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Sample records for neonatal intracranial hemorrhages

  1. Risk factors of intracranial hemorrhage in premature neonates.

    PubMed

    Khalessi, Nasrin; Farahani, Zahra; Shariat, Mamak; Rezaeizadeh, Golnaz

    2014-01-01

    Intraventricular hemorrhage (IVH) is an important cause of brain injury in premature neonates. Current study tries to define associated risk factors of IVH in preterm neonates in Aliasghar Children Hospital during 2008 to 2011. In this study, the risk factors have been evaluated in premature neonates with IVH, who had at least one brain sonography since their admission in NICU. A total of 63 premature neonates with IVH were assessed. Mean gestational age was 29.81 (24-34) weeks and mean birth weight was 1290.83±382.96 gr. Other risk factors such as sex, mode of delivery, history of using infertility drugs, maternal disease, maternal hypertension and preeclampsia, lumbar puncture, ventilator therapy and pneumothorax were considered. Because no absolute treatment for IVH is available, identifying risk factors is important in prevention and management of IVH. PMID:25421841

  2. Platelet Mass Predicts Intracranial Hemorrhage in Neonates With Gram-negative Sepsis.

    PubMed

    Mitsiakos, Georgios; Pana, Zoe-Dorothea; Chatziioannidis, Ilias; Piltsouli, Dimitra; Lazaridou, Eleni; Koulourida, Vasiliki; Papadimitriou, Aikaterini; Nikolaidis, Nikolaos; Roilides, Emmanuel

    2015-10-01

    Neonatal sepsis due to gram-negative bacteria is associated with severe hemorrhagic conditions, such as intracranial hemorrhage (ICH). The aim of the study was to investigate the significance of platelet (PLT) count and platelet mass (PM) in predicting promptly neonatal ICH. Demographics, species, PLT, PM, ICH, and outcome for neonates with gram-negative sepsis for the period 2005 to 2012 were retrospectively recorded. Eighty-four infants were enrolled with median gestational age 30 weeks, median birthweight 1481.5 g, and median age at sepsis diagnosis 23 days. The most frequently isolated bacteria were Enterobacter spp. (38.1%). ICH occurred in 16 neonates (19%), whereas the mortality rate was 25% (21 neonates). The median PLT count and PM at days 1, 2, and 3 after diagnosis of gram-negative sepsis was significantly associated with the presence of ICH. Regression analysis revealed the cutoff predictive value of 355 fL/nL for the PM at day 3 (area under the curve: 75, sensitivity 90%, P=0.002). PM levels could play an important role in predicting the occurrence of ICH in high-risk neonates. PMID:26376234

  3. Epilepsy Following Neonatal Seizures Secondary to Hemorrhagic Stroke in Term Neonates.

    PubMed

    Venkatesan, Charu; Millichap, John J; Krueger, Jena M; Nangia, Srishti; Ritacco, David G; Stack, Cynthia; Nordli, Douglas R

    2016-04-01

    Intracranial hemorrhage accounts for about 50% of all pediatric stroke. Studies of term infants with intracranial hemorrhage have shown favorable motor and cognitive outcome. The goal of this study was to examine the risk of developing epilepsy in full-term infants with intracranial hemorrhage. A retrospective study was performed of term neonates (greater than or equal to 37 weeks gestation) with intracranial hemorrhage and confirmed seizures. Fifteen patients with intracranial hemorrhage and neonatal seizures were identified. Four patients did not have follow-up information beyond the neonatal period (1 death, 3 lost to follow-up after initial clinic visit). The average follow-up period for the remaining 11 patients was approximately 22 months. Ten out of the 11 patients (91%) who were followed were seizure-free and off antiepileptic medications. One patient required a ventriculoperitoneal shunt and subsequently developed infantile spasms. The authors found that overall outcome was favorable with respect to development of epilepsy. PMID:26303411

  4. Dabigatran-Associated Intracranial Hemorrhage

    PubMed Central

    Szarlej, Dorota K.; Rincon, Fred

    2015-01-01

    Dabigatran etexilate is an oral direct thrombin inhibitor approved for prevention of stroke and systemic embolization in patients with nonvalvular atrial fibrillation and for the treatment of venous thromboembolism. Although dabigatran has a favorable safety profile, predictable pharmacokinetics, fewer drug interactions than warfarin, and does not require monitoring, clinical data regarding dabigatran reversal are limited. In addition, currently available laboratory assays allow measurement of the presence, but not extent, of dabigatran-associated anticoagulation. Patient age, renal function, weight, concurrent drug therapy, adherence, and concomitant disease states can affect dabigatran’s efficacy and safety. Management of dabigatran-related intracranial hemorrhage must be approached on a case-by-case basis and include assessment of degree of anticoagulation, severity of hemorrhage, renal function, timing of last dabigatran dose, and risk of thromboembolic events. Initial management includes dabigatran discontinuation and general supportive measures. Oral activated charcoal should be administered in those who ingested dabigatran within 2 hours. Four-factor prothrombin complex concentrates (4PCCs), activated PCC, or recombinant activated factor VII use may be reasonable but is not evidence based. Reserve fresh frozen plasma for patients with dilutional coagulopathy. If readily available, hemodialysis should be considered, particularly in patients with advanced kidney injury or excessive risk of thromboembolic events. More clinical studies are needed to determine a standardized approach to treating dabigatran-associated intracranial hemorrhage. Institutional protocol development will facilitate safe, efficacious, and timely use of the limited management options. PMID:26425251

  5. [Factor VII deficiency revealed by intracranial hemorrhage].

    PubMed

    Sfaihi Ben Mansour, L; Thabet, A; Aloulou, H; Turki, H; Chabchoub, I; Mhiri, F; Mnif, Z; Ben Ali, H; Kammoun, T; Hachicha, M

    2009-07-01

    Constitutional factor VII deficiency is a hereditary disease with recessive autosomic transmission. Its incidence is estimated to be 1/1,000,000 in the general population. We report a case of severe factor VII deficiency in infancy revealed by an intracranial hemorrhage in a 2-month-old infant. We describe the clinical, biological and therapeutic characteristics of this disease. PMID:19409767

  6. A segmentation algorithm of intracranial hemorrhage CT image

    NASA Astrophysics Data System (ADS)

    Wang, Haibo; Chen, Zhiguo; Wang, Jianzhi

    2011-10-01

    To develop a computer aided detection (CAD) system that improves diagnostic accuracy of intracranial hemorrhage on cerebral CT. A method for CT image segmentation of brain is proposed, with which, several regions that are suspicious of hemorrhage can be segmented rapidly and effectively. Extracting intracranial area algorithm is introduced firstly to extract intracranial area. Secondly, FCM is employed twice, we named it with TFCM. FCM is first employed to identify areas of intracranial hemorrhage. Finally, FCM is employed to segment the lesions. Experimental results on real medical images demonstrate the efficiency and effectiveness.

  7. Intracranial hemorrhage in cancer patients treated with anticoagulation.

    PubMed

    Weinstock, Matthew J; Uhlmann, Erik J; Zwicker, Jeffrey I

    2016-04-01

    Both venous thromboembolism and intracranial metastases are common complications in the setting of primary brain tumors and metastatic malignancies. Anticoagulation is indicated in the presence of cancer-associated thrombosis in order to limit the risk of pulmonary embolism; however, there is reluctance to initiate anticoagulation in the setting of intracranial metastatic disease due to potential for intracranial hemorrhage. Recent evidence suggests that therapeutic anticoagulation can be safely administered in the setting of metastatic brain tumors. This review examines the current understanding of the pathophysiology of intracranial hemorrhage in malignancy, describes the incidence of intracranial hemorrhage in the setting of brain tumors with therapeutic anticoagulation, and outlines management strategies relevant to the treatment of intracranial hemorrhage in the setting of anticoagulation. PMID:27067980

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

    PubMed Central

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

    2015-01-01

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

  9. A review of stereotaxy and lysis for intracranial hemorrhage.

    PubMed

    Samadani, Uzma; Rohde, Veit

    2009-01-01

    Intracranial hemorrhage represents a significant cause of human morbidity and mortality, leaving as many as 80% of patients either dead or disabled. Techniques for management of hemorrhage include optimal medical care, craniotomy, endoscopy, and stereotaxy. This work reviews the history of cranial stereotaxy for evacuation of nontraumatic hemorrhage beginning with techniques for mechanical disruption of the coagulated hemorrhage modeled after Archimedes screw. We discuss the properties of urokinase and tissue plasminogen activator, which have been utilized for lysis, and the outcomes after stereotactic fibrinolytic evacuation of intracerebral hemorrhage. The ongoing clinical trials evaluating the efficacy of stereotactic fibrinolysis are also discussed. PMID:18830646

  10. [Intracranial hemorrhage caused by neurosyphilis: a case report].

    PubMed

    Koh, Masaki; Kashiwazaki, Daina; Yamatani, Kazumasa; Kuroda, Satoshi

    2014-08-01

    It is well known that neurosyphilis is a cause of stroke and its main subtype is ischemic stroke. In this report, we present a rare case with intracranial hemorrhage in left frontal lobe and subarachnoid hemorrhage due to neurosyphilis. A 56-year-old man developed conscious disturbance, right hemiparesis, and motor aphasia, and was admitted to our hospital. Rapid plasma reagin(RPR)and fluorescent treponemal antibody-absorption(FTA-ABS)serology was positive in blood and cerebrospinal fluid. MR angiography and 3D-CT angiography demonstrated no vascular abnormalities. He responded well to penicillin treatment, followed by complete resolution of his neurological symptoms. Diagnosis of neurosyphilis is sometimes difficult, as patients usually present with non-specific symptoms such as intracranial hemorrhage. To our knowledge, only 3 cases of intracranial hemorrhage caused by neurosyphilis have been reported previously. This case is reported to raise the awareness of this uncommon but important manifestation of neurosyphilis. PMID:25087758

  11. Seven patients diagnosed as intracranial hemorrhage combined with intracranial tumor: case description and literature review

    PubMed Central

    Zeng, Chun; Tang, Shuang; Jiang, Yongming; Xiong, Xuehua; Zhou, Shuai

    2015-01-01

    In the present study, 7 patients with brain hemorrhage combined with intracranial tumor were investigated for about 3 years. Furthermore, the previous reports related with such cases were also reviewed. In all of these patients, hemorrhage was a main characteristic of the diagnosed neoplasm. The clinical data were identified by computed tomography (CT) scanning in the present study. CT scanning results demonstrated that there was a neoplastic core with high or low density and multifocal clots generally at the borders of the tumors. Increase of tumor tissues with intravenous injection of approximate 70% hypaque was analyzed in all the 7 patients with brain hemorrhage. The parts that were increased showed peripheral distributions corresponding to the hemorrhage sites. In conclusion, the intracranial brain hemorrhage related with the several types of tumors, including hemangiopericytoma, metastatic carcinomas, oligodendroglioma, and glioblastoma multiforme, which may be helpful to these patients. PMID:26770623

  12. A severe case of intracranial hemorrhage due to alloimmune thrombocytopenia.

    PubMed

    Cota, Francesco; Zuppa, Antonio Alberto; Luciano, Rita; Gallini, Francesca; Savarese, Immacolata; Alighieri, Giovanni; Orchi, Claudia; Romagnoli, Costantino

    2008-11-01

    Alloimmune thrombocytopenia (AIT) is an important cause of intrauterine hemorrhagic lesions that result from platelet-antigen incompatibility between mother and foetus. Foetal platelets are destroyed by cross-reactive maternal antibodies that cross the placenta. The most serious complication of AIT is foetal intracranial bleeding that may eventually result in intrauterine death or severe neurological impairments. PMID:19031280

  13. Genes and environment in neonatal intraventricular hemorrhage.

    PubMed

    Ment, Laura R; Ådén, Ulrika; Bauer, Charles R; Bada, Henrietta S; Carlo, Waldemar A; Kaiser, Jeffrey R; Lin, Aiping; Cotten, Charles Michael; Murray, Jeffrey; Page, Grier; Hallman, Mikko; Lifton, Richard P; Zhang, Heping

    2015-12-01

    Emerging data suggest intraventricular hemorrhage (IVH) of the preterm neonate is a complex disorder with contributions from both the environment and the genome. Environmental analyses suggest factors mediating both cerebral blood flow and angiogenesis contribute to IVH, while candidate gene studies report variants in angiogenesis, inflammation, and vascular pathways. Gene-by-environment interactions demonstrate the interaction between the environment and the genome, and a non-replicated genome-wide association study suggests that both environmental and genetic factors contribute to the risk for severe IVH in very low-birth weight preterm neonates. PMID:26516117

  14. Multiple intracranial hemorrhages in pregnancy: A common autoimmune etiology

    PubMed Central

    Pahadiya, Hans Raj; Lakhotia, Manoj; Gandhi, Ronak; Choudhary, Akanksha; Madan, Shiva

    2016-01-01

    Systemic lupus erythematosus (SLE) is an autoimmune disorder, primarily affect female in fertile age. Pregnancy in SLE female is a high-risk situation which can adversely affect maternal-fetal dyad. SLE can flare during pregnancy or in postpartum period. We describe a case of a young pregnant female who presented because of right hemiparesis due multiple hemorrhages in the brain. The first presentation of the SLE with multiple intracranial hemorrhages in pregnancy, preceding the other characteristic clinical symptoms is rare. Here, we high lighten the major neurological issues and maternal-fetal dyad issues in SLE pregnancy and treatment strategies for management of SLE in pregnancy. PMID:27114665

  15. Multiple intracranial hemorrhages in pregnancy: A common autoimmune etiology.

    PubMed

    Pahadiya, Hans Raj; Lakhotia, Manoj; Gandhi, Ronak; Choudhary, Akanksha; Madan, Shiva

    2016-01-01

    Systemic lupus erythematosus (SLE) is an autoimmune disorder, primarily affect female in fertile age. Pregnancy in SLE female is a high-risk situation which can adversely affect maternal-fetal dyad. SLE can flare during pregnancy or in postpartum period. We describe a case of a young pregnant female who presented because of right hemiparesis due multiple hemorrhages in the brain. The first presentation of the SLE with multiple intracranial hemorrhages in pregnancy, preceding the other characteristic clinical symptoms is rare. Here, we high lighten the major neurological issues and maternal-fetal dyad issues in SLE pregnancy and treatment strategies for management of SLE in pregnancy. PMID:27114665

  16. Visuoperceptual sequelae in children with hemophilia and intracranial hemorrhage

    PubMed Central

    Matute, Esmeralda; O’Callaghan, Erin T.; Murray, Joan; Tlacuilo-Parra, Alberto

    2015-01-01

    Background The goal of this study was to examine the impact of focal brain injuries on the outcomes of visual perception and visuospatial abilities in Mexican children with hemophilia who have experienced intracranial hemorrhages. Methods We assessed ten boys who had hemophilia with intracranial hemorrhage (HIC), six boys who had hemophilia without intracranial hemorrhage (HH), and ten boys without hemophilia (CTL). The Verbal (VIQ), Performance IQs (PIQ), and Full Scale IQs (FSIQ) from the Wechsler Intelligence Scale for Children—Mexican Revision, Visual Perception, and Visuospatial Abilities domains, which are from a neuropsychological assessment battery for Spanish-speaking children (ENI), were employed for our analysis. Results The results showed that the HIC group performed in the low-average range on the PIQ and FSIQ, which was lower than the HH group. The HIC group showed low performance on visual perception tests, such as line orientation, fragmented objects, and overlapping figures, compared with their matched controls. Conclusions The results suggest that it is not the ability to recognize objects that is impaired in the HIC group, but the ability to identify objects under less favorable conditions. Our findings may have therapeutic and rehabilitative implications for the management of children with hemophilia and early focal brain lesions. PMID:26835360

  17. [Neonatal adrenal hemorrhage revealed by jaundice: a case report].

    PubMed

    Oulmaati, A; Hays, S; Mory-Thomas, N; Bretones, P; Bensaid, M; Jordan, I; Bonfils, M; Godbert, I; Picaud, J-C

    2012-04-01

    The clinical presentation of adrenal hemorrhage varies, depending on the extent of hemorrhage as well as the amount of adrenal cortex involved by the hemorrhage. We report here a case of neonatal adrenal hemorrhage revealed by late onset of neonatal jaundice. This adrenal hemorrhage most probably resulted from shoulder dystocia. The aim of this work was to focus on the fact that jaundice can be caused by adrenal hemorrhage and to emphasize the crucial importance of abdominal ultrasound in cases of persistent jaundice. PMID:22424898

  18. Age-dependent neonatal intracerebral hemorrhage in plasminogen activator inhibitor 1 knockout mice.

    PubMed

    Leroux, Philippe; Omouendze, Priscilla L; Roy, Vincent; Dourmap, Nathalie; Gonzalez, Bruno J; Brasse-Lagnel, Carole; Carmeliet, Peter; Leroux-Nicollet, Isabelle; Marret, Stéphane

    2014-05-01

    Intracerebral-intraventricular hemorrhages (ICH/IVH) in very preterm neonates are responsible for high mortality and subsequent disabilities. In humans, tissue plasminogen activator (t-PA) initiates fibrinolysis and activates endoluminal-endothelial receptors; dysfunction of the t-PA inhibitor (PAI-1) results in recurrent hemorrhages. We used PAI-1 knockout (PAI-1) mice to examine the role of t-PA in age-dependent intracranial hemorrhages as a possible model of preterm ICH/IVH. Intracortical injection of 2 μL of phosphate-buffered saline produced a small traumatic injury and a high rate of hemorrhage in PAI-1 pups at postnatal day 3 (P3) or P5, whereas it had no effect in wild-type neonates. This resulted in white matter and cortical lesions, ventricle enlargement, hyperlocomotion, and altered cortical levels of serotonin and dopamine in the adult PAI mice. N-methyl-D-aspartate receptor blockers, plasmin- and matrix metalloproteinases inhibitors reduced hemorrhage and tissue lesions. In contrast to P3 to P5, no significant hemorrhages were induced in P10 PAI-1 pups and there were no behavioral or neurochemical alterations in adulthood. These data suggest that microvascular immaturity up to P5 in mice is a determinant factor required for t-PA-dependent vascular rupture. Neonatal PAI-1 mice could be a useful ICH/IVH model for studying the ontogenic window of vascular immaturity and vascular protection against later neurodisabilities. PMID:24709679

  19. Neisseria sicca meningitis following intracranial hemorrhage and ventriculostomy tube placement.

    PubMed

    Carter, J Elliot; Mizell, Kelly N; Evans, Tara N

    2007-12-01

    A normal component of the flora of the oropharynx, Neisseria sicca was first isolated in 1906 and has since been reported as a rare cause of various human infections including endocarditis, pneumonia, sinusitis, sepsis, and urethritis. We report the case of a 44-year-old African-American female with a history of hypertension who presented with complaints of right frontal headache, nausea, photophobia, and vomiting. A computed tomography scan of the patient's brain showed a large subarachnoid hemorrhage, and an arteriogram confirmed a large posterior communicating artery aneurysm. A ventriculostomy tube was placed, and the patient subsequently developed an elevated temperature and elevated white blood cell count. Cerebrospinal fluid studies showed elevated protein and glucose levels and cultures positive for N. sicca. This is only the seventh reported case of culture-proven meningitis related to N. sicca, and the first reported case associated with intracranial hemorrhage and ventriculostomy tube placement. PMID:17904282

  20. Is executive function intact after pediatric intracranial hemorrhage? A sample of Mexican children with hemophilia.

    PubMed

    Morales, Guadalupe; Matute, Esmeralda; Murray, Joan; Hardy, David J; O'Callaghan, Erin T; Tlacuilo-Parra, Alberto

    2013-10-01

    The goal of this study was to examine executive functioning outcomes in children with hemophilia who have suffered intracranial hemorrhage. We assessed 10 boys with hemophilia with intracranial hemorrhage; 6 boys with hemophilia without intracranial hemorrhage; and 10 healthy boys as controls. Intellectual functioning was assessed with subscales from the Wechsler Intelligence Scale for Children-Mexican Revision. Concept formation and reasoning, cognitive flexibility, and planning and organization domains from a neuropsychological assessment battery for Spanish-speaking children were employed for our analysis. Results indicated that children with intracranial hemorrhage demonstrated significant impairment on some measures of executive function compared with the control groups. All differences reflected poorer performance by the intracranial hemorrhage group. These results may reflect the impact of disruption to immature brain circuits and the deficiency of functional specificity within the immature brain. This is the only known study examining neuropsychological functioning in Mexican youth with hemophilia. PMID:23872342

  1. Subarachnoid hemorrhage from intracranial aneurysms during pregnancy and the puerperium.

    PubMed

    Kataoka, Hiroharu; Miyoshi, Takekazu; Neki, Reiko; Yoshimatsu, Jun; Ishibashi-Ueda, Hatsue; Iihara, Koji

    2013-01-01

    Subarachnoid hemorrhage (SAH) due to the rupture of an intracranial aneurysm (IA) is a rare but serious complication of pregnancy and is responsible for important morbidity and mortality during pregnancy. This study reviewed reports of ruptured IA during pregnancy and the puerperium, and our own cases of ruptured IA in pregnant women. Hemorrhage occurred predominantly during the third trimester of pregnancy, when maternal cardiac output and blood volume increase and reach maximum. Physiological and hormonal changes in pregnancy are likely to affect the risk of IA rupture. Ruptured IAs during pregnancy should be managed based on neurosurgical considerations, and the obstetrical management of women with ruptured IAs should be decided according to the severity of SAH and the gestational age. Emergent cesarean section followed by clipping or coiling of aneurysms is indicated if the maternal condition and the gestational age allow such interventions. Although SAH during pregnancy can result in disastrous outcomes, the necessity of intracranial screening for high-risk pregnant women is still controversial. PMID:23979051

  2. Incidence of Intracranial Hemorrhage After a Cranial Operation

    PubMed Central

    Grossman, Robert; Sparrow, Harlan

    2016-01-01

    Objective To describe the characteristics of patients who underwent a cranial operation and postoperatively suffered an intracranial hemorrhage significant enough to require evacuation. Materials & methods  3,109 cranial operations were performed at Houston Methodist Hospital (Texas Medical Center campus) between January 2009 and December 2013. Of these, 59 cases required a second operation for evacuation of an intracranial hemorrhage. The information gathered included the patients’ age, gender, past medical history, medications and laboratory data, initial diagnosis, date/type of first and second operations, duration of hospitalization, discharge condition, and discharge destination. Results The study found a 1.90% rate of a postoperative hemorrhage significant enough to require evacuation after a cranial operation. The average age in the cohort requiring reoperation was 63 +/- 14 years with 42 male and 17 female. Hematoma evacuations were performed at various time intervals depending on the pathology treated at the initial operation. The time to second operation was 2.7 days after intraparenchymal hematoma evacuation, 6.0 days after cerebrovascular surgery, 6.2 days after tumor surgery and 9.7 days after subdural hematoma evacuation. The rate of postoperative hematoma development was 9.1% after a subdural hematoma evacuation, while it was only 1.1% in all other operations. Overall, those requiring hematoma evacuation had a 15% mortality rate, 64% were non-ambulatory, and 54% were discharged to long-term acute care facility, skilled nursing facility, rehabilitation facility or hospice. Conclusions  Neurological outcomes were poor in patients who underwent a cranial operation and required a second operation to remove a hematoma. This study suggests close observation of elderly males after a cranial operation, especially after subdural hematoma evacuation, and longer observation time for patients undergoing subdural hematoma evacuation than intraparenchymal

  3. Intracranial hemorrhage in patients with brain metastases treated with therapeutic enoxaparin: a matched cohort study.

    PubMed

    Donato, Jessica; Campigotto, Federico; Uhlmann, Erik J; Coletti, Erika; Neuberg, Donna; Weber, Griffin M; Zwicker, Jeffrey I

    2015-07-23

    Venous thromboembolism occurs frequently in patients with cancer who have brain metastases, but there is limited evidence supporting the safety of therapeutic anticoagulation. To assess the risk for intracranial hemorrhage associated with the administration of therapeutic doses of low-molecular-weight heparin, we performed a matched, retrospective cohort study of 293 patients with cancer with brain metastases (104 with therapeutic enoxaparin and 189 controls). A blinded review of radiographic imaging was performed, and intracranial hemorrhages were categorized as trace, measurable, and significant. There were no differences observed in the cumulative incidence of intracranial hemorrhage at 1 year in the enoxaparin and control cohorts for measurable (19% vs 21%; Gray test, P = .97; hazard ratio, 1.02; 90% confidence interval [CI], 0.66-1.59), significant (21% vs 22%; P = .87), and total (44% vs 37%; P = .13) intracranial hemorrhages. The risk for intracranial hemorrhage was fourfold higher (adjusted hazard ratio, 3.98; 90% CI, 2.41-6.57; P < .001) in patients with melanoma or renal cell carcinoma (N = 60) than lung cancer (N = 153), but the risk was not influenced by the administration of enoxaparin. Overall survival was similar for the enoxaparin and control cohorts (8.4 vs 9.7 months; Log-rank, P = .65). We conclude that intracranial hemorrhage is frequently observed in patients with brain metastases, but that therapeutic anticoagulation does not increase the risk for intracranial hemorrhage. PMID:25987658

  4. Patterns of Intracranial Hemorrhage in Pediatric Patients with Facial Fractures.

    PubMed

    Marano, Andrew A; Hoppe, Ian C; Halsey, Jordan N; Kordahi, Anthony M; Granick, Mark S; Lee, Edward S

    2016-03-01

    Intracranial hemorrhage (ICH) is a potentially fatal injury accompanying fractures of the cranium and facial skeleton. When occurring at a young age, ICH can lead to developmental delay, cerebral palsy, epilepsy, and death. It is therefore important for clinicians to recognize the presence of ICH early, and understand the factors that affect its prognosis. In this study, we aim to identify diagnostic and prognostic signs for ICH in pediatric facial fracture patients by examining aspects of patient presentation, concomitant injuries, and fracture patterns. Data were collected for all radiologically diagnosed facial fractures between January 2000 and December 2012 at a level I trauma center in Newark, NJ. This was then further refined to include only patients 18 years of age or younger who had a documented ICH. Patient age, Glasgow coma scale (GCS) on presentation, fracture location, type of hemorrhage, and certain aspects of management were collected from these records. Data were then analyzed by either Pearson chi-square test or a t-test to determine significant relationships. A total of 285 pediatric patients were found to have sustained a facial fracture during this time period, 67 of which had concomitant ICH; 46 of these patients were male and 21 were female, with average ages of 14.26 and 9.52 (p < 0.01), respectively. Causes of injury included motor vehicle accidents, pedestrians struck, assault, falls, gunshot injuries, and sports-related injuries. All patients who suffered injuries as a result of violent crimes (assault and gunshot injuries) were male. Although nearly all fracture patterns were significantly associated with the presence of ICH, mandibular fractures showed a significant negative association with the presence of ICH. In addition, patients who received surgical intervention were significantly younger than those who did not (7.7 vs. 13.7, p < 0.05). The GCS was significantly lower in patients who underwent ICP (intracranial pressure

  5. Maternal anti-platelet β3 integrins impair angiogenesis and cause intracranial hemorrhage

    PubMed Central

    Yougbaré, Issaka; Lang, Sean; Yang, Hong; Chen, Pingguo; Zhao, Xu; Tai, Wei-She; Zdravic, Darko; Vadasz, Brian; Li, Conglei; Piran, Siavash; Marshall, Alexandra; Zhu, Guangheng; Tiller, Heidi; Killie, Mette Kjaer; Boyd, Shelley; Leong-Poi, Howard; Wen, Xiao-Yan; Skogen, Bjorn; Adamson, S. Lee; Freedman, John; Ni, Heyu

    2015-01-01

    Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a life-threatening disease in which intracranial hemorrhage (ICH) is the major risk. Although thrombocytopenia, which is caused by maternal antibodies against β3 integrin and occasionally by maternal antibodies against other platelet antigens, such as glycoprotein GPIbα, has long been assumed to be the cause of bleeding, the mechanism of ICH has not been adequately explored. Utilizing murine models of FNAIT and a high-frequency ultrasound imaging system, we found that ICH only occurred in fetuses and neonates with anti–β3 integrin–mediated, but not anti-GPIbα–mediated, FNAIT, despite similar thrombocytopenia in both groups. Only anti–β3 integrin–mediated FNAIT reduced brain and retina vessel density, impaired angiogenic signaling, and increased endothelial cell apoptosis, all of which were abrogated by maternal administration of intravenous immunoglobulin (IVIG). ICH and impairment of retinal angiogenesis were further reproduced in neonates by injection of anti–β3 integrin, but not anti-GPIbα antisera. Utilizing cultured human endothelial cells, we found that cell proliferation, network formation, and AKT phosphorylation were inhibited only by murine anti–β3 integrin antisera and human anti–HPA-1a IgG purified from mothers with FNAIT children. Our data suggest that fetal hemostasis is distinct and that impairment of angiogenesis rather than thrombocytopenia likely causes FNAIT-associated ICH. Additionally, our results indicate that maternal IVIG therapy can effectively prevent this devastating disorder. PMID:25774504

  6. Variability of ICU Use in Adult Patients With Minor Traumatic Intracranial Hemorrhage

    PubMed Central

    Nishijima, Daniel K.; Haukoos, Jason S.; Newgard, Craig D.; Staudenmayer, Kristan; White, Nathan; Slattery, David; Maxim, Preston C.; Gee, Christopher A.; Hsia, Renee Y.; Melnikow, Joy A.; Holmes, James F.

    2013-01-01

    Study objective Patients with minor traumatic intracranial hemorrhage are frequently admitted to the ICU, although many never require critical care interventions. To describe ICU resource use in minor traumatic intracranial hemorrhage, we assess (1) the variability of ICU use in a cohort of patients with minor traumatic intracranial hemorrhage across multiple trauma centers, and (2) the proportion of adult patients with traumatic intracranial hemorrhage who are admitted to the ICU and never receive a critical care intervention during hospitalization. In addition, we evaluate the association between ICU admission and key independent variables. Methods A structured, historical cohort study of adult patients (aged 18 years and older) with minor traumatic intracranial hemorrhage was conducted within a consortium of 8 Level I trauma centers in the western United States from January 2005 to June 2010. The study population included patients with minor traumatic intracranial hemorrhage, defined as an emergency department (ED) Glasgow Coma Scale (GCS) score of 15 (normal mental status) and an Injury Severity Score less than 16 (no other major organ injury). The primary outcome measure was initial ICU admission. The secondary outcome measure was a critical care intervention during hospitalization. Critical care interventions included mechanical ventilation, neurosurgical intervention, transfusion of blood products, vasopressor or inotrope administration, and invasive hemodynamic monitoring. ED disposition and the proportion of ICU patients not receiving a critical care intervention were compared across sites with descriptive statistics. The association between ICU admission and predetermined independent variables was analyzed with multivariable regression. Results Among 11,240 adult patients with traumatic intracranial hemorrhage, 1,412 (13%) had minor traumatic intracranial hemorrhage and complete ED disposition data (mean age 48 years; SD 20 years). ICU use within this

  7. A fast cranial drilling technique in treating severe intracranial hemorrhage

    PubMed Central

    Wei, Jun-Jie; Liu, Hui-Fang; Chai, Shuai; Kang, Xuan-Min

    2015-01-01

    Background: This study is a retrospective case analysis of 143 patients who suffered from severe intracranial hemorrhage and underwent a fast and simple procedure of cranial drilling followed with external ventricle drain treatment (referred as Fast-D here after) during 2003–2013 to evaluate the clinical effectiveness of the treatment. Methods: Fast-D procedure was conducted on 143 patients with severe acute craniocerebral diseases. Those patients were evaluated using activities of daily living (ADL) scales at hospital discharge and after 6-month of physical therapy, and were compared to 36 patients with similar craniocerebral diseases but received the traditional Dandy's surgical treatment. Results: At discharge, 11% (16 cases) was classified as ADL I (fully functional for physical and social activities); 26% (37 cases) had ADL II (fully functional for physical activities but partially impaired for social activities); 34% (49 cases) was ADL III (require assistance performing physical activities); 9% (13 cases) was ADL IV (being conscious, but completely lost ability of physical activities); 27% (10 cases) was ADL V (vegetative stage); and 13% (18 cased) was ADL VI (died) among the 143 patients. Six-month physical therapy improved ADL in 88% of the patients. Those outcomes are equal or better than the more complicated Dandy's procedure probably due to the time-saving factor. Conclusion: Fast-D procedure is much faster (6.7 min vs. 53.6 min of the Dandy's procedure) and can be performed outside operating rooms (computed tomography room or bedside). This technique could serve as a tool to rapidly release intracranial pressure and reduce subsequent morbidity and mortality of severe craniocerebral diseases when resource and condition are limited and more elaborate operating room procedures are not possible. PMID:26539310

  8. Clinical characteristics and risk factors of Intracranial hemorrhage in patients following allogeneic hematopoietic stem cell transplantation.

    PubMed

    Zhang, Xiao-Hui; Wang, Qian-Ming; Chen, Huan; Chen, Yu-Hong; Han, Wei; Wang, Feng-Rong; Wang, Jing-Zhi; Zhang, Yuan-Yuan; Mo, Xiao-Dong; Chen, Yao; Wang, Yu; Chang, Ying-Jun; Xu, Lan-Ping; Liu, Kai-Yan; Huang, Xiao-Jun

    2016-10-01

    Intracranial hemorrhage (ICH) is one of the most life-threatening neurological complications after allogeneic hematopoietic stem cell transplantation. Although cerebral complications and its causes after allo-HSCT are well documented, assessment of the incidence and risk factors of intracranial hemorrhage following allo-HSCT are less discussed. A nested case-control study was conducted involving 160 subjects drawn from 2169 subjects who underwent HSCT at Peking University People's Hospital between 2004 and 2014. Thirty-two patients (1.5 %) with ICH were identified, and 128 controls were matched for age, gender, transplantation type, and time of transplantation. Intracranial hemorrhage was identified by CT scan and/or MRI by searching hospital records. Among the 32 ICH patients, 27 (82.9 %) developed intraparenchymal hemorrhages (IPH), 2 cases (5.7 %) suffered subdural hematomas (SDH), and 3 cases (8.6 %) had multiple hemorrhage lesions in the brain parenchyma. The median time of appearance for cerebral hemorrhages was 147.5 days. Multivariate analysis showed that systemic infections (hazard ratio 2.882, 95 % confidence interval 1.231-6.746), platelet count (5.894, 1.145-30.339), and fibrinogen levels (3.611, 1.528-8.532) were independent risk factors for intracranial hemorrhage among HSCT patients. The cumulative survival rate in the intracranial hemorrhage and control groups were 43.3 and 74.7 % (P = .001), respectively. Intracranial hemorrhage is associated with high mortality and a decreased overall survival rate. Systemic infections, platelet count, and fibrinogen levels were individual independent risk factors. PMID:27485455

  9. Noninvasive Intracranial Pressure Determination in Patients with Subarachnoid Hemorrhage.

    PubMed

    Noraky, James; Verghese, George C; Searls, David E; Lioutas, Vasileios A; Sonni, Shruti; Thomas, Ajith; Heldt, Thomas

    2016-01-01

    Intracranial pressure (ICP) should ideally be measured in many conditions affecting the brain. The invasiveness and associated risks of the measurement modalities in current clinical practice restrict ICP monitoring to a small subset of patients whose diagnosis and treatment could benefit from ICP measurement. To expand validation of a previously proposed model-based approach to continuous, noninvasive, calibration-free, and patient-specific estimation of ICP to patients with subarachnoid hemorrhage (SAH), we made waveform recordings of cerebral blood flow velocity in several major cerebral arteries during routine, clinically indicated transcranial Doppler examinations for vasospasm, along with time-locked waveform recordings of radial artery blood pressure (APB), and ICP was measured via an intraventricular drain catheter. We also recorded the locations to which ICP and ABP were calibrated, to account for a possible hydrostatic pressure difference between measured ABP and the ABP value at a major cerebral vessel. We analyzed 21 data records from five patients and were able to identify 28 data windows from the middle cerebral artery that were of sufficient data quality for the ICP estimation approach. Across these windows, we obtained a mean estimation error of -0.7 mmHg and a standard deviation of the error of 4.0 mmHg. Our estimates show a low bias and reduced variability compared with those we have reported before. PMID:27165879

  10. Migrating lumbar intrathecal catheter fragment associated with intracranial subarachnoid hemorrhage.

    PubMed

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

    2015-01-01

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

  11. Acute brainstem compression by intratumoral hemorrhages in an intracranial hypoglossal schwannoma.

    PubMed

    Inoue, Hiromasa; Nakagawa, Yasuhisa; Ikemura, Mayumi; Usugi, Eri; Kiyofuji, Yuma; Nata, Masayuki

    2013-09-01

    A 77-year-old female in the hospital was found tachycardic and hypothermic by a nurse, and the patient's respiration subsequently ceased. Forensic autopsy revealed an intracranial cystic tumor that would have compressed the brainstem. On microscopic examination, the tumor was diagnosed as an Antoni A schwannoma growth, and recent multiple intratumoral hemorrhages in the intracranial schwannoma were observed, suggesting the sudden enlargement of the intracranial schwannoma due to intratumoral hemorrhaging. Accordingly, we diagnosed the cause of death as brainstem compression induced by the intratumoral hemorrhaging in the intracranial schwannoma. Meanwhile, a rhinopharyngeal tumor was also detected by the autopsy, which was compatible with an antemortem diagnosis of a dumbbell-shaped hypoglossal schwannoma. PMID:23541888

  12. Intracranial chordoma presenting as acute hemorrhage in a child: Case report and literature review

    PubMed Central

    Moore, Kenneth A.; Bohnstedt, Bradley N.; Shah, Sanket U.; Abdulkader, Marwah M.; Bonnin, Jose M.; Ackerman, Laurie L.; Shaikh, Kashif A.; Kralik, Stephen F.; Shah, Mitesh V.

    2015-01-01

    Background: Chordomas are rare, slow-growing malignant neoplasms derived from remnants of the embryological notochord. Pediatric cases comprise only 5% of all chordomas, but more than half of the reported pediatric chordomas are intracranial. For patients of all ages, intracranial chordomas typically present with symptoms such as headaches and progressive neurological deficits occurring over several weeks to many years as they compress or invade local structures. There are only reports of these tumors presenting acutely with intracranial hemorrhage in adult patients. Case Description: A 10-year-old boy presented with acute onset of headache, emesis, and diplopia. Head computed tomography and magnetic resonance imaging of brain were suspicious for a hemorrhagic mass located in the left petroclival region, compressing the ventral pons. The mass was surgically resected and demonstrated acute intratumoral hemorrhage. Pathologic examination was consistent with chordoma. Conclusion: There are few previous reports of petroclival chordomas causing acute intracranial hemorrhage. To the authors’ knowledge, this is the first case of a petroclival chordoma presenting as acute intracranial hemorrhage in a pediatric patient. Although uncommon, it is important to consider chordoma when evaluating a patient of any age presenting with a hemorrhagic lesion of the clivus. PMID:25949851

  13. Candidate gene analysis: severe intraventricular hemorrhage in inborn preterm neonates.

    PubMed

    Adén, Ulrika; Lin, Aiping; Carlo, Waldemar; Leviton, Alan; Murray, Jeffrey C; Hallman, Mikko; Lifton, Richard P; Zhang, Heping; Ment, Laura R

    2013-11-01

    Intraventricular hemorrhage (IVH) is a disorder of complex etiology. We analyzed genotypes for 7 genes from 224 inborn preterm neonates treated with antenatal steroids and grade 3-4 IVH and 389 matched controls. Only methylenetetrahydrofolate reductase was more prevalent in cases of IVH, emphasizing the need for more comprehensive genetic strategies. PMID:23896193

  14. Quantitative head ultrasound measurements to determine thresholds for preterm neonates requiring interventional therapies following intraventricular hemorrhage

    NASA Astrophysics Data System (ADS)

    Kishimoto, Jessica; Fenster, Aaron; Salehi, Fateme; Romano, Walter; Lee, David S. C.; de Ribaupierre, Sandrine

    2016-04-01

    Dilation of the cerebral ventricles is a common condition in preterm neonates with intraventricular hemorrhage (IVH). This post hemorrhagic ventricle dilation (PHVD) can lead to lifelong neurological impairment through ischemic injury due to increased intracranial pressure and without treatment, can lead to death. Clinically, 2D ultrasound (US) through the fontanelles ('soft spots') of the patients are serially acquired to monitor the progression of the ventricle dilation. These images are used to determine when interventional therapies such as needle aspiration of the built up cerebrospinal fluid (CSF) ('ventricle tap', VT) might be indicated for a patient; however, quantitative measurements of the growth of the ventricles are often not performed. There is no consensus on when a neonate with PHVD should have an intervention and often interventions are performed after the potential for brain damage is quite high. Previously we have developed and validated a 3D US system to monitor the progression of ventricle volumes (VV) in IVH patients. We will describe the potential utility of quantitative 2D and 3D US to monitor and manage PHVD in neonates. Specifically, we will look to determine image-based measurement thresholds for patients who will require VT in comparison to patients with PHVD who resolve without intervention. Additionally, since many patients who have an initial VT will require subsequent interventions, we look at the potential for US to determine which PHVD patients will require additional VT after the initial one has been performed.

  15. Beneficial Effect of Hyperbaric Oxygenation After Neonatal Germinal Matrix Hemorrhage

    PubMed Central

    Lekic, Tim; Manaenko, Anatol; Rolland, William; Ostrowski, Robert P.; Virbel, Kelly; Tang, Jiping

    2013-01-01

    Background Germinal matrix hemorrhage (GMH) is a potentially devastating neurological disease of very low birth weight premature infants. This leads to post-hemorrhagic hydrocephalus, cerebral palsy, and mental retardation. Hyperbaric oxygen (HBO) treatment is a broad neuroprotectant after brain injury. This study investigated the therapeutic effect of HBO after neonatal GMH. Methods Neonatal rats underwent stereotaxic infusion of clostridial collagenase into the right germinal matrix (anterior caudate) brain region. Cognitive function was assessed at 3 weeks, and then sensorimotor, cerebral, cardiac, and splenic growths were measured 1 week thereafter. Results Hyperbaric oxygen (HBO) treatment markedly improved upon the mental retardation and cerebral palsy outcome measurements in rats at the juvenile developmental stage. The administration of HBO early after neonatal GMH also normalized brain atrophy, splenomegaly, and cardiac hypertrophy 1 month after injury. Conclusion This study supports the role of hyperbaric oxygen (HBO) treatment in the early period after neonatal GMH. HBO is an effective strategy to help protect the infant’s brain from the post-hemorrhagic consequences of brain atrophy, mental retardation, and cerebral palsy. Further studies are necessary to determine the mechanistic basis of these neuroprotective effects. PMID:21725764

  16. Intraspinal hemorrhage in spontaneous intracranial hypotension: link to superficial siderosis? Report of 2 cases.

    PubMed

    Schievink, Wouter I; Wasserstein, Philip; Maya, M Marcel

    2016-03-01

    Spontaneous intracranial hypotension due to a spinal CSF leak has become a well-recognized cause of headaches, but such spinal CSF leaks also are found in approximately half of patients with superficial siderosis of the CNS. It has been hypothesized that friable vessels at the site of the spinal CSF leak are the likely source of chronic bleeding in these patients, but such an intraspinal hemorrhage has never been visualized. The authors report on 2 patients with spontaneous intracranial hypotension and intraspinal hemorrhage, offering support for this hypothesis. A 33-year-old man and a 62-year-old woman with spontaneous intracranial hypotension were found to have a hemorrhage within the ventral spinal CSF collection and within the thecal sac, respectively. Treatment consisted of microsurgical repair of a ventral dural tear in the first patient and epidural blood patching in the second patient. The authors suggest that spontaneous intracranial hypotension should be included in the differential diagnosis of spontaneous intraspinal hemorrhage, and that the intraspinal hemorrhage can account for the finding of superficial siderosis when the CSF leak remains untreated. PMID:26588500

  17. Risk of intracranial hemorrhage in users of oral antithrombotic drugs: Study protocol for a nationwide study

    PubMed Central

    Gulati, Sasha; Solheim, Ole; Carlsen, Sven M.; Øie, Lise R.; Jensberg, Heidi; Gulati, Agnete M.; Giannadakis, Charalampis; Jakola, Asgeir S.; Salvesen, Øyvind

    2015-01-01

    Background A wide range of antithrombotic medications can be used in the prevention and treatment of thrombosis. Among hemorrhagic complications of antithrombotic drugs, intracranial hemorrhage may have particularly devastating consequences with high morbidity, disability and mortality rates. The incidence and risks of intracranial hemorrhage in patients on antithrombotic treatments from regular clinical practice outside clinical trials remain largely unknown. It is not known if results from clinical trials can be extrapolated to everyday clinical practice. We will conduct a nationwide study to investigate the risks and incidence rates of intracranial hemorrhage in users oral antithrombotic drugs in Norway from 2008 through 2014.   Methods and design The aim of this nationwide study is to investigate the incidence rates of intracranial hemorrhage requiring hospitalization in users of oral antithrombotic drugs. The study will be conducted within the approximately 4.7 million inhabitants of Norway from January 1 st, 2008, to December 31 st, 2014. Treatment and outcome data are obtained from the Norwegian patient registry and the Norwegian prescription database.   Trial registration number Clinicaltrials.gov (NCT02481011) PMID:26918124

  18. Ventricular Tract Hemorrhage Following Intracranial Nail Removal: Utility of Real-time Endovascular Assistance

    PubMed Central

    Rennert, Robert C.; Steinberg, Jeffrey A.; Sack, Jayson; Pannell, J. Scott; Khalessi, Alexander A.

    2016-01-01

    Penetrating brain trauma commonly results in occult neurovascular injury. Detailed cerebrovascular imaging can evaluate the relationship of intracranial foreign bodies to major vascular structures, assess for traumatic pseudoaneurysms, and ensure hemostasis during surgical removal. We report a case of a self-inflicted intracranial nail gun injury causing a communicating ventricular tract hemorrhage upon removal, as well as a delayed pseudoaneurysm. Pre- and post-operative vascular imaging, as well as intra-operative endovascular assistance, was critical to successful foreign body removal in this patient. This report demonstrates the utility of endovascular techniques for the assessment and treatment of occult cerebrovascular injuries from intracranial foreign bodies. PMID:27471490

  19. Ventricular Tract Hemorrhage Following Intracranial Nail Removal: Utility of Real-time Endovascular Assistance.

    PubMed

    Rennert, Robert C; Steinberg, Jeffrey A; Sack, Jayson; Pannell, J Scott; Khalessi, Alexander A

    2016-01-01

    Penetrating brain trauma commonly results in occult neurovascular injury. Detailed cerebrovascular imaging can evaluate the relationship of intracranial foreign bodies to major vascular structures, assess for traumatic pseudoaneurysms, and ensure hemostasis during surgical removal. We report a case of a self-inflicted intracranial nail gun injury causing a communicating ventricular tract hemorrhage upon removal, as well as a delayed pseudoaneurysm. Pre- and post-operative vascular imaging, as well as intra-operative endovascular assistance, was critical to successful foreign body removal in this patient. This report demonstrates the utility of endovascular techniques for the assessment and treatment of occult cerebrovascular injuries from intracranial foreign bodies. PMID:27471490

  20. [Hemorrhagic Adult Unilateral Moyamoya Disease with Multiple Unruptured Intracranial Aneurysms: A Case Report].

    PubMed

    Ozaki, Saya; Inoue, Akihiro; Miyazaki, Hajime; Onoue, Shinji; Ichikawa, Haruhisa; Fukumoto, Shinya; Iwata, Shinji; Kohno, Kanehisa

    2016-02-01

    Adult unilateral moyamoya disease with intracranial aneurysm is frequently reported in the literature, but there is much variation in its treatment. In this case report, we describe the time course and treatment regimen of a patient with moyamoya disease and review the literature regarding moyamoya disease with intracranial aneurysm. A 64-year-old man had untreated intracranial aneurysm and unilateral moyamoya disease for 10 years. He presented with sudden-onset right hemiparesis and aphasia due to a subcortical hemorrhage. He was admitted to the local neurosurgical unit, and upon resolution of symptoms, he was admitted to our hospital. A cerebral angiogram revealed the champagne bottleneck sign of the left carotid artery and obliteration of the top of the left intracranial carotid artery with a moyamoya phenomenon. Two unruptured intracranial aneurysms were identified in the anterior communicating artery(Acom A) and the right intracranial carotid artery(C3). We performed superficial temporal artery-middle cerebral artery anastomosis followed by aneurysmal neck clipping of the Acom A aneurysm. Postoperative imaging showed no new ischemic damage and improved cerebral blood flow. Although the patient experienced temporal worsening of aphasia, his function recovered a few months later and he was able to resume his normal daily life activities. The combination of direct bypass surgery and aneurysmal neck clipping might be a therapeutic option for hemorrhagic unilateral moyamoya disease with unruptured intracranial aneurysm. PMID:26856265

  1. Microglial Cells Prevent Hemorrhage in Neonatal Focal Arterial Stroke.

    PubMed

    Fernández-López, David; Faustino, Joel; Klibanov, Alexander L; Derugin, Nikita; Blanchard, Elodie; Simon, Franziska; Leib, Stephen L; Vexler, Zinaida S

    2016-03-01

    Perinatal stroke leads to significant morbidity and long-term neurological and cognitive deficits. The pathophysiological mechanisms of brain damage depend on brain maturation at the time of stroke. To understand whether microglial cells limit injury after neonatal stroke by preserving neurovascular integrity, we subjected postnatal day 7 (P7) rats depleted of microglial cells, rats with inhibited microglial TGFbr2/ALK5 signaling, and corresponding controls, to transient middle cerebral artery occlusion (tMCAO). Microglial depletion by intracerebral injection of liposome-encapsulated clodronate at P5 significantly reduced vessel coverage and triggered hemorrhages in injured regions 24 h after tMCAO. Lack of microglia did not alter expression or intracellular redistribution of several tight junction proteins, did not affect degradation of collagen IV induced by the tMCAO, but altered cell types producing TGFβ1 and the phosphorylation and intracellular distribution of SMAD2/3. Selective inhibition of TGFbr2/ALK5 signaling in microglia via intracerebral liposome-encapsulated SB-431542 delivery triggered hemorrhages after tMCAO, demonstrating that TGFβ1/TGFbr2/ALK5 signaling in microglia protects from hemorrhages. Consistent with observations in neonatal rats, depletion of microglia before tMCAO in P9 Cx3cr1(GFP/+)/Ccr2(RFP/+) mice exacerbated injury and induced hemorrhages at 24 h. The effects were independent of infiltration of Ccr2(RFP/+) monocytes into injured regions. Cumulatively, in two species, we show that microglial cells protect neonatal brain from hemorrhage after acute ischemic stroke. PMID:26961944

  2. Intraventricular hemorrhage caused by intracranial venous sinus thrombosis

    PubMed Central

    Zhang, Hongbo; Song, Shuijiang; Ouyang, Zhiyuan

    2016-01-01

    Abstract Intraventricular hemorrhage (IVH) may occur as an isolated event from primary ventricular bleeding or as a complication of brain hemorrhage from another etiology. It is associated with high mortality and morbidity. The underlying risk factors include hypertension and aneurysms, among others. However, not all the exact etiologies are known. In this study, a case of a 24-year-old man who suffered from a headache and a decline in memory has been reported. A brain computed tomography scan suggested the diagnosis of spontaneous intraventricular hemorrhage. However, brain magnetic resonance imaging, magnetic resonance venography, and other tests eventually confirmed cerebral venous sinus thrombosis. Cerebral venous sinus thrombosis may be one of the causes of intraventricular hemorrhage and should be considered for unexplained intraventricular hemorrhage. PMID:27428184

  3. Intraventricular hemorrhage caused by intracranial venous sinus thrombosis: Case report.

    PubMed

    Zhang, Hongbo; Song, Shuijiang; Ouyang, Zhiyuan

    2016-07-01

    Intraventricular hemorrhage (IVH) may occur as an isolated event from primary ventricular bleeding or as a complication of brain hemorrhage from another etiology. It is associated with high mortality and morbidity. The underlying risk factors include hypertension and aneurysms, among others. However, not all the exact etiologies are known. In this study, a case of a 24-year-old man who suffered from a headache and a decline in memory has been reported. A brain computed tomography scan suggested the diagnosis of spontaneous intraventricular hemorrhage. However, brain magnetic resonance imaging, magnetic resonance venography, and other tests eventually confirmed cerebral venous sinus thrombosis.Cerebral venous sinus thrombosis may be one of the causes of intraventricular hemorrhage and should be considered for unexplained intraventricular hemorrhage. PMID:27428184

  4. Neuroprotection by Melatonin after Germinal Matrix Hemorrhage in Neonatal Rats

    PubMed Central

    Lekic, Tim; Manaenko, Anatol; Rolland, William; Virbel, Kelly; Hartman, Richard; Tang, Jiping

    2013-01-01

    Background Germinal matrix hemorrhage (GMH) is a devastating neurological disorder of very low birth weight premature infants that leads to post-hemorrhagic hydrocephalus, cerebral palsy, and mental retardation. Melatonin is a potent antioxidant known to reverse free-radical mediated injury in the brain. This study investigated the effect of melatonin treatment after GMH injury. Methods Clostridial collagenase was infused into the right germinal matrix region of neonatal rats with stereotaxic technique. Cognitive function, sensorimotor ability, cerebral, cardiac and splenic growths were measured in juvenile animals. Results Systemic melatonin treatment ameliorated cognitive and sensorimotor dysfunction at the juvenile developmental stage. This hormone also normalized brain atrophy, splenomegaly, and cardiac hypertrophy consequences at 1 month after injury. Conclusion This study supports the role of free radicals in acute neonatal hemorrhagic brain injury. Melatonin is an effective antioxidant that can protect the infant’s brain from the post-hemorrhagic consequences of mental retardation and cerebral palsy. Further mechanistic studies are warranted to determine the mechanisms behind these neuroprotective effects. PMID:21725756

  5. Intracranial calcification in a neonate with the Sturge Weber syndrome and additional problems.

    PubMed

    Alonso, A; Taboada, D; Ceres, L; Beltran, J; Olague, R; Nogues, A

    1979-02-26

    The neonate in this report had severe encephalotrigeminal angiomatosis with intracranial calcification, cranial hemiatrophy, microcephaly and generalised severe cerebral atrophy. Such findings are not common in the newborn with this syndrome. PMID:431990

  6. Spontaneous intracranial hypotension with bilateral subdural hemorrhage: Is conservative management adequate?

    PubMed Central

    Ahmad, Mohammed Tauqeer; Hameed, Shahul; Lin, Kei Pin; Prakash, Kumar M

    2013-01-01

    The aim of this study is to report a case of spontaneous intracranial hypotension complicated by bilateral subdural hemorrhage that resolved with conservative management. A young male presented with severe orthostatic headache associated with dizziness, neck pain and diplopia. Brain imaging revealed characteristic pachymeningeal enhancement and bilateral subdural hemorrhage. Radionuclide cisternography confirmed the Cerebrospinal fluid leak at the cervical 5 and cervical 6 vertebral level. He had clinical and radiological resolution with bed rest, hydration and analgesics and has remained symptom free since then. Spontaneous intracranial hypotension may be complicated by bilateral subdural hemorrhage. A conservative treatment approach is a viable option, as it may help improve the clinical and radiological outcome, especially when interventional facilities are not available. PMID:23661973

  7. Posterior Reversible Encephalopathy Syndrome and Subarachnoid Hemorrhage After Lumboperitoneal Shunt for Fulminant Idiopathic Intracranial Hypertension.

    PubMed

    Fok, Anthony; Chandra, Ronil V; Gutman, Matthew; Ligtermoet, Matthew; Seneviratne, Udaya; Kempster, Peter

    2016-06-01

    A 33-year-old woman presented with severe visual loss from fulminant idiopathic intracranial hypertension. Her lumbar puncture opening pressure was 97 cm H2O. Soon after lumboperitoneal shunt surgery, she had a generalized tonic-clonic seizure. Magnetic resonance imaging demonstrated frontal subarachnoid hemorrhage (SAH) and neuroimaging findings consistent with posterior reversible encephalopathy syndrome (PRES). We hypothesize that an abrupt drop in intracranial pressure after lumboperitoneal shunting led to maladjustment of cerebral vascular autoregulation, which caused SAH and PRES. PMID:26919070

  8. Susceptibility-Based Differentiation of Intracranial Calcification and Hemorrhage in Pediatric Patients.

    PubMed

    Gumus, Kazim; Koc, Gonca; Doganay, Selim; Gorkem, Sureyya B; Dogan, Mehmet S; Canpolat, Mehmet; Coskun, Abdulhakim; Bilgen, Mehmet

    2015-07-01

    Differential diagnosis of intracranial hemorrhage versus calcification on conventional magnetic resonance images (MRIs) is often challenging. Although computed tomography (CT) confirms calcification, phase information obtained during susceptibility-weighted imaging can be useful in distinguishing between 2 pathologies. Fourteen patients previously diagnosed to have hemorrhage or calcification with imaging were included in the study retrospectively. Phase shift values of hemorrhage and calcification were compared by using Student t test. The pathologies identified were tuberous sclerosis, Sturge-Weber syndrome, craniopharyngioma, congenital cytomegalovirus, subependymal hemorrhages, and hemorrhagic microembolic infarction. Calcifications appeared hypointense whereas hemorrhages were hyperintense on phase maps (left-handed magnetic resonance system). Statistical comparison of phase shift values yielded significant difference between hemorrhage versus calcification (P < .01). Phase maps were found to offer valuable data to differentiate 2 pathologies when used complementary to conventional magnetic resonance images. Considering the relatively higher risks of radiation exposure in children, susceptibility-weighted imaging with phase maps may help to waive radiation exposure from CT. PMID:25348417

  9. Cerebral venous dynamics in newborn mice with intracranial hemorrhage studied using wavelets

    NASA Astrophysics Data System (ADS)

    Pavlov, A. N.; Semyachkina-Glushkovskaya, O. V.; Sindeeva, O. A.; Pavlova, O. N.; Shuvalova, E. P.; Huang, Q.; Zhu, D.; Li, P.; Tuchin, V. V.; Luo, Q.

    2015-03-01

    We investigate the stress-induced development of the intracranial hemorrhage in newborn mice with the main attention to its latent stage. Our study is based on the laser speckle contrast imaging of the cerebral venous blood flow and the wavelet-based analysis of experimental data. We study responses of the sagittal sinus in different frequency ranges associated with distinct regulatory mechanisms and discuss significant changes of the spectral power in the frequency area associated with the NO-related endothelial function.

  10. Detrended fluctuation analysis of cerebral venous dynamics in newborn mice with intracranial hemorrhage

    NASA Astrophysics Data System (ADS)

    Pavlov, A. N.; Semyachkina-Glushkovskaya, O. V.; Bibikova, O. A.; Pavlova, O. N.; Mohammad, Y. K.; Huang, Q.; Zhu, D.; Li, P.; Tuchin, V. V.; Luo, Q.

    2015-03-01

    We study pathological changes in cerebral venous dynamics in newborn mice using the laser speckle contrast imaging and the detrended fluctuation analysis with a special attention to the latent stage of the development of the intracranial hemorrhage. We show that this stage is characterized by a high responsiveness of the sagittal sinus to pharmacological stimulations of adrenorelated dilation. We conclude that this effect can be considered as an important mechanism underlying the development of ICH in newborns.

  11. Characterization of neonatal patients with intraventricular hemorrhage using 3D ultrasound cerebral ventricle volumes

    NASA Astrophysics Data System (ADS)

    Kishimoto, Jessica; Fenster, Aaron; Lee, David S. C.; de Ribaupierre, Sandrine

    2015-03-01

    One of the major non-congenital cause of neurological impairment among neonates born very preterm is intraventricular hemorrhage (IVH) - bleeding within the lateral ventricles. Most IVH patients will have a transient period of ventricle dilation that resolves spontaneously. However, those patients most at risk of long-term impairment are those who have progressive ventricle dilation as this causes macrocephaly, an abnormally enlarged head, then later causes increases intracranial pressure (ICP). 2D ultrasound (US) images through the fontanelles of the patients are serially acquired to monitor the progression of the ventricle dilation. These images are used to determine when interventional therapies such as needle aspiration of the built up CSF might be indicated for a patient. Initial therapies usually begin during the third week of life. Such interventions have been shown to decrease morbidity and mortality in IVH patients; however, this comes with risks of further hemorrhage or infection; therefore only patients requiring it should be treated. Previously we have developed and validated a 3D US system to monitor the progression of ventricle volumes (VV) in IVH patients. This system has been validated using phantoms and a small set of patient images. The aim of this work is to determine the ability of 3D US generated VV to categorize patients into those who will require interventional therapies, and those who will have spontaneous resolution. Patients with higher risks could therefore be monitored better, by re-allocating some of the resources as the low risks infants would need less monitoring.

  12. [Puncture aspiration and local fibrinolysis in the surgery of primary non-traumatic intracranial hemorrhages].

    PubMed

    Krylov, V V; Burov, S A; Dash'ian, V G; Galankina, I E

    2008-01-01

    A possibility of evacuation of primary non-traumatic intracranial hematomas with less traumatic effect using puncture aspiration and local fibrinolysis has been studied in 73 patients aged 23-69 years. It has been shown that this method allows an effective (up to 95% of initial volume) evacuation of hypertensive hematomas in most patients. The evacuation of hemorrhage is accompanied by the significant regress of movement disorders already in the early post-operative period that promotes shortening of treatment time in patients with hemorrhage stroke. The positive changes of neurological status are supported by the morphological data on the induction of reparative processes in the perifocal brain tissue against the background of focal fibrinolysis. The reduction of post-operative fatal cases (from 35 to 23%) allows a recommendation of the method described in surgery of hypertensive hemorrhages. PMID:19008848

  13. The Effects of Vasospasm and Re-Bleeding on the Outcome of Patients with Subarachnoid Hemorrhage from Ruptured Intracranial Aneurysm.

    PubMed

    Filipce, Venko; Caparoski, Aleksandar

    2015-01-01

    Vasospasm and re-bleeding after subarachnoid hemorrhage from ruptured intracranial aneurysm are devastating complication that can severely affect the outcome of the patients. We are presenting a series of total number of 224 patients treated and operated at our Department due to subarachnoid hemorrhage, out of which certain number developed vasospasm and re-bleeding. We are evaluating the effect of these complications on the outcome of the patients according to the Glasgow Outcome Scale at the day of discharge. In our experience both vasospasm and ReSAH can significantly influence the outcome of patients with subarachnoid hemorrhage from ruptured intracranial aneurysm. PMID:27442399

  14. Brain Ischemia in Patients with Intracranial Hemorrhage: Pathophysiological Reasoning for Aggressive Diagnostic Management

    PubMed Central

    Naranjo, Daniel; Arkuszewski, Michal; Rudzinski, Wojciech; Melhem, Elias R.; Krejza, Jaroslaw

    2013-01-01

    Summary Patients with intracranial hemorrhage have to be managed aggressively to avoid or minimize secondary brain damage due to ischemia, which contributes to high morbidity and mortality. The risk of brain ischemia, however, is not the same in every patient. The risk of complications associated with an aggressive prophylactic therapy in patients with a low risk of brain ischemia can outweigh the benefits of therapy. Accurate and timely identification of patients at highest risk is a diagnostic challenge. Despite the availability of many diagnostic tools, stroke is common in this population, mostly because the pathogenesis of stroke is frequently multifactorial whereas diagnosticians tend to focus on one or two risk factors. The pathophysiological mechanisms of brain ischemia in patients with intracranial hemorrhage are not yet fully elucidated and there are several important areas of ongoing research. Therefore, this review describes physiological and pathophysiological aspects associated with the development of brain ischemia such as the mechanism of oxygen and carbon dioxide effects on the cerebrovascular system, neurovascular coupling and respiratory and cardiovascular factors influencing cerebral hemodynamics. Consequently, we review investigations of cerebral blood flow disturbances relevant to various hemodynamic states associated with high intracranial pressure, cerebral embolism, and cerebral vasospasm along with current treatment options. PMID:24355179

  15. Reversible coma and Duret hemorrhage after intracranial hypotension from remote lumbar spine surgery: case report.

    PubMed

    Bonow, Robert H; Bales, James W; Morton, Ryan P; Levitt, Michael R; Zhang, Fangyi

    2016-03-01

    Intracranial hypotension is a rare condition caused by spontaneous or iatrogenic CSF leaks that alter normal CSF dynamics. Symptoms range from mild headaches to transtentorial herniation, coma, and death. Duret hemorrhages have been reported to occur in some patients with this condition and are traditionally believed to be associated with a poor neurological outcome. A 73-year-old man with a remote history of spinal fusion presented with syncope and was found to have small subdural hematomas on head CT studies. He was managed nonoperatively and discharged with a Glasgow Coma Scale score of 15, only to return 3 days later with obtundation, fixed downward gaze, anisocoria, and absent cranial nerve reflexes. A CT scan showed Duret hemorrhages and subtle enlargement of the subdural hematomas, though the hematomas remained too small to account for his poor clinical condition. Magnetic resonance imaging of the spine revealed a large lumbar pseudomeningocele in the area of prior fusion. His condition dramatically improved when he was placed in the Trendelenburg position and underwent repair of the pseudomeningocele. He was kept flat for 7 days and was ultimately discharged in good condition. On long-term follow-up, his only identifiable deficit was diplopia due to an internuclear ophthalmoplegia. Intracranial hypotension is a rare condition that can cause profound morbidity, including tonsillar herniation and brainstem hemorrhage. With proper identification and treatment of the CSF leak, patients can make functional recoveries. PMID:26588496

  16. Intracranial complications of Serratia marcescens infection in neonates.

    PubMed

    Madide, Ayanda; Smith, Johan

    2016-01-01

    Even though Serratia marcescens is not one of the most common causes of infection in neonates, it is associated with grave morbidity andmortality. We describe the evolution of brain parenchymal affectation observed in association with S. marcescens infection in neonates. Thisretrospective case series details brain ultrasound findings of five neonates with hospital-acquired S. marcescens infection. Neonatal S. marcescensinfection with or without associated meningitis can be complicated by brain parenchymal affectation, leading to cerebral abscess formation. Itis recommended that all neonates with this infection should undergo neuro-imaging more than once before discharge from hospital; this canbe achieved using bedside ultrasonography. PMID:27032843

  17. Remote intracranial hemorrhage following surgery for giant orbitofrontal growing skull fracture: A lesson learnt.

    PubMed

    Baldawa, Sachin

    2016-01-01

    Growing skull fracture is an extremely rare complication of pediatric head injury, especially in infants. Repair of the dural tear early in the course of development of growing skull fracture has been suggested for a better outcome. Surgical repair of large, tense growing skull fractures, especially those in the communication of the ventricles can lead to potentially life-threatening complications. The author reports a rare case of remote intracranial hemorrhage following surgery for large, tense growing skull fracture in a 12-year-old girl and discusses the likely pathogenesis and possible ways to avoid this life-threatening complication. PMID:27606019

  18. Remote intracranial hemorrhage following surgery for giant orbitofrontal growing skull fracture: A lesson learnt

    PubMed Central

    Baldawa, Sachin

    2016-01-01

    Growing skull fracture is an extremely rare complication of pediatric head injury, especially in infants. Repair of the dural tear early in the course of development of growing skull fracture has been suggested for a better outcome. Surgical repair of large, tense growing skull fractures, especially those in the communication of the ventricles can lead to potentially life-threatening complications. The author reports a rare case of remote intracranial hemorrhage following surgery for large, tense growing skull fracture in a 12-year-old girl and discusses the likely pathogenesis and possible ways to avoid this life-threatening complication. PMID:27606019

  19. Two pediatric cases of variant neurogenic stress cardiomyopathy after intracranial hemorrhage.

    PubMed

    Wittekind, Samuel G; Yanay, Ofer; Johnson, Erin M; Gibbons, Edward F

    2014-10-01

    Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy, is an acquired form of left ventricular systolic dysfunction seen in the setting of physiologic stress and the absence of coronary artery disease. It is thought to be caused by excessive sympathetic stimulation. It is well described in the adult literature associated with subarachnoid hemorrhage where it is known as neurogenic stress cardiomyopathy (NSC), but few such pediatric cases have been reported. We describe our experience with 2 children (13- and 10-year-old girls) who presented with spontaneous intracranial hemorrhage followed by pulmonary edema and shock. Echocardiography revealed similar patterns of left ventricular wall motion abnormalities consistent with NSC, inverted Takotsubo variant. One child progressed to death, whereas the other made a remarkable recovery, including significant improvement in cardiac function over the course of 1 week. We argue that at least 1 of these cases represents true stress-induced cardiomyopathy. This report will alert pediatricians to this transient cardiomyopathy that is likely underdiagnosed in pediatric intensive care. We also highlight the challenges of managing both shock and elevated intracranial pressure in the setting of NSC. PMID:25201800

  20. Initial evaluation of the intracranial pressure in cases of traumatic brain injury without hemorrhage.

    PubMed

    Bekerman, Inessa; Sigal, Tal; Kimiagar, Itzhak; Vaiman, Michael

    2016-09-15

    Our objective was to apply the technique of measuring diameters of optic nerve sheath (ONSD) for the intracranial pressure assessment for the cases with traumatic head injury without hemorrhage. In a retrospective study, CT data of 720 adult patients were collected and analyzed. ONSDs were measured at the point where the ophthalmic artery crosses the optic nerve (anatomical landmark) together with the eyeball transverse diameter (ETD). The ONSD/ETD index was calculated. The correlation analysis was performed with gender, age, the Glasgow Coma Scale score, and the Glasgow Outcome Score. ONSD was enlarged in 82% cases (n=591). Enlarged right/left ONSDs were 6.7±1.0/6.7±0.9mm (cut-off value˃5.5mm). ONSD/ETD ratio was 0.28±0.05 against 0.19±0.02 in healthy adults (p=0.02). We did not find correlation between ONSD/ETD ratio with initial Glasgow Coma Scale score but there was an inverse correlation between ONSD/ETD ratio and the Glasgow Outcome Score (r=-0.64). We conclude that in majority of cases with traumatic head injury without hemorrhage the ONSD is significantly enlarged indicating elevated intracranial pressure even if CT scans are negative. PMID:27538650

  1. Evidence of ventricular contamination of the optical signal in preterm neonates with post hemorrhagic ventricle dilation

    NASA Astrophysics Data System (ADS)

    Kishimoto, J.; Diop, M.; McLachlan, P.; de Ribaupierre, S.; Lee, D. S. C.; St. Lawrence, K.

