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traumatic intracranial hemorrhage

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https://www.readbyqxmd.com/read/28099375/routine-neurosurgical-consultation-is-not-necessary-in-mild-blunt-traumatic-brain-injury
#1
Paul R Lewis, Casey E Dunne, James D Wallace, Jason B Brill, Richard Y Calvo, Jayraan Badiee, Michael J Sise, Vishal Bansal, C Beth Sise, Steven R Shackford
BACKGROUND: The Brain Trauma Foundation guidelines provide indications for neurosurgical intervention in traumatic brain injury (TBI) with moderate or severe intracranial hemorrhage (ICH). In TBI patients with less severe ICH, the utility of neurosurgical consultation remains unclear. We sought to determine if routine neurosurgical consultation is necessary for mild blunt TBI patients with ICH. METHODS: A retrospective cohort study was conducted on 500 consecutive blunt TBI patients aged 15 years or older with Glasgow Coma Scale score ≥13 and ICH on initial head computed tomography (CT) admitted to a Level 1 trauma center over 28 months...
January 17, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28093693/a-simple-post-mortem-room-angiography-method-for-the-investigation-of-traumatic-basal-subarachnoid-hemorrhage
#2
Christopher P Johnson, Mike Murphy, George A Johnson, Stephen M Wills, Jonathan E Medcalf
Identifying the site of vascular bleeding in fatal cases of traumatic basal subarachnoid hemorrhage (TBSAH) is important, but can be very difficult to achieve when there is extensive blood clot in the posterior cranial fossa. Post mortem angiography in these circumstances has been reported previously but with mixed results, and is rarely used in current practice within the United Kingdom. We have developed a simple and effective post mortem angiography method, using fluoroscopy and clear modern contrast medium, suitable for use in the autopsy room...
January 17, 2017: Forensic Science, Medicine, and Pathology
https://www.readbyqxmd.com/read/28091809/a-review-of-penetrating-brain-trauma-epidemiology-pathophysiology-imaging-assessment-complications-and-treatment
#3
REVIEW
Mona T Vakil, Ajay K Singh
Gunshot injuries are the most common cause of penetrating brain injury (PBI) and carry a high morbidity and mortality. The incidence of PBI has increased over the last decade with an estimated 35,000 civilian deaths annually. Patients that survive to reach the hospital require rapid triage and imaging evaluation. CT findings in conjunction with the Glasgow Coma Scale are typically used to determine which patients are surgical candidates. Radiologists should be familiar with the various injury patterns and imaging findings which are poor prognostic indicators, notably brainstem, bilateral hemispheric, multilobar, or transventricular injuries...
January 14, 2017: Emergency Radiology
https://www.readbyqxmd.com/read/28076834/risk-factors-for-posttraumatic-epilepsy-a-systematic-review-and-meta-analysis
#4
REVIEW
Tao Xu, Xinyuan Yu, Shu Ou, Xi Liu, Jinxian Yuan, Hao Huang, Juan Yang, Liang He, Yangmei Chen
OBJECTIVE: A systematic review and meta-analysis was performed to identify risk factors for posttraumatic epilepsy (PTE). METHODS: Two electronic databases (Medline and Embase) were searched to identify studies with a cohort, case-control, or cross-sectional design reporting on epidemiologic evidence regarding risk factors for PTE. RESULTS: Men had a higher risk of developing PTE than women [relative ratio (RR), 1.32; 95% confidence interval (CI), 1...
January 8, 2017: Epilepsy & Behavior: E&B
https://www.readbyqxmd.com/read/28059632/pseudoaneurysm-formation-due-to-rupture-of-intracranial-aneurysms-case-series-and-literature-review
#5
Motohiro Nomura, Kentaro Mori, Akira Tamase, Tomoya Kamide, Syunsuke Seki, Yu Iida, Tatsu Nakano, Yuichi Kawabata, Taro Kitabatake, Teruyuki Nakajima, Kiyoyuki Yasutake, Kei Egami, Tatsunori Takahashi, Mitsuyuki Takahashi, Kunio Yanagimoto
Background Intracranial pseudoaneurysm formation due to a ruptured non-traumatic aneurysm is extremely rare. We describe the radiological findings and management of pseudoaneurysms due to ruptured cerebral aneurysms in our case series and previously reported cases. Patients and methods Four additional and 20 reported patients presenting with subarachnoid hemorrhage (SAH) are included. Radiological findings and clinical features of these patients were reviewed. Results In our series, three-dimensional computed tomographic angiography (3D-CTA) and/or angiography showed an irregular- or snowman-shaped cavity extending from the parent artery...
