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Elguindy MM, Haddad AF, Lu A, Savastano LE. Minimally Invasive Endoscopic Evacuation of Cerebellar Intracerebral Hemorrhage: An Illustrative Case Report. Stroke 2024; 55:e144-e147. [PMID: 38511319 DOI: 10.1161/strokeaha.123.045924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Affiliation(s)
- Mahmoud M Elguindy
- Department of Neurological Surgery, University of California, San Francisco
| | - Alexander F Haddad
- Department of Neurological Surgery, University of California, San Francisco
| | - Alex Lu
- Department of Neurological Surgery, University of California, San Francisco
| | - Luis E Savastano
- Department of Neurological Surgery, University of California, San Francisco
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Rodrigues FM, Santos M, Martins R. Hemorrhagic Presentation in Primary Central Nervous System Lymphoma: A Case Study. Am J Case Rep 2024; 25:e942951. [PMID: 38561939 PMCID: PMC11000205 DOI: 10.12659/ajcr.942951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/13/2024] [Accepted: 02/09/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Primary central nervous system diffuse large B-cell lymphoma (DLBCL) is an extremely aggressive brain disease that rarely affects immunocompetent non-elderly patients, particularly with hemorrhagic presentation. Brain magnetic resonance imaging (MRI) plays an important role in the diagnosis of this entity, which typically demonstrates restricted diffusion and a T2 hypointense appearance, suggesting hypercellularity. CASE REPORT A 44-year-old man came to the emergency department with a persistent and treatment-resistant bilateral frontal headache that had been bothering him for the past 3 weeks. Upon conducting a neurological assessment, the patient displayed temporal disorientation and incoherent speech, but without any observable motor deficits. A non-contrast enhanced brain computed tomography scan was carried out, revealing a hyperattenuating, space-occupying lesion and hemorrhage in the left hemisphere of the brain. Subsequently, brain MRI demonstrated hypointense signal on T2-weighted images, restricted diffusion, and homogeneous lesional contrast enhancement, suggesting a very cellular expansive lesion with hemorrhage. To establish a definitive diagnosis, a brain biopsy was undertaken, confirming the presence of DLBCL of the primary central nervous system (germinal center phenotype). CONCLUSIONS Hemorrhagic presentation of primary central nervous system DLBCL occurs very rarely, particularly in non-elderly immunocompetent patients. Brain MRI plays an important role in the diagnosis of this entity, which allows differentiation from high-grade glial or other lesions that present more frequently with hemorrhage. Therefore, it is crucial to suspect lymphoma before surgical intervention for appropriate patient management.
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Affiliation(s)
| | - Mariana Santos
- Department of Neuroradiology, Hospital de Braga, Braga, Portugal
| | - Ricardo Martins
- Department of Neuroradiology, Hospital de Braga, Braga, Portugal
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3
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Braksick SA, Rabinstein AA. Thrombolysis Is Not Indicated for Minor Strokes If They Are Truly Nondisabling. Stroke 2024. [PMID: 38465619 DOI: 10.1161/strokeaha.124.046549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
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4
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Aziz YN, Khatri P. Intravenous Thrombolysis to Dissolve Acute Stroke Thrombi: Reflections on the Past Decade. Stroke 2024; 55:186-189. [PMID: 38134255 PMCID: PMC11003301 DOI: 10.1161/strokeaha.123.044211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Affiliation(s)
- Yasmin N Aziz
- University of Cincinnati, Department of Neurology and Rehabilitation Medicine, Cincinnati, Ohio
| | - Pooja Khatri
- University of Cincinnati, Department of Neurology and Rehabilitation Medicine, Cincinnati, Ohio
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Lima WDS, Soares MHP, Paschoal EHA, Paschoal JKSF, Paschoal FM, Bor-Seng-Shu E. Intracranial hemorrhages in patients with COVID-19: a systematic review of the literature, regarding six cases in an Amazonian population. Arq Neuropsiquiatr 2023; 81:989-999. [PMID: 38035584 PMCID: PMC10689113 DOI: 10.1055/s-0043-1772834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 05/01/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has emerged as a public health emergency worldwide, predominantly affecting the respiratory tract. However, evidence supports the involvement of extrapulmonary sites, including reports of intracranial hemorrhages. OBJECTIVE To describe six original cases and review the literature on intracranial hemorrhages in patients diagnosed with COVID-19 by molecular methods. METHODS A systematic literature review was performed on MEDLINE, PubMed, and NCBI electronic databases to identify eligible studies. Of the total 1,624 articles retrieved, only 53 articles met the inclusion criteria. RESULTS The overall incidence of intracranial hemorrhage in patients hospitalized for COVID-19 was 0.26%. In this patient group, the mean age was 60 years, and the majority were male (68%) with initial respiratory symptoms (73%) and some comorbidity. Before the diagnosis of hemorrhage, 43% of patients were using anticoagulants, 47.3% at therapeutic doses. The intraparenchymal (50%) was the most affected compartment, followed by the subarachnoid (34%), intraventricular (11%), and subdural (7%). There was a predominance of lobar over non-lobar topographies. Multifocal or multicompartmental hemorrhages were described in 25% of cases. Overall mortality in the cohort studies was 44%, while around 55% of patients were discharged from hospital. CONCLUSION Despite the unusual association, the combination of these two diseases is associated with high rates of mortality and morbidity, as well as more severe clinicoradiological presentations. Further studies are needed to provide robust evidence on the exact pathophysiology behind the occurrence of intracranial hemorrhages after COVID-19 infection.
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Affiliation(s)
- William de Sousa Lima
- Universidade Federal do Pará, Faculdade de Medicina, Departamento de Neurologia do Hospital Universitário João de Barros Barreto, Belém PA, Brazil.
| | - Marcelo Henrique Pereira Soares
- Universidade Federal do Pará, Faculdade de Medicina, Departamento de Neurologia do Hospital Universitário João de Barros Barreto, Belém PA, Brazil.
| | - Eric Homero Albuquerque Paschoal
- Universidade Federal do Pará, Faculdade de Medicina, Departamento de Neurologia do Hospital Universitário João de Barros Barreto, Belém PA, Brazil.
| | | | - Fernando Mendes Paschoal
- Universidade Federal do Pará, Faculdade de Medicina, Departamento de Neurologia do Hospital Universitário João de Barros Barreto, Belém PA, Brazil.
| | - Edson Bor-Seng-Shu
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia do Hospital das Clínicas, São Paulo SP, Brazil.
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Gerstl JVE, Bernstock JD, Kappel AD, Torio EF, Du R. Recurrent Intraventricular Haemorrhage in Cerebral Proliferative Angiopathy - A Case Report and Review of the Literature. Neurohospitalist 2023; 13:345-350. [PMID: 37701260 PMCID: PMC10494813 DOI: 10.1177/19418744231180046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
Cerebral proliferative angiopathy (CPA) is an entity distinct from that of classical arteriovenous malformations. As such, few reports have considered the long-term follow-up of patients with hemorrhage in CPA. Accordingly, herein the authors present a case of recurrent hemorrhage in CPA with 32 years of follow-up and in so doing summarize the literature of hemorrhagic cases in CPA. A 19-year-old presented with focal awareness seizures and diagnostic work-up revealed a left hemispheric vascular lesion. The patient presented again with intracranial hemorrhage at ages 28, 43 and 51. Angioarchitectural workup revealed intermingled brain parenchyma between vascular spaces, absence of dominant feeders and a clear nidus consistent with CPA. The size and diffuse nature of the lesion deemed it inoperable. Given our case and review of the literature it is apparent that CPA has a high risk of re-hemorrhage in the rare event that hemorrhage does occur.
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Affiliation(s)
- Jakob V. E. Gerstl
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Joshua D. Bernstock
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Ari D. Kappel
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Erickson F. Torio
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Rose Du
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Fischer P, Tamim I, Sugimoto K, Morais A, Imai T, Takizawa T, Qin T, Schlunk F, Endres M, Yaseen MA, Chung DY, Sakadzic S, Ayata C. Spreading Depolarizations Suppress Hematoma Growth in Hyperacute Intracerebral Hemorrhage in Mice. Stroke 2023; 54:2640-2651. [PMID: 37610105 PMCID: PMC10530404 DOI: 10.1161/strokeaha.123.042632] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 08/02/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Spreading depolarizations (SDs) occur in all types of brain injury and may be associated with detrimental effects in ischemic stroke and subarachnoid hemorrhage. While rapid hematoma growth during intracerebral hemorrhage triggers SDs, their role in intracerebral hemorrhage is unknown. METHODS We used intrinsic optical signal and laser speckle imaging, combined with electrocorticography, to investigate the effects of SD on hematoma growth during the hyperacute phase (0-4 hours) after intracortical collagenase injection in mice. Hematoma expansion, SDs, and cerebral blood flow were simultaneously monitored under normotensive and hypertensive conditions. RESULTS Spontaneous SDs erupted from the vicinity of the hematoma during rapid hematoma growth. We found that hematoma growth slowed down by >60% immediately after an SD. This effect was even stronger in hypertensive animals with faster hematoma growth. To establish causation, we exogenously induced SDs (every 30 minutes) at a remote site by topical potassium chloride application and found reduced hematoma growth rate and final hemorrhage volume (18.2±5.8 versus 10.7±4.1 mm3). Analysis of cerebral blood flow using laser speckle flowmetry revealed that suppression of hematoma growth by spontaneous or induced SDs coincided and correlated with the characteristic oligemia in the wake of SD, implicating the vasoconstrictive effect of SD as one potential mechanism of action. CONCLUSIONS Our findings reveal that SDs limit hematoma growth during the early hours of intracerebral hemorrhage and decrease final hematoma volume.
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Affiliation(s)
- Paul Fischer
- Neurovascular Research Unit, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, 02129 Massachusetts, USA
- Klinik und Hochschulambulanz für Neurologie, Charité Universitätsmedizin Berlin, NeuroCure Excellence Cluster and Center for Stroke Research, 10117 Berlin, Germany
| | - Isra Tamim
- Neurovascular Research Unit, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, 02129 Massachusetts, USA
- Klinik und Hochschulambulanz für Neurologie, Charité Universitätsmedizin Berlin, NeuroCure Excellence Cluster and Center for Stroke Research, 10117 Berlin, Germany
| | - Kazutaka Sugimoto
- Neurovascular Research Unit, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, 02129 Massachusetts, USA
| | - Andreia Morais
- Neurovascular Research Unit, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, 02129 Massachusetts, USA
| | - Takahiko Imai
- Neurovascular Research Unit, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, 02129 Massachusetts, USA
| | - Tsubasa Takizawa
- Neurovascular Research Unit, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, 02129 Massachusetts, USA
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Tao Qin
- Neurovascular Research Unit, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, 02129 Massachusetts, USA
| | - Frieder Schlunk
- Department of Neuroradiology, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Matthias Endres
- Klinik und Hochschulambulanz für Neurologie, Charité Universitätsmedizin Berlin, NeuroCure Excellence Cluster and Center for Stroke Research, 10117 Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), partner site 10117 Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), partner site 10117 Berlin, Germany
| | - Mohammad A. Yaseen
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, 02129 Massachusetts, USA
| | - David Y. Chung
- Neurovascular Research Unit, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, 02129 Massachusetts, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, 02114 Massachusetts, USA
| | - Sava Sakadzic
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, 02129 Massachusetts, USA
| | - Cenk Ayata
- Neurovascular Research Unit, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, 02129 Massachusetts, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, 02114 Massachusetts, USA
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Mierzwa AT, Al Kasab S, Nelson A, Ortega Gutierrez S, Vivanco-Suarez J, Farooqui M, Jadhav AP, Desai S, Toth G, Alrohimi A, Nguyen TN, Klein P, Abdalkader M, Salahuddin H, Pandey A, Koduri S, Vora N, Aladamat N, Gharaibeh K, Afreen E, Zaidi S, Jumaa M. Comparing Functional Outcomes and Safety Profiles of First-Line Aspiration Thrombectomy Versus Stentriever for Acute Basilar Artery Occlusion: Propensity Analysis of the PC-SEARCH Thrombectomy Registry. Stroke 2023; 54:2512-2521. [PMID: 37747965 DOI: 10.1161/strokeaha.123.043579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/03/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Aspiration catheters (ASPs) and stentriever thrombectomy devices have comparable safety and efficacy in anterior circulation ischemic strokes. However, there is lack of high-quality comparative data in acute basilar artery occlusions. Our objective is to compare the outcomes and safety of ASPs and stentriever devices in acute basilar artery occlusions. METHODS This is an analysis of the retrospectively established PC-SEARCH Thrombectomy (Posterior-Circulation Ischemic Stroke Evaluation: Analyzing Radiographic and Intraprocedural Predictors for Mechanical Thrombectomy) registry. Patients were dichotomized based on their first-line thrombectomy device (ASP and stentriever) and associated with their 90-day functional outcomes, intraprocedural metrics, and safety measures. Propensity analysis based on unequal baseline characteristics was performed. Consecutive patients with acute basilar artery occlusions who received mechanical thrombectomy were included from January 2015 to December 2021. Patients received either first-line contact aspiration or stentriever mechanical thrombectomy. Primary clinical and safety outcomes were 90-day functional independence measured by a modified Rankin Scale score of 0 to 3 and symptomatic intracranial hemorrhage, respectively. Secondary outcomes included puncture-recanalization times, first-pass recanalization rates, crossovers to other thrombectomy device, and neurological/hospital complications. RESULTS Five hundred eighteen patients were included in the registry, and a total of 383 patients were included (mean [SD] age, 65.5 [15] years; 228 [59%] men) in this analysis. Of these, 219 patients were first-line ASP while 164 patients received first-line stentriever devices. Median premorbid modified Rankin Scale was zero and median presenting National Institutes of Health Stroke Scale was 17 (interquartile range, 8-26). The proportion of favorable functional outcome was similar between the 2 techniques before (47.3% versus 42.5%; odds ratio, 1.22 [95% CI, 0.78-1.89]; P=0.38) and after propensity matching (odds ratio, 1.46 [95% CI, 0.85-2.49]; P=0.17). In our propensity-matched cohorts, puncture-recanalization times (18 versus 52 minutes; P<0.01) favored first-line ASP; however, first-pass recanalization rates (43.5% versus 44.5%; P=0.90) were similar between groups. First-line ASP was associated with higher rates of crossover (22% versus 6%; P<0.01), whereas stentriever was associated with higher rates of symptomatic intracranial hemorrhage (9.8% versus 3.4%; P=0.04). CONCLUSIONS First-line ASP and stentriever methods demonstrated similar functional outcome and recanalization rates. Stentriever methods were associated with higher rates of symptomatic intracranial hemorrhage, whereas ASPs were associated with higher rates of crossover to alternative technique in patients with acute basilar occlusions.
