBs) in the bilateral basal ganglia. He experienced migraine at about 10months post-ICH. To our knowledge, this is the first report of ICH in CADASIL patients with Arg90Cys mutation in exon 3. Discussion and conclusions ICH should be considered when evaluating new attacks in CADASIL patients. Thus, MRI screening for CMBs might be helpful in predicting the risk of ICH and guiding antithrombotic therapy. In addition, strict control of hypertension and cautious use of antithrombotics may be important in this context. PMID:24344756

  8. Dengue hemorrhagic fever and the kidney.

    PubMed

    Vachvanichsanong, Prayong; Thisyakorn, Usa; Thisyakorn, Chule

    2016-04-01

    Dengue virus infection (DVI)/dengue hemorrhagic fever (DHF) is a common febrile illness with a variety of severities. The mortality rate is high in dengue shock syndrome (DSS), caused by circulatory failure due to plasma leakage resulting in multi-organ failure. However, acute kidney injury (AKI) is rarely reported. In areas of endemic DVI, the prevalence of AKI due to DVI has been reported to be as high as 6.0 % in children with AKI, and 0.9 % in children with DVI who were admitted to a hospital. The mechanism of AKI in DVI is not clear. It may result from (a) direct injury as in other infectious diseases, (b) an indirect mechanism such as via the immune system, since DHF is an immunological disease, or (c) hypotensive DSS, leading in turn to reduced renal blood supply and renal failure. The mortality rates of DF/DHF, DSS and DHF/DSS-related AKI are <1 %, 12-44 %, and >60 %, respectively. Kidney involvement is not actually that rare, but is under-recognized and often only reported when microscopic hematuria, proteinuria, electrolyte imbalance, or even AKI is found. The prevalence of proteinuria and hematuria has been reported as high as 70-80 % in DVI. A correct diagnosis depends on basic investigations of kidney function such as urinalysis, serum creatinine and electrolytes. Although DVI-related renal involvement is treated supportively, it is still important to make an early diagnosis to prevent AKI and its complications, and if AKI does occur, dialysis may be required. Fortunately, in patients who recover, kidney function usually completely recovers as well. PMID:26699788

  9. Mycobacterium tuberculosis AtsG (Rv0296c), GlmU (Rv1018c) and SahH (Rv3248c) Proteins Function as the Human IL-8-Binding Effectors and Contribute to Pathogen Entry into Human Neutrophils

    PubMed Central

    Dziadek, Bozena; Brzostek, Anna; Grzybowski, Marcin; Fol, Marek; Krupa, Agnieszka; Kryczka, Jakub; Plocinski, Przemyslaw

    2016-01-01

    Mycobacterium tuberculosis is an extremely successful intracellular pathogen that has evolved a broad spectrum of pathogenic mechanisms that enable its manipulation of host defense elements and its survival in the hostile environment inside phagocytes. Cellular influx into the site of mycobacterial entry is mediated by a variety of chemokines, including interleukin-8 (IL-8), and the innate cytokine network is critical for the development of an adaptive immune response and infection control. Using affinity chromatography, liquid chromatography electrospray ionization tandem mass spectrometry and surface plasmon resonance techniques, we identified M. tuberculosis AtsG arylsulphatase, bifunctional glucosamine-1-phosphate acetyltransferase and N-acetylglucosamine-1-phosphate uridyl transferase (GlmU) and S-adenosyl-L-homocysteine hydrolase (SahH) as the pathogen proteins that bind to human IL-8. The interactions of all of the identified proteins (AtsG, GlmU and SahH) with IL-8 were characterized by high binding affinity with KD values of 6.83x10-6 M, 5.24x10-6 M and 7.14x10-10 M, respectively. Furthermore, the construction of Mtb mutant strains overproducing AtsG, GlmU or SahH allowed determination of the contribution of these proteins to mycobacterial entry into human neutrophils. The significantly increased number of intracellularly located bacilli of the overproducing M. tuberculosis mutant strains compared with those of “wild-type” M. tuberculosis and the binding interaction of AtsG, GlmU and SahH proteins with human IL-8 may indicate that these proteins participate in the modulation of the early events of infection with tubercle bacilli and could affect pathogen attachment to target cells. PMID:26829648

  10. The Inner Centromere Protein (INCENP) Coil Is a Single ?-Helix (SAH) Domain That Binds Directly to Microtubules and Is Important for Chromosome Passenger Complex (CPC) Localization and Function in Mitosis.

    PubMed

    Samejima, Kumiko; Platani, Melpomeni; Wolny, Marcin; Ogawa, Hiromi; Vargiu, Giulia; Knight, Peter J; Peckham, Michelle; Earnshaw, William C

    2015-08-28

    The chromosome passenger complex (CPC) is a master regulator of mitosis. Inner centromere protein (INCENP) acts as a scaffold regulating CPC localization and activity. During early mitosis, the N-terminal region of INCENP forms a three-helix bundle with Survivin and Borealin, directing the CPC to the inner centromere where it plays essential roles in chromosome alignment and the spindle assembly checkpoint. The C-terminal IN box region of INCENP is responsible for binding and activating Aurora B kinase. The central region of INCENP has been proposed to comprise a coiled coil domain acting as a spacer between the N- and C-terminal domains that is involved in microtubule binding and regulation of the spindle checkpoint. Here we show that the central region (213 residues) of chicken INCENP is not a coiled coil but a ? 32-nm-long single ?-helix (SAH) domain. The N-terminal half of this domain directly binds to microtubules in vitro. By analogy with previous studies of myosin 10, our data suggest that the INCENP SAH might stretch up to ? 80 nm under physiological forces. Thus, the INCENP SAH could act as a flexible "dog leash," allowing Aurora B to phosphorylate dynamic substrates localized in the outer kinetochore while at the same time being stably anchored to the heterochromatin of the inner centromere. Furthermore, by achieving this flexibility via an SAH domain, the CPC avoids a need for dimerization (required for coiled coil formation), which would greatly complicate regulation of the proximity-induced trans-phosphorylation that is critical for Aurora B activation. PMID:26175154

  11. The Inner Centromere Protein (INCENP) Coil Is a Single ?-Helix (SAH) Domain That Binds Directly to Microtubules and Is Important for Chromosome Passenger Complex (CPC) Localization and Function in Mitosis*

    PubMed Central

    Samejima, Kumiko; Platani, Melpomeni; Wolny, Marcin; Ogawa, Hiromi; Vargiu, Giulia; Knight, Peter J.; Peckham, Michelle; Earnshaw, William C.

    2015-01-01

    The chromosome passenger complex (CPC) is a master regulator of mitosis. Inner centromere protein (INCENP) acts as a scaffold regulating CPC localization and activity. During early mitosis, the N-terminal region of INCENP forms a three-helix bundle with Survivin and Borealin, directing the CPC to the inner centromere where it plays essential roles in chromosome alignment and the spindle assembly checkpoint. The C-terminal IN box region of INCENP is responsible for binding and activating Aurora B kinase. The central region of INCENP has been proposed to comprise a coiled coil domain acting as a spacer between the N- and C-terminal domains that is involved in microtubule binding and regulation of the spindle checkpoint. Here we show that the central region (213 residues) of chicken INCENP is not a coiled coil but a ?32-nm-long single ?-helix (SAH) domain. The N-terminal half of this domain directly binds to microtubules in vitro. By analogy with previous studies of myosin 10, our data suggest that the INCENP SAH might stretch up to ?80 nm under physiological forces. Thus, the INCENP SAH could act as a flexible dog leash, allowing Aurora B to phosphorylate dynamic substrates localized in the outer kinetochore while at the same time being stably anchored to the heterochromatin of the inner centromere. Furthermore, by achieving this flexibility via an SAH domain, the CPC avoids a need for dimerization (required for coiled coil formation), which would greatly complicate regulation of the proximity-induced trans-phosphorylation that is critical for Aurora B activation. PMID:26175154

  12. Vasospasm after intraventricular hemorrhage caused by arteriovenous malformation

    PubMed Central

    Tseng, Wei-Lung; Tsai, Yi-Hsin

    2015-01-01

    Intraventricular hemorrhage (IVH) induced vasospasm is rare in clinical practice. We report a case with vasospasm 10 days after IVH due to thalamic bleeding from an arteriovenous malformation. The vasospasm was so severe that transarterial embolization failed. Follow-up angiography could not reveal the vascular lesion and spontaneous thrombosis was considered. The discussion includes literature review and possible mechanism of such phenomenon. IVH-related vasospasm is rare but should always be kept in mind. Early detection with proper treatment provides better clinical outcome in such cases. PMID:25972942

  13. A Case of Sudden Deafness with Intralabyrinthine Hemorrhage Intralabyrinthine Hemorrhage and Sudden Deafness

    PubMed Central

    Park, Jeong Jin; Jeong, Se Won; Lee, Jae Wook

    2015-01-01

    Sudden hearing deterioration may occur in our population, but it is difficult to explain the exact pathophysiology and the cause. Magnetic resonance imaging (MRI) in sudden sensorineural hearing loss (SSNHL) is usually useful to evaluate neural lesions such as acoustic schwannoma and hemorrhage in labyrinth. Recently some cases of SSNHL caused by intralabyrintine hemorrhage were reported by the advance of MRI. In the case of intralabyrintine hemorrhage, MRI showed a hyperintense signal in the labyrinth on the pre-contrast and contrast enhanced T1-weighted image and relatively weak intensity on T2-weighted image. The prognosis SSNHL by intralabyrintine hemorrhage is generally known to be poor. We report a case of sudden deafness with intralabyrintine hemorrhage who has a history of anticoagulant administration, with a review of literature. PMID:26771018