    2015-03-01

    Dilation of the cerebral ventricles is a common condition in preterm neonates with intraventricular hemorrhage (IVH). This post hemorrhagic ventricle dilation (PHVD) can lead to lifelong neurological impairment through ischemic injury due to increased intracranial pressure (ICP). Interventions, such as ventricular tapping to remove cerebrospinal fluid (CSF), are used to prevent injury, but determining the optimal time for treatment is difficult as clinical signs of increased ICP lack sensitivity. There is a growing interest in using near-infrared spectroscopy (NIRS) because of its ability to monitor cerebral oxygen saturation (StO2) at the bedside. However, the accuracy of NIRS may be affected by signal contamination from enlarged ventricles, especially if there are blood breakdown products (bbp) in CSF following IVH. To investigate this, serial NIR spectra from the head and from CSF samples were acquired over a month from seven IVH patients undergoing treatment for PHVD. Over time, the visual appearance of the CSF samples progressed from dark brown ("tea color") to clear yellow, reflecting the reduction in bbp concentration as confirmed by the stronger absorption around 760 nm at the earlier time points. All CSF samples contained strong absorption at 960 nm due to water. More importantly the same trend in these absorption features was observed in the in vivo spectra, and Monte Carlo simulations confirmed the potential for signal contamination from enlarged ventricles. These findings highlight the challenges of accurately measuring StO2 in this patient population and the necessity of using a hyperspectral NIRS system to resolve the additional chromophores.

  2. Neonatal Brain Hemorrhage (NBH) of Prematurity: Translational Mechanisms of the Vascular-Neural Network

    PubMed Central

    Lekic, Tim; Klebe, Damon; Poblete, Roy; Krafft, Paul R.; Rolland, William B.; Tang, Jiping; Zhang, John H.

    2015-01-01

    Neonatal brain hemorrhage (NBH) of prematurity is an unfortunate consequence of preterm birth. Complications result in shunt dependence and long-term structural changes such as post-hemorrhagic hydrocephalus, periventricular leukomalacia, gliosis, and neurological dysfunction. Several animal models are available to study this condition, and many basic mechanisms, etiological factors, and outcome consequences, are becoming understood. NBH is an important clinical condition, of which treatment may potentially circumvent shunt complication, and improve functional recovery (cerebral palsy, and cognitive impairments). This review highlights key pathophysiological findings of the neonatal vascular-neural network in the context of molecular mechanisms targeting the post-hemorrhagic hydrocephalus affecting this vulnerable infant population. PMID:25620100

  3. Foetal and neonatal intracranial haemorrhage in term newborn infants: Hacettepe University experience.

    PubMed

    Tavil, Betül; Korkmaz, Ayşe; Bayhan, Turan; Aytaç, Selin; Unal, Sule; Kuskonmaz, Baris; Yigit, Sule; Cetin, Mualla; Yurdakök, Murat; Gumruk, Fatma

    2016-03-01

    In this study, we aimed to evaluate the incidence, risk factors, causes and clinical management of intracranial haemorrhage (ICH) diagnosed during foetal life or in the first month of life in term neonates with a discussion of the role of haematological risk factors. This study included term neonates (gestational age 37-42 weeks) with ICH diagnosed, treated and followed up in the Neonatal Intensive Care Unit of Hacettepe University, Ankara, Turkey, between January 1994 and January 2014. Medical follow-up was obtained retrospectively from hospital files and prospectively from telephonic interviews and/or clinical visits. During the study period, 16 term neonates were identified as having ICH in our hospital. In six (37.5%) neonates, ICH was diagnosed during foetal life by obstetric ultrasonography, and in 10 (62.5%) neonates, it has been diagnosed after birth. Haemorrhage types included intraventricular haemorrhage (IVH) in eight (50.0%), intraparenchymal haemorrhage in six (37.5%), subarachnoid haemorrhage in one (6.2%) and subdural haemorrhage in one (6.2%) neonate. IVH was the most common (n = 5/6, 83.3%) haemorrhage type among neonates diagnosed during foetal life. Overall, haemorrhage severity was determined as mild in three (18.7%) neonates, moderate in three (18.75%) neonates and severe in 10 (62.5%) neonates. During follow-up, one infant was diagnosed as afibrinogenemia, one diagnosed as infantile spasm, one cystic fibrosis, one orofaciodigital syndrome and the other diagnosed as Friedrich ataxia. Detailed haematological investigation and search for other underlying diseases are very important to identify the reason of ICH in term neonates. Furthermore, early diagnosis, close monitoring and prompt surgical interventions are significant factors to reduce disabilities. PMID:26829281

  4. Increased Risk of Post-Thrombolysis Intracranial Hemorrhage in Acute Ischemic Stroke Patients with Leukoaraiosis: A Meta-Analysis

    PubMed Central

    Lin, Qianqian; Li, Zhong; Wei, Rui; Lei, Qingfeng; Liu, Yunyun; Cai, Xiaodong

    2016-01-01

    Background Leukoaraiosis is common in patients with acute ischemic stroke. The results from many studies investigating the association between leukoaraiosis and intracranial hemorrhage after thrombolysis remain conflicting. Methods A meta-analysis was performed to compare the risk of post-thrombolytic intracranial hemorrhage in patients with and without leukoaraiosis. Relevant reports were identified by searching PubMed, EmBase, Cochrane Library, and ISI Web of Science through December 2015 using a combination of subjective and random terms. Eligible studies that were original articles with a clear definition of leukoaraiosis and intracranial hemorrhage were selected and analyzed. Funnel plots, Egger’s test, and Begg’s test were conducted to assess the publication bias. Sensitivity analysis was also performed to evaluate the influence of each individual study. Results Eleven trials that enrolled 6912 participants were included. There was a significantly increased risk for acute ischemic stroke patients with leukoaraiosis (odds ratio: 1.89, 95% confidence interval 1.51–2.37, P<0.001). Low heterogeneity and less publication bias was detected among these studies. The results of both computed tomography and magnetic resonance imaging performed on the subgroups of leukoaraiosis were significant. Furthermore, an association between leukoaraiosis and symptomatic intracranial hemorrhage was also confirmed. The odds ratios remained stable with no obvious variations on the sensitivity analysis. The limitations consisted of types of including trials and not matching some baseline variables. Conclusions The results of this meta-analysis show that leukoaraiosis approximately doubles the incidence of intracranial hemorrhage after thrombolytic therapy. However, it does not critically affect decision making regarding thrombolysis for patients with acute ischemic stroke. Additional investigations are required. PMID:27096292

  5. Splenic rupture and intracranial haemorrhage in a haemophilic neonate: case report and literature review.

    PubMed

    Adamu, Ibrahim; Asarian, Armand; Xiao, Philip

    2012-01-01

    Splenic rupture and intracranial haemorrhage are life-threatening conditions infrequently encountered in neonates without history of birth trauma. External manifestations of birth trauma; namely, capput succadeneum and cephalhematoma, when present raise suspicions for more serious intracranial or visceral damage. Rupture of normal spleen without an obvious source of trauma in haemophilic neonate is a rare event. The concurrence of both conditions and the unusual presentation make this case a rare one that is seldom encountered in the literature. Additionally, when splenic rupture occurs, the consensus is to employ all non-operative techniques aimed at salvaging the spleen, thus avoiding the immune-compromised state associated with splenectomy. However, in this case, we present a 3-day-old male with family history of haemophilia A, who was diagnosed with splenic rupture and bilateral subdural haematomas and underwent splenectomy, albeit with post-operative complications, in light of haemodynamic instability and high ongoing transfusion requirements. PMID:22878771

  6. [Intracranial hemorrhage in an infant due to vitamin K deficiency --successful management of spontaneous intracerebral and subjural hematoma].

    PubMed

    Shirai, S; Owada, M; Fujita, Y; Akimoto, M; Hayashi, M

    1976-12-01

    A one-month-old male infant with spontaneous intracerebral and subdural hematomas due to vitamin K deficiency was described. He was breastfed. Loose stools continued and began to contain blood. He had fever, vomiting and convulsion, and became drowsy. The blood studies showed anemia and hypoprothrombinemia. Left carotid angiograms revealed intracerebral and subdural hematomas. He was treated successfully by immediate operation and administration of vitamin K. 2) Vitamin K deficient hemorrhage beyond the immediate newborn period was discussed with reference in the literature. Three etiologic factors included, decreased vitamin K intake, decreased intestinal absorption of vitamin K and decreased production of vitamin K by colon bacteria. The most important factor of the three seemed to be low vitamin K intake. Intracranial hemorrhage was recognized in about one third of the cases in the literature. It was emphasized that vitamin K deficiency occurring beyond the immediate newborn period was very important as a cause of intracranial hemorrhage in infancy. PMID:1036036

  7. Intracranial hemorrhage during aeromedical transport and correlation with high altitude adaptations in the brain.

    PubMed

    Kouliev, Timur; Richardson, Airron; Glushak, Cai

    2012-01-01

    Aeromedical transport is challenging not only because of limitations of equipment, unfamiliar surroundings, and challenging environmental conditions, but also due to difficulty in developing methodologies for research and data collection. To our knowledge, neurological changes at the oxygen tensions of a pressurized cabin have not been systematically studied. Here we report a case of intracranial hemorrhage during aeromedical transport and review the body's cardiovascular and respiratory adaptation to decreased ambient oxygen tension. Previous experience with high altitude cerebral edema serves as guidance for mitigating the effects of vasogenic edema in patients at risk of neurological events who travel by air. Review of this case and relevant altitude-related physiological changes may be grounds for more conservative recommendations on aeromedical transport after an acute neurological event. PMID:27147866

  8. Reversal Strategies for Intracranial Hemorrhages in Patients Taking Oral Factor Xa Inhibitors.

    PubMed

    Karli, Betsy; Bartel, Billie; Pavelko, Rachel

    2015-07-01

    Factor Xa (fXa) inhibitors are becoming more common in clinical practice due to a variety of reasons. Unfortunately, limited data are currently available on the safe and efficacious reversal of these agents. This series presents 3 patient cases of intracranial hemorrhage and illustrates the observed effect of different methodologies undertaken in an attempt to reverse the fXa inhibitors implicated. Additionally, a brief review of the current available literature in reversal strategies is provided. The appropriate reversal for fXa inhibitors at this time is unknown. The cases described indicate that the administration of fresh frozen plasma and 4-factor prothrombin complex concentrate may provide minimal benefit in reversing the coagulation abnormalities caused by fXa inhibitors. However, in a life-threatening situation, the addition of these agents should be considered to prevent further progression of the bleed. PMID:26448667

  9. Reversal Strategies for Intracranial Hemorrhages in Patients Taking Oral Factor Xa Inhibitors

    PubMed Central

    Bartel, Billie; Pavelko, Rachel

    2015-01-01

    Factor Xa (fXa) inhibitors are becoming more common in clinical practice due to a variety of reasons. Unfortunately, limited data are currently available on the safe and efficacious reversal of these agents. This series presents 3 patient cases of intracranial hemorrhage and illustrates the observed effect of different methodologies undertaken in an attempt to reverse the fXa inhibitors implicated. Additionally, a brief review of the current available literature in reversal strategies is provided. The appropriate reversal for fXa inhibitors at this time is unknown. The cases described indicate that the administration of fresh frozen plasma and 4-factor prothrombin complex concentrate may provide minimal benefit in reversing the coagulation abnormalities caused by fXa inhibitors. However, in a life-threatening situation, the addition of these agents should be considered to prevent further progression of the bleed. PMID:26448667

  10. 3D ultrasound system to investigate intraventricular hemorrhage in preterm neonates

    NASA Astrophysics Data System (ADS)

    Kishimoto, J.; de Ribaupierre, S.; Lee, D. S. C.; Mehta, R.; St. Lawrence, K.; Fenster, A.

    2013-11-01

    Intraventricular hemorrhage (IVH) is a common disorder among preterm neonates that is routinely diagnosed and monitored by 2D cranial ultrasound (US). The cerebral ventricles of patients with IVH often have a period of ventricular dilation (ventriculomegaly). This initial increase in ventricle size can either spontaneously resolve, which often shows clinically as a period of stabilization in ventricle size and eventual decline back towards a more normal size, or progressive ventricular dilation that does not stabilize and which may require interventional therapy to reduce symptoms relating to increased intracranial pressure. To improve the characterization of ventricle dilation, we developed a 3D US imaging system that can be used with a conventional clinical US scanner to image the ventricular system of preterm neonates at risk of ventriculomegaly. A motorized transducer housing was designed specifically for hand-held use inside an incubator using a transducer commonly used for cranial 2D US scans. This system was validated using geometric phantoms, US/MRI compatible ventricle volume phantoms, and patient images to determine 3D reconstruction accuracy and inter- and intra-observer volume estimation variability. 3D US geometric reconstruction was found to be accurate with an error of <0.2%. Measured volumes of a US/MRI compatible ventricle-like phantom were within 5% of gold standard water displacement measurements. Intra-class correlation for the three observers was 0.97, showing very high agreement between observers. The coefficient of variation was between 1.8-6.3% for repeated segmentations of the same patient. The minimum detectable difference was calculated to be 0.63 cm3 for a single observer. Results from ANOVA for three observers segmenting three patients of IVH grade II did not show any significant differences (p > 0.05) for the measured ventricle volumes between observers. This 3D US system can reliably produce 3D US images of the neonatal ventricular

  11. Successfully Treated Isolated Posterior Spinal Artery Aneurysm Causing Intracranial Subarachnoid Hemorrhage: Case Report

    PubMed Central

    HORIO, Yoshinobu; KATSUTA, Toshiro; SAMURA, Kazuhiro; WAKUTA, Naoki; FUKUDA, Kenji; HIGASHI, Toshio; INOUE, Tooru

    2015-01-01

    There are very few published reports of rupture of an isolated posterior spinal artery (PSA) aneurysm, and consequently the optimal therapeutic strategy is debatable. An 84-year-old man presented with sudden onset of restlessness and disorientation. Neuroradiological imaging showed an intracranial subarachnoid hemorrhage (SAH) with no visible intracranial vascular lesion. Spinal magnetic resonance imaging (MRI) detected a localized subarachnoid hematoma at Th10–11. Both contrast-enhanced spinal computed tomography and enhanced MRI and magnetic resonance angiography revealed an area of enhancement within the hematoma. Superselective angiography of the left Th12 intercostal artery demonstrated a faintly enhanced spot in the venous phase. Thirteen days after the onset of symptoms, a small fusiform aneurysm situated on the radiculopial artery was resected. The patient's postoperative course was uneventful and he was eventually discharged in an ambulatory condition. To our knowledge, this 84-year-old man is the oldest reported case of surgical management of a ruptured isolated PSA aneurysm. This case illustrates both the validity and efficacy of this therapeutic approach. PMID:26522607

  12. Anosognosia for hemiplegia with preserved awareness of complete cortical blindness following intracranial hemorrhage.

    PubMed

    Prigatano, George P; Matthes, Jessica; Hill, Stacy W; Wolf, Thomas R; Heiserman, Joseph E

    2011-01-01

    A 51-year-old woman presented with anosognosia for hemiplegia (AHP), neglect, and a complete loss of vision, for which she was almost immediately aware. Neuroimaging studies revealed intracranial hemorrhages in the medial temporal lobes bilaterally, extending back to the occipital cortex, but sparing the calcarine cortex. A large right frontal-parietal hemorrhage which extended to the posterior body of the corpus callosum was also observed. The patient's vision slowly improved, and by 11 months post onset, formal visual fields revealed improvement primarily in the left upper quadrants only. In contrast, resolution of her AHP occurred between the 26th and 31st day post onset. Awareness of motor impairment was correlated with her ability to initiate finger tapping in her left hemiplegic/paretic hand. During the time she was unaware of her motor deficits but aware of her visual impairments, her dreams did not reflect concerns over visual or motor limitations. The findings support a "modular" theory of anosognosia. PMID:21194684

  13. Intraventricular Hemorrhage in a Term Neonate: Manifestation of Protein S Deficiency- A Case Report

    PubMed Central

    SAHRIARIAN, Shahriar; AKBARI, Parvin; AMINI, Elahe; DALILI, Hosein; ESMAEILNIA SHRIVANY, Tahereh; NIKNAFS, Nikoo; SHARIAT, Mamak; GHORBAN SABAGH, Vafa

    2016-01-01

    Protein S (PS) is an antithrombotic plasma protein that plays essential roles in limiting thrombus formation in the anticoagulant system. Protein S deficiency is related with recurrent thrombosis. Here, the authors report a case of a term neonate with severe PS deficiency in year 2015, Imam Hospital, Tehran, Iran, that had seizures and intraventricular hemorrhage (IVH) since the age of 3 days. Nine-month follow-up did not show any developmental problems and MRI showed no hemorrhage. PMID:27252923

  14. Reversal of warfarin associated coagulopathy with 4-factor prothrombin complex concentrate in traumatic brain injury and intracranial hemorrhage.

    PubMed

    Yanamadala, Vijay; Walcott, Brian P; Fecci, Peter E; Rozman, Peter; Kumar, Jay I; Nahed, Brian V; Swearingen, Brooke

    2014-11-01

    Warfarin-associated intracranial hemorrhage is associated with a high mortality rate. Ongoing coagulopathy increases the likelihood of hematoma expansion and can result in catastrophic hemorrhage if surgery is performed without reversal. The current standard of care for emergency reversal of warfarin is with fresh frozen plasma (FFP). In April 2013, the USA Food and Drug Administration approved a new reversal agent, 4-factor prothrombin complex concentrate (PCC), which has the potential to more rapidly correct coagulopathy. We sought to determine the feasibility and outcomes of using PCC for neurosurgical patients. A prospective, observational study of all patients undergoing coagulopathy reversal for intracranial hemorrhage from April 2013 to December 2013 at a single, tertiary care center was undertaken. Thirty three patients underwent emergent reversal of coagulopathy using either FFP or PCC at the discretion of the treating physician. Intracranial hemorrhage included subdural hematoma, intraparenchymal hematoma, and subarachnoid hemorrhage. FFP was used in 28 patients and PCC was used in five patients. International normalized ratio at presentation was similar between groups (FFP 2.9, PCC 3.1, p=0.89). The time to reversal was significantly shorter in the PCC group (FFP 256 minutes, PCC 65 minutes, p<0.05). When operations were performed, the time delay to perform operations was also significantly shorter in the PCC group (FFP 307 minutes, PCC 159 minutes, p<0.05). In this preliminary experience, PCC appears to provide a rapid reversal of coagulopathy. Normalization of coagulation parameters may prevent further intracranial hematoma expansion and facilitate rapid surgical evacuation, thereby improving neurological outcomes. PMID:24953825

  15. Rodent neonatal germinal matrix hemorrhage mimics the human brain injury, neurological consequences, and post-hemorrhagic hydrocephalus

    PubMed Central

    Lekic, Tim; Manaenko, Anatol; Rolland, William; Krafft, Paul R.; Peters, Regina; Hartman, Richard E.; Altay, Orhan; Tang, Jiping; Zhang, John H.

    2012-01-01

    Germinal matrix hemorrhage (GMH) is the most common neurological disease of premature newborns. GMH causes neurological sequelae such as cerebral palsy, post-hemorrhagic hydrocephalus, and mental retardation. Despite this, there is no standardized animal model of spontaneous GMH using newborn rats to depict the condition. We asked whether stereotactic injection of collagenase type VII (0.3 U) into the ganglionic eminence of neonatal rats would reproduce the acute brain injury, gliosis, hydrocephalus, periventricular leukomalacia, and attendant neurological consequences found in humans. To test this hypothesis, we used our neonatal rat model of collagenase-induced GMH in P7 pups, and found that the levels of free-radical adducts (nitrotyrosine and 4-hyroxynonenal), proliferation (mammalian target of rapamycin), inflammation (COX-2), blood components (hemoglobin and thrombin), and gliosis (vitronectin and GFAP) were higher in the forebrain of GMH pups, than in controls. Neurobehavioral testing showed that pups with GMH had developmental delay, and the juvenile animals had significant cognitive and motor disability, suggesting clinical relevance of the model. There was also evidence of white-matter reduction, ventricular dilation, and brain atrophy in the GMH animals. This study highlights an instructive animal model of the neurological consequences after germinal matrix hemorrhage, with evidence of brain injuries that can be used to evaluate strategies in the prevention and treatment of post-hemorrhagic complications. PMID:22524990

  16. Microcatheter Contrast Injections during Intra-Arterial Thrombolysis May Increase Intracranial Hemorrhage Risk

    PubMed Central

    Khatri, Pooja; Broderick, Joseph P; Khoury, Jane C; Carrozzella, Janice A; Tomsick, Thomas A

    2008-01-01

    BACKGROUND: During intra-arterial(IA) revascularization, either guide catheter injections of contrast in the neck or microcatheter contrast injections (MCIs) at or beyond the site of an occlusion, can be used to visualize intracranial vasculature. Neurointerventionalists vary widely in their use of MCIs for a given circumstance. We tested the hypothesis that MCIs are a risk factor for intracranial hemorrhage (ICH) in the Interventional Management of Stroke (IMS) I and II trials of combined IV/IA rt-PA therapy. METHODS: All arteriograms with M1, M2, and ICA terminus occlusions were reanalyzed (n=98). The number of MCIs within or distal to the target occlusion was assigned. Post-procedure CTs were reviewed for CEx and ICH. CEx was defined as a hyperdensity suggestive of contrast (Hounsfield unit>90) seen at 24 hours, or present prior to 24 hours and persisting or replaced by ICH at 24 hours. RESULTS: In this IMS subset, the rate of any ICH was 58% (57/98). More MCIs were seen in the ICH group (median=2 vs 1; p=0.04). Increased MCIs were associated with higher ICH rates (p=0.03). MCIs remained associated with ICH in multivariable analysis (p=0.01), as did baseline CT edema/mass effect, atrial fibrillation, time to IV rt-PA initiation, and TICI reperfusion score. MCIs were also associated with CEx in unadjusted and adjusted analyses. CONCLUSIONS: MCIs may risk ICH in the setting of combined IV/IA rt-PA therapy, possibly due to contrast toxicity or pressure transmission by injections. MCIs should be minimized whenever possible. These findings will be tested prospectively in the IMS III trial. PMID:18772441

  17. Delayed hemorrhagic complications after flow diversion for intracranial aneurysms: a literature overview

    PubMed Central

    Rouchaud, Aymeric; Brinjikji, Waleed; Lanzino, Giuseppe; Cloft, Harry J.; Kadirvel, Ramanthan; Kallmes, David F.

    2016-01-01

    Background Delayed aneurysm rupture and delayed intraparenchymal hemorrhages (DIPH) are poorly understood and often fatal complications of flow diversion (FD) for intracranial aneurysms. The purpose of this study was to identify risk factors for these complications. Materials and Methods We performed a systematic review on post-FD delayed aneurysm rupture and DIPH. For each reported case we collected the following information: aneurysm location, size and rupture status, type of flow-diverter used, timing of the hemorrhage, and neurological outcome. We reported descriptive statistics of patients suffering DIPH and delayed aneurysm rupture to determine if there were any characteristics consistently present among patients with these complications. Results We identified 81 delayed aneurysms ruptures and 101 DIPH. 76.6% (45/58) of the delayed ruptures occurred within one month. The prognosis of delayed ruptures was poor, with 81.3% (61/75) experiencing death or poor neurological outcome. Giant aneurysms accounted for 46.3% of ruptures (31/67). 80.9% (55/68) of these aneurysms were initially unruptured. 17.8% (13/73) of the delayed ruptured aneurysms had prior or concomitant coiling. DIPHs were ipsilateral to the treated aneurysm in 82.2% (60/73) of cases. 86.0% (43/50) of the DIPH occurred within one month after FDS. Combined morbidity/mortality rate was 68.5% (50/73 following DIPH. 23.0% of DIPHs (14/61) occurred in patients with giant aneurysms. Conclusions Our study demonstrates that giant aneurysms represent almost 50% of delayed aneurysm ruptures in the flow-diverter literature. About 20% of delayed ruptures occurred despite associated coiling. A substantial proportion of DIPHs occur early following FDS treatment of giant aneurysms. PMID:26553302

  18. Regularization design for high-quality cone-beam CT of intracranial hemorrhage using statistical reconstruction

    NASA Astrophysics Data System (ADS)

    Dang, H.; Stayman, J. W.; Xu, J.; Sisniega, A.; Zbijewski, W.; Wang, X.; Foos, D. H.; Aygun, N.; Koliatsos, V. E.; Siewerdsen, J. H.

    2016-03-01

    Intracranial hemorrhage (ICH) is associated with pathologies such as hemorrhagic stroke and traumatic brain injury. Multi-detector CT is the current front-line imaging modality for detecting ICH (fresh blood contrast 40-80 HU, down to 1 mm). Flat-panel detector (FPD) cone-beam CT (CBCT) offers a potential alternative with a smaller scanner footprint, greater portability, and lower cost potentially well suited to deployment at the point of care outside standard diagnostic radiology and emergency room settings. Previous studies have suggested reliable detection of ICH down to 3 mm in CBCT using high-fidelity artifact correction and penalized weighted least-squared (PWLS) image reconstruction with a post-artifact-correction noise model. However, ICH reconstructed by traditional image regularization exhibits nonuniform spatial resolution and noise due to interaction between the statistical weights and regularization, which potentially degrades the detectability of ICH. In this work, we propose three regularization methods designed to overcome these challenges. The first two compute spatially varying certainty for uniform spatial resolution and noise, respectively. The third computes spatially varying regularization strength to achieve uniform "detectability," combining both spatial resolution and noise in a manner analogous to a delta-function detection task. Experiments were conducted on a CBCT test-bench, and image quality was evaluated for simulated ICH in different regions of an anthropomorphic head. The first two methods improved the uniformity in spatial resolution and noise compared to traditional regularization. The third exhibited the highest uniformity in detectability among all methods and best overall image quality. The proposed regularization provides a valuable means to achieve uniform image quality in CBCT of ICH and is being incorporated in a CBCT prototype for ICH imaging.

  19. Mortality and functional disability after spontaneous intracranial hemorrhage: the predictive impact of overall admission factors.

    PubMed

    Mansouri, Behnam; Heidari, Kamran; Asadollahi, Shadi; Nazari, Maryam; Assarzadegan, Farhad; Amini, Afshin

    2013-11-01

    To determine the effects of different prognostic factors, including previous antiplatelet therapy, admission data, and radiographic findings on discharge and 3-month neurological condition using modified Rankin scale (mRS) and mortality at 30 days and 3-month follow-up in patients presenting to the emergency department with spontaneous intracranial hemorrhage (sICH). Between January and July 2012, 120 consecutive patients (males 62%, females 38%), who were admitted within 48 h of symptoms onset, were included. We recorded the following data on admission: demographics; functional scores of ICH, Glasgow Coma Scale, and National Institutes of Health Stroke Scale; vital signs; smoking status; use of illicit drug; preadmission antiplatelet treatment; results of laboratory tests (platelet count, serum glucose, sodium and creatinine levels, and prothrombin time); and primary neuroimaging findings [intraventricular hemorrhage (IVH), midline shift, and hydrocephalus]. In multivariate analysis using adjusted model for demographics and prior antiplatelet therapy; functional scores, laboratory results, and diabetes history correlated with mortality during 30 days after the event. Moreover, the parameters on the initial computed tomography scan significantly increased 30-day fatality rate and was correlated with increase in the discharge mRS score of survivors. The odds ratio (OR) and 95% confidence interval (CI) of early mortality associated with IVH presentation was 2.34 (CI 1.76-3.02, p = 0.003). The corresponding ORs in those with midline shift displacement and hydrocephalus were 2.18 (95% CI 2.08-3.80, p = 0.01) and 1.62 (95% CI 1.01-2.63, p = 0.02), respectively. In patients with ICH, prognostic factors, include various clinical parameters and paraclinical findings of admission time. PMID:23543380

  20. Anticoagulation Reversal Strategies for Left Ventricular Assist Device Patients Presenting with Acute Intracranial Hemorrhage.

    PubMed

    Wong, Joshua K; Chen, Peter C; Falvey, Jennifer; Melvin, Amber L; Lidder, Alcina K; Lowenstein, Lisa M; Miranpuri, Amrendra S; Knight, Peter A; Massey, H Todd

    2016-01-01

    The safety of alternative vitamin K antagonist (VKA) reversal strategies in patients with left ventricular assist devices (LVAD's) who present with intracranial hemorrhage (ICH) are not well known. A review of LVAD patients with ICH from May 2008 to 2015 was conducted, comparing the safety and efficacy of 4-factor prothrombin complex concentrate-assisted VKA reversal (4F-PCC group, n = 10) to reversal with traditional agents alone (no-PCC group, n = 10). An analysis of a no-reversal strategy in selected patients (n = 11) with ICH was additionally performed. Thirty-one cases of ICH on LVAD support were reviewed. The rate of post reversal thromboembolic events was not significantly different between 4F-PCC and no-PCC patients (0% vs. 10%, p = 1.0); however, the time to VKA reversal was shorter (474 vs. 945 minutes, p = 0.02) and fresh frozen plasma (FFP) requirements lower (1.9 vs. 3.6 units, p = 0.05) in 4F-PCC patients, with no difference in mortality between groups (p = 1.0). Eleven patients (mean ICH volume: 0.4 cm) were successfully managed without active VKA reversal, with no increased hemorrhage noted on neuroimaging. These results suggest that 4F-PCC-assisted reversal in LVAD patients is safe and may improve the efficacy of VKA reversal. Our findings also indicate that carefully selected patients with small ICH volumes may be safely managed by discontinuing anticoagulation and allowing the international normalized ratio (INR) to normalize physiologically. PMID:27347708

  1. Neurodevelopmental Outcomes of Extremely Low Gestational Age Neonates with Low Grade Periventricular-Intraventricular Hemorrhage

    PubMed Central

    Payne, Allison H.; Hintz, Susan R.; Hibbs, Anna Maria; Walsh, Michele C.; Vohr, Betty R.; Bann, Carla M.; Wilson-Costello, Deanne E.

    2014-01-01

    Objective To compare neurodevelopmental outcomes at 18–22 months corrected age for extremely low gestational age infants with low grade (Grade 1 or 2) periventricular-intraventricular hemorrhage to infants with either no hemorrhage or severe (Grade 3 or 4) hemorrhage on cranial ultrasound. Design Longitudinal observational study Setting Sixteen centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network Participants 1472 infants born at <27 weeks gestational age between 2006–2008 with ultrasound results within the first 28 days of life and surviving to 18–22 months with complete follow-up assessments were eligible. Main Exposure Low grade periventricular-intraventricular hemorrhage Outcome Measures Outcomes included cerebral palsy, gross motor functional limitation, Bayley III cognitive and language scores, and composite measures of neurodevelopmental impairment. Regression modeling evaluated the association of hemorrhage severity with adverse outcomes while controlling for potentially confounding variables and center differences. Results Low grade hemorrhage was not associated with significant differences in unadjusted or adjusted risk of any adverse neurodevelopmental outcome compared to infants without hemorrhage. Compared with low grade hemorrhage, severe hemorrhage was associated with decrease in adjusted continuous cognitive (−3.91, [95% Confidence Interval [CI]: −6.41, −1.42]) and language (−3.19 [−6.19, −0.19]) scores as well as increased odds of each adjusted categorical outcome except severe cognitive impairment (OR: 1.46 [0.74, 2.88]) and mild language impairment (OR: 1.35 [0.88, 2.06]). Conclusion At 18–22 months, the neurodevelopmental outcomes of extremely low gestational age infants with low grade periventricular-intraventricular hemorrhage are not significantly different from those without hemorrhage. PMID:23460139

  2. A case of infectious endocarditis-associated crescentic glomerulonephritis with intracranial hemorrhage.

    PubMed

    Miyata, Eri; Nakayama, Masaru; Amano, Kazushi; Hirano, Tadashi; Uesugi, Noriko

    2010-01-01

    A 55-year-old woman was admitted to our hospital because of fever and renal impairment. The patient had undergone a tooth extraction 11 months prior to admission. Echocardiography demonstrated vegetation on the mitral valve, and Streptococcus mitis was detected on blood culture. Accordingly, infectious endocarditis (IE) was diagnosed. Renal biopsy showed crescentic glomerulonephritis. Based on the negative staining for immunoglobulins and complement components in immunofluorescence study and lack of dense deposits on electron microscopy, the renal involvement was considered to be of the pauci-immune type. Subarachnoid hemorrhage (SAH) and subdural hematoma (SDH) developed simultaneously following commencement of antibiotic therapy. The intracranial involvement improved by conservative therapy. Antibiotic treatment resulted in gradual control of IE infection and improvement of renal function. A repeated renal biopsy, performed about 5 months after the first biopsy, showed amelioration of glomerular injury and interstitial damage. To our knowledge, our case was the second to report simultaneous developments of both SAH and SDH secondary to IE. We postulate that the glomerular injury was associated with IE. We report here a rare case of IE-associated crescentic glomerulonephritis with complications of SAH and SDH. PMID:20155718

  3. Protective Effect of Hydrogen Gas Therapy After Germinal Matrix Hemorrhage in Neonatal Rats

    PubMed Central

    Lekic, Tim; Manaenko, Anatol; Rolland, William; Fathali, Nancy; Peterson, Mathew; Tang, Jiping

    2013-01-01

    Background Germinal matrix hemorrhage (GMH) is a neurological disease of very low birth weight premature infants leading to post-hemorrhagic hydrocephalus, cerebral palsy, and mental retardation. Hydrogen (H2) is a potent antioxidant shown to selectively reverse cytotoxic oxygen-radical injury in the brain. This study investigated the therapeutic effect of hydrogen gas after neonatal GMH injury. Methods Neonatal rats underwent stereotaxic infusion of clostridial collagenase into the right germinal matrix brain region. Cognitive function was assessed at 3 weeks, and then sensorimotor function, cerebral, cardiac and splenic growths were measured 1 week thereafter. Results Hydrogen gas inhalation markedly suppressed mental retardation and cerebral palsy outcomes in rats at the juvenile developmental stage. The administration of H2 gas, early after neonatal GMH, also normalized the brain atrophy, splenomegaly and cardiac hypertrophy 1 month after injury. Conclusion This study supports the role of cytotoxic oxygen-radical injury in early neonatal GMH. Hydrogen gas inhalation is an effective strategy to help protect the infant brain from the post-hemorrhagic consequences of brain atrophy, mental retardation and cerebral palsy. Further studies are necessary to determine the mechanistic basis of these protective effects. PMID:21725762

  4. Automatic identification of intracranial hemorrhage in non-contrast CT with large slice thickness for trauma cases

    NASA Astrophysics Data System (ADS)

    Maduskar, Pragnya; Acharyya, Mausumi

    2009-02-01

    In this paper we propose a technique for automatic detection of intracranial hemorrhage (ICH) and acute intracranial hemorrhage (AIH) in brain Computed Tomography (CT) for trauma cases where no contrast can be applied and the CT has large slice thickness. ICH or AIH comprise of internal bleeding (intra-axial) or external (extra-axial) to the brain substance. Large bleeds like in intra-axial region are easy to diagnose whereas it can be challenging if small bleed occurs in extra-axial region particularly in the absence of contrast. Bleed region needs to be distinguished from bleed-look-alike brain regions which are abnormally bright falx and fresh flowing blood. We propose an algorithm for detection of brain bleed in various anatomical locations. A preprocessing step is performed to segment intracranial contents and enhancement of region of interests(ROIs). A number of bleed and bleed-look-alike candidates are identified from a set of 11 available cases. For each candidate texture based features are extracted from non-separable quincunx wavelet transform along with some other descriptive features. The candidates are randomly divided into a training and test set consisting of both bleed and bleed-look- alike. A supervised classifier is designed based on the training sample features. A performance accuracy of 96% is attained for the independent test candidates.

  5. Occurrence and impact of intracranial pressure elevation during treatment of severe intraventricular hemorrhage

    PubMed Central

    Ziai, Wendy C.; Melnychuk, Eric; Thompson, Carol B.; Awad, Issam; Lane, Karen; Hanley, Daniel F.

    2015-01-01

    Objective Elevated intracranial pressure (ICP) is one of the proposed mechanisms leading to poor outcomes in patients with intraventricular hemorrhage (IVH). We sought to characterize the occurrence and significance of intracranial hypertension in severe IVH requiring extraventricular drainage (EVD). Design Prospective analysis from two randomized multicenter clinical trials. Setting Intensive care units of 23 academic hospitals. Patients One hundred patients with obstructive IVH, and intracerebral hemorrhage (ICH) volume < 30cc requiring emergency EVD from two randomized multicenter studies comparing intraventricular recombinant tissue plasminogen activator (rt-PA) (n=78) to placebo (n=22). Interventions ICP was recorded every 4 hours in all patients and before and after a 1 hr EVD closure period post-injection. ICP readings were analyzed at pre-defined thresholds and compared between treatment groups, pre- and post-injection of study agent, and pre- and post-opening of 3rd and 4th ventricles on CT. Impact on 30 day outcomes was assessed. Measurements and Main Results Initial ICP ranged from −2 to 60 mm Hg (median, interquartile range; 11,10). Of 2576 ICP readings, 91.5% (2359) were ≤ 20 mm Hg, 1.6% were >30, 0.5% were >40, and 0.2% were > 50 mm Hg. In a multivariate analysis threshold events > 20 and > 30 mm Hg were more frequent in placebo vs. rt-PA treated groups (p=0.03 and p=0.08, respectively). ICP elevation > 20 mm Hg occurred during a required 1 hr EVD closure interval in 207/868 (23.8%) injections of study agent although early re-opening of the EVD only occurred in 7.9%. After radiographic opening of the lower ventricular system, ICP events > 20 mmHg remained significantly associated with initial IVH volume (p=0.002), and EVD placement ipsilateral to the largest IVH volume (p=0.001), but not with thrombolytic treatment (p=0.05) or ICH volume (p=0.14). VP shunts were required in 13.6% of Pcb and 6.4% of rt-PA treated patients (p=0.37). Percentage of

  6. Influences of developmental age on the resolution of diffuse traumatic intracranial hemorrhage and axonal injury.

    PubMed

    Weeks, Dianne; Sullivan, Sarah; Kilbaugh, Todd; Smith, Colin; Margulies, Susan S

    2014-01-15

    This study investigated the age-dependent injury response of diffuse traumatic axonal injury (TAI) and regional subdural and subarachnoid intracranial hemorrhage (ICH) in two pediatric age groups using a porcine head injury model. Fifty-five 5-day-old and 40 four-week-old piglets-which developmentally correspond to infants and toddlers, respectively-underwent either a sham injury or a single rapid non-impact rotational injury in the sagittal plane and were grouped by post-TBI survival time (sham, 3-8 h, one day, 3-4 days, and 5-6 days). Both age groups exhibited similar initial levels of ICH and a significant reduction of ICH over time (p<0.0001). However, ICH took longer to resolve in the five-day-old age group. At 5-6 days post-injury, ICH in the cerebrum had returned to sham levels in the four-week-old piglets, while the five-day-olds still had significantly elevated cerebral ICH (p=0.012). Both ages also exhibited similar resolution of axonal injury with a peak in TAI at one day post-injury (p<0.03) and significantly elevated levels even at 5-6 days after the injury (p<0.008), which suggests a window of vulnerability to a second insult at one day post-injury that may extend for a prolonged period of time. However, five-day-old piglets had significantly more TAI than four-week-olds overall (p=0.016), which presents some evidence for an increased vulnerability to brain injury in this age group. These results provide insight into an optimal window for clinical intervention, the period of increased susceptibility to a second injury, and an age dependency in brain injury tolerance within the pediatric population. PMID:23984914

  7. Influences of Developmental Age on the Resolution of Diffuse Traumatic Intracranial Hemorrhage and Axonal Injury

    PubMed Central

    Weeks, Dianne; Sullivan, Sarah; Kilbaugh, Todd; Smith, Colin

    2014-01-01

    Abstract This study investigated the age-dependent injury response of diffuse traumatic axonal injury (TAI) and regional subdural and subarachnoid intracranial hemorrhage (ICH) in two pediatric age groups using a porcine head injury model. Fifty-five 5-day-old and 40 four-week-old piglets—which developmentally correspond to infants and toddlers, respectively—underwent either a sham injury or a single rapid non-impact rotational injury in the sagittal plane and were grouped by post-TBI survival time (sham, 3–8 h, one day, 3–4 days, and 5–6 days). Both age groups exhibited similar initial levels of ICH and a significant reduction of ICH over time (p<0.0001). However, ICH took longer to resolve in the five-day-old age group. At 5–6 days post-injury, ICH in the cerebrum had returned to sham levels in the four-week-old piglets, while the five-day-olds still had significantly elevated cerebral ICH (p=0.012). Both ages also exhibited similar resolution of axonal injury with a peak in TAI at one day post-injury (p<0.03) and significantly elevated levels even at 5–6 days after the injury (p<0.008), which suggests a window of vulnerability to a second insult at one day post-injury that may extend for a prolonged period of time. However, five-day-old piglets had significantly more TAI than four-week-olds overall (p=0.016), which presents some evidence for an increased vulnerability to brain injury in this age group. These results provide insight into an optimal window for clinical intervention, the period of increased susceptibility to a second injury, and an age dependency in brain injury tolerance within the pediatric population. PMID:23984914

  8. Characteristics of Symptomatic Intracranial Hemorrhage in Patients Receiving Non-Vitamin K Antagonist Oral Anticoagulant Therapy

    PubMed Central

    2015-01-01

    Objectives The first non-vitamin K antagonist oral anticoagulant (NOAC) introduced to the market in Japan was dabigatran in March 2011, and three more NOACs, rivaroxaban, apixaban, and edoxaban, have since become available. Randomized controlled trials of NOACs have revealed that intracranial hemorrhage (ICH) occurs less frequently with NOACs compared with warfarin. However, the absolute incidence of ICH associated with NOACs has increased with greater use of these anticoagulants, and we wanted to explore the incidence, clinical characteristics, and treatment course of patients with NOACs-associated ICH. Methods We retrospectively analyzed the characteristics of symptomatic ICH patients receiving NOACs between March 2011 and September 2014. Results ICH occurred in 6 patients (5 men, 1 woman; mean ± SD age, 72.8 ± 3.2 years). Mean time to onset was 146.2 ± 111.5 days after starting NOACs. Five patients received rivaroxaban and 1 patient received apixaban. None received dabigatran or edoxaban. Notably, no hematoma expansion was observed within 24 h of onset in the absence of infusion of fresh frozen plasma, activated prothrombin complex concentrate, recombinant activated factor VIIa or hemodialysis. When NOAC therapy was initiated, mean HAS-BLED and PANWARDS scores were 1.5 ± 0.5 and 39.5 ± 7.7, respectively. Mean systolic blood pressure was 137.8 ± 15.9 mmHg within 1 month before spontaneous ICH onset. Conclusion Six symptomatic ICHs occurred early in NOAC therapy but hematoma volume was small and did not expand in the absence of infusion of reversal agents or hemodialysis. The occurrence of ICH during NOAC therapy is possible even when there is acceptable mean systolic blood pressure control (137.8 ± 15.9 mmHg) and HAS-BLED score ≤ 2. Even stricter blood pressure lowering and control within the acceptable range may be advisable to prevent ICH during NOAC therapy. PMID:26171862

  9. The Utility of Near Infrared Spectroscopy in Detecting Intracranial Hemorrhage in Children

    PubMed Central

    Bell, Michael J.; Kochanek, Patrick M.; Berger, Rachel P.

    2012-01-01

    Abstract A prospective case-control study was conducted in a tertiary care pediatric intensive care unit (PICU) to evaluate the use of near infrared spectroscopy (NIRS) for the detection of intracranial hemorrhage (ICH) in children. Subjects 0–14 years of age who had a computed tomography (CT) scan of the head performed as part of clinical care were eligible for enrollment. The children were stratified into two groups based on whether the CT was normal or abnormal. Children in the abnormal imaging cohort were further divided into those with ICH and those with other abnormalities of the brain parenchyma (contusions, diffuse axonal injury [DAI], or cerebral edema) or fractures. NIRS measurements were performed on all subjects within 24 h of head CT. The NIRS operator was blinded to the presence or absence of ICH. NIRS measurements were performed in eight different scalp locations (four bilaterally). A total of 103 measurements were made. The optical density (OD) was automatically calculated by comparing the reflected and diffused optical signal. A ΔOD>0.2 between hemispheres in any scalp location was considered abnormal. NIRS was performed in a total of 28 subjects: 7 had normal imaging and 21 had abnormal imaging. Of those with abnormal imaging, 12 had ICH. The sensitivity and specificity of NIRS at detecting ICH was 1.0 and 0.8, respectively. The positive and negative predictive values were 0.8 and 1.0, respectively. In conclusion, NIRS correctly identified all cases of ICH in this pilot study. Our preliminary results suggest that NIRS may be beneficial in the evaluation of a child with possible ICH. PMID:22098538

  10. A Pilot Prospective Study of Fetomaternal Hemorrhage Identified by Anemia in Asymptomatic Neonates

    PubMed Central

    Stroustrup, Annemarie; Plafkin, Callie

    2016-01-01

    Background Fetomaternal hemorrhage (FMH) is a poorly understood condition in which fetal erythrocytes transfer to the maternal circulation via a faulty placental barrier. Little is known about the true incidence, epidemiology, or pathophysiology of FMH in the general pregnant population as existing studies are based on retrospective cohorts and manifest diagnosis and selection bias. Objective To evaluate the practicability of a prospective study of fetomaternal hemorrhage in the general population based on antepartum maternal blood testing and neonatal anemia. Study Design Prospective cohort study. Result Nineteen pregnant women were enrolled prior to the term delivery of twenty well infants. Five neonates were unexpectedly anemic on first postnatal testing. Antenatal maternal blood samples associated with 2 of 5 anemic newborns had positive Kleihauer-Betke testing while no newborn with a normal postnatal blood count had an associated abnormal Kleihauer-Betke test. Conclusion Clinically significant FMH may be more common than previously thought. Prospective epidemiological study of FMH is feasible. PMID:26765555

  11. Intraventricular hemorrhage in the preterm neonate: timing and cerebral blood flow changes

    SciTech Connect

    Ment, L.R.; Duncan, C.C.; Ehrenkranz, R.A.; Lange, R.C.; Taylor, K.J.; Kleinman, C.S.; Scott, D.T.; Sivo, J.; Gettner, P.

    1984-03-01

    Serial cranial ultrasound studies, 133xenon inhalation cerebral blood flow determinations, and risk factor analyses were performed in 31 preterm neonates. Contrast echocardiographic studies were additionally performed in 16 of these 31 infants. Sixty-one percent were found to have germinal matrix or intraventricular hemorrhage. Seventy-four percent of all hemorrhages were detected by the thirtieth postnatal hour. The patients were divided into three groups: early GMH/IVH by the sixth postnatal hour (eight infants) interval GMH/IVH from 6 hours through 5 days (10), and no GMH/IVH (12). Cerebral blood flow values at 6 postnatal hours were significantly lower for the early GMH/IVH group than for the no GMH/IVH group (P less than 0.01). Progression of GMH/IVH was observed only in those infants with early hemorrhage, and these infants had a significantly higher incidence of neonatal mortality. Ventriculomegaly as determined by ultrasound studies was noted equally in infants with and without GMH/IVH (50%) and was not found to correlate with low cerebral blood flow. The patients with early hemorrhage were distinguishable by their need for more vigorous resuscitation at the time of birth and significantly higher ventilator settings during the first 36 postnatal hours, during which time they also had higher values of PCO2. An equal incidence of patent ductus arteriosus was found across all of the groups. We propose that early GMH/IVH may be related to perinatal events and that the significant decrease in cerebral blood flow found in infants with early GMH/IVH is secondary to the presence of the hemorrhage itself. Progression of early GMH/IVH and new interval GMH/IVH may be related to later neonatal events known to alter cerebral blood flow.

  12. The Diagnosis, Management and Postnatal Prevention of Intraventricular Hemorrhage in the Preterm Neonate

    PubMed Central

    McCrea, Heather J.; Ment, Laura R.

    2010-01-01

    SYNOPSIS Intraventricular hemorrhage occurs in 20 – 25% of very low birth weight preterm neonates and may be associated with significant short- and long-term sequelae. In the newborn period, infants with IVH are at risk for both post-hemorrhagic hydrocephalus and periventricular leukomalacia, while as many as 75% of those with parenchymal involvement of hemorrhage suffer significant neurodevelopmental disability at follow-up. Because of the persistent prevalence of IVH and the significant medical and societal impact of this disease, numerous postnatal pharmacologic prevention strategies have been explored. These must address both the environmental and genetic causes of this injury to developing brain, and randomized clinical prevention trials should provide long-term neurodevelopmental follow-up to assess the impact of preterm birth, injury and pharmacologic intervention on developing brain. PMID:19026340

  13. Differentiation of low-attenuation intracranial hemorrhage and calcification using dual-energy computed tomography in a phantom system

    PubMed Central

    Nute, Jessica L.; Roux, Lucia Le; Chandler, Adam G.; Baladandayuthapani, Veera; Schellingerhout, Dawid; Cody, Dianna D.

    2015-01-01

    Objectives Calcific and hemorrhagic intracranial lesions with attenuation levels of <100 Hounsfield Units (HU) cannot currently be reliably differentiated by single-energy computed tomography (SECT). The proper differentiation of these lesion types would have a multitude of clinical applications. A phantom model was used to test the ability of dual-energy CT (DECT) to differentiate such lesions. Materials and Methods Agar gel-bound ferric oxide and hydroxyapatite were used to model hemorrhage and calcification, respectively. Gel models were scanned using SECT and DECT and organized into SECT attenuation-matched pairs at 16 attenuation levels between 0 and 100 HU. DECT data were analyzed using 3D Gaussian mixture models (GMMs), as well as a simplified threshold plane metric derived from the 3D GMM, to assign voxels to hemorrhagic or calcific categories. Accuracy was calculated by comparing predicted voxel assignments with actual voxel identities. Results We measured 6,032 voxels from each gel model, for a total of 193,024 data points (16 matched model pairs). Both the 3D GMM and its more clinically implementable threshold plane derivative yielded similar results, with >90% accuracy at matched SECT attenuation levels ≥50 HU. Conclusions Hemorrhagic and calcific lesions with attenuation levels between 50 and 100 HU were differentiable using DECT in a clinically relevant phantom system with >90% accuracy. This method warrants further testing for potential clinical applications. PMID:25162534

  14. Management Overview: Taking a Patient with Intracranial Hemorrhage Related to Direct Oral Anticoagulants to the Operating Room.

    PubMed

    Alturki, Abdulrahman; Alamri, Abdullah; Badawy, Mohamed; Teitelbaum, Jeanne

    2016-06-01

    Options for anticoagulation have been expanding constantly during the past few years, providing a greater number of agents for prevention and management of thromboembolic disease. Although heparins and vitamin K antagonists (VKAs) has been used extensively for many decades, their narrow therapeutic range, interactions with other medications and food, and the need for routine monitoring of blood levels have led to the search for less problematic alternatives. Direct oral anticoagulants represent an important advance in anticoagulation therapy, directly inhibiting thrombin (dabigatran) or factor Xa (rivaroxaban, apixaban) they represent an effective and safe alternatives to VKAs and heparins in the prevention and treatment of several thromboembolic disorders. DOCAs are associated with a low overall intracranial hemorrhage risk; however, life-threatening bleeding can occur. Reversal agents are approved for some and under development for others, concerns over the lack of antidotes or difficulty in obtaining them has tempered enthusiasm for their use because of the perception of better safety with heparins and VKAs as a result of the availability of effective reversal strategies. Appropriate use of these agents requires knowledge of their individual characteristics, mechanisms of action, pharmacokinetics, ways of monitoring, and when needed, manage patients in need of urgent surgery especially in life-threatening bleeds. This article provides a suggested comprehensive approach to manage patients with intracranial hemorrhage while on direct oral anticoagulants who require an urgent surgical intervention and who cannot wait for plasma concentration to decline. PMID:26960279

  15. Prognostic factors of early outcome and discharge status in patients undergoing surgical intervention following traumatic intracranial hemorrhage.

    PubMed

    Fujii, Tatsuhiro; Moriel, Gabriela; Kramer, Daniel R; Attenello, Frank; Zada, Gabriel

    2016-09-01

    Over the past several decades, the rate of traumatic brain injury (TBI)-related emergency room visits in the United States has steadily increased, yet mortality in these patients has decreased. This improvement in outcome is largely due to advances in prehospital care, intensive care unit management, and the effectiveness of neurosurgical procedures, such as decompressive craniectomies. It is imperative to identify clinical factors predictive of patients who benefit from early mobilization of resources and operative treatment. Equally important is the identification of patients with good prognostic signs among patients receiving surgical intervention for TBI. We conducted a retrospective chart review of 181 patients requiring craniectomies and craniotomies for decompression or evacuation of an intracranial hemorrhage following TBI at a single level I trauma center between 2008-2010. Demographic features and perioperative clinical characteristics of these patients were examined in relation to favorable outcomes, defined as discharge to home or a rehabilitation facility, and unfavorable outcomes, defined as in-hospital mortality or discharge to step-down medical facilities. Younger age, greater Glasgow Coma Scale (GCS) score on admission, absence of preoperative coagulopathies, absence of hypernatremia, and absence of fever were all independent predictors of favorable outcome. Additionally, increased operative duration and increased length of hospital stay were identified as independent predictors of negative outcomes after surgery. This work supports some of the current prognostic models in the literature and identifies additional clinical variables with predictive value of early outcome and discharge status in patients undergoing surgical evacuation of traumatic intracranial hemorrhages. PMID:27424129

  16. Adjuvant enoxaparin therapy may decrease the incidence of postoperative thrombotic events though does not increase the incidence of postoperative intracranial hemorrhage in patients with meningiomas.

    PubMed

    Cage, Tene A; Lamborn, Kathleen R; Ware, Marcus L; Frankfurt, Anna; Chakalian, Lenna; Berger, Mitchell S; McDermott, Michael W

    2009-05-01

    Patients with brain tumors including intracranial meningiomas are at increased risk for developing deep vein thrombosis (DVTs) and suffering thromboembolic events (VTEs). Many surgeons are concerned that early use of low dose enoxaparin may increase the risk of intracranial hemorrhage which outweighs the benefit of DVT/VTE reduction. We aimed to address concerns around the use of enoxaparin after meningioma resection in the development of postoperative intracranial hemorrhages and DVT/VTEs. This is a retrospective review of 86 patients with intracranial meningiomas who underwent craniectomy and surgical resection of the mass, treated by one attending surgeon at UCSF Medical Center between 2000 and 2005. Within 48 h after surgery patients treated 2003-2005 routinely received enoxaparin therapy unless there was documented intracranial hemorrhage, lumbar subarachnoid drain, enoxaparin hypersensitivity, or thrombocytopenia (n = 24). These were compared to a cohort treated 2000-2002 who did not receive the drug (n = 62). Exclusion criteria were prior VTEs or coagulopathies. The groups were similar in tumor and surgical characteristics. Enoxaparin therapy did not increase the incidence of intracranial hemorrhage following surgical meningioma resection and the incidence of DVTs/VTEs was 0% (n = 0) versus 4.8% (n = 3) in the non-enoxaparin group. Results did not reach statistical significance. In this retrospective study, postoperative administration of enoxaparin following meningioma resection does not increase the risk of intracranial hematoma though enoxaparin administration may slightly decrease the incidence of post-surgical thromboembolic events. Due to study design and power, we were not able to demonstrate DVT/VTE reduction with statistical significance. PMID:19430892

  17. A Novel Preclinical Model of Germinal Matrix Hemorrhage Using Neonatal Rats

    PubMed Central

    Lekic, Tim; Manaenko, Anatol; Rolland, William; Tang, Jiping

    2013-01-01

    Background Germinal matrix hemorrhage (GMH) is a neurological disorder associated with very low birth weight premature infants. This event can lead to post-hemorrhagic hydrocephalus, cerebral palsy, and mental retardation. This study developed a novel animal model for pre-clinical investigations. Methods Neonatal rats underwent infusion of clostridial collagenase into the right germinal matrix (anterior caudate) region using stereotaxic techniques. Developmental milestones were evaluated over 10 days, cognitive function at 3 weeks, and sensorimotor function at 4 weeks after collagenase infusion. This was accomplished by anthropometric quantifications of cranial, cerebral, cardiac, and splenic growths. Results Collagenase infusion led to delays in neonatal developmental milestones, followed by cognitive and sensorimotor dysfunctions in the juvenile animals. Cranial growth was accelerated during the first week after injury, and this was followed by significant brain atrophy, splenomegaly, and cardiac hypertrophy 3 weeks later. Conclusion This study characterized the developmental delays, mental retardation, and cerebral palsy features resembling the long-term clinical course after germinal matrix hemorrhage in premature infants. Pre-clinical testing of therapeutics in this experimental model could lead to improved patient outcomes while expanding upon the pathophysiological understanding of this disease. PMID:21725732

  18. Gene-environment interactions in severe intraventricular hemorrhage of preterm neonates

    PubMed Central

    Ment, Laura R.; Ådén, Ulrika; Lin, Aiping; Kwon, Soo Hyun; Choi, Murim; Hallman, Mikko; Lifton, Richard P.; Zhang, Heping; Bauer, Charles R.

    2014-01-01

    Intraventricular hemorrhage (IVH) of the preterm neonate is a complex developmental disorder, with contributions from both the environment and the genome. IVH, or hemorrhage into the germinal matrix of the developing brain with secondary periventricular infarction, occurs in that critical period of time before the 32nd – 33rd week post-conception and has been attributed to changes in cerebral blood flow to the immature germinal matrix microvasculature. Emerging data suggest that genes subserving coagulation, inflammatory and vascular pathways, and their interactions with environmental triggers may influence both the incidence and severity of cerebral injury and are the subject of this review. Polymorphisms in the Factor V Leiden gene are associated with the atypical timing of IVH suggesting an as yet unknown environmental trigger. The methylenetetra-hydrofolate reeducates (MTHFR) variants render neonates more vulnerable to cerebral injury in the presence of perinatal hypoxia. The present study demonstrates that the MTHFR 677C>T polymorphism and low 5 minute Apgar score additively increase the risk of IVH. Finally, review of published preclinical data suggests the stressors of delivery result in hemorrhage in the presence of mutations in collagen 4A1 (COL4A1), a major structural protein of the developing cerebral vasculature. Maternal genetics and fetal environment may also play a role. PMID:24192699

  19. In-vivo validation of a novel intracranial hemorrhage detector using microwaves

    NASA Astrophysics Data System (ADS)

    Ling, Geoffrey S. F.; Riechers, Ronald G., Sr.; Riechers, Ronald G., Jr.; Pasala, Krishna M.; Zeidman, Seth M.; Rhee, Peter; Wiesmann, William P.

    1999-07-01

    A novel method for identifying and localizing brain hemorrhage is presented. This method uses electromagnetic waves in the microwave and RF region and a modified algorithm previously used for the estimation of the angle of arrival of radar signals. Results are presented applying this device for detecting epidural and intracerebroventricular hemorrhages in anesthetized pig.

  20. Diagnosis of subdural and intraparenchymal intracranial hemorrhage using a microwave-based detector

    NASA Astrophysics Data System (ADS)

    Ling, Geoffrey S. F.; Riechers, Ronald G., Sr.; Pasala, Krishna M.; Blanchard, Jeremy; Rosner, Michael; Day, Keith; Garcia-Pinto, Patricia; Song, Ki-Il; Yun, Catherine; Rawie, Eric; Davis, Jessica; Scott, Joshua; Loh, Yince; Crommett, John W.; Zeidman, Seth M.; Rhee, Peter; Ecklund, James M.; Lockhart, Stephen

    2000-08-01

    A novel method for identifying and localizing brain hemorrhage is presented. The method uses electromagnetic waves in the microwave and RF region and a modified algorithm previously used for the estimation of the angle of arrival of radar signals. Results are presented applying this device for detecting subdural and intraparenchymal hemorrhages in anesthetized pig.

  1. Increased Risk of Intracranial Hemorrhage in Patients With Pregnancy-Induced Hypertension

    PubMed Central

    Lin, Li-Te; Tsui, Kuan-Hao; Cheng, Jiin-Tsuey; Cheng, Jin-Shiung; Huang, Wei-Chun; Liou, Wen-Shiung; Tang, Pei-Ling

    2016-01-01

    Abstract Pregnancy-induced hypertension (PIH) may be a major predictor of pregnancy-associated intracranial hemorrhage (ICH). However, the relationship between PIH and long-term ICH risk is unknown. The objective of the study was to determine the association between PIH and ICH and to identify the predictive risk factors. Patients with newly diagnosed PIH were recruited from the Taiwan National Health Insurance Research Database. PIH patients were divided into gestational hypertension (GH) and preeclampsia groups. The 2 groups were separately compared with matched cohorts of patients without PIH based on age and date of delivery. The occurrence of ICH was evaluated in both cohorts. The overall observational period was from January 1, 2000 to December 31, 2013. Among the 23.3 million individuals registered in the National Health Insurance Research Database, 28,346 PIH patients, including 7390 with GH and 20,956 with preeclampsia, were identified. The incidences of ICH were increased in both groups (incidence rate ratio [IRR] = 3.72 in the GH group, 95% confidence interval [CI] 3.63–3.81, P < 0.0001 and IRR = 8.21 in the preeclampsia group, 95% CI 8.12–8.31, P < 0.0001, respectively). In addition, according to the results of stratification of follow-up years, both groups were associated with a highest risk of ICH at 1 to 5 years of follow-up (IRR = 11.99, 95% CI 11.16–12.88, P < 0.0001 and IRR = 21.83, 95% CI 21.24–22.44, P < 0.0001, respectively). After adjusting for age, parity, severity of PIH, number of PIH occurrences, gestational age, and comorbidities in the multivariate survival analysis using Cox regression model, age ≥30 years (hazard ratio [HR] 1.99, 95% CI 1.27–3.10, P = 0.0026), patients with preeclampsia (HR 2.18, 95% CI 1.22–3.90, P = 0.0089), multiple PIH occurrences (HR 4.08, 95% CI 1.85–9.01, P = 0.0005), hypertension (HR 4.51, 95% CI 1.89–10.74, P = 0.0007), and obesity (HR 7.21, 95

  2. Acute intracranial hemorrhage secondary to thrombocytopenia: CT appearances unaffected by absence of clot retraction

    SciTech Connect

    Pierce, J.N.; Taber, K.H.; Hayman, L.A. )

    1994-02-01

    To describe the in vivo CT appearance of acute intracerebral blood clots formed from anemic platelet-depleted blood. Three patients with intracerebral hemorrhage secondary only to thrombocytopenia were examined with CT within 2 1/2 hours after the onset of clinical symptoms. There were no unusual CT features found in the intracerebral hemorrhages of patients with only thrombocytopenia. Specifically, a hyperdense zone(s) surrounded by areas of decreased density was identified. Clot retraction (which cannot occur in patients with severe thrombocytopenia) is not necessary for the CT appearance of acute intracerebral hemorrhage. 22 refs., 3 figs., 1 tab.

  3. Evaluation of a stand-alone computer-aided detection system for acute intra-cranial hemorrhage in emergency environments

    NASA Astrophysics Data System (ADS)

    Fernandez, James; Deshpande, Ruchi; Wang, Ximing; Liu, Brent; Brazaitis, Michael; Munter, Fletcher; Liu, Margaret

    2011-03-01

    Acute intra-cranial hemorrhage (AIH) may result from traumatic brain injury (TBI). Successful management of AIH depends heavily on the speed and accuracy of diagnosis. Timely diagnosis in emergency environments in both civilian and military settings is difficult primarily due to severe time restraints and lack of resources. Often, diagnosis is performed by emergency physicians rather than trained radiologists. As a result, added support in the form of computer-aided detection (CAD) would greatly enhance the decision-making process and help in providing faster and more accurate diagnosis of AIH. This paper discusses the implementation of a CAD system in an emergency environment, and its efficacy in aiding in the detection of AIH.

  4. Use of Risk Assessment Tool for Inpatient Traumatic Intracranial Hemorrhage after Falls in Acute Care Hospital Setting

    PubMed Central

    Toyabe, Shin-ichi

    2012-01-01

    Severe injuries such as intracranial hemorrhage (ICH) are the most serious problem after falls in hospital, but they have not been considered in risk assessment scores for falls. We tried to determine the risk factors for ICH after falls in 20,320 inpatients (696,364 patient-days) aged from 40 to 90 years who were admitted to a tertiary-care university hospital. Possible risk factors including STRATIFY risk score for falls and FRAX™ risk score for fractures were analyzed by univariate and multivariate analyses. Fallers accounted for 3.2% of the patients, and 5.0% of the fallers suffered major injuries, including peripheral bone fracture (59.6%) and ICH (23.4%). In addition to STRATIFY, FRAX™ was significantly associated not only with bone fractures but also ICH. Concomitant use of risk score for falls and risk score for fractures might be useful for the prediction of major injuries such as ICH after falls. PMID:22980233

  5. Use of risk assessment tool for inpatient traumatic intracranial hemorrhage after falls in acute care hospital setting.