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Affiliation(s)
- Adam T Mierzwa
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, OH (A.T.M., N.A., K.G., E.A., S.Z., M.J.)
- Promedica Stroke Network, Toledo, OH (A.T.M., E.A., S.Z., M.J.)
| | - Sami Al Kasab
- Department of Neurology and Neurosurgery, Medical University of South Carolina, Charleston (S.A.K., A.N.)
| | - Ashley Nelson
- Department of Neurology and Neurosurgery, Medical University of South Carolina, Charleston (S.A.K., A.N.)
| | | | | | | | - Ashutosh P Jadhav
- Department of Neurology, University of Pittsburgh Medical Center, PA (A.P.J., S.D.)
| | - Shashvat Desai
- Department of Neurology, University of Pittsburgh Medical Center, PA (A.P.J., S.D.)
| | - Gabor Toth
- Cleveland Clinic Foundation, OH (G.T., A.A.)
| | | | - Thanh N Nguyen
- Department of Neurology, Radiology, Boston University Chobanian and Avedisian School of Medicine, MA (T.N.N., P.K., M.A.)
| | - Piers Klein
- Department of Neurology, Radiology, Boston University Chobanian and Avedisian School of Medicine, MA (T.N.N., P.K., M.A.)
| | - Mohamad Abdalkader
- Department of Neurology, Radiology, Boston University Chobanian and Avedisian School of Medicine, MA (T.N.N., P.K., M.A.)
| | - Hisham Salahuddin
- Department of Neurology, Antelope Valley Hospital, Los Angeles, CA (H.S.)
| | - Aditya Pandey
- Department of Neurosurgery, University of Michigan, Ann Arbor (A.P., S.K.)
| | - Sravanthi Koduri
- Department of Neurosurgery, University of Michigan, Ann Arbor (A.P., S.K.)
| | - Niraj Vora
- Ohio Health Riverside Methodist Hospital, Columbus (N.V.)
| | - Nameer Aladamat
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, OH (A.T.M., N.A., K.G., E.A., S.Z., M.J.)
| | - Khaled Gharaibeh
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, OH (A.T.M., N.A., K.G., E.A., S.Z., M.J.)
| | - Ehad Afreen
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, OH (A.T.M., N.A., K.G., E.A., S.Z., M.J.)
- Promedica Stroke Network, Toledo, OH (A.T.M., E.A., S.Z., M.J.)
| | - Syed Zaidi
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, OH (A.T.M., N.A., K.G., E.A., S.Z., M.J.)
- Promedica Stroke Network, Toledo, OH (A.T.M., E.A., S.Z., M.J.)
| | - Mouhammad Jumaa
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, OH (A.T.M., N.A., K.G., E.A., S.Z., M.J.)
- Promedica Stroke Network, Toledo, OH (A.T.M., E.A., S.Z., M.J.)
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Zuflacht JP, Levine JM. Stroke and Disseminated Intravascular Coagulation in a Patient With Metastatic Prostate Cancer. Neurohospitalist 2023; 13:285-289. [PMID: 37441215 PMCID: PMC10334056 DOI: 10.1177/19418744231172622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023] Open
Abstract
Cancer and stroke comprise two of the most common causes of death worldwide. Despite a significantly increased risk of stroke among patients with cancer, most stroke trials have excluded patients with malignancy. There is thus limited evidence to help guide management decisions in this complex population. We present the case of a 78-year-old man with recurrent strokes - both ischemic and hemorrhagic - in the setting of newly-identified metastatic prostate cancer. An atypical cause of cancer-associated stroke is reviewed and the management is discussed.
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Affiliation(s)
- Jonah P. Zuflacht
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Joshua M. Levine
- Neurology, Neurosurgery, and Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA
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Hoh BL, Ko NU, Amin-Hanjani S, Chou SHY, Cruz-Flores S, Dangayach NS, Derdeyn CP, Du R, Hänggi D, Hetts SW, Ifejika NL, Johnson R, Keigher KM, Leslie-Mazwi TM, Lucke-Wold B, Rabinstein AA, Robicsek SA, Stapleton CJ, Suarez JI, Tjoumakaris SI, Welch BG. 2023 Guideline for the Management of Patients With Aneurysmal Subarachnoid Hemorrhage: A Guideline From the American Heart Association/American Stroke Association. Stroke 2023; 54:e314-e370. [PMID: 37212182 DOI: 10.1161/str.0000000000000436] [Citation(s) in RCA: 65] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
AIM The "2023 Guideline for the Management of Patients With Aneurysmal Subarachnoid Hemorrhage" replaces the 2012 "Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage." The 2023 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with aneurysmal subarachnoid hemorrhage. METHODS A comprehensive search for literature published since the 2012 guideline, derived from research principally involving human subjects, published in English, and indexed in MEDLINE, PubMed, Cochrane Library, and other selected databases relevant to this guideline, was conducted between March 2022 and June 2022. In addition, the guideline writing group reviewed documents on related subject matter previously published by the American Heart Association. Newer studies published between July 2022 and November 2022 that affected recommendation content, Class of Recommendation, or Level of Evidence were included if appropriate. Structure: Aneurysmal subarachnoid hemorrhage is a significant global public health threat and a severely morbid and often deadly condition. The 2023 aneurysmal subarachnoid hemorrhage guideline provides recommendations based on current evidence for the treatment of these patients. The recommendations present an evidence-based approach to preventing, diagnosing, and managing patients with aneurysmal subarachnoid hemorrhage, with the intent to improve quality of care and align with patients' and their families' and caregivers' interests. Many recommendations from the previous aneurysmal subarachnoid hemorrhage guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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Ruiz AM, Acelas GE, Patiño HM, Vergara JP, Silva MA, Camargo MD. Characteristics of cerebral venous thrombosis in patients from two university hospitals in Colombia between 2018-2020. Biomedica 2023; 43:213-221. [PMID: 37433161 PMCID: PMC10532268 DOI: 10.7705/biomedica.6877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/12/2023] [Indexed: 07/13/2023]
Abstract
INTRODUCTION Cerebral venous thrombosis is an uncommon cause of cerebrovascular disease, which has been increasing worldwide. In Colombia, there are not enough recent studies that allow us to determine epidemiological characteristics of the disease in our population to identify more frequent risk factors and complications according to our living conditions. OBJETIVE To describe clinical, demographic, and radiographic characteristics, and risk factors in a cohort of patients with cerebral venous thrombosis attended at two hospitals in Colombia. MATERIALS AND METHODS Retrospective descriptive study with patients treated in the hospitalization neurology service of two hospitals in Bogotá, Colombia from December 2018 to December 2020. RESULTS Thirty-three patients were included. There was a higher incidence of cerebral venous thrombosis in women of childbearing age in the puerperium (n=7; 33.3%) and associated with autoimmune diseases (n=10; 30.3%). The most common initial symptom was headache (n=31; 93.9 %), followed by neurological focal signs (n=9; 27.2%) and seizures (n=8; 24.2%). Fifty-one percent (n=17) of the patients had a normal physical examination. Cerebral venous infarction occurred in 21.1 % (n=7), subarachnoid hemorrhage in 12.1 % (n=4), and intraparenchymal hematoma in 9 % (n=3) of all the patients. Sixty-point six percent (n=20) of the patients had a total independent Barthel functional scale. None of those died. CONCLUSIONS We found similar sociodemographic, clinical, and radiography characteristics to those reported in the world literature. Regarding the differences, deep cerebral venous circulation was higher than that described in previous studies but without complications increase or mortality.
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Affiliation(s)
| | - Gabriel Esteban Acelas
- Sección Neurología, Hospital de San José, Fundación Universitaria de Ciencias de la Salud, Bogotá, D.C..
| | - Hernán Mauricio Patiño
- Sección Neurología, Hospital de San José, Fundación Universitaria de Ciencias de la Salud, Bogotá, D.C., Colombia; Sección Neurología, Hospital Universitario San José Infantil, Bogotá, D. C., Colombia.
| | - Jean Paul Vergara
- Sección Neurología, Hospital de San José, Fundación Universitaria de Ciencias de la Salud, Bogotá, D.C., Colombia.
| | - Miguel Arturo Silva
- Sección Neurología, Hospital de San José, Fundación Universitaria de Ciencias de la Salud, Bogotá, D.C., Colombia.
| | - María Daniela Camargo
- Sección Neurología, Hospital de San José, Fundación Universitaria de Ciencias de la Salud, Bogotá, D.C..
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Williams JM, Lovelace B, Christoph MJ, Li S, Guo H, Hoover M, Coleman CI. Clinical and health care resource use burden of hospitalizations for oral factor Xa inhibitor-associated major bleeding: A real-world analysis of Medicare beneficiaries. J Am Coll Emerg Physicians Open 2023; 4:e12956. [PMID: 37223213 PMCID: PMC10202196 DOI: 10.1002/emp2.12956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/24/2023] [Accepted: 04/12/2023] [Indexed: 05/25/2023] Open
Abstract
Objective To characterize the burden of illness associated with oral factor Xa (FXa) inhibitor-related bleeding in the US Medicare population. Methods This retrospective cohort study used the full 20% Medicare random sample claims database to identify patients who experienced their first hospitalization for an FXa inhibitor-related major bleed between October 2013 and September 2017. Bleeding types were classified as intracranial hemorrhage (ICH), gastrointestinal (GI), and other. Associations between risk factors and outcomes (in-hospital and 30-day mortality, 30-day readmission, and discharge to a location other than home) adjusted for patient demographic characteristics, baseline clinical conditions, index event characteristics, treatment with hemostatic/factor replacement agents or transfusion (ie, usual care prereversal agent availability), multicompartment ICH and neurosurgical procedures (ICH cohort), and endoscopy (GI cohort) were assessed using multivariable regression and reported as crude incidences and adjusted odds ratios (ORs) stratified by bleed type. Results Of the 11,593 patients identified, 2737 (23.6%) had ICH, 8169 (70.5%) had GI bleeds, and 687 (5.9%) had other bleeds. The incidences of in-hospital mortality, 30-day mortality, need for postdischarge out-of-home care, and 30-day readmission were 15.7%, 29.1%, 78.3%, and 20.3% in the single-compartment ICH cohort, respectively; and 1.7%, 6.8%, 41.3%, and 18.8% in the GI bleeds cohort, respectively. Increased odds of both in-hospital mortality and 30-day mortality were significantly associated with: multicompartment ICH (reference, single compartment ICH; OR = 3.35 [95% confidence interval (CI): 2.41-4.66]; 2.18 [95% CI: 1.63-2.91]), loss of consciousness during index hospitalization (yes vs no; OR = 2.03 [95% CI: 1.38-2.97]; 1.49 [95% CI: 1.11-2.02]), receiving usual care (yes vs no; OR = 1.55 [95% CI: 1.22-1.98]; 1.33 [95% CI: 1.09-1.63]) during index hospitalization, and increasing number of Elixhauser comorbidities at baseline (OR = 1.07 [95% CI: 1.03-1.10]; 1.09 [95% CI: 1.06-1.12]) in the ICH cohort; intensive care unit admission (yes vs no; OR = 1.88 [95% CI: 1.32-2.67]; 1.51 [95% CI: 1.26-1.81]), increasing number of Elixhauser comorbidities at baseline (OR = 1.12 [95% CI: 1.07-1.18]; 1.15 [1.12-1.18]), and increasing age on index date (OR = 1.04 [95% CI: 1.02-1.07]; 1.05 [95% CI: 1.04-1.07]) in the GI bleeds cohort. Conclusions In this large sample of Medicare patients, FXa inhibitor-related major bleeding was associated with substantial burden in terms of adverse clinical outcomes and health care resource use. Incidence of ICH was lower than GI bleeds; however, burden of illness was notably higher with ICH.
