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Hypertensive encephalopathy

Rishi Lumba, Pradeep Mally, Michael Espiritu, Elena V Wachtel
Background Earlier initiation of therapeutic hypothermia in term infants with hypoxic-ischemic encephalopathy has been shown to improve neurological outcomes. The objective of the study was to compare safety and effectiveness of servo-controlled active vs. passive cooling used during neonatal transport in achieving target core temperature. Methods We undertook a prospective cohort quality improvement study with historic controls of therapeutic hypothermia during transport. Primary outcome measures were analyzed: time to cool after initiation of transport, time to achieve target temperature from birth and temperature on arrival to cooling centers...
December 7, 2018: Journal of Perinatal Medicine
Elie Sader, Melissa Rayhill
Headache is a neurologic disorder that displays gender dichotomy. It is well established that there is a strong link between migraine headache and sex hormones, specifically estrogen, which influences the severity of migraines during the menstrual cycle, pregnancy, and menopause. Furthermore, the epidemiology of headaches during pregnancy and the postpartum period is very distinct from that in males or nonpregnant females, in part due to the hemodynamic and hematologic changes that occur during pregnancy. These changes put women at higher risk for cerebral venous thrombosis, hemorrhagic stroke, and hypertensive disorders of pregnancy like preeclampsia, eclampsia, posterior reversible encephalopathy syndrome, and reversible cerebral vasoconstriction syndrome...
December 2018: Seminars in Neurology
Xin-Yu Li, Ke Huang, Dun-Hua Zhou, Yang Li, Hong-Gui Xu, Wen-Jun Weng, Lu-Hong Xu, Jian-Pei Fang
BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is an increasingly recognized serious complication of Cyclosporine A (CSA) and tacrolimus (TAC) use in hematopoietic cell transplantation (HCT) recipients. PROCEDURE: A retrospective study was carried out, including 84 cases of HCT for TM from January 2012 to January 2017. 11 cases were diagnosed with PRES. RESULTS: The cumulative incidence of PRES was 13.4% (95%CI 9.7-17.2%)...
December 2, 2018: Clinical Transplantation
Antoni Riera-Mestre, Jesús Ribas, José Castellote
Hereditary haemorrhagic telangiectasia (HHT) is an autosomal dominant inherited Rare Disease that causes a systemic anomalous vascular overgrowth. The approach and follow-up of these patients should be from multidisciplinary units. Its diagnosis is carried out according to Curaçao clinical Criteria. Telangiectasia in the nasal mucosa cause recurrent epistaxis, the main symptom of HHT and difficult to control. The three types of hepatic shunting, hepatic artery to hepatic vein, hepatic artery to portal vein or to portal vein to hepatic vein, can cause high-output heart failure, portal hypertension or porto-systemic encephalopathy, respectively...
November 27, 2018: Medicina Clínica
Daniele Bongetta, Cesare Zoia, Sabino Luzzi, Mattia Del Maestro, Andrea Peri, Germana Bichisao, Debora Sportiello, Isabella Canavero, Andrea Pietrabissa, Renato J Galzio
Bariatric surgery is gaining popularity as the treatment of choice of morbid obesity since this condition is constantly increasing over the last decades. Several complications have emerged as the number of surgeries and follow-up data increase. No systematic review of the neurosurgery-related potential complications has been performed to date. Objective of this work is to fill this gap. We reviewed the literature for bariatric surgery-related complications involving the neurosurgical practice. Moreover, we present explicative cases dealing with peri- and post-operative therapeutic precautions...
November 13, 2018: Clinical Neurology and Neurosurgery
Emmanuel Weiss, Catherine Paugam-Burtz, Samir Jaber
Liver failure can occur in patients with or without underlying chronic liver disease (mainly cirrhosis) and is, respectively, termed acute on chronic liver failure or acute liver failure (ALF). In both cases, it is associated with marked systemic inflammation and profound hemodynamic disturbances, that is, increased cardiac output, peripheral vasodilation, and decreased systemic vascular resistance, on top of several superimposed etiologies of shock. In patients with cirrhosis, sepsis is the main cause of intensive care unit admission but portal hypertension-related gastrointestinal hemorrhage is also common...
October 2018: Seminars in Respiratory and Critical Care Medicine
Faiza Rasheed, Qasim S Mehdi, Shoaib Bhatti, Muhammad Mannan Ali Khan
Variegate porphyria (VP) is one of the groups of rare inherited disorders of hemoglobin synthesis called Porphyria. It has two distinct manifestations, that is, those of cutaneous and nervous system. Posterior reversible encephalopathy syndrome (PRES) is a rare complication of porphyria. It occurs due to vasogenic edema in white matter of predominantly parieto-occipital lobes, characterized by headache, visual disturbances, altered mental state, hypertension, and seizures. We report a child diagnosed with VP who presents with clinical signs and radiological manifestations suggestive of PRES...
