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Subarachnoid bleed

Marvin Darkwah Oppong, Oliver Gembruch, Daniela Pierscianek, Martin Köhrmann, Christoph Kleinschnitz, Cornelius Deuschl, Christoph Mönninghoff, Klaus Kaier, Michael Forsting, Ulrich Sure, Ramazan Jabbarli
BACKGROUND: Delayed cerebral ischemia (DCI) has a strong impact on outcome of patients with aneurysmal subarachnoid hemorrhage (SAH). Positive effect of antiplatelet therapy on DCI rates has been supposed upon smaller SAH series. OBJECTIVE: To analyze the benefit/risk profile of antiplatelet use in SAH patients. METHODS: This retrospective case-control study was based on institutional observational cohort with 994 SAH patients treated between January 2003 and June 2016...
December 13, 2018: Neurosurgery
Tobechi Mbadugha, Toshihiro Ogiwara, Alhusain Nagm, Takatoshi Hasegawa, Keisuke Kamiya, Samuel Ohaegbulam, Kazuhiro Hongo
Superficial siderosis (SS) associated with craniopharyngioma is an extremely rare occurrence. To our knowledge, only three cases have been reported in literature. Two of the cases occurred following resection of the tumor. Similar to the present case, one of the cases was discovered prior to surgical intervention, 'pure tumor-related' SS. The clinical presentation, diagnosis, management and outcome are discussed in this article. A 50-year-old man presented with an 11-month history of left-sided tinnitus, hearing impairment and a 2-month history of visual disturbance...
December 6, 2018: World Neurosurgery
Erika Hutt, Oussama M Wazni, Walid I Saliba, Mohamed Kanj, Khaldoun G Tarakji, Jose Aguilera, Amr F Barakat, Peter Rasmussen, Ken Uchino, Andrew Russman, Shazam Hussain, Dolora Wisco, Samir Kapadia, Bruce D Lindsay, Ayman A Hussein
BACKGROUND: The Watchman™ device (Boston Scientific, MN), used for left atrial appendage closure (LAAC) was approved for stroke prevention in patients with atrial fibrillation (AF) and an appropriate rationale to avoid long-term oral anticoagulation. Patients with AF and prior intracranial hemorrhage (ICH) were excluded from clinical trials due to perceived risks of peri-operative anticoagulation. OBJECTIVE: We studied the efficacy and safety of LAAC using Watchman™ in patients with AF and prior ICH...
November 19, 2018: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Yi-Chen Li, Rong Wang, Man-Man Xu, Xiang-Ru Jing, Jiye Aa, Run-Bin Sun, Shi-Jie Na, Tao Liu, Xuan-Sheng Ding, Cui-Yun Sun, Wei-Hong Ge
Cerebral metabolism alterations influence cerebrospinal fluid (CSF) composition, and is sensitive to brain injury. In subarachnoid hemorrhage (SAH) patients, Fisher scale, Hunt-Hess scale and World Federation of Neurological Societies (WFNS) grading scales evaluating SAH severity are inadequate to predict long-term outcome; therefore, in an effort to determine metabolite pattern disparity and discover corresponding biomarkers, we designed an untargeted CSF metabolomic research covering a board range of metabolites of SAH patients with different severity and outcome...
December 6, 2018: ACS Chemical Neuroscience
Monica Acciarresi, Riccardo Altavilla, Maria G Mosconi, Valeria Caso
PURPOSE OF REVIEW: The absolute risk of pregnancy-associated intracranial haemorrhage (ICH) has been reported to be relatively low and often associated with high risks of life-long disabilities and mortality. The aim of this narrative review was obtaining a better understanding of the current management practices for ICH, unruptured aneurysms and/or arteriovenous malformations during pregnancy, as well as the effects of future pregnancies, and the uses of oral contraceptive or HRT. RECENT FINDING: General guidelines for the management of ICH are used for pregnant women but additional expedient and thorough evaluation of foetal viability and its gestational age are requested...
November 30, 2018: Current Opinion in Neurology
Susanne Muehlschlegel
PURPOSE OF REVIEW: This article reviews the epidemiology, clinical presentation, diagnosis, and management of patients with aneurysmal subarachnoid hemorrhage (SAH). SAH is a type of hemorrhagic stroke and is a neurologic emergency with substantial morbidity and mortality. This article reviews the most common and potentially life-threatening neurologic and medical complications to promote their early recognition and prevent secondary brain injury. RECENT FINDINGS: Over the past 30 years, the incidence of SAH has remained stable; yet, likely because of improved care in specialized neurocritical care units, discharge mortality has considerably decreased...