January 1, 2017: Neuroradiology Journal
https://www.readbyqxmd.com/read/28054290/treatment-of-hyponatremia-in-patients-with-acute-neurological-injury
#6
Theresa Human, Aaron M Cook, Brian Anger, Kathleen Bledsoe, Amber Castle, David Deen, Haley Gibbs, Christine Lesch, Norah Liang, Karen McAllen, Christopher Morrison, Dennis Parker, A Shaun Rowe, Denise Rhoney, Kiranpal Sangha, Elena Santayana, Scott Taylor, Eljim Tesoro, Gretchen Brophy
BACKGROUND: Little data exist regarding the practice of sodium management in acute neurologically injured patients. This study describes the practice variations, thresholds for treatment, and effectiveness of treatment in this population. METHODS: This retrospective, multicenter, observational study identified 400 ICU patients, from 17 centers, admitted for ≥48 h with subarachnoid hemorrhage (SAH), traumatic brain injury (TBI), intraparenchymal hemorrhage, or intracranial tumors between January 1, 2011 and July 31, 2012...
January 4, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28054289/procalcitonin-is-a-poor-predictor-of-non-infectious-fever-in-the-neurocritical-care-unit
#7
Karin Halvorson, Sameer Shah, Corey Fehnel, Bradford Thompson, N Stevenson Potter, Mitchell Levy, Linda Wendell
BACKGROUND: Fever is a common occurrence in the Neurocritical Care Unit (NCCU). It is reported that up to 50 % of these fevers are associated with a non-infectious source. As this is a diagnosis of exclusion, a complete fever evaluation must be done to rule out infection. Procalcitonin (PCT) has been identified as a possible biomarker to distinguish infectious from non-infectious etiologies of fever. We hypothesized that PCT could be used as a predictor of infectious fever in febrile patients with intracranial hemorrhage admitted to the NCCU...
January 4, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28046516/we-ab-207a-03-a-cbct-head-scanner-for-point-of-care-imaging-of-intracranial-hemorrhage
#8
J Xu, A Sisniega, W Zbijewski, H Dang, J Stayman, X Wang, D Foos, N Aygun, V Koliatsos, J Siewerdsen
PURPOSE: This work reports the design, development, and first technical assessment of a cone-beam CT (CBCT) scanner developed specifically for imaging of acute intracranial hemorrhage (ICH) at the point of care, with target applications in diagnosis and monitoring of traumatic brain injury, stroke, and postsurgical hemorrhage. METHODS: System design employed a task-based image quality model to quantify the influence of factors such as additive noise and high-gain (HG) detector readout on ICH detectability...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28035993/brain-monitoring-in-critically-neurologically-impaired-patients
#9
REVIEW
Salazar Jones, Gary Schwartzbauer, Xiaofeng Jia
Assessment of neurologic injury and the evolution of severe neurologic injury is limited in comatose or critically ill patients that lack a reliable neurologic examination. For common yet severe pathologies such as the comatose state after cardiac arrest, aneurysmal subarachnoid hemorrhage (aSAH), and severe traumatic brain injury (TBI), critical medical decisions are made on the basis of the neurologic injury. Decisions regarding active intensive care management, need for neurosurgical intervention, and withdrawal of care, depend on a reliable, high-quality assessment of the true state of neurologic injury, and have traditionally relied on limited assessments such as intracranial pressure monitoring and electroencephalogram...
December 27, 2016: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/28033118/multi-resolution-statistical-image-reconstruction-for-mitigation-of-truncation-effects-application-to-cone-beam-ct-of-the-head
#10
Hao Dang, J Webster Stayman, Alejandro Sisniega, Wojciech Zbijewski, Jennifer Xu, Xiaohui Wang, David H Foos, Nafi Aygun, Vassilis E Koliatsos, Jeffrey H Siewerdsen
A prototype cone-beam CT (CBCT) head scanner featuring model-based iterative reconstruction (MBIR) has been recently developed and demonstrated the potential for reliable detection of acute intracranial hemorrhage (ICH), which is vital to diagnosis of traumatic brain injury and hemorrhagic stroke. However, data truncation (e.g. due to the head holder) can result in artifacts that reduce image uniformity and challenge ICH detection. We propose a multi-resolution MBIR method with an extended reconstruction field of view (RFOV) to mitigate truncation effects in CBCT of the head...