September 24, 2018: Curēus
Alice Brambilla, Silvia Favilli, Iacopo Olivotto, Giovanni Battista Calabri, Giulio Porcedda, Luciano De Simone, Elena Procopio, Elisabetta Pasquini, Maria Alice Donati
BACKGROUND: Mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like (MELAS) syndrome is a rare condition with heterogeneous clinical presentation. Cardiac involvement commonly develops during adulthood, comprising both structural and conduction/arrhythmic abnormalities; early paediatric onset has rarely been reported. We describe the clinical profile, outcome and clinical implication of MELAS-associated cardiomyopathy at a tertiary referral centre. METHODS: From 2000 to 2016 we enrolled 21 patients affected by genetically-proven MELAS...
October 23, 2018: International Journal of Cardiology
Erica C Camargo, Steven K Feske, Aneesh B Singhal
Pregnancy confers a substantially increased risk of stroke in women. The period of highest risk of stroke is the peripartum/postpartum phase, coinciding with the highest risk for hypertensive disorders of pregnancy and peak gestational hypercoagulability. Hemorrhagic stroke is the most common type of obstetric stroke. Hypertensive disorders of pregnancy are important contributors to obstetric stroke and predispose women to premature cardiovascular disease. The rate of stroke associated with hypertensive disorders of pregnancy has increased in the United States...
February 2019: Neurologic Clinics
Ayan Sen, Hannelisa Callisen, Stacy Libricz, Bhavesh Patel
Despite improvements in overall graft function and patient survival rates after solid organ transplantation, complications can lead to significant morbidity and mortality. Cardiovascular complications include heart failure, arrhythmias leading to sudden death, hypertension, left ventricular hypertrophy, and allograft vasculopathy in heart transplantation. Neurologic complications include stroke, posterior reversible encephalopathy syndrome, infections, neuromuscular disease, seizure disorders, and neoplastic disease...
January 2019: Critical Care Clinics
Dan Hu, Jing Xiong, Yunfei Zha, Zhaohui Zhang
BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic condition which comprises various neurological symptoms. This syndrome could be complicated by intracranial hemorrhage including subarachnoid hemorrhage (SAH). However, SAH is rarely seen in eclamptic patients with PRES. CASE PRESENTATION: A 34-weeks-pregnant woman at the age of 33 was admitted to the obstetrics department because of an episode of generalized tonic-clonic seizure. Before the seizure, the patient had a headache and was found to have an abnormal systolic blood pressure of 160 mmHg...
November 3, 2018: BMC Neurology
Elliot B Tapper, Jad Baki, Neehar D Parikh, Anna S Lok
Cirrhosis is associated with disabling symptoms and diminished health-related quality of life (HRQOL). However, for patients with compensated disease, data are limited regarding associations with poor patient-reported outcomes (PROs). We prospectively enrolled 300 patients with cirrhosis and portal hypertension without a history of hepatic encephalopathy and reviewed medical and pharmacy records. We characterized determinants of PROs using the SF-8 scale (0-100) and sleep quality using the Pittsburgh Sleep Quality Index (poor sleep >5)...
November 1, 2018: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Jerry Matteo, Damian Caci, Erik Soule, James Cunningham, Preston Hood
A transjugular intrahepatic portosystemic shunt is the standard of care for complications of portal hypertension, such as variceal bleeding, refractory ascites, and hepatic hydrothorax. Hepatic encephalopathy, hepatic insufficiency, and right heart failure are the major complications after shunt creation. If medical management is unsuccessful, the interventionalist is consulted to close/revise the shunt. Closure of the shunt results in a dangerously abrupt increase in portal pressure, increasing risk for life-threatening variceal bleeding...
August 22, 2018: Curēus
Marcus Overhaus, Lydia Garcia Park, Rolf Fimmers, Tim R Glowka, Cornelius van Beekum, Steffen Manekeller, Jörg C Kalff, Nico Schaefer, Tim Vilz
BACKGROUND: The most dangerous complication of portal hypertension is the formation of oesophageal varices, as the risk of bleeding is up to 80%. In order to reduce pressure reduction in the portosystemic circulation and as secondary prophylaxis, the TIPSS procedure has proven successful. In patients with portal vein thrombosis, portosystemic shunt surgery is possible to reduce the risk of variceal bleeding. However, if thrombosis of the mesentericoportal axis or hepatic encephalopathy is imminent, interventional or surgical creation of a portosystemic shunt is contraindicated...