December 2018: Continuum: Lifelong Learning in Neurology
(no author information available yet)
Superficial siderosis of the central nervous system (SSCNS) is an uncommon and often unrecognized disorder that results from recurrent and persistent bleeding into the subarachnoid space. Currently, there is no effective treatment for SSCNS. The identification and surgical resolution of the cause of bleeding remains the most reliable method of treatment, but the cause of bleeding is often not apparent. The identified sources of recurrent bleeding have typically included neoplasms, vascular malformations, brachial plexus or nerve root injury or avulsion, and previous head and spinal surgery...
October 1, 2018: Journal of Neurosurgery. Spine
Nobuhiko Arai, Yutaka Mine, Hiroshi Kagami, Makoto Inaba
BACKGROUND: In primary intracerebral hemorrhage, several studies showed that contrast extravasation (CEV) is reported to be an indicator of delayed hematoma expansion, emergent hematoma removal and poor prognosis. On the contrary in head trauma, few researches validated the effectiveness of CEV because of other influences such as subarachnoid hemorrhage (SAH), contusion or brain swelling. The authors experienced a patient showing diffuse SAH caused by traumatic mechanism with acute subdural hematoma (ASDH)...
November 15, 2018: Journal of Craniofacial Surgery
Daniela Müller, Oliver Müller
The aneurysmal subarachnoid hemorrhage is a life threatening disorder associated with high morbidity and mortality. Identification and treatment of the bleeding source is mandatory within the first 24 hours to prevent rebleeding. Patients suffering from subarachnoid hemorrhage should be managed on an intensive care unit experienced in the treatment of this condition. Most frequent complications in the clinical course are hydrocephalus, requiring temporary or permanent shunting, and delayed cerebral ischemia...
October 2018: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
H Khalayleh, G Lin, H Kadar Sfarad, M Mostafa, N Abu Abed, A Imam, A P Zbar, E Mavor
BACKGROUND: There is debate concerning the need for specialist neurosurgical transfer of patients presenting to Level II trauma centers with a minimal head injury (Glasgow Coma Scale ≥13) and a small non-progressive intracranial bleeding (ICB). METHODS: A retrospective chart analysis was performed assessing the outcomes of adult patients presenting with a minor traumatic ICB on initial CT scan (minimal subarachnoid hemorrhage; small-width subdural hematoma without shift; punctate cerebral contusion)...
October 25, 2018: World Journal of Surgery
Isaac Ng, Nikolay Bugaev, Ron Riesenburger, Aaron C Shpiner, Janis L Breeze, Sandra S Arabian, Reuven Rabinovici
Infratentorial traumatic intracranial bleeds (ICBs) are rare and the distribution of subtypes is unknown. To characterize this distribution the National Trauma Data Bank (NTDB) 2014 was queried for adults with single type infratentorial ICB, n = 1,821: subdural hemorrhage (SDH), subarachnoid hemorrhage (SAH), epidural hemorrhage (EDH), and intraparenchymal hemorrhage (IPH). Comparisons were made between the groups with statistical significance determined using chi squared and t-tests. SDH occurred in 29% of patients, mostly in elderly on anti-coagulants (13%) after a fall (77%), 42% of them underwent craniotomy, their mortality was the lowest (4%)...
October 17, 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Murtaza Cakir, Ali Ahiskalioglu, Erdem Karadeniz, Mehmet Dumlu Aydin, Umit Ali Malcok, Celaleddin Soyalp, Cagatay Calikoglu, Goksin Sengul, Sare Sipal, Ahmet Murat Yayik
Stress ulcers is a trouble complication of subarachnoid hemorrhage (SAH). Although gastrointestinal ulcerations may be attributed to increased HCL secretion in SAH; the exact mechanism of that complication has not been investigated definitively. We studied if vagal network degeneration may cause intestinal atrophy following SAH. Study was conducted on 25 rabbits, with 5 control group (Group-A), 5 SHAM group (Group-B), and 15 SAH group via injection of autologue blood to cisterna magna. Seven animals followed for seven days (Early Decapitated-Group-C) and eight animals followed 21 days (Late Decapitated-Group-D)...
October 13, 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Jianfeng Zheng, Rui Xu, Guojing Liu, Zongduo Guo, Xiaochuan Sun
OBJECTIVE: Hypertension is common in patients with aneurysmal subarachnoid hemorrhage (SAH). However, it is still unclear whether premorbid antihypertensive therapy can help to reduce the risk of severe aneurysmal bleeding. Therefore, this study aims to assess the effect of premorbid hypertension control on outcome of patients with aneurysmal SAH. METHODS: We retrospectively reviewed the clinical data of patients with intracranial aneurysms admitted to our institution from February 2012 to December 2017...