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Affiliation(s)
- James M. Williams
- Medical Center Emergency DepartmentMeritus HealthHagerstownMarylandUSA
| | | | | | - Suying Li
- Chronic Disease Research GroupHennepin Healthcare Research InstituteMinneapolisMinnesotaUSA
| | - Haifeng Guo
- Chronic Disease Research GroupHennepin Healthcare Research InstituteMinneapolisMinnesotaUSA
| | - Madison Hoover
- Chronic Disease Research GroupHennepin Healthcare Research InstituteMinneapolisMinnesotaUSA
| | - Craig I. Coleman
- Department of Pharmacy PracticeUniversity of Connecticut School of PharmacyStorrsConnecticutUSA
- Evidence‐based Practice CenterHartford HospitalHartfordConnecticutUSA
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Caldeira D, Alves da Silva P, Pinto FJ. Clinical Outcomes of Anticoagulated Patients With Atrial Fibrillation After Falls or Head Injury: Insights From RE-LY. Stroke 2023; 54:1656-1659. [PMID: 37144391 DOI: 10.1161/strokeaha.122.041628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Falls are always a concern regarding the balance of risk/benefit in patients with atrial fibrillation treated with anticoagulants. In this analysis, we aimed to evaluate the outcomes of patients that had a fall/head injury reported in the RE-LY clinical trial (Randomized Evaluation of Long-Term Anticoagulation Therapy) and to explore the safety of dabigatran (a nonvitamin K antagonist oral anticoagulant). METHODS We performed a post hoc retrospective analysis of intracranial hemorrhage and major bleeding outcomes in the RE-LY trial with 18 113 individuals with atrial fibrillation, according to the status occurrence of falls (or head injury) reported as adverse events. Multivariate Cox regression models were used to provide adjusted hazard ratio (HR) and 95% CI. RESULTS In the study, 974 falls or head injury events were reported among 716 patients (4%). These patients were older and had more frequently comorbidities such as diabetes, previous stroke, or coronary artery disease. Patients with fall had a higher risk of major bleeding (HR, 2.41 [95% CI, 1.90-3.05]), intracranial hemorrhage (HR, 1.69 [95% CI, 1.35-2.13]), and mortality (HR, 3.91 [95% CI, 2.51-6.10]) compared to those who did not have reported falls or head injury. Among patients who had falls, those allocated to dabigatran showed a lower intracranial hemorrhage risk (HR, 0.42 [95% CI, 0.18-0.98]) compared with warfarin. CONCLUSIONS In this population, the risk of falls is important and confers a worse prognosis, increasing intracranial hemorrhage, and major bleeding. Patients who fell and were under dabigatran was associated with lower intracranial hemorrhage risk than those anticoagulated with warfarin, but the analysis was merely exploratory.
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Affiliation(s)
- Daniel Caldeira
- Serviço de Cardiologia, Hospital Universitário de Santa Maria - CHULN, Portugal (D.C., P.A.d.S., F.J.P.)
- Centro Cardiovascular da Universidade de Lisboa - (CCUL@RISE), CAML, CEMBE, Faculdade de Medicina, Universidade de Lisboa, Portugal (D.C., P.A.d.S., F.J.P.)
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina da Universidade de Lisboa, Portugal (D.C.)
| | - Pedro Alves da Silva
- Serviço de Cardiologia, Hospital Universitário de Santa Maria - CHULN, Portugal (D.C., P.A.d.S., F.J.P.)
- Centro Cardiovascular da Universidade de Lisboa - (CCUL@RISE), CAML, CEMBE, Faculdade de Medicina, Universidade de Lisboa, Portugal (D.C., P.A.d.S., F.J.P.)
| | - Fausto J Pinto
- Serviço de Cardiologia, Hospital Universitário de Santa Maria - CHULN, Portugal (D.C., P.A.d.S., F.J.P.)
- Centro Cardiovascular da Universidade de Lisboa - (CCUL@RISE), CAML, CEMBE, Faculdade de Medicina, Universidade de Lisboa, Portugal (D.C., P.A.d.S., F.J.P.)
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Rose D, Cavalier A, Kam W, Cantrell S, Lusk J, Schrag M, Yaghi S, Stretz C, de Havenon A, Saldanha IJ, Wu TY, Ranta A, Barber PA, Marriott E, Feng W, Kosinski AS, Laskowitz D, Poli S, Grory BM. Complications of Intravenous Tenecteplase Versus Alteplase for the Treatment of Acute Ischemic Stroke: A Systematic Review and Meta-Analysis. Stroke 2023; 54:1192-1204. [PMID: 36951049 PMCID: PMC10133185 DOI: 10.1161/strokeaha.122.042335] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/20/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Prior systematic reviews have compared the efficacy of intravenous tenecteplase and alteplase in acute ischemic stroke, assigning their relative complications as a secondary objective. The objective of the present study is to determine whether the risk of treatment complications differs between patients treated with either agent. METHODS We performed a systematic review including interventional studies and prospective and retrospective, observational studies enrolling adult patients treated with intravenous tenecteplase for ischemic stroke (both comparative and noncomparative with alteplase). We searched MEDLINE, Embase, the Cochrane Library, Web of Science, and the www. CLINICALTRIALS gov registry from inception through June 3, 2022. The primary outcome was symptomatic intracranial hemorrhage, and secondary outcomes included any intracranial hemorrhage, angioedema, gastrointestinal hemorrhage, other extracranial hemorrhage, and mortality. We performed random effects meta-analyses where appropriate. Evidence was synthesized as relative risks, comparing risks in patients exposed to tenecteplase versus alteplase and absolute risks in patients treated with tenecteplase. RESULTS Of 2226 records identified, 25 full-text articles (reporting 26 studies of 7913 patients) were included. Sixteen studies included alteplase as a comparator, and 10 were noncomparative. The relative risk of symptomatic intracranial hemorrhage in patients treated with tenecteplase compared with alteplase in the 16 comparative studies was 0.89 ([95% CI, 0.65-1.23]; I2=0%). Among patients treated with low dose (<0.2 mg/kg; 4 studies), medium dose (0.2-0.39 mg/kg; 13 studies), and high dose (≥0.4 mg/kg; 3 studies) tenecteplase, the RRs of symptomatic intracranial hemorrhage were 0.78 ([95% CI, 0.22-2.82]; I2=0%), 0.77 ([95% CI, 0.53-1.14]; I2=0%), and 2.31 ([95% CI, 0.69-7.75]; I2=40%), respectively. The pooled risk of symptomatic intracranial hemorrhage in tenecteplase-treated patients, including comparative and noncomparative studies, was 0.99% ([95% CI, 0%-3.49%]; I2=0%, 7 studies), 1.69% ([95% CI, 1.14%-2.32%]; I2=1%, 23 studies), and 4.19% ([95% CI, 1.92%-7.11%]; I2=52%, 5 studies) within the low-, medium-, and high-dose groups. The risks of any intracranial hemorrhage, mortality, and other studied outcomes were comparable between the 2 agents. CONCLUSIONS Across medium- and low-dose tiers, the risks of complications were generally comparable between those treated with tenecteplase versus alteplase for acute ischemic stroke.
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Affiliation(s)
- Deborah Rose
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Annie Cavalier
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Wayneho Kam
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Sarah Cantrell
- Duke University Medical Center Library & Archives, Durham, NC, USA
- Duke University School of Medicine, Durham, NC, USA
| | - Jay Lusk
- Duke University School of Medicine, Durham, NC, USA
| | - Matthew Schrag
- Department of Neurology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Shadi Yaghi
- Department of Neurology, Alpert Medical School of Brown University, Providence, RI, USA
| | - Christoph Stretz
- Department of Neurology, Alpert Medical School of Brown University, Providence, RI, USA
| | - Adam de Havenon
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Ian J. Saldanha
- Center for Evidence Synthesis in Health, Departments of Health Services, Policy, and Practice and of Epidemiology, Brown School of Public Health, Providence, RI, USA
| | - Teddy Y. Wu
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Anna Ranta
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - P. Alan Barber
- Department of Medicine, University of Auckland, New Zealand
| | - Elizabeth Marriott
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Wayne Feng
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Andrzej S. Kosinski
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Daniel Laskowitz
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Sven Poli
- Department of Neurology & Stroke, University of Tübingen, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Brian Mac Grory
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
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Isennock SM. The Legal Limits of Parental Autonomy: Do Parents Have the Right to Refuse Intramuscular Vitamin K for Their Newborn? HCA Healthc J Med 2023; 4:5-11. [PMID: 37426560 PMCID: PMC10327957 DOI: 10.36518/2689-0216.1289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Description The American Academy of Pediatrics recommends that all newborns receive an intra-muscular (IM) dose of vitamin K within 6 hours of delivery for the prevention of vitamin K deficiency bleeding (VKDB). There has been an increase in the number of parents who have refused the IM vitamin K dose for their infant based on its possible link to leukemia, preservatives that may lead to adverse reactions, and wanting to avoid pain for the infant. When newborns do not receive IM vitamin K, the most serious feared potential complication is intracranial hemorrhage with potential neurologic sequela including seizures, developmental delay, and death. Recent studies support the contention that parents are making the choice to refuse IM vitamin K without sufficient knowledge of the potential consequences. Parental decisions typically align with the best interest of the child; however, when parental decisions veer from the child's best interest, the limit of parental autonomy is tested. The precedent set by previous cases in which parental autonomy was challenged suggests parents should not be able to refuse IM vitamin K because the therapy has nearly no burden and forgoing this therapy has the potential for substantial harm. It has been argued that as long as the degree of intrusion is modest (a single IM injection) and the benefit substantial (prevention of possible death), states are granted the power to mandate the use of such an intervention. Mandated IM vitamin K for all newborns, regardless of parental approval, would rescind some parental autonomy but improve overall beneficence, nonmaleficence, and justice in the care of newborns.
