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https://www.readbyqxmd.com/read/27907969/neuroprotection-in-critical-care-neurology
#1
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
#2
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
#3
Ko-Ting Chen, Shih-Tseng Lee, Chieh-Tsai Wu
OBJECTS: A subset of surgically-treated traumatic brain injury (TBI) patients cannot be stabilized by initial surgery. Mobile computed tomography (mCT) 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 mCT (imCT) on prognosis. METHODS: Out of 1017 surgically-treated TBI patients retrospectively reviewed over a 5-year period (2009-2013), fifty-nine patients required second operations within 72 hours of their initial surgery due to 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
#4
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
https://www.readbyqxmd.com/read/27885890/use-of-a-thrombopoietin-receptor-agonist-in-von-willebrand-disease-type-2b-p-v1316m-with-severe-thrombocytopenia-and-intracranial-hemorrhage
#5
O Espitia, C Ternisien, C Agard, P Boisseau, C V Denis, M Fouassier
We present here a 63-year old woman with a long history of immune thrombocytopenia. She was hospitalized for a traumatic intracranial hemorrhage with thrombocytopenia. Following inefficient treatment of four platelet transfusions, immunoglobulins, and corticosteroids, we initiated treatment with a thrombopoietin (TPO) receptor agonist (eltrombopag 25 mg/d) with a good efficacy. Her mother and sister also had chronic thrombocytopenia. Clinical history, hemostasis results, and gene analysis revealed von Willebrand disease (VWD) type 2B with the mutation (c...
November 25, 2016: Platelets
https://www.readbyqxmd.com/read/27885529/lack-of-aquaporin-9-reduces-brain-angiogenesis-and-exaggerates-neuronal-loss-in-the-hippocampus-following-intracranial-hemorrhage-in-mice
#6
Weiyang Ji, Jing Wang, Jie Xu, Xudong Zhao, Xing Xu, Xiaojie Lu
Intracranial hemorrhage (ICH) is a common subtype of stroke with high morbidity and mortality. However, few clinical therapies that can reduce ICH-induced brain injury and promote the recovery outcome in ICH patients are available to improve the recovery from ICH. Given that aquaporin 9 (AQP9) plays a critical role in brain edema after ischemic stroke and traumatic brain injury and is involved in the regulation of angiogenesis, we examined the role of AQP9 in preventing neuronal loss and in neovascularization in the dorsal hippocampus (DH) after ICH...
November 24, 2016: Journal of Molecular Neuroscience: MN
https://www.readbyqxmd.com/read/27876657/clinical-predictors-of-intracranial-injuries-in-infants-with-minor-head-trauma
#7
Hidenori Ohbuchi, Shinji Hagiwara, Kengo Hirota, Hirokazu Koseki, Yasuhiro Kuroi, Naoyuki Arai, Hidetoshi Kasuya
OBJECTIVE: Minor head trauma is common in children. Though most cases are nonsignificant, minor head trauma can lead to the deterioration of intracranial injuries, which is preventable. The aim of this study was to identify clinical predictors of intracranial injuries in infants with minor head trauma. METHODS: We retrospectively enrolled infants under 11 months with minor head trauma between 2006 and 2013. The following data were recorded: age, sex, cause of trauma, fall height, vomiting, bad temper, size and location of scalp hematoma, fracture, and intracranial injuries on CT...
November 19, 2016: World Neurosurgery
https://www.readbyqxmd.com/read/27872767/diffuse-alveolar-hemorrhage-associated-with-edoxaban-therapy
#8
Kenichi Nitta, Hiroshi Imamura, Akihiro Yashio, Satoko Kashima, Katsunori Mochizuki
Introduction. The main adverse effect of anticoagulant therapy is bleeding, and major bleeding, including intracranial, gastrointestinal, and retroperitoneal bleeding, has been reported as an adverse effect of edoxaban, a direct oral anticoagulant (DOAC). Bleeding during systemic anticoagulation with edoxaban presents a therapeutic conundrum, because there is currently no safe or efficacious reversal agent to stop major bleeding. Case Report. A 51-year-old woman had multiple traumatic injuries, including lower limb fractures...
2016: Case Reports in Critical Care
https://www.readbyqxmd.com/read/27869558/polynitroxylated-pegylated-hemoglobin-a-novel-small-volume-therapeutic-for-traumatic-brain-injury-resuscitation-comparison-to-whole-blood-and-dose-response-evaluation
#9
Erik C Brockman, Travis C Jackson, C Edward Dixon, Hulya Bayir, Robert Clark, Vincent A Vagni, Keri L Janesko, Catherine Byrd, Li Ma, Carleton J C Hsia, Patrick M Kochanek
: Resuscitation with polynitroxylated pegylated hemoglobin (PNPH), a PEGylated bovine hemoglobin decorated with nitroxides, eliminated the need for fluid administration, reduced ICP and brain edema, and produced neuroprotection in vitro and in vivo vs. lactated Ringer's (LR) in experimental traumatic brain injury (TBI) plus hemorrhagic shock (HS). HYPOTHESIS: Resuscitation with PNPH will improve acute physiology vs. whole blood after TBI+HS and will be safe and effective across a wide dosage range...
