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Sample records for acute subarachnoid haemorrhage

  1. Acute subarachnoid haemorrhage and the mysterious ...

    African Journals Online (AJOL)

    Subarachnoid haemorrhage (SAH) is a devastating neurological insult, and is increasingly understood as a multi-system condition initiated in the central nervous system. Perioperative investigation of patients presenting for aneurysm surgery often includes a routine electrocardiogram (ECG) which frequently reveals an ...

  2. Acute neck pain, an atypical presentation of subarachnoid haemorrhage

    OpenAIRE

    Ahmed, Julian; Blakeley, Chris; Sakar, Ramy; Aktar, Khalida; Hashemi, Kambiz

    2007-01-01

    Subarachnoid haemorrhage can be a massively debilitating condition with long‐term repercussions. The “classic” presentation of sudden‐onset severe headache normally raises suspicions. However, if the presentation is atypical, the diagnosis may be missed. We report on a 52‐year‐old man who presented with a 1‐day history of progressively worsening right‐sided neck pain spreading to the chest with associated symptoms of autonomic dysfunction. After initial stabilisation, the patient's Glasgow Co...

  3. Considerable delay in diagnosis and acute management of subarachnoid haemorrhage

    DEFF Research Database (Denmark)

    Larsen, Carl Christian; Eskesen, Vagn; Hauerberg, John

    2010-01-01

    Rebleeding from subarachnoid haemorrhage (SAH) usually occurs within the first six hours after the initial bleeding. Rebleeding can be prevented effectively with tranexamic acid (TXA). Although a broad consensus has evolved that SAH should be treated as an emergency, it is likely that delays do e...... exist in the diagnosis and treatment of SAH patients. The aim of this study was to prospectively assess the interval between symptom onset, emergency room (ER) admission, initial diagnosis and treatment, and final closure of the aneurysm....

  4. Subarachnoid Haemorrhage and Sports

    Directory of Open Access Journals (Sweden)

    Liliana Sousa Nanji

    2015-11-01

    Full Text Available Background: Some cases of subarachnoid haemorrhage (SAH have been associated with vigorous physical activity, including sports. Our research aimed to describe the association between SAH and sports and to identify the types of sports that were more frequently found as precipitating factors in a tertiary single-centre SAH register. Methods: We retrieved information from a prospectively collected SAH registry and reviewed discharge notes of acute SAH patients admitted to the Stroke Unit of Hospital de Santa Maria, Lisbon, between 1995 and 2014. Results: Out of 738 patients included in the analysis, 424 (57.5% cases of SAH were preceded by physical activity. Nine cases (1.2% were associated with sports, namely running (2 cases, aerobics (2 cases, cycling, body balance, dance, surf and windsurf. Patients with SAH while practicing sports were younger than controls (average age 43.1 vs. 57.0 years; p = 0.007. In 1 patient, there was a report of trauma to the neck. Patients in the sports group only had Hunt and Hess scale grades 1 (11.1% or 2 (88.9% at admission, while patients in the control group had a wider distribution in severity. Conclusions: Our findings indicate that SAH precipitated by sports is not very frequent and is uncommonly related to trauma. Patients who suffered SAH associated with sports were younger and apparently had a milder clinical presentation.

  5. Subarachnoid Haemorrhage and Sports.

    Science.gov (United States)

    Sousa Nanji, Liliana; Melo, Teresa P; Canhão, Patrícia; Fonseca, Ana Catarina; Ferro, José Manuel

    2015-01-01

    Some cases of subarachnoid haemorrhage (SAH) have been associated with vigorous physical activity, including sports. Our research aimed to describe the association between SAH and sports and to identify the types of sports that were more frequently found as precipitating factors in a tertiary single-centre SAH register. We retrieved information from a prospectively collected SAH registry and reviewed discharge notes of acute SAH patients admitted to the Stroke Unit of Hospital de Santa Maria, Lisbon, between 1995 and 2014. Out of 738 patients included in the analysis, 424 (57.5%) cases of SAH were preceded by physical activity. Nine cases (1.2%) were associated with sports, namely running (2 cases), aerobics (2 cases), cycling, body balance, dance, surf and windsurf. Patients with SAH while practicing sports were younger than controls (average age 43.1 vs. 57.0 years; p = 0.007). In 1 patient, there was a report of trauma to the neck. Patients in the sports group only had Hunt and Hess scale grades 1 (11.1%) or 2 (88.9%) at admission, while patients in the control group had a wider distribution in severity. Our findings indicate that SAH precipitated by sports is not very frequent and is uncommonly related to trauma. Patients who suffered SAH associated with sports were younger and apparently had a milder clinical presentation.

  6. Bilateral Wyburn-Mason Syndrome presenting as acute subarachnoid haemorrhage - a very rare congenital neurocutaneuos disorder

    DEFF Research Database (Denmark)

    Cortnum, Søren Ole Stigaard; Sørensen, Preben; Andresen, J

    2008-01-01

    . Wyburn-Mason syndrome is a very rare congenital neurocutaneuos disorder comprising of vascular malformations of the retina, ipsilateral cerebral AVMs and occasionally lesions in the oronasopharyngeal area. Subarachnoid haemorrhage associated with Wyburn-Mason syndrome has been described in only 5...

  7. Subarachnoid haemorrhage imitating acute coronary syndrome as a cause of out-of-hospital cardiac arrest - case report.

    Science.gov (United States)

    Lewandowski, Paweł

    2014-01-01

    Severe subarachnoid haemorrhage (SAH) is a common cause of cardiac arrest. The survival of patients with out-of-hospital cardiac arrest (OHCA) due to SAH is extremely poor. Electrocardiographic and echocardiographic changes associated with SAH may mimic changes caused by acute coronary syndromes (ACS) and thus lead to delayed treatment of the primary disease. Misdiagnosed SAH due to ACS mask can have an influence on patient outcomes. A 47-year-old man presented with a history of out-of-hospital cardiac arrest due to asystole. He had a medical history of hypertension, smoking, and a diffuse, severe headache for one week. The ECG showed atrial fibrillation, 0,2 mV ST-segment elevation in leads aVR and V1-V3 and 0.2 mV ST-segment depression in leads I, II, aVL and V4-V6. Echocardiography revealed left ventricular function impairment (ejection fraction < 20%). The CK-MB activity was 98 U L⁻¹ and the troponin I concentration was 0.59 μg L⁻¹. ACS was suspected. Coronarography did not reveal any changes in the coronary arteries. An urgent CT of the head was arranged and showed an extensive SAH. It appears that an urgent CT of the head is the most effective method for the early identification of SAH-induced OHCA, especially in patients with prodromal headache, no history of the symptoms of ACS and CA due to asystole/pulseless electrical activity (PEA). Out-of-hospital cardiac arrest (OHCA) predominantly develops due to acute coronary syndrome (ACS). Extra-cardiac causes, e.g., subarachnoid haemorrhage (SAH), are less common. The purpose of the present case report was to describe a patient with OHCA due to subarachnoid haemorrhage imitating acute coronary syndrome.

  8. Acute Headache at Emergency Department: Reversible Cerebral Vasoconstriction Syndrome Complicated by Subarachnoid Haemorrhage and Cerebral Infarction

    Directory of Open Access Journals (Sweden)

    M. Yger

    2015-01-01

    Full Text Available Introduction. Reversible cerebral vasoconstriction syndrome is becoming widely accepted as a rare cause of both ischemic and haemorrhagic stroke and should be evocated in case of thunderclap headaches associated with stroke. We present the case of a patient with ischemic stroke associated with cortical subarachnoid haemorrhage (cSAH and reversible diffuse arteries narrowing, leading to the diagnosis of reversible vasoconstriction syndrome. Case Report. A 48-year-old woman came to the emergency department because of an unusual thunderclap headache. The computed tomography of the brain completed by CT-angiography was unremarkable. Eleven days later, she was readmitted because of a left hemianopsia. One day after her admission, she developed a sudden left hemiparesis. The brain MRI showed ischemic lesions in the right frontal and occipital lobe and diffuse cSAH. The angiography showed vasoconstriction of the right anterior cerebral artery and stenosis of both middle cerebral arteries. Nimodipine treatment was initiated and vasoconstriction completely regressed on day 16 after the first headache. Conclusion. Our case shows a severe reversible cerebral vasoconstriction syndrome where both haemorrhagic and ischemic complications were present at the same time. The history we reported shows that reversible cerebral vasoconstriction syndrome is still underrecognized, in particular in general emergency departments.

  9. Magnesium in subarachnoid haemorrhage: proven beneficial?

    NARCIS (Netherlands)

    van den Bergh, Walter M.

    2009-01-01

    Subarachnoid haemorrhage (SAH) caused by a ruptured aneurysm accounts for only 5% of strokes, but occurs at a fairly young age and carries a worse prognosis. Delayed cerebral ischaemia (DCI) is an important cause of death and dependence after aneurysmal subarachnoid haemorrhage. The current mainstay

  10. Risk of subarachnoid haemorrhage in first degree relatives of patients with subarachnoid haemorrhage

    DEFF Research Database (Denmark)

    Gaist, D; Vaeth, M; Tsiropoulos, I

    2000-01-01

    . SUBJECTS: Incident cases of subarachnoid haemorrhage admitted to hospital from 1977 to 1995 (9367 patients) and their first degree relatives (14 781). MAIN OUTCOME MEASURES: The incidence rate of subarachnoid haemorrhage was determined for the relatives and compared with that of the entire population...

  11. Magnesium and headache after aneurysmal subarachnoid haemorrhage

    NARCIS (Netherlands)

    Dorhout Mees, S. M.; Bertens, D.; van der Worp, H. B.; Rinkel, G. J. E.; van den Bergh, W. M.

    2010-01-01

    BACKGROUND: In patients with aneurysmal subarachnoid haemorrhage (SAH), headache typically is severe and often requires treatment with opioids. Magnesium has analgesic effects in several conditions, but whether it reduces headache after SAH is unknown. METHODS: In a cohort of 108 SAH patients

  12. Antithrombotic drugs and subarachnoid haemorrhage risk

    DEFF Research Database (Denmark)

    Pottegård, A; García Rodríguez, L A; Poulsen, F R

    2015-01-01

    The study objective was to investigate the relationship between use of antithrombotic drugs and subarachnoid haemorrhage (SAH). We identified patients discharged from Danish neurosurgery units with a first-ever SAH diagnosis in 2000 to 2012 (n=5,834). For each case, we selected 40 age-, sex...

  13. Late cerebral ischaemia after subarachnoid haemorrhage

    DEFF Research Database (Denmark)

    Edvinsson, L; Povlsen, G K

    2011-01-01

    Late cerebral ischaemia after subarachnoid haemorrhage (SAH) carries high morbidity and mortality because of reduced cerebral blood flow (CBF) and subsequent cerebral ischaemia. This is associated with upregulation of contractile receptors in cerebral artery smooth muscles via the activation...... their sensitivity to endogenous agonists such as ET-1 and 5-HT by increasing their smooth muscle expression of receptors for these after SAH. This is associated with reduced CBF and neurological deficits. A number of signal transduction components mediating this receptor upregulation have been identified, including...

  14. Transcranial Doppler velocimetry in aneurysmal subarachnoid haemorrhage

    DEFF Research Database (Denmark)

    Staalsø, J M; Edsen, T; Romner, B

    2013-01-01

    BACKGROUND: /st>Transcranial Doppler measurements of the middle cerebral artery flow velocity are widely used as an indicator of vasospasm after aneurysmal subarachnoid haemorrhage (SAH). We investigated inter- and intraoperator agreement in SAH patients and healthy volunteers using colour......-coded transcranial Doppler (TCCD), with the secondary aim of describing prediction of angiographic vasospasm and mortality. METHODS: /st>Sixty patients and 70 healthy controls were each examined in duplicate by alternating operators. A total of 939 measurements divided on 201 examination sets were conducted by four...

  15. Subarachnoid Haemorrhage: epidemiological studies on aetiology and outcome

    NARCIS (Netherlands)

    R. Risselada (Roelof)

    2010-01-01

    textabstractSubarachnoid haemorrhage (SAH) is bleeding into the subarachnoid space ‒ the area between the arachnoid membrane and the pia mater surrounding the brain. SAH occurs spontaneously or can be caused by traumatic injury of the head. Spontaneous SAH is caused by rupture of an intracranial

  16. Coping strategies in patients following subarachnoid haemorrhage.

    Science.gov (United States)

    Tomberg, T; Orasson, A; Linnamägi, U; Toomela, A; Pulver, A; Asser, T

    2001-09-01

    To assess psychological coping strategies and their relationship with outcome in patients after primary subarachnoid haemorrhage (SAH). In 51 unselected patients (24 males, 27 females; mean age 46 years) in an average 15.7+/-12.0 months after SAH usage of coping strategies were assessed by means of Estonian COPE-D test with 15 four-items scales and compared to those obtained from 51 age-, sex- and education-matched healthy persons. The data were analysed according to age, sex and education of the patients, initial severity of disease, localization of aneurysm and outcome characteristics. Patients after SAH reported using social support strategy less than control persons (Pcoping styles were less used (Pdisability and dependence in daily living. Healthy women used social support more than men; patients and control persons 50 years or older used task-oriented strategies less than younger persons (Pcoping strategies used by patients after SAH differs compared to healthy persons. The differences in using coping strategies are related to age of the patients, functional state and degree of adaptation after SAH.

  17. Xanthochromia after subarachnoid haemorrhage needs no revisitation.

    Science.gov (United States)

    Vermeulen, M; Hasan, D; Blijenberg, B G; Hijdra, A; van Gijn, J

    1989-01-01

    Recently it was contended that it is bloodstained cerebrospinal fluid (CSF) that is important in the diagnosis of subarachnoid haemorrhage (SAH) and not xanthochromia, and also that a normal CT scan and the absence of xanthochromia in the CSF do not exclude a ruptured intracranial aneurysm. The CSF findings were therefore reviewed of 111 patients with a proven SAH. All patients had xanthochromia of the CSF. Lumbar punctures were performed between 12 hours and one week after the ictus. Xanthochromia was still present in all (41) patients after 1 week, in all (32) patients after 2 weeks, in 20 of 22 patients after three weeks and in 10 of 14 patients after four weeks. In six years we identified only 12 patients with sudden headache, normal CT, bloodstained CSF, and no xanthochromia. Angiography was carried out in three and was negative. All 12 patients survived without disability and were not re-admitted with a SAH (mean follow up 4 years). It is concluded that it is still xanthochromia that is important in the diagnosis of SAH and not bloodstained CSF. Furthermore a normal CT scan and the absence of xanthochromia do exclude a ruptured aneurysm, provided xanthochromia is investigated by spectrophotometry and lumbar puncture is carried out between 12 hours and 2 weeks after the ictus. PMID:2769274

  18. Evaluation of a metal artifact reduction algorithm applied to post-interventional flat detector CT in comparison to pre-treatment CT in patients with acute subarachnoid haemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Mennecke, Angelika; Svergun, Stanislav; Doerfler, Arnd; Struffert, Tobias [University of Erlangen-Nuremberg, Department of Neuroradiology, Erlangen (Germany); Scholz, Bernhard [Siemens Healthcare GmbH, Forchheim (Germany); Royalty, Kevin [Siemens Medical Solutions, USA, Inc., Hoffman Estates, IL (United States)

    2017-01-15

    Metal artefacts can impair accurate diagnosis of haemorrhage using flat detector CT (FD-CT), especially after aneurysm coiling. Within this work we evaluate a prototype metal artefact reduction algorithm by comparison of the artefact-reduced and the non-artefact-reduced FD-CT images to pre-treatment FD-CT and multi-slice CT images. Twenty-five patients with acute aneurysmal subarachnoid haemorrhage (SAH) were selected retrospectively. FD-CT and multi-slice CT before endovascular treatment as well as FD-CT data sets after treatment were available for all patients. The algorithm was applied to post-treatment FD-CT. The effect of the algorithm was evaluated utilizing the pre-post concordance of a modified Fisher score, a subjective image quality assessment, the range of the Hounsfield units within three ROIs, and the pre-post slice-wise Pearson correlation. The pre-post concordance of the modified Fisher score, the subjective image quality, and the pre-post correlation of the ranges of the Hounsfield units were significantly higher for artefact-reduced than for non-artefact-reduced images. Within the metal-affected slices, the pre-post slice-wise Pearson correlation coefficient was higher for artefact-reduced than for non-artefact-reduced images. The overall diagnostic quality of the artefact-reduced images was improved and reached the level of the pre-interventional FD-CT images. The metal-unaffected parts of the image were not modified. (orig.)

  19. CT perfusion on admission and cognitive functioning 3 months after aneurysmal subarachnoid haemorrhage

    NARCIS (Netherlands)

    Huenges Wajer, Irene M C; Cremers, Charlotte H P; van Zandvoort, Martine J E; Vergouwen, Mervyn D I; van der Schaaf, Irene C.; Velthuis, Birgitta K.; Dankbaar, Jan Willem; Vos, Pieter C.; Visser-Meily, Johanna M A; Rinkel, Gabriel J E

    2015-01-01

    Many survivors of aneurysmal subarachnoid haemorrhage (aSAH) have persistent cognitive deficits. Underlying causes of these deficits have not been elucidated. We aimed to investigate if cerebral perfusion in the acute phase after aSAH measured with CT perfusion (CTP) is associated with cognitive

  20. Early Intraocular Complications of Subarachnoid Haemorrhage after Aneurysm Rupture.

    Science.gov (United States)

    Obuchowska, Iwona; Turek, Grzegorz; Mariak, Zenon; Mariak, Zofia

    2014-01-01

    The aim of this study was to identify factors predisposing for early intraocular complications of aneurysmal subarachnoid haemorrhage (SAH). The authors analysed 96 selected cases of aneurysmal SAH. Forty patients (42%) demonstrated abnormal fundus findings, including disc swelling (13.5%), retinal haemorrhages (23%), and vitreous haemorrhage (5%). The incidence of intraocular pathologies was significantly higher in patients who lost consciousness at the onset of SAH, were admitted with high scores of the Hunt-Hess and Fisher scales and low score of the Glasgow Coma Scale, as well as in those with arterial hypertension, more sizable aneurysm, and older.

  1. Spinal arachnoiditis and cyst formation with subarachnoid haemorrhage.

    Science.gov (United States)

    Abhinav, Kumar; Bradley, Marcus; Aquilina, Kristian; Patel, Nikunj K

    2012-08-01

    We present the case of a 58-year-old lady with p-ANCA vasculitis who suffered a WFNS grade 1 subarachnoid haemorrhage (Fisher grade 1) secondary to a ruptured left posterior inferior cerebellar artery aneurysm and then developed a rare complication of radiologically progressive spinal arachnoiditis despite maintained clinical response to definitive treatment measures.

  2. Intra-arterial nimodipine for cerebral vasospasm after subarachnoid haemorrhage

    DEFF Research Database (Denmark)

    Bashir, Asma; Andresen, Morten; Bartek, Jiri

    2016-01-01

    Intra-arterial nimodipine (IAN) has shown a promising effect on cerebral vasospasm (CV) after aneurysmal subarachnoid haemorrhage. At our institution, Rigshospitalet, IAN treatment has been used since 2009, but the short- and long-term clinical efficacy of IAN has not yet been assessed. The purpo...

  3. Impact of early surgery after aneurysmal subarachnoid haemorrhage.

    NARCIS (Netherlands)

    Jagt, M. van der; Hasan, D.; Dippel, D.W.; Dijk, E.J.; Avezaat, C.J.; Koudstaal, P.J.

    2009-01-01

    OBJECTIVES: To investigate the effect of early aneurysm surgery (<72 h) on outcome in patients with subarachnoid haemorrhage (SAH). MATERIALS AND METHODS: We studied two consecutive series of patients with aneurysmal SAH [postponed surgery (PS) cohort, n = 118, 1989-1992: surgery was planned on

  4. Subjective hearing impairment after subarachnoid haemorrhage : Prevalence and risk factors

    NARCIS (Netherlands)

    Vos, Erik M.; Greebe, Paut; Visser-Meily, J. M Anne; Rinkel, Gabriel J E; Vergouwen, Mervyn D I

    2017-01-01

    Background Sensorineural hearing impairment is a key symptom in patients with superficial siderosis of the central nervous system, a disease caused by chronic or intermittent haemorrhage into the subarachnoid space. We investigated the prevalence and risk factors of subjective hearing impairment

  5. Pituitary dysfunction following traumatic brain injury or subarachnoid haemorrhage - in "Endocrine Management in the Intensive Care Unit".

    LENUS (Irish Health Repository)

    Hannon, M J

    2012-02-01

    Traumatic brain injury and subarachnoid haemorrhage are important causes of morbidity and mortality in the developed world. There is a large body of evidence that demonstrates that both conditions may adversely affect pituitary function in both the acute and chronic phases of recovery. Diagnosis of hypopituitarism and accurate treatment of pituitary disorders offers the opportunity to improve mortality and outcome in both traumatic brain injury and subarachnoid haemorrhage. In this article, we will review the history and pathophysiology of pituitary function in the acute phase following traumatic brain injury and subarachnoid haemorrhage, and we will discuss in detail three key aspects of pituitary dysfunction which occur in the early course of TBI; acute cortisol deficiency, diabetes insipidus and SIAD.

  6. Clinical management guidelines for subarachnoid haemorrhage. Diagnosis and treatment.

    Science.gov (United States)

    Vivancos, J; Gilo, F; Frutos, R; Maestre, J; García-Pastor, A; Quintana, F; Roda, J M; Ximénez-Carrillo, A; Díez Tejedor, E; Fuentes, B; Alonso de Leciñana, M; Alvarez-Sabin, J; Arenillas, J; Calleja, S; Casado, I; Castellanos, M; Castillo, J; Dávalos, A; Díaz-Otero, F; Egido, J A; Fernández, J C; Freijo, M; Gállego, J; Gil-Núñez, A; Irimia, P; Lago, A; Masjuan, J; Martí-Fábregas, J; Martínez-Sánchez, P; Martínez-Vila, E; Molina, C; Morales, A; Nombela, F; Purroy, F; Ribó, M; Rodríguez-Yañez, M; Roquer, J; Rubio, F; Segura, T; Serena, J; Simal, P; Tejada, J

    2014-01-01

    To update the Spanish Society of Neurology's guidelines for subarachnoid haemorrhage diagnosis and treatment. A review and analysis of the existing literature. Recommendations are given based on the level of evidence for each study reviewed. The most common cause of spontaneous subarachnoid haemorrhage (SAH) is cerebral aneurysm rupture. Its estimated incidence in Spain is 9/100 000 inhabitants/year with a relative frequency of approximately 5% of all strokes. Hypertension and smoking are the main risk factors. Stroke patients require treatment in a specialised centre. Admission to a stroke unit should be considered for SAH patients whose initial clinical condition is good (Grades I or II on the Hunt and Hess scale). We recommend early exclusion of aneurysms from the circulation. The diagnostic study of choice for SAH is brain CT (computed tomography) without contrast. If the test is negative and SAH is still suspected, a lumbar puncture should then be performed. The diagnostic tests recommended in order to determine the source of the haemorrhage are MRI (magnetic resonance imaging) and angiography. Doppler ultrasonography studies are very useful for diagnosing and monitoring vasospasm. Nimodipine is recommended for preventing delayed cerebral ischaemia. Blood pressure treatment and neurovascular intervention may be considered in treating refractory vasospasm. SAH is a severe and complex disease which must be managed in specialised centres by professionals with ample experience in relevant diagnostic and therapeutic processes. Copyright © 2012 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  7. Posterior reversible encephalopathy syndrome (PRES) with sub-arachnoid haemorrhage after bevacizumab and 5-FU.

    Science.gov (United States)

    Massey, Jennifer

    2017-06-01

    PRES is a neurological syndrome characterised by reversible subcortical vasogenic brain oedema in patients with acute neurological signs and symptoms. It occurs in the context of fluctuations in blood pressure, renal failure, autoimmune disorders, eclamptic syndromes and with use of cytotoxic drugs. We present the case of a 60year old female with advanced bowel cancer who was admitted with seizures and sub-arachnoid haemorrhage, with radiographic features of PRES, shortly after receiving bevacizumab (Avastin), a VEGF-inhibitor. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  8. A systematic review of Terson's syndrome: frequency and prognosis after subarachnoid haemorrhage

    Science.gov (United States)

    McCarron, M; Alberts, M; McCarron, P

    2004-01-01

    Methods: Papers relating to vitreous haemorrhage in patients with subarachnoid haemorrhage were retrieved. The only studies considered were those with at least 10 consecutive cases of subarachnoid haemorrhage with or without vitreous haemorrhage. The frequency of vitreous haemorrhage in such cases was calculated in prospective and retrospective studies. Mortality was compared in patients with and without Terson's syndrome. Results: 154 papers were reviewed. Three prospective studies and six retrospective studies satisfied the inclusion criteria. Of 181 patients with subarachnoid haemorrhage assessed prospectively (mean age, 51.7 years), 24 (13%) had vitreous haemorrhage; among 1086 retrospective records, 37 (3%) had documented vitreous haemorrhage (pTerson's syndrome had higher Hunt and Hess grades than those without (mean grade, 3.6 v 2.6). Patients with Terson's syndrome were also more likely to die (13 of 30 (43%) v 31 of 342 (9%); odds ratio 4.8; pTerson's syndrome than retrospective studies, suggesting that vitreous haemorrhage is not well documented. Vitreous haemorrhage is an adverse prognostic finding in patients with subarachnoid haemorrhage. PMID:14966173

  9. Brainstem Auditory Evoked Potentials in Patients with Subarachnoid Haemorrhage

    Directory of Open Access Journals (Sweden)

    Mikhail Matveev

    2009-10-01

    Full Text Available Objective. The aim of the present study is to typify BAEPs configurations of patients with different location of lesions caused by subarachnoid haemorrhage (SAH and the ensuing complications, in view of assessing the auditory-brainstem system disturbance.Methods. The typization was performed by comparing BAEPs with standard patterns from two sets of types of BAEPs by ipsilateral and binaural stimulation and by cross-stimulation.Results. 94 BAEPs were used for collection of normal referential values: for the absolute latencies and the absolute amplitudes of waves I, II, III, IV and V; for inter-peak latencies I-III, II-III, III-V, I-V and II-V; for amplitude ratios I/V and III/V. 146 BAEPs of patients with mild SAH and 55 from patients with severe SAH, were typified. In 5 types of BAEPs out of a total of 11, the percentage of the potentials in patients with mild SAH and severe SAH differed significantly (p<0.01.Conclusions. The use of sets of types of BAEPs by ipsilateral, binaural and cross-stimulation correctly classifies the potentials in patients with mild and severe SAH.

  10. Terson haemorrhage in patients suffering aneurysmal subarachnoid haemorrhage: a prospective analysis of 60 consecutive patients.

    Science.gov (United States)

    Stienen, Martin N; Lücke, Sebastian; Gautschi, Oliver P; Harders, Albrecht

    2012-07-01

    The concomitance of vitreous/subhyaloid haemorrhage (Terson syndrome; TS) and aneurysmal subarachnoid haemorrhage (aSAH) is commonly underestimated. The aim of this study was to determine the incidence of TS and to identify parameters that predispose its development, indicate the severity of the underlying disease, and predict outcome. Sixty consecutive patients suffering from aSAH were included in this study. The admitting Glasgow Coma Scale scores (GCS), Hunt & Hess (H&H) and Fisher grades were documented. All participants were ophthalmologically examined. The outcome at discharge was estimated using the Glasgow Outcome Scale (GOS). Of the 60 patients admitted for aSAH, eleven (18.3%) displayed TS within 24h after aneurysm rupture. Statistical analysis revealed a significant relation between TS and either high Fisher- (3.0 vs. 2.32; p=0.008) or H&H- (4.09 vs. 2.69; p=0.001) and low GCS- (5.55 vs. 12.87; pTerson syndrome is likely to occur in severe aSAH with poor admission scores and indicates a worse functional outcome. An ophthalmological examination is strongly recommended in aSAH patients with poor admission scores. Copyright © 2011 Elsevier B.V. All rights reserved.

  11. Effect of magnesium treatment and glucose levels on delayed cerebral ischemia in patients with subarachnoid hemorrhage : A substudy of the Magnesium in Aneurysmal Subarachnoid Haemorrhage trial (MASH-II)

    NARCIS (Netherlands)

    Leijenaar, Jolien F.; Dorhout Mees, Sanne M.|info:eu-repo/dai/nl/304818828; Algra, Ale|info:eu-repo/dai/nl/07483472X; van den Bergh, Walter M.|info:eu-repo/dai/nl/272886157; Rinkel, Gabriel J. E.|info:eu-repo/dai/nl/085712000

    2015-01-01

    Background: Magnesium treatment did not improve outcome in patients with aneurysmal subarachnoid haemorrhage in the Magnesium in Aneurysmal Subarachnoid Haemorrhage II trial. We hypothesized that high glucose levels may have offset a potential beneficial effect to prevent delayed cerebral ischemia.

  12. Lifetime risks for aneurysmal subarachnoid haemorrhage: multivariable risk stratification.

    Science.gov (United States)

    Vlak, Monique H M; Rinkel, Gabriel J E; Greebe, Paut; Greving, Jacoba P; Algra, Ale

    2013-06-01

    The overall incidence of aneurysmal subarachnoid haemorrhage (aSAH) in western populations is around 9 per 100 000 person-years, which confers to a lifetime risk of around half per cent. Risk factors for aSAH are usually expressed as relative risks and suggest that absolute risks vary considerably according to risk factor profiles, but such estimates are lacking. We aimed to estimate incidence and lifetime risks of aSAH according to risk factor profiles. We used data from 250 patients admitted with aSAH and 574 sex-matched and age-matched controls, who were randomly retrieved from general practitioners files. We determined independent prognostic factors with multivariable logistic regression analyses and assessed discriminatory performance using the area under the receiver operating characteristic curve. Based on the prognostic model we predicted incidences and lifetime risks of aSAH for different risk factor profiles. The four strongest independent predictors for aSAH, namely current smoking (OR 6.0; 95% CI 4.1 to 8.6), a positive family history for aSAH (4.0; 95% CI 2.3 to 7.0), hypertension (2.4; 95% CI 1.5 to 3.8) and hypercholesterolaemia (0.2; 95% CI 0.1 to 0.4), were used in the final prediction model. This model had an area under the receiver operating characteristic curve of 0.73 (95% CI 0.69 to 0.76). Depending on sex, age and the four predictors, the incidence of aSAH ranged from 0.4/100 000 to 298/100 000 person-years and lifetime risk between 0.02% and 7.2%. The incidence and lifetime risk of aSAH in the general population varies widely according to risk factor profiles. Whether persons with high risks benefit from screening should be assessed in cost-effectiveness studies.

  13. [Endovascular versus surgical treatment in subarachnoid haemorrhage: Cost analysis].

    Science.gov (United States)

    Horcajadas Almansa, Angel; Jouma Katati, Majed; Román Cutillas, Ana; Jorques Infante, Ana; Cordero Tous, Nicolás

    2015-01-01

    To analyse costs of endovascular versus surgical treatment in 80 patients with aneurysmal subarachnoid haemorrhage (aSAH). We analysed data on 80 consecutive patients with aSAH between January 2010 and June 2011. Endovascular treatment was used in 57 patients and surgical in 23 patients. Demographic (gender and age) and clinical data (Hunt-Hess and Fisher scales), length of stay (ICU and ward) and results at 6 months (Glasgow outcome scale,[GOS]) were collected. Costs including stay, follow-up, complications and retreatments were calculated. Age was higher in the endovascular group (statistically significant). There were no differences between the 2 groups in Hunt-Hess and Fisher scales. Results at 6 months were also similar, although slightly better in the surgical group. Length of stay was longer in surgical patients, both in ICU (mean 1.4 days) and ward (1.7 days). Hospitalisation length was also related to age and Hunt-Hess and Fisher scales. Costs from embolisation devices, follow-up and retreatment (12% in this series) made final endovascular treatment 4.1% more expensive than surgical treatment (€35,835 versus €34,404). Endovascular procedure (including retreatments) was 110% more expensive than surgical treatment (€8,015 versus €3,817). There are no differences between the 2 treatments in terms of morbidity and mortality. Stability of surgical treatment was higher than that of endovascular, with better occlusion and lower retreatment rates. Endovascular treatment is more expensive in ruptured aneurysms, principally due to embolisation device costs, long-term follow-up and retreatments, in retreatments, in spite of shorter hospital stay. In incidental aneurysms, which usually need shorter hospitalisation, differences between the 2 treatments could be even larger. Copyright © 2013 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  14. Superior cerebellar aneurysm causing subarachnoid haemorrhage in a 17-year-old with alagille syndrome.

    LENUS (Irish Health Repository)

    O'Connell, David

    2012-04-01

    Alagille syndrome is a rare autosomal dominant condition characterised by mutation in Jagged1 gene. Intracranial aneurysms may be seen in this condition and may present as subarachnoid hemorrhage. We describe the first case of superior cerebellar aneurysm rupture causing WFNS grade 1 subarachnoid haemorrhage in a 17-year-old girl. The clinical condition and management of this rare occurrence is discussed with a review of literature.

  15. Spinal arachnoiditis as a consequence of aneurysm-related subarachnoid haemorrhage.

    Science.gov (United States)

    van Heerden, Jolandi; McAuliffe, William

    2013-02-01

    Only a few case reports currently exist regarding symptomatic spinal arachnoiditis following aneurysm-related subarachnoid haemorrhage. We present three patients who developed symptomatic spinal arachnoiditis following spontaneous aneurysm rupture. Following initial aneurysm and subarachnoid haemorrhage management (including ventriculo-peritoneal shunt placement), all three patients developed gradually worsening neurological abnormalities, and subsequent imaging demonstrated spinal arachnoiditis. Despite spinal decompression, all three patients experienced progressively worsening neurological decline. © 2012 The Authors; Journal of Medical Imaging and Radiation Oncology © 2012 The Royal Australian and New Zealand College of Radiologists.

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

    NARCIS (Netherlands)

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

    2007-01-01

    Background and aim: To update our 1996 review on the incidence of subarachnoid haemorrhage (SAH) and assess the relation of incidence with region, age, gender and time period. Methods: We searched for studies on the incidence of SAH published until October 2005. The overall incidences with

  17. Magnesium therapy after aneurysmal subarachnoid haemorrhage a dose-finding study for long term treatment

    NARCIS (Netherlands)

    van den Bergh, W. M.; Albrecht, K. W.; Berkelbach van der Sprenkel, J. W.; Rinkel, G. J. E.

    2003-01-01

    BACKGROUND: Magnesium is a neuroprotective agent which might prevent or reverse delayed cerebral ischemia (DCI) after aneurysmal subarachnoid haemorrhage (SAH). Although the dosage for short-term magnesium therapy is well established, there is lack of knowledge on the dosage for extended use of

  18. Dose evaluation for long-term magnesium treatment in aneurysmal subarachnoid haemorrhage

    NARCIS (Netherlands)

    van Norden, A. G. W.; van den Bergh, W. M.; Rinkel, G. J. E.

    2005-01-01

    BACKGROUND: Magnesium is a neuroprotective agent that might prevent or reverse delayed cerebral ischaemia after aneurysmal subarachnoid haemorrhage (SAH). We are presently running a randomized, placebo-controlled, double blind trial with magnesium sulphate (64 mmol/day intravenously). We studied

  19. Subarachnoid haemorrhage in Sweden 1987-2002 : regional incidence and case fatality rates

    NARCIS (Netherlands)

    Koffijberg, H.; Buskens, E.; Granath, F.; Adami, J.; Ekbom, A.; Rinkel, G. J. E.; Blomqvist, P.

    Background: Incidence estimates of subarachnoid haemorrhage (SAH) in Sweden vary, which may be caused by regional variations. Reliable estimates of age-specific case fatality rates are lacking. We analysed regional incidence rates and case fatality rates of SAH in Sweden. Methods: The Swedish

  20. The effects of continuous prostacyclin infusion on regional blood flow and cerebral vasospasm following subarachnoid haemorrhage

    DEFF Research Database (Denmark)

    Rasmussen, Rune; Wetterslev, Jørn; Stavngaard, Trine

    2012-01-01

    One of the main causes of mortality and morbidity following subarachnoid haemorrhage (SAH) is the development of cerebral vasospasm, a frequent complication arising in the weeks after the initial bleeding. Despite extensive research, to date no effective treatment of vasospasm exists. Prostacycli...

  1. Role of carotid body for neuronal protection in experimental subarachnoid haemorrhage

    Directory of Open Access Journals (Sweden)

    Mehmet Dumlu Aydın

    2013-01-01

    Full Text Available Objective: Carotid bodies are known as main arterialchemoregulatory units. Despite well known that carotidbodies have an important role in cerebral circulation andblood pH regulation, their roles has not been investigatedin subarachnoid haemorrhage. We investigated whetherthere is neuroprotective effect of neuron density of carotidbodies on the brain in subarachnoid haemorrhage.Methods: Twenty hybrid rabbits were studied. Four ofthem were used as reference group (n=4 and the remainingwas obliged to subarachnoid haemorrhage by injectingautologous blood into their cisterna magna (n=16and sacrificed after one month. All carotid bodies andbrains examined histopathologically using by stereologicmethods. The relationship between the neuronal densityof carotid body and degenerated neuron density of thehippocampus were compared statistically.Results: Five rabbits with subarachnoid haemorrhagedead during the follow-up time (n=5. The average neuronaldensity of carotid body was 4500±500 cells/mm3and of hippocampus 170.000±17.000 cell/mm3 in normalrabbit family. The degenerated neuron density ofthe hippocampus was 20.000±3.000 cells/mm3 in rabbitswith have high neuron density of carotid body and was65.000±8.000 cells/mm3 in rabbits with low neuron densityof carotid body. The differences between the neuronaldensity of carotid body and the degenerated neuron numbersof the hippocampus were significant.Conclusion: The neuron density of carotid body mayplay an important role on the protection of brain in subarachnoidhaemorrhage.Key words: Subarachnoid haemorrhage, carotid body,hippocampus, neurodegeneration, cerebral ischemia

  2. Acute recurrent haemorrhage of an intracranial meningioma.

    Science.gov (United States)

    Bellut, David; Nern, Christian; Burkhardt, Jan-Karl; Könü, Dilek; Bertalanffy, Helmut; Krayenbühl, Niklaus

    2011-07-01

    Meningioma-associated haemorrhages are rare. To our knowledge this is the first report of a patient with an acute two-stage haemorrhage of a benign intracranial meningioma (World Health Organization grade I) verified by cranial CT scan and histopathological examination. Early surgery with complete tumour removal led to a good outcome for the patient. Copyright © 2011 Elsevier Ltd. All rights reserved.

  3. [Patients with subarachnoid haemorrhage in poor grade neurological status: Study of prognostic factors].

    Science.gov (United States)

    Sosa-Pérez, Coralia; Morera-Molina, Jesús; Espino-Postigo, Carlos; Jiménez-O'Shanahan, Aruma

    2015-01-01

    To evaluate and predict factors influencing prognosis and/or clinical outcome at 6 months in patients with spontaneous subarachnoid haemorrhage, World Federation of Neurosurgical Societies (WFNS) grades iv and v. This was a retrospective study of a consecutive series of 394 patients admitted to our hospital with clinical and radiological diagnosis of spontaneous subarachnoid haemorrhage, from 1 January 1999 to 30 June 2009. We selected 121 patients who met the criteria of being in WFNS grades iv or v before treatment; 3 patients were excluded due to loss of tracking. The outcome variable was assessed 6 months after the event using the Glasgow Outcome Scale. A P valueGlasgow Coma Scale lower than 7 points (Pde Neurocirugía. Published by Elsevier España. All rights reserved.

  4. Efficacy of intra-arterial nimodipine in the treatment of cerebral vasospasm complicating subarachnoid haemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Hui, C. [Department of Diagnostic Imaging, Monash Medical Centre, Clayton, Vic. (Australia)]. E-mail: cathryn.hui@southernhealth.org.au; Lau, K.P. [Department of Diagnostic Imaging, Monash Medical Centre, Clayton, Vic. (Australia)

    2005-09-01

    AIM: To examine the efficacy and safety of nimodipine as an alternative to papaverine for the treatment of cerebral vasospasm following subarachnoid haemorrhage. METHODS: We retrospectively reviewed the procedure reports, anaesthetic records, clinical charts and CT and angiographic images of 9 patients who had received intra-arterial nimodipine; 1 of these patients received both nimodipine and papaverine. The difference in arterial luminal diameter before and after treatment was calculated as a percentage change. RESULTS: The average dose of nimodipine administered per vessel was 3.3 mg. The mean increase in arterial diameter was 66.6% in the vasospastic segment. There was no significant change in blood pressure of any of the subjects during endovascular treatment of vasospasm. CONCLUSION: Intra-arterial nimodipine is effective in improving angiographic vasospasm complicating subarachnoid haemorrhage. Further studies aimed at examining the clinical benefits of nimodipine are warranted, particularly in view of the low risk of adverse side effects of nimopidine when compared with papaverine.

  5. Erythropoietin in patients with aneurysmal subarachnoid haemorrhage: a double blind randomised clinical trial

    DEFF Research Database (Denmark)

    Springborg, J B; Møller, C; Gideon, P

    2007-01-01

    BACKGROUND: Erythropoietin (EPO) is neuroprotective in experimental models of stroke and subarachnoid haemorrhage (SAH) and possibly in patients with thromboembolic stroke. We studied the efficacy and safety of EPO in patients with SAH. METHODS: A larger scale clinical trial was planned...... no statistically significant group differences in the primary or secondary outcome measures. EPO was well tolerated. CONCLUSIONS: Beneficial effects of EPO in patients with SAH cannot be excluded or concluded on the basis of this study and larger scale trials are warranted....

  6. Immediate coma and poor outcome in subarachnoid haemorrhage are independently associated with an aneurysmal origin.

    Science.gov (United States)

    Tsermoulas, Georgios; Flett, Lisa; Gregson, Barbara; Mitchell, Patrick

    2013-08-01

    Subarachnoid haemorrhage (SAH) may present with coma and this is known to be associated with aneurysmal origin and blood load. Aneurysmal origin is associated with increased blood load and existing data do not allow us to determine if the association between coma and aneurysmal SAH is wholly due to blood load or if aneurysmal origin has an additional independent effect. The objective of our study is to find if an aneurysmal origin is a predictor of acute onset of coma independent of blood load. A series of consecutive patients with spontaneous SAH were divided into two groups: aneurysmal (aSAH) and non-aneurysmal--angiographically negative SAH (naSAH). Blood load was quantified so that the effect of aneurysmal origin could be resolved from the effect of the amount of blood spilled. Non-parametric regression was used to relate blood load to coma and poor outcome rates for aneurysmal bleeds. We analysed a total of 421 patients presenting during the period 2009-2011. Ninety aneurysmal cases presented with coma, seventy immediately in the early phase and seven shortly after rebleeding. None of the naSAH cases presented with immediate coma and 1 developed delayed coma. Delayed coma was associated with acute hydrocephalus in both groups. Aneurysmal origin was found to be an independent determinant of immediate coma (p=0.02) and poor outcome (pcoma and poor outcome in SAH are associated with an aneurysmal origin and do not characterize naSAH. Copyright © 2013 Elsevier B.V. All rights reserved.

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

    Science.gov (United States)

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

    2014-04-01

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

  8. To Look Beyond Vasospasm in Aneurysmal Subarachnoid Haemorrhage

    Directory of Open Access Journals (Sweden)

    Giulia Cossu

    2014-01-01

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

  9. To Look Beyond Vasospasm in Aneurysmal Subarachnoid Haemorrhage

    Science.gov (United States)

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

    2014-01-01

    Delayed cerebral vasospasm has classically been considered the most important and treatable cause of mortality and morbidity in patients with aneurysmal subarachnoid hemorrhage (aSAH). Secondary ischemia (or delayed ischemic neurological deficit, DIND) has been shown to be the leading determinant of poor clinical outcome in patients with aSAH surviving the early phase and cerebral vasospasm has been attributed to being primarily responsible. Recently, various clinical trials aimed at treating vasospasm have produced disappointing results. DIND seems to have a multifactorial etiology and vasospasm may simply represent one contributing factor and not the major determinant. Increasing evidence shows that a series of early secondary cerebral insults may occur following aneurysm rupture (the so-called early brain injury). This further aggravates the initial insult and actually determines the functional outcome. A better understanding of these mechanisms and their prevention in the very early phase is needed to improve the prognosis. The aim of this review is to summarize the existing literature on this topic and so to illustrate how the presence of cerebral vasospasm may not necessarily be a prerequisite for DIND development. The various factors determining DIND that worsen functional outcome and prognosis are then discussed. PMID:24967389

  10. Effect of magnesium treatment and glucose levels on delayed cerebral ischemia in patients with subarachnoid hemorrhage : a substudy of the Magnesium in Aneurysmal Subarachnoid Haemorrhage trial (MASH-II)

    NARCIS (Netherlands)

    Leijenaar, Jolien F.; Mees, Sanne M. Dorhout; Algra, Ale; van den Bergh, Walter M.; Rinkel, Gabriel J. E.

    2015-01-01

    BackgroundMagnesium treatment did not improve outcome in patients with aneurysmal subarachnoid haemorrhage in the Magnesium in Aneurysmal Subarachnoid Haemorrhage II trial. We hypothesized that high glucose levels may have offset a potential beneficial effect to prevent delayed cerebral ischemia. We

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

    DEFF Research Database (Denmark)

    Springborg, Jacob Bertram; Ma, XiaoDong; Rochat, Per

    2002-01-01

    administered recombinant EPO on impaired cerebral blood flow (CBF) autoregulation after experimental subarachnoid haemorrhage (SAH). Four groups of male Sprague-Dawley rats were studied: group A, sham operation plus vehicle; group B, sham operation plus EPO; group C, SAH plus vehicle; group D, SAH plus EPO....... SAH was induced by injection of 0.07 ml of autologous blood into the cisterna magna. EPO (400 iu kg(-1) s.c.) or vehicle was given immediately after the subarachnoid injection of blood or saline. Forty-eight hours after the induction of SAH, CBF autoregulatory function was evaluated using...... the intracarotid (133)Xe method. CBF autoregulation was preserved in both sham-operated groups (lower limits of mean arterial blood pressure: 91+/-3 and 98+/-3 mmHg in groups A and B, respectively). In the vehicle treated SAH-group, autoregulation was abolished and the relationship between CBF and blood pressure...

  12. Spinal arachnoid cyst associated with arachnoiditis following subarachnoid haemorrhage in adult patients: A case report and literature review.

    Science.gov (United States)

    Basaran, Recep; Kaksi, Mustafa; Efendioglu, Mustafa; Onoz, Mustafa; Balkuv, Ece; Kaner, Tuncay

    2015-04-01

    Arachnoiditis is an inflammatory process resulting with the fibrosis of arachnoid mater. It can vary in severity from mild thickenings to catastrophic adhesions that ruins subarachnoid space. As a result, arachnoid cysts can be formed. Arachnoid cyst induced by symptomatic spinal arachnoiditis is a rare complication of subarachnoid haemorrhages. In this article, we aimed to present a case of spinal arachnoid cyst formation following subarachnoid haemorrhage and examine similar cases in the literature. Forty-six years old, previously healthy female patient has been treated medically for headaches due to perimesencephalic subarachnoid bleeding. Approximately two and a half months later, she started to have severe headaches and diplopia. We detected hydrocephalus and performed ventriculoperitoneal shunt surgery. Two months later, she started to have complaints of weakness in her lower extremities. On neurological examination, she had paraparesis and on spinal magnetic resonance imaging she had an arachnoid cyst lengthening from C7 to T2 and compressing the spinal cord posteriorly. We performed partial laminectomy, drainage of arachnoid cyst and replacement of cystopleural T tube shunt. On follow-up, her lower extremity strength has ameliorated. She was taken into a physical therapy and rehabilitation programme. Three months later she was able to walk with a crutch. Subarachnoiditis and associated arachnoid cyst can cause severe morbidity. This rare situation (which especially occurs following subarachnoid haemorrhage of posterior fossa) should be known and physicians should keep in mind that it requires urgent surgical procedure.

  13. Emergency percutaneous transcatheter embolisation of acute arterial haemorrhage.

    LENUS (Irish Health Repository)

    Keeling, A N

    2010-09-01

    The purpose of this study was to review indications, source of haemorrhage, method of embolisation and clinical outcome in patients referred to Interventional Radiology for the emergency management of acute arterial haemorrhage.

  14. Social cognition impairments after aneurysmal subarachnoid haemorrhage: : associations with deficits in interpersonal behaviour, apathy and impaired self-awareness

    NARCIS (Netherlands)

    Buunk, Anne; Spikman, Jacoba M.; Veenstra, Wencke S.; van Laar, Peter Jan; Metzemaekers, Jan D.M.; van Dijk, J. Marc C.; Meiners, Linda C.; Groen, Rob J.M.

    Behavioural disturbances are frequently found after aneurysmal subarachnoid haemorrhage (aSAH). Social cognition impairments have been suggested as a possible underlying mechanism for behavioural problems. Also, aSAH is likely to result in damage affecting frontal-subcortical circuits underlying

  15. Social cognition impairments after aneurysmal subarachnoid haemorrhage : Associations with deficits in interpersonal behaviour, apathy, and impaired self-awareness

    NARCIS (Netherlands)

    Buunk, Anne M.; Spikrnan, Jacoba M.; Veenstra, Wencke S.; van Laar, Peter Jan; Metzemaekers, Jan D. M.; van Dijk, J. Marc C.; Meiners, Linda C.; Groen, Rob J. M.

    Behavioural disturbances are frequently found after aneurysmal subarachnoid haemorrhage (aSAH). Social cognition impairments have been suggested as a possible underlying mechanism for behavioural problems. Also, aSAH is likely to result in damage affecting frontal-subcortical circuits underlying

  16. Increased GFAP and S100beta but not NSE serum levels after subarachnoid haemorrhage are associated with clinical severity.

    NARCIS (Netherlands)

    Vos, P.E.; Gils, M. van; Beems, T.; Zimmerman, C.; Verbeek, M.M.

    2006-01-01

    Assessment of initial disease severity after subarachnoid haemorrhage (SAH) remains difficult. The objective of the study is to identify biochemical markers of brain damage in peripheral blood after SAH. Hospital admission S100beta, glial fibrillary acidic protein (GFAP) and neuron-specific enolase

  17. Traumatic basal subarachnoid haemorrhage or ruptured brain aneurysm in 16-year-old boy? – case report

    Directory of Open Access Journals (Sweden)

    Rafał Skowronek

    2016-09-01

    Full Text Available Traumatic basal subarachnoid haemorrhage (TBSAH represents only 1.8% of all subarachnoid haemorrhage cases diagnosed during autopsy. This report presents such a case from the current practice of the authors. Sixteen-year-old boy was beaten by the aggressors. Suddenly he lost his consciousness and fall after he received a single blow in the neck. He was resuscitated immediately, but died at the scene. During the external examination we did not find any significant external injuries. Autopsy revealed large contusion of right sternocleidomastoid muscle. In the cranial cavity we found extensive subarachnoid haemorrhage, located mainly on brain basis, in the posterior cranial fossa and covering the subtentorial structures. During the preparation of blood vessels we noticed a slight change of morphology suggesting damaged vessel or aneurysm, or vascular malformation located in the basilar artery bifurcation, which was taken to detailed microscopic evaluation using the special stainings. Histological examination showed vital interruption of the basilar artery wall with massive haemorrhage, without the presence of general microscopic pathology. From the medico-legal viewpoint, to determine traumatic background of haemorrhage it is necessary to find the coexistence of the following circumstances: a sustained trauma, post-mortem findings consistent with a time of injury, the presence of temporal relationship between injury and death, and morphological vital injury of the brain vessel, as well as the absence of prior vascular malformations. For this purpose Verhoeff-van Gieson’s, Masson’s, Turnbull’s and Gomori’ histological stainings may be successfully used.

  18. Spinal leptomeningeal metastases of giant cell glioblastoma associated with subarachnoid haemorrhage: case report.

    Science.gov (United States)

    Chang, C C; Kuwana, N; Ito, S; Koike, Y; Kitamura, H

    2001-01-01

    A case of subarachnoid haemorrhage (SAH) due to spinal leptomeningeal metastases of a giant cell glioblastoma is described. A 51 year old male presented with a four week history of headache. Neurological examination was normal except for a slight left hemiparesis. Computed tomography (CT) revealed a large cyst with a mural nodule in the right temporal lobe. The tumour was removed followed by 60 Gy of radiation therapy. Thirty-two months later he developed headache and shoulder pain with symptoms of normal pressure hydrocephalus. Head CT showed ventriculomegaly and SAH. Magnetic resonance imaging showed spinal leptomeningeal metastases at the C4-5, T12, and L2 levels, but no local recurrence or tumour dissemination in the brain. He died 34 months after surgery. Autopsy revealed diffuse SAH over the whole brain and spinal cord, associated with spinal leptomeningeal metastases, but no cerebral aneurysms. Spinal radiotherapy and ventriculoperitoneal shunting could possibly have extended survival in this patient.

  19. [Delays in the arrival of patients with subarachnoid haemorrhage at a tertiary hospital].

    Science.gov (United States)

    Pérez-Nellar, J; Scherle-Matamoros, C E; Montes de Oca, F; González-González, J L; Hierro-Garcia, D

    Patients with subarachnoid haemorrhage should be referred to a tertiary hospital as early as possible. The aim of this research was to study how long these patients take to reach a tertiary care centre in Havana. We conducted a prospective study of patients with subarachnoid haemorrhage who were admitted to the Stroke Unit at the Hospital Hermanos Ameijeiras between January 2005 and December 2007. The time of arrival at the hospital was determined and a comparison was carried out between patients who arrived after 72 hours and those who reached the hospital sooner. The sample studied comprised 94 patients. Only 34 (36%) arrived during the first three days, whereas 13 (13.8%) reached the hospital within the first 24 hours. None of the sociodemographic and clinical variables that were studied was associated with early remission. The length of time spent in hospital by patients admitted during the first 72 hours was 14.9 days, while in the other cases it was 17.57 days (p = 0.248). The greatest impact on early remission to the tertiary centre was on the outcome at discharge on the Rankin scale, which was lower in those who arrived early compared to the rest of the cases (p = 0.05); the same was true of mortality, which was 5.9% in those who arrived within the first 72 hours versus 11.7% in the others (p = 0.04). Only a third of the cases reached hospital during the first 72 hours and this group had a more favourable course.

  20. Cerebrospinal fluid and plasma cytokines after subarachnoid haemorrhage: CSF interleukin-6 may be an early marker of infection

    OpenAIRE

    Hopkins Stephen J; McMahon Catherine J; Singh Navneet; Galea James; Hoadley Margaret; Scarth Sylvia; Patel Hiren; Vail Andy; Hulme Sharon; Rothwell Nancy J; King Andrew T; Tyrrell Pippa J

    2012-01-01

    Abstract Background Cytokines and cytokine receptor concentrations increase in plasma and cerebrospinal fluid (CSF) of patients following subarachnoid haemorrhage (SAH). The relationship between plasma and CSF cytokines, and factors affecting this, are not clear. Methods To help define the relationship, paired plasma and cerebrospinal fluid (CSF) samples were collected from patients subject to ventriculostomy. Concentrations of key inflammatory cytokines, interleukin (IL)-1ß, IL-1 receptor an...

  1. Meta-analysis of the effectiveness and safety of prophylactic use of nimodipine in patients with an aneurysmal subarachnoid haemorrhage.

    Science.gov (United States)

    Liu, Guang Jian; Luo, Jie; Zhang, Li Ping; Wang, Zheng Jun; Xu, Li Li; He, Guo Hou; Zeng, Yan Jun; Wang, Yun Fu

    2011-11-01

    Cerebral vasospasm is an important cause of poor outcomes in subarachnoid haemorrhage patients. This study was designed to assess the effectiveness and safety of nimodipine in the prevention of cerebral vasospasm in aneurysmal subarachnoid haemorrhage patients. We searched Pubmed, OVID, Embase, the Cochrane library, the stroke clinical trial registry, and the National Science and Technology Library database and collected prospective, randomised, controlled clinical trials of the prophylactic use of nimodipine for aneurismal subarachnoid haemorrhage patients. A meta-analysis was performed on the studies that met the criteria for inclusion. Eight studies met the inclusion criteria, and 1514 patients finished trial observation for the different indicators. Compared with the placebo group, fully recovered (all cases) patients increased 64% in the nimodipine group (P = 0.0002, OR = 1.64, 95 percent CI 1.26 - 2.13, NNT=-1.048), fully recovered or moderately disabled (all cases) patients increased 79 percent (P = 0.0007, OR = 1.79, 95% CI 1.28 - 2.51, NNT = -5.889), patient death (in cerebral vasospasm cases) decreased 74% (P = 0.008, OR = 0.26, 95% CI 0.09 - 0.71, NNT = 2.298), the incidence of symptomatic cerebral vasospasm decreased 46% (P nimodipine and placebo groups was not statistically significant (nimodipine group versus placebo group, recurrent haemorrhage P = 0.15, OR = 0.75, 95% CI 0.50 - 1.11; adverse reaction P = 0.59, OR = 1.13, 95% CI 0.71 - 1.81). Compared with placebo, nimodipine can significantly improve clinical outcomes, as assessed by self-formulated standards and Glasgow outcome scores, and it can significantly reduce the occurrence of symptomatic cerebral vasospasm and delayed neurological function deficits (all cases), as well as cerebral infarction, although the incidence rate of recurrent haemorrhage and adverse reactions is not significantly reduced by nimodipine.

  2. Factors associated with poor outcome for aneurysmal subarachnoid haemorrhage in a series of 334 patients.

    Science.gov (United States)

    Rivero Rodríguez, D; Scherle Matamoros, C; Fernández Cúe, L; Miranda Hernández, J L; Pernas Sánchez, Y; Pérez Nellar, J

    This study evaluates care-related sociodemographic, clinical, and imaging factors and influences associated with outcome at discharge in patients with aneurismal subarachnoid haemorrhage. Retrospective cohort study in 334 patients treated at Hospital Hermanos Ameijeiras in Havana, Cuba between October 2005 and June 2014. Logistic regression analysis determined that the following factors were associated with higher risk of poor outcome: age older than 65 years (OR 3.51, 95% CI 1.79-5.7, P=.031), female sex (OR 2.17, 95% CI 1.22-3.84, P=.0067), systolic hypertension (OR 4.82, 95% CI 2.27-9.8, P=.0001), and hyperglycaemia at admission (OR 3.93, 95% CI 2.10-7.53, P=.0003). Certain complications were also associated with poor prognosis, including respiratory infection (OR 2.73, 95% CI 1.27-5.85, P=.0085), electrolyte disturbances (OR 3.33, 95% CI 1.33-8.28, P=.0073), hydrocephalus (OR 2.21, 95% CI 1.05-4.63, P=.0039), rebleeding (OR 16.50, 95% CI 8.24-41.24, P=.0000), symptomatic vasospasm (OR 19.00, 95% CI 8.86-41.24, P=.0000), cerebral ischaemia (OR 3.82, 95% CI 1.87-7.80, P=.000) and multiplex rebleeding (OR 6.69, 95% CI 1.35-36.39, P=.0019). Grades of iii and iv on the World Federation of Neurological Surgeons (OR 2.09, 95% CI 1.12-3.91, P=.0021) and Fisher scales (OR 5.18, 95% CI 2.65-10.29, P=.0008) were also related to poor outcome. Outcome of aneurysmal subarachnoid haemorrhage was related to age, sex, clinical status at admission to the stroke unit, imaging findings according to the Fisher scale, blood pressure, glycaemia and such complications as electrolyte disturbances, hydrocephalus, rebleeding, and multiplex rebleeding. Copyright © 2014 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. Subcortical Hypoperfusion following Surgery For Aneurysmal Subarachnoid Haemorrhage: Implications For Cognitive Performance?

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    C. L. Tooth

    2000-01-01

    Full Text Available The incidence and severity of cognitive deficits after surgery for aneurysmal subarachnoid haemorrhage and their relationship to aneurysm site remains controversial. The aim of this study was to investigate the pattern of regional cerebral blood flow which exists in patients one year post-surgery and to identify whether different patterns exist which may be related to the type of cognitive deficit or the location of the aneurysm. 62 patients underwent cognitive assessment and HMPAO SPECT imaging at a mean time of 12 months following surgery. Results were compared to those from healthy control subjects (n = 55 for neuropsychological testing; n = 14 for SPECT imaging. In the patient group, significant stable cognitive deficits occurred in all cognitive domains but no cognitive measure differentiated aneurysm site. On SPECT images, statistical parametric mapping identified a large common area of subcortical hypoperfusion in the patient group as a whole. The findings of this study suggest a possible link between reduced subcortical function and the extent and severity of cognitive deficits.

  4. Influence of light and time on bilirubin degradation in CSF spectrophotometry for subarachnoid haemorrhage.

    Science.gov (United States)

    Foroughi, Mansoor; Parikh, Dhruv; Wassell, Julie; Hatfield, Richard

    2010-08-01

    Investigation of the influence of light on bilirubin degradation over time in cerebrospinal fluid (CSF) specimens from patients with computed tomography (CT) positive subarachnoid haemorrhage (SAH). Twenty-nine CSF samples were analysed from 23 patients with CT-positive SAH. Samples were divided into two cohorts - one half being stored in the dark, the other in normal room light conditions. Samples were assayed by spectrophotometry 0, 1, 2, 6, 19, 24 and 48 h post-storage. Net bilirubin absorbance (NBA) was measured in absorbance units (AU) by determining the optical density at 476 nm. In 27 of 28 (96%) samples stored in light conditions and 21 of 29 (72%) samples stored in dark, a decline in the amount of bilirubin detected in CSF over time was observed. The rate of bilirubin degradation over 24 h for CSF samples stored in the light ranged from 0.0001 to 0.0048 AU/h (mean 0.0020 AU/h), and was significantly greater (p spectrophotometry cannot be carried out immediately, all such CSF samples should at least be centrifuged immediately, the supernatant protected from light as soon as possible and the collection and analysis times provided in the report.

  5. CT diagnosis of non-traumatic subarachnoid haemorrhage in patients with brain edema

    Energy Technology Data Exchange (ETDEWEB)

    Avrahami, E.; Katz, R.; Rabin, A.; Friedman, V. [Department of Diagnostic Radiology, E. Wolfson Medical Center 58100 Holon (Israel)

    1998-10-01

    The aim of the study is to prove, retrospectively, that it is unlikely that the computerized tomography (CT) diagnosis of subarachnoid haemorrhage (SH) accompanies the CT diagnosis of generalized brain edema. A total of 100 comatose patients underwent CT of the brain. Of this number, 42 underwent an enhanced CT scan. In 26 patients, lumbar puncture was also performed. A control group of ten patients diagnosed with headache and having a normal CT scan underwent NECT and ECT. Measurements of the white and gray matter density in Hounsfield units (HU) were performed in all 110 cases, including the controls. The brain tissue density and the difference between the densities of the white and gray matter were lower in the cases with brain edema than in the controls. The data values were statistically significant. Small cerebral ventricles, sulci and cisterns and small differences between white and gray matter measurements were observed in the CT scans of the brain edema cases. All 100 patients had CT diagnosis of brain edema and SH. There was no bloody or xanthochromic CSF in any of the 26 lumbar punctures performed. In the enhanced CT scans, there was poor or no filling of the lateral sinuses. The compression of the lateral sinuses by the edematous brain tissue most probably results in their stenosis or obstruction due to disturbed brain venous drainage which can mimic CT findings of SH. (Copyright (c) 1998 Elsevier Science B.V., Amsterdam. All rights reserved.)

  6. Effect of nimodipine on cerebral blood flow and cerebrovascular reactivity after subarachnoid haemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Rasmussen, G.; Bergholdt, B.; Sunde, N.; Voldby, B. [Aarhus Univ. Hospital, Dept.of Neurosurgery, Aarhus (Denmark); Dahl, B.; Cold, G. [Aarhus Univ. Hospital, Dept. of Neuroanesthesia, Aarhus (Denmark)

    1999-03-01

    The aim of the present study was to investigate the effect of nimodipine on autoregulation of cerebral blood flow (CBF), CO{sub 2} reactivity and cerebral oxygen metabolism (CMRO{sub 2}) in patients with subarachnoid haemorrhage (SAH). Eight patients with severe SAH were studied with repeated CBF and CMRO{sub 2} measurements on the first day of the bleeding and after at least 12 h of treatment of nimodipine. An initial resting study, an autoregulation study and a hyperventilation study was performed. CBF was measured using the 133-Xenon intravenous method. CMRO{sub 2} was calculated as AVDO{sub 2}xCBF. Nimodipine did not significantly change CBF and CMRO{sub 2} in the initial resting study. After induced arterial hypotension intact autoregulation was found before as well as after treatment with nimodipine. Beneficial effects of nimodipine were found on CO{sub 2} reactivity and CMRO{sub 2} during hypotension that may be explained as a positive effect on cerebral ischaemia. (au) 26 refs.

  7. Aneurysmal subarachnoid haemorrhage (aSAH: Five consecutive years' experience of Fars province, Iran.

    Directory of Open Access Journals (Sweden)

    Abdolkarim Rahmanian

    Full Text Available Subarachnoid haemorrhage (SAH, caused by the rupture of intracranial aneurysms, is a devastating event with high rates of morbidity and mortality. Aneurysmal subarachnoid haemorrhage (aSAH plays a critical role in the potential loss of life as its sufferers are usually of a young age. We aimed to investigate the incidence of aSAH along with the patients' characteristics over five consecutive years in Fars, a large province located in Southern Iran.In this prospective study, anonymous data of all patients diagnosed with aSAH in Fars province were collected after patient admission and surgery. Data from the last national census in 2011 were used to calculate the incidence. The data were analysed using SPSS software version 18 using independent sample t test, chi square test and ANOVA. The significance level was set at 0.05.The number of aSAH cases identified in Fars, Iran, each year varied between 78 (2011 and 98 (2015 for a total of 421 aSAH cases within the 5-year study period. The annual aSAH incidence estimates showed no differences and were 1.65 [95% confidence interval (CI: 1.58-1.72], 1.70 (95%CI: 1.68-1.72, 1.71 (95%CI: 1.63-1.78, 1.82 (95%CI: 1.74-1.9, and 2.05 (95%CI: 1.97-2.13 per 100,000 persons, respectively, for the five consecutive years from 21 March 2011 to 20 March 2016. Hypertension was the most common risk factor, and was found in 198 (48% aSAH patients. Ninety-four (22.5% patients had moderate hydrocephalus on admission. Middle cerebral artery and anterior communicating artery were the most common sites of aneurysms. On admission, 351 (83% patients had a Glasgow Coma Scale score >7, 197 (47% presented with Hunt and Hess score of 1, and 365 (87% had a Fisher score of ≤3. Multiple aneurysms were found in 59 (14% of the 421 cases and the most common risk factors in multiple aneurysms were hypertension in 30 (51% and smoking in 26 (44% cases. Survival data were available only on patients diagnosed in year 2015, and the six

  8. Early rebleeding in patients with subarachnoid haemorrhage under intensive blood pressure management.

    Science.gov (United States)

    Oheda, Motoki; Inamasu, Joji; Moriya, Shigeta; Kumai, Tadashi; Kawazoe, Yushi; Nakae, Shunsuke; Kato, Yoko; Hirose, Yuichi

    2015-08-01

    The objective of this study was to report the frequency and clinical characteristics of early rebleeding in subarachnoid haemorrhage (SAH) patients who underwent intensive blood pressure (BP) management. Patients with aneurysmal SAH frequently present to the emergency department (ED) with elevated BP. Intensive BP management has been recommended to lower the risk of early rebleeding. However, few studies have reported the frequency of early rebleeding in SAH patients undergoing BP management. In our institution, SAH patients with systolic BP (SBP)>140 mmHg received continuous intravenous nicardipine to maintain their SBP within 120±20 mmHg after diagnosis. An attempt to implement intensive BP management was made on 309 consecutive SAH patients who presented to our ED within 48 hours of SAH onset. Overall, 24 (7.8%) of the 309 patients sustained early rebleeding. Fifteen patients sustained early rebleeding before the implementation of BP management, and the other nine sustained early rebleeding after the implementation of BP management. Therefore, the frequency of early rebleeding under BP management was 3.1% (9/294). When the 309 patients were dichotomised using ED SBP of 140 mmHg as a cut off (SBP>140 mmHg; n=239 versus SBP⩽140 mmHg; n=70), the latter counter-intuitively exhibited a significantly higher frequency of early rebleeding (5.9% versus 14.2%; p=0.04). This relatively low frequency of early rebleeding under BP management may be acceptable. However, early rebleeding is not eradicated even with strict BP control as factors other than elevated BP are involved. ED SBP within the target range (SBP⩽140 mmHg) does not negate the risk of early rebleeding. Other treatment options that reduce the risk should also be explored. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. Perfusion-weighted MRI to evaluate cerebral autoregulation in aneurysmal subarachnoid haemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Hattingen, Elke; Blasel, Stella; Dettmann, Edgar; Pilatus, Ulrich; Zanella, Friedhelm E. [University of Frankfurt, Institute of Neuroradiology, Frankfurt (Germany); Vatter, Hartmut; Seifert, Volker [University of Frankfurt, Department of Neurosurgery, Frankfurt (Germany); Weidauer, Stefan [University of Frankfurt, Institute of Neuroradiology, Frankfurt (Germany); Sankt Katharinen Hospital Frankfurt, Department of Neurology, Frankfurt (Germany)

    2008-11-15

    The aim of this study was to evaluate autoregulatory mechanisms in different vascular territories within the first week after aneurysmal subarachnoid haemorrhage (SAH) by perfusion-weighted magnetic resonance imaging (PW-MRI). For this purpose, regional cerebral blood flow and volume (rCVF and rCBV) were measured in relation to different degrees of angiographically visible cerebral vasospasm (CVS). In 51 SAH patients, PW-MRI and digital subtraction angiography were performed about 5 days after onset of SAH. Regional CBF and rCBV were analysed in the territories of the anterior cerebral artery (ACA), the middle cerebral artery (MCA) and the basal ganglia of each hemisphere in relationship to the degree of CVS in the particular territory. Correlations between rCBF, rCBV and CVS were analysed. CVS was found in 22 out of 51 patients in at least one territory. In all territories, rCBV decreased with increasing degree of CVS, correlated with a decrease of rCBF. In the ACA territories, SAH patients with severe CVS had significantly lower rCBF compared to healthy subjects and to SAH patients without CVS. In the basal ganglia, rCBF and rCBV of the control group were significantly higher compared to the patients without and with moderate vasospasms. PW-MRI showed simultaneous decrease of rCBF and rCBV in patients with SAH. The fact that rCBV did not increase in territories with CVS to maintain rCBF reveals dysfunctional vascular autoregulation. Vasospasms in the microvasculature are most evident in the basal ganglia, showing decreased rCBV and rCBF even in SAH patients without CVS. (orig.)

