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


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

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



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


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

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



Subarachnoid hemorrhage due to retained lumbar drain.  


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

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



Recovery from Intracranial Hemorrhage Due to Leptospirosis  

PubMed Central

Intracranial hemorrhage is a rare and fatal presentation of leptospirosis. In this paper we present the case of a 51-year-old male farmer who lives in northern Iran. He came to our hospital with a severe headache. A paraclinical evaluation showed clear signs of thrombocytopenia, and a brain MRI revealed left temporoparietal hemorrhage. Our preliminary diagnosis was Leptospirosis, and after 26 days of hospital care the patient was discharged in good condition. This paper will educationally help physicians in better diagnosis and treatment of leptospirosis.

Babamahmoodi, Farhang; Babamhmoodi, Abdolreza



Bilateral hemorrhagic pleural effusion due to kerosene aspiration  

PubMed Central

Kerosene ingested, intentionally or accidentally, is toxic. Data is scarce on complications and outcomes of hydrocarbon poisoning following kerosene aspiration in adults and there has been no known case of bilateral hemorrhagic effusion occurring due to it in literature. We, hereby, report a case of a bilateral hemorrhagic pleural effusion secondary to hydrocarbon aspiration in a 40-year old adult.

Prasad, Rajendra; Karmakar, Saurabh; Sodhi, Rakhee; Karmakar, Shilpi



Pseudo-subarachnoid hemorrhage and death after a bee sting.  


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

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



Fetal intracranial hemorrhage due to antenatal low dose aspirin intake  

Microsoft Academic Search

Antenatal intake of low dose aspirin is advised 1,2 for prevention of pregnancy induced hypertension, intrauterine growth\\u000a retardation and pre-term labour. Aspirin has an anticoagulant effect due to its action onCyclo-oxygenase and vitamin K dependant coagulation factors. It can readily cross the placental barrier and be a potential cause for bleeding\\u000a tendency in the fetus. Fetal intracranial hemorrhage, following low

C. K. Sasidharan; P. M. Kutty; Ajithkumar; N. Sajith



Cardiac manifestations of subarachnoid hemorrhage.  


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

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



Gastrointestinal Hemorrhage Due to Duodenal Erosion by a Biliary Wallstent  

SciTech Connect

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.

Roebuck, Derek J.; Stanley, Philip [Department of Radiology, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027 (United States); Katz, Michael D. [Department of Radiology, University of Southern California, 1500 San Pablo Street, Los Angeles, CA 90033 (United States); Parry, Robert L. [Department of Surgery, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027 (United States); Haight, Michael A. [Department of Gastroenterology, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027 (United States)



PKC and Rho in vascular smooth muscle: activation by BOXes and SAH CSF.  


Cerebral vasospasm (CV) remains a significant cause of delayed neurological deficit and ischemic damage after subarachnoid hemorrhage (SAH), despite intensive research effort. The current lack of an effective therapeutic approach is somewhat due to our lack of understanding regarding the mechanism by which this pathological constriction develops. Recent evidence implicates bilirubin oxidation products (BOXes) in the etiology of CV after SAH: BOXes are found in cerebrospinal fluid from SAH patients with symptomatic or angiographically visible vasospasm (CSFV) but not in CSF from SAH patients with no vasospasm (CSFC). We have previously published research suggesting that the etiology of CV comprises two components: a physiological stimulation to constrict and a pathological failure to relax. Both these components are elicited by CSFV, but not CSFC, and BOXes synthesized in the laboratory potentiate physiological constriction in arterial smooth muscle in vitro, and elicit contraction in pial arteries in vivo. In this paper, we will present our results concerning the action of BOXes on arterial smooth muscle constriction, compared with CSFV. We will also present evidence implicating temporal changes in PKC isoforms and Rho expression in both BOXes- and CSFV-elicited smooth muscle responses. PMID:17981646

Pyne-Geithman, Gail J; Nair, Sunil G; Caudell, Danielle N; Clark, Joseph F



Life-threatening gastrointestinal hemorrhage due to juvenile polyposis  

Microsoft Academic Search

A 14-yr-old, previously healthy boy presented with massive lower GI hemorrhage. After the routine endoscopic and radiological evaluation, laparotomy and intraoperative colonoscopy revealed multiple polyps in the colon. A hemicolectomy was performed because of the severity of hemorrhage. A diagnosis of juvenile polyposis was made based upon histological findings and the family history. This is an extremely unusual presentation of

Dinesh Pashankar; James J. Murphy; Avrum Ostry; Richard A. Schreiber



Spinal syringomyelia following subarachnoid hemorrhage  

Microsoft Academic Search

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

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


Hemorrhagic stroke: aneurysmal subarachnoid hemorrhage.  


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

Martin, Coleman O; Rymer, Marilyn M


Subarachnoid hemorrhage and negative angiography: clinical course and long-term follow-up.  


The aim of this study was to investigate the long-term natural history of nontraumatic angiogram-negative subarachnoid hemorrhage with typical pretruncal (P-SAH) and diffuse (D-SAH) pattern of hemorrhage. A retrospective review of 102 patients who experienced angiographically negative SAH at our institution was undertaken (11.6% of 882 spontaneous SAH). Follow-ups were obtained at 7.9 to 16 years. In the D-SAH group, 11 patients (13.9%) out of 79 had an aneurysm, and four (5.1%) had rebleeding episodes. In the P-SAH group, the second angiography was negative in all of the 23 cases, and no rebleeding episodes were recorded. The long-term follow-up confirms that P-SAH is a benign disease. A second angiography could not be necessary. D-SAH is probably due to an aneurysm that thrombose early after the bleeding. At short-term follow-up, the sack could frequently recanalize and rebleed, whereas a late follow-up shows that rebleeding is very rare. PMID:21607573

Fontanella, Marco; Rainero, Innocenzo; Panciani, Pier Paolo; Schatlo, Bawarjan; Benevello, Chiara; Garbossa, Diego; Carlino, Christian; Valfrè, Walter; Griva, Federico; Bradac, Gianni Boris; Ducati, Alessandro



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


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

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



Hyperbaric Oxygen for Cerebral Vasospasm and Brain Injury Following Subarachnoid Hemorrhage  

Microsoft Academic Search

The impact of acute brain injury and delayed neurological deficits due to cerebral vasospasm (CVS) are major determinants\\u000a of outcomes after subarachnoid hemorrhage (SAH). Although hyperbaric oxygen (HBO) had been used to treat patients with SAH,\\u000a the supporting evidence and underlying mechanisms have not been systematically reviewed. In the present paper, the overview\\u000a of studies of HBO for cerebral vasospasm

Robert P. Ostrowski; John H. Zhang


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

Microsoft Academic Search

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

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



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


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

Furuno, M; Nishiura, I; Koyama, T



[Case of postpartum intracerebral hemorrhage due to pregnancy induced hypertension].  


A 32-year-old woman, gravida 0, para 0, was admitted to the obstetrics department of our hospital after a cesarean section at 35 weeks of gestation. The cesarean section was performed because pregnancy induced hypertension (PIH) had worsened. The next day, she suddenly became drowsy and developed right hemiparesis and anisocoria. Computed tomography of the brain showed intracerebral hemorrhage in the parietal lobe with uncal herniation. She underwent an urgent craniotomy and removal of the hematoma. Five days later, magnetic resonance angiography (MRA) of the brain showed vasospasm of the bilateral intracranial internal carotid arteries, middle cerebral arteries, and anterior cerebral arteries. Thirteen days later, cerebral angiography showed cessation of vasospasm and vascular abnormalities such as moyamoya disease, arteriovenous malformation and cerebral aneurysm were not observed. Twenty-one days later, MRA showed the absence of vasospasm in those arteries, but her right hemiparesis and sensory aphasia persisted. Twenty-six days later, she was transferred to another hospital for further rehabilitation. Neurosurgeons should be aware of the possibility of intracerebral hemorrhage caused by PIH. In this manuscript, we provide a case presentation and review of the literature. PMID:22128271

Matsuda, Ryosuke; Fujimoto, Takatoshi; Tamura, Kentaro; Motoyama, Yasushi; Park, Young-Su; Nakase, Hiroyuki



Liver hemorrhage due to idiopathic peliosis hepatis successfully treated with hepatic artery embolization.  


Peliosis hepatis is an extremely rare condition that may cause fatal hepatic hemorrhage and liver failure. We report a case of liver hemorrhage due to idiopathic peliosis hepatis. A 60-year-old woman was admitted to our hospital with slight right hypochondriac pain. She went into hemorrhagic shock, and computed tomography (CT) showed multiple low-density areas in the right liver with massive subcapsular blood collection. Selective transfemoral arteriography of the celiac artery revealed no signs of vascular malformation or tumor stain, but showed signs of pooling in the right posterior segmental artery. The artery was embolized with particles of gelatin sponge, and hemostatic control was successful. Although peliosis hepatis is extremely rare, the diagnosis is significant because of its urgent clinical status, and transarterial embolization is a useful and minimally invasive procedure for liver hemorrhage due to peliosis hepatis. PMID:22808612

Suzuki, Shigemasa; Suzuki, Hideki; Mochida, Yasushi; Hirai, Hanako; Yoshida, Takeshi; Ide, Munenori; Tani, Masachika; Shimura, Tatsuo; Morinaga, Nobuhiro; Ishizaki, Masatoshi; Kuwano, Hiroyuki


A case of pure agraphia due to left thalamic hemorrhage.  


Pure agraphia is an isolated writing disturbance without intellectual impairment, aphasia, alexia, or apraxia. The authors report a case of pure agraphia following left thalamic hemorrhage. The patient showed impairment in the writing of both kanji and kana. The most frequent error in the writing of kanji was substitution (46%) followed by no reaction (23%) and partial omission or addition of characters (21%). The copying of kanji by hand was normal. Even when the patient was unable to write a kanji character, he understood the meaning and correctly recited the other readings. He complained that he could not recall the graphic image of the kanji. When we cued the patient by writing a part of a kanji he initially failed to recall, he correctly completed the character. The kanji and kana he was unable to write were inconsistent over time: in some cases he was unable to write words he had successfully written a week before, and vice versa. These findings suggested that the patient's pure agraphia resulted from combined impairments in recalling and selecting letters. While the thalamic lesion might have influenced the manifestation of pure agraphia, the dysfunction seemed to originate from the secondary negative effect of the lesion on the function of the left cerebral cortex. PMID:21319033

Toyokura, Minoru; Kobayashi, Ryouko; Aono, Kouji



P2X7R/cryopyrin inflammasome axis inhibition reduces neuroinflammation after SAH.  


Neuroinflammation contributes to the pathogenesis of early brain injury (EBI) after subarachnoid hemorrhage (SAH). Cytotoxic events following SAH, such as extracellular accumulation of adenosine triphosphate (ATP), may activate the P2X purinoceptor 7 (P2X7R)/cryopyrin inflammasome axis, thus inducing the proinflammatory cytokine IL-1?/IL-18 secretion. We therefore hypothesized that inhibition of P2X7R/cryopyrin inflammasome axis would ameliorate neuroinflammation after SAH. In the present study, SAH was induced by the endovascular perforation in rats. Small interfering RNAs (siRNAs) of P2X7R or cryopyrin were administered intracerebroventricularly 24h before SAH. Brilliant blue G (BBG), a non-competitive antagonist of P2X7R, was administered intraperitoneally 30min following SAH. Post-assessments including SAH severity score, neurobehavioral test, brain water content, Western blot and immunofluorescence, were performed. Administration of P2X7R and cryopyrin siRNA as well as pharmacologic blockade of P2X7R by BBG ameliorated neurological deficits and brain edema at 24h following SAH. Inhibition of P2X7R/cryopyrin inflammasome axis suppressed caspase-1 activation, which subsequently decreased maturation of IL-1?/IL-18. To investigate the link between P2X7R and cryopyrin inflammasome in vivo, Benzoylbenzoyl-ATP (BzATP), a P2X7R agonist, was given to lipopolysaccharide (LPS) primed naive rats with scramble or cryopyrin siRNAs. In LPS-primed naive rats, BzATP induced caspase-1 activation and mature IL-1? release were neutralized by cryopyrin siRNA. Thus, the P2X7R/cryopyrin inflammasome axis may contribute to neuroinflammation via activation of caspase-1 and thereafter mature IL-1?/IL-18 production following SAH. Therapeutic interventions targeting P2X7R/cryopyrin pathway may be a novel approach to ameliorate EBI following SAH. PMID:23816751

Chen, Sheng; Ma, Qingyi; Krafft, Paul R; Hu, Qin; Rolland, William; Sherchan, Prativa; Zhang, Jianmin; Tang, Jiping; Zhang, John H



Subarachnoid and intraventricular hemorrhage due to ruptured aneurysm after combined spinal-epidural anesthesia.  


A patient received combined spinal-epidural anesthesia for a scheduled total knee arthroplasty. After an injection of spinal anesthetic and ephedrine due to a decrease in blood pressure, the patient developed a severe headache. The patient did not respond to verbal command at the completion of the operation. A brain CT scan revealed massive subarachnoid and intraventricular hemorrhages, and a CT angiogram showed a ruptured aneurysm. Severe headaches should not be overlooked in an uncontrolled hypertensive patient during spinal anesthesia because it may imply an intracranial and intraventricular hemorrhage due to the rupture of a hidden aneurysm. PMID:20376909

Chun, Duk-Hee; Kim, Na-Young; Shin, Yang-Sik



Delayed presentation of shock due to retroperitoneal hemorrhage following a fall  

PubMed Central

During trauma the abdomen is one region which cannot be ignored. Due to its Complex anatomy it is very important that all the areas in the abdomen be examined both clinically and radiologicaly to rule out any abdominal bleeding as a cause of Hemorrhagic Shock Following Trauma. Our case justifies the above.

Naguib, Nader N N



Incidence of Recurrent Subarachnoid Hemorrhage After Clipping for Ruptured Intracranial Aneurysms  

Microsoft Academic Search

Background and Purpose—Because intracranial aneurysms develop during life, patients with subarachnoid hemorrhage (SAH) and successfully occluded aneurysms are at risk for a recurrence. We studied the incidence of and risk factors for recurrent SAH in patients who regained independence after SAH and in whom all aneurysms were occluded by means of clipping. Methods—From a cohort of patients with SAH admitted

Marieke J. H. Wermer; Paut Greebe; Ale Algra; Gabriel J. E. Rinkel



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


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 (Wegener's 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

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



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

PubMed Central

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 (Wegener’s 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.

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



CT and clinical features of hemorrhage extending along the pulmonary artery due to ruptured aortic dissection  

Microsoft Academic Search

The purpose was to evaluate CT findings of hemorrhage extending along the pulmonary artery (PA) due to ruptured aortic dissection\\u000a (AD) and its prognostic factors. In 232 patients with Stanford type A AD, 21 patients (9.1%; 11 women; mean 70.3 years) were\\u000a diagnosed. Twelve patients had double-barreled (classic) AD, and nine patients had intramural hematoma (IMH; closed false\\u000a lumen) of the

Eijun Sueyoshi; Yohjiro Matsuoka; Ichiro Sakamoto; Masataka Uetani



Lumbar Catheter for Monitoring of Intracranial Pressure in Patients with PostHemorrhagic Communicating Hydrocephalus  

Microsoft Academic Search

Background  We investigated the feasibility and accuracy of intracranial pressure (ICP)-measurement by lumbar drainage (LD) catheter in\\u000a patients with post-hemorrhagic communicating hydrocephalus (PHCH).\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Patients with subarachnoid hemorrhage (SAH, n = 21) or spontaneous ganglionic hemorrhage (ICH, n = 22) with ventricular involvement and the need for external ventricular drainage (EVD) due to acute hydrocephalus were included.\\u000a When EVD weaning was not feasible due to persistent

Verena SpeckDimitre; Dimitre Staykov; Hagen B. Huttner; Roland Sauer; Stefan Schwab; Juergen Bardutzky



Risk Factors for Aneurysmal Subarachnoid Hemorrhage in Aomori, Japan  

Microsoft Academic Search

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

Hiroki Ohkuma; Hidefumi Tabata; Shigeharu Suzuki; Shafiqul Islam



Prehospital HMG CoA reductase inhibitor use and reduced mortality in hemorrhagic shock due to trauma  

Microsoft Academic Search

Introduction  3-Hydroxy-3-methyl-glutaryl Co-A reductase inhibitors (HMG Co-A reductase inhibitors, statins) are commonly used medications\\u000a for the control of serum cholesterol. Recent data suggests that these medications also modify the inflammatory pathways in\\u000a sepsis, septic shock, and hemorrhagic shock due to ruptured abdominal aortic aneurysms. Statin use in hemorrhagic shock due\\u000a to trauma, however, has conflicting data, with one study showing improvement,

J. M. Feeney; V. Jayaraman; J. Spilka; D. S. Shapiro; S. Ellner; W. T. Marshall; L. M. Jacobs


Severe primary postpartum hemorrhage due to genital tract laceration after operative vaginal delivery: successful treatment with transcatheter arterial embolization  

Microsoft Academic Search

The purpose of this study was to report our experience in the management of severe primary postpartum hemorrhage due to genital\\u000a tract laceration following operative vaginal delivery with forceps using pelvic transcatheter arterial embolization (TAE).\\u000a Ten women (mean age, 31.9 years) with severe primary postpartum hemorrhage due to genital tract laceration after operative\\u000a delivery with forceps were treated with TAE. TAE

Yann Fargeaudou; Philippe Soyer; Olivier Morel; Marc Sirol; Olivier le Dref; Mourad Boudiaf; Henri Dahan; Roland Rymer



John Montgomery's legacy: carbocyclic adenosine analogues as SAH hydrolase inhibitors with broad-spectrum antiviral activity.  


Ever since the S-adenosylhomocysteine (AdoHcy, SAH) hydrolase was recognized as a pharmacological target for antiviral agents (J. A. Montgomery et al., J. Med. Chem. 25:626-629, 1982), an increasing number of adenosine, acyclic adenosine, and carbocyclic adenosine analogues have been described as potent SAH hydrolase inhibitors endowed with broad-spectrum antiviral activity. The antiviral activity spectrum of the SAH hydrolase inhibitors include pox-, rhabdo-, filo-, arena-, paramyxo-, reo-, and retroviruses. Among the most potent SAH hydrolase inhibitors and antiviral agents rank carbocyclic 3-deazaadenosine (C-c3 Ado), neplanocin A, 3-deazaneplanocin A, the 5'-nor derivatives of carbocyclic adenosine (C-Ado, aristeromycin), and the 2-halo (i.e., 2-fluoro) and 6'-R-alkyl (i.e., 6'-R-methyl) derivatives of neplanocin A. These compounds are particularly active against poxviruses (i.e., vaccinia virus), and rhabdoviruses (i.e., vesicular stomatitis virus). The in vivo efficacy of C-c3 Ado and 3-deazaneplanocin A has been established in mouse models for vaccinia virus, vesicular stomatitis virus, and Ebola virus. SAH hydrolase inhibitors such as C-c3Ado and 3-deazaneplanocin A should in thefirst place be considered for therapeutic (or prophylactic) use against poxvirus infections, including smallpox, and hemorrhagic fever virus infections such as Ebola. PMID:16438025

De Clercq, Erik



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

Microsoft Academic Search

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

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



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

PubMed Central

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

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



Suppression of the Rho/Rho-Kinase Pathway and Prevention of Cerebral Vasospasm by Combination Treatment with Statin and Fasudil After Subarachnoid Hemorrhage in Rabbit.  


The Rho/Rho-kinase pathway is considered important in the pathogenesis of sustained smooth muscle cell contraction during cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH). The aims of this study were to investigate whether combination treatment, with pitavastatin as an inhibitor of RhoA and fasudil as an inhibitor of Rho-kinase, prevents the cerebral vasospasm. SAH was simulated using the double-hemorrhage rabbit model, and pitavastatin, or fasudil, or both (combination treatment) were administrated. The basilar artery (BA) cross-sectional area only in the combination treatment group was statistically larger than in the SAH group (p?SAH group (p?SAH group. The expression of endothelial nitric oxide synthase (eNOS), evaluated by immunohistochemistry in the pitavastatin group and the combination group, was higher than in the SAH group. Results indicate that combination treatment could extensively prevent cerebral vasospasm due to the synergic effect of combining pitavastatin and fasudil on the Rho/Rho-kinase pathway and on eNOS. PMID:23658597

Naraoka, Masato; Munakata, Akira; Matsuda, Naoya; Shimamura, Norihito; Ohkuma, Hiroki



Cerebral Energy Metabolism after Subarachnoid Hemorrhage.  

National Technical Information Service (NTIS)

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

J. M. Fein



Cardiac manifestations after subarachnoid hemorrhage: A systematic review of the literature  

Microsoft Academic Search

Cardiac alterations associated with subarachnoid hemorrhage (SAH) have been recognized and frequently reported. We systematically reviewed the literature on MEDLINE using the key words: SAH + (heart, cardiac, electrocardiogram, cardiac enzymes, troponin, myoglobin, echocardiography, scintigraphy, Holter, and regional wall motion abnormalities) and included all articles describing cardiac abnormalities in the course of SAH whether spontaneous or secondary. The diagnosis of

Yasser L. Sakr; Issam Ghosn; Jean Louis Vincent



Multivariate Analysis of Predictors of Cerebral Vasospasm Occurrence After Aneurysmal Subarachnoid Hemorrhage  

Microsoft Academic Search

Background and Purpose—The role of type of treatment on cerebral vasospasm occurrence after aneurysmal subarachnoid hemorrhage (SAH) has not been studied. Through multivariate analysis we determined the independent prognostic factors of the occurrence of symptomatic vasospasm following aneurysmal SAH in a study cohort of 244 patients undergoing either surgical or endovascular treatment. The prognostic factors of sequelae after aneurysmal SAH

Claire Charpentier; Gerard Audibert; Francis Guillemin; Thierry Civit; Xavier Ducrocq; Serge Bracard; Henri Hepner; Luc Picard; Marie Claire Laxenaire


Sentinel Headache and the Risk of Rebleeding After Aneurysmal Subarachnoid Hemorrhage  

Microsoft Academic Search

Background and Purpose—The clinical significance of sentinel headaches in patients with subarachnoid hemorrhage (SAH) is still unknown. We investigated whether patients with a sentinel headache (SH) have a higher rate of rebleeding after SAH. Methods—An SH was defined as a sudden, severe, unknown headache lasting 1 hour with or without accompanying symptoms, not leading to a diagnosis of SAH in

Jurgen Beck; Andreas Raabe; Andrea Szelenyi; Joachim Berkefeld; Rudiger Gerlach; Matthias Setzer; Volker Seifert



Regional Patterns of Left Ventricular Systolic Dysfunction After Subarachnoid Hemorrhage: Evidence for Neurally Mediated Cardiac Injury  

Microsoft Academic Search

Although left ventricular (LV) dysfunction has been described after subarachnoid hemorrhage (SAH), its pathophysiology, regional distribution, and reversibility remain uncertain. To test the hypothesis that regional wall motion patterns in SAH patients do not match the typical patterns observed in coronary artery disease, a segmental wall motion analysis was performed in 30 SAH patients with LV dysfunction. Both regional (n

Jonathan G Zaroff; Guy A Rordorf; Christopher S Ogilvy; Michael H Picard



The Effect of a Simulated Subarachnoid Hemorrhage on Cerebral Blood Flow in The Monkey.  

National Technical Information Service (NTIS)

The hydrogen clearance method was used to measure local and total cerebral blood flow (CBF) in the rhesus monkey before and for 5 hours after a simulated subarachnoid hemorrhage (SAH). CBF remained stable after SAH unless SAH was associated with a fall in...

A. N. Martins T. F. Doyle N. Newby A. I. Kobrine A. Ramirez



Spinal syringomyelia following subarachnoid hemorrhage.  


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

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



Spinal vascular malformations in non-perimesencephalic subarachnoid hemorrhage  

Microsoft Academic Search

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

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



Correlation of Clinical Outcome with Pressure, Oxygen, and Flow-Related Indices of Cerebrovascular Reactivity in Patients Following Aneurysmal SAH  

Microsoft Academic Search

Background  \\u000a Impaired cerebrovascular reactivity (CR) has been reported to be associated with adverse outcome in patients with aneurysmal\\u000a subarachnoid hemorrhage (aSAH). However, CR may be determined using different paradigms and it is unclear, which measurement\\u000a method most suitable reflects the clinical course or is able to predict clinical deterioration.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Twenty-one aSAH patients were included in this study. Following occlusion of

Martin Barth; Johannes Woitzik; Christel Weiss; Elke Muench; Michael Diepers; Peter Schmiedek; Hidetoshi Kasuya; Peter Vajkoczy



Static perfect fluids with Pant-Sah equations of state  

NASA Astrophysics Data System (ADS)

We analyze the 3-parameter family of exact, regular, static, spherically symmetric perfect fluid solutions of Einstein’s 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.

Simon, Walter



Intracranial hemorrhage due to intracranial hypertension caused by the superior vena cava syndrome.  


We report a patient with intracranial hemorrhage secondary to venous hypertension as a result of a giant aortic pseudoaneurysm that compressed the superior vena cava and caused obstruction of the venous return from the brain. To our knowledge, this is the first patient reported to have an intracranial hemorrhage secondary to a superior vena cava syndrome. The condition appears to be caused by a reversible transient rise in intracranial pressure, as a result of compression of the venous return from the brain. Treatment consisted of surgery for the aortic pseudoaneurysm, which led to normalization of the intracranial pressure and resorption of the intracranial hemorrhage. PMID:23665082

Bartek, Jiri; Abedi-Valugerdi, Golbarg; Liska, Jan; Nyström, Harriet; Andresen, Morten; Mathiesen, Tiit



Orbital apex syndrome due to aspergillosis with subsequent fatal subarachnoid hemorrhage  

PubMed Central

Background: Orbital apex syndrome has been described previously as a syndrome involving damage to the oculomotor nerve (III), trochlear nerve (IV), abducens nerve (VI), and ophthalmic branch of the trigeminal nerve (V1), in association with optic nerve dysfunction. It may be caused by inflammatory, infectious, neoplastic, iatrogenic, or vascular processes. Case Description: A 73-year-old female having hypertension and rheumatoid arthritis stage 4 under long-term corticosteroid therapy presented to us with the right side orbital apex syndrome. Her magnetic resonance imaging (MRI) of orbit showed progression of a lesion at the right orbital apex and adjacent right superior orbital fissure with mild extension to the right posterior ethmoid sinus. She underwent endoscopic endonasal transethmoid approach with the removal of the lesion. The pathology showed a picture of fungal infection and the culture of the specimen proved Aspergillus fumigatus. Her postoperative course was smooth until 5 days after surgery, when she suffered a massive spontaneous subarachnoid hemorrhage resulting from a ruptured aneurysm, which was proven by computed tomography angiography (CTA) of brain. Unfortunately, she expired due to central failure. Conclusion: In cases of immunocompromised patients having orbital apex syndrome, fungal infection should be kept in mind. One of the most lethal but rare sequels of CNS fungal infection is intracranial aneurysms. Early diagnosis and radical resection, combined with antifungal medications is the key to save this particular group of patients.

Yip, Chi-Man; Hsu, Shu-Shong; Liao, Wei-Chuan; Chen, Jun-Yih; Liu, Su-Hao; Chen, Chih-Hao



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

PubMed Central

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



Zinc protoporphyrin aggravates cerebral ischemic injury following experimental subarachnoid hemorrhage.  


This study was aimed to evaluate the influence of an antagonist of heme oxygenase, zinc protoporphyrin IX (ZnPPIX), on the production of endogenous carbon monoxide (CO) and the secondary cerebral injury after subarachnoid hemorrhage (SAH). Wistar rats were divided into non-SAH, SAH, and ZnPPIX groups. Autologus arterial hemolysate was injected into rat cisterna magna to induce SAH. CO and cyclic guanosine monophosphate (cGMP) levels in the brain, and lactate dehydrogenase (LDH) activity in serum were determined 24 hours and 72 hours after cisternal injection. It was found that 24 hours and 72 hours after SAH, the CO contents in SAH group were increased by 20.76% and 37.36%, respectively. CO content in ZnPPIX group was statistically lower than that in SAH group. No obvious change of cGMP content in SAH group was found. However, cGMP content in ZnPPIX group was lower than that in SAH group. Serum LDH activity increased significantly after induction of SAH. LDH activity in ZnPPIX group increased to a greater extent. It was concluded that ZnPPIX aggravates the cerebral injury secondary to experimental SAH by inhibiting the production of endogenous CO. The activation of HO/CO pathway is an intrinsic protective mechanism against cerebral ischemic injury after SAH. PMID:16543643

Sun, Bao-Liang; An, Wei; Xia, Zuo-Li; Zheng, Cheng-Bi; Li, Wen-Xia; Yang, Ming-Feng; Zhao, Tong; Ye, Wen-Jing



Bevacizumab for glioblastoma multiforme after traumatic subarachnoid hemorrhage.  


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

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



A Severe Vicious Cycle in Uncontrolled Subarachnoid Hemorrhage: the Effects on Cerebral Blood Flow and Hemodynamic Responses upon Intracranial Hypertension  

Microsoft Academic Search

In subarachnoid hemorrhage (SAH), Cushing postulated that the increase in systemic arterial pressure (SAP) in response to elevation of intracranial pressure (ICP) was beneficial to cerebral perfusion. However, in uncontrolled SAH, the increased SAP may cause more bleeding into the subarachnoid space and further increase the ICP. We created an animal model to simulate SAH by connecting a femoral arterial

Chain-Fa Su; Yi-Ling Yang; Ming-Che Lee; Hsing I Chen


Fatal postpartum air embolism due to uterine inversion and atonic hemorrhage.  


We report a case of a 19-year-old woman who developed a persistent uterine hemorrhage after spontaneous delivery of a healthy child. Emergency laparotomy was indicated and then begun under stable circulatory conditions. Cardiac arrest occurred during the course of massive manual compression and packing of the uterus. After successful resuscitation, a supracervical hysterectomy was performed. During the suturing of the remaining cervix, a second cardiac arrest followed. The procedure was completed under constant external heart massage. Resuscitation was terminated due to the persistence of widened pupils. An autopsy was ordered by the public prosecutor as the manner of death was declared to be unascertained. An X-ray and a CT scan prior to the autopsy showed extensive gas embolism in both arterial and venous vessels extending from the pelvic region to the head. During the autopsy, gas was collected by aspirometer from the right ventricle of the heart. The autopsy showed no additional relevant findings, and gas analysis confirmed the suspicion of air embolism. The histological examination of the excised uterus especially in the corpus/fundus revealed an edema of the local smooth muscle cells and dilated vessels showing no sign of thrombogenesis. Upon evaluation of the clinical records, it became evident that, in addition to uterine atony, there had been a complete uterine inversion. This inversion was manually repositioned. After this maneuver, manual compression was performed. The air embolism, thus, was a complication of the manual repositioning of the uterine inversion. There is no evidence for other possible entries of the detected gas. In order to perform an effective exploration, the availability of all clinical records should be mandatory for medico-legal investigations of unexpected postpartum deaths. PMID:23370575

Banaschak, Sibylle; Janßen, Katharina; Becker, Katrin; Friedrich, Krischan; Rothschild, Markus A



Neurological and neurobehavioral assessment of experimental subarachnoid hemorrhage  

Microsoft Academic Search

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

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



Nonthyroidal illness syndrome in patients with subarachnoid hemorrhage due to intracranial aneurysm.  


We have previously reported that subarachnoid hemorrhage due to ruptured intracranial aneurysm (SH) is associated with changes in the hormonal profile in the first 24 hours after the event. We proposed that the hormonal changes observed are due to the intense stress to which the patients are exposed. However, the thyroidal hormonal profile is indicative of the presence of a nonthyroidal illness syndrome (NTIS). In this paper, we examined whether the change in the thyroid hormone profile is compatible with a NTIS. Two groups of patients were included in the study: A) 30 patients with SH (21 females and 9 males; 41.7+/-11.4 years) and B) a control group including 25 patients with benign diseases of the spine (BDS) (lumbar disc hernia or stable spinal trauma) (8 females and 17 males; 41.3+/-14.2 years). In a subgroup of eight patients of each group serum triiodothyronine (T3) and reverse T3 levels were measured. The blood samples were obtained between 8:00 and 9:00 AM. The following results were obtained: The SH group had smaller serum T3 and free T4 levels than the BDS group (p<0.05): T3 (ng/mL): SH = 58.7+/-1.1 and BDS = 74.5+/-13.9; free T4 (ng/dL): SH = 0.9+/-0.2 and BDS = 1.1+/-0.3. There was no significant difference in the serum levels of total thyroxine (T4) and thyroid-stimulating hormone (TSH) between the two groups: T4 ( microg/dL): SH = 6.9+/-1.1 and BDS = 7.4+/-2.1; TSH ( microUI/mL): SH = 1.5+/-0.8 and BDS = 1.8+/-1,0. In the sample of eight patients of each group we had the following results: T3 (ng/mL): SH = 66.8+/-3.8 and BDS = 77.2+/-1.1 (p <0.05); reverse T3 (ng/dL): SH = 32.8+/-8 and BDS = 24.7+/-2.2 (NS); T3/ reverse T3 ratio: SH = 2.6+/-0.3 and BDS = 3.3+/-0.4 (NS). Thyreoglobulin and microsomal antibodies were not detectable, except in one patient in the SH group. In conclusion, the SH patients present serum levels of T3 and free T4 significantly lower than that of BDS patients; the thyroidal hormone profile suggests that SH patients have developed the nonthyroidal illness syndrome. PMID:15122429

Casulari, Luiz Augusto; Mangieri, Paola; Naves, Luciana A; Suzuki, Kunio; Ferreira, Moema; Domingues, Lucilia



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

PubMed Central

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

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



Severe Hemorrhagic Meningoencephalitis Due to Angiostrongylus cantonensis Among Young Children in Sydney, Australia.  


Angiostrongylus cantonensis is the most common cause of eosinophilic meningitis worldwide. We describe 2 cases among young children from Sydney, Australia, where locally acquired infection of children has not been reported previously. Both cases manifested as severe hemorrhagic meningoencephalitis, one resulting in death. Angiostrongyliasis must be considered in acute neurological presentations occurring among individuals who live in endemic areas. PMID:23843445

Morton, Nikola J; Britton, Philip; Palasanthiran, Pamela; Bye, Ann; Sugo, Ella; Kesson, Alison; Ardern-Holmes, Simone; Snelling, Thomas L



Intracisternal infusion of magnesium sulfate solution improved reduced cerebral blood flow induced by experimental subarachnoid hemorrhage in the rat  

Microsoft Academic Search

Magnesium has neuroprotective and antivasospastic properties in the presence of subarachnoid hemorrhage (SAH). The present\\u000a study investigated the effect of intracisternal administration of magnesium on cerebral vasospasm in the experimental SAH\\u000a rat model. The rat double-SAH model (0.2 mL autologous blood injected twice into the cisterna magna) was used. Normal saline\\u000a (SAH group, N?=?8) or 10 mmol\\/L magnesium sulfate in normal saline

Kentaro Mori; Masahiro Miyazaki; Junko Iwata; Takuji Yamamoto; Yasuaki Nakao



Dysphagia due to Retropharyngeal Abscess that Incidentally Detected in Subarachnoid Hemorrhage Patient  

PubMed Central

Cerebral hemorrhage is one of the most common causes of dysphagia. In many cases, dysphagia gets better once the acute phase has passed. Structural lesions such as thyromegaly, cervical hyperostosis, congenital web, Zenker's diverticulum, neoplasm, radiation fibrosis, and retropharyngeal abscess must be considered as other causes of dysphagia as well. Retropharyngeal abscess seldom occur in adults and if it does so, a search for a prior dental procedure, trauma, head and neck infection is needed. The symptoms may include neck pain, dysphagia, sore throat, and in rare cases, dyspnea accompanied by stridor. We present a case and discuss a patient who had dysphagia and neck pain after a cerebral hemorrhage. Testing revealed a retropharyngeal abscess. The symptoms were successfully treated after the administration of antibiotics.

Lee, Jung Hwan; Kwon, Bum Sun; Ryu, Ki Hyung; Lee, Ho Jun; Park, Young Geun; Chang, Ji Hea; Sim, Kyoung Bo



Hemorrhagic necrosis due to peliosis hepatis: imaging findings and pathological correlation  

Microsoft Academic Search

.   Peliosis hepatis is an uncommon liver condition characterized by blood-filled cavities. We report the CT, angiographic and\\u000a MR features of a case of peliosis hepatis with no obvious etiology and spontaneously regressing hemorrhagic necrosis. Helical\\u000a CT showed multiple peripheral low-density regions with foci of spontaneous high density suggesting the presence of blood component.\\u000a On MR imaging, the multiple peripheral

O. Vignaux; P. Legmann; G. de Pinieux; S. Chaussade; C. Spaulding; D. Couturier; A. Bonnin



Intrapleural hemorrhage due to alteplase use in a 6-year-old boy with pleural effusion  

PubMed Central

Background Intrapleural fibrinolytics have been used successfully worldwide for the management of complicated pleural effusions and empyema. Bleeding complications are usually mentioned as rare side effects, but there is no clear information in the literature addressing the alarming outcome that might result following the use of alteplase as a fibrinolytic in the management of complicated parapneumonic effusions. We present a rare, if not unique, case of intrapleural hemorrhage requiring transfusion after alteplase use as a fibrinolytic in a 6-year-old male with complicated parapneumonic effusion. Methods A search of the PubMed database was carried out, using a combination of the following terms: alteplase, fibrinolytic, intrapleural hemorrhage, and side effects. Results The majority of studies found in the search concentrated on the efficacy of intrapleural fibrinolytics in the management of pleural effusion, but very few of the reports addressed the bleeding complications which may be caused by the treatment. Conclusion Although intrapleural and systemic hemorrhage are rare side effects of intrapleural fibrinolytic use, the health care provider must be watchful for these potentially life-threatening complications. Further studies are needed to understand not only the efficacy of fibrinolytics but also their safety, especially in children.

Hendaus, Mohamed A; Abushahin, Ahmad



Location and Size of Ruptured Intracranial Aneurysm and Serious Clinical Outcomes Early after Subarachnoid Hemorrhage: A Population-Based Study in Australasia  

Microsoft Academic Search

Background: It is uncertain whether the location and size of a ruptured intracranial aneurysm (IA) independently influences the outcome of subarachnoid hemorrhage (SAH). Objective: To determine the independent relationship of location and size of a ruptured IA with serious clinical outcomes after SAH in an Australasian population-based study. Methods: From 432 first-ever cases of primary SAH registered prospectively over 12

Ivy Shiue; Hisatomi Arima; Graeme J. Hankey; Craig S. Anderson



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


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

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



Effects of blockade of cerebral lymphatic drainage on regional cerebral blood flow and brain edema after subarachnoid hemorrhage.  