    PubMed

    Toyabe, Shin-Ichi

    2012-05-01

    Severe injuries such as intracranial hemorrhage (ICH) are the most serious problem after falls in hospital, but they have not been considered in risk assessment scores for falls. We tried to determine the risk factors for ICH after falls in 20,320 inpatients (696,364 patient-days) aged from 40 to 90 years who were admitted to a tertiary-care university hospital. Possible risk factors including STRATIFY risk score for falls and FRAX™ risk score for fractures were analyzed by univariate and multivariate analyses. Fallers accounted for 3.2% of the patients, and 5.0% of the fallers suffered major injuries, including peripheral bone fracture (59.6%) and ICH (23.4%). In addition to STRATIFY, FRAX™ was significantly associated not only with bone fractures but also ICH. Concomitant use of risk score for falls and risk score for fractures might be useful for the prediction of major injuries such as ICH after falls. PMID:22980233

  6. Clinical significance of dynamic monitoring by transcranial doppler ultrasound and intracranial pressure monitor after surgery of hypertensive intracerebral hemorrhage

    PubMed Central

    Liu, Zaiming; Chen, Qianxue; Tian, Daofeng; Wang, Long; Liu, Baohui; Zhang, Shenqi

    2015-01-01

    The aim of this study was to investigate the surgical method of hypertensive intracerebral hemorrhage (HIH) and how to control the postoperative blood pressure. 96 HIH patients were performed the craniotomic hematoma dissection (CHD) and the hematoma-cavity drilling drainage (HCDD), respectively. Meanwhile, the intracranial pressure and mean arterial pressure of each patient were continuously monitored for 7 days, the postoperative 1st, 3rd, 7th and 14th-day average flow velocities and pulsatility indexes of the bilateral middle cerebral arteries were monitored. CHD exhibited the significant difference in the long-term quality of life (ADL classification 6 months later) of patients with hematoma >50 ml than HCDD; furthermore, the postoperative 1st, 3rd, 7th and 14th-day TCD parameter analysis revealed that CHD exhibited better results in relieving the intracranial pressure and improving the cerebral blood flow than HCDD, and the postoperative ICP and MAP monitoring towards all patients could effectively control the blood pressure and prevent the further bleeding. The patients with hematoma >50 ml should choose CHD, and all HIH patients should be routinely performed the ICP and MAP monitoring. PMID:26379963

  7. Multiple hemorrhagic intraparenchymal tumors presenting with fatal intracranial hypertension: A rare manifestation of systemic epithelioid hemangioendothelioma

    PubMed Central

    Tsuchiya, Tsukasa; Oya, Soichi; Mori, Harushi; Matsui, Toru

    2015-01-01

    Background: Epithelioid hemangioendotheliomas (EHE) is an extremely rare tumor that can arise not only intracranially but also systemically. Its radiological characteristics and the mechanism underlying the multiple organ involvement in EHE are poorly understood. Case Description: A 24-year-old woman with a 7-month history of coughing and blood-stained sputum complained of visual disturbance in the right eye that had persisted for 1-month. Magnetic resonance (MR) imaging revealed multiple intraparenchymal masses with low-intensity on MR susceptibility-weighted images with minimal enhancement with gadolinium. Systemic computed tomography revealed multiple nodules in both lungs and the liver. Because her neurological status rapidly deteriorated, brain biopsy of the right frontal mass was performed. The pathological diagnosis was EHE. Over the following 3 months, the patient gradually developed disturbance of consciousness. She died at 4 months after admission because of significant intracranial hypertension. Conclusion: Although intracranial EHEs are extremely rare, they should be included in the differential diagnoses of multiple small-sized masses with low-intensity on MR susceptibility-weighted images. We also emphasize that the systemic involvement of this tumor was more compatible with multicentric development than metastasis. PMID:26539307

  8. Resuscitation from hemorrhagic shock. Alterations of the intracranial pressure after normal saline, 3% saline and dextran-40.

    PubMed Central

    Gunnar, W P; Merlotti, G J; Barrett, J; Jonasson, O

    1986-01-01

    Resuscitation from hemorrhagic shock by infusion of isotonic (normal) saline (NS) is accompanied by a transient elevation in intracranial pressure (ICP), although cerebral edema, as measured by brain weights at 24 hours, is prevented by adequate volume resuscitation. The transient increase in ICP is not observed during hypertonic saline (HS) resuscitation. The effect of colloid resuscitation on ICP is unknown. Beagles were anesthetized, intubated, and ventilated, maintaining pCO2 between 30-45 torr. Femoral artery, pulmonary artery, and urethral catheters were positioned. ICP was measured with a subarachnoid bolt. Forty per cent of the dog's blood volume was shed and the shock state maintained for 1 hour. Resuscitation was done with shed blood and a volume of either NS (n = 5), 3% HS (n = 5), or 10% dextran-40 (D-40, n = 5) equal to the amount of shed blood. Intravascular volume was then maintained with NS. ICP fell from baseline values (4.7 +/- 3.13 mmHg) during the shock state and increased greatly during initial fluid resuscitation in NS and D-40 groups, to 16.0 +/- 5.83 mmHg and 16.2 +/- 2.68 mmHg, respectively. ICP returned to baseline values of 3.0 +/- 1.73 mmHg in the HS group with initial resuscitation and remained at baseline values throughout resuscitation. NS and D-40 ICP were greater than HS ICP at 1 hour (p less than .001) and 2 hours (p less than .05) after resuscitation. These results demonstrate that NS or colloid resuscitation from hemorrhagic shock elevates ICP and that HS prevents elevated ICP. PMID:2431664

  9. Prophylactic Fresh Frozen Plasma Infusion is Ineffective in Reversing Warfarin Anticoagulation and Preventing Delayed Intracranial Hemorrhage After Falls

    PubMed Central

    Reddy, Subhash; Sharma, Rohit; Grotts, Jonathan; Ferrigno, Lisa

    2015-01-01

    Background: Elderly patients, with considerable fall risk, are increasingly anticoagulated to prevent thromboembolic disease. We hypothesized that a policy of prophylactic fresh frozen plasma (FFP) infusion in patients having falls would reverse vitamin K antagonists (VKAs) and that reversal would decrease delayed intracranial hemorrhage (ICH). Methods: A retrospective review of patients with trauma admitted to a level 2 community trauma center was performed from January 2010 until November 2012. Inclusion criteria were: ground level fall (GLF) with suspected head trauma, on VKA, an international normalized ratio (INR) of >1.5, and a negative head computed tomography (CT). Patients were transfused with FFP to a goal INR of <1.5 while observed. Patients were classified as reversed (REV) if the lowest INR achieved within 4 to 24 hours after initial INR was <1.5 or unreversed (NREV) if lowest INR achieved was >1.5. Chi-square and logistic regression were performed. Results: A total of 194 patients met the criteria. In all, 43 (22%) patients were able to be REV, and 151 (78%) patients remained NREV. Unreversed patients were male and younger (P < .05). There was no difference in mean FFP received. Unreversed patients had a higher initial INR of 3.0 compared to REV patients (2.5; P = .018). One patient developed a delayed ICH and belonged to the REV group. Conclusion: The incidence of delayed hemorrhage was 0.5%. A strategy of prophylactic FFP infusion was ineffective in VKA reversal. We recommend against prophylactic infusion of FFP during a period of observation for patients on VKA with suspected head trauma and a negative initial CT. PMID:26425246

  10. Cerebral venous circulatory disturbance as an informative prognostic marker for neonatal hemorrhagic stroke

    NASA Astrophysics Data System (ADS)

    Semyachkina-Glushkovskaya, Oxana; Pavlov, Alexey; Navolokin, Nikita; Lychagov, Vladislav; Abdurashitov, Arkady; Zinchenko, Ekaterina; Gekaluk, Artemiy; Zhu, Dan; Shi, Rui; Luo, Qingming; Tuchin, Valery

    2016-04-01

    Neonatal hemorrhagic stroke (NHS) is a major problem of future generation's health due to the high rate of death and cognitive disability of newborns after NHS. The incidence of NHS in neonates cannot be predicted by standard diagnostic methods. Therefore, the identification of prognostic markers of NHS is crucial. There is evidence that stress-related alterations of cerebral blood flow (CBF) may contribute to NHS. Here, we assessed the stroke-associated CBF abnormalities for high prognosis of NHS using a new model of NHS induced by sound stress in the pre- and post-stroke state. With this aim, we used interdisciplinary methods such as a histological assay of brain tissues, laser speckle contrast imaging and Doppler coherent tomography to monitor cerebral circulation. Our results suggest that the venous stasis with such symptoms as progressive relaxation of cerebral veins, decrease the velocity of blood flow in them are prognostic markers for a risk of NHS and are an informative platform for a future study of corrections of cerebral venous circulatory disturbance related to NHS.

  11. [Local fibrinolysis in surgical treatment of non-traumatic intracranial hemorrhages].

    PubMed

    Krylov, V V; Burov, S A; Dash'ian, V G; Galankina, I E

    2013-01-01

    More than 70% of hypertensive hemorrhages are located in deep brain structures. The removal of such hematomas using encephalotomy is accompanied by additional cerebral trauma and often results in unsatisfactory outcomes. The puncture aspiration with local fibrinolysis is one of the minimal invasive methods for treatment of intracerebral hematomas (ICH). The puncture and aspiration of liquid part of ICH (not more than 20% of ICH volume) is performed via small burr hole. Afterward the catheter is placed into ICH cavity and fibrinolytic is injected via this catheter in postoperative period for lysis of ICH solid part. The lysed blood is aspirated within 1-4 days. The last generations of fibrinolytics are very effective concerning intensity of blood clot lysis and practically have no systematic effect on blood coagulation system during their local usage. Morphological examinations showed that usage of fibrinolysis leads to formation of smaller cysts in the region of former hematoma as well as reparative processes in perihemorrhagical zone are expressed better comparing with treatment methods without usage of fibrinolytics. The morphological pattern is also confirmed by clinical signs of neurological deficit regress corresponding to damage focus. We operated 124 patients with parenchymal hemorrhages and 28 patients with intraventricular hemorrhages using described minimally invasive method at the base of Scientific Research Institute of Emergency Care n.a. N. V. Sklifosovsky. The applied method allowed decreasing lethality from 35% to 21% among patients with parenchymal ICH and from 98% to 48%--among patients with ventricular hemotamponade underwent usage of ventricular drainage combined with local fibrinolysis. PMID:24340958

  12. Fusiform aneurysm of a persistent trigeminal artery associated with rare intracranial arterial variations and subarachnoid hemorrhage.

    PubMed

    Kimball, David; Ples, Horia; Kimball, Heather; Miclaus, Gratian D; Matusz, Petru; Loukas, Marios

    2015-01-01

    The trigeminal artery is one of four primitive anastomoses between the internal carotid artery and vertebrobasilar system that regresses in the sixth week of fetal development. A persistent trigeminal artery (PTA) is generally an incidental finding but may also be associated with intracranial vascular pathologies such as aneurysms, arteriovenous malformations, and cranial nerve compression syndromes. We present an extremely rare case of a right PTA with an associated bleeding fusiform aneurysm located in the carotidian (lateral) part of the PTA. In addition, this rare anatomic variation was associated with bilateral absence of the posterior communicating arteries, a left posterior cerebral artery originating from the left internal carotid artery, and agenesis of the A1 segment of the left anterior cerebral artery. PMID:25053265

  13. Reduced cerebral blood flow and oxygen metabolism in extremely preterm neonates with low-grade germinal matrix- intraventricular hemorrhage

    NASA Astrophysics Data System (ADS)

    Lin, Pei-Yi; Hagan, Katherine; Fenoglio, Angela; Grant, P. Ellen; Franceschini, Maria Angela

    2016-05-01

    Low-grade germinal matrix-intraventricular hemorrhage (GM-IVH) is the most common complication in extremely premature neonates. The occurrence of GM-IVH is highly associated with hemodynamic instability in the premature brain, yet the long-term impact of low-grade GM-IVH on cerebral blood flow and neuronal health have not been fully investigated. We used an innovative combination of frequency-domain near infrared spectroscopy and diffuse correlation spectroscopy (FDNIRS-DCS) to measure cerebral oxygen saturation (SO2) and an index of cerebral blood flow (CBFi) at the infant’s bedside and compute an index of cerebral oxygen metabolism (CMRO2i). We enrolled twenty extremely low gestational age (ELGA) neonates (seven with low-grade GM-IVH) and monitored them weekly until they reached full-term equivalent age. During their hospital stay, we observed consistently lower CBFi and CMRO2i in ELGA neonates with low-grade GM-IVH compared to neonates without hemorrhages. Furthermore, lower CBFi and CMRO2i in the former group persists even after the resolution of the hemorrhage. In contrast, SO2 does not differ between groups. Thus, CBFi and CMRO2i may have better sensitivity than SO2 in detecting GM-IVH-related effects on infant brain development. FDNIRS-DCS methods may have clinical benefit for monitoring the evolution of GM-IVH, evaluating treatment response, and potentially predicting neurodevelopmental outcome.

  14. Reduced cerebral blood flow and oxygen metabolism in extremely preterm neonates with low-grade germinal matrix- intraventricular hemorrhage.

    PubMed

    Lin, Pei-Yi; Hagan, Katherine; Fenoglio, Angela; Grant, P Ellen; Franceschini, Maria Angela

    2016-01-01

    Low-grade germinal matrix-intraventricular hemorrhage (GM-IVH) is the most common complication in extremely premature neonates. The occurrence of GM-IVH is highly associated with hemodynamic instability in the premature brain, yet the long-term impact of low-grade GM-IVH on cerebral blood flow and neuronal health have not been fully investigated. We used an innovative combination of frequency-domain near infrared spectroscopy and diffuse correlation spectroscopy (FDNIRS-DCS) to measure cerebral oxygen saturation (SO2) and an index of cerebral blood flow (CBFi) at the infant's bedside and compute an index of cerebral oxygen metabolism (CMRO2i). We enrolled twenty extremely low gestational age (ELGA) neonates (seven with low-grade GM-IVH) and monitored them weekly until they reached full-term equivalent age. During their hospital stay, we observed consistently lower CBFi and CMRO2i in ELGA neonates with low-grade GM-IVH compared to neonates without hemorrhages. Furthermore, lower CBFi and CMRO2i in the former group persists even after the resolution of the hemorrhage. In contrast, SO2 does not differ between groups. Thus, CBFi and CMRO2i may have better sensitivity than SO2 in detecting GM-IVH-related effects on infant brain development. FDNIRS-DCS methods may have clinical benefit for monitoring the evolution of GM-IVH, evaluating treatment response, and potentially predicting neurodevelopmental outcome. PMID:27181339

  15. Reduced cerebral blood flow and oxygen metabolism in extremely preterm neonates with low-grade germinal matrix- intraventricular hemorrhage

    PubMed Central

    Lin, Pei-Yi; Hagan, Katherine; Fenoglio, Angela; Grant, P. Ellen; Franceschini, Maria Angela

    2016-01-01

    Low-grade germinal matrix-intraventricular hemorrhage (GM-IVH) is the most common complication in extremely premature neonates. The occurrence of GM-IVH is highly associated with hemodynamic instability in the premature brain, yet the long-term impact of low-grade GM-IVH on cerebral blood flow and neuronal health have not been fully investigated. We used an innovative combination of frequency-domain near infrared spectroscopy and diffuse correlation spectroscopy (FDNIRS-DCS) to measure cerebral oxygen saturation (SO2) and an index of cerebral blood flow (CBFi) at the infant’s bedside and compute an index of cerebral oxygen metabolism (CMRO2i). We enrolled twenty extremely low gestational age (ELGA) neonates (seven with low-grade GM-IVH) and monitored them weekly until they reached full-term equivalent age. During their hospital stay, we observed consistently lower CBFi and CMRO2i in ELGA neonates with low-grade GM-IVH compared to neonates without hemorrhages. Furthermore, lower CBFi and CMRO2i in the former group persists even after the resolution of the hemorrhage. In contrast, SO2 does not differ between groups. Thus, CBFi and CMRO2i may have better sensitivity than SO2 in detecting GM-IVH-related effects on infant brain development. FDNIRS-DCS methods may have clinical benefit for monitoring the evolution of GM-IVH, evaluating treatment response, and potentially predicting neurodevelopmental outcome. PMID:27181339

  16. Intracranial hemorrhage in acute and chronic childhood immune thrombocytopenic purpura over a ten-year period: an Egyptian multicenter study.

    PubMed

    Elalfy, Mohsen; Elbarbary, Nancy; Khaddah, Normine; Abdelwahab, Magy; El Rashidy, Farida; Hassab, Hoda; Al-Tonbary, Youssef

    2010-01-01

    Intracranial hemorrhage (ICH) is a rare but major cause of death in immune thrombocytopenic purpura (ITP). The authors reviewed data of 1,840 patient with ITP, from 5 pediatric hematology centers in Egypt from 1997 to 2007, to study the incidence and risk factors of ICH. Ten cases of ICH were identified with a median age at presentation of 7.5 years; 4 patients had acute ITP, 2 persistent and 4 chronic. The platelet count was <10 x 10(9)/l in 7 cases, and only 1 patient had a history of head trauma. Seven children were on treatment prior to or at the time of occurrence of ICH and all were treated by pharmacotherapy. Two children died shortly afterwards due to late referral to a specialized center. Our results suggest that treatment does not prevent ICH and that it can occur at any time during the course of the disease. Delayed referral can be considered a risk factor for unfavorable outcome of ICH, highlighting the importance of teaching sessions for patients and their parents to minimize subsequent morbidity and mortality of ICH in children with ITP. PMID:19955713

  17. A computer-aided detection (CAD) system with a 3D algorithm for small acute intracranial hemorrhage

    NASA Astrophysics Data System (ADS)

    Wang, Ximing; Fernandez, James; Deshpande, Ruchi; Lee, Joon K.; Chan, Tao; Liu, Brent

    2012-02-01

    Acute Intracranial hemorrhage (AIH) requires urgent diagnosis in the emergency setting to mitigate eventual sequelae. However, experienced radiologists may not always be available to make a timely diagnosis. This is especially true for small AIH, defined as lesion smaller than 10 mm in size. A computer-aided detection (CAD) system for the detection of small AIH would facilitate timely diagnosis. A previously developed 2D algorithm shows high false positive rates in the evaluation based on LAC/USC cases, due to the limitation of setting up correct coordinate system for the knowledge-based classification system. To achieve a higher sensitivity and specificity, a new 3D algorithm is developed. The algorithm utilizes a top-hat transformation and dynamic threshold map to detect small AIH lesions. Several key structures of brain are detected and are used to set up a 3D anatomical coordinate system. A rule-based classification of the lesion detected is applied based on the anatomical coordinate system. For convenient evaluation in clinical environment, the CAD module is integrated with a stand-alone system. The CAD is evaluated by small AIH cases and matched normal collected in LAC/USC. The result of 3D CAD and the previous 2D CAD has been compared.

  18. Utility of Repeat Head Computed Tomography for Intracranial Hemorrhage After Trauma and Importance of Direct Patient Care.

    PubMed

    Zimmermann, Mary Ellen; Brown, Zachary; Matemavi, Praise; Melnic, Gloria; Sample, Jason

    2016-01-01

    At many institutions, it is common practice for trauma patients with traumatic intracranial hemorrhage (ICH) to receive routine repeat head computed tomographic (CT) scans after the initial CT scan, regardless of symptoms, to evaluate progression of the injury. The purpose of this study was to assess quantifiable risk factors (age, anticoagulation, gender) that could place patients at greater risk for progression of injury, thus requiring surgical intervention (craniotomy, craniectomy) for which serial CT scanning would be useful. From January 2014 to June 2015, a total of 211 patients presented with traumatic ICH and 198 were eligible for inclusion. Twenty-six patients required operative intervention for ICH. One of 26 patients went to the operating room as a result of repeat head CT scans without associated mental status change, change in neurological examination, or associated symptoms such as nausea or vomiting. Significant changes in patient management due to routine repeat CT scans were not observed. There were no statistically significant risk factors identified to place patients at higher risk for progression of disease. The data from this analysis emphasized the importance of nursing care in identifying and relaying changes in patient condition to the trauma team. PMID:27618379

  19. Subarachnoid hemorrhage due to ruptured intracranial aneurysm following posterior reversible encephalopathy syndrome.

    PubMed

    Nanba, Takamasa; Kashimura, Hiroshi; Saura, Hiroaki; Takeda, Masaru

    2016-01-01

    Although posterior reversible encephalopathy syndrome (PRES) is rarely associated with subarachnoid hemorrhage, to our knowledge, rupture of a concomitant cerebral aneurysm following PRES has not been reported. We describe a patient with atypical PRES involving the brainstem, thalamus, and periventricular white matter without cortical or subcortical edema of the parietooccipital lobe on magnetic resonance imaging, with rupture of a concomitant cerebral aneurysm. Preexisting extremely high blood pressure may trigger atypical PRES, and failure to lower blood pressure may lead to a concomitant aneurysm rupture. In the future treatment of hypertensive urgency with a recurrence of symptoms and mean arterial blood pressure >150 mmHg, it is advisable to immediately hospitalize the patient for aggressive blood pressure management, especially if PRES is suspected based on clinical and radiological features. PMID:27365964

  20. Subarachnoid hemorrhage due to ruptured intracranial aneurysm following posterior reversible encephalopathy syndrome

    PubMed Central

    Nanba, Takamasa; Kashimura, Hiroshi; Saura, Hiroaki; Takeda, Masaru

    2016-01-01

    Although posterior reversible encephalopathy syndrome (PRES) is rarely associated with subarachnoid hemorrhage, to our knowledge, rupture of a concomitant cerebral aneurysm following PRES has not been reported. We describe a patient with atypical PRES involving the brainstem, thalamus, and periventricular white matter without cortical or subcortical edema of the parietooccipital lobe on magnetic resonance imaging, with rupture of a concomitant cerebral aneurysm. Preexisting extremely high blood pressure may trigger atypical PRES, and failure to lower blood pressure may lead to a concomitant aneurysm rupture. In the future treatment of hypertensive urgency with a recurrence of symptoms and mean arterial blood pressure >150 mmHg, it is advisable to immediately hospitalize the patient for aggressive blood pressure management, especially if PRES is suspected based on clinical and radiological features. PMID:27365964

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

    PubMed Central

    Yamaki, Vitor Nagai; Júnior, Fernando Mendes Paschoal; Piske, Ronie Leo; Teixeira, Manoel Jacobsen; Bor-Seng-Shu, Edson

    2015-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  3. Subarachnoid Hemorrhage

    MedlinePlus

    ... can result from the rupture of an intracranial aneurysm — a weakened, dilated area of a blood vessel ... blood vessels in the brain even after the aneurysm that caused the hemorrhage is treated. Most of ...

  4. Intracranial hemorrhage and platelet transfusion after administration of anti-platelets agents: Fukushima Prefecture.

    PubMed

    Suzuki, Yuhko; Sato, Taku; Sakuma, Jun; Ichikawa, Masahiro; Kishida, Yugo; Oda, Keiko; Watanabe, Yoichi; Goto, Takeshi; Sato, Masahiro; Nollet, Kenneth E; Saito, Kiyoshi; Ohto, Hitoshi

    2016-06-01

    We conducted a case series study to assess intracerebral hemorrhage (ICH) in the context of anti-platelets agents (APAs) and platelet (PLT) transfusion in Fukushima Prefecture.This study included patients who were newly diagnosed with ICH between January 2008 and June 2014 in the neurosurgical hospitals of Fukushima Prefecture. Four of ten neurosurgical hospitals responded to our questionnaire. Of 287 ICH patients, 51 (20.6%) were on APA therapy, of whom PLT transfusion was given to only one persistently bleeding patient who was on dual anti-platelet therapy. In a follow-up survey, 30 out of 51 ICH patients on APA therapy, average age 75 years, were analyzed, of whom 21 (70%) were male. The predominant underlying disease was diabetes mellitus. It is interesting to note that peripheral artery disease and aortic aneurysm were among the indications for APAs. ICH was mainly observed supratentorially. Hematoma enlargement was observed in 13 (44.8%) cases. By day 7, 3 patients (10%) had died from complications of ICH. In this study, we show that ICH during APA therapy matched what was observed in Kanagawa Prefecture. Whether or not a national survey differs, we anticipate greater statistical validity and an opportunity to improve patient outcomes in Japan and around the world. PMID:27210309

  5. Hemoglobin-induced neuronal degeneration in the hippocampus after neonatal intraventricular hemorrhage.

    PubMed

    Garton, Thomas P; He, Yangdong; Garton, Hugh J L; Keep, Richard F; Xi, Guohua; Strahle, Jennifer M

    2016-03-15

    Neuronal degeneration following neonatal intraventricular hemorrhage (IVH) is incompletely understood. Understanding the mechanisms of degeneration and cell loss may point toward specific treatments to limit injury. We evaluated the role of hemoglobin (Hb) in cell death after intraventricular injection in neonatal rats. Hb was injected into the right lateral ventricle of post-natal day 7 rats. Rats exposed to anesthesia were used for controls. The CA-1 region of the hippocampus was analyzed via immunohistochemistry, hematoxylin and eosin (H&E) staining, Fluoro-Jade C staining, Western blots, and double-labeling stains. Compared to controls, intraventricular injection of Hb decreased hippocampal volume (27% decrease; p<0.05), induced neuronal loss (31% loss; p<0.01), and increased neuronal degeneration (2.7 fold increase; p<0.01), which were all significantly reduced with the iron chelator, deferoxamine. Hb upregulated p-JNK (1.8 fold increase; p<0.05) and increased expression of the Hb/haptoglobin endocytotic receptor CD163 in neurons in vivo and in vitro (cultured cortical neurons). Hb induced expression of the CD163 receptor, which co-localized with p-JNK in hippocampal neurons, suggesting a potential pathway by which Hb enters the neuron to result in cell death. There were no differences in neuronal loss or degenerating neurons in Hb-injected animals that developed hydrocephalus versus those that did not. Intraventricular injection of Hb causes hippocampal neuronal degeneration and cell loss and increases brain p-JNK levels. p-JNK co-localized with the Hb/haptoglobin receptor CD163, suggesting a novel pathway by which Hb enters the neuron after IVH to result in cell death. PMID:26772987

  6. Porcine pilot study of MRI-guided HIFU treatment for neonatal intraventricular hemorrhage (IVH)

    NASA Astrophysics Data System (ADS)

    Looi, Thomas; Waspe, Adam; Mougenot, Charles; Amaral, Joao; Temple, Michael; Hynynen, Kullervo; Drake, James

    2012-11-01

    Intraventricular hemorrhage (IVH) occurs in 15% of premature babies and 50% of IVH cases progress to posthemorrhagic ventricular dilation due to large blood clots forming in the ventricles. Existing treatments such as tissue plasminogen activator (tPA) and surgical intervention have severe side effects in paediatric patients that include excessive bleeding and complications. This study investigates the feasibility of MR-HIFU for sonothrombolysis of blood clots from IVH using natural acoustic windows, known as fontanelles, in the skulls of newborns. The study involved 2 elements: a phantom study to examine beam limitations and acoustic properties, and an in-vivo porcine study. A phantom skull was created from sample patient data and was used to analyze reachability of the Philips Sonavelle system. Acoustic measurements of the phantom (attenuation of 5-14 dB and speed of sound of 1722-2965 m/s) indicated the phantom effectively mimics neonatal skull bone. For the ex-vivo studies, a porcine clot was created and sonicated for 5 mins at 500W with a 0.5% duty cycle. For the in-vivo experiment, a vertex craniotomy was performed and porcine blood was injected into the lateral ventricle under ultrasound guidance. Sonication using the prior parameters induced cavitation and post-sonication T1 and T2 images verified clot lysis. Further H&E analysis showed no presence of blood in the ventricles. These positive results show that MR-HIFU has potential as a noninvasive tool for sonothrombolysis of neonatal IVH clots.

  7. Portable Wideband Microwave Imaging System for Intracranial Hemorrhage Detection Using Improved Back-projection Algorithm with Model of Effective Head Permittivity.

    PubMed

    Mobashsher, Ahmed Toaha; Mahmoud, A; Abbosh, A M

    2016-01-01

    Intracranial hemorrhage is a medical emergency that requires rapid detection and medication to restrict any brain damage to minimal. Here, an effective wideband microwave head imaging system for on-the-spot detection of intracranial hemorrhage is presented. The operation of the system relies on the dielectric contrast between healthy brain tissues and a hemorrhage that causes a strong microwave scattering. The system uses a compact sensing antenna, which has an ultra-wideband operation with directional radiation, and a portable, compact microwave transceiver for signal transmission and data acquisition. The collected data is processed to create a clear image of the brain using an improved back projection algorithm, which is based on a novel effective head permittivity model. The system is verified in realistic simulation and experimental environments using anatomically and electrically realistic human head phantoms. Quantitative and qualitative comparisons between the images from the proposed and existing algorithms demonstrate significant improvements in detection and localization accuracy. The radiation and thermal safety of the system are examined and verified. Initial human tests are conducted on healthy subjects with different head sizes. The reconstructed images are statistically analyzed and absence of false positive results indicate the efficacy of the proposed system in future preclinical trials. PMID:26842761

  8. Portable Wideband Microwave Imaging System for Intracranial Hemorrhage Detection Using Improved Back-projection Algorithm with Model of Effective Head Permittivity

    NASA Astrophysics Data System (ADS)

    Mobashsher, Ahmed Toaha; Mahmoud, A.; Abbosh, A. M.

    2016-02-01

    Intracranial hemorrhage is a medical emergency that requires rapid detection and medication to restrict any brain damage to minimal. Here, an effective wideband microwave head imaging system for on-the-spot detection of intracranial hemorrhage is presented. The operation of the system relies on the dielectric contrast between healthy brain tissues and a hemorrhage that causes a strong microwave scattering. The system uses a compact sensing antenna, which has an ultra-wideband operation with directional radiation, and a portable, compact microwave transceiver for signal transmission and data acquisition. The collected data is processed to create a clear image of the brain using an improved back projection algorithm, which is based on a novel effective head permittivity model. The system is verified in realistic simulation and experimental environments using anatomically and electrically realistic human head phantoms. Quantitative and qualitative comparisons between the images from the proposed and existing algorithms demonstrate significant improvements in detection and localization accuracy. The radiation and thermal safety of the system are examined and verified. Initial human tests are conducted on healthy subjects with different head sizes. The reconstructed images are statistically analyzed and absence of false positive results indicate the efficacy of the proposed system in future preclinical trials.

  9. Portable Wideband Microwave Imaging System for Intracranial Hemorrhage Detection Using Improved Back-projection Algorithm with Model of Effective Head Permittivity

    PubMed Central

    Mobashsher, Ahmed Toaha; Mahmoud, A.; Abbosh, A. M.

    2016-01-01

    Intracranial hemorrhage is a medical emergency that requires rapid detection and medication to restrict any brain damage to minimal. Here, an effective wideband microwave head imaging system for on-the-spot detection of intracranial hemorrhage is presented. The operation of the system relies on the dielectric contrast between healthy brain tissues and a hemorrhage that causes a strong microwave scattering. The system uses a compact sensing antenna, which has an ultra-wideband operation with directional radiation, and a portable, compact microwave transceiver for signal transmission and data acquisition. The collected data is processed to create a clear image of the brain using an improved back projection algorithm, which is based on a novel effective head permittivity model. The system is verified in realistic simulation and experimental environments using anatomically and electrically realistic human head phantoms. Quantitative and qualitative comparisons between the images from the proposed and existing algorithms demonstrate significant improvements in detection and localization accuracy. The radiation and thermal safety of the system are examined and verified. Initial human tests are conducted on healthy subjects with different head sizes. The reconstructed images are statistically analyzed and absence of false positive results indicate the efficacy of the proposed system in future preclinical trials. PMID:26842761

  10. Finite Element Model Predictions of Intracranial Hemorrhage from Non-Impact, Rapid Head Rotations in the Piglet

    PubMed Central

    Coats, Brittany; Eucker, Stephanie A.; Sullivan, Sarah; Margulies, Susan S.

    2012-01-01

    Clinicians are charged with the significant task of distinguishing between accidental and inflicted head trauma. Oftentimes this distinction is straightforward, but many times probabilities of injuries from accidental scenarios are unknown making the differential diagnosis difficult. For example, it is unknown whether intracranial hemorrhage (IH) can occur at a location other than a focal contact site following a low height fall. To create a foundation for predicting regional IH in infants, we sought to identify the biomechanical response and injury threshold best able to predict IH in 3–5 day old piglets. First, finite element (FE) model simulations of in situ animal studies were performed to ascertain the optimal representation of the pia-arachnoid complex, cerebrospinal fluid and cortical vasculature (PCC) for predicting brain strain and brain/skull displacement. Second, rapid head rotations resulting in various degrees of IH were simulated (n=24) to determine the biomechanical predictor and injury threshold most closely correlated with IH. FE models representing the PCC with either spring connectors or solid elements between the brain and skull resulted in peak brain strain and brain/skull displacement similar to measured values in situ. However, when predicting IH, the spring connector representation of the PCC had the best predictive capability for IH with a sensitivity of 80% and a specificity of 85% when ≥ 1% of all spring connectors had at least a peak strain of 0.31 mm/mm. These findings and reported methodology will be used in the development of a human infant FE model to simulate real-world falls and identify injury thresholds for predicting IH in infants. PMID:22239917

  11. Design and characterization of a dedicated cone-beam CT scanner for detection of acute intracranial hemorrhage

    NASA Astrophysics Data System (ADS)

    Xu, J.; Sisniega, A.; Zbijewski, W.; Dang, H.; Stayman, J. W.; Wang, X.; Foos, D. H.; Aygun, N.; Koliatsos, V. E.; Siewerdsen, J. H.

    2016-03-01

    Purpose: Prompt and reliable detection of intracranial hemorrhage (ICH) has substantial clinical impact in diagnosis and treatment of stroke and traumatic brain injury. This paper describes the design, development, and preliminary performance characterization of a dedicated cone-beam CT (CBCT) head scanner prototype for imaging of acute ICH. Methods: A task-based image quality model was used to analyze the detectability index as a function of system configuration, and hardware design was guided by the results of this model-based optimization. A robust artifact correction pipeline was developed using GPU-accelerated Monte Carlo (MC) scatter simulation, beam hardening corrections, detector veiling glare, and lag deconvolution. An iterative penalized weighted least-squares (PWLS) reconstruction framework with weights adjusted for artifact-corrected projections was developed. Various bowtie filters were investigated for potential dose and image quality benefits, with a MC-based tool providing estimates of spatial dose distribution. Results: The initial prototype will feature a source-detector distance of 1000 mm and source-axis distance of 550 mm, a 43x43 cm2 flat panel detector, and a 15° rotating anode x-ray source with 15 kW power and 0.6 focal spot size. Artifact correction reduced image nonuniformity by ~250 HU, and PWLS reconstruction with modified weights improved the contrast to noise ratio by 20%. Inclusion of a bowtie filter can potentially reduce dose by 50% and improve CNR by 25%. Conclusions: A dedicated CBCT system capable of imaging millimeter-scale acute ICH was designed. Preliminary findings support feasibility of point-of-care applications in TBI and stroke imaging, with clinical studies beginning on a prototype.

  12. Intraoperative imaging for patient safety and QA: detection of intracranial hemorrhage using C-arm cone-beam CT

    NASA Astrophysics Data System (ADS)

    Schafer, Sebastian; Wang, Adam; Otake, Yoshito; Stayman, J. W.; Zbijewski, Wojciech; Kleinszig, Gerhard; Xia, Xuewei; Gallia, Gary L.; Siewerdsen, Jeffrey H.

    2013-03-01

    Intraoperative imaging could improve patient safety and quality assurance (QA) via the detection of subtle complications that might otherwise only be found hours after surgery. Such capability could therefore reduce morbidity and the need for additional intervention. Among the severe adverse events that could be more quickly detected by high-quality intraoperative imaging is acute intracranial hemorrhage (ICH), conventionally assessed using post-operative CT. A mobile C-arm capable of high-quality cone-beam CT (CBCT) in combination with advanced image reconstruction techniques is reported as a means of detecting ICH in the operating room. The system employs an isocentric C-arm with a flat-panel detector in dual gain mode, correction of x-ray scatter and beam-hardening, and a penalized likelihood (PL) iterative reconstruction method. Performance in ICH detection was investigated using a quantitative phantom focusing on (non-contrast-enhanced) blood-brain contrast, an anthropomorphic head phantom, and a porcine model with injection of fresh blood bolus. The visibility of ICH was characterized in terms of contrast-to-noise ratio (CNR) and qualitative evaluation of images by a neurosurgeon. Across a range of size and contrast of the ICH as well as radiation dose from the CBCT scan, the CNR was found to increase from ~2.2-3.7 for conventional filtered backprojection (FBP) to ~3.9-5.4 for PL at equivalent spatial resolution. The porcine model demonstrated superior ICH detectability for PL. The results support the role of high-quality mobile C-arm CBCT employing advanced reconstruction algorithms for detecting subtle complications in the operating room at lower radiation dose and lower cost than intraoperative CT scanners and/or fixedroom C-arms. Such capability could present a potentially valuable aid to patient safety and QA.

  13. A Clinical Decision Rule to Predict Adult Patients with Traumatic Intracranial Hemorrhage Who Do Not Require Intensive Care Unit Admission

    PubMed Central

    Nishijima, Daniel K.; Shahlaie, Kiarash; Echeverri, Angela; Holmes, James F.

    2016-01-01

    Objective To derive a clinical decision rule to identify adult emergency department (ED) patients with traumatic intracranial hemorrhage (tICH) who are at low risk for requiring critical care resources during hospitalization. Methods This is a retrospective cohort study of patients (≥18 years) with tICH presenting to the ED. The need for intensive care unit (ICU) admission was defined as the presence of a critical care intervention including: intubation, neurosurgical intervention, blood product transfusion, vasopressor or inotrope administration, invasive monitoring for hemodynamic instability, emergent treatment for arrhythmia, therapeutic angiography, and cardiopulmonary resuscitation. The decision rule was derived using binary recursive partitioning. Results A total of 432 patients were identified (median age 48 years) of which 174 patients (40%) had a critical care intervention. We performed binary recursive partitioning with Classification and Regression Trees (CART) software to develop the clinical decision rule. Patients with a normal mental status (Glasgow Coma Score=15), isolated head injury, and age < 65 were considered low risk for a critical care intervention. The derived rule had a sensitivity of 98% (95% confidence interval [CI] 94–99), a specificity of 50% (95% CI 44–56), a positive predictive value of 57% (95% CI 51–62), and a negative predictive value of 97% (95% CI 93–99). The area under the curve for the decision rule was 0.74 (95% CI 0.70–0.77). Conclusions This clinical decision rule identifies low risk adult ED patients with tICH who do not need ICU admission. Further validation and refinement of these findings would allow for more appropriate ICU resource utilization. PMID:21839444

  14. Ultrasound findings of mild neonatal periventricular-intraventricular hemorrhage after different treatments

    PubMed Central

    Wang, Sida; Liao, Chunyan; Liang, Shuyuan; Zhong, Danni; Liu, Junjie; Li, Zhixian

    2015-01-01

    Objective: To investigate the ultrasound findings of mild neonatal periventricular-intraventricular hemorrhage (PIVH) after different treatments, and to evaluate the neurological outcomes of mild PIVH with Gesell Development Diagnosis Scale (GDDS). Methods: A total of 194 newborns with grade I-II PIVH were recruited, and findings of cranial ultrasound examination before and 1 month after birth were included for analysis. The echo intensity and size of the lesions were recorded. Results: There was no significant difference in the echo intensity among three groups of grade I PIVH patients (P>0.05). There was significant difference in the echo intensity among three groups of grade II PIVH patients, and the ganglioside had the best therapeutic efficacy (P<0.05). No significant difference was observed in the area change among three groups of grade I PIVH patients (P>0.05). However, significant difference was observed in the area change among three groups of grade II PIVH patients, and ganglioside had a better efficacy than cerebrolysin and control agent (P<0.05), but there was no significant difference between cerebrolysin and control groups (P>0.05). GDDS evaluation showed no significant difference among three groups (P>0.05), and all the patients recovered completely. Conclusion: The efficacy of different treatments for mild PIVH can be reflected in the ultrasound findings. Mild PIVH children generally have a good neurological prognosis. PMID:26131081

  15. Fetal and Neonatal Alloimmune Thrombocytopenia

    PubMed Central

    Espinoza, J P; Caradeux, J; Norwitz, Errol R; Illanes, S E

    2013-01-01

    Fetomaternal alloimmune thrombocytopenia (FMAIT) is a relatively uncommon disease, but is the leading cause of severe thrombocytopenia in the newborn. It can cause severe complications and long-term disabilities. The main objective of screening is to reduce both the morbidity and mortality associated with FMAIT, primarily by preventing intracranial hemorrhage. However, controversy surrounds both pre- and antenatal management. This article discusses pathogenesis, screening, diagnosis, and both pre- and neonatal management of FMAIT. PMID:23687553

  16. Intraventricular hemorrhage of the newborn

    MedlinePlus

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

  17. Evaluation of a computer-aided detection algorithm for timely diagnosis of small acute intracranial hemorrhage on computed tomography in a critical care environment

    NASA Astrophysics Data System (ADS)

    Lee, Joon K.; Chan, Tao; Liu, Brent J.; Huang, H. K.

    2009-02-01

    Detection of acute intracranial hemorrhage (AIH) is a primary task in the interpretation of computed tomography (CT) brain scans of patients suffering from acute neurological disturbances or after head trauma. Interpretation can be difficult especially when the lesion is inconspicuous or the reader is inexperienced. We have previously developed a computeraided detection (CAD) algorithm to detect small AIH. One hundred and thirty five small AIH CT studies from the Los Angeles County (LAC) + USC Hospital were identified and matched by age and sex with one hundred and thirty five normal studies. These cases were then processed using our AIH CAD system to evaluate the efficacy and constraints of the algorithm.

  18. [A Case of Aplastic or Twig-Like Middle Cerebral Artery Presenting with an Intracranial Hemorrhage Two Years after a Transient Ischemic Attack].

    PubMed

    Uchiyama, Taku; Okamoto, Hiroaki; Koguchi, Motofumi; Tajima, Yutaka; Suzuyama, Kenji

    2016-02-01

    Aplastic or twig-like middle cerebral artery (Ap/T-MCA) is a rare anatomical anomaly, which can be associated with intracranial hemorrhage and cerebral ischemia. A 52-year-old woman who presented with sudden headache was admitted to our hospital. Computed tomography (CT) and magnetic resonance imaging showed no abnormality; however, magnetic resonance angiogram revealed an occlusion or severe stenosis in the left middle cerebral artery. Three-dimensional CT angiography demonstrated severe stenosis in the left middle cerebral artery. The patient was discharged without any neurological deficit; however, she subsequently complained of temporary weakness in the right hand. It was possibly due to a transient ischemic attack; therefore, cilostazol 200 mg/day was administered for prevention of cerebral ischemia. Single photon emission computed tomography(with or without administration of acetazolamide)showed neither significant decrease in the cerebral blood flow nor cerebrovascular reactivity; hence, surgical revascularization was not performed. However, two years after the initial admission, she was urgently admitted to our hospital with sudden headache and nausea followed by aphasia and weakness of the right extremities. CT images showed diffuse subarachnoid hemorrhage and intracerebral hemorrhage in the left temporo-parietal lobe. Cerebral angiography revealed that the left middle cerebral artery was Ap/T-MCA without cerebral aneurysms. The patient was treated conservatively, and she eventually recovered without any neurological deficit except mild aphasia. Since Ap/T-MCA is associated with both hemorrhagic and ischemic stroke, antiplatelet therapy should be administered carefully. Moreover, it is necessary to consider extracranial-intracranial bypass to reduce hemodynamic stress on the abnormal vessels. PMID:26856268

  19. Subarachnoid hemorrhage caused by a fungal aneurysm of the vertebral artery as a complication of intracranial aneurysm clipping. Case report.

    PubMed

    Piotrowski, W P; Pilz, P; Chuang, I H

    1990-12-01

    Intracranial aneurysms are an uncommon manifestation of fungal infection. A case is described in which the formation of an aneurysm followed an intracranial intraoperative Aspergillus infection attributable to a long period of preoperative antibiotic medication and immunosuppressive therapy with steroids. PMID:2230983

  20. Intracranial biodegradable silica-based nimodipine drug release implant for treating vasospasm in subarachnoid hemorrhage in an experimental healthy pig and dog model.

    PubMed

    Koskimäki, Janne; Tarkia, Miikka; Ahtola-Sätilä, Tuula; Saloranta, Lasse; Simola, Outi; Forsback, Ari-Pekka; Laakso, Aki; Frantzén, Janek

    2015-01-01

    Nimodipine is a widely used medication for treating delayed cerebral ischemia (DCI) after subarachnoid hemorrhage. When administrated orally or intravenously, systemic hypotension is an undesirable side effect. Intracranial subarachnoid delivery of nimodipine during aneurysm clipping may be more efficient way of preventing vasospasm and DCI due to higher concentration of nimodipine in cerebrospinal fluid (CSF). The risk of systemic hypotension may also be decreased with intracranial delivery. We used animal models to evaluate the feasibility of surgically implanting a silica-based nimodipine releasing implant into the subarachnoid space through a frontotemporal craniotomy. Concentrations of released nimodipine were measured from plasma samples and CSF samples. Implant degradation was followed using CT imaging. After completing the recovery period, full histological examination was performed on the brain and meninges. The in vitro characteristics of the implant were determined. Our results show that the biodegradable silica-based implant can be used for an intracranial drug delivery system and no major histopathological foreign body reactions were observed. CT imaging is a feasible method for determining the degradation of silica implants in vivo. The sustained release profiles of nimodipine in CSF were achieved. Compared to a traditional treatment, higher nimodipine CSF/plasma ratios can be obtained with the implant. PMID:25685803

  1. Optical monitoring of stress-related changes in the brain tissues and vessels associated with hemorrhagic stroke in newborn rats.

    PubMed

    Semyachkina-Glushkovskaya, Oxana; Pavlov, Alexey; Kurths, Jürgen; Borisova, Ekaterina; Gisbrecht, Alexander; Sindeeva, Olga; Abdurashitov, Arkady; Shirokov, Alexander; Navolokin, Nikita; Zinchenko, Ekaterina; Gekalyuk, Artem; Ulanova, Maria; Zhu, Dan; Luo, Qingming; Tuchin, Valery

    2015-10-01

    Stress is a major factor for a risk of cerebrovascular catastrophes. Studying of mechanisms underlying stress-related brain-injures in neonates is crucial for development of strategy to prevent of neonatal stroke. Here, using a model of sound-stress-induced intracranial hemorrhages in newborn rats and optical methods, we found that cerebral veins are more sensitive to the deleterious effect of stress than arteries and microvessels. The development of venous insufficiency with decreased blood outflow from the brain accompanied by hypoxia, reduction of complexity of venous blood flow and high production of beta-arrestin-1 are possible mechanisms responsible for a risk of neonatal hemorrhagic stroke. PMID:26504656

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

    PubMed Central

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

    2013-01-01

    Objective To characterise pregnancies where the fetus or neonate was diagnosed with fetal and neonatal alloimmune thrombocytopenia (FNAIT) and suffered from intracranial haemorrhage (ICH), with special focus on time of bleeding onset. Design Observational cohort study of all recorded cases of ICH caused by FNAIT from the international No IntraCranial Haemorrhage (NOICH) registry during the period 2001–2010. Setting 13 tertiary referral centres from nine countries across the world. Participants 37 mothers and 43 children of FNAIT pregnancies complicated by fetal or neonatal ICH identified from the NOICH registry was included if FNAIT diagnosis and ICH was confirmed. Primary and secondary outcome measures Gestational age at onset of ICH, type of ICH and clinical outcome of ICH were the primary outcome measures. General maternal and neonatal characteristics of pregnancies complicated by fetal/neonatal ICH were secondary outcome measures. Results From a total of 592 FNAIT cases in the registry, 43 confirmed cases of ICH due to FNAIT were included in the study. The majority of bleedings (23/43, 54%) occurred before 28 gestational weeks and often affected the first born child (27/43, 63%). One-third (35%) of the children died within 4 days after delivery. 23 (53%) children survived with severe neurological disabilities and only 5 (12%) were alive and well at time of discharge. Antenatal treatment was not given in most (91%) cases of fetal/neonatal ICH. Conclusions ICH caused by FNAIT often occurs during second trimester and the clinical outcome is poor. In order to prevent ICH caused by FNAIT, at-risk pregnancies must be identified and prevention and/or interventions should start early in the second trimester. PMID:23524102

  3. [Fetal-neonatal alloimmune thrombocytopenia].

    PubMed

    Muñiz-Díaz, E; Ginovart Galiana, G

    2003-06-01

    Fetal-neonatal alloimmune thrombocytopenia is the commonest cause of severe thrombocytopenia in the newborn. This disorder is due to the destruction of fetal platelets by a maternal platelet-specific antibody caused by fetal-maternal incompatibility. The most serious complication is intracranial hemorrhage (10-30 % of newborns), which may cause death (10 % of the reported cases) or irreversible neurological sequelae (20 %). The diagnosis is usually made after birth when most affected neonates have petechiae, purpura or overt bleeding. The degree of severity varies according to platelet count. Current methods allow detection of maternal platelet alloantibodies (usually HPA-1a). Clinical grounds and the exclusion of other causes of neonatal thrombocytopenia are required to establish an accurate diagnosis. Recurrence of this disease is very high and has prompted clinicians to develop antenatal prophylactic programs in subsequent pregnancies. However, the optimal treatment of at-risk pregnancies remains controversial. The early diagnosis of this process allows effective therapy based on the infusion of compatible platelets and IgG immunoglobulins when hemorrhage is not obvious. Antenatal management of subsequent pregnancies can prevent recurrence of thrombocytopenia and intracranial hemorrhage. The aim of this review is to draw pediatricians' attention to the importance of this probably under-diagnosed disease in which early diagnosis can prevent potentially severe complications. PMID:12781112

  4. The “focus on aneurysm” principle: Classification and surgical principles of management of concurrent arterial aneurysm with arteriovenous malformation causing intracranial hemorrhage

    PubMed Central

    Jha, Vikas; Behari, Sanjay; Jaiswal, Awadhesh K.; Bhaisora, Kamlesh Singh; Shende, Yogesh P.; Phadke, Rajendra V.

    2016-01-01

    Context: Concurrent arterial aneurysms (AAs) occurring in 2.7-16.7% patients harboring an arteriovenous malformation (AVM) aggravate the risk of intracranial hemorrhage. Aim: We evaluate the variations of aneurysms simultaneously coexisting with AVMs. A classification-based management strategy and an abbreviated nomenclature that describes their radiological features is also proposed. Setting: Tertiary care academic institute. Statistics: Test of significance applied to determine the factors causing rebleeding in the groups of patients with concurrent AVM and aneurysm and those with only AVMs. Subjects and Methods: Sixteen patients (5 with subarachnoid hemorrhage and 11 with intracerebral/intraventricular hemorrhage; 10 with low flow [LF] and 6 with high flow [HF] AVMs) underwent radiological assessment of Spetzler Martin (SM) grading and flow status of AA + AVM. Their modified Rankin's score (mRS) at admission was compared with their follow-up (F/U) score. Results: Pre-operative mRS was 0 in 5, 2 in 6, 3 in 1, 4 in 3 and 5 in 1; and, SM grade I in 5, II in 3, III in 3, IV in 4 and V in 1 patients, respectively. AA associated AVMs were classified as: (I) Flow-related proximal (n = 2); (II) flow-related distal (n = 3); (III) intranidal (n = 5); (IV) extra-intranidal (n = 2); (V) remote major ipsilateral (n = 1); (VI) remote major contralateral (n = 1); (VII) deep perforator related (n = 1); (VIII) superficial (n = 1); and (IX) distal (n = 0). Their treatment strategy included: Flow related AA, SM I-III LF AVM: aneurysm clipping with AVM excision; nidal-extranidal AA, SM I-III LF AVM: Excision or embolization of both AA + AVM; nidal-extranidal and perforator-related AA, SM IV-V HF AVM: Only endovascular embolization or radiosurgery. Surgical decision-making for remote AA took into account their ipsilateral/contralateral filling status and vessel dominance; and, for AA associated with SM III HF AVM, it varied in each patient based on diffuseness of AVM nidus, flow

  5. Incidence of intracranial hemorrhage and outcomes after ground-level falls in geriatric trauma patients taking preinjury anticoagulants and antiplatelet agents.

    PubMed

    Reddy, Subhash; Sharma, Rohit; Grotts, Jonathan; Ferrigno, Lisa; Kaminski, Stephen

    2014-10-01

    Antiplatelet and anticoagulant medication increases the risk of intracranial hemorrhage (ICH) after a fall in geriatric patients. We sought to determine whether there were differences in ICH rates and outcomes based on type of anticoagulant or antiplatelet agent after a ground-level fall (GLF). Our institutional trauma registry was used to identify patients 65 years old or older after a GLF while taking warfarin, clopidogrel, or aspirin over a 2-year period. Rates and types of ICH and patient outcomes were evaluated. Of 562 patients who met inclusion and exclusion criteria, 218 (38.8%) were on warfarin, 95 (16.9%) were on clopidogrel, and 249 (44.3%) were on aspirin. Overall ICH frequency was 15 per cent with no difference in ICH rate, type of ICH, need for craniotomy, mortality, or intensive care unit or hospital length of stay between groups. Patients with ICH were more likely to present with abnormal Glasgow Coma Score, history of hypertension, and/or loss of consciousness. PMID:25264642

  6. Mechanisms underlying the perifocal neuroprotective effect of the Nrf2–ARE signaling pathway after intracranial hemorrhage

    PubMed Central

    Yin, Xiao-ping; Chen, Zhi-ying; Zhou, Jun; Wu, Dan; Bao, Bing

    2015-01-01

    Background It has been found that nuclear factor erythroid 2-related factor 2/antioxidant response element (Nrf2–ARE) signaling pathway plays a role in antioxidative response, anti-inflammatory response, and neuron-protection in intracerebral hemorrhage (ICH). The aim of this study is to explore mechanisms underlying the perifocal neuroprotective effect of the Nrf2–ARE signaling pathway after ICH. Methods There were a total of 90 rats with basal ganglia hemorrhage, which were randomly divided into the following four groups: ICH (Sprague–Dawley rats with autologous femoral arterial blood injection into the basal ganglia), sulforaphane (SFN) (SFN was intraperitoneally administered into rats), retinoic acid (RA) (RA was intraperitoneally administered into rats), and dimethyl sulfoxide (the rats were treated with dimethyl sulfoxide). We observed the neurological score of the rats in the different groups, and collected brain tissues for immunofluorescence, Western blot, and reverse transcription polymerase chain reaction to detect expression of Nrf2, heme oxygenase (HO-1), nuclear factor-κB (NF-κB), and tumor necrosis factor-α (TNF-α). Results The results indicated that neurological dysfunction of rats was significantly improved in the SFN group, and the expressions of Nrf2 and HO-1 in tissues surrounding the hemorrhage were increased. Also, the level of NF-κB and TNF-α were reduced compared to the ICH group. The RA group exhibited more severe neurological dysfunction and lower levels of Nrf2 and HO-1 than the SFN and ICH groups. Compared to the ICH group, the NF-κB and TNF-α expression in the RA groups was increased. In conclusion, RA inhibits Nrf2 dissociation and translocation into nucleus, thereby suppressing the anti-inflammatory effect of Nrf2–ARE signaling pathway. The activation of Nrf2–ARE signaling pathway by SFN can elevate expression of antioxidant enzyme HO-1, reduce perifocal inflammatory response after ICH, and thus may play a

  7. Attenuation of Acute Phase Injury in Rat Intracranial Hemorrhage by Cerebrolysin that Inhibits Brain Edema and Inflammatory Response.

    PubMed

    Yang, Yang; Zhang, Yan; Wang, Zhaotao; Wang, Shanshan; Gao, Mou; Xu, Ruxiang; Liang, Chunyang; Zhang, Hongtian

    2016-04-01

    The outcome of intracerebral hemorrhage (ICH) is mainly determined by the volume of the hemorrhage core and the secondary brain damage to penumbral tissues due to brain swelling, microcirculation disturbance and inflammation. The present study aims to investigate the protective effects of cerebrolysin on brain edema and inhibition of the inflammation response surrounding the hematoma core in the acute stage after ICH. The ICH model was induced by administration of type VII bacterial collagenase into the stratum of adult rats, which were then randomly divided into three groups: ICH + saline; ICH + Cerebrolysin (5 ml/kg) and sham. Cerebrolysin or saline was administered intraperitoneally 1 h post surgery. Neurological scores, extent of brain edema content and Evans blue dye extravasation were recorded. The levels of pro-inflammatory factors (IL-1β, TNF-α and IL-6) were assayed by Real-time PCR and Elisa kits. Aquaporin-4 (AQP4) and tight junction proteins (TJPs; claudin-5, occludin and zonula occluden-1) expression were measured at multiple time points. The morphological and intercellular changes were characterized by Electron microscopy. It is found that cerebrolysin (5 ml/kg) improved the neurological behavior and reduced the ipsilateral brain water content and Evans blue dye extravasation. After cerebrolysin treated, the levels of pro-inflammatory factors and AQP4 in the peri-hematomal areas were markedly reduced and were accompanied with higher expression of TJPs. Electron microscopy showed the astrocytic swelling and concentrated chromatin in the ICH group and confirmed the cell junction changes. Thus, early cerebrolysin treatment ameliorates secondary injury after ICH and promotes behavioral performance during the acute phase by reducing brain edema, inflammatory response, and blood-brain barrier permeability. PMID:26498936

  8. A Robust Current Pattern for the Detection of Intraventricular Hemorrhage in Neonates Using Electrical Impedance Tomography

    PubMed Central

    Tang, T.; Oh, Sungho; Sadleir, R. J.

    2010-01-01

    We compared two 16-electrode electrical impedance tomography (EIT) current patterns on their ability to reconstruct and quantify small amounts of bleeding inside a neonatal human head using both simulated and phantom data. The current patterns used were an adjacent injection RING pattern (with electrodes located equidistantly on the equator of a sphere) and an EEG current pattern based on the 10–20 EEG electrode layout. Structures mimicking electrically important structures in the infant skull were included in a spherical numerical forward model and their effects on reconstructions were determined. The EEG pattern was found to be a better topology to localize and quantify anomalies within lateral ventricular regions. The RING electrode pattern could not reconstruct anomaly location well, as it could not distinguish different axial positions. The quantification accuracy of the RING pattern was as good as the EEG pattern in noise-free environments. However, the EEG pattern showed better quantification ability than the RING pattern when noise was added. The performance of the EEG pattern improved further with respect to the RING pattern when a fontanel was included in forward models. Significantly better resolution and contrast of reconstructed anomalies was achieved when generated from a model containing such an opening and 50 dB added noise. The EEG method was further applied to reconstruct data from a realistic neonatal head model. Overall, acceptable reconstructions and quantification results were obtained using this model and the homogeneous spherical forward model. PMID:20238166

  9. Protease-activated receptor 1 and 4 signal inhibition reduces preterm neonatal hemorrhagic brain injury

    PubMed Central

    Lekic, Tim; Klebe, Damon; McBride, Devin W; Manaenko, Anatol; Rolland, William B.; Flores, Jerry J.; Altay, Orhan; Tang, Jiping; Zhang, John H.

    2015-01-01

    Background and Purpose This study examines the role of thrombin’s protease-activated receptors (PAR)-1,-4 in mediating cyclooxygenase (COX)-2 and mammalian target of rapamycin (mTOR) following germinal matrix hemorrhage (GMH). Methods GMH was induced by intraparenchymal infusion of bacterial collagenase into the right ganglionic eminence of P7 rat pups. Animals were treated with either PAR-1, -4, COX-2, or mTOR inhibitors by 1 hour, and up to five days. Results We found increased thrombin activity 6–24 hrs after GMH, and PAR-1, -4, inhibition normalized COX-2 and mTOR by 72 hrs. Early treatment with NS398 or rapamycin substantially improved long-term outcomes in juvenile animals. Conclusions Suppressing early PAR signal transduction, and postnatal NS398 or rapamycin treatment, may help reduce GMH severity in susceptible preterm infants. PMID:25931468

  10. Optimal Timing of Mesenchymal Stem Cell Therapy for Neonatal Intraventricular Hemorrhage.

    PubMed

    Park, Won Soon; Sung, Se In; Ahn, So Yoon; Sung, Dong Kyung; Im, Geun Ho; Yoo, Hye Soo; Choi, Soo Jin; Chang, Yun Sil

    2016-01-01

    We recently showed that intraventricular transplantation of human umbilical cord blood (UCB)-derived mesenchymal stem cells (MSCs) significantly attenuated posthemorrhagic hydrocephalus (PHH) and brain injury after severe intraventricular hemorrhage (IVH) in newborn rat pups. The purpose of this study was to optimize the timing of MSC transplantation for severe IVH. Severe IVH was induced by injecting 100 µl of blood into each ventricle of Sprague-Dawley rats on postnatal day 4 (P4). Human UCB-derived MSCs (1 × 10(5) cells in 10 µl of normal saline) were transplanted intraventricularly under stereotaxic guidance either early at P6 or late at P11. Serial brain MRIs and behavioral function tests, such as negative geotaxis and rotarod tests, were performed. At P32, brain tissue samples were obtained for histological and biochemical analyses. Intracerebroventricular transplantation of MSCs significantly attenuated the development of PHH, behavioral impairment, increased apoptosis and astrogliosis, reduced corpus callosum thickness and brain myelination, and upregulated inflammatory cytokines including interleukin (IL)-1α, IL-1β, IL-6, and tumor necrosis factor-α (TNF-α) at P6 but not at P11 after induction of severe IVH. Intracerebroventricular transplantation of human UCB-derived MSCs attenuated PHH and brain injury after severe IVH in newborn rats in a time-dependent manner. Significant neuroprotection was only demonstrated when administered early at 2 days after induction but not late at 7 days after induction of severe IVH. PMID:26440762

  11. Neuron-Specific Enolase, S100 Calcium-Binding Protein B, and Heat Shock Protein 70 Levels in Patients With Intracranial Hemorrhage

    PubMed Central

    Alatas, Ömer Doğan; Gürger, Mehtap; Ateşçelik, Metin; Yildiz, Mustafa; Demir, Caner Feyzi; Kalayci, Mehmet; Ilhan, Nevin; Acar, Ethem

    2015-01-01

    Abstract The authors evaluated neuron-specific enolase (NSE), S100 calcium-binding protein B (S100B), and heat shock protein 70 (HSP 70) levels and their relationships with in-hospital mortality, Glasgow Coma Scale (GCS) scores, and National Institute of Health Stroke Scale (NIHSS) scores. In total, 35 patients older than 18 years were presented to our emergency department and were diagnosed with non-traumatic intracranial hemorrhage (ICH) and 32 healthy controls were included. Blood samples were drawn on days 0 and 5. S100 calcium-binding protein B and HSP levels were significantly higher in patients than in controls on days 0 and 5. Neuron-specific enolase levels were higher in patients than in controls on day 0, but there was no significant difference on day 5. S100 calcium-binding protein B was negatively correlated with GCS, whereas it was positively correlated with NIHSS and bleeding volume. There was also a negative correlation between NSE and GCS, but it was not statistically significant. In addition, no significant correlation was found in terms of bleeding volume or NIHSS. Heat shock protein 70 was negatively correlated with GCS and positively correlated with bleeding volume and NIHSS, but these results were not statistically significant. S100 calcium-binding protein B and HSP 70 levels were significantly higher in those who died compared with survivors. The areas under the curve of S100 B, NSE, and HSP 70 for mortality were 0.635, 0.477, and 0.770, respectively. Neuron-specific enolase, S100B, and HSP 70 levels are simple, inexpensive, and objective measures in cases of ICH. These tests can be used to support an assessment for screening ICH patients with clinical scoring systems, such as GCS and NIHSS. PMID:26559295

  12. Antithrombotic Treatment in Neonatal Cerebral Sinovenous Thrombosis: Results of the International Pediatric Stroke Study

    PubMed Central

    Jordan, Lori C.; Rafay, Mubeen F.; Smith, Sabrina E.; Askalan, Rand; Zamel, Khaled M.; deVeber, Gabrielle; Ashwal, Stephen

    2010-01-01

    Objective To identify predictors of antithrombotic treatment in neonates with cerebral sinovenous thrombosis (CSVT) in a large multi-national study. Study Design Neonates with CSVT from 10 countries were enrolled in the International Pediatric Stroke Study from 2003-2007. Term neonates with CSVT who presented with neurologic symptoms or signs of systemic illness and neuroimaging evidence of thrombus or flow interruption within cerebral venous system were included. Results Of 341 neonates enrolled, 84 had isolated CSVT. Neuroimaging findings, available in 67/84 neonates, included: venous ischemic infarction in 5, hemorrhagic infarction or other intracranial hemorrhage in 13, both infarction and hemorrhage in 26, and no parenchymal lesions in 23. Treatment data, available in 81/84 neonates, included antithrombotic medications in 52% (n=43), comprising heparin (n=14), low molecular weight heparin (n=34), warfarin (n=1) and aspirin (n=2). By univariate logistic regression analysis, deep venous system thrombosis (p=0.05) and location in the United States (p=0.001) predicted non-treatment. Presence of infarction, hemorrhage, dehydration, systemic illness, and age did not predict treatment or non-treatment. In multivariate analysis only geographic location remained significant. Conclusions In neonatal CSVT, regional antithrombotic treatment practices demonstrate considerable variability and uncertainty about the indications for antithrombotic therapy. Additional studies to determine appropriate treatments are warranted. PMID:20149389

  13. Derivation of a Clinical Decision Instrument to Identify Adult Patients with Mild Traumatic Intracranial Hemorrhage at Low Risk for Requiring ICU Admission

    PubMed Central

    Nishijima, Daniel K.; Sena, Matthew J.; Galante, Joseph M.; Shahlaie, Kiarash; London, Jason A.; Melnikow, Joy; Holmes, James F.

    2013-01-01

    Study Objective The objective of this study was to derive a clinical decision instrument with a sensitivity of at least 95% (with upper and lower bounds of the 95% CIs within a 5% range) to identify adult emergency department patients with mild traumatic intracranial hemorrhage (tICH) who are at low risk for requiring critical care resources during hospitalization and thus may not need admission to the ICU. Methods This was a prospective, observational study of adult patients with mild tICH (initial Glasgow Coma Scale [GCS] score 13 to 15 with tICH) presenting to a Level 1 trauma center from July 2009 to February 2013. The need for ICU admission was defined as the presence of an acute critical care intervention (intubation, neurosurgical intervention, blood product transfusion, vasopressor or inotrope administration, invasive monitoring for hemodynamic instability, emergent treatment for arrhythmia or cardiopulmonary resuscitation, therapeutic angiography). We derived the clinical decision instrument using binary recursive partitioning (with a misclassification cost of 20 to 1). The accuracy of the decision instrument was compared to the treating physician’s (emergency medicine faculty) clinical impression. Results A total of 600 patients with mild tICH were enrolled; 116 patients (19%) had a critical care intervention. The derived instrument consisted of four predictor variables: admission GCS score less than 15, non-isolated head injury, age 65 years or older, and evidence of swelling or shift on initial cranial computed tomography scan. The decision instrument identified 114 of 116 patients requiring an acute critical care intervention (sensitivity 98.3%; 95% CI 93.9–99.5%) if at least one variable was present, and 192 of 484 patients that did not have an acute critical care intervention (specificity 39.7%; 95% CI 35.4–44.1%) if no variables were present. Physician clinical impression was slightly less sensitive (90.1%; 95% CI 83.1–94.4%) but overall

  14. [Cerebral hemorrhage].