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

    Directory of Open Access Journals (Sweden)

    Gray Alastair

    2010-04-01

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

  11. Cognitive domain deficits in patients with aneurysmal subarachnoid haemorrhage at 1 year

    Science.gov (United States)

    Wong, George Kwok Chu; Lam, Sandy Wai; Ngai, Karine; Wong, Adrian; Siu, Deyond; Poon, Wai Sang; Mok, Vincent

    2013-01-01

    Background Cognitive domain deficits can occur after aneurysmal subarachnoid haemorrhage (aSAH) though few studies systemically evaluate its impact on 1-year outcomes. Objective We aimed to evaluate the pattern and functional outcome impact of cognitive domain deficits in aSAH patients at 1 year. Methods We carried out a prospective observational study in Hong Kong, during which, 168 aSAH patients (aged 21–75 years and had been admitted within 96 h of ictus) were recruited over a 26-month period. The cognitive function was assessed by a domain-specific neuropsychological assessment battery at 1 year after ictus. The current study is registered at ClinicalTrials.gov of the US National Institutes of Health (NCT01038193). Results Prevalence of individual domain deficits varied between 7% to 15%, and 13% had two or more domain deficits. After adjusting for abbreviated National Institute of Health Stroke Scale and Geriatric Depressive Scale scores, unfavourable outcome (Modified Rankin Scale 3–5) and dependent instrumental activity of daily living (Lawton Instrumental Activity of Daily Living<15) were significantly associated with two or more domain deficits and number of cognitive domain deficits at 1 year. Two or more domain deficits was independently associated with age (OR, 1.1; 95% CI 1.1 to 1.2; p<0.001) and delayed cerebral infarction (OR, 6.1; 95% CI 1.1 to 33.5; p=0.036), after adjustment for years of school education. Interpretation In patients with aSAH, cognitive domain deficits worsened functional outcomes at 1 year. Delayed cerebral infarction was an independent risk factor for two or more domain deficits at 1 year. PMID:23606736

  12. Leukocyte count and incidence of subarachnoid haemorrhage: a prospective cohort study.

    Science.gov (United States)

    Söderholm, Martin; Zia, Elisabet; Hedblad, Bo; Engström, Gunnar

    2014-04-03

    Subarachnoid haemorrhage (SAH) is a devastating disease, in the majority of cases caused by a rupture of an arterial intracranial aneurysm. The effect of systemic low-grade inflammation on incidence of SAH is not known. The purpose of this study was to evaluate the relationship between leukocyte count, a marker of systemic inflammation, and incidence of SAH in a large cohort study. Leukocyte count and other cardiovascular risk factors were measured in 19,794 individuals (17,083 men and 2,711 women, mean age 44 years) participating in a health screening program between 1974 and 1981. Incidence of SAH in relation to baseline leukocyte concentration was studied during a mean follow-up of 27 years in participants free from previous stroke. Ninety-five participants had a SAH, corresponding to an incidence of 22 per 100,000 in women and 17 per 100,000 in men. The hazard ratio for SAH per one standard deviation (2.01 × 10⁹ cells/L) increase of leukocyte concentration was 1.26 (95% CI 1.05-1.53, p = 0.014) after adjustment for several potential confounding factors including smoking. In sensitivity analysis, there was a significant association in smokers but not in non-smokers. High leukocyte count at baseline was associated with increased incidence of SAH, although this relationship might be restricted to smokers. The results support the view that low-grade systemic inflammation could be involved in the pathogenesis of SAH, or constitute an early risk marker for the disease.

  13. Advances in the understanding of delayed cerebral ischaemia after aneurysmal subarachnoid haemorrhage [version 1; referees: 4 approved

    Directory of Open Access Journals (Sweden)

    Liam Flynn

    2015-11-01

    Full Text Available Delayed cerebral ischaemia has been described as the single most important cause of morbidity and mortality in patients who survive the initial aneurysmal subarachnoid haemorrhage. Our understanding of the pathophysiology of delayed cerebral ischaemia is meagre at best and the calcium channel blocker nimodipine remains the only intervention to consistently improve functional outcome after aneurysmal subarachnoid haemorrhage. There is substantial evidence to support cerebral vessel narrowing as a causative factor in delayed cerebral ischaemia, but contemporary research demonstrating improvements in vessel narrowing has failed to show improved functional outcomes. This has encouraged researchers to investigate other potential causes of delayed cerebral ischaemia, such as early brain injury, microthrombosis, and cortical spreading depolarisation. Adherence to a common definition of delayed cerebral ischaemia is needed in order to allow easier assessment of studies using multiple different terms. Furthermore, improved recognition of delayed cerebral ischaemia would not only allow for faster treatment but also better assessment of interventions. Finally, understanding nimodipine’s mechanism of action may allow us to develop similar agents with improved efficacy.

  14. [Aneurysmal subarachnoid haemorrhage: Results after introducing endovascular therapy in a medium-low volume centre].

    Science.gov (United States)

    Delgado-López, Pedro David; López-Martínez, José Luis; Gero-Escapa, María; Martín-Alonso, Javier; Castaño-Blazquez, Miguel; Ossa-Echeverri, Sergio; Martín-Velasco, Vicente; Castilla-Díez, José Manuel

    2016-01-01

    To evaluate the impact of introducing endovascular therapy for patients with aneurysmal subarachnoid haemorrhage (aSAH) in a medium-low volume centre. A retrospective observational study was conducted by comparing the clinical outcome of patients with aSAH before and after introducing endovascular therapy in our centre. The main variables analysed were: type of treatment, hospital and late mortality, intra-procedural morbidity, rate of re-bleeding and vasospasm, and clinical outcome according to the Glasgow Outcome Score (GOS). Seventy-one patients were treated in two periods: 2010-2011 (32 patients; 19 clipped, 6 coiled, 7 untreated), and 2012-2013 (39 patients, 3 clipped, 34 coiled, 2 untreated). No significant differences were found in age, sex, clinical grade at admission, type and location of aneurysm, Fisher score, or in hospital mortality (28.1% vs 25.6%, P=.35), GOS (except for GOS 5: 43.37% vs 53.8%, P=.045), rate of hydrocephalus and rate of vasospasm. The second cohort obtained better results for aggregated GOS 1+2+3 (36.3% vs 43.75%, P=.034) and for GOS 4+5 (61.5% vs 56.25%, P=.078). The percentage of patients left untreated was significantly lower in the second period (5.1% vs 21.8%, P<.01), as well as the rate of re-bleeding (0% vs 9.4%, P<.01). Patients were treated earlier (2.51 vs 3.95 days), and hospital and total stay were lower (15.2 and 24.6 vs 10.3 and 18 days) in the second period, these differences not reaching statistical significance. Endovascular therapy allowed treating more patients with aSAH, and with a lower re-bleeding rate. This led to a modest reduction in morbidity and mortality. Copyright © 2016 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Early versus late readmission of subarachnoid haemorrhage patients into neurocritical care.

    Science.gov (United States)

    Low, Jacob C M; Welbourne, Jessie; McMillan, Helen; Whitfield, Peter C

    2016-10-01

    Subarachnoid haemorrhage (SAH) patients will typically require monitoring in a specialised Neurocritical Care Unit (NCCU) regardless of the primary treatment modality. Once discharged from NCCU, readmission within 48 h is regarded as a "failed" discharge. The aims of this study are to (1) Evaluate the readmission rate of SAH patients into NCCU, (2) Identify the indications for readmission, (3) Analyse clinical parameters on discharge between patients readmitted early and late. Retrospective observational study of the Intensive Care National Audit and Research Centre (ICNARC) database of patients from our unit diagnosed with SAH from January 2009-December 2014, who were readmitted into NCCU. Demographic data, World Federation of Neurosurgical Societies (WFNS) grade, Fisher grade, length of initial and subsequent NCCU stay, time of readmission, indication for readmission, and mortality rate data were collected. Patients were categorised by early (48 h) readmission, and their clinical parameters on NCCU discharge were statistically analysed. Five hundred and seventy-five SAH patients were admitted into NCCU, of which 49 patients (9%) were readmitted after discharge to ward-level care. The mean age of readmitted patients was 64.1 ± 11.6 years old. The most common indications were delayed cerebral ischaemia (DCI) (50%) and infection (19%). Readmitted SAH patients were typically WFNS grade I-II (n = 22) and Fisher grade III-IV (n = 44). 17 (35%) patients were readmitted early, and were older (p = 0.0049) with a lower GCS (p = 0.0077) compared to patients readmitted later. White cell count and C-reactive protein were higher in patients readmitted early, but did not reach statistical significance (p = 0.09, p = 0.07). DCI and infection were the most common indications for NCCU readmission in SAH patients. "Failed" discharged patients from NCCU are typically older with a lower GCS than patients readmitted after 48 h, and therefore

  16. Appreciation of CT-negative, lumbar puncture-positive subarachnoid haemorrhage : risk factors for presence of aneurysms and diagnostic yield of imaging

    NARCIS (Netherlands)

    Bakker, Nicolaas A.; Groen, Rob J. M.; Foumani, Mahrouz; Uyttenboogaart, Maarten; Eshghi, Omid S.; Metzemaekers, Joannes; Luijckx, Gert Jan; van Dijk, J. Marc C.

    OBJECTIVE: Patients without a subarachnoid haemorrhage (SAH) on brain CT scan (CT-negative), but a lumbar puncture (LP)-proven SAH, are a challenging patient category. The optimal diagnostic approach is still a matter of debate. Also, there is little knowledge on the probability of finding an

  17. Simple and validated UHPLC-MS/MS analysis of nimodipine in plasma and cerebrospinal fluid of patients with subarachnoid haemorrhage.

    Science.gov (United States)

    Mohamed, Susan; Riva, Roberto; Contin, Manuela

    2016-08-15

    We present a simple, fast and validated method for the determination of nimodipine in plasma and cerebrospinal fluid (CSF) of patients with subarachnoid haemorrhage using ultra high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS). Plasma or CSF 250μL aliquots were pretreated with acetonitrile spiked with lacosamide as internal standard. The chromatographic separation was performed on a Fusion (3μm) 50×2.0mm I.D. column with gradient elution of 0.1% (v/v) formic acid in water and 0.1% (v/v) formic acid in acetonitrile at a flow rate of 0.35mL/min. The MS/MS ion transitions were 419.1→343 for nimodipine and 251.1→91 for the internal standard. The linearity was determined from 2.0 to 40.0ng/mL in plasma and 40.0-800.0pg/mL in CSF. The lower limit of quantitation (LLOQ) of nimodipine was 0.4ng/mL in plasma and 40pg/mL in CSF. The mean recovery for nimodipine was ≥75% in plasma and ≥90% in CSF at all three considered concentrations. Intra- and interassay precision and accuracy were ≤15% at all quality control concentrations in plasma and CSF. The method was applied to measure plasma and CSF concentrations of nimodipine in a series of patients with subarachnoid haemorrhage treated with intravenous nimodipine. The present procedure, omitting time-consuming liquid-liquid extraction and drying steps, is faster, simpler and cheaper than published LC-MS/MS analytical methods for nimodipine in plasma and the first validated one for nimodipine in CSF. Copyright © 2016 Elsevier B.V. All rights reserved.

  18. Effects of continuous prostacyclin infusion on regional blood flow and cerebral vasospasm following subarachnoid haemorrhage

    DEFF Research Database (Denmark)

    Rasmussen, Rune; Juhler, Marianne; Wetterslev, Jørn

    2014-01-01

    BACKGROUND: One of the main causes of mortality and morbidity following subarachnoid hemorrhage (SAH) is the development of cerebral vasospasm, a frequent complication arising in the weeks after the initial bleeding. Despite extensive research, no effective treatment of vasospasm exists to date. ...

  19. New angiographic measurement tool for analysis of small cerebral vessels: application to a subarachnoid haemorrhage model in the rat

    Energy Technology Data Exchange (ETDEWEB)

    Turowski, B.; Moedder, U. [Heinrich-Heine University, Institute of Diagnostic Radiology, Neuroradiology, Duesselorf (Germany); Haenggi, D.; Steiger, H.J. [Heinrich-Heine University, Department of Neurosurgery, Duesseldorf (Germany); Beck, A.; Aurich, V. [Heinrich-Heine University, Institute of Informatics, Duesseldorf (Germany)

    2007-02-15

    Exact quantification of vasospasm by angiography is known to be difficult especially in small vessels. The purpose of the study was to develop a new method for computerized analysis of small arteries and to demonstrate feasibility on cerebral angiographies of rats acquired on a clinical angiography unit. A new software tool analysing grey values and subtracting background noise was validated on a vessel model. It was tested in practice in animals with subarachnoid haemorrhage (SAH). A total of 28 rats were divided into four groups: SAH untreated, SAH treated with local calcium antagonist, SAH treated with placebo, and sham-operated. The diameters of segments of the internal carotid, caudal cerebral, middle cerebral, rostral cerebral and the stapedial arteries were measured and compared to direct measurements of the diameters on magnified images. There was a direct correlation between the cross-sectional area of vessels measured in a phantom and the measurements acquired using the new image analysis method. The spread of repeated measurements with the new software was small compared to the spread of direct measurements of vessel diameters on magnified images. Application of the measurement tool to experimental SAH in rats showed a statistically significant reduction of vasospasm in the SAH groups treated with nimodipine-releasing pellets in comparison to all the other groups combined. The presented computerized method for analysis of small intracranial vessels is a new method allowing precise relative measurements. Nimodipine-releasing subarachnoidal pellets reduce vasospasm, but further testing with larger numbers is necessary. The tool can be applied to human angiography without modification and offers the promise of substantial progress in the diagnosis of vasospasm after SAH. (orig.)

  20. Interleukin-1 receptor antagonist is beneficial after subarachnoid haemorrhage in rat by blocking haem-driven inflammatory pathology

    Directory of Open Access Journals (Sweden)

    Andrew D. Greenhalgh

    2012-11-01

    Subarachnoid haemorrhage (SAH is a major contributor to the burden of stroke on society. Treatment options are limited and animal models of SAH do not always mimic key pathophysiological hallmarks of the disease, thus hindering development of new therapeutics. Inflammation is strongly associated with brain injury after SAH in animals and patients, and inhibition of the pro-inflammatory cytokine interleukin-1 (IL-1 represents a possible therapeutic target. Here we report that a rupture of the middle cerebral artery in the rat produces heterogeneous infarct patterns similar to those observed in human SAH. Administration of the IL-1 receptor antagonist (IL-1Ra reduced blood-brain barrier breakdown, and the extent of breakdown correlated with brain injury. After SAH, haem oxygenase-1 (HO-1 was strongly expressed around the bleed site and in the cortex and striatum, indicating the presence of free haem, a breakdown product of haemoglobin. HO-1 expression was also found in the same regions as microglial/macrophage expression of IL-1α. The direct effect of haem on IL-1α expression was confirmed in vitro using organotypic slice culture (OSC. Haem-induced cell death was dependent on IL-1 signalling, with IL-1Ra completely blocking cellular injury. Furthermore, stimulation of mouse primary mixed glial cells with haem induced the release of IL-1α, but not IL-1β. Thus, we suggest that haem, released from lysed red blood cells (RBCs in the subarachnoid space, acts as a danger-associated molecular pattern (DAMP driving IL-1-dependent inflammation. These data provide new insights into inflammation after SAH-induced brain injury and suggest IL-1Ra as a candidate therapeutic for the disease.

  1. Prediction of two month modified Rankin Scale with an ordinal prediction model in patients with aneurysmal subarachnoid haemorrhage

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    Sneade Mary

    2010-09-01

    Full Text Available Abstract Background Aneurysmal subarachnoid haemorrhage (aSAH is a devastating event with a frequently disabling outcome. Our aim was to develop a prognostic model to predict an ordinal clinical outcome at two months in patients with aSAH. Methods We studied patients enrolled in the International Subarachnoid Aneurysm Trial (ISAT, a randomized multicentre trial to compare coiling and clipping in aSAH patients. Several models were explored to estimate a patient's outcome according to the modified Rankin Scale (mRS at two months after aSAH. Our final model was validated internally with bootstrapping techniques. Results The study population comprised of 2,128 patients of whom 159 patients died within 2 months (8%. Multivariable proportional odds analysis identified World Federation of Neurosurgical Societies (WFNS grade as the most important predictor, followed by age, sex, lumen size of the aneurysm, Fisher grade, vasospasm on angiography, and treatment modality. The model discriminated moderately between those with poor and good mRS scores (c statistic = 0.65, with minor optimism according to bootstrap re-sampling (optimism corrected c statistic = 0.64. Conclusion We presented a calibrated and internally validated ordinal prognostic model to predict two month mRS in aSAH patients who survived the early stage up till a treatment decision. Although generalizability of the model is limited due to the selected population in which it was developed, this model could eventually be used to support clinical decision making after external validation. Trial Registration International Standard Randomised Controlled Trial, Number ISRCTN49866681

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

    Science.gov (United States)

    2012-01-01

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

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

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    Skrifvars Markus B

    2012-11-01

    Full Text Available Abstract Introduction The prevalence of cardiac arrest among patients with subarachnoid haemorrhage [SAH], and the prevalence of SAH as the cause following out-of-hospital cardiac arrest [OHCA] or in-hospital cardiac arrest [IHCA] is unknown. In addition it is unclear whether cardiopulmonary resuscitation [CPR] and post-resuscitation care management differs, and to what extent this will lead to meaningful survival following cardiac arrest [CA] due to SAH. Aim We reviewed the literature in order to describe; 1.The prevalence and predisposing factors of CA among patients with SAH 2.The prevalence of SAH as the cause of OHCA or IHCA and factors characterising CPR 3.The survival and management of SAH patients with CA. Material and methods The following sources, PubMed, CinAHL and The Cochrane DataBase were searched using the following Medical Subheadings [MeSH]; 1. OHCA, IHCA, heart arrest and 2. subarachnoid haemorrhage. Articles containing relevant data based on the abstract were reviewed in order to find results relevant to the proposed research questions. Manuscripts in other languages than English, animal studies, reviews and case reports were excluded. Results A total of 119 publications were screened for relevance and 13 papers were included. The prevalence of cardiac or respiratory arrest among all patients with SAH is between 3-11%, these patients commonly have a severe SAH with coma, large bleeds and evidence of raised intracerebral pressure on computed tomography scans compared to those who did not experience a CA. The prevalence of patients with SAH as the cause of the arrest among OHCA cases vary between 4 to 8% among those who die before hospital admission, and between 4 to 18% among those who are admitted. The prevalence of SAH as the cause following IHCA is low, around 0.5% according to one recent study. In patients with OHCA survival to hospital discharge is poor with 0 to 2% surviving. The initial rhythm is commonly asystole or

  4. Methadone, codeine and acute haemorrhagic necrotising pancreatitis: which came first?

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    Tormey, William P; Sabah, Muna; Moore, Tara M

    2013-03-10

    Acute haemorrhagic necrotising pancreatitis lead to the death at home of a young female who was on a methadone maintenance programme. Toxic levels of codeine with potentially lethal levels of methadone and morphine were found at post-mortem. Whether opiates caused the pancreatitis or were the consequence of self-medication for pain is impossible to differentiate. Forensic toxicology may pose the question but be unable to provide the answer. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  5. [Re-bleeding predictors in patients with aneurysmal subarachnoid haemorrhage and delayed neurosurgical treatment].

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    Rivero Rodríguez, Dannys; Scherle Matamoros, Claudio; Fernández Cúe, Leda; Miranda Hernández, José Luis; Pernas Sánchez, Yanelis; Pérez Nellar, Jesús

    2016-01-01

    To evaluate the re-bleeding predictors in patients with delayed treatment of aneurysmal subarachnoid hemorrhage. A prospective cohort study enrolled 261 patients with aneurysmal subarachnoid hemorrhage, attending in Hermanos Ameijeiras Hospital from October 2005, and June 2014. An increased re-bleeding risk in the multivariate analysis was associated with grade III (OR 2.01; 95% CI; 1.06-3.84) and grade IV (OR 3.84; 95% CI; 2.06-7.31) on World Federation Neurological Surgeon (WFNS) scale; grade III (OR 2.04; 95% CI; 1.01-4.13) and grade IV (OR 2.12, 95% CI; 1.05-4.28) on the Fischer scale, aneurism location in posterior circulation (OR 2.45, 95% CI; 1.33-4.44), and anterior communicant artery (OR 1.57, 95% CI;1.00-2.46). Hypertension history was present in 60.9% (159 patients) and was also associated with risk of re-bleeding (OR 2.70, 95% CI; 1.00-7.30). Blood pressure, haematocrit, glycemic, aneurysm size, multiple aneurysms, and location in the middle cerebral artery, do not show any relationship. Hypertension history, poor grade (III and IV) on WFNS and Fisher scale and aneurysm location were independent risks factors of re-bleeding in patients with delayed aneurysmal treatment. Copyright © 2014 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  6. Likelihood of aneurysmal subarachnoid haemorrhage in patients with normal unenhanced CT, CSF xanthochromia on spectrophotometry and negative CT angiography.

    Science.gov (United States)

    Rana, A K; Turner, H E; Deans, K A

    2013-01-01

    Patients with suspected subarachnoid haemorrhage, a normal noncontrast computed tomography (CT) and cerebrospinal fluid (CSF) evidence of haemoglobin breakdown products often undergo CT angiography (CTA). If this is normal, then invasive catheter angiography may be offered. In current clinical practice, haemoglobin breakdown products are detected by spectrophotometry rather than visible xanthochromia, and CTA is performed on multidetector scanners. The aim of this study was to determine if such patients should still have a catheter angiography, given the associated risks. Patients positive for CSF spectrophotometry (n=26) were retrospectively identified from the clinical biochemistry information system and imaging data from the electronic radiology records were reviewed. Discharge letters were consulted to relate the biochemistry and radiology results to the final diagnosis. 15 patients with CT angiography were found. Nine patients had normal CT angiography. No causative aneurysms had been missed. One patient had small, coincidental aneurysms missed on initial reading of the CTA. The likelihood of a clinically significant aneurysm in a patient who is CT negative, lumbar puncture positive and CTA negative is low. Double reporting of negative CT angiograms may be advisable.

  7. Diabetes mellitus and the risk of aneurysmal subarachnoid haemorrhage: A systematic review and meta-analysis of current evidence.

    Science.gov (United States)

    Yao, Xi-Yang; Jiang, Cai-Qi; Jia, Gen-Lai; Chen, Gang

    2016-12-01

    Objective This systematic review aimed to define the relationship between diabetes mellitus (DM) and the risk of aneurysmal subarachnoid haemorrhage (aSAH). Methods Studies associated with DM and aSAH published until March 2016 were retrieved from Pubmed, Embase, Web of Science, and Cochrane Library databases. A random-effects model was used to calculate the relative risks (RRs) with 95% confidence intervals (CIs). Results Eighteen observational studies were retrieved. The overall RRs for DM and aSAH were RRs = 0.59 (0.44, 0.79), with moderate heterogeneity ( I(2 )= 55.7%, Pheterogeneity = 0.000). Subgroup analysis by study quality revealed a reduced association between DM and aSAH risk in high quality studies only (RRs = 0.40, 95% CI: 0.29, 0.56; I(2 )= 0.0%, Pheterogeneity = 0.549), therefore study quality may be a source of heterogeneity. Conclusion A potential decreased risk of aSAH in DM patients was found in high quality studies. Further studies are required to confirm this causal relationship and to investigate the biological mechanisms.

  8. Spontaneous subarachnoid haemorrhage from rupture of an anterior communicating artery aneurysm in a patient with pituitary macroadenoma.

    Science.gov (United States)

    Almeida Silva, J M; Campos, R R; Souza, R R; Sette Dos Santos, M E; Aguiar, G B

    2014-01-01

    The presence of a cerebral aneurysm in patients with pituitary adenoma is a rare event. Diagnostic suspicion may stem from magnetic resonance imaging, which should lead to complementary investigation. As for treatment, even in conditions in which there has been no previous bleeding, the simultaneous approach should be considered, prioritising the aneurysm most of the time. The present report describes the case of a patient with a history of pituitary macroadenoma, who had undergone a partial transsphenoidal resection ten years earlier. Admission to our service occurred after a sudden headache followed by mental confusion. A cranial computed tomography showed subarachnoid haemorrhage and expansive suprasellar lesion. Cerebral angiography showed a saccular aneurysm of the anterior communicating complex. The patient underwent a surgical procedure for microsurgical clipping of the aneurysm and partial resection of the pituitary tumour. We have also included a brief review of the literature on this subject. Copyright © 2012 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  9. Comparison of Montreal Cognitive Assessment and Mini-Mental State Examination in Evaluating Cognitive Domain Deficit Following Aneurysmal Subarachnoid Haemorrhage

    Science.gov (United States)

    Wong, George Kwok Chu; Lam, Sandy Wai; Wong, Adrian; Ngai, Karine; Poon, Wai Sang; Mok, Vincent

    2013-01-01

    Objective Cognitive deficits are common after aneurysmal subarachnoid haemorrhage (aSAH), and clinical evaluation is important for their management. Our hypothesis was that the Montreal Cognitive Assessment (MoCa) is superior to the Mini-Mental State Examination (MMSE) in screening for cognitive domain deficit in aSAH patients. Methods We carried out a prospective observational and diagnostic accuracy study on Hong Kong aSAH patients aged 21 to 75 years who had been admitted within 96 hours of ictus. The domain-specific neuropsychological assessment battery, the MoCA and MMSE were administered 2–4 weeks and 1 year after ictus. A cognitive domain deficit was defined as a cognitive domain z score ictus, the MoCA produced higher area under the curve scores for cognitive impairment than the MMSE (MoCA, 0.92; 95% CI, 0.83 to 0.97 versus MMSE, 0.77; 95% CI, 0.66 to 0.83, p = 0.009). Interpretation Cognitive domain deficits and cognitive impairment in patients with aSAH can be screened with the MoCA in both the subacute and chronic phases. PMID:23573223

  10. Severe acute haemorrhagic gastritis controlled by hydrogen peroxide.

    Science.gov (United States)

    Katsinelos, Panagiotis; Kountouras, Jannis; Paroutoglou, George; Beltsis, Athanasios; Mimidis, Kostas; Pilpilidis, Ioannis; Zavos, Christos

    2006-01-01

    A 92-year-old woman presented with severe acute haemorrhagic gastritis due to abuse of non-steroidal anti-inflammatory drugs (NSAIDs). She was treated with instillation of 150 ml 3% hydrogen peroxide (H2O2) every 2 h via a nasogastric tube. The copious amount of bright red blood through the nasogastric tube started to decline substantially after the first administration of H2O2 and continued to reveal clear material during the second and third instillation of H2O2. The total amount of H2O2 administered was 600 ml. No rebleeding and only a few flame-shaped intramucosal haemorrhages were observed on the following four consecutive daily endoscopic evaluations. These are promising observations which will have to be confirmed with respect to the safety and efficacy of H2O2 treatment by further controlled studies.

  11. Crystals seen on CSF microscopy in a case of suspected subarachnoid haemorrhage

    Science.gov (United States)

    Weiand, Daniel; Hanning, Ian; Mouhamadou, Moussa; Wearmouth, Debbie

    2015-01-01

    Although crystals are rarely identified on cerebrospinal fluid (CSF) microscopy, their presence can be of significant diagnostic value. We report a case of oxalate crystals seen on CSF microscopy of a 43-year-old woman. The patient presented with headaches, nausea and vomiting. CT of the head showed a small focus of hyper-density, suspicious of haemorrhage, in the right side of the pontine cistern. CSF cell count was within the normal range. Although no organisms were seen on microscopy, copious oxalate crystals were seen. The same crystals were seen on microscopy of CSF collected in a fluoride oxalate container used for glucose analysis. A follow-up contrast-enhanced CT angiogram did not demonstrate any abnormalities. It transpired that excess CSF had been collected into a fluoride oxalate container. This had subsequently been decanted into a plain container for microbiological analysis. Correct specimen collection should be emphasised when teaching lumbar puncture technique. PMID:26139652

  12. Subarachnoid hemorrhage and rhabdomyolysis induced acute renal failure complicating organophosphate intoxication.

    Science.gov (United States)

    Gokel, Yüksel

    2002-11-01

    Organophosphate is extremely uncommon cause of rhabdomyolysis. This article describe two cases with rhabdomyolysis induced acute renal failure complicating by monocrotophos, an organophosphate compound. First patient had rhabdomyolysis induced acute renal failure and subarachnoid hemorrhage. This is the first reported case of subarachnoid hemorrhage, which may be related with organophosphate intoxication in literature. Second patient described here had rhabdomyolysis induced acute renal failure after organophosphate overdose.

  13. Intra-arterial nimodipine for cerebral vasospasm after subarachnoid haemorrhage: Influence on clinical course and predictors of clinical outcome.

    Science.gov (United States)

    Bashir, Asma; Andresen, Morten; Bartek, Jiri; Cortsen, Marie; Eskesen, Vagn; Wagner, Aase

    2016-02-01

    Intra-arterial nimodipine (IAN) has shown a promising effect on cerebral vasospasm (CV) after aneurysmal subarachnoid haemorrhage. At our institution, Rigshospitalet, IAN treatment has been used since 2009, but the short- and long-term clinical efficacy of IAN has not yet been assessed. The purpose was to evaluate the efficacy and clinical outcome of IAN treatment of symptomatic CV, and to assess the predictors of clinical outcome. Medical records of 25 patients undergoing a total of 41 IAN treatment sessions were retrospectively reviewed. Data on angiographic results, blood-flow velocities and the clinical condition before and after the IAN treatment were recorded. Predictors of the clinical outcome were assessed with a linear regression model. Positive angiographic response was achieved in 95.1% of 41 IAN treatment sessions. Flow-velocity measurements showed no relationship with angiographic responses of IAN. The immediate clinical improvement was observed in three patients (12%). Five patients (20%) had a favourable outcome at discharge and at three-month follow-up; 10 patients (40%) had a moderate to poor outcome; and the rest (40%) died. Increased number of affected vessels and number of procedures carried out per patient, and a trend toward an increased delay time from symptomatic CV to confirming angiographic CV and thus instituting IAN treatment predicted the poor clinical outcome. IAN treatment appears to be effective in reversing angiographic CV. However, it is not always effective in reversing clinical deterioration, as several other factors including treatment delay affect the clinical course. © The Author(s) 2016.

  14. Cerebrospinal fluid and plasma cytokines after subarachnoid haemorrhage: CSF interleukin-6 may be an early marker of infection

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    Hopkins Stephen J

    2012-11-01

    Full Text Available Abstract Background Cytokines and cytokine receptor concentrations increase in plasma and cerebrospinal fluid (CSF of patients following subarachnoid haemorrhage (SAH. The relationship between plasma and CSF cytokines, and factors affecting this, are not clear. Methods To help define the relationship, paired plasma and cerebrospinal fluid (CSF samples were collected from patients subject to ventriculostomy. Concentrations of key inflammatory cytokines, interleukin (IL-1ß, IL-1 receptor antagonist (IL-1Ra, IL-1 receptor 2, IL-6, IL-8, IL-10, tumour necrosis factor (TNF-α, and TNF receptors (TNF-R 1 and 2 were determined by immunoassay of CSF and plasma from 21 patients, where samples were available at three or more time points. Results Plasma concentrations of IL-1ß, IL-1Ra, IL-10, TNF-α and TNF-R1 were similar to those in CSF. Plasma TNF-R2 and IL-1R2 concentrations were higher than in CSF. Concentrations of IL-8 and IL-6 in CSF were approximately10 to 1,000-fold higher than in plasma. There was a weak correlation between CSF and plasma IL-8 concentrations (r = 0.26, but no correlation for IL-6. Differences between the central and peripheral pattern of IL-6 were associated with episodes of ventriculostomy-related infection (VRI. A VRI was associated with CSF IL-6 >10,000 pg/mL (P = 0.0002, although peripheral infection was not significantly associated with plasma IL-6. Conclusions These data suggest that plasma cytokine concentrations cannot be used to identify relative changes in the CSF, but that measurement of CSF IL-6 could provide a useful marker of VRI.

  15. Bedside cerebral microdialysis monitoring of delayed cerebral hypoperfusion in comatose patients with poor grade aneurysmal subarachnoid haemorrhage.

    Science.gov (United States)

    Patet, Camille; Quintard, Hervé; Zerlauth, Jean-Baptiste; Maibach, Thomas; Carteron, Laurent; Suys, Tamarah; Bouzat, Pierre; Bervini, David; Levivier, Marc; Daniel, Roy T; Eckert, Philippe; Meuli, Reto; Oddo, Mauro

    2017-04-01

    Delayed cerebral ischaemia (DCI) is frequent after poor grade aneurysmal subarachnoid haemorrhage (SAH). Owing to the limited accuracy of clinical examination, DCI diagnosis is often based on multimodal monitoring. We examined the value of cerebral microdialysis (CMD) in this setting. 20 comatose SAH participants underwent CMD monitoring-for hourly sampling of cerebral extracellular lactate/pyruvate ratio (LPR) and glucose-and brain perfusion CT (PCT). Patients were categorised as DCI when PCT (8±3 days after SAH) showed cerebral hypoperfusion, defined as cerebral blood flow 5.7 s. Clinicians were blinded to CMD data; for the purpose of the study, only patients who developed cerebral hypoperfusion in anterior and/or middle cerebral arteries were analysed. DCI (n=9/20 patients) was associated with higher CMD LPR (51±36 vs 31±10 in patients without DCI, p=0.0007) and lower CMD glucose (0.64±0.34 vs 1.22±1.05, p=0.0005). In patients with DCI, CMD changes over the 18 hours preceding PCT diagnosis revealed a pattern of CMD LPR increase (coefficient +2.96 (95% CI 0.13 to 5.79), p=0.04) with simultaneous CMD glucose decrease (coefficient -0.06 (95% CI -0.08 to -0.01), p=0.03, mixed-effects multilevel regression model). No significant CMD changes were noted in patients without DCI. In comatose patients with SAH, delayed cerebral hypoperfusion correlates with a CMD pattern of lactate increase and simultaneous glucose decrease. CMD abnormalities became apparent in the hours preceding PCT, thereby suggesting that CMD monitoring may anticipate targeted therapeutic interventions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  16. Preventive Antibiotics and Delayed Cerebral Ischaemia in Patients with Aneurysmal Subarachnoid Haemorrhage Admitted to the Intensive Care Unit.

    Science.gov (United States)

    Gathier, Celine S; Oostdijk, Evelien A; Rinkel, Gabriel J E; Dorhout Mees, Sanne M; Vergouwen, Mervyn D I; de Smet, Anne Marie G A; van de Beek, Diederik; Vandertop, W Peter; Verbaan, Dagmar; Algra, Ale; Bonten, Marc J M; van den Bergh, Walter M

    2016-02-01

    Delayed cerebral ischemia (DCI) is an important contributor to poor outcome after aneurysmal subarachnoid haemorrhage (aSAH). Development of DCI is multifactorial, and inflammation, with or without infection, is one of the factors independently associated with development of DCI and poor outcome. We thus postulated that preventive antibiotics might be associated with a reduced risk of DCI and subsequent poor outcome in aSAH patients. We performed a retrospective cohort-study in intensive care units (ICU) of three university hospitals in The Netherlands. We included consecutive aSAH patients with minimal ICU stay of 72 h who received either preventive antibiotics (SDD: selective digestive tract decontamination including systemic cefotaxime or SOD: selective oropharyngeal decontamination) or no preventive antibiotics. DCI was defined as a new hypodensity on CT with no other explanation than DCI. Hazard ratio's (HR) for DCI and risk ratio's (RR) for 28-day case-fatality and poor outcome at 3 months were calculated, with adjustment (aHR/aRR) for clinical condition on admission, recurrent bleeding, aneurysm treatment modality and treatment site. Of 459 included patients, 274 received preventive antibiotics (SOD or SDD) and 185 did not. With preventive antibiotics, the aHR for DCI was 1.0 (95% CI 0.6-1.8), the aRR for 28-day case-fatality was 1.1 (95% CI 0.7-1.9) and the aRR for poor functional outcome 1.2 (95% CI 1.0-1.4). Preventive antibiotics were not associated with reduced risk of DCI or poor outcome in aSAH patients in the ICU.

  17. Benefit of cerebrospinal fluid spectrophotometry in the assessment of CT scan negative suspected subarachnoid haemorrhage: a diagnostic accuracy study.

    Science.gov (United States)

    Hann, Angus; Chu, Kevin; Greenslade, Jaimi; Williams, Julian; Brown, Anthony

    2015-01-01

    This study aimed to determine if performing cerebrospinal fluid spectrophotometry in addition to visual inspection detects more ruptured cerebral aneurysms than performing cerebrospinal fluid visual inspection alone in patients with a normal head CT scan but suspected of suffering an aneurysmal subarachnoid haemorrhage (SAH). We performed a single-centre retrospective study of patients presenting to the emergency department of a tertiary hospital who underwent both head CT scan and lumbar puncture to exclude SAH. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of an approach utilising both spectrophotometry and visual inspection (combined approach) was compared to visual inspection alone. A total of 409 patients (mean age 37.8 years, 56.2% female) were recruited and six (1.5%) had a cerebral aneurysm on angiography. The sensitivity of visual inspection was 50% (95% confidence interval [CI]: 12.4-82.6%), specificity was 99% (95% CI: 97.5-99.7%), PPV was 42.9% (95% CI: 10.4-81.3%) and NPV was 99.2% (95% CI: 97.8-99.8%). The combined approach had a sensitivity of 100% (95% CI: 54.1-100%), specificity of 79.7% (95% CI: 75.4-83.5%), PPV of 6.8% (95% CI: 2.6-14.3%) and a NPV of 100% (95% CI: 98.8-100%). The sensitivity of the combined approach was not significantly different to that of visual inspection alone (p=0.25). Visual inspection had a significantly higher specificity than the combined approach (p<0.01). The combined approach detected more cases of aneurysmal SAH than visual inspection alone, however the difference in sensitivity was not statistically significant. Visual xanthochromia should prompt angiography because of a superior specificity and PPV. Due to its reduced sensitivity, caution should be applied when using only visual inspection of the supernatant. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

  18. Comparison of montreal cognitive assessment and mini-mental state examination in evaluating cognitive domain deficit following aneurysmal subarachnoid haemorrhage.

    Directory of Open Access Journals (Sweden)

    George Kwok Chu Wong

    Full Text Available Cognitive deficits are common after aneurysmal subarachnoid haemorrhage (aSAH, and clinical evaluation is important for their management. Our hypothesis was that the Montreal Cognitive Assessment (MoCa is superior to the Mini-Mental State Examination (MMSE in screening for cognitive domain deficit in aSAH patients.We carried out a prospective observational and diagnostic accuracy study on Hong Kong aSAH patients aged 21 to 75 years who had been admitted within 96 hours of ictus. The domain-specific neuropsychological assessment battery, the MoCA and MMSE were administered 2-4 weeks and 1 year after ictus. A cognitive domain deficit was defined as a cognitive domain z score <-1.65 (below the fifth percentile. Cognitive impairment was defined as two or more cognitive domain deficits. The study is registered at ClinicalTrials.gov of the US National Institutes of Health (NCT01038193.Both the MoCA and the MMSE were successful in differentiating between patients with and without cognitive domain deficits and cognitive impairment at both assessment periods. At 1 year post-ictus, the MoCA produced higher area under the curve scores for cognitive impairment than the MMSE (MoCA, 0.92; 95% CI, 0.83 to 0.97 versus MMSE, 0.77; 95% CI, 0.66 to 0.83, p = 0.009.Cognitive domain deficits and cognitive impairment in patients with aSAH can be screened with the MoCA in both the subacute and chronic phases.

  19. Predictive model for patients with poor-grade subarachnoid haemorrhage in 30-day observation: a 9-year cohort study.

    Science.gov (United States)

    Szklener, Sebastian; Melges, Anna; Korchut, Agnieszka; Zaluska, Wojciech; Trojanowski, Tomasz; Rejdak, Robert; Rejdak, Konrad

    2015-06-12

    The purpose of this study was to identify prognostic factors and build the predictive model based on poor-grade subarachnoid haemorrhage (SAH) population received only supportive symptomatic treatment. Prospective observational cohort study. Intensive care unit at the Clinical Department of Neurology. A total of 101 patients with spontaneous SAH disqualified from neurosurgical operative treatment due to poor clinical condition. Data were collected over a 9-year period. Unfavourable outcome was defined as a modified Rankin Score ≥ 5 at 30 days of observation. Multivariable logistic regression analysis indicated the World Federation of Neurosurgical Societies Scale score, increasing age, Fisher grade and admission leucocytosis as independent predictive factors. The proposed scale subdivides the study population into four prognostic groups with significantly different outcomes: grade I: probability of favourable outcome 89.9%; grade II: 47.5%; grade III: 4.2%; grade IV: 0%. The receiver operating characteristic (ROC) curve for the prediction of outcome performed by the new scale had an area under the curve (AUC)=0.910 (excellent accuracy). Unfavourable outcome in non-operated patients with poor-grade SAH is strongly predicted by traditional unmodifiable factors such as age, amount of bleeding in CT, level of consciousness as well as leucocytosis. A new predictive scale based on the above parameters seems to reliably predict the outcome and may contribute to more effective planning of therapeutic management in patients with poor-grade SAH. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  20. Admission blood glucose levels and early change of neurological grade in poor-grade patients with aneurysmal subarachnoid haemorrhage.

    Science.gov (United States)

    Sato, M; Nakano, M; Asari, J; Watanabe, K

    2006-06-01

    The neurological grade of poor-grade subarachnoid haemorrhage (SAH) often changes soon after the patient is admitted to the hospital. It is important to closely monitor for such changes within a short period of time after admission; however, there are other problems that can occur during this time such as rebleeding. The aim of this study was to evaluate the relationship between admission blood glucose levels (ABGL) and early change of neurological grade after admission in patients with poor-grade SAH. Forty-six patients with poor-grade SAH (Hunt & Kosnik Grade IV or V), who were admitted within 3 hrs after SAH onset, and who did not have haematomas causing mass effect, or a history of diabetes mellitus, were included in the study. Patients were pretreated to control blood pressure and intracranial pressure, and they were monitored for early change of grade after admission. Blood glucose level was measured at the time of admission. Spontaneous grade improvement was observed in 9 of 17 Grade IV patients and 9 of 29 Grade V patients. The ABGL of the patients with grade improvement were significantly lower than the ABGL of the patients who did not improve or who got worse. ABGL were lower than 180 mg/dl in 15 of 18 patients who showed grade improvement. Our results showed that there was a relationship between ABGL and neurological grade changes which were observed after admission in patients with poor-grade SAH. These results suggest that ABGL might be a useful parameter for making therapeutic decisions.

  1. Outcomes of CSF spectrophotometry in cases of suspected subarachnoid haemorrhage with negative CT: two years retrospective review in a Birmingham hospital.

    Science.gov (United States)

    Bakr, A; Silva, D; Cramb, R; Flint, G; Foroughi, M

    2017-04-01

    The aim of this study was to evaluate the adherence to current guidelines for the investigation of suspected subarachnoid haemorrhage and the prevalence and outcome of computed tomography (CT)-negative aneurysmal subarachnoid haemorrhage. A retrospective review in a single large tertiary referral centre. A total of 796 patients, aged 16-90 years, who underwent lumbar puncture (LP) for suspected subarachnoid haemorrhage (SAH) following a negative or equivocal CT scan between January 2012 and November 2013 (23 months). Xanthochromia reports were obtained using the hospital's department of biochemistry database and clinical data for these patients were reviewed using patient notes. Of 796 CSF reports reviewed, 728 (91%) were negative for xanthochromia, 31 (4%) were positive and 37 (5%) were equivocal. Only 2 out of the 31 patients with positive spectrophotometry results were subsequently found to have an underlying aneurysm on CT angiography. A further 9 out of these 31 patients underwent digital subtraction angiography, with no cerebral aneurysms being detected. Amongst the 37 patients with equivocal xanthochromia reports, 13 underwent CT angiography and only 1 cerebral aneurysm was detected. In patients with clinically suspected SAH but who have negative or questionable CT findings, CSF analysis is likely to be negative in the vast majority of cases, which was 91% in our series. In patients yielding positive or equivocal CSF results the likelihood of an aneurysm being detected is low, amounting to three out of 68 or approximately one in 23 (approximately 4%). Overall in suspected SAH cases where CT scan has been negative, the rate for the detection of cerebral aneurysm is three out of 796 cases (0.4%).

  2. Prevalence of superficial siderosis following singular, acute aneurysmal subarachnoid hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Lummel, N.; Bochmann, K. [Ludwig-Maximilian-University, Department of Neuroradiology, Klinikum Grosshadern, Munich (Germany); Bernau, C. [Leibniz-Rechenzentrum, Munich (Germany); Thon, N. [Ludwig-Maximilian-University, Department of Neurosurgery, Klinikum Grosshadern, Munich (Germany); Linn, J. [Technical University, Department of Neuroradiology, Klinikum Dresden, Dresden (Germany)

    2015-04-01

    Superficial siderosis is presumably a consequence of recurrent bleeding into the subarachnoid space. The objective of this study was to assess the prevalence of superficial siderosis after singular, aneurysmal subarachnoid hemorrhage (SAH) in the long term. We retrospectively identified all patients who presented with a singular, acute, aneurysmal SAH at our institution between 2010 and 2013 and in whom a magnetic resonance imaging (MRI) including T2*-weighted imaging was available at least 4 months after the acute bleeding event. MRI scans were judged concerning the presence and distribution of superficial siderosis. Influence of clinical data, Fisher grade, localization, and cause of SAH as well as the impact of neurosurgical interventions on the occurrence of superficial siderosis was tested. Seventy-two patients with a total of 117 MRIs were included. Mean delay between SAH and the last available MRI was 47.4 months (range 4-129). SAH was Fisher grade 1 in 2 cases, 2 in 4 cases, 3 in 10 cases, and 4 in 56 cases. Superficial siderosis was detected in 39 patients (54.2 %). In all patients with more than one MRI scan, localization and distribution of superficial siderosis did not change over time. Older age (p = 0.02) and higher degree of SAH (p = 0.03) were significantly associated with the development of superficial siderosis. Superficial siderosis develops in approximately half of patients after singular, aneurysmal SAH and might be more common in patients with an older age and a greater amount of blood. However, additional factors must play a role in whether a patient is prone to develop superficial siderosis or not. (orig.)

  3. Role of canine circovirus in dogs with acute haemorrhagic diarrhoea.

    Science.gov (United States)

    Anderson, A; Hartmann, K; Leutenegger, C M; Proksch, A L; Mueller, R S; Unterer, S

    2017-06-03

    Canine circovirus (CanineCV) has been detected in some dogs with severe haemorrhagic diarrhoea, but its pathogenic role is unclear. This study evaluated a suspected association between the presence of CanineCV and acute haemorrhagic diarrhoea syndrome (AHDS) in dogs. The prevalence of CanineCV in dogs with AHDS was compared with that in healthy dogs and those infected with canine parvovirus (CPV). Additionally, time to recovery and mortality rate were compared between CanineCV-positive and CanineCV-negative dogs. Faecal samples of dogs with AHDS (n=55), healthy dogs (n=66) and dogs infected with CPV (n=54) were examined by two real-time TaqMan PCR assays targeting the replicase and capsid genes of CanineCV. CanineCV was detected in faecal samples of two dogs with AHDS, three healthy controls and seven dogs infected with CPV. Among the three groups, there was no significant difference in prevalence of CanineCV. CPV-infected animals that were coinfected with CanineCV had a significantly higher mortality rate compared with those negative for CanineCV. CanineCV does not appear to be the primary causative agent of AHDS in dogs, but might play a role as a negative co-factor in disease outcome in dogs with CPV infection. British Veterinary Association.

  4. Social cognition impairments after aneurysmal subarachnoid haemorrhage: Associations with deficits in interpersonal behaviour, apathy, and impaired self-awareness.

    Science.gov (United States)

    Buunk, Anne M; Spikman, Jacoba M; Veenstra, Wencke S; van Laar, Peter Jan; Metzemaekers, Jan D M; van Dijk, J Marc C; Meiners, Linda C; Groen, Rob J M

    2017-08-01

    Behavioural disturbances are frequently found after aneurysmal subarachnoid haemorrhage (aSAH). Social cognition impairments have been suggested as a possible underlying mechanism for behavioural problems. Also, aSAH is likely to result in damage affecting frontal-subcortical circuits underlying social cognition. Therefore, we aimed to investigate social cognition after aSAH and its associations with behavioural problems (deficits in interpersonal behaviour, apathy, and impaired self-awareness) and focal as well as diffuse brain damage. 88 aSAH patients (in the subacute phase post-aSAH) and 60 age-, sex- and education-matched healthy controls participated. Tasks for emotion recognition, Theory of Mind (ToM), and empathy as well as questionnaires were used. Cortical infarctions in frontal and non-frontal areas on MRI, aneurysm circulation and aSAH-related events were taken into account. Compared to healthy controls, aSAH patients performed significantly worse on tasks for emotion recognition, ToM and empathy. Poor performance on ToM and emotion recognition was associated with proxy-ratings indicating impaired interpersonal behaviour and apathy and with indications of impaired self-awareness. No associations were found between deficits in social cognition and frontal or non-frontal cortical lesions on MRI. Also, aneurysm circulation and aSAH-related events such as hydrocephalus, vasospasm, and treatment method did not explain why and how social cognitive deficits did occur after aSAH. In conclusion, emotion recognition, ToM and empathy were clearly impaired in aSAH patients and these deficits were related to apathy and deficits in interpersonal behaviour as reported by proxies and to impaired self-awareness. This association strengthens the assumption of impaired social cognition as an underlying construct of behavioural problems after aSAH. Consequently, social cognition tests and proxy-ratings should be used in clinical practice, irrespective of lesion location on

  5. Diffuse, non-traumatic, non-aneurysmal subarachnoid haemorrhage during bevacizumab treatment of high grade glioma: case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Arosha S. Dissanayake, MBBS

    2015-06-01

    Full Text Available Background: Bevacizumab is a monoclonal antibody against vascular endothelial growth factor approved by the United States Food and Drug Administration for the treatment of various cancers including refractory high grade glioma. There are case reports of subarachnoid haemorrhage (SAH during bevacizumab treatment though the causative role of the drug in these cases has been obscured by the presence of alternative aetiologies or incomplete investigation. Furthermore, there is no consensus regarding the risk of Central Nervous System (CNS haemorrhage during bevacizumab treatment due to limited available study data. Case Description: A 53 year old female with recurrent gliosarcoma refractory to standard, temozolamide based chemo-radiotherapy presented to our facility in a post-ictal state 16 days after her second dose of intravenous bevacizumab. A Fisher grade III SAH was found on computerised tomography scanning with no causative vascular lesion found on two subsequent digital subtraction angiograms separated by a 10 day period and a Magnetic Resonance Imaging (MRI scan 20 days post-bleed. Given the resolution of symptoms over an uncomplicated 13 day admission, she was discharged home with bevacizumab ceased prior to her scheduled third dose. Conclusion: We discuss here a case of diffuse, non-traumatic SAH during bevacizumab treatment of recurrent gliosarcoma in which alternative aetiologies of haemorrhage were excluded, to our knowledge the first such case in the English language literature. This adverse event is compatible with the known molecular mechanisms of bevacizumab and clinicians should be cognisant of the potential risk of CNS haemorrhage until larger studies are available to quantify this risk.

  6. Effect of intrathecal magnesium sulfate solution injection via a microcatheter in the cisterna magna on cerebral vasospasm in the canine subarachnoid haemorrhage model.

    Science.gov (United States)

    Mori, Kentaro; Yamamoto, Takuji; Miyazaki, Masahiro; Hara, Yasukazu; Aiko, Yasuhisa; Koike, Nobuhiro; Sakamoto, Shinsuke; Nakao, Yasuaki; Esaki, Takanori

    2012-02-01

    To evaluate intracisternal injection of magnesium sulfate (MgSO(4)) solution via a lumbar catheter for the treatment of cerebral vasospasm in the canine subarachnoid haemorrhage (SAH) model. SAH was induced in 7 beagle dogs using the dual haemorrhage model. Vertebral angiography was repeated on Day 1 (before SAH), and on Day 7 (during cerebral vasospasm) before and 1.5 hours after injection of 0.5 mL/kg of 15 mmol/L MgSO(4) in Ringer solution via the tip of a microcatheter placed in the cisterna magna from the lumbar spine. After injection of MgSO(4) solution, the cerebrospinal fluid magnesium ion concentration significantly increased to 3.89 ± 0.97 mEq/L (P < 0.01) from the baseline value (1.49 ± 0.07 mEq/L). The arterial diameters of the basilar artery (BA), vertebral artery (VA), and superior cerebral artery (SCA) on Day 1 were 1.26 ± 0.19 mm, 1.10 ± 0.13 mm, and 0.74 ± 0.21 mm, respectively. On Day 7 before injection, the arterial diameters of the BA, VA, and SCA significantly decreased to 0.75 ± 0.27 mm, 0.74 ± 0.25 mm, and 0.36 ± 0.21 mm, respectively (P < 0.01), due to vasospasm, and were significantly increased to 0.91 ± 0.27 mm (P < 0.01), 0.91 ± 0.31 mm (P < 0.05), and 0.54 ± 0.14 mm (P < 0.01), respectively, after intracisternal injection of MgSO(4) solution. Intracisternal MgSO(4) therapy using a microcatheter from the lumbar spine may be effective against vasospasm in the clinical setting of endovascular treatment of ruptured aneurysm.

  7. Acute Methanol Poisoning: Prevalence and Predisposing Factors of Haemorrhagic and Non-Haemorrhagic Brain Lesions

    Czech Academy of Sciences Publication Activity Database

    Zakharov, S.; Kotíková, K.; Vaněčková, M.; Seidl, Z.; Nurieva, O.; Navrátil, Tomáš; Caganová, B.; Pelclová, D.

    2016-01-01

    Roč. 119, č. 2 (2016), s. 228-238 ISSN 1742-7835 Institutional support: RVO:61388955 Keywords : ACUTE OPTIC NEUROPATHY * FORMATE CONCENTRATIONS * PROGNOSTIC-FACTORS Subject RIV: CG - Electrochemistry Impact factor: 3.176, year: 2016

  8. Current practice in neurocritical care of patients with subarachnoid haemorrhage and severe traumatic brain injury : Results of the Austrian Neurosurvey Study.

    Science.gov (United States)

    Herzer, Günther; Illievich, Udo; Voelckel, Wolfgang G; Trimmel, Helmut

    2016-09-01

    The task force Neuroanaesthesia of the Austrian Society of Anaesthesiology, Resuscitation and Intensive Care Medicine (ÖGARI) is aiming to develop and provide recommendations in order to improve neurocritical care in Austria. Thus, a survey on neurocritical care concepts in Austria regarding intensive care of subarachnoid haemorrhage (SAH) and severe traumatic brain injury (TBI) was performed to assess the current status. An online internet questionnaire comprising 59 items on current concepts of SAH and TBI critical care was sent to 117 anaesthesiology departments. The survey was answered by 30 (25.6 %) of the hospitals, 24 (80 %) of them treating patients with SAH and/or TBI. Data from ten SAH centres reveal that definitive care was achieved within 24 h in all hospitals; a case load >50 per year is noted in 70 % of intensive care units (ICU). In all, 50 % of departments employ written protocols for treatment. Regarding the treatment of TBI patients, 14 answers were received, indicating that 42.9 % of departments provide care for >50 patients per year. Time between arrival and CT scan is discharge from the ICU, there is no evaluation of 1‑year outcome. Definitive care of SAH and TBI patients is achieved timely in Austria. When compared with SAH, more hospitals with lower case loads take care of TBI patients. Written guidelines and protocols at institutional level are often missing. Since routine morbidity and mortality conferences are sparse, and long-term outcome is not assessed, there is room for improvement.

  9. Subarachnoid haemorrhage guidelines and clinical practice: a cross-sectional study of emergency department consultants' and neurospecialists' views and risk tolerances.

    Science.gov (United States)

    Lansley, J; Selai, C; Krishnan, A S; Lobotesis, K; Jäger, H R

    2016-09-15

    To establish if emergency medicine and neuroscience specialist consultants have different risk tolerances for investigation of suspected spontaneous subarachnoid haemorrhage (SAH), and to establish if their risk-benefit appraisals concur with current guidelines. 4 major neuroscience centres in London. 58 consultants in emergency medicine and neuroscience specialities (neurology, neurosurgery and neuroradiology) participated in an anonymous survey. The primary outcome measure was the highest stated acceptable risk of missing SAH in the neurologically intact patient presenting with sudden onset headache. Secondary outcome measures included agreement with guideline recommendations, risk/benefit appraisal and required performance of diagnostic tests, including lumbar puncture. Emergency department clinicians accepted almost 3 times the risk of a missed SAH diagnosis compared with the neuroscience specialists (2.8% vs 1.1%; p=0.02), were more likely to accept a higher risk of missed diagnosis for the benefit of a non-invasive test (p=0.04) and were more likely to disagree with current published guidelines stipulating the need for LP in all CT-negative cases (p=0.001). Divergence from recognised procedures for SAH investigation is often criticised and attributed to a lack of knowledge of guidelines. This study indicates that divergence from guidelines may be explained by alternative risk-benefit appraisals made by doctors with their patients. Guideline recommendations may gain wider acceptance if they accommodate the requirements of the doctors and patients using them. Further study of clinical risk tolerance may help explain patterns of diagnostic test use and other variations in healthcare delivery. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  10. Effects of pressure- and volume-controlled inverse ratio ventilation on haemodynamic variables, intracranial pressure and cerebral perfusion pressure in rabbits: a model of subarachnoid haemorrhage under isoflurane anaesthesia.

    Science.gov (United States)

    Taplu, A; Gökmen, N; Erbayraktar, S; Sade, B; Erkan, N; Karadibak, K; Arkan, A

    2003-09-01

    An inverse I : E ratio (inspiratory time > expiratory time) may have benefits in patients suffering trauma who requiring lung ventilation. However, this application may be deleterious if there is concomitant head injury. We aimed to determine the physiological effects of pressure- and volume-controlled modes of inverse ratio (I : E = 2 : 1) ventilation of the lungs, while maintaining normocapnia, in a rabbit model of raised intracranial pressure (ICP). New Zealand White rabbits were anaesthetized with isoflurane and a tracheostomy was performed. Subarachnoid haemorrhage was simulated in two groups by injecting blood into the cisterna magna. Groups 1 and 2 (n = 6, each), controls, were compared with Groups 3 and 4 (n = 6, each) with the simulated subarachnoid haemorrhage. Each ventilation mode was used with an I : E ratio of 2 : 1 for 30 min. Mean arterial pressure (MAP), ICP, cerebral perfusion pressure (CPP), mean airway pressure (P(AW)) and arterial blood-gas status were measured. Both modes increased mean P(AW) (P < 0.02). This increase was greater with the volume-controlled mode (P < 0.02). The baseline value averaged 5.8 +/- 0.4 and 5.6 +/- 0.3 mmHg in Groups 3 and 4, respectively, and increased to 7.8 +/- 0.3 and 10.8 +/- 0.4 mmHg. Inducing subarachnoid haemorrhage increased ICP and MAP (P < 0.02). Baseline ICPs were 10.3 +/- 0.5 and 10.3 +/- 0.4 mmHg in Groups 1 and 2, respectively, whereas they were 25.4 +/- 1.2 and 25.8 +/- 0.8 mmHg in Groups 3 and 4. However, ICP, MAP and CPP did not differ significantly according to the mode. An already raised ICP was altered by the application of induced mean PAW increases as a consequence of inverse ratio ventilation of the lungs with normocapnia.

  11. Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial

    NARCIS (Netherlands)

    Baharoglu, M. Irem; Cordonnier, Charlotte; Al-Shahi Salman, Rustam; de Gans, Koen; Koopman, Maria M.; Brand, Anneke; Majoie, Charles B.; Beenen, Ludo F.; Marquering, Henk A.; Vermeulen, Marinus; Nederkoorn, Paul J.; de Haan, Rob J.; Roos, Yvo B.; Reitsma, J. B.; Kamphuisen, P. W.; Touzé, E.; Lasne, D.; François, A.; Baharoglu, Irem; Zinkstok, Sanne; Coutinho, Jonathan; Boers, Merel; Geuskens, Ralph; Hart, Groene; Bloodbank, Sanquin; Koopman, Rianne; de Graaf, Reinier; Aerden, Leo; Vermeer, Sarah; Schreuder, Tobien; Schuiling, Wouter; Haag, Den; Bienfait, Henriette; Bakker, Stef; Ziekenhuis, Canisius Wilhelmina; Klijn, Catharina; Bronner, Irene; Ziekenhuis, St Elisabeth; de Kort, Paul; Raaijmakers, Dianne; Visser, Marieke; Ziekenhuis, Catharina; Keizer, Koos; Jansen, Ben; Ziekenhuis, Kruis; van der, Willem; Rooyer, Fergus; Verhey, Hans; Macleod, Mary Joan; Joyson, Anu; Reed, Matthew; Burgess, Seona; Mead, Gillian; Hart, Simon; Muir, Keith; Welch, Angela; Baird, Sally; Smith, Wilma; Huang, Xuya; Moreton, Fiona; Cheripelli, Bharath; El Tawil, Salwa; Baird, Tracey; Duncan, George; Nazir, Fozia; Birschel, Phil; Selvarajah, Johann; Dennis, Martin; Samarasekera, Neshika; Ramsay, Scott; Jackson, Katherine; Ferrigno, Marc; Susen, Sophie; Rossi, Costanza; Dequatre-Ponchelle, Nelly; Bodenant, Marie; Jacquet, Clémence; Oune, Fanny Ben; Ouk, Thavarak; Guégan-Massardier, Evelyne; Ozkul, Ozlem; Fetter, Damien; Duchez, Veronique Le Cam; Soufi, Hicham; Sibon, Igor; Desbruxelles, Sabrina; Renou, Pauline; Ledure, Sylvain; Neau, Philippe; Lamy, Matthias; Timsit, Serge; Viakhireva, Irina; Zuber, Mathieu; Tamazyan, Ruben; Lambert, Claire Join; Alamowitch, Sonia; Favrole, Pascal; Gerotziafas, Grigorios; Mazighi, Mikael; Stapf, Christian; Béjot, Yannick; Giroud, Maurice; Daubail, Benoit; Delpont, Benoit; Resch, Eric

    2016-01-01

    Platelet transfusion after acute spontaneous primary intracerebral haemorrhage in people taking antiplatelet therapy might reduce death or dependence by reducing the extent of the haemorrhage. We aimed to investigate whether platelet transfusion with standard care, compared with standard care alone,

  12. Soetomo score: score model in early identification of acute haemorrhagic stroke

    Directory of Open Access Journals (Sweden)

    Moh Hasan Machfoed

    2016-06-01

    Full Text Available Aim of the study: On financial or facility constraints of brain imaging, score model is used to predict the occurrence of acute haemorrhagic stroke. Accordingly, this study attempts to develop a new score model, called Soetomo score. Material and methods: The researchers performed a cross-sectional study of 176 acute stroke patients with onset of ≤24 hours who visited emergency unit of Dr. Soetomo Hospital from July 14th to December 14th, 2014. The diagnosis of haemorrhagic stroke was confirmed by head computed tomography scan. There were seven predictors of haemorrhagic stroke which were analysed by using bivariate and multivariate analyses. Furthermore, a multiple discriminant analysis resulted in an equation of Soetomo score model. The receiver operating characteristic procedure resulted in the values of area under curve and intersection point identifying haemorrhagic stroke. Afterward, the diagnostic test value was determined. Results: The equation of Soetomo score model was (3 × loss of consciousness + (3.5 × headache + (4 × vomiting − 4.5. Area under curve value of this score was 88.5% (95% confidence interval = 83.3–93.7%. In the Soetomo score model value of ≥−0.75, the score reached the sensitivity of 82.9%, specificity of 83%, positive predictive value of 78.8%, negative predictive value of 86.5%, positive likelihood ratio of 4.88, negative likelihood ratio of 0.21, false negative of 17.1%, false positive of 17%, and accuracy of 83%. Conclusions: The Soetomo score model value of ≥−0.75 can identify acute haemorrhagic stroke properly on the financial or facility constrains of brain imaging.

  13. Severe acute haemorrhagic liver failure in a neonate with a favourable spontaneous outcome

    Energy Technology Data Exchange (ETDEWEB)

    Cavet, Madeleine; Balu, Marie; Garel, Catherine; Ducou le Pointe, Hubert [Universite Pierre et Marie Curie Paris VI, Service de Radiologie, Hopital d' enfants Armand-Trousseau, Paris (France); Mitanchez, Delphine; Alexandre, Marie [Universite Pierre et Marie Curie Paris VI, Service de Neonatologie, Hopital d' enfants Armand-Trousseau, Paris (France); Renolleau, Sylvain [Universite Pierre et Marie Curie Paris VI, Service de Reanimation, Hopital d' enfants Armand-Trousseau, Paris (France); Pariente, Daniele [Hopital de Bicetre, Service de Radiologie Pediatrique, Paris (France)

    2008-10-15

    Acute liver failure in neonates is rare and is frequently associated with an unfavourable outcome. There is no curative treatment other than liver transplantation. Screening for viral, metabolic, toxic or vascular disease is essential to assess the prognosis and to guide specific treatment. Hepatic haemorrhage in neonates is often associated with bacterial infection, trauma and coagulopathies. We present a unique case of neonatal acute liver failure and multifocal massive haemorrhagic intrahepatic lesions of traumatic origin, documented by US and MRI. The patient made a spontaneous recovery. Clinical, biological and imaging outcome was excellent despite the apparent severity of the initial features. The only possible aetiology was a difficult caesarean delivery for mild fetal macrosomia. (orig.)

  14. CASE REPORT Acute pituitary apoplexy complicating a pituitary ...

    African Journals Online (AJOL)

    associated sub-arachnoid haemorrhage can sometimes be present. On T1W MR imaging, in the early acute stage, an enlarged gland that is iso- or hypointense to brain can be seen, while in the late acute or sub-acute stage, a hyperintense gland is seen. Acute compression of the hypothalamus and optic chiasm may cause ...

  15. Hyponatremia in aneurysmal subarachnoid hemorrhage is due to the syndrome of inappropriate antidiuresis and acute glucocorticoid deficiency

    LENUS (Irish Health Repository)

    Hannon, M J

    2011-06-01

    Hyponatraemia is the most common electrolyte abnormality following subarachnoid haemorrhage (SAH) and contributes to increased morbidity and mortality. Retrospective data suggests that the syndrome of inappropriate diuresis (SIAD) is the most common cause of hyponatraemia in SAH, though cerebral salt wasting has been postulated by some workers to be the predominant abnormality. Data which has shown acute glucocorticoid deficiency following SAH has suggested that some cases of euvolaemic hyponatraemia may also be caused by this mechanism.We prospectively studied the hormonal and haemodynamic influences involved in the development of hyponatraemia in 100 patients (61% female, median age 53 (range 16-82)) with non-traumatic aneurysmal SAH. Each patient had plasma sodium (pNa), urea, osmolality, glucose and 0900h cortisol (PC), and urinary sodium and osmolality measured on days 1, 2, 3, 4, 6, 8, 10 and 12 following SAH. Fluid balance and haemodynamic parameters were recorded daily. Results were compared with 15 patients admitted to ITU following vascular surgery. A PC<300nmol\\/L in a patient in ITU was regarded clinically as inappropriately low.49% of patients developed hyponatraemia (pNa<135 mmol\\/L), including 14% who developed clinically significantly hyponatraemia (pNa<130 mmol\\/L). 36\\/49 (73.4%) developed hyponatraemia between days 1 and 3 post SAH. The median duration of hyponatraemia was 3 days (range 1–10 days).In 35\\/49 (71.4%), hyponatraemia was due to SIAD as defined by standard diagnostic criteria. 14% of SAH patients had at least one PC<300nmol\\/L; 5 of these (35.7%) developed hyponatraemia. In 4 patients hyponatraemia was preceded by acute cortisol deficiency and responded to hydrocortisone treatment. In contrast, all controls had PC>500 nmol\\/L on day 1, and >300 nmol on days 3–12. There were no cases of cerebral salt wasting. There was no relationship between the incidence of hyponatraemia and the defined anatomical territory or severity of

  16. Organising pneumonia presenting as acute life threatening pulmonary haemorrhage.

    Science.gov (United States)

    Narasimhaiah, Damodhara Honnavally; Chakravorty, Indranil; Swamy, Rajiv; Prakash, Doraiswamy

    2011-11-08

    Organising pneumonia, previously called bronchiolitis obliterans organising pneumonia is a clinicopathological entity of unknown aetiology, which has been reported with increasing frequency. Various modes of presentation have been described such as cough, fever, weight loss and alveolar opacities on chest radiograph. Haemoptysis as primary presenting symptom has only rarely been reported. The authors report a case in which massive life-threatening haemoptysis was the major presenting symptom. No aetiology was identified for the haemoptysis and the diagnosis was confirmed on postmortem histology. This case highlights the importance of considering organising pneumonia in the differential diagnosis of acute severe haemoptysis.

  17. Syringomyelia due to Lumbar Spinal Fluid Drainage in the Acute Phase of Subarachnoid Hemorrhage: A Case Report.

    Science.gov (United States)

    Machida, Akira; Fujii, Mutsumi; Ishihara, Tasuku; Amano, Eiichiro; Otsu, Shinichi; Fujii, Shoko; Tamada, Natsumi; Kiyokawa, Juri; Yoshimura, Masataka; Hirota, Shin; Yamamoto, Shinji

    2018-01-01

    Lumbar spinal fluid drainage is a common procedure for treating hydrocephalus and alleviating vasospasm by egesting blood in the subarachnoid cavity after subarachnoid hemorrhage. Despite being an effective and safe procedure, cerebrospinal fluid overdrainage might result in serious complications. Here we report the case of a 49-year-old man who suffered from tonsillar herniation with subsequent cervicothoracic syringomyelia in the acute phase of subarachnoid hemorrhage due to vertebral artery dissection. About 2 weeks after lumbar drainage was switched from external ventricular drainage initiated on the day of subarachnoid hemorrhage, the recovery from the disturbance of consciousness revealed tetraplegia, and magnetic resonance imaging demonstrated tonsillar herniation and syringomyelia. Removal of the spinal drain and resumption of external ventricular drainage resulted in the restoration of the herniated tonsils to the normal position and the complete disappearance of syringomyelia 11 days later. We should consider that spinal syringomyelia could develop as a complication of lumbar spinal fluid drainage in the acute phase of thick subarachnoid hemorrhage, particularly in the posterior cranial fossa. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  18. Dysnatremia as a poor prognostic indicator in patients with acute subarachnoid hemorrhage.