The study was designed to observe the influence of blockade of cerebral lymphatic drainage on the regional cerebral blood flow (rCBF) and brain edema after experimental subarachnoid hemorrhage (SAH). Wistar rats were divided into non-SAH, SAH, and SAH plus cervical lymphatic blockade (SAH + CLB) groups. Autologous arterial hemolysate was injected into rat's cisterna magna to induce SAH. The rCBF was recorded continuously by a laser Doppler flowmeter. Intracranial pressure (ICP) was also monitored. After 24 hours and 72 hours of SAH, the rats were sacrificed and the brain was harvested for water content detection. It was found that there was no obvious change of rCBF and brain water content during the experiment in non-SAH group. An immediate and persistent drop in rCBF was found in SAH group. The drop in rCBF was more obvious in SAH + CLB group. CLB also worsened the SAH-induced increase in ICP. The brain water content 24 hours and 72 hours after induction of SAH in SAH group increased significantly. CLB led to a further increase of brain water content. In conclusion, blockade of cerebral lymphatic drainage pathway deteriorates the secondary cerebral ischemia and brain edema after SAH. PMID:16543641

Sun, Bao-Liang; Xia, Zuo-Li; Wang, Jing-Ru; Yuan, Hui; Li, Wen-Xia; Chen, Yu-She; Yang, Ming-Feng; Zhang, Su-Ming



Dynamic alterations of cerebral pial microcirculation during experimental subarachnoid hemorrhage.  


The study aimed to investigate the involvement of cerebral microcirculation turbulence after subarachnoid hemorrhage (SAH). Wistar rats were divided into non-SAH and SAH groups. Autologous arterial hemolysate was injected into rat's cisterna magna to induce SAH. Changes of pial microcirculation within 2 h were observed. It was found that there were no obvious changes of the diameters, flow velocity, and fluid state of microvessels in non-SAH group. With the exception of rare linear-granular flow in A4 arteriole, linear flow was observed in most of the arterioles. There was no blood agglutination in any of the arterioles. After SAH, abnormal cerebral pial microcirculation was found. Spasm of microvessels, decreased blood flow, and agglutination of red blood cells occurred. Five minutes following the induction of SAH, the diameters of the arterioles and venules significantly decreased. The decreased diameters persisted for 2 h after cisternal injection. Decreased flow velocity of venules was found from 5 to 90 min after induction of SAH. Spasm of the basilar artery and increased brain malondialdehyde were also found after SAH. We concluded that cerebral microcirculation turbulence plays an important role in the development of secondary cerebral ischemia following SAH. PMID:18821009

Sun, Bao-Liang; Zheng, Cheng-Bi; Yang, Ming-Feng; Yuan, Hui; Zhang, Su-Ming; Wang, Le-Xin



Surgical procedure and results of cisternal washing therapy for the prevention of cerebral vasospasm following SAH.  


In 1994, we started cisternal washing therapy (CWT) using urokinase combined with head-shaking method in order to prevent cerebral vasospasm. In this paper, we showed the surgical procedure for CWT and reported the effect of this therapy in preventing vasospasm following SAH. A total of 332 consecutive cases with Fisher group 3 SAH since 1988 were analyzed. Of these patients, 118 cases (56 cases before 1994 and 62 cases after 1994) had not CWT, and, 214 cases after 1994 had this therapy. All of these patients had clipping surgery within 3 days following SAH, and had postoperative management both with normovolemia and normal to mild hypertension. In these two groups, the incidence of symptomatic vasospasm (transiently symptomatic vasospasm without infarction), cerebral infarction due to vasospasm on CT, and mortality and morbidity (M&M) due to vasospasm were analyzed. In the group without CWT, the incidences of symptomatic vasospasm, cerebral infarction on CT, and M&M due to vasospasm were 4.2%, 28.8%, and 17.8%, respectively. On the other hand, in the group with CWT, they were 3.7%, 6.5%, and 2.8%, respectively. In the patients with CWT, the incidence of cerebral infarction on CT due to vasospasm and M&M due to vasospasm were significantly (p < 0.05) decreased. CWT was effective in preventing cerebral vasospasm. PMID:21125454

Nakagomi, Tadayoshi; Furuya, Kazuhide; Nagashima, Hiroshi; Tanaka, Jun-Ichi; Ishii, Teruyuki; Takanashi, Shigehiko; Shinohara, Takeyuki; Watanabe, Fumihiro; Ogawa, Akiko; Fujii, Norio; Tamura, Akira



Serial measurement of regional cerebral blood flow in patients with SAH using /sup 133/Xe inhalation and emission computerized tomography  

SciTech Connect

A noninvasive three-dimensional method for measuring cerebral blood flow (CBF), xenon-133 inhalation and emission computerized tomography, was used to investigate the CBF changes accompanying delayed neurological deterioration following subarachnoid hemorrhage (SAH). A total of 67 measurements were performed on 20 patients in Hunt and Hess' clinical Grades I to III in the first 21 days post SAH. Five patients with normal CBF tomograms on admission developed delayed neurological deficits in the 2nd week after hemorrhage, at which time repeat CBF tomograms in four patients revealed large areas of well defined regional flow decrease in the vascular territories of the anterior or middle cerebral arteries. Severe vasospasm was noted in three of these patients in whom arteriography was performed in the 2nd week post SAH. Diffuse bihemispheric CBF decreases were noted later in the course of delayed neurological deficits; however, measurements obtained soon after the onset of focal symptoms suggest that the only CBF decreases directly produced by vasospasm in Grade III patients are regional changes.

Mickey, B.; Vorstrup, S.; Voldby, B.; Lindewald, H.; Harmsen, A.; Lassen, N.A.



Subarachnoid hemorrhage  


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


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


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

Herbert, F A; Orford, R



Successful prevention of neurological deficit in SAH patients with 2-chlorodeoxyadenosine  

Microsoft Academic Search

Summary Twenty patients suffering from subarachnoid haemorrhage due to ruptured intracranial aneurysm and operated on within 72 h after SAH were treated with an experimental immunosuppressive drug 2-chlorodeoxyadenosine (2-CDA). dose 0.05 mg\\/kg\\/day i.v. for 7 days. The 2-CDA treatment was started immediately after angiographic confirmation of ruptured aneurysm, and the standard pharmacological treatment (nimodipine and steroids) was also given. 50%

M. Ryba; P. Grieb; M. Pastuszko; J. Bidzifiski; J. Andrychowski; C. Dziewiecki; P. Bojarski; L. Królicki



Chronic Hydrocephalus after Experimental Subarachnoid Hemorrhage  

PubMed Central

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

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



Automatic detection of the existence of subarachnoid hemorrhage from clinical CT images.  


Subarachnoid hemorrhage (SAH) is a medical emergency which can lead to death or severe disability. Misinterpretation of computed tomography (CT) in patients with SAH is a common problem. How to improve the accuracy of diagnosis is a great challenge to both the clinical physicians and medical researchers. In this paper we proposed a method for the automatic detection of SAH on clinical non-contrast head CT scans. The novelty includes approximation of the subarachnoid space in head CT using an atlas based registration, and exploration of support vector machine to the detection of SAH. The study included 60 patients with SAH and 69 normal controls from clinical hospitals. Thirty patients with SAH and 30 normal controls were used for training, while the rest were used for testing to achieve a testing sensitivity of 100% and specificity of 89.7%. The proposed algorithm might be a potential tool to screen the existence of SAH. PMID:20827565

Li, Yonghong; Wu, Jianhuang; Li, Hongwei; Li, Degang; Du, Xiaohua; Chen, Zhijun; Jia, Fucang; Hu, Qingmao



Beneficial effects of systemic administration of recombinant human erythropoietin in rabbits subjected to subarachnoid hemorrhage  

Microsoft Academic Search

Cerebral vasospasm and ischemic damage are important causes of mortality and morbidity in patients affected by aneurysmal subarachnoid hemorrhage (SAH). Recently, i.p. administration of recombinant human erythropoietin (r-Hu-EPO) has been shown to exert a neuroprotective effect during experimental SAH. The present study was conducted to evaluate further the effect of r-Hu-EPO administration after SAH in rabbits on neurological outcome, degree

Giovanni Grasso; Michele Buemi; Concetta Alafaci; Alessandra Sfacteria; Marcello Passalacqua; Alessio Sturiale; Gioacchino Calapai; Gionata de Vico; Giuseppe Piedimonte; Francesco M. Salpietro; Francesco Tomasello



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

PubMed Central

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

Sharma, Rakesh; Mehta, Yatin; Sapra, Harsh



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

Microsoft Academic Search

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

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



Cocaine Use Is an Independent Risk Factor for Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage  

Microsoft Academic Search

Background and Purpose—Although acute cocaine use has been temporally associated with aneurysmal subarachnoid hemorrhage (aSAH), the prevalence of vasospasm and the clinical outcome of patients experiencing aSAH associated with cocaine exposure are unclear. We have analyzed this patient population in our institution to address these issues. Methods—Between 1992 and 1999, 440 patients presented to our institution with aSAH. This sample

James E. Conway; Rafael J. Tamargo



Risk Factors for Subarachnoid Hemorrhage An Updated Systematic Review of Epidemiological Studies  

Microsoft Academic Search

Background and Purpose—After a 1996 review from our group on risk factors for subarachnoid hemorrhage (SAH), much new information has become available. This article provides an updated overview of risk factors for SAH. Methods—An overview of all longitudinal and case-control studies of risk factors for SAH published in English from 1966 through March 2005. We calculated pooled relative risks (RRs)

Valery L. Feigin; Gabriel J. E. Rinkel; Carlene M. M. Lawes; Ale Algra; Derrick A. Bennett; Jan van Gijn; Craig S. Anderson



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

Microsoft Academic Search

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

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



Amelioration of Vasospasm After Subarachnoid Hemorrhage in Transgenic Mice Overexpressing CuZn-Superoxide Dismutase  

Microsoft Academic Search

Background and Purpose—To clarify the effect of superoxide dismutase (SOD) on vasospasm after subarachnoid hemorrhage (SAH), we investigated sequential changes in arterial diameter after SAH in transgenic mice overexpressing CuZn-SOD (SOD-1). Methods—SOD-transgenic mice and nontransgenic littermates (35 to 40 g) were subjected to SAH produced by endovascular perforation of left anterior cerebral artery. At 4 hours and 1, 3, 7,

Hideyuki Kamii; Ichiro Kato; Hiroyuki Kinouchi; Pak H. Chan; Charles J. Epstein; Atsushi Akabane; Hiroshi Okamoto; Takashi Yoshimoto


Subarachnoid Hemorrhage in Type 1 Diabetes: A prospective cohort study of 4,083 patients with diabetes.  


OBJECTIVE To estimate for the first time the incidence of subarachnoid hemorrhage (SAH) in type 1 diabetes. RESEARCH DESIGN AND METHODS Using the nationwide Finnish Diabetic Nephropathy (FinnDiane) Study cohort of 4,083 patients with type 1 diabetes (mean age of 37.4 ± 11.8 years at enrollment), we analyzed the incidence of first-ever SAH events. RESULTS During the follow-up time of 36,680 person-years (median 9.4 years), 15 patients with type 1 diabetes experienced an aneurysmal or nonaneurysmal SAH, and thus the crude incidence of SAH was 40.9 (95% CI 22.9-67.4) per 100,000 person-years. One patient had a verified aneurysmal SAH, and four patients died suddenly of an SAH, which was most likely caused by an aneurysm. SAHs in 10 out of 15 patients were classified as nonaneurysmal SAH, and thus the crude incidence of nonaneurysmal SAH was 27.3 (13.1-50.1) per 100,000 person-years. None of the nonaneurysmal SAHs were fatal. In univariate analysis, current smokers had a hazard ratio of 4.82 (95% CI 1.31-17.81) for nonaneurysmal SAH. CONCLUSIONS The incidence of nonaneurysmal SAH is high among patients with type 1 diabetes. Our findings suggest that nonaneurysmal SAH is a distinct new microvascular complication in type 1 diabetes. PMID:23877984

Korja, Miikka; Thorn, Lena M; Hägg, Stefanie; Putaala, Jukka; Liebkind, Ron; Harjutsalo, Valma; Forsblom, Carol M; Gordin, Daniel; Tatlisumak, Turgut; Groop, Per-Henrik



Mainly Adrenal Gland Involving NK/T-Cell Nasal Type Lymphoma Diagnosed with Delay due to Mimicking Adrenal Hemorrhage  

PubMed Central

A 29-yr-old man, presented with abdominal pain and fever, had an initial computed tomography (CT) scan revealing low attenuation of both adrenal glands. The initial concern was for tuberculous adrenalitis or autoimmune adrenalitis combined with adrenal hemorrhage. The patient started empirical anti-tuberculous medication, but there was no improvement. Enlargement of cervical lymph nodes were developed after that and excisional biopsy of cervical lymph nodes was performed. Pathological finding of excised lymph nodes was compatible to NK/T-cell lymphoma. The patient died due to the progression of the disease even after undergoing therapeutic trials including chemotherapy. Lymphoma mainly involving adrenal gland in the early stage of the disease is rare and the vast majority of cases that have been reported were of B-cell origin. From this case it is suggested that extra-nodal NK/T-cell lymphoma should be considered as a cause of bilateral adrenal masses although it is rare.

Kang, Seon Mee; Kim, Woong Ji; Lee, Kyung Ae; Baek, Hong Sun; Park, Tae Sun



Electrocardiographic changes in subarachnoid hemorrhage secondary to cerebral aneurysm. Report of 70 cases  

Microsoft Academic Search

Electrocardiographic (ECG) alterations in the course of sub-arachnoid hemorrhage (SAH) have frequently been reported. The most frequent anomalies reported were lengthening of the QT interval, very negative or positive deep T waves, elevation or depression of the ST segment and the presence of U waves. We report 70 cases of SAH secondary to rupture of intracranial aneurysm (part of a

M. Salvati; F. Cosentino; M. Artico; M. Ferrari; D. Franchi; M. Domenicucci; E. Ramundo Orlando; L. Tacconi



Hyperglycemia in aneurysmal subarachnoid hemorrhage: a potentially modifiable risk factor for poor outcome  

Microsoft Academic Search

Hyperglycemia after aneurysmal subarachnoid hemorrhage (aSAH) occurs frequently and is associated with delayed cerebral ischemia (DCI) and poor clinical outcome. In this review, we highlight the mechanisms that cause hyperglycemia after aSAH, and we discuss how hyperglycemia may contribute to poor clinical outcome in these patients. As hyperglycemia is potentially modifiable with intensive insulin therapy (IIT), we systematically reviewed the

Nyika D Kruyt; Geert Jan Biessels; J Hans DeVries; Merel J A Luitse; Marinus Vermeulen; Gabriel J E Rinkel; W Peter Vandertop; Yvo B Roos



Microvascular Endothelial Dysfunction and its Mechanism in a Rat Model of Subarachnoid Hemorrhage  

Microsoft Academic Search

After subarachnoid hemorrhage (SAH), large cerebral arteries are prone to vasospasm. Using a rat model of SAH, we examined whether cortical microvessels dem- onstrate vasomotor changes that may make them prone to spasm and whether endothelial dysfunction may ac- count for any observed changes. Two days after percu- taneous catheterization into the cisterna magna, 0.3 mL of autologous blood was

Kyung W. Park; Caroline Metais; Hai B. Dai; Mark E. Comunale; Frank W. Sellke



Effect of Hypervolemic Therapy on Cerebral Blood Flow After Subarachnoid Hemorrhage A Randomized Controlled Trial  

Microsoft Academic Search

Background and Purpose—Cerebral blood flow (CBF) is reduced after subarachnoid hemorrhage (SAH), and symptomatic vasospasm is a major cause of morbidity and mortality. Volume expansion has been reported to increase CBF after SAH, but CBF values in hypervolemic (HV) and normovolemic (NV) subjects have never been directly compared. Methods—On the day after aneurysm clipping, we randomly assigned 82 patients to

Laura Lennihan; Stephan A. Mayer; Matthew E. Fink; Avis Beckford; Myunghee C. Paik; Haiying Zhang; Ya-Chi Wu; Louise M. Klebanoff; Eric C. Raps; Robert A. Solomon


Hemorrhagic Cystitis due to BK Reactivation in a Young Female Treated for Hodgkin-Disease  

PubMed Central

Hodgkin's lymphoma is a disease with a high rate of curability under classic chemo-radiotherapy regimes. Complications due to chemotherapy could include viral reactivation due to chronic lymphopenia. BK virus (BKV) is a polyoma virus belonging to the Papovaviridae family with antibody seroprevalences in healthy populations varying from 60% to 80%. Initial infections are asymptomatic usually occur in early childhood, after which the viruses remain latent in the kidneys or urothelium. Reactivation of BKV occurs in individuals with severe immunosuppression during HIV infections, transplantation or, exceptionally, after classical chemotherapy. BKV incidence is approximately 0% to 5% in immunocompetent individuals. Reactivation is associated with nephropathy and haemorrhagic cystitis. Herein, we present a case of a haemorrhagic cystitis due to BKV reactivation in a patient with Hodgkin's disease treated with chemotherapy.

Le Calloch, R.; Ianotto, J. C.; Berthou, C.; Tempescul, A.



[Brain natriuretic peptide in subarachnoid hemorrhage].  


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

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



Methicillin Hemorrhagic Cystitis  

PubMed Central

Interstitial nephritis is a recognized complication of methicillin therapy. Hemorrhagic cystitis due to methicillin has not been emphasized. Evidence of hemorrhagic cystitis developed in six patients receiving methicillin therapy and was confirmed by cystoscopy in three of them.

Bracis, R.; Sanders, C. V.; Gilbert, D. N.



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

PubMed Central

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

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



Update in intracerebral hemorrhage.  


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

Aguilar, Maria I; Brott, Thomas G



Update in Intracerebral Hemorrhage  

PubMed Central

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

Aguilar, Maria I.; Brott, Thomas G.



Can S100B Predict Cerebral Vasospasms in Patients Suffering from Subarachnoid Hemorrhage?  

PubMed Central

Background: Protein S100B has proven to be a useful biomarker for cerebral damages. Increased levels of serum and cerebrospinal fluid (CSF) S100B have been shown in patients suffering subarachnoid hemorrhage (SAH), severe head injury and stroke. In patients with SAH, the course of S100B levels has been correlated with neurological deficits and outcome. Cerebral vasospasm is a major contributor to morbidity and mortality. The primary aim of this study was to investigate the potential of S100B protein as a predictor of cerebral vasospasm in patients with severe SAH. Materials and Methods: Patients with SAH, Fisher grade 3 and 4, were included in the study. Five samples of CSF and serum S100B were collected from each patient. The first sample (baseline sample) was drawn within the first 3?days following ictus and the following four samples, once a day on days 5–8, with day of ictus defined as day 1. Clinical suspicion of cerebral vasospasm confirmed by computed tomography angiography was used to diagnose cerebral vasospasm. Results: A total of 18 patients were included. Five patients (28%) developed cerebral vasospasm, two (11%) developed ventriculitis. There were no significant differences between S100B for those with and without vasospasm. Serum S100B levels in patients with vasospasm were slightly lower within the first 5?days following ictus, compared to patients without vasospasm. Two out of five patients had elevated and increasing serum S100B prior to vasospasm. Only one showed a peak level of S100B 1?day before vasospasm could be diagnosed. Due to the low number of patients in the study, statistical significance could not be reached. Conclusion: Neither serum nor CSF S100B can be used as predictor of cerebral vasospasm in patients suffering from SAH.

Amiri, Moshgan; Astrand, Ramona; Romner, Bertil



Anterior ischemic optic neuropathy due to abdominal hemorrhage after laparotomy for uterine myoma  

Microsoft Academic Search

Introduction  This retrospective observational case report describes a very rare but dreadful ocular complication due to severe blood loss\\u000a in association with a major surgical procedure. It is the first time that this complication is reported in gynecological surgery.\\u000a \\u000a \\u000a \\u000a Case report  A previously healthy 41-year-old woman underwent hysterectomy because of large uterine myomas. Postoperatively, she was found\\u000a to be severely anemic (hemoglobin

Bernhard M. Stoffelns



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

Microsoft Academic Search

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

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



Mechanisms in neurogenic stress cardiomyopathy after aneurysmal subarachnoid hemorrhage  

Microsoft Academic Search

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

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



Cardiac troponin I predicts myocardial dysfunction in aneurysmal subarachnoid hemorrhage  

Microsoft Academic Search

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

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



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


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

Whetstone, Kirk E; Crane, Deborah A



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

Microsoft Academic Search

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

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



Time-course of cerebral perfusion and tissue oxygenation in the first 6 h after experimental subarachnoid hemorrhage in rats  

Microsoft Academic Search

Present knowledge about hemodynamic and metabolic changes after subarachnoid hemorrhage (SAH) originates from neuromonitoring usually starting with aneurysm surgery and animal studies that have been focusing on the first 1 to 3 h after SAH. Most patients, however, are referred to treatment several hours after the insult. We examined the course of hemodynamic parameters, cerebral blood flow, and tissue oxygenation

Thomas Westermaier; Alina Jauss; Jörg Eriskat; Ekkehard Kunze; Klaus Roosen



Predictors of Subarachnoid Hemorrhage in Acute Ischemic Stroke with Endovascular Therapy  

PubMed Central

Background and Purpose Subarachnoid hemorrhage (SAH) is a potential hemorrhagic complication after endovascular intracranial recanalization. The purpose of this study was to describe the frequency and predictors of SAH in acute ischemic stroke patients treated endovascularly, and its impact on clinical outcome. Methods Acute ischemic stroke (AIS) patients treated with primary mechanical thrombectomy, intra-arterial thrombolysis (IAT), or both were analyzed. Post-procedural CT and MR images were reviewed to identify the presence of SAH. We assessed any decline in the National Institutes of Health Stroke Scale (NIHSS) score 3 hours post-intervention and outcomes at discharge. Results One hundred twenty-eight patients were treated by primary thrombectomy with Merci Retriever devices, while 31 were treated by primary IAT. Twenty patients experienced SAH- eight with pure SAH, and twelve with co-existing parenchymal hemorrhages. SAH was numerically more frequent with primary thrombectomy than IAT groups (14.1% versus 6.5%, p=0.37). On multivariate analysis, independent predictors of SAH were hypertension (OR 5.39; p=0.035), distal middle cerebral artery (MCA) occlusion (OR 3.53; p=0.027), use of rescue angioplasty after thrombectomy (OR 12.49; p=0.004), and procedure-related vessel perforation (OR 30.72; p<0.001). Patients with extensive SAH or co-existing parenchymal hematomas tended to have more neurologic deterioration at 3 hours (28.6% versus 0%; p=0.11), to be less independent at discharge (modified Rankin Scale ? 2, 0% versus 15.4%; p=0.5); and to more often die during hospitalization (42.9% versus 15.4%; p=0.29). Conclusions Procedure-related vessel perforation, rescue angioplasty after thrombectomy with Merci devices, distal MCA occlusion, and hypertension were independent predictors of SAH following endovascular therapy for AIS. Only extensive SAH or SAH accompanied by severe parenchymal hematomas may worsen clinical outcome at discharge.

Shi, Zhong-Song; Liebeskind, David S; Loh, Yince; Saver, Jeffrey L; Starkman, Sidney; Vespa, Paul M; Gonzalez, Nestor R.; Tateshima, Satoshi; Jahan, Reza; Feng, Lei; Miller, Chad; Ali, Latisha K; Ovbiagele, Bruce; Kim, Doojin; Duckwiler, Gary R; Vinuela, Fernando



Nutritional support and brain tissue glucose metabolism in poor-grade SAH: a retrospective observational study  

PubMed Central

Introduction We sought to determine the effect of nutritional support and insulin infusion therapy on serum and brain glucose levels and cerebral metabolic crisis after aneurysmal subarachnoid hemorrhage (SAH). Methods We used a retrospective observational cohort study of 50 mechanically ventilated poor-grade (Hunt-Hess 4 or 5) aneurysmal SAH patients who underwent brain microdialysis monitoring for an average of 109 hours. Enteral nutrition was started within 72 hours of admission whenever feasible. Intensive insulin therapy was used to maintain serum glucose levels between 5.5 and 7.8 mmol/l. Serum glucose, insulin and caloric intake from enteral tube feeds, dextrose and propofol were recorded hourly. Cerebral metabolic distress was defined as a lactate to pyruvate ratio (LPR) > 40. Time-series data were analyzed using a general linear model extended by generalized estimation equations (GEE). Results Daily mean caloric intake received was 13.8 ± 6.9 cal/kg and mean serum glucose was 7.9 ± 1 mmol/l. A total of 32% of hourly recordings indicated a state of metabolic distress and < 1% indicated a state of critical brain hypoglycemia (< 0.2 mmol/l). Calories received from enteral tube feeds were associated with higher serum glucose concentrations (Wald = 6.07, P = 0.048), more insulin administered (Wald = 108, P < 0.001), higher body mass index (Wald = 213.47, P < 0.001), and lower body temperature (Wald = 4.1, P = 0.043). Enteral feeding (Wald = 1.743, P = 0.418) was not related to brain glucose concentrations after accounting for serum glucose concentrations (Wald = 67.41, P < 0.001). In the presence of metabolic distress, increased insulin administration was associated with a relative reduction of interstitial brain glucose concentrations (Wald = 8.26, P = 0.017), independent of serum glucose levels. Conclusions In the presence of metabolic distress, insulin administration is associated with reductions in brain glucose concentration that are independent of serum glucose levels. Further study is needed to understand how nutritional support and insulin administration can be optimized to minimize secondary injury after subarachnoid hemorrhage.



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


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

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



Cerebral Vasospasm with Ischemia following a Spontaneous Spinal Subarachnoid Hemorrhage  

PubMed Central

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

Shakur, Sophia F.; Farhat, Hamad I.



Ventricular Arrhythmia Risk After Subarachnoid Hemorrhage  

PubMed Central

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

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



Thrombosed vertebral artery aneurysm presenting with hemorrhage and bulbar compression: report of two cases  

Microsoft Academic Search

Bulbar compression by vertebral artery (VA) aneurysm is extremely rare and only reported in a few cases. We report two cases with thrombosed VA aneurysm compressing medulla oblongata; one presented with bulbar apoplexy hemorrhage and the other with subarachnoid hemorrhage (SAH). A 61-year-old male (case 1) presented with consciousness disturbances, left hemiplegia, and subsequent respiratory arrest. He was subjected to

Shin-ichiro Shiraishi; Miki Fujimura; Hiroyuki Kon; Osamu Motohashi; Motonobu Kameyama; Kiyoshi Ishii; Takehide Onuma



Hemorrhagic lacunar stroke.  


A total of 17 patients with lacunar syndromes due to intracerebral hemorrhage or hemorrhagic lacunar stroke (pure motor hemiparesis 9, sensorimotor stroke 5, pure sensory stroke 3) are reported. Data from these patients were obtained from consecutive stroke patients included in the prospective Hospital Sagrat Cor-Aliança Stroke Registry. Hemorrhagic lacunar stroke accounted for 3.8% of all cases of lacunar syndrome (n = 439) and 7.4% of all cases of intracerebral hemorrhage (n = 229) entered in the database. Demographic, anamnestic, clinical and neuroimaging variables in patients with hemorrhagic lacunar stroke, non-lacunar intracerebral hemorrhage and non-hemorrhagic lacunar stroke were compared. Predictors of hemorrhagic lacunar stroke were assessed by logistic regression analysis. Hypertension, cigarette smoking and involvement of the internal capsule were significantly more frequent in patients with hemorrhagic lacunar stroke than in those with non-lacunar intracerebral hemorrhage, whereas nausea and vomiting, altered consciousness, speech disturbances, hemianopia, and ventricular hemorrhage were significantly less frequent. As compared with non-hemorrhagic lacunar stroke, patients with hemorrhagic lacunar stroke were more likely to have hypertension, sudden stroke onset (minutes), head injury, headache, and basal ganglia involvement and less likely to have diabetes, gradual stroke onset (hours), and dysarthria. After multivariate analysis, only headache (OR 10.14), sudden onset (OR 9.89), and dysarthria (OR 0.10) were independent predictors of hemorrhagic lacunar stroke. Accordingly, the presence of headache and sudden onset of symptoms and absence of dysarthria may be useful signs for distinguishing hemorrhagic lacunar stroke from other causes of lacunar stroke. PMID:10773650

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


John Montgomery's Legacy: Carbocyclic Adenosine Analogues as Sah Hydrolase Inhibitors with Broad-Spectrum Antiviral Activity  

Microsoft Academic Search

Ever since the S-adenosylhomocysteine (AdoHcy, SAH) hydrolase was recognized as a pharmacological target for antiviral agents (J. A. Montgomery et al., J. Med. Chem. 25:626–629, 1982), an increasing number of adenosine, acyclic adenosine, and carbocyclic adenosine analogues have been described as potent SAH hydrolase inhibitors endowed with broad-spectrum antiviral activity. The antiviral activity spectrum of the SAH hydrolase inhibitors include

E. De Clercq



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


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

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



Myocardial stunning secondary to aneurysmal subarachnoid hemorrhage  

Microsoft Academic Search

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

Jill W Donaldson; Michael B Pritz



FOS protein expression and role of the vagus nerve in the rat medullary visceral zone in multiple organ dysfunction syndrome caused by subarachnoid hemorrhage  

PubMed Central

This study was designed to observe the role of FOS protein expression in the rat medullary visceral zone (MVZ) in multiple organ dysfunction syndrome (MODS) caused by subarachnoid hemorrhage (SAH), with and without severing the vagus nerve. We also investigated the regulatory and control mechanisms of the MVZ and the vagus nerve in MODS following SAH. A model of MODS following SAH was established by injecting arterial blood into the Willis’ circle. The vagus nerve was cut off and blocked. The FOS protein expression in the MVZ was detected by immunohistochemistry. The positive expression levels of FOS in the MVZ in the SAH and SAH + severed-down vagus nerve (SDV) groups were higher than those in the normal control, sham surgery and SDV groups (P<0.01). However, expression in the SAH+SDV group was lower than that in the SAH group (P<0.01). Inflammatory damage was observed in each visceral organ at every time-phased point in the SAH group and the SAH+SDV group. The most apparent damage was at 24–36 h, consistent with the peak of FOS protein expression; the SAH+SDV group presented a greater level of damage. The inflammatory changes in surrounding visceral organs following SAH correlated with FOS protein expression in the MVZ, which indicates that the MVZ participates in the functional control of surrounding visceral organs following SAH. Severing the subphrenic vagus nerve increases the incidence of MODS following SAH and enhances SAH-induced inflammatory damage to the surrounding visceral organs, which indicates that the vagus nerve plays a role in the protection of the surrounding visceral organs in MODS following SAH.




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


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

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



Hemorrhagic Lacunar Stroke  

Microsoft Academic Search

A total of 17 patients with lacunar syndromes due to intracerebral hemorrhage or hemorrhagic lacunar stroke (pure motor hemiparesis 9, sensorimotor stroke 5, pure sensory stroke 3) are reported. Data from these patients were obtained from consecutive stroke patients included in the prospective Hospital Sagrat Cor-Aliança Stroke Registry. Hemorrhagic lacunar stroke accounted for 3.8% of all cases of lacunar syndrome

Adrià Arboix; Luis García-Eroles; Juan Massons; Montserrat Oliveres; Cecilia Targa



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

Microsoft Academic Search

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

Paul J. Lockhart; Julian F. B. Mercer



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

NASA Astrophysics Data System (ADS)

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

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



Is the circulating plasma volume sufficiently maintained? Fluid management of an aneurysmal subarachnoid hemorrhage in the acute phase.  


Cerebral vasospasm is a well-known cause of mortality and morbidity following aneurysmal subarachnoid hemorrhage (SAH). Prevention of symptomatic cerebral vasospasm is the basic management after SAH. Numerous pharmaceutical therapies and endovascular treatments are available against cerebral vasospasm, but none of them have so far proven to improve the outcome. We have focused on maintaining the circulation volume in order to prevent cerebral vasospasm. But to maintain the central venous pressure, huge infusion volume was required, and hyponatremia was frequently observed due to natriuresis and osmotic diuresis. Excessive natriuresis and diuresis cannot be managed through sodium and water replacement, since sodium replacement induces further natriuresis and diuresis (desalination), and water replacement induces hyponatremia. We therefore administered fludrocortisone and hydrocortisone to inhibit excessive natriuresis and diuresis. The efficacy of sodium reabsorption therapy is extremely high to maintain the circulation volume that might have a therapeutic effect to prevent cerebral vasospasm. In this article, we review our institution's experience regarding the management of patients with aneurysmal SAH and also discuss the importance of water and sodium balance when managing such patients. PMID:22989722

Mori, Tatsuro; Katayama, Yoichi; Igarashi, Takahiro; Moro, Nobuhiro; Kojima, Jun; Hirayama, Teruyasu



Molecular approaches for the treatment of hemorrhagic fever virus infections.  


Viruses causing hemorrhagic fevers in man belong to the following virus groups: togavirus (Chikungunya), flavivirus (dengue, yellow fever, Kyasanur Forest disease, Omsk hemorrhagic fever), arenavirus (Argentinian hemorrhagic fever, Bolivian hemorrhagic fever, Lassa fever), filovirus (Ebola, Marburg), phlebovirus (Rift Valley fever), nairovirus (Crimian-Congo hemorrhagic fever) and hantavirus (hemorrhagic fever with renal syndrome, nephropathic epidemia). Hemorrhagic fever virus infections can be approached by different therapeutic strategies: (i) vaccination; (ii) administration of high-titered antibodies; and (iii) treatment with antiviral drugs. Depending on the molecular target of their interaction, antiviral agents could be classified as follows: IMP dehydrogenase inhibitors (i.e., ribavirin and its derivatives); OMP decarboxylase inhibitors (i.e., pyrazofurin); CTP synthetase inhibitors (i.e., cyclopentylcytosine and cyclopentenylcytosine); SAH hydrolase inhibitors (i.e., neplanocin A); polyanionic substances (i.e., sulfated polymers); interferon and immunomodulators. PMID:8250543

Andrei, G; De Clercq, E



Acute Focal Neurological Deficits in Aneurysmal Subarachnoid Hemorrhage Relation of Clinical Course, CT Findings, and Metabolite Abnormalities Monitored With Bedside Microdialysis  

Microsoft Academic Search

Background and Purpose—We sought (1) to identify early metabolic markers for the development of (ir)reversible neurological deficits and cerebral infarction in subarachnoid hemorrhage (SAH) patients by using the microdialysis technique and (2) to evaluate the influence of intracerebral hemorrhage (ICH) on microdialysis parameters. Methods—We performed a prospective study of 44 SAH patients with acute focal neurological deficits (AFND) occurring acutely

Asita Sarrafzadeh; Daniel Haux; Oliver Sakowitz; Goetz Benndorf; Harry Herzog; Ingeborg Kuechler; Andreas Unterberg


Melatonin alleviates secondary brain damage and neurobehavioral dysfunction after experimental subarachnoid hemorrhage: possible involvement of TLR4-mediated inflammatory pathway.  


Previous studies proved that melatonin protected against secondary brain damage by modulating oxidative stress after experimental subarachnoid hemorrhage (SAH), but it has not been evaluated yet about its effects on inflammatory pathway and secondary cognitive dysfunction in SAH model. This study was undertaken to evaluate the influence of melatonin on toll-like receptor 4 (TLR4) signaling pathway and neurobehavioral tests after SAH. Adult SD rats were divided into four groups: control group (n = 20), SAH group (n = 20), SAH+vehicle group (n = 20), and SAH+melatonin group (n = 20). The rat SAH model was induced by injection of 0.3 mL fresh arterial, nonheparinized blood into the prechiasmatic cistern in 20 s. In SAH+melatonin group, melatonin was administered i.p. at 150 mg/kg at 2 and 24 hr after the induction of SAH. Cognitive and memory changes were investigated in the Morris water maze. Treatment with melatonin markedly decreased the expressions of TLR4 pathway-related agents, such as high-mobility group box 1 (HMGB1), TLR4, nuclear factor-?B (NF-?B), myeloid differentiation factor 88 (MyD88), interleukin-1? (IL-1?), tumor necrosis factor-? (TNF-?), interleukin-6 (IL-6), and inducible nitric oxide synthase (iNOS). Administration of melatonin following SAH significantly ameliorated spatial learning and memory deficits in this prechiasmatic blood injection model. Staining of apoptosis and necrosis indicated that fewer positive cells appeared in melatonin-treated group than SAH+vehicle group. In conclusion, melatonin may attenuate neurobehavioral dysfunction in this SAH model, and melatonin exhibits neuroprotection possibly not only through anti-oxidative pathway but also anti-inflammatory signaling after experimental SAH. PMID:24007200

Wang, Zhong; Wu, Lingyun; You, Wanchun; Ji, Chengyuan; Chen, Gang



Arginine vasopressin as a supplementary vasopressor in refractory hypertensive, hypervolemic, hemodilutional therapy in subarachnoid hemorrhage  

Microsoft Academic Search

Introduction  Hypertensive, hypervolemic, and hemodilutional (HHH) therapy for vasospasm in subarachnoid hemorrhage (SAH) refractory to\\u000a phenylephrine requires high doses of catecholamines, leading to adverse adrenergic effects. Arginine vasopressin (AVP) has\\u000a been shown to stabilize advanced shock states while facilitating reduction of catecholamine doses, but its use has never been\\u000a reported in SAH. In this retrospective study, we investigated the hemodynamic effects

Susanne Muehlschlegel; Martin W. Dunser; Andrea Gabrielli; Volker Wenzel; A. Joseph Layon



Mechanisms of hyperbaric oxygen-induced neuroprotection in a rat model of subarachnoid hemorrhage  

Microsoft Academic Search

Acute cerebral ischemia occurs after subarachnoid hemorrhage (SAH) because of increased intracranial pressure (ICP) and decreased cerebral perfusion pressure (CPP). The effect of hyperbaric oxygen (HBO) on physiological and clinical outcomes after SAH, as well as the expressions of hypoxia-inducible factor-1? (HIF-1?) and its target genes, such as BNIP3 and VEGF was evaluated. Eighty-five male SD rats (300 to 350

Robert P Ostrowski; Austin R T Colohan; John H Zhang



[Two cases of spinal arteriovenous malformation presenting with subarachnoid hemorrhage].  