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Affiliation(s)
- Shannon M. Isennock
- Mercer University School of Medicine, Savannah, GA
- University of Tennessee Health Science Center Graduate Medical Education, Memphis, TN
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Milling TJ, Middeldorp S, Xu L, Koch B, Demchuk A, Eikelboom JW, Verhamme P, Cohen AT, Beyer-Westendorf J, Michael Gibson C, Lopez-Sendon J, Crowther M, Shoamanesh A, Coppens M, Schmidt J, Albaladejo P, Connolly SJ, Bastani A, Clark C, Concha M, Cornell J, Dombrowski K, Fermann G, Fulmer J, Goldstein J, Kereiakes D, Milling T, Pallin D, Patel N, Refaai M, Rehman M, Schmaier A, Schwarz E, Shillinglaw W, Spohn M, Takata T, Venkat A, Welker J, Welsby I, Wilson J, Van Keer L, Verschuren F, Blostein M, Eikelboom J, Althaus K, Berrouschot J, Braun G, Doeppner T, Dziewas R, Genth-Zotz S, Greinacher P, Hamann F, Hanses F, Heide W, Kallmuenzer B, Kermer P, Poli S, Royl G, Schellong S, Schnupp S, Schwarze J, Spies C, Thomalla G, von Mering M, Weissenborn K, Wollenweber F, Gumbinger C, Jaschinski U, Maschke M, Mochmann HC, Pfeilschifter W, Pohlmann C, Zahn R, Bouzat P, Schmidt J, Vallejo C, Floccard B, Coppens M, van Wissen S, Arellano-Rodrigo E, Valles E, Alikhan R, Breen K, Hall R, Crowther M, Albaladejo P, Cohen A, Demchuk A, Schmidt J, Wyse D, Garcia D, Prins M, Nakamya J, Büller H, Mahaffey KW, Alexander JH, Cairns J, Hart R, Joyner C, Raskob G, Schulman S, Veltkamp R, Meeks B, Zotova E, Ahmad S, Pinto T, Baker K, Dykstra A, Holadyk-Gris I, Malvaso A, Demchuk A. Final Study Report of Andexanet Alfa for Major Bleeding With Factor Xa Inhibitors. Circulation 2023; 147:1026-1038. [PMID: 36802876 DOI: 10.1161/circulationaha.121.057844] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND Andexanet alfa is a modified recombinant inactive factor Xa (FXa) designed to reverse FXa inhibitors. ANNEXA-4 (Andexanet Alfa, a Novel Antidote to the Anticoagulation Effects of Factor Xa Inhibitors) was a multicenter, prospective, phase-3b/4, single-group cohort study that evaluated andexanet alfa in patients with acute major bleeding. The results of the final analyses are presented. METHODS Patients with acute major bleeding within 18 hours of FXa inhibitor administration were enrolled. Co-primary end points were anti-FXa activity change from baseline during andexanet alfa treatment and excellent or good hemostatic efficacy, defined by a scale used in previous reversal studies, at 12 hours. The efficacy population included patients with baseline anti-FXa activity levels above predefined thresholds (≥75 ng/mL for apixaban and rivaroxaban, ≥40 ng/mL for edoxaban, and ≥0.25 IU/mL for enoxaparin; reported in the same units used for calibrators) who were adjudicated as meeting major bleeding criteria (modified International Society of Thrombosis and Haemostasis definition). The safety population included all patients. Major bleeding criteria, hemostatic efficacy, thrombotic events (stratified by occurring before or after restart of either prophylactic [ie, a lower dose, for prevention rather than treatment] or full-dose oral anticoagulation), and deaths were assessed by an independent adjudication committee. Median endogenous thrombin potential at baseline and across the follow-up period was a secondary outcome. RESULTS There were 479 patients enrolled (mean age, 78 years; 54% male, 86% White; 81% anticoagulated for atrial fibrillation at a median time of 11.4 hours since last dose, with 245 (51%) on apixaban, 176 (37%) on rivaroxaban, 36 (8%) on edoxaban, and 22 (5%) on enoxaparin. Bleeding was predominantly intracranial (n=331 [69%]) or gastrointestinal (n=109 [23%]). In evaluable apixaban patients (n=172), median anti-FXa activity decreased from 146.9 ng/mL to 10.0 ng/mL (reduction, 93% [95% CI, 94-93]); in rivaroxaban patients (n=132), it decreased from 214.6 ng/mL to 10.8 ng/mL (94% [95% CI, 95-93]); in edoxaban patients (n=28), it decreased from 121.1 ng/mL to 24.4 ng/mL (71% [95% CI, 82-65); and in enoxaparin patients (n=17), it decreased from 0.48 IU/mL to 0.11 IU/mL (75% [95% CI, 79-67]). Excellent or good hemostasis occurred in 274 of 342 evaluable patients (80% [95% CI, 75-84]). In the safety population, thrombotic events occurred in 50 patients (10%); in 16 patients, this occurred during treatment with prophylactic anticoagulation that began after the bleeding event. No thrombotic episodes occurred after oral anticoagulation restart. Specific to certain populations, reduction of anti-FXa activity from baseline to nadir significantly predicted hemostatic efficacy in patients with intracranial hemorrhage (area under the receiver operating characteristic curve, 0.62 [95% CI, 0.54-0.70]) and correlated with lower mortality in patients <75 years of age (adjusted P=0.022; unadjusted P=0.003). Median endogenous thrombin potential was within the normal range by the end of andexanet alfa bolus through 24 hours for all FXa inhibitors. CONCLUSIONS In patients with major bleeding associated with the use of FXa inhibitors, treatment with andexanet alfa reduced anti-FXa activity and was associated with good or excellent hemostatic efficacy in 80% of patients. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02329327.
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Affiliation(s)
- Truman J Milling
- Seton Dell Medical School Stroke Institute, Dell Medical School, University of Texas at Austin (T.J.M.)
| | - Saskia Middeldorp
- Department of Internal Medicine and Radboud Institute of Health Sciences, Nijmegenthe Netherlands (S.M.)
| | - Lizhen Xu
- Population Health Research Institute, McMaster University, HamiltonOntario Canada. (L.X., A.S., S.J.C.)
| | - Bruce Koch
- Alexion, AstraZeneca Rare Disease, BostonMA (B.K.)
| | - Andrew Demchuk
- Departments of Clinical Neurosciences and Radiology, Cumming School of Medicine, University of Calgary, AlbertaCanada (A.D.)
| | - John W Eikelboom
- Department of Medicine, McMaster University, HamiltonOntario Canada. (J.W.E., M. Crowther)
| | - Peter Verhamme
- Center for Molecular and Vascular Biology, University of Leuven, Belgium (P.V.)
| | | | - Jan Beyer-Westendorf
- Department of Medicine I, Division of Hematology and Hemostasis, University Hospital Dresden, Germany (J.B-W.)
| | | | - Jose Lopez-Sendon
- Instituto de Investigación Hospital Universitario, La PazMadridSpain (J. L-S.)
| | - Mark Crowther
- Department of Medicine, McMaster University, HamiltonOntario Canada. (J.W.E., M. Crowther)
| | - Ashkan Shoamanesh
- Population Health Research Institute, McMaster University, HamiltonOntario Canada. (L.X., A.S., S.J.C.)
| | - Michiel Coppens
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands (M. Coppens)
| | - Jeannot Schmidt
- Centre Hospitalier Universitaire de Clermont-Ferrand, France (J.S.)
| | | | - Stuart J Connolly
- Population Health Research Institute, McMaster University, HamiltonOntario Canada. (L.X., A.S., S.J.C.)
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Decker ME, Briski ND, Salem A, Noor E, Khashan A. Methanol Intoxication-Associated Brain Hemorrhages: Can Early Detection Be Life-Saving? A Case Report. Am J Case Rep 2023; 24:e938749. [PMID: 36710478 PMCID: PMC9896127 DOI: 10.12659/ajcr.938749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Methanol can cause many acute complications when ingested, either intentionally or accidentally. One rare complication is cerebral hemorrhage, which can present with focal neurologic deficits, decreased consciousness, and fixed, dilated pupils. With vigilant monitoring of patients in the acute period of toxicity, rapid identification, and initiation of treatment, outcomes can potentially be improved in these patients. CASE REPORT We present a case of a 42-year-old man who presented after ingestion of windshield wiper fluid. Initial symptoms started with fatigue and altered mental status, but he quickly developed abdominal pain and became obtunded. CT initially showed no acute hemorrhage or other pathology, but on day 2, despite receiving fomepizole, bicarbonate, and dialysis, the patient became hypotensive and showed loss of cranial nerve reflexes, and repeated CT head scans showed acute intracranial hemorrhage with mass effect. CONCLUSIONS Although the exact mechanism of intracranial hemorrhage and necrosis following methanol intoxication remains uncertain, we know beyond doubt that it can progress rapidly and lead to severe and irreversible complications, so identifying and treating it immediately is essential. In this case, methanol ingestion was known on presentation, antidote and renal replacement therapy were initiated within hours of ingestion, yet our patient still suffered fatal brain hemorrhage. Important warning signs of acute hemorrhage include loss of cranial nerve reflexes and decrease in consciousness, so these findings warrant further evaluation and prompt neuroimaging, especially in high-risk patients like the one in this report.
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Affiliation(s)
| | | | - Amira Salem
- Department of Internal Medicine, Raritan Bay Medical Center, Perth Amboy, NJ, USA
| | - Emad Noor
- Department of Neurology, JFK Medical Center, Edison, NJ, USA
| | - Abdallah Khashan
- Department of Internal Medicine, Raritan Bay Medical Center, Perth Amboy, NJ, USA,Corresponding Author: Abdallah Khashan, e-mail:
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Lee IH, Ha SK, Lim DJ, Choi JI. Predictors of intracranial hemorrhage after mechanical thrombectomy using a stent-retriever for anterior circulation ischemic stroke: A retrospective study. Medicine (Baltimore) 2023; 102:e32666. [PMID: 36637951 PMCID: PMC9839270 DOI: 10.1097/md.0000000000032666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Intracranial hemorrhage (ICH) after mechanical thrombectomy (MT) is a potentially catastrophic complication. We aimed to identify predictors of hemorrhagic complications following MT using a stent-retriever (SR) for acute ischemic stroke (AIS) patients due to large vessel occlusion of anterior circulation. In consecutive AIS patients, the clinical and procedural variables were retrospectively analyzed. ICH was evaluated on computed tomography performed 24 hours following MT and dichotomized into asymptomatic ICH and symptomatic intracranial hemorrhage (SICH) depending on the presence of neurological deterioration. Using univariate and multivariate analyses, the predictors of ICH and SICH were identified. The optimal cutoff value for predicting SICH was determined by receiver operating characteristic (ROC) analysis. Among 135 patients, ICH was detected in 52 (38.5%), and 17 (12.6%) were classified as having SICH. We found that serum glucose level (odds ratio [OR] 1.016, P = .011) and number of SR passes (OR 2.607, P < .001) were significantly correlated with ICH. Independent predictors of SICH included the baseline Alberta stroke program early computed tomography score (ASPECTS) (OR 0.485, P = .042), time from stroke onset to groin puncture (OTP) (OR 1.033, P = .016), and number of SR passes (OR 2.342, P = .038). In ROC analysis, baseline ASPECTS ≤ 7, OTP > 280 minutes, and SR passes > 3 were the optimal cutoff values for predicting SICH. In conclusion, serum glucose level and SR pass serve as predictors for any form of ICH in large vessel occlusion-induced AIS patients undergoing MT. Moreover, patients with lower ASPECTS, prolonged OTP, and multiple SR passes are more vulnerable to SICH.
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Affiliation(s)
- In-Hyoung Lee
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Korea
| | - Sung-Kon Ha
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Korea
| | - Dong-Jun Lim
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Korea
| | - Jong-Il Choi
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Korea
- * Correspondence: Jong-Il Choi, Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan, Gyeonggi-do 15355, South Korea (e-mail: )
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Muacevic A, Adler JR, Prajapati S, Muzaffar SN, Agrawal A. Expanded Dengue Syndrome Presenting as Intracranial Hemorrhage, Fever, and Rhabdomyolysis: A Case Report. Cureus 2023; 15:e34252. [PMID: 36843708 PMCID: PMC9957551 DOI: 10.7759/cureus.34252] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2023] [Indexed: 01/28/2023] Open
Abstract
Rare clinical manifestations of dengue are included under the expanded dengue syndrome (EDS), with intracranial hemorrhage (ICH) being one of them. We discuss an uncommon presentation of dengue with basal ganglia hemorrhage, hyperthermia, and rhabdomyolysis in a 53-year-old hypertensive female who presented with sudden onset syncope, left-sided weakness, and altered sensorium for days, with high-grade fever and vomiting. The Glasgow coma scale (GCS) score was 5, and the patient was intubated. Noncontrast computerized tomography (NCCT) of the brain revealed right basal ganglia bleeding with intraventricular hemorrhage. Electrocardiography (ECG) revealed sinus tachycardia. The patient had spikes of high-grade fever, rhabdomyolysis, stage III acute kidney disease, and coagulopathy. Dengue IgM antibodies were positive. Treatment was started, and the patient was in the intensive care unit (ICU) for six months, following which she was discharged. Given this, one can speculate on the importance of viral diseases presenting with ICH as these are rare and are diagnosed quite late, which can also prove to be fatal.
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Winkelmeier L, Heit JJ, Adusumilli G, Geest V, Christensen S, Kniep H, van Horn N, Steffen P, Bechstein M, Sporns P, Lansberg MG, Albers GW, Wintermark M, Fiehler J, Faizy TD. Hypoperfusion Intensity Ratio Is Correlated With the Risk of Parenchymal Hematoma After Endovascular Stroke Treatment. Stroke 2023; 54:135-143. [PMID: 36416127 DOI: 10.1161/strokeaha.122.040540] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Parenchymal hematoma (PH) is a major complication after endovascular treatment (EVT) for ischemic stroke. The hypoperfusion intensity ratio (HIR) represents a perfusion parameter reflecting arterial collateralization and cerebral microperfusion in ischemic brain tissue. We hypothesized that HIR correlates with the risk of PH after EVT. METHODS Retrospective multicenter cohort study of patients with large vessel occlusion who underwent EVT between 2013 and 2021 at one of the 2 comprehensive stroke centers (University Medical Center Hamburg-Eppendorf, Germany and Stanford University School of Medicine, CA). HIR was automatically calculated on computed tomography perfusion studies as the ratio of brain volume with time-to-max (Tmax) delay >10 s over volume with Tmax >6 s. Reperfusion hemorrhages were assessed according to the Heidelberg Bleeding Classification. Primary outcome was PH occurrence (PH+) or absence (PH-) on follow-up imaging. Secondary outcome was good clinical outcome defined as a 90-day modified Rankin Scale score of 0 to 2. RESULTS A total of 624 patients met the inclusion criteria. We observed PH in 91 (14.6%) patients after EVT. PH+ patients had higher HIR on admission compared with PH- patients (median, 0.6 versus 0.4; P<0.001). In multivariable regression, higher admission blood glucose (adjusted odds ratio [aOR], 1.08 [95% CI, 1.04-1.13]; P<0.001), extensive baseline infarct defined as Alberta Stroke Program Early CT Score ≤5 (aOR, 2.48 [1.37-4.42]; P=0.002), and higher HIR (aOR, 1.22 [1.09-1.38]; P<0.001) were independent determinants of PH after EVT. Both higher HIR (aOR, 0.83 [0.75-0.92]; P<0.001) and PH on follow-up imaging (aOR, 0.39 [0.18-0.80]; P=0.013) were independently associated with lower odds of achieving good clinical outcome. CONCLUSIONS Poorer (higher) HIR on admission perfusion imaging was strongly associated with PH occurrence after EVT. HIR as a surrogate for cerebral microperfusion might reflect tissue vulnerability for reperfusion hemorrhages. This automated and quickly available perfusion parameter might help to assess the need for intensive medical care after EVT.