    Science.gov (United States)

    Spatenkova, Vera; Bradac, Ondrej; de Lacy, Patricia; Skrabalek, Pavel; Suchomel, Petr

    2017-08-01

    Dysnatremias are common and carry a risk of poor prognosis in acute subarachnoid hemorrhage (SAH) patients. The aim of this study was to determine the frequency and outcome of dysnatremias in 344 SAH patients treated by a targeted sodium management regimen. We performed a 10-year observational dysnatremia study. Hyponatremia was defined as serum sodium (SNa) below 135 mmol/L, hypernatremia SNa above 150 mmol/L. Dysnatremia occurred in 35.8% patients; this was more frequently hyponatremia (19.8%) with a mean SNa 132.23±2.09 mmol/L, (16.0% mild, 3.2% moderate, 0.6% severe). Hypernatremia occurred less commonly in 11.9%, Psodium management regimen in acute SAH patients showed that dysnatremias were frequent, predominantly hyponatremia of which the more usual causes were CSW and not SIADH. Hypernatremia was shown to be an independent risk factor for inpatient mortality and poor outcome.

  19. Superselective arterial embolisation with a liquid polyvinyl alcohol copolymer in patients with acute gastrointestinal haemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Lenhart, Markus; Schneider, Hans [Sozialstiftung Bamberg, Department of Diagnostic and Interventional Radiology, Bamberg (Germany); Paetzel, Christian [Klinikum Weiden, Department of Radiology, Weiden (Germany); Sackmann, Michael [Sozialstiftung Bamberg, Department of Gastroenterology, Bamberg (Germany); Jung, Ernst Michael; Schreyer, Andreas G.; Feuerbach, Stefan; Zorger, Niels [University of Regensburg, Department of Radiology, Regensburg (Germany)

    2010-08-15

    To evaluate the results of emergency embolisation in acute arterial bleeding of the gastrointestinal tract with a liquid polyvinyl alcohol copolymer from two centres. We retrospectively analysed 16 cases (15 patients) of acute arterial bleeding of the gastrointestinal tract where emergency embolotherapy was performed by using the copolymer when acute haemorrhage was not treatable with endoscopic techniques alone. Cause of haemorrhage and technical and clinical success were documented. Arterial embolotherapy was successful in all 16 cases. The technical success rate was 100%. The cause of bleeding was pancreatitis in four, graft-versus-host disease (GVHD) of the colon in three, malignancy in three, angiodysplasia in two, ulcer in two and panarteritis no dosa and trauma in one each. There were no procedure-related complications. No bowel necrosis occurred because of embolisation. In 13 cases, the patients were discharged in good condition (81%); the three patients with GVHD died because of the underlying disease. The copolymer seems to have great potential in embolotherapy of acute arterial gastrointestinal bleeding. In our series none of the patients had rebleeding at the site of embolisation and no clinically obvious bowel necrosis occurred. (orig.)

  20. A case of acute spinal subdural hematoma with subarachnoid hemorrhage: Rapid spontaneous remission, relapse, and complete resolution

    Directory of Open Access Journals (Sweden)

    Michito Namekawa

    2017-06-01

    In addition to rostrocaudal spreading of bloody components in the subdural space, rupture of the hematoma into the subarachnoid space must have released pressure, compressing the spinal cord. In this case report, we also describe the serial MRI studies and note the limitations of the resolution of spinal MRI in the acute phase.

  1. C-arm flat detector computed tomography parenchymal blood volume imaging: the nature of parenchymal blood volume parameter and the feasibility of parenchymal blood volume imaging in aneurysmal subarachnoid haemorrhage patients.

    Science.gov (United States)

    Kamran, Mudassar; Byrne, James V

    2015-09-01

    C-arm flat detector computed tomography (FDCT) parenchymal blood volume (PBV) measurements allow assessment of cerebral haemodynamics in the neurointerventional suite. This paper explores the feasibility of C-arm computed tomography (CT) PBV imaging and the relationship between the C-arm CT PBV and the MR-PWI-derived cerebral blood volume (CBV) and cerebral blood flow (CBF) parameters in aneurysmal subarachnoid haemorrhage (SAH) patients developing delayed cerebral ischemia (DCI). Twenty-six patients with DCI following aneurysmal SAH underwent a research C-arm CT PBV scan using a biplane angiography system and contemporaneous MR-PWI scan as part of a prospective study. Quantitative whole-brain atlas-based volume-of-interest analysis in conjunction with Pearson correlation and Bland-Altman tests was performed to explore the agreement between C-arm CT PBV and MR-derived CBV and CBF measurements. All patients received medical management, while eight patients (31%) underwent selective intra-arterial chemical angioplasty. Colour-coded C-arm CT PBV maps were 91% sensitive and 100% specific in detecting the perfusion abnormalities. C-arm CT rPBV demonstrated good agreement and strong correlation with both MR-rCBV and MR-rCBF measurements; the agreement and correlation were stronger for MR-rCBF relative to MR-rCBV and improved for C-arm CT PBV versus the geometric mean of MR-rCBV and MR-rCBF. Analysis of weighted means showed that the C-arm CT PBV has a preferential blood flow weighting (≈ 60% blood flow and ≈ 40% blood volume weighting). C-arm CT PBV imaging is feasible in DCI following aneurysmal SAH. PBV is a composite perfusion parameter incorporating both blood flow and blood volume weightings. That PBV has preferential (≈ 60%) blood flow weighting is an important finding, which is of clinical significance when interpreting the C-arm CT PBV maps, particularly in the setting of acute brain ischemia.

  2. C-arm flat detector computed tomography parenchymal blood volume imaging: the nature of parenchymal blood volume parameter and the feasibility of parenchymal blood volume imaging in aneurysmal subarachnoid haemorrhage patients

    Energy Technology Data Exchange (ETDEWEB)

    Kamran, Mudassar; Byrne, James V. [University of Oxford, Nuffield Department of Surgical Sciences, Oxford (United Kingdom)

    2015-09-15

    C-arm flat detector computed tomography (FDCT) parenchymal blood volume (PBV) measurements allow assessment of cerebral haemodynamics in the neurointerventional suite. This paper explores the feasibility of C-arm computed tomography (CT) PBV imaging and the relationship between the C-arm CT PBV and the MR-PWI-derived cerebral blood volume (CBV) and cerebral blood flow (CBF) parameters in aneurysmal subarachnoid haemorrhage (SAH) patients developing delayed cerebral ischemia (DCI). Twenty-six patients with DCI following aneurysmal SAH underwent a research C-arm CT PBV scan using a biplane angiography system and contemporaneous MR-PWI scan as part of a prospective study. Quantitative whole-brain atlas-based volume-of-interest analysis in conjunction with Pearson correlation and Bland-Altman tests was performed to explore the agreement between C-arm CT PBV and MR-derived CBV and CBF measurements. All patients received medical management, while eight patients (31 %) underwent selective intra-arterial chemical angioplasty. Colour-coded C-arm CT PBV maps were 91 % sensitive and 100 % specific in detecting the perfusion abnormalities. C-arm CT rPBV demonstrated good agreement and strong correlation with both MR-rCBV and MR-rCBF measurements; the agreement and correlation were stronger for MR-rCBF relative to MR-rCBV and improved for C-arm CT PBV versus the geometric mean of MR-rCBV and MR-rCBF. Analysis of weighted means showed that the C-arm CT PBV has a preferential blood flow weighting (∼60 % blood flow and ∼40 % blood volume weighting). C-arm CT PBV imaging is feasible in DCI following aneurysmal SAH. PBV is a composite perfusion parameter incorporating both blood flow and blood volume weightings. That PBV has preferential (∼60 %) blood flow weighting is an important finding, which is of clinical significance when interpreting the C-arm CT PBV maps, particularly in the setting of acute brain ischemia. (orig.)

  3. Depression remitted after subarachnoid haemorrhage

    DEFF Research Database (Denmark)

    Lauritsen, Lise; Vinberg, Maj

    2015-01-01

    A 65-year-old man was seen in a specialized ambulatory for mood disorders because of treatment-resistant depression. He was treated throughout a period of three years with selective serotonin reuptake inhibitor, dual action, lithium, nortriptyline, reboxetine, aripiprazole, benzodiazepines...

  4. Experimental pancreatitis in the rat: role of bile reflux in sodium taurocholate-induced acute haemorrhagic pancreatitis

    NARCIS (Netherlands)

    Lange, J. F.; van Gool, J.; Tytgat, G. N.

    1986-01-01

    Mortality of sodium taurocholate-induced acute haemorrhagic pancreatitis in the rat was prevented by biliary diversion. Bile reflux into the pancreas after the induction of pancreatitis is postulated to be a major factor affecting mortality of this popular model of acute pancreatitis. The reduction

  5. Acute effects of nimodipine on cerebral vasculature and brain metabolism in high grade subarachnoid hemorrhage patients.

    Science.gov (United States)

    Choi, H Alex; Ko, Sang-Bae; Chen, Huahiou; Gilmore, Emily; Carpenter, Amanda M; Lee, Danielle; Claassen, Jan; Mayer, Stephan A; Schmidt, J Michael; Lee, Kiwon; Connelly, E Sander; Paik, Myunghee; Badjatia, Neeraj

    2012-06-01

    Nimodipine is the only medication shown to improve outcomes after aneurysmal subarachnoid hemorrhage (SAH). Preliminary theories regarding the mechanism by which it prevents vasospasm have been challenged. The acute physiologic and metabolic effects of oral Nimodipine have not been examined in patients with poor-grade SAH. This is an observational study performed in 16 poor-grade SAH patients undergoing multimodality monitoring who received oral Nimodipine as part of routine clinical care. A total of 663 doses of Nimodipine were observed. Changes in physiologic measurements including MAP, CPP, ICP, P(bt)O(2), and CBF were examined. Administration of oral Nimodipine was associated with a 1.33 mmHg decrease in MAP (P Nimodipine was associated with MAP decreases, P(bt)O(2) (1.03 mmHg; P Nimodipine was associated with a decrease in MAP and CPP. When Nimodipine administration was associated with a decrease in MAP, there were concomitant drops in P(bt)O(2) and CBF. These findings suggest that MAP support after oral Nimodipine may be important to maintain adequate CBF in patients with poor-grade subarachnoid hemorrhage.

  6. Ambient temperature and volume of perihematomal edema in acute intracerebral haemorrhage: the INTERACT1 study.

    Science.gov (United States)

    Zheng, Danni; Arima, Hisatomi; Heeley, Emma; Karpin, Anne; Yang, Jie; Chalmers, John; Anderson, Craig S

    2015-01-01

    As no human data exist, we aimed to determine the relation between ambient temperature and volume of perihematomal 'cerebral' edema in acute spontaneous intracerebral haemorrhage (ICH) among Chinese participants of the pilot phase, Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT1). INTERACT1 was a multicenter, open, blind outcome assessed, randomized controlled trial of intensive (systolic target edema volumes. Multivariable regression analyses were performed to evaluate association between ambient temperature and edema volumes. A generalized linear regression model with a generalized estimating equations approach (GEE) was used to assess any association of ambient temperature and change in edema volume over 72 h. A total of 250 of all 384 Chinese participants had complete data that showed positive associations between ambient temperature (mean and minimum temperatures) and edema volumes at each time point over 72 h after hospital admission (all P edema volume after adjustment for confounding variables (all P edema volume in acute spontaneous ICH. © 2014 World Stroke Organization.

  7. Economic modelling of early transjugular intrahepatic portosystemic shunt insertion for acute variceal haemorrhage.

    Science.gov (United States)

    Harman, David J; McCorry, Roger B; Jacob, Ruth P; Lim, Teegan R; O'Neill, Richard; Ryder, Stephen D; James, Martin W; Aithal, Guruprasad P; Guha, Indra N

    2013-02-01

    Early insertion of transjugular intrahepatic portosystemic shunt (TIPS) in high-risk patients with acute variceal haemorrhage reduces rebleeding and mortality. However, the economic benefit of utilizing this approach remains unclear. We evaluated the economic implications of introducing early TIPS into routine algorithms for the management of variceal bleeding. Consecutive patients admitted in 2009 with variceal haemorrhage to two liver units and eligible for early TIPS insertion were identified retrospectively. The costs of a 12-month follow-up from index bleeding admission were calculated--the actual cost of follow-up and rebleeding in this cohort was compared with the theoretical 12-month follow-up costs of instead inserting an early TIPS at index admission. Our findings were subjected to a sensitivity analysis to assess the cost effectiveness of early TIPS insertion compared with standard care. In 2009, 78 patients were admitted to our units with variceal haemorrhage; 27 patients (35%) were eligible for early TIPS insertion. The actual cost of a 12-month follow-up was £138 473.50. Early TIPS insertion, assuming a 3.2% rebleeding rate, would save £534.70 per patient per year (P<0.0001). On sensitivity analysis, early TIPS dominated standard care up to an early TIPS rebleeding rate of 6% and remained cost-effective up to a rebleeding rate of 12%. Early TIPS insertion for high-risk patients with acute variceal bleeding is a cost-efficient intervention. This has important implications for the introduction of early TIPS as standard care and the organization of interventional radiology services.

  8. [Variability in the management of aneurysmal subarachnoid haemorrhage in Spain: Analysis of the prospective multicenter database from the Working Group on Neurovascular Diseases of the Spanish Society of Neurosurgery].

    Science.gov (United States)

    Lagares, Alfonso; Munarriz, Pablo M; Ibáñez, Javier; Arikán, Fuat; Sarabia, Rosario; Morera, Jesús; Gabarrós, Andreu; Horcajadas, Ángel

    2015-01-01

    In aneurysmal subarachnoid haemorrhage, endovascular or surgical exclusion of the aneurysm responsible for the bleeding is mandatory to prevent re-bleeding. In Spain there is no data regarding the frequency of usage of the two techniques, the moment treatment is performed, the existence of variability among the different centres treating these patients or the factors that determine the election of the therapeutic modality. 1) To describe the variability in the use of endovascular treatment or surgery in the treatment of these patients among the participating centres. 2) To establish which factors are related to the election of treatment and outcome. Of all the patients included in the database, we selected 2,150 cases suffering confirmed aneurysmal subarachnoid haemorrhage from 10 centres that included patients regularly during the period between 2004 and 2012 with a data completeness index over 95%. A descriptive analysis on mode of aneurysm treatment was performed. A multivariate analysis of the factors related to treatment modality of the aneurysm and outcome was performed using logistic regression. The ratio endovascular/surgical treatment was 1.32. There was high variability among centres regarding the frequency of endovascular treatment (32-80%). No treatment was given to 17% of the aneurysms, with this percentage being higher in the centres with lower rates of endovascular treatment. Lower volume centres treated aneurysms later. Age and poor clinical grade were factors related to the election of endovascular treatment, while middle cerebral artery location and unfavourable morphological criteria were factors of surgical treatment. The choice of treatment, guideline adherence and centre patient volume were not related to outcome. There is high variability in the election of treatment modality among centres in Spain. Endovascular treatment allows more patients to have their aneurysm treated. Guideline adherence is moderate. Copyright © 2014 Sociedad Espa

  9. Prevalence of electrocardiographic changes in patients with acute aneurysmal subarachnoid hemorrhage and their relationship with outcome

    Directory of Open Access Journals (Sweden)

    Saktheeswaran Mahesh Kumar

    2013-01-01

    Full Text Available Background: Electrocardiographic (ECG alterations occurring after subarachnoid hemorrhage (SAH have been described frequently, but the prognostic significance of these changes has not been well characterized. Aim and Objectives: To report the prevalence and patterns of ECG alterations in patients with acute aneurysmal SAH and to study the relationship between ECG alterations and the neurological outcome, if any. Materials and Methods: Records of consecutive patients admitted to the neurosurgical intensive care unit of the SCTIMST, Trivandrum between January 1999 and January 2011 with acute aneurysmal SAH were retrospectively analyzed. Results: Of the 321 patients with SAH, 190 (59.2% had abnormal ECGs. Repolarization abnormalities were the most common, with T wave inversion in the anterolateral leads occurring in 155 (48.3% patients. By univariate analysis, female sex, Glasgow Coma Score (GCS at admission of I, ST segment depression or T inversion in anterolateral leads, prolonged corrected QT interval, and sinus bradycardia were associated with increased risk of death. By multivariate analysis, only GCS and WFNS grade independently predicted mortality and none of the ECG changes predicted the same. Presence of tall T waves in anterior leads, T inversion in anterolateral leads, sinus bradycardia, and WFNS grade >1 were independently associated with GCS <15 and poor outcome at discharge. Conclusions: In patients with acute aneurysmal SAH, repolarization abnormalities are the commonest ECG alterations. ECG alterations do not independently predict death, but independently predict poor discharge neurological status.

  10. Systolic Blood Pressure Variability is a Novel Risk Factor for Rebleeding in Acute Subarachnoid Hemorrhage

    Science.gov (United States)

    Lin, Qing-Song; Ping-Chen; Lin, Yuan-Xiang; Lin, Zhang-Ya; Yu, Liang-Hong; Dai, Lin-Sun; Kang, De-Zhi

    2016-01-01

    Abstract Rebleeding of an aneurysm is a major cause of morbidity and mortality after subarachnoid hemorrhage (SAH). Whereas numerous studies have demonstrated predictors of rebleeding and effect of systolic blood pressure variability (SBPV) on stroke, few data on the association between SBPV and rebleeding. Here, we sought to identify the effect of SBPV on rebleeding in acute aneurysmal SAH. Case–control study. From January 2010 to June 2015, 612 patients with aneurysmal SAH were enrolled in our tertiary care medical center. Main outcome measures: Consecutive patients with acute (ictus) aneurismal rebleeding or repair or death were retrospectively included. Antihypertensive therapy based on a predefined standardized protocol was prescribed to lower and maintain SBP between 120 and 160 mm Hg. SBP was measured hourly until a censoring event occurred. SBPV was determined as standard deviation (SD) and successive variation (SV). Binary logistic regression was used to assess the association between SBPV and rebleeding. Rebleeding occurred in 61 (10.0%) of the 612 patients. We identified 47 acute rebleeding as cases and 382 early repair or early death as controls. On binary logistic regression analysis, rebleeding was associated with the SD of SBP (odds ratio [OR], 1.254; 95% confidence interval [CI], 1.131–1.391; P < 0.001) and the SV of SBP (OR, 1.131; 95% CI, 1.039–1.231; P = 0.004). No significant difference was seen between rebleeding and mean systolic blood pressure (MSBP). SBPV is associated with increased rates of acute aneurysmal rebleeding. Further prospective research is warranted to confirm that SBP stability prevents acute aneurysm rebleeding. PMID:26986118

  11. The protective effect of a reduction in intestinal flora on mortality of acute haemorrhagic pancreatitis in the rat

    NARCIS (Netherlands)

    Lange, J. F.; van Gool, J.; Tytgat, G. N.

    1987-01-01

    Both colectomy and intestinal lavage combined with kanamycin instillation proved effective in reducing mortality from sodium taurocholate-induced acute haemorrhagic pancreatitis (AHP) in the rat, supporting the concept that the intestinal flora must be considered a major factor influencing mortality

  12. Isolated acute nontraumatic cortical subarachnoid hemorrhage: Etiologies based on MRI findings

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Eun; Kang, Myung Jin; Kim, Sang Hyeon [Dept. of Radiology, Dong-A University Medical Center, Busan (Korea, Republic of)

    2016-06-15

    The purpose of this study was to identify common underlying etiologies that may be responsible for isolated acute nontraumatic cortical subarachnoid hemorrhage (cSAH) by analysis of magnetic resonance imaging (MRI) findings of the brain. From August 2005 to February 2014, 15 cSAH patients were admitted to our institution. All patients with cSAH underwent brain MRI and magnetic resonance angiography as a part of their initial evaluation. An analysis of the patients' medical history, clinical presentations, and brain MRI findings was retrospectively performed. Among the combined pathologies that were suspected causes of cSAH, 11 patients showed acute or subacute cerebral infarctions at the ipsilateral hemisphere of cSAH on the diffusion-weighted images. Four of 11 patients had only cerebral infarction, but the other 7 had combined vasculopathy of extra- and intracranial arteries. Four of 15 patients who did not have cerebral infarction, had intracranial artery stenosis, or showed possible cerebral amyloid angiopathy, or no abnormal findings on the brain MRI. Ischemic stroke, such as cerebral infarction or vasculopathy of the extra and intracranial arteries is regarded as a common underlying etiology of the cSAH based on MRI findings.

  13. Multivariable and Bayesian Network Analysis of Outcome Predictors in Acute Aneurysmal Subarachnoid Hemorrhage: Review of a Pure Surgical Series in the Postinternational Subarachnoid Aneurysm Trial Era.

    Science.gov (United States)

    Zador, Zsolt; Huang, Wendy; Sperrin, Matthew; Lawton, Michael T

    2017-07-31

    Following the International Subarachnoid Aneurysm Trial (ISAT), evolving treatment modalities for acute aneurysmal subarachnoid hemorrhage (aSAH) has changed the case mix of patients undergoing urgent surgical clipping. To update our knowledge on outcome predictors by analyzing admission parameters in a pure surgical series using variable importance ranking and machine learning. We reviewed a single surgeon's case series of 226 patients suffering from aSAH treated with urgent surgical clipping. Predictions were made using logistic regression models, and predictive performance was assessed using areas under the receiver operating curve (AUC). We established variable importance ranking using partial Nagelkerke R 2 scores. Probabilistic associations between variables were depicted using Bayesian networks, a method of machine learning. Importance ranking showed that World Federation of Neurosurgical Societies (WFNS) grade and age were the most influential outcome prognosticators. Inclusion of only these 2 predictors was sufficient to maintain model performance compared to when all variables were considered (AUC = 0.8222, 95% confidence interval (CI): 0.7646-0.88 vs 0.8218, 95% CI: 0.7616-0.8821, respectively, DeLong's P = .992). Bayesian networks showed that age and WFNS grade were associated with several variables such as laboratory results and cardiorespiratory parameters. Our study is the first to report early outcomes and formal predictor importance ranking following aSAH in a post-ISAT surgical case series. Models showed good predictive power with fewer relevant predictors than in similar size series. Bayesian networks proved to be a powerful tool in visualizing the widespread association of the 2 key predictors with admission variables, explaining their importance and demonstrating the potential for hypothesis generation.

  14. A composite neurobehavioral test to evaluate acute functional deficits after cerebellar haemorrhage in rats.

    Science.gov (United States)

    McBride, Devin W; Nowrangi, Derek; Kaur, Harpreet; Wu, Guangyong; Huang, Lei; Lekic, Tim; Tang, Jiping; Zhang, John H

    2017-01-01

    Cerebellar haemorrhage accounts for 5-10% of all intracerebral haemorrhages and leads to severe, long-lasting functional deficits. Currently, there is limited research on this stroke subtype, which may be due to the lack of a suitable composite neuroscoring system specific for cerebellar injury in rodents. The purpose of this study is to develop a comprehensive composite neuroscore test for cerebellar injury using a rat model of cerebellar haemorrhage. Sixty male Sprague-Dawley rats were subjected to either sham surgery or cerebellar haemorrhage. Twenty-four hours post-injury, neurological behaviour was evaluated using 17 cost-effective and easy-to-perform tests, and a composite neuroscore was developed. The composite neuroscore was then used to assess functional recovery over seven days after cerebellar haemorrhage. Differences in the composite neuroscore deficits for the mild and moderate cerebellar haemorrhage models were observed for up to five days post-ictus. Until now, a composite neuroscore for cerebellar injury was not available for rodent studies. Herein, using mild and moderate cerebellar haemorrhage rat models a composite neuroscore for cerebellar injury was developed and used to assess functional deficits after cerebellar haemorrhage. This composite neuroscore may also be useful for other cerebellar injury models.

  15. Acute Cholecystitis as a Cause of Fever in Aneurysmal Subarachnoid Hemorrhage

    Directory of Open Access Journals (Sweden)

    Na Rae Yang

    2017-05-01

    Full Text Available Background Fever is a very common complication that has been related to poor outcomes after aneurysmal subarachnoid hemorrhage (aSAH. The incidence of acalculous cholecystitis is reportedly 0.5%–5% in critically ill patients, and cerebrovascular disease is a risk factor for acute cholecystitis (AC. However, abdominal evaluations are not typically performed for febrile patients who have recently undergone aSAH surgeries. In this study, we discuss our experiences with febrile aSAH patients who were eventually diagnosed with AC. Methods We retrospectively reviewed 192 consecutive patients who underwent aSAH from January 2009 to December 2012. We evaluated their characteristics, vital signs, laboratory findings, radiologic images, and pathological data from hospitalization. We defined fever as a body temperature of >38.3°C, according to the Society of Critical Care Medicine guidelines. We categorized the causes of fever and compared them between patients with and without AC. Results Of the 192 enrolled patients, two had a history of cholecystectomy, and eight (4.2% were eventually diagnosed with AC. Among them, six patients had undergone laparoscopic cholecystectomy. In their pathological findings, two patients showed findings consistent with coexistent chronic cholecystitis, and two showed necrotic changes to the gall bladder. Patients with AC tended to have higher white blood cell counts, aspartame aminotransferase levels, and C-reactive protein levels than patients with fevers from other causes. Predictors of AC in the aSAH group were diabetes mellitus (odds ratio [OR], 8.758; P = 0.033 and the initial consecutive fasting time (OR, 1.325; P = 0.024. Conclusions AC may cause fever in patients with aSAH. When patients with aSAH have a fever, diabetes mellitus and a long fasting time, AC should be suspected. A high degree of suspicion and a thorough abdominal examination of febrile aSAH patients allow for prompt diagnosis and treatment of this

  16. Hypernatremia is a significant risk factor for acute kidney injury after subarachnoid hemorrhage: a retrospective analysis.

    Science.gov (United States)

    Kumar, Avinash B; Shi, Yaping; Shotwell, Matthew S; Richards, Justin; Ehrenfeld, Jesse M

    2015-04-01

    Hypertonic saline therapy is often used in critically ill subarachnoid hemorrhage (SAH) patients for indications ranging from control of intracranial hypertension to managing symptomatic hyponatremia. The risk factors for developing acute kidney injury (AKI) in this patient population are not well defined. To study the role of serum sodium in developing AKI (based on the AKIN definition) in the SAH population admitted to a large academic neurocritical care unit. This is an IRB-approved, retrospective cohort study of patients admitted to a tertiary neuro intensive care unit. We included adult (age ≥ 18 years) SAH patients admitted to the neuro intensive care unit for at least 72 h. Development of AKI after admission to the ICU was defined using the AKIN serum creatinine criteria between 72 h and 14 days following admission. A Cox proportional hazards survival model with multiple time varying covariates was developed to evaluate the effect of maximum sodium exposure on the risk of AKI. Sodium exposure was captured as the running maximum of daily maximum serum sodium concentration (mEq/L). Sodium exposure was used as a surrogate for hypertonic saline therapy. The final cohort of patients included 736 patients admitted to the neuro intensive care unit between 2006 and 2012. The number of patients who developed AKI was 64 (9 %). These patients had an increased length of stay (15.6 ± 9.4 vs. 12.5 ± 8.7 days). The odds of death were more than two fold greater among patients who developed AKI (odds ratio 2.33 95 % CI 1.27, 4.3). Sodium exposure was significantly associated with the hazard of developing AKI, adjusting for age, sex, preexisting renal disease, diabetes mellitus, radiocontrast exposure, number of days on mechanical ventilation, and admission Glasgow Coma Scale score. For each 1 mEq/L increase in the running maximum daily serum sodium, the hazard of developing AKI was increased by 5.4 % (95 % CI 1.4, 9.7). The maximum daily sodium is a significant risk

  17. Acute haemorrhage in patients with advanced head and neck cancer: value of endovascular therapy as palliative treatment option.

    Science.gov (United States)

    Sesterhenn, Andreas M; Iwinska-Zelder, Joanna; Dalchow, Carsten V; Bien, Siegfried; Werner, Jochen A

    2006-02-01

    Acute or subacute haemorrhage is one of the most frightening complications in patients suffering from advanced head and neck cancer. Few articles report experience with superselective endovascular therapy for this purpose. Is endovascular therapy underestimated in the field of palliative head and neck cancer therapy? This study set out to investigate this question. A review was undertaken of the clinical courses of seven patients (six men, one woman) suffering from incurable, advanced head and neck cancer (four pharyngeal, two laryngeal, one neck) and treated with superselective endovascular strategies as an emergency procedure for acute bleeding. All patients were successfully treated without evidence of neurological complication. Patients reached a median survival of 20 weeks (range eight-168 weeks). Following endovascular treatment all patients were discharged from the hospital within several days. Three patients survived almost free of symptoms for several weeks and were able to stay at home with their families until their death. We conclude that in the field of palliative care, superselective endovascular therapy deserves to be considered alongside standard treatment options for the management of acute haemorrhage from advanced head and neck cancer.

  18. Cerebral blood flow and the response to acetazolamide during the acute, subacute, and chronic stages of aneurysmal subarachnoid hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Tanaka, Akira; Yoshinaga, Shinya; Nakayama, Yoshiya; Tomonaga, Masamichi [Fukuoka Univ., Chikushino (Japan). Chikushi Hospital

    1998-10-01

    Cerebral blood flow (CBF) and response to acetazolamide were measured during the acute, subacute, and chronic stages after aneurysmal subarachnoid hemorrhage and correlated with symptomatic vasospasm and clinical outcome in 45 patients who underwent early clipping of ruptured cerebral aneurysms, of whom 18 had symptomatic vasospasm and 27 did not. Xenon-enhanced CT was used to measure CBF in both groups during the acute, subacute, and chronic stages, defined as days 0-4, 5-20, and {>=}21, respectively. Vasoresponse was assessed by the CBF increase in response to 1 g of acetazolamide administered after the baseline CBF study, except in the subacute stage of patients with symptomatic vasospasm. Outcome was scored based on activities of daily living 2-3 months after subarachnoid hemorrhage. CBF values and the response to acetazolamide were preserved during the acute stage but CBF values fell considerably below control values during the subacute stage in patients with vasospasm. The regions with flow values below 15 ml/100 g/min subsequently converted to infarction and the regions with those above 19 ml/100 g/min remained intact without infarction. During the chronic stage, low CBF persisted, but the response to acetazolamide was higher than that of the control group. Outcome scores were good and fair. CBF values were normal during all stages in patients without vasospasm. The response to acetazolamide fell transiently during the subacute stage. All outcome scores were excellent. In conclusion, the CBF informations soon after the onset of symptomatic vasospasm are useful to predict a reversibility of ischemic brain tissue and a final outcome. (K.H.)

  19. Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 2: is recombinant factor VIIa beneficial in the management of acute spontaneous intracerebral haemorrhage?

    Science.gov (United States)

    Dewhirst, Edward

    2013-04-01

    A short-cut review was carried out to establish whether recombinant factor VIIa (rFVIIa) improves survival and functional outcome in acute spontaneous intracranial haemorrhage. Ninety-two papers were found using the reported searches, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. It is concluded that current evidence does not support the use of rFVIIa in acute spontaneous intracranial haemorrhage.

  20. Not All Acute Abdomen Cases in Early Pregnancy Are Ectopic; Expect the Unexpected: Renal Angiomyolipoma Causing Massive Retroperitoneal Haemorrhage

    Directory of Open Access Journals (Sweden)

    Muhammad Asim Rana

    2016-01-01

    Full Text Available Retroperitoneal haemorrhage (or retroperitoneal haematoma refers to an accumulation of blood found in the retroperitoneal space. It is a rare clinical entity with variable aetiology including anticoagulation, ruptured aortic aneurysm, acute pancreatitis, malignancy, and bleeding from renal aneurysm. Diagnosis of retroperitoneal bleed is sometimes missed or delayed as presentation is often nonspecific. Multislice CT and arteriography are important for diagnosis. There is no consensus about the best management plan for patients with retroperitoneal haematoma. Stable patients can be managed with fluid resuscitation, correction of coagulopathy if any, and blood transfusion. Endovascular options involving selective intra-arterial embolisation or stent-grafts are clearly getting more and more popularity. Open repair is usually reserved for cases when there is failure of conservative or endovascular measures to control the bleeding or expertise is unavailable and in cases where the patient is unstable. Mortality of patients with retroperitoneal haematoma remains high if appropriate and timely measures are not taken. Haemorrhage from a benign renal tumour is a rarer entity which is described in this case report which emphasizes that physicians should have a wide index of suspicion when dealing with patients presenting with significant groin, flank, abdominal, or back pain, or haemodynamic instability of unclear cause. Our patient presented with features of acute abdomen and, being pregnant, was thought of having a ruptured ectopic pregnancy.

  1. Not All Acute Abdomen Cases in Early Pregnancy Are Ectopic; Expect the Unexpected: Renal Angiomyolipoma Causing Massive Retroperitoneal Haemorrhage

    Science.gov (United States)

    Mady, Ahmed F.; Jakaraddi, Nagesh; Naser, Kamal

    2016-01-01

    Retroperitoneal haemorrhage (or retroperitoneal haematoma) refers to an accumulation of blood found in the retroperitoneal space. It is a rare clinical entity with variable aetiology including anticoagulation, ruptured aortic aneurysm, acute pancreatitis, malignancy, and bleeding from renal aneurysm. Diagnosis of retroperitoneal bleed is sometimes missed or delayed as presentation is often nonspecific. Multislice CT and arteriography are important for diagnosis. There is no consensus about the best management plan for patients with retroperitoneal haematoma. Stable patients can be managed with fluid resuscitation, correction of coagulopathy if any, and blood transfusion. Endovascular options involving selective intra-arterial embolisation or stent-grafts are clearly getting more and more popularity. Open repair is usually reserved for cases when there is failure of conservative or endovascular measures to control the bleeding or expertise is unavailable and in cases where the patient is unstable. Mortality of patients with retroperitoneal haematoma remains high if appropriate and timely measures are not taken. Haemorrhage from a benign renal tumour is a rarer entity which is described in this case report which emphasizes that physicians should have a wide index of suspicion when dealing with patients presenting with significant groin, flank, abdominal, or back pain, or haemodynamic instability of unclear cause. Our patient presented with features of acute abdomen and, being pregnant, was thought of having a ruptured ectopic pregnancy. PMID:27429809

  2. The role of dual energy CT in differentiating between brain haemorrhage and contrast medium after mechanical revascularisation in acute ischaemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Tijssen, M.P.M.; Stadler, A.A.R.; Zwam, W. van; Graaf, R. de; Postma, A.A. [Maastricht University Medical Centre, Department of Radiology, P.O. Box 5800, Maastricht (Netherlands); Hofman, P.A.M. [Maastricht University Medical Centre, Department of Radiology, P.O. Box 5800, Maastricht (Netherlands); Maastricht University, MhENS School for Mental Health and Neuroscience, Maastricht (Netherlands); Oostenbrugge, R.J. van [Maastricht University Medical Centre, Department of Neurology, P.O. Box 5800, Maastricht (Netherlands); Maastricht University, CARIM School for Cardiovascular Diseases, P.O. Box 616, Maastricht (Netherlands); Klotz, E. [Siemens Healthcare Sector, Computed Tomography, Forchheim (Germany); Wildberger, J.E. [Maastricht University Medical Centre, Department of Radiology, P.O. Box 5800, Maastricht (Netherlands); Maastricht University, CARIM School for Cardiovascular Diseases, P.O. Box 616, Maastricht (Netherlands)

    2014-04-15

    To assess the feasibility of dual energy computed tomography (DE-CT) in intra-arterially treated acute ischaemic stroke patients to discriminate between contrast extravasation and intracerebral haemorrhage. Thirty consecutive acute ischaemic stroke patients following intra-arterial treatment were examined with DE-CT. Simultaneous imaging at 80 kV and 140 kV was employed with calculation of mixed images. Virtual unenhanced non-contrast (VNC) images and iodine overlay maps (IOM) were calculated using a dedicated brain haemorrhage algorithm. Mixed images alone, as ''conventional CT'', and DE-CT interpretations were evaluated and compared with follow-up CT. Eight patients were excluded owing to a lack of follow-up or loss of data. Mixed images showed intracerebral hyperdense areas in 19/22 patients. Both haemorrhage and residual contrast material were present in 1/22. IOM suggested contrast extravasation in 18/22 patients; in 16/18 patients this was confirmed at follow-up. The positive predictive value (PPV) of mixed imaging alone was 25 %, with a negative predictive value (NPV) of 91 % and accuracy of 63 %. The PPV for detection of haemorrhage with DE-CT was 100 %, with an NPV of 89 % and accuracy improved to 89 %. Dual energy computed tomography improves accuracy and diagnostic confidence in early differentiation between intracranial haemorrhage and contrast medium extravasation in acute stroke patients following intra-arterial revascularisation. (orig.)

  3. Acute post-stroke blood pressure relative to premorbid levels in intracerebral haemorrhage versus major ischaemic stroke: a population-based study

    Science.gov (United States)

    Fischer, Urs; Cooney, Marie Therese; Bull, Linda M; Silver, Louise E; Chalmers, John; Anderson, Craig S; Mehta, Ziyah; Rothwell, Peter M

    2014-01-01

    Summary Background It is often assumed that blood pressure increases acutely after major stroke, resulting in so-called post-stroke hypertension. In view of evidence that the risks and benefits of blood pressure-lowering treatment in acute stroke might differ between patients with major ischaemic stroke and those with primary intracerebral haemorrhage, we compared acute-phase and premorbid blood pressure levels in these two disorders. Methods In a population-based study in Oxfordshire, UK, we recruited all patients presenting with stroke between April 1, 2002, and March 31, 2012. We compared all acute-phase post-event blood pressure readings with premorbid readings from 10-year primary care records in all patients with acute major ischaemic stroke (National Institutes of Health Stroke Scale >3) versus those with acute intracerebral haemorrhage. Findings Of 653 consecutive eligible patients, premorbid and acute-phase blood pressure readings were available for 636 (97%) individuals. Premorbid blood pressure (total readings 13 244) had been measured on a median of 17 separate occasions per patient (IQR 8–31). In patients with ischaemic stroke, the first acute-phase systolic blood pressure was much lower than after intracerebral haemorrhage (158·5 mm Hg [SD 30·1] vs 189·8 mm Hg [38·5], pblood pressure after intracerebral haemorrhage was substantially higher than premorbid levels (mean increase of 40·7 mm Hg, pblood pressure also increased steeply in the days and weeks before intracerebral haemorrhage (regression pblood pressure reading after primary intracerebral haemorrhage was more likely than after ischaemic stroke to be the highest ever recorded (OR 3·4, 95% CI 2·3–5·2, pblood pressure within 3 h of onset was 50 mm Hg higher, on average, than the maximum premorbid level whereas that after ischaemic stroke was 5·2 mm Hg lower (pblood pressure is substantially raised compared with usual premorbid levels after intracerebral haemorrhage, whereas acute

  4. [Role of acute alcohol poisoning and craniocerebral trauma in the mechanism of death caused by subarachnoid hemorrhage].

    Science.gov (United States)

    Tang, Yi-kun; Shi, Meng; Ou, Gui-sheng; Zhao, Hu

    2014-10-01

    To investigate the relation between the expression of tPA, MMP-2, MMP-9 and AEG-1 in the human brain tissue and the ethanol concentration under the acute alcohol poison, and to analyze the role of alcohol and trauma in the mechanism of death of subarachnoid hemorrhage. Fifteen real cases were collected in this study. The brain tissues were researched by histological examination and the concentration of ethanol in heart blood were detected. The tPA, MMP-2, MMP-9 and AEG-1 in brainstem, brain and cerebellum were observed respectively by immunohistochemistry. In alcohol poisoning groups with or without trauma, the acute alcohol toxicity resulted in the swelling of brain tissues. The tPA, MMP-2, MMP-9 and AEG-1 of brainstem, brain and cerebellum showed high expression in alcohol victims, and the tPA in cerebellum showed no difference. The expression of the MMP-2, MMP-9 and AEG-1 showed good relation with the ethanol concentration in blood (P 0.6). The expressions of tPA, MMP-2, MMP-9 and AEG-1 are significant higher in alcohol victims, and expressions of MMP-2 and MMP-9 and AEG-1 have positive correlation with the alcohol concentration. The alcohol has acute toxicity to brain cells.

  5. Clinical implications of microvascular obstruction and intramyocardial haemorrhage in acute myocardial infarction using cardiovascular magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Bekkers, Sebastiaan C.A.M.; Smulders, Martijn W.; Waltenberger, Johannes; Gorgels, Anton P.M.; Schalla, Simon [Maastricht University Medical Center, Department of Cardiology, Maastricht (Netherlands); Passos, Valeria Lima [Maastricht University Medical Center, Department of Methodology and Statistics, Maastricht (Netherlands); Leiner, Tim [Maastricht University Medical Center, Department of Radiology, Maastricht (Netherlands)

    2010-11-15

    To investigate the clinical implications of microvascular obstruction (MVO) and intramyocardial haemorrhage (IMH) in acute myocardial infarction (AMI). Ninety patients with a first AMI undergoing primary percutaneous coronary intervention (PCI) were studied. T2-weighted, cine and late gadolinium-enhanced cardiovascular magnetic resonance imaging was performed at 5 {+-} 2 and 103 {+-} 11 days. Patients were categorised into three groups based on the presence or absence of MVO and IMH. MVO was observed in 54% and IMH in 43% of patients, and correlated significantly (r = 0.8, p < 0.001). Pre-PCI thrombolysis in myocardial infarction 3 flow was only observed in MVO(-)/IMH(-) patients. Infarct size and impairment of systolic function were largest in MVO(+)/IMH(+) patients (n = 39, 23 {+-} 9% and 47 {+-} 7%), smallest in MVO(-)/IMH(-) patients (n = 41, 8 {+-} 8% and 55 {+-} 8%) and intermediate in MVO(+)/IMH(-) patients (n = 10, 16 {+-} 7% and 51 {+-} 6%, p < 0.001). LVEF increased in all three subgroups at follow-up, but remained intermediate in MVO(+)/IMH(-) and was lowest in MVO(+)/IMH(+) patients. Using random intercept model analysis, only infarct size was an independent predictor for adverse LV remodelling. Intramyocardial haemorrhage and microvascular obstruction are strongly related. Pre-PCI TIMI 3 flow is less frequently observed in patients with MVO and IMH. Only infarct size was an independent predictor of LV remodelling. (orig.)

  6. GV20-based acupuncture for animal models of acute intracerebral haemorrhage: a preclinical systematic review and meta-analysis.

    Science.gov (United States)

    Li, Hui-qin; Li, Ji-huang; Liu, Ai-ju; Ye, Mai-yun; Zheng, Guo-qing

    2014-12-01

    Spontaneous intracerebral haemorrhage (ICH) is the most devastating subtype of stroke, but there is currently no evidence-based treatment strategy. Acupuncture is a well-known traditional Chinese therapy for stroke-induced disability, and GV20 is the commonly used acupuncture point. To evaluate the efficacy of GV20-based acupuncture in animal models of acute ICH. Studies of GV20-based acupuncture in animal models of acute ICH were identified from six databases up to July 2013. Study quality for each included article was evaluated according to the CAMARADES 10-item checklist. Outcome measures were neurological deficit scores and brain water content. All the data were analysed using RevMan V.5.1 software. Nineteen studies were identified describing procedures involving 1628 animals. The quality score of the studies ranged from 3 to 6, with a mean of 4.6. The global estimate of the effect of GV20-based acupuncture was 0.19 (95% CI 0.13 to 0.25, pacupuncture in animal models of acute ICH, suggesting it as a candidate therapy for acute ICH. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  7. Hydrogen-rich saline injection into the subarachnoid cavity within 2 weeks promotes recovery after acute spinal cord injury

    Directory of Open Access Journals (Sweden)

    Jian-long Wang

    2015-01-01

    Full Text Available Hydrogen can relieve tissue-damaging oxidative stress, inflammation and apoptosis. Injection of hydrogen-rich saline is an effective method for transporting molecular hydrogen. We hypothesized that hydrogen-rich saline would promote the repair of spinal cord injury induced by Allen′s method in rats. At 0.5, 1, 2, 4, 8, 12 and 24 hours after injury, then once daily for 2 weeks, 0.25 mL/kg hydrogen-rich saline was infused into the subarachnoid space through a catheter. Results at 24 hours, 48 hours, 1 week and 2 weeks after injury showed that hydrogen-rich saline markedly reduced cell death, inflammatory cell infiltration, serum malondialdehyde content, and caspase-3 immunoreactivity, elevated serum superoxide dismutase activity and calcitonin gene-related peptide immunoreactivity, and improved motor function in the hindlimb. The present study confirms that hydrogen-rich saline injected within 2 weeks of injury effectively contributes to the repair of spinal cord injury in the acute stage.

  8. Acute Subdural Hematoma and Subarachnoid Hemorrhage Caused by Ruptured Cortical Artery Aneurysm: Case Report and Review of Literature

    Directory of Open Access Journals (Sweden)

    Ahmad Shekarchizadeh

    2017-01-01

    Full Text Available The present report describes an acute subdural hematoma (ASDH associated with subarachnoid hemorrhage (SAH, due to ruptured cortical aneurysm. To our knowledge, extremely rare cases of this sort have been reported so far. A 23-year-old male patient without previous trauma presented with severe headache and rapidly decreasing level of consciousness to decerebrate status. Computed tomography (CT scan has demonstrated an ASDH together with SAH. Hematoma has immediately been evacuated without any evaluation by angiography. After evacuation of the thick subdural clot, a 10-mm aneurysm was revealed on a precentral artery of frontal cortex, which was ligated. However, after 35 days the patient discharged with left side hemiparesis and dysphasia, and just after several months of admission he got symptom free. Ruptured cortical aneurysm should be considered as one of the causes of spontaneous ASDH. Vascular anomaly investigations are suggested for these cases, thus CT angiography or digital subtraction angiography has to be considered if clinical condition allows.

  9. Medida da diferença artério-venosa de oxigênio na monitorização de pacientes com hemorragia subaracnóidea por aneurisma cerebral Measurement of arteriovenous oxygen difference in the monitoring of patients with subarachnoid haemorrhage due to cerebral aneurysm

    Directory of Open Access Journals (Sweden)

    Ronaldo Sérgio Santana Pereira

    1997-01-01

    Full Text Available A diferença artério-venosa de oxigênio (DAVO2, pelo fato de estar relacionada com o metabolismo cerebral, reflete alterações que ocorrem em determinadas situações patológicas, entre elas as causadas pela hemorragia subaracnóidea espontânea (HSAE. Com a finalidade de avaliar a relação entre alterações na DAVO2 com o quadro clínico e a evolução de pacientes com HSAE, devido à ruptura de aneurisma cerebral, este método foi utilizado em 30 pacientes portadores desta patologia, admitidos na Unidade de Neurocirurgia do HBDF. A HSAE foi confirmada por CT de crânio em 17 pacientes e por punção lombar em 13. Dezoito pacientes foram admitidos com Hunt & Hess (H&H I ou II, sete com H&H III e cinco com H&H IV ou V. A medida da DAVO2 baseou-se na equação de Fick e os resultados clínicos foram avaliados pela escala de seqüelas de Glasgow. Dezenove pacientes apresentaram DAVO2 normais (inicialmente e durante a evolução, sendo que três faleceram; cinco tiveram valores de DAVO2 sempre baixos e três faleceram; os restantes seis pacientes tiveram valores da DAVO2 sempre elevados e dois faleceram. Os pacientes com DAVO2 normais tiveram melhor evolução clínica e índice de mortalidade menor, quando comparados com os pacientes com valores anormais da DAVO2 (pThe arterious venous oxygen difference (AVDO2 due to the close relationship with cerebral metabolic rate of oxygen and cerebral blood flow shows metabolic alterations that occur in some pathological situations in the brain including subarachnoid haemorrhage. The AVDO2 was calculated by the Fick equation and the results evaluated by the Glasgow outcome scale. Measurements of arteriojugular oxygen difference were carried out in 30 patients with subarachnoid haemorrhage due to rupture of intracranial aneurysms, as an attempt to monitor the relationship between changes in AVDO2, clinical picture, and evolution of the patients. The subarachnoid haemorrhage was diagnosed by CT scan in

  10. Initial clinical experience with dual-layer detector spectral CT in patients with acute intracerebral haemorrhage: A single-centre pilot study.

    Directory of Open Access Journals (Sweden)

    Soo Buem Cho

    Full Text Available The purpose of this study was to investigate the clinical feasibility of spectral analyses using dual-layer detector spectral computed tomography (CT in acute intracerebral haemorrhage (ICH.We retrospectively reviewed patients with acute ICH who underwent CT angiography on a dual-layer detector spectral CT scanner. A spectral data analysis was performed to detect contrast enhancement in or adjacent to acute ICH by using spectral image reconstructions including monoenergetic (MonoE, virtual noncontrast (VNC, and iodine overlay fusion images. We also acquired a spectral plot to assess material differentiation within lesions.Among the 30 patients, the most common cause of acute ICH was chronic hypertension (18/30, 60% followed by trauma (5/30, 16.7%, brain tumour (3/30, 10%, Moyamoya disease (2/30, 6.7%, and haemorrhagic diathesis from anticoagulation therapy (2/30, 6.7%. Of 30 patients, 13 showed suboptimal iodine suppression in the subcalvarial spaces on VNC images compared with true noncontrast images. The CT angiographic spot sign within the acute ICH was detected in four patients (4/30, 13.3%. All three tumours were metastatic and included lung cancer (n = 2 and hepatocellular carcinoma (n = 1 which showed conspicuous delineation of an enhancing tumour portion in the spectral analysis. Spectral analyses allowed the discrimination of acute haemorrhage and iodine with enhanced lesion visualization on the MonoE images obtained at lower keVs (less than 70 keV and spectral plot.Even though the image quality of VNC is perceived to be inferior, it is feasible to evaluate acute ICH in clinical settings using dual-layer detector spectral CT. The MonoE images taken at lower keVs were useful for depicting contrast enhancing lesion, and spectral plot might be helpful for material differentiation in patients with acute ICH.

  11. Acute hypoxia diminishes the relationship between blood pressure and subarachnoid space width oscillations at the human cardiac frequency.

    Directory of Open Access Journals (Sweden)

    Magdalena Wszedybyl-Winklewska

    Full Text Available Acute hypoxia exerts strong effects on the cardiovascular system. Heart-generated pulsatile cerebrospinal fluid motion is recognised as a key factor ensuring brain homeostasis. We aimed to assess changes in heart-generated coupling between blood pressure (BP and subarachnoid space width (SAS oscillations during hypoxic exposure.Twenty participants were subjected to a controlled decrease in oxygen saturation (SaO2 = 80% for five minutes. BP and heart rate (HR were measured using continuous finger-pulse photoplethysmography, oxyhaemoglobin saturation with an ear-clip sensor, end-tidal CO2 with a gas analyser, and cerebral blood flow velocity (CBFV, pulsatility and resistive indices with Doppler ultrasound. Changes in SAS were recorded with a recently-developed method called near-infrared transillumination/backscattering sounding. Wavelet transform analysis was used to assess the relationship between BP and SAS oscillations.Gradual increases in systolic, diastolic BP and HR were observed immediately after the initiation of hypoxic challenge (at fifth minute +20.1%, +10.2%, +16.5% vs. baseline, respectively; all P<0.01, whereas SAS remained intact (P = NS. Concurrently, the CBFV was stable throughout the procedure, with the only increase observed in the last two minutes of deoxygenation (at the fifth minute +6.8% vs. baseline, P<0.05. The cardiac contribution to the relationship between BP and SAS oscillations diminished immediately after exposure to hypoxia (at the fifth minute, right hemisphere -27.7% and left hemisphere -26.3% vs. baseline; both P<0.05. Wavelet phase coherence did not change throughout the experiment (P = NS.Cerebral haemodynamics seem to be relatively stable during short exposure to normobaric hypoxia. Hypoxia attenuates heart-generated BP SAS coupling.

  12. Influence of Acute Jugular Vein Compression on the Cerebral Blood Flow Velocity, Pial Artery Pulsation and Width of Subarachnoid Space in Humans

    OpenAIRE

    Frydrychowski, Andrzej F.; Winklewski, Pawel J.; Guminski, Wojciech

    2012-01-01

    PURPOSE: The aim of this study was to assess the effect of acute bilateral jugular vein compression on: (1) pial artery pulsation (cc-TQ); (2) cerebral blood flow velocity (CBFV); (3) peripheral blood pressure; and (4) possible relations between mentioned parameters. METHODS: Experiments were performed on a group of 32 healthy 19-30 years old male subjects. cc-TQ and the subarachnoid width (sas-TQ) were measured using near-infrared transillumination/backscattering sounding (NIR-T/BSS), CBFV i...

  13. Successful surgical treatment of descending aorta interruption in a 29-year-old woman with acute paraplegia and subarachnoid hemorrhage: a case report.

    Science.gov (United States)

    Bai, Shutang; Wang, Zhiheng; Zhang, Liang; Fu, Hongdu; Zhuang, Huanwei; Cao, Xianjun; Liang, Liming; Yang, Yanqi

    2015-06-06

    Interruption of the descending aorta is an extremely rare great vessel malformation. In this report, we describe a very unusual case of a 29-year-old female with a 13-year history of hypertension who was found to have an interruption of the descending aorta when she was hospitalized with a subarachnoid hemorrhage and symptoms of acute paraplegia. We successfully surgically corrected the defect using a Gore-Tex® graft to bypass the aortic interruption. The patient's blood pressure postoperatively returned to normal, and the patient recovered completely from her paraplegia by the time of her 5-month follow-up visit.

  14. Intracranial haemorrhage

    African Journals Online (AJOL)

    history in keeping with an ictus, appropriate findings of subarachnoid blood in imaging and then CTA or MRA. CTA is 95% accurate at detecting aneurysms.[10] If the index of suspicion is high and the CT is negative. Fig. 2. A hypertensive patient who presented with sudden-onset left-sided weakness and dysphasia.

  15. Outcome of acute nonvariceal gastrointestinal haemorrhage after nontherapeutic arteriography compared with embolization

    Energy Technology Data Exchange (ETDEWEB)

    Defreyne, Luc; Vanlangenhove, Peter [Department of Vascular and Interventional Radiology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent (Belgium); Decruyenaere, Johan [Department of Intensive Care, Ghent University Hospital, De Pintelaan 185, 9000, Ghent (Belgium); Van Maele, Georges [Department of Medical Informatics and Statistics, Ghent University Hospital, De Pintelaan 185, 9000, Ghent (Belgium); De Vos, Martine [Department of Gastroenterology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent (Belgium); Troisi, Roberto [Department of Hepatobiliary Surgery, Ghent University Hospital, De Pintelaan 185, 9000, Ghent (Belgium); Pattyn, Piet [Department of Gastrointestinal Surgery, Ghent University Hospital, De Pintelaan 185, 9000, Ghent (Belgium)

    2003-12-01

    In acute nonvariceal gastrointestinal (GI) bleeding, immediate arteriographic haemostasis is presently assumed to be a therapeutic advantage. This study assesses whether the risk of a delayed haemostasis, caused by arteriographic findings precluding embolization, might influence patient outcome. We performed a 5.5-year retrospective database search to find all patients referred for arteriography to arrest acute nonvariceal GI bleeding with embolization. The embolized and nonembolized patients were compared for differences in baseline characteristics and bleeding parameters. In both groups the outcome of all endoscopic or surgical interventions after catheterization was included in the follow-up. Clinical success (at 30 days, after all therapy) and in-hospital mortality in the embolized and nonembolized group were compared. We retrieved 63 nonembolized bleedings in 58 patients and 49 embolized bleedings in 49 patients. In the nonembolized group, transfusion need and haemodynamic instability were significantly less severe. Forty-two of 63 (66%) nonembolized bleedings persisted requiring haemostasis by surgery (n=23), endoscopy (n=13) or supportive transfusions. Thirteen of 49 (27%) embolized bleedings recurred and were managed by surgery (n=7), endoscopy (n=3) or transfusion. Overall clinical success rate was 88.9% (56 of 63) in the nonembolized and 87.8% (43 of 49) in the embolized group. Mortality rate was 17.2% (10 of 58) in the nonembolized vs 30.6% (15 of 49) in the embolized patients (P=0.115). Whether or not arteriographic findings afforded the opportunity to embolize, outcome of acute nonvariceal GI bleeding did not differ significantly; however, patients undergoing embolization were more critically bleeding and ill. (orig.)

  16. Clinical course and rebleeding predictors of acute haemorrhagic rectal ulcer: 5-year experience and review of the literature.

    Science.gov (United States)

    Matsumoto, T; Inokuma, T

    2013-07-01

    This study was carried out to clarify the clinical features of acute haemorrhagic rectal ulcer (AHRU) and to determine the risks and predictors of AHRU rebleeding. Forty patients with AHRU were retrospectively analysed. Patient characteristics, endoscopic features and clinical course were investigated and predictors of AHRU rebleeding were analysed. All patients were in a bedridden state as a result of various diseases, and many patients had atherosclerosis-related comorbidities such as hypertension (67.4%), diabetes mellitus (40.0%) and chronic kidney disease (42.5%). All patients had hypoalbuminaemia, 75% of patients were using antithrombotic drugs and 25% of patients were using systemic corticosteroids. Based on colonoscopy, all patients developed ulcers in the distal rectum just above the dentate line and 30% of patients developed whole circumferential ulcers. The median interval between the onset of the bedridden state and the first massive haematochezia was 16 days and 50% of all patients developed rebleeding regardless of the presence or absence of haemostatic therapy. The median time from initial haemostasis to rebleeding was 6 days. Univariate analysis and stepwise multivariate analysis revealed that whole circumferential ulcer (P = 0.036) was a significant independent predictor of AHRU rebleeding. In the present study, we elucidated the clinical features of AHRU in detail and reviewed previous reports of AHRU. Rebleeding of AHRU occurred at a high rate and whole circumferential ulcer was a significant independent predictor of AHRU rebleeding. Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and Ireland.

  17. HIMALAIA (Hypertension Induction in the Management of AneurysmaL subArachnoid haemorrhage with secondary IschaemiA) : a randomized single- blind controlled trial of induced hypertension vs. no induced hypertension in the treatment of delayed cerebral ischemia after subarachnoid hemorrhage

    NARCIS (Netherlands)

    Gathier, C. S.; van den Bergh, W. M.; Slooter, A. J. C.

    RationaleDelayed cerebral ischemia (DCI) is a major complication after aneurysmal subarachnoid hemorrhage (SAH). One option to treat delayed cerebral ischemia is to use induced hypertension, but its efficacy on the eventual outcome has not been proven in a randomized clinical trial. This article

  18. Diagnostic Accuracy of Magnetic Resonance Angiography for Detection of Intracranial Aneurysms in Patients with Acute Subarachnoid Hemorrhage; A Comparison to Digital Subtraction Angiography

    Science.gov (United States)

    Farahmand, Mohammad; Farahangiz, Siamak; Yadollahi, Mahnaz

    2013-01-01

    Objectives: To determine the diagnostic accuracy of magnetic resonance angiography (MRA) compared to intra-arterial digital subtraction angiography (DSA) in detection of intracranial aneurysms in those suffering from acute subarachnoid hemorrhage (SAH). Methods: This observational diagnostic study was performed at a tertiary teaching hospital and reference center in Shiraz, Iran. We included 55 patients who presented to our center with the diagnosis of acute SAH. All the patients underwent MRA and DSA during their hospital course in order to detect the intracranial aneurysms. The time-of-flight MRA protocol was used and the results were compared to the results of DSA as the gold standard test. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for MRA. Results: The mean age of the patients was 46.3 ± 7.9 including 26 (47.3%%) men and 29 (52.7%) women. In 46 patients, 51 intracranial aneurysms were diagnosed by DSA (5 patients had two aneurysms). No evidence of intracranial aneurysm was found in 9 patients with subarachnoid hemorrhage. MRA correctly identified 42 of the 51 aneurysms (sensitivity 82%) and missed 9 small aneurysms (less than 10 mm). MRA revealed one false- positive finding, resulting in a specificity of 88.8%. The PPC and NPV for MRA were 97% and 47%, respectively. The diagnostic accuracy per aneurysm was 0.83 for MRA. Conclusion: High sensitivity and specificity of MRA compared to DSA in diagnosis of intracranial aneurysms in those with acute SAH indicate that MRA could be reliably used as a diagnostic tool for this purpose. However we cannot recommend it as a routine substitute for DSA before surgery. PMID:27162847

  19. NADH fluorescence imaging and the histological impact of cortical spreading depolarization during the acute phase of subarachnoid hemorrhage in rats.

    Science.gov (United States)

    Shimizu, Tomohisa; Hishikawa, Tomohito; Nishihiro, Shingo; Shinji, Yukei; Takasugi, Yuji; Haruma, Jun; Hiramatsu, Masafumi; Kawase, Hirokazu; Sato, Sachiko; Mizoue, Ryoichi; Takeda, Yoshimasa; Sugiu, Kenji; Morimatsu, Hiroshi; Date, Isao

    2018-01-01

    OBJECTIVE Although cortical spreading depolarization (CSD) has been observed during the early phase of subarachnoid hemorrhage (SAH) in clinical settings, the pathogenicity of CSD is unclear. The aim of this study is to elucidate the effects of loss of membrane potential on neuronal damage during the acute phase of SAH. METHODS Twenty-four rats were subjected to SAH by the perforation method. The propagation of depolarization in the brain cortex was examined by using electrodes to monitor 2 direct-current (DC) potentials and obtaining NADH (reduced nicotinamide adenine dinucleotide) fluorescence images while exposing the parietal-temporal cortex to ultraviolet light. Cerebral blood flow (CBF) was monitored in the vicinity of the lateral electrode. Twenty-four hours after onset of SAH, histological damage was evaluated at the DC potential recording sites. RESULTS Changes in DC potentials (n = 48 in total) were sorted into 3 types according to the appearance of ischemic depolarization in the entire hemisphere following induction of SAH. In Type 1 changes (n = 21), ischemic depolarization was not observed during a 1-hour observation period. In Type 2 changes (n = 13), the DC potential demonstrated ischemic depolarization on initiation of SAH and recovered 80% from the maximal DC deflection during a 1-hour observation period (33.3 ± 15.8 minutes). In Type 3 changes (n = 14), the DC potential displayed ischemic depolarization and did not recover during a 1-hour observation period. Histological evaluations at DC potential recording sites showed intact tissue at all sites in the Type 1 group, whereas in the Type 2 and Type 3 groups neuronal damage of varying severity was observed depending on the duration of ischemic depolarization. The duration of depolarization that causes injury to 50% of neurons (P 50 ) was estimated to be 22.4 minutes (95% confidence intervals 17.0-30.3 minutes). CSD was observed in 3 rats at 6 sites in the Type 1 group 5.1 ± 2.2 minutes after

  20. Prediction of escape red blood cell transfusion in expectantly managed women with acute anaemia after postpartum haemorrhage

    NARCIS (Netherlands)

    Prick, B. W.; Schuit, E.; Mignini, L.; Jansen, A. J. G.; van Rhenen, D. J.; Steegers, E. A. P.; Mol, B. W.; Duvekot, J. J.

    2015-01-01

    To determine clinical predictors of escape red blood cell (RBC) transfusion in postpartum anaemic women, initially managed expectantly, and the additional predictive value of health-related quality of life (HRQoL) measures. Secondary analysis of women after postpartum haemorrhage, either randomly

  1. Prediction of escape red blood cell transfusion in expectantly managed women with acute anaemia after postpartum haemorrhage

    NARCIS (Netherlands)

    Prick, B. W.; Schuit, E.|info:eu-repo/dai/nl/341652385; Mignini, L.; Jansen, A. J. G.; van Rhenen, D. J.; Steegers, E. A. P.; Mol, B. W.; Duvekot, J. J.

    2015-01-01

    ObjectiveTo determine clinical predictors of escape red blood cell (RBC) transfusion in postpartum anaemic women, initially managed expectantly, and the additional predictive value of health-related quality of life (HRQoL) measures. DesignSecondary analysis of women after postpartum haemorrhage,

  2. Caudate haemorrhage caused by pseudoaneurysm of accessory middle cerebral artery.

    Science.gov (United States)

    Teramoto, Shinichiro; Tokugawa, Joji; Nakao, Yasuaki; Yamamoto, Takuji

    2015-12-30

    A 68-year-old man experienced a right caudate haemorrhage with intraventricular haemorrhage. Although a subarachnoid haemorrhage was not shown clearly, our investigation demonstrated an aneurysm-like vascular pouch located in the anomalous vessel arising from the A2 segment of the right anterior cerebral artery. Rupture of the vascular pouch was considered to be the cause of the caudate haemorrhage. Neck clipping was performed. In intraoperative observation, the anomalous vessel was diagnosed as a right accessory middle cerebral artery. Histopathology of the saccular wall showed only an adventitia and a fibrin layer, indicating a pseudoaneurysm. We routinely perform detailed vascular evaluation for any cerebrovascular disease. A meticulous vascular survey makes it possible to obtain valuable clues in cases such as caudate haemorrhage due to pseudoaneurysm of the accessory middle cerebral artery, leading to prevention of rebleeding. 2015 BMJ Publishing Group Ltd.

  3. Acute liver failure, multiorgan failure, cerebral oedema, and activation of proangiogenic and antiangiogenic factors in a case of Marburg haemorrhagic fever.

    Science.gov (United States)

    van Paassen, Judith; Bauer, Martijn P; Arbous, M Sesmu; Visser, Leo G; Schmidt-Chanasit, Jonas; Schilling, Stefan; Ölschläger, Stephan; Rieger, Toni; Emmerich, Petra; Schmetz, Christel; van de Berkmortel, Franchette; van Hoek, Bart; van Burgel, Nathalie D; Osterhaus, Albert D; Vossen, Ann Ctm; Günther, Stephan; van Dissel, Jaap T

    2012-08-01

    A woman developed Marburg haemorrhagic fever in the Netherlands, most likely as a consequence of being exposed to virus-infected bats in the python cave in Maramagambo Forest during a visit to Uganda. The clinical syndrome was dominated by acute liver failure with secondary coagulopathy, followed by a severe systemic inflammatory response, multiorgan failure, and fatal cerebral oedema. A high blood viral load persisted during the course of the disease. The initial systemic inflammatory response coincided with peaks in interferon-γ and tumour necrosis factor-α concentrations in the blood. A terminal rise in interleukin-6, placental growth factor (PlGF), and soluble vascular endothelial growth factor receptor-1 (sVEGF-R1) seemed to suggest an advanced pathophysiological stage of Marburg haemorrhagic fever associated with vascular endothelial dysfunction and fatal cerebral oedema. The excess of circulating sVEGF-R1 and the high sVEGF-R1:PlGF ratio shortly before death resemble pathophysiological changes thought to play a causative part in pre-eclampsia. Aggressive critical-care treatment with renal replacement therapy and use of the molecular absorbent recirculation system appeared able to stabilise--at least temporarily--the patient's condition. Copyright © 2012 Elsevier Ltd. All rights reserved.

  4. Neurosarcoidosis-related intracranial haemorrhage: three new cases and a systematic review of the literature.

    LENUS (Irish Health Repository)

    O'Dwyer, J P

    2012-06-09

    BACKGROUND AND PURPOSE: Intracranial haemorrhage in neurosarcoidosis (NS-ICH) is rare, poorly understood and the diagnosis of NS may not be immediately apparent. METHODS: The clinical features of three new NS-ICH cases are described including new neuropathological findings and collated with cases from a systematic literature review. RESULTS: Cases: (i) A 41-year-old man with headaches, hypoandrogenism and encephalopathy developed a cerebellar haemorrhage. He had neuropathological confirmation of NS with biopsy-proven angiocentric granulomata and venous disruption. He responded to immunosuppressive therapy. (ii) A 41-year-old man with no history of hypertension was found unconscious. A subsequently fatal pontine haemorrhage was diagnosed. Liver biopsy revealed sarcoid granulomas. (iii) A 36-year-old man with raised intracranial pressure headaches presented with a seizure and a frontal haemorrhage. Hilar lymph node biopsy confirmed sarcoidosis, and he was treated successfully. Systematic Review: Twelve other published cases were identified and collated with our cases. Average age was 36 years and M:F = 2.3:1; 46% presented with neurological symptoms and 31% had CNS-isolated disease. Immediate symptoms of ICH were acute\\/worsening headache or seizures (60%). ICH was supratentorial (62%), infratentorial (31%) or subarachnoid (7%). 40% had definite NS, 53% probable NS and 7% possible NS (Zajicek criteria). Antigranulomatous\\/immunosuppressive therapy regimens varied and 31% died. CONCLUSIONS: This series expands our knowledge of the pathology of NS-ICH, which may be of arterial or venous origin. One-third have isolated NS. Clinicians should consider NS in young-onset ICH because early aggressive antigranulomatous therapy may improve outcome.

  5. Detection of acute small amount of subarachnoid hemorrhage: Comparison between fluid-attenuated inversion recovery MR imaging and CT

    Directory of Open Access Journals (Sweden)

    Maha K. Abdel Ghaffar

    2014-09-01

    Conclusion: FLAIR MRI was more sensitive and more accurate in the diagnosis of acute SAH than CT scan, having a much higher negative predictive value to exclude acute SAH, however its positive predictive value was slightly lower than CT, but there was no statistically significant difference statistically between the two in diagnosis of SAH.

  6. Haemorrhagic Fevers, Viral

    Science.gov (United States)

    ... is usually applied to disease caused by Arenaviridae (Lassa fever, Junin and Machupo), Bunyaviridae (Crimean-Congo haemorrhagic ... fever Dengue and severe dengue Ebola virus disease Lassa fever Marburg haemorrhagic fever Rift Valley fever Multimedia, ...

  7. Resveratrol Attenuates Acute Inflammatory Injury in Experimental Subarachnoid Hemorrhage in Rats via Inhibition of TLR4 Pathway

    Directory of Open Access Journals (Sweden)

    Xiang-Sheng Zhang

    2016-08-01

    Full Text Available Toll-like receptor 4 (TLR4 has been proven to play a critical role in neuroinflammation and to represent an important therapeutic target following subarachnoid hemorrhage (SAH. Resveratrol (RSV, a natural occurring polyphenolic compound, has a powerful anti-inflammatory property. However, the underlying molecular mechanisms of RSV in protecting against early brain injury (EBI after SAH remain obscure. The purpose of this study was to investigate the effects of RSV on the TLR4-related inflammatory signaling pathway and EBI in rats after SAH. A prechiasmatic cistern SAH model was used in our experiment. The expressions of TLR4, high-mobility group box 1 (HMGB1, myeloid differentiation factor 88 (MyD88, and nuclear factor-κB (NF-κB were evaluated by Western blot and immunohistochemistry. The expressions of Iba-1 and pro-inflammatory cytokines in brain cortex were determined by Western blot, immunofluorescence staining, or enzyme-linked immunosorbent assay. Neural apoptosis, brain edema, and neurological function were further evaluated to investigate the development of EBI. We found that post-SAH treatment with RSV could markedly inhibit the expressions of TLR4, HMGB1, MyD88, and NF-κB. Meanwhile, RSV significantly reduced microglia activation, as well as inflammatory cytokines leading to the amelioration of neural apoptosis, brain edema, and neurological behavior impairment at 24 h after SAH. However, RSV treatment failed to alleviate brain edema and neurological deficits at 72 h after SAH. These results indicated that RSV treatment could alleviate EBI after SAH, at least in part, via inhibition of TLR4-mediated inflammatory signaling pathway.