Two cases of spinal arteriovenous malformation (AVM) with subarachnoid hemorrhage (SAH) are reported. The first case is that of a 14-year-old boy who was transferred to our hospital with a sudden onset of headache. Neurological examination revealed no motosensory deficit, but a brain CT showed a slight diffuse SAH. A left vertebral angiogram demonstrated intramedullary AVM in the cervical region of the spinal cord. This AVM was therefore occluded using a solid embolization material. The patient was then discharged without neurological deficit. The second case is that of a 67-year-old man who visited our hospital with a sudden onset of headache. Neurological examination revealed no motor or sensory deficit, but a brain CT showed SAH, which was dominant in the posterior fossa. Initial cerebral angiography demonstrated no abnormality such as cerebral aneurysm or AVM except for laterality of the C1 radiculo-meningeal artery. A second angiogram on day 11 demonstrated spinal arteriovenous fistula (AVF), which was fed by the left radiculo-meningeal artery and drained to the posterior spinal vein. Embolization for the AVF was performed using liquid material. He was then discharged without neurological deficit. These two cases revealed non-specific SAH symptoms and were indistinguishable from other ruptured aneurysms. Although the brain CT can show a slight SAH or posterior fossa dominant SAH, repeated angiography may be necessary to verify and conclude the diagnosis of spinal AVM. PMID:15352630

Hayashi, Kentaro; Takahata, Hideaki; Nakamura, Minoru



Effects of meteorological factors on the onset of subarachnoid hemorrhage: a time-series analysis.  


Previous studies have suggested a possible association between meteorological factors and the onset of subarachnoid hemorrhage (SAH). We aimed to investigate the relationship between the onset of SAH and meteorological factors based on an hourly time-series analysis. We collected hourly data on transportation of patients with SAH using the ambulance records of the Tokyo Fire Department from January 1 to December 31, 2005. We also collected hourly meteorological data for Tokyo from the Japan Meteorological Agency during the same period. We performed a time-series analysis using the autoregressive integrated moving average (ARIMA) model to control for autocorrelations in the time-series data. There were 1729 patients with SAH (mean age 63.3 years; 60.2% women). We identified two circadian patterns in the onset of SAH: a daily peak at 10 am (p<0.001) and a seasonal peak in February (p<0.001). Based on the ARIMA time-series analysis, significant risk factors associated with the onset of SAH included: low temperature on the previous day (lag time 17h; p=0.005) and on the onset day (lag time 0h; p<0.001); high barometric pressure on the onset day (lag time 0h; p=0.001). Humidity was not associated with the onset of SAH. Among meteorological factors, low temperature and high barometric pressure may be risk factors for the onset of SAH. PMID:18617401

Abe, Toshikazu; Ohde, Sachiko; Ishimatsu, Shinichi; Ogata, Hiromitsu; Hasegawa, Takahiro; Nakamura, Tomohiko; Tokuda, Yasuharu



Subarachnoid hemorrhage model in the rat: modification of the endovascular filament model.  


The present study describes modifications to the endovascular filament model of subarachnoid hemorrhage (SAH) in rats. Specifically, we sought to improve the percentage yield of SAH, reduce mortality rates and better simulate human cerebral aneurysmal rupture. Instead of using a 4-0 prolene suture to induce SAH in the existing endovascular filament model, a hollow and flexible polyetrafluoroethylene (PTFE) tube was maneuvered into the proximal anterior cerebral artery (ACA) to ensure that advancement occurred without producing trauma to the vessels. SAH was induced by advancing a tungsten wire through this tube, perforating the ACA at the desired location. These modifications produced significant improvements over the endovascular filament model. Mortality rate declined from 46 to 19%, and SAH was produced more frequently. With the prolene suture, only 48% of our attempts produced a SAH, and unsuccessful attempts typically resulted in an acute subdural hematoma (ASDH). In contrast, the wire/tubing technique was 90% successful at inducing SAH, and led to a significant reduction of ASDH incidence from 44 to 6%. Additionally, the modified technique produced vasospasm in basilar and middle cerebral arteries post-SAH as well as pseudoaneurysms in the proximal ACA which indicated the location of vessel perforation. PMID:18562012

Park, Ik-Seong; Meno, Joseph R; Witt, Cordelie E; Suttle, Timothy K; Chowdhary, Abhineet; Nguyen, Thien-Son; Ngai, Al C; Britz, Gavin W



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


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

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



Risk factors for hemorrhagic stroke in Wonju, Korea.  


Although stroke is a great public health challenge in Korea, there have have been few epidemiologic studies of the risk factors stroke. A case-control study was performed to evaluate the risk factors for hemorrhagic stroke in Wonju, Korea. Ninety-five subarachnoid hemorrhage (SAH) and 102 intracerebral hemorrhage (ICH) patients aged 21-86 years, and 267 controls were recruited among the inpatients of Wonju Christian Hospital during 1994-1995. Information was gathered through interview and examinations. After adjustment for age and sex, family and past history of hypertension, drinking habits, age of menarche, height, weight, body mass index, waist and hip circumference, earlobe crease, prothrombin time, white blood cell count, hemoglobin, and total cholesterol were all found to be significantly associated with both SAH and ICH. The risk factor significantly associated only with ICH was smoking habits. In multiple logistics analyses, the independent risk factors for SAH and ICH were the same. Those included family and past history of hypertension, age of menarche, earlobe crease, prothrombin time, white blood cell count, hemoglobin and total cholesterol. In general, the risk factors for SAH and ICH were similar with each other, except smoking habits. Risk factors found in this study congruent with previous studies were family and past history of hypertension, drinking habits, body mass index, prothrombin time, white blood cell count, and hemoglobin. Those incongruent or rather newly found were age of menarche, a big physique, earlobe crease, and total cholesterol. PMID:9664827

Park, J K; Kim, H J; Chang, S J; Koh, S B; Koh, S Y



Predictors Analysis of Symptomatic Cerebral Vasospasm After Subarachnoid Hemorrhage  

Microsoft Academic Search

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

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


Iatrogenic dural arteriovenous fistula and aneurysmal subarachnoid hemorrhage.  


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

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



The SAH domain extends the functional length of the myosin lever  

PubMed Central

Stable, single alpha-helix (SAH) domains are widely distributed in the proteome, including in myosins, but their functions are unknown. To test whether SAH domains can act as levers, we replaced four of the six calmodulin-binding IQ motifs in the levers of mouse myosin 5a (Myo5) with the putative SAH domain of Dictyostelium myosin MyoM of similar length. The SAH domain was inserted between the IQ motifs and the coiled coil in a Myo5 HMM construct in which the levers were truncated from six to two IQ motifs (Myo5–2IQ). Electron microscopy of this chimera (Myo5–2IQ-SAH) showed the SAH domain was straight and 17 nm long as predicted, restoring the truncated lever to the length of wild-type (Myo5–6IQ). The powerstroke (of 21.5 nm) measured in the optical trap was slightly less than that for Myo5–6IQ but much greater than for Myo5–2IQ. Myo5–2IQ-SAH moved processively along actin at physiological ATP concentrations with similar stride and run lengths to Myo5–6IQ in in-vitro single molecule assays. In comparison, Myo5–2IQ is not processive under these conditions. Solution biochemical experiments indicated that the rear head did not mechanically gate the rate of ADP release from the lead head, unlike Myo5–6IQ. These data show that the SAH domain can form part of a functional lever in myosins, although its mechanical stiffness might be lower. More generally, we conclude that SAH domains can act as stiff structural extensions in aqueous solution and this structural role may be important in other proteins.

Baboolal, Thomas G.; Sakamoto, Takeshi; Forgacs, Eva; White, Howard D.; Jackson, Scott M.; Takagi, Yasuharu; Farrow, Rachel E.; Molloy, Justin E.; Knight, Peter J.; Sellers, James R.; Peckham, Michelle



Improving CPAP use by patients with the sleep apnoea\\/hypopnoea syndrome (SAHS)  

Microsoft Academic Search

Though continuous positive airway pressure (CPAP) is the treatment of choice for the sleep apnoea\\/hypopnoea syndrome (SAHS), suboptimal adherence to CPAP is common. Internationally, some 5–50% of SAHS patients recommended for CPAP either reject this treatment option or discontinue within the first week, and 12–25% of remaining patients can be expected to have discontinued CPAP by 3 years. Biomedical investigations

Heather M. Engleman; Matt R. Wild



The safety and feasibility of continuous intravenous magnesium sulfate for prevention of cerebral vasospasm in aneurysmal subarachnoid hemorrhage  

Microsoft Academic Search

Introduction: Cerebral vasospasm in aneurysmal subarachnoid hemorrhage (SAH) is associated with poor outcome. The safety and feasibility\\u000a of continuous high-dose intravenous magnesium sulfate (MgSO4) for the prevention of cerebral vasospasm and ischemic cerebral injury has not been well studied.\\u000a \\u000a \\u000a Methods: Patients presenting to our center within 72 hours of aneurysmal SAH (confirmed by computed tomography [CT] scanning and cerebral\\u000a angiography)

Abutaher M. Yahia; Jawad F. Kirmani; Adnan I. Qureshi; Lee R. Guterman; L. Nelson Hopkins



Hemorrhagic stroke: intracerebral hemorrhage.  


Intracerebral hemorrhage (ICH) is a devastating event, carrying a very high morbidity and mortality rate. Hypertension and age-related amyloid angiopathy are the strongest risk factors for ICH, but smoking, anticoagulation with warfarin, excessive alcohol intake and cocaine also increase risk. This, the fourth in a Missouri Medicine series on stroke summarizes the clinical and imaging aspects of making the diagnosis of ICH. Current medical and surgical therapies are discussed as well as predictors of outcome and recommendations for secondary prevention. PMID:21462612

Rymer, Marilyn M


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

SciTech Connect

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.

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



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

PubMed Central

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.

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



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


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

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



[Hemorrhagic disorders].  


Patients suffering from hemorrhagic disorders often present with only minimal bleeding during surgery or injuries. However, some patients have life-threatening bleeding. Simple screening tests can be used to find the cause of the bleeding: patient and family histories provide information on whether the bleeding tendency is hereditary or acquired. Clinical examination can reveal the bleeding type. Measurement of platelet count can be used to exclude thrombocytopenia. Coagulation tests, such as prothrombin time (PT, Quick) and activated partial thromboplastin time (aPTT) can supply initial information concerning deficiency states of coagulation factors. Bleeding time is often prolonged in patients suffering from von Willebrand disease, thrombocytopenia or thrombocytopathy. If--due to the results of these screening tests-further testing of particular coagulation factors or platelet function is needed, then patients should be referred to a centre specialized in blood coagulation. PMID:22718259

Kemkes-Matthes, B; Heidinger, K; Kirsch-Altena, A; Fischer, R



Intracisternal infusion of magnesium sulfate solution improved reduced cerebral blood flow induced by experimental subarachnoid hemorrhage in the rat.  


Magnesium has neuroprotective and antivasospastic properties in the presence of subarachnoid hemorrhage (SAH). The present study investigated the effect of intracisternal administration of magnesium on cerebral vasospasm in the experimental SAH rat model. The rat double-SAH model (0.2 mL autologous blood injected twice into the cisterna magna) was used. Normal saline (SAH group, N=8) or 10 mmol/L magnesium sulfate in normal saline (SAH + MG group, N=8) was infused into the cisterna magna at 1.5 microL/min for 30 min on day 5. Control rats without SAH also received intracisternal infusion of normal saline (control group, N=6). Local cerebral blood flow (CBF) at 24 locations and the weighted average were quantitatively measured by the autoradiographic technique using [(14)C]iodoantipyrine during infusion. The weighted average CBF was significantly reduced (P<0.01, Student's t-test) in the SAH group (0.78+/-0.16 mL g(-1) min(-1)) compared to the control group (1.0+/-0.15 mL g(-1) min(-1)) and was significantly improved (P<0.01, Student's t-test) in the SAH + MG group (0.98+/-0.18 mL g(-1) min(-1)). Local CBF was significantly reduced (P<0.05, unpaired t test) in 16 locations in the SAH group and significantly improved (P < 0.05, unpaired t test) in 12 locations in the SAH + MG group. Intracisternal infusion of magnesium sulfate significantly improved reduced CBF induced by experimental SAH in the rat. PMID:18253770

Mori, Kentaro; Miyazaki, Masahiro; Iwata, Junko; Yamamoto, Takuji; Nakao, Yasuaki



Impact of anesthesia on pathophysiology and mortality following subarachnoid hemorrhage in rats  

PubMed Central

Background Anesthesia is indispensable for in vivo research but has the intrinsic potential to alter study results. The aim of the current study was to investigate the impact of three common anesthesia protocols on physiological parameters and outcome following the most common experimental model for subarachnoid hemorrhage (SAH), endovascular perforation. Methods Sprague-Dawley rats (n = 38) were randomly assigned to (1) chloral hydrate, (2) isoflurane or (3) midazolam/medetomidine/fentanyl (MMF) anesthesia. Arterial blood gases, intracranial pressure (ICP), mean arterial blood pressure (MAP), cerebral perfusion pressure (CPP), and regional cerebral blood flow (rCBF) were monitored before and for 3 hours after SAH. Brain water content, mortality and rate of secondary bleeding were also evaluated. Results Under baseline conditions isoflurane anesthesia resulted in deterioration of respiratory parameters (arterial pCO2 and pO2) and increased brain water content. After SAH, isoflurane and chloral hydrate were associated with reduced MAP, incomplete recovery of post-hemorrhagic rCBF (23 ± 13% and 87 ± 18% of baseline, respectively) and a high anesthesia-related mortality (17 and 50%, respectively). Anesthesia with MMF provided stable hemodynamics (MAP between 100-110 mmHg), high post-hemorrhagic rCBF values, and a high rate of re-bleedings (> 50%), a phenomenon often observed after SAH in humans. Conclusion Based on these findings we recommend anesthesia with MMF for the endovascular perforation model of SAH.



Dissection aneurysm of the radiculomedullary branch of the artery of Adamkiewicz with subarachnoid hemorrhage.  


A 60-year-old female presented with sudden onset of severe headache and back pain, followed by nausea. The initial head computed tomography (CT) scan revealed posterior fossa subarachnoid hemorrhage (SAH). Spinal T(2)-weighted magnetic resonance imaging demonstrated SAH, and a homogeneous and slightly low signal intensity mass at T11. Spinal angiography in the early arterial phase revealed a small pearl and string-like aneurysm of the proximal radiculomedullary artery on the left side at the T12 level. Forty days after the onset of SAH, CT angiography demonstrated complete occlusion of the dissecting aneurysm and the preserved anterior spinal artery. The present case of ruptured dissecting aneurysm of the radiculomedullary branch of the artery of Adamkiewicz with SAH underwent subsequent spontaneous occlusion, indicating that the wait-and-see strategy may be justified and will provide adequate treatment. PMID:21946730

Iihoshi, Satoshi; Miyata, Kei; Murakami, Tomohiro; Kaneko, Takahisa; Koyanagi, Izumi



Brain edema formation correlates with perfusion deficit during the first six hours after experimental subarachnoid hemorrhage in rats  

PubMed Central

Background Severe brain edema is observed in a number of patients suffering from subarachnoid hemorrhage (SAH). Little is known about its pathogenesis and time-course in the first hours after SAH. This study was performed to investigate the development of brain edema and its correlation with brain perfusion after experimental SAH. Methods Male Sprague–Dawley rats, randomly assigned to one of six groups (n = 8), were subjected to SAH using the endovascular filament model or underwent a sham operation. Animals were sacrificed 15, 30, 60, 180 or 360 minutes after SAH. Intracranial pressure (ICP), mean arterial blood pressure (MABP), cerebral perfusion pressure (CPP) and bilateral local cerebral blood flow (LCBF) were continuously measured. Brain water content (BWC) was determined by the wet/dry-weight method. Results After SAH, CPP and LCBF rapidly decreased. The decline of LCBF markedly exceeded the decline of CPP and persisted until the end of the observation period. BWC continuously increased. A significant correlation was observed between the BWC and the extent of the perfusion deficit in animals sacrificed after 180 and 360 minutes. Conclusions The significant correlation with the perfusion deficit after SAH suggests that the development of brain edema is related to the extent of ischemia and acute vasoconstriction in the first hours after SAH.



The first clinical case due to AP92 like strain of Crimean-Congo Hemorrhagic Fever virus and a field survey  

PubMed Central

Background Crimean-Congo Hemorrhagic Fever (CCHF) is a fatal infection, but no clinical case due to AP92 strain was reported. We described the first clinical case due to AP92 like CCHFV. Methods A case infected by a AP92 like CCHFV was detected in Balkanian part of Turkey. Diagnosis was confirmed by RT-PCR and sequencing. A human serologic and tick survey studies were performed in the region, where the case detected. Results Thirty eight individuals out of 741 were found to be anti CCHFV IgM positive. The attack rate for overall CCHFV was calculated as 5.2%. In univariate analyses, CCHFV IgM positivity was found to be associated with the age (p < 0.001), male gender (p = 0.001), agricultural activity (p = 0.036), and history of tick bite (p = 0.014). In multivariate analysis, older age (OR: 1.03, CI:1.01–1.05, p < 0.001), male gender were found to be the risk factors (OR: 2.5, CI:1.15–5.63, p = 0.020) for CCHFV infection. Conclusion This is the first human case with AP92 like CCHFV infection. Furthermore, this is the first report of AP92 like strain in Turkey. In the region, elderly males carry the highest risk for CCHFV infection.



Spontaneous subperiosteal orbital hemorrhage.  


Abstract Subperiosteal orbital hemorrhage typically results from trauma. Spontaneous subperiosteal orbital hemorrhage (SSOH) is rare and has been reported with sudden elevation of cranial venous pressure, bleeding diathesis, and sinusitis. This article presents a series of 9 patients (11 orbits) with SSOH and review the associated systemic conditions. 10 out of 11 orbits (91%) underwent surgical intervention due to advanced orbital signs or poor vision. PMID:23895577

Elia, Maxwell D; Shield, David; Kazim, Michael; Shinder, Roman; Yoon, Michael; McCulley, Timothy J; Shore, John W; Greene, Daniel; Servat, Juan J; Levin, Flora



Hematoma in the splenium of the corpus callosum in the subacute stage of subarachnoid hemorrhage--three case reports.  


Three patients developed hemorrhage in the splenium of the corpus callosum 2 weeks after the onset of subarachnoid hemorrhage (SAH) associated with acute hydrocephalus. Computed tomography performed a few days after the onset showed a low density area in the splenium of corpus callosum in all three patients, and preventive measures against symptomatic vasospasm were begun, including vasodilator administration. Computed tomography showed hemorrhage in the splenium of the corpus callosum 17 to 22 days after onset of SAH, manifesting as mental deterioration or headache. Antivasospasm agents were immediately discontinued, and strict blood control measures were instituted. Splenial hematoma is another potential cause of neurological deterioration after surgery for SAH, in addition to vasospasm, hydrocephalus, and rebleeding. PMID:20339269

Sorimachi, Takatoshi; Yajima, Naoki; Sasaki, Osamu; Koike, Tetsuo; Fujii, Yukihiko



Prevalence and Risk Factors for Multiple Simultaneous Intracerebral Hemorrhages  

Microsoft Academic Search

Background: Multiple simultaneous intracerebral hemorrhages (MSICH) are rare. We aimed to describe the frequency and potential risk factors for MSICH. Methods: We reviewed 522 consecutive patients admitted to our institution with spontaneous ICH between August 1, 2006 and November 30, 2009. Patients with traumatic hemorrhages, predominantly subarachnoid or intraventricular hemorrhages, hemorrhagic transformation of ischemic infarcts, and hemorrhages due to cerebral

Andrew Stemer; Bichun Ouyang; Vivien H. Lee; Shyam Prabhakaran



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

PubMed Central

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

Macdonald, R. Loch



Adenosine A2A receptors in early ischemic vascular injury after subarachnoid hemorrhage  

PubMed Central

Object The role of adenosine A2A receptors (A2AR) in the early vascular response after subarachnoid hemorrhage (SAH) is not known. In other forms of cerebral ischemia both activation and inhibition of A2AR is reported to be beneficial. However, these studies mainly used pharmacological receptor modulation and most of the agents available exhibit low specificity. We used adenosine A2A receptor knockout mice to study the role of A2AR in the early vascular response to SAH. Method SAH was induced in the wild type (WT; C57BL/6) and A2AR knockout mice (A2AR-KO) by endovascular puncture. Cerebral blood flow (CBF), intracranial pressure (ICP) and blood pressure (BP) were recorded, cerebral perfusion pressure (CPP) was deduced. Animals were sacrificed at 1, 3 and 6 hours after SAH or sham surgery. Coronal brain sections were immunostained for collagen-IV; major protein of basal lamina. The internal diameter of major cerebral arteries and the area fraction of collagen-IV positive microvessels (<100?m) were determined. Results Initial ICP rise and CPP fall at SAH induction was similar but CBF fall was significantly smaller in A2AR-KO as compared to WT cohorts. The internal diameter of major cerebral vessels decreased progressively after SAH. The extent of diameter reduction was significantly less in A2AR-KO than in WT mice. Collagen-IV immunostaining decreased progressively after SAH. The decrease was significantly less in A2AR-KO than in WT. Conclusion Our results demonstrate that global inactivation of A2AR decreases the intensity of the early vascular response to SAH. Early inhibition of A2AR after SAH might reduce cerebral injury.

Sehba, Fatima A.; Flores, Rowena; Muller, Artur; Friedrich, Victor; Chen, Jiang-Fan; Britz, Gavin W.; Winn, H. Richard; Bederson, Joshua B.



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

Microsoft Academic Search

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

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



Plasma Concentrations of Brain Natriuretic Peptide in Patients With Subarachnoid Hemorrhage  

Microsoft Academic Search

Background and Purpose—Hyponatremia after subarachnoid hemorrhage (SAH) is commonly associated with diuresis and natriuresis, but the causes are still controversial. We investigated whether brain natriuretic peptide (BNP) was related to such hyponatremia. Methods—Plasma BNP concentrations were measured by immunoradiometric assay in 18 patients at 0 to 2 days (period 1), 7 to 9 days (period 2), and .14 days (period

Mamoru Tomida; Masaaki Muraki; Kenichi Uemura; Kenji Yamasaki


Red blood cell transfusion in patients with subarachnoid hemorrhage: a multidisciplinary North American survey  

Microsoft Academic Search

ABSTRACT: INTRODUCTION: Anemia is associated with poor outcomes in patients with aneurysmal subarachnoid hemorrhage (SAH). It remains unclear whether this association can be modified with more aggressive use of red blood cell (RBC) transfusions. The degree to which restrictive thresholds have been adopted in neurocritical care patients remains unknown. METHODS: We performed a survey of North American academic neurointensivists, vascular

Andreas H Kramer; Michael N Diringer; Jose I Suarez; Andrew M Naidech; Loch R Macdonald; Peter D Le Roux



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

Microsoft Academic Search

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

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



The Effect of Intracisternal Phentolamine on Cerebral Blood Flow after Simulated Subarachnoid Hemorrhage.  

National Technical Information Service (NTIS)

The hydrogen clearance method was used to measure total and focal blood flow (CBF) in the monkey before and for 5 hours after a simulated subarachnoid hemorrhage (SAH). Some monkeys also received 0.2-1.0 mg/kg phentolamine intracisternally 3 hours after S...

A. N. Martins N. Newby T. F. Doyle A. I. Kobrine A. Ramirez



Intracranial vertebral artery dissection with subarachnoid hemorrhage following child abuse.  


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

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



Intracranial vertebral artery dissection with subarachnoid hemorrhage following child abuse  

Microsoft Academic Search

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

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



Molecular insights of SAH enzyme catalysis and implication for inhibitor design.  


Biological transmethylation reaction is a key step in the duplication of virus life cycle, in which S-adenosylmethionine plays as the methyl donor. The product of this reactions, S-adenosylhomocysteine (AdoHcy) inhibits the transmethylation process. AdoHcy is hydrolysed to adenosine and L-homocysteine by the action of S-adenosylhomocysteine hydrolase (SAH). Thus the virus life cycle should be cut off once the action of SAH is inhibited. Our study was focussed on the discovery of potential inhibitor against SAH. We performed a similarity search in Traditional Chinese Medicine Database and retrieved 17 hits with high similarity. After that we virtually docked the 17 compounds as well as the natural substrates to the hydrolase using Autodock 3.0.1 software. Then we discussed about the mechanism of the inhibition reaction, followed by proposing the potential inhibitors by comparing best docked solutions and possible modification for the best inhibitors. PMID:17069857

Wei, Huachun; Zhang, Rui; Wang, Chunfang; Zheng, Huiqin; Li, Aixiu; Chou, Kuo-Chen; Wei, Dong-Qing



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

SciTech Connect

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

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



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


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

Sun, Qing; Wang, Fan; Li, Wei; Li, Weide; Hu, Yang-Chun; Li, Song; Zhu, Jian-Hong; Zhou, Mengliang; Hang, Chun-Hua



Regulation of enhanced cerebrovascular expression of proinflammatory mediators in experimental subarachnoid hemorrhage via the mitogen-activated protein kinase kinase/extracellular signal-regulated kinase pathway  

PubMed Central

Background Subarachnoid hemorrhage (SAH) is associated with high morbidity and mortality. It is suggested that the associated inflammation is mediated through activation of the mitogen-activated protein kinase (MAPK) pathway which plays a crucial role in the pathogenesis of delayed cerebral ischemia after SAH. The aim of this study was first to investigate the timecourse of altered expression of proinflammatory cytokines and matrix metalloproteinase in the cerebral arteries walls following SAH. Secondly, we investigated whether administration of a specific mitogen-activated protein kinase kinase (MEK)1/2 inhibitor, U0126, given at 6 h after SAH prevents activation of the MEK/extracellular signal-regulated kinase 1/2 pathway and the upregulation of cerebrovascular inflammatory mediators and improves neurological function. Methods SAH was induced in rats by injection of 250 ?l of autologous blood into basal cisterns. U0126 was given intracisternally using two treatment regimens: (A) treatments at 6, 12, 24 and 36 h after SAH and experiments terminated at 48 h after SAH, or (B) treatments at 6, 12, and 24 h after SAH and terminated at 72 h after SAH. Cerebral arteries were harvested and interleukin (IL)-6, IL-1?, tumor necrosis factor ? (TNF)?, matrix metalloproteinase (MMP)-9 and phosphorylated ERK1/2 (pERK1/2) levels investigated by immunohistochemistry. Early activation of pERK1/2 was measured by western blot. Functional neurological outcome after SAH was also analyzed. Results Expression levels of IL-1?, IL-6, MMP-9 and pERK1/2 proteins were elevated over time with an early increase at around 6 h and a late peak at 48 to 72 h post-SAH in cerebral arteries. Enhanced expression of TNF? in cerebral arteries started at 24 h and increased until 96 h. In addition, SAH induced sensorimotor and spontaneous behavior deficits in the animals. Treatment with U0126 starting at 6 h after SAH prevented activation of MEK-ERK1/2 signaling. Further, U0126 significantly decreased the upregulation of inflammation proteins at 48 and 72 h following SAH and improved neurological function. We found no differences between treatment regimens A and B. Conclusions These results show that SAH induces early activation of the MEK-ERK1/2 pathway in cerebral artery walls, which is associated with upregulation of proinflammatory cytokines and MMP-9. Inhibition of the MEK-ERK1/2 pathway by U0126 starting at 6 h post-SAH prevented upregulation of cytokines and MMP-9 in cerebral vessels, and improved neurological outcome.



Evaluation of MTA\\/SAH Nucleosidase Inhibitors as Potential Antibiotics for Lyme Disease  

Microsoft Academic Search

Drug development against bacterial pathogens lags behind the emergence of antibiotic resistance, creating an urgent need for the identification of physiological and metabolic target unique to pathogens. One such class of molecules is the MTA\\/ SAH nucleosidases involved in purine and methionine salvage, polyamine synthesis and production of quorum sensing autoinducers. Nucleosidase inhibition should cause an accumulation of intracellular MTA

Jorge Martinez



Depletion of Ly6G/C+ cells ameliorates delayed cerebral vasospasm in subarachnoid hemorrhage  

PubMed Central

Background The etiology of delayed cerebral vasospasm (DCV) after aneurismal subarachnoid hemorrhage (SAH) has remained elusive. Growing evidence supports a role for inflammation in the pathogenesis of DCV. We showed that CSF neutrophils predict which patients will develop DCV. Methods We evaluated a murine model of SAH to test the hypothesis that myeloid cells are required for the cerebral damage associated with DCV. Results SAH was associated with decreased middle cerebral artery caliber on day 1 which normalized at day 3 and recurred at day 6. In addition, behavioral testing with a Barnes maze showed executive dysfunction that progressively worsened after the seventh day post hemorrhage. To test the role of innate immune responses, we administrated a myeloid cell-depleting monoclonal antibody against Ly6G/C prior to experimental SAH. Myeloid cell depletion ameliorated angiographic vasospasm measured by MCA vessel caliber and normalized behavioral testing. Conclusion Our findings support the role of Ly6G/C+ cells in the development of DCV after SAH and suggest that immune modulation of neutrophils or other Ly6G/C+ cells may be a strategy for the prevention of DCV.

Altay, Tamer; Smithason, Saksith; Moore, Shari Korday; Ransohoff, Richard M.



Investigation of the presence of human or bovine respiratory syncytial virus in the lungs of mink (Neovison vison) with hemorrhagic pneumonia due to Pseudomonas aeruginosa  

PubMed Central

Background Hemorrhagic pneumonia is a disease of farmed mink (Neovison vison) caused by Pseudomonas aeruginosa. The disease is highly seasonal in Danish mink with outbreaks occurring almost exclusively in the autumn. Human respiratory syncytial virus (RSV) has been shown to augment infection with P. aeruginosa in mice and to promote adhesion of P. aeruginosa to human respiratory cells. Findings We tested 50 lung specimens from mink with hemorrhagic pneumonia for bovine RSV by reverse transcriptase polymerase chain reaction (PCR) and for human RSV by a commercial real-time PCR. RSV was not found. Conclusions This study indicates that human and bovine RSV is not a major co-factor for development of hemorrhagic pneumonia in Danish mink.



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


Intracellular Ca(2+) release events ('Ca(2+) sparks') and transient activation of large-conductance Ca(2+)-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 Ca(2+) 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 Ca(2+) spark activity, reflecting a decrease in the number of functional Ca(2+) spark discharge sites. Patch-clamp electrophysiology showed a similar reduction in Ca(2+) spark-induced transient BK currents, without change in BK channel density or single-channel properties. Consistent with a reduction in active Ca(2+) 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 Ca(2+) sparks (ryanodine) or BK channels (paxilline) constricted arteries from control, but not from SAH animals. This study shows that SAH-induced decreased subcellular Ca(2+) 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

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



Diagnostic value of a ghrelin test for the diagnosis of GH deficiency after subarachnoid hemorrhage  

PubMed Central

Objective To determine the diagnostic value of a ghrelin test in the diagnosis of GH deficiency (GHD) shortly after aneurysmal subarachnoid hemorrhage (SAH). Design Prospective single-center observational cohort study. Methods A ghrelin test was assessed after the acute phase of SAH and a GH-releasing hormone (GHRH)–arginine test 6 months post SAH. Primary outcome was the diagnostic value of a ghrelin test compared with the GHRH–arginine test in the diagnosis of GHD. The secondary outcome was to assess the safety of the ghrelin test, including patients' comfort, adverse events, and idiosyncratic reactions. Results Forty-three survivors of SAH were included (15 males, 35%, mean age 56.6±11.7). Six out of 43 (14%) SAH survivors were diagnosed with GHD by GHRH–arginine test. In GHD subjects, median GH peak during ghrelin test was significantly lower than that of non-GHD subjects (5.4 vs 16.6, P=0.002). Receiver operating characteristics analysis showed an area under the curve of 0.869. A cutoff limit of a GH peak of 15??g/l corresponded with a sensitivity of 100% and a false-positive rate of 40%. No adverse events or idiosyncratic reactions were observed in subjects undergoing a ghrelin test, except for one subject who reported flushing shortly after ghrelin infusion. Conclusion Owing to its convenience, validity, and safety, the ghrelin test might be a valuable GH provocative test, especially in the early phase of SAH.

Blijdorp, K; Khajeh, L; Ribbers, G M; Sneekes, E M; Heijenbrok-Kal, M H; van den Berg-Emons, H J G; van der Lely, A J; van Kooten, F; Neggers, S J C M M



A modified double injection model of cisterna magna for the study of delayed cerebral vasospasm following subarachnoid hemorrhage in rats  

PubMed Central

Delayed cerebral vasospasm following subarachnoid hemorrhage (SAH) is a serious medical complication, characterized by constriction of cerebral arteries leading to varying degrees of cerebral ischemia. Numerous clinical and experimental studies have been performed in the last decades; however, the pathophysiologic mechanism of cerebral vasospasm after SAH still remains unclear. Among a variety of experimental SAH models, the double hemorrhage rat model involving direct injection of autologous arterial blood into the cisterna magna has been used most frequently for the study of delayed cerebral vasospasm following SAH in last years. Despite the simplicity of the technique, the second blood injection into the cisterna magna may result in brainstem injury leading to high mortality. Therefore, a modified double hemorrhage model of cisterna magna has been developed in rat recently. We describe here step by step the surgical technique to induce double SAH and compare the degree of vasospasm with other cisterna magna rat models using histological assessment of the diameter and cross-sectional area of the basilar artery.



Spontaneous intracranial hypotension presenting as pseudo-subarachnoid hemorrhage on CT scan.  


We report a 20-year-old man who suffered from severe headache. A brain CT scan revealed that he had diffuse brain swelling and increased attenuation of the basal cisterns and Sylvian fissure. Subarachnoid hemorrhage (SAH) was diagnosed but the results of CT angiography and conventional arterioangiography were negative. His headache relapsed and remitted several times during the following months. Brain MRI demonstrated brain sagging with a crowded foramen magnum. Spontaneous intracranial hypotension (SIH) was finally diagnosed and his headache subsided after application of an epidural blood patch. Pseudo-SAH on CT scan is an unusual manifestation of SIH that often results in delay of diagnosis and adequate treatment. PMID:21745742

Koh, Elly; Huang, Shih-Hao; Lai, Yen-Jun; Hong, Chien-Tai



Transdermal Nicotine Replacement Therapy in Cigarette Smokers with Acute Subarachnoid Hemorrhage  

Microsoft Academic Search

Background  We evaluated the safety of nicotine replacement therapy (NRT) in active smokers with acute (aneurysmal) subarachnoid hemorrhage\\u000a (SAH).\\u000a \\u000a \\u000a \\u000a \\u000a Methods  A retrospective observational cohort study was conducted in a prospectively collected database including all SAH patients\\u000a admitted to an 18-bed neuro-ICU between January 1, 2001 and October 1, 2007. Univariate and multivariable models were constructed,\\u000a employing stepwise logistic regression. The primary endpoint

David B. SederJ; J. Michael Schmidt; Neeraj Badjatia; Luis Fernandez; Fred Rincon; Jan Claassen; Errol Gordon; Emmanuel Carrera; Pedro Kurtz; Kiwon Lee; E. Sander Connolly; Stephan A. Mayer



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

PubMed Central

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

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



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

PubMed Central

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



Spontaneous bilateral carotid and vertebral artery dissections associated with multiple disparate intracranial aneurysms, subarachnoid hemorrhage and spontaneous resolution  

Microsoft Academic Search

Spontaneous bilateral carotid and vertebral artery dissections (CADs and VADs) are rare. A 29-year-old female presented with a collapse, 4 weeks after a sudden onset of severe neck and shoulder pain. CT scan revealed diffuse subarachnoid hemorrhage (SAH) and early hydrocephalus. Angiography revealed bilateral CADs and VADs, along with multiple fusiform and saccular aneurysms. Systemic vessels – including the renal

Laurence A. G. Marshman; Luke Ball; Changez K. Jadun



Has admission blood pressure any prognostic value in patients with subarachnoid hemorrhage: an emergency department experience.  


Hypertension is a well-known risk factor for the development and rupture of cerebral aneurysms. The authors conducted a study to investigate the prognostic value of admission blood pressure (BP) on prognosis in patients with subarachnoid hemorrhage (SAH). Two hundred patients with SAH were divided into two groups according to Hunt Hess score (good prognosis: 1 to 3, and poor prognosis: 4 and 5) and according to death in hospital (surveyed and died). The prognostic factors of SAH and BP changes according to Hunt Hess scores in the acute stages of the event were evaluated. Admission mean arterial BP values of the patients who died in hospital were significantly lower than in the patients who were surveyed (P=.026). The admission mean arterial BP values were found to be lower in the poor prognostic patients (Hunt Hess score of 4 and 5) (P<.001). Decreased admission BP values were found to be associated with poor prognosis and mortality. PMID:24088282

Duran, Latif; Balci, Kemal; Kati, Celal; Akdemir, H?z?r Ufuk; Kocabicak, Ersoy; Do?ruel, Canan



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


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

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



Hyperglycemia in aneurysmal subarachnoid hemorrhage: a potentially modifiable risk factor for poor outcome  

PubMed Central

Hyperglycemia after aneurysmal subarachnoid hemorrhage (aSAH) occurs frequently and is associated with delayed cerebral ischemia (DCI) and poor clinical outcome. In this review, we highlight the mechanisms that cause hyperglycemia after aSAH, and we discuss how hyperglycemia may contribute to poor clinical outcome in these patients. As hyperglycemia is potentially modifiable with intensive insulin therapy (IIT), we systematically reviewed the literature on IIT in aSAH patients. In these patients, IIT seems to be difficult to achieve in terms of lowering blood glucose levels substantially without an increased risk of (serious) hypoglycemia. Therefore, before initiating a large-scale randomized trial to investigate the clinical benefit of IIT, phase II studies, possibly with the help of cerebral blood glucose monitoring by microdialysis, will first have to improve this therapy in terms of both safety and adequacy.

Kruyt, Nyika D; Biessels, Geert Jan; DeVries, J Hans; Luitse, Merel J A; Vermeulen, Marinus; Rinkel, Gabriel J E; Vandertop, W Peter; Roos, Yvo B



Magnesium and the inflammatory response: potential pathophysiological implications in the management of patients with aneurysmal subarachnoid hemorrhage?  