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Affiliation(s)
- Laurens Winkelmeier
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.W., V.G., H.K., N.v.H., P.S., M.B., P.S., J.F., T.D.F.)
| | - Jeremy J Heit
- Department of Radiology, Stanford University School of Medicine, CA (J.J.H., G.A.)
| | - Gautam Adusumilli
- Department of Radiology, Stanford University School of Medicine, CA (J.J.H., G.A.)
| | - Vincent Geest
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.W., V.G., H.K., N.v.H., P.S., M.B., P.S., J.F., T.D.F.)
| | - Soren Christensen
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA (S.C., M.G.L., G.W.A.)
| | - Helge Kniep
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.W., V.G., H.K., N.v.H., P.S., M.B., P.S., J.F., T.D.F.)
| | - Noel van Horn
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.W., V.G., H.K., N.v.H., P.S., M.B., P.S., J.F., T.D.F.)
| | - Paul Steffen
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.W., V.G., H.K., N.v.H., P.S., M.B., P.S., J.F., T.D.F.)
| | - Matthias Bechstein
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.W., V.G., H.K., N.v.H., P.S., M.B., P.S., J.F., T.D.F.)
| | - Peter Sporns
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.W., V.G., H.K., N.v.H., P.S., M.B., P.S., J.F., T.D.F.).,Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Switzerland (P.S.)
| | - Maarten G Lansberg
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA (S.C., M.G.L., G.W.A.)
| | - Gregory W Albers
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA (S.C., M.G.L., G.W.A.)
| | - Max Wintermark
- Department of Neuroradiology, MD Anderson, Houston, TX (M.W.)
| | - Jens Fiehler
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.W., V.G., H.K., N.v.H., P.S., M.B., P.S., J.F., T.D.F.)
| | - Tobias D Faizy
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.W., V.G., H.K., N.v.H., P.S., M.B., P.S., J.F., T.D.F.)
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21
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Isokuortti H, Iverson GL, Posti JP, Berghem K, Kotilainen AK, Luoto TM. Risk for intracranial hemorrhage in individuals after mild traumatic brain injury who are taking serotonergic antidepressants. Front Neurol 2022; 13:952188. [PMID: 36570453 PMCID: PMC9768034 DOI: 10.3389/fneur.2022.952188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/18/2022] [Indexed: 12/13/2022] Open
Abstract
Background Serotonergic antidepressants may predispose to bleeding, but little is known of the risk for traumatic intracranial bleeding. Methods This was a prospective case-control study of 218 patients with mild traumatic brain injuries (TBI) who were treated at a Finnish tertiary trauma hospital. Injury-related information and clinical findings were prospectively collected in the emergency department. Detailed pre-injury health history was collected from electronic medical records. Information on the use of serotonergic antidepressants was attained from the Finnish national prescription registry. All head CT scans were reviewed by a neuroradiologist based on the Common Data Elements. Cases were patients with traumatic intracranial hemorrhage on head CT. Controls were patients from the same cohort, but without traumatic intracranial lesions on CT. The proportion with traumatic intracranial bleeding for patients on serotonergic antidepressant medication was compared to the proportion for patients not on serotonergic medication. Results The study cohort consisted of 24 cases with traumatic intracranial bleeding and 194 injured controls. The median age of the sample was 70 years (interquartile range = 50-83). One fifth (21.6%) of all the patients were taking a serotonergic antidepressant. Of the patients on an antidepressant, 10.6% (5/47) had an acute hemorrhagic lesion compared to 11.1% (19/171) of those who were not on an antidepressant (p = 0.927). In the regression analysis, traumatic intracranial hemorrhage was not associated with antidepressant use. Conclusion Serotonergic antidepressant use was not associated with an increased risk of traumatic intracranial hemorrhage after a mild TBI. The patients in this relatively small cohort were mostly middle-aged and older adults. These factors limit the generalizability of the results in younger patients with mild TBI.
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Affiliation(s)
- Harri Isokuortti
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland,*Correspondence: Harri Isokuortti
| | - Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and the Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, MA, United States
| | - Jussi P. Posti
- Neurocenter, Department of Neurosurgery, and Turku Brain Injury Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Ksenia Berghem
- Medical Imaging Centre, Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - Anna-Kerttu Kotilainen
- Department of Surgery, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Teemu M. Luoto
- Department of Neurosurgery, Tampere University Hospital and Tampere University, Tampere, Finland
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22
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Høllesli LJ, Ajmi SC, Kurz MW, Tysland TB, Hagir M, Dalen I, Qvindesland SA, Ersdal H, Kurz KD. Simulation-based team-training in acute stroke: Is it safe to speed up? Brain Behav 2022; 12:e2814. [PMID: 36416494 PMCID: PMC9759129 DOI: 10.1002/brb3.2814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 10/01/2022] [Accepted: 10/18/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In acute ischemic stroke (AIS), rapid treatment with intravenous thrombolysis (IVT) is crucial for good clinical outcome. Weekly simulation-based team-training of the stroke treatment team was implemented, resulting in faster treatment times. The aim of this study was to assess whether this time reduction led to a higher proportion of stroke mimics (SMs) among patients who received IVT for presumed AIS, and whether these SM patients were harmed by intracranial hemorrhage (ICH). METHODS All suspected AIS patients treated with IVT between January 1, 2015 and December 31, 2020 were prospectively registered. In 2017, weekly in situ simulation-based team-training involving the whole stroke treatment team was introduced. To analyze possible unintended effects of simulation training, the proportion of SMs among patients who received IVT for presumed AIS were identified by clinical and radiological evaluation. Additionally, we identified the extent of symptomatic ICH (sICH) in IVT-treated SM patients. RESULTS From 2015 to 2020, 959 patients were treated with IVT for symptoms of AIS. After introduction of simulation training, the proportion of patients treated with IVT who were later diagnosed as SMs increased significantly (15.9% vs. 24.4%, p = .003). There were no ICH complications in the SM patients treated before, whereas two SM patients suffered from asymptomatic ICH after introduction of simulation training (p = 1.0). When subgrouping SMs into prespecified categories, only the group diagnosed with peripheral vertigo increased significantly (2.5% vs. 8.6%, p < .001). CONCLUSIONS Simulation training of the acute stroke treatment team was associated with an increase in the proportion of patients treated with IVT for a suspected AIS who were later diagnosed with peripheral vertigo. The proportion of other SM groups among IVT-treated patients did not change significantly. No sICH was detected in IVT-treated SM patients.
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Affiliation(s)
- Liv Jorunn Høllesli
- Stavanger Medical Imaging Laboratory (SMIL), Department of Radiology, Stavanger University Hospital, Stavanger, Norway.,Department of Electrical Engineering and Computer Science, University of Stavanger, Stavanger, Norway
| | - Soffien Chadli Ajmi
- Neurology Research Group, Department of Neurology, Stavanger University Hospital, Stavanger, Norway.,Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway
| | - Martin W Kurz
- Neurology Research Group, Department of Neurology, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Thomas Bailey Tysland
- Neurology Research Group, Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Morten Hagir
- Department of Radiology, Hospital of Southern Norway Kristiansand, Kristiansand, Norway
| | - Ingvild Dalen
- Department of Research, Section of Biostatistics, Stavanger University Hospital, Stavanger, Norway
| | - Sigrun Anna Qvindesland
- Department of Research, Simulation Section, Stavanger University Hospital, Stavanger, Norway
| | - Hege Ersdal
- Critical Care and Anesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Kathinka D Kurz
- Stavanger Medical Imaging Laboratory (SMIL), Department of Radiology, Stavanger University Hospital, Stavanger, Norway.,Department of Electrical Engineering and Computer Science, University of Stavanger, Stavanger, Norway
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Che R, Zhang M, Sun H, Ma J, Hu W, Liu X, Ji X. Long-term outcome of cerebral amyloid angiopathy-related hemorrhage. CNS Neurosci Ther 2022; 28:1829-1837. [PMID: 35975394 PMCID: PMC9532921 DOI: 10.1111/cns.13922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 11/30/2022] Open
Abstract
Object The long‐term functional outcome of cerebral amyloid angiopathy‐related hemorrhage (CAAH) patients is unclear. We sought to assess the long‐term functional outcome of CAAH and determine the prognostic factors associated with unfavorable outcomes. Methods We enrolled consecutive CAAH patients from 2014 to 2020 in this observational study. Baseline characteristics and clinical outcomes were presented. Multivariable logistic regression analysis was performed to identify the prognostic factors associated with long‐term outcome. Results Among the 141 CAAH patients, 76 (53.9%) achieved favorable outcomes and 28 (19.9%) of them died at 1‐year follow‐up. For the longer‐term follow‐up with a median observation time of 19.0 (interquartile range, 12.0–26.5) months, 71 (50.4%) patients obtained favorable outcomes while 33 (23.4%) died. GCS on admission (OR, 0.109; 95% CI, 0.021–0.556; p = 0.008), recurrence of ICH (OR, 2923.687; 95% CI, 6.282–1360730.14; p = 0.011), WML grade 3–4 (OR, 31.007; 95% CI, 1.041–923.573; p = 0.047), severe central atrophy (OR, 4220.303; 95% CI, 9.135–1949674.84; p = 0.008) assessed by CT was identified as independent predictors for long‐term outcome. Interpretation Nearly 50% of CAAH patients achieved favorable outcomes at long‐term follow‐up. GCS, recurrence of ICH, WML grade and cerebral atrophy were identified as independent prognostic factors of long‐term outcome.
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Affiliation(s)
- Ruiwen Che
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine, Beijing, China
| | - Mengke Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hailiang Sun
- Department of Neurosurgery, Beijing Fengtai You'anmen Hospital, Beijing, China
| | - Jin Ma
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wenbo Hu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xin Liu
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xunming Ji
- Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine, Beijing, China.,Department of Neurosurgery, Xuan Wu Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Brain Disorders, Beijing, China.,Capital Medical University, Beijing, China
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24
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Affiliation(s)
- Claire J Creutzfeldt
- Department of Neurology (C.J.C., T.M.L.-M.), University of Washington, Seattle.,Cambia Palliative Care Center of Excellence (C.J.C.), University of Washington, Seattle.,Harborview Medical Center, Seattle, WA (C.J.C., M.R.L., T.M.L.-M.)
| | - Michael R Levitt
- Department of Neurological Surgery (M.R.L.), University of Washington, Seattle.,Harborview Medical Center, Seattle, WA (C.J.C., M.R.L., T.M.L.-M.)
| | - Thabele M Leslie-Mazwi
- Department of Neurology (C.J.C., T.M.L.-M.), University of Washington, Seattle.,Harborview Medical Center, Seattle, WA (C.J.C., M.R.L., T.M.L.-M.)
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25
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Rauch S, Müller HP, Dreyhaupt J, Ludolph AC, Kassubek J, Althaus K. Andexanet Alfa for Reversal of Factor Xa Inhibitors in Intracranial Hemorrhage: Observational Cohort Study. J Clin Med 2022; 11. [PMID: 35743469 DOI: 10.3390/jcm11123399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 05/31/2022] [Accepted: 06/10/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Intracranial hemorrhage (ICH) is associated with high mortality and morbidity, especially in patients under anticoagulative treatment. Andexanet alfa (AA) is a modified recombinant form of human factor Xa (FXa) developed for reversal of FXa-inhibitors, e.g., in the event of ICH, but experience is still limited. Methods: This monocentric retrospective observational cohort study included 46 patients with acute FXa-inhibitor-associated non-traumatic ICH (FXa-I-ICH) of whom 23 were treated with AA within 12 h after symptom onset, compared to 23 patients with usual care (UC). Volumetrically analyzed hematoma expansion (HE) in brain imaging, clinical outcome and incidence of adverse events were analyzed. Results: All patients (mean age 79.8 ± 7.2 years) were effectively anticoagulated. The cohort included severely ill patients with large hematoma volumes (median 20.4, IQR 7.8−39.0 mL). Efficacy, as assessed by HE in imaging, was very good in the AA-group. There was no (0.0%) relevant HE (>33%) in contrast to UC-group (26.1%). Nevertheless, we observed a high incidence of thromboembolic events (30.4% vs. 4.4%) and non-favorable outcomes (death/palliative condition) in 43.5% vs. 26.1%. Conclusions: There was no HE in the volumetric neuroimaging assessment in the AA-group, but clinical outcomes remained often worse. Large randomized trials for the use of AA in patients with acute FXa-inhibitor-associated ICH are needed to investigate the clinical outcome in consideration of the rates of thromboembolism.