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

    PubMed

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

    2012-09-01

    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

  15. Intraparenchymal hemorrhage after heroin use.

    PubMed

    Kumar, Neha; Bhalla, Mary Colleen; Frey, Jennifer A; Southern, Alison

    2015-08-01

    Heroin-associated stroke is a rare complication of use. Various proposed mechanisms of heroin-associated ischemic stroke have been proposed, including the following: cardioembolism in the setting of infective endocarditis, hypoxic ischemic brain injury in the setting of hypoxemia and hypotension, and infective arteritis or vasculitis from drug adulterants. A previously healthy 28-year-old woman presented to the emergency department with altered mental status and normal vitals after she was found wandering outside her apartment. During ambulance transport, she endorsed heroin use. The patient was alert but could not recall her name, place, or time. She intermittently responded "I don't know" to questioning and could not perform simple commands. No motor or sensory deficits were apparent other than sluggish pinpoint pupils. There were no signs of trauma other than antecubital track marks. Her laboratory results were unremarkable. Reevaluation at 2 hours after presentation showed persistent confusion and disorientation. A computed tomographic scan of the head was obtained, which showed a large 5.1 5-cm intraparenchymal hemorrhage in the left frontal lobe, vasogenic edema, and a 5-mm midline shift. A workup for cardioembolic, vasculitis, and other etiologies for stroke did not reveal an underlying cause. The patient remained confused with significant memory loss throughout her hospital stay and was eventually discharged to a long-term care facility. Drug abuse should be considered a risk factor for stoke in young adults. In patients with persistent neurologic deficits, physicians must be vigilant and order appropriate workup while managing drug overdose. PMID:25656330

  16. Adventitial Perfusion and Intraplaque Hemorrhage

    PubMed Central

    Sun, Jie; Song, Yan; Chen, Huijun; Kerwin, William S.; Hippe, Daniel S.; Dong, Li; Chen, Min; Zhou, Cheng; Hatsukami, Thomas S.; Yuan, Chun

    2014-01-01

    Background and Purpose Autopsy studies have suggested a relationship between intraplaque hemorrhage (IPH) and vasa vasorum, which arise primarily from the adventitia. Adventitial vasa vasorum can be characterized in the carotid arteries by estimating perfusion parameters via dynamic contrast-enhanced MRI. The purpose of this investigation was to use dynamic contrast-enhanced MRI to test in vivo in a clinical population whether adventitial perfusion, indicative of vasa vasorum microstructure, is associated with IPH. Methods Symptomatic patients with carotid plaque ipsilateral to the ischemic event underwent bilateral carotid artery MRI examination, which included multicontrast sequences for detecting IPH and a dynamic contrast-enhanced MRI sequence for characterizing adventitial perfusion. Kinetic modeling of the dynamic contrast-enhanced MRI time series was performed to estimate adventitial vp (fractional plasma volume, reflecting local blood supply) and Ktrans (transfer constant, reflecting vessel surface area, and permeability). Results From the 27 patients (22 men; 69±10 years of age) recruited, adventitial perfusion parameters were obtained in 50 arteries. The presence of IPH was associated with a significantly higher value in adventitial Ktrans (0.142±0.042 vs 0.112±0.029 min−1; P<0.001) but not in vp (0.163±0.064 vs 0.149±0.062; P=0.338). This relationship remained after adjusting for symptomatic status, degree of stenosis, and other confounding factors. Conclusions This study demonstrated an independent pathophysiological link between the adventitia and IPH and related it to the microstructure of adventitial vasa vasorum. Adventitial perfusion imaging may be useful in studying plaque pathogenesis, but further examination through prospective studies is needed. PMID:23471271

  17. Diffusion tensor imaging in hemorrhagic stroke.

    PubMed

    Chaudhary, Neeraj; Pandey, Aditya S; Gemmete, Joseph J; Hua, Ya; Huang, Yining; Gu, Yuxiang; Xi, Guohua

    2015-10-01

    Diffusion tensor imaging (DTI) has evolved considerably over the last decade to now be knocking on the doors of wider clinical applications. There have been several efforts over the last decade to seek valuable and reliable application of DTI in different neurological disorders. The role of DTI in predicting outcomes in patients with brain tumors has been extensively studied and has become a fairly established clinical tool in this scenario. More recently DTI has been applied in mild traumatic brain injury to predict clinical outcomes based on DTI of the white matter tracts. The resolution of white matter fiber tractography based on DTI has improved over the years with increased magnet strength and better tractography post-processing. The role of DTI in hemorrhagic stroke has been studied preliminarily in the scientific literature. There is some evidence that DTI may be efficacious in predicting outcomes of motor function in animal models of intracranial hemorrhage. Only a handful of studies of DTI have been performed in subarachnoid hemorrhage or intraventricular hemorrhage scenarios. In this manuscript we will review the evolution of DTI, the existing evidence for its role in hemorrhagic stroke and discuss possible application of this non-invasive evaluation technique of human cerebral white matter tracts in the future. PMID:26015333

  18. Overview of ultrasound-induced lung hemorrhage

    NASA Astrophysics Data System (ADS)

    O'Brien, William D.; Simpson, Douglas G.; Frizzell, Leon A.; Oelze, Michael L.; Zachary, James F.

    2003-10-01

    It is well documented that ultrasound-induced lung hemorrhage can occur in mice, rats, rabbits, pigs, and monkeys. Our own experimental studies have focused on mice, rats, and pigs as animal models. The characteristics of the lesions produced in mice, rats and pigs were similar to those described in studies by our research group and others, suggesting a common pathogenesis for the initiation and propagation of the lesions at the macroscopic and microscopic levels. Five experimental in vivo studies have been conducted to evaluate whether cavitation is responsible for ultrasound-induced lung hemorrhage. The studies evaluated the dependencies of hydrostatic pressure, frequency, pulse polarity, contrast agents and lung inflation, and the results of each study appeared inconsistent with the hypothesis that the mechanism for the production of a lung hemorrhage was inertial cavitation. Other dependencies evaluated included beam width, pulse repetition frequency, pulse duration, exposure duration, and animal species and age. The thresholds for producing ultrasound-induced lung hemorrhage, in general, were less than the FDA's regulatory limit of a Mechanical Index (MI) of 1.9. Further, the MI does not appear to provide a risk-based index for lung hemorrhage. [Work supported by NIH Grant No. R01EB02641.

  19. Bullous and hemorrhagic lichen sclerosus - Case report*

    PubMed Central

    Lima, Raquel Sucupira Andrade; Maquin, Gustavo vila; Schettini, Antnio Pedro Mendes; Santos, Mnica

    2015-01-01

    Lichen sclerosus is a chronic inflammatory disease, usually located in the genital area. The etiology of lichen sclerosus is multifactorial, with participation of genetic, autoimmune, infectious and hormonal factors. Bullous clinical form stems from hydropic degeneration of the basal membrane, constituting a less frequent variant of the disease. In this work, we report the case of a female patient, 55 years old, who in the last three years presented whitish plaques, with horny spikes, located on back and arms. Some of these lesions evolved with hemorrhagic blisters, which after histopathological examination confirmed the diagnosis of bullous and hemorrhagic lichen sclerosus. The patient was treated with high-potency topical corticosteroid for two months, resulting in remission of bullous and hemorrhagic lesions. PMID:26312692

  20. Radiation-induced spinal cord hemorrhage (hematomyelia).

    PubMed

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

    2014-10-23

    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

  1. Complications and follow up of subarachnoid hemorrhages.

    PubMed

    Danire, F; Gascou, G; Menjot de Champfleur, N; Machi, P; Leboucq, N; Riquelme, C; Ruiz, C; Bonaf, A; Costalat, V

    2015-01-01

    Complications of subarachnoid hemorrhage are the major life threatening and functional components of the follow up of a ruptured aneurysm. Knowing how to identify these is a key challenge. They vary in type throughout the postoperative follow up period. The aim of this article is firstly to list the main complications of the acute phase (rebleeding, acute hydrocephalus, acute ischemic injury and non-neurological complications), the subacute phase (vasospasm) and the chronic phase of subarachnoid hemorrhages: (chronic hydrocephalus and cognitive disorders) and to describe their major clinical and radiological features. Secondly, we describe the long-term follow up strategy for patients who have suffered a subarachnoid hemorrhage and have been treated endovascularly or by surgery. This follow up involves a combination of clinical consultations, cerebral MRI and at least one review angiogram. PMID:26119863

  2. Intraventricular Hemorrhage and Early Hematoma Expansion in Patients with Intracerebral Hemorrhage

    PubMed Central

    Li, Qi; Huang, Yuan-Jun; Zhang, Gang; Lv, Fa-Jin; Wei, Xiao; Dong, Mei-Xue; Chen, Jian-Jun; Zhang, Li-Juan; Qin, Xin-Yue; Xie, Peng

    2015-01-01

    Intraventricular hemorrhage is associated with poor functional outcomes in patients with intracerebral hemorrhage (ICH). We aimed to investigate the association between intraventricular hemorrhage and early hematoma expansion in patients with ICH. Patients with ICH who underwent a baseline CT scan within six hours after onset of symptoms were included. The follow-up CT scan was performed within 24?hours after the baseline CT scan. Univariate and multivariable logistic regression were used to assess the relationship between presence of intraventricular hemorrhage and early hematoma expansion. A total of 160 patients were included in the study. Significant hematoma growth was observed in 52 (32.5%) patients presenting within six hours after onset of symptoms. Intraventricular hemorrhage was observed in 66 (41.25%) patients with ICH. Multivariate analyses demonstrated that a short time from onset to baseline CT scan, the initial hematoma volume, and the presence of intraventricular hemorrhage on follow-up CT scan were independently associated with hematoma enlargement. The presence of intraventricular hemorrhage on follow-up CT scan can be associated with hematoma expansion in patients with ICH. PMID:26087142

  3. Initial Clinical Status and Spot Sign Are Associated with Intraoperative Aneurysm Rupture in Patients Undergoing Surgical Clipping for Aneurysmal Subarachnoid Hemorrhage.