Cerebral vasospasm and delayed cerebral ischemia remain an unsolved problem in patients with aneurysmal subarachnoid hemorrhage (SAH). In theory, high-dose magnesium sulfate (MgSO(4)) therapy offers vascular and neuroprotective benefits and is therefore currently under evaluation. The intensity of the inflammatory response after SAH is associated with the outcome. The aim of the current study was to evaluate a possible link between the inflammatory response and MgSO(4) therapy, since magnesium (Mg(2+)) has anti-inflammatory properties. In 15 patients with SAH, inflammatory cytokine levels in the cerebrospinal fluid (CSF) and peripheral blood were determined daily using an enzyme-linked immunosorbent assay between day 4 and day 12. Eight patients were treated with standard therapy alone (group 1) and seven patients were treated with an additional, high-dose of MgSO(4) (group 2). Serum Mg(2+) levels in group 2 were significantly higher compared to group 1: 1.48 ± 0.04 mmol/L versus 0.90 ± 0.01 mmol/L, ?<0.001. Interleukin-6 (IL-6) in the CSF was significantly lower in group 2 compared to group 1: 6680 ± 989 vs.11079 ± 1277 pg/mL, ? = 0.021. A trend towards lower systemic IL-6 levels was found in group 2: 58 ± 7 versus 104 ± 21 pg/mL, ? = 0.052. Systemic IL-1? levels were significantly lower in group 2: 0.66 ± 0.11 and 0.15 ± 0.01 pg/mL (?<0.001), while the CSF levels did not differ. Tumor necrosis factor-? levels did not differ between the two groups. Although there were more patients with favorable outcome in group 2, the difference was not statistically significant. This was probably due to the small sample size. The results indicate a suppression of inflammatory cytokine release, in particular IL-6, in patients treated with high-dose MgSO(4). These results call for further studies of the effect of Mg(2+) on the inflammatory signaling pathway with regard to delayed cerebral ischemia following SAH. PMID:22966500

Muroi, Carl; Burkhardt, Jan-Karl; Hugelshofer, Michael; Seule, Martin; Mishima, Kenichi; Keller, Emanuela



Subarachnoid Hemorrhage Mimicking Leakage of Contrast Media After Coronary Angiography  

PubMed Central

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

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



Circulatory and vascular changes after aneurysmal subarachnoid hemorrhage.  


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

Wan, H; Loch Macdonald, R



Musical murmurs in human cerebral arteries after subarachnoid hemorrhage.  


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

Aaslid, R; Nornes, H



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

PubMed Central

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

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



Spontaneous Retroperitoneal Hemorrhage (Wunderlich Syndrome) due to Large Upper Pole Renal Angiomyolipoma: Does Robotic-Assisted Laparoscopic Partial Nephrectomy Have a Role in Primary Treatment?  

PubMed Central

Spontaneous rapture with consequent retroperitoneal hemorrhage (Wunderlich's syndrome) is the complication mostly feared from large renal angiomyolipomas (RAMLs). In hemodynamic stable patients, minimal invasive therapies have superseded open surgery as the mainstay of treatment, with contemporary cases mostly treated by selective arterial embolization. Robotic-assisted laparoscopic partial nephrectomy (RALPN) is an established minimal access treatment that has been used in the past for benign and malignant lesions of the kidney in the elective setting, but rarely in urgent situations as primary treatment. We present a case of a ruptured RAML in a young female treated effectively by RALPN.

Ploumidis, Achilles; Katafigiotis, Ioannis; Thanou, Maria; Bodozoglou, Nikos; Athanasiou, Labros; Ploumidis, Antonios



Nuclear factor-?B/Bcl-XL pathway is involved in the protective effect of hydrogen-rich saline on the brain following experimental subarachnoid hemorrhage in rabbits.  


Early brain injury (EBI), a significant contributor to poor outcome after subarachnoid hemorrhage (SAH), is intimately associated with neuronal apoptosis. Recently, the protective role of hydrogen (H2 ) in the brain has been widely studied, but the underlying mechanism remains elusive. Numerous studies have shown nuclear factor-?B (NF-?B) as a crucial survival pathway in neurons. Here we investigated the role of H2 in EBI following SAH, focusing on the NF-?B pathway. A double blood injection model was used to produce experimental SAH, and H2 -rich saline was injected intraperitoneally. NF-?B activity within the occipital cortex was measured. Immunofluorescence was performed to demonstrate the activation of NF-?B; Bcl-xL and cleaved caspase-3 were determined via Western blot. Gene expression of Bcl-xL was detected by real-time PCR, and TUNEL and Nissl staining were performed to illustrate brain injury in the occipital cortex. SAH induced a significant increase of cleaved caspase-3. Correspondingly, TUNEL staining demonstrated obvious neuronal apoptosis following SAH. In contrast, H2 treatment markedly increased NF-?B activity and the expression of Bcl-xL and decreased the level of cleaved caspase-3. Additionally, H2 treatment significantly reduced post-SAH neuronal apoptosis. The current study shows that H2 treatment alleviates EBI in the rabbits following SAH and that NF-?B/Bcl-xL pathway is involved in the protective role of H2 . © 2013 Wiley Periodicals, Inc. PMID:24105634

Zhuang, Zong; Sun, Xue-Jun; Zhang, Xing; Liu, Huan-Dong; You, Wan-Chun; Ma, Chi-Yuan; Zhu, Lin; Zhou, Meng-Liang; Shi, Ji-Xin



[Alveolar hemorrhage].  


Diffuse alveolar hemorrhage (DAH) is defined by the presence of red blood cells originating from the lung capillaries or venules within the alveoli. The diagnosis is established on clinical features, radiological pattern, and especially bronchoalveolar lavage. Diffuse alveolar hemorrhage may have many immune or non-immune causes. Immune causes of DAH include vasculitides, connective tissue diseases, especially systemic lupus erythematosus, and antiglomerular basement membrane antibody disease (Goodpasture's syndrome). Treatment is both supportive and causal, often based on high dose corticosteroids and immunosuppressive therapy (especially intravenous cyclophosphamide). Plasma exchanges are performed in antiglomerular basement membrane antibody disease and systemic lupus erythematosus, and are considered in systemic vasculitis. Non-immune causes of DAH mainly include heart diseases, coagulation disorders, infections, drug toxicities and idiopathic DAH. Treatment of non-immune DAH is that of its cause. Whatever the cause, DAH is an emergency requiring prompt assessment and early treatment. PMID:22963805

Traclet, J; Lazor, R; Cordier, J-F; Cottin, V



Intraventricular hemorrhage  

PubMed Central

Background: Spontaneous intracerebral hemorrhage (ICH) is frequently associated with intraventricular hemorrhage (IVH), which is an independent predictor of poor outcome. The purpose of this study was to examine the relationship between ICH volume and anatomic location to IVH, and to determine if ICH decompression into the ventricle is truly beneficial. Methods: We retrospectively analyzed the CT scans and charts of all patients with ICH admitted to our stroke center over a 3-year period. Outcome data were collected using our prospective stroke registry. Results: We identified 406 patients with ICH. A total of 45% had IVH. Thalamic and caudate locations had the highest IVH frequency (69% and 100%). ICH volume and ICH location were predictors of IVH (p < 0.001). Within each location, decompression ranges (specific volume ranges where ventricular rupture tends to occur) were established. Patients with IVH were twice as likely to have a poor outcome (discharge modified Rankin scale of 4 to 6) (OR 2.25, p = 0.001) when compared to patients without IVH. Caudate location was associated with a good outcome despite 100% incidence of IVH. Spontaneous ventricular decompression was not associated with better outcome, regardless of parenchymal volume reduction (p = 0.72). Conclusions: Intraventricular hemorrhage (IVH) occurs in nearly half of patients with spontaneous intracerebral hemorrhage (ICH) and is related to ICH volume and location. IVH is likely to occur within the “decompression ranges” that take into account both ICH location and volume. Further, spontaneous ventricular decompression does not translate to better clinical outcome. This information may prove useful for future ICH trials, and to the clinician communicating with patients and families.

Hallevi, H.; Albright, K.C.; Aronowski, J.; Barreto, A.D.; Martin-Schild, S.; Khaja, A.M.; Gonzales, N.R.; Illoh, K.; Noser, E.A.; Grotta, J.C.



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


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

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



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

SciTech Connect

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

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



Roller coaster-associated subarachnoid hemorrhage--report of 2 cases.  


The most common neurological injuries associated with roller coaster rides are subdural hematoma and cervical artery dissection. We report two cases of roller-coaster associated subarachnoid hemorrhage (SAH). A 40-year-old healthy man developed a strong, holocephalic headache during a roller coaster ride. SAH Hunt & Hess grade II and Fisher grade 3 was diagnosed. An underlying aneurysm of the anterior communicating artery was successfully treated with coil embolization. A 41-year-old female (smoker, otherwise healthy) experienced a sudden, strong headache and diplopia during a roller coaster ride. A perimesencephalic SAH (Hunt & Hess grade II, Fisher grade 3) was disclosed by a CT scan. No aneurysm was detected on angiography. Both patients were discharged without neurological disability. In conclusion, SAH is a rare but relevant differential diagnosis in cases of acute headache during roller coaster rides. Both aneurysmal and non-aneurysmal perimesencephalic SAH can occur. A combination of mechanical factors and excessive blood pressure rises in vulnerable persons is discussed. PMID:22177088

Rutsch, Sebastian; Niesen, Wolf-Dirk; Meckel, Stephan; Reinhard, Matthias



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

PubMed Central

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

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



Protein therapy using heme-oxygenase-1 fused to a polyarginine transduction domain attenuates cerebral vasospasm after experimental subarachnoid hemorrhage  

PubMed Central

A sequence of 11 consecutive arginine residues (11R) is one of the best protein transduction domains for introducing proteins into cell membranes. Heme-oxygenase-1 (HO-1) is involved in heme catabolism and reduces the contractile effect of hemoglobin after subarachnoid hemorrhage (SAH). Therefore, we constructed 11R-fused HO-1 protein to achieve successful transduction of the protein into the cerebral arteries and examined the therapeutic effect of the 11R-HO-1 protein for cerebral vasospasm (CV) after SAH. We injected the 11R-HO-1 protein into the cisterna magna of male rats and, several hours after the injection, performed immunofluorescence staining and western blotting analysis of the rat basilar arteries (BAs) to determine transduction efficacy. We also assessed intraarterial HO-1 activity as cGMP (cyclic guanosine 3?, 5?-cyclic monophosphate) accumulation in SAH and determined whether protein transduction of 11R-HO-1 quantified the therapeutic effect in a rat double-hemorrhage model of SAH. The BAs expressed significantly more HO-1 in the group injected with 11R-HO-1 (3.56±0.54 (11R-HO-1) versus control (saline)), and transduction of 11R-HO-1 resulted in higher activity (>3.25-fold) in rat BAs with SAH. Moreover, the results of the rat double-hemorrhage model showed that the 11R-HO-1 protein significantly attenuated CV after SAH (317.59±23.48??m (11R-HO-1) versus 270.08±14.66??m (11R-fused enhanced green fluorescent protein), 252.05±13.95??m (saline), P<0.01).

Ogawa, Tomoyuki; Hanggi, Daniel; Wu, Yumei; Michiue, Hiroyuki; Tomizawa, Kazuhito; Ono, Shigeki; Matsui, Hideki; Date, Isao; Steiger, Hans-Jakob



Phenylpropanolamine and cerebral hemorrhage  

SciTech Connect

Computerized tomography, carotid angiograms, and arteriography were used to diagnose several cases of cerebral hemorrhage following the use of phenylpropanolamine. The angiographic picture in one of the three cases was similar to that previously described in association with amphetamine abuse and pseudoephedrine overdose, both substances being chemically and pharmacologically similar to phenylpropanolamine. The study suggests that the arterial change responsible for symptoms may be due to spasm rather than arteriopathy. 14 references, 5 figures.

McDowell, J.R.; LeBlanc, H.J.



Hypercholesterolemia increases vasospasm resulting from basilar artery subarachnoid hemorrhage in rabbits which is attenuated by Vitamin E  

PubMed Central

Background: Aneurysm rupture results in subarachnoid hemorrhage (SAH) with subsequent vasospasm in the cerebral and cerebellar major arteries. In recent years, there has been increasing evidence that hypercholesterolemia plays a role in the pathology of SAH. It is known that hypercholesterolemia is one of the major risk factors for the development of atherosclerosis. Among the factors that have been found to retard the development of atherosclerosis is the intake of a sufficient amount of Vitamin E. An inverse association between serum Vitamin E and coronary heart disease mortality has been demonstrated in epidemiologic studies. Therefore, we tested, in an established model of enhanced cholesterol feed in rabbits, the effects of hypercholesterolemia on vasospasm after SAH by using computed tomography (CT) angiograms of the rabbit basilar artery; in addition, we tested the effects of Vitamin E on these conditions, which have not been studied up to now. Methods: In this study rabbits were divided into 3 major groups: control, cholesterol fed, and cholesterol + Vitamin E fed. Hypercholesterolemia was induced by a 2% cholesterol-containing diet. Three rabbit groups were fed rabbit diet; one group was fed a diet that also contained 2% cholesterol and another group was fed a diet containing 2% cholesterol and they received i.m. injections of 50 mg/kg of Vitamin E. After 8 weeks, SAH was induced by the double-hemorrhage method and distilled water was injected into cisterna magna. Blood was taken to measure serum cholesterol and Vitamin E levels. Basilar artery samples were taken for microscopic examination. CT angiography and measurement of basilar artery diameter were performed at days 0 and 3 after SAH. Results: Two percent cholesterol diet supplementation for 8 weeks resulted in a significant increase in serum cholesterol levels. Light microscopic analysis of basilar artery of hypercholesterolemic rabbits showed disturbances in the subendothelial and medial layers, degeneration of elastic fibers in the medial layer from endothelial cell desquamation, and a reduction of waves in the endothelial layer. However, the cholesterol + Vitamin E group did not exhibit these changes. The mean diameter of the basilar artery after SAH induction in the cholesterol-treated group was decreased 47% compared with the mean diameter of the control group. This value was less affected in cholesterol + Vitamin E-treated rabbits, which decreased 18% compared with the mean diameter of the control group. Conclusions: Hypercholesterolemia-related changes in the basilar artery aggravate vasospasm after SAH. Adding Vitamin E to cholesterol-treated rabbits decreased the degree of vasospasm following SAH in the rabbit basilar artery SAH model. We suggest that Vitamin E supplements and a low cholesterol diet may potentially diminish SAH complicated by vasospasm in high-risk patients.

Sasani, Mehdi; Yazgan, Burak; Celebi, Irfan; Aytan, Nurgul; Catalgol, Betul; Oktenoglu, Tunc; Kaner, Tuncay; Ozer, Nesrin Kartal; Ozer, Ali Fahir



Postpartum hemorrhage.  


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

Su, Cindy W



Activation of Nuclear Factor-?B in the Brain after Experimental Subarachnoid Hemorrhage and Its Potential Role in Delayed Brain Injury  

PubMed Central

It has been reported that inflammation is involved in brain injury after subarachnoid hemorrhage (SAH). Nuclear factor-?B (NF-?B) is a key transcriptional regulator of inflammatory genes. Here, we used pyrrolidine dithiocarbamate(PDTC), an inhibitor of NF-?B, through intracisternal injection to study the role of NF-?B in delayed brain injury after SAH. A total of 55 rabbits were randomly divided into five groups: the control group; the SAH groups including Day-3, 5, and 7 SAH groups (the rabbits in these groups were sacrificed at 3, 5, 7 days after SAH, respectively); and the PDTC group (n?=?11 for each group). Electrophoretic mobility shift assay (EMSA) was performed to detect NF-?B DNA-binding activity. The mRNA levels of tumor necrosis factor (TNF)-?, interleukin (IL)-1?, and intercellular adhesion molecule (ICAM)-1 were evaluated by RT-PCR analysis. Deoxyribonucleic acid fragmentation was detected by TUNEL and p65 immunoactivity was assessed by immunohistochemistry. Our results showed the activation of NF-?B after SAH, especially at day 3 and 5. The activated p65 was detected in neurons. NF-?B DNA-binding activity was suppressed by intracisternal administration of PDTC. Increased levels of the TNF-?, IL-1?, and ICAM-1 mRNA were found in the brain at day 5 after SAH, and which were suppressed in the PDTC group. The number of TUNEL-positive cells also decreased significantly in the PDTC group compared with that in the Day-5 SAH group. These results demonstrated that the activated NF-?B in neurons after SAH plays an important role in regulating the expressions of inflammatory genes in the brain, and ultimately contributes to delayed brain injury.

You, Wan-Chun; Wang, Chun-xi; Pan, Yun-xi; Zhang, Xin; Zhou, Xiao-ming; Zhang, Xiang-sheng; Shi, Ji-xin; Zhou, Meng-liang



A novel inhibitor of inflammatory cytokine production (CNI-1493) reduces rodent post-hemorrhagic vasospasm  

Microsoft Academic Search

Introduction  Cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH) is a devastating complication, yet despite multiple lines\\u000a of investigation an effective treatment remains lacking. Cytokine-mediated inflammation has been implicated as a causative\\u000a factor in the development of posthemorrhagic vasospasm. In previous experiments using the rat femoral artery model of vasospasm,\\u000a we demonstrated that elevated levels of the proinflammatory cytokine interleukin (IL)-6 are

George Bowman; Robert H. Bonneau; Vernon M. Chinchilli; Kevin J. Tracey; Kevin M. Cockroft



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

Microsoft Academic Search

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

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



Cerebellar infarcts and hemorrhages.  


Cerebellar infarction accounts for about 3.4% of all ischemic strokes. Cerebellar syndromes are principally characterized by cerebellar symptoms and signs which depend on the involved vascular territories. In the Perugia Stroke Registry, infarct areas have included the superior cerebellar artery region in 36% of patients, the anterior inferior cerebellar artery region in 12%, and the posterior inferior cerebellar artery region in 40%; 12% of patients have had multiple vascular region involvement. 50% of the patients have had concurrent brainstem infarcts. Cerebellar hemorrhage accounts for about 10% of all intracranial hemorrhages and about 10% of all cerebellar strokes. Both stroke types can be worsened by complications due to a significant mass effect and brainstem compression. These events can lead to clinical deterioration which induces stupor and coma with a very high fatality rate. PMID:22377889

Venti, Michele



Does Isolated Traumatic Subarachnoid Hemorrhage Affect Outcome in Patients With Mild Traumatic Brain Injury?  


BACKGROUND:: The importance of isolated traumatic subarachnoid hemorrhage (SAH) in relation to functional outcome in patients with mild traumatic brain injury (TBI) has not been frequently studied. The aim of this study was to compare the impact of isolated SAH with normal computed tomographic (CT) scan on outcome of patients with mild TBI. METHODS:: This is a retrospective study of clinical records and CT scans of all patients with mild TBI (Glasgow Coma Scale score ?13) evaluated from January 1, 2010, to March 15, 2010, at our institution. The patients were divided into 2 groups: isolated SAH and normal CT scan. The telephonic Glasgow Outcome Scale-Extended, Rivermead Post-Concussion Symptoms Questionnaire (RPCSQ), and Rivermead Head Injury Follow-up Questionnaire (RHFUQ) scores were used to assess outcome after 1 year of injury. Independent sample t test in SPSS was used to assess difference in outcome. RESULTS:: A total of 1149 patients with mild TBI were evaluated during study period. Among them, 34 (2.9%) patients had isolated SAH. Twenty-eight patients were male and 6 were female, with a mean age of 36.5 years. Subarachnoid hemorrhage was cortical in 19 (55.9%) patients, interhemispheric in 3 (8.8%) patients, Sylvian fissure in 2 (5.9%) patients, and basal cisternal in 1 (2.9%) patient. Nine (26.5%) patients had SAH at multiple locations. The mean RPCSQ and RHFUQ scores for patients with isolated SAH were 1.38 ± 2.40 and 1.11 ±3.305, respectively. The mean RPCSQ and RHFUQ scores for patients with normal CT scans were 0.40 ± 1.549 and 0.533 ± 1.59, respectively. There was no significant difference in the outcome scores between the SAH and the normal CT scan groups (RHFUQ, P = .45; RPCSQ, P = .248). CONCLUSION:: In our study sample of patients with mild TBI, there is no difference in outcome of patients with isolated SAH compared with those with normal CT scans 1 year after injury. PMID:22832372

Deepika, Akhil; Munivenkatappa, Ashok; Devi, Bhagavatula Indira; Shukla, Dhaval



Dissecting aneurysm of the anterior cerebral artery with severe subarachnoid hemorrhage during treatment for cerebral infarction.  


Intracranial dissecting aneurysms cause ischemia, but anticoagulation or antiplatelet agents are administered to most ischemic patients without angiographical investigation. A 55-year-old woman succumbed to a subarachnoid hemorrhage (SAH) during antiplatelet therapy for ischemia caused by a dissecting aneurysm at the anterior cerebral artery, which was identified by conventional angiography on day 11 after admission. The authors emphasize that all dissecting aneurysms manifesting ischemic attack can cause hemorrhage. Therefore, emergency angiography is recommended for patients with ischemia complaining of a headache. If dissection is identified, it may be better to regulate the blood pressure of the patient strictly without anticoagulation or antiplatelet therapy. PMID:12793716

Yamada, Shoko M; Nakane, Makoto; Aoki, Makoto; Nakayama, Hitoshi



Recent advances in diagnostic approaches for sub-arachnoid hemorrhage  

PubMed Central

Sub-arachnoid hemorrhage (SAH) has been easily one of the most debilitating neurosurgical entities as far as stroke related case mortality and morbidity rates are concerned. To date, it has case fatality rates ranging from 32-67%. Advances in the diagnostic accuracy of the available imaging methods have contributed significantly in reducing morbidity associated with this deadly disease. We currently have computed tomography angiography (CTA), magnetic resonance angiography (MRA) and the digital subtraction angiography (DSA) including three dimensional DSA as the mainstay diagnostic techniques. The non-invasive angiography in the form of CTA and MRA has evolved in the last decade as rapid, easily available, and economical means of diagnosing the cause of SAH. The role of three dimensional computed tomography angiography (3D-CTA) in management of aneurysms has been fairly acknowledged in the past. There have been numerous articles in the literature regarding its potential threat to the conventional “gold standard” DSA. The most recent addition has been the introduction of the fourth dimension to the established 3D-CT angiography (4D-CTA). At many centers, DSA is still treated as the first choice of investigation. Although, CT angiography still has some limitations, it can provide an unmatched multi-directional view of the aneurysmal morphology and its surroundings including relations with the skull base and blood vessels. We study the recent advances in the diagnostic approaches to SAH with special emphasis on 3D-CTA and 4D-CTA as the upcoming technologies.

Kumar, Ashish; Kato, Yoko; Hayakawa, Motoharu; Junpei, ODA; Watabe, Takeya; Imizu, Shuei; Oguri, Daikichi; Hirose, Yuichi



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

PubMed Central

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

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



Acute hypoperfusion immediately after subarachnoid hemorrhage: a xenon contrast-enhanced CT study.  


The acute neurological deficit present immediately after subarachnoid hemorrhage (SAH) correlates with overall outcome. Only limited data are available to quantify changes in cerebral perfusion in this acute phase, and this study sought to characterize those changes within the first 12 h post-SAH. Xenon contrast-enhanced CT scanning was performed in 17 patients (Hunt and Hess grade [HH] 1-3, n = 9; HH 4-5, n = 8) within 12 h after SAH. Cerebral blood flow (CBF) was analyzed in all cortical and central vascular regions of interest (ROI), as well as infratentorial ROI. Hemodynamic stress distribution (central/cortical ROI) was also calculated. Asymptomatic patients without perfusion deficits served as controls (n = 5), and Glasgow Outcome Scale score (GOS) was determined 3 months after the event. Intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were within normal limits in all patients. CBF was significantly reduced in all patients with SAH (34 mL/100 g x min) compared to controls (67 mL/100 g x min; p < 0.001). Patients in better clinical condition (HH 1-3) presented with significantly less reduction of CBF (41 mL/100 g x min) compared to patients with more severe hemorrhage (HH 4-5: 24 mL/100 g x min; p < 0.001), and had better outcomes. Changes in perfusion were more pronounced in supratentorial than in infratentorial ROI. Hemodynamic stress distribution was most pronounced in patients with higher HH grade (p < 0.05). The first 12 h after SAH are characterized by persistent, severe reduction of CBF, which in turn correlates with HH grade, but is independent of ICP or CPP. Acute peripheral vasospasm of the microvasculature, not detectable by conventional angiography, may account for this early phase of prolonged hypoperfusion. PMID:19929373

Schubert, Gerrit Alexander; Seiz, Marcel; Hegewald, Aldemar Andrés; Manville, Jérôme; Thomé, Claudius



Safety and pharmacokinetics of sodium nitrite in patients with subarachnoid hemorrhage: a Phase IIA study.  


Object Intravenous sodium nitrite has been shown to prevent and reverse cerebral vasospasm in a primate model of subarachnoid hemorrhage (SAH). The present Phase IIA dose-escalation study of sodium nitrite was conducted to determine the compound's safety in humans with aneurysmal SAH and to establish its pharmacokinetics during a 14-day infusion. Methods In 18 patients (3 cohorts of 6 patients each) with SAH from a ruptured cerebral aneurysm, nitrite (3 patients) or saline (3 patients) was infused. Sodium nitrite and saline were delivered intravenously for 14 days, and a dose-escalation scheme was used for the nitrite, with a maximum dose of 64 nmol/kg/min. Sodium nitrite blood levels were frequently sampled and measured using mass spectroscopy, and blood methemoglobin levels were continuously monitored using a pulse oximeter. Results In the 14-day infusions in critically ill patients with SAH, there was no toxicity or systemic hypotension, and blood methemoglobin levels remained at 3.3% or less in all patients. Nitrite levels increased rapidly during intravenous infusion and reached steady-state levels by 12 hours after the start of infusion on Day 1. The nitrite plasma half-life was less than 1 hour across all dose levels evaluated after stopping nitrite infusions on Day 14. Conclusions Previous preclinical investigations of sodium nitrite for the prevention and reversal of vasospasm in a primate model of SAH were effective using doses similar to the highest dose examined in the current study (64 nmol/kg/min). Results of the current study suggest that safe and potentially therapeutic levels of nitrite can be achieved and sustained in critically ill patients after SAH from a ruptured cerebral aneurysm. Clinical trial registration no.: NCT00873015 ( ). PMID:23706046

Oldfield, Edward H; Loomba, Johanna J; Monteith, Stephen J; Crowley, R Webster; Medel, Ricky; Gress, Daryl R; Kassell, Neal F; Dumont, Aaron S; Sherman, Craig



Isoflurane delays the development of early brain injury after subarachnoid hemorrhage through sphingosine-related pathway activation in mice  

PubMed Central

Objective Isoflurane, a volatile anesthetic agent, has been recognized for its potential neuroprotective properties and has antiapoptotic effects. We examined whether isoflurane posttreatment is protective against early brain injury (EBI) after subarachnoid hemorrhage (SAH) and determined whether this effect needs sphingosine-related pathway activation. Design Controlled in vivo laboratory study. Setting Animal research laboratory. Subjects 179 eight-week-old male CD-1 mice weighing 30 to 38 g. Interventions SAH was induced in mice by endovascular perforation. Animals were randomly assigned to sham-operated, SAH-vehicle, and SAH+2% isoflurane. Neurobehavioral function and brain edema were evaluated at 24 and 72 hours. The expression of sphingosine kinase (SphK), phosphorylated Akt (p-Akt) and cleaved caspase-3 was determined by Western blotting and immunofluorescence. Neuronal cell death was examined by terminal deoxynucleotidyl transferase-mediated uridine 5?-triphosphate-biotin nick end-labeling staining. Effects of a SphK inhibitor DMS, or a sphingosine 1 phosphate receptor inhibitor VPC23019 on isoflurane’s protective action against post-SAH EBI were also examined. Measurements and Main Results Isoflurane significantly improved neurobehavioral function and brain edema at 24 hours but not 72 hours after SAH. At 24 hours, isoflurane attenuated neuronal cell death in the cortex, associated with an increase in SphK1 and p-Akt, and a decrease in cleaved caspase-3. The beneficial effects of isoflurane were abolished by DMS and VPC23019. Conclusions Isoflurane posttreatment delays the development of post-SAH EBI through antiapoptotic mechanisms including sphingosine-related pathway activation, implying its use for anesthesia during acute aneurysm surgery or intervention.

Altay, Orhan; Hasegawa, Yu; Sherchan, Prativa; Suzuki, Hidenori; Khatibi, Nikan H.; Tang, Jiping; Zhang, John H.



The proposal of subgroups for grade V on World Federation of Neurologic Surgeons Grading for subarachnoid hemorrhage.  


Aim: Some of cases suffering from subarachnoid hemorrhages (SAHs) in grade V on World Federation of Neurologic Surgeons (WFNS) grading can gain a good prognosis. The outcome of patients of SAH in grade V on WFNS grading in their institute was here investigated. Methods: Between April 2007 and July 2012, consecutive 37 patients had SAH diagnosed on CT scan and were classified in grade V on WFNS grading in Kosei General Hospital. There were seventeen male and twenty female patients. We were assigned to patients with spontaneous respiration and without oculomotor palsy (N group, N.=11), and patients with oculomotor palsy (O group, N.=26). Patients were evaluated by mRS. Results: The prognosis in N group was significantly better than in O group (P<0.001). Conclusion: Surgical treatments should be considered for SAH patients without oculomotor palsy. It is necessary to make subgroups in grade V on WFNS grading in order to decide operative indication and evaluate the treatment results of SAH in grade V. PMID:24091433

Nakagawa, M; Sugiu, K; Tokunaga, K; Sakamoto, C; Fujiwara, K



The value of perfusion computed tomography in predicting clinically relevant vasospasm in patients with aneurysmal subarachnoid hemorrhage.  


Delayed cerebral ischemia remains a severe potential complication of aneurysmal subarachnoid hemorrhage (SAH) possibly leading to death and disability. We evaluated a semiquantitative and visual analysis of perfusion computed tomography (PCT) as a predictor of clinically relevant vasospasm (CRV) in patients with aneurysmal SAH. Thirty-eight patients with aneurysmal SAH were analyzed yielding 145 PCT scans. PCT, clinical examination, and transcranial Doppler ultrasound (TCD) were performed on days 3, 7, 10, and 14 after hemorrhage. Cerebral blood flow, cerebral blood volume, and time to peak (TTP) were analyzed semiquantitatively using six regions of interest, and visually for signs of cerebral hypoperfusion. CRV was defined as secondary cerebral infarction (CI) seen on cranial computed tomography scans and/or delayed neurological deterioration (DND). CI occurred in 13 (34.2 %) and DND in 11 patients (28.9 %). With TCD as pretest, TTP had a sensitivity of 90 % and a specificity of 72 % (cutoff value, 0.963) as predictor for CI. TTP's sensitivity as predictor for DND was 90 % with a specificity of 61.1 % (cutoff value, 0.983). Visual analysis of TTP showed a negative predictive value of 100 % with a positive predictive value of 52 %. TTP is a sensitive and specific perfusion parameter in predicting CI in patients with SAH. Its use in the clinical setting may optimize the early treatment of patients at risk for vasospasm before the onset of clinical deterioration, especially when applying TCD as pretest. Further investigation in a larger patient population is required. PMID:23104502

Hickmann, Anne-Katrin; Langner, Sönke; Kirsch, Michael; Baldauf, Jörg; Müller, Cornelia; Khaw, Alexander; Schroeder, Henry W S



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

NASA Astrophysics Data System (ADS)

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.

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.



Clinical review: Prevention and therapy of vasospasm in subarachnoid hemorrhage  

PubMed Central

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

Keyrouz, Salah G; Diringer, Michael N



Potential contribution of SOCC to cerebral vasospasm after experimental subarachnoid hemorrhage in rats.  


Cerebral vasospasm (CVS) is the most treatable component of subarachnoid hemorrhage (SAH), which can be reduced by endothelin receptor antagonists. Endothelin-evoked vasospasm is considered to be mediated by Ca(2+) influx in the smooth muscle through voltage-dependent Ca(2+) channel (VDCC) and nonselective cation channels (NSCC). Because VDCC antagonists such as nimodipine have been shown to be relatively less effective than the endothelin receptor antagonists, it is assumed that NSCC maybe a more important component in mediating Ca(2+) influx during CVS. In this study, we used the basilar arteries from a "two-hemorrhage" rat model of SAH to investigate expressions of transient receptor potential channel 1 (TRPC1), transient receptor potential channel 3 (TRPC3) and stromal interaction molecule 1 (STIM1), which are considered as the promising candidates constituting NSCC. To investigate the possible role of NSCC in phenotypic switching, we performed immunohistochemical staining to examine expressions of SM?-actin and PCNA, markers of smooth muscle phenotypic switching. We found that the basilar arteries exhibited vasospasm after SAH and that vasospasm became more severe on days 5 and 7 after SAH. Elevated mRNA and protein expressions of TRPC1 and STIM1 were detected after SAH and peaked on days 5 and 7, which was in a parallel time course to the development of cerebral vasospasm. The mRNA and protein expressions of TRPC3 were not changed in the SAH group when compared with those in the control. Results of immunohistochemical staining with anti-PCNA and anti-SM?-actin antibodies also showed enhanced expression of PCNA and disappearance of SM?-actin from day 1 to day 7. Taken together, the above results supported a novel mechanism that the components of store-operated calcium channels, TRPC1 and STIM1 mediated the Ca(2+) influx and phenotypic switching in smooth muscle cells, which promoted the development of vasospasm after SAH. TRPC3, which is a component of receptor-operated calcium channels, was not involved in the above-mentioned mechanism. PMID:23542055

Song, Jin-Ning; Yan, Wen-Tao; An, Ji-Yang; Hao, Guang-Shan; Guo, Xiao-Ye; Zhang, Ming; Li, Yu; Li, Dan-Dong; Sun, Peng



Rat model of intracerebellar hemorrhage  

Microsoft Academic Search

Approximately 15% of all strokes are due to intracerebral hemorrhage (ICH) and of these, 5-10% occur in the cerebellum. The\\u000a resultant mortality is around 20-30%. However, there is no well-established animal model to address this important clinical\\u000a problem.\\u000a \\u000a We induced intracerebellar hemorrhage in rats using stereotaxic colla-genase injection through a burr-hole into right cerebellum.\\u000a Dosage-dependent effect of collagenase (0.2, 0.4,

T. Lekic; J. Tang; J. H. Zhang


Pharmacologic reduction of angiographic vasospasm in experimental subarachnoid hemorrhage: systematic review and meta-analysis.  


Animal models have been developed to simulate angiographic vasospasm secondary to subarachnoid hemorrhage (SAH) and to test pharmacologic treatments. Our aim was to evaluate the effect of pharmacologic treatments that have been tested in humans and in preclinical studies to determine if animal models inform results reported in humans. A systematic review and meta-analysis of SAH studies was performed. We investigated predictors of translation from animals to humans with multivariate logistic regression. Pharmacologic reduction of vasospasm was effective in mice, rats, rabbits, dogs, nonhuman primates (standard mean difference of -1.74; 95% confidence interval -2.04 to -1.44) and humans. Animal studies were generally of poor methodologic quality and there was evidence of publication bias. Subgroup analysis by drug and species showed that statins, tissue plasminogen activator, erythropoietin, endothelin receptor antagonists, calcium channel antagonists, fasudil, and tirilazad were effective whereas magnesium was not. Only evaluation of vasospasm >3 days after SAH was independently associated with successful translation. We conclude that reduction of vasospasm is effective in animals and humans and that evaluation of vasospasm >3 days after SAH may be preferable for preclinical models. PMID:22534672

Zoerle, Tommaso; Ilodigwe, Don C; Wan, Hoyee; Lakovic, Katarina; Sabri, Mohammed; Ai, Jinglu; Macdonald, R Loch



L-arginine improves cerebral blood perfusion and vasomotion of microvessels following subarachnoid hemorrhage in rats.  


The purpose of this study is to investigate the effect of L-arginine (L-Arg) on cerebral blood perfusion and vasomotion (perfusion motion) in microvessels following subarachnoid hemorrhage (SAH). Rat noncraniotomy SAH models were used and animals were divided into sham-operated, saline-treated, and L-Arg-treated groups. L-Arg was injected intraperitoneally 30 minutes before the operation and repeated every 6 hours, with a single dose of 0.5 g/kg bw. Dynamic changes in regional cerebral blood flow (CBF) and vasomotion within 24 hours were measured using a laser Doppler flow-meter probe. Serum nitric oxide (nitrite/nitrate) and plasma endothelin-1 levels were also measured at different time points within 24 hours. Morphologic changes in neurons in the hippocampus CA1 region were examined. SAH gave rise to an immediate and persistent decrease in CBF in saline-treated rats. Abnormal vasomotions with decreased frequency and amplitude were observed. Serum nitric oxide decreased, while plasma endothelin-1 increased significantly. Neurons in the hippocampus CA1 region were severely damaged. The above pathological alterations in the L-Arg-treated group were alleviated. It was concluded that L-Arg, which increases cerebral blood perfusion and improves vasomotions of microvessels by enhancing nitric oxide levels and decreasing endothelin-1 levels in blood, exerts a protective effect on secondary cerebral ischemic injury following experimental SAH. PMID:14724366

Sun, Bao-Liang; Zhang, Su-Ming; Xia, Zuo-Li; Yang, Ming-Feng; Yuan, Hui; Zhang, Jian; Xiu, Rui-Juan



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

PubMed Central

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

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



[Our experience with esophagogastric hemorrhages].  


A study was made of 129 cases of upper digestive hemorrhage in patients with portal hypertension admitted at the Surgical Clinic of the Institute of Medicine of Chi?in?u. About 30% of the patients were late admitted, this delay being due to a misjudgment of patients' state and unawareness of the possibility a new and fatal hemorrhage may occur. A change in Blakemore tube design was done. Its use together with the routine hemostatic therapy resulted in hemostasis and discharge of 42% of the admitted patients. When conservative treatment failed and a recurrence of hemorrhage was imminent, emergency surgery was performed. The Tanner-Petrov surgery, splenorenal anastomosis and various types of organopexy combined with splenectomy proved to be the most successful. General lethality in the patients subjected to these surgeries was 6.2%, a smaller figure than that mentioned in the literature. PMID:1823442

Danu, M; Tîbîrn?, C; Stavinski, R; Nama?co, N


Intracranial hemorrhage in adult patients with hematological malignancies  

PubMed Central

Background Clinical characteristics and outcomes of intracranial hemorrhage (ICH) among adult patients with various hematological malignancies are limited. Methods A total of 2,574 adult patients diagnosed with hematological malignancies admitted to a single university hospital were enrolled into this study between 2001 and 2010. The clinical characteristics, image reports and outcomes were retrospectively analyzed. Results A total of 72 patients (48 men and 24 women) with a median age of 56 (range 18 to 86) had an ICH. The overall ICH incidence was 2.8% among adult patients with hematological malignancies. The incidence of ICH was higher in acute myeloid leukemia (AML) patients than in patients with other hematological malignancies (6.3% vs 1.1%, P = 0.001). ICH was more common among patients with central nervous system (CNS) involvement of lymphoma than among patients with CNS involved acute leukemia (P <0.001). Sites of ICH occurrence included the cerebral cortex (60 patients, 83%), basal ganglia (13 patients, 18%), cerebellum (10 patients, 14%), and brainstem (5 patients, 7%). A total of 33 patients (46%) had multifocal hemorrhages. In all, 56 patients (77%) had intraparenchymal hemorrhage, 22 patients (31%) had subdural hemorrhage, 15 patients (21%) had subarachnoid hemorrhage (SAH), and 3 patients (4%) had epidural hemorrhage. A total of 22 patients had 2 or more types of ICH. In all, 46 (64%) patients died of ICH within 30 days of diagnosis, irrespective of the type of hematological malignancy. Multivariate analysis revealed three independent prognostic factors: prolonged prothrombin time (P = 0.008), SAH (P = 0.021), and multifocal cerebral hemorrhage (P = 0.026). Conclusions The incidence of ICH in patients with AML is higher than patients with other hematological malignancies. But in those with intracranial malignant disease, patients with CNS involved lymphoma were more prone to ICH than patients with CNS involved acute leukemia. Mortality was similar regardless of the type of hematological malignancy. Neuroimaging studies of the location and type of ICH could assist with prognosis prediction for patients with hematological malignancies.