    PubMed

    Nakase, Hiroyuki; Motoyama, Yasushi; Yamada, Shuichi

    2016-04-01

    Intracerebral hemorrhage (ICH) remains a serious condition for which early aggressive care is warranted. Japanese evidence-based stroke guidelines were published in 2015 to present the current and comprehensive recommendations for the diagnosis and treatment of stroke. In the spontaneous ICH, topics focused on prevention, management in the acute and chronic stage, complications, management of coagulopathy and blood pressure, prevention and control of secondary brain injury and intracranial pressure, the role of surgery, and other pathologies of ICH. The management of ICH in pregnancy and the puerperium was newly added. These guidelines provide a framework for goal-directed treatment of the patient with ICH. PMID:27333758

  15. Mucopolysaccharidosis IIIB confers enhanced neonatal intracranial transduction by AAV8 but not by 5, 9 or rh10

    PubMed Central

    Gilkes, J A; Bloom, M D; Heldermon, C D

    2016-01-01

    Sanfilippo syndrome type B (mucopolysaccharidosis IIIB, MPS IIIB) is a lysosomal storage disease resulting from deficiency of N-acetyl-glucosaminidase (NAGLU) activity. To determine the possible therapeutic utility of recombinant adeno-associated virus (rAAV) in early gene therapy-based interventions, we performed a comprehensive assessment of transduction and biodistribution profiles of four central nervous system (CNS) administered rAAV serotypes, -5, -8, -9 and -rh10. To simulate optimal earliest treatment of the disease, each rAAV serotype was injected into the CNS of neonatal MPS IIIB and control animals. We observed marked differences in biodistribution and transduction profiles between the serotypes and this differed in MPS IIIB compared with healthy control mice. Overall, in control mice, all serotypes performed comparably, although some differences were observed in certain focal areas. In MPS IIIB mice, AAV8 was more efficient than AAV5, -9 and -rh10 for gene delivery to most structures analyzed, including the cerebral cortex, hippocampus and thalamus. Noteworthy, the pattern of biodistribution within the CNS varied by serotype and genotype. Interestingly, AAV8 also produced the highest green fluorescent protein intensity levels compared with any other serotype and demonstrated improved transduction in NAGLU compared with control brains. Importantly, we also show leakage of AAV8, -9 and -rh10, but not AAV5, from CNS parenchyma to systemic organs. Overall, our data suggest that AAV8 represents the best therapeutic gene transfer vector for early intervention in MPS IIIB. PMID:26674264

  16. Mucopolysaccharidosis IIIB confers enhanced neonatal intracranial transduction by AAV8 but not by 5, 9 or rh10.

    PubMed

    Gilkes, J A; Bloom, M D; Heldermon, C D

    2016-03-01

    Sanfilippo syndrome type B (mucopolysaccharidosis IIIB, MPS IIIB) is a lysosomal storage disease resulting from deficiency of N-acetyl-glucosaminidase (NAGLU) activity. To determine the possible therapeutic utility of recombinant adeno-associated virus (rAAV) in early gene therapy-based interventions, we performed a comprehensive assessment of transduction and biodistribution profiles of four central nervous system (CNS) administered rAAV serotypes, -5, -8, -9 and -rh10. To simulate optimal earliest treatment of the disease, each rAAV serotype was injected into the CNS of neonatal MPS IIIB and control animals. We observed marked differences in biodistribution and transduction profiles between the serotypes and this differed in MPS IIIB compared with healthy control mice. Overall, in control mice, all serotypes performed comparably, although some differences were observed in certain focal areas. In MPS IIIB mice, AAV8 was more efficient than AAV5, -9 and -rh10 for gene delivery to most structures analyzed, including the cerebral cortex, hippocampus and thalamus. Noteworthy, the pattern of biodistribution within the CNS varied by serotype and genotype. Interestingly, AAV8 also produced the highest green fluorescent protein intensity levels compared with any other serotype and demonstrated improved transduction in NAGLU compared with control brains. Importantly, we also show leakage of AAV8, -9 and -rh10, but not AAV5, from CNS parenchyma to systemic organs. Overall, our data suggest that AAV8 represents the best therapeutic gene transfer vector for early intervention in MPS IIIB. PMID:26674264

  17. Primary Intracranial Synovial Sarcoma.

    PubMed

    Patel, Mohit; Li, Luyuan; Nguyen, Ha Son; Doan, Ninh; Sinson, Grant; Mueller, Wade

    2016-01-01

    Background. Synovial sarcoma is an aggressive soft tissue sarcoma with uncertain histological origin. The pathology frequently presents as a localized disease, especially near large joints around the knee and thigh. Intracranial disease, which is rare, has been reported as metastasis from synovial sarcoma. We report a case with no obvious primary extracranial pathology, suggesting primary intracranial disease; this has not been reported in the literature. Case Description. A 21-year-old male, with a prior right skull lesion resection for atypical spindle cell neoplasm, presented with headaches, gait instability, left arm weakness, and left homonymous hemianopsia. CT of head demonstrated a right parietal hemorrhagic lesion with mass effect, requiring surgical decompression. Histopathology revealed synovial sarcoma. FISH analysis noted the existence of the t(X;18)(p11.2;q11.2) chromosomal translocation. PET scan did not show other metastatic disease. He underwent stereotactic radiotherapy and adjuvant chemotherapy. At 2-year follow-up, he remained nonfocal without recurrence. Conclusion. We report the first known case of primary intracranial synovial sarcoma. Moreover, we stress that intracranial lesions may have a tendency for hemorrhage, requiring urgent lifesaving decompression. PMID:27247811

  18. Primary Intracranial Synovial Sarcoma

    PubMed Central

    Li, Luyuan; Sinson, Grant; Mueller, Wade

    2016-01-01

    Background. Synovial sarcoma is an aggressive soft tissue sarcoma with uncertain histological origin. The pathology frequently presents as a localized disease, especially near large joints around the knee and thigh. Intracranial disease, which is rare, has been reported as metastasis from synovial sarcoma. We report a case with no obvious primary extracranial pathology, suggesting primary intracranial disease; this has not been reported in the literature. Case Description. A 21-year-old male, with a prior right skull lesion resection for atypical spindle cell neoplasm, presented with headaches, gait instability, left arm weakness, and left homonymous hemianopsia. CT of head demonstrated a right parietal hemorrhagic lesion with mass effect, requiring surgical decompression. Histopathology revealed synovial sarcoma. FISH analysis noted the existence of the t(X;18)(p11.2;q11.2) chromosomal translocation. PET scan did not show other metastatic disease. He underwent stereotactic radiotherapy and adjuvant chemotherapy. At 2-year follow-up, he remained nonfocal without recurrence. Conclusion. We report the first known case of primary intracranial synovial sarcoma. Moreover, we stress that intracranial lesions may have a tendency for hemorrhage, requiring urgent lifesaving decompression. PMID:27247811

  19. Intracranial aneurysm and sildenafil

    PubMed Central

    Edriss, Hawa; Nugent, Kenneth

    2016-01-01

    Sildenafil is one of the most commonly used drugs for the treatment of erectile dysfunction. To date, we found five reported cases of intracerebral bleeding and two reported cases of subarachnoid hemorrhage related to sildenafil use. We report a 49-year-old hypertensive and diabetic patient who presented with acute pulmonary edema and loss of consciousness following ingestion of 100 mg of sildenafil prior to sexual intercourse. He was not previously aware of the presence of an aneurysm and had no family history of it. Computed tomography of his head revealed a subarachnoid hemorrhage due to rupture of a saccular aneurysm with subsequent repeat hemorrhage within a few hours of presentation. A sudden increase in blood pressure led to pulmonary edema. Studies have shown that sildenafil acts on phosphodiesterase-1, -2 and -5 receptors and leads to a secondary increase in intracerebral circulation and vasodilatory effects, leading to sympathetic overactivity which increases the risk for intracranial bleeding. PMID:27034561

  20. Successful management of neonatal alloimmune thrombocytopenia in the second pregnancy: a case report

    PubMed Central

    Conti, Fabiana Mendes; Hibner, Sergio; Costa, Thiago Henrique; Dezan, Marcia Regina; Aravechia, Maria Giselda; Pereira, Ricardo Antonio D'Almeida; Kondo, Andrea Tiemi; D'Amico, Élbio Antônio; Mota, Mariza; Kutner, José Mauro

    2014-01-01

    ABSTRACT Neonatal alloimmune thrombocytopenia is a serious disease, in which the mother produces antibodies against fetal platelet antigens inherited from the father; it is still an underdiagnosed disease. This disease is considered the platelet counterpart of the RhD hemolytic disease of the fetus and newborn, yet in neonatal alloimmune thrombocytopenia the first child is affected with fetal and/or neonatal thrombocytopenia. There is a significant risk of intracranial hemorrhage and severe neurological impairment, with a tendency for earlier and more severe thrombocytopenia in subsequent pregnancies. This article reports a case of neonatal alloimmune thrombocytopenia in the second pregnancy affected and discusses diagnosis, management and the clinical importance of this disease. PMID:24728253

  1. Monitoring intracranial pressure based on F-P

    NASA Astrophysics Data System (ADS)

    Cai, Ting; Tong, Xinglin; Chen, Guangxi

    2013-09-01

    Intracranial pressure is an important monitoring indicator of neurosurgery. In this paper we adopt all-fiber FP fiber optic sensor, using a minimally invasive operation to realize real-time dynamic monitoring intracranial pressure of the hemorrhage rats, and observe their intracranial pressure regularity of dynamic changes. Preliminary results verify the effectiveness of applications and feasibility, providing some basis for human brain minimally invasive intracranial pressure measurement.

  2. Multi-site evaluation of a computer aided detection (CAD) algorithm for small acute intra-cranial hemorrhage and development of a stand-alone CAD system ready for deployment in a clinical environment

    NASA Astrophysics Data System (ADS)

    Deshpande, Ruchi R.; Fernandez, James; Lee, Joon K.; Chan, Tao; Liu, Brent J.; Huang, H. K.

    2010-03-01

    Timely detection of Acute Intra-cranial Hemorrhage (AIH) in an emergency environment is essential for the triage of patients suffering from Traumatic Brain Injury. Moreover, the small size of lesions and lack of experience on the reader's part could lead to difficulties in the detection of AIH. A CT based CAD algorithm for the detection of AIH has been developed in order to improve upon the current standard of identification and treatment of AIH. A retrospective analysis of the algorithm has already been carried out with 135 AIH CT studies with 135 matched normal head CT studies from the Los Angeles County General Hospital/ University of Southern California Hospital System (LAC/USC). In the next step, AIH studies have been collected from Walter Reed Army Medical Center, and are currently being processed using the AIH CAD system as part of implementing a multi-site assessment and evaluation of the performance of the algorithm. The sensitivity and specificity numbers from the Walter Reed study will be compared with the numbers from the LAC/USC study to determine if there are differences in the presentation and detection due to the difference in the nature of trauma between the two sites. Simultaneously, a stand-alone system with a user friendly GUI has been developed to facilitate implementation in a clinical setting.

  3. [Hemorrhagic stroke associated to neurocysticercosis].

    PubMed

    Tellez-Zenteno, J F; Negrete-Pulido, O; Cantú, C; Márquez, C; Vega-Boada, F; García Ramos, G

    2003-06-01

    A well-known complication of neurocysticercosis is cerebral arteritis, which is usually manifested by cerebral ischemia. Only anecdotal cases of hemorrhagic stroke associated to this parasitosis have been described. Previously there are only two reported cases of this association. One of these cases had an intracystic hemorrhage confirmed by autopsy without cerebrovascular risk factors. Autopsy revealed an inflammatory arteriopathy adjacent to the cyst intracystic hemorrhage. The second case had a subarachnoidal hemorrhage secondary to the rupture of an aneurysm in the right anteroinferior cerebellar artery. At surgery, the aneurysm was found to be surrounded by a thickened-leptomeninges, which histologically showed the presence of cysticercous with dense inflammation. Our first patient was a 32 year-old female developed a lenticulo-capsular hemorrhage around a cysticercotic lesion. The second patient was a 34 year-old male developed an intracystic hemorrhage. As cerebral angiography was normal in both patients, cerebral hemorrhages were considered to be related to cysticercotic arteritis of small penetrating vessels. We conclude that cysticercosis is associated with differenttypes of intracranial hemorrhage, as documented the present cases. In neurocysticercosis endemic areas, cysticercotic arteritis should be added to the list of causes of intracranial hemorrhage in young people. PMID:12768515

  4. Minocycline Attenuates Neonatal Germinal-Matrix-Hemorrhage-Induced Neuroinflammation and Brain Edema by Activating Cannabinoid Receptor 2.

    PubMed

    Tang, Jun; Chen, Qianwei; Guo, Jing; Yang, Liming; Tao, Yihao; Li, Lin; Miao, Hongping; Feng, Hua; Chen, Zhi; Zhu, Gang

    2016-04-01

    Germinal matrix hemorrhage (GMH) is the most common neurological disease of premature newborns leading to detrimental neurological sequelae. Minocycline has been reported to play a key role in neurological inflammatory diseases by controlling some mechanisms that involve cannabinoid receptor 2 (CB2R). The current study investigated whether minocycline reduces neuroinflammation and protects the brain from injury in a rat model of collagenase-induced GMH by regulating CB2R activity. To test this hypothesis, the effects of minocycline and a CB2R antagonist (AM630) were evaluated in male rat pups that were post-natal day 7 (P7) after GMH. We found that minocycline can lead to increased CB2R mRNA expression and protein expression in microglia. Minocycline significantly reduced GMH-induced brain edema, microglial activation, and lateral ventricular volume. Additionally, minocycline enhanced cortical thickness after injury. All of these neuroprotective effects of minocycline were prevented by AM630. A cannabinoid CB2 agonist (JWH133) was used to strengthen the hypothesis, which showed the identical neuroprotective effects of minocycline. Our study demonstrates, for the first time, that minocycline attenuates neuroinflammation and brain injury in a rat model of GMH, and activation of CBR2 was partially involved in these processes. PMID:25833102

  5. Endovascular treatment of intracranial aneurysms.

    PubMed

    Diaz, Orlando; Rangel-Castilla, Leonardo

    2016-01-01

    Intracranial aneurysms are abnormal dilations of the intracranial vessels, in which all the layers of the vascular wall are affected by degenerative changes that lead to distension of the vessel. Intracranial aneurysms can be classified based on their anatomic location, size, and morphology. Subarachnoid hemorrhage is the most devastating clinical presentation. The goal of preventing hemorrhage or rehemorrhage can only be achieved by excluding the aneurysm from the cerebral circulation. Endovascular or surgical clipping can achieve this goal. Multiple surgical and endovascular approaches have been described for treatment of intracranial aneurysm. Surgical approaches for anterior-circulation intracranial aneurysms include: pterional, orbitozygomatic, and lateral supraorbital craniotomies. Modern microsurgical techniques involve skull base dissection to achieve adequate exposure with minimal brain retraction. Endovascular techniques can be divided into: parent artery reconstruction with coil deposition (primary coil, balloon-assisted coiling, stent-assisted coiling, and other new techniques such as neck reconstruction devices and intraluminal occlusion devices); reconstruction with flow diversion; and deconstructive techniques with involving parent artery sacrifice with or without bypass. PMID:27430470

  6. Management of Unruptured Intracranial Aneurysms.

    PubMed

    Nasr, Deena M; Brown, Robert D

    2016-09-01

    Unruptured intracranial aneurysms (UIA) occur in approximately 2-3 % of the population. Most of these lesions are incidentally found, asymptomatic and typically carry a benign course. Although the risk of aneurysmal subarachnoid hemorrhage is low, this complication can result in significant morbidity and mortality, making assessment of this risk the cornerstone of UIA management. This article reviews important factors to consider when managing unruptured intracranial aneurysms including patient demographics, comorbidities, family history, symptom status, and aneurysm characteristics. It also addresses screening, monitoring, medical management and current surgical and endovascular therapies. PMID:27443382

  7. In vivo quantification of intraventricular hemorrhage in a neonatal piglet model using an EEG-layout based electrical impedance tomography array.

    PubMed

    Tang, Te; Weiss, Michael D; Borum, Peggy; Turovets, Sergei; Tucker, Don; Sadleir, Rosalind

    2016-06-01

    Intraventricular hemorrhage (IVH) is a common occurrence in the days immediately after premature birth. It has been correlated with outcomes such as periventricular leukomalacia (PVL), cerebral palsy and developmental delay. The causes and evolution of IVH are unclear; it has been associated with fluctuations in blood pressure, damage to the subventricular zone and seizures. At present, ultrasound is the most commonly used method for detection of IVH, but is used retrospectively. Without the presence of adequate therapies to avert IVH, the use of a continuous monitoring technique may be somewhat moot. While treatments to mitigate the damage caused by IVH are still under development, the principal benefit of a continuous monitoring technique will be in investigations into the etiology of IVH, and its associations with periventricular injury and blood pressure fluctuations. Electrical impedance tomography (EIT) is potentially of use in this context as accumulating blood displaces higher conductivity cerebrospinal fluid (CSF) in the ventricles. We devised an electrode array and EIT measurement strategy that performed well in detection of simulated ventricular blood in computer models and phantom studies. In this study we describe results of pilot in vivo experiments on neonatal piglets, and show that EIT has high sensitivity and specificity to small quantities of blood (<1 ml) introduced into the ventricle. EIT images were processed to an index representing the quantity of accumulated blood (the 'quantity index', QI). We found that QI values were linearly related to fluid quantity, and that the slope of the curve was consistent between measurements on different subjects. Linear discriminant analysis showed a false positive rate of 0%, and receiver operator characteristic analysis found area under curve values greater than 0.98 to administered volumes between 0.5, and 2.0 ml. We believe our study indicates that this method may be well suited to quantitative

  8. Coil Embolization for Intracranial Aneurysms

    PubMed Central

    2006-01-01

    , resulting in a subarachnoid hemorrhage (SAH), the mortality rate can be 40% to 50%, with severe morbidity of 10% to 20%. The reported overall risk of rupture is 1.9% per year and is higher for women, cigarette smokers, and cocaine users, and in aneurysms that are symptomatic, greater than 10 mm in diameter, or located in the posterior circulation. If left untreated, there is a considerable risk of repeat hemorrhage in a ruptured aneurysm that results in increased mortality. In Ontario, intracranial aneurysms occur in about 1% to 4% of the population, and the annual incidence of SAH is about 10 cases per 100,000 people. In 2004-2005, about 660 intracranial aneurysm repairs were performed in Ontario. Treatment of Intracranial Aneurysms Treatment of an unruptured aneurysm attempts to prevent the aneurysm from rupturing. The treatment of a ruptured intracranial aneurysm aims to prevent further hemorrhage. There are 3 approaches to treating an intracranial aneurysm. Small, asymptomatic aneurysms less than 10 mm in diameter may be monitored without any intervention other than treatment for underlying risk factors such as hypertension. Open surgical clipping, involves craniotomy, brain retraction, and placement of a silver clip across the neck of the aneurysm while a patient is under general anesthesia. This procedure is associated with surgical risks and neurological deficits. Endovascular coil embolization, introduced in the 1990s, is the health technology under review. Literature Review Methods The Medical Advisory Secretariat searched the International Health Technology Assessment (INAHTA) Database and the Cochrane Database of Systematic Reviews to identify relevant systematic reviews. OVID Medline, Medline In-Process and Other Non-Indexed Citations, and Embase were searched for English-language journal articles that reported primary data on the effectiveness or cost-effectiveness of treatments for intracranial aneurysms, obtained in a clinical setting or analyses of primary

  9. [Convulsions in neonatal period and infancy with rare etiology (neurogenetic disease)].

    PubMed

    Nagy, Andrea; Szever, Zsuzsa; Kormos, Zsuzsa; Székely, Emoke; Tóth, Edit; Smidéliusz, Lajos; Horváth, Rita; Karcagi, Vera; Schuler, Agnes; Jávorszky, Eszter

    2008-11-30

    Authors summarized the etiology of convulsions in neonatal period and infancy (hypoxia, intracranial hemorrhage, infections of central nervous system, metabolic background, chromosomal abnormalities, brain developmental abnormalities, benign neonatal convulsions, benign neonatal familial convulsions, drug withdrawal, inborn error of metabolism). They suggest screening examinations after convulsion, summarized the basic principle of tandem examination and review a proposal at suspicion of inborn error of enzyme defects (aminoacidemias, defects of fatty acid oxidation, organic acidemias). They present case history of two patients suffered in extraordinary inborn error of enzyme defect (SCO2 gene mutation, propionic acidemia). Diagnosis originated in Helm P61 Hospital (settlement Madarász Hospital) with a Hungarian and international cooperation. PMID:19070318

  10. Extracorporeal membrane oxygenation therapy in neonates with septic shock.

    PubMed

    McCune, S; Short, B L; Miller, M K; Lotze, A; Anderson, K D

    1990-05-01

    Neonatal septic shock has significant morbidity and mortality with current therapeutic measures. At Children's National Medical Center, from June 1984 to October 1986, 10 of 100 patients treated with venoarterial extracorporeal membrane oxygenation (ECMO) had a documented diagnosis of septic shock. All of these infants fulfilled criteria consistent with 80% mortality using conventional intensive medical management. However, the survival rate for the septic neonates in this study was 100%. Compared with other groups of infants treated with ECMO, these septic neonates required significantly more ventilatory support after ECMO and had a higher incidence of chronic lung disease (30% v 12%). The septic neonates were also at higher risk for intracranial hemorrhage than the other infants treated with ECMO (40% v 26%). The necessity for prolonged intubation after ECMO for patients with septic shock suggests that this condition may be associated with additional structural damage not seen with meconium aspiration syndrome or respiratory distress syndrome. Nevertheless, for neonatal patients with septic shock unresponsive to conventional medical management, ECMO must be considered a viable alternative treatment. PMID:2352078

  11. Management of Symptomatic Intracranial Stenosis.

    PubMed

    Hoak, David A; Lutsep, Helmi L

    2016-09-01

    Intracranial atherosclerotic disease is a common cause of stroke worldwide, causing approximately 10 % of strokes in the USA and up to 50 % in Asian populations. Recurrent stroke risks are particularly high in those with a stenosis of 70 % or more and a recent transient ischemic attack or stroke. Warfarin has been associated with higher major hemorrhage rates and no reduction of recurrent stroke compared to aspirin in patients with symptomatic intracranial stenosis. After early trials showed the feasibility of stenting, two randomized trials compared stenting plus medical management to medical management alone in symptomatic intracranial stenosis. Stenting was linked with increased risk and showed no benefit in any subpopulation of patients. Aggressive medical management in the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial was associated with half the risk of stroke compared to that in similar patients in a previous symptomatic intracranial stenosis trial after adjustment of confounding characteristics. Aggressive medical management comprises risk factor control, including a target systolic blood pressure <140 mmHg, a low density lipoprotein <70 mg/dL, hemoglobin A1C <7.0 %, and lifestyle management that incorporates exercise, smoking cessation and weight management, and the use of antithrombotics. PMID:27443379

  12. Neonatal neurosonography: A pictorial essay

    PubMed Central

    Bhat, Venkatraman; Bhat, Varun

    2014-01-01

    Neurosonography is a simple, established non-invasive technique for the intracranial assessment of preterm neonate. Apart from established indication in the evaluation of periventricular haemorrhage, it provides clue to wide range of pathology. This presentation provides a quick roadmap to the technique, imaging anatomy and spectrum of pathological imaging appearances encountered in neonates. PMID:25489132

  13. Intracranial germinoma

    PubMed Central

    Reddy, Manoj P.; Doughty, Kyle E.; Armstrong, Danielle; Melguizo-Gavilanes, Isaac; Cheek, Brennen S.; Opatowsky, Michael J.

    2015-01-01

    Pineal region tumors make up less than 1% of all intracranial neoplasms, with the majority being of germ cell origin. We describe the diagnostic evaluation and treatment of a patient presenting with neurological deficits who was found to have a germinoma of the pineal gland. PMID:25552796

  14. Management of Intraventricular Hemorrhage

    PubMed Central

    Hinson, Holly E.; Ziai, Wendy C.

    2011-01-01

    Brain hemorrhage is the most fatal form of stroke and has the highest morbidity of any stroke subtype. Intraventricular extension of hemorrhage (IVH) is a particularly poor prognostic sign, with expected mortality between 50% and 80%. IVH is a significant and independent contributor to morbidity and mortality, yet therapy directed at ameliorating intraventricular clot has been limited. Conventional therapy centers on managing hypertension and intracranial pressure while correcting coagulopathy and avoiding complications such as rebleeding and hydrocephalus. Surgical therapy alone has not changed the natural history of the disease significantly. However, fibrinolysis in combination with extraventricular drainage shows promise as a technique to reduce intraventricular clot volume and to manage the concomitant complications of IVH. PMID:20425231

  15. Hemorrhagic Stroke

    MedlinePlus

    A stroke is a medical emergency. There are two types - ischemic and hemorrhagic. Hemorrhagic stroke is the less common type. It happens when ... an artery wall that breaks open. Symptoms of stroke are Sudden numbness or weakness of the face, ...

  16. Time trends of neonatal mortality by causes of death in Shenyang, 1997–2014

    PubMed Central

    Wu, Qi-Jun; Li, Li-Li; Li, Jing; Zhou, Chen; Huang, Yan-Hong

    2016-01-01

    To investigate the rate and time trends of neonatal mortality from 1997 to 2014 in Shenyang, which were previously rarely reported upon by developing countries, data on 4719 neonatal deaths (0–28 days) and 970,583 live births from the Shenyang Women and Children Health Care Centre were analyzed. Neonatal mortality rates (per 1000 live births), percent change, and annual percent change (APC) were calculated. During the observation period, neonatal mortality in Shenyang significantly decreased by 7.04%, 8.33%, and 5.35% per year overall, in urban and rural areas, respectively. When grouped by category of neonatal death, the time trends of three categories showed statistically significant decreases: congenital malformations (APC = −9.97%), diseases of the perinatal period (APC = −6.04%), and diseases of the respiratory system (APC = −8.52%). Congenital malformations, diseases of the respiratory system, and diseases of the nervous system and sense organs were the three major contributors to the aforementioned decreasing trend, which accounted for 58.71% in overall areas. Among selective causes of neonatal death, the neonatal mortality rates of pneumonia, congenital heart disease, preterm birth and low birth weight, birth asphyxia, and intracranial hemorrhage of the newborn significantly decreased 7.87%, 7.32%, 2.47%, 11.04%, and 10.68% per year, respectively. In summary, neonatal mortality rates decreased in Shenyang during the 17-year study period. Future studies are warranted to further investigate the factors contributing to the neonatal mortality trends in China. PMID:26918828

  17. Dengue hemorrhagic fever

    MedlinePlus

    Hemorrhagic dengue; Dengue shock syndrome; Philippine hemorrhagic fever; Thai hemorrhagic fever; Singapore hemorrhagic fever ... Four different dengue viruses are known to cause dengue hemorrhagic fever. Dengue hemorrhagic fever occurs when a person is bitten by ...

  18. Morphometrical analysis of retinal hemorrhages in the shaken baby syndrome.

    PubMed

    Betz, P; Puschel, K; Miltner, E; Lignitz, E; Eisenmenger, W

    1996-03-01

    A morphometrical analysis of retinal hemorrhages was performed in cases of physical child abuse including the shaken baby syndrome and in controls (severe head injury, intravital brain death, non-traumatic intracranial hemorrhage, SIDS including cardiopulmonary resuscitation). The extent of the retinal hemorrhages was significantly different between both groups. In all cases of physical child abuse, massive retinal hemorrhages in at least one eye could be found ranging between a maximum value of 19.2 and 73.2% of the entire retinal area. In contrast, only two cases of the control group (severe head injury with skull fractures and intracranial bleeding following traffic accident or fall) showed slight hemorrhages of 3.33 or 1.18% of the retinal area but only in one eye. Therefore, the results provide evidence that massive intraretinal hemorrhages indicate violent shaking -- in particular in association with other signs of physical child abuse. PMID:8855047

  19. Cranial computed tomography and real-time sonography in full-term neonates and infants

    SciTech Connect

    Siegel, M.J.; Patel, J.; Gado, M.H.; Shackelford, G.D.

    1983-10-01

    The results of cranial ultrasonography (US) and computed tomography (CT) were compared in 52 full-term neonates and young infants. The chief indications for examination included: increasing head size, dysmorphic features, myelomeningocele, inflammatory disease, and asphyxia. Disorders detected included hydrocephalus, parenchymal abnormalities, intracranial hemorrhage, extraparenchymal fluid collections, and vascular and other developmental malformations. CT and US essentially were equivalent in detecting hydrocephalus, moderate to large intraventricular hemorrhages or subdural collections, and large focal parenchymal lesions, although CT was somewhat better in determining the level and cause of obstruction in patients with hydrocephalus and characterizing parenchymal abnormalities. CT was more sensitive than ultrasound in detecting subarachnoid hemorrhage (100% vs. 0%), diffuse parenchymal abnormality (100% vs. 33%), and small intraventricular hemorrhages (100% vs. 0%) but these lesions often were not clinically significant. The results suggest that US should be used as the primary neuroradiological examination in term infants; CT probably should be reserved for further investigation after US in those patients with a history of hypoxia and progressive clinical deterioration.

  20. Intravenous digital subtraction angiography in the investigation of intracranial disease

    SciTech Connect

    DeFilipp, G.J.; Pinto, R.S.; Lin, J.P.; Kricheff, I.I.

    1983-07-01

    Eighty-six patients who presented with a variety of intracranial lesions were examined with intravenous digital subtraction angiogrphy (IV-DSA). A grading system was used to evaluate the ability IV-DSA to answer specific diagnostic questions regarding intracranial tumors, vasospasm following subarachnoid hemorrhage, lesions of the sella, dural sinus occlusion, and post-therapeutic embolization. Eighty-four percent of the examinations provided clinically useful information. In 15% of the cases limited but useful information was obtained; only 1% of the examinations provided no useful information. We conclude that IV-DSA can routinely provide useful information in the evaluation of the variety of intracranial lesions described above.

  1. Warning leak of intracranial aneurysm masquerading as sinus node dysfunction: A case report

    PubMed Central

    Bisht, Devendra Singh; Garg, Nitin

    2015-01-01

    We describe the successful endovascular repair of an intracranial aneurysm causing subarachnoid hemorrhage in a 62-year-old man, who was initially diagnosed and treated as a case of symptomatic sinus bradycardia. The aim of this report and following discussion is to discuss the subtle warning signs of intracranial aneurysm that may masquerade as sinus node dysfunction. PMID:27489696

  2. Cerebral amyloid angiopathy causing large contralateral hemorrhage during surgery for lobar hemorrhage: a case report.

    PubMed

    Arishima, Hidetaka; Neishi, Hiroyuki; Kodera, Toshiaki; Kitai, Ryuhei; Kikuta, Ken-ichiro

    2015-03-01

    We report a rare case of cerebral amyloid angiopathy (CAA) causing large contralateral hemorrhage during surgery for lobar hemorrhage. A 62-year-old woman presented with lobar hemorrhage in the left frontal and parietal lobes recurring over the previous 1 month. Because we could not detect the origin of the lobar hemorrhage, we performed a biopsy around the lobar hemorrhage site with the removal of a hematoma. During the surgery, we identified acute brain swelling without bleeding from the operative field. Intraoperative computed tomography demonstrated new large lobar hemorrhage of the right parietal lobe, which we could promptly remove. Specimens around hematomas on both sides were pathologically diagnosed as CAA on immunohistochemical examination. After the surgery, she suffered from lobar hemorrhage three times in the space of only 3 months. To the best of our knowledge, there has been no reported case of CAA causing intracranial hemorrhage of another lesion during surgery. Neurosurgeons should know a possibility of intraoperative hemorrhage in surgeries for lobar hemorrhage caused by CAA. PMID:25601180

  3. Increased intracranial pressure

    MedlinePlus

    Increased intracranial pressure is a rise in the pressure inside the skull that can result from or cause brain injury. ... Increased intracranial pressure can be due to a rise in pressure of the cerebrospinal fluid. This is ...

  4. Intracranial Vascular Treatments

    MedlinePlus

    ... most commonly used in the treatment of intracranial aneurysms. Mechanical retrievers/aspiration systems: used to remove clots ... passageway between an artery and a vein. intracranial aneurysms, a ballooning out of the wall of an ...

  5. Subarachnoid hemorrhage

    MedlinePlus

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

  6. Subarachnoid hemorrhage

    MedlinePlus

    ... malformation (AVM) Bleeding disorder Bleeding from a cerebral aneurysm Head injury Unknown cause (idiopathic) Use of blood ... subarachnoid hemorrhage is motor vehicle crashes. Risks include: Aneurysm in other blood vessels Fibromuscular dysplasia (FMD) and ...

  7. Pulmonary hypoplasia on preterm infant associated with diffuse chorioamniotic hemosiderosis caused by intrauterine hemorrhage due to massive subchorial hematoma: report of a neonatal autopsy case.

    PubMed

    Yamada, Sohsuke; Marutani, Takamitsu; Hisaoka, Masanori; Tasaki, Takashi; Nabeshima, Atsunori; Shiraishi, Mika; Sasaguri, Yasuyuki

    2012-08-01

    A male infant born prematurely at 31 weeks of gestation weighed 789 g and had mildly brown-colored oral/tracheal aspirates at delivery. The amniotic fluid was also discolored, and its index was below 5. The patient died of hypoxemic respiratory and cardiac failure 2 hours after birth. The maternal profiles showed placenta previa and intrauterine growth restriction (IUGR) at 22 weeks of gestation, and revealed recurrent episodes of antenatal and substantial vaginal bleeding and oligohydramnios, indicating chronic abruption-oligohydramnios sequence. The thickened placenta, weighing 275 g, grossly displayed unevenness and diffuse opacity with green to brown discoloration in the chorioamniotic surface, and revealed chronic massive subchorial hematomas (Breus' mole) with old peripheral blood clot, circumvallation, and infarction. Microscopically, diffuse Berlin-blue staining-positive hemosiderin deposits were readily encountered in the chorioamniotic layers of the chorionic plate, consistent with diffuse chorioamniotic hemosiderosis (DCH) due to Breus' mole, accompanied by diffuse amniotic necrosis. At autopsy, an external examination showed several surface anomalies and marked pulmonary hypoplasia, 0.006 (less 0.012) of lung:body weight ratio. Since Breus' mole has a close relationship with intrauterine hemorrhage, resulting in DCH, IUGR, and/or pulmonary hypoplasia of the newborn, the present features might be typical. PMID:22827763

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

    PubMed

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

    2012-09-01

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

  9. Fetal hydrocephalus and neonatal stroke as the first presentation of protein C deficiency.

    PubMed

    Ichiyama, Masako; Ohga, Shouichi; Ochiai, Masayuki; Fukushima, Kotaro; Ishimura, Masataka; Torio, Michiko; Urata, Michiyo; Hotta, Taeko; Kang, Dongchon; Hara, Toshiro

    2016-02-01

    Severe protein C-deficiency is a rare heritable thrombophilia of the newborn. Infants with biallelic PROC mutations present purpura fulminans and intracranial thromboembolism, while the prenatal onset of mutated heterozygotes remains unclear. We herewith present the first case of fetal ventriculomegaly and neonatal stroke associated with heterozygous PROC mutation. The infant was born to a healthy mother at 38 gestational weeks. The fetal growth had been normal, but the routine ultrasound screening had indicated mild hydrocephalus at 28 weeks of gestation. He developed convulsions two days after birth. Computed tomography of the brain revealed multiple hemorrhagic infarctions and ventriculomegaly. Dissociated levels of the plasma activity between protein C (21%) and protein S (42%) reached to determine the heterozygote of PROC c.574_576delAAG, a common thrombophilic predisposition in Asian ancestries. PC-mutant heterozygotes may have a limited high risk of cerebral thromboembolism during the perinatal course. PMID:26250584

  10. Angioplasty and Stenting for Intracranial Stenosis

    PubMed Central

    IZUMI, Takashi; IMAMURA, Hirotoshi; SAKAI, Nobuyuki; MIYACHI, Shigeru

    2014-01-01

    Of the patients enrolled in the Japanese Registry of Neuroendovascular Therapy (JR-NET), a surveillance study in Japanese, 1133 patients who underwent intracranial percutaneous transluminal angioplasty (PTA)/stenting for intracranial stenosis during the period from 2005 to 2009 were investigated. A technical success was achieved in 98.3% of the patients, and 70.5% and 7.5% had a residual stenosis of < 30% and ≥ 50%, respectively. The incidence of ischemic complications and hemorrhagic complications was as low as 7.7% and 2.5%, respectively, but tended to increase in patients who underwent stenting. While a significant correlation with ischemic complications was observed in previously untreated patients and patients who underwent stenting followed by post-dilatation, a significant correlation with hemorrhagic complications was observed in patients who received emergency treatment and those treated between 24 hours and 14 days of the onset. Flexible intracranial stents are expected to contribute to improvement in the treatment outcome. PMID:24390191

  11. Delayed Vasospasm after Aneurysmal Subarachnoid Hemorrhage in Behcet Syndrome

    PubMed Central

    Kim, Jun Hak; Lee, Si-Un; Huh, Choonwoong; Oh, Chang Wan; Bang, Jae Seung

    2016-01-01

    A man visited the emergency room with a headache. Brain computed tomography showed aneurysmal subarachnoid hemorrhage (SAH) and multiple aneurysms. After aneurysm clipping surgery, the patient was discharged. After 5 days, he was admitted to the hospital with skin ulceration and was diagnosed with Behcet syndrome. An angiogram taken 7 weeks after aneurysmal SAH showed intracranial vasospasm. Because inflammation in Behcet syndrome may aggravate intracranial vasospasm, intracranial vasospasm after aneurysmal SAH in Behcet syndrome should be monitored for longer compared to general aneurysmal SAH. PMID:27114963

  12. Intracranial Pressure Monitoring in Acute Liver Failure: Institutional Case Series.

    PubMed

    Maloney, Patrick R; Mallory, Grant W; Atkinson, John L D; Wijdicks, Eelco F; Rabinstein, Alejandro A; Van Gompel, Jamie J

    2016-08-01

    Acute liver failure (ALF) has been associated with cerebral edema and elevated intracranial pressure (ICP), which may be managed utilizing an ICP monitor. The most feared complication of placement is catastrophic intracranial hemorrhage in the setting of severe coagulopathy. Previous studies reported hemorrhage rates between 3.8-22 % among various devices, with epidural catheters having lower hemorrhage rates and precision relative to subdural bolts and intraparenchymal catheters. We sought to identify institutional hemorrhagic rates of ICP monitoring in ALF and its associated factors in a modern series guided by protocol implantation. Patient records treated for ALF with ICP monitoring at Mayo Clinic in Rochester, MN from 1995 to 2014 were reviewed. Protocalized since 1995, epidural (EP) ICP monitors were first used followed by intraparenchymal (IP) for stage III-IV hepatic encephalopathy. The following variables and outcomes were collected: patient demographics, ICPs and treatment methods, laboratory data, imaging studies, number of days for ICP monitoring, radiographic and symptomatic hemorrhage rates, orthotopic liver transplantation rates, and death. A total of 20 ICP monitors were placed for ALF, 7 EP, and 13 IP. International normalized ratio (INR) at placement of an EP monitor was 2.4 (1.7-3.2) with maximum of 2.7 (2.0-3.6) over the following 2.3 (1-3) days. Mean EP ICP at placement was 36.3 (11-55) and maximum of 43.1 (20-70) mm Hg. INR at placement of an IP monitor was 1.3 (<0.8-3.0) with maximum value of 2.9 (1.6-5.4) over the following 4.2 (2-6) days. Mean IP ICP at placement was 9.9 (2-19) and maximum was 39.8 (11-100) mm Hg. There was one asymptomatic hemorrhage in the EP group (14.3 % hemorrhage rate) and two hemorrhages in the IP group (hemorrhage rate was 15.4 %), both of which were fatal. Overall mortality rate in the EP group was 71.4 % (5/7) with two patients receiving transplantation, and one death in the transplant group. Overall mortality

  13. Molecular basis and genetic predisposition to intracranial aneurysm

    PubMed Central

    Weinsheimer, Shantel; Ronkainen, Antti; Kuivaniemi, Helena

    2014-01-01

    Intracranial aneurysms, also called cerebral aneurysms, are dilatations in the arteries that supply blood to the brain. Rupture of an intracranial aneurysm leads to a subarachnoid hemorrhage, which is fatal in about 50% of the cases. Intracranial aneurysms can be repaired surgically or endovascularly, or by combining these two treatment modalities. They are relatively common with an estimated prevalence of unruptured aneurysms of 2%–6% in the adult population, and are considered a complex disease with both genetic and environmental risk factors. Known risk factors include smoking, hypertension, increasing age, and positive family history for intracranial aneurysms. Identifying the molecular mechanisms underlying the pathogenesis of intracranial aneurysms is complex. Genome-wide approaches such as DNA linkage and genetic association studies, as well as microarray-based mRNA expression studies, provide unbiased approaches to identify genetic risk factors and dissecting the molecular pathobiology of intracranial aneurysms. The ultimate goal of these studies is to use the information in clinical practice to predict an individual's risk for developing an aneurysm or monitor its growth or rupture risk. Another important goal is to design new therapies based on the information on mechanisms of disease processes to prevent the development or halt the progression of intracranial aneurysms. PMID:25117779

  14. Urinary Allantoin Is Elevated in Severe Intraventricular Hemorrhage in the Preterm Newborn.

    PubMed

    Esiaba, Ijeoma; Angeles, Danilyn M; Holden, Megan S; Tan, John B C; Asmerom, Yayesh; Gollin, Gerald; Boskovic, Danilo S

    2016-04-01

    Germinal matrix intraventricular hemorrhage (IVH) is the most common type of intracranial hemorrhage observed in preterm neonates. It is a precursor of poor neurocognitive development, cerebral palsy, and death. The pathophysiology is not well defined, but damage to the fragile germinal matrix vasculature may be due to free radicals generated during inflammation and as a consequence of ischemia followed by reperfusion. Assessment of the oxidative stress status in these infants is therefore important. Urinary allantoin concentration was measured in preterm neonates as a marker of oxidative stress associated with IVH. Urine was collected from 44 preterm neonates at four time points between 24 and 72 hours of life (HOL), and the allantoin content was determined by gas chromatography mass spectrometry (GCMS). Records were retrospectively reviewed, and the incidence and severity of IVH was categorized as follows: no IVH (n = 24), mild (grade 1-2) IVH (n = 13), and severe (grade 3-4) IVH (n = 7). Neonates with severe IVH showed significantly elevated allantoin levels vs subjects with no IVH from 36 HOL (0.098 ± 0.013 μmol and 0.043 ± 0.007 μmol, respectively, p = 0.002). The allantoin concentration remained elevated even at 72 HOL (0.079 ± 0.014 μmol and 0.033 ± 0.008 μmol, respectively, p = 0.021). There were no significant differences in allantoin levels in the no IVH and mild IVH groups. IVH was diagnosed by head imaging on average at about 11th postnatal day. Urinary allantoin levels were significantly elevated during the first 3 days of life in the neonates subsequently diagnosed with severe IVH, suggesting that oxidative stress might be a crucial factor in IVH pathogenesis. Further studies are needed to assess the usefulness of urinary allantoin in early identification of preterm infants at risk for or with severe IVH and monitoring of the response to interventions designed to prevent or treat it. PMID:25994284

  15. Idiopathic intracranial hypertension presenting as postpartum headache.

    PubMed

    Mathew, Mariam; Salahuddin, Ayesha; Mathew, Namitha R; Nandhagopal, Ramachandiran

    2016-01-01

    Postpartum headache is described as headache and neck or shoulder pain during the first 6 weeks after delivery. Common causes of headache in the puerperium are migraine headache and tension headache; other causes include pre-eclampsia/eclampsia, post-dural puncture headache, cortical vein thrombosis, subarachnoid hemorrhage, posterior reversible leukoencephalopathy syndrome, brain tumor, cerebral ischemia, meningitis, and so forth. Idiopathic intracranial hypertension (IIH) is a rare cause of postpartum headache. It is usually associated with papilledema, headache, and elevated intracranial pressure without any focal neurologic abnormality in an otherwise healthy person. It is more commonly seen in obese women of reproductive age group, but rare during pregnancy and postpartum. We present a case of IIH who presented to us 18 days after cesarean section with severe headache and was successfully managed. PMID:26818168

  16. Giant intracranial aneurysms: rapid sequential computed tomography

    SciTech Connect

    Pinto, R.S.; Cohen, W.A.; Kricheff, I.I.; Redington, R.W.; Berninger, W.H.

    1982-11-01

    Giant intracranial aneurysms often present as mass lesions rather than with subarachnoid hemorrhage. Routine computed tomographic (CT) scans with contrast material will generally detect them, but erroneous diagnosis of basal meningioma is possible. Rapid sequential scanning (dynamic CT) after bolus injection of 40 ml of Renografin-76 can conclusively demonstrate an intracranial aneurysm, differentiating it from other lesions by transit-time analysis of the passage of contrast medium. In five patients, the dynamics of contrast bolus transit in aneurysms were consistently different from the dynamics in pituitary tumors, craniopharyngiomas, and meningiomas, thereby allowing a specific diagnosis. Dynamic CT was also useful after treatment of the aneurysms by carotid artery ligation and may be used as an alternative to angiographic evaluation in determining luminal patency or thrombosis.

  17. Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)

    MedlinePlus

    ... Asked Questions Español Condiciones Chinese Conditions Idiopathic Intracranial Hypertension (Pseudotumor Cerebri) En Español Read in Chinese What is idiopathic intracranial hypertension? Idiopathic intracranial hypertension (IIH) is a disorder that ...

  18. Genetic factors involves in intracranial aneurysms – actualities

    PubMed Central

    Mohan, D; Munteanu, V; Coman, T; Ciurea, AV

    2015-01-01

    Intracranial aneurysm (IA) is a common vascular disorder, which frequently leads to fatal vascular rupture leading to subarachnoid hemorrhage (SAH). Although various acquired risk factors associated with IAs have been identified, heritable conditions are associated with IAs formation but these syndromes account for less than 1% of all IAs in the population. Cerebral aneurysm disease is related to hemodynamic and genetic factors, associated with structural weakness in the arterial wall, which was acquired by a specific, often unknown, event. Possibly, the trigger moment of aneurysm formation may depend on the dynamic arterial growth, which is closely related to aging/ atherosclerosis. Genetic factors are known to have an important role in IA pathogenesis. Literature data provide complementary evidence that the variants on chromosomes 8q and 9p are associated with IA and that the risk of IA in patients with these variants is greatly increased with cigarette smoking. Intracranial aneurysms are acquired lesions (5-10% of the population). In comparison with sporadic aneurysms, familial aneurysms tend to be larger, more often located in the middle cerebral artery, and more likely to be multiple. Abbreviations: DNA = deoxyribonucleic acid, FIA = familial Intracranial Aneurysm, GWAS = genome-wide association studies, IL-6 = interleukin-6, ISUIA = International Study of Unruptured Intracranial Aneurysms, IA = Intracranial aneurysm, mRNA = Messager ribonucleic acid, SNPs = single-nucleotide polymorphisms, SMCs = smooth muscle cells, sIAs = sporadic IAs, SAH = subarachnoid hemorrhage, TNF-α = tumor necrosis factor-alpha, COL4A1 = type IV collagen alpha-1 PMID:26351537

  19. Treatment of ruptured intracranial dissecting aneurysms in Hong Kong

    PubMed Central

    Wong, George Kwok Chu; Tang, Hoi Bun; Poon, Wai Sang; Yu, Simon Chun Ho

    2010-01-01

    Background: Data suggests that hemorrhagic presentations occur in 20% of internal carotid artery dissections and 50% of vertebral artery dissections. A Finnish study has reported favorable outcomes in only 32% of patients. We aimed to review the epidemiology and management outcomes in a Chinese population. Methods: We reviewed the aneurysmal subarachnoid hemorrhage registry of patients who presented with intracranial dissecting aneurysms at a neurosurgical center in Hong Kong over a five-year period. Results: A total of 23 patients with intracranial dissecting aneurysms were identified, accounting for 8% of all spontaneous subarachnoid hemorrhage patients. Forty-eight percent of the patients identified were treated by main trunk occlusion and 39% were treated by embolization or stent-assisted embolization or stent alone. Thirteen percent were managed by craniotomy and trapping or wrapping. Favorable outcomes at six months were achieved in 67%. Conclusions: Patients with intracranial dissecting aneurysms account for a significant proportion of the cases of spontaneous subarachnoid hemorrhage in our population. Carefully selected endovascular and microsurgical treatments can lead to management outcomes similar to patients with saccular aneurysms. PMID:21206536

  20. Multiple Intracranial Arteriovenous Fistulas in Cowden Syndrome.

    PubMed

    Prats-Sánchez, Luis A; Hervás-García, Jose V; Becerra, Juan L; Lozano, Manuel; Castaño, Carlos; Munuera, Josep; Escudero, Domingo; García-Esperón, Carlos

    2016-06-01

    Cowden syndrome is a rare autosomal dominant disease. It is characterized by multiple noncancerous tumorlike growths called hamartomas, which typically are found in the skin, oral mucosa, thyroid, breast, and gastrointestinal tract. It carries with it a potential risk of malignant transformation, especially of the breast and thyroid. In 80% of the cases, the human tumor suppressor gene, phosphatase and tensin homolog (PTEN), is mutated in the germ line. We report a patient with Cowden syndrome who presented with generalized seizure and left anterior temporal hemorrhage and a nontraumatic subarachnoid hemorrhage due to multiple intracranial arteriovenous fistulas (AVFs). We discuss previous reports about vascular malformations in patients with Cowden syndrome and PTEN mutations. Importantly, we hypothesize that the production of multiple AVFs in our patient was associated with PTEN mutation. PMID:27105569

  1. Intracranial fungal aneurysm caused by Candida endocarditis.

    PubMed

    Takeda, S; Wakabayashi, K; Yamazaki, K; Miyakawa, T; Arai, H

    1998-01-01

    We describe a 67-year-old man who died 4 days after suffering a subarachnoid hemorrhage. Autopsy revealed a fresh subarachnoid hemorrhage and a ruptured fungal aneurysm near the trifurcation of the right middle cerebral artery. In comparison with 21 previously reported cases in which the fungal aneurysms were proved to be intracranial, the present case had several characteristic features: the causative fungus of the aneurysm was Candida (only one such case has been reported previously). The aneurysm was caused by direct Candida invasion of the arterial wall from the Candida embolus (previously reported aneurysms have been caused by direct invasion of the arterial wall during fungal meningitis). The source of the Candida was endocarditis (the main sources of fungus in previously reported cases have been sinusitis, dental extraction wounds, and some forms of surgery). We describe the features of this rare autopsy case of a ruptured fungal aneurysm caused by Candida originating from endocarditis and review the literature. PMID:9707334

  2. Intracranial venous thrombosis complicating oral contraception

    PubMed Central

    Dindar, F.; Platts, M. E.

    1974-01-01

    Four days after the onset of a severe headache a 22-year-old woman who had been taking oral contraceptives for less than three weeks had a convulsion, followed by right hemiparesis. Other focal neurologic signs and evidence of raised intracranial pressure appeared, and she became comatose on the seventh day. A left craniotomy revealed extensive cerebral venous thrombosis. She died the next day. On postmortem examination extensive thrombosis of the superior sagittal sinus and draining cerebral veins, and multiple areas of cerebral hemorrhage and hemorrhagic infarction were seen. Some of the superficial cerebral veins showed focal necrosis of their walls, and the lateral lacunae of the superior sagittal sinus contained proliferating endothelial cells. The adrenal veins were also thrombosed. The significance of these findings is discussed. The literature on cerebrovascular complications of oral contraception, particularly cerebral venous thrombosis, is reviewed. ImagesFIG. 1FIG. 2FIG. 3FIG. 4FIG. 5FIG. 6 PMID:4413961

  3. [Hemorrhagic disorders in pregnancy].

    PubMed

    Ludwig, H

    1999-10-01

    When bleeding disorders coincide with pregnancy, they might be congenital or acquired diseases, if not arising as a more acute complication of the pregnancy itself. The paper gives a review of the most common bleeding disorders out of internal medical constellations. History taking is the most effective way to open the diagnostic approach. If childbearing is desired the couple in question should be counselled accordingly in collaboration with a hematologist. Some conditions might be unfavourable, e.g. hemophila in male offspring, others might be serious but manageable, as in v. Willebrand-Disease or autoimmunologic thrombocytopenic purpura. Prenatal invasive diagnostics with fetal blood sampling at an early stage of pregnancy may reduce the hazards for the baby insofar, as it allows the more precise estimation of fetal risks at birth. Cesarean section will not in all cases be the way of choice (e.g. in v. Willebrand-Disease), in others it might be the better way to deliver a fetus at risk in order to avoid intracranial hemorrhage (in severe cases of ITP). Always both, mother and fetus, are at risk, but almost in any cases in different shades and grades of severeness. There is rarely a firm correlation of the maternal and the fetal hemostatic parameters in cases of connatal or acquired hemorrhagic disorders. Pregnancy itself leads to a certain compensation of defects in clotting factors, since the synthesis of factors increase or they are circulating more in activated form. Pregnancy is a state of a silently ongoing intravascular coagulation at least in the uteroplacental circulation. From there it is linked with the general circulation of the maternal organism. When immunologic etiologies in thrombocytopenias play a role, there will always be the incalculable rate of placental transfer of antiplatelet-antibodies to the fetus. The entire field requires knowledge, counseling, collaboration and foresight. PMID:10549234

  4. Intracranial taser dart penetration: Literature review and surgical management

    PubMed Central

    Kaloostian, PE; Tran, H

    2012-01-01

    We report the case of a fourteen-year-old female who obtained TASER dart penetration to her right parietal region. She was neurologically intact with headache. CT scan of the head demonstrated TASER penetration intracranially without hemorrhage. Attempts were made at sterile removal of TASER at bedside under sedation. This caused the TASER to break at multiple points leaving only an intracranial component. She was urgently taken to the operating room for craniectomy for TASER removal. After reviewing the literature of an additional two patients, we suggest patients should not have attempts at removing device at bedside and should be taken to the operating room for adequate removal and washout. PMID:24960679

  5. Unruptured Intracranial Aneurysms:

    PubMed Central

    Raymond, J.; Nguyen, T.; Chagnon, M.; Gevry, G.

    2007-01-01

    'if a man will begin with certainties, he shall end in doubts; 'but if he will be content to begin with doubts he shall end in certainties'. Sir Francis Bacon, The Advancement of Learning Summary In the absence of level one evidence, the treatment of unruptured intracranial aneurysms is grounded on opinions. Results of the largest registry available, ISUIA (the International Study on Unruptured Intraacranial Aneurysms) suggest that surgical or endovascular treatments are rarely justified. Yet the unruptured aneurysm is the most frequent indication for treatment in many endovascular centres. In preparation for the initiation of a randomized trial, we aimed at a better knowledge of endovascular expert opinions on unruptured aneurysms. We administered a standard questionnaire to 175 endovascular experts gathered at the WFITN meeting in Val d'lsère in 2007. Four paradigm unruptured aneurysms were used to poll opinions on risks of treatment or observation, as well as on their willingness to treat, observe or propose to the patient participation in a randomized trial, using six questions for each aneurysm. Opinions varied widely among lesions and among participants. Most participants (92.5%) were consistent, as they would offer treatment only if their estimate of the ten-year risk of spontaneous hemorrhage would exceed risks of treatment. Estimates of the natural history were consistently higher than that reported by ISUIA. Conversely, treatment risks were underestimated compared to those reported in ISUIA, but within the range reported in a recent French registry (ATENA). Participants were more confident in their evaluation of treatment risks and in their skills at treating aneurysms than in their estimates of risks of rupture entailed by the presence of the lesion, the latter being anchored at or close to 1% /year. The gulf between expert opinions, clinical practices and available data from registries persist. Expert opinions are compatible with the primary hypothesis

  6. Heparin is not required for peripheral intravenous locks in neonates

    PubMed Central

    Brown, Krista; Tay-Uyboco, Jean S; McMillan, Douglas D

    1999-01-01

    OBJECTIVE: To determine the relative efficacy and safety of peripheral intravenous locks maintained with heparin saline solutions compared with those maintained with normal saline. DESIGN: Randomized, controlled trial comparing the two methods of maintaining peripheral intravenous locks. SETTING: Infants in the neonatal intensive care unit (NICU) at Foothills Hospital, Calgary, Alberta. PATIENTS: Neonates requiring the maintenance of intravenous locks for medications, primarily antibiotics, were randomly placed in either a heparin saline (n=93) or normal saline (n=93) group. INTERVENTIONS: Patients were chosen to receive either heparinized saline (5 units/mL) or normal saline, 0.3 mL in the intravenous catheter every 6 h, administered by nursing staff in a blinded manner. RESULTS: There was no difference in catheter lifespan (39±24 h for the heparinized saline group; 34±22 h for the normal saline group) and no difference in the number of intravenous catheters per patient (1.9 heparinized group, 1.6 normal saline group). There were no differences in the reasons for catheter removal, complications at the skin site or systemic bleeding including intracranial hemorrhage between the two groups. The risk of catheter occlusion was inversely correlated with gestational age and the administration of vancomycin and cefotaxime versus ampicillin and gentamicin. CONCLUSIONS: Heparin is not required for the maintenance of peripheral intravenous locks in neonates regardless of the solution used. Catheter occlusion is more likely to be associated with a low gestational age and the administration of vancomycin and cefotaxime versus ampicillin and gentamicin. PMID:20212988

  7. Jugular Foramen Arteriovenous Shunt with Subarachnoid Hemorrhage

    PubMed Central

    Rodesch, G.; Comoy, J.; Hurth, M.; Lasjaunias, P.

    1991-01-01

    The authors report the case of a 37-year-old man with an extracerebral arteriovenous fistula at the skull base, revealed by subarachnoid and intraventricular hemorrhage. The malformation was fed by the neuromeningeal trunk of the ascending pharyngeal artery and drained into left laterobulbar veins. Embolization with bucrylate was performed and occluded totally the shunting zone. A 1-year follow-up angiogram confirmed the good stability of the result, the patient being asymptomatic. This case emphasizes the quality of results that can be obtained with bucrylate in arterioverious fistulas presenting with hemorrhage. It confirms that the external carotid artery must be studied when dealing with intracranial hemorrhage. On the other hand, magnetic resonance imaging and angiography may depict vascular abnormalities but do not always indicate the shunting area, thus the pathologic type of the malformation. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5Figure 5p136-b PMID:17170835

  8. Stem Cells for Neonatal Brain Disorders.

    PubMed

    Ahn, So Yoon; Chang, Yun Sil; Park, Won Soon

    2016-01-01

    Despite recent advances in neonatal intensive care medicine, neonatal brain injury resulting from intraventricular hemorrhage or hypoxic-ischemic encephalopathy remains a major cause of neonatal mortality and neurologic morbidities in survivors. Several studies have indicated that stem cell therapy is a promising novel therapy for neonatal brain injury resulting from these disorders. This review summarizes recent advances in stem cell research for treating neonatal brain injury due to intraventricular hemorrhage or hypoxic-ischemic encephalopathy with a particular focus on preclinical data, covering important issues for clinical translation such as optimal cell type, route, dose and timing of stem cell therapy, and translation of these preclinical results into a clinical trial. PMID:27251746

  9. Feasibility and methodology of optical coherence tomography imaging of human intracranial aneurysms: ex vivo pilot study

    NASA Astrophysics Data System (ADS)

    Vuong, Barry; Sun, Cuiru; Khiel, Tim-Rasmus; Gardecki, Joseph A.; Standish, Beau A.; da Costa, Leodante; de Morais, Josaphat; Tearney, Guillermo J.; Yang, Victor X. D.

    2012-02-01

    Rupture of intracranial aneurysm is a common cause of subarachnoid hemorrhage. An aneurysm may undergo microscopic morphological changes or remodeling of the vessel wall prior to rupture, which could potentially be imaged. In this study we present methods of tissue sample preparation of intracranial aneurysms and correlation between optical coherence tomography imaging and routine histology. OCT has a potential future in the assessment of microscopic features of aneurysms, which may correlate to the risk of rupture.

  10. Intracranial pressure monitoring

    MedlinePlus

    ... head. The monitor senses the pressure inside the skull and sends measurements to a recording device. ... are 3 ways to monitor pressure in the skull (intracranial pressure). INTRAVENTRICULAR CATHETER The intraventricular catheter is ...

  11. Intracranial pressure monitoring

    MedlinePlus

    ICP monitoring; CSF pressure monitoring ... There are 3 ways to monitor pressure in the skull (intracranial pressure). INTRAVENTRICULAR CATHETER The intraventricular catheter is the most accurate monitoring method. To insert an intraventricular catheter, a ...

  12. [Real-time ultrasonography in neonatal diagnosis].

    PubMed

    Nogués, A; Morales, A; Munguía, C; Pagola, C; Arena, J

    1982-11-01

    Real time ultrasonography is a diagnostic technique very widely used in pediatrics and with specific applications in neonatology. Bedside its use in Neonatal I.C.U. it has many interesting aspects for intraabdominal and intracranial pathology. In some particular conditions this procedure can be the first diagnostic tool. Conventional X-rays can be performed after sonographic data have been analyzed. PMID:7168508

  13. Risk factors associated with retinal hemorrhage in suspected abusive head trauma

    PubMed Central

    Burkhart, Zachary N.; Thurber, Clinton J.; Chuang, Alice Z.; Kumar, Kartik S.; Davis, Garvin H.; Kellaway, Judianne

    2015-01-01

    Purpose To determine risk factors associated with retinal hemorrhage (RH) in pediatric abusive head trauma (AHT) suspects. Methods Records of children aged 0–3 years hospitalized for suspected AHT from January 2007 to November 2011 were retrospectively reviewed in this case–control study. Children were classified into case and control groups based on RH presence. Medical history, presenting symptoms, reasons, and characteristics of injury were recorded. Logistic regression analysis was performed to identify risk factors. Results A total of 168 children (104 males) were included. Of these, 103 were classified as cases and 65 as controls. The mean age (with standard deviation) was 9.3 ± 8.3 months (range, 1 day-36 months). Of the 103 cases, 22 (21%) had subretinal hemorrhage, 9 (9%) had retinoschisis, and 1 (1%) had vitreous hemorrhage. Children presenting with lethargy or altered mental status (P < 0.0001), subdural hemorrhage (P < 0.0001), and other radiologic findings (eg, cerebral ischemia, diffuse axonal injury, hydrocephalus, or solid organ injury; P = 0.01546) were likely to have RH. All 23 children with skull or nonskull fracture without intracranial hemorrhage did not have RH (P < 0.0001 both categories). Conclusions Retinal hemorrhages were almost never found in the absence of intracranial hemorrhage and not found in the setting of fracture without intracranial hemorrhage. PMID:25828822

  14. Monitoring of Intracranial Pressure in Patients with Traumatic Brain Injury

    PubMed Central

    Hawthorne, Christopher; Piper, Ian

    2014-01-01

    Since Monro published his observations on the nature of the contents of the intracranial space in 1783, there has been investigation of the unique relationship between the contents of the skull and the intracranial pressure (ICP). This is particularly true following traumatic brain injury (TBI), where it is clear that elevated ICP due to the underlying pathological processes is associated with a poorer clinical outcome. Consequently, there is considerable interest in monitoring and manipulating ICP in patients with TBI. The two techniques most commonly used in clinical practice to monitor ICP are via an intraventricular or intraparenchymal catheter with a microtransducer system. Both of these techniques are invasive and are thus associated with complications such as hemorrhage and infection. For this reason, significant research effort has been directed toward development of a non-invasive method to measure ICP. The principle aims of ICP monitoring in TBI are to allow early detection of secondary hemorrhage and to guide therapies that limit intracranial hypertension (ICH) and optimize cerebral perfusion. However, information from the ICP value and the ICP waveform can also be used to assess the intracranial volume–pressure relationship, estimate cerebrovascular pressure reactivity, and attempt to forecast future episodes of ICH. PMID:25076934

  15. Monitoring of intracranial pressure in patients with traumatic brain injury.

    PubMed

    Hawthorne, Christopher; Piper, Ian

    2014-01-01

    Since Monro published his observations on the nature of the contents of the intracranial space in 1783, there has been investigation of the unique relationship between the contents of the skull and the intracranial pressure (ICP). This is particularly true following traumatic brain injury (TBI), where it is clear that elevated ICP due to the underlying pathological processes is associated with a poorer clinical outcome. Consequently, there is considerable interest in monitoring and manipulating ICP in patients with TBI. The two techniques most commonly used in clinical practice to monitor ICP are via an intraventricular or intraparenchymal catheter with a microtransducer system. Both of these techniques are invasive and are thus associated with complications such as hemorrhage and infection. For this reason, significant research effort has been directed toward development of a non-invasive method to measure ICP. The principle aims of ICP monitoring in TBI are to allow early detection of secondary hemorrhage and to guide therapies that limit intracranial hypertension (ICH) and optimize cerebral perfusion. However, information from the ICP value and the ICP waveform can also be used to assess the intracranial volume-pressure relationship, estimate cerebrovascular pressure reactivity, and attempt to forecast future episodes of ICH. PMID:25076934

  16. Innocent blood: a history of hemorrhagic disease of the newborn.

    PubMed

    Obladen, Michael

    2015-01-01

    Hemorrhages occurring in the newborn without trauma have been observed by obstetricians since the 17th century, but have been considered different diseases depending on their location. Umbilical hemorrhage associated with obstructed bile canals was described by Cheyne in 1802. Grandidier in 1871 and Townsend in 1894 grouped together various forms of neonatal bleeds and associated them with disturbed coagulation. When the clotting system became better understood in the last decade of the 19th century, effective symptomatic treatment was developed: gelatin, serum injection, and the transfusion of fresh blood. In 1935, Dam detected the function of vitamin K in the coagulation system and 4 years later, Waddell introduced vitamin K administration into therapy and prevention of neonatal hemorrhagic disease. Kernicterus occurred when high doses of synthetic water-soluble vitamin K analogues were given to preterm infants, reminding physicians that progress in neonatal therapy rests on the cornerstones of controlled trials and follow-up. PMID:25678347

  17. Prenatal diagnosis of fetal adrenal hemorrhage and endocrinologic evaluation

    PubMed Central

    Shin, Se In; Yoo, Ji Geun; Park, In Yang

    2016-01-01

    We present a case of a fetal adrenal hemorrhage, a rare disease in fetal life, detected prenatally at 36 weeks' gestation by ultrasound. Routine ultrasound examination at 36 weeks' gestation by primary obstetrician showed a cyst on the fetal suprarenal area. Initially, the suspected diagnosis was a fetal adrenal hemorrhage, but we should diagnose differently from neuroblastoma. Subsequent ultrasound examination at 38 and 39 weeks' gestation showed increase of the cyst in size. A 3.34-kg-male neonate was born by spontaneous vaginal delivery at 39 weeks' gestation. The diagnosis of adrenal hemorrhage was confirmed by postnatal follow-up sonograms and magnetic resonance imaging. Course and sonographic signs were typical for adrenal hemorrhage and the neonate was therefore managed without surgical exploration. PMID:27200316

  18. Single Phase Dual-energy CT Angiography: One-stop-shop Tool for Evaluating Aneurysmal Subarachnoid Hemorrhage

    PubMed Central

    Ni, Qian Qian; Tang, Chun Xiang; Zhao, Yan E; Zhou, Chang Sheng; Chen, Guo Zhong; Lu, Guang Ming; Zhang, Long Jiang

    2016-01-01

    Aneurysmal subarachnoid hemorrhages have extremely high case fatality in clinic. Early and rapid identifications of ruptured intracranial aneurysms seem to be especially important. Here we evaluate clinical value of single phase contrast-enhanced dual-energy CT angiograph (DE-CTA) as a one-stop-shop tool in detecting aneurysmal subarachnoid hemorrhage. One hundred and five patients who underwent true non-enhanced CT (TNCT), contrast-enhanced DE-CTA and digital subtraction angiography (DSA) were included. Image quality and detectability of intracranial hemorrhage were evaluated and compared between virtual non-enhanced CT (VNCT) images reconstructed from DE-CTA and TNCT. There was no statistical difference in image quality (P > 0.05) between VNCT and TNCT. The agreement of VNCT and TNCT in detecting intracranial hemorrhage reached 98.1% on a per-patient basis. With DSA as reference standard, sensitivity and specificity on a per-patient were 98.3% and 97.9% for DE-CTA in intracranial aneurysm detection. Effective dose of DE-CTA was reduced by 75.0% compared to conventional digital subtraction CTA. Thus, single phase contrast-enhanced DE-CTA is optimal reliable one-stop-shop tool for detecting intracranial hemorrhage with VNCT and intracranial aneurysms with DE-CTA with substantial radiation dose reduction compared with conventional digital subtraction CTA. PMID:27222163

  19. [Acute lymphoblastic leukemia presenting with multiple hemorrhagic brain metastases (case report)].