    PubMed

    Burkhardt, Jan-Karl; Neidert, Marian Christoph; Mohme, Malte; Seifert, Burkhardt; Regli, Luca; Bozinov, Oliver

    2016-03-01

    Objective?To assess clinical and radiographic risk factors for intraoperative aneurysm rupture (ioAR) during surgical clipping after aneurysmal subarachnoid hemorrhage (aSAH) and to analyze its influence on patient outcome. Methods?Patient selection was based on a retrospective analysis of our prospective subarachnoid hemorrhage patient database including consecutive patients between January 2008 and August 2012 with aSAH undergoing microsurgical clipping. Demographic data, cardiovascular risk factors, preoperative radiologic aneurysm characteristics, as well as timing of surgery and preoperative severity grades (Hunt and Hess [HH], Fisher, World Federation of Neurological Societies [WFNS]), were collected from hospital charts and surgery videos and compared between patients with and without ioAR. Results?Of 100 patients (38 men, 62 women) with a median age of 57.4 years (range: 23-85 years), ioAR occurred in 34 cases (34%). Univariate analyses showed that severity grades were significantly higher in the ioAR group (Fisher p?=?0.012; HH p?=?0.002; WFNS p?=?0.023). IoAR was significantly associated with intracerebral hemorrhage (ICH) (23% versus 47%; p?=?0.013) and the spot sign as an indicator of active bleeding within the ICH (0% vs 44%; p?=?0.007). Multivariate analysis showed that HH was the only significant predictor of ioAR (p?=?0.03; odds ratio: 2.3; 95% confidence interval, 1.1-5.0). With a mean follow-up of 17.6 months (??16.6), Glasgow Outcome Scale score, mortality rate (12% versus 15%; p?=?0.82), delayed cerebral ischemia (36% versus 38%; p?=?0.51), and shunt dependency (32% versus 44%; p?=?0.23) were comparable between the non-ioAR and ioAR group. Conclusions?Initial clinical status and spot sign were associated with ioAR during microsurgical clipping of ruptured aneurysms. However, there was no difference regarding clinical outcome and complications of the two groups. PMID:26216733

  4. Hyperkinetic Movement Disorder Secondary to Punctate Hemorrhage in Lateral Ventricle Lining

    PubMed Central

    Zafar, Atif; Abdin, Sahrish

    2015-01-01

    We present the case of an elderly male with hyperkinetic movements of the right arm and leg due to a small hemorrhage in the lateral aspect of the left lateral ventricle atrium. As per our database search, this is a unique presentation of a stroke in this particular location. PMID:25802502

  5. Visual field defect as a presenting sign for hemorrhagic stroke caused by sildenafil.

    PubMed

    Mehdizadeh, Morteza; Hosseini, Hamid; Yazdchi, Taher; Farahangiz, Siamak

    2008-01-01

    Herein, we describe the presenting symptoms, history, ophthalmic examination, visual fields and brain magnetic resonance imaging of a patient who developed left homonymous hemianopia due to right occipital lobe hemorrhage after ingestion of sildenafil citrate (Novagra Forte). To the best of our knowledge, association of homonymous hemianopia with sildenafil usage has not been reported before. PMID:18292633

  6. A rare case of internal jugular vein aneurysm with massive hemorrhage in neurofibromatosis type 1.

    PubMed

    Hiraki, Tsubasa; Higashi, Michiyo; Goto, Yuko; Kitazono, Ikumi; Yokoyama, Seiya; Iuchi, Hiroyuki; Nagano, Hiromi; Tanimoto, Akihide; Yonezawa, Suguru

    2014-01-01

    Neurofibromatosis Type 1 (NF1) is a relatively common autosomal dominant disorder. Vascular involvement is a well-recognized manifestation of NF1, but venous aneurysm associated with NF1 is extremely rare. We present a case of an NF1 patient with a left internal jugular vein aneurysm with massive hemorrhage occurring during surgery. Due to the extreme fragility of both the aneurismal wall and the surrounding tissue, the patient developed severe intraoperative bleeding. Pathological examination confirmed aneurismal wall infiltration of the neurofibromatosis. Physicians should be aware that hemorrhagic complication in NF1 can occur and be fatal. PMID:24630569

  7. The hemorrhagic fevers of Southern Africa with special reference to studies in the South African Institute for Medical Research.

    PubMed Central

    Gear, J. H.

    1982-01-01

    In this review of studies on the hemorrhagic fevers of Southern Africa carried out in the South African Institute for Medical Research, attention has been called to occurrence of meningococcal septicemia in recruits to the mining industry and South African Army, to cases of staphylococcal and streptococcal septicemia with hemorrhagic manifestations, and to the occurrence of plague which, in its septicemic form, may cause a hemorrhagic state. "Onyalai," a bleeding disease in tropical Africa, often fatal, was related to profound thrombocytopenia possibly following administration of toxic witch doctor medicine. Spirochetal diseases, and rickettsial diseases in their severe forms, are often manifested with hemorrhagic complications. Of enterovirus infections, Coxsackie B viruses occasionally caused severe hepatitis associated with bleeding, especially in newborn babies. Cases of hemorrhagic fever presenting in February-March, 1975 are described. The first outbreak was due to Marburg virus disease and the second, which included seven fatal cases, was caused by Rift Valley fever virus. In recent cases of hemorrhagic fever a variety of infective organisms have been incriminated including bacterial infections, rickettsial diseases, and virus diseases, including Herpesvirus hominis; in one patient, the hemorrhagic state was related to rubella. A boy who died in a hemorrhagic state was found to have Congo fever; another patient who died of severe bleeding from the lungs was infected with Leptospira canicola, and two patients who developed a hemorrhagic state after a safari trip in Northern Botswana were infected with Trypanosoma rhodesiense. An illness manifested by high fever and melena developed in a young man after a visit to Zimbabwe; the patient was found to have both malaria and Marburg virus disease. PMID:6897472

  8. Liver Transplantation for Hereditary Hemorrhagic Telangiectasia

    PubMed Central

    Lerut, Jan; Orlando, Giuseppe; Adam, Ren; Sabb, Carlo; Pfitzmann, Robert; Klempnauer, Jurgen; Belghiti, Jacques; Pirenne, Jacques; Thevenot, Thierry; Hillert, Christian; Brown, Colin M.; Gonze, Dominique; Karam, Vincent; Boillot, Olivier

    2006-01-01

    Background: Hereditary hemorrhagic telangiectasia (HHT) or Rendu-Osler-Weber disease is a rare disease characterized by the presence of arteriovenous malformations. Hepatic involvement can lead to life-threatening conditions. Material and Methods: Forty patients, reported to the European Liver Transplant Registry, were analyzed to define the role of liver transplantation in the treatment of the hepatic disease form. Indications for transplantation were classified according to Garcia-Tsao: cardiac failure (14 patients), biliary necrosis causing hepatic failure (12 patients), severe portal hypertension (5 patients), cardiac failure and biliary necrosis (6 patients), cardiac failure and portal hypertension (2 patients), and cardiac failure associated with biliary necrosis and portal hypertension (1 patient). Eighteen (81%) of 22 patients had pulmonary artery hypertension. Twelve (30%) patients had pretransplant hepatic interventions. Follow-up was complete for all patients with a mean of 69 months (range, 0230 months). Results: One-, 5- and 10-year actuarial patient and graft survival rates are 82.5%. Six of the 7 pretransplant procedures performed on the hepatic artery were severely complicated. Cardiovascular function documented in 24 patients improved in 18 patients and remained stable in 5 patients; 1 patient died perioperatively of acute heart failure. Twenty-four (60%) patients had post-transplant complications, all but one occurring within the first 4 posttransplant months. Seven (17.5%) patients died perioperatively, 6 of them due to bleeding and 1 due to cardiac failure; 1 (2.5%) patient died late due to chronic rejection. There were 2 possible recurrences. Quality of life markedly improved in all 32 surviving patients. Conclusion: The results of the largest reported transplant series in the treatment of hepatic-based HHT are excellent. Elimination of hepatobiliary sepsis and reversal of cardiopulmonary changes dramatically improve quality of life of the recipients. LT should be proposed earlier in the course of symptomatic hepatic HHT presenting with life-threatening conditions. Palliative interventions, especially on the hepatic artery, should be avoided in view of their high (infectious) complication rate. PMID:17122610

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

    PubMed Central

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

    2011-01-01

    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

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

    PubMed Central

    Packer, Clifford D.

    2014-01-01

    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

  11. Treatment of Hemorrhagic Vocal Polyps by Pulsed Dye Laser-Assisted Laryngomicrosurgery

    PubMed Central

    Byeon, Hyung Kwon; Han, Ji Hyuk; Choi, Byeong Il; Hwang, Hye Jin; Kim, Ji-Hoon; Choi, Hong-Shik

    2015-01-01

    Objective. Conventional surgical techniques of laryngomicrosurgery (LMS) on hemorrhagic vocal polyps are often difficult due to obscuration of the surgical field by inadvertent bleeding from the lesion, and there are often significant amounts of mucosal epithelium loss. Here, we introduce our surgical technique using pulsed dye laser (PDL), which can effectively resect the polyp with vocal fold mucosa preservation. Methods. Patients who were diagnosed with hemorrhagic vocal polyp and who were surgically managed using PDL from March 2013 to October 2014 were retrospectively reviewed. Preoperative and postoperative clinical outcomes and surgical findings were evaluated. Results. A total of 39 patients were treated with PDL-assisted enucleation LMS. The average age was 43.7 years (range 20–73), and there were 20 males and 19 females (17 professional voice users). In all cases, the hemorrhagic polyp was successfully enucleated after application of PDL, thereby preserving the overlying epithelium. Postoperative voice outcomes were favorable with clear preservation of the vocal fold mucosal wave. Conclusion. PDL-assisted enucleation LMS for the treatment of hemorrhagic vocal polyps can be a safe and effective surgical technique. It can be considered a promising treatment option for hemorrhagic vocal polyps. PMID:26557700

  12. Psychopharmacologic intervention after hemorrhagic basal ganglia damage.

    PubMed

    Al Owesie, Rafat Mohammed; Morton, Catherine Saino

    2012-11-15

    Traumatic brain injury (TBI) can result in cognitive and behavioral impairments such as poor attention, learning, memory and planning ability and uncontrolled crying that can be more persistent problems than the physical disabilities. Cognitive enhancers have been shown to improve cognitive and behavioral impairments in patients with hemorrhagic basal ganglia lesions as well as other forms of TBI. There is little research about the use of cognitive enhancers after hemorrhagic basal ganglia damage. We present a case of a 38 year old male who made significant recovery with the use of cognitive enhancers. PMID:22795553

  13. Hemorrhage Detection and Segmentation in Traumatic Pelvic Injuries

    PubMed Central

    Davuluri, Pavani; Wu, Jie; Tang, Yang; Cockrell, Charles H.; Ward, Kevin R.; Najarian, Kayvan; Hargraves, Rosalyn H.