  8. The effect of tracheotomy on drug consumption in patients with acute aneurysmal subarachnoid hemorrhage: an observational study.

    Science.gov (United States)

    Rosseland, Leiv Arne; Narum, Jon; Stubhaug, Audun; Kongsgaard, Ulf; Sorteberg, Wilhelm; Sorteberg, Angelika

    2015-01-01

    Patients with aneurysmal subarachnoid hemorrhage (aSAH) are common in intensive care units (ICU). In patients with aSAH, sedation is used as a neuroprotective measure in order to secure adequate cerebral perfusion pressure (CPP). Compared with the use of an endotracheal tube, a tracheotomy has the advantage of securing the airway at a much lower level of distress, and aSAH patients can often be awakened more rapidly. Little is known about the impact of tracheotomy on the consumption of sedative/analgesic and vasoactive drugs and the maintenance of CPP within defined limits in aSAH patients. We conducted an observational study of aSAH patients who underwent percutaneous tracheotomy. A prospective registry of patient data was supplemented with retrospective retrievals from medical records. Sedative, analgesic and vasoactive drug doses were registered for 3 days prior to and after percutaneous tracheotomy, respectively. Blood pressure, CPP, and the mode of mechanical ventilation were registered 24 h prior to and after tracheotomy. Between January 2001 and June 2009, 902 aSAH patients were admitted to our hospital; 74 (8%) were deeply comatose/dying upon arrival. The ruptured aneurysm was repaired in 828 patients (surgical repair 50%) and percutaneous tracheotomy was performed 182 times in 178 patients (59 men and 119 women). This subpopulation (178 of 828 patients) was significantly older (56 vs. 53 years) and presented with a more severe Hunt & Hess grade (p tracheotomy caused a marked decline in mean daily consumption of the analgesics/sedatives fentanyl, midazolam, and propofol, as well as the vasoactive drugs noradrenaline and dopamine. These declines were statistically and clinically significant. The mean CPP was 76 mmHg (SD 8.6) the day before and 79 mmHg (SD 9.6) 24 h after percutaneous tracheotomy. After percutaneous tracheotomy, mechanical ventilatory support could be reduced to a patient-controlled ventilatory support mode in a significant number of

  9. The relation between hypointense core, microvascular obstruction and intramyocardial haemorrhage in acute reperfused myocardial infarction assessed by cardiac magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Kandler, Diana; Luecke, Christian; Grothoff, Matthias; Andres, Claudia; Lehmkuhl, Lukas; Nitzsche, Stefan; Riese, Franziska; Gutberlet, Matthias [University Leipzig - Heart Centre, Department of Diagnostic and Interventional Radiology, Leipzig (Germany); Mende, Meinhard [University Leipzig, Coordination Centre for Clinical Trials, Leipzig (Germany); Waha, Suzanne de; Desch, Steffen; Lurz, Philipp; Eitel, Ingo [University Leipzig - Heart Centre, Department of Internal Medicine/ Cardiology, Leipzig (Germany)

    2014-12-15

    Intramyocardial haemorrhage (IMH) and microvascular obstruction (MVO) represent reperfusion injury after reperfused ST-elevation myocardial infarction (STEMI) with prognostic impact and ''hypointense core'' (HIC) appearance in T{sub 2}-weighted images. We aimed to distinguish between IMH and MVO by using T{sub 2}{sup *}-weighted cardiovascular magnetic resonance imaging (CMR) and analysed influencing factors for IMH development. A total of 151 patients with acute STEMI underwent CMR after primary angioplasty. T{sub 2}-STIR sequences were used to identify HIC, late gadolinium enhancement to visualise MVO and T{sub 2}{sup *}-weighted sequences to detect IMH. IMH{sup +}/IMH{sup -} patients were compared considering infarct size, myocardial salvage, thrombolysis in myocardial infarction (TIMI) flow, reperfusion time, ventricular volumes, function and pre-interventional medication. Seventy-six patients (50 %) were IMH{sup +}, 82 (54 %) demonstrated HIC and 100 (66 %) MVO. IMH was detectable without HIC in 16 %, without MVO in 5 % and HIC without MVO in 6 %. Multivariable analyses revealed that IMH was associated with significant lower left ventricular ejection fraction and myocardial salvage index, larger left ventricular volume and infarct size. Patients with TIMI flow grade ≤1 before angioplasty demonstrated IMH significantly more often. IMH is associated with impaired left ventricular function and higher infarct size. T{sub 2} and HIC imaging showed moderate agreement for IMH detection. T{sub 2}{sup *} imaging might be the preferred CMR imaging method for comprehensive IMH assessment. (orig.)

  10. Intra-arterial nimodipine for the treatment of vasospasm due to aneurysmal subarachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    Chiriac A.

    2016-12-01

    Full Text Available The cerebral vasospasm is still considered the most devastating complication for the patients with aneurysmal subarachnoid haemorrhage. The aim of this study was to evaluate the efficiency of intra-arterial nimodipine administration in cerebral vasospasm diminutions and outcome of the patients.

  11. [Subhyaloid macular haemorrhage in Terson syndrome, treated by rupture of the posterior hyaloid using YAG laser].

    Science.gov (United States)

    Sánchez Ferreiro, A V; Muñoz Bellido, L

    2014-02-01

    We present the case of a 48 year-old man who had a sudden onset of vomiting, headache and loss of consciousness. The visual acuity was severely reduced in the left eye, with a large subhyaloid haemorrhage being observed in the fundus. The combination of subarachnoid haemorrhage and a vitreous haemorrhage is called Terson syndrome. The details of the treatment of this case with YAG laser are also discussed. Copyright © 2011 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.

  12. Influence of acute jugular vein compression on the cerebral blood flow velocity, pial artery pulsation and width of subarachnoid space in humans.

    Directory of Open Access Journals (Sweden)

    Andrzej F Frydrychowski

    Full Text Available PURPOSE: The aim of this study was to assess the effect of acute bilateral jugular vein compression on: (1 pial artery pulsation (cc-TQ; (2 cerebral blood flow velocity (CBFV; (3 peripheral blood pressure; and (4 possible relations between mentioned parameters. METHODS: Experiments were performed on a group of 32 healthy 19-30 years old male subjects. cc-TQ and the subarachnoid width (sas-TQ were measured using near-infrared transillumination/backscattering sounding (NIR-T/BSS, CBFV in the left anterior cerebral artery using transcranial Doppler, blood pressure was measured using Finapres, while end-tidal CO(2 was measured using medical gas analyser. Bilateral jugular vein compression was achieved with the use of a sphygmomanometer held on the neck of the participant and pumped at the pressure of 40 mmHg, and was performed in the bend-over (BOPT and swayed to the back (initial position. RESULTS: In the first group (n = 10 during BOPT, sas-TQ and pulse pressure (PP decreased (-17.6% and -17.9%, respectively and CBFV increased (+35.0%, while cc-TQ did not change (+1.91%. In the second group, in the initial position (n = 22 cc-TQ and CBFV increased (106.6% and 20.1%, respectively, while sas-TQ and PP decreases were not statistically significant (-15.5% and -9.0%, respectively. End-tidal CO(2 remained stable during BOPT and venous compression in both groups. Significant interdependence between changes in cc-TQ and PP after bilateral jugular vein compression in the initial position was found (r = -0.74. CONCLUSIONS: Acute bilateral jugular venous insufficiency leads to hyperkinetic cerebral circulation characterised by augmented pial artery pulsation and CBFV and direct transmission of PP into the brain microcirculation. The Windkessel effect with impaired jugular outflow and more likely increased intracranial pressure is described. This study clarifies the potential mechanism linking jugular outflow insufficiency with arterial small vessel cerebral

  13. Influence of acute jugular vein compression on the cerebral blood flow velocity, pial artery pulsation and width of subarachnoid space in humans.

    Science.gov (United States)

    Frydrychowski, Andrzej F; Winklewski, Pawel J; Guminski, Wojciech

    2012-01-01

    The aim of this study was to assess the effect of acute bilateral jugular vein compression on: (1) pial artery pulsation (cc-TQ); (2) cerebral blood flow velocity (CBFV); (3) peripheral blood pressure; and (4) possible relations between mentioned parameters. Experiments were performed on a group of 32 healthy 19-30 years old male subjects. cc-TQ and the subarachnoid width (sas-TQ) were measured using near-infrared transillumination/backscattering sounding (NIR-T/BSS), CBFV in the left anterior cerebral artery using transcranial Doppler, blood pressure was measured using Finapres, while end-tidal CO(2) was measured using medical gas analyser. Bilateral jugular vein compression was achieved with the use of a sphygmomanometer held on the neck of the participant and pumped at the pressure of 40 mmHg, and was performed in the bend-over (BOPT) and swayed to the back (initial) position. In the first group (n = 10) during BOPT, sas-TQ and pulse pressure (PP) decreased (-17.6% and -17.9%, respectively) and CBFV increased (+35.0%), while cc-TQ did not change (+1.91%). In the second group, in the initial position (n = 22) cc-TQ and CBFV increased (106.6% and 20.1%, respectively), while sas-TQ and PP decreases were not statistically significant (-15.5% and -9.0%, respectively). End-tidal CO(2) remained stable during BOPT and venous compression in both groups. Significant interdependence between changes in cc-TQ and PP after bilateral jugular vein compression in the initial position was found (r = -0.74). Acute bilateral jugular venous insufficiency leads to hyperkinetic cerebral circulation characterised by augmented pial artery pulsation and CBFV and direct transmission of PP into the brain microcirculation. The Windkessel effect with impaired jugular outflow and more likely increased intracranial pressure is described. This study clarifies the potential mechanism linking jugular outflow insufficiency with arterial small vessel cerebral disease.

  14. The value of MRI in angiogram-negative intracranial haemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Renowden, S.A. (Dept. of Neuroradiology, Radcliffe Infirmary, Oxford (United Kingdom)); Molyneux, A.J. (Dept. of Neuroradiology, Radcliffe Infirmary, Oxford (United Kingdom)); Anslow, P. (Dept. of Neuroradiology, Radcliffe Infirmary, Oxford (United Kingdom)); Byrne, J.V. (Dept. of Neuroradiology, Radcliffe Infirmary, Oxford (United Kingdom))

    1994-08-01

    In one year, cerebral angiograms were performed for intracranial haemorrhage (ICH) on 334 patients. No cause for haemorrhage could be identified in 41 (12 %), 30 of whom had predominantly subarachnoid (SAH) and 11 predominantly parenchymal haemorrhage (PH). These patients were prospectively examined by cranial MRI 1-6 weeks after the ictus. The MRI studies were positive in 7 patients (17 %). In the 30 patients examined after SAH, 2 studies were positive, showing an aneurysm in one case and a brain stem lesion of uncertain aetiology in the other. In those examined after PH, cavernous angiomas were shown in 2, a tumour in 1 and a vascular malformation in another; useful diagnostic information was thus obtained in 36 % of this group. (orig.)

  15. Trends in monitoring patients with aneurysmal subarachnoid haemorrhage

    DEFF Research Database (Denmark)

    Springborg, J B; Frederiksen, H-J; Eskesen, V

    2005-01-01

    complications. Currently, several neuro-monitoring techniques are available; this review describes the most frequently used techniques and discusses indications for their use, and their value in diagnosis and prognosis. None of the techniques, when considered in isolation, has proved sufficient after SAH...

  16. Viral Haemorrhagic Septicaemia Virus

    DEFF Research Database (Denmark)

    Olesen, Niels Jørgen; Skall, Helle Frank

    2013-01-01

    This chapter covers the genetics (genotypes and serotypes), clinical signs, host species, transmission, prevalence, diagnosis, control and prevention of viral haemorrhagic septicaemia virus.......This chapter covers the genetics (genotypes and serotypes), clinical signs, host species, transmission, prevalence, diagnosis, control and prevention of viral haemorrhagic septicaemia virus....

  17. Case report: Profound hypotension associated with labetalol therapy in a patient with cerebral aneurysms and subarachnoid hemorrhage

    National Research Council Canada - National Science Library

    Jivraj, Sana; Mazer, C David; Baker, Andrew J; Choi, Mabel; Hare, Gregory M. T

    2006-01-01

    Labetalol is an effective antihypertensive medication frequently used to treat systemic hypertension in acute care settings, including the management of hypertension associated with a subarachnoid hemorrhage...

  18. Ebolavirus and Haemorrhagic Syndrome

    Directory of Open Access Journals (Sweden)

    Gerald A. Matua

    2015-05-01

    Full Text Available The Ebola virus is a highly virulent, single-stranded ribonucleic acid virus which affects both humans and apes and has fast become one of the world’s most feared pathogens. The virus induces acute fever and death, with haemorrhagic syndrome occurring in up to 90% of patients. The known species within the genus Ebolavirus are Bundibugyo, Sudan, Zaïre, Reston and Taï Forest. Although endemic in Africa, Ebola has caused worldwide anxiety due to media hype and concerns about its international spread, including through bioterrorism. The high fatality rate is attributed to unavailability of a standard treatment regimen or vaccine. The disease is frightening since it is characterised by rapid immune suppression and systemic inflammatory response, causing multi-organ and system failure, shock and often death. Currently, disease management is largely supportive, with containment efforts geared towards mitigating the spread of the virus. This review describes the classification, morphology, infective process, natural ecology, transmission, epidemic patterns, diagnosis, clinical features and immunology of Ebola, including management and epidemic containment strategies.

  19. Evaluation of VCAM-1 and ICAM-1 concentration and values of global tests concerning the coagulation system of patients suffering from subarachnoid haemorrage.

    Science.gov (United States)

    Al-Drawi, Abu-Sitta; Wiciński, Michał; Grześk, Grzegorz; Szadujkis-Szadurska, Katarzyna; Grześk, Elżbieta; Węclewicz, Mateusz Maciej; Michalska, Agnieszka; Czeczuk, Anna; Huk-Wieliczuk, Elżbieta

    2016-12-23

    The term 'subarachnoid haemorrhage' (SAH) stands for bleeding into the subarachnoid space, regardless of its source. It may be of primary character when the source of bleeding is situated within the subarachnoid space. Subarachnoid haemorrhage is often described as spontaneous bleeding, mainly in order to differentiate it from post-traumatic bleeding. The aim of the study was to evaluate the concentration of ICAM-1 and VCAM-1 in the blood of patients in the early phase following subarachnoid haemorrhage in terms of searching for markers useful in subarachnoid bleeding diagnostics and monitoring a patient's clinical state. The study comprised 85 patients (47 women, 38 men), aged 29-81 (average 53±12 years), suffering from subarachnoid haemorrhage. The control group comprised 45 healthy people selected according to gender and age corresponding with the experimental group. The study revealed that the concentration of ICAM-1 and VCAM-1 was significantly higher in patients suffering from subarachnoid haemorrhage. Additionally, the concentration of fibrinogen decreased, aPTT was shorter and the concentration of D-dimers increased. The studied parameters did not differ with respect to the age or gender of the patients. It was stated that according to the Hunt and Hess scale, the concentration of ICAM-1 was considerably higher in the group of patients in the most severe neurological state, compared to other patients. It was also observed that the concentration of fibrinogen was significantly higher, aPTT was shorter, and the concentration of D-dimers increased in the afore-mentioned group. Evaluation of the concentration of adhesion molecules, as well as values of global tests concerning the coagulation system, may serve as a useful diagnostic tool for SAH.

  20. Characterizing amide proton transfer imaging in haemorrhage brain lesions using 3T MRI

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Ha-Kyu [Philips Korea, Seoul (Korea, Republic of); Korea Basic Science Institute, Chungcheongbuk-do (Korea, Republic of); Han, Kyunghwa [Yonsei University College of Medicine, Department of Radiology and Research Institute of Radiological Science, Seodaemun-gu, Seoul (Korea, Republic of); Yonsei University College of Medicine, Yonsei Biomedical Research Institute, Seoul (Korea, Republic of); Zhou, Jinyuan [Johns Hopkins University School of Medicine, Division of MRI Research, Department of Radiology, Baltimore, MD (United States); Zhao, Yansong [Philips Healthcare, MR Clinical Science, Cleveland, OH (United States); Choi, Yoon Seong; Lee, Seung-Koo; Ahn, Sung Soo [Yonsei University College of Medicine, Department of Radiology and Research Institute of Radiological Science, Seodaemun-gu, Seoul (Korea, Republic of)

    2017-04-15

    The aim of this study was to characterize amide proton transfer (APT)-weighted signals in acute and subacute haemorrhage brain lesions of various underlying aetiologies. Twenty-three patients with symptomatic haemorrhage brain lesions including tumorous (n = 16) and non-tumorous lesions (n = 7) were evaluated. APT imaging was performed and analyzed with magnetization transfer ratio asymmetry (MTR{sub asym}). Regions of interest were defined as the enhancing portion (when present), acute or subacute haemorrhage, and normal-appearing white matter based on anatomical MRI. MTR{sub asym} values were compared among groups and components using a linear mixed model. MTR{sub asym} values were 3.68 % in acute haemorrhage, 1.6 % in subacute haemorrhage, 2.65 % in the enhancing portion, and 0.38 % in normal white matter. According to the linear mixed model, the distribution of MTR{sub asym} values among components was not significantly different between tumour and non-tumour groups. MTR{sub asym} in acute haemorrhage was significantly higher than those in the other regions regardless of underlying pathology. Acute haemorrhages showed high MTR{sub asym} regardless of the underlying pathology, whereas subacute haemorrhages showed lower MTR{sub asym} than acute haemorrhages. These results can aid in the interpretation of APT imaging in haemorrhage brain lesions. (orig.)

  1. Magnesium in subarachnoid hemorrhage

    NARCIS (Netherlands)

    Bergh, W.M. (Walter Marcel) van den

    2004-01-01

    The main objective of this thesis was to determine the role of serum magnesium in the pathophysiology after subarachnoid hemorrhage (SAH) and to assess the effect of magnesium treatment in reducing cerebral ischemia in experimental SAH and in improving clinical outcome in patients with

  2. Lethal subarachnoid bleeding under immunosuppressive therapy due to mycotic arteritis

    Energy Technology Data Exchange (ETDEWEB)

    Weigel, S.; Kloska, S.; Freund, M. [Dept. of Clinical Radiology, Univ. Hospital of Muenster, Muenster (Germany); Kehl, H.G. [Dept. of Pediatric Cardiology, Univ. Hospital of Muenster, Muenster (Germany)

    2003-12-01

    A subarachnoid haemorrhage (SAH) occurred 67 days after cardiac transplantation in 10-year-old girl with consecutive immunocompromising therapy. Neither digital subtraction angiography (DSA) nor computed tomographic angiography showed signs of intracranial vascular malformations. One month before the lethal SAH occurred, she had developed arterial hypertension and attacks of severe headache with cerebrospinal fluid (CSF) pleocytosis while CT scans showed an infarct of the left thalamus. Pathologic findings established the rare diagnosis of SAH due to aspergillosis-related mycotic arteritis. Imaging characteristics are presented. (orig.)

  3. Magnetic resonance imaging of aneurysmal subarachnoid hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Ogawa, Toshihide; Shimosegawa, Eku; Inugami, Atsushi; Shishido, Fumio; Fujita, Hideaki; Ito, Hiroshi; Uemura, Kazuo; Yasui, Nobuyuki (Research Inst. of Brain and Blood Vessels, Akita (Japan))

    1991-11-01

    Magnetic resonance imaging of subarachnoid hemorrhage (SAH) due to aneurysm rupture was evaluated in relation to CT findings in nine patients. Six patients were studied within 3 days and the other three patients were studied 4 to 6 days from the ictus of SAH using a 0.5 Tesla superconducting unit. In all of the patients, hematoma in the subarachnoid space and ventricles was demonstrated by the proton density-weighted spin echo sequence, which showed that bloody cerebrospinal fluid (CSF) had a higher signal intensity than brain tissue or normal CSF. Magnetic resonance imaging was more sensitive in detecting SAH and more informative as to the site of the ruptured aneurysm than CT. Despite some limitations in applying it to patients with acute SAH, magnetic resonace imaging has clear advantages in the diagnosis of SAH. (author).

  4. Evaluation of VCAM-1 and ICAM-1 concentration and values of global tests concerning the coagulation system of patients suffering from subarachnoid haemorrage

    Directory of Open Access Journals (Sweden)

    Abu-Sitta Al-Drawi

    2016-09-01

    Full Text Available [b]Introduction. [/b]The term ‘subarachnoid haemorrhage’ (SAH stands for bleeding into the subarachnoid space, regardless of its source. It may be of primary character when the source of bleeding is situated within the subarachnoid space. Subarachnoid haemorrhage is often described as spontaneous bleeding, mainly in order to differentiate it from post-traumatic bleeding. [b]Objective.[/b] The aim of the study was to evaluate the concentration of ICAM-1 and VCAM-1 in the blood of patients in the early phase following subarachnoid haemorrhage in terms of searching for markers useful in subarachnoid bleeding diagnostics and monitoring a patient’s clinical state. [b]Materials and method. [/b]The study comprised 85 patients (47 women, 38 men, aged 29–81 (average 53±12 years, suffering from subarachnoid haemorrhage. The control group comprised 45 healthy people selected according to gender and age corresponding with the experimental group. [b]Results. [/b]The study revealed that the concentration of ICAM-1 and VCAM-1 was significantly higher in patients suffering from subarachnoid haemorrhage. Additionally, the concentration of fibrinogen decreased, aPTT was shorter and the concentration of D-dimers increased. The studied parameters did not differ with respect to the age or gender of the patients. It was stated that according to the Hunt and Hess scale, the concentration of ICAM-1 was considerably higher in the group of patients in the most severe neurological state, compared to other patients. It was also observed that the concentration of fibrinogen was significantly higher, aPTT was shorter, and the concentration of D-dimers increased in the afore-mentioned group. [b]Conclusions[/b]. Evaluation of the concentration of adhesion molecules, as well as values of global tests concerning the coagulation system, may serve as a useful diagnostic tool for SAH.

  5. Excessive work and risk of haemorrhagic stroke: a nationwide case-control study.

    Science.gov (United States)

    Kim, Beom Joon; Lee, Seung-Hoon; Ryu, Wi-Sun; Kim, Chi Kyung; Chung, Jong-Won; Kim, Dohoung; Park, Hong-Kyun; Bae, Hee-Joon; Park, Byung-Joo; Yoon, Byung-Woo

    2013-10-01

    Adverse effect of excessive work on health has been suggested previously, but it was not documented in cerebrovascular diseases. The authors investigated whether excessive working conditions would associate with increased risk of haemorrhagic stroke. A nationwide matched case-control study database, which contains 940 cases of incident haemorrhagic stroke (498 intracerebral haemorrhages and 442 sub-arachnoid haemorrhages) with 1880 gender- and age- (± 5-year) matched controls, was analysed. Work-related information based on the regular job situation, including type of occupation, regular working time, duration of strenuous activity during regular work and shift work, was gathered through face-to-face interviews. Conditional logistic regression analyses were used for the multivariable analyses. Compared with white-collar workers, blue-collar workers had a higher risk for haemorrhagic stroke (odds ratio, 1.33 [95% confidence interval, 1.06-1.66]). Longer regular working time was associated with increased risk of haemorrhagic stroke [odds ratio, 1.38 (95% confidence interval, 1.05-1.81) for 8-12 h/day; odds ratio, 1.95 (95% confidence interval, 1.33-2.86) for ≥ 13 h/day; compared with ≤ 4 h/day]. Exposure to ≥ 8 h/week of strenuous activity also associated haemorrhagic stroke risk [odds ratio, 1.61 (95% confidence interval, 1.26-2.05); compared with no strenuous activity]. Shift work was not associated with haemorrhagic stroke (P = 0.98). Positive associations between working condition indices and haemorrhagic stroke risk were consistent regardless of haemorrhagic stroke sub-types and current employment status. Blue-collar occupation, longer regular working time and extended duration of strenuous activity during work may relate to an increased risk of haemorrhagic stroke. © 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.

  6. Thalamic haemorrhage vs internal capsule-basal ganglia haemorrhage: clinical profile and predictors of in-hospital mortality

    Directory of Open Access Journals (Sweden)

    García-Eroles Luis

    2007-10-01

    Full Text Available Abstract Background There is a paucity of clinical studies focused specifically on intracerebral haemorrhages of subcortical topography, a subject matter of interest to clinicians involved in stroke management. This single centre, retrospective study was conducted with the following objectives: a to describe the aetiological, clinical and prognostic characteristics of patients with thalamic haemorrhage as compared with that of patients with internal capsule-basal ganglia haemorrhage, and b to identify predictors of in-hospital mortality in patients with thalamic haemorrhage. Methods Forty-seven patients with thalamic haemorrhage were included in the "Sagrat Cor Hospital of Barcelona Stroke Registry" during a period of 17 years. Data from stroke patients are entered in the stroke registry following a standardized protocol with 161 items regarding demographics, risk factors, clinical features, laboratory and neuroimaging data, complications and outcome. The region of the intracranial haemorrhage was identified on computerized tomographic (CT scans and/or magnetic resonance imaging (MRI of the brain. Results Thalamic haemorrhage accounted for 1.4% of all cases of stroke (n = 3420 and 13% of intracerebral haemorrhage (n = 364. Hypertension (53.2%, vascular malformations (6.4%, haematological conditions (4.3% and anticoagulation (2.1% were the main causes of thalamic haemorrhage. In-hospital mortality was 19% (n = 9. Sensory deficit, speech disturbances and lacunar syndrome were significantly associated with thalamic haemorrhage, whereas altered consciousness (odds ratio [OR] = 39.56, intraventricular involvement (OR = 24.74 and age (OR = 1.23, were independent predictors of in-hospital mortality. Conclusion One in 8 patients with acute intracerebral haemorrhage had a thalamic hematoma. Altered consciousness, intraventricular extension of the hematoma and advanced age were determinants of a poor early outcome.

  7. Pulmonary haemorrhage and nephritis

    African Journals Online (AJOL)

    1983-04-30

    Apr 30, 1983 ... haemorrhage and glomerulonephritis, but there was no other clinical evidence for this diagnosis and the anti-DNA antibody titre was not raised. The patient did not have granulomas or ulcers in the upper respiratory tract suggestive of Wegener's granulomatosis, which is usually more common in the 4th and.

  8. Inappropriate acute neurosurgical bed occupancy and short falls in rehabilitation: implications for the National Service Framework.

    Science.gov (United States)

    Bradley, L J; Kirker, S G B; Corteen, E; Seeley, H M; Pickard, J D; Hutchinson, P J

    2006-02-01

    Patients undergoing neurosurgical intervention may require different types of organized rehabilitation. A prospective study was performed of the care needs of neurosurgical inpatients between the ages of 16 and 70 years who were in acute wards for more than 2 weeks. Only 58% of bed occupancy days were devoted to essential acute neurosurgical ward management. This figure was even lower for patients admitted with subarachnoid haemorrhage (36%) or traumatic brain injury (38%). Overall, 21% of bed days would have more appropriately spent in 'rapid access'/acute rehabilitation beds, 13% in 'active participation' rehabilitation beds and 5% in cognitive/behavioural rehabilitation units. Addressing this unmet need would increase the availability of acute neurosurgery beds, without needing to build and staff more neurosurgery wards.

  9. Ebola haemorrhagic fever

    Science.gov (United States)

    Feldmann, Heinz; Geisbert, Thomas W

    2012-01-01

    Ebola viruses are the causative agents of a severe form of viral haemorrhagic fever in man, designated Ebola haemorrhagic fever, and are endemic in regions of central Africa. The exception is the species Reston Ebola virus, which has not been associated with human disease and is found in the Philippines. Ebola virus constitutes an important local public health threat in Africa, with a worldwide effect through imported infections and through the fear of misuse for biological terrorism. Ebola virus is thought to also have a detrimental effect on the great ape population in Africa. Case-fatality rates of the African species in man are as high as 90%, with no prophylaxis or treatment available. Ebola virus infections are characterised by immune suppression and a systemic inflammatory response that causes impairment of the vascular, coagulation, and immune systems, leading to multiorgan failure and shock, and thus, in some ways, resembling septic shock. PMID:21084112

  10. Expulsive choroidal haemorrhage

    Directory of Open Access Journals (Sweden)

    Srinivasan M

    1992-01-01

    Full Text Available Expulsive choroidal haemorrhage is a dramatic and serious complication of cataract surgery that occurred in five patients out of ten thousand consecutive cataract surgeries performed by the author during the year 1989 and 1990. Report about this dreaded complication after cataract surgery are scanty and as far as I can remember I have not seen any report in Indian ophthalmic literature recently. Since cataract surgery forms the major part of intra ocular surgeries performed in our country, I thought it would be appropriate to report about this rare complication which may occur to all of us. Out of five cases 3 were males and 2 were females in the age group ranging between 45-72 years. Two eyes regained vision up to 6/12 after intra operative expulsive haemorrhage. All the eyes were salvaged by doing anterior sclerotomy. Diabetes, hypertension, glaucoma and myopia are the commonest predisposing factors.

  11. Haemorrhage from Pancreatic Pseudocysts Presenting as Upper Gastrointestinal Haemorrhage

    Directory of Open Access Journals (Sweden)

    Giuseppe Garcea

    2004-04-01

    Full Text Available Haemorrhage is a rare but frequently fatal complication of pancreatic pseudocysts. The high mortality associated with pancreatic haemorrhage makes prompt and aggressive management essential. Occasionally, haemorrhage may present atypically, leading to delay in its diagnosis and management. This report details a case of pancreatic haemorrhage presenting as an upper gastrointestinal bleed and discusses the subsequent management. When managing patients with pancreatic pseudocysts who present with the stigmata of upper gastrointestinal bleeding, the possibility that the bleeding originates from the pancreas must always be borne in mind.

  12. Early maternal death due to acute encephalitis

    Directory of Open Access Journals (Sweden)

    M Vidanapathirana

    2014-03-01

    Full Text Available Maternal death in an unmarried woman poses a medico-legal challenge. A 24-year-old unmarried schoolteacher, residing at a boarding place, had been admitted to hospital in a state of cardiac arrest. At the autopsy, mild to moderate congestion of subarachnoid vessels and oedema of the brain was noted. An un-interfered foetus of 15 weeks with an intact sac and placental tissues were seen. Genital tract injuries were not present. Histopathological examination showed diffuse perivascular cuffing by mononuclear cells suggestive of viral encephalitis, considering the circumstances of death and the social stigma of pregnancy in this unmarried teacher, the possibility of attempted suicide by ingestion of a poison was considered. Abrus precatorius (olinda seeds commonly found in the area is known to produce acute encephalitis as well as haemorrhagic gastroenteritis and pulmonary congestion was also considered as a possible cause for this unusual presentation

  13. How often is haemosiderin not visible on routine MRI following traumatic intracerebral haemorrhage?

    Energy Technology Data Exchange (ETDEWEB)

    Wardlaw, J.M.; Statham, P.F.X. [Dept. of Clinical Neurosciences, Western General Hospital, Edinburgh (United Kingdom)

    2000-02-01

    Intracerebral haemorrhage may be visible indefinitely on MRI, due to persistence of haemosiderin in macrophages around the lesion, but it is not clear whether all haemorrhages produce haemosiderin or, if not, what proportion cannot be identified as former haemorrhages on routine MRI. We performed routine MRI (spin-echo T2- and proton-density weighted images) in 116 survivors of moderate to severe head injury, 1-5 years after injury. We reviewed the images blindly and correlated them with CT in the acute stage, to determine how many haemorrhages from the acute stage were identifiable by virtue of haemosiderin deposition on late MRI. Of 106 haemorrhages in 78 patients on CT at the time of injury, 96 (90 %) were visible as haemosiderin on late MRI. Of the old haemorrhages without haemosiderin, seven of ten were in patients where another haemorrhage with haemosiderin was still visible elsewhere in the brain. No patient or haemorrhage features explained the formation or absence of haemosiderin. Thus about 10 % of definite haematomas show no trace of haemosiderin on routine spin-echo MRI. Radiologists should be alerted to supplement routine spin-echo with gradient-echo sequences if there is a reason to suspect, or specifically exclude, prior haemorrhage. (orig.)

  14. Neurosurgical management of L-asparaginase induced haemorrhagic stroke.

    LENUS (Irish Health Repository)

    Ogbodo, Elisha

    2012-01-01

    The authors describe a case of L-asparaginase induced intracranial thrombosis and subsequent haemorrhage in a newly diagnosed 30-year-old man with acute lymphoblastic leukaemia who was successfully managed by surgical intervention. At presentation, he had a Glasgow Coma Score of 7\\/15, was aphasic and had dense right hemiplegia. Neuroimaging revealed an acute anterior left middle cerebral artery infarct with parenchymal haemorrhagic conversion, mass effect and subfalcine herniation. He subsequently underwent left frontal craniotomy and evacuation of large frontal haematoma and decompressive craniectomy for cerebral oedema. Six months postoperatively he underwent titanium cranioplasty. He had made good clinical recovery and is currently mobilising independently with mild occasional episodes of expressive dysphasia, difficulty with fine motor movement on the right side, and has remained seizure free. This is the first documented case of L-asparaginase induced haemorrhagic stroke managed by neurosurgical intervention. The authors emphasise the possible role of surgery in managing chemotherapy induced intracranial complications.

  15. Spontaneous haemorrhage and rupture of third ventricular colloid cyst.

    LENUS (Irish Health Repository)

    Ogbodo, Elisha

    2012-01-01

    Acute bleeding within a colloid cyst of the third ventricle represents a rare event causing sudden increase in the cyst volume that may lead to acute hydrocephalus and rapid neurological deterioration. We report a case of spontaneous rupture of haemorrhagic third ventricular colloid cyst and its management. A 77-year-old ex-smoker presented with unsteady gait, incontinence and gradually worsening confusion over a 3-week period. Brain CT scan findings were highly suggestive of a third ventricular colloid cyst with intraventricular rupture. He underwent cyst excision and histopathology, which confirmed the radiological diagnosis with evidence of haemorrhage within the cyst. A ventriculo peritoneal shunt was performed for delayed hydrocephalus. Surgical management of these patients must include emergency ventriculostomy followed by prompt surgical removal of the haemorrhagic cyst.

  16. Accidental Haemorrhage and Fetal Prognosis

    African Journals Online (AJOL)

    1974-04-17

    Apr 17, 1974 ... perinatal mortality associated with accidental haemorrhage. The importance of clinical signs in determining fetal prognosis is discussed. A suggested clinical approach to cases of accidental haemorrhage, where on admission the fetus is found to be alive in utero, is given. S. Afr. Med. l., 48, 764 (1974).

  17. Aspirin and aneurysmal subarachnoid hemorrhage.

    Science.gov (United States)

    Gross, Bradley A; Rosalind Lai, Pui Man; Frerichs, Kai U; Du, Rose

    2014-12-01

    Recent evidence has suggested a potential beneficial effect of aspirin on the risk of aneurysm rupture. This benefit must be weighed against its potential adverse effects as an antiplatelet agent in the setting of acute aneurysmal subarachnoid hemorrhage (SAH). A total of 747 consecutive patients with cerebral aneurysms were reviewed, comparing demographics, aneurysm features, presenting clinical and radiographic grades, vasospasm, and outcome at 1 year between patients with aneurysmal SAH taking aspirin on presentation and those who were not. The rate of hemorrhagic presentation was significantly greater in patients not taking aspirin (40% vs. 28%; P = 0.016). Among 274 patients presenting with aneurysmal SAH, there was no significant difference in presenting clinical (Hunt and Hess) and radiographic (Fisher) grade between patients taking aspirin and those who were not. There was also no significant difference in the rate of subsequent angiographic and delayed cerebral ischemia. Multivariate analysis of outcome at 1 year found only increasing age (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.04-1.12), Hunt and Hess grade (OR 3.01, 95% CI 1.81-5.03), and associated hypertension (OR 3.30, 95% CI 1.39-7.81) to be statistically significant risk factors for poor outcome (death or dependence), whereas aspirin use was not associated with poor outcome (OR 1.19, 95% CI 0.35-4.09; P = 0.78). In the present study, patients taking aspirin had a lower rate of hemorrhagic presentation. In addition, taking aspirin did not adversely impact presenting clinical grade or radiographic grade, vasospasm, and outcome in the setting of aneurysmal SAH. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. Subarachnoid-subarachnoid bypass for spinal adhesive arachnoiditis.

    Science.gov (United States)

    Tachibana, Toshiya; Moriyama, Tokuhide; Maruo, Keishi; Inoue, Shinichi; Arizumi, Fumihiro; Yoshiya, Shinichi

    2014-11-01

    The authors report a case of adhesive arachnoiditis (AA) and arachnoid cyst successfully treated by subarachnoid to subarachnoid bypass (S-S bypass). Arachnoid cysts or syringes sometimes compress the spinal cord and cause compressive myelopathy that requires surgical treatment. However, surgical treatment for AA is challenging. A 57-year-old woman developed leg pain and gait disturbance. A dorsal arachnoid cyst compressed the spinal cord at T7-9, the spinal cord was swollen, and a small syrinx was present at T9-10. An S-S bypass was performed from T6-7 to T11-12. The patient's gait disturbance resolved immediately after surgery. Two years later, a small arachnoid cyst developed. However, there was no neurological deterioration. The myelopathy associated with thoracic spinal AA, subarachnoid cyst, and syrinx improved after S-S bypass.

  19. Detection of Subarachnoid Hemorrhage at Acute and Subacute/Chronic Stages: Comparison of Four Magnetic Resonance Imaging Pulse Sequences and Computed Tomography

    Directory of Open Access Journals (Sweden)

    Mei-Kang Yuan

    2005-03-01

    Conclusion: FLAIR and GE T2* MRI pulse sequences, and CT scans, are all statistically significant indicators of acute SAH. GE T2*-weighted images are statistically significant indicators of subacute-to-chronic SAH, whereas other MRI pulse sequences, and CT scans, are not.

  20. Review: Overview of postpartum haemorrhage as a global problem ...

    African Journals Online (AJOL)

    Postpartum haemorrhage (PPH) is a major cause of maternal morbidity and mortality in under-resourced settings. It is also a major cause of severe acute morbidity in well-resourced settings. The maternal mortality ratio for PPH in South Africa in the years 2005-2007 was 18.8 deaths per 100,000 live births; there were 491 ...

  1. Haemorrhagic Lumbar Juxtafacet Cyst with Ligamentum Flavum Involvement

    Directory of Open Access Journals (Sweden)

    Finn Ghent

    2014-01-01

    Full Text Available Juxtafacet cysts are an uncommon cause of radiculopathy. They occur most frequently in the lumbar region, and their distribution across the spine correlates with mobility. Haemorrhagic complications are rare and may occur in the absence of any provocation, although there is some association with anticoagulation and trauma. We present a case of acute radiculopathy due to an L5/S1 juxtafacet cyst with unprovoked haemorrhage which was found to extend into ligamentum flavum. The patient underwent uncomplicated microscope assisted decompression with excellent results. The demographics, presentation, aetiology, and management of juxtafacet cysts are discussed.

  2. Intracerebral haemorrhage after carotid endarterectomy

    DEFF Research Database (Denmark)

    Schroeder, T; Sillesen, H; Boesen, J

    1987-01-01

    Among 662 consecutive carotid endarterectomies eight cases of postoperative ipsilateral intracerebral haemorrhage were identified, occurring into brain areas which, preoperatively were without infarction. As blood pressures across the stenosis were routinely measured during surgery, the internal...

  3. Haemorrhagic pulmonary oedema following postoperative ...

    African Journals Online (AJOL)

    Haemorrhagic pulmonary oedema following postoperative laryngospasm after ear reconstructive surgery: A case report. ... Nigerian Journal of Plastic Surgery ... report by Oswalt in 1977 some cases of postanaesthetic laryngospasm causing pulmonary oedema, have been reported in the anaesthesia and surgery literature.

  4. Consequences and coping strategies six years after a subarachnoid hemorrhage - A qualitative study.

    Directory of Open Access Journals (Sweden)

    Hanna C Persson

    Full Text Available After a subarachnoid haemorrhage (SAH, continuing impairment is common and may impact the person's life. There is a lack of knowledge regarding long-term consequences experienced.To explore experiences of the care and rehabilitation as well as the consequences and strategies used to cope with everyday life six years post SAH.An explorative interview study with a qualitative design. Individual interviews, with open ended questions, using an interview guide were performed with sixteen participants (mean age 63, 8 men, 8 women six years post SAH. Data was analyzed according to a descriptive thematic analysis, and themes were discovered inductively.Two major themes from the analysis, both including four sub-themes, were identified; these themes were consequences of the SAH and coping strategies. Participants were grateful to have survived the SAH and most were satisfied with their acute medical care. If discharged directly from the neurosurgical unit participants can feel abandoned. In contrast, participants who were referred to a rehabilitation clinic felt supported and informed. Cognitive problems, such as impaired memory and mental fatigue, were reported as still present six years post SAH. Coping strategies were; receiving support from family, society, employers, or technical equipment. At work, talking to colleagues and to taking breaks were common. Participants described hiding their symptoms from employers and friends, as well as trying to continue doing tasks in the same manner as prior to the SAH. If this was not possible, some refrained from doing these tasks. They went through a mourning process, fear, and worries.Participants reported several long-term consequences which impacted on their daily lives post SAH, and different coping strategies were used to cope with these problems. Participants reported lack of awareness regarding the consequences of SAH and stressed the importance of structured multidisciplinary follow-ups, which mostly

  5. Vesical Artery Embolization in Haemorrhagic Cystitis in Children

    Energy Technology Data Exchange (ETDEWEB)

    García-Gámez, Andrés, E-mail: agargamez@gmail.com; Bermúdez Bencerrey, Patricia, E-mail: PBERMUDE@clinic.ub.es [Hospital Clinic (Spain); Brio-Sanagustin, Sonia, E-mail: sbrio@santpau.cat [Hospital de la Santa Creu y Sant Pau (Spain); Guerrero Vara, Rubén, E-mail: rguerrerov@santpau.cat [Hospital Clinic (Spain); Sisinni, Luisa, E-mail: lsisinni@santpau.cat [Hospital de la Santa Creu y Sant Pau (Spain); Stuart, Sam, E-mail: sam.stuart@gosh.nhs.uk; Roebuck, Derek, E-mail: Derek.Roebuck@gosh.nhs.uk [Great Ormond Street Hospital for Children (United Kingdom); Gómez Muñoz, Fernando, E-mail: FEGOMEZ@clinic.ub.es [Hospital Clinic (Spain)

    2016-07-15

    Haemorrhagic cystitis is an uncommon and, in its severe form, potentially life-threatening complication of haematopoietic stem cell transplantation or cancer therapy in children. The severe form involves macroscopic haematuria with blood clots, urinary obstruction and/or renal impairment. There are many therapeutic options to treat acute haemorrhage, but only recombinant factor VII has a high level of clinical evidence in children. Supraselective vesical artery embolization (SVAE) is an increasingly used therapeutic procedure for controlling haemorrhage in adults, but is less commonly used in children. This might be due to several factors, such as the invasive nature of the procedure, lack of appropriate medical experience and possible long-term side effects. We present three cases of children successfully treated by means of effective SVAE.

  6. Copeptin in aneurysmal subarachnoid hemorrhage

    OpenAIRE

    Tamargo, Rafael J

    2012-01-01

    Copeptin is a peptide derived from pre-provasospression along with arginine vasospressin. In the setting of aneurysmal subarachnoid hemorrhage (SAH), elevated serum copeptin levels correlate with vasospasm, inpatient mortality, mortality at 1 year, and poor functional outcome at 1 year. The potential role of serum copeptin levels in the management of patients with aneurysmal SAH is promising and should be explored further.

  7. Non-aneurysmal subarachnoid hemorrhage

    DEFF Research Database (Denmark)

    Bashir, Asma; Mikkelsen, Ronni; Sørensen, Leif

    2017-01-01

    Purpose Repeat imaging in patients with non-aneurysmal subarachnoid hemorrhage (NASAH) remains controversial. We aim to report our experience with NASAH with different hemorrhage patterns, and to investigate the need for further diagnostic workup to determine the underlying cause of hemorrhage. M...

  8. [Subarachnoid hemorrhage associated to subhyaloid hemorrhage: "Terson syndrome"].

    Science.gov (United States)

    Castaño-Duque, C H; Pons-Irazazabal, L C; López-Moreno, J L

    1997-07-01

    The combination of subarachnoid hemorrhage (SAH) and subhyaloid hemorrhage is known as 'Terson syndrome'. Retinal hemorrhage is commonly observed clinically in the optic fundi of patients with SAH, however, subhyaloid hemorrhage of the globe in the setting of SAH has been rarely on CT of the brain. Several mechanisms of subhyaloid hemorrhage have been proposed: a. A sudden increase in intracranial pressure (ICP) forces blood from the subarachnoid space directly into the preretinal space. b. A sudden rise in ICP is thought to decrease venous return to the cavernous sinus from the veins draining the globe. The increased retinal venous pressure results in stasis followed by vessel rupture. c. A sudden rise in ICP obstructs both the retinochoroidal anastomoses and the central retinal vein due to a rapid effusion of CSF through the communication of the subarachnoid space with the optic nerve sheat. This produces an acute decrease in venous drainage from the retina and results in stasis and hemorrhage. A 35 year old man, with a history of a non controlled arterial hypertension, dilated cardiopathy and 'agitation episodes'. He had a spontaneous intracranial hemorrhage, consistent in a parenchymal hematoma ruptured into ventricles and subarachnoid space. The CT showed through optic nerve sheath this hemorrhage extended to subhyaloid space. The patient came in coma 'dépassé' and brain death. We report a case of Terson syndrome demonstrated by CT. This CT allow see the blood from the subarachnoid space erupt directly into the preretinal space through optic nerve sheath, confirming one the proposed mechanism for this syndrome.

  9. Emergency Imaging of Intracerebral Haemorrhage.

    Science.gov (United States)

    Alobeidi, Farah; Aviv, Richard I

    2015-01-01

    Spontaneous intracerebral haemorrhage (ICH) is a devastating condition with high mortality and morbidity despite advances in neurocritical care. Early deterioration is common in the first few hours after ICH onset, secondary to rapid haematoma expansion and growth. Rapid diagnosis and aggressive early management of these patients are therefore crucial. Imaging plays a key role in establishing the diagnosis and the underlying aetiology of ICH, identifying complications and predicting patients who are at high risk for haematoma expansion. In this chapter, we present an evidence-based imaging framework for the management of spontaneous ICH in the acute setting. Non-enhanced computed tomography is long established as the gold standard for ICH diagnosis but has limitations in demonstrating the underlying aetiology in cases of secondary ICH. There is now growing evidence for the ability of non-invasive angiography to establish the underlying aetiology and to predict further haematoma expansion. The presence of small enhancing foci within the haematoma on computed tomography angiography (CTA), the CTA Spot Sign, has been prospectively validated as a predictor of haematoma expansion. Early identification of patients at risk of haematoma expansion allows for the appropriate escalation of care to a neurosurgical team, admission to a neurocritical care unit, appropriate supportive therapy and targeted novel medical and surgical interventions. Catheter angiography, which remains the gold standard for identifying underlying secondary vascular lesions, should be used in selected cases. However, non-invasive vascular imaging should be considered as an important step in the diagnosis and early management of secondary ICH patients. Previous concerns related to the radiation dose, contrast-induced nephropathy and cost are addressed in this chapter. Recently, animal models have enabled the qualitative assessment of haematoma expansion, and our increased understanding of ICH may

  10. Symptomatic tarlov cyst following spontaneous subarachnoid hemorrhage.

    Science.gov (United States)

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

    2011-08-01

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

  11. Symptomatic Tarlov Cyst Following Spontaneous Subarachnoid Hemorrhage

    OpenAIRE

    Kong, Woo Keun; Cho, Keun-Tae; 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.

  12. An atypical case of dengue haemorrhagic fever presenting as quadriparesis due to compressive myelopathy.

    Science.gov (United States)

    Verma, S P; Himanshu, D; Tripathi, A K; Vaish, A K; Jain, Nirdesh

    2011-03-25

    Dengue haemorrhagic fever is a serious presentation of dengue viral infection. Case reports of cerebral haemorrhage due to dengue are rare. The authors report a rare case of dengue haemorrhagic fever presenting with fever and acute onset progressive quadriparesis of the upper motor neuron type. Rare cases of quadriparesis in dengue fever have been reported in the literature due to myositis, Guillain-Barre syndrome, myelitis and hypokalaemia. This case on investigations was found to have extramedullary compression due to haematoma in the cervical region as the cause of quadriparesis.

  13. Cerebral vasospasm after subarachnoid hemorrhage.

    Science.gov (United States)

    Janjua, Nazli; Mayer, Stephan A

    2003-04-01

    To summarize new pathophysiologic insights and recent advances in the diagnosis and treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Important, newly recognized mediators of cerebral arterial spasm after subarachnoid hemorrhage include superoxide free radicals, ferrous hemoglobin (which acts as a nitric oxide scavenger), endothelins, protein kinase C, and rho kinase. Microvascular dysfunction and autoregulatory failure also has been an area of increasing research focus in recent years. New diagnostic modalities include measures of cerebral blood flow such as single-photon emission computed tomography and perfusion computed tomography, magnetic resonance imaging, intracranial brain oxygen tension probes, and jugular venous oxygen saturation monitors. Proton magnetic resonance spectroscopy and microdialysis can detect tissue biochemical abnormalities, but these techniques have not found their way into routine clinical practice as of yet. In addition to nimodipine and hypertensive hypervolemic therapy, promising new treatments for vasospasm or its ischemic complications include magnesium sulfate, fasudil hydrochloride, tirilazad mesylate, erythropoietin, and induced hypothermia. Balloon angioplasty has emerged as the primary weapon for treating medically refractory ischemia from vasospasm and in many centers is being used as a first-line treatment or even prophylactically. The neurointensive care management of vasospasm after subarachnoid hemorrhage has evolved significantly over the past 10 years, with many new diagnostic modalities and promising treatments now available. Clinical trials are needed to evaluate the efficacy of these new techniques and to further define the optimal management of this often devastating complication. Copyright 2003 Lippincott Williams & Wilkins

  14. THE PREVALENCE OF INTRAVENTRICULAR HAEMORRHAGE

    African Journals Online (AJOL)

    Esem

    Health, United States of America. REFERENCES. 1. Annibale D. J, Hill J.: Periventricular-Intraventricular haemorrhage. emedicine specialties>paediatrics: cardiac diseases and critical care medicine>neonatology, November 2008. 2. Behrman R. E, Kliegman R. M., Jenson H. B. Nelson th textbook of paediatrics,17 edition, ...

  15. Haemorrhage in intracranial tuber- culosis

    African Journals Online (AJOL)

    lous meningitis (TBM).1-5 TBM is thought to arise from cerebrospinal ... patients are on treatment for TB.6. The co-occurrence of .... erebral, intraventricular, and sub- arachnoid spaces. Our case highlights intracranial haemorrhage as a potential additional cause of death in TBM. Treatment would require search for an ...

  16. THE PREVALENCE OF INTRAVENTRICULAR HAEMORRHAGE

    African Journals Online (AJOL)

    Esem

    Department of Paediatrics and Child Health, University Teaching Hospital, Lusaka. *Corresponding Author. Justin Mulindwa ... haemorrhage in preterm infants with birth weight 1.5kg and less was 34.2% in the first seven days of ..... American Journal of Perinatology; 2007 Jan;. 24(1):17-21. Medical Journal of Zambia, Vol.

  17. Intracranial aneurysms in patients with subarachnoid hemorrhage : CT angiography as a primary examination tool for diagnosis--systematic review and meta-analysis

    NARCIS (Netherlands)

    Westerlaan, Henriette E.; van Dijk, J. M. C.; Jansen -van der Weide, Marijke; de Groot, Jan Cees; Groen, Rob J. M.; Mooij, Jan Jakob A.; Oudkerk, Matthijs

    Purpose: To calculate the sensitivity and specificity of computed tomographic (CT) angiography in the diagnosis of cerebral aneurysms in patients with acute subarachnoid hemorrhage (SAH) at presentation. Materials and Methods: A systematic search for relevant studies was performed of the

  18. Emergency diagnosis of subarachnoid hemorrhage: an evidence-based debate.

    Science.gov (United States)

    Farzad, Ali; Radin, Bethany; Oh, Jason S; Teague, Heidi M; Euerle, Brian D; Nable, J V; Liferidge, Aisha T; Windsor, T Andrew; Witting, Michael D

    2013-05-01

    The diagnosis of subarachnoid hemorrhage is of paramount concern in patients presenting to the Emergency Department (ED) with acute headache. Computed tomography followed by lumbar puncture is a time-honored practice, but recent technologic advances in magnetic resonance imaging with magnetic resonance angiography and computed tomography with computed tomography angiography can present alternatives for clinicians and patients. The aim of this article was to compare diagnostic strategies for ED patients in whom subarachnoid hemorrhage is suspected. We analyze and discuss current protocols, in addition to summarizing the advantages and disadvantages of each method. Through our residency's journal club, we organized an evidence-based debate that pitted proponents of the three subarachnoid hemorrhage diagnostic strategies against one another. Proponents of each strategy described its advantages and disadvantages. Briefly, computed tomography/lumbar puncture is time honored and effective, but is limited by complications and indeterminate lumbar puncture results. Magnetic resonance imaging with magnetic resonance angiography might be more effective in late presentations and can visualize aneurysms, yet has limited availability. Computed tomography with computed tomography angiography offers rapid diagnosis and is considered the most sensitive for diagnosing aneurysms, but has the highest radiation exposure. Each of the three strategies used to diagnose subarachnoid hemorrhage has advantages and disadvantages with which clinicians should be familiar. Patient factors (e.g., age, body habitus, and risk factors), presentation factors (e.g., time from headache onset and severity of presentation), and institutional factors (availability of magnetic resonance imaging with magnetic resonance angiography) can influence the choice of protocol. Copyright © 2013 Elsevier Inc. All rights reserved.

  19. The initial time-course of headache in patients with spontaneous subarachnoid hemorrhage

    NARCIS (Netherlands)

    Čomić, Hata; Rinkel, Gabriel J.E.|info:eu-repo/dai/nl/085712000; Vergouwen, Mervyn D.I.|info:eu-repo/dai/nl/320630544

    2017-01-01

    Background If acute severe headache disappears early after its onset, the question arises whether subarachnoid hemorrhage (SAH) should still be ruled out. We studied the initial time-course and minimal duration of headache in a consecutive series of neurologically intact patients with spontaneous

  20. Transfusion policy after severe postpartum haemorrhage: a randomised non-inferiority trial

    NARCIS (Netherlands)

    Prick, B. W.; Jansen, A. J. G.; Steegers, E. A. P.; Hop, W. C. J.; Essink-Bot, M. L.; Uyl-de Groot, C. A.; Akerboom, B. M. C.; van Alphen, M.; Bloemenkamp, K. W. M.; Boers, K. E.; Bremer, H. A.; Kwee, A.; van Loon, A. J.; Metz, G. C. H.; Papatsonis, D. N. M.; van der Post, J. A. M.; Porath, M. M.; Rijnders, R. J. P.; Roumen, F. J. M. E.; Scheepers, H. C. J.; Schippers, D. H.; Schuitemaker, N. W. E.; Stigter, R. H.; Woiski, M. D.; Mol, B. W. J.; van Rhenen, D. J.; Duvekot, J. J.

    2014-01-01

    To assess the effect of red blood cell (RBC) transfusion on quality of life in acutely anaemic women after postpartum haemorrhage. Randomised non-inferiority trial. Thirty-seven Dutch university and general hospitals. Women with acute anaemia (haemoglobin 4.8-7.9 g/dl [3.0-4.9 mmol/l] 12-24 hours

  1. Intracranial haemorrhage: an incidental finding at magnetic resonance imaging in a cohort of late preterm and term infants

    Energy Technology Data Exchange (ETDEWEB)

    Sirgiovanni, Ida; Groppo, Michela; Bassi, Laura; Passera, Sofia; Schiavolin, Paola; Fumagalli, Monica; Mosca, Fabio [Universita degli Studi di Milano, Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan (Italy); Avignone, Sabrina; Cinnante, Claudia; Triulzi, Fabio [Universita degli Studi di Milano, Department of Neuroradiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan (Italy); Lista, Gianluca [V. Buzzi Children' s Hospital, ICP, Neonatal Intensive Care Unit, Milan (Italy)

    2014-03-15

    Intracranial haemorrhage (ICH) in term newborns has been increasingly recognised but the occurrence in late preterm infants and the clinical presentation are still unclear. To investigate the appearance of intracranial haemorrhage at MRI in a cohort of infants born at 34 weeks' gestation or more and to correlate MRI findings with neonatal symptoms. We retrospectively reviewed neonatal brain MRI scans performed during a 3-year period. We included neonates ≥34 weeks' gestation with intracranial haemorrhage and compared findings with those in babies without intracranial haemorrhage. Babies were classified into three groups according to haemorrhage location: (1) infratentorial, (2) infra- and supratentorial, (3) infra- and supratentorial + parenchymal involvement. Intracranial haemorrhage was observed in 36/240 babies (15%). All of these 36 had subdural haemorrhage. Sixteen babies were included in group 1; 16 in group 2; 4 in group 3. All infants in groups 1 and 2 were asymptomatic except one who was affected by intraventricular haemorrhage grade 3. Among the infants in group 3, who had intracranial haemorrhage with parenchymal involvement, three of the four (75%) presented with acute neurological symptoms. Uncomplicated spontaneous vaginal delivery was reported in 20/36 neonates (56%), vacuum extraction in 4 (11%) and caesarean section in 12 (33%). Babies with intracranial haemorrhage had significantly higher gestational age (38 ± 2 weeks vs. 37 ± 2 weeks) and birth weight (3,097 ± 485 g vs. 2,803 ± 741 g) compared to babies without intracranial haemorrhage and were more likely to be delivered vaginally than by caesarian section. Mild intracranial haemorrhage (groups 1 and 2) is relatively common in late preterm and term infants, although it mostly represents an incidental finding in clinically asymptomatic babies; early neurological symptoms appear to be related to parenchymal involvement. (orig.)

  2. ORIGINAL ARTICLES Acute haemorrhagic conjunctivitis epidemics ...

    African Journals Online (AJOL)

    Many cases of conjunctivitis were reported in mid-2010 in Dar es. Salaam,1 of a kind that has been reported in the region since the. 1980s. Conjunctivitis is generally caused by an allergic reaction or infection (usually viral but sometimes bacterial).2 The causes have been confused by health care personnel in developed ...

  3. Prognostic significance of delayed intraventricular haemorrhage in the INTERACT studies.

    Science.gov (United States)

    Moullaali, Tom J; Sato, Shoichiro; Wang, Xia; Rabinstein, Alejandro A; Arima, Hisatomi; Carcel, Cheryl; Chen, Guofang; Robinson, Thompson; Heeley, Emma; Chan, Edward; Delcourt, Candice; Stapf, Christian; Cordonnier, Charlotte; Lindley, Richard I; Chalmers, John; Anderson, Craig S

    2017-01-01

    Intraventricular extension of intracerebral haemorrhage (ICH) predicts poor outcome, but the significance of delayed intraventricular haemorrhage (dIVH) is less well defined. We determined the prognostic significance of dIVH in the Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trials (INTERACT 1 and 2). Pooled analyses of the INTERACT CT substudies-international, multicentre, prospective, open, blinded end point, randomised controlled trials of patients with acute spontaneous ICH and elevated systolic blood pressure (SBP)-randomly assigned to intensive (<140 mm Hg) or guideline-based (<180 mm Hg) SBP management. Participants had blinded central analyses of baseline and 24 h CTs, with dIVH defined as new intraventricular haemorrhage (IVH) on the latter scan. Outcomes of death and major disability were defined by modified Rankin Scale scores at 90 days. There were 349 (27%) of 1310 patients with baseline IVH, and 107 (11%) of 961 initially IVH-free patients who developed dIVH. Significant associations of dIVH were prior warfarin anticoagulation, high (≥15) baseline National Institutes of Health Stroke Scale score, larger (≥15 mL) ICH volume, greater ICH growth and higher achieved SBP over 24 h. Compared with those who were IVH-free, dIVH had greater odds of 90-day death or major disability versus initial IVH (adjusted ORs 2.84 (95% CI 1.52 to 5.28) and 1.87 (1.36 to 2.56), respectively (p trend <0.0001)). Although linked to factors determining greater ICH growth including poor SBP control, dIVH is independently associated with poor outcome in acute small to moderate-size ICH. NCT00226096 and NCT00716079. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  4. Balantidium coli-induced pulmonary haemorrhage with iron deficiency.

    Science.gov (United States)

    Koopowitz, A; Smith, P; van Rensburg, N; Rudman, A

    2010-07-26

    Balantidium coli, a ciliated protozoan parasite that infects primates and pigs, and is the largest protozoan to infect humans, is a well-known cause of diarrhoea and dysentery in humans. Extra-intestinal disease is uncommon, however. We describe a case of lung involvement, with severe pulmonary haemorrhage resulting in iron deficiency anaemia and respiratory failure, of a 20-year-old, immune-competent man. Diagnosis was made by bronchial biopsy and lavage, which showed numerous trophozoites compatible with B. coli with a background of acute inflammatory cells. The origin of infection was not clear, but inhalation of pig manure was postulated as there was no history of intestinal disease. The patient was treated with oxytetracyline and metronidazole, kept in an ICU, improved within 48 hours, and was discharged within 4 days. B. coli infection should be considered as part of the differential diagnosis of pulmonary haemorrhage.

  5. Troponin elevation in subarachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    Ioannis N. Mavridis

    2015-03-01

    Full Text Available Troponin (tr elevation in aneurysmal subarachnoid hemorrhage (SAH patients is often difficult to be appropriately assessed by clinicians, causing even disagreements regarding its management between neurosurgeons and cardiologists. The purpose of this article was to review the literature regarding the clinical interpretation of tr elevation in SAH. We searched for articles in PubMed using the key words: “troponin elevation” and “subarachnoid hemorrhage”. All of them, as well as relative neurosurgical books, were used for this review. Some type of cardiovascular abnormality develops in most SAH patients. Neurogenic stunned myocardium is a frequent SAH complication, due to catecholamine surge which induces cardiac injury, as evidenced by increased serum tr levels, electrocardiographic (ECG changes and cardiac wall motion abnormalities. Tr elevation, usually modest, is an early and specific marker for cardiac involvement after SAH and its levels peak about two days after SAH. Cardiac tr elevation predictors include poor clinical grade, intraventricular hemorrhage, loss of consciousness at ictus, global cerebral edema, female sex, large body surface area, lower systolic blood pressure, higher heart rate and prolonged Q-Tc interval. Elevated tr levels are associated with disability and death (especially tr >1 μg/L, worse neurological grade, systolic and diastolic cardiac dysfunction, pulmonary congestion, longer intensive care unit stay and incidence of vasospasm. Tr elevation is a common finding in SAH patients and constitutes a rightful cause of worry about the patients' cardiac function and prognosis. It should be therefore early detected, carefully monitored and appropriately managed by clinicians.

  6. Lumbar puncture in acute admissions to an adult medical ward

    African Journals Online (AJOL)

    Suspected multiple sclerosis - very rare in. Africa. Methods. From January t6 June 1986, 1,908 patients were admitted to the adult medical wards,. Kamuzu Central Hospital, Lilongwe. Lumbar puncture was considered necessary in 15 I, patients because of a clinical suspicion' of meningitis or subarachnoid haemorrhage. A.

  7. Erythropoietin in the cerebrospinal fluid of patients with aneurysmal subarachnoid haemorrhage originates from the brain

    DEFF Research Database (Denmark)

    Springborg, Jacob Bertram; Sonne, Bjarne; Frederiksen, Hans Jørgen

    2003-01-01

    . We collected a total of 83 corresponding serum and CSF samples from 18 patients with aneurysmal SAH and compared the concentrations of EPO with those of blood-derived markers of blood-brain barrier function (albumin, transferrin, alpha(2)-macroglobulin) and with those of proteins with well-known CNS...... synthesis (prealbumin, apolipoprotein E). The EPO concentration in CSF was 0.93 (0.82) mU/ml (median and inter-quartile range). Nine patients presented CSF-EPO values above 1 mU/ml. CSF levels did not correlate with serum concentrations and were independent of blood-brain barrier integrity suggesting...

  8. Is intra arterial nimodipine really beneficial in vasospasm following aneurysmal subarachnoid haemorrhage?

    Science.gov (United States)

    Goel, Rajeev; Aggarwal, Ashish; Salunke, Pravin; Kumar, Ajay; Chhabra, Rajesh

    2016-08-01

    Object/Background: Vasospasm is a common cause of mortality and morbidity following rupture of intracranial aneurysm. Hemodynamic therapy instituted in these patients in the past has been replaced by direct manipulation of the spastic vessels by angioplasty and intra-arterial infusion of vasodilators. However, no case control studies exist proving its superiority. The purpose of our study was to compare the efficacy of intra-arterial nimodipine (IAN) to that of hemodynamic therapy in patients with vasospasm following aSAH. Fifty-three patients who developed vasospasm following aSAH were included in the study. IAN was instilled in addition to hemodynamic therapy in 39 patients and 14 patients (who refused to give consent for IAN) were continued on hemodynamic therapy alone and served as controls. The response to IAN was studied on angiogram. The clinical response was assessed in both the groups at regular intervals. IAN was repeated if necessary. The outcome (GOS) at discharge and at 3 months after discharge was compared. Thirty-six (92.3%) out of 39 patients showed immediate angiographic reversal of vasospasm.28 of them showed clinical response, of which only 11 had lasting response. 11(28.2%) of 39 patients who received IAN had a good outcome at discharge and 23(58.9%) had a favourable outcome at 3 months follow up. In those who received hemodynamic therapy alone, 4 out of 14(28.6%) patients had a good outcome at discharge and 8 (57.1%) a favourable outcome at 3 months. Angiographic reversal of vasospasm is seen in majority of the patients following IAN. However, this does not necessarily translate into a long lasting clinical response. The final outcome in patients who received hemodynamic therapy is comparable to those who received additional IAN. IAN does not appear to provide a major added advantage over the conventional hemodynamic therapy.

  9. Impaired endothelial function after aneurysmal subarachnoid haemorrhage correlates with arginine:asymmetric dimethylarginine ratio

    DEFF Research Database (Denmark)

    Bergström, A; Staalsø, J M; Romner, B

    2014-01-01

    ) measured by peripheral arterial tonometry and plasma concentrations of S-100B protein, nitrite/nitrate, arginine, and asymmetric dimethyl arginine (ADMA). Clinical variables were flow velocity in the middle cerebral artery (VMCA), angiographic vasospasm, delayed neurological deficit, and 30 day survival...

  10. Progressive DNA and RNA damage from oxidation after aneurysmal subarachnoid haemorrhage in humans

    DEFF Research Database (Denmark)

    Jorgensen, Anders; Staalsoe, Jonatan M; Simonsen, Anja H

    2018-01-01

    ictus and 45 age-matched healthy control subjects. At baseline, both markers were significantly increased in patients compared to controls (p values 20-fold above control levels) from day 5-14. None of the markers predicted the occurrence...

  11. Ultrasonically detectable cerebellar haemorrhage in preterm infants.

    LENUS (Irish Health Repository)

    McCarthy, Lisa Kenyon

    2011-07-01

    To determine the frequency and pattern of cerebellar haemorrhage (CBH) on routine cranial ultrasound (cUS) imaging in infants of ≤32 weeks gestation, and to investigate how extremely preterm infants with CBH differ from those with severe intraventricular haemorrhage (IVH).

  12. Secondary postpartum haemorrhage with uterine artery ...

    African Journals Online (AJOL)

    Uterine artery pseudoaneurysm (PA) is a rare but serious complication of caesarean section (C/S). If inadequately treated, it can lead to life-threatening postpartum haemorrhage. We report the case of a 28-year-old woman who developed secondary postpartum haemorrhage resulting from uterine artery PA after C/S.

  13. Desmopressin Acetate in Intracranial Haemorrhage

    Directory of Open Access Journals (Sweden)

    Thomas Kapapa

    2014-01-01

    Full Text Available 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.

  14. Impact of subclinical haemorrhage on the pituitary gland in patients with pituitary adenomas.

    Science.gov (United States)

    Kinoshita, Yasuyuki; Tominaga, Atsushi; Usui, Satoshi; Arita, Kazunori; Sugiyama, Kazuhiko; Kurisu, Kaoru

    2014-05-01

    Advanced magnetic resonance imaging (MRI) and optical instruments for surgery frequently demonstrate subclinical haemorrhage in pituitary adenomas; however, the effects of subclinical haemorrhage on pituitary glands remain unclear. We sought to clarify the pituitary function in patients with subclinical pituitary adenoma haemorrhage (SPAH). Between January 2006 and December 2012, we retrospectively reviewed 328 consecutive patients who underwent surgery for pituitary adenoma. SPAH was defined as an intratumoral haemorrhage based on both 3 tesla MRI and operative findings, with no clinical symptoms of acute pituitary adenoma apoplexy. The pituitary dysfunction assessed using pre- and postoperative provocative tests was investigated in patients categorized into three groups: nonapoplectic adenoma, adenoma with SPAH and adenoma with clinical apoplexy. The main outcome measure was the incidence of pituitary dysfunction. The overall incidence of nonapoplectic adenomas, adenomas with SPAH and adenomas with clinical apoplexy was 82·3%, 14·3% and 3·4%, respectively. Clinical pituitary apoplexy frequently occurred in male patients with large nonfunctioning adenomas, causing pituitary dysfunction. Contrastingly, the incidence of SPAH was significantly higher in the patients with prolactinoma (P = 0·0260), including those with relatively small adenomas (P = 0·0007). No medications, such as dopamine agonists or somatostatin analogues, were observed to affect the occurrence of SPAH. No deterioration of the pituitary function was observed in the SPAH patients in comparison with the patients with nonapoplectic adenoma, and the size of the haematoma occupying the pituitary adenoma did not exhibit any relationships with the deterioration of the pituitary function. Furthermore, SPAH caused no deterioration of the pituitary function after a surgery based on the postoperative provocation tests. Subclinical pituitary adenoma haemorrhage does not cause any added dysfunction in

  15. Necrosis and haemorrhage of the putamen in methanol poisoning shown on MRI

    Energy Technology Data Exchange (ETDEWEB)

    Kuteifan, K.; Gutbub, A.M.; Laplatte, G. [Service de Reanimation Medicale, Centre Hospitalier Louis Pasteur, Colmar (France); Oesterle, H.; Tajahmady, T. [Service de Neuroradiologie, Centre Hospitalier Louis Pasteur, Colmar (France)

    1998-03-01

    Methanol, a highly toxic substance, is used as an industrial solvent and in automobile antifreeze. Acute methanol poisoning produces severe metabolic acidosis and serious neurologic sequelae. We describe a 50-year-old woman with accidental methanol intoxication who was in a vegetative state. MRI showed haemorrhagic necrosis of the putamina and oedema in the deep white matter. (orig.) With 1 fig., 8 refs.