November 21, 2016: Journal of Neurotrauma
https://www.readbyqxmd.com/read/27858189/ambulatory-or-inpatient-management-of-mild-tbi-in-children-a-post-concussion-analysis
#10
Danielle S Wendling-Keim, Adriana König, Hans-Georg Dietz, Markus Lehner
BACKGROUND: Diagnosis and treatment of children with mild traumatic brain injury (mTBI) remain a challenge since initial signs and symptoms do not always indicate the severity of the trauma. Therefore, guidelines regarding the decision upon imaging methods and ambulatory or hospitalized treatment are needed. The goal of our study was to investigate if the standard that was allied from the PECARN rules and is applied in this study can ensure that patients with clinically important brain injury are recognized and leads to outcomes with a low complication rate, a high patient satisfaction and minimal post-concussion syndrome incidence...
November 17, 2016: Pediatric Surgery International
https://www.readbyqxmd.com/read/27857928/spinal-subarachnoid-hemorrhage-migrated-from-traumatic-intracranial-subarachnoid-hemorrhage
#11
Tae Jin Kim, Eun Jung Koh, Keun-Tae Cho
Very rarely, spinal subarachnoid hemorrhage (SSAH) can occur without any direct spinal injury in patients with traumatic intracranial SAH. A-59-year-old male with traumatic intracranial subarachnoid hemorrhage (SAH) presented with pain and numbness in his buttock and thigh two days after trauma. Pain and numbness rapidly worsened and perianal numbness and voiding difficulty began on the next day. Magnetic resonance imaging showed intraspinal hemorrhage in the lumbosacral region. The cauda equina was displaced and compressed...
October 2016: Korean Journal of Neurotrauma
https://www.readbyqxmd.com/read/27857815/the-role-of-the-iron-stain-in-assessing-intracranial-hemorrhage
#12
Rudy J Castellani, Gruschenka Mojica, George Perry
The timing of the breakdown of red blood cells and organization of hemorrhage has significance in the catabolism of heme and the processing of iron, but also has a practical application in terms of assigning, or attempting to assign, a time course with respect to traumatic events (e.g. contusions and hemorrhages). Attempts to date contusions, however, have generally been unsuccessful by macroscopic observation, whereas the microscopic observations provide broad data but are also anatomically imprecise as a function of time...
2016: Open Neurology Journal
https://www.readbyqxmd.com/read/27847770/delayed-rebleeding-of-cerebral-aneurysm-misdiagnosed-as-traumatic-subarachnoid-hemorrhage
#13
Seung-Yoon Song, Dae-Won Kim, Jong-Tae Park, Sung-Don Kang
An intracranial saccular aneurysm is uncommonly diagnosed in a patient with closed head trauma. We herein present a patient with delayed rebleeding of a cerebral aneurysm misdiagnosed as traumatic subarachnoid hemorrhage (SAH). A 26-year-old female visited our emergency department because of headache after a motorcycle accident. Brain computed tomography (CT) showed a right-side dominant SAH in Sylvian fissure. Although traumatic SAH was strongly suggested because of the history of head trauma, we performed a CT angiogram to exclude any vascular abnormalities...
September 2016: Journal of Cerebrovascular and Endovascular Neurosurgery
https://www.readbyqxmd.com/read/27836703/surgical-treatment-of-traumatic-intracranial-aneurysms-experiences-at-a-single-center-over-30-years
#14
Seung-Hoon Jung, Sung-Hyun Kim, Tae-Sun Kim, Sung-Pil Joo
OBJECTIVE: Traumatic intracranial aneurysms (tIA) are rare and are associated with high rates of morbidity and mortality. We describe our experiences with tIA at our institution. METHODS: We retrospectively reviewed records from patients who underwent treatment for tIA between January 1986 and December 2015. RESULTS: Data from 5,532 patients diagnosed with cerebral aneurysms between January 1986 and December 2015 in our hospital were reviewed...