October 12, 2018: Acta Neurochirurgica
Mat Goebel, Christopher Tainter, Christopher Kahn, James V Dunford, John Serra, Jodie Pierce, J Joelle Donofrio
BACKGROUND: Left ventricular assist devices (LVADs) are used with increasing frequency and left in place for longer periods of time. Prior publications have focused on the mechanics of troubleshooting the device itself. We aim to describe the epidemiology of LVAD patient presentations to emergency medical services (EMS), prehospital assessments and interventions, and hospital outcomes. METHODS: This is a retrospective chart review of known LVAD patients that belong to a single academic center's heart failure program who activated the 9-1-1 system and were transported by an urban EMS system to one of the center's 2 emergency departments between January 2012 and December 2015...
November 5, 2018: Prehospital Emergency Care
Marco Zenteno, Angel Lee, Luis Rafael Moscote-Salazar
Persistent primitive trigeminal artery (PPTA), a fetal carotid-basilar anastomosis, is the most common embryological vascular remnant persisting into adult age. However, reported cases associated with cerebral aneurysms are rare. A 33-year-old female presented with an extremely rare PPTA-basilar artery (PPTA-BA) aneurysm manifesting as subarachnoid hemorrhage. Computed tomography revealed subarachnoid bleeding in the prepontine cistern, and cerebral angiography disclosed a PPTA-BA aneurysm. The aneurysm was managed with stent-assisted coiling technique to achieve complete obliteration...
July 2018: Asian Journal of Neurosurgery
Hansen Deng, John K Yue, Beata Durcanova, Javid Sadjadi
Alcohol intoxication is a common risk factor of traumatic brain injury (TBI) and carries a significant health-care burden on underserved patients. Patients with chronic alcohol use may suffer a spectrum of bleeding diatheses from hepatic dysfunction not well studied in the context of TBI. A feared sequela of TBI is the development of coagulopathy resulting in worsened intracranial bleeding. We report the clinical course of an intoxicated patient found down with blunt head trauma and concurrent alcoholic cirrhosis who was awake and responsive in the field...
October 2018: Journal of Neurosciences in Rural Practice
Si Un Lee, Yoonjin Kwak, Chang Wan Oh, O-Ki Kwon, Seung Pil Ban, Tackeun Kim, Hyoung Soo Byoun, Gheeyoung Choe, Young Deok Kim, Jae Seung Bang
Blood blister-like aneurysms (BBAs) are an important cause of subarachnoid hemorrhage (SAH), but proper treatment is uncertain due to the poor prognosis of these aneurysms. The pathogenesis of BBAs remains unclear and few studies have reported on histological examinations of BBAs because it is difficult to obtain a specimen due to a high risk of intraoperative bleeding. In this report, BBAs were histopathologically examined in two patients who presented with SAH due to rupture of a BBA that was treated with surgical trapping and bypass surgery...
September 27, 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Mohamad Syafeeq Faeez Md Noh, Anna Misyail Abdul Rashid
BACKGROUND: The computed tomography (CT) finding of a pseudo-subarachnoid hemorrhage (SAH) may lead the treating physician into a diagnostic dilemma. We present a case of a pseudo-SAH in a patient with post-resuscitative encephalopathy, secondary to a newly diagnosed bleeding pulmonary arterio-venous malformation (AVM). CASE PRESENTATION: A 19-year-old female presented acutely with massive hemoptysis. Cardiopulmonary resuscitation (CPR) followed, and the patient was subsequently intubated for airway protection with intensive care unit (ICU) admission...
September 28, 2018: BMC Neurology
Teresa A Allison, Pei Jen Lin, Jennifer A Gass, Kenneth Chong, Samuel J Prater, Miguel A Escobar, Heather D Hartman
OBJECTIVE: This study investigated the percentage of patients who achieved hemostasis with 4-factor prothrombin complex concentrate (4-factor PCC) 35 U/kg. The primary end point was to determine the effect of 4-factor PCC 35 U/kg on bleeding progression, assessed using computed tomography. METHODS: This was a retrospective, observational, single-center study conducted in patients with a major bleed admitted to a level 1 trauma center from May 1, 2013, to June 15, 2015, who received 4-factor PCC 35 U/kg for reversal of a direct factor Xa inhibitor taken prior to admission...
September 24, 2018: Journal of Intensive Care Medicine
Helen Wong, Luke Hodgson, Jillian Banfield, Jai J S Shankar
BACKGROUND: In patients with subarachnoid haemorrhage (SAH) and a negative finding on CT angiography (CTA), further imaging with digital subtraction angiography (DSA) is commonly performed to identify the source of bleeding. The purpose of this study was to investigate whether negative findings on CTA can reliably exclude aneurysms in patients with acute SAH. METHODS: This retrospective study identified all DSAs performed between August 2010 and July 2014 within our institution...
September 2018: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
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