  16. Prolonged Paroxysmal Sympathetic Storming Associated with Spontaneous Subarachnoid Hemorrhage

    Directory of Open Access Journals (Sweden)

    Yan Liu

    2013-01-01

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

  17. Volumetric Integral Phase-shift Spectroscopy for Noninvasive Detection of Hemispheric Bioimpedance Asymmetry in Acute Brain Pathology

    Science.gov (United States)

    2018-01-18

    Stroke; Stroke, Acute; Ischemic Stroke; Hemorrhage; Clot (Blood); Brain; Subarachnoid Hemorrhage; Cerebral Infarction; Cerebral Hemorrhage; Cerebral Stroke; Intracerebral Hemorrhage; Intracerebral Injury

  18. Aetiology and treatment of severe postpartum haemorrhage

    DEFF Research Database (Denmark)

    Edwards, Hellen

    2017-01-01

    This thesis is comprised of three studies focusing on severe postpartum haemorrhage (PPH). PPH is a major cause of maternal morbidity and mortality worldwide. Risk factors include retained placenta, prolonged duration of the third stage of labour, previous caesarean section, and operative vaginal...... delivery. Occurrence and development of PPH are, however, unpredictable and can sometimes give rise to massive haemorrhage or even hysterectomy and maternal death. Severe haemorrhage can lead to coagulopathy causing further haemorrhage and requiring substitution with blood transfusions. The aim...... transfusion at 6 weeks postpartum. A total of 249 women were randomised to either 2 grams of fibrinogen or placebo. The mean concentration of fibrinogen increased significantly in the intervention group compared to the placebo group (0.40 g/L, confidence interval: 0.15-0.65), but there was no difference...

  19. Social cognition impairments after aneurysmal subarachnoid hemorrhage

    NARCIS (Netherlands)

    Buunk, Anne; Spikman, Jacoba; Veenstra, Wencke; Groen, Rob J.M.; Meiners, Linda

    2016-01-01

    Objective: Impaired social cognition (SC) is a possible underlying cause of behavioral and interpersonal changes after aneurysmal subarachnoid hemorrhage (aSAH). To date, SC has not been investigated after aSAH. Therefore, we aimed to investigate SC after aSAH and its relationship with frontal

  20. Vasovagal Bradycardia During Subarachnoid Anaesthesia for ...

    African Journals Online (AJOL)

    There is an increasing use of central neuraxial blocks for lower abdominal surgeries. Increased vagal tone under subarachnoid block is a well-known phenomenon and can have non-classical presentations. It can manifest with bradycardia, hypotension, bronchospasm, coronary artery spasm and cardiac arrest. In a patient ...

  1. Effect of simvastatin in patients with aneurysmal subarachnoid hemorrhage: A systematic review and meta-analysis.

    Science.gov (United States)

    Liu, Hongju; Xu, Xiaoli

    2017-12-01

    Simvastatin might be beneficial to the patients with aneurysmal subarachnoid hemorrhage. However, the results remained controversial. We conducted a systematic review and meta-analysis to explore the efficacy of simvastatin for aneurysmal subarachnoid hemorrhage. PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of simvastatin versus placebo on aneurysmal subarachnoid hemorrhage were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcomes were delayed ischaemic deficit and delayed cerebral infarction. Meta-analysis was performed using the random-effect model. Six RCTs involving 1053 patients were included in the meta-analysis. Overall, compared with control intervention, simvastatin intervention had no influence on delayed ischaemic deficit (RR=0.99; 95% CI=0.78 to 1.27; P=0.96), delayed cerebral infarction (RR=1.17; 95% CI=0.60 to 2.29; P=0.65), mRS≤2 (RR=0.97; 95% CI=0.87 to 1.09; P=0.61), vasospasm (RR=0.79; 95% CI=0.49 to 1.29; P=0.35), ICU stay (Std. mean difference=0.04; 95% CI=-0.54 to 0.63; P=0.88), hospital stay (Std. mean difference=0.01; 95% CI=-0.13 to 0.14; P=0.90) and mortality (RR=0.71; 95% CI=0.25 to 2.05; P=0.53) after aneurysmal subarachnoid hemorrhage. Compared to control intervention, simvastatin intervention was found to have no influence on delayed ischaemic deficit, delayed cerebral infarction, mRS≤2, vasospasm, ICU stay, hospital stay, and mortality in patients with acute aneurysmal subarachnoid hemorrhage. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Intracranial haemorrhage among a population of haemophilic patients in Brazil.

    Science.gov (United States)

    Antunes, S V; Vicari, P; Cavalheiro, S; Bordin, J O

    2003-09-01

    Intracranial haemorrhage (ICH) is a common cause of morbidity and mortality in haemophilic patients. The overall incidence of ICH has been reported to range from 2.2% to 7.5% in patients with haemophilia. From 1987 to 2001, 401 haemophilic patients from the Serviço de Hemofilia, Disciplina de Hematologia e Hemoterapia, Universidade Federal de São Paulo were evaluated. The episodes of ICH were documented by CT scan and the anatomic location, clinical presentation, relationship to trauma and clinical factors, including the presence of HIV infection and the presence of inhibitor, were reviewed. Among 401 haemophilic patients, 45 ICH episodes in 35 (8.7%) patients with age ranging from 4 days to 49 years (mean 10.6 years) were observed. A history of recent trauma was documented in 24 (53.3%) cases. Seventeen (37.8%) episodes occurred in more than one site of bleeding, 12 (26.7%) were subdural, seven (15.5%) subarachnoid, four (8.9%) epidural, two (4.4%) intracerebral and one (2.2%) intraventricular. The most frequent symptoms were headache and drowsiness. All patients were submitted to replacement therapy and neurosurgical intervention was performed in eight (17.8%) patients. Despite the treatment, three (8.6%) haemophilia A patients died due to the ICH event and three presented late sequelae. The most important aspect of ICH management is the early replacement therapy in haemophilic patients. This prompt treatment will increase the chances of a better prognosis. Another impact measure consists in the administration of the deficient coagulation factor after every head trauma, even when considered minor.

  3. Intracerebral haemorrhage in the oldest old: a population-based study (Vantaa 85+

    Directory of Open Access Journals (Sweden)

    Maarit eTanskanen

    2012-06-01

    Full Text Available Aims: Very elderly subjects form the fastest growing population in the world. Most of the studies on intracerebral haemorrhage (ICH have been carried out on younger patients. We aimed to investigate the prevalence and risk factors of ICH in the oldest old.Materials and methods: The brains of 300 autopsied individuals (248 females, 52 males, mean age at death 92  3.7 years were investigated as part of the prospective population-based Vantaa 85+ study. After macroscopic investigation, the presence and extent of microscopic brain haemorrhages (MH was analyzed by counting the number of iron containing macrophages (siderophages in the Prussian blue stain. Deposits with > 5 siderophages were defined as MH+. Genotyping of apolipoprotein E (APOE and the analysis of microscopic (MI or larger infarctions and cerebral amyloid angiopathy (CAA were performed using standardized methods. Regression analysis was used to predict the presence of ICH, with and without co-localized CAA, adjusted for age at death and gender. Results: The prevalence of macroscopic ICH was 2%, of large lobar haemorrhage (LH and deep haemorrhage (DH 1% for each, and of subarachnoid haemorrhage (SAH 0.3%. 62% had MH and 15.3% MH+. 55.9% of subjects with MH and 81.2% of those with MH+ showed MH / MH+ and CAA in the same brain region (MHCAA and MH+CAA, respectively. MH was associated with none of the clinical, genetic or neuropathological conditions analyzed. The subjects with MH+, MHCAA and MH+CAA expressed the APOE ε4 allele (OR 3.681, 3.291, 7.522, respectively. Siderophages in MH+CAA co-localized with CAA and with two thirds of the MI in the tissue sections. Conclusion: Macroscopic ICH was rare in the very elderly. MH was frequent and clinically insignificant. MH+ was rare but closely related with APOE ε4 genotype and the presence of severe CAA and infarction. MH+ is the putative histological counterpart of the MH lesions visible in the MRI (microbleeds, either with or without

  4. Subarachnoid hemorrhage after aneurysm surgery

    Directory of Open Access Journals (Sweden)

    Carlos Gilberto Carlotti Junior

    1996-06-01

    Full Text Available The surgical treatment of intracranial aneurysms by clipping is recognized as effective and definitive. However some cases that suffered a new subarachnoid hemorrhage (SAH some time after they were submitted to aneurysm clipping have raised doubts about the concept of "cure"after this treatment. Eleven patients previously submitted to aneurysm clipping who presented a new SAH were analyzed. The time elapsed from surgery to SAH varied from 3 to 10 years. After SAH four patients had a poor outcome. The new episode of SAH occurred due to intrinsic factors of the cerebral vasculature: 1. a weak point of the vessel wall near the previous aneurysm, 2. a weak point of another vessel far from the previous aneurysm, 3. a previous infundibular dilation of the posterior communicating artery; and due to technical problems: 1. aneurysm not identified during the previous treatment, 2. aneurysm deliberately left untreated, 3. persistence of the aneurysm due to inappropriate surgery, 4. persistency of part of the aneurysm neck after clipping and 5. slipping of the clip from the neck of the aneurysm. The measures to prevent new SAH after surgery start with adequate preoperative angiographic studies, a careful inspection of the position of the clip and emptying of the aneurysm. Early angiography studies may reveal a persistent neck and later ones may reveal newly developed aneurysms. In conclusion, SAH after aneurysm clipping is a late and severe phenomenon and the concept of "cure" after this surgery should be interpreted with caution.O tratamento cirúrgico dos aneurismas cerebrais através de sua clipagem é reconhecido como eficaz e definitivo. Entretanto alguns casos sofrem nova hemorragia algum tempo após a cirurgia, deixando dúvidas sobre a "cura" pelo tratamento. Onze pacientes submetidos anteriormente a clipagem do aneurisma e que apresentaram nova hemorragia foram analisados. O intervalo de tempo da cirurgia para a nova hemorragia foi de 3 a 10 anos

  5. Transcortical sensory aphasia due to a left frontal subcortical haemorrhage.

    Science.gov (United States)

    Maeshima, S; Kuwata, T; Masuo, O; Yamaga, H; Okita, R; Ozaki, F; Moriwaki, H; Roger, P

    1999-11-01

    A case of transcortical sensory aphasia caused by a cerebral haemorrhage in the left frontal lobe is presented. A 72-year-old right-handed woman was admitted to the hospital, with a history of acute onset of speech disturbance and headache. On initial assessment, her spontaneous speech was fluent. She had no difficulty initiating speech, articulated normally, and did not exhibit logorrhea. Her ability to repeat phonemes and short sentences (5-6 words) was fully preserved, however she had severe difficulty with visual recognition of words, and with aural comprehension at the word level, although she was able to read words aloud. Computed tomography and magnetic resonance imaging showed cerebral haemorrhage in the left frontal lobe, involving the superior and middle frontal gyrus. Single photon emission CT revealed a wider area of low perfusion over the entire left frontal lobe, including the superior, middle and inferior frontal gyrus. The aphasia symptoms, mainly poor comprehension, disappeared quickly several weeks after the event. This may have been due to a reduction in the size of the haematoma and a resolution of the oedema around the haematoma. Clinically, the transcortical sensory aphasia in this case was indistinguishable from that caused by damage to the posterior language areas. Further case reports of transcortical sensory aphasia associated with frontal lobe lesions would help to confirm whether a relatively rapid recovery is characteristic in cases such as this.

  6. Spinal subarachnoid hemorrhage complicating oral anticoagulant therapy

    Energy Technology Data Exchange (ETDEWEB)

    Cihangiroglu, Mutlu E-mail: mmutlucihan@hotmail.com; Bulut, Serpil; Nayak, Sundeep

    2001-09-01

    Spinal subarachnoid hemorrhage (SAH) is rare clinical entity possible owing to the diluting and fibrinolytic effects of cerebrospinal fluid (CSF). When it occurs, it is most commonly encountered in the thoracic segment of the subarachnoid space. We present a case of a 50-year-old man who sustained spinal SAH in the cervical and thoracic segments related to anticoagulant therapy. He progressed to significant neurological deficit since he was inoperable, an observation that supports the need for decompression surgery. We should be aware of potential hematomyelia should a patient on anticoagulant therapy develop neurological symptoms localized to the spinal cord. When available, magnetic resonance (MR) imaging is the modality of choice to diagnose and follow-up spinal SAH.

  7. Haemorrhagic shock due to spontaneous splenic haemorrhage complicating antiplatelet therapy: endovascular management

    Directory of Open Access Journals (Sweden)

    Garge S Shaileshkumar

    2015-01-01

    Full Text Available Spontaneous splenic haemorrahge and rupture is a rare but life-threatening condition requiring urgent diagnosis and treatment. Splenic haemorrhage and rupture precipitated by thrombolytic or antiocoagulant therapy has been reported frequently in the literature, but only two cases due to ticlopidine and one case due to salicyclate have been reported. We report the case of a 54-year-old man with haemorrhagic shock due to spontaneous splenic haemorrhage and rupture following dual antiplatelet (aspirin and clopidogrel therapy. He was successfully treated with selective angioembolization of the bleeding branch of the splenic artery.

  8. Neuroinvasive Infection from O117:K52:H-Escherichia coli following Acute Pyelonephritis

    Directory of Open Access Journals (Sweden)

    H. Cromlin

    2017-01-01

    Full Text Available Spontaneous or nosocomial Escherichia coli meningitis remains rare in healthy adults but is still carrying a high mortality rate despite adapted antimicrobial treatment for susceptible strains. A 39-year-old woman was admitted to the hospital with severe subarachnoid haemorrhage complicated by acute hydrocephalus. On hospital day 10, she developed Streptococcus anginosus septicaemia and urinary tract infection due to a multisensitive strain of E. coli. This infection was successfully controlled by antimicrobial therapy. As a late complication in the neurosurgical ward (day 39, she developed fever, alteration of consciousness, and shock, leading to the diagnosis of bacterial meningitis. The culture of blood, cerebrospinal fluid, and urine grew positive for a multisensitive E. coli. The strain was identified as O117:K52:H, a serotype that was until now never associated with acute meningitis or brain abscesses. The source appeared to be the urinary tract with the demonstration of acute pyelonephritis. The patient died on day 94 from delayed complications of multiple brain abscesses.

  9. Syrinx to Subarachnoid Shunting for Syringomyelia.

    Science.gov (United States)

    Davidson, Keryn A; Rogers, Jeffrey M; Stoodley, Marcus A

    2017-10-07

    Surgery for syringomyelia generally aims to treat the underlying cause, if it is known. Optimal management is unclear for idiopathic syringomyelia, or when treatment of the putative cause has failed or is high risk. Syrinx to subarachnoid shunting is an option for these cases; a series is reported to assess the outcomes of this approach. We retrospectively analyzed the clinical and radiologic features of a consecutive series of patients with syringomyelia treated with syrinx to subarachnoid shunting. Forty-one patients (19 male, 4-79 years old) were treated from 2000 to 2016, including 15 patients with idiopathic syringomyelia, 13 with spinal trauma, 5 with Chiari malformation, 4 with arachnoiditis, 3 with tethered cord, and 1 with arachnoid bands. The patients were treated with a syrinx to subarachnoid shunt, and a subset also underwent expansile duraplasty. At follow-up (3-108 months, mean 36 months) syrinx size was reduced in 37 patients, and there was improvement or stabilization of symptoms in all but 1 patient. Three patients had temporary lower limb sensory symptoms after surgery. Other complications were 2 transient cerebrospinal fluid leaks, a pseudomeningocoele, and 1 postoperative myocardial infarction. Two cases of shunt dislodgement required reoperation, and a third case required early reoperation for an enlarging syrinx. There were no cases of shunt blockage or infection. Syrinx to subarachnoid shunting is a safe and effective treatment for idiopathic syringomyelia and for patients who are not suitable for, or have not responded to, other treatment. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Immediate post-partum haemorrhage: Epidemiological aspects and ...

    African Journals Online (AJOL)

    The majority of deliveries (90%) were vaginal. ... post-partum haemorrhage was a third stage of labour bleeding (66%) followed by genital lesions (32%). ..... Seattle Path. TrAININg To MANAgE. poST-pArTUM HAEMorrHAgE. Most readers know that immediate post-partum haemorrhage is a problem in South Sudan as well ...

  11. Emergency laparotomy for peripartum haemorrhage in Bida North ...

    African Journals Online (AJOL)

    Subject: All patients with peripartum haemorrhage (ruptured gravid uterus and uncontrollable post partum haemorrhage) that needed emergency laparotomy between 1 June, 2000 31 May, 2004. Methods: A detailed history including biosocial and possible predisposing factors to peripartum haemorrhage at presentation ...

  12. Dengue and dengue haemorrhagic fever: Indian perspective

    Indian Academy of Sciences (India)

    PRAKASH KUMAR

    problems of dengue is presented here. [Chaturvedi U C and Nagar R 2008 Dengue and dengue haemorrhagic fever: Indian perspective; J. Biosci. ..... crisis management. We need dedicated teams to solve the problems and minimize the human suffering. Acknowledgements. We thank Dr. Cecilia Dayaraj, Division of ...

  13. Cyclophosphamide induced Haemorrhagic Cystitis; a review of ...

    African Journals Online (AJOL)

    Cyclophosphamide is an akylating agent widely used in the management of both malignant and non neoplastic disorders. We undertook this review to assess the advancement in knowledge regarding the aetiopathogenesis and current management approaches of haemorrhagic cystitis resulting from the use of ...

  14. Necrotising haemorrhagic pancreatitis with intra-abdominal ...

    African Journals Online (AJOL)

    Severe necrotising haemorrhagic pancreatitis is a challenging clinical condition that carries a high mortality especially in resource-limited settings. The management requires a multidisciplinary approach in a well-equipped critical care unit. The decision for operative versus conservative management is a close call and one ...

  15. Bilateral benign haemorrhagic adrenal cysts in Beckwith ...

    African Journals Online (AJOL)

    Beckwith-Wiedemann syndrome is the most common overgrowth malformation syndrome. The classical features include macrosomia, macroglossia, omphalocele and ear lobe anomalies. Among the associated adrenal anomalies, foetal cortical cytomegaly, outer cortical haemorrhage and unilateral benign cysts are well ...

  16. Ebola haemorrhagic fever among hospitalised children and ...

    African Journals Online (AJOL)

    Background : A unique feature of previous Ebola outbreaks has been the relative sparing of children. For the first time, an out break of an unusual illness-Ebola haemorrhagic fever occurred in Northern Uganda - Gulu district. Objectives : To describe the epidemiologic and clinical aspects of hospitalised children and ...

  17. Review: Medical treatment of postpartum haemorrhage | Hofmeyr ...

    African Journals Online (AJOL)

    Postpartum haemorrhage (PPH) may occur unexpectedly in any woman who has given birth. All birth attendants must have the skills and knowledge to manage PPH quickly and effectively. This may include rubbing up the uterus and bimanual compression, resuscitation, removal of retained placental tissue and surgical ...

  18. Managing Major Early (Primary) Postpartum Haemorrhage in ...

    African Journals Online (AJOL)

    Major primary postpartum haemorrhage continues to top the list of causes of maternal mortality worldwide. Delays in the correction of hypovolaemia, diagnosis and treatment of bleeding disorders and initiation of surgery are preventable factors responsible for majority of the deaths. The situation is worse in the developing ...

  19. Sanitation of viral haemorrhagic septicaemia (VHS)

    DEFF Research Database (Denmark)

    Olesen, Niels Jørgen

    1998-01-01

    A sanitation programme for stamping-out viral haemorrhagic septicaemia (VHS) was implemented in Denmark in 1965. The programme has resulted in a dramatic reduction in the number of infected rainbow trout farms, from approximate to 400 to 26. The programme is carried out on a voluntary basis...

  20. Case Report: Adrenal Haemorrhage: Clinical Presentation And ...

    African Journals Online (AJOL)

    Neonatal Adrenal Haemorrhage (NAH) is a rare condition resulting from a variety of aetiological factors. It has a potential for a catastrophic outcome, thus underscoring the need for a high index of suspicion and a reliable/accurate method of diagnosis. This case report is to alert on the diagnostic possibility of NAH and ...

  1. Atlanto-axial rotatory fixation caused by spontaneous intracerebral haemorrhage in a child.

    Science.gov (United States)

    Kombogiorgas, Dimitris; Hussain, Ihsan; Sgouros, Spyros

    2006-09-01

    Atlanto-axial rotatory fixation is rare in children and usually associated with upper respiratory tract infection or trauma. We present a patient who developed the condition acutely as a consequence of rapidly evolving hemiplegia secondary to intracerebral haemorrhage. A previously well 12-year-old boy suddenly developed left hemiparesis within 30 min. Soon after, he developed painful torticollis. On examination, a dense left hemiplegia was associated with left facial and hypoglossal weakness. On computerised tomography (CT) scan there was an intracerebral haemorrhage in the deep aspect of the right frontal lobe in the corona radiata, with extension in the ventricular system. The plain radiographs of the cervical spine, and CT scan later, confirmed the presence of C1-C2 rotatory subluxation. The haematoma was aspirated stereotactically through a burr hole, and at the same session, the subluxation was reduced by manipulation and traction of the cervical spine. The patient was treated with a hard collar. The torticollis did not recur. The hemiparesis resolved within 6 months. A subsequent magnetic resonance imaging and magnetic resonance angiography scan indicated possible arterio-venous malformation (AVM) at the site of the haemorrhage, which was confirmed with digital subtraction angiography. The AVM was surgically excised 1 year from the original haemorrhage. In the absence of any other predisposing factor, it is postulated that the acute atlanto-axial rotatory subluxation was secondary to the acute loss of muscular tone due to the acute hemiparesis. This explains that the subluxation has not recurred a year after, while the hemiparesis has completely resolved.

  2. Frequency and appearance of hemosiderin depositions after aneurysmal subarachnoid hemorrhage treated by endovascular therapy

    Energy Technology Data Exchange (ETDEWEB)

    Falter, Bernhard; Wiesmann, Martin; Freiherr, Jessica; Nikoubashman, Omid; Mull, Michael [University Hospital Aachen RWTH, Department of Neuroradiology, Aachen (Germany)

    2015-10-15

    It is still unclear how often subarachnoid hemorrhage (SAH) leads to chronic hemosiderin depositions. In this study, we aimed to determine the frequency of chronic hemosiderin depositions after aneurysmal SAH in patients who did not undergo surgery. Furthermore, we analyzed typical MRI patterns of chronic SAH and sought to obtain information on the temporal course of MRI signal changes. We retrospectively analyzed 90 patients who had undergone endovascular treatment for acute aneurysmal SAH. In all patients, initial CT studies and at least one T2*-weighted MRI obtained 6 months or later after SAH were analyzed for the presence and anatomical distribution of SAH or chronic hemosiderin depositions. In total, 185 T2*-weighted MRI studies obtained between 2 days and 148 months after SAH were evaluated (mean follow-up 30.2 months). On MRI studies obtained later than 6 months after SAH, subpial hemosiderin depositions were found in 50 patients (55.5 %). Most frequent localizations were the parenchyma adjacent to the frontal and parietal sulci and the insular cisterns. While the appearance of hemosiderin depositions was dynamic within the first 3 months, no changes were found during subsequent follow-up. MR signal changes were not only conclusive with subarachnoid hemosiderin depositions but in many cases also resembled those that have been associated with cortical hemosiderosis. T2*-weighted MRI is an effective means of diagnosing prior SAH. Our study suggests that chronic hemosiderin depositions can be found in a considerable number of patients after a single event of subarachnoid hemorrhage. (orig.)

  3. Frequency and appearance of hemosiderin depositions after aneurysmal subarachnoid hemorrhage treated by endovascular therapy.

    Science.gov (United States)

    Falter, Bernhard; Wiesmann, Martin; Freiherr, Jessica; Nikoubashman, Omid; Mull, Michael

    2015-10-01

    It is still unclear how often subarachnoid hemorrhage (SAH) leads to chronic hemosiderin depositions. In this study, we aimed to determine the frequency of chronic hemosiderin depositions after aneurysmal SAH in patients who did not undergo surgery. Furthermore, we analyzed typical MRI patterns of chronic SAH and sought to obtain information on the temporal course of MRI signal changes. We retrospectively analyzed 90 patients who had undergone endovascular treatment for acute aneurysmal SAH. In all patients, initial CT studies and at least one T2*-weighted MRI obtained 6 months or later after SAH were analyzed for the presence and anatomical distribution of SAH or chronic hemosiderin depositions. In total, 185 T2*-weighted MRI studies obtained between 2 days and 148 months after SAH were evaluated (mean follow-up 30.2 months). On MRI studies obtained later than 6 months after SAH, subpial hemosiderin depositions were found in 50 patients (55.5%). Most frequent localizations were the parenchyma adjacent to the frontal and parietal sulci and the insular cisterns. While the appearance of hemosiderin depositions was dynamic within the first 3 months, no changes were found during subsequent follow-up. MR signal changes were not only conclusive with subarachnoid hemosiderin depositions but in many cases also resembled those that have been associated with cortical hemosiderosis. T2*-weighted MRI is an effective means of diagnosing prior SAH. Our study suggests that chronic hemosiderin depositions can be found in a considerable number of patients after a single event of subarachnoid hemorrhage.

  4. Nd:YAG laser hyaloidotomy for valsalva pre-macular haemorrhage.

    LENUS (Irish Health Repository)

    Kirwan, R P

    2012-02-01

    AIM: To report a case of successful drainage of a large pre-macular haemorrhage using laser photo-disruption of the posterior hyaloid membrane. MATERIALS AND METHODS: A case report. RESULTS: A 47-year-old man presented acutely to our emergency department complaining of a 24-h history of sudden onset, painless and persistent loss of vision in his left eye. Immediately before noticing this loss of vision, he had been vomiting violently from excessive alcohol intake. The left visual acuity was counting fingers. Dilated fundoscopy of the left eye revealed a large pre-macular haemorrhage which was 14 disc diametres in size. Clotting investigations were normal. A diagnosis of valsalva retinopathy was made and the patient elected to receive a prompt neodymium-doped yttrium aluminium garnet (Nd:YAG) laser posterior hyaloidotomy as an outpatient. At 1 week follow-up, the haemorrhage had drained completely into the vitreous space revealing a healthy macula and the visual acuity had improved to 6\\/12 unaided. At 6-month follow-up the left visual acuity stabilised at 6\\/9 unaided. CONCLUSION: Nd:YAG laser posterior hyaloidotomy is a useful outpatient procedure for successful clearance of large pre-macular haemorrhages that offers patients rapid recovery of visual acuity and the avoidance of more invasive intraocular surgery.

  5. Predictive Factors for Rebleeding After Aneurysmal Subarachnoid Hemorrhage : Rebleeding Aneurysmal Subarachnoid Hemorrhage Study

    NARCIS (Netherlands)

    van Donkelaar, Carlina; Bakker, Nicolaas A.; Veeger, Nic J. G. M.; Uyttenboogaart, Maarten; Metzemaekers, Jan D. M.; Luijckx, Gert-Jan; Groen, Rob J. M.; van Dijk, J. Marc C.

    Background and Purpose-Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating type of stroke associated with high morbidity and mortality. One of the most feared complications is an early rebleeding before aneurysm repair. Predictors for such an often fatal rebleeding are largely unknown. We

  6. Arachnoid granulation affected by subarachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    R.P. Chopard

    1993-11-01

    Full Text Available The purpose of this study was to investigate using light microscopy the fibro-cellular components of arachnoid granulations affected by mild and severe subarachnoid hemorrage. The erythrocytes were in the channels delimitated by collagenous and elastic bundles and arachnoid cells, showing their tortuous and intercommunicating row from the pedicle to the fibrous capsule. The core portion of the pedicle and the center represented a principal route to the bulk outflow of cerebrospinal fluid and erythrocytes. In the severe hemorrhage, the fibrocellular components are desorganized, increasing the extracellular channels. We could see arachnoid granulations without erythrocytes, which cells showed big round nucleous suggesting their transformation into phagocytic cells.

  7. What Factors Determine Treatment Outcome in Aneurysmal Subarachnoid Hemorrhage in the Modern Era? A Post Hoc STASH Analysis.

    Science.gov (United States)

    Teo, Mario; Guilfoyle, Mathew R; Turner, Carole; Kirkpatrick, Peter J

    2017-09-01

    The management of aneurysmal subarachnoid hemorrhage (aSAH) has changed dramatically in the last few decades with the publication of a few major studies, including ISAT (International Subarachnoid Aneurysm Trial, the International Cooperative Study on the Timing of Aneurysm Surgery Study). The aim of this study is to analyze the outcome of patients with aSAH based on a contemporary series, identify the risk factors for poor outcome, and focus on patients with good-grade aSAH (to match the ISAT cohort). Baseline demographic and outcome data (modified Rankin Scale) were available for the 803 patients recruited from the STASH (Simvastatin in Aneurysmal Subarachnoid Haemorrhage) trial for post hoc analysis, using a χ2 test or 2-sample t test. Logistic regression analysis was performed to assess the risk factors for poor outcome at 6 months. Propensity matched analysis comparing coiling and clipping, and subgroup analysis of good-grade patients (World Federation of Neurosurgical Societies grade I-II) were also performed. Logistic regression analysis showed that the treatment modality (i.e., coiling or clipping) was not associated with poor outcome at 6 months (P = 0.839). The risk factors associated with poor outcome at 6 months were poor admission World Federation of Neurosurgical Societies grade (P < 0.0001), Fisher grade on initial computed tomography scan (P = 0.013), and the development of delayed cerebral ischemia (P < 0.0001). Subgroup analysis for good-grade patients only showed that 82% of patients after coiling and 78% of patients after clipping were classed as good outcome at 6 months (P = 0.181). In the current era of aSAH management, apart from patients' admission status, SAH blood load and the development of delayed cerebral ischemia, treatment modality with either coiling or clipping was not associated with poor outcome difference at 6 months. Copyright © 2017. Published by Elsevier Inc.

  8. Comparative efficacy of meloxicam and placebo in vasospasm of patients with subarachnoid hemorrhage.

    Science.gov (United States)

    Ghodsi, Seyed Mohammad; Mohebbi, Niayesh; Naderi, Soheil; Anbarloie, Mousareza; Aoude, Ahmad; Habibi Pasdar, Seyed Sohail

    2015-01-01

    Cerebral vasospasm considered to be a serious cause of morbidity and mortality following subarachnoid haemorrhage (SAH).Despite several available therapeutic options, current protocols do not prevent major consequences of vasospasm. Inflammation is believed to play an important role in post-haemorrhagic vasospasm. Meloxicam is a non-steroidal anti-inflammatory drug. The aim of this study was to compare the efficacy of meloxicam versus placebo on vasospasm in patients with SAH. In this randomized, double-blind, placebo-controlled trial, SAH patients randomly received 7.5 mg meloxicam or placebo twice daily for 7 days. End points were, middle cerebral artery velocity obtained with transcranial doppler, in-hospital mortality, hospital stay and discharge Glasgow Outcome Scale. Eighty-one patients enrolled in the study. (40 received meloxicam, 41 received placebo). Baseline characteristics were similar between the groups. There were no differences in length of hospitalization (17.4 ± 3.1 vs 18.6 ± 4.2 days; p = 0.145), in-hospital mortality rate (15 vs 22%; p-value=0.569), or GOS (p = 0.972) between the two groups. MCA velocity were slightly less in patients who had received meloxicam, but not to a significant degree (p-value=0. 564(. No side effect has been detected for meloxicam. This study did not prove meloxicam efficacy in vasospasm of SAH patients. But it demonstrated that clinical trial of meloxicam in these patients is feasible and probably safe. The effectiveness of meloxicam on cerebral vasospasm has to be studied in larger trials.

  9. Outcome following subdural haemorrhages in infancy

    OpenAIRE

    Jayawant, Sandeep; Parr, Jeremy,

    2007-01-01

    Subdural haemorrhages (SDH) are associated with significant neurodisability in affected individuals. The incidence of SDH in infants is between 12 and 25 cases per 100 000 children and most detected SDH are due to physical abuse. In the infant brain, SDH are caused by tearing of the bridging veins in the subdural space and may result in significant brain injury. The challenge of assessing outcome in infants with SDH is evaluating whether SDH or other accompanying brain insults are instrumenta...

  10. A rare cause of fatal intracranial haemorrhage.

    LENUS (Irish Health Repository)

    Neligan, A

    2012-01-31

    INTRODUCTION: We report the case of a 53-year-old farmer with a 5-day history of severe headache, photophobia and neck stiffness. Full blood count (platelets 173), coagulation screen were normal throughout. Liver function tests remained normal apart from an elevated gamma-GT (156). CT Brain was normal. CSF analysis showed a WCC of 454\\/mm(3) (60% lymphocytes), elevated CSF protein (1.42 g\\/l) and a normal CSF glucose. He was commenced on IV antibiotics and IV acyclivor and improved. On day 3 of admission, he complained of a sudden severe headache, became unresponsive (GCS 3\\/15). INVESTIGATIONS: CT Brain showed a massive left intraventricular haemorrhage. He died 4 days later. Subsequent serum serology for leptospirosis was positive. A repeat sample taken 4 days post-admission, showed a rising IgM indicating active leptospirosis. Detailed pathological examination confirmed intracerebral haemorrhage with normal cerebral vasculature. CONCLUSION: Leptospirosis is a rare cause of intracerebral haemorrhage even in the absence of coagulopathy.

  11. Isolated Subarachnoidal Hemorrhage following Carotid Endarterectomy

    Directory of Open Access Journals (Sweden)

    Marie Bodenant

    2010-06-01

    Full Text Available Cerebral hyperperfusion syndrome is a rare but well-described complication following carotid endarterectomy or stenting. Clinical signs are ipsilateral, throbbing, unilateral headache with nausea or vomiting, seizures, and neurological deficits, with or without intracerebral abnormalities on CT scan, such as brain edema or intracerebral hemorrhage. Subarachnoidal hemorrhage is rarely described especially if it occurs isolated. We describe a 74-year-old man with a history of high blood pressure, hypercholesterolemia, atrioventricular block with pacemaker, and ischemic cardiopathy with coronary bypass. He underwent right carotid endarterectomy for a 90% NASCET asymptomatic stenosis. Four days after surgery, he complained of unusual headaches with right, throbbing hemicrania. Nine days after surgery, he presented with left hemiplegia and a partial motor seizure. He had fluctuant altered consciousness, left hemiplegia, and left visual and sensory neglect. Brain CT showed right frontal subarachnoidal hemorrhage without parenchymal bleeding. Cerebral angiography found no cerebral aneurysm, no vascular malformation, but a vasospasm of the left middle cerebral artery. Transcranial Doppler confirmed this vasospasm. Evolution was favorable with no recurrence of seizures but with an improvement of the neurological deficits and vasospasm. Physicians should bear in mind this very rare complication of endarterectomy and immediately perform neuroimaging in case of unusual headache following endarterectomy or angioplasty.

  12. Subarachnoid hemorrhage due to retained lumbar drain.

    Science.gov (United States)

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

    2011-12-01

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

  13. Spontaneous spinal subarachnoid hemorrhage after severe coughing: a case report.

    Science.gov (United States)

    Oji, Yutaka; Noda, Kazuyuki; Tokugawa, Joji; Yamashiro, Kazuo; Hattori, Nobutaka; Okuma, Yasuyuki

    2013-12-23

    Spinal subarachnoid hemorrhage has many causes including trauma, vascular malformations, aneurysms, spinal cord tumors, coagulation abnormalities, use of anticoagulants, systemic lupus erythematosus, or Behçet's disease. We report on a rare case of a spontaneous spinal subarachnoid hemorrhage after severe coughing of unknown origin. To the best of our knowledge, this is the first report of spontaneous spinal subarachnoid hemorrhage after severe coughing. A 66-year-old Japanese woman initially complained of headache with severe back pain after severe coughing. She was referred to our neurology department 6 days after her first visit to our hospital. No neurological deficits were revealed except for meningism. Computed tomography of her head revealed no abnormality. A lumbar puncture showed bloody cerebrospinal fluid with xanthochromia. Cerebral angiography revealed no abnormality. Magnetic resonance imaging of her lumbar spine revealed subarachnoid hemorrhage. Spinal angiography revealed no abnormality. The diagnosis of spontaneous spinal subarachnoid hemorrhage was made. She recovered with conservative treatment and her neurological status was normal 2 years after the onset. Spontaneous spinal subarachnoid hemorrhage could be caused by rapid changes in intrathoracic and intra-abdominal pressure. Spontaneous subarachnoid hemorrhage should be considered when sudden back pain associated with severe headache develops. Even though emergent surgical decompression is necessary when the neurological state progressively deteriorates, conservative treatment with close monitoring of the symptoms can be recommended for patients with a stable neurological status.

  14. [Costs of subarachnoid vs. general anaesthesia for caesarean section].

    Science.gov (United States)

    Kwiatosz-Muc, Magdalena; Wdowiak, Leszek; Nestorowicz, Andrzej; Kowalczyk, Michał

    2010-01-01

    Modern medicine is becoming increasingly aware of economic-organizational aspects. In the field of anaesthesiology, the number of agents used markedly increases due to continuous pharmacological progress. A high proportion of them are expensive. The aim of the study was to compare hospital costs of general vs. subarachnoid anaesthesia for Caesarean section. Costs were assessed from the perspective of a service provider. Direct costs were measured using the micro-cost method based on detailed data of the resources used during anaesthetic procedures. Non-medical costs were calculated by the direct allocation method (costs of auxiliary units). Unit costs of hospitalization were determined using the "top-to-bottom" assessment. Costs related to anaesthetic staff work were calculated by the micro-cost method based on duration of anaesthesia. Sensitivity analysis was performed. Mean direct cost of general anaesthesia for Caesarean section was lower than of subarachnoid anaesthesia. Mean personnel cost of subarachnoid anaesthesia was found to be higher compared to general anaesthesia. Costs of pharmaceuticals for general anaesthesia were lower than for subarachnoid one. Costs of medical materials related to the method used were significantly higher in subarachnoid anaesthesia. Subarachnoid anaesthesia takes more time than general one, which results in higher costs of medical staff work. Avoiding inhalation anaesthetics (sevoflurane) makes indirect costs of general anaesthesia lower compared to subarachnoid anaesthesia.

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

    Science.gov (United States)

    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. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Bevacizumab in vitreous haemorrhage secondary to radiation retinopathy

    Science.gov (United States)

    Montero, Javier Antonio; Yanez-Castro, Giovanni; Sanchis-Merino, Maria Eugenia; Ruiz-Moreno, Jose Maria

    2014-01-01

    Radiation retinopathy is a delayed-onset side effect of radiation exposure caused by retinal ischaemia that may induce proliferative retinopathy with neovascularisation, vitreous haemorrhage and macular oedema. An otherwise healthy, 51-year-old male patient who had been diagnosed with olfactory neuroblastoma and undergone complete surgical removal of the lesion followed by cranial irradiation developed bilateral cataracts and radiation retinopathy. The patient was treated by panretinal photocoagulation (PRP), followed by three-port pars-plana vitrectomy. Recurrent episodes of vitreous haemorrhages occurred following surgery and the patient was successfully treated by one intravitreal injection of bevacizumab with resolution of vitreous blood. Vitreous haemorrhage recurred 6 months later and a scheduled treatment with intravitreal bevacizumab every 4 months was established, preventing further haemorrhagic episodes. Six months after the last injection, a new episode of vitreous haemorrhage occurred. Scheduled intravitreal bevacizumab injections may help prevent recurrent vitreous haemorrhages in vitrectomised patients with radiation retinopathy. PMID:24510700

  17. The outbreak and control of Ebola viral haemorrhagic fever in a Ugandan medical school.

    Science.gov (United States)

    Bitekyerezo, Medard; Kyobutungi, Catherine; Kizza, Ruth; Mugeni, James; Munyarugero, Emmanuel; Tirwomwe, Francis; Twongyeirwe, Eunice; Muhindo, George; Nakibuuka, Victoria; Nakate, Maimuna; John, Laurence; Ruiz, Ana; Frame, Karen; Priotto, Gerardo; Pepper, Larry; Kabakyenga, Jerome; Baingana, Sheila; Ledo, Dennis

    2002-01-01

    Uganda has just experienced the largest outbreak of Ebola haemorrhagic fever (EHF) ever recorded. Mbarara University Teaching Hospital (MUTH) is responsible for training approximately one-third of Uganda's doctors. Mbarara is located in SouthWest Uganda, 614 km from Gulu, the main epicentre of the outbreak. On 23 October a patient was admitted to the medical ward of MUTH with an acute fever. He soon exhibited haemorrhagic symptoms and died. He was later confirmed to have suffered Ebola. Three more patients subsequently contracted the disease. All died. There were no further cases in Mbarara. No members of staff or medical student was infected. We give details of the clinical features of those patients who contracted the disease, the setting up of an Ebola isolation unit, the case surveillance and the search for the source of the outbreak. The implications for similar institutions in East Africa are discussed.

  18. Haemorrhage in pregnancy: information given to women in Chiradzulu (Malawi

    Directory of Open Access Journals (Sweden)

    H Kapyepye

    2006-09-01

    Full Text Available Advising women on , haemorrhage in pregnancy could, be viewed, as an integral aspect of maternal health care in M alawi. The WHO (1999 confirmed, that haemorrhage in pregnancy was not only a direct reason for maternal mortality but also a major cause of maternal death. The question on the nature of information that midwives and traditional birth attendants (referred to as TBA’s in the Chiradzulu district in Malawi gave with regard to haemorrhage in pregnancy, therefore arose. Research available focused on the women’s knowledge about the complications of pregnancy but not on the nature of information women received from midwives and TBA’s. This study explored and described the nature of information that was given to rural women in the Chiradzulu district by the midwives and TBA’s regarding haemorrhage in pregnancy. The findings revealed that although both the midwives and TBA’s included important information about haemorrhage in pregnancy, there were deficiencies in some critical areas. Examples of these deficiencies were the definition of haemorrhage in pregnancy; the predisposing factors for antepartum and postpartum haemorrhage and deficiencies in the nature of information on the management and referral of haemorrhaging patients. The findings provided insights into the nature of the information that was provided to the women regarding haemorrhage in pregnancy in the Chiradzulu district in Malawi. Thereafter guidelines were developed for the provision of this information. Finally a follow-up study was recommended after implementation of these guidelines in the district to evaluate the change in the nature of the information communicated to patients regarding haemorrhage by midwives and TBA’s. In this study, haemorrhage during pregnancy referred to the perinatal phase, including antepartum, intrapartum and postpartum haemorrhage.

  19. ELECTROCARDIOGRAPHIC CHANGES OBSERVED IN HAEMORRHAGIC AND ISCHAEMIC CEREBROVASCULAR DISEASES

    Directory of Open Access Journals (Sweden)

    Channappa

    2016-03-01

    Full Text Available INTRODUCTION Cardiac abnormalities are relatively common after acute neurologic injury. Disturbances can vary in severity from transient ECG abnormalities to profound myocardial injury and dysfunction. CNS is involved in the generation of cardiac arrhythmias and dysfunction even in an otherwise normal myocardium. AIM To find out proportion of ECG changes observed in ischaemic and haemorrhagic stroke. MATERIALS AND METHODS The Electrocardiographs of 100 patients with acute stroke were studied to find out the types of ECG abnormalities among different types of stroke. RESULTS In our study, the most common ECG abnormalities associated with stroke were prolonged QTc interval, ST-T segment abnormalities, prominent U wave and arrhythmias. Trop-I was positive in 12.8% patients with ECG changes. Statistical significance was found in association with Trop-I positivity and ST depression. CONCLUSION Usually patients with heart disease present with arrhythmias and Ischaemic like ECG changes. But these changes are also seen most often in the patients with presenting with stroke who didn’t have any past history of heart disease. This shows that arrhythmias and ischaemic ECG abnormalities are primarily evolved due to central nervous system disorders.

  20. JMBR VOLUME 16 Number 1 June 2017.cdr

    African Journals Online (AJOL)

    Fine Print

    2017-06-01

    2348060696870. 2Anarado A.N. Department of Nursing ... in conditions like acute stroke, subarachnoid haemorrhage, acute. [2] poisoning and ... nurse's attitude towards the use of GCS . Despite the increasing incidence and prevalence of ...

  1. Life Satisfaction and Return to Work After Aneurysmal Subarachnoid Hemorrhage

    NARCIS (Netherlands)

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

    2011-01-01

    This study was conducted to investigate life satisfaction and employment status after aneurysmal subarachnoid hemorrhage (SAH) and to explain the associations between life satisfaction and demographic, disease-related, psychological, and personality characteristics. Subjects with SAH (n = 141)

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

    NARCIS (Netherlands)

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

    Cardiac abnormalities after subarachnoid hemorrhage (SAH) such as electrocardiographic changes, echocardiographic wall motion abnormalities, and elevated troponin levels are independently associated with a poor prognosis. They are caused by catecholaminergic stress coinciding with influx of

  3. Prediction of outcome after subarachnoid hemorrhage : Timing of clinical assessment

    NARCIS (Netherlands)

    van Donkelaar, Carlina E.; Bakker, Nicolaas A.; Veeger, Nic J. G. M.; Uyttenboogaart, Maarten; Metzemaekers, Jan D. M.; Eshghi, Omid S.; Mazuri, Aryan; Foumani, Mahrouz; Luijckx, Gert-Jan; Groen, Rob J. M.; van Dijk, J. Marc C.

    OBJECTIVE Currently, early prediction of outcome after spontaneous subarachnoid hemorrhage (SAH) lacks accuracy despite multiple studies addressing this issue. The clinical condition of the patient on admission as assessed using the World Federation of Neurosurgical Societies (WFNS) grading scale is

  4. Continuous EEG Monitoring in Aneurysmal Subarachnoid Hemorrhage

    DEFF Research Database (Denmark)

    Kondziella, Daniel; Friberg, Christian Kærsmose; Wellwood, Ian

    2015-01-01

    BACKGROUND: Continuous EEG (cEEG) may allow monitoring of patients with aneurysmal subarachnoid hemorrhage (SAH) for delayed cerebral ischemia (DCI) and seizures, including non-convulsive seizures (NCSz), and non-convulsive status epilepticus (NCSE). We aimed to evaluate: (a) the diagnostic...... accuracy of cEEG as a confirmatory test, (b) the prognostic value of EEG patterns suggestive of seizures and DCI, and (c) the effectiveness of intensified neuromonitoring using cEEG in terms of improved clinical outcome following SAH. METHODS: A systematic review was performed with eligible studies...... selected from multiple indexing databases through June 2014. The methodological quality of these studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2. RESULTS: Eighteen studies were identified, including cEEG data from 481 patients with aneurysmal SAH. NCSz were diagnosed in 7...

  5. Severe Crimean-Congo haemorrhagic fever presented with massive retroperitoneal haemorrhage that recovered without antiviral treatment

    DEFF Research Database (Denmark)

    Gharabaghi, Mehrnaz Asadi; Chinikar, Sadegh; Ghiasi, Seyyed Mojtaba

    2011-01-01

    Crimean-Congo haemorrhagic fever (CCHF) is a tickborne viral zoonosis with up to 50% mortality in humans caused by CCHF virus belonging to the genus Nairovirus, family Bunyaviridae. The geographical distribution of CCHF cases corresponds closely with the distribution of principle tick vectors...

  6. Aneurysmal SubArachnoid Hemorrhage—Red Blood Cell Transfusion And Outcome (SAHaRA): a pilot randomised controlled trial protocol

    Science.gov (United States)

    English, Shane W; Fergusson, D; Chassé, M; Lauzier, F; Griesdale, D; Algird, A; Kramer, A; Tinmouth, A; Lum, C; Sinclair, J; Marshall, S; Dowlatshahi, D; Boutin, A; Pagliarello, G; McIntyre, L A

    2016-01-01

    Introduction Anaemia is common in aneurysmal subarachnoid haemorrhage (aSAH) and is a potential critical modifiable factor affecting secondary injury. Despite physiological evidence and management guidelines that support maintaining a higher haemoglobin level in patients with aSAH, current practice is one of a more restrictive approach to transfusion. The goal of this multicentre pilot trial is to determine the feasibility of successfully conducting a red blood cell (RBC) transfusion trial in adult patients with acute aSAH and anaemia (Hb ≤100 g/L), comparing a liberal transfusion strategy (Hb ≤100 g/L) with a restrictive strategy (Hb ≤80 g/L) on the combined rate of death and severe disability at 12 months. Methods Design This is a multicentre open-label randomised controlled pilot trial at 5 academic tertiary care centres. Population We are targeting adult aSAH patients within 14 days of their initial bleed and with anaemia (Hb ≤110 g/L). Randomisation Central computer-generated randomisation, stratified by centre, will be undertaken from the host centre. Randomisation into 1 of the 2 treatment arms will occur when the haemoglobin levels of eligible patients fall to ≤100 g/L. Intervention Patients will be randomly assigned to either a liberal (threshold: Hb ≤100 g/L) or a restrictive transfusion strategy (threshold: Hb ≤80 g/L). Outcome Primary: Centre randomisation rate over the study period. Secondary: (1) transfusion threshold adherence; (2) study RBC transfusion protocol adherence; and (3) outcome assessment including vital status at hospital discharge, modified Rankin Score at 6 and 12 months and Functional Independence Measure and EuroQOL Quality of Life Scale scores at 12 months. Outcome measures will be reported in aggregate. Ethics and dissemination The study protocol has been approved by the host centre (OHSN-REB 20150433-01H). This study will determine the feasibility of conducting the large pragmatic RCT comparing 2

  7. European research priorities for intracerebral haemorrhage

    DEFF Research Database (Denmark)

    Steiner, Thorsten; Petersson, Jesper; Al-Shahi Salman, Rustam

    2011-01-01

    . No standardised diagnostic workup for the detection of the various underlying causes of ICH currently exists, and the evidence for medical or surgical therapeutic interventions remains limited. A dedicated European research programme for ICH is needed to identify ways to reduce the burden of ICH-related death...... and disability. The European Research Network on Intracerebral Haemorrhage EURONICH is a multidisciplinary academic research collaboration that has been established to define current research priorities and to conduct large clinical studies on all aspects of ICH....

  8. Septicaemia and adrenal haemorrhage in congenital asplenia.

    Science.gov (United States)

    Dyke, M P; Martin, R P; Berry, P J

    1991-01-01

    Five patients developed overwhelming infection as a result of congenital asplenia, which was previously unsuspected in all cases. Each illness followed a fulminant course resulting in death within 24 hours. They illustrate the respective roles of Haemophilus influenzae infection (n = 4) and adrenal haemorrhage (n = 4) in this condition. We suggest a management protocol for screening infants with abnormalities of the atria or viscera with splenic ultrasound and examination of a blood film for Howell-Jolly bodies. Vaccination and prophylactic antibiotics should be considered for those at risk. Vigorous use of parenteral antibiotics and steroids in suspected infection is recommended. PMID:2039257

  9. Late onset retinoblastoma presenting with vitreous haemorrhage

    DEFF Research Database (Denmark)

    Bagger, Mette; Prause, Jan Ulrik; Heegard, Steffen

    2012-01-01

    in the retina. A vascularized gelatinous mass was revealed after vitrectomy. Later the patient developed white cysts in the anterior chamber and histological findings were indicative of a retinoblastoma. The patient was enucleated and the diagnosis of retinoblastoma was confirmed. Intraocular surgery in young...... people with unknown retinoblastoma enhances the risk of metastasis development, orbital recurrence and death. Unexplained vitreous haemorrhage can obscure the view of a tumour but ultrasonic findings of a retinal mass calls for further imaging e.g. through MRI. The case illustrates the importance...

  10. Genetic heterogeneity in hereditary haemorrhagic telangiectasia.

    Science.gov (United States)

    Porteous, M E; Curtis, A; Williams, O; Marchuk, D; Bhattacharya, S S; Burn, J

    1994-01-01

    A locus causing hereditary haemorrhagic telangiectasia (HHT) has recently been mapped to 9q34 in four families and designated HHT1. In this paper, the results of a linkage study showing genetic heterogeneity in four families in whom HHT is segregating are reported. All the previously reported 9q34 linked families contain at least one affected member with a symptomatic pulmonary arteriovenous malformation. We postulate that clinical heterogeneity may also be a feature of HHT with a significantly higher predisposition to symptomatic PAVMs associated with the HHT1 linked families. PMID:7891373

  11. Imported viral haemorrhagic fever with a potential for person-to-person transmission: review and recommendations for initial management of a suspected case in Belgium.

    Science.gov (United States)

    Colebunders, R; Van Esbroeck, M; Moreau, M; Borchert, M

    2002-01-01

    Viral haemorrhagic fevers are caused by a wide range of viruses. There are 4 types of viruses well known to spread from person to person and able to cause nosocomial outbreaks with a high case fatality rate: an arenavirus (Lassa fever and more exceptionally the Junin and Machupo virus), a bunyavirus (Crimean-Congo haemorrhagic fever) and the Filoviridae (Ebola and Marburg viruses). So far there have been only a limited number of imported cases of viral haemorrhagic fever in industrialized countries. In recent years an increasing number of outbreaks of filovirus infections have occurred in Africa and in 2000 5 cases of Lassa fever were brought from Sierra Leone to Europe. Therefore European physicians should consider the possibility of a viral haemorrhagic fever in an acutely ill patient just returning from Africa or South-America with fever for which there is no obvious cause. Such patients should be questioned for risk factors for viral haemorrhagic fever. Using universal precautions for handling blood and body fluids and barrier nursing techniques there is little risk that if a patient with viral haemorrhagic fever arrives in Belgium there will be secondary cases.

  12. Cortical spreading ischaemia is a novel process involved in ischaemic damage in patients with aneurysmal subarachnoid haemorrhage

    DEFF Research Database (Denmark)

    Dreier, Jens P; Major, Sebastian; Manning, Andrew

    2009-01-01

    The term cortical spreading depolarization (CSD) describes a wave of mass neuronal depolarization associated with net influx of cations and water. Clusters of prolonged CSDs were measured time-locked to progressive ischaemic damage in human cortex. CSD induces tone alterations in resistance vessels...... to tissue hypoxia. Clusters of prolonged CSDs were measured in five patients in close proximity to structural brain damage as assessed by neuroimaging. Clusters were associated with CSD-induced spreading hypoperfusions, which were significantly longer in duration (up to 144 min) than those of isolated CSDs......-invasive detection of CSD. Low-frequency vascular fluctuations (LF-VF) (f brain's resting neuronal activity. CSD provides a depolarization block of the resting activity, recorded electrophysiologically as spreading depression of high...

  13. Cerebral abscesses among Danish patients with hereditary haemorrhagic telangiectasia

    DEFF Research Database (Denmark)

    Kjeldsen, A D; Tørring, P M; Nissen, H

    2013-01-01

    Hereditary haemorrhagic telangiectasia (HHT) is a dominantly inherited disease characterized by a wide variety of clinical manifestations, including pulmonary arteriovenous malformations (PAVMs), which due to paradoxical embolization may cause cerebral abscess.......Hereditary haemorrhagic telangiectasia (HHT) is a dominantly inherited disease characterized by a wide variety of clinical manifestations, including pulmonary arteriovenous malformations (PAVMs), which due to paradoxical embolization may cause cerebral abscess....

  14. Massive Haemorrhagic Ascites and Pleural effusion: An Unusual ...

    African Journals Online (AJOL)

    The association between endometriosis and haemorrhagic (bloody) ascites is rare.Since its first description by Brews in 1954,only a few sporadic cases have been reported in the literature. We report a case of massive haemorrhagic ascites associated with right-sided pleural effussion.Therapeutic paracentesis of eight litres ...

  15. Surveillance of viral haemorrhagic fevers in Ghana: entomological ...

    African Journals Online (AJOL)

    Results: A total of 2804 households were surveyed to estimate larval indices and man-vector contacts of potential vectors of viral haemorrhagic fevers such as Yellow fever and ... variations and the dry season was identified as the high-risk period for transmission of viral haemorrhagic fevers and possible disease outbreaks.

  16. Postpartum Haemorrhage in a Secondary Level Health Care Centre ...

    African Journals Online (AJOL)

    Background: Postpartum haemorrhage [PPH] is a major cause of maternal morbidity and mortality in Nigeria. Some women are at greater risk of postpartum haemorrhage than others. Obstetric care is provided at three levels of care in Nigeria; primary, secondary and tertiary (specialist care) levels, with substantial difference ...

  17. Primary postpartum haemorrhage at the university of Port Harcourt ...

    African Journals Online (AJOL)

    Background: Postpartum haemorrhage (PPH) is a leading global cause of severe maternal morbidity and mortality. Approximately 14 million women suffer postpartum haemorrhage annually and at least 128,000 of these women bleed to death. Most of these deaths, which occur within four hours of delivery and are as a ...

  18. Henoch-Schönlein purpura with intracerebral haemorrhage in an adult patient: a case report

    Directory of Open Access Journals (Sweden)

    Karamadoukis Lazarus

    2008-06-01

    Full Text Available Abstract Introduction Henoch-Schönlein purpura is a small vessel vasculitis that affects mainly the skin, joints, gastrointestinal tract and kidneys. The central nervous system is also occasionally affected, although the majority of patients experience only mild symptoms such as headaches and behavioural changes. Intracerebral haemorrhage is a rare complication of Henoch-Schönlein purpura that so far has mainly been described in children and young adolescence. Case presentation We describe a 42-year-old man with Henoch-Schönlein purpura who developed an acute intracerebral haemorrhage that coincided with a reactivation of his vasculitis and the development of renal failure following discontinuation of steroids. In this patient, both the Henoch-Schönlein purpura and his neurological symptoms were successfully treated with intravenous cyclophosphamide and methylprednisolone, followed by a short course of oral cyclophosphamide and long-term oral prednisolone. His renal function also recovered sufficiently not to require renal replacement therapy. Conclusion The management of Henoch-Schönlein nephritis remains unclear, especially in the presence of severe complications such as intracerebral haemorrhage. We describe a successful outcome in such a patient.

  19. Serial CT and MRI of ischaemic cerebral infarcts: frequency and clinical impact of haemorrhagic transformation

    Energy Technology Data Exchange (ETDEWEB)

    Mayer, T.E.; Brueckmann, H. [Muenchen Univ. (Germany). Abt. fuer Neuroradiologie; Schulte-Altedorneburg, G. [Dept. of Radiology/Neuroradiology, University Medical School of Luebeck (Germany); Droste, D.W. [Dept. of Neurology, University Medical School of Luebeck (Germany)

    2000-04-01

    The frequency, predisposing factors and clinical consequences of haemorrhagic infarcts and damaged blood-brain barrier as shown by contrast enhancement (CE) in ischaemic cerebral infarcts are controversial. We prospectively compared the sensitivity of CT and MRI to haemorrhagic transformation (HT) and CE. We also wished to investigate the clinical significance of HT and factors possibly associated with it. We studied 36 patients with acute ischaemic infarcts in the middle cerebral artery territory during the first 2 weeks after the ictus. After CT and rating of the neurological deficit on admission, serial examinations with clinical neuromonitoring, contrast-enhanced CT and MRI were done on the same day. The occurrence and severity of HT were correlated with CE, stroke mechanism, infarct size, development of neurological deficits and antithrombotic treatment. The frequency of HT detected by MRI was 80 %. CE usually preceded HT or was seen simultaneously. MRI had a higher sensitivity than CT to HT and CE. Severity of HT was positively correlated with infarct size (P < 0.01). HT had no influence on patient's neurological status. Neither the type of antithrombotic treatment nor the stroke mechanism was associated with the severity of HT. No parenchymal haemorrhage occurred. (orig.)

  20. Molecular diagnosis of Haemorrhagic Septicaemia - A Review

    Directory of Open Access Journals (Sweden)

    Ranjan Rajeev

    2011-08-01

    Full Text Available Pasteurella multocida is associated with hemorrhagic septicaemia in cattle and buffaloes, pneumonic pasteurellosis in sheep and goats, fowl cholera in poultry, atrophic rhinitis in pigs and snuffles in rabbits. Haemorrhagic septicaemia is caused by Pasteurella multocida type B:2, B:2,5 and B:5 in Asian countries and type E:2 in African countries. Pasteurella multocida have five types of capsular serotype i.e. type A, B, D, E and F. Diagnosis of the disease is mainly based on the clinical sign and symptom, post mortem findings. Confirmatory diagnosis is done by isolation and identification of causative agent. A variety of laboratory diagnostic techniques have been developed over the years for pasteurellosis and used routinely in the laboratory. Among these techniques molecular techniques of diagnosis is most important. This technique not only gives diagnosis but it also provides information regarding capsular type of Pasteurella multocida. Techniques which are used for molecular diagnosis of haemorrhagic septicaemia are PCR based diagnosis, Restriction endonuclease analysis (REA, Ribotyping, Colony hybridization assay, Filled alternation gel electrophoresis (FAGE, Detection of Pasteurella multocida by Real Time PCR. Among these techniques real time PCR is most sensitive and specific. [Vet. World 2011; 4(4.000: 189-192

  1. Olivary degeneration after cerebellar or brain stem haemorrhage: MRI

    Energy Technology Data Exchange (ETDEWEB)

    Uchino, A. (Dept. of Radiology, Kyushu Univ. Hospital, Fukuoka (Japan) Dept. of Radiology, Kyushu Rosai Hospital, Kitakyushu (Japan)); Hasuo, K. (Dept. of Radiology, Kyushu Univ. Hospital, Fukuoka (Japan)); Uchida, K. (Dept. of Radiology, Kyushu Rosai Hospital, Kitakyushu (Japan)); Matsumoto, S. (Dept. of Radiology, Kyushu Univ. Hospital, Fukuoka (Japan)); Tsukamoto, Y. (Dept. of Radiology, Kyushu Rosai Hospital, Kitakyushu (Japan)); Ohno, M. (Dept. of Radiology, Kyushu Rosai Hospital, Kitakyushu (Japan)); Masuda, K. (Dept. of Radiology, Kyushu Univ. Hospital, Fukuoka (Japan))

    1993-05-01

    Magnetic resonance (MR) images of seven patients with olivary degeneration caused by cerebellar or brain stem haemorrhages were reviewed. In four patients with cerebellar haemorrhage, old haematomas were identified as being located in the dentate nucleus; the contralateral inferior olivary nuclei were hyperintense on proton-density- and T2-weighted images. In two patients with pontine haemorrhages, the old haematomas were in the tegmentum and the ipsilateral inferior olivary nuclei, which were hyperintense. In one case of midbrain haemorrhage, the inferior olivary nuclei were hyperintense bilaterally. The briefest interval from the ictus to MRI was 2 months. Hypertrophic olivary nuclei were observed only at least 4 months after the ictus. Olivary degeneration after cerebellar or brain stem haemorrhage should not be confused with ischaemic, neoplastic, or other primary pathological conditions of the medulla. (orig.)

  2. [Subarachnoid hemorrhage: epidemiology, social impact and a multidisciplinary approach].

    Science.gov (United States)

    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.

  3. [Terson syndrome: a frequently missed ophthalmologic complication in subarachnoid hemorrhage].

    Science.gov (United States)

    Wiethölter, S; Steube, D; Stotz, H P

    1998-01-01

    The syndrome of intra-vitreous bleeding in association with subarachnoid hemorrhage (SAH) was first described by the French ophthalmologist Albert Terson. In the last 10 years, 31 articles describing 202 cases of Terson's syndrome (TS) were published. Only 3 out of the 31 were printed in non-ophthalmological journals. The findings of our prospective study underline the fact that too little attention is paid to TS in the early treatment of patients with SAH. Between 1/95 and 8/97, 89 patients with spontaneous SAH (7% of all admissions) were transferred to our hospital for post acute phase rehabilitation. Out of these, 13 patients (19 eyes) could be diagnosed with TS. This corresponds to an incidence of 14.6% of all patients with SAH (previous studies: 2-27%). However, only one patient had been correctly diagnosed with TS in the referring clinic. Early recognition of TS is of high importance since diminuation of visual acuity even to functional blindness, complicated in the bilateral case, can hamper the rehabilitative process considerably. Moreover, complications can lead to significant and irreversible damage, i.e. proliferative vitreo-retinopathy (PVR), retinal breaks, traction amotio, and cataract. Suspicion of TS is raised in either cooperative patients complaining of compromised visual acuity or in patients where funduscopy shows vitreous opacity. According to our results, visual evoked potentials (VEP) have only a limited role in diagnosis because of their low sensitivity. Not infrequently, however, VEP may point to accompanying optic nerve atrophy, thereby suggesting conservative treatment. Absolute indications for surgical interventions are PVR and its sequelae; relative indications are subjective visual impairment, impediment of rehabilitation, or lack of spontaneous resorption of the hemorrhage. The surgical procedure of choice is the pars plana vitrectomy (PPV). Rare complications of this operation are retinal damage, endophthalmitis, and reoccurrence of

  4. Urotensinergic system genes in experimental subarachnoid hemorrhage.

    Science.gov (United States)

    Muñoz-Sánchez, M Á; Rodríguez-Rodríguez, A; Egea-Guerrero, J J; Gordillo-Escobar, E; Vilches-Arenas, Á; Carrillo-Vico, A; Guerrero, J M; Murillo-Cabezas, F

    2017-01-09

    Cerebral vasospasm, one of the main complications of subarachnoid hemorrhage (SAH), is characterized by arterial constriction and mainly occurs from day 4 until the second week after the event. Urotensin-II (U-II) has been described as the most potent vasoconstrictor peptide in mammals. An analysis is made of the serum U-II concentrations and mRNA expression levels of U-II, urotensin related peptide (URP) and urotensin receptor (UT) genes in an experimental murine model of SAH. An experimental study was carried out. Experimental operating room of the Biomedicine Institute of Seville (IBiS), Virgen del Rocío University Hospital (Seville, Spain). 96 Wistar rats: 74 SAH and 22 sham intervention animals. Day 1: blood sampling, followed by the percutaneous injection of 100μl saline (sham) or blood (SAH) into the subarachnoid space. Day 5: blood sampling, followed by sacrifice of the animals. Weight, early mortality, serum U-II levels, mRNA values for U-II, URP and UT. Serum U-II levels increased in the SAH group from day 1 (0.62pg/mL [IQR 0.36-1.08]) to day 5 (0.74pg/mL [IQR 0.39-1.43]) (p<0.05), though not in the sham group (0.56pg/mL [IQR 0.06-0.83] day 1; 0.37pg/mL [IQR 0.23-0.62] day 5; p=0.959). Between-group differences were found on day 5 (p<0.05). The ROC analysis showed that the day 5 serum U-II levels (AUC=0.691), URP mRNA (AUC=0.706) and UT mRNA (AUC=0.713) could discriminate between sham and SAH rats. The normal serum U-II concentration range in rats was 0.56pg/mL (IQR 0.06-0.83). The urotensinergic system is upregulated on day 5 in an experimental model of SAH. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  5. Hyperglycemia and Clinical Outcome in Aneurysmal Subarachnoid Hemorrhage A Meta-Analysis

    NARCIS (Netherlands)

    Kruyt, Nyika D.; Biessels, Geert Jan; de Haan, Rob J.; Vermeulen, Marinus; Rinkel, Gabriel J. E.; Coert, Bert; Roos, Yvo B. W. E. M.

    2009-01-01

    Background and Purpose-Hyperglycemia may worsen outcome after aneurysmal subarachnoid hemorrhage. We performed a systematic review to investigate the relation between admission hyperglycemia and outcome after aneurysmal subarachnoid hemorrhage. Methods-We included cohort studies or clinical trials

  6. Fever after aneurysmal subarachnoid hemorrhage: relation with extent of hydrocephalus and amount of extravasated blood

    NARCIS (Netherlands)

    Dorhout Mees, Sanne M.; Luitse, Merel J. A.; van den Bergh, Walter M.; Rinkel, Gabriel J. E.

    2008-01-01

    BACKGROUND AND PURPOSE: Fever after aneurysmal subarachnoid hemorrhage is associated with poor outcome. Because hydrocephalus and extravasated blood may influence thermoregulation, we determined whether these factors increase the risk for fever after subarachnoid hemorrhage. METHODS: Fever within 14

  7. Successful Resolution of Preretinal Haemorrhage with Intravitreal Ranibizumab

    Directory of Open Access Journals (Sweden)

    Baharuddin Noorlaila

    2016-01-01

    Full Text Available We would like to report two cases of preretinal haemorrhage from two different aetiology courses of bleeding being treated with intravitreal ranibizumab and its outcome. Our first case was a 39-year-old man with a diagnosis of severe aplastic anaemia that presented with bilateral premacular haemorrhages in both eyes. His right eye vision was 6/45 and it was counting finger in the left eye. He was treated with intravitreal ranibizumab once to the right eye and twice to the left eye. Right eye showed complete resolution of premacular haemorrhage and minimal residual premacular haemorrhage in the left eye at 3 months after initial presentation. Our second case was a 32-year-old healthy teacher that presented with preretinal haemorrhage at superotemporal region extending to macular area in left eye secondary to valsalva retinopathy. Her left vision was counting finger. She was treated with single intravitreal ranibizumab to the left eye. There was significant reduction of premacular haemorrhage and her left eye vision improved to 6/6 at 10 weeks after injection. Both cases had favourable outcome with intravitreal ranibizumab and can be considered as nonsurgical treatment option in treating premacular haemorrhage.

  8. The association between hypertension and traumatic intracranial haemorrhage.

    Science.gov (United States)

    Hsiao, Kuang-Yu; Lin, Leng-Chieh; Li, Wen-Cheng; Lin, Martin Hisu-Chu; Wang, Cheng-Hsien; Chen, Kai-Hua

    2015-05-01

    Control of blood pressure is considered essential in the management of trauma patients. In patients with head injuries, both hypotension and hypertension are associated with poor outcomes. The present study was undertaken to ascertain whether hypertension at emergency triage is associated with traumatic intracranial haemorrhage. From September 2012 to August 2013, data were collected prospectively for patients who presented with head injury and who received a brain CT examination at a university hospital. Factors associated with intracranial haemorrhage were identified, and logistic regression analysis was used to examine the association between hypertension at emergency department triage and traumatic brain haemorrhage. Of a total of 1457 patients enrolled in this study, 252 (17.3%) experienced traumatic intracranial haemorrhage. After controlling for factors associated with traumatic intracranial haemorrhage, an increased risk of intracranial haemorrhage following an initial brain CT scan was identified for patients presenting initially with a systolic blood pressure ≥ 180 mm Hg (odds ratio, 1.80; 95% confidence interval, 1.20-2.71, compared with those with 90-139 mm Hg). The presence of hypertension at emergency triage is associated with traumatic intracranial haemorrhage. Copyright © 2014 Elsevier Ltd. All rights reserved.