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

Microsoft Academic Search

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

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



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

PubMed Central

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.

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



The impact of experimental preconditioning using vascular endothelial growth factor in stroke and subarachnoid hemorrhage.  


Vascular endothelial growth factor (VEGF) stimulating angiogenesis was shown to be a potential novel therapeutic approach for the treatment of ischemic vascular diseases. The goal of the present study was to examine whether transfection of VEGF before occurrence of major stroke (part I) and cerebral vasospasm after experimental subarachnoid hemorrhage (SAH; part II) develops neuroprotective qualities. A total of 25 (part I) and 26 (part II) brains were analyzed, respectively. In part one, a significant reduction of infarct volume in the VEGF-treated stroke animals (43% reduction, P < 0.05) could be detected. In part two, significant vasospasm was induced in all hemorrhage groups (P < 0.02). Analyzing microperfusion, a significant higher amount of perfused vessels could be detected (P < 0.01), whereas no significant effect could be detected towards macroperfusion. Histologically, no infarctions were observed in the VEGF-treated SAH group and the sham-operated group. Minor infarction in terms of vasospasm-induced small lesions could be detected in the control vector transduced group (P = 0.05) and saline-treated group (P = 0.09). The present study demonstrates the preconditioning impact of systemic intramuscular VEGF injection in animals after major stroke and induced severe vasospasm after SAH. PMID:23634319

Eicker, Sven Oliver; Hoppe, Moritz; Etminan, Nima; Macht, Stephan; Perrin, Jason; Steiger, Hans-Jakob; Hänggi, Daniel



Role of ERK1\\/2 and vascular cell proliferation in cerebral vasospasm after experimental subarachnoid hemorrhage  

Microsoft Academic Search

Background  Although there are still some unresolved aspects, current research has revealed that vascular cell proliferation probably\\u000a plays an important part in the pathological formation process of cerebral vasospasm. Using a “two-hemorrhage” model of subarachnoid\\u000a hemorrhage (SAH), this study investigated the function of ERK1\\/2 and vascular wall cell proliferation in pathological development\\u000a of cerebral vasospasm.\\u000a \\u000a \\u000a \\u000a Methods  Fifty rabbits were randomly divided into

Duo Chen; Jian-Jun Chen; Qiang Yin; Jun-Hong Guan; Yun-Hui Liu



Fusiform Lenticulostriate Artery Aneurysm with Subarachnoid Hemorrhage: The Role for Superselective Angiography in Treatment Planning  

PubMed Central

Summary Aneurysms of the lenticulostriatal perforating arteries are rare and either involve the middle cerebral artery-perforator junction or are located distally in basal ganglia. We describe a rare ruptured fusiform lenticulostriatal perforating artery aneurysm arising from a proximal M2 MCA branch, discerned on superselective microcatheter angiography, presenting solely with subarachnoid hemorrhage (SAH). A 50-year-old previously healthy man presented with diffuse SAH and negative CT angiogram. Cerebral angiogram demonstrated a 2 mm fusiform aneurysm presumably arising from the right lateral lenticulostriate perforator but the exact origin of the perforator was unclear. Superselective angiography was required to precisely delineate the aneurysm and its vessel of origin and directly influenced treatment planning (surgical trapping). Superselective microcatheter angiography provides both an option for endovascular therapy as well as more accurate delineation for surgical planning for these rare aneurysms.

Kochar, P.S.; Morrish, W.F.; Hudon, M.E.; Wong, J.H.; Goyal, M.



Increase ICAM-1 and LFA-1 expression by cerebrospinal fluid of subarachnoid hemorrhage patients: involvement of TNF-?.  


Subarachnoid hemorrhage (SAH) is a frequent occurrence in cerebrovascular accidents, and inflammation occurs in the subarachnoid space after SAH. Arachnoid cells have the capability to present antigens and active T-lymphocytes after stimulation by cerebrospinal fluid (CSF). However, the effect of CSF on T-lymphocytes and arachnoid cell adhesion was not clearly understood. In this study, we used ELISA to detected tumor necrosis factor-? (TNF-?) content in CSF of SAH patients. CSF or recombinant TNF-? were applied on arachnoid cells and T-lymphoctes, and RT-PCR and western blotting were performed to determine the expression of intercellular adhesion molecule-1 (ICAM-1) in arachnoid cells and Lymphocyte Function-Associated Antigen-1 (LFA-1) in T-lymphocytes, respectively. Meanwhile, the Matrix Metal Proteinase-9 (MMP-9) expression in these cells was also determined. We found that the content of TNF-? in the CSF was significantly increased in the CSF of SAH patients (from 22 ± 8 pg/mL of healthy people to 436-450 pg/mL of SAH patients). Treatement with CSF could increase the expression of ICAM-1 in arachnoid cells and that of LFA-1 in T-lymphocytes, mainly through the increased levels of TNF-?. We also found that the co-culture of arachnoid cells and T-lymphocytes increased the expression of MMP-9 in both cells through the interaction of ICAM-1 of and LFA-1. All of these results suggested that arachnoid cells are involved in the T-lymphocytes invasion in the subarachnoid space after SAH. PMID:23548604

Xie, Xin; Wu, Xiaokang; Cui, Jihong; Li, Hongmin; Yan, Xingrong



Intraventricular fibrinolysis for severe aneurysmal intraventricular hemorrhage: a randomized controlled trial and meta-analysis.  


The aim of this study was to assess the safety and efficacy of intraventricular fibrinolysis (IVF) for aneurysmal subarachnoid hemorrhage (aSAH) with severe intraventricular hemorrhage (IVH). In this randomized controlled trial, between 2005 and 2009, patients with aSAH and severe IVH were randomly assigned into two groups: one treated with external ventricular drainage (EVD) combined with intraventricular recombinant tissue plasminogen activator (rt-PA) and the second with EVD alone. The primary end-point was mortality rate within the first 30 days. We performed meta-analysis including all published articles that compared IVF + EVD to EVD alone in patients with aSAH IVH. Eleven patients were included in the rt-PA group, eight in the control group. At 30 days, mortality rate was lower in the rt-PA group (45.5 vs. 62.5 %), but results were not statistically significant (p?=?0.65). Clearance of third and fourth ventricles was obtained previously in the rt-PA group (4.25 days) compared to the control group (10.67 days) (p?=?0.001). There was no statistically significant difference concerning the occurrence of complications. The meta-analysis showed a better survival rate with IVF without raised statistical significance (odds ratio?=?0.32 [95 % confidence interval, 0.10-1.03]). This study shows that IVF is as safe as EVD alone for aSAH with severe IVH. It accelerates blood clot resolution in the ventricular system. Mortality rate could be improved by IVF but without significant results. Because of the severity and rarity of this pathology, a multicenter study is required. Clinical Trial Registration Information: (NCT00823485). PMID:23636409

Litrico, Stephane; Almairac, Fabien; Gaberel, Thomas; Ramakrishna, Rohan; Fontaine, Denys; Sedat, Jacques; Lonjon, Michel; Paquis, Philippe



A Risk Score for In-Hospital Death in Patients Admitted With Ischemic or Hemorrhagic Stroke  

PubMed Central

Background We aimed to derive and validate a single risk score for predicting death from ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Methods and Results Data from 333 865 stroke patients (IS, 82.4%; ICH, 11.2%; SAH, 2.6%; uncertain type, 3.8%) in the Get With The Guidelines—Stroke database were used. In?hospital mortality varied greatly according to stroke type (IS, 5.5%; ICH, 27.2%; SAH, 25.1%; unknown type, 6.0%; P<0.001). The patients were randomly divided into derivation (60%) and validation (40%) samples. Logistic regression was used to determine the independent predictors of mortality and to assign point scores for a prediction model in the overall population and in the subset with the National Institutes of Health Stroke Scale (NIHSS) recorded (37.1%). The c statistic, a measure of how well the models discriminate the risk of death, was 0.78 in the overall validation sample and 0.86 in the model including NIHSS. The model with NIHSS performed nearly as well in each stroke type as in the overall model including all types (c statistics for IS alone, 0.85; for ICH alone, 0.83; for SAH alone, 0.83; uncertain type alone, 0.86). The calibration of the model was excellent, as demonstrated by plots of observed versus predicted mortality. Conclusions A single prediction score for all stroke types can be used to predict risk of in?hospital death following stroke admission. Incorporation of NIHSS information substantially improves this predictive accuracy.

Smith, Eric E.; Shobha, Nandavar; Dai, David; Olson, DaiWai M.; Reeves, Mathew J.; Saver, Jeffrey L.; Hernandez, Adrian F.; Peterson, Eric D.; Fonarow, Gregg C.; Schwamm, Lee H.



Retinal hemorrhage after cardiopulmonary resuscitation with chest compressions.  


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

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



Recent advances in diagnostic approaches for sub-arachnoid hemorrhage.  


Sub-arachnoid hemorrhage (SAH) has been easily one of the most debilitating neurosurgical entities as far as stroke related case mortality and morbidity rates are concerned. To date, it has case fatality rates ranging from 32-67%. Advances in the diagnostic accuracy of the available imaging methods have contributed significantly in reducing morbidity associated with this deadly disease. We currently have computed tomography angiography (CTA), magnetic resonance angiography (MRA) and the digital subtraction angiography (DSA) including three dimensional DSA as the mainstay diagnostic techniques. The non-invasive angiography in the form of CTA and MRA has evolved in the last decade as rapid, easily available, and economical means of diagnosing the cause of SAH. The role of three dimensional computed tomography angiography (3D-CTA) in management of aneurysms has been fairly acknowledged in the past. There have been numerous articles in the literature regarding its potential threat to the conventional "gold standard" DSA. The most recent addition has been the introduction of the fourth dimension to the established 3D-CT angiography (4D-CTA). At many centers, DSA is still treated as the first choice of investigation. Although, CT angiography still has some limitations, it can provide an unmatched multi-directional view of the aneurysmal morphology and its surroundings including relations with the skull base and blood vessels. We study the recent advances in the diagnostic approaches to SAH with special emphasis on 3D-CTA and 4D-CTA as the upcoming technologies. PMID:22347331

Kumar, Ashish; Kato, Yoko; Hayakawa, Motoharu; Junpei, Oda; Watabe, Takeya; Imizu, Shuei; Oguri, Daikichi; Hirose, Yuichi



Latin American hemorrhagic fever.  


Several viral and bacterial agents are responsible for hemorrhagic fever in Latin America, but there are three agents that are only present in this region: (1) the Junin virus, (2) the Machupo virus, and (3) the Guanaritovirus, members of the Tacaribe complex of the family Arenaviridae and responsible for the Argentinian, Bolivian, and Venezuelan hemorrhagic fever. The clinical manifestations of hemorrhagic fever are similar for the three viruses, mainly myalgia, arthralgia, headache, relative bradycardia, conjunctivitis, nausea, vomiting, diarrhea, and hemorrhagic disorders. In this article, the three viruses, their causes, and manifestations are discussed. PMID:8021448

Vainrub, B; Salas, R



[Ruptured dissecting aneurysm of the vertebral artery concurrent with contralateral intracerebellar hemorrhage].  


A case of a dissecting vertebral aneurysm concurrent with contralateral cerebellar hemorrhage is reported. A 69-year-old man was referred to our hospital for treatment of subarachnoid hemorrhage (SAH). On admission, CT scanning showed SAH and left cerebellar hematoma. Angiography was performed and it revealed a dissecting aneurysm of the right vertebral artery. Proximal clipping of the right vertebral dissecting artery was performed through right suboccipital craniotomy. During the operation, the cerebellar hemisphere gradually became firm, but the operation was finished without any complications. After the operation, the patient's consciousness level decreased from somnolence to semicomatose for a period of 2 hours 30 min. CT scanning showed the left cerebellar hematoma expanding. The cerebellar hematoma was evacuated immediately by midline suboccipital craniectomy, and the patient's consciousness level improved. In such a case, care must be taken to discover the cause of the expansion and to prevent concurrent hematoma during the operation. Through this case, discussion was held concerning the pitfalls of treatment of aneurysmal subarachnoid hemorrhage concurrent with intracerebral hematoma in the remote region. PMID:11260895

Ochiai, H; Yamakawa, Y; Kawasoe, T



Global cerebral atrophy after subarachnoid hemorrhage: a possible marker of acute brain injury and assessment of its impact on outcome.  


There is a correlation between poor neuropsychological outcome and focal regions of atrophy in patients with subarachnoid hemorrhage (SAH). No study has investigated the impact of global brain atrophy on outcome after SAH. In other neurological disorders, such as multiple sclerosis, a correlation has been found between global atrophy and outcome. This analysis of patients entered into a randomized clinical trial of clazosentan in patients with SAH (CONSCIOUS-1) investigated the relationship between global cerebral atrophy, clinical factors, and outcome.The 413 patients in the CONSCIOUS-1 study underwent cranial computed tomography (CT) on admission and 6 weeks after SAH. After patients with large clip/coil artefacts and those with infarctions on CT were excluded, 97 patients remained and had voxel-based volumetric measurements of the baseline and 6-week CT scans. The percentage difference in volume between times was taken and analysed against clinical variables. Relationships were modeled using univariate and multivariate analysis.Age, female gender, and higher body temperature during the patient's stay in the intensive care unit were significantly correlated with brain atrophy. Greater brain atrophy significantly correlated with poor outcome (modified Rankin scale), more severe neurological deficits on the National Institute of Health Stroke Scale (NIHSS), and poorer health status (EQ-5D). PMID:22890637

Tam, Alan K H; Ilodigwe, Don; Li, Zeyu; Schweizer, Tom A; Macdonald, R Loch



The German database on hypopituitarism after traumatic brain injury and aneurysmal subarachnoid hemorrhage - description, objectives and design.  


Within the last years, a number of clinical studies have addressed the topic of hypothalamo-pituitary dysfunction following traumatic brain injury (TBI) and aneurysmal subarachnoid hemorrhage (SAH). Clinical studies oftentimes reflect the investigation of highly selective patient groups, very standardized test procedures and may be influenced by a publication bias. Epidemiological data on the prevalence and incidence of hypopituitarism after TBI and SAH in the general population still do not exist. Moreover, very little is known about risk factors and clinical characteristics of pituitary impairment after brain damage. Epidemiologic surveys which aggregate information of many different treatment centers become an increasingly important means of bridging the gap between standardized study situations and clinical practice. Therefore, a multi-center, structured data assessment to create a national registry of TBI and SAH patients has been established in 2005. The Structured Data Assessment of Hypopituitarism after TBI and SAH is coordinated by the Department of Endocrinology, Max-Planck-Institute in Munich with participation of at present 13 neurosurgical, rehabilitation and endocrinological centers in Germany and one Austrian center. Within this database, a large scope of very detailed, clinical, endocrine and outcome information is collected. It also offers the possibility of long-term follow up of the recorded patients. This is the first report of the registry describing goals, organization, methodology, funding and the descriptive data of the first 1,242 patients entered until November 20th, 2008. PMID:20533178

Kreitschmann-Andermahr, I; Hartmann, Y; Poll, E; Schneider, H J; Buchfelder, M; Stalla, G K



Shunt-dependent hydrocephalus following subarachnoid hemorrhage correlates with increased S100B levels in cerebrospinal fluid and serum.  


Posthemorrhagic hydrocephalus requiring permanent ventriculoperitoneal shunt placement is a major complication of aneurysmal subarachnoid hemorrhage (SAH). High S100B serum and cerebrospinal fluid (CSF) levels are considered to reflect the severity of brain injury. We prospectively assessed whether S100B levels in serum and CSF were predictive parameters for permanent shunt requirement following aneurysmal SAH. In patients suffering from aneurysmal SAH and treated with an external ventricular drain (EVD), S100B levels in serum and CSF were measured daily as long as the EVD was in place. S100B levels of patients who passed their EVD challenge were compared with those patients who required a permanent ventriculoperitoneal shunt placement. Out of 68 patients included in the study, 43 patients (63.2%) passed the EVD challenge and in 25 patients (36.8%) permanent ventriculoperitoneal shunting was performed. Group comparison revealed that in patients who required shunt placement, S100B was significantly higher in CSF (p < 0.05 at days 2, 4, 6, 10; p < 0.005 at days 1, 3, 5, 7, 8, 9) and serum (p < 0.05 at days 4-7) compared with patients who could be weaned from the EVD. Assessment of S100B levels in CSF and serum may be useful as a predictive parameter for shunt dependency in patients with posthemorrhagic hydrocephalus following aneurysmal SAH. PMID:22327696

Brandner, S; Xu, Y; Schmidt, C; Emtmann, Irene; Buchfelder, Michael; Kleindienst, Andrea



ERK1\\/2 inhibition attenuates cerebral blood flow reduction and abolishes ETB and 5HT1B receptor upregulation after subarachnoid hemorrhage in rat  

Microsoft Academic Search

Upregulation of endothelin B (ETB) and 5-hydroxytryptamine 1B (5-HT1B) receptors via transcription has been found after experimental subarachnoid hemorrhage (SAH), and this is associated with enhanced phosphorylation of the mitogen-activated protein kinase (MAPK) extracellular signal-regulated kinase (ERK1\\/2). In the present study, we hypothesized that inhibition of ERK1\\/2 alters the ETB and 5-HT1B receptor upregulation and at the same time prevents

Saema A S Beg; Jacob A Hansen-Schwartz; Petter J Vikman; Cang-Bao Xu; Lars I H Edvinsson; SAS Beg



Myocardial Dysfunction in Subarachnoid Hemorrhage: Prognostication by Echo Cardiography and Cardiac Enzymes. A Prospective Study  

Microsoft Academic Search

\\u000a \\u000a Background  The myocardial dysfunction in nontraumatic sub-arachnoid hemorrhage (SAH) is not well understood. Borderline elevations of\\u000a cardiac biomarkers, electrocardiographic repolarization abnormalities and systolic dysfunction have been reported but the\\u000a clinical significance of these abnormalities is uncertain.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Patients without history of cardiac disease were prospectively evaluated for cardiac dysfunction. Myocardial regional wall\\u000a motion and left ventricular ejection fraction (LVEF) were serially studied

Prasad Vannemreddy; Prasanna Venkatesh; Kumar Dinesh; Pratap Reddy; Anil Nanda


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

Microsoft Academic Search

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

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



Spontaneous expulsive suprachoroidal hemorrhage caused by decompensated liver disease  

PubMed Central

Expulsive suprachoroidal hemorrhage can be surgical or spontaneous. Spontaneous expulsive suprachoroidal hemorrhage (SESCH) is a rare entity. Most of the reported cases of SESCH were caused by a combination of corneal pathology and glaucoma. We are reporting a rare presentation of SESCH with no pre-existing glaucoma or corneal pathology and caused by massive intra- and peri-ocular hemorrhage due to decompensated liver disease.

Srikanth, Krishnagopal; Kumar, M Ashok



Clinical review: Hemorrhagic shock  

Microsoft Academic Search

This review addresses the pathophysiology and treatment of hemorrhagic shock – a condition produced by rapid and significant loss of intravascular volume, which may lead sequentially to hemodynamic instability, decreases in oxygen delivery, decreased tissue perfusion, cellular hypoxia, organ damage, and death. Hemorrhagic shock can be rapidly fatal. The primary goals are to stop the bleeding and to restore circulating

Guillermo Gutierrez; H David Reines; Marian E Wulf-Gutierrez



Seizures and intracranial hemorrhage.  


Seizures and intracranial hemorrhage are possible medical diseases that any obstetrician may encounter. This article reviews the cause, treatment, and medical management in pregnancy for seizures and intracranial hemorrhage, and how the two can overlap into preeclampsia or eclampsia. This article also highlights some challenging management issues from the obstetrician's perspective. PMID:23466140

Wilson, Karen L; Alexander, James M



Hemorrhagic prepatellar bursitis  

Microsoft Academic Search

Simple prepatellar bursitis is easily diagnosed both clinically and by MRI. MRI shows the typical T1 and T2 lengthening of\\u000a fluid within the bursa. However, because of complex MRI appearance of hemorrhage, chronic hemorrhagic bursitis and the size\\u000a of the prepatellar mass the clinical and MRI appearance can be very different.

F. Donahue; D. Turkel; W. Mnaymneh; L. Ghandur-Mnaymneh



Thalamic infarcts and hemorrhages.  


The anatomy and supply of thalamic arteries are briefly described here. Thalamic infarcts and small-size hemorrhages are classified according to their sites: (1) posterolateral, (2) anterolateral, (3) medial, and (4) dorsal. (1) Posterolateral hemorrhages or lateral thalamic infarcts are usually characterized by severe motor impairment and sensory loss. Transient reduced consciousness, vertical-gaze abnormalities, and small fixed pupils may be evidenced. (2) Patients with anterolateral hemorrhages or tuberothalamic artery infarcts present frontal-type neuropsychological symptoms associated with mild hemiparesis and hemihypesthesia. (3) Medially located hemorrhages or paramedian artery infarcts have decreased levels of consciousness, vertical- and horizontal-gaze abnormalities, amnesia, and abulia. (4) Dorsal hemorrhages or posterior choroidal artery infarcts present with minimal transient hemiparesis and hemihypesthesia; apraxia, aphasia, and amnesia have also been described. PMID:22377880

Amici, Serena



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


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

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



Spinal subarachnoid hemorrhage accompanied with intraventricular hemorrhage  

PubMed Central

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

Fatehi, Farzad; Basiri, Keivan; Ghorbani, Askar



Chance of aneurysm in patients suspected of SAH who have a 'negative' CT scan but a 'positive' lumbar puncture.  


In patients with sudden severe headache and a negative computed tomography (CT) scan, a lumbar puncture (LP) is performed to rule in or out a subarachnoid haemorrhage (SAH), but this procedure is under debate. In a hospital-based series of 30 patients with sudden headache, a negative CT scan but a positive LP (defined as detection of bilirubin >0.05 at wavelength 458 nm), we studied the chance of harbouring an aneurysm and the clinical outcome. Aneurysms were found in none of both patients who presented within 3 days, in 8 of the 18 (44%) who presented within 4-7 days and in 5 of the 10 (50%) who presented within 8-14 days. Of the 13 patients with an aneurysm, 3 (23%) had poor outcome. In patients who present late after sudden headache, the yield in terms of aneurysms is high in those who have a positive lumbar puncture. In patients with an aneurysm as cause of the positive lumbar puncture, outcome is in the same range as in SAH patients admitted in good clinical condition. PMID:21901483

Horstman, P; Linn, F H H; Voorbij, H A M; Rinkel, G J E



Terson's syndrome as the initial symptom of subarachnoid hemorrhage caused by ruptured vertebral artery aneurysm. Case report.  


A 61-year-old male initially presented to the ophthalmology department complaining of sudden visual loss. Fundus photography and ultrasonography followed by computed tomography identified Terson's syndrome caused by subarachnoid hemorrhage (SAH). Cerebral angiography revealed a dissecting aneurysm of the left vertebral artery. Other than obtunded visual acuity, his neurological examination was normal and he denied any headache. He was treated conservatively with pain and blood pressure control. He complained of headache associated with rerupture of the aneurysm on day 5. The patient died of rerupture on day 14. The clinical course of this patient indicates that Terson's syndrome may occur without sudden increase of intracranial pressure. Terson's syndrome may occur as a rare initial clinical sign of SAH caused by ruptured cerebral aneurysm. PMID:16861828

Inoue, Tomohiro; Tsutsumi, Kazuo; Shigeeda, Takashi



[Blood blister-like aneurysm on the posterior wall of the internal carotid artery causing subarachnoid hemorrhage: a case report].  


We report a case of blood blister-like aneurysm(BBA)on the posterior wall of the internal carotid artery(ICA)causing subarachnoid hemorrhage(SAH). A 45-year-old man suffering from SAH(WFNS grade 5)was referred to our hospital. 3D-CT angiography showed a BBA on the posterior wall of the ICA. The aneurysm had been enlarged for a few days. Therefore we performed coil embolization. Four weeks after the operation, the aneurysm was found to have regrown. In the second operation the aneurysm was successfully treated by the ICA proximal occlusion with extracranial-intracranial bypass. Postoperative follow-up cerebral angiography detected no aneurysm. To our knowledge, BBA on the posterior wall of the ICA is rare. Radical surgery with bypass should be performed as soon as possible when the BBA is found to regrow. We discuss the clinical characteristics with a review of the literature. PMID:23459520

Koguchi, Motofumi; Suzuyama, Kenji; Uchiyama, Taku; Okamoto, Hiroaki; Takase, Yukinori; Kawashima, Masatou; Matsushima, Toshio



An Insular Outbreak of Dengue Hemorrhagic Fever. I. Epidemiologic Observations.  

National Technical Information Service (NTIS)

Between 10 July and 23 October 1966 an epidemic of dengue hemorrhagic fever occurred on an island in the Gulf of Thailand. Fourteen cases of dengue-shock syndrome (with one death) and 20 of hemorrhagic-fever syndrome due to dengue occurred. An additional ...

P. E. Winter T. M. Yuill S. Udomaskdi D. Gould S. Nantapanich



Structured assessment of hypopituitarism after traumatic brain injury and aneurysmal subarachnoid hemorrhage in 1242 patients: the German interdisciplinary database.  


Clinical studies have demonstrated that traumatic brain injury (TBI) and aneurysmal subarachnoid hemorrhage (SAH) are frequent causes of long-term disturbances of hypothalamo-pituitary function. This study aimed to assess the prevalence and associated factors of post-traumatic hypopituitarism in a large national registry of patients with TBI and SAH. Data were collected from 14 centers in Germany and Austria treating patients for TBI or SAH and performing endocrine assessments. Data were collected using a structured, internet-based study sheet, obtaining information on clinical, radiological, and hormonal parameters. A total of 1242 patients (825 TBI, age 43.5±19.7 years; 417 SAH, age 49.7±11.8 years) were included. We studied the prevalence of hypopituitarism reported based on different definitions of laboratory values and stimulation tests. Stimulation tests for the corticotropic and somatotropic axes were performed in 26% and 22% of the patients, respectively. The prevalence of hypopituitarism in the chronic phase (at least 5 months after the event) by laboratory values, physician diagnoses, and stimulation tests, was 35%, 36%, and 70%, respectively. Hypopituitarism was less common in the acute phase. According to the frequency of endocrine dysfunction, pituitary hormone secretion was impaired in the following sequence: ACTH, LH/FSH, GH, and TSH. TBI patients with abnormal stimulation tests had suffered from more severe TBI than patients with normal stimulation tests. In conclusion, our data confirm that hypopituitarism is a common complication of TBI and SAH. It is possible that patients with a higher likelihood of hypopituitarism were selected for endocrine stimulation tests. PMID:21671796

Schneider, Harald J; Schneider, Manfred; Kreitschmann-Andermahr, Ilonka; Tuschy, Ulrich; Wallaschofski, Henri; Fleck, Steffen; Faust, Michael; Renner, Caroline I E; Kopczak, Anna; Saller, Bernhard; Buchfelder, Michael; Jordan, Martina; Stalla, Günter K



Inhibition of SAH-hydrolase activity during seed germination leads to deregulation of flowering genes and altered flower morphology in tobacco.  


Developmental processes are closely connected to certain states of epigenetic information which, among others, rely on methylation of chromatin. S-adenosylmethionine (SAM) and S-adenosylhomocysteine (SAH) are key cofactors of enzymes catalyzing DNA and histone methylation. To study the consequences of altered SAH/SAM levels on plant development we applied 9-(S)-(2,3-dihydroxypropyl)-adenine (DHPA), an inhibitor of SAH-hydrolase, on tobacco seeds during a short phase of germination period (6 days). The transient drug treatment induced: (1) dosage-dependent global DNA hypomethylation mitotically transmitted to adult plants; (2) pleiotropic developmental defects including decreased apical dominance, altered leaf and flower symmetry, flower whorl malformations and reduced fertility; (3) dramatic upregulation of floral organ identity genes NTDEF, NTGLO and NAG1 in leaves. We conclude that temporal SAH-hydrolase inhibition deregulated floral genes expression probably via chromatin methylation changes. The data further show that plants might be particularly sensitive to accurate setting of SAH/SAM levels during critical developmental periods. PMID:21274566

Fulne?ek, Jaroslav; Matyášek, Roman; Votruba, Ivan; Holý, Antonín; K?ížová, Kate?ina; Kova?ík, Aleš



Hereditary Hemorrhagic Telangiectasia - HHT  


... IR Treatments Abdominal aortic aneurysms Angiography Angioplasty and stent placement Cancer - bone Cancer - breast Cancer - kidney Cancer - ... Causes Life-threatening Malformations in Blood Vessels Throughout Body Hereditary Hemorrhagic Telangiectasia (HHT) is a genetic disorder ...


Microwave hemorrhagic stroke detector  


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

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



Microwave hemorrhagic stroke detector  


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

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



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...


Microwave hemorrhagic stroke detector  

SciTech Connect

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

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



Microwave hemorrhagic stroke detector  

SciTech Connect

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

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



Family and friends' fears of recurrence: impact on the patient's recovery after subarachnoid hemorrhage.  


Object Patients with subarachnoid hemorrhage (SAH) and their close friends and family may be excessively fearful that the patient will have a recurrence, and such fears could play a critical role in the poor recovery shown by many patients The authors examined whether these fears could account for significant variance in psychosocial outcomes. Methods The authors prospectively studied a sample of 69 patients with SAH alongside their spouse, other family member, and/or close friend identified as their significant other (SO). The patient/SO pairs were assessed at 13 months postictus for their fears of recurrence and for health-related quality of life on the 8 domains of the 36-Item Short Form Health Survey. Results The SOs were found to be significantly more fearful of SAH recurrence than the patients. The SO's fears also explained unique variance in the patient's recovery on 4 of the 36-Item Short Form Health Survey domains over and above the patient's own fears, demographic and/or neurological variables, and the patient's history of psychiatric or neurological problems. The domains affected reflected activity-based and functional aspects of the patient's quality of life as opposed to more general characteristics of their emotional well-being or physical health state. Conclusions The patient's recovery may be compromised if their spouse, close family, and/or friends are excessively fearful about their suffering a recurrence. Perhaps the SO's fears cause them to be overprotective of the patient and to restrict their day-to-day activities. Attention must therefore be given to the experience of having a loved one suffer from an SAH, and alleviating the caregiver's fears could help to promote a better outcome for the patient. PMID:23876000

Covey, Judith; Noble, Adam J; Schenk, Thomas



MR angiography in patients with subarachnoid hemorrhage: adequate to evaluate vasospasm-induced vascular narrowing?  


The diagnosis of cerebral vasospasm (CVS) following subarachnoid hemorrhage (SAH) is still challenging. We evaluate the accuracy of time of flight MR angiography (TOF-MRA) to assess the arterial diameters of the circle of Willis in SAH patients with suspected CVS. MR examinations (1.5 Tesla) including 3D TOF-MRA with maximum intensity projections (MIP) and digital subtraction angiography (DSA) were performed within 24 h in 21 patients with acute aneurysmal SAH and suspicion of CVS. Arterial diameters of the circle of Willis including the distal internal carotid artery (ICA) were measured as ratios to the extradural ICA in standard projections. The diagnosis of CVS was established by comparing the luminal size of baseline and follow-up DSA. The correlation between the arterial ratios measured on MIP angiograms and on follow-up DSA was assessed with Pearson's linear regression analysis. Arterial ratios on MIP angiograms were categorized as correct, overestimated, and underestimated compared to the ratios on follow-up DSA. Pearson's correlation coefficient between the ratios of MIP angiograms and DSA was r?=?0.5799 and the regression coefficient was b?=?0.4775. Highest correlation was found for the category of severe CVS (r?=?0.8201). Of all MIP angiograms, 34.9% showed consistent results compared to the DSA, while 44.2% of MIP images overestimated the vascular narrowing. Standard MIP angiograms from TOF-MRA are not accurate to assess vascular narrowing in patients with suspected CVS after aneurysmal SAH. The multifocal arterial stenoses in CVS may induce severe changes in blood flow dynamics, which compromise the diagnostic accuracy of the TOF-MRA. PMID:20532584

Hattingen, Elke; Blasel, Stella; Dumesnil, Richard; Vatter, Hartmut; Zanella, Friedhelm E; Weidauer, Stefan



Mucormycosis-associated intracranial hemorrhage.  


Rhinoorbitocerebral mucormycosis is a devastating infection being increasingly recognized in immunocompromised hosts and carries poor prognosis. Early recognition and treatment are critical in order to improve clinical outcomes and decrease the development of complications. Fatal cerebral infarctions have been described in patients with rhinoorbitocerebral mucormycosis, likely due to the thrombotic occlusion of the affected blood vessels directly invaded by this aggressive mycotic infection. We report a patient that presented with aplastic anemia, subsequently complicated by systemic mucormycosis, which generated reactive plasmacytosis, and developed intracranial infarction and hemorrhage. PMID:23103724

Munoz, Javier; Hughes, Amy; Guo, Yue



A case of fetal leukemia with intracranial hemorrhage and early-onset jaundice  

Microsoft Academic Search

We report a case of a neonate who was diagnosed as having congenital leukemia after presenting with an intracranial hemorrhage.\\u000a The chief symptom was early-onset jaundice due to the hemorrhage. The intracranial hemorrhage and post-hemorrhage hydrocephalus\\u000a advanced. In addition, the leukemia worsened leading to death at 14 days old. The possibility of leukemia, although rare,\\u000a should be considered as a cause

Michiru Ito; Shigeru Nishimaki; Yusuke Nakano; Fumiko Tanaka; Hiroaki Goto; Shumpei Yokota



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


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

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



Fatal subarachnoid hemorrhage following traumatic rupture of the internal carotid artery.  


Traumatic subarachnoid hemorrhage (TSAH) is a life-threatening intracranial bleed often associated with violent assault or motor vehicle accidents. The vast majority of TSAH is associated with rupture of the vertebral artery, although rare cases of traumatic aneurysm of the internal carotid artery (ICA) have been reported. A 27-year-old man was found bleeding and unresponsive following a violent altercation in which he received repeated blows to the head and neck. CT scan showed acute SAH, and death ensued within 24 h. Autopsy revealed generalized bruising of the face, a complete midline mandibular fracture, and massive basal SAH resulting from traumatic rupture of the right terminal internal carotid artery at the origin of the middle cerebral artery. Anterior and posterior neck dissection revealed focal hemorrhage associated with the right neural arch of the first cervical vertebra (C1). Autopsy findings were consistent with TSAH resulting from rupture of the ICA following blunt force trauma to the head. The rupture site in TSAH can be difficult to locate, and injury to the ICA may be overlooked if not routinely examined. Dissection of the neck and skull base is required to ensure accurate identification of the site of vascular injury. PMID:22824587

Salvatori, Marcus; Kodikara, Sarathchandra; Pollanen, Michael



Pulmonary complications in fatal acute hemorrhagic pancreatitis  

Microsoft Academic Search

Morphological changes of the lung occur frequently in fatal acute hemorrhagic pancreatitis. The pulmonary alterations are independent of mechanical ventilation and therefore not due to iatrogenic damage caused by high inspired oxygen concentrations. The histological findings are similar to those seen in the so-called shock lung syndrome. The pulmonary lesion develops progressively and three stages can be separated: early, late,

P. G. Lankisch; G. Rahlf; H. Koop



[Spontaneous subarachnoid hemorrhage].  


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

Steinmetz, H



Microcatheter embolization of hemorrhages  

SciTech Connect

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

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



The Use of Cardiac Troponin-I (cTnI) to Determine the Incidence of Myocardial Ischemia and Injury in Patients with Aneurysmal and Presumed Aneurysmal Subarachnoid Hemorrhage  

Microsoft Academic Search

Summary   A prospective single center study was performed to determine the minimal preoperative incidence of unrecognized cardiac injury\\u000a in patients suffering aneurysmal and presumed aneurysmal subarachnoid hemorrhage (SAH). When caring for such patients in the\\u000a pre- and post operative period clinicians must be aware of the possibility of cardiac injury even when a history of previous\\u000a cardiac symptomatology is not

M. B. Horowitz; D. Willet; J. Keffer



Hemorrhagic disease of the newborn  


... a higher rate of bleeding inside the skull (intracranial hemorrhage) associated with the late onset condition. ... Bleeding inside the skull (intracranial hemorrhage), with possible brain damage Death Severe bleeding


Aneurysmal Subarachnoid Hemorrhage in Third and Fourth Decades of Life  

PubMed Central

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

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



Thrombosed vertebral artery aneurysm presenting with hemorrhage and bulbar compression: report of two cases.  


Bulbar compression by vertebral artery (VA) aneurysm is extremely rare and only reported in a few cases. We report two cases with thrombosed VA aneurysm compressing medulla oblongata; one presented with bulbar apoplexy hemorrhage and the other with subarachnoid hemorrhage (SAH). A 61-year-old male (case 1) presented with consciousness disturbances, left hemiplegia, and subsequent respiratory arrest. He was subjected to controlled ventilation, and computed tomography (CT) scan showed bulbar hemorrhage. Magnetic resonance imaging (MRI) and digital subtraction angiogram (DSA) revealed fusiform right VA aneurysm with partial thrombosis and bulbar compression. Intra-aneurysmal embolization with Guglielmi detachable coils (GDCs) relieved his clinical symptom including respiratory disturbance. Three months after the onset, he remained moderately disabled. A 76-year-old male (case 2) presented with severe headache and subsequent respiratory disturbance. CT scan on admission showed subarachnoid hemorrhage with acute hydrocephalus. Ventricular drainage rapidly improved consciousness while respiratory disturbance persisted over several days. MRI and DSA suggested spontaneous thrombosis of the right VA dissection with bulbar compression. He showed gradual recovery of his respiration over a week. After ventriculo-peritoneal shunting, he was transferred with moderate disability. These results suggest that the elimination of the pulsatile effect of VA aneurysm adjacent to medulla oblongata can improve symptoms caused by aneurysm-related compression. Early diagnosis and appropriate treatment such as intra-aneurysmal embolization for ameliorating the blood flow inside the aneurysm can relieve mass effect and clinical symptoms. PMID:15708227

Shiraishi, Shin-ichiro; Fujimura, Miki; Kon, Hiroyuki; Motohashi, Osamu; Kameyama, Motonobu; Ishii, Kiyoshi; Onuma, Takehide



Intravitreal ranibizumab in treating extensive traumatic submacular hemorrhage.  