    PubMed

    Halefoğlu, Ahmet M; Ertürk, Mehmet; Ozel, Alper; Calişkan, K Can

    2004-06-01

    Intracranial metastases represent 7-17% of all brain tumors. Renal cell carcinoma, thyroid cancer, choriocarcinoma, melanoma, retinoblastoma, lung cancer and breast cancer have a propensity for producing hemorrhagic brain metastases. Leukemias have also been rarely reported to cause hemorrhagic brain metastases. We describe an 18-year-old girl diagnosed as acute lymphoblastic leukemia presenting with multiple hemorrhagic brain metastases. MRI demonstrated high signal intensity lesions on both T1- and T2-weighted images which were characteristic for extracellular methemoglobin and consistent with hemorrhagic metastases. PMID:15236125

  20. Fetal/Neonatal Alloimmune Thrombocytopenia: Pathogenesis, Diagnostics and Prevention.

    PubMed

    Brojer, Ewa; Husebekk, Anne; Dębska, Marzena; Uhrynowska, Małgorzata; Guz, Katarzyna; Orzińska, Agnieszka; Dębski, Romuald; Maślanka, Krystyna

    2016-08-01

    Fetal/neonatal alloimmune thrombocytopenia (FNAIT) is a relatively rare condition (1/1000-1/2000) that was granted orphan status by the European Medicines Agency in 2011. Clinical consequences of FNAIT, however, may be severe. A thrombocytopenic fetus or new-born is at risk of intracranial hemorrhage that may result in lifelong disability or death. Preventing such bleeding is thus vital and requires a solution. Anti-HPA1a antibodies are the most frequent cause of FNAIT in Caucasians. Its pathogenesis is similar to hemolytic disease of the newborn (HDN) due to anti-RhD antibodies, but is characterized by platelet destruction and is more often observed in the first pregnancy. In 75 % of these women, alloimmunization by HPA-1a antigens, however, occurs at delivery, which enables development of antibody-mediated immune suppression to prevent maternal immunization. As for HDN, the recurrence rate of FNAIT is high. For advancing diagnostic efforts and treatment, it is thereby crucial to understand the pathogenesis of FNAIT, including cellular immunity involvement. This review presents the current knowledge on FNAIT. Also described is a program for HPA-1a screening in identifying HPA-1a negative pregnant women at risk of immunization. This program is now performed at the Institute of Hematology and Transfusion Medicine in cooperation with the Department of Obstetrics and Gynecology of the Medical Centre of Postgraduate Education in Warsaw as well as the UiT The Arctic University of Norway. PMID:26564154

  1. Neonatal Intensive Care Units Nurses’ Attitude Toward Advantages and Disadvantages of Open vs Closed Endotracheal Suction

    PubMed Central

    Valizadeh, Leila; Janani, Raheleh; Janani, Leila; Galechi, Fatemeh

    2014-01-01

    Background: The vital issue of protecting the airway and maintaining ventilation in preterm infants makes tracheal suctioning an important procedure. The decision to use closed or open endotracheal suction method depends on the clinical status of infants and the nurses’ skills and preferences. Objectives: The current study aimed to compare the two methods based on the perceptions of the nurses working in Neonatal Intensive Care Units (NICU). Patients and Methods: A comparative-descriptive study carried out on 35 NICU nurses in Taleghani and Al-Zahra teaching hospitals in Tabriz, Iran, in 2013. Data were collected by self-administered questionnaire (13 Items). Data analysis, including t-test was performed using SPSS Ver. 13. A P ≤ 0.05 was considered statistically sig­nificant. Results: According to the nurses’ point of view, there are differences between characteristics of open and closed endotracheal suctioning methods (P < 0.001). By using closed endotracheal suction, the risk of traumatizing airway, developing pneumonia, increasing intracranial pressure, prolonging emergency suctioning, developing intra-ventricular hemorrhage, blood stream infection, physiological instability and lowering positive end-expiratory pressure (PEEP) are reduced. Meanwhile, lower cost, lower risk of extubation, comfort and easy washing procedure were reported as advantages of open suction. Conclusion: Closed endotracheal suctioning was evaluated to be better than the open method in the preterm neonates. More studies, especially experimental and efficient cost analysis, are recommended. PMID:25414901

  2. Primary Intracranial Choriocarcinoma Located in the Suprasellar Region

    PubMed Central

    Li, Xiuli; Murayama, Kazuhiro; Watanabe, Ayumi; Abe, Masato; Toyama, Hiroshi

    2016-01-01

    A 10 year old girl was admitted to our hospital due to headache, nausea, and weight loss for about half a year. She also had visual field disorders. Suprasellar tumor was found by X-ray computed tomography, and magnetic resonance imaging showed a ring-like lobulated enhanced mass with hemorrhage and necrosis. Biopsy of this lesion showed primary intracranial choriocarcinoma on histopathological examination. The serum human chorionic gonadotropin (hCG) level was measured after the biopsy and was elevated at 71,298.2 IU/L. The patient died due to hydrocephalus caused by an increase in the size of the tumor with a larger amount of hemorrhage than the preoperative features. If young patients present with a suprasellar lobulated mass with hemorrhage, the serum hCG level should be measured before operation. PMID:27499824

  3. Current strategies for the management of aneurysmal subarachnoid hemorrhage.

    PubMed

    Solomon, R A; Fink, M E

    1987-07-01

    Subarachnoid hemorrhage (SAH) from a ruptured intracranial aneurysm represents a major health issue. Although most people who experience an aneurysmal SAH survive to be admitted to a hospital, less than one third of these patients ever return to their premorbid status. Clearly, morbidity of this magnitude demands reevaluation of the clinical approach to this problem. This article reviews the natural history of aneurysmal SAH, and examines the current therapeutic strategies that have been suggested to improve the outcome. Careful evaluation of the existing data suggests that early aneurysm surgery and aggressive postoperative volume expansion therapy constitute the best presently available approach to patients with ruptured intracranial aneurysms. PMID:3297009

  4. Meningocele-induced positional syncope and retinal hemorrhage.

    PubMed

    Bekavac, Ivo; Halloran, John I

    2003-05-01

    Meningocele is recognized as a rare, usually asymptomatic condition not associated with acute neurologic symptoms. We herein describe the case of a patient with a longstanding history of a lower back "mass" and recurrent syncope who became acutely unresponsive and developed bilateral retinal hemorrhages when she was placed in the supine position to undergo carotid sonography. MR imaging revealed a large, dorsal lumbar meningocele. The episode likely was caused by acutely increased intracranial pressure caused by displacement of CSF from the meningocele intracranially. PMID:12748081

  5. Neonatal sepsis

    MedlinePlus

    ... BE. Perinatal viral infections. In Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's Neonatal-Perinatal ... K. Postnatal bacterial infections. In Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's Neonatal-Perinatal ...

  6. Neurosonography of the pre-term neonate

    SciTech Connect

    Grant, E.G.

    1986-01-01

    This book provides a description of our present understanding of the premature brain as seen through the eyes of the sonogram. Neurosonography of the Pre-Term Neonate ties the pathophysiology, anatomy and the all important clinical follow-up data to the sonogram. The book is divided into five sections: Scanning Techniques and Normal Anatomy, Pathophysiology of Germinal Matrix Related Hemorrhage and Ischemia, Neurosonography - Germinal Matrix Related Hemorrhage - Periventricular Leukomalacia, Incidence and Outcome - Germinal Matrix Related Hemorrhage - Periventricular Leukomalacia and Comparison of Two Modalities: Ultrasound versus Computed Tomography.

  7. Primary Intracranial Leptomeningeal Melanomatosis

    PubMed Central

    Kim, Do-Hyoung; Lee, Chae-Heuck; Joo, Mee

    2015-01-01

    Primary intracranial malignant melanoma is a very rare and highly aggressive tumor with poor prognosis. A 66-year-old female patient presented a headache that had been slowly progressing for several months. A large benign pigmented skin lesion was found on her back. A brain MRI showed multiple linear signal changes with branching pattern and strong enhancement in the temporal lobe. The cytological and immunohiostochemical cerebrospinal fluid examination confirmed malignant melanoma. A biopsy confirmed that the pigmented skin lesion on the back and the conjunctiva were benign nevi. We report a case of primary intracranial malignant melanoma and review relevant literatures. PMID:26819692

  8. Fatal Intraventricular Hemorrhage After the Extracranial Carotid Artery Angioplasty and Stent Placement

    SciTech Connect

    Krajickova, Dagmar Krajina, Antonin; Nova, Marketa; Raupach, Jan

    2005-05-15

    We report on a 72-year-old female with an unusual intracranial bleeding complication after an extracranial carotid artery stenting procedure performed for a tight left ICA stenosis associated with contralateral carotid occlusion. Two hours after the procedure, the initial signs of intracranial bleeding appeared that led to the patient's demise 5 days later. A brain CT showed and autopsy proved massive intraventricular bleeding. To our knowledge, our case is only the second report of isolated reperfusion intraventricular hemorrhage post-CAS.

  9. Critical Care Management of Intracerebral Hemorrhage.

    PubMed

    Morawo, Adeolu O; Gilmore, Emily J

    2016-06-01

    Spontaneous intracerebral hemorrhage (ICH), the most devastating and debilitating form of stroke, remains a major healthcare concern all over the world. Intracerebral hemorrhage is frequently managed in critical care settings where intensive monitoring and treatment are employed to prevent and address primary and secondary brain injury as well as other medical complications that may arise. Although there has been increasing data guiding the management of ICH in the past decade, prognosis remains dismal. In this article, the authors discuss the risk factors for ICH, the role of imaging, the major targets of neurocritical care management, the etiology and management of raised intracranial pressure, as well as prevention of and prompt response to the emergence of medical complications. They also discuss the effect of early withdrawal of life-sustaining therapy on prognosis. Finally, we outline several clinical trials that hold promise in improving our management of ICH in the near future. PMID:27214697

  10. Intracranial atherosclerosis following radiotherapy

    SciTech Connect

    Werner, M.H.; Burger, P.C.; Heinz, E.R.; Friedman, A.H.; Halperin, E.C.; Schold, S.C. Jr.

    1988-07-01

    We describe a case of severe intracranial atherosclerosis in a young man who had received therapeutic radiation for a presumed brain neoplasm. Since there was no evidence of vascular disease outside the radiation ports, we speculate that accelerated atherosclerosis was induced by radiation and that hyperlipidemia may have predisposed him to this effect.

  11. The clinical significance of small subarachnoid hemorrhages.

    PubMed

    Albertine, Paul; Borofsky, Samuel; Brown, Derek; Patel, Smita; Lee, Woojin; Caputy, Anthony; Taheri, M Reza

    2016-06-01

    With advancing technology, the sensitivity of computed tomography (CT) for the detection of traumatic subarachnoid hemorrhage (tSAH) continues to improve. Increased resolution has allowed for the detection of hemorrhage that is limited to one or two images of the CT exam. At our institution, all patients with a SAH require intensive care unit (ICU) admission, regardless of size. It was our hypothesis that patients with small subarachnoid hemorrhage experience favorable outcomes, and may not require the intensive monitoring offered in the ICU. This retrospective study evaluated 62 patients between 2011 and 2014 who presented to our Level I trauma center emergency room for acute traumatic injuries, and found to have subarachnoid hemorrhages on CT examination. The grade of subarachnoid hemorrhage was determined using previously utilized scoring systems, such as the Fisher, Modified Fisher, and Claassen grading systems. Electronic medical records were used to evaluate for medical decline, neurological decline, neurosurgical intervention, and overall hospital course. Admitting co-morbidities were noted, as were the presence of patient intoxication and use of anticoagulants. Patient outcomes were based on discharge summaries upon which the neurological status of the patient was assessed. Each patient was given a score based on the Glasgow outcome scale. The clinical and imaging profile of 62 patients with traumatic SAH were studied. Of the 62 patients, 0 % underwent neurosurgical intervention, 6.5 % had calvarial fractures, 25.8 % had additional intracranial hemorrhages, 27.4 % of the patients had significant co-morbidities, and 1.6 % of the patients expired. Patients with low-grade tSAH spent less time in the ICU, demonstrated neurological and medical stability during hospitalization. None of the patients with low-grade SAH experienced seizure during their admission. In our study, patients with low-grade tSAH demonstrated favorable clinical outcomes. This suggests

  12. Primary intracranial choriocarcinoma: MR imaging findings.

    PubMed

    Lv, X-F; Qiu, Y-W; Zhang, X-L; Han, L-J; Qiu, S-J; Xiong, W; Wen, G; Zhang, Y-Z; Zhang, J

    2010-11-01

    PICCC is the rarest, most malignant primary intracranial GCT. The purpose of this study was to describe and characterize the MR imaging findings in a series of 7 patients (6 males and 1 female; mean age, 11.9 years) with pathologically proved PICCC in our institution from 2004 to 2009. All tumors were located within the pineal (n = 6) or suprasellar (n = 1) regions. On T2-weighted MR imaging, the lesions appeared markedly heterogeneous with areas of both hypointensity and hyperintensity reflecting the histologic heterogeneity, including hemorrhage, fibrosis, cysts, or necrosis. Heterogeneous (n = 7), ringlike (n = 4), and/or intratumoral nodular (n = 3) enhancement was noted on T1-weighted images with gadolinium. These MR imaging findings, combined with patient age and serum β-HCG levels, may prove helpful in distinguishing PICCC from the more common primary brain tumors, thereby avoiding biopsy of this highly vascular tumor. PMID:20616180

  13. Management of atypical eclampsia with intraventricular hemorrhage: A rare experience and learning!

    PubMed Central

    Gupta, Kewal Krishan; Goyal, Lajya Devi

    2015-01-01

    Cerebrovascular accident during hypertensive disorder of pregnancy is a rare entity, but carries high risk of mortality and morbidity due to its unpredictable onset and late diagnosis. Here, we report an unusual case of 20-year-old primigravida with 34 weeks gestation having no risk factor, which developed sudden atypical eclampsia and intracranial hemorrhage within few hours. She was successfully managed by multidisciplinary approach including emergency cesarean section and conservative neurological treatment for intraventricular hemorrhage. PMID:26417139

  14. The spectrum of intracranial aneurysms in pediatrics.

    PubMed

    Kanaan, I; Lasjaunias, P; Coates, R

    1995-03-01

    Intracranial aneurysms are rare in children, accounting for merely 0.5-4.6% of all aneurysms. Several characteristics distinguish them from aneurysms in adults: male predominance; higher incidence of unusual location, such as peripheral or posterior circulation; and a greater number of large and giant aneurysms. These unique features can be attributed to the higher incidence of traumatic, infectious, developmental, and congenital lesions. Subarachnoid hemorrhage is not the exclusive mode of presentation; neuro-compressive signs and symptoms are also frequently seen. The treatment of intracranial aneurysms in pediatrics is dictated by their unusual pathology and liability to rehemorrhage. Although direct clipping has been the standard surgical technique, certain obsolete or innovative procedures should also be considered, such as entrapment, proximal occlusion, and endovascular embolisation, or even, in some cases, the non-invasive treatment of "watch and wait" for a spontaneous thrombosis. Six representative cases from King Faisal Specialist Hospital and Research Centre are reviewed. They reflect the diversity of the problem and the multi-disciplinary approach to the treatment. PMID:7627578

  15. Delayed chronic intracranial subdural hematoma complicating resection of a tanycytic thoracic ependymoma

    PubMed Central

    Maugeri, Rosario; Giugno, Antonella; Graziano, Francesca; Visocchi, Massimiliano; Giller, Cole; Iacopino, Domenico Gerardo

    2016-01-01

    Background: To demonstrate that the diagnosis of an intracranial subdural hematoma should be considered for patients presenting with acute or delayed symptoms of intracranial pathology following resection of a spinal tumor. Case Description: We present a case of a 57-year-old woman found to have a chronic subdural hematoma 1 month following resection of a thoracic extramedullary ependymoma. Evacuation of the hematoma through a burr hole relieved the presenting symptoms and signs. Resolution of the hematoma was confirmed with a computed tomography (CT) scan. Conclusion: Headache and other symptoms not referable to spinal pathology should be regarded as a warning sign of an intracranial subdural hematoma, and a CT scan of the head should be obtained. The mechanism of the development of the hematoma may be related to the leakage of cerebrospinal fluid with subsequent intracranial hypotension leading to an expanding subdural space and hemorrhage. PMID:26862454

  16. Warfarin and low-dose aspirin for stroke prevention from severe intracranial stenosis.

    PubMed

    Bekavac, I; Hanna, J P; Sila, C A; Furland, A J

    1999-01-01

    Management of symptomatic, intracranial, large-arterial atherosclerosis is controversial. We assessed the safety and efficacy of combining warfarin and low-dose aspirin to prevent stroke from intracranial atherosclerotic stenosis failing prior treatment with either aspirin or warfarin. Patients with severe intracranial stenosis were prescribed combination therapy, warfarin (international normalized ratio [INR] 2 to 3) and aspirin 81 mg daily. Ten men and six women treated with combination therapy had one recurrent ischemic event during 382 months of therapy. No patient suffered a myocardial infarction or sudden vascular death. No serious hemorrhagic complication occurred. The combination of warfarin and low-dose aspirin seems safe and effective in preventing recurrent stroke from symptomatic, intracranial, large-arterial occlusive disease after failure with either aspirin or warfarin monotherapy. PMID:17895135

  17. Intracranial chondroma: a rare entity

    PubMed Central

    Maheshwari, Veena; Mehdi, Ghazala; Varshney, Manoranjan; Jain, Anshu; Vashishtha, Sonal; Gaur, Kavita; Srivastava, Vinod Kumar

    2011-01-01

    Intracranial chondroma is a rare benign cartilaginous tumour with an incidence of less than 1% of all primary intracranial tumours. The authors are reporting here a case of intracranial chondroma in a 40-year-old man who presented with 5-month history of headache and gradual diminution of vision. A tentative diagnosis of chondroma was made on imprint cytology which was confirmed on histopathological examination. PMID:22696735

  18. Multiple Intracranial Aneurysms Associated with Behçet's Disease

    PubMed Central

    Ha, Sangwoo; Kim, Jaeho; Kim, Chong-gue

    2016-01-01

    Behçet's disease is an inflammatory disorder involving multiple organs. Its cause is still unknown, but vasculitis is the major pathologic characteristic. The common vascular lesions associated with Behçet's disease are aneurysm formation, arterial or venous occlusive diseases, and varices. Arterial aneurysms mostly occur in large arteries. Intracranial aneurysms hardly occur with Behçet's disease. We would like to present a 41-year-old female patient with Behçet's disease who showed symptoms of severe headache due to subarachnoid hemorrhage. Brain computed tomography revealed multiple aneurysms. We also present a literature review of intracranial arterial aneurysms associated with Behçet's disease. PMID:27114964

  19. Small Intracranial Aneurysm Treatment Using Target ® Ultrasoft ™ Coils

    PubMed Central

    Jindal, Gaurav; Miller, Timothy; Iyohe, Moronke; Shivashankar, Ravi; Prasad, Vikram; Gandhi, Dheeraj

    2016-01-01

    Purpose The introduction of small, soft, complex-shaped microcoils has helped facilitate the endovascular treatment of small intracranial aneurysms (IAs) over the last several years. Here, we evaluate the initial safety and efficacy of treating small IAs using only Target® Ultrasoft™ coils. Materials and methods A retrospective review of a prospectively maintained clinical database at a single, high volume, teaching hospital was performed from September 2011 to May 2015. IAs smaller than or equal to 5.0 mm in maximal dimension treated with only Target® Ultrasoft™ coils were included. Results A total of 50 patients with 50 intracranial aneurysms were included. Subarachnoid hemorrhage from index aneurysm rupture was the indication for treatment in 23 of 50 (46%) cases, and prior subarachnoid hemorrhage (SAH) from another aneurysm was the indication for treatment in eight of 50 (16%) cases. The complete aneurysm occlusion rate was 70% (35/50), the minimal residual aneurysm rate was 14% (7/50), and residual aneurysm rate was 16% (8/50). One intraoperative aneurysm rupture occurred. Three patients died during hospitalization from clinical sequelae of subarachnoid hemorrhage. Follow-up at a mean of 13.6 months demonstrated complete aneurysm occlusion in 75% (30/40) of cases, near complete occlusion in 15% (6/40) of cases, and residual aneurysm in 10% (4/40) of cases, all four of which were retreated. Conclusion Our initial results using only Target® Ultrasoft™ coils for the endovascular treatment of small intracranial aneurysms demonstrate initial excellent safety and efficacy profiles. PMID:27403224

  20. Intracranial extra-axial hemangioma in a newborn: A case report and literature review

    PubMed Central

    Dalsin, Marcos; Silva, Rafael Sodré; Galdino Chaves, Jennyfer Paula; Oliveira, Francine Hehn; Martins Antunes, Ápio Cláudio; Vedolin, Leonardo Modesti

    2016-01-01

    Background: Congenital hemangiomas are benign vascular tumors, and the intracranial counterpart was described in very few cases. Case Description: A newborn presented with an intracranial tumor associated with an arachnoid cyst, diagnosed by antenatal ultrasound at 37 weeks of gestation. Surgery was indicated due to increased head circumference and bulging fontanelle, and a complete resection of an extra-axial red–brown tumor was performed at the 3rd week of life. Microscopy revealed a hemangioma. Conclusion: Hemangioma is a rare differential diagnosis that must be considered in extra-axial intracranial tumors affecting infants and neonates. The radiological features are not helpful in differentiating from other tumors, and surgery is indicated when the diagnosis is uncertain or whenever there are signs of increased intracranial pressure. PMID:27274403

  1. Neonatal alloimmune thrombocytopenia: pathogenesis, diagnosis and management

    PubMed Central

    Peterson, Julie A.; McFarland, Janice G.; Curtis, Brian R.; Aster, Richard H.

    2014-01-01

    Summary Neonatal alloimmune thrombocytopenia, (NAIT) is caused by maternal antibodies raised against alloantigens carried on fetal platelets. Although many cases are mild, NAIT is a significant cause of morbidity and mortality in newborns and is the most common cause of intracranial haemorrhage in full-term infants. In this report, we review the pathogenesis, clinical presentation, laboratory diagnosis and prenatal and post-natal management of NAIT and highlight areas of controversy that deserve the attention of clinical and laboratory investigators. PMID:23384054

  2. Clinical review: Critical care management of spontaneous intracerebral hemorrhage

    PubMed Central

    Rincon, Fred; Mayer, Stephan A

    2008-01-01

    Intracerebral hemorrhage is by far the most destructive form of stroke. The clinical presentation is characterized by a rapidly deteriorating neurological exam coupled with signs and symptoms of elevated intracranial pressure. The diagnosis is easily established by the use of computed tomography or magnetic resonance imaging. Ventilatory support, blood pressure control, reversal of any preexisting coagulopathy, intracranial pressure monitoring, osmotherapy, fever control, seizure prophylaxis, treatment of hyerglycemia, and nutritional supplementation are the cornerstones of supportive care in the intensive care unit. Dexamethasone and other glucocorticoids should be avoided. Ventricular drainage should be performed urgently in all stuporous or comatose patients with intraventricular blood and acute hydrocephalus. Emergent surgical evacuation or hemicraniectomy should be considered for patients with large (>3 cm) cerebellar hemorrhages, and in those with large lobar hemorrhages, significant mass effect, and a deteriorating neurological exam. Apart from management in a specialized stroke or neurological intensive care unit, no specific medical therapies have been shown to consistently improve outcome after intracerebral hemorrhage. PMID:19108704

  3. A Long-Term Follow-up of Pontine Hemorrhage With Hearing Loss

    PubMed Central

    Kim, Seung Ki; Kim, Ae Ryoung; Kim, Joon Yeop

    2015-01-01

    A pontine intracranial hemorrhage (ICH) evokes several neurological symptoms, due to the various nuclei and nerve fibers; however, hearing loss from a pontine ICH is rare. We have experienced a non-traumatic pontine ICH patient, with hearing loss. A 43-year-old male patient had a massive pontine hemorrhage; his brain magnetic resonance imaging revealed the hemorrhage on the bilateral dorsal pons, with the involvement of the trapezoid body. Also, profound hearing loss on the pure-tone audiogram and abnormal brainstem auditory evoked potential were noticed. Fifty-two months of long-term follow-up did not reveal any definite improvement on the patient's hearing ability. PMID:26361602

  4. Intracranial Hypertension in Children without Papilledema.

    PubMed

    Chelse, Ana B; Epstein, Leon G

    2015-08-01

    Researchers at Nationwide Children's Hospital studied the frequency of intracranial hypertension without papilledema in children followed in a multispecialty pediatric intracranial hypertension clinic. PMID:26933598

  5. Infantile intracranial aneurysm of the superior cerebellar artery.

    PubMed

    Del Santo, Molly Ann; Cordina, Steve Mario

    2016-01-01

    Intracranial aneurysms in the pediatric population are rare. We report a case of a 3-month-old infant who presented with inconsolable crying, vomiting, and sunset eye sign. CT revealed a subarachnoid hemorrhage, with CT angiogram revealing a superior cerebellar artery aneurysm. An external ventricular drain was placed for acute management of hydrocephalus, with definitive treatment by endovascular technique with a total of six microcoils to embolize the aneurysm. Serial transcranial Dopplers revealed no subsequent vasospasm. Although aneurysms in the pediatric population are rare, once the diagnosis is established, early treatment results in better outcomes. PMID:26929222

  6. Hemorrhage Rates From Brain Arteriovenous Malformation in Hereditary Hemorrhagic Telangiectasia Patients

    PubMed Central

    Kim, Helen; Nelson, Jeffrey; Krings, Timo; terBrugge, Karel G.; McCulloch, Charles E.; Lawton, Michael T.; Young, William L.; Faughnan, Marie E.

    2015-01-01

    Background and Purpose Hereditary hemorrhagic telangiectasia (HHT) is a systemic disease characterized by mucocutaneous telangiectasias, epistaxis, and arteriovenous malformations (AVM). Intracranial hemorrhage (ICH) rates in this population are not well described. We report ICH rates and characteristics in HHT patients with brain arteriovenous malformations (HHT-BAVM). Methods We studied the first 153 HHT-BAVM patients with follow-up data enrolled in the Brain Vascular Malformation Consortium HHT Project. We estimated ICH rates after BAVM diagnosis. Results The majority of patients were female (58%) and Caucasian (98%). The mean age at BAVM diagnosis was 31±19 years (range: 0–70), with 61% of cases diagnosed upon asymptomatic screening. Overall, 14% presented with ICH; among symptomatic cases, 37% presented ruptured. During 493 patient-years of follow-up, 5 ICH events occurred yielding a rate of 1.02% per-year (95% CI: 0.42–2.44%). ICH-free survival differed significantly by ICH presentation (P=0.003); ruptured cases had a higher ICH rate (10.07%, 95% CI: 3.25–31.21%) than unruptured cases (0.43%, 95% CI: 0.11–1.73%). Conclusions HHT-BAVM patients who present with hemorrhage are at a higher risk for re-hemorrhage compared to BAVMs detected pre-symptomatically. PMID:25858236

  7. Asymptomatic Intracranial Foreign Body: An Incidental Finding on Radiography

    PubMed Central

    Maghsoudi, Mohammadreza; Shahbazzadegan, Bita; Pezeshki, Arastoo

    2016-01-01

    Introduction Intracranial needles are rare entities. Intracranial foreign bodies due to non-missile intracranial penetrations are one of the most rarely encountered situations in neurosurgery. Sewing needles are among the more unusual foreign bodies that may be found in the brain. Although uncommon, foreign body cases are important and interesting. Foreign bodies enter the body through trauma or iatrogenic injuries. Needles are mostly inserted through fontanelles, cranial sutures, and more rarely through the orbits in infancy for the purpose of killing unwanted babies. Case Presentation This article presents a case of intracranial foreign body found upon radiography. A 24-year-old female, who two days prior to presentation suffered only once from dizziness, and was otherwise healthy. Conclusions Because this incident may have occurred during the patient’s neonatal period, it may be a case of child abuse. In spite of the very limited number of cases in the literature, having a stepmother, a stepfather, or a babysitter, being the youngest child, or having family members who suffer from psychiatric disorders, (especially if these relatives are responsible for child care), living in a society that allows homicide of children born from extramarital relationships, and being female have been suggested as possible risk factors. PMID:27626006

  8. Reversible cerebral vasoconstriction syndrome and nonaneurysmal subarachnoid hemorrhage

    PubMed Central

    Barboza, Miguel A; Maud, Alberto; Rodriguez, Gustavo J

    2014-01-01

    Background Reversible cerebral vasoconstriction syndrome was first described by Call, Fleming, and colleagues. Clinically this entity presents acutely, with severe waxing and waning headaches (“thunderclap”), and occasional fluctuating neurological signs. Case presentation We present four subsequent cases of patients with severe thunderclap headache and brain tomography with evidence of subarachnoid hemorrhage. The brain angiogram showed no aneurysm but intracranial vasculopathy consistent with multiple areas of stenosis and dilatation (angiographic beading) in different territories. Conclusion Neurologists should be aware of Call Fleming syndrome presenting with severe headache and associated convexity subarachnoid hemorrhage. After other diagnoses are excluded, patients can be reassured about favorable prognosis with symptomatic management. Abbreviations RCVS Reversible cerebral vasoconstriction syndrome CT Computed tomography SAH Subarachnoid hemorrhage MR Magnetic resonance CTA Computed tomography angiography MRA Magnetic resonance angiography PMID:25132905

  9. Hemorrhagic Stroke in Children

    PubMed Central

    Hillis M.D., Argye E.

    2007-01-01

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

  10. Unusual Finding of Vertebral Artery Fenestration in Spontaneous Deep Nuclear Hemorrhage

    PubMed Central

    Bhattarai, Binod; Munakomi, Sunil; Chaudhary, Pramod

    2016-01-01

    Vertebral artery fenestration is accidentally detected during angiography or autopsy. Spontaneous deep nuclear hemorrhage in association with vertebral artery fenestration is a very unusual finding in angiography. Such an unusual finding has not been reported in the English literature. Here, we report two cases of spontaneous deep nuclear hemorrhage that presented with features of raised intracranial pressure. Computed tomography revealed a deep nuclear acute bleed in both cases. Digital subtraction angiographic findings were normal other than the presence of a long segment vertebral artery fenestration. Both extracranial and intracranial variations were detected. Although the existence of vascular fenestration in the vertebrobasilar system produces less clinical importance, it may influence the management of cervical and intracranial pathologies to avoid iatrogenic injury.  PMID:26918218

  11. Intracranial haemorrhage in pregnancy

    PubMed Central

    Fairhall, Jacob M; Stoodley, Marcus A

    2009-01-01

    Intracranial haemorrhage (ICH) is a rare, yet potentially devastating event in pregnancy. There is a risk of maternal mortality or morbidity and a significant risk to the unborn child. The risk of haemorrhage increases during the third trimester and is greatest during parturition and the puerperium. ICH can be extradural, subdural, subarachnoid or intraparenchymal. Causes of bleeding include trauma, arteriovenous malformations, aneurysms, preeclampsia/eclampsia and venous thrombosis. Urgent neurosurgical conditions generally outweigh obstetric considerations in management decisions, although anaesthetic and surgical modifications can be made to minimize adverse effects to the fetus.

  12. Neonatal pulmonary hemosiderosis.

    PubMed

    Limme, Boris; Nicolescu, Ramona; Misson, Jean-Paul

    2014-01-01

    Idiopathic pulmonary hemosiderosis (IPH) is a rare complex entity characterized clinically by acute or recurrent episodes of hemoptysis secondary to diffuse alveolar hemorrhage. The radiographic features are variable, including diffuse alveolar-type infiltrates, and interstitial reticular and micronodular patterns. We describe a 3-week-old infant presenting with hemoptysis and moderate respiratory distress. Idiopathic pulmonary hemosiderosis was the first working diagnosis at the Emergency Department and was confirmed, 2 weeks later, by histological studies (bronchoalveolar lavage). The immunosuppressive therapy by 1 mg/kg/d prednisone was immediately started, the baby returned home on steroid therapy at a dose of 0,5 mg/kg/d. The diagnosis of idiopathic pulmonary hemosiderosis should be evocated at any age, even in the neonate, when the clinical presentation (hemoptysis and abnormal radiological chest images) is strongly suggestive. PMID:25389504

  13. Neonatal hypotonia.

    PubMed

    Sparks, Susan E

    2015-06-01

    Neonatal hypotonia is a common problem in the neonatal intensive care unit. The genetic differential diagnosis is broad, encompassing primary muscular dystrophies, chromosome abnormalities, neuropathies, and inborn errors of metabolism. Recognition of hypotonia is relatively straightforward, but determining the cause can be challenging. It is important for the neonatologist to have an organized approach to the assessment of neonatal hypotonia. Physical examination and history alongside basic laboratory testing and imaging aid in the differential diagnosis. Identification of the cause is essential for determining prognosis, associated morbidities, and recurrence risk. The prevailing therapeutic modality is physical, occupational, speech/feeding, and respiratory therapy. PMID:26042909

  14. Ectopic intracranial germinoma.

    PubMed

    Shankar, Samantha; Wu, Xiao; Kalra, Vivek B; Huttner, Anita J; Malhotra, Ajay

    2016-09-01

    Intracranial ectopic germinomas are often associated with synchronous midline disease. Germinomas involving the corpus callosum are exceedingly rare. The reported imaging appearance is not as varied as one might expect and a review of the literature reveals a few common imaging features amongst most ectopic lesions, including cyst formation. We report a 24-year-old man with panhypopituitarism. Neuroimaging revealed three enhancing lesions involving the pituitary infundibulum, the pineal region, and a parenchymal lesion involving the genu of the corpus callosum. The described ectopic mass, a parenchymal lesion, was associated with small peripheral cysts. Stereotactic biopsy and histopathological evaluation revealed this mass to be a germinoma. Following chemotherapy and radiation therapy, there was near-total resolution of the intracranial disease. Preoperative imaging plays an important role, not only in delineating the extent of disease, but also in assisting in generating an appropriate differential diagnosis. Germinomas in the corpus callosum are exceedingly rare but should be considered in the differential of any young patient with a characteristic cystic and solid intra-axial mass. PMID:27050919

  15. Fatal cerebellar hemorrhage as an initial presentation of medulloblastoma in a child

    PubMed Central

    Menekse, Guner; Gezercan, Yurdal; Demirturk, Pelin; Uysal, Ismail; Okten, Ali Ihsan

    2015-01-01

    Children with medulloblastomas most commonly present with signs and symptoms of elevated intracranial pressure due to obstructive hydrocephalus, especially headaches and vomiting. However, some pediatric patients present with sudden neurological deterioration due to intracerebellar hemorrhage associated with medulloblastoma, although very few reports exist that document this phenomenon. An 8-year-old girl was admitted to our emergency department who presented with sudden loss of consciousness, vomiting, and bradycardia. The neuroradiological evaluation revealed a hemorrhagic mass lesion in the posterior fossa. Urgent evacuation of the hematoma was performed. The postoperative course was uneventful, and the postoperative histopathological examination revealed the lesion to be a medulloblastoma. This report presents an unusual case of a medulloblastoma presenting with fatal intracranial hemorrhage in a child. The clinical features and intraoperative and pathologic findings of the case are discussed. PMID:26557180

  16. Neonatal conjunctivitis

    MedlinePlus

    Newborn conjunctivitis; Conjunctivitis of the newborn; Ophthalmia neonatorum; Eye infection - neonatal conjunctivitis ... diseases spread through sexual contact to prevent newborn conjunctivitis caused by these infections. Putting eye drops into ...

  17. Neonatal Death

    MedlinePlus

    ... story First Candle Centering Corporation The Compassionate Friends Star Legacy Foundation Last reviewed: November, 2015 Neonatal death ... story First Candle Centering Corporation The Compassionate Friends Star Legacy Foundation Last reviewed: November, 2015 Complications & Loss ...

  18. Neonatal sepsis

    MedlinePlus

    ... and some strains of streptococcus. Group B streptococcus (GBS) has been a major cause of neonatal sepsis. ... an infant's risk of early-onset bacterial sepsis: GBS colonization during pregnancy Preterm delivery Water breaking (rupture ...

  19. Thalamic infarcts and hemorrhages.

    PubMed

    Amici, Serena

    2012-01-01

    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

  20. Neurodevelopmental impairment following neonatal hyperoxia in the mouse.

    PubMed

    Ramani, Manimaran; van Groen, Thomas; Kadish, Inga; Bulger, Arlene; Ambalavanan, Namasivayam

    2013-02-01

    Extremely premature infants are often exposed to supra-physiologic concentrations of oxygen, and frequently have hypoxemic episodes. These preterm infants are at high risk (~40%) for neurodevelopmental impairment (NDI) even in the absence of obvious intracranial pathology such as intraventricular hemorrhage or periventricular leukomalacia. The etiology for NDI has not been determined, and there are no animal models to simulate neurodevelopmental outcomes of prematurity. Our objectives were to develop and characterize a mouse model to determine long-term effects of chronic hypoxia or hyperoxia exposure on neurodevelopment. Newborn C57BL/6 mice were exposed to hypoxia (12% O(2)) or hyperoxia (85% O(2)) from postnatal days 1 to 14 and then returned to air. At 12-14 weeks of age, neurobehavioral assessment (Water Maze test, Novel Object Recognition test, Open Field test, Elevated Plus Maze, and Rotarod test) was performed, followed by MRI and brain histology. Neurobehavioral testing revealed that hyperoxia-exposed mice did poorly on the water maze and novel object recognition tests compared to air-exposed mice. MRI demonstrated smaller hippocampi in hyperoxia- and hypoxia-exposed mice with a greater reduction in hyperoxia-exposed mice, including a smaller cerebellum in hyperoxia-exposed mice. Brain histology showed reduced CA1 and CA3 and increased dentate gyral width in hippocampus. In conclusion, neonatal hyperoxia in mice leads to abnormal neurobehavior, primarily deficits in spatial and recognition memory, associated with smaller hippocampal sizes, similar to findings in ex-preterm infants. This animal model may be useful to determine mechanisms underlying developmental programming of NDI in preterm infants, and for evaluation of therapeutic strategies. PMID:23064437

  1. Decompressive craniectomy for arteriovenous malformation-related intracerebral hemorrhage.

    PubMed

    Takeuchi, Satoru; Takasato, Yoshio; Masaoka, Hiroyuki; Nagatani, Kimihiro; Otani, Naoki; Wada, Kojiro; Mori, Kentaro

    2015-03-01

    Arteriovenous malformation (AVM)-related intracerebral hemorrhage (ICH) is the cause of approximately 2-3% of ICH and is an important factor in the significant morbidity and mortality in patients with AVM. Decompressive craniectomy (DC) is a surgical procedure to relieve malignant elevation of intracranial pressure. The use of DC to treat patients with AVM-ICH has been much less common. The present study describes our experience with DC for AVM-ICH and discusses the safety of this procedure. The present retrospective analysis compared 12 consecutive patients treated with DC for AVM-ICH with 23 patients treated with DC for hypertensive ICH. Nine patients were male and three were female, aged from 11 to 53 years (mean, 31.7 years). Hematoma volumes ranged from 50 to 106 ml (mean, 75.8 ml). The outcomes were good recovery in one patient, moderate disability in three, severe disability in seven, and vegetative state in one. Complications after DC included subdural hygroma in four patients, hydrocephalus in one, intracranial infection in two, and intracranial hemorrhage in one. No significant difference was found in the incidence of complications between DC for large AVM-ICH and DC for hypertensive ICH. In conclusion, the present study found no significant difference in the incidence of complications between DC for large AVM-ICH and DC for hypertensive ICH. Further investigations including a prospective randomized trial are needed to confirm the safety and efficacy of DC for the treatment of large AVM-ICH. PMID:25564272

  2. Infrequent Hemorrhagic Complications Following Surgical Drainage of Chronic Subdural Hematomas

    PubMed Central

    Sangiorgi, Simone; Bifone, Lidia; Balbi, Sergio

    2015-01-01

    Chronic subdural hematomas mainly occur amongst elderly people and usually develop after minor head injuries. In younger patients, subdural collections may be related to hypertension, coagulopathies, vascular abnormalities, and substance abuse. Different techniques can be used for the surgical treatment of symptomatic chronic subdural hematomas : single or double burr-hole evacuation, with or without subdural drainage, twist-drill craniostomies and classical craniotomies. Failure of the brain to re-expand, pneumocephalus, incomplete evacuation, and recurrence of the fluid collection are common complications following these procedures. Acute subdural hematomas may also occur. Rarely reported hemorrhagic complications include subarachnoid, intracerebral, intraventricular, and remote cerebellar hemorrhages. The causes of such uncommon complications are difficult to explain and remain poorly understood. Overdrainage and intracranial hypotension, rapid brain decompression and shift of the intracranial contents, cerebrospinal fluid loss, vascular dysregulation and impairment of venous outflow are the main mechanisms discussed in the literature. In this article we report three cases of different post-operative intracranial bleeding and review the related literature. PMID:26113968

  3. Infrequent Hemorrhagic Complications Following Surgical Drainage of Chronic Subdural Hematomas.

    PubMed

    Rusconi, Angelo; Sangiorgi, Simone; Bifone, Lidia; Balbi, Sergio

    2015-05-01

    Chronic subdural hematomas mainly occur amongst elderly people and usually develop after minor head injuries. In younger patients, subdural collections may be related to hypertension, coagulopathies, vascular abnormalities, and substance abuse. Different techniques can be used for the surgical treatment of symptomatic chronic subdural hematomas : single or double burr-hole evacuation, with or without subdural drainage, twist-drill craniostomies and classical craniotomies. Failure of the brain to re-expand, pneumocephalus, incomplete evacuation, and recurrence of the fluid collection are common complications following these procedures. Acute subdural hematomas may also occur. Rarely reported hemorrhagic complications include subarachnoid, intracerebral, intraventricular, and remote cerebellar hemorrhages. The causes of such uncommon complications are difficult to explain and remain poorly understood. Overdrainage and intracranial hypotension, rapid brain decompression and shift of the intracranial contents, cerebrospinal fluid loss, vascular dysregulation and impairment of venous outflow are the main mechanisms discussed in the literature. In this article we report three cases of different post-operative intracranial bleeding and review the related literature. PMID:26113968

  4. Targeting heme oxygenase after intracerebral hemorrhage

    PubMed Central

    Chen-Roetling, Jing; Lu, Xiangping; Regan, Raymond F.

    2015-01-01

    Intracerebral hemorrhage (ICH) is the primary event in approximately 10% of strokes, and has higher rates of morbidity and mortality than ischemic stroke. Experimental evidence suggests that the toxicity of hemoglobin and its degradation products contributes to secondary injury that may be amenable to therapeutic intervention. Hemin, the oxidized form of heme, accumulates in intracranial hematomas to cytotoxic levels. The rate limiting step of its breakdown is catalyzed by the heme oxygenase (HO) enzymes, which consist of inducible HO-1 and constitutively-expressed HO-2. The effect of these enzymes on perihematomal injury and neurological outcome has been investigated in ICH models using both genetic and pharmacological approaches to alter their expression, with variable results reported. These findings are summarized and reconciled in this review; therapeutic strategies that may optimize HO expression and activity after ICH are described. PMID:25642455

  5. Small subdural hemorrhages: is routine intensive care unit admission necessary?

    PubMed

    Albertine, Paul; Borofsky, Samuel; Brown, Derek; Patel, Smita; Lee, Woojin; Caputy, Anthony; Taheri, M Reza

    2016-03-01

    With advancing technology, the sensitivity of computed tomography (CT) for the detection of subdural hematoma (SDH) continues to improve. In some cases, the finding is limited to one or 2 images of the CT examination. At our institution, all patients with an SDH require intensive care unit (ICU) admission, regardless of size. In this report, we tested the hypothesis that patients with a small traumatic SDH on their presenting CT examination do not require the intensive monitoring offered in the ICU and can instead be managed on a hospital unit with a lower level of monitoring. This is a retrospective study of patients evaluated and treated at a level I trauma center for acute traumatic intracranial hemorrhage between 2011 and 2014. The clinical and imaging profile of 87 patients with traumatic SDH were studied. Patients with small isolated traumatic subdural hemorrhage (tSDH) (<10cm(3) blood volume) spent less time in the ICU, demonstrated neurologic and medical stability during hospitalization, and did not require any neurosurgical intervention. It is our recommendation that patients with isolated tSDH (<10cm(3)) do not require ICU monitoring. Patients with small tSDH and additional intracranial hemorrhages overall show low rates of medical decline (4%) and neurologic decline (4%) but may still benefit from ICU observation. Patients with tSDH greater than 10cm(3) overall demonstrated poor clinical courses and outcome and would benefit ICU monitoring. PMID:26795895

  6. Neonatal pain

    PubMed Central

    Walker, Suellen M

    2014-01-01

    Effective management of procedural and postoperative pain in neonates is required to minimize acute physiological and behavioral distress and may also improve acute and long-term outcomes. Painful stimuli activate nociceptive pathways, from the periphery to the cortex, in neonates and behavioral responses form the basis for validated pain assessment tools. However, there is an increasing awareness of the need to not only reduce acute behavioral responses to pain in neonates, but also to protect the developing nervous system from persistent sensitization of pain pathways and potential damaging effects of altered neural activity on central nervous system development. Analgesic requirements are influenced by age-related changes in both pharmacokinetic and pharmacodynamic response, and increasing data are available to guide safe and effective dosing with opioids and paracetamol. Regional analgesic techniques provide effective perioperative analgesia, but higher complication rates in neonates emphasize the importance of monitoring and choice of the most appropriate drug and dose. There have been significant improvements in the understanding and management of neonatal pain, but additional research evidence will further reduce the need to extrapolate data from older age groups. Translation into improved clinical care will continue to depend on an integrated approach to implementation that encompasses assessment and titration against individual response, education and training, and audit and feedback. PMID:24330444

  7. Modeling of Intracranial Pressure Dynamics

    PubMed Central

    Griffith, Richard L.; Sullivan, Humbert G.; Miller, J. Douglas

    1978-01-01

    Digital computer simulation is utilized to test hypotheses regarding poorly understood mechanisms of intracranial pressure change. The simulation produces graphic output similar to records from polygraph recorders used in patient monitoring and in animal experimentation. The structure of the model is discussed. The mathematic model perfected by the comparison between simulation and experiment will constitute a formulation of medical information applicable to automated clinical monitoring and treatment of intracranial hypertension.

  8. Viral Hemorrhagic Fevers

    MedlinePlus

    ... Fever with Renal Syndrome Hendra Virus Disease Kyasanur Forest Disease Lassa Fever Lymphocytic Choriomeningitis (LCM) Marburg Hemorrhagic ... the rodent species carrying several of the New World arenaviruses, live in geographically restricted areas. Therefore, the ...

  9. Hereditary Hemorrhagic Telangiectasia - HHT

    MedlinePlus

    ... Throughout Body Hereditary Hemorrhagic Telangiectasia (HHT) is a genetic disorder that affects about one in 5,000 people and causes arterial blood to flow directly into the veins, creating weakened ballooned vessels that can rupture. Interventional radiologists ...

  10. Microwave hemorrhagic stroke detector

    DOEpatents

    Haddad, Waleed S.; Trebes, James E.

    2007-06-05

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

  11. 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...

  12. Microwave hemorrhagic stroke detector

    DOEpatents

    Haddad, Waleed S.; Trebes, James E.

    2002-01-01

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

  13. Neonatal transfusion.

    PubMed

    Kelly, Anne M; Williamson, Lorna M

    2013-11-01

    Neonates and particularly preterm neonates are frequent recipients of large volumes of blood products relative to their size. Good quality evidence for transfusion practice in this patient group has been lacking but is now increasing. Triggers for red cell transfusion are now better defined, with on-going trials of platelet transfusions likely to yield similar evidence. Transfusion is now extremely safe, but complications such as transfusion associated acute lung injury (TRALI) and transfusion associated circulatory overload (TACO) are likely to be under recognised, particularly in the sick extremely preterm neonate with respiratory symptoms. This review summarises the rationale and current practice with regard to blood component therapy. Background data on component specifications and hazards of transfusion are provided. Indications for transfusion of specific products including red cells, platelets, and plasma are discussed, and their use is illustrated by case examples. PMID:24095206

  14. Neonatal Stridor

    PubMed Central

    Daniel, Matija; Cheng, Alan

    2012-01-01

    Neonatal stridor is an important condition, in many cases implying an impending disaster with a very compromised airway. It is a sign that has to be considered with the rest of the history and examination findings, and appropriate investigations should then be undertaken to confirm the source of the noise. Neonates with stridor should be managed in a multidisciplinary setting, by clinicians familiar with the intricate physiology of these children, and with access to the multitude of medical and surgical investigative and therapeutic options required to provide first-rate care. PMID:22235209

  15. Nonlocal Intracranial Cavity Extraction

    PubMed Central

    Manjón, José V.; Eskildsen, Simon F.; Coupé, Pierrick; Romero, José E.; Collins, D. Louis; Robles, Montserrat

    2014-01-01

    Automatic and accurate methods to estimate normalized regional brain volumes from MRI data are valuable tools which may help to obtain an objective diagnosis and followup of many neurological diseases. To estimate such regional brain volumes, the intracranial cavity volume (ICV) is often used for normalization. However, the high variability of brain shape and size due to normal intersubject variability, normal changes occurring over the lifespan, and abnormal changes due to disease makes the ICV estimation problem challenging. In this paper, we present a new approach to perform ICV extraction based on the use of a library of prelabeled brain images to capture the large variability of brain shapes. To this end, an improved nonlocal label fusion scheme based on BEaST technique is proposed to increase the accuracy of the ICV estimation. The proposed method is compared with recent state-of-the-art methods and the results demonstrate an improved performance both in terms of accuracy and reproducibility while maintaining a reduced computational burden. PMID:25328511

  16. Intracranial complications following mastoidectomy.

    PubMed

    Migirov, Lela; Eyal, Ana; Kronenberg, Jona

    2004-01-01

    Mastoidectomy is a common surgical procedure in otology. However, postoperative complications of various degrees of severity may occur. We present 4 children who underwent mastoidectomy for middle ear and mastoid disease and developed postoperative intracranial complications. One child was operated on for brain abscess 1 week after the initial mastoidectomy. Another child appeared with seizures 5 days after the initial mastoidectomy and a subdural empyema was drained during revision surgery. Large bone defects with exposed middle cranial fossa dura were found at revision surgery in both cases and Proteus vulgaris and methicillin-resistant Staphylococcus aureus were isolated from the mastoid and abscess cavities in these children. A small epidural collection was diagnosed in the third patient 2 days after initial mastoid surgery and was managed with intravenous antibiotics only. The other child was found to have sigmoid sinus thrombosis the day after mastoidectomy that was performed for nonresponsive acute mastoiditis. This child received both intravenous antibiotics and anticoagulants. Timely revision surgery, combinations of third- or fourth-generation cephalosporins with vancomycin or metronidazole and the addition of anticoagulants in cases of sinus thrombosis can lead to full recovery. PMID:15689642

  17. Ehrlichia Meningitis Mimicking Aneurysmal Subarachnoid Hemorrhage

    PubMed Central

    Dredla, Brynn

    2015-01-01

    Thunderclap headache is a sudden and severe headache that can occur after an aneurysmal subarachnoid hemorrhage (SAH). Subarachnoid hemorrhage is a medical emergency that requires prompt attention and hospitalization. Patients with thunderclap headache often undergo a noncontrast head computed tomography (CT) scan to ascertain SAH bleeding and, if the scan is negative, then undergo a lumbar puncture to look for cerebrospinal fluid (CSF) red blood cells (RBCs), which would be consistent with an aneurysmal leak. If the initial CT is negative and CSF is positive for RBCs, patients are usually admitted to the hospital for evaluation of intracranial aneurysm. We encountered a patient with thunderclap headache whose initial head CT was negative for SAH and whose CSF tested positive for RBCs. The patient was referred to our center for evaluation and management of aneurysmal SAH. However, on careful review of the patient’s medical history, serum laboratory values, and spinal fluid values, the patient was diagnosed with Ehrlichia chaffeensis meningitis. While Ehrlichia meningitis is rare, it is important to recognize the clinical clues that could help avoid formal cerebral angiography, a costly and potentially unnecessary procedure. We present how this case represented a cognitive framing bias and anchoring heuristic as well as steps that medical providers can use to prevent such cognitive errors in diagnosis. PMID:27053985

  18. Neonatal meningitis.

    PubMed

    Heath, P T; Nik Yusoff, N K; Baker, C J

    2003-05-01

    Twelve years ago an annotation was published in Archives of Disease in Childhood regarding the antibiotic treatment of suspected neonatal meningitis. The authors recommended the use of cephalosporins rather than chloramphenicol and advocated intraventricular aminoglycoside treatment in selected cases. They noted the absence of clinical trials with third generation cephalosporins that showed an improvement in mortality or neurological outcome. PMID:12719388

  19. Intracranial sonography in infancy.

    PubMed

    Harmat, G

    1985-01-01

    Neonates and older infants were subjected to sonography through the anterior fontanelle with grey-scale compound scanner. The patients were referred to us from neurosurgery or showed clinical symptoms of perinatal CNS damage (ventricular or intracerebral haemorrhage, subdural effusion, etc.) or malformations (meningomyelocele, encephalocele, cystic brain, cerebral dysgenesis, etc.). Sonography is the simplest non-invasive diagnostic method to exclude suspected hydrocephalus in cases of macrocephalus, or when the head of premature infants grows more rapidly than the rest of the body. When screening showed alterations, sonography was performed weekly or fortnightly according to the extent of deviation from the normal. In cases of progressive hydrocephalus, when shunt surgery was indicated, ultrasound was used to monitor the operation of the shunt. In early age, ultrasound is a tool equal in value to CT, but is far less expensive and the examination can safely be repeated at any time. PMID:3885973

  20. Severe subdural hemorrhage due to minimal prenatal trauma.

    PubMed

    Piastra, Marco; Pietrini, Domenico; Massimi, Luca; Caldarelli, Massimo; De Luca, Daniele; Del Lungo, Laura Minguell; De Carolis, Maria Pia; Di Rocco, Concezio; Conti, Giorgio; Zecca, Enrico

    2009-12-01

    The authors report a case of minimal prenatal trauma producing a large subdural hematoma in the fetus, which was diagnosed in utero by MR imaging. The occurrence of such a complication is extremely rare in the absence of significant maternal trauma. Prenatally diagnosed intracranial hemorrhages, particularly those that are subdural in origin, have a poor prognosis in most cases. After birth, brain compression required a complex neurosurgical intervention because simple hematoma evacuation was not possible. The clinical and neurological outcome at 6 months was excellent, as confirmed by the neuroimaging findings. PMID:19951041

  1. Sonographic Diagnosis of Fetal Adrenal Hemorrhage Complicating a Vein of Galen Aneurysmal Malformation

    PubMed Central

    Kütük, Mehmet Serdar; Doğanay, Selim; Özdemir, Ahmet; Görkem, Süreyya Burcu; Öztürk, Adnan

    2016-01-01

    Background: The vein of Galen aneurysmal malformation (VGAM) is a rare intracranial vascular malformation which causes end-organ ischemia or venous congestion due to heart failure. Adrenal hemorrhage associated with VGAM has not been reported in the literature. We present the imaging findings of a fetal VGAM with adrenal hemorrhage. Case Report: A 26 year-old primigravida woman whose fetus with VGAM and mild cardiomegaly was scanned in the 34th week. On fetal ultrasound, a hyperechoic, well-circumscribed mass in the left suprarenal region was shown. Fetal and postnatal magnetic resonance imaging confirmed the diagnosis of adrenal hemorrhage. The baby died after delivery. Conclusion: Adrenal hemorrhage can complicate VGAM in fetuses with severe heart failure. Evaluation of the adrenal gland in affected cases may contribute to the prenatal counseling, and postnatal management. PMID:26966627

  2. Hepatopulmonary syndrome and venous emboli causing intracerebral hemorrhages after liver transplantation: a case report.

    PubMed

    Abrams, G A; Rose, K; Fallon, M B; McGuire, B M; Bloomer, J R; van Leeuwen, D J; Tutton, T; Sellers, M T; Eckhoff, D E; Bynon, J S

    1999-12-15

    Increasing experience has fostered the acceptance of liver transplantation as a treatment for patients with hepatopulmonary syndrome. Morbidity and mortality is most commonly attributed to progressive arterial hypoxemia postoperatively. A cerebral hemorrhage has been reported in one patient with hepatopulmonary syndrome after transplantation. However, a postmortem examination of the brain was not performed and the pathogenesis or type of cerebral hemorrhage was undefined. We report on a patient with severe hepatopulmonary syndrome who developed multiple intracranial hemorrhages after transplantation. The intracerebral hemorrhages were most consistent with an embolic etiology on postmortem examination. We postulate that venous embolization, caused by the manipulation of a Swan Ganz catheter in a thrombosed central vein, resulted in pulmonary emboli that passed through dilated intrapulmonary vessels into the cerebral microcirculation. Special attention to central venous catheters and avoidance of manipulation may be warranted in subjects with severe hepatopulmonary syndrome after liver transplantation. PMID:10609961

  3. Neonatal Infectious Diseases: Evaluation of Neonatal Sepsis

    PubMed Central

    Spearman, Paul W.; Stoll, Barbara J.

    2015-01-01

    Synopsis Neonatal sepsis remains a feared cause of morbidity and mortality in the neonatal period. Maternal, neonatal and environmental factors are associated with risk of infection, and a combination of prevention strategies, judicious neonatal evaluation and early initiation of therapy are required to prevent adverse outcomes. The following chapter reviews recent trends in epidemiology, and provides an update on risk factors, diagnostic methods and management of neonatal sepsis. PMID:23481106

  4. Primary intracranial lymphomas

    PubMed Central

    Mufti, Shagufta T.; Baeesa, Saleh S.; Al-Maghrabi, Jaudah A.

    2016-01-01

    Background: Primary CNS lymphoma (PCNSL), a rare form of aggressive extranodal non-Hodgkin's lymphoma (NHL), has increased in incidence during the last three decades and occurs in both immune compromised and immune competent hosts. It has an overall poor prognosis. Objective: This study attempts to further delineate the clinico-pathological, immunohistochemical and radiological profile of PCNSL at Jeddah to King Faisal Hospital and Research Center. Methods: Computerized search through the archives of King Faisal Hospital and Research Centre between July 2000- December 2012 identified 15 patients with pathologically confirmed PCNSL. These were analyzed retrospectively. Their clinico-pathological, immunohistochemical and radiological data were analyzed. Results: Of the 15 PCNSL patients, 8 (53.3%) were females and 7 (46.6%) were males. There was female predilection especially in the age group of 40-59 years. Mean age at diagnosis for all patients was 50.4 years. There was no patient in the pediatric age group. The most common location in the brain was the frontal region in 7 patients (46.6%), 7 (46.6%) had multiple intracranial masses; all 15 (100%) were Non Hodgkin B-cell lymphomas, among which 13 (86.6%) were diffuse large B-cell lymphomas. All 15 (100%) cases showed diffuse and strong positivity for CD 45, and CD 20. Fourteen patients were immune competent while one was immune compromised. Conclusions: PCNSL often occurs in middle-aged and aged patients. There is female predilection especially in the middle age. Frontal region is the most common location with diffuse large B-cell lymphoma being the predominant subtype. PMID:27366250

  5. Neoadjuvant Chemotherapy for Facilitating Surgical Resection of Infantile Massive Intracranial Immature Teratoma.

    PubMed

    Kitahara, Takahiro; Tsuji, Yoshihito; Shirase, Tomoyuki; Yukawa, Hiroyuki; Takeichi, Yasuhiro; Yamazoe, Naohiro

    2016-01-01

    Immature teratoma (IMT) is the most frequent histological subtype of infantile intracranial teratoma, the most common congenital brain tumor. IMT contains incompletely differentiated components resembling fetal tissues. Infantile intracranial IMT has a dismal prognosis, because it is often inoperable due to its massive size and high vascularity. Neoadjuvant chemotherapy has been shown to be effective in decreasing tumor volume and vascularity to facilitate surgical resection in other types of infantile brain tumors. However, only one recent case report described the effectiveness of neoadjuvant chemotherapy for infantile intracranial IMT in the literature, even though it is common entity with a poor prognosis in infants. Here, we describe the case of a 2-month-old male infant with a very large intracranial IMT. Maximal surgical resection was first attempted but was unsuccessful because of severe intraoperative hemorrhage. Neoadjuvant carboplatin and etoposide (CARE) chemotherapy was then administered with the aim of shrinking and devascularizing the tumor. After neoadjuvant chemotherapy, tumor size did not decrease, but intraoperative blood loss significantly decreased and near-total resection was achieved by the second and third surgery. The patient underwent adjuvant CARE chemotherapy and has been alive for 3 years after surgery without tumor regrowth. Even when neoadjuvant chemotherapy does not decrease tumor volume of infantile intracranial IMT, surgical resection should be tried because chemotherapy can facilitate surgical resection and improve clinical outcome by reducing tumor vascularity. PMID:27039944

  6. Neonatal Transfusion Practice: When do Neonates Need Red Blood Cells or Platelets?

    PubMed

    Del Vecchio, Antonio; Franco, Caterina; Petrillo, Flavia; D'Amato, Gabriele

    2016-09-01

    Based on small studies and not on statistically valid clinical trials, guidelines for neonatal transfusions remain controversial and practices vary greatly. Premature infants and critically ill neonates in the neonatal intensive care unit (NICU) often require blood transfusions and extremely preterm neonates receive at least one red blood cell transfusion during their hospital stay. Transfusions to neonates convey both benefits and risks and consequently it is imperative to establish specific guidelines to improve practice and avoid unnecessary transfusions. Appropriate and lifesaving platelet transfusion in thrombocytopenic bleeding neonates pertains to 2% of all neonates in NICUs. Inversely, 98% of platelet transfusions are given prophylactically, in the absence of bleeding, with the assumption that this reduces the risk of a serious hemorrhage. To date, no evidence base is available for assigning a platelet transfusion trigger to NICU patients. Each NICU should approve specific guidelines that best suit its local clinical practice. Therefore, whatever guidelines are chosen in deciding when to transfuse, what is most important is to adhere strictly to the guidelines adopted, thus limiting unnecessary transfusions that convey no benefits and carry both known and unknown risks. PMID:27603540

  7. Treatment of intracranial foreign body.

    PubMed

    Karadas, Sevdegul; Dursun, Recep; Kiymaz, Nejmi

    2014-07-01

    Craniospinal penetrating foreign body (FB) injuries are interesting, but rarely observed, cases. They are important in terms of the complications that they may cause. The etiologies of craniospinal penetrating injuries and intracranial FB are also different. Though a sewing needle is more rarely seen in an intracranial FB, it may occur as atttempted infanticide or as a result of an accident especially in early childhood before the closure of fontanels. We detected an intracranial sewing needle in the head radiograph of a case admitted to the emergency department for another reason. We present this case since this is a rare injury and the etiologies of craniospinal penetrating foreign body have different characteristics. PMID:25255596

  8. Noninvasive detection of intracerebral hemorrhage using near-infrared spectroscopy (NIRS)

    NASA Astrophysics Data System (ADS)

    Hennes, Hans-Juergen; Lott, Carsten; Windirsch, Michael; Hanley, Daniel F.; Boor, Stephan; Brambrink, Ansgar; Dick, Wolfgang

    1998-01-01

    Intracerebral Hemorrhage (IH) is an important cause of secondary brain injury in neurosurgical patients. Early identification and treatment improve neurologic outcome. We have tested Near Infrared Spectroscopy (NIRS) as an alternative noninvasive diagnostic tool compared to CT-Scans to detect IH. We prospectively studied 212 patients with neurologic symptoms associated with intracranial pathology before performing a CT-scan. NIRS signals indicated pathologies in 181 cases (sensitivity 0.96; specificity 0.29). In a subgroup of subdural hematomas NIRS detected 45 of 46 hematomas (sensitivity 0.96; specificity 0.79). Identification of intracerebral hemorrhage using NIRS has the potential to allow early treatment, thus possibly avoiding further injury.

  9. Noninvasive detection of intracerebral hemorrhage using near-infrared spectroscopy (NIRS)

    NASA Astrophysics Data System (ADS)

    Hennes, Hans J.; Lott, C.; Windirsch, Michael; Hanley, Daniel F.; Boor, Stephan; Brambrink, Ansgar; Dick, Wolfgang

    1997-12-01

    Intracerebral Hemorrhage (IH) is an important cause of secondary brain injury in neurosurgical patients. Early identification and treatment improve neurologic outcome. We have tested Near Infrared Spectroscopy (NIRS) as an alternative noninvasive diagnostic tool compared to CT-Scans to detect IH. We prospectively studied 212 patients with neurologic symptoms associated with intracranial pathology before performing a CT-scan. NIRS signals indicated pathologies in 181 cases (sensitivity 0.96; specificity 0.29). In a subgroup of subdural hematomas NIRS detected 45 of 46 hematomas (sensitivity 0.96; specificity 0.79). Identification of intracerebral hemorrhage using NIRS has the potential to allow early treatment, thus possibly avoiding further injury.

  10. [Local fibrinolytic technique in surgery of traumatic inctracranial hemorrhages].

    PubMed

    Krylov, V V; Burov, S A; Galankina, I E; Dash'ian, V G

    2006-01-01

    The emergence of neuroimaging techniques and new surgical technologies (neuroendocopy, navigation systems) in neurosurgery has substantially changed views of surgery for traumatic intracranial hematomas. The local fibrinolytic technique that has been applied to 40 victims aged 18 to 67 years (mean age 42.1 +/- 2 years) who had 18-to-97-cm3 hematomas is a promising direction of mini-invasive surgery for traumatic intracranial hematomas in patients in the compensated and subcompensated state. There were 32 males and 8 females. The procedure of the surgical intervention involves drainage of intracranial hematoma, followed by clot lysis and liquid blood aspiration along the drainage. A good outcome with a complete hematoma removal and clinical symptom regression was observed in 26 patients, a fair result with preservation of moderate neurological symptoms at hospital discharge was noted in 2 patients; 3 victims died. Recurrent bleedings were seen in 4 patients with epidural hematomas. A morphological study revealed the typical features of the morphogenesis of traumatic hematomas and perifocal brain tissue during local fibrinolytic therapy, which suggests that the area of damaging effect of bleeding on the adjacent brain tissue is decreased. Local fibrinolysis in surgery of traumatic intracranial hematomas may be considered to be one of the promising lines of treatment policy along with the existing traditional and current techniques and may be used as the method of choice in surgery of traumatic intracranial hematomas in patients in the compensated state. Removal of epidural hematomas through local fibrinolysis should be limited due to a high risk of recurrent hemorrhage and may be made only in a restricted contingent of patients with severe concomitant injury and concurrent somatic diseases when the risk of combined anesthesia and that of a longer operation are rather high. Moreover, of promise is that subtentorial epidural hematomas may be aspirated without

  11. Marburg Hemorrhagic Fever (Marburg HF)

    MedlinePlus

    ... The CDC Cancel Submit Search The CDC Marburg hemorrhagic fever (Marburg HF) Note: Javascript is disabled or is ... was first recognized in 1967, when outbreaks of hemorrhagic fever occurred simultaneously in laboratories in Marburg and Frankfurt, ...

  12. PRIMARY POSTPARTUM HEMORRHAGE

    PubMed Central

    Melody, George F.

    1951-01-01

    Postpartum hemorrhage is the outstanding cause of maternal mortality, and a redoubtable contributor to puerperal death from other causes, notably infection and renal failure. The clinical situations in which hemorrhage is liable to occur must be better known, so that anticipatory and preventive measures can be taken. Recent knowledge about defibrinated blood in women with degenerative changes at the placental site must be incorporated in the thinking and practice of physicians dealing with obstetrical cases. The indications, limitations, and hazards of the various anesthetic methods available for parturient women should be carefully considered in the circumstances of each case. ImagesFigure 1.Figure 2.Figure 3. PMID:14886749

  13. Hereditary Hemorrhagic Telangiectasia.

    PubMed

    Parambil, Joseph G

    2016-09-01

    Hereditary hemorrhagic telangiectasia (HHT) is an underrecognized and underdiagnosed autosomal-dominant angiodysplasia that has an estimated prevalence of 1 in 5000 individuals, with variable clinical presentations even within family members with identical mutations. The most common manifestations are telangiectasias of the skin and nasal mucosa. However, HHT can often be complicated by the presence of arteriovenous malformations and telangiectasias in the lungs, brain, gastrointestinal tract, and liver that are often silent and can lead to life-threatening complications of stroke and hemorrhage. This article reviews HHT for the pulmonologist, who is not uncommonly the first practitioner to encounter these patients. PMID:27514597

  14. Subarachnoid Hemorrhage: An Update.

    PubMed

    Dority, Jeremy S; Oldham, Jeffrey S

    2016-09-01

    Subarachnoid hemorrhage (SAH) is a debilitating, although uncommon, type of stroke with high morbidity, mortality, and economic impact. Modern 30-day mortality is as high as 40%, and about 50% of survivors have permanent disability. Care at high-volume centers with dedicated neurointensive care units is recommended. Euvolemia, not hypervolemia, should be targeted, and the aneurysm should be secured early. Neither statin therapy nor magnesium infusions should be initiated for delayed cerebral ischemia. Cerebral vasospasm is just one component of delayed cerebral edema. Hyponatremia is common in subarachnoid hemorrhage and is associated with longer length of stay, but not increased mortality. PMID:27521199

  15. Pontine infarcts and hemorrhages.

    PubMed

    Moncayo, Jorge

    2012-01-01

    Pontine infarcts are often part of a large ischemia involving the brainstem, although infarcts may be restricted to the pons. In both cases, infarcts in the pons are characterized by interesting clinical patterns resulting from a variety of cranial nerve dysfunctions, eye movement disorders and motor, sensory and cerebellar manifestations, either isolated or in combination. The anteromedial and anterolateral territories are the most commonly involved. Penetrating branch artery disease is the most common etiology. Ten percent of all intracerebral hemorrhages are located in the pons, and small hemorrhages in this brainstem structure may, in some instances, give rise to unusual clinical manifestations. PMID:22377887

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

    PubMed

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

    2014-03-01

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

  17. Clinical analysis of cases of neonatal Streptococcus agalactiae sepsis.

    PubMed

    Zeng, S J; Tang, X S; Zhao, W L; Qiu, H X; Wang, H; Feng, Z C

    2016-01-01

    With the advent of antibiotic resistance, pathogenic bacteria have become a major threat in cases of neonatal sepsis; however, guidelines for treatment have not yet been standardized. In this study, 15 cases of neonatal Streptococcus agalactiae sepsis from our hospital were retrospectively analyzed. Of these, nine cases showed early-onset and six cases showed late-onset sepsis. Pathogens were characterized by genotyping and antibiotic sensitivity tests on blood cultures. Results demonstrated that in cases with early-onset sepsis, clinical manifestations affected mainly the respiratory tract, while late-onset sepsis was accompanied by intracranial infection. Therefore, we suggest including a cerebrospinal fluid examination when diagnosing neonatal sepsis. Bacterial genotyping indicated the bacteria were mainly type Ib, Ia, and III S. agalactiae. We recommend treatment with penicillin or ampicillin, since bacteria were resistant to clindamycin and tetracycline. In conclusion, our results provide valuable information for the clinical treatment of S. agalactiae sepsis in neonatal infants. PMID:27323190

  18. Intraventricular Hemorrhage and Post Hemorrhagic Hydrocephalus among Very-Low-Birth-Weight Infants in Korea

    PubMed Central

    Ahn, So Yoon; Shim, So-Yeon

    2015-01-01

    Here, we aimed to evaluate the incidence and mortality of intraventricular hemorrhage (IVH) and post-hemorrhagic hydrocephalus (PHH) among very-low-birth-weight (VLBW) infants in Korea and assess the associated factors of PHH. This cohort study used prospectively collected data from the Korean Neonatal Network (KNN). Among 2,386 VLBW infants in the KNN database born between January 2013 and June 2014, 63 infants who died without brain ultrasonography results were excluded. Maternal demographics and neonatal clinical characteristics were assessed. The overall incidence of IVH in all the VLBW infants was 42.2% (987 of 2,323), while those of IVH grade 1, 2, 3, and 4 were 25.1%, 7.0%, 4.8%, and 5.5%, respectively. The incidence and severity of IVH showed a negatively correlating trend with gestational age and birth weight. PHH developed in 0%, 3.5%, 36.1%, and 63.8% of the surviving infants with IVH grades 1, 2, 3, and 4, respectively. Overall, in the VLBW infants, the IVH-associated mortality rate was 1.0% (24/2,323). Only IVH grade severity was proven to be an associated with PHH development in infants with IVH grades 3-4. This is the first Korean national report of IVH and PHH incidences in VLBW infants. Further risk factor analyses or quality improvement studies to reduce IVH are warranted. PMID:26566358

  19. [The use of frameless neuronavigation in the surgery of hemorrhagic stroke].