  9. Focal spinal arachnoiditis increases subarachnoid space pressure: a computational study.

    Science.gov (United States)

    Bilston, L E; Fletcher, D F; Stoodley, M A

    2006-07-01

    Enlarging fluid filled cystic cavitations form within the spinal cord in up to 28% of spinal cord injured patients. These post-traumatic syrinxes can cause neurological deterioration and current treatment results are unsatisfactory. Localized scar tissue (arachnoiditis) within the subarachnoid space at the level of injury has been suggested to be involved in the pathogenesis of syrinx formation. This study tests the hypothesis that pressure pulses in the subarachnoid space are accentuated adjacent to regions of arachnoiditis, which may drive fluid into the spinal cord and contribute to syrinx formation. An axisymmetric, cylindrical computational fluid dynamics model was developed to represent the subarachnoid space under normal physiological conditions and in the presence of arachnoiditis. Cerebrospinal fluid flow into the model was estimated from magnetic resonance imaging flow studies. Arachnoiditis was modelled as a porous obstruction in the subarachnoid space. Peak fluid pressures were higher above the obstruction than in the absence of obstruction. The peak pressures were strongly dependent on the permeability of the obstruction. Elevations in subarachnoid space pressures due to arachnoiditis may facilitate fluid flow into the spinal cord, enhancing syrinx formation. This suggests that it may be worthwhile to investigate strategies that inhibit arachnoiditis or minimize systolic pressure peaks for treating or preventing syringomyelia.

  10. Predictors of Symptomatic Cerebral Vasospasm in Spontaneous Subarachnoid Hemorrhage

    Directory of Open Access Journals (Sweden)

    Ezequiel López Espinosa

    2014-10-01

    Full Text Available Background: subarachnoid hemorrhage accounts for only 2 to 5 % of all cerebrovascular diseases; however it causes approximately 25 % of all deaths related to them. Objective: to identify the factors contributing to the prediction of symptomatic cerebral vasospasm in patients diagnosed with subarachnoid hemorrhage. Methods: a prospective longitudinal study was conducted in 73 patients aged 15 years or more with subarachnoid hemorrhage admitted to the Carlos Manuel de Céspedes Provincial General Hospital in Granma province from January 2010 through October 2011. Descriptive and inferential statistics in addition to clinical epidemiology resources were used. Results: among the patients studied, 15 developed symptomatic cerebral vasospasm (20.5 %. Closely-related factors included: advanced age, loss of consciousness at the time of onset, intracranial hypertension as major clinical syndrome, water-electrolyte imbalance and respiratory arrhythmias. Low scores on the Glasgow Coma scale and high scores on the Hunt and Hess scale and the World Federation of Neurosurgical Societies scale are related to the presence of symptomatic cerebral vasospasm in spontaneous subarachnoid hemorrhage. Conclusions: in most cases, diagnosis of vasospasm after subarachnoid hemorrhage is clinically established. Relying on clinical predictors can be useful.

  11. [Massive alveolar haemorrhage in Wegener's granulomatosis].

    Science.gov (United States)

    Valero-Roldán, J; Nuñez-Castillo, D; Fernández-Fígares, C; López-Leiva, I

    2014-01-01

    Wegener's granulomatosis is a systemic vasculitis with involvement of primary granulomatous upper and lower respiratory tract, glomerulonephritis and vasculitis of small vessels. The lung disease ranges from asymptomatic pulmonary nodules to pulmonary infiltrates and fulminant alveolar haemorrhage. The prognosis is poor due to kidney and respiratory failure, although the data are changing due to new treatments with glucocorticoids and cyclophosphamide. We report a case with severe lung disease, which after appropriate anamnesis, multiple tests, and optimal sequential action, the patient was diagnosed with Wegener's granulomatosis. This disease has a low incidence in the Emergency Department, where the patient history supported by the appropriate additional provides a diagnostic suspicion. It is important that the Emergency Department has the skills to manage the stability in these patients in order to resolve their symptoms. Copyright © 2013 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  12. Pulmonary vascular complications of hereditary haemorrhagic telangiectasia.

    Science.gov (United States)

    Circo, Sebastian; Gossage, James R

    2014-09-01

    The purpose of this study is to present the latest advances and recommendations in the diagnosis and treatment of pulmonary vascular complications associated with hereditary haemorrhagic telangiectasia (HHT): pulmonary arteriovenous malformations (PAVMs), pulmonary arterial hypertension (PAH), pulmonary hypertension associated with high output cardiac failure or liver vascular malformations, haemoptysis, haemothorax and thromboembolic disease. Transthoracic contrast echocardiography has been validated as a screening tool for PAVM in patients with suspected HHT. Advancements in genetic testing support its use in family members at risk as a cost-effective measure. Therapy with bevacizumab in patients with high output cardiac failure and severe liver AVMs showed promising results. PAH tends to be more aggressive in HHT type 2 patients. Patients suffering from this elusive disease should be referred to HHT specialized centres to ensure a standardized and timely approach to diagnosis and management.

  13. Copeptin as a marker for severity and prognosis of aneurysmal subarachnoid hemorrhage.

    Directory of Open Access Journals (Sweden)

    Christian Fung

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

  14. Filoviral haemorrhagic fevers: A threat to Zambia?

    Directory of Open Access Journals (Sweden)

    Katendi Changula

    2012-06-01

    Full Text Available Filoviral haemorrhagic fevers (FVHF are caused by agents belonging to Filoviridae family, Ebola and Marburg viruses. They are amongst the most lethal pathogens known to infect humans. Incidence of FVHF outbreaks are increasing, with affected number of patients on the rise. Whilst there has been no report yet of FVHF in Zambia, its proximity to Angola and Democratic Republic of Congo, which have recorded major outbreaks, as well as the open borders, increased trade and annual migration of bats between these countries, puts Zambia at present and increased risk. Previous studies have indicated bats as potential reservoir hosts for filoviruses. An increasing population with an increasing demand for resources has forced incursion into previously uninhabited land, potentially bringing them into contact with unknown pathogens, reservoir hosts and/or amplifying hosts. The recent discovery of a novel arenavirus, Lujo, highlights the potential that every region, including Zambia, has for being the epicentre or primary focus for emerging and re-emerging infections. It is therefore imperative that surveillance for potential emerging infections, such as viral haemorrhagic fevers be instituted. In order to accomplish this surveillance, rapid detection, identification and monitoring of agents in patients and potential reservoirs is needed. International co-operation is the strategy of choice for the surveillance and fight against emerging infections. Due to the extensive area in which filoviral infections can occur, a regional approach to surveillance activities is required, with regional referral centres. There is a need to adopt shared policies for the prevention and control of infectious diseases. There is also need for optimisation of currently available tests and development of new diagnostic tests, in order to have robust, highly sensitive and specific diagnostic tests that can be used even where there are inadequate laboratories and diagnostic services.

  15. Cerebral Vasospasm after Subarachnoid Hemorrhage and Tadalafil-Nimodipine Hypothesis

    Directory of Open Access Journals (Sweden)

    Rayka Sharifian

    2013-07-01

    Full Text Available Cerebral vasospasm following subarachnoid hemorrhage (SAH is a common reaction induced by multiple factors with unclear mechanisms. This complication is difficult to treat and puts patient at risk for developing a delayed ischemic neurological deficit that can lead to substantial morbidity and mortality. Although numerous strategies have been suggested for the treatment and prevention of cerebral vasospasm following SAH, no definitive effect has been concluded in this regard. In this paper, we hypothesize that phosphodiesterase-5 inhibitors, tadalafil, can be used together with nimodipine, a calcium channel blocker, to prevent vasospasm in patients with subarachnoid hemorrhage. With synergic effects, the proposed drugs can promote relaxation of smooth muscles in spastic vessels. Keywords: Cerebral vasospasm; nimodipine; phosphodiesterase-5 inhibitor; subarachnoid hemorrhage; tadalafil

  16. Terson Syndrome in Aneurysmal Subarachnoid Hemorrhage: A Case Report.

    Science.gov (United States)

    Lee, Sang-Hee; Seo, Jeong-Hwan; Park, Sung-Hee; Won, Yu Hui; Ko, Myoung-Hwan

    2015-08-01

    Terson syndrome refers to oculocerebral syndrome of retinal and vitreous hemorrhage associated with spontaneous subarachnoid hemorrhage or all forms of intracranial bleeding. Recent observations have indicated that patients with spontaneous subarachnoid hemorrhage have an 18% to 20% concurrent incidence of retinal and vitreous hemorrhages with about 4% incidence of vitreous hemorrhage alone. Clinical ophthalmologic findings may have significant diagnostic and prognostic value for clinicians. Here we report a 45-year-old female patient who suffered from blurred vision after subarachnoid hemorrhage. She was diagnosed as Terson syndrome. After vitrectomy, she recovered with normal visual acuity which facilitated the rehabilitative process. We also performed visual evoked potentials to investigate abnormalities of visual dysfunction. Based on this case, we emphasize the importance of early diagnosis of Terson syndrome.

  17. Subarachnoid hemosiderin deposition after subarachnoid hemorrhage on T2*-weighted MRI correlates with the location of disturbed cerebrospinal fluid flow on computed tomography cisternography.

    Science.gov (United States)

    Horita, Yoshifumi; Imaizumi, Toshio; Hashimoto, Yuji; Niwa, Jun

    2008-01-01

    A 72-year-old male was admitted with subarachnoid hemorrhage associated with a ruptured cerebral aneurysm. The aneurysm was treated with clipping soon after radiological examination. Eight weeks after the treatment, the patient suffered from secondary hydrocephalus resulting from blockage of the subarachnoid space due to subarachnoid granulation. Previous pathological examination revealed the granulation was associated with hemosiderin deposition. We investigated subarachnoid hemosiderin deposition in this patient using T2*-weighted (T2*-w) magnetic resonance image (MRI), a sensitive method for hemosiderin detection. computed tomography (CT) cisternography demonstrated that cerebrospinal fluid (CSF) flow was disturbed adjacent to sites of subarachnoid hemosiderin deposition on T2*-w MRI. Placement of a ventriculo-peritoneal shunt contributed to neurological improvement. In this case, T2*-w MRI was an effective means of diagnosing the location of disturbed CSF flow associated with subarachnoid hemosiderin deposition.

  18. Course of Participation after Subarachnoid Hemorrhage.

    Science.gov (United States)

    Kruisheer, Elize M; Huenges Wajer, Irene M C; Visser-Meily, Johanna M A; Post, Marcel W M

    2017-05-01

    The study aimed to investigate participation problems in patients with subarachnoid hemorrhage (SAH), and the course of participation between 3 and 12 months post-SAH, and to identify determinants of this course. This is a prospective cohort study. The study was done in the SAH outpatient clinic at the University Medical Center Utrecht. Subjects included patients independent in activities of daily living who visited the SAH outpatient clinic for a routine follow-up visit 3 months after the event. Participation was assessed using the restrictions scale of the Utrecht Scale for Evaluation of Rehabilitation-Participation at 3, 6, and 12 months post-SAH. Repeated measures analysis of variance was conducted to identify possible determinants of participation (demographic and SAH characteristics, mood, and cognition). One hundred patients were included. Three months after SAH, the most commonly reported restrictions concerned work/unpaid work/education (70.5%), housekeeping (50.0%), and going out (45.2%). Twelve months post-SAH, patients felt most restricted in work/unpaid work/education (24.5%), housekeeping (23.5%), and chores in and around the house (16.3%). Participation scores increased significantly between 3 and 6 months, and between 3 and 12 months, post-SAH. The course of participation was associated with mood, cognition, and gender, but was in the multivariate analysis only determined by mood (F [1, 74] = 18.31, P = .000, partial eta squared: .20), showing lower participation scores at each time point for patients with mood disturbance. Participation in functionally independent SAH patients improved over time. However, 1 out of 3 patients (34.9%) still reported one or more participation restrictions 12 months post-SAH. Mood disturbance was negatively associated with the course of participation after SAH. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  19. Diagnosis and Management of Subarachnoid Hemorrhage.

    Science.gov (United States)

    Suarez, Jose I

    2015-10-01

    The purpose of this article is to present the epidemiology, clinical presentation, and management of patients with subarachnoid hemorrhage (SAH). SAH is a neurologic emergency that carries high morbidity and mortality. Patients with SAH are at risk for several significant neurologic complications, including hydrocephalus, cerebral edema, delayed cerebral ischemia, rebleeding, seizures, and neuroendocrine abnormalities that lead to impaired body regulation of sodium, water, and glucose. The incidence of SAH has remained stable, but mortality of hospitalized patients has significantly declined over the past 3 decades. Many common therapies for SAH have created controversy, and various recent neuroprotective clinical trials have produced negative results. However, the publication of two consensus guidelines by the American Heart Association/American Stroke Association and the Neurocritical Care Society have provided a clarification for what should constitute best practice for patients with SAH. The most important of those recommendations include the following: admission of patients to high-volume centers (defined as more than 35 patients with SAH per year) under the management of a specialized and multidisciplinary team; early identification and management of the bleeding source; evaluation and treatment decision for unsecured aneurysms by a multidisciplinary team made up of cerebrovascular neurosurgeons, endovascular practitioners, and neurointensivists; management of patients in the neurocritical care unit with oral nimodipine, blood pressure control, euvolemia, and frequent monitoring for neurologic and systemic complications; and delayed cerebral ischemia secondary to cerebral vasospasm should be treated with induced hypertension and endovascular therapies once confirmed. SAH is a devastating neurologic disease. Management of patients with SAH should adhere to currently available treatment guidelines. Several aspects of SAH management remain controversial and need

  20. Diffuse infiltrating retinoblastoma invading subarachnoid space

    Directory of Open Access Journals (Sweden)

    Kase S

    2011-06-01

    .Keywords: diffuse infiltrating retinoblastoma, subarachnoid space, optic nerve

  1. Neonatal bilateral diaphragmatic paralysis caused by brain stem haemorrhage.

    OpenAIRE

    Blazer, S; Hemli, J A; Sujov, P O; Braun, J.

    1989-01-01

    We describe a neonate with severe bilateral diaphragmatic paralysis caused by haemorrhage in the lower brain stem. To our knowledge this association has not been previously reported in the English medical literature.

  2. Marburg haemorrhagic fever: A rare but fatal disease

    African Journals Online (AJOL)

    47(4): 21). Introduction. Marburg haemorrhagic fever was initially detected in 1967 following simultaneous outbreaks in Marburg and Frankfurt,. Germany and Belgrade (former Yugoslavia). The outbreaks occurred in laboratory workers handling ...

  3. Clinical relevance of cortical spreading depression in neurological disorders: migraine, malignant stroke, subarachnoid and intracranial hemorrhage, and traumatic brain injury

    DEFF Research Database (Denmark)

    Lauritzen, Martin; Dreier, Jens Peter; Fabricius, Martin

    2011-01-01

    Cortical spreading depression (CSD) and depolarization waves are associated with dramatic failure of brain ion homeostasis, efflux of excitatory amino acids from nerve cells, increased energy metabolism and changes in cerebral blood flow (CBF). There is strong clinical and experimental evidence...... treatment strategies, which may be used to prevent or attenuate secondary neuronal damage in acutely injured human brain cortex caused by depolarization waves....... to suggest that CSD is involved in the mechanism of migraine, stroke, subarachnoid hemorrhage and traumatic brain injury. The implications of these findings are widespread and suggest that intrinsic brain mechanisms have the potential to worsen the outcome of cerebrovascular episodes or brain trauma...

  4. Volemic Resuscitation in a Patient with Multiple Traumas and Haemorrhagic Shock. Anti-oxidative Therapy Management in Critical Patients. A Case Report

    Directory of Open Access Journals (Sweden)

    Bedreag Ovidiu Horea

    2016-03-01

    Full Text Available A patient with multiple traumas is usually found in severe haemorrhagic shock. In 40% of the cases, the patient with multiple traumas and haemorrhagic shock cannot recover due to secondary injuries and complications associated with the shock. In this paper we present the case of a male patient 30 years old, who suffered a car accident. The patient is admitted in our hospital with haemorrhagic shock due to femur fracture, acute cranial-cerebral trauma and severe thoracic trauma with bleeding scalp wound, associated with lethal triad of trauma. The clinical and biological parameters demand massive transfusion with packed red blood cells (PRBCs, fresh frozen plasma (FFP, cryoprecipitate (CRY and colloidal solution (CO sustained with vassopresor for the haemodynamic stabilisation. During his stay in the ICU, the patient benefits from anti-oxidative therapy with Vitamin C, Vitamin E and Vitamin B1. After 14 days the clinical state of the patient improves and he is transferred in Polytrauma Department.

  5. Nimodipine in aneurysmal subarachnoid hemorrhage: a randomized study of intravenous or peroral administration

    DEFF Research Database (Denmark)

    Kronvall, Erik; Undrén, Per; Rommer, Bertil Roland

    2009-01-01

    OBJECT: The calcium antagonist nimodipine has been shown to reduce the incidence of ischemic complications following aneurysmal subarachnoid hemorrhage (SAH). Although most randomized studies have been focused on the effect of the peroral administration of nimodipine, intravenous infusion...... is an alternative and the preferred mode of treatment in many centers. It is unknown whether the route of administration is of any importance for the clinical efficacy of the drug. METHODS: One hundred six patients with acute aneurysmal SAH were randomized to receive either peroral or intravenous nimodipine...... of patients with new infarctions on MR imaging. CONCLUSIONS: The results suggest that there is no clinically relevant difference in efficacy between peroral and intravenous administration of nimodipine in preventing DINDs or cerebral vasospasm following SAH....

  6. Dementia risk after spontaneous intracerebral haemorrhage: a prospective cohort study.

    Science.gov (United States)

    Moulin, Solène; Labreuche, Julien; Bombois, Stéphanie; Rossi, Costanza; Boulouis, Gregoire; Hénon, Hilde; Duhamel, Alain; Leys, Didier; Cordonnier, Charlotte

    2016-07-01

    Dementia occurs in at least 10% of patients within 1 year after stroke. However, the risk of dementia after spontaneous intracerebral haemorrhage that accounts for about 15% of all strokes has not been investigated in prospective studies. We aimed to determine the incidence of dementia and risk factors after an intracerebral haemorrhage. We did a prospective observational cohort study in patients with spontaneous intracerebral haemorrhage from the Prognosis of Intracerebral Haemorrhage (PITCH) cohort who were admitted to Lille University Hospital, Lille, France. We included patients aged 18 years and older with parenchymal haemorrhage on the first CT scan. Exclusion criteria were pure intraventricular haemorrhage; intracerebral haemorrhage resulting from intracranial vascular malformation, intracranial venous thrombosis, head trauma, or tumour; haemorrhagic transformation within an infarct; and referral from other hospitals. Median follow-up was 6 years. We studied risk factors (clinical and neuroradiological [MRI] biomarkers) of new-onset dementia as per a prespecified subgroup analysis, according to intracerebral haemorrhage location. Dementia diagnosis was based on the National Institute on Aging-Alzheimer's Association criteria for all-cause dementia. We did multivariable analyses using competing risk analyses, with death during follow-up as a competing event. From the 560 patients with spontaneous intracerebral haemorrhage enrolled in the PITCH cohort between Nov 3, 2004 and March 29, 2009, we included 218 patients (median age 67·5 years) without pre-existing dementia who were alive at 6 months follow-up. 63 patients developed new-onset dementia leading to an incidence rate of 14·2% (95% CI 10·0-19·3) at 1 year after intracerebral haemorrhage, and incidence reached 28·3% (22·4-34·5) at 4 years. The incidence of new-onset dementia was more than two times higher in patients with lobar intracerebral haemorrhage (incidence at 1 year 23·4%, 14·6-33·3

  7. MRI demonstration of subarachnoid neurocysticercosis simulating metastatic disease

    Energy Technology Data Exchange (ETDEWEB)

    Lau, K.Y.; Roebuck, D.J.; Metreweli, C. [Dept. of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, Shatin NT (Hong Kong); Mok, V.; Kay, R. [Dept. of Neurology, Prince of Wales Hospital, Shatin, NT (Hong Kong); Ng, H.K.; Teo, J.G.C. [Dept. of Anatomical and Cellular Pathology, Prince of Wales Hospital, Shatin, NT (Hong Kong); Lam, J.; Poon, W. [Dept. of Neurosurgery, Prince of Wales Hospital, Shatin, NT (Hong Kong)

    1998-11-01

    We present a patient with neurocysticercosis with spinal subarachnoid spread who presented with lower back pain and progressive numbness and weakness of the left leg. MRI of the spine simulated metastasis. MRI of the brain demonstrated a ``bunch of grapes`` appearance in the basal cisterns, characteristic of cysticercosis. (orig.) With 2 figs., 17 refs.

  8. Subarachnoid hemorrhage: risks of aneurysm rupture and delayed cerebral ischemia

    NARCIS (Netherlands)

    de Rooij, N.K.

    2013-01-01

    Three percent of the population harbors an intracranial aneurysm. A minority of these aneurysms will rupture and cause a subarachnoid hemorrhage (SAH). SAH is a devastating disease with high case fatality and morbidity. A major contributor to the poor outcome after SAH is delayed cerebral ischemia

  9. The effects of treating hypertension following aneurysmal subarachnoid hemorrhage

    NARCIS (Netherlands)

    Wijdicks, E. F.; Vermeulen, M.; Murray, G. D.; Hijdra, A.; van Gijn, J.

    1990-01-01

    We investigated in a consecutive series of 134 patients with aneurysmal subarachnoid hemorrhage whether institution of antihypertensive treatment was related to the incidence of cerebral ischemia and rebleeding. The aim of hypertensive treatment was to reduce the diastolic blood pressure to levels

  10. Subarachnoid hemorrhage: long-term consequences & stem cell treatment

    NARCIS (Netherlands)

    Kooijman, E.

    2014-01-01

    Subarachnoid hemorrhage (SAH) represents a considerable health problem that strikes patients at a relatively young age. At present, limited options are available to treat the devastating consequences of SAH. The endovascular puncture model is a suitable animal model to study the pathophysiological

  11. Aneurysmal Subarachnoid Hemorrhage and Neuroinflammation: A Comprehensive Review

    Directory of Open Access Journals (Sweden)

    Brandon P. Lucke-Wold

    2016-04-01

    Full Text Available Aneurysmal subarachnoid hemorrhage (SAH can lead to devastating outcomes including vasospasm, cognitive decline, and even death. Currently, treatment options are limited for this potentially life threatening injury. Recent evidence suggests that neuroinflammation plays a critical role in injury expansion and brain damage. Red blood cell breakdown products can lead to the release of inflammatory cytokines that trigger vasospasm and tissue injury. Preclinical models have been used successfully to improve understanding about neuroinflammation following aneurysmal rupture. The focus of this review is to provide an overview of how neuroinflammation relates to secondary outcomes such as vasospasm after aneurysmal rupture and to critically discuss pharmaceutical agents that warrant further investigation for the treatment of subarachnoid hemorrhage. We provide a concise overview of the neuroinflammatory pathways that are upregulated following aneurysmal rupture and how these pathways correlate to long-term outcomes. Treatment of aneurysm rupture is limited and few pharmaceutical drugs are available. Through improved understanding of biochemical mechanisms of injury, novel treatment solutions are being developed that target neuroinflammation. In the final sections of this review, we highlight a few of these novel treatment approaches and emphasize why targeting neuroinflammation following aneurysmal subarachnoid hemorrhage may improve patient care. We encourage ongoing research into the pathophysiology of aneurysmal subarachnoid hemorrhage, especially in regards to neuroinflammatory cascades and the translation to randomized clinical trials.

  12. Dabigatran ameliorates post-haemorrhagic hydrocephalus development after germinal matrix haemorrhage in neonatal rat pups.

    Science.gov (United States)

    Klebe, Damon; Flores, Jerry J; McBride, Devin W; Krafft, Paul R; Rolland, William B; Lekic, Tim; Zhang, John H

    2017-09-01

    We aim to determine if direct thrombin inhibition by dabigatran will improve long-term brain morphological and neurofunctional outcomes and if potential therapeutic effects are dependent upon reduced PAR-1 stimulation and consequent mTOR activation. Germinal matrix haemorrhage was induced by stereotaxically injecting 0.3 U type VII-S collagenase into the germinal matrix of P7 rat pups. Animals were divided into five groups: sham, vehicle (5% DMSO), dabigatran intraperitoneal, dabigatran intraperitoneal + TFLLR-NH2 (PAR-1 agonist) intranasal, SCH79797 (PAR-1 antagonist) intraperitoneal, and dabigatran intranasal. Neurofunctional outcomes were determined by Morris water maze, rotarod, and foot fault evaluations at three weeks. Brain morphological outcomes were determined by histological Nissl staining at four weeks. Expression levels of p-mTOR/p-p70s6k at three days and vitronectin/fibronectin at 28 days were quantified. Intranasal and intraperitoneal dabigatran promoted long-term neurofunctional recovery, improved brain morphological outcomes, and reduced intracranial pressure at four weeks after GMH. PAR-1 stimulation tended to reverse dabigatran's effects on post-haemorrhagic hydrocephalus development. Dabigatran also reduced expression of short-term p-mTOR and long-term extracellular matrix proteins, which tended to be reversed by PAR-1 agonist co-administration. PAR-1 inhibition alone, however, did not achieve the same therapeutic effects as dabigatran administration.

  13. Proteomic Expression Changes in Large Cerebral Arteries After Experimental Subarachnoid Hemorrhage in Rat Are Regulated by the MEK-ERK1/2 Pathway

    DEFF Research Database (Denmark)

    Müller, Anne H; Edwards, Alistair V G; Larsen, Martin R

    2017-01-01

    Subarachnoid hemorrhage (SAH) is a serious clinical condition where leakage of blood into the subarachnoid space causes an acute rise in intracranial pressure and reduces cerebral blood flow, which may lead to delayed cerebral ischemia and poor outcome. In experimental SAH, we have previously shown...... that the outcome can be significantly improved by early inhibition of the MAPK/ERK kinase/extracellular signal-regulated kinase (MEK/ERK1/2) pathway. The aim of this study was to apply mass spectrometry to investigate the overall late effects of experimental SAH on cerebrovascular protein expression. SAH...... was induced in rats that were treated with the MEK1/2 inhibitor U0126 or vehicle. Neurological outcome was assessed using a battery of behavioral tests. Specific protein expression of large cerebral arteries was analyzed quantitatively with high-throughput tandem mass spectrometry. SAH resulted in a marked...

  14. Nosocomial outbreak of Crimean-Congo haemorrhagic fever.

    Science.gov (United States)

    Naderi, H R; Sarvghad, M R; Bojdy, A; Hadizadeh, M R; Sadeghi, R; Sheybani, F

    2011-06-01

    We report a nosocomial outbreak of Crimean-Congo haemorrhagic fever (CCHF) that affected six patients in June 2009 in Ghaem Hospital, Mashhad, Iran, apparently related to one index case. The last four cases were healthcare workers. Infection was spread by percutaneous exposure to two cases, and probably by direct contact with blood, clothes and sheets, to three others. The diagnosis in the two fatal cases was not confirmed virologically. The diagnosis in four cases who survived was confirmed by specific reverse transcription polymerase chain reaction. The patients were treated with ribavirin. In endemic areas, every patient presenting with a febrile haemorrhagic syndrome should be considered to have a viral haemorrhagic fever until proven otherwise. Patients who meet the criteria for probable CCHF should be admitted to hospital and treated with ribavirin. Appropriate isolation precautions should be immediately initiated.

  15. Bilateral adrenal haemorrhage secondary to intra-abdominal sepsis: a case report.

    LENUS (Irish Health Repository)

    Egan, Aoife M

    2012-01-31

    INTRODUCTION: Bilateral adrenal haemorrhage is a rare cause of adrenal failure. Clinical features are non-specific and therefore a high index of suspicion must be maintained in patients at risk. Predisposing factors include infection, malignancy and the post-operative state. CASE PRESENTATION: We report the case of a patient who underwent a left hemicolectomy with primary anastomosis and formation of a defunctioning loop ileostomy for an obstructing colon carcinoma at the splenic flexure. En-bloc splenectomy was performed to ensure an oncologic resection. The patient developed a purulent abdominal collection post-operatively and became septic with hypotension and pyrexia. This precipitated acute bilateral adrenal haemorrhage with consequent adrenal insufficiency. Clinical suspicion was confirmed by radiological findings and a co-syntropin test. Following drainage of the collection, antibiotic therapy and corticosteroid replacement, the patient made an excellent recovery. CONCLUSION: This case highlights the importance of prompt diagnosis and treatment of adrenal failure. In their absence, this condition can rapidly lead to death of the patient.

  16. Incomplete cauda equina syndrome secondary to haemorrhage within a Tarlov cyst.

    Science.gov (United States)

    Yates, Joseph R; Jones, Conor S; Stokes, Oliver M; Hutton, Michael

    2017-08-07

    Sacral perineural (Tarlov) cysts are benign, cerebrospinal fluid containing lesions of the spinal nerve root sheath. They are usually asymptomatic; however, a small proportion have the potential to cause compression of nerve roots and/or the cauda equina.We report a case of a 61-year-old man who presented with acute onset back pain associated with bilateral radiculopathy. Between referral and consultation, the patient developed urinary dysfunction which resolved spontaneously.MRI revealed haemorrhage within a Tarlov cyst, resulting in compression of the cauda equina. Due to the considerable clinical improvement at the time of consultation, surgical decompression of the cyst was not considered to be indicated.An interval MRI scan 8 weeks later demonstrated that the haemorrhage within the perineural cyst had spontaneously resolved and the patient remained asymptomatic at 5-year follow-up. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  17. Long-lived CD8+ T cell responses following Crimean-Congo haemorrhagic fever virus infection.

    Science.gov (United States)

    Goedhals, Dominique; Paweska, Janusz T; Burt, Felicity J

    2017-12-01

    Crimean-Congo haemorrhagic fever virus (CCHFV) is a member of the Orthonairovirus genus of the Nairoviridae family and is associated with haemorrhagic fever in humans. Although T lymphocyte responses are known to play a role in protection from and clearance of viral infections, specific T cell epitopes have yet to be identified for CCHFV following infection. A panel of overlapping peptides covering the CCHFV nucleoprotein and the structural glycoproteins, GN and GC, were screened by ELISpot assay to detect interferon gamma (IFN-γ) production in vitro by peripheral blood mononuclear cells from eleven survivors with previous laboratory confirmed CCHFV infection. Reactive peptides were located predominantly on the nucleoprotein, with only one survivor reacting to two peptides from the glycoprotein GC. No single epitope was immunodominant, however all but one survivor showed reactivity to at least one T cell epitope. The responses were present at high frequency and detectable several years after the acute infection despite the absence of continued antigenic stimulation. T cell depletion studies confirmed that IFN-γ production as detected using the ELISpot assay was mediated chiefly by CD8+ T cells. This is the first description of CD8+ T cell epitopic regions for CCHFV and provides confirmation of long-lived T cell responses in survivors of CCHFV infection.

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

    NARCIS (Netherlands)

    Altenstadt, J.F.V.A.; Hukkelhoven, C.W.P.M.; van Roosmalen, J.; Bloemenkamp, K.W.M.

    2013-01-01

    Background: Postpartum haemorrhage is a leading cause of maternal morbidity and mortality worldwide. Identifying risk indicators for postpartum haemorrhage is crucial to predict this life threatening condition. Another major contributor to maternal morbidity and mortality is pre-eclampsia. Previous

  19. Intracranial hypotension caused by cisternal irrigation for vasospasm after subarachnoid hemorrhage: a case report

    OpenAIRE

    Ishida, Atsushi; Matsuo, Seigo

    2014-01-01

    Introduction Vasospasm is the most common cause of complication after a subarachnoid hemorrhage and tremendous efforts have been made to prevent it. A subarachnoid clot is the cause of the vasospasm and dissolving and washing it out is considered to be the best practice. Cisternal irrigation with urokinase and ascorbic acid has been widely used due to its proven effect. Case presentation A 60-year-old Japanese male presented with a severe headache was diagnosed with a subarachnoid hemorrhage ...

  20. Surfactant for pulmonary haemorrhage in neonates.

    Science.gov (United States)

    Aziz, Abdul; Ohlsson, Arne

    2012-07-11

    In the 1960s and 1970s, pulmonary haemorrhage (PH) occurred mainly in full-term infants with pre-existing illness with an incidence of 1.3 per 1000 live births. Risk factors for PH included severity of illness, intrauterine growth restriction, patent ductus arteriosus (PDA), coagulopathy and the need for assisted ventilation. Presently, PH occurs in 3% to 5% of preterm ventilated infants with severe respiratory distress syndrome (RDS) who often have a PDA and have received surfactant. The cause of PH is thought to be due to rapid lowering of intrapulmonary pressure, which facilitates left to right shunting across a PDA and an increase in pulmonary blood flow. Retrospective case reports and one prospective uncontrolled study have shown promising results for surfactant in treating PH. To evaluate the effect of surfactant treatment compared to placebo or no intervention on mortality and morbidities in neonates with PH. For this update The Cochrane Library, Issue 2, 2012; MEDLINE; EMBASE; CINAHL; Clinicaltrials.gov; Controlled-trials.com; proceedings (2000 to 2011) of the Annual Meetings of the Pediatric Academic Societies (Abstracts2View) and Web of Science were searched on 8 February 2012. Randomised or quasi-randomised controlled trials that evaluated the effect of surfactant in the treatment of PH in intubated term or preterm (neonates with PH. Infants were included up to 44 weeks' postmenstrual age. The interventions studied were intratracheal instillation of surfactant (natural or synthetic, regardless of dose) versus placebo or no intervention. If studies were identified by the literature search, the planned analyses included risk ratio, risk difference, number needed to treat to benefit or to harm for dichotomous outcomes, and mean difference for continuous outcomes, with their 95% confidence intervals. A fixed-effect model would be used for meta-analyses. The risk of bias for included trials would be assessed. Heterogeneity tests, including the I(2) statistic

  1. Regulatory T cells ameliorate tissue plasminogen activator-induced brain haemorrhage after stroke.

    Science.gov (United States)

    Mao, Leilei; Li, Peiying; Zhu, Wen; Cai, Wei; Liu, Zongjian; Wang, Yanling; Luo, Wenli; Stetler, Ruth A; Leak, Rehana K; Yu, Weifeng; Gao, Yanqin; Chen, Jun; Chen, Gang; Hu, Xiaoming

    2017-07-01

    Delayed thrombolytic treatment with recombinant tissue plasminogen activator (tPA) may exacerbate blood-brain barrier breakdown after ischaemic stroke and lead to lethal haemorrhagic transformation. The immune system is a dynamic modulator of stroke response, and excessive immune cell accumulation in the cerebral vasculature is associated with compromised integrity of the blood-brain barrier. We previously reported that regulatory T cells, which function to suppress excessive immune responses, ameliorated blood-brain barrier damage after cerebral ischaemia. This study assessed the impact of regulatory T cells in the context of tPA-induced brain haemorrhage and investigated the underlying mechanisms of action. The number of circulating regulatory T cells in stroke patients was dramatically reduced soon after stroke onset (84 acute ischaemic stroke patients with or without intravenous tPA treatment, compared to 115 age and gender-matched healthy controls). Although stroke patients without tPA treatment gradually repopulated the numbers of circulating regulatory T cells within the first 7 days after stroke, post-ischaemic tPA treatment led to sustained suppression of regulatory T cells in the blood. We then used the murine suture and embolic middle cerebral artery occlusion models of stroke to investigate the therapeutic potential of adoptive regulatory T cell transfer against tPA-induced haemorrhagic transformation. Delayed administration of tPA (10 mg/kg) resulted in haemorrhagic transformation in the ischaemic territory 1 day after ischaemia. When regulatory T cells (2 × 106/mouse) were intravenously administered immediately after delayed tPA treatment in ischaemic mice, haemorrhagic transformation was significantly decreased, and this was associated with improved sensorimotor functions. Blood-brain barrier disruption and tight junction damages were observed in the presence of delayed tPA after stroke, but were mitigated by regulatory T cell transfer. Mechanistic

  2. Perforated ileal duplication cyst with haemorrhagic pseudocyst formation

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Im Kyung; Kim, Bong Soo; Kim, Heung Chul; Lee, In Sun; Hwang, Woo Chul [Department of Radiology, College of Medicine, Hallym University (Korea); Namkung, Sook [Department of Radiology, College of Medicine, Hallym University (Korea); Department of Radiology, Chuncheon Sacred Heart Hospital, 153 Kyo-dong, Chuncheon, Kangwon-do, 200-704 (Korea)

    2003-07-01

    Duplication cysts of the gastrointestinal tract are rare congenital abnormalities. Ectopic gastric mucosa, which can be found in duplications, may cause peptic ulceration, gastrointestinal bleeding or perforation. We report a 1-year-old boy with a perforated ileal duplication cyst with haemorrhagic pseudocyst formation caused by peptic ulceration of the duplication cyst. It presented a snowman-like appearance consisting of a small, thick-walled, true enteric cyst and a large, thin-walled haemorrhagic pseudocyst on US and CT. It is an unusual manifestation of a duplication cyst, which has not been reported in the English language literature. (orig.)

  3. Eradication of viral haemorrhagic septicaemia in Danish aquaculture

    DEFF Research Database (Denmark)

    Olesen, Niels Jørgen; Skall, Helle Frank; Jensen, Britt Bang

    Eradication of viral haemorrhagic septicaemia in Danish aquaculture Olesen N.J.1, Skall H.F.1, Jensen B.B.2, Henriksen N.H.3, Mellergård S.4, H. Korsholm H.5 1National Veterinary Institute, Technical University of Denmark, Aarhus, Denmark 2Norwegian Veterinary Institute, Oslo, Norway 3Danish...... Aquaculture Association, Silkeborg, Denmark 4Danish Veterinary and Food Administration, Glostrup, Denmark 5Danish Veterinary and Food Administration, Vejle, Denmark Viral haemorrhagic septicaemia (VHS) virus was first isolated in Denmark in 1962, when more than half of the approximately 800 Danish fish farms...

  4. Traumatic Haemorrhagic Cervical Lymphadenopathy with Underlying Infectious Mononucleosis

    Directory of Open Access Journals (Sweden)

    George Rahmani

    2017-01-01

    Full Text Available A 16-year-old male presented to the Emergency Department with a painful 3 × 3 cm left-sided neck swelling six hours following blunt trauma to the neck from a heavy swinging door. A CT angiogram was performed which revealed a large haemorrhagic lymph node as well as generalised cervical lymphadenopathy. The patient was eventually diagnosed with infectious mononucleosis. This case report describes a rare case of traumatic haemorrhagic cervical lymphadenopathy with an underlying diagnosis of infectious mononucleosis.

  5. [Neurologic complications of subarachnoid hemorrhage due to intracranial aneurysm rupture].

    Science.gov (United States)

    Rama-Maceiras, P; Fàbregas Julià, N; Ingelmo Ingelmo, I; Hernández-Palazón, J

    2010-12-01

    The high rates of morbidity and mortality after subarachnoid hemorrhage due to spontaneous rupture of an intracranial aneurysm are mainly the result of neurologic complications. Sixty years after cerebral vasospasm was first described, this problem remains unsolved in spite of its highly adverse effect on prognosis after aneurysmatic rupture. Treatment is somewhat empirical, given that uncertainties remain in our understanding of the pathophysiology of this vascular complication, which involves structural and biochemical changes in the endothelium and smooth muscle of vessels. Vasospasm that is refractory to treatment leads to cerebral infarction. Prophylaxis, early diagnosis, and adequate treatment of neurologic complications are key elements in the management of vasospasm if neurologic damage, lengthy hospital stays, and increased use of health care resources are to be avoided. New approaches to early treatment of cerebral lesions and cortical ischemia in cases of subarachnoid hemorrhage due to aneurysm rupture should lead to more effective, specific management.

  6. Intracranial vertebral artery dissection with subarachnoid hemorrhage following child abuse

    Energy Technology Data Exchange (ETDEWEB)

    Nguyen, Pamela H.; Burrowes, Delilah M.; Ali, Saad; Shaibani, Ali [Feinberg School of Medicine of Northwestern University, Department of Radiology, Chicago, IL (United States); Bowman, Robin M. [Feinberg School of Medicine of Northwestern University, Department of Neurological Surgery, Chicago, IL (United States)

    2007-06-15

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

  7. Intrathecal gadodiamide for identifying subarachnoid and ventricular neurocysticercosis.

    Science.gov (United States)

    Higuera-Calleja, Jesús; Góngora-Rivera, Fernando; Soto-Hernández, José Luis; Del-Brutto, Oscar H; Moreno-Andrade, Talía; Gutiérrez-Alvarado, Ramón; Rodríguez-Carbajal, Jesús

    2015-07-01

    Some neurocysticercosis cysts may remain hidden despite novel MRI sequences. This study evaluates the diagnostic value of gadodiamide (GDD)-contrasted MRI cisternography in selected cases of neurocysticercosis. We included patients aged 18-65 years with a probable diagnosis of subarachnoid cysticercosis in whom previous neuroimaging studies failed to demonstrate the presence of cysts. One millilitre of GDD was administered intrathecally as a contrast agent with subsequent performance of MRI. Fourteen patients were included. Optimal contrast diffusion was achieved in nine patients, and partial diffusion was achieved in 4. Intracranial vesicles were identified in 10 patients, with the presence of more than 60 basal subarachnoid vesicles being revealed in all, with five cysts in the fourth ventricle in four patients and a floating cyst in the lateral ventricle in one. In one case, intrathecal GDD demonstrated spinal cysticercosis. No adverse events were reported after intrathecal GDD administration. Intrathecal GDD administration is useful for the diagnosis of subarachnoid and intraventricular neurocysticercosis and can be used to improve diagnostic accuracy in selected cases. © 2015 John Wiley & Sons Ltd.

  8. Pseudarthrosis due to galvanic corrosion presenting as subarachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    Rosemary Noel Beavers

    2017-01-01

    Full Text Available Two unlike metals near one another can break down as they move toward electrochemical equilibrium resulting in galvanic corrosion. We describe a case of electrochemical corrosion resulting in pseudarthrosis, followed by instrumentation failure leading to subarachnoid hemorrhage. A 53-year-old female with a history of cervical instability and two separate prior cervical fusion surgery with sublaminar cables presented with new onset severe neck pain. Restricted range of motion in her neck and bilateral Hoffman's was noted. X-ray of her cervical spine was negative. A noncontrast CT scan of her head and neck showed subarachnoid hemorrhage in the prepontine and cervicomedullary cisterns. Neurosurgical intervention involved removal of prior stainless steel and titanium cables, repair of cerebrospinal fluid leak, and nonsegmental C1–C3 instrumented fusion. She tolerated the surgery well and followed up without complication. Galvanic corrosion of the Brook's fusion secondary to current flow between dissimilar metal alloys resulted in catastrophic instrumentation failure and subarachnoid hemorrhage.

  9. The efficacy of resection of an intradural extramedullary foramen magnum cavernous malformation presenting with repeated subarachnoid hemorrhage: a case report.

    Science.gov (United States)

    Oishi, Tomoya; Sakai, Naoto; Sameshima, Tetsuro; Kawaji, Hiroshi; Namba, Hiroki

    2017-03-09

    Intradural extramedullary cavernous angiomas of the central nervous system are a rare type of cavernous angioma, but they can cause fatal subarachnoid hemorrhage. The efficacy of resection for this type of cavernous malformations remains uncertain. This is the first report to recommend surgical resection of these types of lesions regardless of the fatal condition. Our patient was a 70-year-old Japanese man who experienced a sudden onset of an occipital headache, followed by bilateral abducens nerve palsy. Magnetic resonance imaging revealed a small amount of hemorrhage in both of the lateral ventricles and an intradural extramedullary mass lesion in the left side of his foramen magnum. Two weeks after the appearance of initial symptoms, he became comatose. A computed tomography scan showed an increase in the subarachnoid intraventricular hemorrhaging and of the acute hydrocephalus. Following ventricular drainage, total tumor resection was performed using the lateral suboccipital transcondylar approach in conjunction with a first cervical hemilaminectomy. We observed a grape-like vascular-rich tumor with calcification that was adhering tightly to the wall of his left vertebral artery. A histopathological examination of the surgery specimen identified it as a cavernous angioma. After placement of a ventriculoperitoneal shunt and 2 months of rehabilitation, he recovered completely. An intradural extramedullary foramen magnum cavernous malformation is quite rare. The fragile surface of our patient's lesion was causing repeated subarachnoid hemorrhage and consequently progressive fatal neurological deterioration. Surgical resection of the lesion to prevent repeated hemorrhage was performed and he recovered fully. Therefore, we recommend surgical resection of the lesion regardless of the potentially fatal condition.

  10. Reduced activity of TAFI (thrombin-activatable fibrinolysis inhibitor) in acute promyelocytic leukaemia

    NARCIS (Netherlands)

    Meijers, JCM; Oudijk, EJD; Mosnier, LO; Nieuwenhuis, HK; Fijnheer, R; Bouma, Bonno N.; Bos, R

    Acute promyelocytic leukaemia (APL) is a disease that is distinguished from other leukaemias by the high potential for early haemorrhagic death. Several processes are involved, such as disseminated intravascular coagulation and hyperfibrinolysis. Recently, TAFI (thrombin-activatable fibrinolysis

  11. Predictive Factors for Rebleeding After Aneurysmal Subarachnoid Hemorrhage: Rebleeding Aneurysmal Subarachnoid Hemorrhage Study.

    Science.gov (United States)

    van Donkelaar, Carlina E; Bakker, Nicolaas A; Veeger, Nic J G M; Uyttenboogaart, Maarten; Metzemaekers, Jan D M; Luijckx, Gert-Jan; Groen, Rob J M; van Dijk, J Marc C

    2015-08-01

    Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating type of stroke associated with high morbidity and mortality. One of the most feared complications is an early rebleeding before aneurysm repair. Predictors for such an often fatal rebleeding are largely unknown. We therefore aimed to determine predictors for an early rebleeding after aSAH in relation with time after ictus. This observational prospective cohort study included all consecutive patients admitted with aSAH between January 1998 and December 2014 (n=1337) at our University Neurovascular Center. Clinical predictors for rebleeding ≤24 hours were identified using multivariable Cox regression analyses. Kaplan-Meier analyses were applied to evaluate the time of rebleeding ≤72 hours after aSAH. A modified Fisher grade of 3 to 4 was a predictor for an in-hospital rebleeding ≤24 hours after ictus (adjusted hazard ratio, 4.4; 95% confidence interval, 2.1-10.6; Pnumbers needed to treat to prevent 1 rebleeding ≤24 hours was calculated 15 (95% confidence interval, 10-25). Also, the initiation of external cerebrospinal fluid-drainage (adjusted hazard ratio, 1.9; 95% confidence interval, 1.4-2.5; Phours. Cumulative in-hospital rebleeding rates were 5.8% ≤24 hours, and 1.2% in the time frame 24-72 hours after ictus. In our opinion, timing of treatment of aSAH patients, especially those with an modified Fisher grade of 3 or 4 in a good clinical condition, should be reconsidered. These aSAH patients might be regarded a medical emergency, requiring aneurysm repair as soon as possible. In this respect, our findings should provoke the debate on timing of aneurysm repair, especially in patients considered to be at high risk for rebleeding. © 2015 American Heart Association, Inc.

  12. Retroperitoneal haemorrhage in renal angiomyolipoma causing hepatic functional decompensation: a case report

    Directory of Open Access Journals (Sweden)

    Wajed Julekha R

    2007-09-01

    Full Text Available Abstract Renal angiomyolipomata usually present as incidental findings on routine imaging, but rarely they may give rise to significant haemorrhage. If bleeding occurs, first-line treatment is currently angiography with selective embolisation. Prophylactic embolisation may be considered in some cases, depending on lesion size and patient co-morbidities. We present a case of retroperitoneal bleeding from a renal angiomyolipoma in a patient with known cirrhosis of the liver, which caused acute deterioration of liver function and consequent hepatic encephalopathy. Selective embolisation of the lesion was performed with a good subsequent outcome. Such functional hepatic decompensation has not previously been reported in this context and we suggest the use of prophylactic embolisation for incidental renal angiomyolipomata, regardless of size, in all patients with chronic liver disease to prevent this potentially life-threatening complication.

  13. The Successful Use of Extracorporeal Membrane Oxygenation in Systemic Lupus Erythematosus-Induced Diffuse Alveolar Haemorrhage

    Directory of Open Access Journals (Sweden)

    Faye Pais

    2017-01-01

    Full Text Available Diffuse alveolar haemorrhage (DAH is a catastrophic pulmonary complication of systemic lupus erythematosus. It can result in refractory hypoxaemia despite mechanical ventilation. Increasing lung compliance and worsening pulmonary hypertension can potentiate cardiogenic shock from acute right ventricular failure. In such patients with cardiopulmonary collapse, veno-arterial (V-A ECMO maybe a viable option that can provide the required haemodynamic support. However, the use of V-A ECMO in such patients is limited due to an associated increased risk of bleeding. Our case report describes the successful use of V-A ECMO without the use of systemic anticoagulation in a patient with DAH. Despite the absence of systemic anticoagulation, no thrombotic complications within the circuit were noted.

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

    Directory of Open Access Journals (Sweden)

    David J. Blacker

    2013-01-01

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

  15. Psychosocial implications of post-partum haemorrhage and ...

    African Journals Online (AJOL)

    ... PPH because it an emergency situation in order to prevent maternal mortality. Psychosocial support should be provided for the woman and her family in order to prevent long lasting negative psychosocial outcomes after complicated childbirth. Keywords: Psychosocial Implications, Post-Partum Haemorrhage, Maternal ...

  16. Life threatening vaginal haemorrhage from coital laceration in a post ...

    African Journals Online (AJOL)

    Background: Life threatening coital laceration from consensual intercourse in the postmenopausal period is unusual without any predisposing factors(s). The usual site of occurrence is the right side of the posterior fornix. Aim: To report a case of haemorrhagic shock from coital laceration. Design: Case report. Case report: A ...

  17. Surveillance of viral haemorrhagic fevers in Ghana: entomological ...

    African Journals Online (AJOL)

    Results: A total of 2804 households were surveyed to estimate larval indices and man-vector contacts of potential vectors of viral haemorrhagic fevers such as Yellow fever and Dengue. Over 56% households in each study site were positive for Aedes larvae. Relatively higher Breteaux index (BI) and Container index (CI) ...

  18. Periventricular-intraventricular haemorrhage in low-birth-weight ...

    African Journals Online (AJOL)

    The prevalence of periventricular-intraventricular haemorrhage (PV-IVH) aInong very-low-birthweight infants at Baragwanath Hospital has not been well docwnented. In this prospective study, a total of 282 live-born infants with birth weights of 1 000 - 1 749 g were studied over a 41/2-month period. Every infant had at least ...

  19. Expression of VP60 gene from rabbit haemorrhagic disease virus ...

    African Journals Online (AJOL)

    The VP60 gene from rabbit haemorrhagic disease virus (RHDV) YL strain in Northeast of China, under control of the ats1A promoter from Rubisco small subunit genes of Arabidopsis thaliana, was introduced into the transfer deoxyribonucleic acid (T-DNA) region of plant transfer vector pCAMBIA1300 and transferred to ...

  20. Rainbow trout offspring with different resistance to viral haemorrhagic septicaemia

    DEFF Research Database (Denmark)

    Slierendrecht, W.J.; Olesen, Niels Jørgen; Juul-Madsen, H.R.

    2001-01-01

    To study immunological and immunogenetical parameters related to resistance against viral haemorrhagic septicaemia (VHS), attempts to make gynogenetic strains of rainbow trout selected for high and low resistance to VHS were initiated in 1988. The first gynogenetic generation of inbreeding resulted...

  1. Haemorrhage in the labyrinth caused by anticoagulant therapy: case report

    Energy Technology Data Exchange (ETDEWEB)

    Callonnec, F.; Gerardin, E.; Thiebot, J. [Department of Radiology, Rouen University Hospital, 1 rue de Germont, F-76031 Rouen cedex (France); Marie, J.P.; Andrieu Guitrancourt, J. [Department of Otolaryngology, Rouen University Hospital (France); Marsot-Dupuch, K. [Department of Radiology, St. Antoine, Paris University Hospital (France)

    1999-06-01

    We report a patient who experienced a severe vertiginous episode with bilateral tinnitus and progressive right-sided hearing loss. She had Marfan`s disease and was on anticoagulant treatment. The fluid in the labyrinth gave higher signal than cerebrospinal fluid on T1-weighted images, suggesting haemorrhage. The radiological follow-up is discussed. (orig.) With 2 figs., 11 refs.

  2. Pattern of Antepartum Haemorrhage at the Lagos University ...

    African Journals Online (AJOL)

    Errata: Note that the original file was found to have errors. The erroneous file was removed and only the corrected file is now available for download (errata). The incidence of Antepartum Haemorrhage (APH) was 3.5%. Placenta praevia with an incidence of 2.0% constituted 58.4% of the cause of APH, followed by placental ...

  3. Risk factors associated with postpartum haemorrhage at Juba ...

    African Journals Online (AJOL)

    Objective: To study risk factors associated with post partum haemorrhage (PPH) in Juba Teaching Hospital, South Sudan. Method: An unmatched case control study was conducted in which 44 cases and 88 controls were involved, from September to December 2011. Data were collected using a structured questionnaire in ...

  4. Uterine artery embolization: an effective treatment for intractable obstetric haemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Hong, T.-M.; Tseng, H.-S. E-mail: hstseng@vghtpe.gov.tw; Lee, R.-C.; Wang, J.-H.; Chang, C.-Y

    2004-01-01

    AIM: To present the findings of uterine artery embolization (UAE) in the management of obstetric haemorrhage. MATERIALS AND METHODS: From October 1999 to February 2003, 10 women with postpartum haemorrhage (n=7) and post-abortion haemorrhage with placenta accreta (n=3), were referred to our department for pelvic angiography and possible arterial embolization. RESULTS: Angiography revealed engorged and tortuous uterine arteries in all patients; and contrast medium extravasation in three patients. Eight patients (three with and five without detectable active bleeding) then underwent bilateral UAE. Medium-sized (250-355 {mu}m) polyvinyl alcohol particles were injected via a coaxial catheter into the uterine arteries, followed by gelatin sponge pieces via a 4 F Cobra catheter. Microcoil devascularization was also performed in the two patients with visible, active bleeding. The vaginal bleeding resolved in all patients, without any ischaemic complications. At follow-up, all patients who underwent UAE had normal menstruation; three of them subsequently gave birth to full-term healthy babies. CONCLUSION: Selective UAE by the coaxial method is safe and effective to control obstetric haemorrhage, with the potential to preserve fertility.

  5. Massive pulmonary haemorrhage as a cause of death in the ...

    African Journals Online (AJOL)

    Obstetric information revealed that 29 mothers (93.5%) experienced obstetric complications, viz. preeclampsia/ eclampsia syndrome 21 (64.5%), abruptio placentae 5 (16.1 %) and previous pregnancy losses 9 ... The majority of babies suffering pulmonary haemorrhage were not associated with intensive care management.

  6. Acute hepatic encephalopathy with diffuse cortical lesions

    Energy Technology Data Exchange (ETDEWEB)

    Arnold, S.M.; Spreer, J.; Schumacher, M. [Section of Neuroradiology, Univ. of Freiburg (Germany); Els, T. [Dept. of Neurology, University of Freiburg (Germany)

    2001-07-01

    Acute hepatic encephalopathy is a poorly defined syndrome of heterogeneous aetiology. We report a 49-year-old woman with alcoholic cirrhosis and hereditary haemorrhagic telangiectasia who developed acute hepatic coma induced by severe gastrointestinal bleeding. Laboratory analysis revealed excessively elevated blood ammonia. MRI showed lesions compatible with chronic hepatic encephalopathy and widespread cortical signal change sparing the perirolandic and occipital cortex. The cortical lesions resembled those of hypoxic brain damage and were interpreted as acute toxic cortical laminar necrosis. (orig.)

  7. Assay of Serum Sodium Balance Disturbance in Spontaneous Subarachnoid Hemorrhage and Relation to Prognosis of Disease

    Directory of Open Access Journals (Sweden)

    M. Sabouri

    2006-07-01

    Full Text Available Introduction & Objective: Electrolyte disturbances are frequently observed during the acute period after spontaneous subarachnoid hemorrhage (SAH. Hyponatremia and hypernatremia are the most common electrolyte disturbance in acute period of disease, and these disturbances may worsen cerebral edema and mass effect. We performed this study to determine the prognostic significance of serum sodium concentration abnormalities.Materials & Methods: This study was performed as prospective analytic cross sectional in Kashani and Alzahra Hospitals of Isfahan during 2003-2004. The presence of hypernatremia (serum sodium concentration of>145m mol/L and hyponatremia (serum sodium concentration of<135mmol/l was determined with serum sodium measurements at admission and 3, 6 and 9 days after SAH, then the effects of hypernatremia and hyponatremia on three-month outcomes were analyzed after adjustment for age, sex, preexiting HTN , admission GCS score, initial mean arterial pressure and finding of Brain CT Scan and Brain angiography. Patients with symptomatic vasospasm were excluded.Results: The analysis of data showed that from 100 participated patients in this study 18% developed hypernatremia and 42% developed hyponatremria. Hypernatemia was significantly assiociated with poor outcomes compared with hyponatremia (odds ratio, 2.63- CI 95% . Conclusion: Hyponatremia seems to be more common than hypernatremia after SAH. Hypernatrenia after SAH associted with poor outcome and this association is independet of previously identified outcome predictors, including age, sex, admission GCS Score, and X.Ray finding.

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

    Science.gov (United States)

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

    2016-01-01

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

  9. ACQUIRED UTERINE HYPOPLASIA AFTER POSTPARTUM HAEMORRHAGE WITH WORST PROGNOSIS – A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Bhavishya

    2016-03-01

    Full Text Available INTRODUCTION Postpartum haemorrhage is defined as a loss of more than 500 mL of blood after delivery. 1 Postpartum haemorrhage is responsible for around 25% of maternal morbidity worldwide (WHO, 2007. Postpartum haemorrhage can also be a cause of long term severe morbidity with approximately 12% of women who survive postpartum haemorrhage will have severe anaemia. 2 This is a case report of a patient who has come with complaints of secondary amenorrhoea three years since last child birth. The patient has a history of atonic postpartum haemorrhage. On examination by USG & MRI, the uterus was hypoplastic.

  10. Automatic detection of surgical haemorrhage using computer vision.

    Science.gov (United States)

    Garcia-Martinez, Alvaro; Vicente-Samper, Jose María; Sabater-Navarro, José María

    2017-05-01

    On occasions, a surgical intervention can be associated with serious, potentially life-threatening complications. One of these complications is a haemorrhage during the operation, an unsolved issue that could delay the intervention or even cause the patient's death. On laparoscopic surgery this complication is even more dangerous, due to the limited vision and mobility imposed by the minimally invasive techniques. In this paper it is described a computer vision algorithm designed to analyse the images captured by a laparoscopic camera, classifying the pixels of each frame in blood pixels and background pixels and finally detecting a massive haemorrhage. The pixel classification is carried out by comparing the parameter B/R and G/R of the RGB space colour of each pixel with a threshold obtained using the global average of the whole frame of these parameters. The detection of and starting haemorrhage is achieved by analysing the variation of the previous parameters and the amount of pixel blood classified. When classifying in vitro images, the proposed algorithm obtains accuracy over 96%, but during the analysis of an in vivo images obtained from real operations, the results worsen slightly due to poor illumination, visual interferences or sudden moves of the camera, obtaining accuracy over 88%. The detection of haemorrhages directly depends of the correct classification of blood pixels, so the analysis achieves an accuracy of 78%. The proposed algorithm turns out to be a good starting point for an automatic detection of blood and bleeding in the surgical environment which can be applied to enhance the surgeon vision, for example showing the last frame previous to a massive haemorrhage where the incision could be seen using augmented reality capabilities. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. Flair MR imaging in the Detection of subarachnoid hemorrhage : comparison with CT and T1-weighted MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Min, Soo Hyun; Kim, Soo Youn; Lee, Ghi Jai; Shim, Jae Chan; Oh, Tae Kyung; Kim, Ho Kyun [College of Medicine, Jnje University, Seoul (Korea, Republic of)

    2000-03-01

    To compare the findings of fluid-attenuated inversion recovery (FLAIR) MR imaging in the detection of subarachnoid hemorrhage (SAH), with those of precontrast CT and T1-weighted MR imaging. In 13 patients (14 cases) with SAH, FLAIR MR images were retrospectively analyzed and compared with CT (10 patients, 11 cases) and T1-weighted MR images (9 cases). SAH was confirmed on the basis of high density along the subarachnoid space, as seen on precontrast CT, or lumbar puncture. MR imaging was performed on a 1.0T unit. FLAIR MR and CT images were obtained during the acute stage(less than 3 days after ictus) in 10 and 9 cases, respectively, during the subacute stage (4-14 days after ictus) in two cases and one, respectively, and during the chronic stage (more than 15 days after ictus) in two cases and one, respectively. CT was performed before FLAIR MR imaging, and the interval between CT and FLAIR ranged from 24 hours (6 cases) to 2-3 (2 cases) or 4-7 days (3 cases). In each study, the conspicuity of visualization of SAH was graded as excellent, good, fair, or negative at five locations (sylvian fissure, cortical sulci, anterior basal cistern, posterior basal cistern, and perimesencephalic cistern). In all cases, subarachnoid hemorrhages were demonstrated as high signal intensity areas on FLAIR images. The detection rates for SAH on CT and T1-weighted MR images were 100% (11/11) and 89% (8/9), respectively. FLAIR was superior to T1-weighted imaging in the detection of SAH at all sites except the anterior basal cistern (p less than 0.05) and superior to CT in the detection of SAH at the cortical sulci (p less than 0.05). On FLAIR MR images, subarachnoid hemorrhages at all stages are demonstrated as high signal intensity areas; the FLAIR MR sequence is thus considered useful in the detection of SAH. In particular FLAIR is more sensitive than CT for the detection of SAH in the cortical sulci. (author)

  12. M5 segment aneurysm presenting as "pure acute SDH".

    Science.gov (United States)

    Singla, Navneet; Tripathi, Manjul; Chhabra, Rajesh

    2014-10-01

    Spontaneous "pure acute subdural hematoma (SDH)" is arguably a rare condition. We report on a pregnant female patient presenting as spontaneous acute SDH without subarachnoid hemorrhage (SAH) due to rupture of distal (M5 segment) middle cerebral artery aneurysm. We hereby discuss the diagnostic dilemma of this rare condition, along with the need for watchful evaluation of acute SDH without preceding head injury presenting in emergency outpatient departments, especially when it is first encountered by a trainee resident.

  13. M5 segment aneurysm presenting as "pure acute SDH"

    Directory of Open Access Journals (Sweden)

    Navneet Singla

    2014-01-01

    Full Text Available Spontaneous "pure acute subdural hematoma (SDH" is arguably a rare condition. We report on a pregnant female patient presenting as spontaneous acute SDH without subarachnoid hemorrhage (SAH due to rupture of distal (M5 segment middle cerebral artery aneurysm. We hereby discuss the diagnostic dilemma of this rare condition, along with the need for watchful evaluation of acute SDH without preceding head injury presenting in emergency outpatient departments, especially when it is first encountered by a trainee resident.

  14. Prediction of 60-Day Case Fatality After Aneurysmal Subarachnoid Hemorrhage : External Validation of a Prediction Model

    NARCIS (Netherlands)

    Dijkland, Simone A.; Roozenbeek, Bob; Brouwer, Patrick A.; Lingsma, Hester F.; Dippel, Diederik W.; Vergouw, Leonie J.; Vergouwen, Mervyn D.; van der Jagt, Mathieu

    OBJECTIVE:: External validation of prognostic models is crucial but rarely done. Our aim was to externally validate a prognostic model to predict 60-day case fatality after aneurysmal subarachnoid hemorrhage developed from the International Subarachnoid Aneurysm Trial in a retrospective unselected

  15. Hyperalgesic effect of subarachnoid administration of phentolamine in mice

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    Desiré Carlos Callegari

    2015-04-01

    Full Text Available BACKGROUND AND OBJECTIVES: Painful phenomenon is one of the most important and complex experiences. Phentolamine is a non-selective alpha-adrenergic antagonist. The objective of this study was to compare the effect of increasing doses of phentolamine into subarachnoid space in rats in the modulation of painful phenomenon. METHODS: 84 male Wistar rats were divided into formalin and plantar incision groups, subdivided into six subgroups (n = 7. Control group received only saline (10 µL; active subgroups received phentolamine 10 µmg (GF10, 20 mg (GF20, 30 mg (GF30, 40 mg (GF40, and 50 g (GF50. In formalin group, pain was induced by injection of 50 µL of 2% formalin in dorsal region of right posterior paw. In plantar incision group, pain was induced by plantar incision and evaluated using von Frey filaments. Induction and maintenance of anesthesia were performed with 3% halothane for catheter placement into subarachnoid space and plantar incision. Statistical analysis was performed using the JMP program from SAS with 5% significance level. RESULTS: Phentolamine at doses of 20 and 30 g increased the algesic response in the intermediate phase of the formalin test. In plantar incision test, it had hyperalgic effect on first, third, fifth, and seventh days at a dose of 10 g and on first, third, and fifth days at a dose of 20 g and on fifth day at a dose of 30 g. CONCLUSION: Subarachnoid administration of phentolamine showed hyperalgesic effect, possibly due to the involvement of different subclasses of alpha-adrenergic receptors in modulating pain pathways.

  16. Brain lactate metabolism in humans with subarachnoid hemorrhage.

    Science.gov (United States)

    Oddo, Mauro; Levine, Joshua M; Frangos, Suzanne; Maloney-Wilensky, Eileen; Carrera, Emmanuel; Daniel, Roy T; Levivier, Marc; Magistretti, Pierre J; LeRoux, Peter D

    2012-05-01

    Lactate is central for the regulation of brain metabolism and is an alternative substrate to glucose after injury. Brain lactate metabolism in patients with subarachnoid hemorrhage has not been fully elucidated. Thirty-one subarachnoid hemorrhage patients monitored with cerebral microdialysis (CMD) and brain oxygen (PbtO(2)) were studied. Samples with elevated CMD lactate (>4 mmol/L) were matched to PbtO(2) and CMD pyruvate and categorized as hypoxic (PbtO(2) 119 μmol/L) versus nonhyperglycolytic. Median per patient samples with elevated CMD lactate was 54% (interquartile range, 11%-80%). Lactate elevations were more often attributable to cerebral hyperglycolysis (78%; interquartile range, 5%-98%) than brain hypoxia (11%; interquartile range, 4%-75%). Mortality was associated with increased percentage of samples with elevated lactate and brain hypoxia (28% [interquartile range 9%-95%] in nonsurvivors versus 9% [interquartile range 3%-17%] in survivors; P=0.02) and lower percentage of elevated lactate and cerebral hyperglycolysis (13% [interquartile range, 1%-87%] versus 88% [interquartile range, 27%-99%]; P=0.07). Cerebral hyperglycolytic lactate production predicted good 6-month outcome (odds ratio for modified Rankin Scale score, 0-3 1.49; CI, 1.08-2.05; P=0.016), whereas increased lactate with brain hypoxia was associated with a reduced likelihood of good outcome (OR, 0.78; CI, 0.59-1.03; P=0.08). Brain lactate is frequently elevated in subarachnoid hemorrhage patients, predominantly because of hyperglycolysis rather than hypoxia. A pattern of increased cerebral hyperglycolytic lactate was associated with good long-term recovery. Our data suggest that lactate may be used as an aerobic substrate by the injured human brain.

  17. [Cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Therapeutic value of treatment with calcium antagonists, hypervolemic hemodilution and induced arterial hypertension].

    Science.gov (United States)

    Hansen, D; Hannemann, L; Specht, M; Schaffartzik, W

    1995-04-01

    Only 53%-58% of patients with a subarachnoid haemorrhage (SAB) following the rupture of a cerebral aneurysm survive without neurological damage. Morbidity and mortality are closely related to the delayed ischaemic neurological deficit due to cerebral vasospasm. The following review gives an account of pathophysiological mechanisms; the importance of treatment with calcium antagonists, hypervolaemic haemodilution, and induced arterial hypertension is discussed in light of the current literature. PATHOPHYSIOLOGY. In addition to other vasoactive substances in the blood, haemoglobin, which is released from lysed erythrocytes on the 2nd to 4th day after the haemorrhage, plays an important role in inducing vasospasm. An inflammatory angiopathy ensues, with complete resolution after 6-12 weeks. The cerebral blood flow (CBF) is reduced depending on the extent of vasospasm. Irreversible infarction may follow the decrease of CBF below a critical value. Severe vasospasm causes autoregulatory disturbances and reduced responsiveness of cerebral vessels to CO2. CALCIUM ANTAGONISTS. The calcium blocker nimodipine causes dilatation of small pial vessels with increased CBF. However, systemic vasodilation with the subsequent fall in blood pressure may limit the increase in CBF. Furthermore, it is known that nimodipine decreases intracellular calcium concentrations resulting in some protection against ischaemic cellular injury. Seven placebo-controlled clinical studies have shown that nimodipine improves the outcome of patients with severe neurological damage due to cerebral vasospasm. HYPERVOLAEMIC HAEMODILUTION. Volume expansion and haemodilution to a hematocrit of 30%-33% is suggested to improve cerebral perfusion during vasospasm. The central venous and pulmonary capillary wedge pressures should be 10-12 mm Hg and 15-18 mm Hg, respectively. But there is no evidence of improved outcome with this measure, and pulmonary edema is a frequent side effect. However, impairment of

  18. Anaesthesia in a patient with subarachanoidal haemorrhage and high oxygen affinity haemoglobinopathy (HB york: case report

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    Monaca Enrico

    2012-08-01

    Full Text Available Abstract Background Approximately 90 haemoglobinopathies have been identified that result in abnormally high oxygen affinity. One of these is haemoglobinopathy York (HbY, first described in 1976. HbY causes an extreme leftward shift of the oxygen dissociation curve with the P50 value changing to 12.5 - 15.5 mmHg (normal value 26.7 mmHg, indicating that approximately half of the haemoglobin is not available as oxygen carrier. Patients with haemoglobinopathies with increased oxygen affinity could suffer from the risk developing ischaemic complications due to a lack of functional oxygen carriers. This is, to best of our knowledge, the first case report on a patient with HbY published in connection with anesthesia. Case Presentation A 42-year-old female with a severe headache and Glasgow coma scale (GCS of 15 was admitted to the neurosurgical intensive care unit with a ruptured, right sided ICA aneurysm with consecutive subarachnoid haemorrhage [Fisher III, World Federation of Neurosurgical Societies (WFNS I]. The medical history of the patient included an erythrocytosis (Hb 17.5 g/dl on the base of a high-oxygen-affinity haemoglobinopathy, called Hb York (HbY. With no time available to take special preoperative precautions, rapid blood loss occurred during the first attempt to clip the aneurysm. General transfusion procedures, according to the guidelines based on haemoglobin and haematocrit values, could not be applied due to the uncertainty in the oxygen carrier reduction. To maintain tissue oxygen supply, clinical indicators of ischaemia were instead utilized to gauge the appropriate required blood products, crystalloids and colloids replacements. Despite this, the patient survived the neurosurgical intervention without any neurological deficit. Conclusions Family members of patients with HbY (and other haemoglobinopathies with increased oxygen affinity should undergo clinical assessment, particularly if they are polycythaemic. If the diagnosis

  19. A case report on subarachnoid and intraventricular neurocysticercosis

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    Chen Shang

    2015-01-01

    Full Text Available Neurocysticercosis is the most common central nervous system helminthic infection in humans. We hereby present a case combining two rare manifestations of neurocysticercosis: the subarachnoid and intraventricular forms. The patient presented with hydrocephalus and neurologic deficits and although endoscopic removal of the cysts and two cycles of postoperative cysticidal drugs resulted in resolution of symptoms, they later recurred. Ventriculoperitoneal shunt placement and a further cycle of albendazole plus dexamethasone led to substantial clinical improvement. Extraparenchymal neurocysticercosis may be challenging to diagnose and treat and is usually associated with a poorer prognosis. Clinicians should be aware of this condition.