Herein, we report our experience in treating extensive traumatic submacular hemorrhage with a single dose of intravitreal ranibizumab. A 23-year-old healthy Malay man presented with a progressive reduction of central vision in the left eye of 2 days' duration following a history of blunt trauma. Visual acuity was reduced to counting fingers. Examination revealed infero-temporal subconjunctival hemorrhage, traumatic anterior uveitis, and an extensive sub-macular hemorrhage with suspicion of a choroidal rupture in the affected eye. He was initially treated conservatively with topical prednisolone acetate 1%. The subconjunctival hemorrhage and anterior uveitis resolved but his vision remained poor with minimal resolution of the submacular hemorrhage at 1 week follow-up (day 12 post-trauma). In view of the poor resolution of submacular hemorrhage, he was treated with a single dose of 0.5 mg intravitreal ranibizumab at day 20 post-trauma. At 4 weeks post-intravitreal ranibizumab, there was an improvement in visual acuity (from counting fingers to 6/45) and complete resolution of the submacular hemorrhage with presence of a choroidal rupture scar temporal to the fovea, which was not seen clearly at presentation due to obscuration by blood. His visual acuity further improved to 6/18 at 3 months post-trauma. Although this single case had a favorable outcome, a large population cohort study is needed to establish the effectiveness of intravitreal ranibizumab in treating extensive traumatic submacular hemorrhage. PMID:23589678

Abdul-Salim, Ismail; Embong, Zunaina; Khairy-Shamel, Sonny-Teo; Raja-Azmi, Mohd-Noor



Intraventricular Hemorrhage: An Update  

Microsoft Academic Search

Although the incidence of intraventricular hemorrhage (IVH) has decreased in recent years, the increasing survival rates for the smallest premature infants indicate that the lesion will continue to be a major problem in neonatal intensive care facilities. We review prenatal, perinatal, and postnatal variables that have been associated with enhanced risk of IVH and address some of the methodological limitations

Karl C. K. Kuban; Joseph J. Volpe



Korean Hemorrhagic Fever.  

National Technical Information Service (NTIS)

The causative agent of Korean hemorrhagic fever was first isolated in 1976 from the rodent Apodemus agrarius coreae and it is registered as Hantaan virus. This report presents the results on (1) the first visualization of Hantaan virus by EM and (2) intra...

H. W. Lee



Korean Hemorrhagic Fever.  

National Technical Information Service (NTIS)

This report presents the results on (1) isolation of Korean hemorrhagic fever (KHF) virus from patients (2) antibody responses in animals (3) the ratio of clinical and subclinical infection (4) cultivation of the virus in a tissue culture cells and (5) ve...

H. W. Lee



Clinical review: Hemorrhagic shock  

PubMed Central

This review addresses the pathophysiology and treatment of hemorrhagic shock – a condition produced by rapid and significant loss of intravascular volume, which may lead sequentially to hemodynamic instability, decreases in oxygen delivery, decreased tissue perfusion, cellular hypoxia, organ damage, and death. Hemorrhagic shock can be rapidly fatal. The primary goals are to stop the bleeding and to restore circulating blood volume. Resuscitation may well depend on the estimated severity of hemorrhage. It now appears that patients with moderate hypotension from bleeding may benefit by delaying massive fluid resuscitation until they reach a definitive care facility. On the other hand, the use of intravenous fluids, crystalloids or colloids, and blood products can be life saving in those patients who are in severe hemorrhagic shock. The optimal method of resuscitation has not been clearly established. A hemoglobin level of 7–8 g/dl appears to be an appropriate threshold for transfusion in critically ill patients with no evidence of tissue hypoxia. However, maintaining a higher hemoglobin level of 10 g/dl is a reasonable goal in actively bleeding patients, the elderly, or individuals who are at risk for myocardial infarction. Moreover, hemoglobin concentration should not be the only therapeutic guide in actively bleeding patients. Instead, therapy should be aimed at restoring intravascular volume and adequate hemodynamic parameters.

Gutierrez, Guillermo; Reines, H David; Wulf-Gutierrez, Marian E



Cerebrospinal Fluid Catecholamine Levels as Predictors of Outcome in Subarachnoid Hemorrhage  

PubMed Central

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

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



[Effects of hyperoxia, glycerol and ventricular drainage on ICP and CBF in patients with increased ICP due to CSF circulatory-absorbance disturbance].  


The effects of hyperoxia, glycerol and ventricular drainage on intracranial pressure (ICP) and cerebral blood flow (CBF) were studied in cases with cerebrospinal fluid (CSF) circulatory-absorbance disturbance due to subarachnoid hemorrhage (SAH) or intraventricular hematoma. Ventricular fluid pressure (VFP) was monitored through a controlled ventricular drainage (CVD) tube using a Statham P-50 pressure transducer. CBF was measured by the 10mCi133Xe intravenous injection method using a Valmet BI-1400 rCBF analyzer. ISI (initial slope index) was used for the CBF value. Studied cases were 19 SAH patients and 2 hypertensive intracerebral hematoma cases with intraventricular hematoma. Hyperoxia included hyperbaric oxygen (HBO), reduced ICP and CBF. During pure oxygen inhalation at atmospheric pressure (1ATA . O2), there was a tendency toward a relationship showing that the higher the resting state ICP, the lesser the likelihood of a CBF decrease. This may indicate that increased ICP impairs cerebral vascular reactivity to hyperoxia in relation to the degree of elevation. The effects of hyperoxia on ICP and CBF were temporary and they promptly returned to the resting state after cessation of oxygen inhalation. In some cases, there was a rebound phenomenon in ICP after HBO. Glycerol administration reduced ICP and increased CBF. There was no clear correlation between resting state ICP and CBF increase after glycerol administration. The effects of glycerol were also temporary. ICP control by opening CVD increased CBF. There was a correlation between the level of resting state ICP and the CBF increase after the opening of CVD. In cases with CSF circulatory-absorbance disturbance, elevated ICP reduced CBF and may further worsen the cerebral damage.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3580214

Ohta, H; Suzuki, E; Hinuma, Y; Kawamura, S; Nemoto, M; Hadeishi, H



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


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

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



A severe vicious cycle in uncontrolled subarachnoid hemorrhage: the effects on cerebral blood flow and hemodynamic responses upon intracranial hypertension.  


In subarachnoid hemorrhage (SAH), Cushing postulated that the increase in systemic arterial pressure (SAP) in response to elevation of intracranial pressure (ICP) was beneficial to cerebral perfusion. However, in uncontrolled SAH, the increased SAP may cause more bleeding into the subarachnoid space and further increase the ICP. We created an animal model to simulate SAH by connecting a femoral arterial catheter to the subarachnoid space. The global cerebral blood flow (CBF) was measured with a venous outflow method. The purposes were to observe the CBF change under the simulated SAH, and to evaluate the effects of an adrenergic blocker and a vasodilator. In addition, spectral analysis of the aortic pressure and flow was employed for the analysis of hemodynamic changes at various ICP levels. When the femoral arterial blood was allowed to flow into the subarachnoid space, the ICP was elevated. The Cushing response to increased ICP caused an increase in SAP. A vicious cycle was generated between ICP and SAP. The CBF under the vicious cycle was greatly depressed. The dog developed pulmonary edema (PE) within 5 mins. An alpha-adrenergic blocker (phentolamine) and a vasodilator (nitroprusside) were beneficial to the reduction of SAP and ICP, improvement of CBF, and prevention of PE. Hemodynamic analysis revealed that graded increases in ICP caused increases in SAP, total peripheral resistance, arterial impedance, and pulse reflection with decreases in stroke volume, cardiac output and arterial compliance. The hemodynamic changes may contribute to acute left ventricular failure that leads to pressure and volume loading in the lung circulation, and finally acute PE. PMID:16900706

Su, Chain-Fa; Yang, Yi-Ling; Lee, Ming-Che; Chen, Hsing I



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

PubMed Central

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



Cerebral Perfusion Pressure Thresholds for Brain Tissue Hypoxia and Metabolic Crisis after Poor-Grade Subarachnoid Hemorrhage  

PubMed Central

Background and Purpose To identify a minimally-acceptable CPP threshold above which the risk of brain tissue hypoxia (BTH) and oxidative metabolic crisis is reduced for patients with SAH. Methods We studied thirty poor-grade SAH patients who underwent brain multimodality monitoring (3042 hours). Physiological measures were averaged over 60 minutes for each collected microdialysis sample. Metabolic crisis was defined as a lactate/pyruvate ratio (LPR) >40 with a brain glucose concentration ?0.7 mmol/L. BTH was defined as PbtO2 <20 mm Hg. Outcome was assessed at 3 months with the modified Rankin Scale. Results Multivariable analyses adjusting for admission Hunt-Hess grade, intraventricular hemorrhage, systemic glucose, and end-tidal CO2 revealed that CPP ?70 mm Hg was significantly associated with an increased risk of BTH (OR=2.0; 95%-CI: 1.2–3.3, P=0.007) and metabolic crisis (OR=2.1; 95%-CI 1.2–3.7, P=0.007). Death-or-severe-disability at 3 months was significantly associated with metabolic crisis (OR 5.4; 95%-CI: 1.8–16, P=0.002) and BTH (OR 5.1; 95%-CI: 1.2–23, P=0.03) after adjusting for admission Hunt-Hess grade. Conclusions Metabolic crisis and BTH are associated with mortality and poor functional recovery after SAH. CPP levels below 70 mm Hg was associated with metabolic crisis and BTH and may increase the risk of secondary brain injury in poor-grade SAH patients.

Schmidt, J. Michael; Ko, Sang-Bae; Helbok, Raimund; Kurtz, Pedro; Stuart, R. Morgan; Presciutti, Mary; Fernandez, Luis; Lee, Kiwon; Badjatia, Neeraj; Connolly, E. Sander; Claassen, Jan; Mayer, Stephan A.



[Bolivian hemorrhagic fever].  


Analysis of data of the available literature on epidemiology of Bolivian hemorrhagic fever, manifestations of human disease, biological properties of the causative agent and development carried out abroad of means and methods of diagnostics, prophylaxis and therapy of this infection that presents a potential threat for the population and economy of the Russian Federation in case of introduction of the causative agent is presented. PMID:24000605

Markin, V A; Pantiukhov, V B; Markov, V I; Bondarev, V P


Retinal hemorrhagic lesions from femtosecond visible laser pulses  

NASA Astrophysics Data System (ADS)

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.

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



Relationship between Angiographic Vasospasm and Regional Hypoperfusion In Aneurysmal Subarachnoid Hemorrhage  

PubMed Central

Background Angiographic vasospasm frequently complicates subarachnoid hemorrhage (SAH) and has been implicated in the development of delayed cerebral ischemia. Whether large-vessel narrowing adequately accounts for the critical reductions in regional cerebral blood flow (CBF) underlying ischemia is unclear. We sought to clarify the relationship between angiographic vasospasm and regional hypoperfusion. Methods 25 patients with aneurysmal SAH underwent cerebral catheter angiography and 15O-PET imaging within 1 day of each other (median of 7 days after SAH). Severity of vasospasm was assessed in each intracranial artery while cerebral blood flow (CBF) and oxygen extraction fraction (OEF) were measured in 28 brain regions distributed across these vascular territories. We analyzed the association between vasospasm and perfusion and compared frequency of hypoperfusion (CBF < 25 ml/100g/min) and oligemia (low oxygen delivery with OEF ? 0.5) in territories with vs. without significant vasospasm. Results 24% of 652 brain regions were supplied by vessels with significant vasospasm. CBF was lower in such regions (38.6±12 vs. 48.7±16 ml/100g/min) while OEF was higher (0.48±0.19 vs. 0.37±0.14, both p<0.001). Hypoperfusion was seen in 46 regions (7%) but 66% of these were supplied by vessels with no significant vasospasm; 24% occurred in patients without angiographic vasospasm. Similarly, oligemia occurred more frequently outside territories with vasospasm. Conclusions Angiographic vasospasm is associated with reductions in cerebral perfusion. However, regional hypoperfusion and oligemia frequently occurred in territories and patients without vasospasm. Other factors in addition to large-vessel narrowing must contribute to critical reductions in perfusion.

Dhar, Rajat; Scalfani, Michael T; Blackburn, Spiros; Zazulia, Allyson R; Videen, Tom; Diringer, Michael



Urea for treatment of acute SIADH in patients with subarachnoid hemorrhage: a single-center experience  

PubMed Central

Background Hyponatremia occurring as a result of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) or cerebral salt wasting syndrome is a common complication in patients with subarachnoid hemorrhage (SAH). The efficacy and safety of urea as treatment for SIADH-induced hyponatremia has not been reported in this population. Methods This is a retrospective analysis of all patients admitted to our department for nontraumatic SAH between January 2003 and December 2008 (n?=?368). All patients with SIADH-induced hyponatremia (plasma sodium??20 mEq/L, and osmolality?>?200 mOsm/kg; absence of overt dehydration or hypovolemia; no peripheral edema or renal failure; no history of adrenal or thyroid disease) routinely received urea per os when hyponatremia was associated with clinical deterioration or remained less than 130 mEq/L despite saline solution administration. Results Forty-two patients developed SIADH and were treated with urea. Urea was started after a median of 7 (IQR, 5–10) days and given orally at doses of 15–30 g tid or qid for a median of 5 (IQR, 3–7) days. The median plasma sodium increase over the first day of treatment was 3 (IQR, 1–6) mEq/L. Hyponatremia was corrected in all patients, with median times to Na+ >130 and >135 mEq/L of 1 (IQR, 1–2) and 3 (IQR, 2–4) days, respectively. Urea was well tolerated, and no adverse effects were reported. Conclusions Oral urea is an effective and well-tolerated treatment for SIADH-induced hyponatremia in SAH patients.



Role of Endothelin-1 in Human Aneurysmal Subarachnoid Hemorrhage: Associations with Vasospasm and Delayed Cerebral Ischemia  

PubMed Central

Background Endothelin-1 (ET-1) is a potent vasoconstrictor implicated in the pathogenesis of vasospasm and delayed cerebral ischemia (DCI) in aneurysmal subarachnoid hemorrhage (aSAH) patients. The aim of this study was to investigate the relationship between cerebrospinal fluid (CSF) ET-1 levels and angiographic vasospasm and DCI. Methods Patients with aSAH were consented (n = 106). Cerebral vasospasm was determined by angiography. DCI was determined by transcranial Doppler (TCD) results and/or angiogram results with corresponding clinical deterioration. CSF ET-1 levels over 14 days after the initial insult was quantified by ELISA. ET-1 analysis included a group-based trajectory analysis and ET-1 exposure rate during 24, 48, and 72 h prior to, as well as 72 h post angiography, or clinical deterioration. Results Trajectory analysis revealed two distinct groups of subjects with 56% of patients in the low ET-1 trajectory group (mean at day 1 = 0.31 pg/ml; SE = 0.04; mean at day 14 = 0.41 pg/ml; SE = 0.15) and 44% of patients in the high ET-1 trajectory group (mean at day 1 = 0.65 pg/ml; SE = 0.08; mean at day 14 = 0.61 pg/ml; SE = 0.06). Furthermore, we observed that ET-1 exposure rate 72 h before angiography and clinical spasm was a significant predictor of both angiographic vasospasm and DCI, whereas, ET-1 exposure after angiography and clinical spasm was not associated with either angiographic vasospasm or DCI. Conclusion Based on these results we conclude that ET-1 concentrations are elevated in a sub-group of patients and that the acute (72 h prior to angiography and clinical neurological deterioration), but not chronic, elevations in CSF ET-1 concentrations are indicative of the pathogenic alterations of vasospasm and DCI in aSAH patients.

Thampatty, Bhavani P.; Sherwood, Paula R.; Gallek, Matthew J.; Crago, Elizabeth A.; Ren, Dianxu; Hricik, Allison J.; Kuo, Chien-Wen J.; Klamerus, Megan M.; Alexander, Sheila A.; Bender, Catherine M.; Hoffman, Leslie A.; Horowitz, Michael B.; Kassam, Amin B.; Poloyac, Samuel M.



Permanent cerebrospinal fluid diversion in subarachnoid hemorrhage: Influence of physician practice style  

PubMed Central

Background: Acute hydrocephalus (HCP) after aneurysmal subarachnoid hemorrhage (SAH) often persists. Our previous study described factors that singly and combined in a formula correlate with permanent CSF diversion. We now aimed to determine whether the same parameters are applicable at an institution with different HCP management practice. Methods: We reviewed records of 181 consecutive patients who presented with SAH and received an external ventricular drain (EVD) for acute HCP. After exclusion and inclusion criteria were met, 71 patients were analyzed. Data included admission Fisher and Hunt and Hess grades, aneurysm location, treatment modality, ventricle size, CSF cell counts and protein levels, length of stay (LOS) in the hospital, and the presence of craniectomy. Outcome measures were: (1) initial EVD challenge outcome; (2) shunting within 3 months; and (3) LOS. Results: Shunting correlated with Hunt and Hess grade, CSF protein, and the presence of craniectomy. The formula derived in our previous study demonstrated a weaker correlation with initial EVD challenge failure. Several parameters that correlated with shunting in the previous study were instead associated with LOS in this study. Conclusions: The decision to shunt depends on management choices in the context of a disease process that may improve over time. Based on the treatment strategy, the shunting rate may be lowered but LOS increased. Markers of disease severity in patients with HCP after SAH correlate with both shunt placement and LOS. This is the first study to directly evaluate the effect of different practice styles on the shunting rate. Differences in HCP management practices should inform the design of prospective studies.

Esposito, Domenic P.; Goldenberg, Fernando D.; Frank, Jeffrey I.; Ardelt, Agnieszka A.; Roitberg, Ben Z.



Genetics Home Reference: Hereditary hemorrhagic telangiectasia  


... serious problems may arise from hemorrhages in the brain, liver, lungs, or other organs. Forms of hereditary hemorrhagic telangiectasia include type 1, type 2, type 3, and juvenile polyposis/hereditary hemorrhagic telangiectasia syndrome. People with type ...


Brainstem hemorrhage in descending transtentorial herniation (Duret hemorrhage)  

Microsoft Academic Search

Objectives: To review clinical and radiological findings in patients with Duret hemorrhages and to discuss the pathophysiology and differential diagnosis of these lesions. Patients and methods: We reviewed the case records of four patients with Duret hemorrhages who had been admitted to the neurological intensive care unit with supratentorial mass lesions. Results: Descending transtentorial and subfalcine herniations were present in

Paul M. Parizel; Smitha Makkat; Philippe G. Jorens; Özkan Özsarlak; Patrick Cras; Johan W. Van Goethem; Luc van den Hauwe; Jan Verlooy; Arthur M. De Schepper



Hemorrhage and Hemorrhagic Shock in Swine: A Review.  

National Technical Information Service (NTIS)

A review of the literature shows that porcine models have been used extensively over the past 20 years to study the effects of hemorrhagic hypotension and shock. In pigs, as in humans, hemorrhage causes a decrease in cardiac output, a primary defect that ...

J. P. Hannon



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

Microsoft Academic Search

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

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



Management of acute submacular hemorrhage using recombinant tissue plasminogen activator and gas  

Microsoft Academic Search

·?Purpose: To assess the effects of intravitreal injection of recombinant tissue plasminogen activator (rTPA) and gas on submacular\\u000a hemorrhage in age-related macular degeneration (ARMD). · Methods: Eleven consecutive patients (11 eyes) with subretinal hemorrhage\\u000a due to ARMD involving the fovea with elevation of the neurosensory retina were included in this study. Subretinal hemorrhage\\u000a occured 12?h to 14 days before onset

L. Hesse; Jörg Schmidt; Peter Kroll



Neurotransmitter Amines in Hemorrhagic Shock.  

National Technical Information Service (NTIS)

Intravenous infusion of ATP-MgCl as part of resuscitation from hemorrhagic shock gives transiently better high-energy phosphate levels in the liver with no apparent benefit to the brain. Investigations into combinations of hemorrhagic shock and hypoxia in...

H. J. Proctor C. Cairns D. Fillipo G. W. Palladino M. J. Rosner



Crimean-Congo Hemorrhagic Fever.  

National Technical Information Service (NTIS)

Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne disease caused by the arbovirus Crimean-Congo hemorrhagic fever virus (CCHFV), which is a member of the Nairovirus genus (family Bunyaviridae). CCHF was first recognized during a large outbreak among ...

C. A. Whitehouse




PubMed Central

Two thousand five hundred forty-five cases of upper gastrointestinal tract hemorrhage were studied especially with a view to determining the indications for urgent surgical treatment. Decisions as to whether and when to operate were as follows: Immediate operation for patients over 50 years with a good history of ulcer and a severe initial bleed. Operation after the first repetition of bleeding in patients (1) over 50 with a good history and a mild initial bleed, (2) over 50 with inconclusive history but severe initial bleed, (3) under 50 with a good history and a severe initial bleed. In all other cases, operation was used only if conservative treatment failed. Absolute indications for operation were (a) association with perforation, (b) association with stenosis, (c) persistence of severe ulcer pain after hemorrhage, (d) continuous bleeding. Since operation is to be avoided if possible in cases of esophagitis, erosive gastritis and small acute or subacute ulcers, emergency gastroscopy has valuable uses. Where operation is deemed necessary and no obvious lesion found at laparotomy, blind gastrectomy* appears to be the most satisfactory procedure. The mortality rate associated with upper gastrointestinal tract bleeding in patients less than 60 years of age was low (2.5 per cent). Even in cases in which operation was required, it was 6.2 per cent. Over 60 years the mortality rises steeply with increasing age, and in cases of operation the rise is even steeper. By using the methods of selection the overall mortality rate was appreciably reduced.

Desmond, Andrew More



Viral hemorrhagic fevers.  


A taxonomically diverse set of single-stranded ribonucleic acid(ssRNA) viruses from four diverse viral families Arenaviridae,Bunyaviridae, Filoviridae, and Flaviviridae cause an acute systemic febrile syndrome called viral hemorrhagic fever (VHF). The syndrome produces combinations of prostration, malaise, increased vascular permeability, and coagulation maladies. In severe illness,VHF may include generalized bleeding but the bleeding does not typically constitute a life-threatening loss of blood volume. To a certain extent, it is a sign of damage to the vascular endothelium and is an indicator of disease severity in specific target organs. Although the viruses that cause hemorrhagic fever (HF) can productively replicate in endothelial cells, much of the disease pathology including impairment to the vascular system is thought to result primarily from the release of a variety of mediators from virus-infected cells, such as monocytes and macrophages that subsequently alter vascular function and trigger the coagulation disorders that epitomize these infections. While significant progress has been made over the last several years in dissecting out the molecular biology and pathogenesis of the HF viruses, there are currently no vaccines or drugs licensed available for most of the VHFs. PMID:16815457

Marty, Aileen M; Jahrling, Peter B; Geisbert, Thomas W



Heavy proteinuria following dengue hemorrhagic fever.  


We report a case of nephrotic range proteinuria with 24-hour urine protein level of 335.7 mg/kg/day which developed following dengue hemorrhagic fever. Due to prolonged hypoalbuminemia from renal loss, right pleural effusion persisted and required pleuracentesis. The patient did not have classical nephrotic syndrome. The proteinuria improved without specific treatment. A renal biopsy was not performed due to self-resolution of the proteinuria and azotemia. Heavy proteinuria is not a typical characteristic of dengue virus infection, therefore the pathophysiology of this nephropathy has not been well described to date. PMID:21706936

Hutspardol, Sakara; Prommalikit, Olarn; Upiya, Nuttaphol; Chataroopwijit, Jintana; Khemakanok, Khemika; Assadamongkol, Kesara



Isolated arterioportal fistula presenting with variceal hemorrhage  

PubMed Central

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

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



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

PubMed Central

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

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



[Traumatic basal subarachnoid hemorrhage].  


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

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



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

PubMed Central

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



Hemorrhagic shock: The "physiology approach"  

PubMed Central

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

Bonanno, Fabrizio Giuseppe



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


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

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



Causes of metabolic acidosis in canine hemorrhagic shock: role of unmeasured ions  

Microsoft Academic Search

INTRODUCTION: Metabolic acidosis during hemorrhagic shock is common and conventionally considered to be due to hyperlactatemia. There is increasing awareness, however, that other nonlactate, unmeasured anions contribute to this type of acidosis. METHODS: Eleven anesthetized dogs were hemorrhaged to a mean arterial pressure of 45 mm Hg and were kept at this level until a metabolic oxygen debt of 120

Dirk Bruegger; Gregor I Kemming; Matthias Jacob; Franz G Meisner; Christoph J Wojtczyk; Kristian B Packert; Peter E Keipert; N Simon Faithfull; Oliver P Habler; Bernhard F Becker; Markus Rehm



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


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

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



Cerebral hemorrhage in Fabry's disease.  


Fabry's disease is an X-linked lysosomal storage disorder resulting from alpha-galactosidase A deficiency. Although ischemic stroke is recognized as an important manifestation of Fabry's disease, hemorrhagic stroke is considered to be rare. Here, we report our recent clinical experience with three hemizygous male patients with Fabry's disease who developed cerebral hemorrhage. One patient had classic type Fabry's disease with p.Ala37Val mutation and others had cerebrovascular variant with p.Glu66Gln mutation. Degeneration of the cerebral small arteries secondary to deposition of glycosphingolipids and aging, in addition to hypertension and antiplatelet/anticoagulant agents, are considered to be contributing factors for hemorrhage. Fabry's disease is frequently associated with not only ischemic but also hemorrhagic stroke, especially in elderly patients. PMID:20300124

Nakamura, Katsuya; Sekijima, Yoshiki; Nakamura, Kimitoshi; Hattori, Kiyoko; Nagamatsu, Kiyoshiro; Shimizu, Yusaku; Yasude, Takuji; Ushiyama, Masao; Endo, Fumio; Fukushima, Yoshimitsu; Ikeda, Shu-ichi



Analysis of subarachnoid hemorrhage according to the Japanese Standard Stroke Registry Study--incidence, outcome, and comparison with the International Subarachnoid Aneurysm Trial.  


The data for subarachnoid hemorrhage (SAH) from the Japanese Standard Stroke Registry Study (JSSRS) were analyzed to evaluate the incidence of SAH according to age, neurological grading and outcome, and outcome of surgical clipping, for comparison with the International Subarachnoid Aneurysm Trial (ISAT). From the ISSRS data, the peak incidence of SAH was the sixth decade in males and the eighth decade in females. The overall mortality was 22%, and good outcome, better than 2 on the modified Rankin Scale (mRS), at discharge was achieved in 58% of cases. Radical treatment was performed in 62.6% of all SAH cases, 58.7% with surgical clipping and 3.2% with endovascular coiling. Poor outcome, worse than 3 on the mRS, occurred in 26.6% of patients under 60 years, 47.3% between 60-69 years, 54.2% between 70-79 years, and 72.9% 80 years or over. From the ISAT data, 88% of patients were in grades 1-2 of the World Federation of Neurological Surgeons (WFNS) grading system in both surgical clipping and endovascular coiling groups, 94% in grades 1-3, and 98% in grades 1-4. Poor outcome, worse than 3 on the mRS, at 2 months occurred in 25.4% and 36.4% of patients with endovascular coiling and surgical clipping, respectively. Limiting the patients in the JSSRS to WFNS grades 1-2 showed poor outcome, worse than 3 on the mRS, occurred in 12.8%, and in grades 1-3 and 1-4 occurred in only 16.3% and 23.0%, respectively. PMID:15200066

Ikawa, Fusao; Ohbayashi, Naohiko; Imada, Yasutaka; Matsushige, Toshinori; Kajihara, Yosuke; Inagawa, Tetsuji; Kobayashi, Shotai



Delayed massive hemorrhage due to external iliac artery pseudo-aneurysm and uretero-iliac artery fistula following robotic radical cystectomy and intracorporeal Studer pouch reconstruction: Endovascular management of an unusual complication.  


We report a very unusual complication of uretero-iliac artery fistula that developed following robotic radical cystectomy (RARC), bilateral extended pelvic lymph node dissection and intracorporeal Studer pouch reconstruction. Our patient was a 54-year-old male who was admitted 1 month after undergoing robotic surgery due to intermittently occurring massive transurethral bleeding necessitating blood transfusion that stopped by itself. Angiography showed a right external iliac artery pseudo-aneurysm and a fistula tract between the pseudo-aneurysm and Wallace type ureteral anostomosis that was successfully treated by an angiographic endovascular stent insertion at this level. Uretero-iliac artery fistula might occur following RARC, bilateral extended pelvic lymph node dissection and intracorporeal Studer pouch reconstruction leading to intermittently massive transurethral bleeding. Angiography and stenting are important for diagnosis and successful treatment of this rare entity. PMID:24069106

Atmaca, Ali Fuat; Canda, Abdullah Erdem; Gumus, Mehmet; Asil, Erem; Balbay, Mevlana Derya



Delayed massive hemorrhage due to external iliac artery pseudo-aneurysm and uretero-iliac artery fistula following robotic radical cystectomy and intracorporeal Studer pouch reconstruction: Endovascular management of an unusual complication  

PubMed Central

We report a very unusual complication of uretero-iliac artery fistula that developed following robotic radical cystectomy (RARC), bilateral extended pelvic lymph node dissection and intracorporeal Studer pouch reconstruction. Our patient was a 54-year-old male who was admitted 1 month after undergoing robotic surgery due to intermittently occurring massive transurethral bleeding necessitating blood transfusion that stopped by itself. Angiography showed a right external iliac artery pseudo-aneurysm and a fistula tract between the pseudo-aneurysm and Wallace type ureteral anostomosis that was successfully treated by an angiographic endovascular stent insertion at this level. Uretero-iliac artery fistula might occur following RARC, bilateral extended pelvic lymph node dissection and intracorporeal Studer pouch reconstruction leading to intermittently massive transurethral bleeding. Angiography and stenting are important for diagnosis and successful treatment of this rare entity.

Atmaca, Ali Fuat; Canda, Abdullah Erdem; Gumus, Mehmet; Asil, Erem; Balbay, Mevlana Derya



Adrenal hemorrhage in the newborn.  


Massive adrenal hemorrhage of the newborn is a rare phenomenon. The pathogenesis is still unclear; massive hemorrhage has been observed in newborns after difficult and prolonged deliveries or placental bleeding, and in small prematures with intrapartum anoxia. The authors report a newborn operated on the fifth day of life after its general condition had deteriorated progressively. A retroperitoneal hematoma had formed subsequent to rupture of one suprarenal gland. After surgical removal of the hematoma, the child recovered fully. PMID:6878721

Ausserer, O; Ortore, P G; Sarra, A; von Fioreschy, G



[Takayasu's disease and cerebromeningeal hemorrhage].  


A 53-old-woman with both Takayasu disease and intracerebral hemorrhage is reported. Non-specific aorto-arteritis was acquired, while aneurysm on arteria cerebri media is probably of congenital origin. The association of these two syndromes is, judging by this facts, accidental. Nevertheless, it should be taken into consideration than panarteritis had a significant role in formation of aneurysm and favored the appearance of hemorrhage. PMID:2572045

Dimitrijevi?, J; Dzirlo, K; Stankovi?, D; Simi?, L; Bokonji?, R



Acute Hydrocephalus After Subarachnoid Hemorrhage  

Microsoft Academic Search

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

Oscar Suarez-Rivera



Dengue and Dengue Hemorrhagic Fever  

PubMed Central

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.

Gubler, Duane J.



[Treatment of acute esophago-gastric hemorrhage].  


Experience in the treatment of 129 patients with esophagogastric hemorrhage due to portal hypertension is discussed. An original modification of the design of Blakemore's tube is suggested, with the use of which the results of nonoperative treatment were improved and the mortality among this category of patients was reduced. Operation was performed on 75 patients. The total mortality among all hospitalized patients was 6.2%. The Tanner-Petrov operation was carried out on 55 patients, splenorenal anastomosis was formed in 6, organopexy was conducted on 4, splenectomy in combination with organopexy in 8, and portocaval anastomosis was formed in 2 patients. Three patients died after the operation. PMID:1803098

Tsybyrné, K A; Danu, M I; Stabinski?, R A; Namashko, M V



Performance of Third-generation FloTrac/Vigileo system during hyperdynamic therapy for delayed cerebral ischemia after subarachnoid hemorrhage  

PubMed Central

Background: Monitoring of cardiac output (CO) is important for promising safe approach to goal-directed hemodynamic therapy for delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH), but is often precluded by the invasiveness and complexity of ongoing monitoring modalities. We examined the clinical utility of less-invasive management using an uncalibrated arterial pressure waveform-derived cardiac output (APCO) monitor with refined algorithm (Third-generation FloTrac/Vigileo, Edwards, Irvine, CA, USA) during hyperdynamic therapy for post-SAH DCI, compared with transpulmonary thermodilution (PiCCO, Pulsion, Munich, Germany) as a reference technique. Methods: Forty-five patients who underwent surgical clipping within 24 h of SAH onset and subsequently developed clinical deterioration attributable to DCI were investigated. Validation of the APCO-derived cardiac index (CI) during dobutamine-induced hyperdynamic therapy was compared with a reference CI analyzed by transpulmonary thermodilution in 20 patients. In a subsequent trial of 48 cases, the overall clinical results from patients managed with each device were compared. Results: The APCO underestimated CI with an overall bias ± SD of 0.33 ± 0.26 L/min/m2 compared with transpulmonary thermodilution, resulting in an error of 14.9%. The trends of CI for both techniques at each dobutamine dose were similar (r2= 0.77; P < 0.0001). No statistically significant differences were observed between the device groups for frequencies of neurological improvement, cerebral infarction, cardiopulmonary complications, or functional outcomes at 3 months. Conclusions: These data suggest that the refined APCO tends to underestimate CI compared with reference transpulmonary thermodilution during hyperdynamic therapy with dobutamine for reversing DCI, but may be acceptable in this select category of patients to obtain comparable clinical results.

Mutoh, Tatsushi; Ishikawa, Tatsuya; Kobayashi, Shinya; Suzuki, Akifumi; Yasui, Nobuyuki



Initial resuscitation of hemorrhagic shock  

PubMed Central

The primary treatment of hemorrhagic shock is control of the source of bleeding as soon as possible and fluid replacement. In controlled hemorrhagic shock (CHS) where the source of bleeding has been occluded fluid replacement is aimed toward normalization of hemodynamic parameters. In uncontrolled hemorrhagic shock (UCHS) in which bleeding has temporarily stopped because of hypotension, vasoconstriction, and clot formation, fluid treatment is aimed at restoration of radial pulse, or restoration of sensorium or obtaining a blood pressure of 80 mmHg by aliquots of 250 ml of lactated Ringer's solution (hypotensive resuscitation). When evacuation time is shorter than one hour (usually urban trauma) immediate evacuation to a surgical facility is indicated after airway and breathing (A, B) have been secured ("scoop and run"). Precious time is not wasted by introducing an intravenous line. When expected evacuation time exceeds one hour an intravenous line is introduced and fluid treatment started before evacuation. Crystalloid solutions and blood transfusion are the mainstays of pre-hospital and in-hospital treatment of hemorrhagic shock. In the pre-hospital setting four types of fluid are presently recommended: crystalloid solutions, colloid solutions, hypertonic saline and oxygen-carrying blood substitutes. In unstable or unresponsive hemorrhagic shock surgical treatment is mandatory as soon as possible to control the source of bleeding.

Krausz, Michael M



Subarachnoid hemorrhage in the rat: cerebral blood flow and glucose metabolism during the late phase of cerebral vasospasm  

SciTech Connect

A double-isotope technique for the simultaneous measurement of CBF and CMRglu was applied to a subarachnoid hemorrhage (SAH) model in the rat. Cisternal injection of 0.07 ml blood caused a rather uniform 20% reduction in CBF together with an increase in glucose utilization of 30% during the late phase of vasospasm. In one-third of the SAH animals, there were focal areas where the flow was lowered to 30% of the control values and the glucose uptake increased to approximately 250% of control. We suggest that blood in the subarachnoid space via a neural mechanism induces the global flow and metabolic changes, and that the foci are caused by vasospasm superimposed on the global flow and metabolic changes. In the double-isotope autoradiographic technique, (/sup 14/C)iodoantipyrine and (/sup 3/H)deoxyglucose were used for CBF and CMRglu measurements, respectively, in the same animal. In half of the sections, the (/sup 14/C)iodoantipyrine was extracted using 2,2-dimethoxypropane before the section was placed on a /sup 3/H- and /sup 14/C-sensitive film. The other sections were placed on x-ray film with an emulsion insensitive to /sup 3/H. The validity of the double-isotope method was tested by comparing the data with those obtained in animals receiving a single isotope. The CBF and metabolic values obtained in the two groups were similar.

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



Lymphocytic choriomeningitis virus infection in FVB mouse produces hemorrhagic disease.  


The viral family Arenaviridae includes a number of viruses that can cause hemorrhagic fever in humans. Arenavirus infection often involves multiple organs and can lead to capillary instability, impaired hemostasis, and death. Preclinical testing for development of antiviral or therapeutics is in part hampered due to a lack of an immunologically well-defined rodent model that exhibits similar acute hemorrhagic illness or sequelae compared to the human disease. We have identified the FVB mouse strain, which succumbs to a hemorrhagic fever-like illness when infected with lymphocytic choriomeningitis virus (LCMV). FVB mice infected with LCMV demonstrate high mortality associated with thrombocytopenia, hepatocellular and splenic necrosis, and cutaneous hemorrhage. Investigation of inflammatory mediators revealed increased IFN-?, IL-6 and IL-17, along with increased chemokine production, at early times after LCMV infection, which suggests that a viral-induced host immune response is the cause of the pathology. Depletion of T cells at time of infection prevented mortality in all treated animals. Antisense-targeted reduction of IL-17 cytokine responsiveness provided significant protection from hemorrhagic pathology. F1 mice derived from FVB×C57BL/6 mating exhibit disease signs and mortality concomitant with the FVB challenged mice, extending this model to more widely available immunological tools. This report offers a novel animal model for arenavirus research and pre-clinical therapeutic testing. PMID:23300439

Schnell, Frederick J; Sundholm, Sarah; Crumley, Stacy; Iversen, Patrick L; Mourich, Dan V



Alpha 1-antitrypsin activity in subarachnoid hemorrhage.  