    PubMed

    Krylov, V V; Dash'ian, V G; Shaklunov, A A; Burov, S A

    2008-01-01

    The application of CT-navigation in emergency neurosurgery for the calculation of surgery assets in 42 patients with hypertensive intracranial hemorrhages is presented. The relative simplicity and high precision of navigation (on average 2,2 +/- 1 mm) made it possible to use the method in emergency surgery of deep intracranial hematomas. The application of CT navigation in combination with neuroendoscopy and local fibrinolysis of hemorrhages allowed to decrease the post-surgery brain trauma and reduce the volume of intervention due to the high precision of calculation that resulted in the improvement of surgical outcome. The total post-operative mortality was 24%. In 94% of survived patients positive changes in neurological status were observed in 2-4 weeks after the surgery. PMID:19431271

  20. Maternal and neonatal outcomes of macrosomic pregnancies

    PubMed Central

    Weissmann-Brenner, Alina; Simchen, Michal J.; Zilberberg, Eran; Kalter, Anat; Weisz, Boaz; Achiron, Reuven; Dulitzky, Mordechai

    2012-01-01

    Summary Background To compare maternal and neonatal outcomes of term macrosomic and adequate for gestational age (AGA) pregnancies. Material/Methods A retrospective analysis was performed on all term singleton macrosomic (birth weight ≥4000 g) and AGA (birth weight >10th percentile and <4000 g) pregnancies delivered at our hospital between 2004 and 2008. Data collected included maternal age, gestational age at delivery, mode of delivery, birth weight, fetal gender, maternal and neonatal complications. Comparisons were made between macrosomic and AGA pregnancies and between different severities of macrosomia (4000–4250 g, 4250–4500 g and ≥4500 g). Results The study population comprised of 34,685 pregnancies. 2077 neonates had birth weight ≥4000 g. Maternal age and gestational age at delivery were significantly higher for macrosomic neonates. Significantly more macrosomic neonates were born by cesarean section, and were complicated with shoulder dystocia, neonatal hypoglycemia, and had longer hospitalization period (both in vaginal and cesarean deliveries). Specifically, the odds ratio (OR) relative to AGA pregnancies for each macrosomic category (4000–4250 g, 4250–4500 g and ≥4500 g) of shoulder dystocia was 2.37, 2.24, 7.61, respectively, and for neonatal hypoglycemia 4.24, 4.41, 4.15, respectively. The risk of post partum hemorrhage was statistically increased when birth weight was >4500 g (OR=5.23) but not for birth weight between 4000–4500 g. No differences were found in the rates of extensive perineal lacerations between AGA and the different macrosomic groups. Conclusions Macrosomia is associated with increased rate of cesarean section, shoulder dystocia, neonatal hypoglycemia, and longer hospitalization, but not associated with excessive perineal tears. Increased risk of PPH was found in the >4500g group. PMID:22936200

  1. [PREVFNAIT prevention of foetal/neonatal alloimmune thrombocytopenia (FNAIT) in Polish foetuses and newborns--the PREVFNAIT program].

    PubMed

    Uhrynowska, Małgorzata Ewa; Dębska, Marzena; Guz, Katarzyna; Orzińska, Agnieszka; Wróbel, Agnieszka; Maślanka, Krystyna; Dębski, Romuald; Brojer, Ewa

    2015-01-01

    The scientific goals related to the grant include 1) estimation of FNAIT prevalence in Poland and 2) search for biomarkers to predict the risk of the antibody production and severity of fetal thrombocytopenia. Fetal/Neonatal Alloimmune Thrombocytopenia (FNAIT) is caused by destruction of fetal blood platelets due to maternal antibodies. This condition, which most commonly results from incompatibility between the mother and the fetus for the Human Platelet Antigen-1a (HPA-1a), may lead to intracranial hemorrhage, damage of the central nervous system (CNS) and even death of the fetus or the newborn. It can be the cause of strokes in term newborns. FNAIT is usually attributed to the presence of anti-HPA-1a antibodies. Its incidence rate is estimated at approximately 1/1000-2000 live births. In the absence of a screening program, it is usually diagnosed after birth of a child with symptoms of thrombocytopenia or CNS hemorrhage. Monitoring of antibody production and thrombocytopenia treatment to effectively minimize the risk of stroke are therefore launched only at the next pregnancy. Testing indications are broader to include fetal ultrasound for symptoms of stroke to the CNS, ventricular enlargement or hydrocephalus, and obstetric failure. Diagnostic process is also recommended prior to the planned cordocentesis, in vitro fertilization and in sisters of mothers with children with FNAIT history. HPA-1a testing remains the best method for diagnosing pregnancies at risk. The detection frequency for FNAIT in Poland remains low. Therefore, the Institute of Hematology and Transfusion Medicine (IHTM) will have performed such HPA-1a antigen testing in 30 000 Polish women within the framework of the PREVFNAIT program by March 2016. HPA-1a negative women (2% of the population) are a risk group for production of anti- HPA-1a antibodies responsible for FNAIT therefore all of them will be monitored for the presence and activity of anti-HPA-1a antibodies. Such testing will be

  2. Neonatal circumcision.

    PubMed

    Lerman, S E; Liao, J C

    2001-12-01

    The merits of neonatal circumcision continue to be debated hotly. Some argue that circumcision is a "uniquely American medical enigma." Most of the world's male population remains uncircumcised; however, most boys born in the United States continue to undergo neonatal circumcision. Review of existing literature supports that most children who are uncircumcised do well from a medical standpoint and, thus, the question of whether US health care practitioners are subjecting neonates to an unnecessary surgical procedure remains. The medical benefits of circumcision are multiple, but most are small. The clearest medical benefit of circumcision is the relative reduction in the risk for a UTI, especially in early infancy. Although this risk [figure: see text] is real, the absolute numbers are small (risk ranges from 1 in 100 to 1 in 1000), and one investigator has estimated that it may take approximately 80 neonatal circumcisions to prevent one UTI. In the case of a patient with known urologic abnormalities that predispose to UTI, neonatal circumcision has a clearer role in terms of medical benefit to the patient. Most of the other medical benefits of circumcision probably can be realized without circumcision as long as access to clean water and proper penile hygiene are achieved. Proper penile hygiene should all but eliminate the risk for foreskin-related medical problems that will require circumcision. Moreover, proper hygiene and access to clean water has been shown to reduce the rate of development of squamous cell carcinoma of the penis in the uncircumcised population. Proper techniques on the care of the foreskin are illustrated in the American Academy of Pediatrics pamphlet titled "How to care for the uncircumcised penis." Regarding the relationship between STDs and circumcision, patient education and the practice of low-risk sexual behavior make a far greater impact than does routine circumcision in hopes of reducing the spread of HIV and other STDs. Nevertheless

  3. Atraumatic multifocal intracerebral hemorrhage.

    PubMed

    Fetcko, Kaleigh M; Hendricks, Benjamin K; Scott, John; Cohen-Gadol, Aaron A

    2016-09-01

    This article describes a patient with atraumatic multifocal intracerebral, subarachnoid, and bilateral frontal convexity acute subdural hematomas. The patient is a 46-year-old Caucasian man who presented with a spontaneous severe progressive headache. Following a description of the case, this article reviews the reported incidence, proposed etiology, and current management strategies for multifocal spontaneous intracerebral hemorrhage. PMID:27234608

  4. Intracranial haemorrhage and child abuse.

    PubMed

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

    1994-01-01

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

  5. Intracranial Schwannoma in a Cow

    PubMed Central

    Mitcham, S. A.; Kasari, T. R.; Parent, J. M.; Naylor, J. M.

    1984-01-01

    A nine year old Hereford crossbred cow with a history of progressive neurological signs was referred to the Western College of Veterinary Medicine, Saskatoon. A large intracranial mass, histologically identified as a schwannoma, was found to be compressing the left brain stem and appeared to have arisen from the left fifth cranial nerve. ImagesFigure 1.Figure 2.Figure 3. PMID:17422375

  6. Amphetamine abuse and intracranial haemorrhage.

    PubMed Central

    Buxton, N; McConachie, N S

    2000-01-01

    Amphetamines taken by any route can cause cerebral vasculitis and intracranial haemorrhage. 8 cases were seen in a neurosurgical unit over 3.5 years. The published work indicates that those who experience these complications, mainly young adults, have poor outcomes. PMID:11089483

  7. Intracranial pressure and skull remodeling

    PubMed Central

    McCulley, Timothy J.; Jordan Piluek, W.; Chang, Jessica

    2014-01-01

    In this article we review bony changes resulting from alterations in intracranial pressure (ICP) and the implications for ophthalmologists and the patients for whom we care. Before addressing ophthalmic implications, we will begin with a brief overview of bone remodeling. Bony changes seen with chronic intracranial hypotension and hypertension will be discussed. The primary objective of this review was to bring attention to bony changes seen with chronic intracranial hypotension. Intracranial hypotension skull remodeling can result in enophthalmos. In advanced disease enophthalmos develops to a degree that is truly disfiguring. The most common finding for which subjects are referred is ocular surface disease, related to loss of contact between the eyelids and the cornea. Other abnormalities seen include abnormal ocular motility and optic atrophy. Recognition of such changes is important to allow for diagnosis and treatment prior to advanced clinical deterioration. Routine radiographic assessment of bony changes may allow for the identification of patient with abnormal ICP prior to the development of clinically significant disease. PMID:25859141

  8. Intracranial hypertension: classification and patterns of evolution

    PubMed Central

    Iencean, SM

    2008-01-01

    Intracranial hypertension (ICH) was systematized in four categories according to its aetiology and pathogenic mechanisms: parenchymatous ICH with an intrinsic cerebral cause; vascular ICH, which has its aetiology in disorders of cerebral blood circulation; ICH caused by disorders of cerebro–spinal fluid dynamics and idiopathic ICH. The increase of intracranial pressure is the first to happen and then intracranial hypertension develops from this initial effect becoming symptomatic; it then acquires its individuality, surpassing the initial disease. The intracranial hypertension syndrome corresponds to the stage at which the increased intracranial pressure can be compensated and the acute form of intracranial hypertension is equivalent to a decompensated ICH syndrome. The decompensation of intracranial hypertension is a condition of instability and appears when the normal intrinsic ratio of intracranial pressure – time fluctuation is changed. The essential conditions for decompensation of intracranial hypertension are: the speed of intracranial pressure increase over normal values, the highest value of abnormal intracranial pressure and the duration of high ICP values. Medical objectives are preventing ICP from exceeding 20 mm Hg and maintaining a normal cerebral blood flow. The emergency therapy is the same for the acute form but each of the four forms of ICH has a specific therapy, according to the pathogenic mechanism and if possible to aetiology. PMID:20108456

  9. Intranasal Osteopontin for Rodent Germinal Matrix Hemorrhage.

    PubMed

    Malaguit, Jay; Casel, Darlene; Dixon, Brandon; Doycheva, Desislava; Tang, Jiping; Zhang, John H; Lekic, Tim

    2016-01-01

    Germinal matrix hemorrhage (GMH) is the most common and devastating neurological problem of premature infants. Current treatment is largely ineffective and GMH has been nonpreventable. Osteopontin (OPN) is an endogenous protein that has been shown to be neuroprotective, however, it has not been tested in GMH. P7 neonatal rats were subjected to stereotactic ganglionic eminence collagenase infusion. Groups were as follows: (1) sham, (2) GMH + vehicle, (3) GMH + intranasal OPN. Seventy-two hours later, the animals were evaluated using righting reflex, blood-brain barrier (BBB) permeability by Evans blue dye leakage, brain water content, and hemoglobin assay. Intranasal OPN improved outcomes after GMH by attenuation of brain swelling, BBB function, re-bleeding, and neurological outcomes. OPN may play an important role in enhancing neuroprotective brain signaling following GMH. These observed effects may offer novel possibilities for therapy in this patient population. PMID:26463952

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

    PubMed

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

    2015-03-01

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

  11. Prohemostatic interventions in obstetric hemorrhage.

    PubMed

    Bonnet, Marie-Pierre; Basso, Olga

    2012-04-01

    Obstetric hemorrhage is a major cause of maternal morbidity and mortality. Pregnancy is associated with substantial hemostatic changes, resulting in a relatively hypercoagulable state. Acquired coagulopathy can, however, develop rapidly in severe obstetric hemorrhage. Therefore, prohemostatic treatments based on high fresh frozen plasma and red blood cell (FFP:RBC) ratio transfusion and procoagulant agents (fibrinogen concentrates, recombinant activated factor VII, and tranexamic acid) are crucial aspects of management. Often, evidence from trauma patients is applied to obstetric hemorrhage management, although distinct differences exist between the two situations. Therefore, until efficacy and safety are demonstrated in obstetric hemorrhage, clinicians should be cautious about wholesale adoption of high FFP:RBC ratio products. Applications of transfusion protocols, dedicated to massive obstetric hemorrhage and multidisciplinarily developed, currently remain the best available option. Similarly, while procoagulant agents appear promising in treatment of obstetric hemorrhage, caution is nonetheless warranted as long as clear evidence in the context of obstetric hemorrhage is lacking. PMID:22510859

  12. Radiotherapy-related intracranial aneurysms: A role for conservative management

    PubMed Central

    Parag, Sayal; Arif, Zafar; Chittoor, Rajaraman

    2016-01-01

    Background: Radiotherapy-related intracranial aneurysms are a recognized but rare phenomenon and often present following rupture leading to subarachnoid hemorrhage. Treatment poses a particular dilemma and both endovascular, and surgical approaches have been used with varied success. We present the case of a radiotherapy-related aneurysm treated conservatively with a favorable outcome. Case Description: A 37-year-old man was diagnosed with a left temporal lobe mass for which he underwent an uneventful craniotomy and debulking. Histology revealed Grade III anaplastic astrocytoma following which he received radiotherapy. Three years later, he presented with subacute headache and transient dysphasia. Computed tomography and catheter angiography revealed a fusiform aneurysm of the supramarginal branch of the left middle cerebral artery with probable intra-aneurysmal thrombus. Adjacent vessels also showed mild vasculitic changes. Trial balloon occlusion of the parent vessel resulted in profound dysphasia and was therefore abandoned. Bypass surgery or stent placement was deemed to have too high a risk of neurological deficit, and keeping in mind, the diagnosis of anaplastic astrocytoma, conservative management was pursued with partial thrombosis noted on serial imaging and stable appearances subsequently at 42 months’ follow-up. Conclusion: Conservative management can be pursued in selective cases of radiotherapy-related aneurysms, particularly if the risk of treating is too high and in the context of intracranial malignancy with limited lifespan. PMID:27313964

  13. Intracranial Aneurysms: Review of Current Treatment Options and Outcomes

    PubMed Central

    Seibert, Brad; Tummala, Ramachandra P.; Chow, Ricky; Faridar, Alireza; Mousavi, Seyed A.; Divani, Afshin A.

    2011-01-01

    Intracranial aneurysms are present in roughly 5% of the population, yet most are often asymptomatic and never detected. Development of an aneurysm typically occurs during adulthood, while formation and growth are associated with risk factors such as age, hypertension, pre-existing familial conditions, and smoking. Subarachnoid hemorrhage, the most common presentation due to aneurysm rupture, represents a serious medical condition often leading to severe neurological deficit or death. Recent technological advances in imaging modalities, along with increased understanding of natural history and prevalence of aneurysms, have increased detection of asymptomatic unruptured intracranial aneurysms (UIA). Studies reporting on the risk of rupture and outcomes have provided much insight, but the debate remains of how and when unruptured aneurysms should be managed. Treatment methods include two major intervention options: clipping of the aneurysm and endovascular methods such as coiling, stent-assisted coiling, and flow diversion stents. The studies reviewed here support the generalized notion that endovascular treatment of UIA provides a safe and effective alternative to surgical treatment. The risks associated with endovascular repair are lower and incur shorter hospital stays for appropriately selected patients. The endovascular treatment option should be considered based on factors such as aneurysm size, location, patient medical history, and operator experience. PMID:21779274

  14. Interleukin-6 as a Prognostic Biomarker in Ruptured Intracranial Aneurysms

    PubMed Central

    Kao, Hung-Wen; Kuo, Chen-Ling; Huang, Ching-Shan; Tseng, Wan-Min; Lin, Ching-Po

    2015-01-01

    Background Interleukin-6 (IL-6), a proinflammatory cytokine, was found to surge in the cerebral spinal fluid after aneurysmal subarachnoid hemorrhage (SAH). We hypothesized that the plasma level of IL-6 could be an independent biomarker in predicting clinical outcome of patients with ruptured intracranial aneurysm. Methods We prospectively included 53 consecutive patients treated with platinum coil embolization of the ruptured intracranial aneurysm. Plasma IL-6 levels were measured in the blood samples at the orifices of the aneurysms and from peripheral veins. The outcome measure was the modified Rankin Scale one month after SAH. Multiple logistic regression analyses were used to evaluate the associations between the plasma IL-6 levels and the neurological outcome. Results Significant risk factors for the poor outcome were old age, low Glasgow Coma Scale (GCS) on day 0, high Fisher grades, and high aneurysmal and venous IL-6 levels in univariate analyses. Aneurysmal IL-6 levels showed modest to moderate correlations with GCS on day 0, vasospasm grade and Fisher grade. A strong correlation was found between the aneurysmal and the corresponding venous IL-6 levels (ρ = 0.721; P<0.001). In the multiple logistic regression models, the poor 30-day mRS was significantly associated with high aneurysmal IL-6 level (OR, 17.97; 95% CI, 1.51–214.33; P = 0.022) and marginally associated with high venous IL-6 level (OR, 12.71; 95% CI, 0.90–180.35; P = 0.022) after adjusting for dichotomized age, GCS on day 0, and vasospasm and Fisher grades. Conclusions The plasma level of IL-6 is an independent prognostic biomarker that could be used to aid in the identification of patients at high-risk of poor neurological outcome after rupture of the intracranial aneurysm. PMID:26176774

  15. Foetal and neonatal alloimmune thrombocytopaenia

    PubMed Central

    Kaplan, Cecile

    2006-01-01

    Foetal/neonatal alloimmune thrombocytopaenia (NAIT) results from maternal alloimmunisation against foetal platelet antigens inherited from the father and different from those present in the mother, and usually presents as a severe isolated thrombocytopaenia in otherwise healthy newborns. The incidence has been estimated at 1/800 to 1/1 000 live births. NAIT has been considered to be the platelet counterpart of Rh Haemolytic Disease of the Newborn (RHD). Unlike RHD, NAIT can occur during a first pregnancy. The spectrum of the disease may range from sub-clinical moderate thrombocytopaenia to life-threatening bleeding in the neonatal period. Mildly affected infants may be asymptomatic. In those with severe thrombocytopaenia, the most common presentations are petechiae, purpura or cephalohaematoma at birth, associated with major risk of intracranial haemorrhage (up to 20% of reported cases), which leads to death or neurological sequelae. Alloimmune thrombocytopaenia is more often unexpected and is usually diagnosed after birth. Once suspected, the diagnosis is confirmed by demonstration of maternal antiplatelet alloantibodies directed against a paternal antigen inherited by the foetus/neonate. Post-natal management involves transfusion of platelets devoid of this antigen, and should not be delayed by biological confirmation of the diagnosis (once the diagnosis is suspected), especially in case of severe thrombocytopaenia. Prompt diagnosis and treatment are essential to reduce the chances of death and disability due to haemorrhage. Due to the high rate of recurrence and increased severity of the foetal thrombocytopaenia in successive pregnancies, antenatal therapy should be offered. However, management of high-risk pregnancies is still a matter of discussion. PMID:17032445

  16. [A neonate with pustules].

    PubMed

    Groot, Dominique T; van den Broek, Annique J M

    2016-01-01

    We describe a female neonate with non-grouped pustules directly postpartum without clinical signs of illness. There were no red maculae. At follow-up some pustules had turned to pigmented maculae, which confirmed the diagnosis of neonatal pustular melanosis. This benign transient condition occurs in 4-8% of dark-coloured neonates and in <1% of white neonates. PMID:26840934

  17. Phenylpropanolamine and cerebral hemorrhage

    SciTech Connect

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

    1985-05-01

    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.

  18. [Spontaneous intraperitoneal hemorrhage: etiology].

    PubMed

    Ksontini, R; Roulet, D; Cosendey, B A; Cavin, R

    2001-10-01

    Spontaneous intraperitoneal hemorrhage is a rare and sometime fatal condition. The clinical presentation may range from a non-specific abdominal pain to an acute abdomen with hemodynamic instability. Often, a preoperative diagnosis cannot be obtained. Immediate surgical exploration remains the treatment of choice. However, pre or postoperative diagnosis can sometime be confirmed and treated with interventional radiology. In rare cases, the site of bleeding remains unknown despite intraoperative exploration and radiographic studies. PMID:11715286

  19. Hemorrhagic cerebrovascular disease.

    PubMed

    Romero, Javier M; Rosand, Jonathan

    2016-01-01

    Primary or nontraumatic spontaneous intracerebral hemorrhage (ICH) accounts for 10-15% of all strokes, and has a poor prognosis. ICH has a mortality rate of almost 50% when associated with intraventricular hemorrhage within the first month, and 80% rate of dependency at 6 months from onset. Neuroimaging is critical in identifying the underlying etiology and thus assisting in the important therapeutic decisions. There are several imaging modalities available in the workup of patients who present with ICH, including computed tomography (CT), magnetic resonance imaging (MRI), and digital subtraction angiography (DSA). A review of the current imaging approach, as well as a differential diagnosis of etiologies and imaging manifestations of primary versus secondary intraparenchymal hemorrhage, is presented. Active bleeding occurs in the first hours after symptom onset, with early neurologic deterioration. Identifying those patients who are more likely to have hematoma expansion is an active area of research, and there are many ongoing therapeutic trials targeting this specific patient population at risk. PMID:27432674

  20. Intracranial Rosai-Dorfman disease.

    PubMed

    Huang, Bo Yuan; Zong, Miao; Zong, Wen Jing; Sun, Yan Hui; Zhang, Hua; Zhang, Hong Bo

    2016-10-01

    Rosai-Dorfman disease (RDD) is a rare histioproliferative disorder that only occasionally involves the central nervous system. We present the diagnosis and treatment of five patients with intracranial RDD. The patients were preoperatively misdiagnosed as meningioma or eosinophilic granuloma. All five patients were treated by total or subtotal surgical resection and none of them experienced recurrence. Histopathological examination showed a characteristic emperipolesis, the lymphocytes were engulfed in the S-100 protein and CD68 positive histiocytes, with negative expression of CD1a. Preoperative diagnosis of intracranial RDD is still challenging because the lesion is usually a dural-based lesion that mimics a meningioma. Surgical resection is an effective treatment and radiotherapy, steroid and chemotherapy has not demonstrated reliable therapeutic efficiency. PMID:27561856

  1. Neonatal resuscitation: Current issues

    PubMed Central

    Chadha, Indu A

    2010-01-01

    The following guidelines are intended for practitioners responsible for resuscitating neonates. They apply primarily to neonates undergoing transition from intrauterine to extrauterine life. The updated guidelines on Neonatal Resuscitation have assimilated the latest evidence in neonatal resuscitation. Important changes with regard to the old guidelines and recommendations for daily practice are provided. Current controversial issues concerning neonatal resuscitation are reviewed and argued in the context of the ILCOR 2005 consensus. PMID:21189881

  2. Clinical Analysis of Intracranial Hemangiopericytoma

    PubMed Central

    Park, Byoung-Joo; Hong, Yong-Kil; Jeun, Sin-Soo; Lee, Kwan-Sung; Lee, Youn-Soo

    2013-01-01

    Objective Intracranial hemangiopericytomas (HPCs) are rare tumors with aggressive behavior, including local recurrence and distant metastasis. We conducted this retrospective study to evaluate the efficacy of grossly total resection and adjuvant radiotherapy (RT) for these tumors. Methods A total of 13 patients treated for intracranial HPC from January 1995 through May 2013 were included in this retrospective study. We analyzed the clinical presentations, radiologic appearances, treatment results, and follow-up outcomes, as well as reviewed other studies. Results The ages of the patients at the time of diagnosis ranged from 26 to 73 years (mean : 48 years). The majority of the patients were male (92.3%), and the majority of the tumors were located in the parasagittal and falx. The ratio of intracranial HPCs to meningiomas was 13 : 598 in same period, or 2.2%. Seven patients (53.8%) had anaplastic HPCs. Nine patients (69.2%) underwent gross total tumor resection in the first operation without mortality. Eleven patients (84.6%) underwent postoperative adjuvant RT. Follow-up period ranged from 13 to 185 months (mean : 54.3 months). The local recurrence rate was 46.2% (6/13), and there were no distant metastases. The 10-year survival rate after initial surgery was 83.9%. The initial mean Karnofsky performance scale (KPS) was 70.8 and the final mean KPS was 64.6. Conclusion Gross total tumor resection upon initial surgery is very important. We believe that adjuvant RT is helpful even with maximal tumor resection. Molecular biologic analyses and chemotherapy studies are required to achieve better outcomes in recurrent intracranial HPCs. PMID:24294454

  3. Intracranial ependymoma: factors affecting outcome.

    PubMed

    Massimino, Maura; Buttarelli, Francesca R; Antonelli, Manila; Gandola, Lorenza; Modena, Piergiorgio; Giangaspero, Felice

    2009-03-01

    Ependymomas account for 2-9% of all neuroepithelial tumors, amounting to 6-12% of all intracranial tumors in children and up to 30% of those in children younger than 3 years. Recent findings provide evidence that intracranial and spinal ependymomas share similar molecular profiles with the radial glia of their corresponding locations. The management of intracranial ependymoma is still not optimal. The 5-year progression-free survival for children with ependymoma ranges between 30 and 50% with a worse prognosis for patients with residual disease after surgery. The prognostic relevance of most factors are still being debated. Recent studies, in which the current WHO classification criteria were applied, reported the relationship between histological grade and outcome. Biomolecular studies have identified that gain of 1q25 and EGFR overexpression correlate to poor prognosis, whereas low expression of nucleolin correlated with a favorable outcome. Ependymomas have been considered a 'surgical disease', where completeness of excision can be reached in approximately half of the cases. At present the standard treatment is radiation therapy for all patients after gross-total or near-total resection. For high-risk patients, with residual tumor, an interesting, although experimental, approach could be chemotherapy followed by secondary surgery and postoperative conformal irradiation. PMID:19284379

  4. [Neonatal cholestasis].

    PubMed

    Lacaille, F

    2016-03-01

    "Cholestasis" means abnormal synthesis or secretion of bile. The main symptom in a neonate or infant is jaundice. Urine is dark, staining diapers, and stools are variably pale or white. Vitamin K should be injected (to prevent coagulation disorders due to malabsorption). The two diagnoses requiring urgent treatment are urinary tract infection and biliary atresia. If stools are permanently white, biliary atresia is highly probable. A few genetic causes of intrahepatic cholestasis should be screened and corrective surgery organized. The diseases responsible for cholestasis in this age group are described as well as the investigations and treatments, including the management of non-specific complications of cholestasis. A delay in the diagnosis of biliary atresia can have such severe consequences that consultation with a hepatology unit or transfer should be easy and rapid. PMID:26850153

  5. Isolated Cranial Nerve-III Palsy Secondary to Perimesencephalic Subarachnoid Hemorrhage

    PubMed Central

    Abbatemarco, Justin R.

    2016-01-01

    We describe isolated cranial nerve-III palsy as a rare clinical finding in a patient with perimesencephalic subarachnoid hemorrhage. In this unusual case, the patient presented with complete cranial nerve-III palsy including ptosis and pupillary involvement. Initial studies revealed subarachnoid hemorrhage in the perimesencephalic, prepontine, and interpeduncular cisterns. Angiographic studies were negative for an intracranial aneurysm. The patient's neurological deficits improved with no residual deficits on follow-up several months after initial presentation. Our case report supports the notion that patients with perimesencephalic subarachnoid hemorrhage have an excellent prognosis. Our report further adds a case of isolated cranial nerve-III palsy as a rare initial presentation of this type of bleeding, adding to the limited body of the literature. PMID:26949557

  6. Clinical results of stereotactic heavy-charged-particle radiosurgery for intracranial angiographically occult vascular malformations

    SciTech Connect

    Levy, R.P.; Fabrikant, J.I.; Phillips, M.H.; Frankel, K.A.; Steinberg, G.K.; Marks, M.P.; DeLaPaz, R.L.; Chuang, F.Y.S.; Lyman, J.T.

    1989-12-01

    Angiographically occult vascular malformations (AOVMs) of the brain have been recognized for many years to cause neurologic morbidity and mortality. They generally become symptomatic due to intracranial hemorrhage, focal mass effect, seizures or headaches. The true incidence of AOVMs is unknown, but autopsy studies suggest that they are more common than high-flow angiographically demonstrable arteriovenous malformations (AVMs). We have developed stereotactic heavy-charged-particle Bragg peak radiosurgery for the treatment of inoperable intracranial vascular malformations, using the helium ion beams at the Lawrence Berkeley Laboratory 184-inch Synchrocyclotron and Bevatron. This report describes the protocol for patient selection, radiosurgical treatment planning method, clinical and neuroradiologic results and complications encountered, and discusses the strengths and limitations of the method. 10 refs., 1 fig.

  7. Positron emission tomography in the newborn: extensive impairment of regional cerebral blood flow with intraventricular hemorrhage and hemorrhagic intracerebral involvement

    SciTech Connect

    Volpe, J.J.; Herscovitch, P.; Perlman, J.M.; Raichle, M.E.

    1983-11-01

    Positron emission tomography (PET) now provides the capability of measuring regional cerebral blood flow with high resolution and little risk. In this study, we utilized PET in six premature infants (920 to 1,200 g) with major intraventricular hemorrhage and hemorrhagic intracerebral involvement to measure regional cerebral blood flow during the acute period (5 to 17 days of age). Cerebral blood flow was determined after intravenous injection of H/sub 2/O, labeled with the positron-emitting isotope, /sup 15/O. Findings were similar and dramatic in all six infants. In the area of hemorrhagic intracerebral involvement, little or no cerebral blood flow was detected. However, in addition, surprisingly, a marked two- to fourfold reduction in cerebral blood flow was observed throughout the affected hemisphere, well posterior and lateral to the intracerebral hematoma, including cerebral white matter and, to a lesser extent, frontal, temporal, and parietal cortex. In the one infant studied a second time, ie, at 3 months of age, the extent and severity of the decreased cerebral blood flows in the affected hemisphere were similar to those observed on the study during the neonatal period. At the three autopsies, the affected left hemisphere showed extensive infarction, corroborating the PET scans. These observations, the first demonstration of the use of PET in the determination of regional cerebral blood flow in the newborn, show marked impairments in regional cerebral blood flow in the hemisphere containing an apparently restricted intracerebral hematoma, indicating that the hemorrhagic intracerebral involvement is only a component of a much larger lesion, ischemic in basic nature, ie, an infarction. This large ischemic lesion explains the poor neurologic outcome in infants with intraventricular hemorrhage and hemorrhagic intracerebral involvement.

  8. The Stress and Vascular Catastrophes in Newborn Rats: Mechanisms Preceding and Accompanying the Brain Hemorrhages

    PubMed Central

    Semyachkina-Glushkovskaya, Oxana; Borisova, Ekaterina; Abakumov, Maxim; Gorin, Dmitry; Avramov, Latchezar; Fedosov, Ivan; Namykin, Anton; Abdurashitov, Arkady; Serov, Alexander; Pavlov, Alexey; Zinchenko, Ekaterina; Lychagov, Vlad; Navolokin, Nikita; Shirokov, Alexander; Maslyakova, Galina; Zhu, Dan; Luo, Qingming; Chekhonin, Vladimir; Tuchin, Valery; Kurths, Jürgen

    2016-01-01

    In this study, we analyzed the time-depended scenario of stress response cascade preceding and accompanying brain hemorrhages in newborn rats using an interdisciplinary approach based on: a morphological analysis of brain tissues, coherent-domain optical technologies for visualization of the cerebral blood flow, monitoring of the cerebral oxygenation and the deformability of red blood cells (RBCs). Using a model of stress-induced brain hemorrhages (sound stress, 120 dB, 370 Hz), we studied changes in neonatal brain 2, 4, 6, 8 h after stress (the pre-hemorrhage, latent period) and 24 h after stress (the post-hemorrhage period). We found that latent period of brain hemorrhages is accompanied by gradual pathological changes in systemic, metabolic, and cellular levels of stress. The incidence of brain hemorrhages is characterized by a progression of these changes and the irreversible cell death in the brain areas involved in higher mental functions. These processes are realized via a time-depended reduction of cerebral venous blood flow and oxygenation that was accompanied by an increase in RBCs deformability. The significant depletion of the molecular layer of the prefrontal cortex and the pyramidal neurons, which are crucial for associative learning and attention, is developed as a consequence of homeostasis imbalance. Thus, stress-induced processes preceding and accompanying brain hemorrhages in neonatal period contribute to serious injuries of the brain blood circulation, cerebral metabolic activity and structural elements of cognitive function. These results are an informative platform for further studies of mechanisms underlying stress-induced brain hemorrhages during the first days of life that will improve the future generation's health. PMID:27378933

  9. The Stress and Vascular Catastrophes in Newborn Rats: Mechanisms Preceding and Accompanying the Brain Hemorrhages.

    PubMed

    Semyachkina-Glushkovskaya, Oxana; Borisova, Ekaterina; Abakumov, Maxim; Gorin, Dmitry; Avramov, Latchezar; Fedosov, Ivan; Namykin, Anton; Abdurashitov, Arkady; Serov, Alexander; Pavlov, Alexey; Zinchenko, Ekaterina; Lychagov, Vlad; Navolokin, Nikita; Shirokov, Alexander; Maslyakova, Galina; Zhu, Dan; Luo, Qingming; Chekhonin, Vladimir; Tuchin, Valery; Kurths, Jürgen

    2016-01-01

    In this study, we analyzed the time-depended scenario of stress response cascade preceding and accompanying brain hemorrhages in newborn rats using an interdisciplinary approach based on: a morphological analysis of brain tissues, coherent-domain optical technologies for visualization of the cerebral blood flow, monitoring of the cerebral oxygenation and the deformability of red blood cells (RBCs). Using a model of stress-induced brain hemorrhages (sound stress, 120 dB, 370 Hz), we studied changes in neonatal brain 2, 4, 6, 8 h after stress (the pre-hemorrhage, latent period) and 24 h after stress (the post-hemorrhage period). We found that latent period of brain hemorrhages is accompanied by gradual pathological changes in systemic, metabolic, and cellular levels of stress. The incidence of brain hemorrhages is characterized by a progression of these changes and the irreversible cell death in the brain areas involved in higher mental functions. These processes are realized via a time-depended reduction of cerebral venous blood flow and oxygenation that was accompanied by an increase in RBCs deformability. The significant depletion of the molecular layer of the prefrontal cortex and the pyramidal neurons, which are crucial for associative learning and attention, is developed as a consequence of homeostasis imbalance. Thus, stress-induced processes preceding and accompanying brain hemorrhages in neonatal period contribute to serious injuries of the brain blood circulation, cerebral metabolic activity and structural elements of cognitive function. These results are an informative platform for further studies of mechanisms underlying stress-induced brain hemorrhages during the first days of life that will improve the future generation's health. PMID:27378933

  10. Bleeding and clotting in hereditary hemorrhagic telangiectasia

    PubMed Central

    Dittus, Christopher; Streiff, Michael; Ansell, Jack

    2015-01-01

    Hereditary hemorrhagic telangiectasia (HHT) is a relatively common inherited vascular disorder that was first described in 1864, and is notable for epistaxis, telangiectasia, and arterial venous malformations. While genetic tests are available, the diagnosis remains clinical, and is based on the Curacao criteria. Patients with HHT are at increased risk for both bleeding and clotting events. Because of these competing complications, hematologists are often faced with difficult clinical decisions. While the majority of management decisions revolve around bleeding complications, it is not infrequent for these patients to require anticoagulation for thrombosis. Any anticoagulation recommendations must take into account the bleeding risks associated with HHT. Recent reviews have found that HHT patients can be safely anticoagulated, with the most frequent complication being worsened epistaxis. Large clinical trials have shown that factor IIa and Xa inhibitors have less intracranial bleeding than warfarin, and basic coagulation research has provided a possible mechanism. This article describes the anticoagulation dilemma posed when a 62-year-old female patient with a history of bleeding events associated with HHT was diagnosed with a pulmonary embolism. The subsequent discussion focuses on the approach to anticoagulation in the HHT patient, and addresses the role of the new oral anticoagulants. PMID:25879004

  11. Hemorrhagic radiation cystitis.

    PubMed

    Mendenhall, William M; Henderson, Randal H; Costa, Joseph A; Hoppe, Bradford S; Dagan, Roi; Bryant, Curtis M; Nichols, Romaine C; Williams, Christopher R; Harris, Stephanie E; Mendenhall, Nancy P

    2015-06-01

    The optimal management of persistent hemorrhagic radiation cystitis is ill-defined. Various options are available and include oral agents (ie, sodium pentosan polysulfate), intravenous drugs (ie, WF10), topical agents (ie, formalin), hyperbaric oxygen, and endoscopic procedures (ie, electrical cautery, argon plasma coagulation, laser coagulation). In general, it is best to manage patients conservatively and intervene only when necessary with the option least likely to exacerbate the cystitis. More aggressive measures should be employed only when more conservative approaches fail. Bladder biopsies should be avoided, unless findings suggest a bladder tumor, because they may precipitate a complication. PMID:24322335

  12. Treatment of a giant arteriovenous malformation associated with intracranial aneurysm rupture during pregnancy: A case report

    PubMed Central

    Chen, Junhui; Wang, Yuhai; Li, Peipei; Chen, Weiliang; Zhou, Jingxu; Hu, Xu; Zhu, Jie; Jiang, Bingjie

    2016-01-01

    Arteriovenous malformations (AVMs) associated with aneurysm have rarely been reported in the literature. The present study reports the case of a 21-year-old pregnant female patient who presented with a subarachnoid hemorrhage and an intracranial hematoma located in the anterior end of the corpus callosum. Furthermore, an anterior cerebral aneurysm and an AVM were identified by digital subtraction angiography and magnetic resonance angiography. The aneurysm was clipped and the AVM was successfully removed by microsurgery. The diagnosis of AVM associated with an aneurysm was confirmed via intraoperative and postoperative pathological examinations. By performing a review of the current literature, issues and surgical considerations associated with AVM associated with aneurysm were analyzed.

  13. Neonatal euthanasia.

    PubMed

    Kon, Alexander A

    2009-12-01

    Despite advances in the care of infants, there remain many newborns whose medical conditions are incompatible with sustained life. At times, healthcare providers and parents may agree that prolonging life is not an appropriate goal of care, and they may redirect treatment to alleviate suffering. While pediatric palliative treatment protocols are gaining greater acceptance, there remain some children whose suffering is unrelenting despite maximal efforts. Due to the realization that some infants suffer unbearably (ie, the burdens of suffering outweigh the benefits of life), the Dutch have developed a protocol for euthanizing these newborns. In this review, I examine the ethical aspects of 6 forms of end of life care, explain the ethical arguments in support of euthanasia, review the history and verbiage of the United States regulations governing limiting and withdrawing life-prolonging interventions in infants, describe the 3 categories of neonates for whom the Dutch provide euthanasia, review the published analyses of the Dutch protocol, and finally present some practical considerations should some form of euthanasia ever be deemed appropriate. PMID:19914522

  14. Intracranial volume in craniosynostotic rabbits.

    PubMed

    Mooney, M P; Burrows, A M; Wigginton, W; Singhal, V K; Losken, H W; Smith, T D; Dechant, J; Towbin, A; Cooper, G M; Towbin, R; Siegel, M I

    1998-05-01

    Although craniosynostosis alters brain growth direction resulting in compensatory changes in the neurocranium, it has been suggested that such compensations occur with little reduction in intracranial volume (ICV). This hypothesis was tested in a rabbit model with nonsyndromic, familial coronal suture synostosis. Cross-sectional three-dimensional computed tomographic head scans were obtained from 79 rabbits (25 normal, 28 with delayed-onset synostosis, and 26 with early-onset synostosis) at 25, 42, and 126 days of age. Intracranial contents were reconstructed and indirect ICV was calculated. Results revealed that by 25 days of age the intracranial contents from early-onset synostosed rabbit skulls showed rostral (anterior) constrictions and a "beaten copper" morphology in the parietal and temporal regions compared with the other two groups. These deformities increased in severity with age. Quantitatively, ICV was significantly reduced (P < 0.05) by 7% in rabbits with early-onset synostosis compared with both control rabbits and rabbits with delayed-onset synostosis at 25 days of age. By 126 days of age, ICV in rabbits with synostosis was significantly reduced (p < 0.05) by 11% in early-onset synostosis and by 8% in delayed-onset synostosis compared with normal rabbits. Results suggest that in rabbits with uncorrected craniosynostosis, compensatory changes in the neurocranium were not adequate to allow normal expansion of the neurocapsular matrix. Further research is needed to determine if ICV reduction is correlated with cerebral atrophy or cerebral spinal fluid (i.e., ventricular or subarachnoid) space compression in this model. PMID:9693554

  15. Analysis of subconjunctival hemorrhage

    PubMed Central

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

    2013-01-01

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

  16. Transnasal, intracranial penetrating injury treated endoscopically.

    PubMed

    Cetinkaya, Erdem Atalay; Okan, Cinemre; Pelin, Kesapli

    2006-04-01

    Intracranial penetrating injury through the nose is uncommon. We present the case of a four-year-old girl who sustained a transnasal, intracranial penetrating injury with a sharp wooden object. We performed endoscopic removal of the foreign body and repair of the associated cerebrospinal fluid fistula. PMID:16623978

  17. Acute surgical management in idiopathic intracranial hypertension

    PubMed Central

    Zakaria, Zaitun; Fenton, Eoin; Sattar, Muhammad Taufiq

    2012-01-01

    Idiopathic intracranial hypertension is a headache syndrome with progressive symptoms of raised intracranial pressure. Most commonly, it is a slow process where surveillance and medical management are the main treatment modalities. We describe herein an acute presentation with bilateral sixth nerve palsies, papilloedema and visual deterioration, where acute surgical intervention was a vision-saving operation. PMID:23239783

  18. Megadolicho vascular malformation of the intracranial arteries.

    PubMed

    Lodder, J; Janevski, B; van der Lugt, P J

    1981-01-01

    A patient is presented suffering a hemiparesis. Megadolicho-vascular malformation of the intracranial part of the internal carotid arteries and some of its branches and of the basilar artery was suggested by CT and confirmed by angiography. The value of CT compared with angiography in relation to intracranial megadolicho vascular malformations is discussed. PMID:6273040

  19. Minimally invasive evacuation of spontaneous intracerebral hemorrhage using sonothrombolysis

    PubMed Central

    Newell, David W.; Shah, M. Mohsin; Wilcox, Robert; Hansmann, Douglas R.; Melnychuk, Erik; Muschelli, John; Hanley, Daniel F.

    2013-01-01

    Object Catheter-based evacuation is a novel surgical approach for the treatment of brain hemorrhage. The object of this study was to evaluate the safety and efficacy of ultrasound in combination with recombinant tissue plasminogen activator (rt-PA) delivered through a microcatheter directly into spontaneous intraventricular (IVH) or intracerebral (ICH) hemorrhage in humans. Methods Thirty-three patients presenting to the Swedish Medical Center in Seattle, Washington, with ICH and IVH were screened between November 21, 2008, and July 13, 2009, for entry into this study. Entry criteria included the spontaneous onset of intracranial hemorrhage ≥ 25 ml and/or IVH producing ventricular obstruction. Nine patients (6 males and 3 females, with an average age of 63 years [range 38–83 years]) who met the entry criteria consented to participate and were entered into the trial. A ventricular drainage catheter and an ultrasound microcatheter were stereotactically delivered together, directly into the IVH or ICH. Recombinant tissue plasminogen activator and 24 hours of continuous ultrasound were delivered to the clot. Gravity drainage was performed. In patients with IVHs, 3 mg of rt-PA was injected; in patients with intraparenchymal hemorrhages, 0.9 mg of rt-PA was injected. The rt-PA was delivered in 3 doses over 24 hours. Results All patients had significant volume reductions in the treated hemorrhage. The mean percentage volume reduction after 24 hours of therapy, as determined on CT and compared with pretreatment stability scans, was 59 ± 5% (mean ± SEM) for ICH and 45.1 ± 13% for IVH (1 patient with ICH was excluded from analysis because of catheter breakage). There were no intracranial infections and no significant episodes of rebleeding according to clinical or CT assessment. One death occurred by 30 days after admission. Clinical improvements as determined by a decrease in the National Institutes of Health Stroke Scale score were demonstrated at 30 days after

  20. Routine neonatal circumcision?

    PubMed Central

    Tran, P. T.; Giacomantonio, M.

    1996-01-01

    Routine neonatal circumcision is still a controversial procedure. This article attempts to clarify some of the advantages and disadvantages of neonatal circumcision. The increased rate of penile cancer among uncircumcised men appears to justify the procedure, but that alone is not sufficient justification. The final decision on neonatal circumcision should be made by parents with balanced counsel from attending physicians. PMID:8939321

  1. Desmopressin Acetate in Intracranial Haemorrhage

    PubMed Central

    Kapapa, Thomas; Röhrer, Stefan; Struve, Sabine; Petscher, Matthias; König, Ralph; Wirtz, Christian Rainer; Woischneck, Dieter

    2014-01-01

    Introduction. The secondary increase in the size of intracranial haematomas as a result of spontaneous haemorrhage or trauma is of particular relevance in the event of prior intake of platelet aggregation inhibitors. We describe the effect of desmopressin acetate as a means of temporarily stabilising the platelet function. Patients and Methods. The platelet function was analysed in 10 patients who had received single (N = 4) or multiple (N = 6) doses of acetylsalicylic acid and 3 patients (control group) who had not taken acetylsalicylic acid. All subjects had suffered intracranial haemorrhage. Analysis was performed before, half an hour and three hours after administration of desmopressin acetate. Statistical analysis was performed by applying a level of significance of P ≤ 0.05. Results. (1) Platelet function returned to normal 30 minutes after administration of desmopressin acetate. (2) The platelet function worsened again after three hours. (3) There were no complications related to electrolytes or fluid balance. Conclusion. Desmopressin acetate can stabilise the platelet function in neurosurgical patients who have received acetylsalicylic acid prior to surgery without causing transfusion-related side effects or a loss of time. The effect is, however, limited and influenced by the frequency of drug intake. Further controls are needed in neurosurgical patients. PMID:25610644

  2. Unique Neural Circuitry for Neonatal Olfactory Learning

    PubMed Central

    Moriceau, Stephanie; Sullivan, Regina M.

    2007-01-01

    Imprinting ensures that the infant forms the caregiver attachment necessary for altricial species survival. In our mammalian model of imprinting, neonatal rats rapidly learn the odor-based maternal attachment. This rapid learning requires reward-evoked locus ceruleus (LC) release of copious amounts of norepinephrine (NE) into the olfactory bulb. This imprinting ends at postnatal day 10 (P10) and is associated with a dramatic reduction in reward-evoked LC NE release. Here we assess whether the functional emergence of LC α2 inhibitory autoreceptors and the downregulation of LC α1 excitatory autoreceptors underlie the dramatic reduction in NE release associated with termination of the sensitive period. Postsensitive period pups (P12) were implanted with either LC or olfactory bulb cannulas, classically conditioned with intracranial drug infusions (P14), and tested for an odor preference (P15). During conditioning, a novel odor was paired with either olfactory bulb infusion of a β-receptor agonist (isoproterenol) to assess the target effects of NE or direct LC cholinergic stimulation combined with α2 antagonists and α1 agonists in a mixture to reinstate neonatal levels of LC autoreceptor activity to assess the source of NE. Pups learned an odor preference when the odor was paired with either olfactory bulb isoproterenol infusion or reinstatement of neonatal LC receptor activity. These results suggest that LC autoreceptor functional changes rather than olfactory bulb changes underlie sensitive period termination. PMID:14762136

  3. Fetal and neonatal alloimmune thrombocytopenia: prenatal interventions.

    PubMed

    Kamphuis, Marije M; Oepkes, Dick

    2011-07-01

    Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a potentially devastating condition, which may lead to intracranial haemorrhage (ICH) in the fetus or neonate, often with death or major neurological damage as consequence. In the absence of screening, preventive measures are only possible in the next pregnancy of women with an affected child. Controversy exists on the best intervention to minimise the risk of ICH. Most centres have abandoned treatment with serial fetal blood sampling (FBS) and platelet transfusions, because of a high rate of complications and the availability of quite effective non-invasive alternatives. In pregnancies with FNAIT and a previous affected child without ICH, weekly intravenous administration of immunoglobulins to the mother appears close to 100% effective to prevent fetal or neonatal ICH. Some centres add prednisone; this combination leads to slightly higher platelet counts at birth. In pregnant women with a previous child with ICH, the recurrence risk seems particularly high, and more aggressive maternal medical treatment is recommended, starting earlier with immunoglobulins. Whether a higher intravenous immunoglobulin dose or the addition of prednisone is really necessary is unclear. What does seem to be clear is that the use of FBS should be minimised, possibly even abandoned completely. PMID:21618560

  4. Neuroinflammation after intracerebral hemorrhage

    PubMed Central

    Mracsko, Eva; Veltkamp, Roland

    2014-01-01

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

  5. Viral Hemorrhagic Fever Diagnostics.

    PubMed

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

    2016-01-15

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

  6. Spontaneous intracranial hypotension: diagnosis to management.

    PubMed

    Limaye, Kaustubh; Samant, Rohan; Lee, Ricky W

    2016-06-01

    Spontaneous Intracranial Hypotension typically occurs from spontaneous CSF leak. CSF volume depletion rather than decrease in CSF pressure is thought to be the main causative feature for intracranial hypotension. More and more cases of intracranial hypotension are getting diagnosed with the advances in the imaging. The advances in the imaging have also led to the better understanding of the dynamic changes that occur with intracranial hypotension. The old theories of CSF overproduction or CSF underproduction have not been substantially associated with intracranial hypotension. It has also led to the fore different atypical clinical features and presentations. Although, it has been known for a long time, the diagnosis is still challenging and dilemma persists over one diagnostic modality over other and the subsequent management. Spontaneous CSF leaks occur at the spinal level and the skull base and other locations are rare. The anatomy of spontaneous intracranial hypotension is a very complex process with significant overlap in connective tissue disorders, previous dural weakness or meningeal diverticula. To localize the location of the CSF leak-CT myelography is the modality of choice. CSF cysternography may provide additional confirmation in uncertain cases and also MRI spine imaging may be of significant help in some cases. Spontaneous intracranial hypotension continues to be a diagnostic dilemma and our effort was to consolidate available information on the clinical features, diagnostics, and management for a practicing neurologist for a "15-20 min quick update of the topic". PMID:26661291

  7. Race against the clock: overcoming challenges in the management of anticoagulant-associated intracerebral hemorrhage.

    PubMed

    Le Roux, Peter; Pollack, Charles V; Milan, Melissa; Schaefer, Alisa

    2014-08-01

    Patients receiving anticoagulation therapy who present with any type of intracranial hemorrhage--including subdural hematoma, epidural hematoma, subarachnoid hemorrhage, and intracerebral hemorrhage (ICH)--require urgent correction of their coagulopathy to prevent hemorrhage expansion, limit tissue damage, and facilitate surgical intervention as necessary. The focus of this review is acute ICH, but the principles of management for anticoagulation-associated ICH (AAICH) apply to patients with all types of intracranial hemorrhage, whether acute or chronic. A number of therapies--including fresh frozen plasma (FFP), intravenous vitamin K, activated and inactivated prothrombin complex concentrates (PCCs), and recombinant activated factor VII (rFVIIa)--have been used alone or in combination to treat AAICH to reverse anticoagulation, help achieve hemodynamic stability, limit hematoma expansion, and prepare the patient for possible surgical intervention. However, there is a paucity of high-quality data to direct such therapy. The use of 3-factor PCC (activated and inactivated) and rFVIIa to treat AAICH constitutes off-label use of these therapies in the United States. However, in April 2013, the US Food and Drug Administration (FDA) approved Kcentra (a 4-factor PCC) for the urgent reversal of vitamin K antagonist (VKA) anticoagulation in adults with acute major bleeding. Plasma is the only other product approved for this use in the United States. (1) Inconsistent recommendations, significant barriers (e.g., clinician-, therapy-, or logistics-based barriers), and a lack of approved treatment pathways in some institutions can be potential impediments to timely and evidence-based management of AAICH with available therapies. Patient assessment, therapy selection, whether to use a reversal or factor repletion agent alone or in combination with other agents, determination of site-of-care management, eligibility for neurosurgery, and potential hematoma evacuation are the

  8. Immune Responses in Neonates

    PubMed Central

    Basha, Saleem; Surendran, Naveen; Pichichero, Michael

    2015-01-01

    Neonates have little immunological memory and a developing immune system, which increases their vulnerability to infectious agents. Recent advances in understanding of neonatal immunity indicate that both innate and adaptive responses are dependent on precursor frequency of lymphocytes, antigenic dose and mode of exposure. Studies in neonatal mouse models and human umbilical cord blood cells demonstrate the capability of neonatal immune cells to produce immune responses similar to adults in some aspects but not others. This review focuses mainly on the developmental and functional mechanisms of the human neonatal immune system. In particular, the mechanism of innate and adaptive immunity and the role of neutrophils, antigen presenting cells, differences in subclasses of T lymphocytes (Th1, Th2, Tregs) and B cells are discussed. In addition, we have included the recent developments in neonatal mouse immune system. Understanding neonatal immunity is essential to development of therapeutic vaccines to combat newly emerging infectious agents. PMID:25088080

  9. Pharmacological management of pain after intracranial surgery.

    PubMed

    Leith, B

    1998-08-01

    Some healthcare professionals continue to believe that patients experience minimal pain and discomfort after intracranial surgery. However, clinical experience indicates that many patients experience significant pain after craniotomy. Despite research which supports the use of morphine as a method of pain control after intracranial surgery, some healthcare professionals continue to administer only codeine, which may be ineffective. Inadequate pain control can be associated with a variety of negative physiological and psychological consequences. Neuroscience nurses are challenged to re-evaluate their current beliefs and practices related to pain and pain control after intracranial surgery. PMID:9791776

  10. Fatal transorbital penetrating intracranial injury caused by a bicycle hand brake

    PubMed Central

    2012-01-01

    A transorbital penetrating intracranial injury is a rare and severe traumatic brain injury. Patients with this type of injury may present dramatically, but often the injury is subtle and therefore easily overlooked and not recognized in the first place. We present the case of a 45-year-old female admitted to the emergency department after she fell with her bike and the bicycle brake handle penetrated her left eye. A computerized tomography of the cerebrum showed a fracture of the superior orbital roof with multiple bone fragments extending into the brain near the circle of Willis. A pneumocephalus and traumatic frontobasal, intraventricular and subdural hemorrhage was seen. The patient deteriorated suddenly and was transferred to a neurosurgical center where she underwent an emergency craniotomy with evacuation of the intracerebral hematoma and an intraventricular drain was placed. After surgery, the patient’s condition deteriorated, and total compression of the brain stem occurred, upon which the patient was declared brain dead. Our case report shows that the Glasgow Coma Scale score at admission is not always a good predictor of the severity of the injury. Even when there is minimal suspicion of a penetrating intracranial injury, a computerized tomography should be performed immediately, independent of the patient’s Glasgow Coma Scale score. A direct transfer to a specialized neurosurgical center is recommended because this injury often results in death due to fatal complications such as intracerebral hemorrhage, pneumocephalus and brain stem injury. PMID:22989177

  11. [Radiotherapy of benign intracranial tumors].

    PubMed

    Delannes, M; Latorzeff, I; Chand, M E; Huchet, A; Dupin, C; Colin, P

    2016-09-01

    Most of the benign intracranial tumors are meningiomas, vestibular schwannomas, pituitary adenomas, craniopharyngiomas, and glomus tumors. Some of them grow very slowly, and can be observed without specific treatment, especially if they are asymptomatic. Symptomatic or growing tumors are treated by surgery, which is the reference treatment. When surgery is not possible, due to the location of the lesion, or general conditions, radiotherapy can be applied, as it is if there is a postoperative growing residual tumor, or a local relapse. Indications have to be discussed in polydisciplinary meetings, with precise evaluation of the benefit and risks of the treatments. The techniques to be used are the most modern ones, as multimodal imaging and image-guided radiation therapy. Stereotactic treatments, using fractionated or single doses depending on the size or the location of the tumors, are commonly realized, to avoid as much a possible the occurrence of late side effects. PMID:27523417

  12. Intracranial ROSAI-DORFMAN Disease

    PubMed Central

    Mahzoni, Parvin; Zavareh, Mohsen Hani Tabaei; Bagheri, Marzie; Hani, Neda; Moqtader, Babak

    2012-01-01

    Rosai-Dorfman disease is a benign lymphohistiocytosis that often involve lymph nodes and present as massive lymphadenopathy with sinus histiocytosis. The disease is rarely associated with intracranial involvement. Herein, we report a 33-years-old man with recent onset of unconsciousness. According to his past medical history, he was suffering from frontal headache, ataxia and dizziness with no sensory or motor defect since August 2010. At initial work up, MRI showed infiltrating mass in the left parietal region. Microscopically, the mass consisted of infiltration of abundant lymphoplasma cells, neutrophils and some histiocytes scattered in fibrotic background. Emperipolesis (lymphocytophagocytosis) of histiocytic cells made the diagnosis of Rosai-Dorfman disease. Rosai-Dorfman disease should be added in the list of differential diagnosis for a dural mass mimicking meningioma or cerebral mass mimicking glioma, therefore, immunohistochemical staining for EMA, S100 and CD1a should be performed to rule out the differential diagnosis. PMID:23267385

  13. Management of raised intracranial pressure.

    PubMed Central

    Pickard, J D; Czosnyka, M

    1993-01-01

    This review has been written at an unfortunate time. Novel questions are being asked of the old therapies and there is an abundance of new strategies both to lower ICP and protect the brain against cerebral ischaemia. In the United Kingdom, the problem is to ensure that appropriate patients continue to be referred to centres where clinical trials of high quality can be undertaken. One of the success stories of the past decade has been the decline in the number of road accidents as a result of seat belt legislation, improvements in car design and the drink/driving laws. Hence, fortunately there are fewer patients with head injuries to treat and it is even more important that patients are appropriately referred if studies to assess efficacy of the new strategies are not to be thwarted. The nihilistic concept that intensive investigation with ICP monitoring for patients with diffuse head injury or brain swelling following evacuation of a haematoma or a contusion has no proven beneficial effect on outcome, requires revision. A cocktail of therapies may be required that can be created only when patients are monitored in sufficient detail to reveal the mechanisms underlying their individual ICP problem. Ethical problems may arise over how aggressively therapy for intracranial hypertension should be pursued and for how long. There has always been the concern that cranial decompression or prolonged barbiturate coma may preserve patients but with unacceptably severe disability. Some patients may be salvaged from herniating with massive cerebral infarction with the use of osmotherapy but is the outcome acceptable? Similar considerations apply to some children with metabolic encephalopathies. Where such considerations have been scrutinised in patients with severe head injury, the whole spectrum of outcomes appears to be shifted so that the number of severe disabilities and persistent vegetative states are not increased. However, it is important to be sensitive to such issues

  14. Detection of acute cerebral hemorrhage in rabbits by magnetic induction

    PubMed Central

    Sun, J.; Jin, G.; Qin, M.X.; Wan, Z.B.; Wang, J.B.; Wang, C.; Guo, W.Y.; Xu, L.; Ning, X.; Xu, J.; Pu, X.J.; Chen, M.S.; Zhao, H.M.

    2014-01-01

    Acute cerebral hemorrhage (ACH) is an important clinical problem that is often monitored and studied with expensive devices such as computed tomography, magnetic resonance imaging, and positron emission tomography. These devices are not readily available in economically underdeveloped regions of the world, emergency departments, and emergency zones. We have developed a less expensive tool for non-contact monitoring of ACH. The system measures the magnetic induction phase shift (MIPS) between the electromagnetic signals on two coils. ACH was induced in 6 experimental rabbits and edema was induced in 4 control rabbits by stereotactic methods, and their intracranial pressure and heart rate were monitored for 1 h. Signals were continuously monitored for up to 1 h at an exciting frequency of 10.7 MHz. Autologous blood was administered to the experimental group, and saline to the control group (1 to 3 mL) by injection of 1-mL every 5 min. The results showed a significant increase in MIPS as a function of the injection volume, but the heart rate was stable. In the experimental (ACH) group, there was a statistically significant positive correlation of the intracranial pressure and MIPS. The change of MIPS was greater in the ACH group than in the control group. This high-sensitivity system could detect a 1-mL change in blood volume. The MIPS was significantly related to the intracranial pressure. This observation suggests that the method could be valuable for detecting early warning signs in emergency medicine and critical care units. PMID:24519130

  15. Pathogenesis of arenavirus hemorrhagic fevers.

    PubMed

    Moraz, Marie-Laurence; Kunz, Stefan

    2011-01-01

    Viral hemorrhagic fevers (VHFs) caused by arenaviruses belong to the most devastating emerging human diseases and represent serious public health problems. Arenavirus VHFs in humans are acute diseases characterized by fever and, in severe cases, different degrees of hemorrhages associated with a shock syndrome in the terminal stage. Over the past years, much has been learned about the pathogenesis of arenaviruses at the cellular level, in particular their ability to subvert the host cell's innate antiviral defenses. Clinical studies and novel animal models have provided important new information about the interaction of hemorrhagic arenaviruses with the host's adaptive immune system, in particular virus-induced immunosuppression, and have provided the first hints towards an understanding of the terminal hemorrhagic shock syndrome. The scope of this article is to review our current knowledge on arenavirus VHF pathogenesis with an emphasis on recent developments. PMID:21171877

  16. Cerebral Cavernous Malformation and Hemorrhage

    MedlinePlus

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

  17. Methods for improved hemorrhage control

    PubMed Central

    2004-01-01

    Trauma is the leading cause of death from age 1 to 34 years and is the fifth leading cause of death overall in the USA, with uncontrolled hemorrhage being the leading cause of potentially preventable death. Improving our ability to control hemorrhage may represent the next major hurdle in reducing trauma mortality. New techniques, devices, and drugs for hemorrhage control are being developed and applied across the continuum of trauma care: prehospital, emergency room, and operative and postoperative critical care. This brief review focuses on drugs directed at life-threatening hemorrhage. The most important of these new drugs are injectable hemostatics, fibrin foams, and dressings. The available animal studies are encouraging and human studies are required. PMID:15196327

  18. [Intracranial pressure changes during xenon anesthesia in neurosurgical patients without intracranial hypertention].

    PubMed

    Rylova, A V; Lubnin, A Iu

    2011-01-01

    Xenon assures rapid awakening and stable hemodynamics, it also has some neuroprotective effect. This is the reason why it may become an anesthetic of choice in neurosurgery. Still there is little and controversial data on its impact upon ICP. This is the first study of xenon effect upon intracranial pressure, cerebral perfusion pressure and cerebrovascular reactivity during xenon anesthesia in neurosurgical patients without intracranial hypertension. We report a slight increase in intracranial and a slight decrease in cerebral perfusion pressure during xenon anesthesia and show that cerebrovascular reactivity is preserved. Thus we conclude that xenon anesthesia is safe for neurosurgical patients without intracranial hypertension. PMID:21957614

  19. Doppler velocimetry of ductus venous in preterm fetuses with brain sparing effect: neonatal outcome

    PubMed Central

    Cosmo, Ynesmara Coelho; Júnior, Edward Araujo; de Sá, Renato Augusto Moreira; de Carvalho, Paulo Roberto Nassar; Mattar, Rosiane; Lopes, Laudelino Marques; Nardozza, Luciano Marcondes Machado; de Souza, Eduardo; Moron, Antonio Fernandes

    2012-01-01

    Summary Objective to evaluate the relationship between ductus venous (DV) and Doppler velocimetry in neonatal outcome in severe compromised preterm fetuses. Methods the study was designed as an observational and cross-sectional study with 52 premature neonates with brain sparing effect. The criteria of neonatal severe morbidity were: severe intraventricular hemorrhage (grades 3 or 4), retinopathy of prematurity (grade 3 or 4), cystic periventricular leukomalatia, bronchopneumo dysplasia and neonatal mortality. The fetuses were divided in two groups: group 0 - all the fetuses with ventricular systole/atrial contraction (S/A) in DV ratio values less them 3.4; group 1 - fetuses with values of S/A ratio greater than 3.4. Results 42% of fetuses showed abnormal S/A ratio in DV and 48% showed birth weight below percentile 3 for gestational age. There was no statistical significance comparing the 02 groups according to bronchopneumo dysplasia, retinopathy of prematurity (grade 3 or 4) and intraventricular hemorrhage (grade 3 or 4). Only one fetus presented cystic periventricular leukomalatia. We found statistically significant association between abnormal DV S/A ratio and neonatal mortality (CI 95%, 1.28 –38.22, p< 0.002). Conclusions our results suggest that abnormal DV blood flow detected by Doppler examination isn’t associated with severe neonatal morbidity but with neonatal mortality. PMID:23181172

  20. Hemorrhagic complications in dermatologic surgery

    PubMed Central

    Bunick, Christopher G.; Aasi, Sumaira Z.