  20. Plasticity of cerebrovascular smooth muscle cells after subarachnoid hemorrhage

    DEFF Research Database (Denmark)

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

    2014-01-01

    Subarachnoid hemorrhage (SAH) is most often followed by a delayed phase of cerebral ischemia which is associated with high morbidity and mortality rates. The causes underlying this delayed phase are still unsettled, but are believed to include cerebral vasospasm, cortical spreading depression......, inflammatory reactions, and microthrombosis. Additionally, a large body of evidence indicates that vascular plasticity plays an important role in SAH pathophysiology, and this review aims to summarize our current knowledge on the phenotypic changes of vascular smooth muscle cells of the cerebral vasculature...

  1. Matrix Metalloproteinases in Cerebral Vasospasm following Aneurysmal Subarachnoid Hemorrhage

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    Vivek Mehta

    2013-01-01

    Full Text Available Delayed cerebral vasospasm is a significant cause of morbidity and mortality following aneurysmal subarachnoid hemorrhage (SAH. While the cellular mechanisms underlying vasospasm remain unclear, it is believed that inflammation may play a critical role in vasospasm. Matrix metalloproteinasees (MMPs are a family of extracellular and membrane-bound proteases capable of degrading the blood-rain barrier (BBB. As such, MMP upregulation following SAH may result in a proinflammatory extravascular environment capable of inciting delayed cerebral vasospasm. This paper presents an overview of MMPs and describes existing data pertinent to delayed cerebral vasospasm.

  2. Does Ondansetron Modify Sympathectomy Due to Subarachnoid Anesthesia?

    DEFF Research Database (Denmark)

    Terkawi, Abdullah S; Mavridis, Dimitris; Flood, Pamela

    2016-01-01

    randomized placebo-controlled trials (1,045 subjects) were identified and analyzed. By using conventional meta-analyses, the authors determined that ondansetron was associated with reduction in the incidence of hypotension (relative risk = 0.62 [95% CI, 0.46 to 0.83], P = 0.001; TSA-adjusted CI, 0.34 to 1...... reduces the incidence of hypotension and bradycardia after subarachnoid anesthesia due to the risk of bias and information sizes less than the required. As results from meta-analysis are given significant weight, it is important to carefully evaluate the quality of the evidence that is input....

  3. A cytological and histological study of acute premyelocytic leukaemia

    Science.gov (United States)

    Bernard, Jean; Lasneret, J.; Chome, J.; Levy, J. P.; Boiron, M.

    1963-01-01

    Among the acute leukaemias of the granulocytic group, acute premyelocytic leukaemia is distinguished by the severity of its haemorrhages, the frequency of hypofibrinaemia, a rapidly fatal course, and an unusual cellular hyperplasia. Myelograms show an increased proportion (average 80%) of characteristic cells of large diameter, with numerous azurophil granules. The infiltration of other organs is inconstant. Images PMID:14044032

  4. Severe cerebral hypovolemia on perfusion CT and lower body weight are associated with parenchymal haemorrhage after thrombolysis

    Energy Technology Data Exchange (ETDEWEB)

    Tsetsou, S.; Eskandari, A.; Michel, P. [Centre Hospitalier Universitaire Vaudois and University of Lausanne CHUV, Department of Neurology, Lausanne (Switzerland); Amiguet, M. [Centre Hospitalier Universitaire Vaudois and University of Lausanne, Institute of Social and Preventive Medicine, Lausanne (Switzerland); Meuli, R.; Maeder, P. [Centre Hospitalier Universitaire Vaudois and University of Lausanne, Department of Radiology, Lausanne (Switzerland); Jiang, B.; Wintermark, M. [Stanford University and Medical Center, Department of Radiology, Neuroradiology Division, Stanford, CA (United States)

    2017-01-15

    Haemorrhagic transformation of acute ischemic stroke (AIS) and particularly parenchymal haemorrhage (PH) remains a feared complication of intravenous thrombolysis (IVT). We aimed to identify clinical and perfusion CT (PCT) variables which are independently associated with PHs. In this observational cohort study, based on the Acute Stroke Registry Analysis of Lausanne (ASTRAL) from 2003 to December 2013, we selected patients with AIS involving the middle cerebral artery (MCA) territory who were thrombolysed within 4.5 h of symptoms' onset and who had a good quality baseline PCT at the beginning of IVT. In addition to demographic, clinical, laboratory and non-contrast CT data, volumes of salvageable tissue and ischemic core on PCT, as well as absolute CBF and CBV values within the ischemic regions were compared in patients with and without PH in multivariate analysis. Of the 190 included patients, 24 (12.6%) presented a PH (11 had PH1 and 13 had PH2). In multivariate analysis of the clinical and radiological variables, the lowest CBV in the core and lower body weight was both significantly associated with PH (p = 0.009 and p = 0.024, respectively). In thrombolysed MCA strokes, maximal hypoperfusion severity depicted by lowest CBV values in the core region and lower body weight are independently correlated with PH. This information, if confirmed in other case series, may add to the stratification of revascularisation decisions in patients with a perceived high PH risk. (orig.)

  5. Experimental intracerebral haemorrhage: the effect of nimodipine pretreatment.

    OpenAIRE

    Sinar, E J; Mendelow, A D; Graham, D I; Teasdale, G M

    1988-01-01

    The effect of pretreatment with the calcium antagonist nimodipine on the pathophysiological events which follow an intracerebral haemorrhage in rats was compared with a similar control group. Cerebral blood flow was higher and the amount of pathologically determined ischaemic damage measured by light microscopy was less in the nimodipine pretreated group. Bloodbrain barrier permeability was increased in the nimodipine group, but there was no evidence of cerebral oedema. Nimodipine appeared to...

  6. Development of vaccines against Crimean-Congo haemorrhagic fever virus

    OpenAIRE

    Dowall, Stuart D.; Carroll, Miles W.; Hewson, Roger

    2017-01-01

    Crimean-Congo haemorrhagic fever virus (CCHFV) is a deadly human pathogen of the utmost seriousness being highly lethal causing devastating disease symptoms that result in intense and prolonged suffering to those infected. During the past 40 years, this virus has repeatedly caused sporadic outbreaks responsible for relatively low numbers of human casualties, but with an alarming fatality rate of up to 80% in clinically infected patients. CCHFV is transmitted to humans by Hyalomma ticks and co...

  7. Effect of methylene blue on resuscitation after haemorrhagic shock.

    Science.gov (United States)

    Jeroukhimov, I; Weinbroum, A; Ben-Avraham, R; Abu-Abid, S; Michowitz, M; Kluger, Y

    2001-10-01

    To compare prehospital hypotensive resuscitation with volume resuscitation, and find out whether reagents that inhibit free-oxygen radical formation, such as methylene blue, can improve resuscitation and survival. Randomised controlled trial. Animal laboratory, Israel. 48 adult male Wistar rats. After 30 minutes of controlled haemorrhage, rats were subjected to 60 minutes of uncontrolled haemorrhage with simultaneous resuscitation. Hartmann's solution alone, or with blood or with a bolus of methylene blue were infused to maintain the mean arterial pressure (MAP) at 80 or 40 mm Hg. Then haemorrhage was stopped and Hartmann's solution plus whole blood were infused to obtain a MAP that was within normal limits. Volumes of shed blood and resuscitation fluids, MAP, packed cell volume, blood pH and base deficit, and survival. During uncontrolled haemorrhage. a MAP of 80 mm Hg could not be reached in animals resuscitated with Hartmann's solution alone, and all died. All the rats given Hartmann's solution with a bolus of methylene blue or with whole blood achieved a higher MAP. MAP of 40 mm Hg was attained in all animals regardless of the resuscitation fluid. Only 15 of 24 animals resuscitated to a MAP of 80 mm Hg survived, compared with 22 survivors of the 24 rats resuscitated to a MAP of 40 mm Hg (p <0.04). Methylene blue or whole blood drastically reduced the volumes of shed blood and of fluids required, and moderated the reduction in packed cell volume, particularly during hypotensive resuscitation. Hypotensive protocols should be used to improve survival. Methylene blue given with the electrolyte solutions could negate their detrimental effects during resuscitation.

  8. Surgical Trial in Lobar Intracerebral Haemorrhage (STICH II Protocol

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    Rowan Elise N

    2011-05-01

    Full Text Available Abstract Background Within the spectrum of spontaneous intracerebral haemorrhage there are some patients with large or space occupying haemorrhage who require surgery for neurological deterioration and others with small haematomas who should be managed conservatively. There is equipoise about the management of patients between these two extremes. In particular there is some evidence that patients with lobar haematomas and no intraventricular haemorrhage might benefit from haematoma evacuation. The STICH II study will establish whether a policy of earlier surgical evacuation of the haematoma in selected patients will improve outcome compared to a policy of initial conservative treatment. Methods/Design an international multicentre randomised parallel group trial. Only patients for whom the treating neurosurgeon is in equipoise about the benefits of early craniotomy compared to initial conservative treatment are eligible. All patients must have a CT scan confirming spontaneous lobar intracerebral haemorrhage (≤1 cm from the cortex surface of the brain and 10-100 ml in volume. Any clotting or coagulation problems must be corrected and randomisation must take place within 48 hours of ictus. With 600 patients, the study will be able to demonstrate a 12% benefit from surgery (2p Stratified randomisation is undertaken using a central 24 hour randomisation service accessed by telephone or web. Patients randomised to early surgery should have the operation within 12 hours. Information about the status (Glasgow Coma Score and focal signs of all patients through the first five days of their trial progress is also collected in addition to another CT scan at about five days (+/- 2 days. Outcome is measured at six months via a postal questionnaire to the patient. Primary outcome is death or severe disability defined using a prognosis based 8 point Glasgow Outcome Scale. Secondary outcomes include: Mortality, Rankin, Barthel, EuroQol, and Survival. Trial

  9. The diagnostic quandary of hereditary haemorrhagic telangiectasia vs. CREST syndrome.

    Science.gov (United States)

    Lee, J B; Ben-Aviv, D; Covello, S P

    2001-10-01

    The distribution and clinical appearance of the telangiectasia in the CREST syndrome (calcinosis, Raynaud's phenomenon, oesophageal involvement, sclerodactyly, telangiectasia) and hereditary haemorrhagic telangiectasia (HHT) are very similar. Several previously reported cases of the CREST syndrome simulating HHT illustrate this diagnostic quandary. We report a patient who met the diagnostic criteria for both the CREST syndrome and HHT, and discuss the distinguishing features of the two diseases, including the distinctive histopathological findings of telangiectasia in HHT.

  10. Blood products and their use in traumatic major haemorrhage.

    Science.gov (United States)

    Deveau, Simon Ross

    2016-02-01

    Blood loss due to trauma is a leading cause of death in young people and is the result of the 'lethal triad' of hypothermia, acidosis and coagulopathy, which collectively reduce haemostasis. Emergency department nurses can help to reverse the triad through the timely and efficient use of blood products and fluids. This article briefly examines different blood groups, describes the elements of the lethal triad, and discusses the blood products used to transfuse patients with major haemorrhage.

  11. Management of postpartum haemorrhage [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Marie Pierre Bonnet

    2016-06-01

    Full Text Available Postpartum Haemorrhage (PPH is a major cause of maternal morbidity and mortality. Treatment of acquired coagulopathy observed in severe PPH is an important part of PPH management, but is mainly based on literature in trauma patients, and data thus should be interpreted with caution. This review describes recent advances in transfusion strategy and in the use of tranexamic acid and fibrinogen concentrates in women with PPH.

  12. Cardiac tamponade in acute rheumatic carditis.

    OpenAIRE

    Tan, A T; Mah, P K; Chia, B L

    1983-01-01

    In patients with valvular heart disease, fever, and cardiomegaly echocardiography is an invaluable noninvasive tool. In this report we describe a young female presenting with cardiac tamponade due to acute rheumatic carditis. Echocardiography showed an exudative pericardial effusion which was haemorrhagic on pericardiocentesis. She responded to steroid therapy with resolution of carditis and pericardial effusion.

  13. Quality of Life Following Permanent Neurological Damage after Subarachnoid Block

    Directory of Open Access Journals (Sweden)

    Yvonne Dabota Buowari

    2011-01-01

    Full Text Available Introduction. Caesarean section is the commonest operation carried out in females of the reproductive age group. Spinal anaesthesia is commonly used for caesarean section with its risk. Permanent paralysis of the lower limbs following subarachnoid block is a rare complication but can occur even in the best of hands. Case Summary. This is a 29-year-old final-year university student now 34 years old who had emergency caesarean section for cephalopelvic disproportion in 2005 under spinal anaesthesia in a low-resource setting in a developing country. She developed permanent neurological deficit thereafter. She had urinary and faecal incontinence for one year. She lost one academic session at her school because of long hospital stay and is now confined to a wheel chair. She celebrated her daughter's fifth birthday in October, 2010. Although there is ability in inability, she is now disabled. Conclusion. It is important for clinicians to recognise the complications of subarachnoid block promptly to avoid delay in treatment and severe neurological deficits.

  14. Possible Role of Inflammation and Galectin-3 in Brain Injury after Subarachnoid Hemorrhage.

    Science.gov (United States)

    Nishikawa, Hirofumi; Suzuki, Hidenori

    2018-02-07

    Aneurysmal subarachnoid hemorrhage (SAH) is known as one of the most devastating diseases in the central nervous system. In the past few decades, research on SAH has focused on cerebral vasospasm to prevent post-SAH delayed cerebral ischemia (DCI) and to improve outcomes. However, increasing evidence has suggested that early brain injury (EBI) is an important mechanism contributing to DCI, cerebral vasospasm as well as poor outcomes. Though the mechanism of EBI is very complex, inflammation is thought to play a pivotal role in EBI. Galectin-3 is a unique chimera type in the galectin family characterized by its β-galactoside-binding lectin, which mediates various pathologies, such as fibrosis, cell adhesion, and inflammation. Recently, two clinical studies revealed galectin-3 to be a possible prognostic biomarker in SAH patients. In addition, our recent report suggested that higher acute-stage plasma galectin-3 levels correlated with subsequent development of delayed cerebral infarction that was not associated with vasospasm in SAH patients. We review the possible role and molecular mechanisms of inflammation as well as galectin-3 in brain injuries, especially focusing on EBI after SAH, and discuss galectin-3 as a potential new therapeutic or research target in post-SAH brain injuries.

  15. The relation of early hypernatremia with clinical outcome in patients suffering from aneurysmal subarachnoid hemorrhage.

    Science.gov (United States)

    Beseoglu, Kerim; Etminan, Nima; Steiger, Hans-Jakob; Hänggi, Daniel

    2014-08-01

    Sodium dysregulation in the course after aneurysmal subarachnoid hemorrhage (aSAH) has been identified as one contributor to adverse clinical outcome. However, the correlation of acute dysnatremia and early brain injury (EBI) remains unclear. We investigated the early course and prognostic relevance of changes in serum sodium concentrations and its relation to EBI after aSAH. Retrospectively, the serum sodium concentration (SSC) of 264 patients with aSAH was analyzed. The first SSC was obtained within 8h after initial ictus and then repeatedly analyzed every 8h over the first five days. Incidence of hypernatremia (defined as SSC>145mmol/l) was correlated with initial neurological condition according to World Federation of Neurological Surgeons grade (WFNS), incidence of delayed cerebral ischemia (DCI) and clinical outcome at 12 month according to modified Rankin Scale (mRS). Within 56h, 82 patients (31.1%) developed hypernatremia which correlated significantly with initial neurological condition (phypernatremia within 56h after aSAH was shown to be an independent predictor for poor neurological outcome. Early serum sodium levels after aSAH can be considered as surrogate markers to predict outcome after aSAH irrespective to the occurrence of DCI. However, prospective studies are necessary to validate this concept. Copyright © 2014 Elsevier B.V. All rights reserved.

  16. Hypothesis on the Role of Cryptochromes in Inflammation and Subarachnoid Hemorrhage Outcome.

    Science.gov (United States)

    Nogueira, Adriano Barreto; Nogueira, Ariel Barreto; Veiga, José Carlos Esteves; Teixeira, Manoel Jacobsen

    2017-01-01

    We have recently found that the temperature variability (TV) in the day-night cycle may predict the mean intracranial pressure in the following 24 h (ICP24) in subarachnoid hemorrhage (SAH) patients under multimodality monitoring, sedation, and hypothermia (hypothesis derived from these observations is that CRYs modulate the circadian oscillation of temperature even during therapeutic hypothermia and improve outcome in SAH through decrease in inflammation. A strategy to test this hypothesis is to measure periodically during the acute phase of high-grade SAH the level of CRYs in cerebrospinal fluid (CSF) and circulating white blood cells, and to correlate these levels with outcome, TV, ICP24, and pro- and anti-inflammatory markers in CSF and blood. If this hypothesis is true, the development of therapies targeting inflammation in SAH could take advantage of cryptochrome properties. It has been shown that blue light phototherapy increases the expression of CRYs in blood mononuclear cells in jaundiced neonates. Likewise, visual stimulus with flashing light improves Alzheimer's disease features in experimental model and there is a prominent expression of CRYs in the retina. Remarkably, recent evidence showed that hCRY2 responds to electromagnetic fields, which could be one elusive mechanism of action of transcranial magnetic stimulation and a reason for its use in SAH.

  17. Inversion of neurovascular coupling after subarachnoid hemorrhage in vivo.

    Science.gov (United States)

    Balbi, Matilde; Koide, Masayo; Wellman, George C; Plesnila, Nikolaus

    2017-11-01

    Subarachnoid hemorrhage (SAH) induces acute changes in the cerebral microcirculation. Recent findings ex vivo suggest neurovascular coupling (NVC), the process that increases cerebral blood flow upon neuronal activity, is also impaired after SAH. The aim of the current study was to investigate whether this occurs also in vivo. C57BL/6 mice were subjected to either sham surgery or SAH by filament perforation. Twenty-four hours later NVC was tested by forepaw stimulation and CO2 reactivity by inhalation of 10% CO2. Vessel diameter was assessed in vivo by two-photon microscopy. NVC was also investigated ex vivo using brain slices. Cerebral arterioles of sham-operated mice dilated to 130% of baseline upon CO2 inhalation or forepaw stimulation and cerebral blood flow (CBF) increased. Following SAH, however, CO2 reactivity was completely lost and the majority of cerebral arterioles showed paradoxical constriction in vivo and ex vivo resulting in a reduced CBF response. As previous results showed intact NVC 3 h after SAH, the current findings indicate that impairment of NVC after cerebral hemorrhage occurs secondarily and is progressive. Since neuronal activity-induced vasoconstriction (inverse NVC) is likely to further aggravate SAH-induced cerebral ischemia and subsequent brain damage, inverse NVC may represent a novel therapeutic target after SAH.

  18. The initial time-course of headache in patients with spontaneous subarachnoid hemorrhage.

    Science.gov (United States)

    Čomić, Hata; Rinkel, Gabriel J E; Vergouwen, Mervyn D I

    2017-08-15

    If acute severe headache disappears early after its onset, the question arises whether subarachnoid hemorrhage (SAH) should still be ruled out. We studied the initial time-course and minimal duration of headache in a consecutive series of neurologically intact patients with spontaneous SAH. We included patients admitted between 2012 and 2015 within 48h after spontaneous SAH with a normal level of consciousness and no focal deficits. We retrieved data on headache severity, measured with a Numeric Rating Scale (NRS), ictus. We analyzed the proportion of patients with a first NRS 0 and NRS ictus and minimal headache duration. Patients were censored in case of a decrease in level of consciousness, aneurysm treatment, or early discharge. We included 106 patients (62 aneurysmal SAH, 33 perimesencephalic hemorrhage, 11 other spontaneous SAH). All patients were treated with analgesics. Within 48h after ictus, a first NRS 0 was reported by 9 patients (8%;95%CI:3%-14%) and a first NRS ictus. In a cohort of SAH patients with a normal level of consciousness and no focal deficits who all used analgetics, headache disappeared in around 10% within 48h after ictus. Our data indicate that a diagnostic work-up for SAH is also needed in patients using analgesics in whom headache has disappeared after 10h. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. Terson syndrome: an underrecognized cause of reversible vision loss in patients with subarachnoid hemorrhage.

    Science.gov (United States)

    Middleton, Kim; Esselman, Peter; Lim, P Chuwn

    2012-03-01

    Terson syndrome is a known complication of subarachnoid hemorrhage (SAH) that causes potentially reversible vision loss. It develops after SAH because of vitreous hemorrhage caused by retinal capillary disruption. Case series report an incidence of Terson syndrome in approximately 8%-15% of patients with SAH. Nonetheless, the medical literature regarding this condition is primarily found within neurosurgical and ophthalmologic journals with little mention within the rehabilitation medicine literature. Physiatrists must be aware of this clinical presentation to coordinate the care of patients with SAH who develop vision loss and develop a rehabilitation plan that addresses the co-morbid motor, sensory, and cognitive impairments. Physiatrists may be the first to identify visual loss, are well equipped to emphasize compensatory strategies, and are well positioned to coordinate surgical treatment for visual recovery in appropriate cases. In this report, we describe the case of a young woman with SAH and Terson syndrome through her acute hospital admission, rehabilitation treatment, ophthalmologic management, and outcome, describing the salient epidemiology, pathophysiology, diagnostic workup, and treatment options.

  20. Electrocardiographic abnormalities in acute cerebro-vascular accidents and their correlation with cerebro-spinal fluid pressure and serum electrolytes

    Directory of Open Access Journals (Sweden)

    Gambhir M

    1978-01-01

    Full Text Available Electrocardiographic studies have been carried out in 50 patients with acute cerebrovascular accidents. These cases included 31 cases from non-haemorrhagic group and 19 cases from haemor-rhagic group. `T′ or T-U wave abnormalities were seen in 63.1% of cases in haemorrhagic group and in 35.4% of cases from non-hae-morrhagic group. Abnormal prolongation of QTc interval (105% of normal i.e. 0.45 Secs. was observed in 73.6% cases from haemorrhagic group and in 35.4% of cases from non-haemorrhagic group. On comparing these two groups it was found that QTc was signi-ficantly more prolonged in patiens of haemorrhagic group than non--haemorrhagic group. The CSF pressure was found to be signi-ficantly more in patients with ECG abnormalities. However, there teas no correlation between serum electrolyte levels and ECG abnormalities. After 2 weeks, the ECG abnormalities disappeared, except in two cases from haemorrhagic group. There was no signi-ficant difference in the incidence of mortality between patient having ECG abnormalities and the patients without ECG abnormalities. In the light of these findings the probable mechanism of production of ECG changes in acute cerebrovascular accidents is discussed.

  1. New sites of localisation of Pasteurella multocida B:2 in buffalo surviving experimental haemorrhagic septicaemia.

    Science.gov (United States)

    Annas, Salleh; Zamri-Saad, Mohammad; Jesse, Faez Firdaus Abdullah; Zunita, Zakaria

    2014-04-11

    Haemorrhagic septicaemia (HS) is an acute septicaemic disease of buffalo and cattle caused by Pasteurella multocida B:2 and E:2. Field outbreaks of HS are known to result in localisation of bacteria in the tonsils of surviving buffalo, confirming that animals can become carriers and the role of respiratory tract in the transmission of the disease. This report describes additional sites of localisation of P. multocida B:2 in surviving buffalo following experimental induction of HS. Following P. multocida B:2 infection, all calves in group 1 and one calf in group 2 that was allowed to commingle with infected calves from group 1 were euthanised within 48 h. Pasteurella multocida B:2 was detected from the nasal and rectal swab samples on days 5 and 6 from the remaining calves in group 2. The first injection of dexamethasone into the carrier animals resulted in reemergence in samples from the nose, rectum and vagina. However, subsequent dexamethasone injections failed to re-activate P. multocida B:2. When surviving carrier calves in group 2 were euthanised at the end of the experiment, P. multocida B:2 was detected in the lungs and various organs of the respiratory, gastrointestinal and urinary tracts. Commingling naive buffalo calves with calves acutely infected with P. multocida B:2 resulted in carriers among surviving buffalo. Pasteurella was found in various organs of the respiratory, gastrointestinal and urinary tracts, suggesting their role in the pathogenesis of HS.

  2. Predicting return to work after subarachnoid hemorrhage using the Montreal Cognitive Assessment (MoCA).

    Science.gov (United States)

    Wallmark, Svante; Ronne-Engström, Elisabeth; Lundström, Erik

    2016-02-01

    Returning to work is a major issue for patients having had an aneurysmal subarachnoid hemorrhage (SAH). It is important, at an early stage, to identify the patients that are unlikely to return to work. The objective of this study was to assess the predictive value of the Montreal Cognitive Assessment (MoCA) at 6 months after ictus on return to work at 12 months. In this prospective study were 96 patients with SAH included in the acute phase. Cognitive functions were assessed at 6 months using the MoCA and return to work at 12 months. The predictive value of MoCA on return to work was analyzed using the area under the receiver operating characteristic curve as well as logistic regression. Of those that had work before the SAH, 52 % were working at 12 months after the ictus. These patients had scored significantly better on MoCA at 6 months (p = 0.01). The area under the receiver operating characteristic curve was 0.75. By using a cut-off on MoCA of work. Adding data from the acute phase to the MoCA in a logistic regression model increased the percentage of patients correctly classified as returned/not returned to work by 2 %. Returning to work is a major issue for SAH patients. It is important to identify factors that may interfere with a patient's ability to return to work, and address these issues appropriately. In our study, estimating cognitive functions at 6 months after SAH using the MoCA alone allowed us to predict return to work correctly in 68 % of the cases. We feel that this provides useful information in planning rehabilitation, but that other post-SAH symptoms have to be considered as well.

  3. Time-dependent test characteristics of head computed tomography in patients suspected of nontraumatic subarachnoid hemorrhage.

    Science.gov (United States)

    Backes, Daan; Rinkel, Gabriel J E; Kemperman, Hans; Linn, Francisca H H; Vergouwen, Mervyn D I

    2012-08-01

    A recent study suggested that in patients with acute headache suspicious of nontraumatic subarachnoid hemorrhage (SAH), cerebrospinal fluid (CSF) analysis is not needed to rule out SAH if head CT performed ≤6 hours after ictus is negative. Before implementation in daily practice, these results need replication. Therefore, we investigated test characteristics of head CT in patients with a clinical suspicion of SAH. Patients suspicious of SAH and a normal level of consciousness presenting to our tertiary care hospital between 2005 and 2012 were included. All patients had a head CT interpreted by experienced neuroradiologists and CSF spectrophotometry if head CT was negative or inconclusive. We determined test characteristics with 95% confidence intervals (CI) for nontraumatic SAH of head CT performed ≤6 or >6 hours after onset of headache. Sensitivity of head CT ≤6 hours after ictus (n=137) was 98.5% (95% CI, 92.1%-100%), diagnosing all patients with aneurysmal and perimesencephalic SAH, but not with a cervical arteriovenous malformation. Sensitivity of head CT performed >6 hours after ictus (n=113) was 90.0% (95% CI, 76.3-97.2). After exclusion of patients with an atypical presentation without headache, sensitivity, specificity, negative predictive value, and positive predictive value of head CT ≤6 hours were all 100%. In patients presenting with acute headache and a normal head CT ≤6 hours after ictus, as interpreted by experienced neuroradiologists, there is no added value of CSF analysis. In patients with an atypical presentation without headache and in patients presenting >6 hours after ictus, CSF analysis is still indicated.

  4. Brain Natriuretic Peptide Concentrations After Aneurysmal Subarachnoid Hemorrhage: Relationship with Hypovolemia and Hyponatremia

    NARCIS (Netherlands)

    Mees, Sanne M. Dorhout; Hoff, Reinier G.; Rinkel, Gabriel J. E.; Algra, Ale; van den Bergh, Walter M.

    2011-01-01

    Hyponatremia and hypovolemia occur often after aneurysmal subarachnoid hemorrhage (SAH) and are associated with poor outcome. The authors investigated whether brain natriuretic peptide (BNP) is related to hypovolemia and hyponatremia after SAH and whether it can differentiate between hypovolemic and

  5. Case Series Of Ruptured Jamaican Berry Aneurysms

    African Journals Online (AJOL)

    was predominant. There were no cerebro-vascular spasms postoperatively. Greek -- -- ANEURYSMA (Ana= up or across, eurys = wide or broad). Key Words: Subarachnoid Haemorrhage, Cerebro-Vascular Spasms. rupture spontaneously into the subarachnoid space, causing subarachnoid haemorrhage. Rupture could.

  6. Recurrent craniospinal subarachnoid hemorrhage in cerebral amyloid angiopathy

    Directory of Open Access Journals (Sweden)

    Mathew Alexander

    2013-01-01

    Full Text Available Cerebral amyloid angiopathy (CAA usually manifests as cerebral hemorrhage, especially as nontraumatic hemorrhages in normotensive elderly patients. Other manifestations are subarachnoid (SAH, subdural, intraventricular hemorrhage (IVH and superficial hemosiderosis. A 52-year-old hypertensive woman presented with recurrent neurological deficits over a period of 2 years. Her serial brain magnetic resonance imaging and computed tomography scans showed recurrent SAH hemorrhage, and also intracerebral, IVH and spinal hemorrhage, with superficial siderosis. Cerebral angiograms were normal. Right frontal lobe biopsy showed features of CAA. CAA can present with unexplained recurrent SAH hemorrhage, and may be the initial and prominent finding in the course of disease in addition to superficial cortical siderosis and intracerebal and spinal hemorrhages.

  7. [Giant racemose subarachnoid and intraventricular neurocysticercosis: A case report].

    Science.gov (United States)

    Sanchez-Larsen, Alvaro; Monteagudo, Maria; Lozano-Setien, Elena; Garcia-Garcia, Jorge

    2015-01-01

    Neurocysticercosis is the most frequent parasitic disease of the central nervous system. It is caused by the larvae of Taenia solium, which can affect different anatomical sites. In Spain there is an increasing prevalence mainly due to immigration from endemic areas. The extraparenchymal forms are less common, but more serious because they usually develop complications. Neuroimaging plays a major role in the diagnosis and follow-up of this disease, supported by serology and a compatible clinical and epidemiological context. First-line treatments are cysticidal drugs such as albendazole and praziquantel, usually coadministered with corticosteroids, and in some cases surgery is indicated. We here report a case of neurocysticercosis with simultaneous intraventricular and giant racemose subarachnoid involvement. Copyright © 2015 Asociación Argentina de Microbiología. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. The Harmful Effects of Subarachnoid Hemorrhage on Extracerebral Organs

    Directory of Open Access Journals (Sweden)

    Sheng Chen

    2014-01-01

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

  9. Hydrocephalus after Subarachnoid Hemorrhage: Pathophysiology, Diagnosis, and Treatment

    Directory of Open Access Journals (Sweden)

    Sheng Chen

    2017-01-01

    Full Text Available Hydrocephalus (HCP is a common complication in patients with subarachnoid hemorrhage. In this review, we summarize the advanced research on HCP and discuss the understanding of the molecular originators of HCP and the development of diagnoses and remedies of HCP after SAH. It has been reported that inflammation, apoptosis, autophagy, and oxidative stress are the important causes of HCP, and well-known molecules including transforming growth factor, matrix metalloproteinases, and iron terminally lead to fibrosis and blockage of HCP. Potential medicines for HCP are still in preclinical status, and surgery is the most prevalent and efficient therapy, despite respective risks of different surgical methods, including lamina terminalis fenestration, ventricle-peritoneal shunting, and lumbar-peritoneal shunting. HCP remains an ailment that cannot be ignored and even with various solutions the medical community is still trying to understand and settle why and how it develops and accordingly improve the prognosis of these patients with HCP.

  10. Pre-eclampsia increases the risk of postpartum haemorrhage: a nationwide cohort study in the Netherlands.

    Directory of Open Access Journals (Sweden)

    Joost F von Schmidt auf Altenstadt

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

  11. Copeptin Levels in Cerebral Infarction, Intracranial Hemorrhage and Subarachnoid Hemorrhage.

    Science.gov (United States)

    Aksu, Feyza; Gurger, Mehtap; Yilmaz, Mustafa; Atescelik, Metin; Yildiz, Mustafa; Ilhan, Nevin; Ilhan, Selcuk; Goktekin, Mehmet C

    2016-12-01

    To determine copeptin levels in patients with suspected intracranial events and to determine whether copeptin levels could be used in the discrimination of cerebral infarction, intracranial hemorrhage, and subarachnoid hemorrhage in the emergency room. Blood samples were obtained from the patients prior to imaging to determine the levels of copeptin. Patients were divided into diagnostic groups after the imaging. One hundred and seventy-six participants, who were enrolled in the study, were as follows: 50 cerebral infarction (CI) patients (M/F: 24/26), 47 intracranial hemorrhage (ICH) patients (M/F: 27/20), 29 subarachnoid hemorrhage (SAH) patients (M/F: 17/12) and 50 healthy controls. Differences and correlations between groups were analyzed. Plasma levels of copeptin in patients with CI, ICH, and SAH were 5.49 ng/dL (IQR 4.73 to 6.96), 4.50 ng/dL (IQR 3.04 to 9.77), and 5.90 ng/dL (IQR 3.11 to 13.26), respectively. It was found to be 2.0 ng/dL (IQR 1.57 to 2.5) in healthy volunteers. There was no significant correlation between copeptin levels and Intracerebral Hemorrhage Score (ICHS) (r = 0.231, p = 0.118). However, significant positive correlation was found between copeptin levels with the National Institutes of Health Stroke Scale (NIHSS) (r = 0.365, p = 0.009) and the BotterelHunt and Hess Scale (BHHS) (r = 0.590, p = 0.001). The copeptin levels of 41 (32.5%) patients who died were found to be significantly higher than those 85 (67.5%) patients who were discharged (p Copeptin levels in patients with CI, ICH, and SAH are significantly higher than healthy volunteers, but the plasma level of copeptin is not decisive in the discrimination of CI, ICH, and SAH.

  12. Clinical relevance of cortical spreading depression in neurological disorders: migraine, malignant stroke, subarachnoid and intracranial hemorrhage, and traumatic brain injury.

    Science.gov (United States)

    Lauritzen, Martin; Dreier, Jens Peter; Fabricius, Martin; Hartings, Jed A; Graf, Rudolf; Strong, Anthony John

    2011-01-01

    Cortical spreading depression (CSD) and depolarization waves are associated with dramatic failure of brain ion homeostasis, efflux of excitatory amino acids from nerve cells, increased energy metabolism and changes in cerebral blood flow (CBF). There is strong clinical and experimental evidence to suggest that CSD is involved in the mechanism of migraine, stroke, subarachnoid hemorrhage and traumatic brain injury. The implications of these findings are widespread and suggest that intrinsic brain mechanisms have the potential to worsen the outcome of cerebrovascular episodes or brain trauma. The consequences of these intrinsic mechanisms are intimately linked to the composition of the brain extracellular microenvironment and to the level of brain perfusion and in consequence brain energy supply. This paper summarizes the evidence provided by novel invasive techniques, which implicates CSD as a pathophysiological mechanism for this group of acute neurological disorders. The findings have implications for monitoring and treatment of patients with acute brain disorders in the intensive care unit. Drawing on the large body of experimental findings from animal studies of CSD obtained during decades we suggest treatment strategies, which may be used to prevent or attenuate secondary neuronal damage in acutely injured human brain cortex caused by depolarization waves.

  13. Recurrent Subarachnoid Bleeding and Superficial Siderosis in a Patient with Histopathologically Proven Cerebral Amyloid Angiopathy

    Science.gov (United States)

    Profice, P.; Pilato, F.; Della Marca, Giacomo; Colosimo, C.; Gaudino, S.; Arena, V.; Pavone, A.; Di Lazzaro, Vincenzo

    2011-01-01

    A 68-year-old man with a history of hypertension presented with recurrent subarachnoid bleeding. Brain MRI showed superficial siderosis, and diagnostic cerebral angiograms did not show any intracranial vascular malformation or arterial aneurism. Post mortem neuropathological examination of the brain was consistent with a diagnosis of cerebral amyloid angiopathy. Clinicians should be aware that cerebral amyloid angiopathy should be considered in patients with unexplained recurrent subarachnoid bleeding, even in cases without familial clustering or transthyretin variant. PMID:21720529

  14. Acute Compressive Ulnar Neuropathy in a Patient of Dengue Fever: An Unusual Presentation

    Directory of Open Access Journals (Sweden)

    Anil K Mehtani

    2013-04-01

    Full Text Available Introduction: Dengue haemorrhagic fever is known for its haemorrhagic and neurologic complications. Neurologic complications are caused by three mechanism namely neurotropism, systemic complications causing encephalopathy and postinfectious immune-mediated mechanisms. However acute compressive neuropathy due to haemorrhage is not frequent and we could find no literature describing this Case Report: We report a case of acute compressive ulnar neuropathy due to peri neural hematoma, following an attempt at intravenous cannulation in the cubital fossa in a patient of dengue haemorrhagic fever with thrombocytopenia. Immediate fasciotomy and removal of haematoma was performed to relieve the symptoms. Conclusion: Compression neuropathies can be seen in dengue hemorrhagic fever and removal of compressing hematoma relieves symptoms. Keywords: Dengue haemmorrhagic fever; coagulopathy; peri neural haematoma.

  15. Evolution of the fish rhabdovirus viral haemorrhagic septicaemia virus

    DEFF Research Database (Denmark)

    Einer-Jensen, Katja; Ahrens, Peter; Forsberg, Roald

    2004-01-01

    Viral haemorrhagic septicaemia (VHS) caused by the rhabdovirus VHSV is economically the most important viral disease in European rainbow trout farming. Until 1989, this virus was mainly isolated from freshwater salmonids but in the last decade, it has also been isolated from an increasing number...... of free-living marine fish species. To study the genetic evolution of VHSV, the entire G gene from 74 isolates was analysed. VHSV from wild marine species caught in the Baltic Sea, Skagerrak, Kattegat, North Sea, and English Channel and European freshwater isolates, appeared to share a recent common...

  16. Intracerebral haemorrhage in primary and metastatic brain tumours.

    Science.gov (United States)

    Salmaggi, Andrea; Erbetta, Alessandra; Silvani, Antonio; Maderna, Emanuela; Pollo, Bianca

    2008-09-01

    Intracerebral haemorrhage may both be a presenting manifestation in unrecognised brain tumour or--more frequently--take place in the disease course of known/suspected brain tumour due to diagnostic/therapeutic procedures, including biopsy, locoregional treatments and anti-angiogenic therapies. Apart from the difficulties inherent to accurate neuroradiological diagnosis in selected cases with small tumour volume, the main clinical problem that neurologists face is represented by decision making in prophylaxis/treatment of venous thromboembolism in these patients. These points are briefly discussed and available evidence on the last point is commented on.

  17. A Case of Haemorrhagic Constrictive Pericarditis with Bilateral Pleural Effusions

    Directory of Open Access Journals (Sweden)

    Hans A. Reyes

    2016-01-01

    Full Text Available Presentation of pericardial disease is diverse, with the viral aetiology being the most common cause; however, when haemorrhagic pericardial effusion is present, these causes are narrowed to few aetiologies. We present a case of a young female of African descent who presented with diffuse abdominal pain and vomiting. Initial work-up showed pericardial effusion with impending echocardiographic findings of cardiac tamponade and bilateral pleural effusions. Procedures included a left video-assisted thoracoscopic surgery (VATS with pericardial window. We consider that it is important for all physicians to be aware of not only typical presentation but also atypical and unusual clinical picture of pericardial disease.

  18. Subarachnoid space diameter in chromosomally abnormal fetuses at 11-13 weeks' gestation.

    Science.gov (United States)

    Ferreira, Carolina; Rouxinol-Dias, Ana Lidia; Loureiro, Teresa; Nicolaides, Kypros

    2018-01-16

    To examine the subarachnoid space diameters in chromosomally abnormal fetuses at 11-13 weeks' gestation. Stored three-dimensional (3D) ultrasound volumes of the fetal head at 11-13 weeks' gestation from 407 euploid and 88 chromosomally abnormal fetuses (trisomy 21, n = 40; trisomy 18, n = 19; trisomy 13, n = 7; triploidy, n = 14; Turner syndrome, n = 8) were analyzed. The subarachnoid space diameters, measured in the sagittal and transverse planes of the fetal head, in relation to biparietal diameter (BPD) in each group of aneuploidies was compared to that in euploid fetuses. A total of 20 head volumes were randomly selected and all the measurements were recorded by two different observers to examine the interobserver variability in measurements. In euploid fetuses, the anteroposterior, transverse and sagittal diameters of the subarachnoid space increased with BPD. The median of the observed to expected diameters for BPD were significantly increased in triploidy and trisomy 13 but were not significantly altered in trisomies 21 and 18 or Turner syndrome. In triploidy, the subarachnoid space diameters for BPD were above the 95th centile of euploid fetuses in 92.9% (13 of 14) cases. The intraclass reliability or agreement was excellent for all three subarachnoid space diameters. Most fetuses with triploidy at 11-13 weeks' gestation demonstrate increased subarachnoid space diameters.

  19. Protein kinase C inhibition prevents upregulation of vascular ET(B) and 5-HT(1B) receptors and reverses cerebral blood flow reduction after subarachnoid haemorrhage in rats

    DEFF Research Database (Denmark)

    Beg, Saema S; Hansen-Schwartz, Jacob A; Vikman, Petter J

    2007-01-01

    type 1B (5-HT(1B)) receptor upregulation and prevent the associated cerebral blood flow (CBF) reduction. The PKC inhibitor RO-31-7549 or vehicle was injected intracisternally after the induced SAH in rats (n=3 to 10 in each groups for each method). The involvement of the PKC isoforms was investigated...

  20. Haemostatic effect and tissue reactions of methods and agents used for haemorrhage control in apical surgery

    DEFF Research Database (Denmark)

    Jensen, Simon Storgaard; Yazdi, P M; Hjørting-Hansen, Erik

    2010-01-01

    To compare the haemostatic effect and tissue reactions of different agents and methods used for haemorrhage control in apical surgery.......To compare the haemostatic effect and tissue reactions of different agents and methods used for haemorrhage control in apical surgery....

  1. Causes of Vitreous Haemorrhage In Port Harcourt; A 3 Year Review.

    African Journals Online (AJOL)

    Alasia Datonye

    Visual loss in cases of vitreous haemorrhage depends on the density of the haemorrhage and even 10 micolitres of blood can reduce vision to hand. 1 movement. Our study revealed that our patients had visual loss ranging from hand movement(HM) to 'no light perception'(NLP) (see Table 2). This pattern of the presenting.

  2. Trade practices are main factors involved in the transmission of viral haemorrhagic septicaemia

    DEFF Research Database (Denmark)

    Reichert, M.; Matras, M.; Skall, Helle Frank

    2013-01-01

    Viral haemorrhagic septicaemia (VHS), caused by the novirhabdovirus viral haemorrhagic septicaemia virus (VHSV), causes significant economic problems to European rainbow trout, Oncorhynchus mykiss (Walbaum), production. The virus isolates can be divided into four distinct genotypes with additiona...... cause of virus transmission appears to be movement of fish. At least in Polish circumstances trading practices appear to have significant impact on spreading of VHSV infection....

  3. An increase in rates of obstetric haemorrhage in a setting of high ...

    African Journals Online (AJOL)

    Cases of OH (including abruptio placentae, placenta praevia, unspecified antepartum haemorrhage (APH), and postpartum haemorrhage (PPH)) were identified from maternity delivery records, and the relevant data extracted. Results. We analysed the records of 448 women diagnosed with OH. Even though the incidence ...

  4. Case report: profound hypotension associated with labetalol therapy in a patient with cerebral aneurysms and subarachnoid hemorrhage.

    Science.gov (United States)

    Jivraj, Sana; Mazer, C David; Baker, Andrew J; Choi, Mabel; Hare, Gregory M T

    2006-07-01

    Labetalol is an effective antihypertensive medication frequently used to treat systemic hypertension in acute care settings, including the management of hypertension associated with a subarachnoid hemorrhage. We present a case of profound hypotension, refractory to inotropic and vasopressor therapy following an iv infusion of labetalol. Initiation of an iv labetalol infusion resulted in good blood pressure control in a patient suffering from a Fisher grade 3 subarachnoid hemorrhage with an initial Glascow coma scale of 14/15 and mild hydrocephalus. Progressive deterioration of neurological symptoms and evidence of worsening hydrocephalus preceded the sudden development of profound hypotension (60/35 mmHg) and bradycardia with a minimum heart rate of 40 beats.min(-1). Initial resuscitative efforts included administration of intravascular fluid, hypertonic saline, atropine, adrenalin (more than 10 mg in divided doses) and noradrenalin. These measures restored the blood pressure to 80/45 with a HR of 98 beats.min(-1). Intraoperative placement of an intraventricular drain released cerebrospinal fluid under pressure with an initial intracranial pressure of 15 cm H(2)O. A combination of adrenalin, noradrenalin, dopamine and vasopressin infusions were required to restore the blood pressure to 130/65 mmHg after an additional two hours. All inotropic and vasopressor support was weaned off after the 14th hr (about two drug half-lives). The patient was awake and responsive the following day, with no obvious neurological consequences. No evidence of neurological injury, drug administration error or myocardial dysfunction was documented. The episode of profound hypotension which occurred after initiating a labetolol infusion required maximal combined vasopressor therapy to restore the blood pressure suggesting that this patient demonstrated an extreme sensitivity to labetalol. Combination therapy with adrenergic and nonadrenergic agonists may be required for optimal treatment

  5. The Socioeconomic Impacts of Clinically Diagnosed Haemorrhagic Septicaemia on Smallholder Large Ruminant Farmers in Cambodia.

    Science.gov (United States)

    Kawasaki, M; Young, J R; Suon, S; Bush, R D; Windsor, P A

    2015-10-01

    Haemorrhagic septicaemia (HS) is an acute fatal infectious disease of mainly cattle and buffalo and outbreaks occur commonly in Cambodia. Disease outbreak reports were examined to select five villages from three provinces for a retrospective investigation of HS epidemiology and socioeconomic impact on smallholders, with an aim of identifying potential benefits from improving disease prevention through biosecurity and vaccination. The Village Animal Health Worker (VAHW) or Chief in each village and 66 affected smallholders were surveyed. At the village level, 24% of all households were affected with an estimated mean village herd morbidity of 10.1% and mortality of 28.8%. Affected farmers reported HS disease morbidity and mortality at 42.7% and 63.6% respectively. Buffalo had a higher morbidity (OR = 2.3; P = 0.003) and mortality (OR = 6.9; P productivity and profitability. Addressing HS disease control requires a focus on improving smallholder farmer knowledge of biosecurity and vaccination and should be priority to stakeholders interested in addressing regional food insecurity and poverty reduction. © 2013 Blackwell Verlag GmbH.

  6. Procoagulant Phospholipids and Tissue Factor Activity in Cerebrospinal Fluid from Patients with Intracerebral Haemorrhage

    Directory of Open Access Journals (Sweden)

    Patrick Van Dreden

    2014-01-01

    Full Text Available Brain contains large amounts of tissue factor, the major initiator of the coagulation cascade. Neuronal apoptosis after intracerebral haemorrhage (ICH leads to the shedding of procoagulant phospholipids (PPLs. The aim of this study was to investigate the generation of PPL, tissue factor activity (TFa, and D-Dimer (D-Di in the cerebrospinal fluid (CSF at the acute phase of ICH in comparison with other brain diseases and to examine the relationship between these factors and the outcome of ICH. CSF was collected from 112 patients within 48 hours of hospital admission. Thirty-one patients with no neurological or biochemical abnormalities were used to establish reference range in the CSF (“controls”. Thirty had suffered an ICH, and 51 other neurological diagnoses [12: ventricular drainage following brain surgery, 13: viral meningitis, 15: bacterial meningitis, and 11 a neurodegenerative disease (NDD]. PPL was measured using a factor Xa-based coagulation assay and TFa by one home test. PPL, D-Di, and TFa were significantly higher (P<0.001 in the CSF of patients with ICH than in controls. TFa levels were significantly (P<0.05 higher in ICH than in patients with meningitides or NDD. Higher levels (P<0.05 of TFa were observed in patients with ICH who died than in survivors. TFa measurement in the CSF of patients with ICH could constitute a new prognostic marker.

  7. Prevalence of adrenal haemorrhage in non-surviving patients with burns.

    Science.gov (United States)

    Kallinen, Outi; Koljonen, Virve

    2011-11-01

    The purpose of this study was to investigate the prevalence of adrenal haemorrhage (AH) in non-surviving patients with severe burns by combining the clinical notes and autopsy data. A retrospective review of all adult (age >18 years) burn patients who died in the Helsinki Burn Centre, Helsinki, Finland during 1.1.1995 to 31.12.2005 was conducted. Patients diagnosed with AH either in the clinical charts or in the autopsy reports were sorted out. Special attention was paid to the course of events preceding death and autopsy findings. We identified four patients, creating a prevalence of 5.6%. None of the patients was diagnosed with AH alive. Three patients we diagnosed with bilateral AH, all young men. Cause of death was multiple organ failure (MOF) in all three cases. On the autopsy, they were diagnosed with 5±1 organ failures. One case of unilateral AH was established, an elderly male with hot air sauna burns. Clinical charts and autopsy data suggest idiopathic AH. The prevalence of AH is higher than previously estimated in non-surviving patients with burns. Bilateral AH occurred later then 1 week after the burn trauma. Bilateral AH always presented with sepsis, multiple organ failure and acute renal failure. Copyright © 2011 Elsevier Ltd and ISBI. All rights reserved.

  8. Ascending haemorrhagic myelomalacia associated with systemic hypertension in a hyperthyroid cat

    Directory of Open Access Journals (Sweden)

    Alexandra Ferreira

    2015-06-01

    Full Text Available Case summary An 8-year-old domestic shorthair neutered male cat was presented with acute onset of paraplegia, absent nociception on the pelvic limbs, tail and perianal area, and a previous history of uncontrolled hyperthyroidism (even after thyroidectomy and chronic hypertension. The magnetic resonance findings (heterogeneous intramedullary ill-defined area, isointense on T1-weighted and hyperintense on short tau inversion recovery and T2-weighted scans between T12 and L5 spinal cord segments were consistent with ascending haemorrhagic myelomalacia, which was confirmed by histopathology. It also revealed myelomalacia associated with diffuse arteriolar hyalinosis, similar to the reports found with hypertensive encephalopathy. Relevance and novel information Myelomalacia should be considered as a possible outcome in cats with hypertension. Considering that hypertension is a common consequence of hyperthyroidism, emphasis should be given to blood pressure monitoring, especially after treatment of this condition. We describe the histopathological changes occurring in the spinal cord associated with a state of hypertension.

  9. Serum magnesium levels and clinical outcome of aneurysmal subarachnoid hemorrhage: a study in 60 patients

    Directory of Open Access Journals (Sweden)

    Habibi Z

    2008-06-01

    Full Text Available Background: Hypomagnesemia is commonly encountered in patients with a wide variety of diseases including subarachnoid hemorrhage (SAH, cardiovascular emergencies, head trauma, migraine attacks, seizure and preeclampsia. It seems to be associated with a poor clinical outcome. This study considers the prevalence and temporal distribution of hypomagnesemia after aneurysmal SAH and its correlation with the severity of SAH, delayed cerebral ischemia (DCI as well as the neurological outcome after a period of three months.Methods: Between 2003 and 2008, 60 patients were admitted to the emergency ward of Imam Khomeini Hospital with acute SAH. Serum magnesium levels were measured during the first 72 hours, days 4-7, and second and third weeks after SAH. The three-month outcome was assessed according to the Glasgow Outcome Scale (GOS. Clinical SAH grading was performed according to the criteria of the World Federation of Neurological Surgeons (WFNS and the patients were allocated to "Good" (GOS = 4, 5 and "Poor" (GOS= 1-3 outcome groups. The prevalence of hypomagnesemia was assessed in both patient groups. Fisher exact test was used to analyze data.Results: Hypomagnesemia occurred in 22% of patients during the first 72 hours after SAH. It was associated with more prevalent DCI (p<0.05, whereas low serum magnesium levels during days 4-7 17% of patients and the second week (22% of patients after SAH were correlated with poor clinical outcome (p<0.05. No correlation was found between first 72 hour-hypomagnesemia and poor clinical outcome at three months.Conclusion: Hypomagnesemia occurs after aneurysmal SAH and it may predict the occurrence of DCI, while low serum magnesium levels during days 4-7 and within the second week of event predict poor clinical outcome at three months. Treatment of this electrolyte disturbance may have a favourable effect on the clinical outcome of patients with aneurysmal SAH.

  10. Nimodipine Dose Reductions in the Treatment of Patients with Aneurysmal Subarachnoid Hemorrhage.

    Science.gov (United States)

    Sandow, Nora; Diesing, Dominik; Sarrafzadeh, Asita; Vajkoczy, Peter; Wolf, Stefan

    2016-08-01

    The incidence of cerebral infarction and poor outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH) is reduced by oral nimodipine but acute effects of the drug may include a significant decrease in mean arterial blood pressure (MAP). A dose reduction or discontinuation of the drug is recommended if recurrent MAP drops occur. The aim of our study was to evaluate the frequency and clinical significance of nimodipine dose modifications in patients suffering from aSAH. 270 patients were included in our retrospective analysis of consecutively collected data of patients suffering from aSAH. The local treatment protocol was in accordance to national and international guidelines. Nimodipine was intended to be applied orally with a dosage of 60 mg every 4 h. Only 43.6 % of patients eligible for vasospasm prophylaxis with nimodipine received the full daily dose of 60 mg every 4 h. In 28.6 %, the dose had to be reduced by 50 % due to a significant reduction in blood pressure after administration and/or high dose of catecholamines. In 27.7 % of patients, oral administration of the drug was discontinued for the same reason. Dose reduction and discontinuation occurred with a significantly higher frequency in patients in poor clinical condition. Application of the full nimodipine dosage decreased the risk of unfavorable clinical outcome in multivariate analysis (OR 0.895, p = 0.029). Our results show that dose reduction or discontinuation of nimodipine due to changes in MAP occur frequently in clinical routine and may be associated with unfavorable clinical outcome.

  11. Serum nesfatin-1 levels: a potential new biomarker in patients with subarachnoid hemorrhage.

    Science.gov (United States)

    Cakir, Murteza; Calikoglu, Cagatay; Yılmaz, Atilla; Akpinar, Erol; Bayraktutan, Zafer; Topcu, Atilla

    2017-02-01

    Acute subarachnoid hemorrhage (SAH) is a neurological emergency with significant potential for long-term morbidity and mortality. Nesfatin-1 is a polypeptide which is found in various regions of the brain that play role in the feeding and metabolic regulation. So this study aimed to investigate if nesfatin-1 levels in patients with SAH, could be used as a marker for the severity and prognosis. Forty-eight consecutive patients (except those excluded) admitted to the emergency service of our hospital and hospitalized at our clinic with the diagnosis of aneurysmal SAH between 2011 and 2013 were included in the study and followed up for six months for outcome. The control group consisted of 48 healthy individuals of similar age and gender. During the 6-month follow-up, 7 of 48 patients died and 16 (33.3%) patients had poor Glasgow Outcome Score (GOS) scores. In the study group, the mean nesfatin-1 level was significantly higher than the control group (7.36 ± 2.5 pg/ml and 4.29 ± 2.02 pg/ml, respectively; p < 0.01). The mean nesfatin-1 level was 11.58 ± 0.87 pg/ml in the non-survival group and 6.64 ± 1.89 pg/ml in the survival group. Furthermore, it was 10.22 ± 1.42 pg/ml in patients with poor outcome in terms of GOS and 5.93 ± 1.46 pg/ml in those with good outcome. The nesfatin-1 levels significantly increased with worsening of GOS, the World Federation of Neurological Surgeons grading system, and Fisher scores and increasing plasma C-reactive protein levels (p < 0.01 for all). The present study is the first that shows the mortality/poor outcome of the SAH with assessing serum nesfatin-1 levels. So levels of nesfatin-1 might be useful in SAH management.

  12. Cerebrospinal Fluid and Microdialysis Cytokines in Aneurysmal Subarachnoid Hemorrhage: A Scoping Systematic Review

    Directory of Open Access Journals (Sweden)

    Frederick A. Zeiler

    2017-08-01

    Full Text Available ObjectiveTo perform two scoping systematic reviews of the literature on cytokine measurement in cerebral microdialysis (CMD and cerebrospinal fluid (CSF in aneurysmal subarachnoid hemorrhage (SAH patients, aiming to summarize the evidence relating cytokine levels to pathophysiology, disease progression, and outcome.MethodsTwo separate systematic reviews were conducted: one for CMD cytokines and the second for CSF cytokines.Data sourcesArticles from MEDLINE, BIOSIS, EMBASE, Global Health, Scopus, Cochrane Library (inception to October 2016, reference lists of relevant articles, and gray literature were searched.Study selectionTwo reviewers independently identified all manuscripts utilizing predefined inclusion/exclusion criteria. A two-tier filter of references was conducted.Data extractionPatient demographic and study data were extracted to tables.ResultsThere were 9 studies identified describing the analysis of cytokines via CMD in 246 aneurysmal SAH patients. Similarly, 20 studies were identified describing the analysis of CSF cytokines in 630 patients. The two scoping systematic reviews demonstrated the following: (1 limited literature available on CMD cytokine measurement in aneurysmal SAH with some preliminary data supporting feasibility of measurement and potential association between interleukin (IL-6 and patient outcome. (2 Various CSF measured cytokines may be associated with patient outcome at 3–6 months, including IL-1ra, IL-6, IL-8, and tumor necrosis factor-alpha. (3 There is a small literature body supporting an association between acute/subacute CSF transforming growth factor levels and the development of chronic hydrocephalus at 2–3 months.ConclusionThe evaluation of CMD and CSF cytokines is an emerging area of the literature in aneurysmal SAH. Further large prospective multicenter studies on cytokines in CMD and CSF need to be conducted.

  13. Call for uniform neuropsychological assessment after aneurysmal subarachnoid hemorrhage: Swiss recommendations.

    Science.gov (United States)

    Zweifel-Zehnder, Antoinette E; Stienen, Martin N; Chicherio, Christian; Studerus-Germann, Aline; Bläsi, Stefan; Rossi, Stefania; Gutbrod, Klemens; Schmid, Nicole; Beaud, Valérie; Mondadori, Christian; Brugger, Peter; Sacco, Leonardo; Müri, Rene; Hildebrandt, Gerhard; Fournier, Jean-Yves; Keller, Emanuela; Regli, Luca; Fandino, Javier; Mariani, Luigi; Raabe, Andreas; Daniel, Roy Thomas; Reinert, Michael; Robert, Thomas; Schatlo, Bawarjan; Bijlenga, Philippe; Schaller, Karl; Monsch, Andreas U

    2015-09-01

    In a high proportion of patients with favorable outcome after aneurysmal subarachnoid hemorrhage (aSAH), neuropsychological deficits, depression, anxiety, and fatigue are responsible for the inability to return to their regular premorbid life and pursue their professional careers. These problems often remain unrecognized, as no recommendations concerning a standardized comprehensive assessment have yet found entry into clinical routines. To establish a nationwide standard concerning a comprehensive assessment after aSAH, representatives of all neuropsychological and neurosurgical departments of those eight Swiss centers treating acute aSAH have agreed on a common protocol. In addition, a battery of questionnaires and neuropsychological tests was selected, optimally suited to the deficits found most prevalent in aSAH patients that was available in different languages and standardized. We propose a baseline inpatient neuropsychological screening using the Montreal Cognitive Assessment (MoCA) between days 14 and 28 after aSAH. In an outpatient setting at 3 and 12 months after bleeding, we recommend a neuropsychological examination, testing all relevant domains including attention, speed of information processing, executive functions, verbal and visual learning/memory, language, visuo-perceptual abilities, and premorbid intelligence. In addition, a detailed assessment capturing anxiety, depression, fatigue, symptoms of frontal lobe affection, and quality of life should be performed. This standardized neuropsychological assessment will lead to a more comprehensive assessment of the patient, facilitate the detection and subsequent treatment of previously unrecognized but relevant impairments, and help to determine the incidence, characteristics, modifiable risk factors, and the clinical course of these impairments after aSAH.

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

    Energy Technology Data Exchange (ETDEWEB)

    Yan, Huiying [Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing 210002, Jiangsu Province (China); Hao, Shuangying; Sun, Xiaoyan [Jiangsu Key Laboratory for Molecular Medicine, Medical School of Nanjing University, 22 Hankou Road, Nanjing 210093, Jiangsu Province (China); Zhang, Dingding; Gao, Xin; Yu, Zhuang [Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing 210002, Jiangsu Province (China); Li, Kuanyu, E-mail: likuanyu@nju.edu.cn [Jiangsu Key Laboratory for Molecular Medicine, Medical School of Nanjing University, 22 Hankou Road, Nanjing 210093, Jiangsu Province (China); Hang, Chun-Hua, E-mail: hang_neurosurgery@163.com [Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing 210002, Jiangsu Province (China)

    2015-01-24

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

  15. Cerebral inflammatory response and predictors of admission clinical grade after aneurysmal subarachnoid hemorrhage.

    Science.gov (United States)

    Hanafy, Khalid A; Morgan Stuart, R; Fernandez, Luis; Schmidt, J Michael; Claassen, Jan; Lee, Kiwon; Sander Connolly, E; Mayer, Stephan A; Badjatia, Neeraj

    2010-01-01

    Poor admission clinical grade is the most important determinant of outcome after aneurysmal subarachnoid hemorrhage (aSAH); however, little attention has been focused on independent predictors of poor admission clinical grade. We hypothesized that the cerebral inflammatory response initiated at the time of aneurysm rupture contributes to ultra-early brain injury and poor admission clinical grade. We sought to identify factors known to contribute to cerebral inflammation as well as markers of cerebral dysfunction that were associated with poor admission clinical grade. Between 1997 and 2008, 850 consecutive SAH patients were enrolled in our prospective database. Demographic data, physiological parameters, and location and volume of blood were recorded. After univariate analysis, significant variables were entered into a logistic regression model to identify significant associations with poor admission clinical grade (Hunt-Hess grade 4-5). Independent predictors of poor admission grade included a SAH sum score >15/30 (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.5-3.6), an intraventricular hemorrhage sum score >1/12 (OR 3.1, 95% CI 2.1-4.8), aneurysm size >10mm (OR 1.7, 95% CI 1.1-2.6), body temperature 38.3 degrees C (OR 2.5, 95% CI 1.1-5.4), and hyperglycemia >200mg/dL (OR 2.7, 95% CI 1.6-4.5). In a large, consecutive series of prospectively enrolled patients with SAH, the inflammatory response at the time of aneurysm rupture, as reflected by the volume and location of the hemoglobin burden, hyperthermia, and perturbed glucose metabolism, independently predicts poor admission Hunt-Hess grade. Strategies for mitigating the inflammatory response to aneurysmal rupture in the hyper-acute setting may improve the admission clinical grade, which may in turn improve outcomes. Copyright (c) 2009 Elsevier Ltd. All rights reserved.

  16. Equal contribution of increased intracranial pressure and subarachnoid blood to cerebral blood flow reduction and receptor upregulation after subarachnoid hemorrhage. Laboratory investigation

    DEFF Research Database (Denmark)

    Ansar, Saema; Edvinsson, Lars

    2009-01-01

    . The effects in all parameters were more pronounced for SAH than for saline injection. CONCLUSIONS: This study revealed that both the elevation of intracranial pressure and subarachnoid blood per se contribute approximately equally to the late CBF reductions and receptor upregulation following SAH....

  17. Predictors of In-Hospital Death After Aneurysmal Subarachnoid Hemorrhage: Analysis of a Nationwide Database (Swiss SOS [Swiss Study on Aneurysmal Subarachnoid Hemorrhage]).

    Science.gov (United States)

    Stienen, Martin Nikolaus; Germans, Menno; Burkhardt, Jan-Karl; Neidert, Marian C; Fung, Christian; Bervini, David; Zumofen, Daniel; Röthlisberger, Michel; Marbacher, Serge; Maduri, Rodolfo; Robert, Thomas; Seule, Martin A; Bijlenga, Philippe; Schaller, Karl; Fandino, Javier; Smoll, Nicolas R; Maldaner, Nicolai; Finkenstädt, Sina; Esposito, Giuseppe; Schatlo, Bawarjan; Keller, Emanuela; Bozinov, Oliver; Regli, Luca

    2018-02-01

    To identify predictors of in-hospital mortality in patients with aneurysmal subarachnoid hemorrhage and to estimate their impact. Retrospective analysis of prospective data from a nationwide multicenter registry on all aneurysmal subarachnoid hemorrhage cases admitted to a tertiary neurosurgical department in Switzerland (Swiss SOS [Swiss Study on Aneurysmal Subarachnoid Hemorrhage]; 2009-2015). Both clinical and radiological independent predictors of in-hospital mortality were identified, and their effect size was determined by calculating adjusted odds ratios (aORs) using multivariate logistic regression. Survival was displayed using Kaplan-Meier curves. Data of n=1866 aneurysmal subarachnoid hemorrhage patients in the Swiss SOS database were available. In-hospital mortality was 20% (n=373). In n=197 patients (10.6%), active treatment was discontinued after hospital admission (no aneurysm occlusion attempted), and this cohort was excluded from analysis of the main statistical model. In the remaining n=1669 patients, the rate of in-hospital mortality was 13.9% (n=232). Strong independent predictors of in-hospital mortality were rebleeding (aOR, 7.69; 95% confidence interval, 3.00-19.71; PURL: http://www.clinicaltrials.gov. Unique identifier: NCT03245866. © 2018 American Heart Association, Inc.

  18. Acute disseminated encephalomyelitis, with massive necrosis of the spinal cord, probably due to antitetanus serum

    Science.gov (United States)

    Miller, A. A.; Ramsden, F.

    1962-01-01

    The clinical and pathological findings are described of a fatal case of acute haemorrhagic leucoencephalitis and disseminated encephalomyelitis with acute necrosis of the white matter of the spinal cord. It is suggested that the reaction was a severe immunological response of an allergic nature, probably due to antitetanus serum. Images PMID:14473939

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

    Science.gov (United States)

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

    1995-01-01

    Clinical and neuropathological findings are reported in 63 patients with hereditary cerebral haemorrhage with amyloid angiopathy. Patients had mostly recurrent strokes, and at least 80% of these were haemorrhages. Almost a third of the patients died within a year of their first and only recorded haemorrhage, half of them within two weeks. This angiopathy was restricted to the cerebral and cerebellar cortex and its covering leptomeninges. As the most important consequence, haemorrhagic infarcts and haemorrhages occurred in the subcortical white matter--that is, the region most vulnerable to impaired cortical circulation. Further development of these subcortical lesions gives rise to the fatal haemorrhages seen at necropsy. In so far as dementia occurs this is likely to result from multiple microinfarcts or haemorrhages. In most cases preamyloid lesions or diffuse plaques and early plaques were seen. No other type of plaque or neurofibrillary degeneration was found. The plaques occur in conjunction with the angiopathy, but may not occur even when the angiopathy is severe. In one patient plaques were totally absent. Angiopathy and plaques may be the result of the same mutation, the expression of which is governed by tissue factors or phenotypic differences between individual subjects. Images PMID:7608669

  20. Uterine arteriovenous malformation--a rare cause of uterine haemorrhage.

    Science.gov (United States)

    Manolitsas, T; Hurley, V; Gilford, E

    1994-05-01

    Uterine arteriovenous malformation (AVM) is a rare cause of massive uterine bleeding, with 70 cases reported in the English literature. Although uterine AVM is a rare cause of menorrhagia or postmenopausal bleeding, it is important to consider in the assessment of a patient with abnormal (especially heavy) uterine bleeding because accurate diagnosis can allow appropriate treatment to be planned and avoid hysterectomy in women who wish to retain their reproductive capacity. Until relatively recently this condition was difficult to diagnose and management almost always required hysterectomy. Special investigations (hysteroscopy, Doppler flow ultrasound and pelvic angiography) are important for diagnosis and assessment. Transcatheter embolization has replaced hysterectomy as the treatment of choice in women who wish to retain their fertility. Curettage may precipitate life-threatening haemorrhage and is therefore contraindicated when uterine AVM is suspected.

  1. National mutation study among Danish patients with hereditary haemorrhagic telangiectasia

    DEFF Research Database (Denmark)

    Tørring, P M; Brusgaard, K; Ousager, L B

    2014-01-01

    carry mutations in the ENG, ACVRL1 or SMAD4 genes. Here, we report on the genetic heterogeneity in the Danish national HHT population and address the prevalence of pulmonary arteriovenous malformations (PAVM). Probands of 107 apparently unrelated families received genetic testing, including sequencing....... Large deletions were identified in ENG and ACVRL1. The prevalence of PAVM was 52.3% in patients with an ENG mutation and 12.9% in the ACVRL1 mutation carriers. We diagnosed 80% of the patients clinically, fulfilling the Curaçao criteria, and those remaining were diagnosed by genetic testing......Hereditary haemorrhagic telangiectasia (HHT) is an autosomal dominantly inherited vascular disease characterized by the presence of mucocutaneous telangiectasia and visceral arteriovenous malformations (AVM). The clinical diagnosis of HHT is based on the Curaçao criteria. About 85% of HHT patients...