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26
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Hoshino T, Sato S, Kushi K, Tanaka Y, Mochizuki T, Ishikawa T, Shima S, Ryu B, Inoue T, Okada Y, Niimi Y. Tortuosity of middle cerebral artery M1 segment and outcomes after mechanical thrombectomy. Interv Neuroradiol 2022:15910199221104922. [PMID: 35656743 DOI: 10.1177/15910199221104922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We aimed to quantify the tortuosity of the middle cerebral artery (MCA) and assess its effects on radiological and clinical outcomes in patients with acute MCA occlusions who received mechanical thrombectomy (MT). METHODS This retrospective study enrolled 53 patients with acute ischemic stroke due to MCA M1 or M2 segment occlusion who underwent MT using stent retrievers (SRs). Tortuosity index (TI) was defined to quantify the tortuosity of the MCA M1 segment using the following formula: (actual distance / straight distance) × 100. For each patient, four TIs were measured in the anteroposterior and caudal views for both ipsilateral and contralateral sides to the occluded site (TI-APi, TI-APc, TI-CAUi, and TI-CAUc, respectively) using magnetic resonance angiography (MRA) or computed tomography angiography (CTA). We defined the first-pass effect (FPE) as first-pass mTICI classification ≥2b reperfusion. RESULTS Patients who did not achieve FPE had significantly higher TI-APi (112 vs. 106; P = 0.004), TI-APc (111 vs. 105; P = 0.005), TI-CAUi (110 vs. 105; P = 0.002), and TI-CAUc (110 vs. 105; P = 0.001) than those who achieved FPE. In multivariable analysis, higher TI-APi, TI-CAUi, and TI-APc were independently associated with an increased rate of unsuccessful FPE (odds ratio (OR) [95% confidence interval (CI)]: 1.25 [1.02-1.61], 1.21 [1.01-1.45], and 1.27 [1.03-1.73], respectively). TI-CAUi, TI-APc, and TI-CAUc were also independent predictors of the occurrence of intracranial hemorrhage after MT (OR [95% CI]: 1.15 [1.01-1.38], 1.14 [1.01-1.38], 1.25 [1.02-1.52], respectively). CONCLUSIONS The TIs of the MCA M1 segment on both ipsilateral and contralateral sides were associated with unfavourable outcomes after MT.
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Affiliation(s)
- Takao Hoshino
- Department of Neuroendovascular Therapy, 83911St Luke's International Hospital, Chuo-ku, Tokyo, Japan
- Department of Neurology, 13131Tokyo Women's Medical University, Tokyo, Shinjuku-ku, Tokyo, Japan
| | - Shinsuke Sato
- Department of Neuroendovascular Therapy, 83911St Luke's International Hospital, Chuo-ku, Tokyo, Japan
- Department of Neurosurgery, 83911St Luke's International Hospital, Chuo-ku, Tokyo, Japan
- Department of Neurosurgery, 13131Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Kazuki Kushi
- Department of Neuroendovascular Therapy, 83911St Luke's International Hospital, Chuo-ku, Tokyo, Japan
- Department of Neurosurgery, 83911St Luke's International Hospital, Chuo-ku, Tokyo, Japan
- Department of Neurosurgery, 13131Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Yukiko Tanaka
- Department of Neuroendovascular Therapy, 83911St Luke's International Hospital, Chuo-ku, Tokyo, Japan
- Department of Neurosurgery, 83911St Luke's International Hospital, Chuo-ku, Tokyo, Japan
- Department of Neurosurgery, 13131Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Tatsuki Mochizuki
- Department of Neuroendovascular Therapy, 83911St Luke's International Hospital, Chuo-ku, Tokyo, Japan
- Department of Neurosurgery, 83911St Luke's International Hospital, Chuo-ku, Tokyo, Japan
| | - Tomomi Ishikawa
- Department of Neuroendovascular Therapy, 83911St Luke's International Hospital, Chuo-ku, Tokyo, Japan
- Department of Neurosurgery, 83911St Luke's International Hospital, Chuo-ku, Tokyo, Japan
- Department of Neurosurgery, 13131Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Shogo Shima
- Department of Neuroendovascular Therapy, 83911St Luke's International Hospital, Chuo-ku, Tokyo, Japan
- Department of Neurosurgery, 83911St Luke's International Hospital, Chuo-ku, Tokyo, Japan
| | - Bikei Ryu
- Department of Neuroendovascular Therapy, 83911St Luke's International Hospital, Chuo-ku, Tokyo, Japan
- Department of Neurosurgery, 83911St Luke's International Hospital, Chuo-ku, Tokyo, Japan
- Department of Neurosurgery, 13131Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Tatsuya Inoue
- Department of Neuroendovascular Therapy, 83911St Luke's International Hospital, Chuo-ku, Tokyo, Japan
- Department of Neurosurgery, 83911St Luke's International Hospital, Chuo-ku, Tokyo, Japan
- Department of Neurosurgery, 13131Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Yoshikazu Okada
- Department of Neurosurgery, 83911St Luke's International Hospital, Chuo-ku, Tokyo, Japan
| | - Yasunari Niimi
- Department of Neuroendovascular Therapy, 83911St Luke's International Hospital, Chuo-ku, Tokyo, Japan
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Iadecola C, Fisher M, Sacco RL. Introduction to the Compendium on Stroke and Neurocognitive Impairment. Circ Res 2022; 130:1073-1074. [PMID: 35420917 DOI: 10.1161/circresaha.122.321073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Costantino Iadecola
- Weill Cornell Medicine, Feil Family Brain and Mind Research Institute, New York, NY (C.I.)
| | - Marc Fisher
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (M.F.)
| | - Ralph L Sacco
- Department of Neurology, Miller School of Medicine, University of Miami, FL (R.L.S.)
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Qdaisat A, Yeung SJ, Rojas Hernandez CH, Samudrala P, Kamal M, Li Z, Wechsler AH. Characteristics and Outcomes of Intracranial Hemorrhage in Cancer Patients Visiting the Emergency Department. J Clin Med 2022; 11:643. [PMID: 35160096 DOI: 10.3390/jcm11030643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 11/17/2022] Open
Abstract
Intracranial hemorrhage (ICH) is a dreaded complication of both cancer and its treatment. To evaluate the characteristics and clinical outcomes of cancer patients with ICH, we identified all patients with ICH who visited The University of Texas MD Anderson Cancer Center emergency department between 1 September 2006 and 16 February 2016. Clinical and radiologic data were collected and compared. Logistic regression analyses were used to determine the association between clinical variables and various outcomes. During the period studied, 704 confirmed acute ICH cases were identified. In-hospital, 7-day, and 30-day mortality rates were 15.1, 11.4, and 25.6%, respectively. Hypertension was most predictive of intensive care unit admission (OR = 1.52, 95% CI = 1.09–2.12, p = 0.013). Low platelet count was associated with both in-hospital mortality (OR = 0.96, 95% CI = 0.94–0.99, p = 0.008) and 30-day mortality (OR = 0.98, 95% CI = 0.96–1.00, p = 0.016). Radiologic findings, especially herniation and hydrocephalus, were strong predictors of short-term mortality. Among known risk factors of ICH, those most helpful in predicting cancer patient outcomes were hypertension, low platelet count, and the presence of hydrocephalus or herniation. Understanding how the clinical presentation, risk factors, and imaging findings correlate with patient morbidity and mortality is helpful in guiding the diagnostic evaluation and aggressiveness of care for ICH in cancer patients.
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Lin PY, Chen YC, Sun YT. Cerebral Venous Thrombosis Mimicking Acute Ischemic Stroke in the Emergency Assessment of Thrombolysis Eligibility: Learning from a Misdiagnosed Case. Acta Neurol Taiwan 2021; 30(4):155-161. [PMID: 34841501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Cerebral venous thrombosis (CVT) occasionally presents with acute focal neurologic signs, mimicking arterial stroke syndrome. Diagnosing CVT in the setting of thrombolysis eligibility evaluation is challenging. We reported this case to discuss the promptly recognizing CVT in the setting of thrombolysis eligibility evaluation, and review the literature of thrombolytic therapy in CVT patients. CASE REPORT A 57-year-old man presented with acute-onset right upper extremity monoparesis, right facial palsy, and aphasia. He underwent emergent thrombolysis with recombinant tissue plasminogen activator according to American Stroke Association guidelines. Subsequently, CVT was identified on multiphase computed tomography (CT) angiography. His symptoms initially improved but subsequently deteriorated because of intracranial hemorrhage. Cryoprecipitate and tranexamic acid were immediately administered. Anticoagulation was started 24 hours after the onset of hemorrhage. His modified Rankin Scale score was 4 at 120 days after the hemorrhage. CONCLUSION Patients with CVT have a higher risk of thrombolysis-related intracranial hemorrhage than other stroke mimics. A greater focus on noncontrast brain CT and the venous phase of CT angiography help identifying this stroke mimic before thrombolysis.
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Affiliation(s)
- Po-Yu Lin
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ying-Chen Chen
- Department of Diagnostic Radiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yuan-Ting Sun
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Genomic Medicine, National Cheng Kung University Hospital, College of Medicine National Cheng Kung University, Tainan, Taiwan
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Ali M, van Os HJA, van der Weerd N, Schoones JW, Heymans MW, Kruyt ND, Visser MC, Wermer MJH. Sex Differences in Presentation of Stroke: A Systematic Review and Meta-Analysis. Stroke 2021; 53:345-354. [PMID: 34903037 PMCID: PMC8785516 DOI: 10.1161/strokeaha.120.034040] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE Women have worse outcomes than men after stroke. Differences in presentation may lead to misdiagnosis and, in part, explain these disparities. We investigated whether there are sex differences in clinical presentation of acute stroke or transient ischemic attack. METHODS We conducted a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Inclusion criteria were (1) cohort, cross-sectional, case-control, or randomized controlled trial design; (2) admission for (suspicion of) ischemic or hemorrhagic stroke or transient ischemic attack; and (3) comparisons possible between sexes in ≥1 nonfocal or focal acute stroke symptom(s). A random-effects model was used for our analyses. We performed sensitivity and subanalyses to help explain heterogeneity and used the Newcastle-Ottawa Scale to assess bias. RESULTS We included 60 studies (n=582 844; 50% women). In women, headache (pooled odds ratio [OR], 1.24 [95% CI, 1.11-1.39]; I2=75.2%; 30 studies) occurred more frequently than in men with any type of stroke, as well as changes in consciousness/mental status (OR, 1.38 [95% CI, 1.19-1.61]; I2=95.0%; 17 studies) and coma/stupor (OR, 1.39 [95% CI, 1.25-1.55]; I2=27.0%; 13 studies). Aspecific or other neurological symptoms (nonrotatory dizziness and non-neurological symptoms) occurred less frequently in women (OR, 0.96 [95% CI, 0.94-0.97]; I2=0.1%; 5 studies). Overall, the presence of focal symptoms was not associated with sex (pooled OR, 1.03) although dysarthria (OR, 1.14 [95% CI, 1.04-1.24]; I2=48.6%; 11 studies) and vertigo (OR, 1.23 [95% CI, 1.13-1.34]; I2=44.0%; 8 studies) occurred more frequently, whereas symptoms of paresis/hemiparesis (OR, 0.73 [95% CI, 0.54-0.97]; I2=72.6%; 7 studies) and focal visual disturbances (OR, 0.83 [95% CI, 0.70-0.99]; I2=62.8%; 16 studies) occurred less frequently in women compared with men with any type of stroke. Most studies contained possible sources of bias. CONCLUSIONS There may be substantive differences in nonfocal and focal stroke symptoms between men and women presenting with acute stroke or transient ischemic attack, but sufficiently high-quality studies are lacking. More studies are needed to address this because sex differences in presentation may lead to misdiagnosis and undertreatment.