    2012-01-01

    Automated hemorrhage detection and segmentation in traumatic pelvic injuries is vital for fast and accurate treatment decision making. Hemorrhage is the main cause of deaths in patients within first 24 hours after the injury. It is very time consuming for physicians to analyze all Computed Tomography (CT) images manually. As time is crucial in emergence medicine, analyzing medical images manually delays the decision-making process. Automated hemorrhage detection and segmentation can significantly help physicians to analyze these images and make fast and accurate decisions. Hemorrhage segmentation is a crucial step in the accurate diagnosis and treatment decision-making process. This paper presents a novel rule-based hemorrhage segmentation technique that utilizes pelvic anatomical information to segment hemorrhage accurately. An evaluation measure is used to quantify the accuracy of hemorrhage segmentation. The results show that the proposed method is able to segment hemorrhage very well, and the results are promising. PMID:22919433

  14. A Case of Acute Bilateral Retrocochlear Hearing Loss as an Initial Symptom of Unilateral Thalamic Hemorrhage

    PubMed Central

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

    2014-01-01

    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

  15. Low-dose ribavirin potentiates the antiviral activity of favipiravir against hemorrhagic fever viruses.

    PubMed

    Westover, Jonna B; Sefing, Eric J; Bailey, Kevin W; Van Wettere, Arnaud J; Jung, Kie-Hoon; Dagley, Ashley; Wandersee, Luci; Downs, Brittney; Smee, Donald F; Furuta, Yousuke; Bray, Mike; Gowen, Brian B

    2016-02-01

    Favipiravir is approved in Japan to treat novel or re-emerging influenza viruses, and is active against a broad spectrum of RNA viruses, including Ebola. Ribavirin is the only other licensed drug with activity against multiple RNA viruses. Recent studies show that ribavirin and favipiravir act synergistically to inhibit bunyavirus infections in cultured cells and laboratory mice, likely due to their different mechanisms of action. Convalescent immune globulin is the only approved treatment for Argentine hemorrhagic fever caused by the rodent-borne Junin arenavirus. We previously reported that favipiravir is highly effective in a number of small animal models of Argentine hemorrhagic fever. We now report that addition of low dose of ribavirin synergistically potentiates the activity of favipiravir against Junin virus infection of guinea pigs and another arenavirus, Pichinde virus infection of hamsters. This suggests that the efficacy of favipiravir against hemorrhagic fever viruses can be further enhanced through the addition of low-dose ribavirin. PMID:26711718

  16. Case Report: Postpartum hemorrhage associated with Dengue with warning signs in a term pregnancy and delivery

    PubMed Central

    Phi Hung, Le; Diem Nghi, Tran; Hoang Anh, Nguyen; Van Hieu, Mai; Thien Luan, Nguyen; Phuoc Long, Nguyen; Trong Thach, Than

    2015-01-01

    Background: Dengue infection during peripartum period, although rare in endemic regions, has challenged clinicians regarding its management, especially if a parturient woman experiences postpartum hemorrhage due to a classical risk factor of maternal bleeding. Case: A full-term pregnant Vietnamese woman was diagnosed with polyhydramnios and Dengue with warning signs (DWS). She was administered platelet transfusion prior to delivery and then gave birth to a healthy newborn. After active management of the third stage of labor, the patient suffered a postpartum hemorrhage which was caused by uterine atony and accompanied with thrombocytopenia. Therefore, we decided to administer uterotonic drugs and additionally transfuse platelets. Conclusion: We describe a case of postpartum hemorrhage caused by uterine atony and coinciding with Dengue infection during delivery period, which is a rare clinical entity. With timely detection and management, the patient was finally discharged without complications. PMID:26925224

  17. Clinical strategies for supporting the untransfusable hemorrhaging patient

    PubMed Central

    Hulsey, Meredith E.; Newhouse, Mike; Holmes, Houston E.; Mays, Edward J.

    2009-01-01

    Hemorrhaging patients who cannot be transfused due to personal beliefs or the lack of compatible blood products provide a unique challenge for clinicians. Here we describe a 58-year-old African American man with a history of sickle cell–beta+ thalassemia who had recently received a multiunit exchange transfusion and developed hematochezia followed by severe anemia. Due to the presence of multiple alloantibodies, no compatible packed red blood cell (pRBC) units could initially be located. The patient was managed with mechanical ventilation, colloid and crystalloid solutions, procoagulants, and recombinant erythropoietin. After an extensive search by our blood bank, enough compatible pRBC units were identified and the patient survived without significant clinical sequelae. Management of the untransfusable hemorrhaging patient requires a multidisciplined approach, with coordination between blood banks, hematologists, intensivists, and other specialists. Steps should be taken to avoid or limit blood loss, identify compatible pRBC units, control hypotension, maximize oxygen delivery, minimize metabolic demand, and stimulate erythropoiesis. In dire circumstances, use of experimental hemoglobin substitutes or transfusion of the least serologically incompatible pRBCs available may be considered. PMID:19865501

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

    PubMed Central

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

    2013-01-01

    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

  19. Association between S100B Levels and Long-Term Outcome after Aneurysmal Subarachnoid Hemorrhage: Systematic Review and Pooled Analysis

    PubMed Central

    Lai, Pui Man Rosalind; Du, Rose

    2016-01-01

    S100 calcium binding protein B (S100B), a well-studied marker for neurologic injury, has been suggested as a candidate for predicting outcome after subarachnoid hemorrhage. We performed a pooled analysis summarizing the associations between S100B protein in serum and cerebrospinal fluid (CSF) with radiographic vasospasm, delayed ischemic neurologic deficit (DIND), delayed cerebral infarction, and Glasgow Outcome Scale (GOS) outcome. A literature search using PubMed, the Cochrane Library, and the EMBASE databases was performed to identify relevant studies published up to May 2015. The weighted Stouffer’s Z method was used to perform a pooled analysis of outcome measures with greater than three studies. A total of 13 studies were included in this review. Higher serum S100B level was found to be associated with cerebral infarction as diagnosed by CT (padj = 3.1 x 10−4) and worse GOS outcome (padj = 5.5 x 10−11). There was no association found between serum and CSF S100B with radiographic vasospasm or DIND. S100B is a potential prognostic marker for aSAH outcome. PMID:27007976

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

    PubMed

    Kapinos, Gregory

    2015-01-01

    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

  1. Candidate gene analysis: Severe intraventricular hemorrhage in inborn preterm neonates

    PubMed Central

    Ådén, Ulrika; Lin, Aiping; Carlo, Waldemar; Leviton, Alan; Murray, Jeffrey C.; Hallman, Mikko; Lifton, Richard P.; Zhang, Heping; Ment, Laura R.

    2013-01-01

    Intraventricular hemorrhage is a disorder of complex etiology. We analyzed genotypes for 7 genes from 224 inborn preterm neonates treated with antenatal steroids and Grade 3-4 intraventricular hemorrhage and 389 matched controls. Only methylenetetrahydrofolate reductase was more prevalent in cases of intraventricular hemorrhage, emphasizing the need for more comprehensive genetic strategies. PMID:23896193

  2. Fahr's Disease Presenting with Aneurysmal Subarachnoid Hemorrhage

    PubMed Central

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

    2012-01-01

    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

  3. Fahr's Disease Presenting with Aneurysmal Subarachnoid Hemorrhage.

    PubMed

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

    2012-01-01

    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

  4. Epizootic hemorrhagic disease in Alberta, Canada.

    PubMed

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

    2014-07-01

    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

  5. Acute Hemorrhagic Leukoencephalitis Associated With Autoimmune Myopathy

    PubMed Central

    Duggal, Neeta; Ahmed, Iftekhar; Duggal, Nikki

    2014-01-01

    Introduction Acute hemorrhagic leukoencephalitis is a rare acute inflammatory myelinopathy of central nervous system with high mortality. We report a case of an unusual presentation of acute hemorrhagic leukoencephalitis with autoimmune myopathy and a complete recovery with steroids and plasmapheresis. Methods A 24-year-old female admitted with generalized seizure, lethargy, but no focal neurological signs. Head scans revealed right frontal hypodensity with loss of basal cisterns, mild transfalcine shift to the left, a mass lesion with abnormal signal and multiple small hemorrhages. Biopsy pathology showed white matter demyelinating lesions with necrotizing destruction of small vessels and acute inflammation. EMG was consistent with demyelinating diffuse polyneuropathy and myopathy. Pathology of muscle showed myopathic changes suggestive of autoimmune myopathy. Results Patient was initially treated with Dexamethasone, Mannitol, Keppra, Antibiotics and Acyclovir. Later when she developed diffuse polyneuropathy and myopathy, she was given plasmapheresis. The patient responded to the treatment and made a full recovery. Conclusion Acute hemorrhagic leukoencephalitis is a rare and usually fatal disorder. The etiology of AHLE remains clear; cross-reactivity between human myelin antigens and viral or bacterial antigens is thought to initiate an immune process causing demyelination. Usually the autoimmune process targets CNS myelin and spares the peripheral; however, in this case there was diffuse involvement of central and peripheral myelin and muscle. PMID:25422709