  2. Hereditary haemorrhagic telangiectasia: a cause of preventable morbidity and mortality.

    LENUS (Irish Health Repository)

    Brady, A P

    2012-01-31

    Hereditary haemorrhagic telangiectasia (HHT) is an autosomal dominant condition whose effects are mediated through deficient blood vessel formation and regeneration, with multisystem involvement. Patients are usually aware of resulting skin telangiectasia and epistaxis, but are also exposed to dangers posed by occult vascular malformations in other organs. About 15-35% of HHT patients have pulmonary AVMs (PAVMs), 10% have cerebral AVMs (CAVMs), 25-33% suffer significant GI blood loss from GI tract telangiectasia, and an unknown but high percentage have liver involvement. In total, 10% of affected individuals die prematurely or suffer major disability from HHT, largely because of bleeding from CAVMs and PAVMs, or paradoxical embolization through PAVMs. Screening for and early intervention to treat occult PAVMs and CAVMs can largely eliminate these risks, and should be undertaken in a specialist centre. The National HHT Center in The Mercy University Hospital in Cork is the referral centre for HHT screening in Ireland.

  3. Genetic population structure of marine viral haemorrhagic septicaemia virus (VHSV)

    DEFF Research Database (Denmark)

    Snow, M.; Bain, N.; Black, J.

    2004-01-01

    The nucleotide sequences of a specific region of the nucleoprotein gene were compared in order to investigate the genetic population structure of marine viral haemorrhagic septicaemia virus (VHSV). Analysis of the sequence from 128 isolates of diverse geographic and host origin renders...... this the most comprehensive molecular epidemiological study of marine VHSV conducted to date. Phylogenetic analysis of nucleoprotein gene sequences confirmed the existence of the 4 major genotypes previously identified based on N- and subsequent G-gene based analyses. The range of Genotype I included subgroups...... of isolates associated with rainbow trout aquaculture (Genotype la) and those from the Baltic marine environment (Genotype Ib) to emphasise the relatively close genetic relationship between these isolates. The existence of an additional genotype circulating within the Baltic Sea (Genotype II) was also...

  4. The role of fibrinogen and haemostatic assessment in postpartum haemorrhage

    DEFF Research Database (Denmark)

    Wikkelsø, Anne Juul

    2015-01-01

    describes the protocol for a RCT of early fibrinogen supplementation in women with severe postpartum haemorrhage. Several practical, ethical and trial management challenges need to be addressed when conducting independent clinical research involving parturients with severe bleeding, placebo......) and subsequent severity of bleeding. Fibrinogen concentrate may be prescribed to correct acquired hypofibrinogenaemia, but evidence is lacking regarding the treatment efficacy. This thesis assesses the current evidence for the use of fibrinogen concentrate and haemostatic assessment in bleeding patients...... with special attention to the obstetrical population. It includes five papers: In Paper I the benefits or harms of fibrinogen concentrate in bleeding patients in general was evaluated using a systematic Cochrane review methodology with metaanalysis of all published randomized controlled trials (RCTs). Six...

  5. A new uterine compression suture for postpartum haemorrhage with atony.

    Science.gov (United States)

    Zheng, J; Xiong, X; Ma, Q; Zhang, X; Li, M

    2011-02-01

    Postpartum haemorrhage (PPH) is a major cause of worldwide maternal mortality and is still associated with significant morbidity. After the B-Lynch suture was reported in 1997, several different uterine compression sutures were found to be successful in controlling PPH. In this paper, we describe another simple variation of the uterine compression suture technique, which was performed without an incision in the uterine wall, without entering the uterine cavity and without suturing the anterior and posterior walls of the uterus together, so minimising the trauma to the uterus. This new uterine compression suture is an effective and safe surgical treatment for PPH caused by atony. It has the potential to apply to intractable PPH after vaginal delivery.

  6. Pre-emptive treatment with fibrinogen concentrate for postpartum haemorrhage

    DEFF Research Database (Denmark)

    Wikkelsø, A J; Edwards, H M; Afshari, A

    2015-01-01

    BACKGROUND: In early postpartum haemorrhage (PPH), a low concentration of fibrinogen is associated with excessive subsequent bleeding and blood transfusion. We hypothesized that pre-emptive treatment with fibrinogen concentrate reduces the need for red blood cell (RBC) transfusion in patients...... and the fibrinogen concentration at inclusion. The primary outcome was RBC transfusion up to 6 weeks postpartum. Secondary outcomes were total blood loss, total amount of blood transfused, occurrence of rebleeding, haemoglobin ... concentrate, thereby significantly increasing fibrinogen concentration compared with placebo by 0.40 g litre(-1) (95% confidence interval, 0.15-0.65; P=0.002). Postpartum blood transfusion occurred in 25 (20%) of the fibrinogen group and 26 (22%) of the placebo group (relative risk, 0.95; 95% confidence...

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

    Science.gov (United States)

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

    2006-01-01

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

  8. Haemorrhagic fever with renal syndrome in Montenegro, 2004-14.

    Science.gov (United States)

    Vratnica, Zoran; Busani, Luca; Zekovic, Željka; Rakocevic, Božidarka; Medenica, Sanja; Urciuoli, Roberta; Rezza, Giovanni; Mugoša, Boban

    2017-12-01

    From 2004 to 2014, 106 cases of Human haemorrhagic fever with renal syndrome were notified in Montenegro, with a peak in 2014. Most of the cases occurred in summer, in the North-east and Central Montenegro, a hilly/mountainous area, that provides suitable habitats for the main rodent carriers. Cases were mainly males (71) and exposures were often working outdoor or spending time visiting mountains and lakes. Incidence correlated with average annual temperature increase and average annual rainfalls decrease, but not with land cover. Environment and climate effects on HFRS in Montenegro need further investigation to get insight into future trends. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  9. Influence of traditional Chinese medicine constitution type on the susceptibility of hypertensive cases to intracerebral haemorrhage.

    Science.gov (United States)

    Han, Shu-hui; Zheng, Jian-ming; Li, Kang-zeng; Liu, You-rong; Ye, Ming-yan

    2014-12-01

    To explore the influence of Chinese medicine constitution type on the susceptibility of hypertensive patients to intracerebral haemorrhage. Primary hypertensive patients were studied and divided into the hypertension and the hypertensive intracerebral haemorrhage groups, depending on whether or not the patients had intracerebral haemorrhage. The demographic characteristics, physiological characteristics, living habits, biochemical tests, other chronic diseases, Chinese medicine constitution type, etc. were collected and compared between the two groups. The neurological deficit in the hypertensive intracerebral haemorrhage group was also compared among the different constitution types. A total of 304 patients participated in this investigation, including 213 cases in the hypertension group and 91 cases in the hypertensive intracerebral haemorrhage group. The percentages of dampness-heat and qi-depression types in the intracerebral haemorrhage group were greater than those with the same types in the hypertension group (20.9% vs 6.1%, 22.0% vs 8.0%; Ptype were different between genders in both groups. In addition, there were more male cases (14/20) with qi-depression type and more female cases (7/8) with phlegm-dampness type in the hypertensive intracerebral haemorrhage group than those with the same types (3/17 and 9/34, respectively) in the hypertension group (Ptypes had greater levels of blood lipids in the intracerebral haemorrhage group than those with the same types in the hypertension group (Ptype presented with a more severe neurological deficit than those with the other types (Ptype might have an impact on the susceptibility of hypertensive patients to have an intracerebral haemorrhage. The heat-dampness and qi-depression types might lead to greater susceptibility than the other types. In addition, the patient's gender and blood lipids might also influence the susceptibility along with the constitution type.

  10. Vasospasm following aneurysmal subarachnoid hemorrhage: Thrombocytopenia a marker

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    Ashish Aggarwal

    2013-01-01

    Full Text Available Background: Symptomatic vasospasm (SV is often seen after aneurysmal subarachnoid hemorrhage (aSAH. The pathophysiology suggests that platelets initiate the process and are consumed. This is likely to result in thrombocytopenia. The objective of this study was to find out if thrombocytopenia preceded or followed SV and to analyze the relationship between the two. Materials and Methods: The platelet counts of 74 patients were studied on day 1, 3, 5, 7, 9, 11, and 14 following aSAH. Clinical symptoms and raised velocities on transcranial Doppler were studied on the same days to determine SV. The relationship of platelet counts and SV were analyzed. Results: Thirty-nine (52.7% patients developed SV. Platelet counts dropped on postictal day (PID 3-7 and SV was commonly seen on PID 5-9. The median platelet counts were significantly lower in patients with SV when compared to those without SV. Platelet count 5 times for a patient with relative thrombocytopenia especially on PID 5-9. Additionally, it appears that thrombocytopenia precedes vasospasm and may be an independent predictor. However, this requires further studies for validation.

  11. Effect of Aneurysmal Subarachnoid Hemorrhage on Word Generation

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    Daniella Ladowski

    2014-01-01

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

  12. FMRI of working memory impairment after recovery from subarachnoid hemorrhage.

    Science.gov (United States)

    Ellmore, Timothy M; Rohlffs, Fiona; Khursheed, Faraz

    2013-01-01

    Recovery from aneurysmal subarachnoid hemorrhage (SAH) is often incomplete and accompanied by subtle but persistent cognitive deficits. Previous neuropsychological reports indicate these deficits include most prominently memory impairment, with working memory particularly affected. The neural basis of these memory deficits remains unknown and unexplored by functional magnetic resonance imaging (fMRI). In the present study, patients who experienced (SAH) underwent fMRI during the performance of a verbal working memory paradigm. Behavioral results indicated a subtle but statistically significant impairment relative to healthy subjects in working memory performance accuracy, which was accompanied by relatively increased blood-oxygen level dependent signal in widespread left and right hemisphere cortical areas during periods of encoding, maintenance, and retrieval. Activity increases remained after factoring out inter-individual differences in age and task performance, and included most notably left hemisphere regions associated with phonological loop processing, bilateral sensorimotor regions, and right hemisphere dorsolateral prefrontal cortex. We conclude that deficits in verbal working memory following recovery from (SAH) are accompanied by widespread differences in hemodynamic correlates of neural activity. These differences are discussed with respect to the immediate and delayed focal and global brain damage that can occur following (SAH), and the possibility that this damage induces subcortical disconnection and subsequent decreased efficiency in neural processing.

  13. Upregulation of Relaxin after Experimental Subarachnoid Hemorrhage in Rabbits

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    Yuichiro Kikkawa

    2014-01-01

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

  14. Subarachnoid Hemorrhage, Spreading Depolarizations and Impaired Neurovascular Coupling

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    Masayo Koide

    2013-01-01

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

  15. Stroke and acute myocardial infarction in the Swedish Sami population: incidence and mortality in relation to income and level of education.

    Science.gov (United States)

    Sjölander, Per; Hassler, Sven; Janlert, Urban

    2008-01-01

    Gender differences in cardiovascular diseases (CVD) among the Sami have been reported previously. The aim of the present study was to investigate the incidence of and mortality from stroke, subarachnoid haemorrhage (SAH), and acute myocardial infarction (AMI) in the Swedish Sami population between 1985 and 2002, and to analyse the potential impact of income and level of education on cardiovascular morbidity and mortality. A Sami cohort of 15,914 persons (4,465 reindeer herding and 11,449 non-herding Sami) were followed up from 1985 to 2002 with regard to incidence and mortality rates of AMI, stroke, and SAH. Incidence and mortality ratios were calculated using a demographically matched non-Sami control population (DMC) as the standard (71,550 persons). There was no elevated risk of developing AMI among the Sami compared with the DMC. However, the mortality ratio of AMI was significantly higher for Sami women. Higher incidence rates of stroke and SAH for both Sami men and women was observed, but no differences in mortality rates. Apart from the reindeer-herding men who demonstrated lower levels of income and education, the income and education levels among Sami were similar to the DMC. High mortality rates from AMI rather than stroke explain the excess mortality for CVD previously shown among Sami women. The results suggest that the differences in incidence of stroke between herding and non-herding Sami men, and between Sami women and non-Sami women, are caused by behavioural and psychosocial risk factors rather than by traditional socioeconomic ones.

  16. ROLE OF HYSTEROSCOPY IN THE MANAGEMENT OF SECONDARY POSTPARTUM HAEMORRHAGE

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    Krupa Patalay

    2016-03-01

    Full Text Available INTRODUCTION Secondary postpartum haemorrhage [PPH] or puerperal haemorrhage, though rare can sometimes cause severe morbidity needing prolonged hospitalisation. Majority of the cases can be managed medically, a few of them requiring surgical interventions. With retained placental tissue being a common cause, emptying the uterus in the puerperium can be difficult and dangerous too as the wall is soft and perforation chances are high. Hysteroscopic evaluation of the puerperal uterus gives us a better picture of the retained bits of placental tissue, and helps in complete evacuation of the tissue without causing much trauma to the fragile uterine wall. It is also more specific than ultrasonogram [USG] to rule out the presence of retained tissue. MATERIAL AND METHODS 17 patients who had secondary PPH and did not respond to the initial medical management were included in the study. Hysteroscopy was done in these cases. Definitive pathology was found in 12 cases; 7 cases had polypoidal tissue [retained bits of placenta], 3 cases had placental tissue adherent to the caesarean scar [placenta accreta] and 2 cases had submucous fibroids. RESULTS In cases which had retained placental bits, the tissue could be visualised, its exact location noted and the entire tissue could be removed without inciting much trauma to the uterine wall. In cases with placenta accreta, gentle extraction of the adherent tissue could be done without traumatising the scar. In one case which had multiple fibroids with irregular uterine cavity, hysteroscopy helped in localising the retained tissue. CONCLUSION Hysteroscopy is a useful modality in managing cases of secondary PPH, who have persistent bleeding in the postpartum period.

  17. Clinico-radiological features of subarachnoid hyperintensity on diffusion-weighted images in patients with meningitis

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    Kawaguchi, T., E-mail: madarafuebuki@yahoo.co.jp [Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya (Japan); Sakurai, K.; Hara, M. [Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya (Japan); Muto, M. [Department of Radiology, Okazaki City Hospital, Okazaki, Aichi (Japan); Nakagawa, M. [Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya (Japan); Tohyama, J. [Department of Radiology, Toyota-kai Medical Corporation Kariya Toyota General Hospital, Kariya, Aichi (Japan); Oguri, T. [Department of Neurology and Neuroscience, Nagoya City University Graduate School of Medical Sciences, Nagoya (Japan); Mitake, S. [Department of Neurology, Tosei General Hospital, Seto-shi, Aichi (Japan); Maeda, M. [Department of Radiology, Mie University School of Medicine, Tsu, Mie (Japan); Matsukawa, N.; Ojika, K. [Department of Neurology and Neuroscience, Nagoya City University Graduate School of Medical Sciences, Nagoya (Japan); Shibamoto, Y. [Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya (Japan)

    2012-04-15

    Aim: To investigate the clinical and radiological features of meningitis with subarachnoid diffusion-weighted imaging (DWI) hyperintensity. Materials and methods: The clinical features, laboratory data, and radiological findings, including the number and distribution of subarachnoid DWI hyperintense lesions and other radiological abnormalities, of 18 patients seen at five institutions were evaluated. Results: The patients consisted of eight males and 10 females, whose ages ranged from 4 months to 82 years (median 65 years). Causative organisms were bacteria in 15 patients, including Haemophilus influenzae, Streptococcus pneumoniae, Streptococcus agalactiae, Staphylococcus aureus, Klebsiella pneumoniae, and Listeria monocytogenes. The remaining three were fungal meningitis caused by Cryptococcus neoformans. Subarachnoid DWI hyperintense lesions were multiple in 16 of the 18 cases (89%) and predominantly distributed around the frontal lobe in 16 of the 18 cases (89%). In addition to subarachnoid abnormality, subdural empyema, cerebral infarction, and intraventricular empyema were found in 50, 39, and 39%, respectively. Compared with paediatric patients, adult patients with bacterial meningitis tended to have poor prognoses (7/10 versus 1/5; p = 0.1). Conclusion: Both bacterial and fungal meningitis could cause subarachnoid hyperintensity on DWI, predominantly around the frontal lobe. This finding is often associated with poor prognosis in adult bacterial meningitis.

  18. Original surgical treatment of thoracolumbar subarachnoid cysts in six chondrodystrophic dogs.

    Science.gov (United States)

    Bismuth, Camille; Ferrand, François-Xavier; Millet, Mathilde; Buttin, Philippe; Fau, Didier; Cachon, Thibaut; Viguier, Eric; Escriou, Catherine; Carozzo, Claude

    2014-05-16

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

  19. Intracranial hypotension caused by cisternal irrigation for vasospasm after subarachnoid hemorrhage: a case report.

    Science.gov (United States)

    Ishida, Atsushi; Matsuo, Seigo

    2014-09-15

    Vasospasm is the most common cause of complication after a subarachnoid hemorrhage and tremendous efforts have been made to prevent it. A subarachnoid clot is the cause of the vasospasm and dissolving and washing it out is considered to be the best practice. Cisternal irrigation with urokinase and ascorbic acid has been widely used due to its proven effect. A 60-year-old Japanese male presented with a severe headache was diagnosed with a subarachnoid hemorrhage and an immediate surgical obliteration was successfully performed. After clipping the aneurysm, a cisternal drainage tube was placed in the chiasmatic cistern. In order to clear the thick subarachnoid hemorrhage, a cisternal irrigation was performed. However, his consciousness deteriorated and his left pupil became dilated on the next day. A T1 sagittal magnetic resonance imaging scan showed an evidence of marked brain sagging with mild tonsillar descent. We continued intensive hydration and head-down positioning and the brain sagging was shown to have improved in the follow-up magnetic resonance imaging scan. We present a case in which our patient experienced brain sagging after a cisternal irrigation of a subarachnoid hemorrhage. A subdural hematoma and low intracranial pressure suggested intracranial hypotension. Sagittal magnetic resonance imaging images are useful to evaluate brain sagging and are shown sequentially here in our case report.

  20. Terson syndrome in subarachnoid hemorrhage, intracerebral hemorrhage, and traumatic brain injury.

    Science.gov (United States)

    Czorlich, Patrick; Skevas, Christos; Knospe, Volker; Vettorazzi, Eik; Richard, Gisbert; Wagenfeld, Lars; Westphal, Manfred; Regelsberger, Jan

    2015-01-01

    This prospective trial was designed to evaluate the incidence of Terson syndrome in patients suffering from subarachnoid hemorrhage, intracerebral hemorrhage, or traumatic brain injury and whether consequences necessarily derive from the intraocular hemorrhage itself. Two ophthalmologic examinations were performed to identify patients with Terson syndrome. Data on initial Glasgow Coma Scale, Hunt and Hess and Fisher grades, aneurysm site and diameter, and volume of hemorrhage in intracerebral hemorrhage patients were correlated to the location and course of Terson syndrome. Follow-up was performed after 3 months, including clinical and ophthalmologic investigations. The data showed that 16 of 83 subarachnoid hemorrhage patients (19.3%), 2 of 22 intracerebral hemorrhage patients (9.1%), and 1 of 32 traumatic brain injury patients (3.1%) suffered from Terson syndrome. Low Glasgow Coma Scale (p = 0.002), high Hunt and Hess grade (p Terson syndrome. The neurological outcome in subarachnoid hemorrhage patients suffering from Terson syndrome was worse compared with that of subarachnoid hemorrhage patients without Terson syndrome (p = 0.005), and vitrectomy was performed in seven eyes of six patients due to poor visual acuity. Terson syndrome is underestimated in patients with subarachnoid hemorrhage and a rare pathology in intracerebral hemorrhage as well as in traumatic brain injury patients. Spontaneous regression of the intraocular hemorrhage may be seen, but in half of the patients, vitrectomy is necessary to prevent permanent visual deterioration.

  1. High frequency of spinal involvement in patients with basal subarachnoid neurocysticercosis

    Science.gov (United States)

    Callacondo, D.; Garcia, H.H.; Gonzales, I.; Escalante, D.; Gilman, Robert H.; Tsang, Victor C.W.; Gonzalez, Armando; Lopez, Maria T.; Gavidia, Cesar M.; Martinez, Manuel; Alvarado, Manuel; Porras, Miguel; Saavedra, Herbert; Rodriguez, Silvia; Verastegui, Manuela; Mayta, Holger; Herrera, Genaro; Lescano, Andres G.; Zimic, Mirko; Gonzalvez, Guillermo; Moyano, Luz M.; Ayvar, Viterbo; Diaz, Andre

    2012-01-01

    Objective: To determine the frequency of spinal neurocysticercosis (NCC) in patients with basal subarachnoid NCC compared with that in individuals with viable limited intraparenchymal NCC (≤20 live cysts in the brain). Methods: We performed a prospective observational case-control study of patients with NCC involving the basal cisterns or patients with only limited intraparenchymal NCC. All patients underwent MRI examinations of the brain and the entire spinal cord to assess spinal involvement. Results: Twenty-seven patients with limited intraparenchymal NCC, and 28 patients with basal subarachnoid NCC were included in the study. Spinal involvement was found in 17 patients with basal subarachnoid NCC and in only one patient with limited intraparenchymal NCC (odds ratio 40.18, 95% confidence interval 4.74–340.31; p < 0.0001). All patients had extramedullary (intradural) spinal NCC, and the lumbosacral region was the most frequently involved (89%). Patients with extensive spinal NCC more frequently had ventriculoperitoneal shunt placement (7 of 7 vs 3 of 11; p = 0.004) and tended to have a longer duration of neurologic symptoms than those with regional involvement (72 months vs 24 months; p = 0.062). Conclusions: The spinal subarachnoid space is commonly involved in patients with basal subarachnoid NCC, compared with those with only intraparenchymal brain cysts. Spinal cord involvement probably explains serious late complications including chronic meningitis and gait disorders that were described before the introduction of antiparasitic therapy. MRI of the spine should be performed in basal subarachnoid disease to document spinal involvement, prevent complications, and monitor for recurrent disease. PMID:22517102

  2. Nimodipine for the prevention of cerebral vasospasm after subarachnoid hemorrhage in 12 children.

    Science.gov (United States)

    Heffren, Josh; McIntosh, Angela M; Reiter, Pamela D

    2015-03-01

    Subarachnoid hemorrhage is a rare, but life-threatening neurological emergency. Cerebral vasospasm is a complication of subarachnoid hemorrhage that contributes significantly to morbidity and mortality. Nimodipine has been used in adults to reduce the incidence of cerebral vasospasm after subarachnoid hemorrhage and improve long-term outcomes. There are, however, no data in children. Records of children with a confirmed diagnosis of subarachnoid hemorrhage who received nimodipine between January 1, 2005 and August 31, 2013 were reviewed. Dosing of nimodipine and associated hypotensive events were recorded. Transcranial Doppler ultrasonography, cranial computerized tomography, and angiography were followed as a measure of cerebral vasospasm, rebleeding, and subsequent infarction. Twelve children (average age 11.8 ± 3.3 years, age range 3.5 to 17.3 years) were included. Aneurysm was responsible for the highest percentage (41.7%) of subarachnoid hemorrhage events. The mean dose of oral nimodipine was 1 mg/kg every 4 hours and was associated with a high rate of hypotension requiring intervention or dose modification. Clinical outcomes while on nimodipine therapy varied; evidence of vasospasm was observed in 67%, new infarction in 33%, and rebleeding in 17%. Functional and cognitive deficits were minor in two-thirds and absent in the remaining individuals. All patients survived until hospital discharge. Oral nimodipine after subarachnoid hemorrhage in children does not eliminate vasospasm, rebleeding, or infarction and is associated with significant hypotension. Nevertheless, clinical outcomes appear favorable relative to the adult population who receive nimodipine. Further study, with dose titration, is warranted. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Blood, sweat and tears: androgenic-anabolic steroid misuse and recurrent primary post-tonsillectomy haemorrhage

    National Research Council Canada - National Science Library

    Fox, Richard; Varadharajan, Kiran; Patel, Bhavesh; Beegun, Issa

    2014-01-01

    .... Thorough coagulation screen was normal. Recurrent primary haemorrhage occurred 3 h post-operatively requiring immediate surgical intervention, removal of the inferior poles, precautionary throat packs, intubation and observation...

  4. Use of recombinant activated factor VII in a case of severe postpartum haemorrhage.

    Science.gov (United States)

    Verre, M; Bossio, F; Mammone, A; Piccirillo, M; Tancioni, F; Varano, M

    2006-02-01

    We describe the case of a 24 year old woman, affected by haemorrhagic shock due to post-partum uterine atony, who underwent an emergency hysterectomy with persistent postoperative bleeding, successfully treated with recombinant activated factor VII (Novoseven).

  5. Cerebral Venous Thrombosis Presented as Subarachnoid Hemorrhage and Treated with Anticoagulants

    Directory of Open Access Journals (Sweden)

    M Zare

    2005-07-01

    Full Text Available A 45-year-old woman was brought into the emergency room of Al-Zahra hospital, Isfahan, after her first generalized tonic-clonic seizure and a history of thunderclap occipital headache ten days before the first seizure. Examination revealed mild confusion and slight left hemiparesis with facial weakness and no meningeal irritation signs. CT scan showed subarachnoid hemorrhage (SAH and MRI demanstrated left lateral, sigmoid and sagittal sinus thromboses. Angiography was normal. She was treated by anticoagulants in spite of hemorraghic parenchymal lesion. Key words: Cerebral venous thrombosis, Subarachnoid hemorrhage, Anticoagulant therapy

  6. An uncommon initial presentation of snake bite-subarachnoid hemorrhage: A case report with literature review.

    Science.gov (United States)

    Roy, Manoj Kumar; Dutta, Joydip; Chatterjee, Apratim; Sarkar, Anup; Roy, Koushik; Agarwal, Rakhesh; Lahiri, Durjoy; Biswas, Amrito; Mondal, Anupam; Maity, Pranab; Mukhopadhyay, Jotideb

    2015-01-01

    Snake bites are very common in India, particularly in West Bengal. Snake bite can cause various hematological, neuromyopathical complications. It can be very fatal if not detected and treated early. Timely intervention can save the patient. We are reporting a case of hematotoxic Russell viper snake bite presented with subarachnoid hemorrhage. Patient was successfully treated with antivenom serum (AVS) along with other conservative management. Subarachnoid hemorrhage as an initial presentation in viper bite is very rare and we discuss the case with proper literature review.

  7. Protective Role of P450 Epoxyeicosanoids in Subarachnoid Hemorrhage

    Science.gov (United States)

    Siler, Dominic A.; Martini, Ross; Ward, Jonathan; Nelson, Jonathan; Borkar, Rohan; Zuloaga, Kristen; Liu, Jesse; Fairbanks, Stacy; Raskin, Jeffrey; Anderson, Valerie; Dogan, Aclan; Wang, Ruikang K.; Alkayed, Nabil J.; Cetas, Justin S.

    2015-01-01

    Background Patients recovering from aneurysmal subarachnoid hemorrhage (SAH) are at risk for developing delayed cerebral ischemia (DCI). Experimental and human studies implicate the vasoconstrictor P450 eicosanoid 20-hydroxyeicosatetraenoic acid (20-HETE) in the pathogenesis of DCI. To date, no studies have evaluated the role of vasodilator epoxyeicosatrienoic acids (EETs) in DCI. Methods Using mass spectrometry, we measured P450 eicosanoids in cerebrospinal fluid (CSF) from 34 SAH patients from 1 to 14 days after admission. CSF eicosanoid levels were compared in patients who experienced DCI versus those who did not. We then studied the effect of EETs in a model of SAH using mice lacking the enzyme soluble epoxide hydrolase, which catabolizes EETs into their inactive diol. To assess changes in vessel morphology and cortical perfusion in the mouse brain we used optical microangiography, a non-invasive coherence based imaging technique. Results Along with increases in 20-HETE, we found that CSF levels of 14, 15-EET were elevated in SAH patients compared to control CSF, and levels were significantly higher in patients who experienced DCI compared to those who did not. Mice lacking sEH had elevated 14, 15-EET and were protected from the delayed decrease in microvascular cortical perfusion after SAH, compared to wild type mice. Conclusions Our findings suggest that P450 eicosanoids play an important role in the pathogenesis of DCI. While 20-HETE may contribute to the development of DCI, 14, 15-EET may afford protection against DCI. Strategies to enhance 14, 15-EET, including sEH inhibition, should be considered as part of a comprehensive approach to preventing DCI. PMID:25231529

  8. Timing of deep vein thrombosis formation after aneurysmal subarachnoid hemorrhage

    Science.gov (United States)

    Liang, Conrad W.; Su, Kimmy; Liu, Jesse J.; Dogan, Aclan; Hinson, Holly E.

    2015-01-01

    OBJECT Deep vein thrombosis (DVT) is a common complication of aneurysmal subarachnoid hemorrhage (aSAH). The time period of greatest risk for developing DVT after aSAH is not currently known. aSAH induces a prothrombotic state, which may contribute to DVT formation. Using repeated ultrasound screening, the hypothesis that patients would be at greatest risk for developing DVT in the subacute post-rupture period was tested. METHODS One hundred ninety-eight patients with aSAH admitted to the Oregon Health & Science University Neurosciences Intensive Care Unit between April 2008 and March 2012 were included in a retrospective analysis. Ultrasound screening was performed every 5.2 ± 3.3 days between admission and discharge. The chi-square test was used to compare DVT incidence during different time periods of interest. Patient baseline characteristics as well as stroke severity and hospital complications were evaluated in univariate and multivariate analyses. RESULTS Forty-two (21%) of 198 patients were diagnosed with DVT, and 3 (2%) of 198 patients were symptomatic. Twenty-nine (69%) of the 42 cases of DVT were first detected between Days 3 and 14, compared with 3 cases (7%) detected between Days 0 and 3 and 10 cases (24%) detected after Day 14 (p < 0.05). The postrupture 5-day window of highest risk for DVT development was between Days 5 and 9 (40%, p < 0.05). In the multivariate analysis, length of hospital stay and use of mechanical prophylaxis alone were significantly associated with DVT formation. CONCLUSIONS DVT formation most commonly occurs in the first 2 weeks following aSAH, with detection in this cohort peaking between Days 5 and 9. Chemoprophylaxis is associated with a significantly lower incidence of DVT. PMID:26162047

  9. Continuous EEG monitoring in aneurysmal subarachnoid hemorrhage: a systematic review.

    Science.gov (United States)

    Kondziella, Daniel; Friberg, Christian K; Wellwood, Ian; Reiffurth, Clemens; Fabricius, Martin; Dreier, Jens P

    2015-06-01

    Continuous EEG (cEEG) may allow monitoring of patients with aneurysmal subarachnoid hemorrhage (SAH) for delayed cerebral ischemia (DCI) and seizures, including non-convulsive seizures (NCSz), and non-convulsive status epilepticus (NCSE). We aimed to evaluate: (a) the diagnostic accuracy of cEEG as a confirmatory test, (b) the prognostic value of EEG patterns suggestive of seizures and DCI, and (c) the effectiveness of intensified neuromonitoring using cEEG in terms of improved clinical outcome following SAH. A systematic review was performed with eligible studies selected from multiple indexing databases through June 2014. The methodological quality of these studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2. Eighteen studies were identified, including cEEG data from 481 patients with aneurysmal SAH. NCSz were diagnosed in 7-18 % of patients; NCSE in 3-13 %. NCSE was associated with increased age (mean age 68 years) and mortality (82-100 %) compared to the entire patient population (53.9 years; mortality 13 %; p values EEG patterns suggestive of DCI included decreased alpha/delta ratio, relative alpha variability, and total power. All studies were subject to a high risk of bias concerning patient selection and cEEG methodology. cEEG monitoring following SAH detects an increased number of subclinical seizures and may predict DCI many hours in advance. NCSE is associated with high mortality and morbidity, whereas for DCI identified by cEEG this association is less clear. Prospective randomized controlled multicenter trials are needed to evaluate the benefits (or risks) of intensified treatment of seizures and DCI following SAH.

  10. [Wegener granulomatosis and aneurysmal subarachnoid hemorrhage: an insignificant association?].

    Science.gov (United States)

    Marnet, D; Ginguené, C; Marcos, A; Cahen, R; Mac Gregor, B; Turjman, F; Vallée, B

    2010-08-01

    Wegener granulomatosis (WG) is an uncommon systemic necrotizing vasculitis that demonstrates renal and respiratory tropism. While the pathogenesis of WG remains controversial, autoimmune and inflammatory mechanisms are likely to be involved. The nervous system could be affected in up to 54% of cases. Although central nervous system involvement has been reported in 7-11% of cases, aneurysmal subarachnoid hemorrhage (SAH) occurrence is exceptional. We describe the third reported case of WG-related aneurysmal SAH and then discuss the diagnosis and pathogenesis of WG along with the physiopathology of intracranial aneurysm in light of recent data reported in the literature. A 63-year-old woman with WG was referred to our neurosurgical department for aneurysmal SAH. The vasculitis diagnosis had been established 4 years earlier when she presented with chronic sinusitis, recurrent cystitis, and renal failure. The cerebral angiography revealed an anterior communicating artery dysplastic aneurysm. The neurosurgical management of the aneurysm was scheduled but delayed because the patient was experiencing a vasculitis flare-up. Immunosuppressive therapy and intravenous corticotherapy were given, with the patient's improvement, allowing neurosurgical clipping of the aneurysm. Wegener granulomatosis-related aneurysmal SAH is an exceptional condition in neurovascular pathology. As inflammatory mechanisms are involved in the pathogenesis of aneurysm, the vasculitis flare-up could account for this SAH. The management of WG could benefit from anti-inflammatory therapy, as could the vasculitis-related SAH. SAH occurrence in patients with systemic vasculitis could indicate a vasculitis flare-up. Copyright (c) 2010 Elsevier Masson SAS. All rights reserved.

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

    Science.gov (United States)

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

    2011-01-01

    This study was conducted to investigate life satisfaction and employment status after aneurysmal subarachnoid hemorrhage (SAH) and to explain the associations between life satisfaction and demographic, disease-related, psychological, and personality characteristics. Subjects with SAH (n = 141) living at home 2-4 years after the SAH responded to a mailed questionnaire. Outcomes were life satisfaction, as measured with the Life Satisfaction Questionnaire 9 (LiSat-9), and employment status. Determinants in multiple regression analysis were demographic and SAH characteristics, subjective complaints (eg, mood disorder, fatigue, cognitive complaints), and personality characteristics (eg, neuroticism, passive coping style). Of the 141 subjects, 64 (46.7%) had a Glasgow Outcome Scale score of V (good outcome) at discharge. Mean subject age was 51.4 ± 12.3 years, and mean time after SAH was 36.1 ± 7.9 months. Of the 88 subjects who were working at the time of the SAH, 54 (61.4%) returned to work, but only 31 (35.2%) resumed their work completely. The subjects were least satisfied with their vocational situation (51.9% satisfied) and sexual life (51.7%) and were most satisfied with their relationships (75.2%-88.7%) and self-care ability (88.6%). Age (β value = 0.17), return to work after SAH (0.19), disability at hospital discharge (0.25), worsened mood (-0.37), and passive coping (-0.25) together accounted for 47.2% of the life satisfaction scores. Our data indicate that return to work is a major issue for individuals who survive an SAH. Not returning to work, disability, depression, and passive coping are associated with reduced life satisfaction. Thus, vocational reintegration after SAH merits more attention during rehabilitation. Copyright © 2011 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  12. Hyponatremia after aneurysmal subarachnoid hemorrhage: Implications and outcomes

    Directory of Open Access Journals (Sweden)

    P P Saramma

    2013-01-01

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

  13. Circadian variation in ictus of aneurysmal subarachnoid hemorrhage.

    Science.gov (United States)

    Temes, Richard E; Bleck, Thomas; Dugar, Siddharth; Ouyang, Bichun; Mohammad, Yousef; John, Sayona; Patel, Pratik; Lee, Vivien; Prabhakaran, Shyam; Quigg, Mark

    2012-04-01

    Temporal patterns in aneurysmal subarachnoid hemorrhage (aSAH) may provide insight into modulation, and therefore, prevention of hemorrhage. We investigated the time of hemorrhage and its relationship to traditional risk factors among patients admitted with aSAH. Admitted patients with aSAH were prospectively followed through outcomes and baseline demographics were abstracted through chart review. The group temporal distribution by hour of onset was summarized with cosinor nonlinear least squares. aSAH onset was gathered into night (2300-0500), morning (0500-1100), afternoon (1100-1700), and evening (0500-2300) daily phases. The odds ratio (OR) with 95% CI was calculated for having an aSAH during the morning, afternoon, and evening hours using night as a reference. Multinomial logit models were fitted using aSAH cases across time blocks to determine their associations with different risk factors. 202 patients had the hour of hemorrhage available, and 49 had phase identifiable [total 251: 38 (15%) night, 98 (39%) morning, 58 (23%) afternoon, 57 (23%) evening]. The peak hours of aSAH were between 0700 and 0800 representing 13% of the sample, with a significant cosinor-fitted phase of 7.33(95% CI 5.30, 9.36). For all aSAH cases, morning onset was significantly more common than night onset (OR = 2.58, 95% CI = 1.77-3.75). Nonsmokers were more likely to have aSAH in the morning than smokers (P = 0.043, OR = 3.10, 95% CI = 1.33-7.23). aSAH occur in a diurnal, morning prevalent pattern regardless of traditional aSAH risk factors. The association of these risk factors with existing onset patterns should be investigated in future studies.

  14. The Early Endocrine Stress Response in Experimental Subarachnoid Hemorrhage.

    Directory of Open Access Journals (Sweden)

    Christoffer Nyberg

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

  15. Treatment of poor-grade subarachnoid hemorrhage trial.

    Science.gov (United States)

    Mitra, D; Gregson, B; Jayakrishnan, V; Gholkar, A; Vincent, A; White, P; Mitchell, P

    2015-01-01

    Management of poor-grade subarachnoid hemorrhage is based on limited evidence from small single-center retrospective observational studies. The purpose of this study was to undertake a single-center randomized controlled feasibility trial comparing a strategy of early endovascular aneurysm treatment with treatment after neurologic recovery in this group of patients. Patients with poor-grade SAH were randomized within 24 hours of admission to early treatment or treatment after neurologic recovery. If a patient was randomized to early treatment, the aneurysm was treated endovascularly within 24 hours of randomization. Recruitment rate, safety profile, and functional outcome at the time of discharge and at 6 months were assessed. Fourteen of 51 patients screened were eligible for the trial. Of these 14, 8 patients were randomized (57%). All patients in the early coiling arm received treatment within 24 hours of randomization. There was no treatment-related complication. Overall, good outcome occurred in 25% of patients; the mortality rate was 75%. Patients in the early treatment arm (n = 5) had a good outcome rate of 20%, while those in treatment after neurologic recovery arm (n = 3) had a good outcome rate of 33.3%. This was a feasibility study that demonstrated that recruitment and randomization for comparing management strategies in poor-grade SAH are feasible. The recruitment rate among eligible patients was encouraging (57%), though a number of patients had to be excluded due to ineligibility. A multicenter study is necessary to recruit the numbers required to compare the clinical outcomes of these management strategies. © 2015 by American Journal of Neuroradiology.

  16. Comparative Evaluation of Crystalloid Resuscitation Rate in a Human Model of Compensated Haemorrhagic Shock

    OpenAIRE

    Ho, Loretta; Lau, Lawrence; Churilov, Leonid; Riedel, Bernhard; McNicol, Larry; Hahn, Robert G; Weinberg, Laurence

    2016-01-01

    ABSTRACT Introduction: The most effective rate of fluid resuscitation in haemorrhagic shock is unknown. Methods: We performed a randomized crossover pilot study in a healthy volunteer model of compensated haemorrhagic shock. Following venesection of 15?mL/kg of blood, participants were randomized to 20?mL/kg of crystalloid over 10 min (FAST treatment) or 30 min (SLOW treatment). The primary end point was oxygen delivery (DO2). Secondary end points included pressure and flow-based haemodynamic...

  17. Bakri balloon as a uterus preserving treatment of uncontrollable haemorrhage one month post-partum

    DEFF Research Database (Denmark)

    Bonnici, Mia; Markauskas, Algirdas; Munk, Torben

    2014-01-01

    In this case Bakri balloon was used to stop haemorrhage one month post-partum. The case introduces the use of this device outside usual indications. A 27-year-old woman was admitted several times with vaginal bleeding after caesarean section. She was treated pharmacologically and with curettage....... One month post-partum hysteroscopic removal of placental tissue was done. During this uncontrollable haemorrhage occurred and hysterectomy was considered. An attempt to save the uterus with Bakri balloon was made succesfully....

  18. The FIB-PPH trial: fibrinogen concentrate as initial treatment for postpartum haemorrhage: study protocol for a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Wikkelsoe Anne

    2012-07-01

    Full Text Available Abstract Background Postpartum haemorrhage (PPH remains a leading cause of maternal mortality worldwide. In Denmark 2% of parturients receive blood transfusion. During the course of bleeding fibrinogen (coagulation factor I may be depleted and fall to critically low levels, impairing haemostasis and thus worsening the ongoing bleeding. A plasma level of fibrinogen below 2 g/L in the early phase of postpartum haemorrhage is associated with subsequent development of severe haemorrhage. Use of fibrinogen concentrate allows high-dose substitution without the need for blood type crossmatch. So far no publications of randomised controlled trials involving acutely bleeding patients in the obstetrical setting have been published. This trial aims to investigate if early treatment with fibrinogen concentrate reduces the need for blood transfusion in women suffering severe PPH. Methods/Design In this randomised placebo-controlled double-blind multicentre trial, parturients with primary PPH are eligible following vaginal delivery in case of: manual removal of placenta (blood loss ≥ 500 ml or manual exploration of the uterus after the birth of placenta (blood loss ≥ 1000 ml. Caesarean sections are also eligible in case of perioperative blood loss ≥ 1000 ml. The exclusion criteria are known inherited haemostatic deficiencies, prepartum treatment with antithrombotics, pre-pregnancy weight Primary outcome is the need for blood transfusion. To investigate a 33% reduction in the need for blood transfusion, a total of 245 patients will be included. Four university-affiliated public tertiary care hospitals will include patients during a two-year period. Adverse events including thrombosis are assessed in accordance with International Conference on Harmonisation (ICH good clinical practice (GCP. Discussion A widespread belief in the benefits of early fibrinogen substitution in cases of PPH has led to increased off-label use. The FIB

  19. Intracranial haemorrhage in the course of ischaemic stroke in patients receiving IV thrombolytic therapy – a study of 141 patients from Gliwice and its vicinity. An attempt to determine risk factors based on authors’ own experience

    Directory of Open Access Journals (Sweden)

    Witold Opiełka

    2015-12-01

    Full Text Available Introduction: Systemic thrombolytic therapy using recombinant tissue plasminogen activator is a recognised method for the causative treatment of acute ischaemic stroke. The aim of this study was to determine the safety of thrombolytic treatment, the incidence of the most dangerous complication – intracranial haemorrhage and to assess its influence on the final therapeutic outcome. An additional aim was to identify risk factors. Material and methods: A total of 141 patients treated from January 2013 to June 2015 at the Stroke Unit were included in the analysis. The patients were assessed in terms of neurological deficit according to the National Institutes of Health Stroke Scale, their functional status using the modified Rankin Scale and Brunnstrom motor ability scale. A multivariate analysis of different risk factors for intracranial haemorrhage was performed. Results: Symptomatic intracranial haemorrhage occurred in 3.5% of cases, asymptomatic haemorrhage was reported in 7.1% of cases. A statistically significant difference was found in mortality rate (p = 0.0043 between the thrombolytic subgroup (5% and the group not receiving causative therapy (13%. The neurological status in the subgroup with symptomatic intracranial haemorrhage deteriorated in the 2nd hour of treatment, then it remained stable and reached a high value of the National Institutes of Health Stroke Scale median – 23; it differed significantly compared to other patients (p = 0.009 in the 2nd hour; p = 0.001 on day 7. The functional status of patients with symptomatic intracranial haemorrhage did not improve; it was assessed at baseline and at the end of treatment and remained at the same level (modified Rankin Scale – median = 5 and 5. There was a significant increase in mobility, presenting as a 2 point drop in the median, in other patients. Conclusions: Thrombolytic treatment is a relatively safe procedure. Mortality during hospital treatment in the

  20. Equal contribution of increased intracranial pressure and subarachnoid blood to cerebral blood flow reduction and receptor upregulation after subarachnoid hemorrhage. Laboratory investigation

    DEFF Research Database (Denmark)

    Ansar, Saema; Edvinsson, Lars

    2009-01-01

    . The effects in all parameters were more pronounced for SAH than for saline injection. CONCLUSIONS: This study revealed that both the elevation of intracranial pressure and subarachnoid blood per se contribute approximately equally to the late CBF reductions and receptor upregulation following SAH.......OBJECT: Cerebral ischemia remains the key cause of disability and death in the late phase after subarachnoid hemorrhage (SAH), and its pathogenesis is still poorly understood. The purpose of this study was to examine whether the change in intracranial pressure or the extravasated blood causes...... the late cerebral ischemia and the upregulation of receptors or the cerebral vasoconstriction observed following SAH. METHODS: Rats were allocated to 1 of 3 experimental conditions: 1) cisternal injection of 250 microl blood (SAH Group), 2) cisternal injection of 250 microl NaCl (Saline Group), or 3...

  1. Evaluation of the toxicity of onyx compared with n-butyl 2-cyanoacrylate in the subarachnoid space of a rabbit model: an experimental research

    Energy Technology Data Exchange (ETDEWEB)

    Bakar, Bulent [Kirikkale University, School of Medicine, Department of Neurosurgery, Kirikkale (Turkey); Kirikkale University Faculty of Medicine, Department of Neurosurgery, Kirikkale (Turkey); Oruckaptan, Hakan H.; Hazer, Burcu D. [Hacettepe University, School of Medicine, Department of Neurosurgery, Ankara (Turkey); Saatci, Isil [Hacettepe University, School of Medicine, Department of Radiology, Ankara (Turkey); Atilla, Pergin; Muftuoglu, Sevda F. [Hacettepe University, School of Medicine, Department of Histology and Embriology, Ankara (Turkey); Kilic, Kamer [Hacettepe University, School of Medicine, Department of Biochemistry, Ankara (Turkey)

    2010-02-15

    The toxic effects of onyx, its solvent dimethyl sulphoxide (DMSO), and n-butyl 2-cyanoacrylate (NBCA) were evaluated after infusion into the subaracnoid space of a rabbit model. Each of the two various concentrations of onyx, pure DMSO, NBCA, and normal saline solution were percutaneously infused into the pontocerebellar cisternae of 39 domestic male albino rabbits, after which, the brain stems and medial cerebellar tissues were harvested for biochemical and histopathological studies. The specimens infused in various concentration of onyx, DMSO, and NBCA showed neural tissue necrosis and edema with inflammatory cell infiltration in the acute stage. Although the mean values of the lipid peroxidase in the control, saline, and NBCA groups were found to be almost similar, they were found to be low in the onyx and DMSO groups. This experimental study suggests that NBCA, and various concentrations of onyx and DMSO have toxic effects on the neural tissues of rabbits when infused into the subarachnoid space. (orig.)

  2. Idiopathic Bilateral Suprachoroidal Haemorrhage: A Rare Case Presentation

    Directory of Open Access Journals (Sweden)

    Komal Saluja

    2017-01-01

    Full Text Available 55-year-old male presented with sudden onset painful diminution of vision in both eyes. On local examination, his visual acuity was FC at 2 metres in right eye and FC at 1 m in left eye. The IOP in right eye was 46 mm Hg and 44 mm Hg in left eye. The patient was admitted and started on injection mannitol, oral syrup glycerol, and oral acetazolamide. Locally, timolol maleate and brimonidine were also started. The next day, his IOP was 17 mm Hg bilaterally but his visual acuity deteriorated to FC 1 m in right eye and hand movement in left eye with inaccurate projection of rays in both eyes. USG B-scan was performed which revealed bilateral choroidal detachment. The echotexture of fluid was suggestive of haemorrhage. As the IOP was controlled, systemic hyperosmotic/antiglaucoma agents were withdrawn in stepwise fashion over next two days. The patient was started on oral prednisolone. At 2 weeks, the visual acuity in both eyes was only perception of light, with inaccurate PR. IOP was 10 mm Hg in both eyes. USG B-scan revealed resorption of the hemorrhage, with partial resolution of the choroidal detachment. The final BCVA was 6/18 and 6/12 in right and left eye.

  3. Quality of care in the management of major obstetric haemorrhage.

    LENUS (Irish Health Repository)

    Johnson, S N

    2012-02-01

    Substandard care is reported to occur in a large number of cases of major obstetric haemorrhage (MOH). A prospective audit was carried out by a multidisciplinary team at our hospital over a one year period to assess the quality of care (QOC) delivered to women experiencing MOH. MOH was defined according to criteria outlined in the Scottish Audit of Maternal Morbidity (SAMM). 31 cases were identified yielding an incidence of 3.5\\/1000 deliveries. The predominant causes were uterine atony 11 (35.4%), retained products of conception 6 (19.3%) and placenta praevia\\/accreta 6 (19.3%). Excellent initial resuscitation and monitoring was noted with a high level of senior staff input. Indicators of QOC compared favourably with the SAMM. Areas for improvement were identified. This pilot study demonstrates the feasibility of detailed prospective data collection in MOH in a busy Dublin obstetric unit with a view to developing a national audit. Standardization of definitions allows for international comparisons.

  4. Development of vaccines against Crimean-Congo haemorrhagic fever virus.

    Science.gov (United States)

    Dowall, Stuart D; Carroll, Miles W; Hewson, Roger

    2017-10-20

    Crimean-Congo haemorrhagic fever virus (CCHFV) is a deadly human pathogen of the utmost seriousness being highly lethal causing devastating disease symptoms that result in intense and prolonged suffering to those infected. During the past 40years, this virus has repeatedly caused sporadic outbreaks responsible for relatively low numbers of human casualties, but with an alarming fatality rate of up to 80% in clinically infected patients. CCHFV is transmitted to humans by Hyalomma ticks and contact with the blood of viremic livestock, additionally cases of human-to-human transmission are not uncommon in nosocomial settings. The incidence of CCHF closely matches the geographical range of permissive ticks, which are widespread throughout Africa, Asia, the Middle East and Europe. As such, CCHFV is the most widespread tick-borne virus on earth. It is a concern that recent data shows the geographic distribution of Hyalomma ticks is expanding. Migratory birds are also disseminating Hyalomma ticks into more northerly parts of Europe thus potentially exposing naïve human populations to CCHFV. The virus has been imported into the UK on two occasions in the last five years with the first fatal case being confirmed in 2012. A licensed vaccine to CCHF is not available. In this review, we discuss the background and complications surrounding this limitation and examine the current status and recent advances in the development of vaccines against CCHFV. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  5. Endovascular management of delayed post-pancreatectomy haemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Pottier, Edwige [Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Department of Radiology, Clichy, Hauts-de-Seine (France); Ronot, Maxime; Vilgrain, Valerie [Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Department of Radiology, Clichy, Hauts-de-Seine (France); University Paris Diderot, Paris (France); INSERM U1149, centre de recherche biomedicale Bichat-Beaujon, CRB3, Paris (France); Gaujoux, Sebastien; Cesaretti, Manuela; Barbier, Louise [APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Department of Surgery, Clichy, Hauts-de-Seine (France); Sauvanet, Alain [University Paris Diderot, Paris (France); APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Department of Surgery, Clichy, Hauts-de-Seine (France)

    2016-10-15

    To assess the patient outcome after endovascular treatment of delayed post-pancreatectomy haemorrhage (PPH) as first-line treatment. Between January 2005 and November 2013, all consecutive patients referred for endovascular treatment of PPH were included. Active bleeding, pseudoaneurysms, collections and the involved artery were recorded on pretreatment CT. Endovascular procedures were classified as technical success (source of bleeding identified on angiogram and treated), technical failure (source of bleeding identified but incompletely treated) and abstention (no abnormality identified, no treatment performed). Factors associated with rebleeding were analysed. Sixty-nine patients (53 men) were included (mean 59 years old (32-75)). Pretreatment CT showed 27 (39 %) active bleeding. In 22 (32 %) cases, no involved artery was identified. Technical success, failure and abstention were observed in 48 (70 %), 9 (13 %) and 12 patients (17 %), respectively. Thirty patients (43 %) experienced rebleeding. Rebleeding rates were 29 %, 58 % and 100 % in case of success, abstention and failure (p < 0.001). Treatment failure/abstention was the only factor associated with rebleeding. Overall, 74 % of the patients were successfully treated by endovascular procedure(s) alone. After a first endovascular procedure for PPH, the rebleeding rate is high and depends upon the success of the procedure. Most patients are successfully treated by endovascular approach(es) alone. (orig.)

  6. Rabbit haemorrhagic disease: virus persistence and adaptation in Australia.

    Science.gov (United States)

    Schwensow, Nina I; Cooke, Brian; Kovaliski, John; Sinclair, Ron; Peacock, David; Fickel, Joerns; Sommer, Simone

    2014-11-01

    In Australia, the rabbit haemorrhagic disease virus (RHDV) has been used since 1996 to reduce numbers of introduced European rabbits (Oryctolagus cuniculus) which have a devastating impact on the native Australian environment. RHDV causes regular, short disease outbreaks, but little is known about how the virus persists and survives between epidemics. We examined the initial spread of RHDV to show that even upon its initial spread, the virus circulated continuously on a regional scale rather than persisting at a local population level and that Australian rabbit populations are highly interconnected by virus-carrying flying vectors. Sequencing data obtained from a single rabbit population showed that the viruses that caused an epidemic each year seldom bore close genetic resemblance to those present in previous years. Together, these data suggest that RHDV survives in the Australian environment through its ability to spread amongst rabbit subpopulations. This is consistent with modelling results that indicated that in a large interconnected rabbit meta-population, RHDV should maintain high virulence, cause short, strong disease outbreaks but show low persistence in any given subpopulation. This new epidemiological framework is important for understanding virus-host co-evolution and future disease management options of pest species to secure Australia's remaining natural biodiversity.

  7. [Ebola and Marburg fever--outbreaks of viral haemorrhagic fever].

    Science.gov (United States)

    Chlíbek, R; Smetana, J; Vacková, M

    2006-12-01

    With an increasing frequency of traveling and tourism to exotic countries, a new threat-import of rare, very dangerous infections-emerges in humane medicine. Ebola fever and Marburg fever, whose agents come from the same group of Filoviridae family, belong among these diseases. The natural reservoir of these viruses has not yet been precisely determined. The pathogenesis of the diseases is not absolutely clear, there is neither a possibility of vaccination, nor an effective treatment. Fever and haemorrhagic diathesis belong to the basic symptoms of the diseases. Most of the infected persons die, the death rate is 70-88 %. The history of Ebola fever is relatively short-30 years, Marburg fever is known almost 40 years. Hundreds of people have died of these diseases so far. The study involves epidemics recorded in the world and their epidemiological relations. Not a single case has been recorded in the Czech Republic, nevertheless a sick traveler or infected animals are the highest risk of import these diseases. In our conditions, the medical staff belong to a highly endangered group of people because of stringent isolation of patients, strict rules of barrier treatment regime and high infectivity of the diseases. For this reason, the public should be prepared for possible contact with these highly virulent infections.

  8. Clinical Trials in Cardiac Arrest and Subarachnoid Hemorrhage: Lessons from the Past and Ideas for the Future

    Directory of Open Access Journals (Sweden)

    Jennifer A. Frontera

    2013-01-01

    Full Text Available Introduction. Elevated intracranial pressure that occurs at the time of cerebral aneurysm rupture can lead to inadequate cerebral blood flow, which may mimic the brain injury cascade that occurs after cardiac arrest. Insights from clinical trials in cardiac arrest may provide direction for future early brain injury research after subarachnoid hemorrhage (SAH. Methods. A search of PubMed from 1980 to 2012 and clinicaltrials.gov was conducted to identify published and ongoing randomized clinical trials in aneurysmal SAH and cardiac arrest patients. Only English, adult, human studies with primary or secondary mortality or neurological outcomes were included. Results. A total of 142 trials (82 SAH, 60 cardiac arrest met the review criteria (103 published, 39 ongoing. The majority of both published and ongoing SAH trials focus on delayed secondary insults after SAH (70%, while 100% of cardiac arrest trials tested interventions within the first few hours of ictus. No SAH trials addressing treatment of early brain injury were identified. Twenty-nine percent of SAH and 13% of cardiac arrest trials showed outcome benefit, though there is no overlap mechanistically. Conclusions. Clinical trials in SAH assessing acute brain injury are warranted and successful interventions identified by the cardiac arrest literature may be reasonable targets of the study.

  9. Early blood pressure lowering treatment in acute stroke. Ordinal analysis of vascular events in the Scandinavian Candesartan Acute Stroke Trial (SCAST)

    DEFF Research Database (Denmark)

    Jusufovic, Mirza; Sandset, Else Charlotte; Bath, Philip M

    2016-01-01

    OBJECTIVE: Early blood pressure-lowering treatment appears to be beneficial in patients with acute intracerebral haemorrhage and potentially in ischaemic stroke. We used a new method for analysis of vascular events in the Scandinavian Candesartan Acute Stroke Trial to see if the effect was depend......OBJECTIVE: Early blood pressure-lowering treatment appears to be beneficial in patients with acute intracerebral haemorrhage and potentially in ischaemic stroke. We used a new method for analysis of vascular events in the Scandinavian Candesartan Acute Stroke Trial to see if the effect...... was dependent on the timing of treatment. METHODS: Scandinavian Candesartan Acute Stroke Trial was a randomized controlled and placebo-controlled trial of candesartan within 30 h of ischaemic or haemorrhagic stroke. Of 2029 patients, 231 (11.4%) had a vascular event (vascular death, nonfatal stroke or nonfatal...... logistic regression for analysis and adjusted for predefined prognostic variables. RESULTS: Candesartan had no overall effect on vascular events (adjusted common odds ratio 1.11, 95% confidence interval 0.84-1.47, P = 0.48), and the effects were the same in ischaemic and haemorrhagic stroke. Among...

  10. Subarachnoid hemorrhage and hormonal factors in women. A population-based case-control study.

    Science.gov (United States)

    Longstreth, W T; Nelson, L M; Koepsell, T D; van Belle, G

    1994-08-01

    To determine the degree to which endogenous and exogenous hormonal factors influence the risk for subarachnoid hemorrhage in women. A population-based case-control study. King County, Washington. 103 women with an incident, spontaneous subarachnoid hemorrhage and 2 age- and sex-matched controls per case-patient who were identified through random-digit dialing. Information on exposures was collected during in-person interviews of case-patients, controls, and their surrogates. Premenopausal women, especially those without a history of smoking or hypertension, were at a reduced risk for subarachnoid hemorrhage compared with age-matched postmenopausal women (odds ratio, 0.24; 95% CI, 0.09 to 0.68). The use of hormone replacement therapy was associated with a reduced risk (odds ratio, 0.47; CI, 0.26 to 0.86); the reduction was significantly greater in women who had smoked than in those that had never smoked. Of the 23 premenopausal case-patients, 74% were either menstruating when hemorrhaging occurred or had had their last menstrual period 21 or more days before hemorrhaging compared with the expected 43% (difference, 31%; CI, 4% to 58%). Premenopausal women are at reduced risk for subarachnoid hemorrhage, especially those without a history of smoking or hypertension. Hormone replacement therapy reduced the risk only in postmenopausal women who had ever smoked. Among women still menstruating, the risk for hemorrhage was greatest in the perimenstrual period.

  11. Transcranial Doppler Waveforms During Intra-aortic Balloon Pump Counterpulsation for Vasospasm Detection After Subarachnoid Hemorrhage.

    Science.gov (United States)

    Morris, Nicholas A; Manning, Nathan; Marshall, Randolph S; Connolly, E Sander; Claassen, Jan; Agarwal, Sachin; Roh, David J; Schmidt, J Michael; Park, Soojin

    2017-07-21

    Transcranial Doppler ultrasound is a standard screening tool for vasospasm after subarachnoid hemorrhage. Prevention of vasospasm-induced delayed cerebral ischemia after subarachnoid hemorrhage depends on optimization of cerebral perfusion pressure, which can be challenged by neurogenic stress cardiomyopathy. Intra-aortic balloon pumps have been utilized to augment cerebral perfusion, but they change the transcranial Doppler waveform, altering its interpretability for vasospasm screening. To assess the features of the transcranial Doppler waveform that correlate with vasospasm. We retrospectively reviewed cases of subarachnoid hemorrhage that underwent same-day transcranial Doppler ultrasound and angiography. Transcranial Doppler waveforms were assessed for mean velocity, peak systolic velocity, balloon pump-augmented diastolic velocity, and a novel feature, "delta velocity" (balloon pump-augmented velocity - systolic velocity). Relationship of flow velocity features to vasospasm was estimated by generalized estimating equation models using a Gaussian distribution and an exchangeable correlation structure. There were 31 transcranial Doppler and angiography pairings (12 CT angiography/19 digital subtraction angiography) from 4 patients. Fourteen pairings had proximal vasospasm by angiography. Delta velocity was associated with proximal vasospasm (coefficient -6.8 [95% CI -9.8 to -3.8], P  Doppler flow velocity feature, may reflect vasospasm in patients with subarachnoid hemorrhage and intra-aortic balloon pumps.

  12. Different CT perfusion algorithms in the detection of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

    NARCIS (Netherlands)

    Cremers, Charlotte H P; Dankbaar, Jan Willem|info:eu-repo/dai/nl/314079408; Vergouwen, Mervyn D I|info:eu-repo/dai/nl/320630544; Vos, Pieter C.|info:eu-repo/dai/nl/298986140; Bennink, Edwin|info:eu-repo/dai/nl/358202906; Rinkel, Gabriel J E|info:eu-repo/dai/nl/085712000; Velthuis, Birgitta K.|info:eu-repo/dai/nl/176956301; van der Schaaf, Irene C.|info:eu-repo/dai/nl/29133489X

    2015-01-01

    Introduction: Tracer delay-sensitive perfusion algorithms in CT perfusion (CTP) result in an overestimation of the extent of ischemia in thromboembolic stroke. In diagnosing delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH), delayed arrival of contrast due to vasospasm

  13. Methods of evaluation of smell in victims of subarachnoid hemorrhage patients: a systematic review.

    Science.gov (United States)

    Lima, Sandro Júnior Henrique; Azevedo Filho, Hildo Rocha Cirne de; Silva, Hilton Justino da

    2016-01-01

    To systematically review the methods for evaluation of smell in aneurysmal subarachnoid hemorrhage victims and to identify the changes found with the use of these methods. The literature search was performed in PubMed search platform and in the databases Web of Science, Scopus, PsycINFO, CINAHL, and ScienceDirect in August and September 2014. Original articles published in any language, which addressed smell changes in aneurysmal subarachnoid hemorrhage and addressed to evaluate this function through specific methods were included. Review studies, case studies, book chapters, editorial, and studies that address the nonaneurysmal subarachnoid hemorrhage were excluded. The following variables were considered in data analysis: author/year, country, sample/age, treatment, method, the moment of smell evaluation, and results. The search for articles resulted in 1,763 articles, of which, 9 original articles were selected for this review. It was observed that all articles were from European and Asian countries. Standardized and nonstandardized tests and questionnaires were used in olfactory assessment, and the goals ranged from assessing the smell before and/or after surgery in this population. Heterogeneity was observed in the methods used to evaluate the smell in aneurysmal subarachnoid hemorrhage and in the methods selected for application of evaluations. In addition, studies have demonstrated the existence of olfactory deficits in patients and the relationship between surgery and olfactory dysfunction.

  14. Continuous EEG Monitoring for Early Detection of Delayed Cerebral Ischemia in Subarachnoid Hemorrhage: A Pilot Study

    NARCIS (Netherlands)

    Rots, M.L.; Putten, M.J. van; Hoedemaekers, C.W.; Horn, J.

    2016-01-01

    INTRODUCTION: Early identification of delayed cerebral ischemia (DCI) in patients with aneurysmal subarachnoid hemorrhage (aSAH) is a major challenge. The aim of this study was to investigate whether quantitative EEG (qEEG) features can detect DCI prior to clinical or radiographic findings. METHODS:

  15. Meta-analysis of APOE genotype and subarachnoid hemorrhage - Clinical outcome and delayed ischemia

    NARCIS (Netherlands)

    Lanterna, L. A.; Ruigrok, Y.; Alexander, S.; Tang, J.; Biroli, F.; Dunn, L. T.; Poon, S.

    2007-01-01

    Background: Emerging evidence suggests that the APOE4 allele may increase the risk of a negative outcome in patients with aneurysmal subarachnoid hemorrhage (SAH), but the results are conflicting. A genetic variable predicting the individual clinical course is currently lacking. Objective: To

  16. Detection of hemosiderin deposition by T2*-weighted MRI after subarachnoid hemorrhage.

    Science.gov (United States)

    Imaizumi, Toshio; Chiba, Masahiko; Honma, Toshimi; Niwa, Jun

    2003-07-01

    Subarachnoid hemorrhage (SAH) is very difficult to diagnose several months after its onset. We thus investigated subarachnoid hemosiderin deposition well after SAH by T2*-weighted MRI, a sensitive method for hemosiderin detection. To investigate how hemosiderin deposition as confirmed by T2*-weighted MRI contributes to the determination of prior SAH and how the extent of hemosiderin deposition is associated with a number of clinical factors, we retrospectively analyzed 58 patients >3 months after SAH associated with ruptured aneurysms. We also investigated 209 healthy volunteers as controls. T2*-weighted MRI demonstrated subarachnoid hemosiderin deposition in 72.4% of the SAH patients, whereas no deposition was seen in the healthy volunteer group. The hemosiderin was preferentially deposited in the subarachnoid space near a ruptured aneurysm. Odds ratios (ORs) were estimated from logistic regression analyses correlating hemosiderin deposition with other factors. Age (>or=54 years) (OR, 5.1; 95% CI, 1.03 to 25.0; P=0.046), Fisher grade 3 on initial CT (OR, 8.0; 95% CI, 1.26 to 50.4; P=0.027), and Karnofsky Scale score hemosiderin deposition levels. T2*-weighted MRI is an effective means of diagnosing prior SAH and may also reveal the location of a ruptured aneurysm. The extent of hemosiderin deposition was significantly associated with several factors, including age, CT findings, and poor prognosis.

  17. Nosocomial infections after aneurysmal subarachnoid hemorrhage : time course and causative pathogens

    NARCIS (Netherlands)

    Laban, Kamil G.|info:eu-repo/dai/nl/413919870; Rinkel, Gabriel J. E.|info:eu-repo/dai/nl/085712000; Vergouwen, Mervyn D. I.|info:eu-repo/dai/nl/320630544

    BackgroundNosocomial infections after aneurysmal subarachnoid hemorrhage (aSAH) are associated with prolonged length of stay and poor functional outcome. It remains unclear if infections result in prolonged length of stay or, vice versa, if prolonged length of stay results in more infections. Before

  18. Differential regulation of matrix-metalloproteinases and their tissue inhibitors in patients with aneurysmal subarachnoid hemorrhage.

    Directory of Open Access Journals (Sweden)

    Marlene Fischer

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

  19. Ventilation practices in subarachnoid hemorrhage: a cohort study exploring the use of lung protective ventilation.

    Science.gov (United States)

    Marhong, Jonathan D; Ferguson, Niall D; Singh, Jeffrey M

    2014-10-01

    Acute respiratory distress syndrome (ARDS) is common following aneurysmal subarachnoid hemorrhage (SAH), but the influence of mechanical ventilator settings on its development is unclear. We sought to determine adherence to lung protective thresholds in ventilated patients with SAH and describe the association between ventilator settings and subsequent development of ARDS. We conducted a retrospective cohort study of consecutive patients receiving mechanical ventilation within 72 h of SAH at a single academic center. Ventilator settings and blood gas data were collected twice daily for the first 7 days of ventilation along with ICU and hospital outcomes. Lung protective ventilation was defined as follows: tidal volume ≤8 mL/kg of predicted body weight, positive end-expiratory pressure (PEEP) ≥5 cm H(2)O, and peak or plateau pressure ≤30 cm H(2)O. The development of ARDS was ascertained retrospectively by PaO(2)/FiO(2) ≤300 with new bilateral lung opacities on chest X-ray within one day of hypoxemia. We identified 62 patients who underwent early mechanical ventilation following SAH. PS and Continuous Positive Airway Pressure were common ventilator modes with a median tidal volume of 7.8 mL/kg [interquartile range 6.8-8.8], median peak pressure of 14 cm H(2)O [IQR 12-17], and median PEEP of 5 cm H(2)O [IQR 5-6]. Adherence to tidal volumes ≤8 mL/kg was seen in 64 % of all observations and peak pressures lung protective criteria were seen in 58 % of all observations. Thirty-one patients (50 %) were determined to have ARDS. ARDS patients were more frequently ventilated with a peak pressure >30 cm H(2)O (11.3 % of ARDS ventilation days vs. 0 % of non-ARDS ventilation days; p ventilation frequently breathe spontaneously, generating tidal volumes above usual protective thresholds regardless of meeting ARDS criteria. In patients with SAH, the presence of an additional ARDS risk factor should prompt close screening for the development of ARDS and consideration of

  20. Hypothesis on the Role of Cryptochromes in Inflammation and Subarachnoid Hemorrhage Outcome

    Directory of Open Access Journals (Sweden)

    Adriano Barreto Nogueira

    2017-11-01

    Full Text Available We have recently found that the temperature variability (TV in the day–night cycle may predict the mean intracranial pressure in the following 24 h (ICP24 in subarachnoid hemorrhage (SAH patients under multimodality monitoring, sedation, and hypothermia (<35°C. Specifically, we found that ICP24 = 6 (4 − TV mmHg. TV is the ratio between the coefficient of variation of temperature during the nocturnal and the preceding diurnal periods. This result suggests that the circadian clock reflects brain plasticity mechanisms and its malfunctioning leads to deterioration of the neurologic status. The sleep–wake cycle is absent in these patients and their circadian clock can function properly only by environment light-independent mechanisms. One mechanism involves the circadian clock proteins named cryptochromes (CRYs. CRYs are highly preserved and widespread in the evolutionary tree, are expressed in different cell types in humans [type II CRYs, in two forms: human cryptochrome 1 and 2 (hCRY1 and hCRY2], and in certain species, respond to blue light and play role in magnetoreception. Interestingly, SAH outcome seems to correlate with inflammation, and CRYs decrease inflammatory activity. Our hypothesis derived from these observations is that CRYs modulate the circadian oscillation of temperature even during therapeutic hypothermia and improve outcome in SAH through decrease in inflammation. A strategy to test this hypothesis is to measure periodically during the acute phase of high-grade SAH the level of CRYs in cerebrospinal fluid (CSF and circulating white blood cells, and to correlate these levels with outcome, TV, ICP24, and pro- and anti-inflammatory markers in CSF and blood. If this hypothesis is true, the development of therapies targeting inflammation in SAH could take advantage of cryptochrome properties. It has been shown that blue light phototherapy increases the expression of CRYs in blood mononuclear cells in jaundiced