    2014-01-01

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

  1. Modulating the Immune Response Towards a Neuroregenerative Peri-injury Milieu After Cerebral Hemorrhage.

    PubMed

    Klebe, Damon; McBride, Devin; Flores, Jerry J; Zhang, John H; Tang, Jiping

    2015-12-01

    Cerebral hemorrhages account for 15-20 % of stroke sub-types and have very poor prognoses. The mortality rate for cerebral hemorrhage patients is between 40 and 50 %, of which at least half of the deaths occur within the first 2 days, and 75 % of survivors are incapable of living independently after 1 year. Current emergency interventions involve lowering blood pressure and reducing intracranial pressure by controlled ventilations or, in the worst case scenarios, surgical intervention. Some hemostatic and coagulatherapeutic interventions are being investigated, although a few that were promising in experimental studies have failed in clinical trials. No significant immunomodulatory intervention, however, exists for clinical management of cerebral hemorrhage. The inflammatory response following cerebral hemorrhage is particularly harmful in the acute stage because blood-brain barrier disruption is amplified and surrounding tissue is destroyed by secreted proteases and reactive oxygen species from infiltrated leukocytes. In this review, we discuss both the destructive and regenerative roles the immune response play following cerebral hemorrhage and focus on microglia, macrophages, and T-lymphocytes as the primary agents directing the response. Microglia, macrophages, and T-lymphocytes each have sub-types that significantly influence the over-arching immune response towards either a pro-inflammatory, destructive, or an anti-inflammatory, regenerative, state. Both pre-clinical and clinical studies of cerebral hemorrhages that selectively target these immune cells are reviewed and we suggest immunomodulatory therapies that reduce inflammation, while augmenting neural repair, will improve overall cerebral hemorrhage outcomes. PMID:25946986

  2. Neonatal cranial sonography: A concise review for clinicians

    PubMed Central

    Gupta, Pankaj; Sodhi, Kushaljit Singh; Saxena, Akshay Kumar; Khandelwal, Niranjan; Singhi, Pratibha

    2016-01-01

    Cranial sonography continues to hold an important place in neonatal care. Attributes favorable to sonography that make it almost indispensable for routine care of the newborn includes easy access, low cost, portability, lack of ionizing radiations and exemption from sedation or anaesthesia. Cranial sonography has highest impact in neonates suspected to have meningitis and its complications; perinatal ischemia particularly periventricular leukomalacia (PVL); hydrocephalus resulting from multitude of causes and hemorrhage. Not withstanding this, cranial sonography has yielded results for a repertoire of indications. Approach to cranial sonography involves knowledge of the normal developmental anatomy of brain parenchyma for correct interpretation. Correct technique, taking advantage of multiple sonographic windows and variable frequencies of the ultrasound probes allows a detailed and comprehensive examination of brain parenchyma. In this review, we discuss the technique, normal and variant anatomy as well as disease entities of neonatal cranial sonography. PMID:27195026

  3. Disseminated neonatal herpetic infection simulating abusive anal trauma.

    PubMed

    Panella, Michael

    2011-07-01

    Potential simulators of premortem trauma present problems of misinterpretation and possible false accusations of caregivers. A case of unsuspected neonatal herpes is reported with associated perianal ecchymosis that raises the possibility of sexual abuse. The decedent was an 8-day-old newborn infant who was born by Cesarean section and treated for 5 days postdelivery for sepsis. The newborn infant was discharged home but returned 2 days later with probable sepsis and new onset of perianal hemorrhage. She died 1 day later with autopsy, revealing neonatal disseminated herpetic infection with early anal involvement consisting of microscopic ulcerations with leukocytoclastic-like vasculitis and rare viral cytopathic changes. These histological changes produced grossly appearing anal ecchymosis with an absence of typical herpetic vesiculopapular lesions, which simulated abusive trauma. This case highlights the importance of considering occult neonatal herpes with associated perianal ecchymosis when presented with possible abusive anal trauma in a newborn infant. PMID:21496019

  4. Dengue and Dengue Hemorrhagic Fever

    PubMed Central

    Gubler, Duane J.

    1998-01-01

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

  5. Unique remodeling processes after vascular injury in intracranial arteries: analysis using a novel mouse model.

    PubMed

    Shimamura, Munehisa; Nakagami, Hironori; Sata, Masataka; Takaoka, Minoru; Azuma, Junya; Kiomy Osako, Mariana; Koriyama, Hiroshi; Kurinami, Hitomi; Wakayama, Kouji; Miyake, Takashi; Morishita, Ryuichi

    2013-08-01

    The effectiveness of angioplasty and stenting in intracranial atherosclerotic diseases is controversial due to high rates of delayed restenosis and hemorrhage compared with extracranial arteries. However, the mechanisms underlying these differences are still unclear, because their pathophysiology is yet to be examined. To address this issue, we established a novel vascular injury model in the intracranial internal carotid arteries (IICAs) in mice, and analyzed the remodeling process in comparison to that of the femoral arteries (FAs). In IICAs, neointimal hyperplasia was observed from day 14 and grew until day 56. Although smooth muscle cells (SMCs) emerged in the neointima from day 28, SMCs in the injured media were continuously lost with eventual extinction of the media. Re-endothelialization was started from day 7 and completed on day 28. Accumulation of macrophages was continued in the adventitia until day 56. Compared with FAs, the following points are unique in IICAs: (1) delayed continuous formation of neointima; (2) accumulation of macrophages in the media on day 14; (3) continuous loss of SMCs in the media followed by extinction of the media itself; and (4) continuously growing adventitia. These pathophysiologic differences might be associated with unfavorable outcomes in percutaneous transluminal angioplasty and stenting in intracranial arteries. PMID:23571280

  6. Change in neonatal care pattern and neonatal mortality in a rural medical college.

    PubMed

    Chaturvedi, P; Potdar, S

    1988-02-01

    Due to the nonavailability of separate nursing staff for a special care neonatal unit in a rural medical college, the strategy for neonatal care of high risk babies was changed from January 1, 1985 onwards. These babies were managed mainly in postnatal wards with emphasis on maternal involvement reinforced by day-to-day orientation of mothers, nurses, and doctors to neonatal care. The incidence of fullterm (FT), preterm (PT), and low birthweight (LBW) babies were comparable in 1984 and 1985. The overall neonatal mortality (NM) was 8.3% in 1984 and 4.3% in 1985, NM in PT was 50.8% in 1984 and 30.0% in 1985, and NM in LBW was 17.0% in 1984 and 9.3% in 1985. These rates were reduced by approximately 40-50% of that recorded in 1984. The difference in all groups was statistically significant. However, the NM in the VLBW (1500 g) did not change substantially. Deaths due to severe asphyxia and intraventricular hemorrhage were reduced from 4.03% of all livebirths in 1984 to 2.2%, the difference being statistically significant. The most significant reeducation was seen in deaths due to infection which dropped from 2.45% of total livebirths in 1984 to 0.88% of the total in 1985. With this experience, the authors recommend the measures adopted by them to reduce the NM, especially in small centers and rural areas where nursing and other facilities are not optimal. PMID:3246397

  7. Intracranial capillary hemangioma in an elderly patient

    PubMed Central

    Okamoto, Ai; Nakagawa, Ichiro; Matsuda, Ryosuke; Nishimura, Fumihiko; Motoyama, Yasushi; Park, Young-Su; Nakamura, Mitsutoshi; Nakase, Hiroyuki

    2015-01-01

    Background: Capillary hemangiomas are neoplasms involving skin and soft tissue in infants. These lesions rarely involved an intracranial space and reported age distribution ranges from infancy to middle age. We report an extremely rare case of rapidly rising intracranial capillary hemangioma in an elderly woman. Case Description: The 82-year-old woman presented with vomiting, reduced level of consciousness, and worsening mental state. Computed tomography showed a contrast-enhanced extra-axial lesion in the left frontal operculum, although no intracranial mass lesion was identifiable from magnetic resonance imaging taken 2 years earlier. Complete surgical excision was performed and histopathological examination diagnosed benign capillary hemangioma consisting of a variety of dilated capillary blood vessels lined by endothelial cells. Conclusion: This is the first description of rapid growth of an intracranial capillary hemangioma in an elderly woman. These lesions are exceedingly rare in the elderly population, but still show the capacity for rapid growth. Complete excision would prevent further recurrence. PMID:26664868

  8. Remotely-powered intracranial pressure monitor

    NASA Technical Reports Server (NTRS)

    Fryer, T. B.

    1979-01-01

    Implantable RF powered monitor uses capacitive transducer and stiff metal diaphragm that gives high stability for long term intracranial pressure monitoring. Design of monitor reduces risk of infection while improving patient comfort and mobility.

  9. Intracranial complications of transorbital stab wounds.

    PubMed Central

    De Villiers, J C; Sevel, D

    1975-01-01

    Oscular and orbital injuries due to stab wounds may mask underlying serious intracranial damage. The correct clinical assessment and treatment of such cases require the attention of a team comprising a neurosurgeon, ophthalmologist, otolaryngologist, and plastic surgeon. Images PMID:1125159

  10. Thoracic epidural blood patch with high volume blood for cerebrospinal fluid leakage of cervical spine (C2-3) complicated with spontaneous intracranial hypotension.

    PubMed

    Chuang, Yi-Shan; Ju, Da-Tong; Chiu, Tai-Hsiang; Huang, Yi-Hsuan; Cherng, Chen-Hwan; Wu, Zhi-Fu

    2015-09-01

    Acute and chronic subdural hemorrhage in a 33 year old woman with severe headache from occipital to frontal regions and dull neck pain was diagnosed on magnetic resonance image, which revealed cerebrospinal fluid leakage at C2-3 with spontaneous intracranial hypotension. Successful treatment was performed by epidural blood patch from the level of T7-T8 with injection of 20 mL of autologous blood. PMID:26209024

  11. Emergency endovascular revascularization of tandem occlusions: Internal carotid artery dissection and intracranial large artery embolism.

    PubMed

    Cohen, José E; Leker, Ronen R; Eichel, Roni; Gomori, Moshe; Itshayek, Eyal

    2016-06-01

    Internal carotid artery dissection (ICAD) with concomitant occlusive intracranial large artery emboli is an infrequent cause of acute stroke, with poor response to intravenous thrombolysis. Reports on the management of this entity are limited. We present our recent experience in the endovascular management of occlusive ICAD and major intracranial occlusion. Consecutive anterior circulation acute stroke patients meeting Medical Center criteria for endovascular management of ICAD from June 2011 to June 2015 were included. Clinical, imaging, and procedure data were collected retrospectively under Institutional Review Board approval. The endovascular procedure for carotid artery revascularization and intracranial stent thrombectomy is described. Six patients met inclusion criteria (National Institutes of Health Stroke Scale score 12-24, time from symptom onset 2-8hours). Revascularization of the extracranial carotid dissection and stent thrombectomy were achieved in 5/6 patients, resulting in complete recanalization (Thrombolysis in Myocardial Infarction flow grade 3 in a mean 2.7hours), and modified Rankin Scale score 0-2 at 90 day follow-up. In one patient, attempts to microcatheterize the true arterial lumen failed and thrombectomy was therefore not feasible. No arterial dissection, arterial rupture or accidental stent detachment occurred, and there was no intracerebral hemorrhage or hemorrhagic transformation. Our preliminary data on this selected subgroup of patients suggest the presented approach is safe, feasible in a significant proportion of patients, and efficacious in achieving arterial recanalization and improving patient outcome. Crossing the dissected segment remains the most important limiting factor in achieving successful ICA recanalization. Further evaluation in larger series is warranted. PMID:26924182

  12. Perspective: Update on Idiopathic Intracranial Hypertension

    PubMed Central

    Bruce, Beau B.; Biousse, Valérie; Newman, Nancy J.

    2011-01-01

    Purpose Provide an update on various features of idiopathic intracranial hypertension. Design Perspective. Methods Selected articles on the epidemiology, clinical and imaging features, natural history, pathophysiology, and treatment of idiopathic intracranial hypertension were reviewed and interpreted in the context of the authors’ clinical and research experience. Results Idiopathic intracranial hypertension is primarily a disease of obese women of childbearing age, but it can affect patients of any weight, sex, and age. Although a relatively rare disorder, idiopathic intracranial hypertension’s associated costs in the U.S. entail hundreds of millions of dollars. Even following treatment, headaches are frequently persistent and may require the continued involvement of a neurologist. Quality of life reductions and depression are common among idiopathic intracranial hypertension patients. However, visual dysfunction, especially visual field abnormalities, represents the major morbidity of this disorder, and serial automated perimetry remains the primary mode of patient monitoring. Patients who are men, black, very obese, or anemic are at higher risk of visual loss. Vitamin A metabolism, adipose tissue as an actively secreting endocrine tissue, and cerebral venous abnormalities are areas of active study regarding idiopathic intracranial hypertension’s pathophysiology. Treatment studies show that lumbar puncture is a valuable treatment (in addition to its crucial diagnostic role) and that weight management is critical. However, open questions remain regarding the efficacy of acetazolamide, CSF diversion procedures, and cerebral venous stenting. Conclusions Many questions remain unanswered about idiopathic intracranial hypertension. Ongoing studies, especially an ongoing NIH-funded clinical trial of acetazolamide, should provide more insight into this important, yet poorly understood syndrome of isolated intracranial hypertension. PMID:21696699

  13. Intracranial aneurysms: analysis of results of microneurosurgery.

    PubMed Central

    Adams, C B; Loach, A B; O'laoire, S A

    1976-01-01

    Subarachnoid haemorrhage from intracranial aneurysms has a poor prognosis. Operative management of intracranial aneurysms was once considered ineffective. The first 100 cases treated by micorsurgery were analysed to see whether mortality and morbidity were reduced. Modern surgical techniques halved the total mortality but the morbidity was unaltered. Results can be improved by delaying surgery seven days and by treating any hypertension before surgery. PMID:963461

  14. Does computed tomography permeability predict hemorrhagic transformation after ischemic stroke?

    PubMed Central

    Yen, Peggy; Cobb, Allison; Shankar, Jai Jai Shiva

    2016-01-01

    AIM: To use perfusion-derived permeability-surface area product maps to predict hemorrhagic transformation following thrombolytic treatment for acute ischemic stroke. METHODS: We retrospectively analyzed our prospectively kept acute stroke database over five consecutive months for patients with symptoms of acute ischemic stroke (AIS) who had computed tomography (CT) perfusion (CTP) done at arrival. Patients included in the analyses also had to have a follow-up CT. The permeability-surface area product maps (PS) was calculated for the side of the ischemia and/or infarction and for the contralateral unaffected side at the same level. The cerebral blood flow map was used to delineate the ischemic territory. Next, a region of interest was drawn at the centre of this territory on the PS parametric map. Finally, a mirror region of interest was created on the contralateral side at the same level. The relative permeability-surface area product maps (rPS) provided an internal control and was calculated as the ratio of the PS on the side of the AIS to the PS on the contralateral side. A student t-test was performed after log conversion of rPS between patients with and without hemorrhagic transformation. Log conversion was used to convert the data into normal distribution to use t-test. For the group of patients who experienced intracranial bleed, a student t-test was performed between those with only petechial hemorrhage and those with more severe parenchymal hematoma with subarachnoid haemorrhage. RESULTS: Of 84 patients with AIS and CTP at admission, only 42 patients had a follow-up CT. The rPS derived using the normal side as the internal control was significantly higher (P = 0.003) for the 15 cases of hemorrhagic transformation (1.71 + 1.64) compared to 27 cases that did not have any (1.07 + 1.30). Patients with values above the overall mean rPS of 1.3 had an increased likelihood of subsequent hemorrhagic transformation. The sensitivity of using this score to predict

  15. Brain injury causes loss of cardiovascular response to hemorrhagic shock.

    PubMed

    Fulton, R L; Flynn, W J; Mancino, M; Bowles, D; Cryer, H M

    1993-01-01

    The combined cardiovascular effects of hemorrhagic shock and mechanical brain injury were modeled in five groups of pigs. Standard and hypertonic saline resuscitation of hypotension were evaluated. Changes in mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), intracranial pressure (ICP), and brain water were measured. Brain injury (BI) was produced with a fluid percussion device that generated an extradural pressure of 3.5 x 10(5) N/m2 for 400 msec. Shock was caused by bleeding to a MAP of 60 mm Hg for 60 minutes and then resuscitated with shed blood only or shed blood plus 0.9% or 1.8% saline. Brain-injured only and shocked-only pigs served as controls. We found that brain injury alone caused refractory hypotension. Less shed blood was required to produce shock in brain injured animals (p < .05). Shock accompanied by brain injury was not reversed with crystalloid solutions. Volumes of saline required to restore blood pressure were large (> 6 L in 3 hours). 1.8% saline produced less rise in ICP than 0.9% saline but was less effective in restoring blood pressure. Brain edema was not decreased with 1.8% saline. Brain injury altered vascular compensation to hemorrhage and made accepted resuscitative measures ineffective. PMID:8512886

  16. Diagnosis and Management of Coagulopathy-Related Intracerebral Hemorrhage.

    PubMed

    VanDerWerf, Joshua; Kumar, Monisha A

    2016-06-01

    Coagulopathy, defined as impaired clot formation, is common in intensive care units (ICUs). Many physiological derangements lead to dysfunctional hemostasis in the ICU; most of these are acquired rather than congenital. Coagulopathies in the ICU are often related to systemic diseases, autoimmune dysfunction, acute infection, organ dysfunction, therapeutic medications, and/or other medical treatments. A significant complication of coagulopathy in the critically ill is major bleeding, defined as fatal hemorrhage, hemodynamic instability, transfusion requirement, or intracranial hematomas. Coagulopathy in the ICU often poses complex management dilemmas, especially when coagulopathy coexists with a thrombotic state. Coagulopathy associated with intracerebral hemorrhage (ICH) bears directly on neurologic prognosis and functional outcome. There is a paucity of high-quality evidence for the management of coagulopathies in neurocritical care; however, data derived from studies of patients with ICH may inform treatment decisions. This article focuses on acquired conditions such as pharmacological therapies, organ failure, and platelet dysfunction that are often associated with defective clot formation in the ICU that result in or exacerbate ICH. PMID:27214703

  17. Large acute cerebral hemorrhage presenting with pure alexia.

    PubMed

    Thomas, Jarred J; Sanford, Janyce M

    2007-04-01

    Alexia (the acquired inability to read) is an uncommon presenting complaint in the emergency department (ED). It is usually associated with a lesion in the brain located within the dominant hemisphere near the parieto-occipital junction, with some involvement of the splenium of the corpus callosum. Our review of the literature revealed multiple distinct causes for the finding of alexia, and a majority of the cases uncovered also involved agraphia (the acquired inability to write) and frequently visual field defects. We present the case of an otherwise healthy 35-year-old white man who arrived at our ED with the chief complaint of having difficulty reading. He was, however, able to write, and he exhibited no defects in his visual fields on gross testing in our ED. The patient was found to have a large, acute, intraparenchymal hemorrhage in the right posterior/inferior parietal cortex, very near the occipital lobe. We present this case, followed by a brief discussion, to heighten awareness of the complaint of alexia with or without agraphia as a possible presenting symptom of intracranial hemorrhage, or ischemic cerebrovascular accident. PMID:17083996

  18. Stent-Grafts in the Management of Hemorrhagic Complications Related to Hemostatic Closure Devices: Report of Two Cases

    SciTech Connect

    Giansante Abud, Daniel; Mounayer, Charbel; Saint-Maurice, Jean Pierre; Salles Rezende, Marco Tulio; Houdart, Emmanuel; Moret, Jacques

    2007-02-15

    We report 2 cases of hemorrhagic complications related to use of the Angio-Seal hemostatic closure device that were successfully managed with stent-grafts. Two patients with subarachnoid hemorrhage were referred to our departments for endovascular treatment of ruptured intracranial aneurysms. The treatment was performed through a femoral access; the sheaths were removed immediately after the procedures, and the punctures sites closed by Angio-Seals. Both patients presented clinical signs of hypovolemic shock after treatment. The diagnosis of active bleeding through the puncture site was made by emergency digital subtraction angiography. The lesions were managed with stent-grafts. The use of stent-grafts proved to be efficient in the management of these life-threatening hemorrhagic complications following the use of the Angio-Seal hemostatic closure device.

  19. Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993–2012

    PubMed Central

    Stoll, Barbara J.; Hansen, Nellie I.; Bell, Edward F.; Walsh, Michele C.; Carlo, Waldemar A.; Shankaran, Seetha; Laptook, Abbot R.; Sánchez, Pablo J.; Van Meurs, Krisa P.; Wyckoff, Myra; Das, Abhik; Hale, Ellen C.; Ball, M. Bethany; Newman, Nancy S.; Schibler, Kurt; Poindexter, Brenda B.; Kennedy, Kathleen A.; Cotten, C. Michael; Watterberg, Kristi L.; D’Angio, Carl T.; DeMauro, Sara B.; Truog, William E.; Devaskar, Uday; Higgins, Rosemary D.

    2016-01-01

    Importance Extremely preterm infants contribute disproportionately to neonatal morbidity and mortality. Objective To review 20-year trends in maternal/neonatal care, complications, and mortality among extremely preterm infants born at Neonatal Research Network centers. Design, Setting, Participants Prospective registry of 34,636 infants 22–28 weeks’ gestational age (GA) and 401–1500 gram birthweight born at 26 Network centers, 1993–2012. Exposure Extremely preterm birth. Main Outcomes Maternal/neonatal care, morbidities, and survival. Major morbidities, reported for infants who survived more than 12 hours, were: severe necrotizing enterocolitis, infection, bronchopulmonary dysplasia, severe intracranial hemorrhage, cystic periventricular leukomalacia, and/or severe retinopathy of prematurity. Regression models assessed yearly changes, adjusting for study center, race/ethnicity, GA, birthweight for GA, and sex. Results Use of antenatal corticosteroids increased from 1993 to 2012 (348/1431 [24%] to 1674/1919 [87%], p<0.001), as did cesarean delivery (625/1431 [44%] to 1227/1921 [64%], p<0.001). Delivery room intubation decreased from 1144/1433 (80%) in 1993 to 1253/1922 (65%) in 2012 (p<0.001). After increasing in the 1990s, postnatal steroid use declined to 141/1757 (8%) in 2004 (p<0.001), with no significant change thereafter. Although most infants were ventilated, continuous positive airway pressure without ventilation increased from 120/1666 (7%) in 2002 to 190/1756 (11%) in 2012 (p<0.001). Despite no improvement from 1993 to 2004, rates of late-onset sepsis declined between 2005 and 2012 for infants of each GA (median GA 26 weeks, 109/296 [37%] to 85/320 [27%], adjusted relative risk [aRR]: 0.93 [95% CI, 0.92–0.94]). Rates of other morbidities declined, but bronchopulmonary dysplasia increased between 2009 and 2012 for infants 26–27 weeks (26 weeks, 130/258 [50%] to 164/297 [55%], p<0.001). Survival increased between 2009 and 2012 for infants 23

  20. Acute and Chronic Fetal Anemia as a Result of Fetomaternal Hemorrhage

    PubMed Central

    Swanson, Tara

    2014-01-01

    Introduction. Fetomaternal hemorrhage represents a transfer of fetal blood to the maternal circulation. Although many etiologies have been described, most causes of fetomaternal hemorrhage remain unidentified. The differentiation between acute and chronic fetomaternal hemorrhage may be accomplished antenatally and may influence perinatal management. Case. A 36-year-old gravida 6 para 3 presented at 37 and 5/7 completed gestational weeks with ultrasound findings suggestive of chronic fetal anemia such as right ventricular enlargement, diminished cerebral vascular resistance, and elevated middle cerebral artery end-diastolic velocity. On the other hand, signs of acute fetal decompensation such as deterioration of the fetal heart tracing, diminished biophysical score, decreased cord pH, and increased cord base deficit were noted. Following delivery, the neonate's initial hemoglobin was 4.0 g/dL and the maternal KB ratio was 0.015 indicative of a significant fetomaternal hemorrhage. Discussion. One should consider FMH as part of the differential diagnosis for fetal or immediate neonatal anemia. We describe a unique case of FMH that demonstrated both acute and chronic clinical features. It is our hope that this case will assist practitioners in differentiating acute FMH that may require emergent delivery from chronic FMH which may be able to be expectantly managed. PMID:24804127

  1. Aspirin as a risk factor for hemorrhage in patients with head injuries.

    PubMed

    Reymond, M A; Marbet, G; Radü, E W; Gratzl, O

    1992-01-01

    The role of aspirin as a risk factor in the occurrence of intracranial bleeding following head injury was investigated. Chronic subdural hematoma appears to be a suitable model for the evaluation of risk factors in the development of hemorrhage. The most common risk factors found in our study were, apart from age, chronic alcohol abuse (28%), consumption of cumarin-derivates (21%), aspirin (13%), and heparin (5%). A patient undergoing aspirin treatment must be considered at risk of development of chronic subdural hematoma. Aspirin should not be prescribed to patients with post-traumatic headaches. PMID:1584433

  2. Aneurysmal Subarachnoid Hemorrhage.

    PubMed

    D'Souza, Stanlies

    2015-07-01

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

  3. Aneurysmal Subarachnoid Hemorrhage

    PubMed Central

    2015-01-01

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

  4. [Subarachnoid hemorrhage: epidemiology, social impact and a multidisciplinary approach].

    PubMed

    Ingelmo Ingelmo, I; Fàbregas Julià, N; Rama-Maceiras, P; Hernández-Palazón, J; Rubio Romero, R; Carmona Aurioles, J

    2010-12-01

    Cerebrovascular disease, whether ischemic or hemorrhagic, is a worldwide problem, representing personal tragedy, great social and economic consequences, and a heavy burden on the health care system. Estimated to be responsible for up to 10% of mortality in industrialized countries, cerebrovascular disease also affects individuals who are still in the workforce, with consequent loss of productive years. Subarachnoid hemorrhage (SAH) is a type of cerebrovascular accident that leads to around 5% of all strokes. SAH is most often due to trauma but may also be spontaneous, in which case the cause may be a ruptured intracranial aneurysm (80%) or arteriovenous malformation or any other abnormality of the blood or vessels (20%). Although both the diagnosis and treatment of aneurysmal SAH has improved in recent years, related morbidity and mortality remains high: 50% of patients die from the initial hemorrhage or later complications. If patients whose brain function is permanently damaged are added to the count, the percentage of cases leading to severe consequences rises to 70%. The burden of care of patients who are left incapacitated by SAH falls to the family or to private and public institutions. The economic cost is considerable and the loss of quality of life for both the patient and the family is great. Given the magnitude of this problem, the provision of adequate prophylaxis is essential; also needed are organizational models that aim to reduce mortality as well as related complications. Aneurysmal SAH is a condition which must be approached in a coordinated, multidisciplinary way both during the acute phase and throughout rehabilitation in order to lower the risk of unwanted outcomes. PMID:21298906

  5. Obstetric hemorrhage: A global review.

    PubMed

    Goffman, Dena; Nathan, Lisa; Chazotte, Cynthia

    2016-03-01

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

  6. Primary Neonatal Diaphragmatic Abscess

    PubMed Central

    Zouari, Mohamed; Jallouli, Mohamed; Ben Thabet, Afef; Ben Dhaou, Mahdi; Gargouri, Abdellatif; Mhiri, Riadh

    2015-01-01

    Neonatal diaphragmatic abscesses are extremely rare and they usually develop by direct extension from a liver abscess. The first case of primary diaphragmatic abscess in a neonate is reported and the difficulties of diagnosing this rare entity are discussed. PMID:26023529

  7. Crimean-Congo Hemorrhagic Fever (CCHF)

    MedlinePlus

    ... Congo Hemorrhagic Fever (CCHF) [PDF - 2 pages] Virus Ecology Viral Hemorrhagic Fever (VHF) Information for Specific Groups ... Diagnosis Treatment Prevention Outbreak Distribution Map Resources Virus Ecology File Formats Help: How do I view different ...

  8. Primary Stenting of Intracranial Atherosclerotic Stenoses

    SciTech Connect

    Straube, T. Stingele, Robert; Jansen, Olav

    2005-04-15

    Purpose: To determine the feasibility and safety of stenting intracranial atherosclerotic stenoses.Methods: In 12 patients the results of primary intracranial stenting were evaluated retrospectively. Patient ages ranged from 49 to 79 years (mean 64 years). Six patients presented with stenoses in the anterior circulation, and six had stenosis in the posterior circulation. One patient presented with extra- and intracranial tandem stenosis of the left internal carotid artery. Three patients presented with acute basilar thrombosis, caused by high-grade basilar stenoses.Results: Intracranial stenoses were successfully stented in 11 of 12 patients. In one patient the stent could not be advanced over the carotid siphon to reach the stenosis of the ophthalmic internal carotid artery. Follow-up digital subtraction angiographic studies were obtained in two patients who had presented with new neurologic signs or symptoms. In both cases the angiogram did not show any relevant stenotic endothelial hyperplasia. In one patient, after local thrombolysis the stenosis turned out to be so narrow that balloon angioplasty had to be performed before stent deployment. All three patients treated for stenosis-related basilar thrombosis died due to brainstem infarction that had ensued before the intervention.Conclusions: Prophylactic primary stenting of intracranial stenoses of the anterior or posterior cerebral circulation can be performed with a low complication rate; technical problems such as stent flexibility must still be solved. Local thrombolysis followed by stenting in stenosis-related thrombotic occlusion is technically possible.

  9. Hyperprolactinemia due to spontaneous intracranial hypotension.

    PubMed

    Schievink, Wouter I; Nuño, Miriam; Rozen, Todd D; Maya, M Marcel; Mamelak, Adam N; Carmichael, John; Bonert, Vivien S

    2015-05-01

    OBJECT Spontaneous intracranial hypotension is an increasingly recognized cause of headaches. Pituitary enlargement and brain sagging are common findings on MRI in patients with this disorder. The authors therefore investigated pituitary function in patients with spontaneous intracranial hypotension. METHODS Pituitary hormones were measured in a group of 42 consecutive patients with spontaneous intracranial hypotension. For patients with hyperprolactinemia, prolactin levels also were measured following treatment. Magnetic resonance imaging was performed prior to and following treatment. RESULTS The study group consisted of 27 women and 15 men with a mean age at onset of symptoms of 52.2 ± 10.7 years (mean ± SD; range 17-72 years). Hyperprolactinemia was detected in 10 patients (24%), ranging from 16 ng/ml to 96.6 ng/ml in men (normal range 3-14.7 ng/ml) and from 31.3 ng/ml to 102.5 ng/ml in women (normal range 3.8-23.2 ng/ml). In a multivariate analysis, only brain sagging on MRI was associated with hyperprolactinemia. Brain sagging was present in 60% of patients with hyperprolactinemia and in 19% of patients with normal prolactin levels (p = 0.02). Following successful treatment of the spontaneous intracranial hypotension, hyperprolactinemia resolved, along with normalization of brain MRI findings in all 10 patients. CONCLUSIONS Spontaneous intracranial hypotension is a previously undescribed cause of hyperprolactinemia. Brain sagging causing distortion of the pituitary stalk (stalk effect) may be responsible for the hyperprolactinemia. PMID:25380110

  10. Quantitative intracerebral brain hemorrhage analysis

    NASA Astrophysics Data System (ADS)

    Loncaric, Sven; Dhawan, Atam P.; Cosic, Dubravko; Kovacevic, Domagoj; Broderick, Joseph; Brott, Thomas

    1999-05-01

    In this paper a system for 3-D quantitative analysis of human spontaneous intracerebral brain hemorrhage (ICH) is described. The purpose of the developed system is to perform quantitative 3-D measurements of the parameters of ICH region and from computed tomography (CT) images. The measured parameter in this phase of the system development is volume of the hemorrhage region. The goal of the project is to measure parameters for a large number of patients having ICH and to correlate measured parameters to patient morbidity and mortality.

  11. Growing Hemorrhagic Choroidal Fissure Cyst

    PubMed Central

    Gelal, Fazıl; Gurkan, Gokhan; Feran, Hamit

    2016-01-01

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

  12. Symptomatic Tarlov Cyst Following Spontaneous Subarachnoid Hemorrhage

    PubMed Central

    Kong, Woo Keun; Hong, Seung-Koan

    2011-01-01

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

  13. Children With Intracranial Arachnoid Cysts

    PubMed Central

    Tan, Zhen; Li, Yongxin; Zhu, Fengjun; Zang, Dongdong; Zhao, Cailei; Li, Cong; Tong, Dan; Zhang, Heye; Chen, Qian

    2015-01-01

    Abstract We performed a dynamic study of arachnoid cysts (ACs) using magnetic resonance cisternography (MRC) and proposed a classification of ACs. Twenty-three suitable patients in our hospital entered into this study according to our inclusion criteria. MRC images were collected in all the subjects at 1 and 24 hours after the administration of intrathecal gadolinium-diethylenetriamine penta-acetic acid (Gd-DTPA). We allocate the enrolled patients into 2 groups, MRC group and surgery group. The MRC results were considered before treatment in 1 group (MRC group, 13 patients), whereas another group was surgically treated without considering the MRC results (surgery group, 10 patients). We calculated the enhanced area of cyst using modified MacDonald Criteria from the images and measured the surrounding subarachnoid area as the reference. We found that it was practically useful to quantify 3 types of ACs, complete communicating, incomplete communicating, and noncommunicating, according to MRC results in this study. All the subjects in both groups are closely observed before the treatment and the follow-up using the MRI examination. In the surgery group, 5 patients were found that the area of cysts shrank in the follow-up stage. However, there was no significant difference in the percentage shrinkage area between the 2 groups. We concluded that MRC with Gd-DTPA as a contrast agent is of significant clinical value for the diagnosis and treatment of children with intracranial ACs. This classification based on dynamic MRC is useful for making surgical recommendations. PMID:26554773

  14. [Suppurative intracranial infections in Africa].

    PubMed

    Loembe, P M; Okome-Kouakou, M; Alliez, B

    1997-01-01

    The purpose of this study was to review recent African literature on suppurative intracranial infection and its implications for neurosurgery. In order of decreasing frequency the main lesions are brain abscess, subdural empyema, and epidural abscess. Despite progress in diagnostic imaging and availability of antibiotic therapy, these lesions still cause disturbingly high morbidity and mortality especially in sub-Saharan Africa where diagnosis is often delayed. The male-to-female ratio was 3.6:1 and 70 to 80% of patients were under the age of 20 years. Spread from the paranasal sinus or ear was the most common mechanism of infection. Hematogenous processes accounted for 22% of cases and the origin was undetermined in 11% to 26% of cases. Staphylococcus aureus and enteric gram-negative bacilli were the most common bacteria identified but cultures were reported as sterile in 30% to 50% of cases. While ultrasonography can be useful in newborns with an open fontanelle, arteriography is often the only feasible procedure for diagnosis in Black Africa. The diagnostic modality of choice is computed tomography which allows precise mapping prior to neurosurgery. Introduction of computed tomography in some African cities has led to a decrease in mortality ranging from 4.7% to 43%. The most effective treatment is a combination of appropriate antimicrobial therapy and surgical decompression of expanding lesions. The main procedures are aspiration through burr holes and craniotomy. Use of this combined strategy requires close cooperation between the neurosurgeon, infectious disease specialist, and microbiologist. Therapeutic indications are discussed within the context of Black Africa. PMID:9304016

  15. CT demonstration of bilateral adrenal hemorrhage

    SciTech Connect

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

    1983-08-01

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

  16. The Effect of Facilitated Tucking during Endotracheal Suctioning on Procedural Pain in Preterm Neonates: A Randomized Controlled Crossover Study

    PubMed Central

    Alinejad-Naeini, Mona; Mohagheghi, Parisa; Peyrovi, Hamid; Mehran, Abbas

    2014-01-01

    Background: Premature infants not only feel and understand the pain, but also respond more intensively compared with term infants. Non-pharmacological methods of pain control are suitable to relieve pain in painful procedures. The facilitated tucking position is considered as a non-pharmacological method of pain control in infants; however, its impact on frequent and repeated procedural pain such as endotracheal suctioning remains to be studied. Objectives: This paper is the report of a study that examined the impact of facilitated tucking position on behavioral pain during suctioning in premature neonates. Design: This was a clinical trial study with a crossover design. Settings: The study was conducted in a level II Neonatal Intensive Care Unit, located in a teaching hospital, affiliated to Tehran University of Medical Sciences, Tehran, Iran. Participants: Thirty four infants were enrolled in this study based on the following inclusion criteria: age between 29 to 37 weeks of gestational age, birth weight 1200 grams or more, having an endotracheal tube, no congenital anomalies, no seizures diagnosis, no chest tubes, no intracranial hemorrhage higher than degree II, not receiving opiates and sedatives four hours before intervention and not receiving any painful procedure at least half an hour before the intervention. Methods: The samples were randomly received a sequence of suctioning with/without or suctioning without/with facilitated tucking. Preterm Infant Pain Profile (PIPP) was used to collect the data. SPSS version 16.0 for Windows (SPSS Inc., Chicago, IL, USA) was used for statistical analysis. Results: While 38.2% of infants experienced severe pain during suctioning without intervention, only 8.8% of them experienced severe pain during suctioning with intervention. The results of the paired t-test show that there is a statistically significant difference in the mean scores of pain between non-intervention and intervention cases (p<0.001), and the mean pain

  17. An Update on Idiopathic Intracranial Hypertension

    PubMed Central

    Thurtell, Matthew J.; Bruce, Beau B.; Newman, Nancy J.; Biousse, Valérie

    2013-01-01

    Idiopathic intracranial hypertension (IIH) is a condition of unknown etiology often encountered in neurologic practice. It produces non-localizing symptoms and signs of raised intracranial pressure and, when left untreated, can result in severe irreversible visual loss. It most commonly occurs in obese women of childbearing age, but it can also occur in children, men, non-obese adults, and older adults. While it is frequently associated with obesity, it can be associated with other conditions, such as obstructive sleep apnea and transverse cerebral venous sinus stenoses. Recent identification of subgroups at high risk for irreversible visual loss, including black patients, men, and patients with fulminant forms of IIH, help guide the optimal management and follow-up. Ongoing studies of venous anatomy and physiology in IIH patients, as well as a recently begun randomized clinical treatment trial, should provide more insights into this common yet poorly understood syndrome of isolated intracranial hypertension. PMID:20944524

  18. Intracranial Hypertension Without Papilledema in Children.

    PubMed

    Aylward, Shawn C; Aronowitz, Catherine; Roach, E Steve

    2016-02-01

    This study aims to determine the frequency of intracranial hypertension without papilledema in children. Charts of patients evaluated in a pediatric intracranial hypertension clinic at our institution were retrospectively reviewed. The patients were divided into 2 groups depending on whether they had presence or absence of optic nerve edema at the time of presentation. Age, body mass index, and opening cerebrospinal fluid pressures were considered continuous variables and compared by Wilcoxon rank sum test because of non-normality. A P-value of 0.05 was considered significant. A total of 228 charts were reviewed; 152 patients met the criteria for intracranial hypertension, and 27 patients (17.8%) met the criteria of headache without optic nerve edema. There was no clinically significant difference in age, body mass index, opening pressure, and modified opening pressure between the 2 groups. PMID:26012507

  19. Risk of Hemorrhage in Combined Neuroform Stenting and Coil Embolization of Acutely Ruptured Intracranial Aneurysms

    PubMed Central

    Jankowitz, B.; Thomas, A.J.; Vora, N.; Gupta, R.; Levy, E.; Yamamoto, J.; Kassam, A.; Gologorsky, Y.; Panapitiya, N.; Sandhu, E.; Crago, E.; Hricik, A.; Lee, K.; Gallek, M.; Jovin, T.; Horowitz, M.

    2008-01-01

    Summary Stenting as adjuvant therapy for the coiling of acutely ruptured aneurysms remains controversial due to the necessity of anticoagulation and antiplatelet medications. We report our experience using the Neuroform stent in the management of 41 aneurysms in 40 patients over a period of three years. For aneurysms whose open surgical risk remains excessive with a morphology that would preclude complete embolization, the risks of stenting may be warranted. PMID:20557738

  20. Mathematical Modelling of Cerebral Blood Circulation and Cerebral Autoregulation: Towards Preventing Intracranial Hemorrhages in Preterm Newborns

    PubMed Central

    Botkin, Nikolai; Alves-Pinto, Ana

    2014-01-01

    Impaired cerebral autoregulation leads to fluctuations in cerebral blood flow, which can be especially dangerous for immature brain of preterm newborns. In this paper, two mathematical models of cerebral autoregulation are discussed. The first one is an enhancement of a vascular model proposed by Piechnik et al. We extend this model by adding a polynomial dependence of the vascular radius on the arterial blood pressure and adjusting the polynomial coefficients to experimental data to gain the autoregulation behavior. Moreover, the inclusion of a Preisach hysteresis operator, simulating a hysteretic dependence of the cerebral blood flow on the arterial pressure, is tested. The second model couples the blood vessel system model by Piechnik et al. with an ordinary differential equation model of cerebral autoregulation by Ursino and Lodi. An optimal control setting is proposed for a simplified variant of this coupled model. The objective of the control is the maintenance of the autoregulatory function for a wider range of the arterial pressure. The control can be interpreted as the effect of a medicament changing the cerebral blood flow by, for example, dilation of blood vessels. Advanced numerical methods developed by the authors are applied for the numerical treatment of the control problem. PMID:25126111

  1. 21 CFR 882.1620 - Intracranial pressure monitoring device.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Intracranial pressure monitoring device. 882.1620... pressure monitoring device. (a) Identification. An intracranial pressure monitoring device is a device used for short-term monitoring and recording of intracranial pressures and pressure trends. The...

  2. 21 CFR 882.1620 - Intracranial pressure monitoring device.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Intracranial pressure monitoring device. 882.1620... pressure monitoring device. (a) Identification. An intracranial pressure monitoring device is a device used for short-term monitoring and recording of intracranial pressures and pressure trends. The...

  3. 21 CFR 882.1620 - Intracranial pressure monitoring device.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Intracranial pressure monitoring device. 882.1620... pressure monitoring device. (a) Identification. An intracranial pressure monitoring device is a device used for short-term monitoring and recording of intracranial pressures and pressure trends. The...

  4. Intraventricular hemorrhage of the newborn

    MedlinePlus

    ... needed to place a tube (shunt) in the brain to drain fluid. Outlook (Prognosis) How well the infant does depends on how premature the baby is and the grade of the hemorrhage. Less than half of babies with lower-grade ... Browse the Encyclopedia A.D. ...

  5. Prolonged abulia following putaminal hemorrhage.

    PubMed

    Nagaratnam, N; Fanella, S; Gopinath, S; Goodwin, A

    2001-01-01

    Abulia, akinetic mutism, and other conditions causing reduced activity and slowness are a continuum of severity of behavior. Unilateral lesions usually cause transient symptoms. This article describes a patient with prolonged abulia lasting 12 weeks after aspontaneous left putaminal hemorrhage. He developed seizures that could be a contributing factor. The pathophysiologic mechanisms are discussed. PMID:17903806

  6. Measuring Intracranial Pressure And Volume Noninvasively

    NASA Technical Reports Server (NTRS)

    Cantrell, John H.; Yost, William T.

    1994-01-01

    Ultrasonic technique eliminates need to drill into brain cavity. Intracranial dynamics instrument probes cranium ultrasonically to obtain data for determination of intracranial pressure (ICP) and pressure-volume index (PVI). Instrument determines sensitivity of skull to changes in pressure and by use of mechanical device to exert external calibrated pressure on skull. By monitoring volume of blood flowing into jugular vein, one determines change of volume of blood in cranial system. By measuring response of skull to increasing pressure (where pressure increased by tilting patient known amount) and by using cranial blood pressure, one determines intial pressure in cerebrospinal fluid. Once PVI determined, ICP determined.

  7. Spontaneous intracranial hypotension syndrome treated with fludrocortisone.

    PubMed

    Rizk, Marwan; El Khatib, Mohammad; Yamout, Bassem; Hujeily, Elissar; Ayoub, Sophie; Ayoub, Chakib; Skaf, Ghassan

    2015-01-01

    Spontaneous intracranial hypotension is a rare syndrome characterized by orthostatic headache not associated with trauma or dural puncture. In most cases, it is caused by a spontaneous spinal cerebrospinal fluid leakage as demonstrated by neuroradiological studies. The standard of care consists of conservative treatment including bed rest, hydration, and administration of caffeine or glucocorticoids. When such conservative therapy fails, an epidural blood patch is recommended. In this report, we describe the treatment of 2 patients with spontaneous intracranial hypotension who failed conservative treatment and went on to have complete and sustained resolution of their symptoms after the administration of oral fludrocortisone. PMID:25612272

  8. Simulation of the human intracranial arterial tree.

    PubMed

    Grinberg, Leopold; Anor, Tomer; Cheever, Elizabeth; Madsen, Joseph R; Karniadakis, George Em

    2009-06-13

    High-resolution unsteady three-dimensional flow simulations in large intracranial arterial networks of a healthy subject and a patient with hydrocephalus have been performed. The large size of the computational domains requires the use of thousands of computer processors and solution of the flow equations with approximately one billion degrees of freedom. We have developed and implemented a two-level domain decomposition method, and a new type of outflow boundary condition to control flow rates at tens of terminal vessels of the arterial network. In this paper, we demonstrate the flow patterns in the normal and abnormal intracranial arterial networks using patient-specific data. PMID:19414460

  9. Chorioamnionitis: Implications for the Neonate Jessica

    PubMed Central

    Ericson, Jessica E; Laughon, Matthew M

    2014-01-01

    Chorioamnionitis (CA) is a perinatal condition characterized by inflammation of the fetal membranes. The incidence of CA increases with decreasing gestational age at birth. When CA is suspect based on clinical criteria, pathologic assessment of the placenta should be performed. While the mechanisms are not entirely clear, CA predisposes infants to premature birth, neonatal sepsis and intraventricular hemorrhage. The role of CA in respiratory distress syndrome, bronchopulmonary dysplasia, and neurodevelopmental impairment is mixed. Prevention and treatment of CA are not well defined. The use of antibiotics for preterm premature rupture of membranes reduces the incidence of CA and increases the length of time to delivery. Antibiotics are recommended for infants exposed to CA while laboratory studies are being performed. PMID:25678002

  10. Pathophysiology and management of intracranial arterial stenosis around the circle of Willis associated with hyperthyroidism: case reports and literature review.

    PubMed

    Matano, Fumihiro; Murai, Yasuo; Adachi, Koji; Kitamura, Takayuki; Teramoto, Akira

    2014-04-01

    Cases of moyamoya disease or intracranial arterial stenosis around the circle of Willis (M/IAS) associated with hyperthyroidism have been reported. However, most of these previous reports were of the ischemic form of M/IAS and primary hyperthyroidism. To the best of our knowledge, no studies have documented therapy for M/IAS associated with hyperthyroidism. We discuss four previously unreported cases, including those involving the intracerebral hemorrhage form and thyroid-stimulating hormone (TSH) secretion from a pituitary adenoma (secondary hyperthyroidism). We analyzed data from 52 previously reported cases, including the 4 cases presented here, and discuss M/IAS associated with hyperthyroidism, treatment options, pathophysiology, the ischemic and hemorrhagic forms, secondary hyperthyroidism, and the relevant literature. Hyperthyroidism results in thyrotoxicosis and the stimulation of the superior cervical ganglion by TSH antibodies and f-T3/f-T4. Consequently, hypercoagulability and stenosis of the cerebral artery can occur. There are many reports of ischemic M/IAS associated with hyperthyroidism. A conservative approach to treatment is important in such cases; for example, antithyroid therapy should be the first choice to treat ischemic M/IAS. There have been only a limited number of reports on hemorrhagic M/IAS. We presume that hemorrhagic M/IAS tears the weakened vasculature in a manner similar to that of normal M/IAS (with no complicating hyperthyroidism). The authors also reported M/IAS associated with secondary hyperthyroidism due to pituitary thyroid secreting hormone secreting adenoma. PMID:24249431

  11. Oral Lesions in Neonates

    PubMed Central

    Rao, Roopa S; Majumdar, Barnali; Jafer, Mohammed; Maralingannavar, Mahesh; Sukumaran, Anil

    2016-01-01

    ABSTRACT Oral lesions in neonates represent a wide range of diseases often creating apprehension and anxiety among parents. Early examination and prompt diagnosis can aid in prudent management and serve as baseline against the future course of the disease. The present review aims to enlist and describe the diagnostic features of commonly encountered oral lesions in neonates. How to cite this article: Patil S, Rao RS, Majumdar B, Jafer M, Maralingannavar M, Sukumaran A. Oral Lesions in Neonates. Int J Clin Pediatr Dent 2016;9(2):131-138. PMID:27365934

  12. Oral Lesions in Neonates.

    PubMed

    Patil, Shankargouda; Rao, Roopa S; Majumdar, Barnali; Jafer, Mohammed; Maralingannavar, Mahesh; Sukumaran, Anil

    2016-01-01

    Oral lesions in neonates represent a wide range of diseases often creating apprehension and anxiety among parents. Early examination and prompt diagnosis can aid in prudent management and serve as baseline against the future course of the disease. The present review aims to enlist and describe the diagnostic features of commonly encountered oral lesions in neonates. How to cite this article: Patil S, Rao RS, Majumdar B, Jafer M, Maralingannavar M, Sukumaran A. Oral Lesions in Neonates. Int J Clin Pediatr Dent 2016;9(2):131-138. PMID:27365934

  13. Intraventricular hemorrhage expansion in patients with spontaneous intracerebral hemorrhage

    PubMed Central

    Witsch, Jens; Bruce, Eliza; Meyers, Emma; Velazquez, Angela; Schmidt, J. Michael; Suwatcharangkoon, Sureerat; Agarwal, Sachin; Park, Soojin; Falo, M. Cristina; Connolly, E. Sander

    2015-01-01

    Objective: To evaluate whether delayed appearance of intraventricular hemorrhage (dIVH) represents an independent entity from intraventricular hemorrhage (IVH) present on admission CT or is primarily related to the time interval between symptom onset and admission CT. Methods: A total of 282 spontaneous intracerebral hemorrhage (ICH) patients, admitted February 2009–March 2014 to the neurological intensive care unit of a tertiary care university hospital, were prospectively enrolled in the ICH Outcomes Project. Multivariate logistic regression was used to determine associations with acute mortality and functional long-term outcome (modified Rankin Scale). Results: A cohort of 282 ICH patients was retrospectively studied: 151 (53.5%) had intraventricular hemorrhage on initial CT scan (iIVH). Of the remaining 131 patients, 19 (14.5%) developed IVH after the initial CT scan (dIVH). The median times from symptom onset to admission CT were 1.1, 6.0, and 7.4 hours for the dIVH, iIVH, and no IVH groups (Mann-Whitney U test, dIVH vs iIVH, p < 0.001) and median time from onset to dIVH detection was 7.2 hours. The increase in ICH volume following hospital admission was larger in dIVH than in iIVH and no IVH patients (mean 17.6, 0.2, and 0.4 mL). After controlling for components of the ICH score and hematoma expansion, presence of IVH on initial CT was associated with discharge mortality and poor outcome at 3, 6, and 12 months, but dIVH was not associated with any of the outcome measures. Conclusions: In ICH patients, associated IVH on admission imaging is commonly encountered and is associated with poor long-term outcome. In contrast, dIVH on subsequent scans is far less common and does not appear to portend worse outcome. PMID:25663233

  14. CSF imaging in benign intracranial hypertension

    PubMed Central

    James, A. Everette; Harbert, J. C.; Hoffer, P. B.; DeLand, F. H.

    1974-01-01

    The cisternographic images in 10 patients with benign intracranial hypertension were reviewed. Nine were normal. Transfer of labelled tracer from the subarachnoid space was measured in five patients and was found to be abnormal in only two. The relation of these findings to the proposed pathophysiological alterations is discussed. Images

  15. [Neonatal herpes simplex infection].

    PubMed

    van Ham-Borawitz, V E J; Stam, E D; Welborn, K M; Sas, T C J

    2016-01-01

    Neonatal encephalitis caused by herpes simplex virus (HSV) is a familiar disease with a high mortality and morbidity rate. Isolated skin-eye-mouth infection is less familiar among professionals. In this article we present two neonates with an isolated skin lesion caused by an HSV infection. Of the neonates infected with HSV, 40-45% show isolated skin-eye-mouth disease. With correct treatment, the risk of spread to the central nervous system will decrease from 50-60% to 5-10%. Typical HSV skin lesions may present at a late stage of the disease or may be masked by a secondary bacterial infection. When a neonate presents with atypical skin lesions starting 7-12 days after the birth, immediate testing for HSV and immediate treatment are required, to decrease the risk of further progression of the disease. PMID:27122069

  16. Neonatal pain management

    PubMed Central

    Bhalla, Tarun; Shepherd, Ed; Tobias, Joseph D.

    2014-01-01

    The past 2-3 decades have seen dramatic changes in the approach to pain management in the neonate. These practices started with refuting previously held misconceptions regarding nociception in preterm infants. Although neonates were initially thought to have limited response to painful stimuli, it was demonstrated that the developmental immaturity of the central nervous system makes the neonate more likely to feel pain. It was further demonstrated that untreated pain can have long-lasting physiologic and neurodevelopmental consequences. These concerns have resulted in a significant emphasis on improving and optimizing the techniques of analgesia for neonates and infants. The following article will review techniques for pain assessment, prevention, and treatment in this population with a specific focus on acute pain related to medical and surgical conditions. PMID:25538531

  17. Neonatal respiratory distress syndrome

    MedlinePlus

    Hyaline membrane disease (HMD); Infant respiratory distress syndrome; Respiratory distress syndrome in infants; RDS - infants ... Neonatal RDS occurs in infants whose lungs have not yet fully ... disease is mainly caused by a lack of a slippery substance in ...

  18. Neonatal abstinence syndrome

    MedlinePlus

    NAS; Neonatal abstinence symptoms ... may contribute to the severity of a baby's NAS symptoms. ... symptoms of withdrawal. Even after medical treatment for NAS is over and babies leave the hospital, they ...

  19. Maternal and neonatal tetanus.

    PubMed

    Thwaites, C Louise; Beeching, Nicholas J; Newton, Charles R

    2015-01-24

    Maternal and neonatal tetanus is still a substantial but preventable cause of mortality in many developing countries. Case fatality from these diseases remains high and treatment is limited by scarcity of resources and effective drug treatments. The Maternal and Neonatal Tetanus Elimination Initiative, launched by WHO and its partners, has made substantial progress in eliminating maternal and neonatal tetanus. Sustained emphasis on improvement of vaccination coverage, birth hygiene, and surveillance, with specific approaches in high-risk areas, has meant that the incidence of the disease continues to fall. Despite this progress, an estimated 58,000 neonates and an unknown number of mothers die every year from tetanus. As of June, 2014, 24 countries are still to eliminate the disease. Maintenance of elimination needs ongoing vaccination programmes and improved public health infrastructure. PMID:25149223

  20. Neonatal polycystic kidney disease.

    PubMed

    Verghese, Priya; Miyashita, Yosuke

    2014-09-01

    This article provides an up-to-date comprehensive review and summary on neonatal polycystic kidney disease (PKD) with emphasis on the differential diagnosis, clinical manifestations, diagnostic techniques, and potential therapeutic approaches for the major causes of neonatal PKD, namely hereditary disease, including autosomal recessive and autosomal dominant PKD and nonhereditary PKD, with particular emphasis on multicystic dysplastic kidney. A brief overview of obstructive cystic dysplasia and simple and complex cysts is also included. PMID:25155726

  1. Stereotactic radiosurgery of small intracranial tumors: Neuropathological correlation in three patients

    SciTech Connect

    Thompson, B.G.; Coffey, R.J.; Flickinger, J.C.; Lunsford, L.D. )

    1990-02-01

    The mechanism by which radiosurgery can stop the growth of some tumors is poorly understood, in part because postmortem neuropathological findings in patients have been reported only rarely. To define further the effects of radiosurgery, we present the correlation among clinical, neuroimaging, and neuropathological data in three patients with different intracranial tumors who died between 2 and 39 weeks after radiosurgery. The target volumes in two patients with malignant tumors showed sharply demarcated coagulative necrosis. In the third patient, who had a benign acoustic nerve tumor, neuropathological examination found intratumoral hemorrhage and cyst formation, but no necrosis. Radiosurgery appears to cause acute necrosis of malignant cells, although its effectiveness may be limited by the infiltrative nature of some tumors. In benign tumors, necrosis following radiosurgery is relatively delayed, and may not be required for growth arrest.

  2. The @neurIST ontology of intracranial aneurysms: providing terminological services for an integrated IT infrastructure.

    PubMed

    Boeker, Martin; Stenzhorn, Holger; Kumpf, Kai; Bijlenga, Philippe; Schulz, Stefan; Hanser, Susanne

    2007-01-01

    The @neurIST ontology is currently under development within the scope of the European project @neurIST intended to serve as a module in a complex architecture aiming at providing a better understanding and management of intracranial aneurysms and subarachnoid hemorrhages. Due to the integrative structure of the project the ontology needs to represent entities from various disciplines on a large spatial and temporal scale. Initial term acquisition was performed by exploiting a database scaffold, literature analysis and communications with domain experts. The ontology design is based on the DOLCE upper ontology and other existing domain ontologies were linked or partly included whenever appropriate (e.g., the FMA for anatomical entities and the UMLS for definitions and lexical information). About 2300 predominantly medical entities were represented but also a multitude of biomolecular, epidemiological, and hemodynamic entities. The usage of the ontology in the project comprises terminological control, text mining, annotation, and data mediation. PMID:18693797

  3. Incidental diagnosis of two intracranial aneurysms following surgical evacuation of chronic subdural hematoma

    PubMed Central

    Das, Joe M.; Rajmohan, B. P.; Sharmad, M. S.; Peethambaran, Anilkumar

    2015-01-01

    The development of subarachnoid hemorrhage (SAH) following evacuation of chronic subdural hematoma (CSDH) is a very rare phenomenon. SAH in this context occurring secondary to intracranial aneurysm rupture is still rare. We report a case of an elderly lady who presented with right hemiplegia and altered sensorium. Computed tomography (CT) scan of the brain revealed a left fronto-temporoparietal CSDH with midline shift, which was promptly evacuated surgically via a single burr-hole. Postoperatively, her level of consciousness deteriorated and there was increased the amount of drain. Emergency CT of the brain revealed diffuse SAH. CT cerebral angiogram revealed one aneurysm each in the right internal carotid artery and anterior communicating artery. Meanwhile, her consciousness level improved on conservative management. The relatives were not keen for further follow-up. PMID:25972954

  4. Incidental diagnosis of two intracranial aneurysms following surgical evacuation of chronic subdural hematoma.

    PubMed

    Das, Joe M; Rajmohan, B P; Sharmad, M S; Peethambaran, Anilkumar

    2015-01-01

    The development of subarachnoid hemorrhage (SAH) following evacuation of chronic subdural hematoma (CSDH) is a very rare phenomenon. SAH in this context occurring secondary to intracranial aneurysm rupture is still rare. We report a case of an elderly lady who presented with right hemiplegia and altered sensorium. Computed tomography (CT) scan of the brain revealed a left fronto-temporoparietal CSDH with midline shift, which was promptly evacuated surgically via a single burr-hole. Postoperatively, her level of consciousness deteriorated and there was increased the amount of drain. Emergency CT of the brain revealed diffuse SAH. CT cerebral angiogram revealed one aneurysm each in the right internal carotid artery and anterior communicating artery. Meanwhile, her consciousness level improved on conservative management. The relatives were not keen for further follow-up. PMID:25972954

  5. Scintigraphic demonstration of intracranial communication between arachnoid cyst and associated subdural hematoma

    SciTech Connect

    Yokoyama, K.; Tonami, N.; Kimura, M.; Kinoshita, A.; Aburano, T.; Hisada, K.

    1989-05-01

    An arachnoid cyst found to have a communication to an associated subdural hematoma was demonstrated with the Tc-99m DTPA brain scintigraphy. Although arachnoid cysts are known to be silent, when a patient with an arachnoid cyst develops signs of increased intracranial pressure or neurological deficits, the presence of a complication, including subdural hematoma, intracystic hemorrhage or subdural hygroma, is highly suspected. In the present case, the patient with an arachnoid cyst had a subdural hematoma following minor head injury. Tc-99m DTPA brain scintigraphy showed abnormal accumulation of the tracer not only in the hematoma but in the arachnoid cyst. This observation suggested communication of the two lesions, which was confirmed at surgery.

  6. Neonatal clinical pharmacology

    PubMed Central

    Allegaert, Karel; van de Velde, Marc; van den Anker, John

    2013-01-01

    Effective and safe drug administration in neonates should be based on integrated knowledge on the evolving physiological characteristics of the infant who will receive the drug, and the pharmacokinetics (PK) and pharmacodynamics (PD) of a given drug. Consequently, clinical pharmacology in neonates is as dynamic and diverse as the neonates we admit to our units while covariates explaining the variability are at least as relevant as median estimates. The unique setting of neonatal clinical pharmacology will be highlighted based on the hazards of simple extrapolation of maturational drug clearance when only based on ‘adult’ metabolism (propofol, paracetamol). Secondly, maturational trends are not at the same pace for all maturational processes. This will be illustrated based on the differences between hepatic and renal maturation (tramadol, morphine, midazolam). Finally, pharmacogenetics should be tailored to neonates, not just mirror adult concepts. Because of this diversity, clinical research in the field of neonatal clinical pharmacology is urgently needed, and facilitated through PK/PD modeling. In addition, irrespective of already available data to guide pharmacotherapy, pharmacovigilance is needed to recognize specific side effects. Consequently, paediatric anesthesiologists should consider to contribute to improved pharmacotherapy through clinical trial design and collaboration, as well as reporting on adverse effects of specific drugs. PMID:23617305

  7. Neonatal surgery in Africa.

    PubMed

    Chirdan, Lohfa B; Ngiloi, Petronilla J; Elhalaby, Essam A

    2012-05-01

    The management of neonatal surgical problems continues to pose considerable challenges, particularly in low-resource settings. The burden of neonatal surgical diseases in Africa is not well documented. The characteristics of some neonatal surgical problems are highlighted. Late presentation coupled with poor understanding of the milieu interior of the neonates by incompetent health care providers and poorly equipped hospitals combine to give rise to the unacceptable high morbidity and mortality in most parts of Africa. Proper training of all staff involved in neonatal health care coupled with community awareness must be vigorously pursued by all stakeholders. Various governments throughout the continent of Africa, in conjunction with international donor agencies, must not only provide an adequate budget for health care services and improve infrastructures, but must also deliberately encourage and provide funding for neonatal surgical care and research across the continent. The well-established pediatric surgical training programs, particularly in North and South Africa, should hold the moral responsibility of training all possible numbers of young surgeons from other African countries that do not have any existing pediatric surgical training programs or those countries suffering from remarkable shortage of trained pediatric surgeons. PMID:22475121

  8. [Neonatal Dengue. Presentation of clinical cases].

    PubMed

    Romero-Santacruz, Edith; Lira-Canul, Janeth Jaqueline; Pacheco-Tugores, Fredy; Palma-Chan, Adolfo Gonzalo

    2015-05-01

    Dengue is an infectious disease caused by a flavivirus, with four serotypes, transmitted by the mosquito Aedes aegypti. In Mexico it is a public health problem, especially in the region of central and southeast of the country. The disease can be asymptomatic or present serious forms and even death. It is confirmed by detection of the NS1 Antigen; IgM antibodies, polymerase chain reaction and virus isolation. The vertical transmission to de newborn has been little studied. 7 cases in neonates from November to December 2011 are reported. All patients were male, obtained by caesarean section between 34 and 40 weeks of gestation, whose mothers were enrolled with fever and symptoms associated with dengue disease and serology positive for dengue. Six with positive AgNS1 and one positive IgM; one mother died. All the newborns had positive serology for dengue, 4 with positive AgNS1 and 3 positive IgM. The clinical features of the newborn ranged from asymptomatic to one serious dengue fever, shock and hemorrhage. The symptomatic 6 attended with thrombocytopenia, changes in temperature and unspecific disturbance. The severity of mothers conditioned disrepair product at birth, but not with subsequent gravity of the new born. Vertical trasmission of dengue should be suspected in risk areas, to maintain vigilance and to give early treatment. Also is neccesary promote the realization of specific diagnostic and therapeutic guidelines to the neonatal period. PMID:26233977

  9. Gastrointestinal hemorrhage: evaluation with MDCT.

    PubMed

    Soto, Jorge A; Park, Seong Ho; Fletcher, Joel G; Fidler, Jeff L

    2015-06-01

    Gastrointestinal (GI) bleeding is a common medical problem, with high associated morbidity and mortality. The clinical presentation of gastrointestinal hemorrhage varies with the location of the bleeding source, the intensity of the bleed, and the presence of comorbidities that affect the ability to tolerate blood loss. Conventional endoscopic examinations are usually the initial diagnostic tests in patients presenting with overt gastrointestinal hemorrhage. However, implementation of upper tract endoscopy and colonoscopy in the emergency setting can be challenging due to inconsistent availability of the service and difficulties in achieving adequate colonic cleansing in emergent situations. Thus, imaging tests are often relied upon to establish the location and the cause of bleeding, either for initial diagnosis or after non-revealing upper and lower tract endoscopies ("obscure" bleeding). This article discusses the imaging evaluation of patients with gastrointestinal bleeding and reviews the imaging appearance of the most common causes, taking into account the two most relevant clinical presentations: overt bleeding and obscure bleeding. PMID:25637128

  10. Maternal alloimmunization against the rare platelet-specific antigen HPA-9b (Maxa) is an important cause of neonatal alloimmune thrombocytopenia

    PubMed Central

    Peterson, Julie A.; Balthazor, Stephanie M.; Curtis, Brian R.; McFarland, Janice G.; Aster, Richard H.