November 8, 2016: World Neurosurgery
https://www.readbyqxmd.com/read/27833676/variation-of-blunt-traumatic-injury-with-age-in-older-adults-statewide-analysis-2011-14
#15
Emily Earl-Royal, Frances Shofer, Dominique Ruggieri, Rosemary Frasso, Daniel Holena
INTRODUCTION: Traumatic injury is a leading cause of death and disability in adults ≥ 65 years old, but there are few epidemiological studies addressing this issue. The aim of this study was to assess how characteristics of blunt traumatic injuries in adults ≥ 65 vary by age. METHODS: Using data from the a single-state trauma registry, this retrospective cohort study examined injured patients ≥ 65 admitted to all Level I and Level II trauma centers in Pennsylvania between 2011 and 2014 (n=38,562)...
November 2016: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27823754/utility-of-clinical-decision-rule-for-intensive-care-unit-admission-in-patients-with-traumatic-intracranial-hemorrhage
#16
Brandt D Whitehurst, Jared Reyes, Stephen D Helmer, James M Haan
BACKGROUND: Recent literature suggests the majority of traumatic intracranial hemorrhage does not require intervention. One recently described clinical decision rule was sensitive in identifying patients requiring critical care interventions in an urban setting. We sought to validate its effectiveness in our predominately rural setting. METHODS: A retrospective study was conducted of adult patients with traumatic intracranial hemorrhage. The rule, based on age, initial Glasgow coma scale score, and presence of a non-isolated head injury, was applied to externally validate the previously reported findings...
October 8, 2016: American Journal of Surgery
https://www.readbyqxmd.com/read/27822741/isolated-brain-trauma-in-cats-triggers-rapid-onset-of-hypovolemia
#17
Peter Bentzer, Per-Olof Grände
BACKGROUND: Hemodynamic instability responsive to fluid resuscitation is common after a traumatic brain injury (TBI), also in the absence of systemic hemorrhage. The present study tests if an isolated severe TBI induces a decrease in plasma volume (PV). METHODS: The study was performed in three groups of anesthetized and tracheostomized male cats (n = 21). In one group (n = 8), the cats were prepared with a cranial borehole (10 mm i.d) used to expose the brain to a fluid percussion brain injury (FPI) (1...
November 7, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/27817917/visual-outcomes-after-vitrectomy-for-terson-syndrome-secondary-to-traumatic-brain-injury
#18
Raja Narayanan, Stanford C Taylor, Ashraya Nayaka, Riddhima Deshpande, Daniel St Aubin, Frank N Hrisomalos, Jonathan Hu, Rithwick Rajagopal, Asheesh Tewari, Rajendra S Apte
PURPOSE: To evaluate visual outcomes after vitrectomy for intraocular hemorrhages secondary to traumatic brain injury. DESIGN: Retrospective, observational case series. PARTICIPANTS: A total of 28 eyes in 20 patients undergoing vitrectomy for Terson syndrome secondary to traumatic brain injury between 1997 and 2015. METHODS: We reviewed the records of patients undergoing a standard 20-gauge or 23-gauge pars plana vitrectomy for intraocular hemorrhages secondary to traumatic brain injury, and the timing of vitrectomy in relation to the inciting intracranial event was recorded...
November 3, 2016: Ophthalmology
https://www.readbyqxmd.com/read/27800464/traumatic-globe-subluxation-and-intracranial-injury-caused-by-bicycle-brake-handle
#19
Ceren Poroy, Cansu Cibik, Bulent Yazici
INTRODUCTION: Penetration of a bicycle brake handle into the orbit is a rare and serious type of trauma. Globe subluxation due to such trauma has not been previously reported. CASE PRESENTATION: A 10-year-old girl presented after falling from a bicycle, which resulted in the handbrake penetrating her right upper eyelid. On examination, the globe was subluxated anteriorly, there was no light perception, and the pupilla was fixed and dilated. Radiologic studies revealed orbitonasal fractures, hemorrhage, emphysema in the orbit and cranium, and rupture of the extraocular muscles...
September 2016: Archives of Trauma Research
https://www.readbyqxmd.com/read/27798539/pediatric-minor-traumatic-brain-injury-with-intracranial-hemorrhage-identifying-low-risk-patients-who-may-not-benefit-from-icu-admission
#20
Erin Comer Burns, Beech Burns, Craig D Newgard, Amber Laurie, Rongwei Fu, Theresa Graif, Casey S Ward, Abbie Bauer, David Steinhardt, Laura M Ibsen, David M Spiro
BACKGROUND: Pediatric patients with any severity of traumatic intracranial hemorrhage (tICH) are often admitted to intensive care units (ICUs) for early detection of secondary injury. We hypothesize that there is a subset of these patients with mild injury and tICH for whom ICU care is unnecessary. OBJECTIVES: To quantify tICH frequency and describe disposition and to identify patients at low risk of inpatient critical care intervention (CCI). METHODS: We retrospectively reviewed patients aged 0 to 17 years with tICH at a single level I trauma center from 2008 to 2013...
October 28, 2016: Pediatric Emergency Care
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