January 21, 2017: Physics in Medicine and Biology
https://www.readbyqxmd.com/read/28019651/infratentorial-superficial-siderosis-classification-diagnostic-criteria-and-rational-investigation-pathway
#11
Duncan Wilson, Fiona Chatterjee, Simon F Farmer, Peter Rudge, Mark O McCarron, Peter Cowley, David J Werring
Central nervous system infratentorial superficial siderosis (iSS) is increasingly detected by blood-sensitive MRI sequences. Despite this, there are no standardized diagnostic criteria, and the clinical-radiological spectrum, causes and optimum investigation strategy are not established. We reviewed clinical and radiological details of patients with iSS assessed at a specialist neurological center from 2004-2016 using pre-defined standardized radiological criteria. All imaging findings were rated blinded to clinical details...
December 26, 2016: Annals of Neurology
https://www.readbyqxmd.com/read/28007364/factor-eight-inhibitor-bypassing-agent-feiba-for-reversal-of-target-specific-oral-anticoagulants-in-life-threatening-intracranial-bleeding
#12
Gordon Mao, Lauren King, Sarah Young, Richard Kaplan
INTRODUCTION: As increasing number of patients present to emergency departments with life threatening hemorrhages, particularly intracranial hemorrhage on anticoagulation physicians must be cognizant of the limitations of the available reversal options. Based upon the available literature, our institution formulated a reversal algorithm for patients with life-threatening bleeding on factor Xa inhibitors by administering factor eight inhibitor bypassing agent (FEIBA) 20 units/kg. METHODS: A retrospective chart review was performed to include all patients who received FEIBA per institutional protocol...
December 19, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27987314/risk-benefit-and-cost-thresholds-for-emergency-department-testing-a-cross-sectional-scenario-based-study
#13
Arjun Prasad Meka, Jonathan Douglas Porath, Rahul Iyengar, Chelsea Morrow, Angela Fagerlin, William J Meurer
INTRODUCTION: While diagnostic testing is common in the emergency department, the value of some testing is questionable. The purpose of this study was to assess how varying levels of benefit, risk, and costs influenced an individual's desire to have diagnostic testing. METHODS: A survey through Amazon Mechanical Turk presented hypothetical clinical situations: low risk chest pain and minor traumatic brain injury. Each scenario included three given variables (benefit, risk, and cost), that was independently randomly varied over four possible values (0...
December 17, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27982555/how-to-manage-blood-pressure-after-brain-injury
#14
Laurent Carteron, Fabio S Taccone, Mauro Oddo
Manipulation of blood pressure (BP) is a mainstay of therapy in patients with acute brain injury (ABI). In the early emergent phase (first hours from injury), depending on intracranial pathology, BP manipulation aims to 1) limit the progression of parenchymal hematomas or hemorrhagic transformation (in patients with ischemic/hemorrhagic stroke and aneurysmal subarachnoid hemorrhage [SAH]), and 2) attenuate hypoperfusion and secondary cerebral ischemic insults (in patients with traumatic brain injury [TBI])...
December 16, 2016: Minerva Anestesiologica
https://www.readbyqxmd.com/read/27924287/transient-oliguria-during-anesthesia-in-cerebral-salt-wasting-syndrome
#15
Kwang Ho Lee, Jong Taek Park, Dong Woo Cho, Seung Woo Song, Hyun Kyo Lim
Cerebral salt wasting syndrome is a hyponatremic and hypovolemic condition caused by intracranial disorders, such as head injury, subarachnoid hemorrhage, brain tumor, and brain operations. We report a case of a 5-year-old girl that had cerebral salt wasting syndrome with marked polyuria who showed transient oliguria during general anesthesia. The patient had undergone an operation for traumatic intracranial hemorrhage three months prior and has had marked polyuria and hyponatremia since then. After induction of anesthesia for cranioplasty, the patient had oliguria during surgery and then resumed polyuria in the post-operative period...