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Affiliation(s)
- Mariam Ali
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands (M.A., M.C.V.)
| | - Hendrikus J A van Os
- Department of Neurology, Leiden University Medical Center, the Netherlands. (H.J.A.v.O., N.v.d.W., N.D.K., M.J.H.W.)
| | - Nelleke van der Weerd
- Department of Neurology, Leiden University Medical Center, the Netherlands. (H.J.A.v.O., N.v.d.W., N.D.K., M.J.H.W.)
| | - Jan W Schoones
- Walaeus Library, Leiden University Medical Center, the Netherlands. (J.W.S.)
| | - Martijn W Heymans
- Department of Clinical Epidemiology and Biostatistics, Amsterdam UMC, the Netherlands (M.W.H.)
| | - Nyika D Kruyt
- Department of Neurology, Leiden University Medical Center, the Netherlands. (H.J.A.v.O., N.v.d.W., N.D.K., M.J.H.W.)
| | - Marieke C Visser
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands (M.A., M.C.V.)
| | - Marieke J H Wermer
- Department of Neurology, Leiden University Medical Center, the Netherlands. (H.J.A.v.O., N.v.d.W., N.D.K., M.J.H.W.)
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Isokuortti H, Iverson GL, Posti JP, Ruuskanen JO, Brander A, Kataja A, Nikula M, Öhman J, Luoto TM. Serotonergic Antidepressants and Risk for Traumatic Intracranial Bleeding. Front Neurol 2021; 12:758707. [PMID: 34777229 PMCID: PMC8581291 DOI: 10.3389/fneur.2021.758707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 09/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Serotonergic antidepressants may predispose to bleeding but the effect on traumatic intracranial bleeding is unknown. Methods: The rate of intracranial bleeding in patients with antidepressant medication was compared to patients not antidepressants in a cohort of patients with acute head injury. This association was examined by using a consecutive cohort of head trauma patients from a Finnish tertiary center emergency department (Tampere University Hospital, Tampere, Finland). All consecutive (2010-2012) adult patients (n = 2,890; median age = 58; male = 56%, CT-positive = 22%, antithrombotic medication users = 25%, antidepressant users = 10%) who underwent head CT due to head trauma in the emergency department were included. Results: Male gender, GCS <15, older age, and anticoagulation were associated with an increased risk for traumatic intracranial bleeding. There were 17.8% of patients not taking antidepressants and 18.3% of patients on an antidepressant who had traumatic intracranial bleeding (p = 0.830). Among patients who were taking antithrombotic medication, 16.6% of the patients not taking antidepressant medication, and 22.5% of the patients taking antidepressant medication, had bleeding (p = 0.239). In a regression analysis, traumatic intracranial hemorrhage was not associated with antidepressant use. Conclusions: Serotonergic antidepressant use was not associated with an increased risk of traumatic intracranial hemorrhage.
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Affiliation(s)
- Harri Isokuortti
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Center for Health and Rehabilitation Research, Spaulding Rehabilitation Hospital and Spaulding Research Institute, Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, United States
| | - Jussi P Posti
- Department of Neurosurgery, Neurocenter, Turku Brain Injury Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Jori O Ruuskanen
- Division of Clinical Neurosciences, Department of Neurology, Turku University Hospital and University of Turku, Turku, Finland.,Medbase Ltd., Turku, Finland
| | - Antti Brander
- Department of Radiology, Medical Imaging Centre, Tampere University Hospital, Tampere, Finland
| | - Anneli Kataja
- Department of Radiology, Medical Imaging Centre, Tampere University Hospital, Tampere, Finland
| | - Milaja Nikula
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Juha Öhman
- Department of Neurosurgery, Tampere University Hospital, Tampere, Finland
| | - Teemu M Luoto
- Department of Neurosurgery, Tampere University Hospital and Tampere University, Tampere, Finland
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Sokołowska B, Kozińska J, Szczepanek D, Wąsik-Szczepanek E, Kozioł M, Majowicz D, Juda A, Hus M. An epileptic seizure and haemorrhage into the ventricular system of the brain as the first manifestations of acquired haemophilia A - Case report. Ann Agric Environ Med 2021; 28:531-533. [PMID: 34558281 DOI: 10.26444/aaem/140306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Acquired haemophilia (AH) is a suddenly occurring severe blood diathesis that affects both males and females and is caused by autoantibodies which inhibit coagulation factor VIII. The report describes an unusual case of acquired haemophilia in which an epileptic seizure and haemorrhage into the ventricular system of the brain were the first manifestations of the disease. In addition, APTT was prolonged to 94.6 seconds and the factor VIII level was as low as 1.5%. The level of anti-FVIII antibody was extremely high - 272BU/ml. The patient did not undergo invasive diagnostic procedure or an operation. Recombinant factor VIIa was used to control the bleeding. In order to eradicate the inhibitor, the patient received prednisone and cyclophosphamide. Complete remission was achieved after 5.5 weeks of treatment.
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Affiliation(s)
- Bożena Sokołowska
- Department of Haematooncology and Bone Marrow Transplantation, Medical University, Lublin, Poland
| | - Justyna Kozińska
- Department of Haematooncology and Bone Marrow Transplantation, Medical University, Lublin, Poland
| | - Dariusz Szczepanek
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University, Lublin, Poland
| | - Ewa Wąsik-Szczepanek
- Department of Haematooncology and Bone Marrow Transplantation, Medical University, Lublin, Poland
| | - Magdalena Kozioł
- Department of Haematooncology and Bone Marrow Transplantation, Medical University, Lublin, Poland
| | - Daria Majowicz
- Department of Haematooncology and Bone Marrow Transplantation, Medical University, Lublin, Poland
| | - Adrian Juda
- Department of Haematooncology and Bone Marrow Transplantation, Medical University, Lublin, Poland
| | - Marek Hus
- Department of Haematooncology and Bone Marrow Transplantation, Medical University, Lublin, Poland
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Carlsson M, Wilsgaard T, Johnsen SH, Johnsen LH, Løchen ML, Njølstad I, Mathiesen EB. Long-Term Survival, Causes of Death, and Trends in 5-Year Mortality After Intracerebral Hemorrhage: The Tromsø Study. Stroke 2021; 52:3883-3890. [PMID: 34496620 DOI: 10.1161/strokeaha.120.032750] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Data on long-term survival after intracerebral hemorrhage (ICH) are scarce. In a population-based nested case-control study, we compared long-term survival and causes of death within 5 years in 30-day survivors of first-ever ICH and controls, assessed the impact of cardiovascular risk factors on 5-year mortality, and analyzed time trend in 5-year mortality in ICH patients over 2 decades. METHODS We included 219 participants from the population-based Tromsø Study, who after the baseline participation had a first-ever ICH between 1994 to 2013 and 1095 age- and sex-matched participants without ICH. Cumulative survival was presented using the Kaplan-Meier method. Hazard ratios (HRs) for mortality and for the association between cardiovascular risk factors and 5-year mortality in 30-day survivors were estimated by stratified Cox proportional hazards models. Trend in 5-year mortality was assessed by logistic regression. RESULTS Risk of death during follow-up (median time, 4.8 years) was increased in the ICH group compared with controls (HR, 1.62 [95% CI, 1.27-2.06]). Cardiovascular disease was the leading cause of death, with a higher proportion in ICH patients (22.9% versus 9.0%; P<0.001). Smoking increased the risk of 5-year mortality in cases and controls (HR, 1.59 [95% CI, 1.15-2.19]), whereas serum cholesterol was associated with 5-year mortality in cases only (HR, 1.39 [95% CI, 1.04-1.86]). Use of anticoagulants at ICH onset increased the risk of death (HR, 2.09 [95% CI, 1.09-4.00]). There was no difference according to ICH location (HR, 1.15 [95% CI, 0.56-2.37]). Five-year mortality did not change during the study period (odds ratio per calendar year, 1.01 [95% CI, 0.93-1.09]). CONCLUSIONS Survival rates were significantly lower in cases than in controls, driven by a 2-fold increased risk of cardiovascular death. Smoking, serum cholesterol, and use of anticoagulant drugs were associated with increased risk of death in ICH patients. Five-year mortality rates in ICH patients remained stable over time.
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Affiliation(s)
- Maria Carlsson
- Department of Clinical Medicine (M.C., S.H.J., L.-H.J., E.B.M.), UiT The Arctic University of Norway, Tromsø.,Department of Neurology, Nordland Hospital Trust, Bodø, Norway (M.C.)
| | - Tom Wilsgaard
- Department of Community Medicine (T.W., M.-L.L., I.N.), UiT The Arctic University of Norway, Tromsø
| | - Stein Harald Johnsen
- Department of Clinical Medicine (M.C., S.H.J., L.-H.J., E.B.M.), UiT The Arctic University of Norway, Tromsø.,Department of Neurology (S.H.J., E.B.M.), University Hospital of North Norway, Tromsø
| | - Liv-Hege Johnsen
- Department of Clinical Medicine (M.C., S.H.J., L.-H.J., E.B.M.), UiT The Arctic University of Norway, Tromsø.,Department of Radiology (L.-H.J.), University Hospital of North Norway, Tromsø
| | - Maja-Lisa Løchen
- Department of Community Medicine (T.W., M.-L.L., I.N.), UiT The Arctic University of Norway, Tromsø
| | - Inger Njølstad
- Department of Community Medicine (T.W., M.-L.L., I.N.), UiT The Arctic University of Norway, Tromsø
| | - Ellisiv B Mathiesen
- Department of Clinical Medicine (M.C., S.H.J., L.-H.J., E.B.M.), UiT The Arctic University of Norway, Tromsø.,Department of Neurology (S.H.J., E.B.M.), University Hospital of North Norway, Tromsø
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Guisado-Alonso D, Martínez-Domeño A, Prats-Sánchez L, Delgado-Mederos R, Camps-Renom P, Abilleira S, de la Ossa NP, Ramos-Pachón A, Cardona P, Rodríguez-Campello A, Molina CA, Rudilosso S, Martí-Fàbregas J. Reasons for Not Performing Mechanical Thrombectomy: A Population-Based Study of Stroke Codes. Stroke 2021; 52:2746-2753. [PMID: 34289711 DOI: 10.1161/strokeaha.120.032648] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Daniel Guisado-Alonso
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Spain (D.G.-A., A.M.-D., L.P.-S., R.D.-M., P.C.-R., J.M.-F.)
| | - Alejandro Martínez-Domeño
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Spain (D.G.-A., A.M.-D., L.P.-S., R.D.-M., P.C.-R., J.M.-F.)
| | - Luis Prats-Sánchez
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Spain (D.G.-A., A.M.-D., L.P.-S., R.D.-M., P.C.-R., J.M.-F.)
| | - Raquel Delgado-Mederos
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Spain (D.G.-A., A.M.-D., L.P.-S., R.D.-M., P.C.-R., J.M.-F.)
| | - Pol Camps-Renom
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Spain (D.G.-A., A.M.-D., L.P.-S., R.D.-M., P.C.-R., J.M.-F.)
| | - Sònia Abilleira
- Stroke Programme, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A., N.P.d.l.O.)
| | - Natalia Pérez de la Ossa
- Stroke Programme, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A., N.P.d.l.O.)
| | - Anna Ramos-Pachón
- Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (A.R.-P)
| | - Pere Cardona
- Department of Neurology, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.)
| | | | - Carlos A Molina
- Department of Neurology, Hospital Vall d'Hebrón, Barcelona, Spain (C.A.M.)
| | | | - Joan Martí-Fàbregas
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Universitat Autònoma de Barcelona (Department of Medicine), Spain (D.G.-A., A.M.-D., L.P.-S., R.D.-M., P.C.-R., J.M.-F.)
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Dragan B, Adamik B, Burzynska M, Dragan SL, Gozdzik W. Platelet Receptor Activity for Predicting Survival in Patients with Intracranial Bleeding. J Clin Med 2021; 10:2205. [PMID: 34069736 DOI: 10.3390/jcm10102205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/06/2021] [Accepted: 05/17/2021] [Indexed: 11/16/2022] Open
Abstract
Blood coagulation disorders in patients with intracranial bleeding as a result of head injuries or ruptured aneurysms are a diagnostic and therapeutic problem and appropriate assessments are needed to limit CNS damage and to implement preventive measures. The aim of the study was to monitor changes in platelet aggregation and to assess the importance of platelet dysfunction for predicting survival. Platelet receptor function analysis was performed using the agonists arachidonic acid (ASPI), adenosine diphosphate (ADP), collagen (COL), thrombin receptor activating protein (TRAP), ristocetin (RISTO) upon admission to the ICU and on days 2, 3, and 5. On admission, the ASPI, ADP, COL, TRAP, and RISTO tests indicated there was reduced platelet aggregation, despite there being a normal platelet count. In ‘Non-survivors’, the platelet response to all agonists was suppressed throughout the study period, while in ‘Survivors’ it improved. Measuring platelet function in ICU patients with intracranial bleeding is a strong predictor related to outcome: patients with impaired platelet aggregation had a lower 28-day survival rate compared to patients with normal platelet aggregation (log-rank test p = 0.014). The results indicated that measuring platelet aggregation can be helpful in the early detection, diagnosis, and treatment of bleeding disorders.