  6. Uterine artery embolization for primary postpartum hemorrhage

    PubMed Central

    Kim, Tae-Hee; Lee, Hae-Hyeog; Kim, Jun-Mo; Ryu, Ae-Li; Chung, Soo-Ho; Seok Lee, Woo

    2013-01-01

    Background: Postpartum hemorrhage is the leading cause of severe maternal morbidity and death. A prompt management of uterine artery embolization (UAE) is important for a good outcome. UAE is generally accepted to be a safe and reliable procedure. Objective: To estimate critical patient characteristics influencing the success of UAE for the treatment of emergent primary postpartum hemorrhage. Materials and Methods: This was a cross sectional study that reviewed 121 patients who were diagnosed primary postpartum hemorrhage between February 2002 and December 2009 at a tertiary treatment center among 4,022 deliveries. We evaluated patient clinical characteristics associated with a successful surgical outcome of UAE. Results: The success rate for UAE was 96%. For two cases, UAE complication was associated with fever (>38.5oC). Five patients had problems that required admission to the intensive care unit (ICU). Conclusion: To increase the surgical success rate and lower the number of ICU admissions, the decision to treat primary postpartum hemorrhage using UAE should be based on individual patient clinical findings under the direction of obstetrics staff and an interventional radiologist. PMID:24639786

  7. [Hemorrhagic stroke and new oral anticoagulants].

    PubMed

    Derlon, V; Corbonnois, G; Martin, M; Toussaint-Hacquard, M; Audibert, G

    2014-01-01

    The recent release of new oral anticoagulants (NOAC) raises the question of the management of intracranial hemorrhage occurring during treatment with these molecules. Dabigatran, rivaroxaban and apixaban have different pharmacological characteristics that physicians need to know to adjust their prescription to each patient. Studies of efficacy and safety prior to the marketing of these molecules showed a decreased risk of intracranial hemorrhage compared with vitamin K antagonists. However, no reliable data are available regarding the prognosis of these hemorrhages occurring during NOAC treatment. In addition, there is no specific antidote and reversal protocol validated in humans. So, physicians are in a difficult situation when critical bleeding occurs. The timing of recovering normal hemostatic capacity is then a determinant factor of prognosis. Studies in animals or healthy volunteers showed a correction of the biological parameters using prothrombin complex concentrates activated or not, without reducing the volume of hematoma. On this basis, proposals have been issued by the french group of interest for perioperative hemostasis (GIHP) for the management of bleeding under NOAC treatment, which include management of intracranial hemorrhage. PMID:25282445

  8. Long-term persistent fetomaternal hemorrhage

    PubMed Central

    Umazume, Takeshi; Morikawa, Mamoru; Yamada, Takahiro; Cho, Kazutoshi; Masauzi, Nobuo; Minakami, Hisanori

    2015-01-01

    Key Clinical Message It is not clear that how long the affected fetuses can tolerate fetomaternal hemorrhage (FMH). Incidental serial measurements of the fetal peak systolic velocity of the middle cerebral artery and the retrospective analysis of stocked blood available incidentally indicated that our patient had suffered from FMH for at least 2 weeks prior to delivery. PMID:26576272

  9. Vitreous Hemorrhage in Pediatric Age Group

    PubMed Central

    AlHarkan, Dora H.; Kahtani, Eman S.; Gikandi, Priscilla W.

    2014-01-01

    Purpose. To identify and study causes of vitreous hemorrhage (VH) in pediatric age group and to investigate factors predicting visual and anatomical outcomes. Procedure. A retrospective review of patients aged 16 years or less with the diagnosis of vitreous hemorrhage from January 2005 until December 2010. Results. A total number of 230 patients (240 eyes) were identified. Traumatic vitreous hemorrhage accounted for 82.5%. In cases of accidental trauma, final visual acuity of 20/200 was significantly associated with visual acuity of ≥20/200 at presentation and the absence of retinal detachment at last follow-up. Patients with nontraumatic vitreous hemorrhage were significantly younger with higher rates of enucleation/evisceration/exenteration and retinal detachment at last follow-up compared to traumatic cases. Conclusion. Trauma is the most common cause of VH in pediatric age group. In this group, initial visual acuity was the most important predictor for visual outcome, and the presence of retinal detachment is a negative predictor for final good visual outcome. The outcome is significantly worse in nontraumatic cases compared to traumatic cases. PMID:25505975

  10. Unilateral adrenal hemorrhagic infarction in essential thrombocythemia.

    PubMed

    Burnet, G; Lambert, M; Annet, L; Lefebvre, C

    2015-12-01

    Adrenal hemorrhage is a rare disease associated with various conditions. We report a case of a 68-year-old woman with abdominal and back pain. The diagnostic work-up showed a left adrenal gland infarction associated with essential thrombocythemia. Treatment consisted in painkillers and treating the underlying condition in order to prevent further thrombotic events. PMID:26133054

  11. Unraveling the distinctive features of hemorrhagic and non-hemorrhagic snake venom metalloproteinases using molecular simulations.

    PubMed

    de Souza, Raoni Almeida; Daz, Natalia; Nagem, Ronaldo Alves Pinto; Ferreira, Rafaela Salgado; Surez, Dimas

    2016-01-01

    Snake venom metalloproteinases are important toxins that play fundamental roles during envenomation. They share a structurally similar catalytic domain, but with diverse hemorrhagic capabilities. To understand the structural basis for this difference, we build and compare two dynamical models, one for the hemorrhagic atroxlysin-I from Bothrops atrox and the other for the non-hemorraghic leucurolysin-a from Bothrops leucurus. The analysis of the extended molecular dynamics simulations shows some changes in the local structure, flexibility and surface determinants that can contribute to explain the different hemorrhagic activity of the two enzymes. In agreement with previous results, the long ?-loop (from residue 149 to 177) has a larger mobility in the hemorrhagic protein. In addition, we find some potentially-relevant differences at the base of the S1' pocket, what may be interesting for the structure-based design of new anti-venom agents. However, the sharpest differences in the computational models of atroxlysin-I and leucurolysin-a are observed in the surface electrostatic potential around the active site region, suggesting thus that the hemorrhagic versus non-hemorrhagic activity is probably determined by protein surface determinants. PMID:26676823

  12. Complications and mortality in hereditary hemorrhagic telangiectasia

    PubMed Central

    McKeever, Tricia M.; Hall, Ian P.; Hubbard, Richard B.; Fogarty, Andrew W.

    2015-01-01

    Objectives: Studies report that the risks of significant neurologic complications (including stroke, cerebral abscess, and migraine) and hemorrhagic sequelae are high in patients with hereditary hemorrhagic telangiectasia (HHT), and that life expectancy in this cohort is reduced. However, most published cohorts derive from specialist centers, which may be susceptible to bias. Methods: We used a population-based approach to estimate the risks of developing neurologic and hemorrhagic complications of HHT, the association of a diagnosis of HHT with common cardiovascular and malignant comorbidities, and also long-term survival of those with the disease. Results: From a UK primary care database of 3.5 million patients (The Health Improvement Network), we identified 675 cases with a diagnosis of HHT and compared them with 6,696 controls matched by age, sex, and primary care practice. Risks of stroke (odds ratio [OR] 1.8, 95% confidence interval [CI] 1.22.6), cerebral abscess (OR 30.0, CI 3.1288), and migraine (OR 1.7, CI 1.32.2) were elevated over controls. Bleeding complications including epistaxis (OR 11.6, CI 9.114.7) and gastrointestinal hemorrhage (OR 6.1, CI 2.813.4) were more common in cases with HHT. Survival of cases with HHT was poorer than controls with a hazard ratio for death of 2.0 (CI 1.62.6) and a median age at death 3 years younger. Conclusions: Patients with HHT are at substantially increased risk of serious neurologic and hemorrhagic complications of the disease. Because a diagnosis of HHT is associated with a significantly poorer survival compared with those who have no disease, evaluation of new strategies to improve clinical management is required. PMID:25862798

  13. Delayed subarachnoid hemorrhage following failed odontoid screw fixation.

    PubMed

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

    2011-06-01

    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

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

    PubMed Central

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

    2011-01-01

    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 heparinplatelet 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

  15. Infection Control During Filoviral Hemorrhagic Fever Outbreaks

    PubMed Central

    Vanessa, N Raabe; Matthias, Borchert

    2012-01-01

    Breaking the human-to-human transmission cycle remains the cornerstone of infection control during filoviral (Ebola and Marburg) hemorrhagic fever outbreaks. This requires effective identification and isolation of cases, timely contact tracing and monitoring, proper usage of barrier personal protection gear by health workers, and safely conducted burials. Solely implementing these measures is insufficient for infection control; control efforts must be culturally sensitive and conducted in a transparent manner to promote the necessary trust between the community and infection control team in order to succeed. This article provides a review of the literature on infection control during filoviral hemorrhagic fever outbreaks focusing on outbreaks in a developing setting and lessons learned from previous outbreaks. The primary search database used to review the literature was PUBMED, the National Library of Medicine website. PMID:22529631

  16. An Update on Crimean Congo Hemorrhagic Fever

    PubMed Central

    Appannanavar, Suma B; Mishra, Baijayantimala

    2011-01-01

    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

  17. Viruses Causing Hemorrhagic Fever. Safety Laboratory Procedures

    PubMed Central

    Cobo, Fernando

    2016-01-01

    Viral hemorrhagic fevers are diseases caused by viruses which belong to different families, many of them causing severe diseases. These viruses may produce different symptomatology together with a severe multisystem syndrome, and the final result might be the production of hemorrhages in several sites of the body. The majority of them have no other treatment than supportive therapy, although some antiviral drugs can be used in some circumstances. Transmission of VHF has been demonstrated through contact with animal vectors or person-to-person through the contact with body fluids. No risk of transmission has been found during the incubation period, but when the viral load is high the risk of transmission is greatest. Both health care and clinical laboratory workers must safely handle patients and specimens by taking all required precautions during their management. PMID:27014378