An altered equilibrium of protease/protease-inhibitor factors may be involved in the pathogenesis of aneurysm rupture: alpha 1-antitrypsin (alpha 1-AT) represents the most relevant inhibitor of elastase, a proteolytic enzyme enhancing catabolic processes of collagen metabolism. In the present study we test the hypothesis whether the activity of alpha 1-AT is altered in SAH patients; 5 cases with unruptured intracranial aneurysm and 27 patients with diagnosis of aneurysm SAH were included in the study. Blood samples were obtained immediately at admission. As control samples we consider the 5 cases of unruptured aneurysm, 15 cases of unruptured aortic aneurysms and 10 patients with non-vascular CNS diseases. Measurement of alpha 1-AT level was determined by immunoturbidimetric method. Serum levels of alpha 1-AT are significantly lower in patients admitted within 72 hours after SAH, if compared to patients admitted in a delayed phase. The linear relationship between alpha 1-AT and collagenase inhibitory percentage capacity (CIC) was shown to be different in the 4 subgroups considered, and so were the mean % CIC values in the between-groups comparison, except for unruptured aneurysm vs controls. The alpha 1-AT CIC in patients with SAH is shown to be the lowest when compared to controls and unruptured aneurysms (p = 0.0001). PMID:8684266

Tartara, F; Gaetani, P; Tancioni, F; Guagliano, A; Klersy, C; Forlino, A; Marzatico, F; Rodriguez y Baena, R



Hemorrhagic stroke associated with pulmonary edema and catastrophic cardiac failure.  


Cerebral arteriovenous fistula (AVF) is a vascular malformation that is rare in the pediatric population. Older children with cerebral AVF tend to present with neurologic problems related to intracranial venous hypertension or intracranial hemorrhage. Cardiac and pulmonary complications following acute neurologic injury such as subarachnoid hemorrhage are common in adults, but are rarely reported in children. However, complications have been reported in cases of enterovirus 71 rhombencephalitis in infants and children and can cause high morbidity and mortality. Here, we report a 14-year-old boy who presented with cardiac failure associated with pulmonary edema following cerebral hemorrhagic stroke due to AVF. After aggressive investigation and management, we intervened before significant hypoxia and hypotension developed, potentially reducing the risk of long-term adverse neurologic consequences in this patient. PMID:18947007

Lee, Jiun-Chang; Lin, Jainn-Jim; Lin, Kuang-Lin; Hsia, Shao-Hsuan; Wu, Chang-Teng; Wong, Alex Mun-Ching



Diffuse alveolar hemorrhage as a manifestation of Behçet disease.  


Diffuse alveolar hemorrhage (DAH) is a rare life-threatening condition which refers to the presence of red blood cells within alveoli deriving from hemorrhage originating in the pulmonary microvasculature. It differs from alveolar filling, in which blood cells derive from localized bleeding, usually of bronchial origin. DAH may be part of diffuse alveolar injury of any origin. DAH should be considered a medical emergency due to the significant morbidity and mortality associated with respiratory failure, when secondary to impaired oxygen uptake from alveoli filled with erythrocytes. Patients with alveolar hemorrhage present with non-specific symptoms like dyspnea, cough and hemoptysis, which is not always present. They may develop acutely or insidiously over a few days. We present a case of a patient with probable Behçet's disease complicated by pulmonary capillaritis and DAH resulting in refractory respiratory failure and death. PMID:23884031

Grosso, V; Boveri, E; Bogliolo, L; Montecucco, C; Caporali, R



Hemorrhagic and thrombotic complications in bone marrow transplant recipients.  


Hemostatic challenges occur throughout the period of stem cell transplantation (SCT). Endothelial cells injury due to chemotherapy, growth factors, intravenous catheter, and graft-versus-host disease and profound thrombocytopenia are the major components involved in the hemostatic complications. Diffuse alveolar hemorrhage and hemorrhagic cystitis are severe complications in SCT recipients with high morbidity and mortality rate and no effective treatment. Common thrombotic manifestations include Veno-occlusive disease (VOD) and central venous lines thrombosis. More intensive conditioning regimens and mismatch donors increase the risk of hemostatic complications. Management of hemostatic and thrombotic complications is discussed including current data on the role of recombinant factor VIIa for severe hemorrhage and defibrotide for VOD. PMID:18023720

Nadir, Yona; Brenner, Benjamin



Cerebellar hemorrhage after spine fixation misdiagnosed as a complication of narcotics use -A case report-  

PubMed Central

Cerebellar hemorrhage occurs mainly due to hypertension. Postoperative cerebellar hemorrhage is known to be associated frequently with frontotemporal craniotomy, but quite rare with spine operation. A 56-year-old female received spinal fixation due to continuous leg tingling sensation for since two years ago. Twenty-one hours after operation, she was disoriented and unresponsive to voice. Performed computed tomography showed both cerebellar hemorrhage. An emergency decompressive craniotomy was carried out to remove the hematoma. On the basis of this case, we reported this complications and reviewed related literature.

Yang, Ki-Hwan; Han, Jeong Uk; Jung, Jong-Kwon; Lee, Doo Ik; Hwang, Sung-Il



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


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

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



Life-threatening hemorrhage due to uterine vascular abnormality.  


A case is reported of a 25-year-old woman stricken with prolonged and life-threatening menorrhagia from abnormal uterine vessels resembling hemangioma cavernosum. The condition was suspected at ultrasonic investigation. Hysterectomy was performed as an emergency operation. PMID:3051884

Jensen, H; Petersen, K; Lenz, S; Ilum, L; Olsen, C R



Protection of Minocycline on Early Brain Injury After Subarachnoid Hemorrhage in Rats  

Microsoft Academic Search

\\u000a Minocycline has been shown to be neuroprotective in cerebral ischemia and in other models of brain injury. Our goal is to\\u000a observe the protection of minocycline on EBI after SAH and the mechanism. 48 adult male SD rats were randomly divided into\\u000a four groups: the sham-operated group, SAH group, vehicle group (SAH + normal sodium), and minocycline group (SAH +

Zong-duo Guo; Hai-tao Wu; Xiao-chuan Sun; Xiao-dong Zhang; John H. Zhang


Bolivian Hemorrhagic Fever: A Pathologic Description.  

National Technical Information Service (NTIS)

In 1963, an epidemic of viral hemorrhagic fever affected several hundred natives in San Joaquin, Bolivia. The mortality was 18%. This report describes the pathologic changes of Bolivian hemorrhagic fever based upon observations on eight cases that were au...

P. L. Child R. B. MacKenzie L. R. Valverde K. M. Johsnon



An Unusual Cause of Subarachnoid Hemorrhage  

PubMed Central

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



A warfarin-induced subconjunctival hemorrhage  

Microsoft Academic Search

BackgroundPatients who are on warfarin therapy may present with a variety of ocular side effects, particularly hemorrhages. These ocular events may be the only indication that the patient is at risk for serious sequelae, including hemorrhagic stoke.

Marie I. Bodack



Acute hemorrhagic edema of infancy.  


Acute hemorrhagic edema of infancy is a distinctive, cutaneous small vessel leukocytoclastic vasculitis of young children with dramatic characteristic skin findings. It is characterized by low- grade fever, erythematous edema, and purpuric lesions mainly on the face and extremities. Visceral involvement is uncommon, and spontaneous recovery usually occurs within one to three weeks without sequelae. The main differential diagnosis is Henoch-Schönlein purpura. We report this case to highlight the condition and emphasize its benign nature. We describe a classic case of acute hemorrhagic edema of infancy, and comment on the clinical features, pathology, treatment, and prognosis. The disease has spontaneous recovery without sequelae. PMID:18154430

Javidi, Zari; Maleki, Masoud; Mashayekhi, Vahid; Tayebi-Maybodi, Naser; Nahidi, Yalda



Symptomatic Tarlov Cyst Following Spontaneous Subarachnoid Hemorrhage  

PubMed Central

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

Kong, Woo Keun; Hong, Seung-Koan



Symptomatic tarlov cyst following spontaneous subarachnoid hemorrhage.  


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

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



CT demonstration of bilateral adrenal hemorrhage  

SciTech Connect

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.

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



Clinical significance of fetal intracranial hemorrhage  

Microsoft Academic Search

OBJECTIVE: We reviewed our experience with six consecutive cases of fetal intracranial hemorrhage and the cases published in the English literature in an attempt to devise an original prognostic scoring system for antenatal intracranial hemorrhage. STUDY DESIGN: The series included the cases of fetal intracranial hemorrhage detected at our institution between 1992 and 1994 by transabdominal ultrasonography. In addition, we

Vergani; Strobelt; Locatelli; Paterlini; Tagliabue; Parravicini; Ghidini



Prevention of intraventricular hemorrhage in preterm infants  

Microsoft Academic Search

Prematurely born infants with intraventricular hemorrhage (IVH) suffer significant morbidity and mortality, particularly those infants with high grade hemorrhage. The more premature infants have a higher incidence, experiencing more severe IVH. Early onset IVH is also likely to be severe and to progress to a higher grade. The etiology of intraventricular hemorrhages is clearly multifactorial, with differing sets of risk

John T. Wells; Laura R. Ment



Pathophysiology and management of subretinal hemorrhage  

Microsoft Academic Search

Subretinal hemorrhage can arise from the retinal and\\/or choroidal circulation. Significant subretinal hemorrhage occurs in several conditions, but most commonly is associated with age-related macular degeneration, presumed ocular histoplasmosis, high myopia, retinal arterial macroaneurysm, and trauma. Released toxins, outer retinal shear forces, and a diffusion barrier created by subretinal hemorrhage all contribute to photoreceptor damage and visual loss. The use

Michael A. Hochman; Christopher M. Seery; Marco A. Zarbin



Effect of Clazosentan in Patients with Aneurysmal Subarachnoid Hemorrhage: A Meta-Analysis of Randomized Controlled Trials  

PubMed Central

Background Cerebral vasospasm is the most important potentially treatable cause of mortality and morbidity following aneurysmal subarachnoid hemorrhage (aSAH). Clazosentan, a selective endothelinreceptor antagonist, has been suggested to help reduce the incidence of vasospasm in patients with aSAH. However, the results were controversial in previous trials. This meta-analysis attempts to assess the effect of clazosentan in patients with aSAH. Methodology/Principal Findings We systematically searched Pubmed, Embase, and the Cochrane Library from their inception until June, 2012. All randomized controlled trials (RCTs) related to the effect of clazosentan in aSAH were included. The primary outcomes included the incidence of angiographic vasospasm, new cerebral infarction (NCI), delayed ischemic neurological deficits (DIND), and vasospasm-related morbidity/mortality (M/M); the second outcomes included the occurrence of rescue therapy, all-cause-mortality, and poor outcome. 4 RCTs were included with a total of 2156 patients. The risk of angiographic vasospasm (relative risk [RR]?=?0.58; 95% CI, 0.48 to 0.71), DIND (RR?=?0.76; 95% CI, 0.62 to 0.92), and vasospasm-related M/M (RR?=?0.80; 95% CI, 0.67 to 0.96) were statistically significantly reduced in the clazosentan group. Patients treated with clazosentan had a reduced occurrence of rescue therapy (RR?=?0.62; 95% CI, 0.49 to 0.79). However, no statistically significant effects were observed in NCI (RR?=?0.74; 95% CI, 0.52 to 1.04), mortality (RR?=?1.03; 95% CI, 0.71 to 1.49), and poor outcome (RR?=?1.12; 95% CI, 0.96 to 1.30). Conclusions/Significance Our pooling data supports that clazosentan is probably effective in preventing the occurrence of angiographic vasospasm, vasospasm-related DIND, vasospasm related M/M, and rescue therapy. However, no evidence lends significant supports to the benefits of clazosentan in decreasing the occurrence of NCI, mortality or improving the functional outcome.

Li, Wei-Qing; Huang, Cheng-Guang; Lu, Yi-Cheng; Hou, Li-Jun



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


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

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



Acute hemorrhagic necrosis of tumors induced by interleukin-1 alpha: effects independent of tumor necrosis factor.  


Tumor necrosis factor (TNF), a protein synthesized in response to the endotoxin bacterial lipopolysaccharide (LPS), is the classical mediator of acute hemorrhagic necrosis of tumors. We have demonstrated that interleukin-1 alpha (IL-1 alpha), with a spectrum of activities very similar to those of TNF, also causes acute hemorrhagic necrosis of tumors. Both TNF and IL-1 induce a cascade of events including the synthesis or release of each other. The present studies were thus undertaken to determine whether the hemorrhagic necrosis induced in tumors by IL-1 alpha is due to TNF. Kinetic parameters of IL-1 alpha-induced hemorrhage were similar to those observed with recombinant murine TNF-alpha (TNF-alpha) or LPS in RIF-1 fibrosarcomas in C3H/HeN (endotoxin-sensitive) mice. However, the amount of TNF found in the sera or tumors of animals treated with LPS was more than 20-fold higher than in mice treated with IL-1 alpha, and LPS induced similar degrees of hemorrhagic necrosis, which was measured by determining the packed volume of red blood cells by 59Fe labeling. A low but significantly hemorrhagic dose of IL-1 alpha induced no detectable TNF in tumors. Pretreatment with 250 micrograms of neutralizing antibody to TNF had no effect on IL-1 alpha-induced hemorrhage, whereas TNF-alpha- and LPS-induced hemorrhagic effects were significantly reduced. These results demonstrate an important antitumor activity of IL-1 alpha that appears to be independent of TNF. PMID:2061944

Johnson, C S; Chang, M J; Braunschweiger, P G; Furmanski, P



Femoral access in 100 consecutive subarachnoid hemorrhage patients: the "craniotomy" of endovascular neurosurgery  

PubMed Central

Background Femoral access is a fundamental element of catheter-based cerebral angiography. Knowledge of location of the common femoral artery (CFA) bifurcation is important as the risk of retroperitoneal bleeding is increased if the puncture is superior to the inguinal ligament and there is an increased risk of thrombosis and arteriovenous fistula formation if the puncture is distal into branch vessels. We sought to characterize the location of the CFA bifurcation along with the presence of significant atherosclerosis or iliac tortuosity in a contemporary series of subarachnoid hemorrhage (SAH) patients. Findings The records of a prospective single-center aneurysm database were reviewed to identify 100 consecutive SAH patients. Using an oblique femoral arteriogram, the presence of significant atherosclerosis, iliac tortuosity, and the CFA bifurcation were assessed. The CFA bifurcation was graded according to its position with respect to the femoral head: below (grade 1), lower half (grade 2), and above the upper half (grade 3). We found a CFA bifurcation grade 1 in 50 patients (50%, mean age 51.2 years), grade 2 in 40 patients (40%, mean age 55.5 years), and grade 3 in 10 patients (10%, mean age 58.2 years). Whereas 30 of 90 patients with CFA grades I or II were male (33%), only 10% with grade 3 were male (1 of 10, p = 0.12). Mean age for significant atherosclerosis was 65.5 +/- 2.6 years versus 50.9 +/- 1.6 years (p < 0.001) without, and iliac tortuosity was 64.9 +/- 2.4 years versus 50.3 +/- 1.6 years (p < 0.001) without. Conclusions Although a requisite element of endovascular treatment in SAH patients, femoral access can be complicated by a high common femoral artery bifurcation and the presence of atherosclerotic disease and/or iliac artery tortuosity. In this study, we found a grade 3 (above the femoral head) CFA bifurcation in 10% patients, with 90% of these patients being female. We also found the presence of atherosclerotic disease and iliac tortuosity to be significantly more likely in patients older than 65 years of age.



Hemorrhagic shock in the dog  

Microsoft Academic Search

Summary Oxygen consumption, hemodynamics, and regional blood flow (with the radioactive microspheres technique) were determined in 12 anesthetized dogs subjected to hemorrhagic shock. The animals were kept in hypotension at 40 mm Hg, until 15% of the maximum shed blood had been infused to keep arterial pressure stable, whereafter all the shed blood was retransfused. Cardiac output (CO) decreased to

M. H. Schoenberg; C. Lundberg; B. Gerdin; G. Smedegård; K. Messmer; K.-E. Arfors



A Giant Hemorrhagic Adrenal Pseudocyst  

Microsoft Academic Search

Objective: To report a rare case of a giant hemorrhagic adrenal pseudocyst and highlight the importance of this entity to clinicians. Case Presentation: A 57-year-old woman presented with a 1-year history of abdominal pain and distension. Ultrasonography and multislice computed tomography revealed a giant cystic (partially solid) mass over the left suprarenal region measuring 20 × 17 × 15 cm.

Goran Stimac; Josip Katusic; Mario Sucic; Mario Ledinsky; Bozo Kruslin; Davor Trnski



[Enteroviruses responsible for acute hemorrhagic conjunctivitis].  


Acute hemorrhagic conjunctivitis (AHC) is an epidemic form of highly contagious conjunctivitis, characterized by conjunctival hemorrhages. The first AHC outbreak was described in 1969 in Ghana, West Africa, and was called Apollo disease, from the Apollo landing on the moon. This outbreak was caused by Enterovirus 70 (EV70) together with a Coxsackievirus A24 (CVA24v) variant, which are the major etiological agents involved in AHC outbreaks worldwide. AHC is known to be directly transmitted by close person-to-person contact or indirectly through soiled ophthalmological materials or unsafe recreational water. Recently, a possible airborne virus spread was suggested which could explain the high transmission rate of the disease. In the absence of a specific antiviral therapy, a rapid diagnosis of the causative agent is required to distinguish AHC due to enteroviruses from other ocular infectious diseases, for there are active drugs, or to quickly implement proper public health measures to limit the extension of the outbreak. However, virus identification remains difficult and time-consuming. Moreover, virological diagnosis is difficult to implement in developing countries where AHC has recently become a major problem for public health. PMID:19836177

Lévêque, N; Huguet, P; Norder, H; Chomel, J-J



Preretinal/intraretinal hemorrhages: a photographic essay.  


A 24-year-old Caucasian woman spontaneously developed four hemorrhages, each with a "preretinal" or "subhyaloid" appearance. The largest was in the macular area: the others were more peripheral. The central hemorrhage followed a characteristic pattern of reabsorption, while the peripheral ones followed a different pattern, which seems consistent with the formation of a clot, removal of blood pigments, and ultimate removal of the fibrin. The photographs suggest that the hemorrhage in the macular area had both intra- and pre-retinal components. Aside from a history of lupus erythematosus (which was in remission when the hemorrhages occurred), there was no other apparent ocular or systemic cause for the hemorrhages. PMID:3397492

Williams, T D



[In-hospital mortality due to stroke].  


Overall mortality due to stroke has decreased in the last three decades probable due to a better control of vascular risk factors. In-hospital mortality of stroke patients has been estimated to be between 6 and 14% in most of the series reported. However, data from recent clinical trials suggest that these figures may be substantially lower. Data from FLENI Stroke Data Bank and institutional mortality records between 2000 and 2010 were reviewed. Ischemic stroke subtypes were classified according to TOAST criteria and hemorrhagic stroke subtypes were classified as intraparenchymal hematoma, aneurismatic subarachnoid hemorrhage, arterio-venous malformation, and other intraparenchymal hematomas. A total of 1514 patients were studied. Of these, 1079 (71%) were ischemic strokes,39% large vessels, 27% cardioembolic, 9% lacunar, 14% unknown etiology, and 11% others etiologies. There were 435 (29%) hemorrhagic strokes, 27% intraparenchymal hematomas, 30% aneurismatic subarachnoid hemorrhage, 25% arterio-venous malformation, and 18% other intraparenchymal hematomas. Moreover, 38 in-hospital deaths were recorded (17 ischemic strokes and 21 hemorrhagic strokes), accounting for 2.5% overall mortality (1.7% in ischemic strokes and 4.8% in hemorrhagic strokes). No deaths occurred associated with the use of intravenous fibrinolytics occurred. In our Centre in-hospital mortality in patients with stroke was low. Management of these patients in a Centre dedicated to neurological diseases along with a multidisciplinary approach from medical and non-medical staff trained in the care of cerebrovascular diseases could, at least in part, account for these results. PMID:23924531

Rodríguez Lucci, Federico; Pujol Lereis, Virginia; Ameriso, Sebastián; Povedano, Guillermo; Díaz, María F; Hlavnicka, Alejandro; Wainsztein, Néstor A; Ameriso, Sebastián F



Dengue hemorrhagic fever: A rare cause of pituitary tumor hemorrhage and reversible vision loss  

PubMed Central

Dengue hemorrhagic fever leading to hemorrhage in pituitary adenoma is not reported till date: We herein report the first case of bilateral visual loss secondary to pituitary adenoma hemorrhage associated with dengue hemorrhagic fever. Urgent transnasal trans sphenoidal decompression of the macroadenoma prevented permanent visual loss in this patient. Pituitary apoplexy should be considered as differential diagnosis of visual deterioration apart from retinal hemorrhage, maculopathy, and optic neuropathy in cases of dengue hemorrhagic fever. Early decompression of optic nerves helped in the restoration of vision.

Kumar, Vimal; Kataria, Rashim; Mehta, V S



Treatment of Rectal Hemorrhage by Coil Embolization  

SciTech Connect

Four patients, aged 54-84 years, presenting with life-threatening rectal bleeding from the superior hemorrhoidal artery, underwent percutaneous fibered platinum coil embolization via coaxial catheters. Pre-procedure sigmoidoscopy had failed to identify the source of hemorrhage, because the rectum was filled with fresh blood. Embolization was technically and clinically successful in all four patients. Subsequent sigmoidoscopy confirmed the diagnoses in three patients as a solitary rectal ulcer, iatrogenic traumatic ulceration following manual evacuation, and a rectal Dieulafoy's lesion. The other case was angiographically seen to be due to a rectal angiodysplasia. Embolization is an effective procedure in life-threatening superior hemorrhoidal arterial bleeding when endoscopic treatment fails, and should be preferred to rectosigmoid resection.

Dobson, Craig Charles; Nicholson, Anthony A. [Department of Radiology, Hull Royal Infirmary, Anlaby Road, Hull, East Yorkshire HU3 2JZ (United Kingdom)



Treatment of rectal hemorrhage by coil embolization  

SciTech Connect

Four patients, aged 54-84 years, presenting with life-threatening rectal bleeding from the superior hemorrhoidal artery, underwent percutaneous fibered platinum coil embolization via coaxial catheters. Preprocedure sigmoidoscopy had failed to identify the source of hemorrhage, because the rectum was filled with fresh blood. Embolization was technically and clinically successful in all four patients. Subsequent sigmoidoscopy confirmed the diagnoses in three patients as a solitary rectal ulcer, iatrogenic traumatic ulceration following manual evacuation, and a rectal Dieulafoy's lesion. The other case was angiographically seen to be due to a rectal angiodysplasia. Embolization is an effective procedure in life-threatening superior hemorrhoidal arterial bleeding when endoscopic treatment fails, and should be preferred to rectosigmoid resection.

Dobson, Craig Charles; Nicholson, Anthony A. [Hull Royal Infirmary, Department of Radiology (United Kingdom)



Alpha1-antitrypsin activity in subarachnoid hemorrhage  

Microsoft Academic Search

An altered equilibrium of protease\\/protease-inhibitor factors may be involved in the pathogenesis of aneurysm rupture: ?1-antitrypsin (?1-AT) represents the most relevant inhibitor of elastase, a proteolytic enzyme enhancing catabolic processes of collagen metabolism. In the present study we test the hypothesis whether the activity of ?1-AT is altered in SAH patients; 5 cases with unruptured intracranial aneurysm and 27 patients

Fulvio Tartara; Paolo Gaetani; Flavio Tancioni; Alberto Guagliano; Catherine Klersy; Antonella Forlino; F. Marzatico; Riccardo Rodriguez y Baena



[Misoprostol for treating postpartum hemorrhages].  


Postpartum hemorrhage is defined by bleeding > 500 mL through the vagina. It is one of the obstetrical complications that obstetricians fear most. It is the leading cause of maternal mortality in the world, especially in developing countries. The reference treatments in France are parenteral oxytocin and sulprostone. Sulprostone involves sometimes fatal side effects, and must be administered only in appropriate health care facilities. It also has the major disadvantage of requiring refrigeration. Misoprostol has uterotonic properties that have led to its occasional off-label use in the treatment of postpartum hemorrhage, by rectal or sublingual administration, as an alternative to sulprostone. A careful review of the literature on this particular use of misoprostol is essential. PMID:17643941

Godard, Clémence; Berhoune, Malik; Bertrand, Eric; Schlatter, Joël; Chiadmi, Fouad; Toledano, Audrey; Cisternino, Salvatore; Fontan, Jean-Eudes



Circumstances Precipitating Aneurysmal Subarachnoid Hemorrhage  

Microsoft Academic Search

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

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




Microsoft Academic Search

A report of 19 cases of serologically-proven dengue hemorrhagic fever (DHF) in infants aged 3-12 months who were admitted to the Department of Pediatrics, Chon Buri Regional Hospital, Thailand, during 1995 to 1998. Subjects were 8 males and 11 females, with the peak age of 8 months. Four cases (21%) had DHF and other common co-infections ie pneumonia (2 cases),

Suchat Hongsiriwon



Warfarin-associated intracerebral hemorrhage  

Microsoft Academic Search

Intracerebral hemorrhage (ICH) is the most serious complication of oral anticoagulant therapy (OAT), with mortality in excess\\u000a of 50%. Major risk factors are advanced patient age, elevated systolic blood pressure, intensity of anticoagulation, and previous\\u000a cerebral ischemia. A number of acute treatments are available, but all have significant side effects and no randomized clinical\\u000a trials assessing clinical outcome have been

Anna Cavallini; Simona Fanucchi; Alessandra Persico



Imaging of Hereditary Hemorrhagic Telangiectasia  

Microsoft Academic Search

This pictorial review is based on our experience of the follow-up of 120 patients at our multidisciplinary center for hereditary\\u000a hemorrhagic telangiectasia (HHT). Rendu-Osler-Weber disease or HHT is a multiorgan autosomal dominant disorder with high penetrance,\\u000a characterized by epistaxis, mucocutaneous telangiectasis, and visceral arteriovenous malformations (AVMs). The research on\\u000a gene mutations is fundamental and family screening by clinical examination, chest

Marie-France Carette; Cosmina Nedelcu; Marc Tassart; Jean-Didier Grange; Marie Wislez; Antoine Khalil



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


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

Chang, Youn Hyuk; Hwang, Sung-Kyun



Nd:YAG laser treatment for Valsalva premacular hemorrhages: 6 month follow up  

Microsoft Academic Search

The aim of this study was to determine visual outcomes, complications, and long-term effects of drainage of preretinal (premacular)\\u000a hemorrhage into the vitreous with Neodymium (Nd)-YAG laser in patients due to Valsalva retinopathy. A total of 12 patients\\u000a with preretinal and premacular hemorrhage presumably caused by Valsalva maneuver was studied. All patients denied any history\\u000a of ocular disease prior to

Mohammad Tariq Khan; Muhammad Usman Saeed; Mohammad Sohail Shehzad; Zaheeruddin Aqil Qazi



Hemorrhagic Cytomegalovirus Colitis in a Postoperative Colon Cancer Patient  

PubMed Central

We report a case of hemorrhagic cytomegalovirus (CMV) colitis, occurring in a postoperative patient due to a weakened immune system. An 85-year-old woman with a medical history, including chronic renal failure treated with oral administration of prednisolone, underwent colectomy due to an ascending colon cancer. While the postoperative course was favorable, she exhibited acute severe abdominal pain and massive bloody discharge after 11 days of surgery. Her colonoscopic examination showed multiple longitudinal ulcers on the anastomosis. In addition to these endoscopic findings, her past medical history helped suggest CMV colitis. Because serological testing revealed positive CMV antigen, she was finally given a diagnosis of CMV colitis and received intravenous ganciclovir for the initial treatment. Hemorrhagic CMV colitis after colectomy is an important postoperative complication; we therefore present our case with diagnosis and treatment experience.

Saito, Motonobu; Ishino, Atsushi; Ito, Taisuke; Sakuma, Takeshi; Matsuzaki, Masami; Katagata, Naoto; Watanabe, Fumiaki; Takenoshita, Seiichi; Nomizu, Tadashi



Multiple intracranial hemorrhages after cervical spinal surgery.  


A 69-year-old woman presented with a rare case of multiple supra- and infratentorial intracranial hemorrhages after cervical laminoplasty for cervical spondylotic myelopathy without intraoperative liquorrhea. A wound drainage tube under negative pressure was placed with subsequent 380 ml of drainage in the first 12 hours. She had no complaint of headache and nausea at that time. Computed tomography of the brain obtained at 15 hours after surgery demonstrated cerebellar hemorrhage, acute subdural hemorrhage, subarachnoid hemorrhage, supratentorial intraparenchymal hemorrhage, and pneumocephalus. She was treated medically without consequent neurological deficits other than right hemianopsia. Overdrainage of cerebrospinal fluid through an occult dural tear might cause severely low intracranial pressure with subsequent multiple intracranial hemorrhages. Wound drainage should be controlled thoroughly even in patients without intraoperative liquorrhea. PMID:23006877

Takahashi, Yuichi; Nishida, Kenki; Ogawa, Koichi; Yasuhara, Takao; Kumamoto, Shinji; Niimura, Tatsuomi; Tanoue, Takashi



Subarachnoid hemorrhage and cerebral vasospasm - Literature review  

PubMed Central

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

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



Dopamine D2-Receptor-Mediated Increase in Vascular and Endothelial NOS Activity Ameliorates Cerebral Vasospasm After Subarachnoid Hemorrhage In Vitro  

PubMed Central

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.

Caudell, Danielle N.; Cooper, Matthew; Clark, Joseph F.; Shutter, Lori A.



Pulmonary hemorrhage resulting from bungee jumping.  


Pulmonary hemorrhage is a relatively common complication of blunt chest trauma. Occasionally, it may result from pulmonary barotrauma after scuba diving or from sports activities not associated with barotrauma such as long breath-hold diving. We report a case of symmetric diffuse upper lobe hemorrhage resulting from a bungee jump in a previously healthy man. Bungee jumping is an increasingly popular sport with relatively few reported injuries. To our knowledge pulmonary hemorrhage in this setting has not yet been described. PMID:18043394

Manos, Daria; Hamer, Okka; Müller, Nestor L



Ethyl pyruvate improves survival in awake hemorrhage  

Microsoft Academic Search

Classical experimental models of hemorrhage are characterized by the use of anesthetics that may interfere with the typical\\u000a immune responses and pathology of hemorrhage\\/resuscitation. Thus, therapeutic strategies successful in anesthetized animals\\u000a might not be beneficial in clinical trials. In this study, we analyzed whether ethyl pyruvate could provide therapeutic benefits\\u000a during resuscitation in awake (unanesthetized) hemorrhage. Our results indicate that

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



Outcomes in Children With Hemorrhagic Stroke  

PubMed Central

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.

Lo, Warren D.; Hajek, Christine; Pappa, Christopher; Wang, Wei; Zumberge, Nicholas



External ventricular drainage for intraventricular hemorrhage.  


Hemorrhagic stroke accounts for only 10% to 15% of all strokes; however, it is associated with devastating outcomes. Extension of intracranial hemorrhage (ICH) into the ventricles or intraventricular hemorrhage (IVH) has been consistently demonstrated as an independent predictor of poor outcome. In most circumstances the increased intracranial pressure and acute hydrocephalus caused by ICH is managed by placement of an external ventricular drain (EVD). We present a systematic review of the literature on the topic of EVD in the setting of IVH hemorrhage, articulating the scope of the problem and prognostic factors, clinical indications, surgical adjuncts, and other management issues. PMID:22002766

Dey, Mahua; Jaffe, Jennifer; Stadnik, Agnieszka; Awad, Issam A



Cocaine induced intracerebral hemorrhage: Analysis of predisposing factors and mechanisms causing hemorrhagic strokes  

Microsoft Academic Search

We analyzed 26 autopsy cases of cocaine induced intracerebral hemorrhage and compared those findings with those of 26 autopsy cases of cocaine induced cerebral aneurysm rupture. The incidence of hypertensive cardiovascular disease (HCVD) was significantly higher in persons with intracerebral hemorrhage than in those with aneurysm rupture. Our findings suggest that HCVD predisposes to cocaine induced intracerebral hemorrhage. We propose

Kazuhiko Kibayashi; Angeline R Mastri; Charles S Hirsch



Antenatal risk factors for germinal matrix hemorrhage and intraventricular hemorrhage in preterm infants  

Microsoft Academic Search

Objectives: This study was designed to evaluate the effect of antenatal risk factors on the occurrence of germinal matrix hemorrhage or intraventricular hemorrhage in preterm infants. Study design: Antenatal factors were evaluated in 302 infants delivered between 24 and 33 completed weeks gestation. Ultrasonographic screening of intracranial hemorrhage was carried out in all the infants. The association between risk factors

Arsenio Spinillo; Alessandra Ometto; Roberto Bottino; Gaia Piazzi; Angela Iasci; Giorgio Rondini



Influence of Fever and Hospital-Acquired Infection on the Incidence of Delayed Neurological Deficit and Poor Outcome after Aneurysmal Subarachnoid Hemorrhage  

PubMed Central

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.

Douds, G. Logan; Tadzong, Bi; Agarwal, Akash D.; Krishnamurthy, Satish; Lehman, Erik B.; Cockroft, Kevin M.



Warfarin-associated intracerebral hemorrhage.  


Intracerebral hemorrhage (ICH) is the most serious complication of oral anticoagulant therapy (OAT), with mortality in excess of 50%. Major risk factors are advanced patient age, elevated systolic blood pressure, intensity of anticoagulation, and previous cerebral ischemia. A number of acute treatments are available, but all have significant side effects and no randomized clinical trials assessing clinical outcome have been performed. Future trials will have to address choice and dose of agent, the timing of its administration, and the risk of side effects. PMID:18690514

Cavallini, Anna; Fanucchi, Simona; Persico, Alessandra



Timing of symptomatic vasospasm in aneurysmal subarachnoid hemorrhage: the effect of treatment modality and clinical implications.  


A better prediction of the time course of symptomatic vasospasm (SVSP) might have a significant impact on the management and prevention of delayed neurologic ischemic deficit (DIND). We studied the influence of the treatment for ruptured aneurysm on SVSP timing. We retrospectively analyzed data of consecutive patients with aneurysmal subarachnoid hemorrhage (aSAH) admitted in our center between 1999 and 2005, treated within 72 hours of the rupture by surgical clipping or endovascular coiling and in accordance with our neuroscience unit protocol. We analyzed the presence of SVSP and recorded the timing of occurrence after the aneurysmal repair intervention. Data on demographics, premorbid conditions, time elapsed from the subarachnoid hemorrhage onset and intervention, and clinical and radiologic characteristics at admission were collected. The first occurrence of postintervention SVSP was recorded and compared between the 2 treatment groups using a proportional hazards regression model, including significant covariates. Of the 67 patients analyzed, 21 (31%) underwent endovascular coiling and 46 (69%) underwent surgical clipping. The baseline variables were similar in the 2 groups. The median time from the procedure to clinical vasospasm was 4 days in the coiled patients and 7 days in the clipped patients. In a proportional hazards model regression analysis including age, sex, Fisher and Hunt-Hess grades, time between onset to procedure, and intervention type, only intervention type emerged as a significant predictor of time to SVSP after intervention (likelihood ratio chi2 = 16.8; P < .00). Treatment modality of ruptured intracranial aneurysm may influence the timing of SVSP occurrence. PMID:20189086

Ionita, Catalina C; Baker, John; Graffagnino, Carmelo; Alexander, Michael J; Friedman, Allan H; Zaidat, Osama O



Key events in microvascular damage induced by snake venom hemorrhagic metalloproteinases.  


Hemorrhage is one of the most significant effects in envenomings induced by viperid snakebites. Damage to the microvasculature, induced by snake venom metalloproteinases (SVMPs), is the main event responsible for this effect. The precise mechanism by which SVMPs disrupt the microvasculature has remained elusive, although recent developments provide valuable clues to deciphering the details of this pathological effect. The main targets of hemorrhagic SVMPs are components of basement membrane (BM) and surrounding extracellular matrix (ECM), which provide mechanical stability to capillaries. P-III SVMPs, comprising disintegrin-like and cysteine-rich domains in addition to the catalytic domain, are more potent hemorrhagic toxins than P-I SVMPs, constituted only by the metalloproteinase domain. This is likely due to the presence of exosites in the additional domains, which contribute to the binding of SVMPs to relevant targets in the microvasculature. Recent in vivo studies have shown that P-III SVMPs are preferentially located in microvessels. On the other hand, the structural determinants responsible for the different hemorrhagic potential of P-I SVMPs remain largely unknown, although backbone flexibility in a loop located near the active site is likely to play a role. Moreover, hemorrhagic and non-hemorrhagic SVMPs differ in their capacity to hydrolyze in vivo key BM proteins, such as type IV collagen and perlecan, as well as other ECM proteins, like types VI and XV collagens, which play a critical role by connecting BM components to perivascular fibrillar collagens. The evidence gathered support a two-step model for the pathogenesis of SVMP-induced hemorrhage: initially, hemorrhagic SVMPs bind to and hydrolyze components of the BM and associated extracellular matrix proteins that play a key role in the mechanical stability of BM. In conditions of normal blood flow in the tissues, such cleavage results in the weakening, distension and eventual disruption of capillary wall due to the action of biophysical forces operating in vivo. PMID:21447411

Escalante, Teresa; Rucavado, Alexandra; Fox, Jay W; Gutiérrez, José María



Eggshell calcification after intrathyroidal hemorrhage of retrosternal thyroid  

PubMed Central

We report a rare event of old hemorrhage into a thyroid causing respiratory distress. A 67-year-old man with chronic cough and recent dysphagia was found to have a retrosternal mass extending into the visceral mediastinum on chest roentgenogram. A computed tomographic (CT) scan confirmed eggshell callcification, which was 53 × 53 × 80 mm in size a retrosternal thyroid mass and revealed significant tracheal deviation to the right due to an extensive mass surrounded by a calcificated capsule in the left lobe of the thyroid gland with extension to the upper mediastinum. He successfully underwent left lobectomy of the thyroid gland with sternotomy. The pathological examination revealed intrathyroidal hemorrhage of the thyroid gland with massive intracystic old bleeding.

Yuzbasioglu, Mehmet Fatih; Ozkaya, Mesut; Ezberci, Fikret; Senoglu, Nimet; Kizildag, Betul



AntiShock Garments for Obstetric Hemorrhage  

Microsoft Academic Search

Annually, over 500,000 women die from complications of pregnancy and childbirth; the majority die from hemorrhage and shock. Obstetrical hemorrhage of all etiologies, such as uterine atony, ruptured uterus, and ruptured ectopic, can cause massive blood loss resulting in severe shock. Unless women can access fluid replacement, blood transfusions, and, often, surgery, the shock leads to organ failure and death.

Suellen Miller; Aderinola Ojengbede; Janet Turan; Oladosu Ojengbede; Elizabeth Butrick; Paul Hensleigh



Postpartum hemorrhage: use of hemostatic combat gauze.  