October 2018: Zentralblatt Für Chirurgie
Francesca Romana Ponziani, Mariella Faccia, Maria Assunta Zocco, Valerio Giannelli, Adriano Pellicelli, Giuseppe Maria Ettorre, Nicoletta De Matthaeis, Fabrizio Pizzolante, Anna Maria De Gaetano, Laura Riccardi, Maurizio Pompili, Gian Ludovico Rapaccini
Congenital extrahepatic portosystemic shunt (CEPS), also known as Abernethy malformation, is a rare condition in which the splenomesenteric blood drains directly into a systemic vein, bypassing the liver through a complete or partial shunt. The diagnosis is frequently made during childhood in the setting of neonatal cholestasis, hypergalactosemia, failure to thrive, mental retardation or other congenital defects. In adulthood, CEPS is usually found incidentally during diagnostic work-up for abdominal pain, liver test abnormalities, liver nodules, portopulmonary hypertension, portopulmonary syndrome or portosystemic encephalopathy...
October 24, 2018: Journal of Ultrasound
Shuchun Ou, Lu Xia, Li Wang, Li Xia, Qin Zhou, Songqing Pan
Typical neuroimaging findings of posterior reversible encephalopathy syndrome include symmetrical white matter edema in subcortical white matter of bilateral occipital and parietal lobes, although variations do occur and more and more attention is being focused upon disease of infratentorial-isolated involved posterior reversible encephalopathy syndrome. In this article, we described 1 case of posterior reversible encephalopathy syndrome with isolated infratentorial brain involvement and reviewed the literature to identify an additional 36 cases in the PubMed database...
2018: Frontiers in Neurology
D S Karagiannakis, T Voulgaris, S I Siakavellas, G V Papatheodoridis, J Vlachogiannakos
Portal hypertension (PH) is a major complication of liver cirrhosis, as it predisposes to the development of serious clinical manifestations such as ascites, hepatic encephalopathy and variceal bleeding. Till now, the measurement of hepatic vein pressure gradient (HVPG) is the gold standard method to ascertain the presence and significance of PH, as many studies have shown its correlation with the appearance of varices and the possibility of variceal bleeding. However, the invasiveness of this procedure makes it difficult to be used in daily clinical practice...
October 21, 2018: Scandinavian Journal of Gastroenterology
M A Aller, N Arias, J Blanco-Rivero, J L Arias, J Arias
Hepatic encephalopathy is a severe complication of both chronic and acute liver diseases. The term hepatic encephalopathy stems from the belief that hepatic insufficiency is its fundamental etiopathogenic factor. However, most clinical cases show liver failure along with mesenteric venous portal hypertension. This portal hypertension would explain the abnormal mechanical forces suffered by the digestive tract in the early stages of the disorder. These forces could regulate some gut biochemical pathological pathways in a process known as mechanotransduction...
October 21, 2018: Journal of Gastroenterology and Hepatology
Ching-Yi Tsai, Yan-Yuen Poon, Julie Y H Chan, Samuel H H Chan
By applying diffusion tensor imaging (DTI) as a physiological tool to evaluate changes in functional connectivity between key brainstem nuclei in the baroreflex neural circuits of mice and rats, recent work has revealed several hitherto unidentified phenomena regarding baroreflex functionality. (1) The presence of robust functional connectivity between nucleus tractus solitarii (NTS) and nucleus ambiguus (NA) or rostral ventrolateral medulla (RVLM) offers a holistic view on the moment-to-moment modus operandi of the cardiac vagal baroreflex or baroreflex-mediated sympathetic vasomotor tone...
October 16, 2018: Journal of Physiology
M H Liu, F Zhou, X B Wang, L P Chen, G Z Li, Q Zhao
Objective: To investigate the incidence rate of transjugular intrahepatic portosystemic shunt (TIPS) complications in the treatment of cirrhotic portal hypertension, and analyze the cause of complication to management methods. Methods: Data of 116 patients obtained from Zhongnan Hospital of Wuhan University were retrospectively analyzed. Portal venous pressure, routine blood test, coagulation test, liver and kidney function test, ammonia blood test, imaging and endoscopy reports were collected before and after procedure...
August 20, 2018: Zhonghua Gan Zang Bing za Zhi, Zhonghua Ganzangbing Zazhi, Chinese Journal of Hepatology
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