  18. Alteration of cytokine profile following hemorrhagic shock.

    PubMed

    Lu, Sumin; Aguilar, Alex; Subramani, Kumar; Poulose, Ninu; Ayub, Ahmar; Raju, Raghavan

    2016-05-01

    Hemorrhage is one of the leading causes of death in patients with trauma. We recently demonstrated that resveratrol can improve cardiac function and prolong life following severe hemorrhagic injury (HI) in a rat model. The present work is focused on determining changes in NF-κB dependent gene expression in the heart and the systemic cytokine milieu following HI and the effect of resveratrol treatment. The results indicate an increase in phosphorylated NF-κB in the heart with a concomitant increase in the expression of NF-κB dependent genes following HI. There was also a significant increase of systemic cytokine levels, both pro and anti-inflammatory, following HI and resolution when treated with resveratrol. This study demonstrates the potential role NF-κB has in the physiological response to HI and the effectiveness of resveratrol in reducing immune activation. PMID:26851979

  19. Epidemiology of intracranial aneurysm and subarachnoid hemorrhage.

    PubMed

    Pfohman, M; Criddle, L M

    2001-02-01

    Intracranial aneurysmal hemorrhage is a common but devastating condition associated with significant morbidity and mortality. Epidemiologic studies have identified risk factors associated with this condition. Genetic factors involve family history and the presence of certain heritable connective tissue disorders such as Ehlers-Danlos syndrome, Marfan's syndrome, neurofibromatosis, and polycystic kidney disease. Acquired factors include traumatic brain injury, sepsis, smoking, and hypertension. Management of these patients consists of prevention, patient screening, and prophylactic aneurysm repair. PMID:11233360

  20. Renal Hemorrhagic Actinomycotic Abscess in Pregnancy

    PubMed Central

    Smid, Marcela C.; Bhardwaj, Neha R.; Di Giovanni, Laura M.; Eggener, Scott; Torre, Micaela Della

    2014-01-01

    Actinomyces israelii is a gram-positive, filamentous anaerobic bacteria colonizing the oral and gastrointestinal tracts. Retroperitoneal actinomycotic abscess is uncommon and its rare presentation as a hemorrhagic mass may be confused with malignancy. We present a case of this unusual infection complicating pregnancy. Increased awareness of actinomycotic abscess in the differential diagnosis of renal mass concerning for malignancy is critical to early recognition and treatment of this rare infection and most importantly, avoidance of unnecessary surgical intervention. PMID:24757509

  1. Subperiosteal Orbital Hemorrhage Complicating Cardiac Surgery

    SciTech Connect

    Peden, Marc C.; Bhatti, M. Tariq

    2004-09-15

    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.

  2. Biomarkers and vasospasm after aneurysmal subarachnoid hemorrhage.

    PubMed

    Jordan, J Dedrick; Nyquist, Paul

    2010-04-01

    Subarachnoid hemorrhage from the rupture of a saccular aneurysm is a devastating neurological disease that has a high morbidity and mortality not only from the initial hemorrhage, but also from the delayed complications, such as cerebral vasospasm. Cerebral vasospasm can lead to delayed ischemic injury 1 to 2 weeks after the initial hemorrhage. Although the pathophysiology of vasospasm has been described for decades, the molecular basis remains poorly understood. With the many advances in the past decade in the development of sensitive molecular biological techniques, imaging, biochemical purification, and protein identification, new insights are beginning to reveal the etiology of vasospasm. These findings will not only help to identify markers of vasospasm and prognostic outcome, but will also yield potential therapeutic targets for the treatment of this disease. This review focuses on the methods available for the identification of biological markers of vasospasm and their limitations, the current understanding as to the utility and prognostic significance of identified biomarkers, the utility of these biomarkers in predicting vasospasm and outcome, and future directions of research in this field. PMID:20380977

  3. Rehabilitation Outcomes: Ischemic versus Hemorrhagic Strokes

    PubMed Central

    Perna, Robert; Temple, Jessica

    2015-01-01

    Background. Ischemic and hemorrhagic strokes have different pathophysiologies and possibly different long-term cerebral and functional implications. Hemorrhagic strokes expose the brain to irritating effects of blood and ischemic strokes reflect localized or diffuse cerebral vascular pathology. Methods. Participants were individuals who suffered either an ischemic (n = 172) or hemorrhagic stroke (n = 112) within the past six months and were involved in a postacute neurorehabilitation program. Participants completed three months of postacute neurorehabilitation and the Mayo Portland Adaptability Inventory-4 (MPAI-4) at admission and discharge. Admission MPAI-4 scores and level of functioning were comparable. Results. Group ANOVA comparisons show no significant group differences at admission or discharge or difference in change scores. Both groups showed considerably reduced levels of productivity/employment after discharge as compared to preinjury levels. Conclusions. Though the pathophysiology of these types of strokes is different, both ultimately result in ischemic injuries, possibly accounting for lack of findings of differences between groups. In the present study, participants in both groups experienced similar functional levels across all three MPAI-4 domains both at admission and discharge. Limitations of this study include a highly educated sample and few outcome measures. PMID:26246694

  4. Hemorrhage control by microsecond electrical pulses

    NASA Astrophysics Data System (ADS)

    Mandel, Yossi; Manivanh, Richard; Dalal, Roopa; Huie, Phil; Wang, Jenny; Brinton, Mark; Palanker, Daniel

    2013-02-01

    Non-compressible hemorrhages are the most common preventable cause of death on battlefield or in civilian traumatic injuries. We report the use of sub-millisecond pulses of electric current to induce rapid constriction in femoral and mesenteric arteries and veins in rats. Extent of vascular constriction could be modulated by pulse duration, amplitude and repetition rate. Electrically-induced vasoconstriction could be maintained at steady level until the end of stimulation, and blood vessels dilated back to their original size within a few minutes after the end of stimulation. At higher settings, a blood clotting could be introduced, leading to complete and permanent occlusion of the vessels. The latter regime dramatically decreased the bleeding rate in the injured femoral and mesenteric arteries, with a complete hemorrhage arrest achieved within seconds. The average blood loss from the treated femoral artery was about 7 times less than that of a non-treated control. This new treatment modality offers a promising approach to non-damaging control of bleeding during surgery, and to efficient hemorrhage arrest in trauma patients.

  5. Histopathology of hemorrhagic enteritis in turkeys.

    PubMed

    Fujiwara, H; Tanaami, S; Yamaguchi, M; Yoshino, T

    1975-01-01

    In the summer of 1972, a disease of turkeys manifesting hemorrhagic diarrhea as a main clinical symptom and hemorrhagic enteritis as a necropsy finding broke out on a turkey farm in Japan. Seven-week-old Large White turkeys suffering from this disease were studied histopathologically and electron microscopically. Clinically, affected birds showed bloody diarrhea. Death occurred to them after an acute course. In the blood film, immature monocytes were higher in count in them than in healthy birds. Necropsy revealed a number of dark red bloody clots in the intestinal tract, many petechiae in the mucous membrane of small intestine and ceca, and atrophy of the spleen. The histopathological changes characteristic of this disease were acute hemorrhagic enteritis, degenerative changes of lymphatic tissue, proliferation of reticuloendothelial cells all over the body, and formation of intranuclear inclusion bodies in these cells. By electron microscopy, viral particles showing a crystalline array were found in the nuclei of reticuloendothelial cells. Viral particles which had electron-dense nucleoids and a naked hexagonal shape were about 80 nm in average diameter. The ultrastructural features of those inclusion bodies were identical with those of avian adenovirus. PMID:170543

  6. Pathogenesis of Hemorrhage Induced by Rattlesnake Venom

    PubMed Central

    Ownby, Charlotte L.; Kainer, Robert A.; Tu, Anthony T.

    1974-01-01

    The pathogenesis of hemorrhage induced by rattlesnake (Crotalus atrox) venom was investigated at the electron microscopic level. Swiss-Webster white mice were injected intramuscularly with one-fifth the LD50 dose of whole venom. Muscle samples were obtained by biopsy 2 minutes, 30 minutes and 3 hours after venom injection. Capillaries in the endomysium were in various stages of degeneration. Endothelial cells of damaged capillaries contained dilatated endoplasmic reticulum and perinuclear space, and, in many cases, swollen cytoplasm. Blebbing of endothelial cytoplasm of swollen and nonswollen cells was observed. These changes were followed by rupture of the plasma membrane which resulted in the subsequent extravasation of blood. Platelet aggregations plugged gaps in vessel walls and often completely occluded the lumina of capillaries. The experimental injection of rattlesnake venom induced hemorrhage by rhexis. The same or a similar pathogenesis is probably responsible for hemorrhage which occurs in actual snakebite cases. ImagesFig 1Fig 2Fig 3Fig 10Fig 11Fig 4Fig 5Fig 6Fig 7Fig 8Fig 9 PMID:4843388

  7. Vaccines for Viral Hemorrhagic Fevers Progress and Shortcomings

    PubMed Central

    Falzarano, Darryl; Feldmann, Heinz

    2013-01-01

    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 and Rift Valley Fever virus, which recently have seen significant progress in putting forward new and improved vaccines, respectively. Experimental vaccines for filoviruses and Lassa virus 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

  8. Animal Models of Tick-Borne Hemorrhagic Fever Viruses

    PubMed Central

    Zivcec, Marko; Safronetz, David; Feldmann, Heinz

    2013-01-01

    Tick-borne hemorrhagic fever viruses (TBHFV) are detected throughout the African and Eurasian continents and are an emerging or re-emerging threat to many nations. Due to the largely sporadic incidences of these severe diseases, information on human cases and research activities in general have been limited. In the past decade, however, novel TBHFVs have emerged and areas of endemicity have expanded. Therefore, the development of countermeasures is of utmost importance in combating TBHFV as elimination of vectors and interrupting enzootic cycles is all but impossible and ecologically questionable. As in vivo models are the only way to test efficacy and safety of countermeasures, understanding of the available animal models and the development and refinement of animal models is critical in negating the detrimental impact of TBHFVs on public and animal health. PMID:25437041

  9. Application of current hemorrhage control techniques for backcountry care: part one, tourniquets and hemorrhage control adjuncts.