Cheap and simple interventions that are intended to minimize postpartum hemorrhage are of major public health concern. We report a case of postpartum hemorrhage in which conservative interventions had failed. The use of a chitosan-covered gauze that originally was developed for combat trauma allowed us to achieve hemostasis, and a seemingly inevitable hysterectomy was avoided. PMID:22011588

Schmid, Bernd C; Rezniczek, Günther A; Rolf, Norbert; Maul, Holger



Systemic sclerosis complicated by diffuse alveolar hemorrhage.  


A 38-year-old woman with limited cutaneous systemic sclerosis and pulmonary fibrosis developed diffuse alveolar hemorrhage during the course of her disease that responded well to steroids. We present the clinical history of the patient and discuss the different theories behind the association. The importance of steroid therapy for treatment of alveolar hemorrhage in this particular condition is emphasized. PMID:11535951

Chaer, R A; Massad, M G; Evans, A; Olopade, C; Varga, J


Hemorrhagic Vestibular Schwannoma: Review of the Literature.  


BACKGROUND: Clinically significant intratumoral hemorrhage historically has been reported in only a small fraction of vestibular schwannomas (VS). Patients with hemorrhagic VS are more likely to present with neurologic deficits and have worse outcomes than patients with nonhemorrhagic VS. The purpose of this study is to analyze characteristics that may predispose VS to hemorrhage and that may prove helpful in the management and treatment of VS. METHODS: A literature search was conducted using National Library of Medicine and National Institutes of Health databases to identify articles pertaining to intratumoral hemorrhage in VS. The authors selected 39 cases, described in 18 published articles, to review. RESULTS: Average patient age and tumor size in hemorrhagic cases of VS did not differ significantly from nonhemorrhagic cases of VS. Facial nerve dysfunction at presentation occurred with greater frequency in cases of hemorrhagic VS (33.3%) than in nonhemorrhagic VS (6.0%). Death occurred much more frequently in cases of hemorrhagic VS (10.0%) than in nonhemorrhagic VS (0.2%). Abnormality of tumor-associated vasculature was noted histologically in many cases, and a large number of the cases reported prior treatment by stereotactic radiosurgery. CONCLUSIONS: Understanding the origins and clinical implications of intratumoral hemorrhage in VS could potentially assist in clinical decision making and patient counseling. PMID:23454397

Niknafs, Yashar S; Wang, Anthony C; Than, Khoi D; Etame, Arnold B; Thompson, B Gregory; Sullivan, Stephen E



Intraventricular hemorrhage in the preterm infant  

Microsoft Academic Search

Intraventricular hemorrhage (IVH) is a common neonatal morbidity among premature infants which is diagnosed by cranial ultrasound in the newborn special care unit. Although very premature infants are more likely to experience the highest grades of hemorrhage, a number of perinatal and postnatal events have been shown to be associated with it's occurence. Factors such as vaginal delivery, labor, and

B. Vohr; L. R. Ment



Hemorrhagic Disease in Bighorn Sheep in Arizona  

Microsoft Academic Search

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

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


Delayed cerebral ischemia and spreading depolarization in absence of angiographic vasospasm after subarachnoid hemorrhage  

PubMed Central

It has been hypothesized that vasospasm is the prime mechanism of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH). Recently, it was found that clusters of spreading depolarizations (SDs) are associated with DCI. Surgical placement of nicardipine prolonged-release implants (NPRIs) was shown to strongly attenuate vasospasm. In the present study, we tested whether SDs and DCI are abolished when vasospasm is reduced or abolished by NPRIs. After aneurysm clipping, 10 NPRIs were placed next to the proximal intracranial vessels. The SDs were recorded using a subdural electrode strip. Proximal vasospasm was assessed by digital subtraction angiography (DSA). 534 SDs were recorded in 10 of 13 patients (77%). Digital subtraction angiography revealed no vasospasm in 8 of 13 patients (62%) and only mild or moderate vasospasm in the remaining. Five patients developed DCI associated with clusters of SD despite the absence of angiographic vasospasm in three of those patients. The number of SDs correlated significantly with the development of DCI. This may explain why reduction of angiographic vasospasm alone has not been sufficient to improve outcome in some clinical studies.

Woitzik, Johannes; Dreier, Jens P; Hecht, Nils; Fiss, Ingo; Sandow, Nora; Major, Sebastian; Winkler, Maren; Dahlem, Yuliya A; Manville, Jerome; Diepers, Michael; Muench, Elke; Kasuya, Hidetoshi; Schmiedek, Peter; Vajkoczy, Peter



Delayed cerebral ischemia and spreading depolarization in absence of angiographic vasospasm after subarachnoid hemorrhage.  


It has been hypothesized that vasospasm is the prime mechanism of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH). Recently, it was found that clusters of spreading depolarizations (SDs) are associated with DCI. Surgical placement of nicardipine prolonged-release implants (NPRIs) was shown to strongly attenuate vasospasm. In the present study, we tested whether SDs and DCI are abolished when vasospasm is reduced or abolished by NPRIs. After aneurysm clipping, 10 NPRIs were placed next to the proximal intracranial vessels. The SDs were recorded using a subdural electrode strip. Proximal vasospasm was assessed by digital subtraction angiography (DSA). 534 SDs were recorded in 10 of 13 patients (77%). Digital subtraction angiography revealed no vasospasm in 8 of 13 patients (62%) and only mild or moderate vasospasm in the remaining. Five patients developed DCI associated with clusters of SD despite the absence of angiographic vasospasm in three of those patients. The number of SDs correlated significantly with the development of DCI. This may explain why reduction of angiographic vasospasm alone has not been sufficient to improve outcome in some clinical studies. PMID:22146193

Woitzik, Johannes; Dreier, Jens P; Hecht, Nils; Fiss, Ingo; Sandow, Nora; Major, Sebastian; Winkler, Maren; Dahlem, Yuliya A; Manville, Jerome; Diepers, Michael; Muench, Elke; Kasuya, Hidetoshi; Schmiedek, Peter; Vajkoczy, Peter



Subchorionic hemorrhage treatment with dydrogesterone.  


The objective of the study was to evaluate the efficacy of progestogenic therapy for the prevention of spontaneous abortions in patients with subchorionic hemorrhage. One hundred pregnant women with bleeding and ultrasonographic evidence of subchorionic hematoma were treated with oral dydrogesterone 40 mg/day. Only cases in which the embryo was viable were included. The follow-up included ultrasonography and intravaginal examination. Of the 100 pregnancies, 93 had a favorable evolution with maintenance of pregnancy. The abortion rate was therefore 7%. This compares with an abortion rate of 18.7% obtained in a previous study in women with subchorionic hematoma treated with micronized progesterone. The abortion rate was therefore reduced by up to 37% with dydrogesterone, as most cases had large-volume hematomas at the first visit and thus a poor prognosis. In conclusion, the marked immunomodulatory effect of dydrogesterone in maintaining a T helper-2 cytokine balance means that it is a good choice for preventing abortion in women suffering from subchorionic hemorrhage. PMID:17943544

Pelinescu-Onciul, Dimitrie



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


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

Nakaguchi, Hiroshi; Teraoka, Akira


Studies of the coagulation system and blood pressure during experimental Bolivian hemorrhagic fever in rhesus monkeys.  


Experimental infection of rhesus monkeys (Macaca mulatta) with Machupo virus produced a hemorrhagic disease similar to that of Bolivian hemorrhagic fever in humans. The disease in infected animals was also characterized by the development of hypotension and coagulation abnormalities as indicated by severe thrombocytopenia and prolongation of the activated partial thromboplastin time. Evidence for disseminated intravascular coagulation was inconclusive due to the presence of normal to elevated fibrinogen levels, relatively low levels of circulating fibrin split products, and the lack of widespread fibrin thrombus deposition. The most likely causes of the hemorrhagic tendencies of this disease in infected monkeys were thrombocytopenia and decreased synthesis of coagulation and other plasma proteins due to severe hepatocellular necrosis. Hypotension may also have been due to decreased plasma protein synthesis. PMID:103447

Scott, S K; Hickman, R L; Lang, C M; Eddy, G A; Hilmas, D E; Spertzel, R O



Postpartum hemorrhage balloon tamponade catheter  

US Patent & Trademark Office Database

A balloon tamponade catheter for controlling uterine postpartum hemorrhage has an elongated body with a balloon at a marginal distal end of the elongated body for insertion into the uterus. The balloon preferably has a pear-shaped appearance. The balloon may have a first hemisphere that is located on the catheter distal to second, smaller hemisphere. The first hemisphere has a plane of maximum diameter that is larger than the second hemisphere's plane of maximum diameter. Between the two planes of maximum diameter, the balloon comprises a transition section. In some cases, the transition section bows inward towards the elongated body when the balloon is uninflated and/or inflated. Additionally, the elongated body preferably does not extend distally past the distal end of the first hemisphere.



Neurodevelopmental Outcome in Survivors of Periventricular Hemorrhagic Infarction  

Microsoft Academic Search

OBJECTIVES. Periventricular hemorrhagic infarction is a serious complication of ger- minal matrix-intraventricular hemorrhage in premature infants. Our objective was to determine the neurodevelopmental and adaptive outcomes of periventricu- lar hemorrhagic infarction survivors and identify early cranial ultrasound predic- tors of adverse outcome. METHODS. We retrospectively evaluated all cranial ultrasounds of 30 premature infants with periventricular hemorrhagic infarction and assigned a

Haim Bassan; Catherine Limperopoulos; Karen Visconti; D. Luisa Mayer; Henry A. Feldman; Lauren Avery



Upper Gastrointestinal Hemorrhage--Diagnosis and Management  

PubMed Central

The current management of a patient with upper gastrointestinal hemorrhage involves three steps: initial correction of unstable hemodynamics, obtaining the specific diagnosis of the lesion responsible for gastrointestinal blood loss, and therapy directed at the specific bleeding lesion. The current approach to upper gastrointestinal hemorrhage is carrying out upper gastrointestinal endoscopy following stabilization of the patient. Although improved morbidity and mortality statistics have been slow to appear, the use of endoscopy permits appropriate therapy directed at the specific lesion. Specific therapeutic measures have been outlined for seven common causes of upper gastrointestinal hemorrhage. The advent of therapeutic endoscopy promises to bring further advances in therapy in the near future.

Midgley, Robert C.; Cantor, David



[Massive bilateral adrenal hemorrhage: role of imaging].  


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

Kably, M I; Zamiati, W; Benkirane, H; Kadiri, R



[Blindness caused by retrobulbar hemorrhage (orbital compartment syndrome)].  


In the author's department, 5 patients developed retrobulbar hemorrhage from the 199 patients with midface fractures, between August 2007 and March 2010 (2.5%). 4 of these patients became irreversibly blind on the affected eye. With timely treatment, one patient avoided blindness. The author presents a retrospective analysis of the patients from different departments with midface/orbital fractures and blindness. Bleeding and oedema behind the eyeball due to midface/orbital fractures in the relatively non-expandable orbit results a quick elevation of orbital pressure and consequently diminished circulation, ischemia, and later necrosis of the optic nerve (orbital compartment syndrome) with irreversible blindness. Immediate medical (high dose of intravenous steroids, mannitol, acetazolamide) and surgical intervention (lateral canthotomy, cantholysis, orbitotomy) on noticing the signs (proptosis, ecchymosis, ophthalmoplegia, mydriasis) and symptoms (pain, diplopia, decreased visual acuity, blindness), of a retrobulbar hemorrhage could theoretically give a chance to save the affected eye. Treatment started beyond 20 minutes of onset of blindness, might not revert the vision. Unfortunately, the description and treatment of the retrobulbar hemorrhage and the orbital compartment syndrome is not within the curriculum of the medical university, thus young colleagues could have vague idea about the diagnosis, the urgency and the treatment - as shown in these cases. With the introduction of these cases the author would like to highlight the signs, symptoms and necessary treatment. Knowledge of the disease could also increase the detected number of retrobulbar hemorrhages, which might be less rare than we think. Including the disease into the medical curriculum and postgraduate trainings could help to reduce the number of sad cases in the future. PMID:20826378

Klenk, Gusztáv



Pancreatic pseudocyst hemorrhage controlled by transcatheter embolization  

SciTech Connect

This case of massive duodenal hemorrhage through the pancreatic pseudocyst, caused by rupture of a pseudoaneurysm of the gastroduodenal artery, was successfully controlled by transcatheder embolization. Embolization is a useful alternative to surgery in high-risk patients.

Kuroda, C.; Kawamoto, S.; Hori, S.; Yoshioka, H.; Nakamura, H.; Miyata, M.; Nakao, K.



Retinal hemorrhage in abusive head trauma.  


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

Levin, Alex V



Studies of Hemostasis in Thai Hemorrhagic Fever.  

National Technical Information Service (NTIS)

Studies of hemostasis were performed on 27 children with Thai hemorrhagic fever from dengue virus during September, 1962. The most common finding was moderate to severe thrombocytopenia. The platelet count was usually decreased when the patients were firs...

H. J. Weiss S. B. Halstead



Dabigatran, intracranial hemorrhage, and the neurosurgeon.  


Dabigatran etexilate (Pradaxa) is a novel oral anticoagulant that has gained FDA approval for the prevention of ischemic stroke and systemic embolism in patients with nonvalvular atrial fibrillation. In randomized trials, the incidence of hemorrhagic events has been demonstrated to be lower in patients treated with dabigatran compared with the traditional anticoagulant warfarin. However, dabigatran does not have reliable laboratory tests to measure levels of anticoagulation and there is no pharmacological antidote. These drawbacks are challenging in the setting of intracerebral hemorrhage. In this article, the authors provide background information on dabigatran, review the existing anecdotal experiences with treating intracerebral hemorrhage related to dabigatran therapy, present a case study of intracranial hemorrhage in a patient being treated with dabigatran, and suggest clinical management strategies. The development of reversal agents is urgently needed given the growing number of patients treated with this medication. PMID:23634926

Awad, Ahmed J; Walcott, Brian P; Stapleton, Christopher J; Yanamadala, Vijay; Nahed, Brian V; Coumans, Jean-Valery



Acute adrenal hemorrhage after blunt trauma  

Microsoft Academic Search

Objective  To determine the appropriate management of adrenal hemorrhage in patients with severe chest and upper abdominal blunt trauma.\\u000a \\u000a \\u000a \\u000a Materials and Methods  We reviewed 7 patients who suffered from severe traumatic adrenal hemorrhage after a traffic accident (n = 4) or fall (n = 3). Contrast-enhanced CT images were analyzed for multi-organ traumatic injury, hematoma size, extravasation, and pseudoaneurysm\\u000a formation. We also

O. Ikeda; Joji Urata; Yushi Araki; Shunji Yoshimatsu; Shuichi Kume; Yoshitsugu Torigoe; Yasuyuki Yamashita



Reperfusion Hemorrhage Following Superior Mesenteric Artery Stenting  

SciTech Connect

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

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



Pulmonary hemorrhage resulting from roller coaster.  


Roller coasters are probably one of the more popular rides at amusement parks around the world, and there are few reported injuries. We report a case of symmetric diffuse upper lobe hemorrhage resulting from roller coaster in a previously healthy woman. The clinical course, management, and etiology of her case are discussed; and the literature is reviewed. To our knowledge, pulmonary hemorrhage in this setting has not yet been described. PMID:20825914

Yin, Ming; Tian, Qing; Shen, Hong



Critical care management of subarachnoid hemorrhage  

Microsoft Academic Search

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

Joshua M. Levine



The Management of Lower Gastrointestinal Hemorrhage  

Microsoft Academic Search

\\u000a PURPOSE  Gastrointestinal hemorrhage is a common clinical problem, which accounts for approximately 1 to 2 percent of acute hospital\\u000a admissions. The colon is responsible for approximately 87 to 95 percent of all cases of lower gastrointestinal bleeding, with\\u000a the remaining cases arising in the small bowel. The etiology, diagnostic evaluation, management, and treatment options available\\u000a for lower gastrointestinal hemorrhage were reviewed.

Rebecca E. Hoedema; Martin A. Luchtefeld



Hemorrhagic disease in bighorn sheep in Arizona.  


Two bighorn sheep from Arizona (USA) were submitted for necropsy. One was a Rocky Mountain bighorn (Ovis canadensis canadensis) and the other was a desert bighorn (Ovis canadensis mexicana). Both had lesions consistent with those of hemorrhagic disease (HD). Epizootic hemorrhagic disease virus (EHDV) type-2 and bluetongue virus (BTV) type-17, respectively, were isolated from the sheep tissues. To our knowledge, HD caused by either EHDV or BTV infection has not been documented previously in Arizona bighorn sheep. PMID:11838210

Noon, Ted H; Wesche, Shannon Lynn; Cagle, Dave; Mead, Daniel G; Bicknell, Edward J; Bradley, Gregory A; Riplog-Peterson, Shawnee; Edsall, Dave; Reggiardo, Carlos



Dengue hemorrhagic fever: Clinical manifestations and management  

Microsoft Academic Search

Dengue virus infection may remain asymptomatic or manifest as nonspecific viral infection to life threatening dengue hemorrhagic\\u000a fever (DHF)\\/dengue shock syndrome (DSS). Patients with DHF\\/DSS have fever, hemorrhagic manifestations along with thrombocytopenia\\u000a and hemoconcentration. Thrombocytopenia and hemoconcentration are distinguishing features between DHF\\/DSS and dengue fever\\u000a (DF). Some patients with dengue fever may have significant bleed and mild thrombocytopenia but no

S. K. Kabra; Y. Jain; T. Singhal; V. H. Ratageri



[Hemorrhage, hemostasis and thrombosis in surgery].  


Surgery is a leading cause of major hemorrhage as well as of thrombosis unless patients are administered appropriate antithrombotic prophylaxis after their thrombo-hemorrhagic risk has been stratified. Therefore, thorough preoperative evaluation is essential to minimize surgical complications. In cases of incoercible bleeding, drugs such as desmopressin, synthetic antifibrinolytics or recombinant factor VII can be administered. To prevent postoperative thrombosis, low molecular weight heparins or pentasaccharide have been shown to significantly reduce the incidence of thromboembolism. PMID:19589403

Páramo, José A



Intradural intraneural hemorrhagic cyst resulting in progressive cauda equina syndrome after anticoagulation therapy: case report.  


Study Design: Case report.Objective: To report a case of lumbar intraneural hemorrhagic cyst after anticoagulation therapy that caused progressive radiculopathy and cauda equina syndrome. The possible pathogenic mechanism, associated diseases, and treatment options are discussed.Summary of Background Data: Various pathologic processes can cause progressive cauda equina syndrome. However, there have been no reports of progressive cauda equina syndrome due to compression from an intraneural hemorrhagic cyst after anticoagulation therapy.Methods: A case of lumbar intradural intraneural hemorrhagic cyst with progressive cauda equina syndrome after anticoagulation therapy is presented.Results: A 42-year-old female patient complained atpresentation of progressive bilateral lower extremity radiating pain, numbness and urinary difficulty during the previous 2 months. Lumbar magnetic resonance imaging (MRI) revealed an L1 cystic lesion with marked mass effect on the surrounding nerve roots. Complete drainage and excision of the lesion was performed which resulted in excellent postoperative symptoms relief. Pathologic examination revealed no definite neoplastic process except some nerve fibers with hemosiderin stain along the cyst wall. Based on a combination of intraoperative findings and pathology, an intradural intraneural hemorrhagic cyst that developed after systemic anticocagulation therapy was diagnosed.Conclusion: This is the first report of an intradural intraneural hemorrhagic cyst causing progressive cauda equina syndrome due to anticoagulation therapy. Surgical excision of the cyst is the definite treatment of choice. PMID:24042718

Hsieh, Po-Chuan; Jung, Shih-Ming; Wu, Chieh-Tsai; Chen, Jyi-Feng; Lee, Shih-Tseng



Hyperbaric oxygen: Primary treatment of radiation-induced hemorrhagic cystitis  

SciTech Connect

Of 8 patients with symptoms of advanced cystitis due to pelvic radiation treated with hyperbaric oxygen 7 are persistently improved during followup. All 6 patients treated for gross hematuria requiring hospitalization have been free of symptoms for an average of 24 months (range 6 to 43 months). One patient treated for stress incontinence currently is dry despite little change in bladder capacity, implying salutary effect from hyperbaric oxygen on the sphincter mechanism. One patient with radiation-induced prostatitis failed to respond. This experience suggests that hyperbaric oxygen should be considered the primary treatment for patients with symptomatic radiation-induced hemorrhagic cystitis.

Weiss, J.P.; Neville, E.C.



Lumbar drainage for communicating hydrocephalus after ICH with ventricular hemorrhage  

Microsoft Academic Search

Introduction  Our objective was to investigate the feasibility of lumbar drainage (LD) as a new therapeutic approach for the treatment of\\u000a communicating hydrocephalus in patients with supratentorial intracerebral hemorrhage (ICH) and ventricular extension (IVH)\\u000a who initially required an external ventricular drain (EVD).\\u000a \\u000a \\u000a \\u000a Methods  Three consecutive patients with ICH and severe IVH were treated with EVD immediately after admission due to acute obstructive

Hagen B. Huttner; Stefan Schwab; Jürgen Bardutzky



Liver repair and hemorrhage control using laser soldering of liquid albumin in a porcine model  

Microsoft Academic Search

The purpose of this study was to evaluate laser soldering using liquid albumin for welding liver lacerations and sealing raw surfaces created by segmental resection of a lobe. Major liver trauma has a high mortality due to immediate exsanguination and a delayed morbidity and mortality from septicemia, peritonitis, biliary fistulae and delayed secondary hemorrhage. Eight laceration injuries (6 cm long

Yasmin Wadia; Hua Xie; Michio Kajitani; Kenton W. Gregory; Scott A. Prahl



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

Microsoft Academic Search

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

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



Reduced iron-associated antioxidants in premature newborns suffering intracerebral hemorrhage  

Microsoft Academic Search

Oxygen radical injury may be a common pathogenic mechanism in several neonatal diseases. The term “oxygen radical disease of prematurity” has been proposed in the face of the greater incidence of intracerebral hemorrhage, bronchopulmonary dysplasia, and retinopathy in premature neonates. To test the hypothesis that overload with ionic iron due to decreased concentrations of iron-oxidizing and iron-binding proteins induces free

Gerd M. Lackmann; Lutz Hesse; Uwe Töllner



Evidence for high risk of cerebral hemorrhage in chronic dialysis patients  

Microsoft Academic Search

Evidence for high risk of cerebral hemorrhage in chronic dialysis patients. One-half of the total deaths in chronic dialysis patients are due to cardiovascular disease; however, the precise incidence and relative risk of those compared to normals are not known. Therefore, we sought to determine the annual incidence of cardiovascular disease and relative risk of those on chronic dialysis to

Kunitoshi Iseki; Kunihiko Kinjo; Yorio Kimura; Akira Osawa; Koshiro Fukiyama



Characterization of Hemorrhagic Fever with Renal Syndrome Caused by Hantaviruses, Estonia  

PubMed Central

Thirty cases of hemorrhagic fever with renal syndrome (HFRS) due to Puumala virus (PUUV), Saaremaa virus (SAAV), and Dobrava virus infection were confirmed in Estonia. Except for the levels of serum creatinine, no remarkable differences were found in the clinical course of HFRS caused by PUUV and SAAV.

Golovljova, Irina; Vasilenko, Veera; Mittzenkov, Vassili; Prukk, Tiina; Seppet, Elviira; Vene, Sirkka; Settergren, Bo; Plyusnin, Alexander



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


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

Ren, Xianqing; Zhang, Wenjuan; Dang, Weili; Zhai, Wensheng; Guo, Qingyin; Ding, Yin; Yang, Xiaoqing



Glucose-6-Phosphate Dehydrogenase Deficiency and Adrenal Hemorrhage in a Filipino Neonate with Hyperbilirubinemia  

PubMed Central

We report on a Filipino neonate with early onset and prolonged hyperbilirubinemia who was delivered by a vacuum extraction due to a prolonged labor. Subsequent studies revealed adrenal hemorrhage and glucose-6-phosphate dehydrogenase (G6PD) deficiency. It is likely that asphyxia and resultant hypoxia underlie the occurrence of adrenal hemorrhage and the clinical manifestation of G6PD deficiency and that the presence of the two events explains the early onset and prolonged hyperbilirubinemia of this neonate. Our results represent the importance of examining possible underlying factors for the development of severe, early onset, or prolonged hyperbilirubinemia.

Ohishi, Akira; Ueno, Daizo; Ogata, Tsutomu



Seizures after Spontaneous Intracerebral Hemorrhage  

PubMed Central

Objective In patients with spontaneous intracerebral hemorrhage (ICH), the risk factors for seizure and the effect of prophylactic anticonvulsants are not well known. This study aimed to determine the risk factor for seizures and the role for prophylactic anticonvulsants after spontaneous ICH. Methods Between 2005 and 2010, 263 consecutive patients with spontaneous ICH were retrospectively assessed with a mean follow-up of 19.5 months using medical records, updated clinical information and, when necessary, direct patient contact. The seizures were classified as early (within 1 week of ICH) or late (more than 1 week after ICH). The outcomes were measured with the Glasgow Outcome Scale at discharge and the modified Rankin Scale (mRS) at both 2 weeks and discharge. Results Twenty-two patients (8.4%; 9 patients with early seizures and 13 patients with late seizures) developed seizures after spontaneous ICH. Out of 263 patients, prophylactic anticonvulsants were administered in 216 patients. The prophylactic anticonvulsants were not associated with a reduced risk of early (p=0.094) or late seizures (p=0.326). Instead, the factors associated with early seizure were cortical involvement (p<0.001) and younger age (60 years or less) (p=0.046). The risk of late seizure was increased by cortical involvement (p<0.001) and communicating hydrocephalus (p=0.004). The prophylactic anticonvulsants were associated with a worse mRS at 2 weeks (p=0.024) and at last follow-up (p=0.034). Conclusion Cortical involvement may be a factor for provoked seizures. Although the incidence of early seizures tended to decrease in patients prescribed prophylactic anticonvulsants, no statistical difference was found.

Woo, Kwang-Moo; Cho, Keun-Tae



Hereditary hemorrhagic telangiectasia: diagnosis and management.  


Hereditary hemorrhagic telangiectasia is an uncommon autosomal dominant disease that occurs in approximately one in 5,000 to 8,000 persons. This multisystem disorder can affect the nose, skin, gastrointestinal tract, lungs, liver, and brain. Epistaxis is the most common presenting problem, occurring in 90 percent of affected patients. Approximately 15 to 30 percent of patients with hereditary hemorrhagic telangiectasia will have an arteriovenous malformation in the lungs and more than 10 percent will have one in the brain. The symptoms of hereditary hemorrhagic telangiectasia are often unrecognized. Many patients, even those with affected family members, may go undiagnosed. Hereditary hemorrhagic telangiectasia is a clinical diagnosis that is based on the presence of three of four criteria (i.e., epistaxis, telangiectasias, visceral arteriovenous malformations, or family history of the disease). Screening and treatment recommendations have been created in an attempt to limit the morbidity and mortality associated with this disease. Patients with confirmed or suspected hereditary hemorrhagic telangiectasia should be screened for brain and lung arteriovenous malformations using magnetic resonance imaging of the brain and contrast echocardiography. Pulmonary arteriovenous malformations can be treated with embolization. Patients with a history of pulmonary arteriovenous malformations or those who have not been screened should use antibiotic prophylaxis before dental treatment, endoscopy, or other procedures that could cause bacteremia because of the risk of paradoxical brain embolism or infection. PMID:20879701

Olitsky, Scott E



Intramedullary spinal cord cavernous malformations: clinical features and risk of hemorrhage.  


The aim of this study was to review the natural history of symptomatic intramedullary spinal cord (IMSC) cavernous malformations in order to analyze the underlying mechanisms leading to symptoms and determine the potential risk of lesional hemorrhage. Between January 1990 and June 2001, ten consecutive patients with IMSC cavernous malformations were treated surgically in our institution. Age ranged from 17 to 73 years (mean 34.5). All patients became symptomatic due to one or more hemorrhages leading to neurological deficits of different severity, with a more aggressive course for upper cervical lesions. Pre- and postoperative patient condition was classified according to the Frankel scale. Four patients experienced one hemorrhage, four patients two, one patient three, and another one five repeated hemorrhages. The annual retrospective hemorrhage rate for symptomatic IMSC cavernous malformations was 4.5% per patient/year, with a prospective rehemorrhage risk of 66% per patient/year. The postoperative condition was improved in four patients and unchanged in six, and none grew worse. Detailed analysis of history and clinical course in all patients revealed an acute onset of symptoms with subsequent neurological deterioration after each bleeding episode. Based on the significant risk of rehemorrhage and the gratifying functional results, surgery is indicated for symptomatic IMSC cavernous malformations. PMID:12690529

Sandalcioglu, Ibrahim Erol; Wiedemayer, Helmut; Gasser, Thomas; Asgari, Siamek; Engelhorn, Tobias; Stolke, Dietmar



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

PubMed Central

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

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



Right atrial myxoma as a possible cause of hemorrhagic stroke and sudden death  

PubMed Central

Right atrial myxomas are rare primary tumors of the heart. They may remain asymptomatic or eventually cause constitutional signs and symptoms. Less frequently, obstruction of the tricuspid valve occurs, resulting in exertional dyspnea, syncope, or sudden death. Neurological manifestation as initial presentation of atrial myxomas is rarely, if ever, associated with right atrial myxomas and may be secondary to cerebral infarction, cerebral hemorrhage and, more rarely subarachnoid hemorrhage. We review the case of a previously unknown, middle-aged Nigerian man who presented to hospital with severe headache and sudden loss of consciousness. A clinical diagnosis of hypertensive hemorrhagic cerebrovascular accident was made. The patient died suddenly a few hours after presentation. Post-mortem examination revealed a small intracerebral hemorrhage in the left superior temporal lobe as well as a large right atrial myxoma, a ventricular septal defect in the muscular septum, and right ventricular hypertrophy. The liver showed fatty change while the kidneys showed evidence of benign nephrosclerosis. Right atrial myxomas may, therefore, be remotely considered as a cause of intracranial hemorrhage, especially in the presence of predisposing cardiac anomalies such as a ventricular septal defect. Similarly, being a known cause of right heart failure, sudden death, and other constitutional derangements, it may contribute significantly to disease outcome. Hence, it should be given due consideration in the differential diagnosis of cerebrovascular accidents.

Sabageh, Donatus; Odujoko, Oluwole Olaniyi; Komolafe, Akinwumi Oluwole



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


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

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



Successful management of warfarin-exacerbated diffuse alveolar hemorrhage using an extracorporeal membrane oxygenation  

PubMed Central

Although diffuse alveolar hemorrhage complicating warfarin therapy is rare, it generally has a worsening clinical course and can be a life threatening condition. A 56-year-old male who had undergone a pulmonary lobectomy for lung cancer 2 years before had received warfarin for about 5 months due to pulmonary vein thrombosis. The patient presented with severe dyspnea and had prolonged anticoagulation values. Chest X-ray and computed tomography revealed diffuse pulmonary consolidations, and bronchoalveolar lavage demonstrated diffuse alveolar hemorrhage. The reversal of anticoagulation was initiated, and extracorporeal membrane oxygenation was performed for refractory respiratory failure that did not improve despite maximal mechanical ventilatory support. The diffuse alveolar infiltrations resolved after 5 days, and we successfully weaned off both extracorporeal membrane oxygenation and mechanical ventilation. Herein we report the detailed course of a case that was successfully treated with extracorporeal membrane oxygenation as a bridge-to-recovery for warfarin- exacerbated diffuse alveolar hemorrhage.



Clinical strategies for supporting the untransfusable hemorrhaging patient  

PubMed Central

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.

Hulsey, Meredith E.; Newhouse, Mike; Holmes, Houston E.; Mays, Edward J.



Duret hemorrhage: demonstration of ruptured paramedian pontine branches of the basilar artery on minimally invasive, whole body postmortem CT angiography.  


A 25 year old male died suddenly and unexpectedly. Postmortem CT scanning revealed marked raised intracranial pressure with brainstem compression due to subarachnoid, subdural and parenchymal hemorrhage. A hyperdense mass at the termination of the right internal carotid artery was thought to represent an aneurysm. Postmortem, whole body CT angiography failed to fill the aneurysm but did demonstrate multiple central pontine linear enhancing structures in continuity with the mid basilar artery and small foci of contrast leak into the adjacent mid pontine parenchyma. Autopsy confirmed subarachnoid hemorrhage, a thrombosed and ruptured proximal right middle cerebral artery aneurysm and Duret hemorrhages in the mid pons. This finding supports the theory that Duret hemorrhages occur as a result of perforating pontine branch of the basilar arterial rupture but does not exclude the contribution of venous congestion. PMID:22484970

Chew, Ka Lip; Baber, Yeliena; Iles, Linda; O'Donnell, Christopher



Renin responses to hemorrhage to conscious rats  

SciTech Connect

The authors investigated the role of beta adrenergic inhibition on the renin response to graded hemorrhage (hem) in conscious rats. Chronic femoral arterial (for measurement of mean arterial pressure - MAP) and venous (for drug infusion) catheters were implanted at least 5 days before experimentation. Hem was administered in < 2 min. 10 rats (CTL) were exposed to a total of 21 episodes of hemorrhage. 13 rats (B-block) were given 1 mg/kg propranolol hydrochloride iv 20 min prior to hem (24 episodes total). Plasma renin activity (PRA) was measured by radioimmunoassay. Pre-hem PRA levels were measured in the first 1 ml of hem blood. Hem resulted in hem volume-dependent decreases in blood pressure and increases in PRA. B-block did not significantly alter the mean renin response to hemorrhage.

Roarty, T.P.; Chadwick, K.J.; Raff, H.



Renin responses to hemorrhage in conscious rats  

SciTech Connect

The authors investigated the role of beta adrenergic inhibition on the renin response to graded hemorrhage (hem) in conscious rats. Chronic femoral arterial (for measurement of mean arterial pressure - MAP) and venous (for drug infusion) catheters were implanted at least 5 days before experimentation. Hem was administered in < 2 min. 10 rats (CTL) were exposed to a total of 21 episodes of hemorrhage. 13 rats (B-block) were given 1 mg/kg propranolol hydrochloride iv 20 min prior to hem (24 episodes total). Plasma renin activity (PRA) was measured by radioimmunoassay. Pre-hem PRA levels were measured in the first 1 ml of hem blood. Hem resulted in hem volume-dependent decreases in blood pressure and increase-response to hemorrhage.

Roarty, T.P.; Chadwick. K.J.; Raff, H.



Anaplastic astrocytoma masquerading as hemorrhagic stroke.  


Although primary and metastatic brain tumors can cause intracranial hemorrhage, thalamic hemorrhage as the first presentation of an anaplastic astrocytoma has not been reported. We report a 47-year-old man who first presented with hypertensive hemorrhagic stroke. He improved with aggressive blood pressure control and recovered with minimal residual deficit within 10days. This led to the initial misdiagnosis of uncontrolled hypertension as the cause of the stroke. He deteriorated rapidly 4months later. A biopsy revealed an anaplastic astrocytoma. Misdiagnosis of tumor as stroke can occur in patients with vascular risk factors who do not have a previous history of neoplasia. Our case report is to heighten the awareness of the incidence of tumor apoplexy masquerading as stroke. PMID:23510543

Li, Lejun; Yin, Junxiang; Li, Yumei; Tian, Wei; Qiao, Benyu; Tang, Zhiwei; Shi, Jiong



MR of hemorrhage: a new approach.  


Using a modification of the partial saturation (PS) pulse sequence, we developed an MR method that permits the acquisition of highly T1- and T2-weighted images of the head and body in as little as 10 sec. The PS images, which were acquired at 0.6 T in a series of six patients with acute and subacute hemorrhage, showed a striking reduction in the signal intensity of hemorrhagic lesions. This effect, which is related to bulk magnetic susceptibility variations, was either minimal or absent on conventional T1- and T2-weighted spin-echo (SE) images. Our results suggest that high-field systems are not needed in order to image acute and subacute hemorrhage. PMID:3096097

Edelman, R R; Johnson, K; Buxton, R; Shoukimas, G; Rosen, B R; Davis, K R; Brady, T J


Early Physiological Responses to Hemorrhagic Hypotension  

PubMed Central

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

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



Differential Diagnosis of Hemorrhagic Fever of the Crimean Type.  

National Technical Information Service (NTIS)

The most important manifestations of Crimean hemorrhagic fever in differential diagnosis are: acute onset, with general infection signs (chills, rheumatic pains, etc.), hemorrhagic syndrome, which appears at definite periods of the illness (most frequentl...

E. V. Leshchinskaya



Glucose Metabolism Following Severe Hemorrhage in the Conscious Dog.  

National Technical Information Service (NTIS)

The kinetics of glucose utilization before and after major hemorrhage was investigated by the primed infusion technique in eight conscious dogs given glucose-UC(14) alone or in combination with glucose-2-H(3). Following hemorrhage, arterial glucose concen...

R. Wiener J. J. Spitzer



Recurrence of Epidemic Dengue Hemorrhagic Fever in an Insular Setting.  

National Technical Information Service (NTIS)

Epidemic dengue hemorrhagic fever recurred in 1967 on an island in the Gulf of Thailand. All cases seen were categorized by clinical syndrome as shock, hemorrhagic fever, dengue fever, or undifferentiated fever. Paired serum samples were examined for HI, ...

P. E. Winter S. Nantapanich A. Nisalak S. Udomsakdi R. W. Dewey



Nonaneurysmal Subarachnoid Hemorrhage after Udenafil Intake.  


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

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



Expulsive hemorrhage: report of five cases.  


Five cases of expulsive hemorrhage occurring over a period of one year were reviewed. Two cases occurred during a trabeculectomy procedure. There appear to be multiple factors playing a role in the etiology of expulsive hemorrhage. There was not a single common factor among these 5 cases, except for the conjectural presence of some kind of vascular disease. However, there were some important factors that may have played a role such as glaucoma, hypertension, vascular disease, and general anesthesia (and sudden decompression of the globe). PMID:736415

Tarakji, M S; Matta, C S



Congenital glioblastoma multiforme with abnormal vascularity presenting as intracranial hemorrhage in prenatal ultrasound  

Microsoft Academic Search

Background  A rare case of a congenital brain neoplasm with intratumoral massive hemorrhage suggested by prenatal ultrasound examination in a 32-week gestational age male fetus is reported. The child died shortly after birth due to cardiorespiratory insufficiency.Methods  Autopsy disclosed a large well-delimited tumor with a sponge-like appearance due to high vascularization, which involved nearly the whole left cerebral hemisphere and led to

Manfred Sell; Sabine Huber-Schumacher; Frank K. H. van Landeghem



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

PubMed Central

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

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



Intracranial Hemorrhage in Term Newborns: Management and Outcomes  

Microsoft Academic Search

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

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