September 2016: Journal of Lifestyle Medicine
https://www.readbyqxmd.com/read/27923754/successful-coil-embolization-of-pediatric-carotid-cavernous-fistula-due-to-ruptured-posttraumatic-giant-internal-carotid-artery-aneurysm
#16
Daisuke Wajima, Ichiro Nakagawa, Hun Soo Park, Shohei Yokoyama, Takeshi Wada, Kimihiko Kichikawa, Hiroyuki Nakase
BACKGROUND: The goal of the treatment of direct carotid cavernous fistula (CCF) is to occlude the arteriovenous shunt and to preserve the patency of the concerned internal carotid artery. However, for the ipsilateral posttraumatic fragile cerebrum, coil embolization plus parent artery occlusion for the high-flow direct CCF is better for the prevention of hyperperfusion syndrome and intracranial hemorrhage. We experienced such a case and managed it successfully. CASE DESCRIPTION: A 6-year-old boy had severe head trauma caused by being hit by a car...
December 5, 2016: World Neurosurgery
https://www.readbyqxmd.com/read/27907969/neuroprotection-in-critical-care-neurology
#17
Menno R Germans, Hieronymus D Boogaarts, R Loch Macdonald
Ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and traumatic brain injury-all have in common early brain injury due to brain tissue destruction, reduced cerebral blood flow and oxygen delivery, and overall substantial morbidity and mortality. The pathophysiology of brain tissue damage likely includes common cellular mechanisms. Neuroprotection has seldom, if ever, been shown to reduce early brain injury. Secondary brain injury develops after these conditions due to macroscopic events such as increased intracranial pressure and reduced cerebral blood flow, as well as cellular processes including vascular damage, inflammation, and apoptotic/necrotic cell death...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27903938/post-noac-portuguese-observational-study-of-intracranial-hemorrhage-on-non-vitamin-k-antagonist-oral-anticoagulants
#18
Cláudia Marques-Matos, José Nuno Alves, João Pedro Marto, Joana Afonso Ribeiro, Ana Monteiro, José Araújo, Fernando Silva, Fátima Grenho, Miguel Viana-Baptista, João Sargento-Freitas, João Pinho, Elsa Azevedo
BACKGROUND: There is a lower reported incidence of intracranial hemorrhage with non-vitamin K antagonist oral anticoagulants compared with vitamin K antagonist. However, the functional outcome and mortality of intracranial hemorrhage patients were not assessed. AIMS: To compare the outcome of vitamin K antagonists- and non-vitamin K antagonist oral anticoagulants-related intracranial hemorrhage. METHODS: We included consecutive patients with acute non-traumatic intracranial hemorrhage on oral anticoagulation therapy admitted between January 2013 and June 2015 at four university hospitals...
November 30, 2016: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/27890762/the-clinical-value-of-intraoperative-mobile-computed-tomography-in-managing-high-risk-surgical-patients-with-traumatic-brain-injury-a-single-tertiary-trauma-center-experience
#19
Ko-Ting Chen, Shih-Tseng Lee, Chieh-Tsai Wu
OBJECTIVE: A subset of surgically treated patients with traumatic brain injury (TBI) cannot be stabilized by initial surgery. Mobile computed tomography (CT) provides real-time information for diagnosis in these TBI surgically high-risk (TBI-SHR) patients. The objective of this study was to analyze a 5-year series of TBI-SHR patients to evaluate the impact of intraoperative mobile CT (imCT) on prognosis. METHODS: Of 1017 surgically treated patients with TBI retrospectively reviewed over a 5-year period (2009-2013), 59 patients required second operations within 72 hours of their initial surgery because of progressive or delayed hematomas (TBI-SHR group)...
November 24, 2016: World Neurosurgery
https://www.readbyqxmd.com/read/27889194/usefulness-of-thromboelastography-in-the-detection-and-management-of-tissue-plasminogen-activator-associated-hyperfibrinolysis
#20
Francesca Rosafio, Laura Vandelli, Guido Bigliardi, Francesco Cavallieri, Maria Luisa Dell'Acqua, Livio Picchetto, Andrea Zini
Rotation thromboelastometry is a viscoelastometric method that provides a rapid assessment of a patient's hemostatic processes in emergency settings, allowing prompt identification of specific coagulation abnormalities. Its results thus might guide targeted replacement therapy in hemorrhagic conditions, in case of platelet or coagulation factor deficiency, or hyperfibrinolysis, which is difficult to identify otherwise. Although currently used in emergency and traumatic surgery, there are limited data about thromboelastometry in ischemic stroke, particularly in monitoring the coagulative response to recombinant tissue plasminogen activator after intravenous thrombolysis (IVT)...
November 23, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
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