    PubMed

    Drew, Brendon; Bennett, Brad L; Littlejohn, Lanny

    2015-06-01

    Decade-long advancements in battlefield medicine have revolutionized the treatment of traumatic hemorrhage and have led to a significant reduction in mortality. Older methods such as limb elevation and pressure points are no longer recommended. Tourniquets have had a profound effect on lives saved without the commonly feared safety issues that have made them controversial. Unique tourniquet designs for inguinal and abdominal regions are now available for areas not amenable to current fielded extremity tourniquets. This article, the first of two parts, reviews the literature for advancements in prehospital hemorrhage control for any provider in the austere setting. It emphasizes the significant evidence-based advances in tourniquet use on the extremities that have occurred in battlefield trauma medicine since 2001 and reviews the newer junctional tourniquet devices. Recommendations are made for equipment and techniques for controlling hemorrhage in the wilderness setting. PMID:25704875

  10. Uterine Balloon Tamponade in Combination with Topical Administration of Tranexamic Acid for Management of Postpartum Hemorrhage

    PubMed Central

    Kinugasa, Masato; Tamai, Hanako; Miyake, Mayu; Shimizu, Takashi

    2015-01-01

    While uterine balloon tamponade is an effective modality for control of postpartum hemorrhage, the reported success rates have ranged from the level of 60% to the level of 80%. In unsuccessful cases, more invasive interventions are needed, including hysterectomy as a last resort. We developed a modified tamponade method and applied it to two cases of refractory postpartum hemorrhage after vaginal delivery. The first case was accompanied by uterine myoma and low-lying placenta. After an induced delivery, the patient had excessive hemorrhage due to uterine atony. Despite oxytocin infusion and bimanual uterine compression, the total blood loss was estimated at 2,800?mL or more. The second case was diagnosed as placental abruption complicated by fetal death and severe disseminated intravascular coagulation, subsequently. A profuse hemorrhage continued despite administration of uterotonics, fluid, and blood transfusion. The total blood loss was more than 5,000?mL. In each case, an intrauterine balloon catheter was wrapped in gauze impregnated with tranexamic acid, inserted into the uterus, and inflated sufficiently with sterile water. In this way, mechanical compression by a balloon and a topical antifibrinolytic agent were combined together. This method brought complete hemostasis and no further treatments were needed. Both the women left hospital in stable condition. PMID:25861495

  11. Endoscopic Surgery for Hemorrhagic Pineal Cyst Following Antiplatelet Therapy: Case Report

    PubMed Central

    Tamura, Yoji; Yamada, Yoshitaka; Tucker, Adam; Ukita, Tohru; Tsuji, Masao; Miyake, Hiroji; Kuroiwa, Toshihiko

    2013-01-01

    Pineal cysts of the third ventricle presenting with acute obstructive hydrocephalus due to internal cystic hemorrhage are a rare clinical entity. The authors report a case of a 61-year-old man taking antiplatelet medication who suffered from a hemorrhagic pineal cyst and was treated with endoscopic surgery. One month prior to treatment, the patient was diagnosed with a brainstem infarction and received clopidogrel in addition to aspirin. A small incidental pineal cyst was concurrently diagnosed using magnetic resonance (MR) imaging which was intended to be followed conservatively. The patient presented with a sudden onset of headache and diplopia. On admission, the neurological examination revealed clouding of consciousness and Parinaud syndrome. Computerized tomography (CT) scans demonstrated a hemorrhagic mass lesion in the posterior third ventricle. The patient underwent emergency external ventricular drainage with staged endoscopic biopsy and third ventriculostomy using a flexible videoscope. Histological examination revealed pineal tissue with necrotic change and no evidence of tumor cells. One year later MR imaging demonstrated no evidence of cystic lesion and a flow void between third ventricle and prepontine cistern. In patients with asymptomatic pineal cysts who are treated with antiplatelet therapy, it is important to be aware of the risk of pineal apoplexy. Endoscopic management can be effective for treatment of hemorrhagic pineal cyst with obstructive hydrocephalus. PMID:24067776

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

    PubMed Central

    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.

    2014-01-01

    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, Pdgfbret/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

  13. Hemorrhage, infection, toxemia, and cardiac disease, 1954-85: causes for their declining role in maternal mortality.

    PubMed Central

    Sachs, B P; Brown, D A; Driscoll, S G; Schulman, E; Acker, D; Ransil, B J; Jewett, J F

    1988-01-01

    Hemorrhage, infection, toxemia, and cardiac disease are no longer the leading causes of maternal death. We studied factors causing their decline in incidence using data collected by the Committee on Maternal Welfare of the Massachusetts Medical Society between 1954 and 1985. The dramatic decline in incidence of these conditions in the Commonwealth during the study period appears to have been due to both legislative actions and improvements in medical practice. The legislative actions included licensing of maternity services, blood banks, and legalization of abortion. Cardiac-related mortality has declined due to a reduction in the prevalence of rheumatic heart disease. Changes in clinical practice that stand out were the aggressive control of the hypertensive component of toxemia leading to a reduced incidence of intracranial hemorrhage, the prompt recourse to blood transfusion for hemorrhage, and the use of broad spectrum antibiotics. PMID:3369599

  14. Histological characterization of hemorrhages in muscles of broiler chickens.

    PubMed

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

    2000-01-01

    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

  15. Scintigraphic documentation of hemorrhage from coronary artery bypass graft

    SciTech Connect

    Orzel, J.A.; Baisden, C.E.

    1986-11-01

    Tc-99m labeled RBC imaging was used to conclusively demonstrate continuing intrathoracic hemorrhage from the anastomotic site of a coronary artery bypass graft. Demonstration of continuing hemorrhage and localization of the most likely site of bleeding resulted in timely and appropriate surgical intervention, which resulted in hemostasis and eventual patient recovery. Tc-99m RBC imaging may be an ideal noninvasive technique to investigate the site and activity of intrathoracic hemorrhage after coronary bypass surgery and other thoracic procedures.

  16. Pathology of retinal hemorrhage in abusive head trauma.

    PubMed

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

    2009-12-01

    Abusive head injury, characterized by repeated acceleration-deceleration forces, is associated with retinal hemorrhages as demonstrated in many clinical and postmortem studies. The theory that vitreoretinal traction is the major factor in the pathogenesis of retinal hemorrhages is presently the most widely accepted explanation based on different lines of research. Postmortem examination of the eye and orbital structures is essential for recognizing abusive head injury and also for identifying other possible medical conditions which can cause retinal hemorrhage. PMID:20024631

  17. Cerebral venous sinus thrombosis with cerebral hemorrhage during early pregnancy

    PubMed Central

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

    2015-01-01

    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

  18. Spontaneous Primary Intraventricular Hemorrhage: Clinical Features and Early Outcome

    PubMed Central

    Arboix, Adri; Garca-Eroles, Luis; Vicens, Adela; Oliveres, Montserrat; Massons, Joan

    2012-01-01

    Purpose. Primary hemorrhage in the ventricular system without a recognizable parenchymal component is very rare. This single-center retrospective study aimed to further characterize the clinical characteristics and early outcome of this stroke subtype. Methods. All patients with primary intraventricular hemorrhage included in a prospective hospital-based stroke registry over a 19-year period were assessed. A standardized protocol with 161 items, including demographics, risk factors, clinical data, neuroimaging findings, and outcome, was used for data collection. A comparison was made between the groups of primary intraventricular hemorrhage and subcortical intracerebral hemorrhage. Predictors of primary intraventricular hemorrhage were identified by logistic regression analysis. Results. There were 12 patients with primary intraventricular hemorrhage (0.31% of all cases of stroke included in the database) and 133 in the cohort of subcortical hemorrhage. Very old age (?85 years) (odds ratio (OR) 9.89), atrial fibrillation (OR 8.92), headache (OR 6.89), and altered consciousness (OR 4.36) were independent predictors of intraventricular hemorrhage. The overall in-hospital mortality rate was 41.7% (5/12) but increased to 60% (3/5) in patients aged 85 years or older. Conclusion. Although primary intraventricular hemorrhage is uncommon, it is a severe clinical condition with a high early mortality. The prognosis is particularly poor in very old patients. PMID:22966468

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

    PubMed Central

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

    2014-01-01

    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

  20. Hemorrhagic fevers, with special reference to recent outbreaks in southern Africa.

    PubMed

    Gear, J H

    1979-01-01

    In considering the diagnosis of a patient admitted to the Johannesburg Hospital, suffering from an illness characterized by high fever and complicated by a hemorrhagic state from which he died, a list of possible causes of his illness was drawn up. This list included the arthropodborne viral infections prevalent in southern Africa, namely, chikungunya fever, Sindbis fever, West Nile fever, yellow fever, and Rift Valley fever; viral infections associated with rodents, such as Lassa fever; the viral infection associated with monkeys, Marburg virus disease; the rickettsial infections; tick-bite fever (the variety of spotted fever of tick typhus occurring in southern Africa) and Q fever; the bacterial infections, especially the coccal infections, plague septicemia, and meningococcal, staphylococcal, and streptococcal septicemia; and the blood protozoal infections malaria and trypanosomiasis. In addition, rubella, Gasser's syndrome, Henoch-Schönlein purpura, and viperine snakebite were briefly described in this review. All of these conditions may be complicated by the development of a hemorrhagic state. The circulation of large numbers of infecting organisms, by they viruses, rickettsiae, bacteria, or protozoa, may initiate the coagulation cascade, the formation of fibrin and its deposition in the finer blood vessels, and the aggregation and entanglement of platelets resulting in marked thrombocytopenia and bleeding. This bleeding tendency is greatly aggravated when the infection specifically involves the parenchymal cells of the liver; such a condition results in defective formation of coagulation factors such as prothrombin. The proper care of patients in whom a hemorrhagic state has developed requires urgent and accurate diagnosis followed by immediate and appropriate treatment that will combat the infection and alleviate the hemorrhagic state and liver disorder. If the hemorrhagic state is due to one of the dangerous infectious fevers, adequate protection of the medical, nursing, and laboratory staff concerned is also vital. PMID:399369