    2006-01-01

    BACKGROUND Neonatal alloimmune thrombocytopenia (NATP) is an important cause of morbidity and mortality in the newborn. Optimal management of subsequent pregnancies requires knowledge of the alloantigen that caused maternal immunization, but this is possible only in a minority of cases. This study investigated whether this can be explained in part by maternal immunization against the “rare” alloantigen HPA-9b (Maxa), implicated previously only in a single NATP case. STUDY DESIGN AND METHODS Archived paternal DNA from unresolved cases of NATP and normal individuals was typed for platelet (PLT)-specific antigens with real-time polymerase chain reaction and direct sequencing. PLT-specific alloantibodies were characterized by flow cytometry and solid-phase enzyme-linked immunosorbent assay. Recombinant GPIIb/IIIa was expressed in stably transfected Chinese hamster ovary cells. Clinical information was obtained directly from attending physicians. RESULTS Six of 217 fathers were positive for the presence of HPA-9b (Maxa), an incidence about seven times that in the general population. In each of five cases studied, maternal serum samples reacted with intact paternal PLTs and paternal GPIIb/IIIa. Only one of three serum samples tested recognized recombinant GPIIb/IIIa carrying the HPA-9b (Maxa) mutation. These seemingly discrepant reactions may reflect different requirements for oligosaccharides linked to residues close to the mutation in GPIIb that determines HPA-9b (Maxa). NATP in the affected children was severe and was associated with intracranial hemorrhage in three of six infants on whom information was obtained. CONCLUSIONS Maternal immunization against HPA-9b (Maxa) is an important cause of NATP and should be considered in cases of apparent NATP not resolved on the basis of maternal-fetal incompatibility for “common” PLT antigens. PMID:16131382

  11. Eimeria macusaniensis associated lesions in neonate alpacas dying from enterotoxemia.

    PubMed

    Rosadio, R; Londoñe, P; Pérez, D; Castillo, H; Véliz, A; Llanco, L; Yaya, K; Maturrano, L

    2010-02-26

    Histopathological analysis of 108 intestine samples (103 grossly affected ileum and 5 jejunum) taken from Clostridium-induced neonatal alpaca (Vicugna pacos) enterotoxemia mortalities collected in the Departments of Arequipa, Puno and Cusco of southern Peru during the 2005-2008 birth seasons (January-March), revealed the presence of large numbers of both asexual and sexual stages of Eimeria macusaniensis in 33/108 (30.55%) of the samples with moderate to severe necrotized and/or hemorrhagic enteritis. It is proposed that damage to the mucosa produced by coccidial infections may facilitate overgrowth of Clostridium perfringens with toxin production leading to fatal enterotoxemia. PMID:19926224

  12. Imaging of adrenal and renal hemorrhage.

    PubMed

    Hammond, Nancy A; Lostumbo, Antonella; Adam, Sharon Z; Remer, Erick M; Nikolaidis, Paul; Yaghmai, Vahid; Berggruen, Senta M; Miller, Frank H

    2015-10-01

    Hemorrhage of the kidneys and adrenal glands has many etiologies. In the adrenal glands, trauma, anticoagulation, stress, sepsis, surgery, and neoplasms are common causes of hemorrhage. In the kidneys, reasons for hemorrhage include trauma, bleeding diathesis, vascular diseases, infection, infarction, hemorrhagic cyst rupture, the Antopol-Goldman lesion, and neoplasms. Angiomyolipoma and renal cell carcinoma are the neoplasms most commonly associated with hemorrhage in the kidneys and adrenal cortical carcinoma, metastases, and pheochromocytoma are associated with hemorrhage in the adrenal glands. Understanding the computed tomography and magnetic resonance imaging features, and causes of hemorrhage in the kidneys and adrenal glands is critical. It is also important to keep in mind that mimickers of hemorrhage exist, including lymphoma in both the kidneys and adrenal glands, and melanoma metastases in the adrenal glands. Appropriate imaging follow-up of renal and adrenal hemorrhage should occur to exclude an underlying malignancy as the cause. If there is suspicion for malignancy that cannot be definitively diagnosed on imaging, surgery or biopsy may be warranted. Angiography may be indicated when there is a suspected underlying vascular disease. Unnecessary intervention, such as nephrectomy, may be avoided in patients with benign causes or no underlying disease. Appropriate management is dependent on accurate diagnosis of the cause of renal or adrenal hemorrhage and it is incumbent upon the radiologist to determine the etiology. PMID:26036792

  13. Acute suprachoroidal hemorrhage during phacoemulsification.

    PubMed

    Nambiar, A K; Fox, P D

    2000-06-01

    We present a case of acute suprachoroidal hemorrhage that developed during routine phacoemulsification in an 85-year-old patient after uneventful administration of periocular anesthesia. Pre-existing risk factors included advanced age, glaucoma, myopia, and hypertension. The scleral tunnel prevented major expulsion of intraocular contents; however, raised intraocular pressure prevented intraocular lens implantation. The rarity of this condition raises questions regarding the further management and precautions related to it. PMID:10889443

  14. Risk Factors for Periventricular-Intraventricular Hemorrhage in Premature Infants

    PubMed Central

    Lee, Ju Young; Jung, Euiseok; Kim, Eun Sun; Shim, Gyu Hong; Lee, Hyun Joo; Lee, Jin A; Choi, Chang Won; Kim, Ee-Kyung; Kim, Beyong Il; Choi, Jung-Hwan

    2010-01-01

    Periventricular-intraventricular hemorrhage (PV-IVH) is a major cause of neurological disabilities in preterm newborns. This study aimed to determine the perinatal factors associated with PV-IVH. We conducted a retrospective case-control study from preterm infants born at ≤34 weeks of gestation and admitted to Neonatal Intensive Care Units of Seoul National University Children's Hospital and Seoul National University Bundang Hospital between June 2003 and December 2007. Neonates with no cranial sonographic data or infants transferred from other centers after three days of age were excluded. Of 1,044 eligible subjects, 59 infants with PV-IVH grade 2, 3, and 4 were allocated to the case group. The control group consisted of 118 infants without PV-IVH who were matched for gestational age and birth weight to each case of PV-IVH. At the multivariate logistic regression model, metabolic acidosis (odds ratio [OR]: 6.94; 95% confidence interval [CI]: 1.12-43.23) and use of inotropes (OR: 3.70; 95% CI: 1.16-11.84) were associated with an increased risk of PV-IVH. Maternal use of antenatal corticosteroids decreases the risk of PV-IVH (OR: 0.36; 95% CI: 0.14-0.92). PMID:20191041

  15. Hemorrhagic presentations of cerebellar pilocytic astrocytomas in children resulting in death: report of 2 cases.

    PubMed

    Wilson, Mitchell P; Johnson, Edward S; Hawkins, Cynthia; Atkins, Kerry; Alshaya, Wael; Pugh, Jeffrey A

    2016-04-01

    Acute hemorrhagic presentation in pilocytic astrocytomas (PAs) has become increasingly recognized. This type of presentation poses a clinically emergent situation in those hemorrhages arising in PAs of the cerebellum, the most frequent site, because of the limited capacity of the posterior fossa to compensate for mass effect, predisposing to rapid neurological deterioration. As examples, we describe two cases of fatal hemorrhagic cerebellar PAs: one of a child with a slowly growing stereotypical WHO Grade I PA with a 1-year period of symptomatology that preceded a rapid clinical deterioration, and another of an asymptomatic child having a PA variant, presenting with progressive obtundation following a presumed Valsalva event. These two scenarios parallel previous reports in the literature of either a setting of progressive expression of cerebellar dysfunction and transient episodes of raised intracranial pressure (ICP), or abrupt onset of features of increased ICP in a previously well child. The literature is further reviewed for a current understanding of the factors that predispose, initiate and propagate bleeding, with specific reference to the role of vascular endothelial growth factor and other angiogenic agents in the genesis and stability of the vasculature in PAs. In this context, we propose that obliterative vascular mural hyalinization with associated altered flow dynamics and microaneurysm formation was the pathogenesis of the hemorrhage in our first case. In the second case, large tumor size, increased growth rate, looseness of the background myxoid matrix, and thinness of the tumor blood vessels with calcospherite deposition predisposed to vascular leakage and bleeding concurrent with sudden increases in intravascular hydrostatic pressure. In that cerebellar PAs are common, this report underscores the importance of considering in the differential diagnosis the possibility of a spontaneous hemorrhage in a posterior fossa PA in a child presenting with a

  16. Progressive Intracranial Vertebral Artery Dissection Presenting with Isolated Trigeminal Neuralgia-Like Facial Pain

    PubMed Central

    Nakamizo, Tomoki; Koide, Takashi; Miyazaki, Hiromichi

    2015-01-01

    Intracranial vertebral artery dissection (IVAD) is a potentially life-threatening disease, which usually presents with ischemic stroke or subarachnoid hemorrhage. IVAD presenting with isolated facial pain is rare, and no case with isolated trigeminal neuralgia- (TN-) like facial pain has been reported. Here, we report the case of a 57-year-old male with IVAD who presented with acute isolated TN-like facial pain that extended from his left cheek to his left forehead and auricle. He felt a brief stabbing pain when his face was touched in the territory of the first and second divisions of the left trigeminal nerve. There were no other neurological signs. Magnetic resonance imaging (MRI) of the brain 7 days after onset revealed dissection of the left intracranial vertebral artery without brain infarction. The pain gradually disappeared in approximately 6 weeks, and the patient remained asymptomatic thereafter, except for a brief episode of vertigo. Follow-up MRI revealed progressive narrowing of the artery without brain infarction. This case indicates that IVAD can present with isolated facial pain that mimics TN. IVAD should be considered in the differential diagnosis of acute facial pain or TN. PMID:26146576

  17. Evidence of redistribution of cerebral blood flow during treatment for an intracranial arteriovenous malformation

    SciTech Connect

    Batjer, H.H.; Purdy, P.D.; Giller, C.A.; Samson, D.S. )

    1989-10-01

    The presence of an intracranial arteriovenous malformation has a dramatic impact on local circulatory dynamics. Treatment of some arteriovenous malformations can result in disastrous hyperemic states caused by redistribution of previously shunted blood. This report describes serial hemodynamic measurements of both cerebral blood flow and flow velocity in 3 patients during treatment for arteriovenous malformations. Measurements of cerebral blood flow were made by computed tomographic scan employing the stable xenon inhalation technique; flow velocity, including autoregulatory characteristics, was measured by transcranial Doppler ultrasonogram. Substantial hyperemia developed in one patient (Case 1) after resection and in another (Case 3) after embolization. Embolization resulted in restoration of normal regional cerebral blood flow in a patient who demonstrated hypoperfusion before treatment (Case 2). In Patient 1, postoperative hyperemia was associated with persistently elevated flow velocities, and may have been accompanied by hemispheric neurological deficits. Sequential hemodynamic measurements may predict patients at risk of perioperative complications, and may become useful clinical guidelines for the extent and timing of embolization and for the timing of surgery after intracranial hemorrhage or preoperative embolization procedures.

  18. Subdural porous and notched mini-grid electrodes for wireless intracranial electroencephalographic recordings

    PubMed Central

    Salam, Muhammad Tariqus; Gélinas, Sébastien; Desgent, Sébastien; Duss, Sandra; Bernier Turmel, Félix; Carmant, Lionel; Sawan, Mohamad; Nguyen, Dang Khoa

    2014-01-01

    Background Intracranial electroencephalography (EEG) studies are widely used in the presurgical evaluation of drug-refractory patients with partial epilepsy. Because chronic implantation of intracranial electrodes carries a risk of infection, hemorrhage, and edema, it is best to limit the number of electrodes used without compromising the ability to localize the epileptogenic zone (EZ). There is always a risk that an intracranial study may fail to identify the EZ because of suboptimal coverage. We present a new subdural electrode design that will allow better sampling of suspected areas of epileptogenicity with lower risk to patients. Method Impedance of the proposed electrodes was characterized in vitro using electrochemical impedance spectroscopy. The appearance of the novel electrodes on magnetic resonance imaging (MRI) was tested by placing the electrodes into a gel solution (0.9% NaCl with 14 g gelatin). In vivo neural recordings were performed in male Sprague Dawley rats. Performance comparisons were made using microelectrode recordings from rat cortex and subdural/depth recordings from epileptic patients. Histological examinations of rat brain after 3-week icEEG intracerebral electroencephalography (icEEG) recordings were performed. Results The in vitro results showed minimum impedances for optimum choice of pure gold materials for electrode contacts and wire. Different attributes of the new electrodes were identified on MRI. The results of in vivo recordings demonstrated signal stability, 50% noise reduction, and up to 6 dB signal-to-noise ratio (SNR) improvement as compared to commercial electrodes. The wireless icEEG recording system demonstrated on average a 2% normalized root-mean-square (RMS) deviation. Following the long-term icEEG recording, brain histological results showed no abnormal tissue reaction in the underlying cortex. Conclusion The proposed subdural electrode system features attributes that could potentially translate into better ic

  19. Computed tomography and magnetic resonance features of intracranial hemangioendothelioma: A study of 7 cases

    PubMed Central

    TIAN, WEI-ZHONG; YU, XIANG-RONG; WANG, WEI-WEI; ZHANG, BO; XIA, JIAN-GUO; LIU, HAN-QIU

    2016-01-01

    The current study aimed to present the neuroradiological and histopathological features of intracranial hemangioendothelioma (HE). The computed tomography (CT; n=3) and magnetic resonance imaging (MRI; n=7) features, and the clinical presentations of 7 patients with pathologically documented HEs were retrospectively analyzed. Lesions were observed in the right side of the skull (the frontal bone in 1 patient and the parietal bone in 1 patient), the tentorium (2 patients), the cerebral falx (1 patient), the right cavernous sinus (1 patient) and the right temporal lobe (1 patient). The tumor was lobulated in 5 cases and round in 2 cases. The majority of tumors appeared isointense or hypointense with multiple scattered hyperintensities on T1-weighted MRI. Moreover, the lesions appeared as inhomogeneous hyperintense regions with multiple enlarged and tortuous blood flow voids on T2-weighted MRI. The lesions also showed marked gadolinium enhancement in a honeycomb pattern. CT scan results showed a isoattenuation region (32–47 HU), with numerous small, round, high-density foci. The 2 cases with skull lesions presented with local bone destruction and discontinuous bone lines of the tabula interna ossis cranii. In 1 case, MR angiography revealed abnormal vessels in the basilar region. A total of 4 cases were epithelial HE, 2 were retiform HE and 1 was kaposiform HE. Histological examination revealed endothelial cell proliferation with vascular lesions and a mucous matrix or dense fibrous mesenchyme. In conclusion, intracranial HE is rare, but should be considered in the differential diagnosis when evaluating intracranial neoplasms. A well-defined lobulated mass and imaging features that include internal heterogeneity, small scattered hemorrhages and thromboses, signal voids of vessels, and marked and delayed enhancement may confirm the diagnosis of HE. PMID:27123072

  20. Central nervous system patholgoy associated with mask ventilation in the very low birthweight infant: a new etiology for intracerebellar hemorrhages.

    PubMed

    Pape, K E; Armstrong, D L; Fitzhardinge, P M

    1976-10-01

    Mask-applied ventilatory support was noted to cause severe head molding in infants with birthweights under 1,501 gm. To determine if this molding was detrimental to the infant, the neonatal course and autopsy findings were reviewed for 106 infants. Twenty significant intracerebellar hemorrhages were found. An association between these hemorrhages and mask-applied positive pressure ventilation was demonstrated (P = .05). This relationship was maintained when all cases of generalized bleeding dyscrasia were removed (P = .021). It is proposed that the distortional forces produced by the mask attachment, together with the buffeting effect of intermittent positive-pressure ventilation, are causally related to the production of intracerebellar hemorrhages by direct contusion, by ischemic stasis, or by altered venous drainage. The authors urge strong caution when dealing with the small premature infant in using any attachment device that causes molding of the cranial vault, particularly in the occipital area. PMID:787912

  1. A rabbit model of human familial, nonsyndromic unicoronal suture synostosis. II. Intracranial contents, intracranial volume, and intracranial pressure.

    PubMed

    Mooney, M P; Siegel, M I; Burrows, A M; Smith, T D; Losken, H W; Dechant, J; Cooper, G; Fellows-Mayle, W; Kapucu, M R; Kapucu, L O

    1998-06-01

    This two-part study reviews data from a recently developed colony of New Zealand white rabbits with familial, nonsyndromic unilateral coronal suture synostosis, and this second part presents neuropathological findings and age-related changes in intracranial volume (ICV) and intracranial pressure (ICP) in 106 normal rabbits and 56 craniosynostotic rabbits from this colony. Brain morphology and anteroposterior length were described in 44 rabbit fetuses and perinates (27 normal; 17 synostosed). Middle meningeal artery patterns were qualitatively assessed from 2-D PCC MRI VENC scans and endocranial tracings from 15, 126-day-old rabbits (8 normal, 7 rabbits with unicoronal synostosis). Brain metabolism was evaluated by assessing 18F-FDG uptake with high-resolution PET scanning in 7, 25-day-old rabbits (3 normal, 4 with unicoronal or bicoronal synostosis). Intracranial contents and ICV were assessed using 3-D CT scanning of the skulls of 30 rabbits (20 normal,10 with unicoronal synostosis) at 42 and 126 days of age. Serial ICP data were collected from 66 rabbits (49 normal; 17 with unicoronal synostosis) at 25 and 42 days of age. ICP was assessed in the epidural space using a Codman NeuroMonitor microsensor transducer. Results revealed that cerebral cortex morphology was similar between normal and synostosed fetuses around the time of synostosis. Significantly (P<0.05) decreased A-P cerebral hemisphere growth rates and asymmetrical cortical remodeling were noted with increasing age in synostotic rabbits. In addition, rabbits with unicoronal suture synostosis exhibited asymmetrical middle meningeal artery patterns, decreased and asymmetrical brain metabolism, a "beaten-copper" intracranial appearance, significantly (P<0.05) decreased ICV, and significantly (P<0.01) elevated ICP compared with normal control rabbits. The advantages and disadvantages of these rabbits as a model for human familial, nonsyndromic unicoronal suture synostosis are discussed, especially in light

  2. Pulmonary hemorrhage resulting from bungee jumping.

    PubMed

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

    2007-11-01

    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

  3. Neurogenic stress cardiomyopathy associated with subarachnoid hemorrhage.

    PubMed

    Pinnamaneni, Sowmya; Dutta, Tanya; Melcer, Joshua; Aronow, Wilbert S

    2015-01-01

    Cardiac manifestations are recognized complications of subarachnoid hemorrhage. Neurogenic stress cardiomyopathy is one complication that is seen in acute subarachnoid hemorrhage. It can present as transient diffuse left ventricular dysfunction or as transient regional wall motion abnormalities. It occurs more frequently with neurologically severe-grade subarachnoid hemorrhage and is associated with increased morbidity and poor clinical outcomes. Managing this subset of patients is challenging. Early identification followed by a multidisciplinary team approach can potentially improve outcomes. PMID:25606704

  4. NEONATAL DESTRUCTION OF DOPAMINERGIC NEURONS

    EPA Science Inventory

    Rats treated as neonates with 6-hydroxydopamine are proposed to model the dopamine deficiency associated with Lesch-Nyhan syndrome (LNS). o understand the neurobiological basis of specific behaviors in LNS, investigations were undertaken in these neonatally lesioned rats. everal ...

  5. Spontaneous Massive Adrenal Hemorrhage: A Management Dilemma

    PubMed Central

    Agarwal, Anshuman

    2015-01-01

    Abstract Adrenal hemorrhage (AH) is a rare but life-threatening condition. Small focal hemorrhage may present subclinically, but massive hemorrhage may lead to rapid cardiovascular collapse and ultimately death if not diagnosed appropriately and treated quickly. Most cases reported in the literature have been treated conservatively. In an event of increasing hemorrhage during conservative management, it may be tricky to intervene surgically because of the hematoma around the gland. Here we describe a case where we managed a large spontaneous AH by a combination of angioembolization and laparoscopic adrenalectomy. PMID:27579389

  6. Hemorrhagic cystitis: A challenge to the urologist

    PubMed Central

    Manikandan, R.; Kumar, Santosh; Dorairajan, Lalgudi N.

    2010-01-01

    Severe hemorrhagic cystitis often arises from anticancer chemotherapy or radiotherapy for pelvic malignancies. Infectious etiologies are less common causes except in immunocompromised hosts. These cases can be challenging problems for the urologist and a source of substantial morbidity and sometimes mortality for the patients. A variety of modalities of treatment have been described for the management of hemorrhagic cystitis but there is none that is uniformly effective. Some progress has been made in the understanding and management of viral hemorrhagic cystitis. This article reviews the common causes of severe hemorrhagic cystitis and the currently available management options. PMID:20877590

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

    PubMed Central

    2012-01-01

    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. PMID:22414527

  8. Chronic basilar artery dissection with an associated symptomatic aneurysm presenting with massive subarachnoid hemorrhage.

    PubMed

    Cohen, José E; Moscovici, Samuel; Rajz, Gustavo; Vargas, Andres; Itshayek, Eyal

    2016-08-01

    Basilar artery dissection (BAD) is a rare condition with a worse prognosis than a dissection limited to the vertebral artery. We report a rare case of chronic BAD with an associated symptomatic aneurysm presenting with massive subarachnoid hemorrhage (SAH) in a 54-year-old woman. The diagnosis of acute BAD could only be made retrospectively, based on clinical and neuroradiological studies from a hospital admission 10months earlier. Angiography performed after her SAH showed unequivocal signs of imperfect healing; she was either post-recanalization of a complete occlusion or post-dissection. Residual multi-channel intraluminal defects led to the development of a small aneurysm, which was responsible for the massive hemorrhage. The occurrence of an associated aneurysm, and wall disease, but not an intraluminal process, reinforces the diagnosis of dissection. The patient was fully recovered at 90day follow-up. This case reinforces the need for long-term neuroradiological surveillance after non-hemorrhagic intracranial dissections to detect the development of de novo aneurysms. PMID:26960262

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

    PubMed

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

    2014-11-01

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

  10. The relationship of subarachnoid hemorrhage and the need for postoperative shunting.

    PubMed

    Vale, F L; Bradley, E L; Fisher, W S

    1997-03-01

    The incidence of chronic hydrocephalus requiring shunting after aneurysmal subarachnoid hemorrhage (SAH) is not precisely known. The authors investigated whether the need for ventriculoperitoneal (VP) shunting can be predicted by initial Hunt and Hess grade or Fisher computerized tomography score. One hundred eight patients who presented with SAH and underwent 116 surgical procedures for aneurysm clipping were evaluated retrospectively to determine the incidence of chronic hydrocephalus. Chronic hydrocephalus was defined as clinically and radiographically demonstrated hydrocephalus that lasted 2 weeks or longer after the original hemorrhage and that required shunting. All SAH patients were managed in a similar fashion with induced hypervolemia, relative hemodilution, and hypertension complemented by a course of calcium channel blockers. The majority of patients underwent perioperative extracranial ventricular drainage to allow intraoperative brain relaxation and to assist intracranial pressure management. The overall mortality rate of the study group was 17%. Of the surviving patients, 20% underwent VP shunt placement secondary to chronic hydrocephalus. There were no statistically significant relationships between chronic hydrocephalus and patient age or gender, aneurysm type and size, or use of a perioperative drain. There was a high clinical correlation between chronic hydrocephalus and admission Hunt and Hess grades and Fisher grades (p < 0.05). All of the patients who survived a second bleeding episode and almost 46% of the patients who presented with intraventricular hemorrhage required placement of a VP shunt. The authors present predictive tables of chronic hydrocephalus based on the patient's admission Hunt and Hess grade and Fisher classification. PMID:9046303

  11. Method for noninvasive intracranial pressure measurement

    SciTech Connect

    Sinha, Dipen N.

    2000-01-01

    An ultrasonic-based method for continuous, noninvasive intracranial pressure (ICP) measurement and monitoring is described. The stress level in the skull bone is affected by pressure. This also changes the interfacial conditions between the dura matter and the skull bone. Standing waves may be set up in the skull bone and the layers in contact with the bone. At specific frequencies, there are resonance peaks in the response of the skull which can be readily detected by sweeping the excitation frequency on an excitation transducer in contact with a subject's head, while monitoring the standing wave characteristics from the signal received on a second, receiving transducer similarly in contact with the subject's head. At a chosen frequency, the phase difference between the excitation signal and the received signal can be determined. This difference can be related to the intracranial pressure and changes therein.

  12. Intracranial Artery Calcification and Its Clinical Significance

    PubMed Central

    Wu, Xiao Hong; Wang, Li Juan; Wong, Ka Sing

    2016-01-01

    Intracranial arterial calcification (IAC) is an easily identifiable entity on plain head computed tomography scans. Recent studies have found high prevalence rates for IAC worldwide, and this may be associated with ischemic stroke and cognitive decline. Aging, traditional cardiovascular risk factors, and chronic kidney disease have been found to be associated with IAC. The severity of IAC can be assessed using different visual grading scales or various quantitative methods (by measuring volume or intensity). An objective method for assessing IAC using consistent criteria is urgently required to facilitate comparisons between multiple studies involving diverse populations. There is accumulating evidence from clinical studies that IAC could be utilized as an indicator of intracranial atherosclerosis. However, the pathophysiology underlying the potential correlation between IAC and ischemic stroke—through direct arterial stenosis or plaque stability—remains to be determined. More well-designed clinical studies are needed to explore the predictive values of IAC in vascular events and the underlying pathophysiological mechanisms. PMID:27165425

  13. Isolated Intracranial Rosai-Dorfman Disease

    PubMed Central

    Taufiq, Md.; Khair, Abul; Begum, Ferdousy; Akhter, Shabnam; Shamim Farooq, Md.; Kamal, Mohammed

    2016-01-01

    Background. Rosai-Dorfman disease (RDD) is a benign histiocytic proliferative disorder of unknown etiology. This rare condition commonly causes massive cervical lymphadenopathy. Intracranial RDD without any nodal involvement is extremely rare. Case Report. A young Bangladeshi male complained of bilateral complete blindness with left sided deafness for about three years. There was no lymphadenopathy. MRI and CT scan of brain suggested an inflammatory/neoplastic (?meningioma) lesion located at left parasellar region which extended frontally to encircle both optic nerves and also to left prepontine area. Histopathologically the lesion was diagnosed as RDD. The patient was treated with steroid and significant clinical improvement observed. Conclusion. The prognosis of intracranial RDD is not poor. It can be treated with surgery with or without corticosteroids, chemotherapy, and so forth. But as the condition is extremely rare and often misdiagnosed, the clinician, radiologist, and histopathologist should have a suspicion in their mind about the possibility of RDD. PMID:26949555

  14. [Therapeutic activity of gemcitabine in intracranial tumors].

    PubMed

    Stukov, A N; Filatova, L V; Latipova, D Kh; Bespalov, V G; Belyaeva, O A; Kireeva, G S; Vasilieva, I N; Alexandrov, V A; Maidin, M A; Semenov, A L; Vershinina, S F; Markochev, A B; Abduloeva, N Kh; Chubenko, V A; Semiglazova, T Yu

    2015-01-01

    Gemcitabine is known to exert a therapeutic effect on brain tumors despite the limited permeability of the blood-brain barrier (BBB). In our experimental research single intraperitoneal (i.p.) injection of gemcitabine 25 mg/kg provided increase in median survival of mice with intracranially transplanted Ehrlich carcinoma by 41-89% (p < 0.001). In this experimental model i.p. administration of gemcitabine (permeability of the BBB of less than 10%), carmustine (good permeability of the BBB), cyclophosphamide (poor permeability of the BBB) and cisplatin (doesn't penetrate through the BBB) increased median survival of mice by 88% (p < 0.001), 59% (p = 0.001), 35% (p = 0.005) and 18% (p = 0.302) respectively. Considering strong correlation between antitumor activity of the drugs (carmustine, cyclophosphamide and cisplatin) and their permeability of the BBB, efficacy of gemcitabine in intracranial tumors could be due to its wide range of therapeutic doses. PMID:26087611

  15. Ruptured, Intracranial Dermoid Cyst - A Visual Diagnosis?

    PubMed Central

    Scheer, Fabian; Andresen, Reimer

    2016-01-01

    Dermoid cysts are a very rare entity of intracranial tumours. The traumatic or non-traumatic rupture of the cyst wall is a serious complication that can be treated surgically or conservatively depending on the clinical symptoms. However, more common entities have to be considered as a differential diagnosis. We report on a female patient who was admitted with complaints of significant, prolonged headache and diffuse pain. Analysis of her blood and cerebrospinal fluid indicated no clear pathology. A CT examination of the head revealed a ruptured dermoid cyst adjacent to the left sphenoidal bone. An additional MRI was conducted to confirm the CT findings and rule out an intracranial ischemia or vasospasms. A conservative therapy was scheduled and the patient recovered well. Using current imaging techniques, especially magnetic resonance imaging, it is possible to identify a ruptured dermoid cyst by its pathognomonic signal behavior and rule out potentially life threatening complications. PMID:27190918

  16. [Intracranial arterial aneurysm in children. A cooperative study. Apropos of 43 cases].

    PubMed

    Roche, J L; Choux, M; Czorny, A; Dhellemmes, P; Fast, M; Frerebeau, P; Lapras, C; Sautreaux, J L

    1988-01-01

    This joint study describes 43 cases of intracranial arterial aneurysms in children diagnosed on the basis of clinical symptoms. In the pediatric age group, this malformation is notable because of the marked sex predilection in males (70%) and an unequal topographic incidence in the circle of Willis, where carotid artery (39.3%) and anterior communicating artery lesions (30%) predominate. The most frequent clinical sign was subarachnoid hemorrhage (81%), although symptoms caused by compression revealed the abnormality in 2.3% of patients. In this series, 11% of the patients suffered a head injury at the time of the hemorrhagic accident; this finding has been reported previously in the literature. Today, treatment is always surgical, consisting in removal of the aneurysmal sac. Surgical results are encouraging; all grade lesions considered together, 63.4% of the children were cured without any sequelae, 19.5% lost one school year but were able to lead a normal life, and 4.8% remained severely handicapped; overall postoperative mortality was 12.3%. Cerebral plasticity and tolerance of spasm in children are fundamental features of this aneurysmal pathology which partially explain the favorable results obtained with surgery. PMID:3059206

  17. Multiple Intracranial Aneurysms in HIV Infection.

    PubMed

    Dhawan, Sumeet R; Gupta, Anju; Gupta, Vivek; Singhi, Pratibha D

    2016-08-01

    Neurological findings in HIV are common and include cognitive impairment, microcephaly, nonspecific white matter lesions and seizures. Cerebral vasculopathy and stroke are uncommon and may be due to primary HIV vasculopathy or opportunistic infections such as tuberculosis and cryptococcal meningitis. The authors describe a 7-y-old boy who presented with severe headache and was detected to have aneurysmal bleed due to intracranial aneurysm. PMID:27072660

  18. Filum ependymoma mimicking spontaneous intracranial hypotension.

    PubMed

    Schievink, Wouter I; Akopov, Sergey E

    2005-05-01

    A 34-year-old man with a 2-week history of orthostatic headaches and a "dry tap" at lumbar puncture was found to have a lumbar intradural mass on magnetic resonance imaging (MRI) examination. A myxopapillary ependymoma was resected and the patient's headache completely resolved. The combination of spontaneous orthostatic headaches and a "dry tap" at the time of lumbar puncture does not always indicate the presence of a spontaneous cerebrospinal fluid (CSF) leak and intracranial hypotension. PMID:15953283

  19. A novel guide catheter enabling intracranial placement.

    PubMed

    Hurley, Michael C; Sherma, Arun K; Surdell, Daniel; Shaibani, Ali; Bendok, Bernard R

    2009-11-15

    We describe use of a novel guide, catheter with a soft and pliable, 6-cm or 12-cm distal segment that enables distal, including intracranial, placement--the Neuron guide catheter (Penumbra, San Leandro, CA)--in the treatment of 11 cases with a range of neuroendovascular lesions. We were able to advance the Neuron guide catheter to the intended level in each case and suffered no complications related to catheter spasm, dissection, thrombosis or thromboembolism. PMID:19670314

  20. Intracranial capillary hemangioma mimicking a dissociative disorder

    PubMed Central

    John, Santosh G.; Pillai, Unnikrishnan; Lacasse, Alexander

    2012-01-01

    Capillary hemangiomas, hamartomatous proliferation of vascular endothelial cells, are rare in the central nervous system (CNS). Intracranial capillary hemangiomas presenting with reversible behavioral abnormalities and focal neurological deficits have rarely been reported. We report a case of CNS capillary hemangioma presenting with transient focal neurological deficits and behavioral abnormalities mimicking Ganser's syndrome. Patient underwent total excision of the vascular malformation, resulting in complete resolution of his symptoms. PMID:24765434

  1. Intracranial Carotid Calcification on Cranial Computed Tomography

    PubMed Central

    Subedi, Deepak; Zishan, Umme Sara; Chappell, Francesca; Gregoriades, Maria-Lena; Sudlow, Cathie; Sellar, Robin

    2015-01-01

    Background and Purpose— Intracranial internal carotid artery calcification is associated with cerebrovascular risk factors and stroke, but few quantification methods are available. We tested the reliability of visual scoring, semiautomated Agatston score, and calcium volume measurement in patients with recent stroke. Methods— We used scans from a prospective hospital stroke registry and included patients with anterior circulation ischemic stroke or transient ischemic stroke whose noncontrast cranial computed tomographic scans were available electronically. Two raters measured semiautomatic quantitative Agatston score, and calcium volume, and performed qualitative visual scoring using the original 4-point Woodcock score and a modified Woodcock score, where each image on which the internal carotid arteries appeared was scored and the slice scores summed. Results— Intra- and interobserver coefficient of variations were 8.8% and 16.5% for Agatston, 8.8% and 15.5% for calcium volume, and 5.7% and 5.4% for the modified Woodcock visual score, respectively. The modified Woodcock visual score correlated strongly with both Agatston and calcium volume quantitative measures (both R2=0.84; P<0.0001); calcium volume increased by 0.47-mm/point increase in modified Woodcock visual score. Intracranial internal carotid artery calcification increased with age by all measures (eg, visual score, Spearman ρ=0.4; P=0.005). Conclusions— Visual scores correlate highly with quantitative intracranial internal carotid artery calcification measures, with excellent observer agreements. Visual intracranial internal carotid artery scores could be a rapid and practical method for epidemiological studies. PMID:26251250

  2. [Treatment of neonatal hyperbilirubinemia

    PubMed

    Carvalho, M D

    2001-07-01

    OBJECTIVE: To review the recent medical literature on the treatment of neonatal jaundice, focusing on practical aspects that are relevant to pediatricians and neonatologists. SOURCES: An extensive review of the related literature was performed, also including the authors clinical experience in this field of investigation. SUMMARY OF THE FINDINGS: Jaundice is very common among infants during the first days of life. Several factors such as maternal and neonatal history have to be considered before implementing treatment. Significant advances have been made in the past few years concerning the treatment of jaundiced newborn infants. This review focuses on three forms of treatment of neonatal hyperbilirubinemia: phototherapy, exchange transfusion and the use of drugs to reduce serum bilirubin concentration. CONCLUSIONS: Nowadays, the in-depth knowledge about the mechanism of action of phototherapy, the development of intensified phototherapy units and the use of drugs to reduce bilirubin formation, have contributed to significantly decrease the need for exchange transfusion. PMID:14676895

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

    PubMed

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

    2016-02-01

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

  4. Acute management of poor condition subarachnoid hemorrhage patients

    PubMed Central

    Eleftherios, Archavlis; Carvi y Nievas, Mario Nazareno

    2007-01-01

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

  5. Intracranial bacterial infections of oral origin.

    PubMed

    Moazzam, Alan A; Rajagopal, Sowmya M; Sedghizadeh, Parish P; Zada, Gabriel; Habibian, Mina

    2015-05-01

    Brain abscesses are rare but potentially deadly complications of odontogenic infections. This phenomenon has been described mainly in the form of case reports, as large-scale studies are difficult to perform. We compiled a total of 60 previously published cases of such a complication to investigate the predisposing factors, microbiology, and clinical outcomes of intracranial abscesses of odontogenic origin. A systematic review of the literature using the PubMed database was performed. Men accounted for 82.1% of cases, and the mean age was 42.1 years. Caries with periapical involvement and periodontitis were the two most common intra-oral sources, and wisdom tooth extraction was the most common preceding dental procedure. In 56.4% of cases, there were obvious signs of dental disease prior to development of intracranial infection. Commonly implicated microorganisms included Streptococcus viridans (especially the anginosus group), Actinomyces, Peptostreptococcus, Prevotella, Fusobacterium, Aggregatibacter actinomycetemcomitans and Eikenella corrodens. There was an 8.3% mortality rate. Intracranial abscesses can form anywhere within the brain, and appear unrelated to the side of dental involvement. This suggests that hematogenous spread is the most likely route of dissemination. PMID:25800939

  6. Gamma Knife radiosurgery for intracranial hemangioblastoma.

    PubMed

    Silva, Danilo; Grabowski, Mathew M; Juthani, Rupa; Sharma, Mayur; Angelov, Lilyana; Vogelbaum, Michael A; Chao, Samuel; Suh, John; Mohammadi, Alireza; Barnett, Gene H

    2016-09-01

    Gamma knife radiosurgery (GKRS) has become a treatment option for intracranial hemangioblastomas, especially in patients with poor clinical status and also high-risk surgical candidates. The objective of this study was to analyze clinical outcome and tumor control rates. Retrospective chart review revealed 12 patients with a total of 20 intracranial hemangioblastomas treated with GKRS from May 1998 until December 2014. Kaplan-Meier plots were used to calculate the actuarial local tumor control rates and rate of recurrence following GKRS. Univariate analysis, including log rank test and Wilcoxon test were used on the Kaplan-Meier plots to evaluate the predictors of tumor progression. Two-tailed p value of <0.05 was considered as significant. Median follow-up was 64months (2-184). Median tumor volume pre-GKRS was 946mm(3) (79-15970), while median tumor volume post-GKRS was 356mm(3) (30-5404). Complications were seen in two patients. Tumor control rates were 100% at 1year, 90% at 3years, and 85% at 5years, using the Kaplan-Meier method. There were no statistically significant univariate predictors of progression identified, although there was a trend towards successful tumor control in solid tumors (p=0.07). GKRS is an effective and safe option for treating intracranial hemangioblastoma with favorable tumor control rates. PMID:27422585

  7. Spaceflight-Induced Intracranial Hypertension: An Overview

    NASA Technical Reports Server (NTRS)

    Traver, William J.

    2011-01-01

    This slide presentation is an overview of the some of the known results of spaceflight induced intracranial hypertension. Historical information from Gemini 5, Apollo, and the space shuttle programs indicated that some vision impairment was reported and a comparison between these historical missions and present missions is included. Optic Disc Edema, Globe Flattening, Choroidal Folds, Hyperopic Shifts and Raised Intracranial Pressure has occurred in Astronauts During and After Long Duration Space Flight. Views illustrate the occurrence of Optic Disc Edema, Globe Flattening, and Choroidal Folds. There are views of the Arachnoid Granulations and Venous return, and the question of spinal or venous compliance issues is discussed. The question of increased blood flow and its relation to increased Cerebrospinal fluid (CSF) is raised. Most observed on-orbit papilledema does not progress, and this might be a function of plateau homeostasis for the higher level of intracranial pressure. There are seven cases of astronauts experiencing in flight and post flight symptoms, which are summarized and follow-up is reviewed along with a comparison of the treatment options. The question is "is there other involvement besides vision," and other Clinical implications are raised,

  8. Detection of increased intracranial pressure by ultrasound.

    PubMed

    Hightower, Stephanie; Chin, Eric J; Heiner, Jason D

    2012-01-01

    Increases in intracranial pressure (ICP) may damage the brain by compression of its structures or restriction of its blood flow, and medical providers my encounter elevated ICP in conventional and non-conventional medical settings. Early identification of elevated ICP is critical to ensuring timely and appropriate management. However, few diagnostic methods are available for detecting increased ICP in an acutely ill patient, which can be performed quickly and noninvasively at the bedside. The optic nerve sheath is a continuation of the dura mater of the central nervous system and can be viewed by ocular ultrasound. Pressure changes within the intracranial cavity affect the diameter of the optic nerve sheath. Data acquired from multiple clinical settings suggest that millimetric increases in the optic nerve sheath diameter detected via ocular ultrasound correlate with increasing levels of ICP. In this review, we discuss the use of ocular ultrasound to evaluate for the presence of elevated ICP via assessment of optic nerve sheath diameter, and describe critical aspects of this valuable diagnostic procedure. Ultrasound is increasingly becoming a medical fixture in the modern battlefield where other diagnostic modalities can be unavailable or impractical to employ. As Special Forces and other austere medical providers become increasingly familiar with ultrasound, ocular ultrasound for the assessment of increased intracranial pressure may help optimize their ability to provide the most effective medical management for their patients. PMID:23032316

  9. Neonatal herpes simplex virus.

    PubMed

    Berardi, Alberto; Lugli, Licia; Rossi, Cecilia; Maria, Chiara Laguardia; Guidotti, Isotta; Gallo, Claudio; Ferrari, Fabrizio

    2011-10-01

    Herpes simplex virus is an important cause of neonatal infection, which can lead to death or long-term disabilities. Rarely in utero, the transmission frequently occurs during delivery. The disease may be disseminated, localized to the central nervous system, or involving skin, eye and/or mouth. Mortality rates markedly decreased with high-dose antiviral treatment. Diagnosis of neonatal infection is based on viral isolation from ulcerated vesicles or by scarifying mucocutaneous lesions. Recently polymerase chain reaction plays a central role for both viral detection (skin, mucosal, cerebrospinal fluid samples) and response to therapy. Vertical transmission may be decreased by prophylactic antiviral treatment. PMID:21942600

  10. Fetomaternal Hemorrhage following Placement of an Intrauterine Pressure Catheter: Report of a New Association

    PubMed Central

    Mirza, Fadi G.; Thaker, Harshwardhan M.; Flejter, Wendy L.; D'Alton, Mary E.

    2015-01-01

    Fetomaternal hemorrhage (FMH) can be associated with significant perinatal mortality. Our review of the literature did not identify any cases of FMH following placement of an intrauterine pressure catheter (IUPC). In our case, an IUPC was inserted in a patient undergoing induction of labor at term. Fetal bradycardia ensued shortly after placement, warranting an emergent cesarean delivery. Severe neonatal anemia was identified, and evaluation of maternal blood was consistent with massive FMH. This is the first reported association between FMH and IUPC placement. If this relationship is validated in future reports, appropriate changes in clinical practice may be warranted. PMID:26417466

  11. Sonographic findings in bacterial meningitis in neonates and young infants.

    PubMed

    Yikilmaz, Ali; Taylor, George A

    2008-02-01

    Cranial sonography plays an important role in the initial evaluation of infants with suspected bacterial meningitis and in monitoring for complications of the disease. Echogenic widening of the brain sulci, meningeal thickening and hyperemia suggest the diagnosis in an at-risk population. Sonography can identify the presence of extra-axial fluid collections, and color Doppler sonography can be very helpful in differentiating benign enlargement of subarachnoid spaces from subdural effusions. Intraventricular debris and stranding, and an irregular and echogenic ependyma are highly suggestive findings associated with ventriculitis. Sonography can play an important role in the detection of postinfectious hydrocephalus, in the determination of the level of obstruction, and in the evaluation of intracranial compliance. Focal or diffuse parenchymal involvement can represent parenchymal involvement by cerebritis, infarction, secondary hemorrhage or early abscess. PMID:17611750

  12. Intraventricular hemorrhage and long-term outcome in the premature infant.

    PubMed

    Wildrick, D

    1997-10-01

    Intraventricular hemorrhage (IVH) is a common, serious problem among premature infants. With advances in neonatal care, improved survival rates of small premature infants and improved diagnostic capabilities, IVH is seen with increased frequency in the high-risk nursery. Studies indicate 15-20% of premature infants (birth weight less than 1,500 gms), have been noted to have IVH Many of these neonates survive beyond infancy and may subsequently be seen in pediatric neurosurgery and neurology clinics with long-term problems such as hydrocephalus, cerebral palsy, mental retardation and seizures. Although long-term sequelae are not always present, it is beneficial for the neuroscience nurse to be able to understand the mechanisms of brain injury with IVH in order to anticipate long-term problems and provide comprehensive follow-up care for infants and children with this diagnosis. PMID:9361998

  13. [Intracranial volume reserve assessment based on ICP pulse wave analysis].

    PubMed

    Berdyga, J; Czernicki, Z; Jurkiewicz, J

    1994-01-01

    ICP waves were analysed in the situation of expanding intracranial mass. The aim of the study was to determine how big the intracranial added volume has to be in order to produce significant changes of harmonic disturbances index (HFC) of ICP pulse waves. The diagnostic value of HFC and other parameters was compared. The following other parameters were studied: intracranial pressure (ICP), CSF outflow resistance (R), volume pressure response (VPR) and visual evoked potentials (VEP). It was found that ICP wave analysis very clearly reflects the intracranial volume-pressure relation changes. PMID:8028705

  14. Imaging and interventions in idiopathic intracranial hypertension: A pictorial essay.

    PubMed

    Sivasankar, Rajeev; Pant, Rochan; Indrajit, Inna K; Negi, Raj S; Sahu, Samresh; Hashim, P I; D'Souza, John

    2015-01-01

    Intracranial hypertension is a syndrome of elevated intracranial pressure that can be primary or secondary. The primary form, now termed idiopathic intracranial hypertension (IIH), was in the past a disease of exclusion and imaging played a limited role of excluding organic causes of raised intracranial pressure. However imaging markers have been described with patients with IIH at the orbit, sella and cerebral venous system. We wish to reiterate the characteristic imaging features of this poorly understood disease and also emphasise that stenting of the transverse sinus in select cases of IIH is an efficacious option. PMID:26752823

  15. Imaging and interventions in idiopathic intracranial hypertension: A pictorial essay

    PubMed Central

    Sivasankar, Rajeev; Pant, Rochan; Indrajit, Inna K; Negi, Raj S; Sahu, Samresh; Hashim, PI; D’Souza, John

    2015-01-01

    Intracranial hypertension is a syndrome of elevated intracranial pressure that can be primary or secondary. The primary form, now termed idiopathic intracranial hypertension (IIH), was in the past a disease of exclusion and imaging played a limited role of excluding organic causes of raised intracranial pressure. However imaging markers have been described with patients with IIH at the orbit, sella and cerebral venous system. We wish to reiterate the characteristic imaging features of this poorly understood disease and also emphasise that stenting of the transverse sinus in select cases of IIH is an efficacious option. PMID:26752823

  16. Acute Stroke and Obstruction of the Extracranial Carotid Artery Combined with Intracranial Tandem Occlusion: Results of Interventional Revascularization

    SciTech Connect

    Lescher, Stephanie Czeppan, Katja; Porto, Luciana; Singer, Oliver C.; Berkefeld, Joachim

    2015-04-15

    PurposeDue to high thrombus load, acute stroke patients with tandem obstructions of the extra- and intracranial carotid arteries or the middle cerebral artery show a very limited response to systemic thrombolysis. Interventional treatment with mechanical thrombectomy—often in combination with acute stenting of underlying atherosclerotic stenosis or dissection—is increasingly used. It has been shown that such complex interventions are technically feasible. The lack of optimal management strategies and clinical data encouraged us to review our acute stroke interventions in patient with anterior circulation tandem lesions to determine lesion patterns, interventional approaches, and angiographic or clinical outcomes.Patients and MethodsWe retrospectively analyzed a series of 39 consecutive patients with intracranial vessel occlusion of the anterior circulation simultaneously presenting with high-grade cervical internal carotid artery (ICA) stenosis or occlusion.ResultsEmergency ICA stent implantation was technically feasible in all patients, and intracranial recanalization with TICI ≥ 2b was reached in a large number of patients (64 %). Good clinical outcomes (mRS ≤ 2 at 3 months) were achieved in one third of the patients (36 %). Symptomatic hemorrhages occurred in four patients (10 %). Mortality was 10 %.ConclusionEndovascular recanalization of acute cervical carotid artery occlusion was technically feasible in all patients, and resulted in high extra- and intracranial revascularization rates. A trend for favorable clinical outcome was seen in a higher TICI score, younger age, good collateral status, and combined IV rTPA and endovascular therapy.

  17. Efficacy of Proximal Aspiration Thrombectomy for Using Balloon-Tipped Guide Catheter in Acute Intracranial Internal Carotid Artery Occlusion

    PubMed Central

    Kim, Yong-Won; Hwang, Yang-Ha; Park, Jaechan; Kim, Yong-Sun

    2016-01-01

    Objective Mechanical thrombectomy (MT) for acute intracranial internal carotid artery (ICA) occlusion is often complicated by difficult revascularization and non-involved territory embolization possibly related with larger clot-burden. This study aims to evaluate the efficacy of proximal aspiration thrombectomy (PAT) using a balloon-tipped guide catheter for clot-burden reduction in such cases with period-to-period analysis (period 1 : standard MT without PAT; period 2 : PAT first, then standard MT for the remaining occlusion). Methods Eighty-six patients who underwent MT for acute intracranial ICA occlusion were included in this analysis from the prospectively maintained stroke registry (33 patients in period 1 and 53 in period 2). In period 2, 'responder' was defined as a case where some amount of clot was retrieved by PAT and the following angiography showed partial or full recanalization. Results Fifteen of fifty-three patients in period 2 (28.3%) were 'responders' to PAT. There was a significantly higher incidence of atrial fibrillation in the 'responder' subgroup. Period 2 showed a significantly shorter puncture-to-reperfusion time (94.5 minutes vs. 56.0 minutes; p=0.002), a significantly higher Thrombolysis in Cerebral Infarction of 2b-3 reperfusion (45.5% vs. 73.6%; p=0.009), but only a trend for better 3-month favorable outcome (mRS 0–2; 36.4% vs. 54.7%; p=0.097). There was no increase in the incidence of procedure-related complications or intracranial hemorrhage in period 2. Conclusion A strategy of PAT before standard MT may result in shorter puncture-to-reperfusion time and better angiographic outcome than a strategy of standard MT for acute intracranial ICA occlusion. PMID:27446520

  18. Analysis of S100 calcium binding protein B serum levels in different types of traumatic intracranial lesions.

    PubMed

    Wolf, Harald; Frantal, Sophie; Pajenda, Gholam; Leitgeb, Johannes; Sarahrudi, Kambiz; Hajdu, Stefan

    2015-01-01

    The objective of this study was to determine whether the type of intracranial traumatic lesions, the number of simultaneous traumatic lesions, and the occurrence of skull and facial bone fractures have an influence on S100 calcium binding protein B (S100B) serum levels. Patients with blunt traumatic brain injury were prospectively enrolled into this cohort study over a period of 13 months. Venous blood samples were obtained prior to emergency cranial CT scan in all patients within 3 h after injury. The patients were then assigned into six groups: 1) concussion, 2) epidural hematoma, 3) subdural hematoma, 4) subarachnoid hemorrhage, 5) brain contusions, and 6) brain edema. The study included 1696 head trauma patients with a mean age of 57.7 ± 25.3 years, and 126 patients (8%) had 182 traumatic lesions on CT. Significant differences in S100B serum levels were found between cerebral edema and the other four bleeding groups: epidural p = 0.0002, subdural p < 0.0001, subarachnoid p = 0.0001, brain contusions p = 0.0003, and concussion p < 0.0001. Significant differences in S100B values between patients with one or two intracranial lesions (p = 0.014) or with three (p < 0.0001) simultaneous intracranial lesions were found. In patients with intracranial traumatic lesions, skull fractures, as well as skull and facial bone fractures occurring together, were identified as significant additional factors for the increase in serum S100B levels (p < 0.0001). Older age was also associated with elevated S100B serum levels (p < 0.0001). Our data show that peak S100B serum levels were found in patients with cerebral edema and brain contusions. PMID:25068442

  19. Scrotal Swelling in the Neonate

    PubMed Central

    Basta, Amaya M.; Courtier, Jesse; Phelps, Andrew; Copp, Hillary L.; MacKenzie, John D.

    2016-01-01

    Discovery of scrotal swelling in a neonate can be a source of anxiety for parents, clinicians, and sonologists alike. This pictorial essay provides a focused review of commonly encountered scrotal masses and mimics specific to the neonatal setting. Although malignancy is a concern, it is very uncommon, as most neonatal scrotal masses are benign. Key discriminating features and management options are highlighted to improve the radiologist’s ability to diagnose neonatal scrotal conditions and guide treatment decisions. Neonatal scrotal processes ranging from common to uncommon will be discussed. PMID:25715370

  20. [Neonatal morbidity and hospital mortality of preterm triplets.

    PubMed

    Lamshing-Salinas, Priscilla; Rend Ón-Macías, Mario Enrique; Iglesias-Leboreiro, José; Bernárdez-Zapata, Isabel; Braverman-Bronstein, Ariela

    2013-01-01

    Background: multiple gestations have caused an increase in vulnerable preterm births. Our objective was to analyze neonatal morbidity and mortality in preterm triplets. Methods: we analyzed a cohort of 30 triplets in an obstetrics and gynecology hospital. Data were obtained during pregnancy, childbirth and neonatal period: birth order, sex, weight, height, malformations, advanced resuscitation, assisted ventilation, intraventricular hemorrhage, necrotizing enterocolitis, sepsis, pulmonary hypertension, bronchopulmonary dysplasia, days of hospitalization, and death. Results: 90 infants were analyzed. There was an omphalopagus con-joined twins case; 42 (70 %) had between 30-33 weeks and six between 24-29; 19 (21 %) had low weight for gestational age, and 18 (30 %) had a major malformation; 27 % required ventilatory support, 33 % sepsis, 32 % necrotizing enterocolitis, 21 % pulmonary hypertension, 14 % bronchopulmonary dysplasia and 2 % intraventricular hemorrhage, without statistically significant differences related to the order, presentation at birth, sex and number of placentas and amniotic sacs. Eight 24-week triplets died, four over 28 weeks, and a siamese (p = 38). There was no difference in hospital days between triplets. Conclusions: the triplets mortality is low and mainly associated with extreme prematurity, intrauterine growth restriction and sepsis. PMID:24290011

  1. Spontaneous Retroperitoneal Hemorrhage from Adrenal Artery Aneurysm

    SciTech Connect

    Gonzalez Valverde, F.M. Balsalobre, M.; Torregrosa, N.; Molto, M.; Gomez Ramos, M.J.; Vazquez Rojas, J.L.

    2007-04-15

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

  2. Spontaneous bilateral adrenal hemorrhage following cholecystectomy

    PubMed Central

    Dahan, Meryl; Lim, Chetana; Salloum, Chady

    2016-01-01

    Postoperative bilateral adrenal hemorrhage is a rare but potentially life-threatening complication. This diagnosis is often missed because the symptoms and laboratory results are usually nonspecific. We report a case of bilateral adrenal hemorrhage associated with acute primary adrenal insufficiency following laparoscopic cholecystectomy. The knowledge of this uncommon complication following any abdominal surgery allows timey diagnosis and rapid treatment. PMID:27275469

  3. Epizootic hemorrhagic disease in a yak

    PubMed Central

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

    2014-01-01

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

  4. Bullous hemorrhagic dermatosis induced by enoxaparin.

    PubMed

    Gouveia, Ana Isabel; Lopes, Leonor; Soares-Almeida, Luis; Filipe, Paulo

    2016-06-01

    The bullous hemorrhagic dermatosis induced by enoxaparin is a rare adverse reaction, which may be under-reported given its favorable evolution. We report a 71-year-old man who developed hemorrhagic bullae at sites distant from subcutaneous enoxaparin injections. It is important that clinicians be aware of the different adverse reactions of these widely used drugs. PMID:25942690

  5. Diffuse Alveolar Hemorrhage Associated with Warfarin Therapy

    PubMed Central

    Kaya, Bülent; Yildiz, Ibrahim; Baha, Reshat Mehmet; Zeytun, Neslihan Ebru Eryaşar; Yetisgen, Azize

    2015-01-01

    Diffuse alveolar hemorrhage (DAH) is a life-threatening clinical pathologic syndrome caused by a variety of diseases. We report a case of DAH related to therapy of warfarin use. In this case report, we present the diffuse alveolar hemorrhage case as a rare and life-threatening complication of warfarin. PMID:26347781

  6. Macrovascular Lesions Underlying Spontaneous Intracerebral Hemorrhage.

    PubMed

    Yeung, Jacky; Cord, Branden J; O'Rourke, Timothy K; Maina, Renee M; Sommaruga, Samuel; Matouk, Charles C

    2016-06-01

    Spontaneous intracerebral hemorrhage (ICH) is a morbid disease with a high case fatality rate. Prognosis, rehemorrhage rates, and acute, clinical decision making are greatly affected by the underlying etiology of hemorrhage. This review focuses on the evaluation, diagnosis, and management of structural, macrovascular lesions presenting with ICH, including ruptured aneurysms, brain arteriovenous malformations, cranial dural arteriovenous fistulas, and cerebral cavernous malformations. PMID:27214699

  7. [Hemorrhagic complications during warfarin treatment].

    PubMed

    Gumulec, J; Kessler, P; Penka, M; Klodová, D; Králová, S; Brejcha, M; Wróbel, M; Sumná, E; Blatný, J; Klaricová, K; Riedlová, P; Lasota, Z

    2006-03-01

    Bleeding is probably the major complication of anticoagulant treatment with vitamin K antagonists represented nowadays mostly by warfarin in the Czech Republic. The main risk factors in hemorrhagic complications of warfarinisation are the intensity and instability of the anticoagulant treatment, individual patient characteristics, warfarin interactions with other drugs and the length of the anticoagulant therapy. Severe bleeding in warfarin patients is most effectively brought about by a fast and complete undoing of the anticoagulation effect of the drug employing the prothrombin complex concentrate and slow i.v. vitamin K1 infusion regardless of the reason for the anticoagulation. This approach can secure the minimalisation of the bleeding's negative consequences. A less severe bleeding or asymptomatic increase in the international normalized ratio can be treated effectively by skipping or decreasing of the warfarin dosage and/or oral administration of vitamin K1 (i.v. administration only in selected higher risk cases) that does result only in a partial consolidation of coagulopathy but of such type that the risk of thrombotic event requires. The article's goal is to contribute to the treatment standardization in patients with warfarin overdose and/or with hemorrhagic complications due to warfarin treatment and it is available at www.thrombosis.cz. The guidelines include a ready-reference chart whose objective is immediate and quick crash course in the clinical practice. PMID:16637455

  8. [Treatment alternatives in massive hemorrhage].

    PubMed

    Fernández-Hinojosa, E; Murillo-Cabezas, F; Puppo-Moreno, A; Leal-Noval, S R

    2012-10-01

    Massive hemorrhage is the main cause of mortality and morbidity in trauma patients, and is one of the most important causes in any patient following major surgery. Conventional treatment consists of volume replacement, including the transfusion of blood products, so that tissue perfusion and oxygenation may be maintained. Associated hypothermia, acidosis and coagulopathy is a lethal triad. This review focuses on the latest therapeutic management of massive hemorrhage. The authors advocate the use of crystalloids as per protocol (controlled volumes) in order to achieve a systolic blood pressure of 85mmHg. The administration of the three blood products (red cells, plasma, and platelets) should be on a 1:1:1 basis. Where possible, this in turn should be guided by thromboelastography performed at point of care near the patient. Coagulopathy can occur early and late. With the exception of tranexamic acid, the cost-benefit relationships of the hemostatic agents, such as fibrinogen, prothrombin complex, and recombinant F VII, are subject to discussion. PMID:22321860

  9. Subchorionic hemorrhage treatment with dydrogesterone.

    PubMed

    Pelinescu-Onciul, Dimitrie

    2007-10-01

    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

  10. Phase Contrast Imaging in Neonates

    PubMed Central

    Zhong, Kai; Ernst, Thomas; Buchthal, Steve; Speck, Oliver; Anderson, Lynn; Chang, Linda

    2011-01-01

    Magnetic resonance phase images can yield superior gray and white matter contrast compared to conventional magnitude images. However, the underlying contrast mechanisms are not yet fully understood. Previous studies have been limited to high field acquisitions in adult volunteers and patients. In this study, phase imaging in the neonatal brain is demonstrated for the first time. Compared to adults, phase differences between gray and white matter are significantly reduced but not inverted in neonates with little myelination and iron deposits in their brains. The remaining phase difference between the neonatal and adult brains may be due to different macromolecule concentration in the unmyelinated brain of the neonates and thus different frequency due to water macromolecule exchange. Additionally, the susceptibility contrast from brain myelination can be separately studied in neonates during brain development. Therefore, magnetic resonance phase imaging is suggested as a novel tool to study neonatal brain development and pathologies in neonates. PMID:21232619

  11. [Recommendations for neonatal transport].

    PubMed

    Moreno Hernando, J; Thió Lluch, M; Salguero García, E; Rite Gracia, S; Fernández Lorenzo, J R; Echaniz Urcelay, I; Botet Mussons, F; Herranz Carrillo, G; Sánchez Luna, M

    2013-08-01

    During pregnancy, it is not always possible to identify maternal or foetal risk factors. Infants requiring specialised medical care are not always born in centres providing intensive care and will need to be transferred to a referral centre where intensive care can be provided. Therefore Neonatal Transport needs to be considered as part of the organisation of perinatal health care. The aim of Neonatal Transport is to transfer a newborn infant requiring intensive care to a centre where specialised resources and experience can be provided for the appropriate assessment and continuing treatment of a sick newborn infant. Intrauterine transfer is the ideal mode of transport when the birth of an infant with risk factors is diagnosed. Unfortunately, not all problems can be detected in advance with enough time to safely transfer a pregnant woman. Around 30- 50% of risk factors will be diagnosed during labour or soon after birth. Therefore, it is important to have the knowledge and resources to resuscitate and stabilise a newborn infant, as well as a specialised neonatal transport system. With this specialised transport it is possible to transfer newly born infants with the same level of care that they would receive if they had been born in a referral hospital, without increasing their risks or affecting the wellbeing of the newborn. The Standards Committee of the Spanish Society of Neonatology reviewed and updated recommendations for intrauterine transport and indications for neonatal transfer. They also reviewed organisational and logistic factors involved with performing neonatal transport. The Committee review included the type of personnel who should be involved; communication between referral and receiving hospitals; documentation; mode of transport; equipment to stabilise newly born infants; management during transfer, and admission at the referral hospital. PMID:23434016

  12. Maternal, neonatal and community factors influencing neonatal mortality in Brazil.

    PubMed

    Machado, Carla Jorge; Hill, Kenneth

    2005-03-01

    Child mortality (the mortality of children less than five years old) declined considerably in the developing world in the 1990s, but infant mortality declined less. The reductions in neonatal mortality were not impressive and, as a consequence, there is an increasing percentage of infant deaths in the neonatal period. Any further reduction in child mortality, therefore, requires an understanding of the determinants of neonatal mortality. 209,628 birth and 2581 neonatal death records for the 1998 birth cohort from the city of São Paulo, Brazil, were probabilistically matched. Data were from SINASC and SIM, Information Systems on Live Births and Deaths of Brazil. Logistic regression was used to find the association between neonatal mortality and the following risk factors: birth weight, gestational age, Apgar scores at 1 and 5 minutes, delivery mode, plurality, sex, maternal education, maternal age, number of prior losses, prenatal care, race, parity and community development. Infants of older mothers were less likely to die in the neonatal period. Caesarean delivery was not found to be associated with neonatal mortality. Low birth weight, pre-term birth and low Apgar scores were associated with neonatal death. Having a mother who lives in the highest developed community decreased the odds of neonatal death, suggesting that factors not measured in this study are behind such association. This result may also indicate that other factors over and above biological and more proximate factors could affect neonatal death. PMID:15768774

  13. Predictors of outcome in childhood intracerebral hemorrhage: a prospective consecutive cohort study

    PubMed Central

    Beslow, Lauren A; Licht, Daniel J; Smith, Sabrina E; Storm, Phillip B; Heuer, Gregory G; Zimmerman, Robert A; Feiler, Alana M; Kasner, Scott E; Ichord, Rebecca N; Jordan, Lori C

    2010-01-01

    Background and Purpose To describe features of children with intracerebral hemorrhage (ICH) and to determine predictors of short-term outcome in a single-center prospective cohort study. Methods Single-center prospective consecutive cohort study of spontaneous ICH in children age 1-18 years from January 2006 to June 2008. Exclusion criteria were inciting trauma; intracranial tumor; isolated epidural, subdural, intraventricular, or subarachnoid hemorrhage; hemorrhagic transformation of ischemic stroke; and cerebral sinovenous thrombosis. Hospitalization records were abstracted. Follow-up assessments included outcome scores using the Pediatric Stroke Outcome Measure (PSOM) and King's Outcome Scale for Childhood Head Injury (KOSCHI). ICH volumes and total brain volumes (TBV) were measured by manual tracing. Results Twenty-two patients, median age of 10.3 years (range 4.2-16.6 years), had presenting symptoms of headache in 77%, focal deficits 50%, altered mental status 50%, and seizures 41%. Vascular malformations caused hemorrhage in 91%. Surgical treatment (hematoma evacuation, lesion embolization or excision) was performed during acute hospitalization in 50%. One patient died acutely. At median follow-up of 3.5 months (range 0.3-7.5 months), 71% of survivors had neurological deficits; 55% had clinically significant disability. Outcome based on PSOM and KOSCHI scores was worse in patients with ICH volume >2% of TBV (p=0.023) and altered mental status at presentation (p = 0.005). Conclusions Spontaneous childhood ICH was due mostly to vascular malformations. Acute surgical intervention was commonly performed. Although death was rare, 71% of survivors had persisting neurological deficits. Larger ICH volume and altered mental status predicted clinically significant disability. PMID:20019325

  14. Elevated Cellular Retinoic Acid Binding Protein-I in Cerebrospinal Fluid of Patients with Hemorrhagic Cerebrovascular Diseases : Preliminary Study

    PubMed Central

    Jeon, Jin Pyeong; Cho, Won-Sang; Kang, Hyun-Seung; Kim, Seung-Ki; Oh, Chang Wan

    2015-01-01

    Objective Elevated cellular retinoic acid binding protein-I (CRABP-I) is thought to be related to the abnormal proliferation and migration of smooth muscle cells (SMCs). Accordingly, a higher CRABP-I level could cause disorganized vessel walls by causing immature SMC phenotypes and altering extracellular matrix proteins which could result in vulnerable arterial walls with inadequate responses to hemodynamic stress. We hypothesized that elevated CRABP-I level in the cerebrospinal fluid (CSF) could be related to subarachnoid hemorrhage (SAH). Moreover, we also extended this hypothesis in patients with vascular malformation according to the presence of hemorrhage. Methods We investigated the CSF of 26 patients : SAH, n=7; unruptured intracranial aneurysm (UIA), n=7; arteriovenous malformation (AVM), n=4; cavernous malformation (CM), n=3; control group, n=5. The optical density of CRABP-I was confirmed by Western blotting and presented as mean±standard error of the measurement. Results CRABP-I in SAH (0.33±0.09) was significantly higher than that in the UIA (0.12±0.01, p=0.033) or control group (0.10±0.01, p=0.012). Hemorrhage presenting AVM (mean 0.45, ranged 0.30-0.59) had a higher CRABP-I level than that in AVM without hemorrhage presentation (mean 0.16, ranged 0.14-0.17). The CRABP-I intensity in CM with hemorrhage was 0.21 and 0.31, and for CM without hemorrhage 0.14. Overall, the hemorrhage presenting group (n=11, 0.34±0.06) showed a significantly higher CRABP-I intensity than that of the non-hemorrhage presenting group (n=10, 0.13±0.01, p=0.001). Conclusion The results suggest that elevated CRABP-I in the CSF could be related with aneurysm rupture. Additionally, a higher CRABP-I level seems to be associated with hemorrhage development in vascular malformation. PMID:25733988

  15. Platelet interaction within giant intracranial aneurysms

    SciTech Connect

    Sutherland, G.R.; King, M.E.; Peerless, S.J.; Vezina, W.C.; Brown, G.W.; Chamberlain, M.J.

    1982-01-01

    Turbulence within intracranial aneurysms may result in tearing of the aneurysmal wall, exposing the subendothelial matrix to circulating platelets. In this study, platelet interaction in giant intracranial aneurysms was evaluated by a dual-isotope technique employing In-labeled platelets and Tc-labeled red blood cells. The use of two isotopes allows the subtraction of the blood pool and the calculation of the ratio indium deposited:indium blood pool (In(D)/In(BP)). A ratio greater than zero indicates platelet deposition within aneurysm. Thirteen patients were evaluated in this way, with platelet deposition demonstrated in six. In these six patients, the ratio In(D)/In(BP) was found to be significantly elevated, with a mean value of 0.96 +/- 0.65. Three of these six patients has symptoms of recurrent transient neurological deficits; one of these three suffered a complete stroke following documentation of platelet deposition. In this case, the aneurysm was obtained at surgery and was found to contain intraluminal platelet aggregation when viewed by scanning electron microscopy. In the remaining seven patients, the ratio IN(D)/In(BP) was found not to be significantly elevated (mean -0.03 and/- 0.06), indicating the absence of active platelet deposition. Two of these patients had prior symptoms of cerebral ischemia; one of these was found to have an ulcer in the ipsilateral internal carotid artery which was probably responsible for thromboembolic events to the hemisphere. The authors conclude that platelet aggregation occurs more frequently than previously recognized in giant intracranial aneurysms, and their data substantiate the hypothesis that platelet metabolic products or thrombi originating from a large aneurysm may embolize to distal cerebral vessels.

  16. Intracranial subdural hygroma after Le Fort I osteotomy.

    PubMed

    Thompson, William L; Lee, Michael; MacIntosh, Robert Bruce

    2015-04-01

    Various intra- and postoperative complications have been well-documented after Le Fort I osteotomies; however, an intracranial subdural hygroma has not yet been reported in oral and maxillofacial studies. We report a unique case of an intracranial subdural hygroma requiring neurosurgical intervention after Le Fort I advancement. PMID:25631863

  17. Intracranial hypertension secondary to a skull lesion without mass effect.

    PubMed

    Serlin, Yonatan; Benifla, Mony; Kesler, Anat; Cohen, Avi; Shelef, Ilan

    2016-09-01

    We report and discuss five patients with intracranial hypertension due to a skull lesion reducing cerebral sinus patency with a compressive, non-thrombotic mechanism. We illustrate the importance of a high level of suspicion for this condition in patients presenting with headache, papilledema and increased intracranial pressure in the absence of focal signs or radiological evidence of mass effect. PMID:27283387

  18. A Practical Approach to the Diagnosis of Spontaneous Intracranial Hypotension.

    PubMed

    Steenerson, Kristen; Halker, Rashmi

    2015-08-01

    Spontaneous intracranial hypotension can be difficult to diagnose as there are a number of tests available and knowing how to appropriately choose amongst them is not always easy. In this article, we will review the available diagnostic options and provide a practical approach to the workup of a patient with suspected intracranial hypotension. PMID:26077206

  19. [Intracranial tumors and epileptic seizures: treatment principles].

    PubMed

    Rossetti, Andrea O; Vulliémoz, Serge

    2016-04-27

    Epileptic seizures represent a relatively frequent issue in patients with intracranial neoplasms, and very frequently imply the start of an antiepileptic treatment as secondary prophylaxis. Even if the current level of evidence is relatively low, compounds with a limited risk of pharmacokinetic interactions are clearly preferred. Levetiracetam is probably the most prescribed agent in this setting, while pregabalin, valproate, lacosamide and lamotrigine are valuable alternatives. The treatment choice has to consider the different profiles of side effects and should be tailored to each patient. In this setting, a multidisciplinary approach including general practicioner, oncologist and neurologist is strongly advocated. PMID:27281943

  20. Clarithromycin Culprit of Benign Intracranial Hypertension

    PubMed Central

    Khan, Habib Rehman; Mason, Colin; Mulcahy, Riona

    2015-01-01

    Benign intracranial hypertension is characterized with increase in CSF opening pressure with no specific etiology. It is predominantly found in women of child bearing age and particularly in individuals with obesity. Visual disturbances or loss and associated headaches are common and can lead to blindness if left untreated. Diagnosis can be achieved once other causes of visual loss, headaches and high opening pressures are excluded. Management consists of serial optic disc assessments although no specific treatment is available despite recent trials using carbonic anhydrase inhibitors. Diet modification and weight management can help in therapy. PMID:26713029