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

    PubMed

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

    2015-01-01

    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 1.5 ml blood/100 g body weight over a period of 10 min. 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 200 nmol) 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 (50 nmol; i.c.v.) completely blocked histamine-evoked hemodynamic and extracellular posterior hypothalamic ACh and Ch changes, whereas H2 and H3/H4 receptor blockers ranitidine (50 nmol; i.c.v.) and thioperamide (50 nmol; 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

  2. Update on exercise-induced pulmonary hemorrhage.

    PubMed

    Sullivan, Stacey; Hinchcliff, Kenneth

    2015-04-01

    Exercise-induced pulmonary hemorrhage (EIPH) is an important disease of horses that perform high-intensity athletic activity. EIPH is an ongoing concern for the racing industry because of its high prevalence; potential impact on performance; welfare concerns; and use of prophylactic medications, such as furosemide, on race day. During the last 10 years, significant progress has been made in understanding the pathogenesis and risk factors for EIPH and the impact of the disease on performance and career. This article summarizes the most recent advances in EIPH. PMID:25770069

  3. Endothelial cells in dengue hemorrhagic fever.

    PubMed

    Srikiatkhachorn, Anon; Kelley, James F

    2014-09-01

    Therapies to prevent or reverse endothelial dysfunction and vascular leak found in dengue hemorrhagic fever (DHF) have not been identified. In this review we summarize dengue viruses and the spectrum of human disease and highlight evidence of endothelial cell dysfunction in DHF based on studies in patients and mouse and tissue culture models. Evidence suggests that both virus antigen and host immune response, can cause endothelial cell dysfunction and weaken endothelial barrier integrity. We suggest possible therapeutic interventions and highlight how therapies targeting altered endothelial function might be evaluated in animal models and in patients with DHF. PMID:25025934

  4. Fatal pulmonary hemorrhage after taking anticoagulation medication

    PubMed Central

    Hammar, Samuel P.

    2015-01-01

    We describe a 64-year-old man with extensive diffuse acute lung hemorrhage, presumably as a result of anticoagulation therapy. We evaluated reports in the literature concerning acute exacerbation (acute lung injury of unknown cause) in UIP and other forms of fibrotic interstitial pneumonias. We also evaluated autopsy tissue in this case in order to determine the cause of death in this 64-year-old man, who was initially thought to have an asbestos-related disease. Based on the autopsy findings, this man died as a result of anticoagulation therapy; specifically, the use of Xarelto® (rivaroxaban). PMID:26236607

  5. Emergence of Crimean-Congo hemorrhagic fever.

    PubMed

    Leblebicioglu, Hakan; Ozaras, Resat; Erciyas-Yavuz, Kiraz

    2015-11-01

    Crimean-Congo hemorrhagic fever (CCHF) is a life-threatening tick-borne infection in Africa and Eurasia. Although knowledge of epidemiology is increasing, the global extent and risk of infection is not well described. A niche-modeling framework has been used to map the global distribution of risk for CCHF based on analysis of human CCHF reports. The new risk maps provide a valuable starting point for understanding the zoonotic niche of CCHF. Migratory birds travelling across continents may also introduce CCHF to new areas through attached ticks. There is an overlap between CCHF endemic areas and breeding and wintering grounds of migratory birds. PMID:26464230

  6. Hemorrhage Near Fetal Rat Bone: Preliminary Results

    NASA Astrophysics Data System (ADS)

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

    2006-05-01

    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 μs. 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.

  7. Endothelial Cells in Dengue Hemorrhagic Fever

    PubMed Central

    Kelley, James F.

    2014-01-01

    Therapies to prevent or reverse endothelial dysfunction and vascular leak found in dengue hemorrhagic fever (DHF) have not been identified. In this review we summarize dengue viruses and the spectrum of human disease and highlight evidence of endothelial cell dysfunction in DHF based on studies in patients and mouse and tissue culture models. Evidence suggests that both virus antigen and host immune response, can cause endothelial cell dysfunction and weaken endothelial barrier integrity. We suggest possible therapeutic interventions and highlight how therapies targeting altered endothelial function might be evaluated in animal models and in patients with DHF. PMID:25025934

  8. Thalamic Reorganization in Chronic Patients With Intracerebral Hemorrhage

    PubMed Central

    Jang, Sung Ho; Chang, Chul Hoon; Kim, Seong Ho; Jung, Young Jin; Hong, Ji Heon

    2015-01-01

    Abstract The aim of this study was to investigate changes of synaptic area of the spinothalamic tract and its thalamocortical pathway (STT) in the thalamus in chronic patients with putaminal hemorrhage. Twenty four patients with a lesion in the ventral posterior lateral nucleus (VPL) of the thalamus following putaminal hemorrhage were recruited for this study. The subscale for tactile sensation of the Nottingham Sensory Assessment (NSA) was used for the determination of somatosensory function. Diffusion tensor tractography of the STT was reconstructed using the Functional Magnetic Resonance Imaging of the Brain Software Library. We classified patients according to 2 groups: the VPL group, patients whose STTs were synapsed in the VPL; and the non-VPL group, patients whose STTs were synapsed in other thalamic areas, except for the VPL. Thirteen patients belonged to the VPL group, and 8 patients belonged to the non-VPL group. Three patients were excluded from grouping due to interrupted integrity of the STTs. The tactile sensation score of the NSA in the non-VPL group (10.50 ± 0.93) was significantly decreased compared with that of the VPL group (19.45 ± 1.33) (P < 0.05). We found that 2 types of patient had recovered via the VPL area or other areas of the STT. It appears that patients who showed shifting of the thalamic synaptic area of the STT might have recovered by the process of thalamic reorganization following thalamic injury. In addition, thalamic reorganization appears to be related to poorer somatosensory outcome. PMID:26313781

  9. Multiple Intracerebral Hemorrhages in an Old Patient with Rheumatoid Arthritis.

    PubMed

    Cojocaru, Inimioara Mihaela; Ştefănescu, V; Traşcă, Daniela; Şerban-Pereţeanu, Adelina; Chicoş, B; Cojocaru, M

    2015-01-01

    A 78-year-old Caucasian man was admitted in the Department of Neurology for visual disturbances, started two days before. The next day the patient experienced headache, fever and gait disturbances. He had hypertension, diabetes mellitus, an ischemic stroke 13 years ago, longstanding seronegative rheumatoid arthritis (17 years), polynodular goiter, right ischio-pubian fracture and right femoral vein thrombosis a year ago due to a car accident, since he is treated with oral anticoagulants associated to antiaggregant, hypotensors, statin and oral antidiabetics. The neurologic examination had evidenced nuchal rigidity, left homonymous hemianopsia, left central facial palsy, ataxia of the inferior limbs with wide-based gait, achilean reflexes abolished bilaterally, bilaterally abolished plantar reflexes, ideomotor apraxia, dysarthria, hypoprosexia, and preserved consciousness patient. A non-contrast cerebral CT scan had shown right temporal and parieto-occipital intraparenchymatous hemorrhages, a right frontal sequelar lesion, multiple old lacunar infarets, cortical atrophy. Laboratory findings included an inflammatory syndrome, absence of rheumatoid arthritis positive serology, normal coagulogram, an elevated proteinuria. The cerebral IRM performed on the seventh day of hospitalisation was suggestive for subacute right parietal hemorrhage, old cerebral infarction in the right anterior cerebral artery area, old lacunar infarcts and cerebral atrophy. The anticoagulant and antiaggregant treatment was stopped after a generalized tonic-clonic seizure occurred. Antiedematous, hypotensor, anticonvulsivant, beta-blocker, and symptomatic treatment was started, while the antidiabetic treatment was continued. All symptoms remitted. Arguments for amyloid angiopathy in our patient are previous non-cardioembolic ischemic stroke and a chronic inflammatory disease- rheumatoid arthritis in his personal medical history. PMID:26939215

  10. Epizootic hemorrhagic disease virus in captive bison, elk, white-tailed deer, cattle, and goats from Colorado

    Technology Transfer Automated Retrieval System (TEKTRAN)

    A captive wildlife research facility in Fort Collins, Colorado experienced mortality in white-tailed deer (Odocoileus virginianus) due to epizootic hemorrhagic disease virus (EHDV) infection in late summer and early fall of 2007. RNA from EHDV was amplified by RT-PCR from the spleen and lung tissue...

  11. Blocking neutrophil diapedesis prevents hemorrhage during thrombocytopenia

    PubMed Central

    Hillgruber, Carina; Pppelmann, Birgit; Weishaupt, Carsten; Steingrber, Annika Kathrin; Wessel, Florian; Berdel, Wolfgang E.; Gessner, J. Engelbert; Ho-Tin-No, Benot

    2015-01-01

    Spontaneous organ hemorrhage is the major complication in thrombocytopenia with a potential fatal outcome. However, the exact mechanisms regulating vascular integrity are still unknown. Here, we demonstrate that neutrophils recruited to inflammatory sites are the cellular culprits inducing thrombocytopenic tissue hemorrhage. Exposure of thrombocytopenic mice to UVB light provokes cutaneous petechial blee