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Cascone AE, Daley MJ, Pan N, Padilla-Tolentino E, Milling TJ. Low-dose versus standard-dose four-factor prothrombin complex concentrate for factor-Xa inhibitor reversal in spontaneous and traumatic intracranial hemorrhage. Pharmacotherapy 2021; 41:501-507. [PMID: 33866591 DOI: 10.1002/phar.2525] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/12/2021] [Accepted: 03/12/2021] [Indexed: 01/05/2023]
Abstract
STUDY OBJECTIVES Current neurocritical care guidelines recommend 50 IU/kg four-factor prothrombin complex concentrate (4PCC) for factor Xa inhibitor (FXaI) reversal in intracranial hemorrhage (ICH) based on few clinical studies conducted among non-ICH subjects. Two recent studies suggest that low-dose (25 IU/kg) 4PCC may be similar to 50 IU/kg in reversal of FXaI in ICH, and both 25 and 50 IU/kg doses are used in clinical practice for this indication. To our knowledge, no studies have directly compared 25 IU/kg versus 50 IU/kg 4PCC for FXaI reversal in ICH. The purpose of this study is to determine whether there is a difference in hemostatic efficacy between 25 IU/kg versus 50 IU/kg 4PCC for FXaI reversal in ICH. DESIGN This multicenter, retrospective cohort study was performed in five hospitals in central Texas from November 2013 to December 2019. DATA SOURCE Patients were identified with a medication use report of 4PCC and were classified in the low- or standard-dose group based on whether the 25 IU/kg or 50 IU/kg dose was received, respectively. PATIENTS A total of 93 patients were included (25 IU/kg, n = 62; 50 IU/kg, n = 31). MEASUREMENTS AND MAIN RESULTS There was no difference in hemostatic efficacy between groups (82.3% low dose vs. 83.9% standard dose, p = 0.846). No differences were identified in-hospital mortality, length of stay, thrombotic events, or the need for surgery or additional blood products between groups. CONCLUSION For the reversal of FXaI in ICH, a 25 IU/kg dose may be an effective alternative to 50 IU/kg 4PCC dosing.
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Affiliation(s)
- Ava E Cascone
- Department of Pharmacy, Boston Medical Center, Boston, Massachusetts, USA
| | | | - Neil Pan
- Department of Pharmacy, Ascension Seton, Austin, Texas, USA
| | | | - Truman J Milling
- Department of Surgery, Dell Seton Medical Center at the University of Texas, Austin, Texas, USA.,Department of Neurology, Dell Seton Medical Center at the University of Texas, Austin, Texas, USA
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Shahjouei S, Tsivgoulis G, Farahmand G, Koza E, Mowla A, Vafaei Sadr A, Kia A, Vaghefi Far A, Mondello S, Cernigliaro A, Ranta A, Punter M, Khodadadi F, Naderi S, Sabra M, Ramezani M, Amini Harandi A, Olulana O, Chaudhary D, Lyoubi A, Campbell BCV, Arenillas JF, Bock D, Montaner J, Aghayari Sheikh Neshin S, Aguiar de Sousa D, Tenser MS, Aires A, Alfonso MDL, Alizada O, Azevedo E, Goyal N, Babaeepour Z, Banihashemi G, Bonati LH, Cereda CW, Chang JJ, Crnjakovic M, De Marchis GM, Del Sette M, Ebrahimzadeh SA, Farhoudi M, Gandoglia I, Gonçalves B, Griessenauer CJ, Murat Hanci M, Katsanos AH, Krogias C, Leker RR, Lotman L, Mai J, Male S, Malhotra K, Malojcic B, Mesquita T, Mir Ghasemi A, Mohamed Aref H, Mohseni Afshar Z, Moon J, Niemelä M, Rezai Jahromi B, Nolan L, Pandhi A, Park JH, Marto JP, Purroy F, Ranji-Burachaloo S, Carreira NR, Requena M, Rubiera M, Sajedi SA, Sargento-Freitas J, Sharma VK, Steiner T, Tempro K, Turc G, Ahmadzadeh Y, Almasi-Dooghaee M, Assarzadegan F, Babazadeh A, Baharvahdat H, Cardoso FB, Dev A, Ghorbani M, Hamidi A, Hasheminejad ZS, Hojjat-Anasri Komachali S, Khorvash F, Kobeissy F, Mirkarimi H, Mohammadi-Vosough E, Misra D, Noorian AR, Nowrouzi-Sohrabi P, Paybast S, Poorsaadat L, Roozbeh M, Sabayan B, Salehizadeh S, Saberi A, Sepehrnia M, Vahabizad F, Yasuda TA, Ghabaee M, Rahimian N, Harirchian MH, Borhani-Haghighi A, Azarpazhooh MR, Arora R, Ansari S, Avula V, Li J, Abedi V, Zand R. SARS-CoV-2 and Stroke Characteristics: A Report From the Multinational COVID-19 Stroke Study Group. Stroke 2021; 52:e117-e130. [PMID: 33878892 PMCID: PMC8078130 DOI: 10.1161/strokeaha.120.032927] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose: Stroke is reported as a consequence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in several reports. However, data are sparse regarding the details of these patients in a multinational and large scale. Methods: We conducted a multinational observational study on features of consecutive acute ischemic stroke, intracranial hemorrhage, and cerebral venous or sinus thrombosis among SARS-CoV-2–infected patients. We further investigated the risk of large vessel occlusion, stroke severity as measured by the National Institutes of Health Stroke Scale, and stroke subtype as measured by the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria among patients with acute ischemic stroke. In addition, we explored the neuroimaging findings, features of patients who were asymptomatic for SARS-CoV-2 infection at stroke onset, and the impact of geographic regions and countries’ health expenditure on outcomes. Results: Among the 136 tertiary centers of 32 countries who participated in this study, 71 centers from 17 countries had at least 1 eligible stroke patient. Of 432 patients included, 323 (74.8%) had acute ischemic stroke, 91 (21.1%) intracranial hemorrhage, and 18 (4.2%) cerebral venous or sinus thrombosis. A total of 183 (42.4%) patients were women, 104 (24.1%) patients were <55 years of age, and 105 (24.4%) patients had no identifiable vascular risk factors. Among acute ischemic stroke patients, 44.5% (126 of 283 patients) had large vessel occlusion; 10% had small artery occlusion according to the TOAST criteria. We observed a lower median National Institutes of Health Stroke Scale (8 [3–17] versus 11 [5–17]; P=0.02) and higher rate of mechanical thrombectomy (12.4% versus 2%; P<0.001) in countries with middle-to-high health expenditure when compared with countries with lower health expenditure. Among 380 patients who had known interval onset of the SARS-CoV-2 and stroke, 144 (37.8%) were asymptomatic at the time of admission for SARS-CoV-2 infection. Conclusions: We observed a considerably higher rate of large vessel occlusions, a much lower rate of small vessel occlusion and lacunar infarction, and a considerable number of young stroke when compared with the population studies before the pandemic. The rate of mechanical thrombectomy was significantly lower in countries with lower health expenditures.
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Affiliation(s)
- Shima Shahjouei
- Neurology Department, Neuroscience Institute, Geisinger Health System, PA (S. Shahjouei, A. Mowla, D.C., C.J.G., R.Z.)
| | - Georgios Tsivgoulis
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, Greece (G. Tsivgoulis, A.H.K.)
| | - Ghasem Farahmand
- Iranian Center of Neurological Research, Neuroscience Institute (G.F., S.R.-B., M. Ghabaee, M.H.H.), Tehran University of Medical Sciences, Iran.,Neurology Department (G.F., A.V.F., M. Ghabaee), Tehran University of Medical Sciences, Iran
| | - Eric Koza
- Geisinger Commonwealth School of Medicine, Scranton, PA (E.K., O.O.)
| | - Ashkan Mowla
- Neurology Department, Neuroscience Institute, Geisinger Health System, PA (S. Shahjouei, A. Mowla, D.C., C.J.G., R.Z.).,Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, CA (A. Mowla, M.S.T.)
| | - Alireza Vafaei Sadr
- Department de Physique Theorique and Center for Astroparticle Physics, University Geneva, Switzerland (A.V.S.)
| | - Arash Kia
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Institute for Healthcare Delivery Science, New York City, NY (A.K.)
| | - Alaleh Vaghefi Far
- Neurology Department (G.F., A.V.F., M. Ghabaee), Tehran University of Medical Sciences, Iran
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy (S. Mondello)
| | | | - Annemarei Ranta
- Department of Neurology, Wellington Hospital, New Zealand and Department of Medicine, University of Otago, New Zealand (A.R., M.P.)
| | - Martin Punter
- Department of Neurology, Wellington Hospital, New Zealand and Department of Medicine, University of Otago, New Zealand (A.R., M.P.)
| | - Faezeh Khodadadi
- PES University, Bangaluru, Karnataka, India (F. Khodadadi, A.D.)
| | - Soheil Naderi
- Department of Neurosurgery (S.N.), Tehran University of Medical Sciences, Iran
| | - Mirna Sabra
- Neurosciences Research Center, Lebanese University/Medical School, Beirut, Lebanon (M. Sabra, F. Kobeissy)
| | - Mahtab Ramezani
- Neurology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran (M. Ramezani, A.A.H.)
| | - Ali Amini Harandi
- Neurology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran (M. Ramezani, A.A.H.)
| | - Oluwaseyi Olulana
- Geisinger Commonwealth School of Medicine, Scranton, PA (E.K., O.O.)
| | - Durgesh Chaudhary
- Neurology Department, Neuroscience Institute, Geisinger Health System, PA (S. Shahjouei, A. Mowla, D.C., C.J.G., R.Z.)
| | - Aicha Lyoubi
- Neurology Department, Delafontaine Hospital, Saint-Denis, France (A.L.)
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (B.C.V.C.)
| | - Juan F Arenillas
- Department of Neurology, University of Valladolid, Spain (J.F.A., M.D.L.A.)
| | - Daniel Bock
- Department of Cardiology, Klinikum Frankfurt Höchst, Germany (D.B.)
| | - Joan Montaner
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain (J. Montaner)
| | | | - Diana Aguiar de Sousa
- Department of Neurology (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal.,Department of Neurology, Hospital de Santa Maria, University of Lisbon, Portugal (D.A.d.S.)
| | - Matthew S Tenser
- Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, CA (A. Mowla, M.S.T.)
| | - Ana Aires
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal (A.A., E.A.).,Department of Medicine, University of Porto, Portugal (A.A., E.A.)
| | | | - Orkhan Alizada
- Neurosurgery Department, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Turkey (O.A., M.M.H.)
| | - Elsa Azevedo
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal (A.A., E.A.).,Department of Medicine, University of Porto, Portugal (A.A., E.A.)
| | - Nitin Goyal
- Department of Neurology, University of Tennessee (N.G., A.P., S.A.)
| | | | - Gelareh Banihashemi
- Imam Khomeini Hospital, and Neurology Department, Sina Hospital (G.B., F.V.), Tehran University of Medical Sciences, Iran
| | - Leo H Bonati
- Department of Neurology and Stroke Unit, University Hospital Basel, Switzerland (L.H.B.)
| | - Carlo W Cereda
- Stroke Center, Neurocenter of Southern Switzerland, Lugano (C.W.C.)
| | - Jason J Chang
- Department of Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC (J.J.C.)
| | - Miljenko Crnjakovic
- Intensive Care Unit, Department of Neurology, Clinical Hospital Dubrava, Zagreb, Croatia (M.C.)
| | - Gian Marco De Marchis
- Neurorehabilitation Unit, University Center for Medicine of Aging and Rehabilitation Basel, Felix Platter Hospital, University of Basel, Switzerland (G.D.M.)
| | | | | | - Mehdi Farhoudi
- Neurosciences Research Center, Tabriz University of Medical Sciences, Iran (M.F.)
| | | | - Bruno Gonçalves
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, France (B.G., G. Turc)
| | - Christoph J Griessenauer
- Neurology Department, Neuroscience Institute, Geisinger Health System, PA (S. Shahjouei, A. Mowla, D.C., C.J.G., R.Z.)
| | - Mehmet Murat Hanci
- Neurosurgery Department, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Turkey (O.A., M.M.H.)
| | - Aristeidis H Katsanos
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, Greece (G. Tsivgoulis, A.H.K.).,Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, ON, Canada (A.H.K.)
| | - Christos Krogias
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Germany (C.K.)
| | - Ronen R Leker
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel (R.R.L.)
| | - Lev Lotman
- Department of Neurology, Albany Medical Center, NY (L.L., L.N., K.T.)
| | - Jeffrey Mai
- Department of Neurosurgery, Georgetown University and MedStar Washington Hospital Center, DC (J. Mai)
| | - Shailesh Male
- Department of Neurosurgery, Vidant Medical Center, Greenville, NC (S. Male)
| | - Konark Malhotra
- Department of Neurology, Allegheny Health Network, Pittsburgh, PA (K.M.)
| | - Branko Malojcic
- Department of Neurology, TIA Clinic, University Hospital Centre Zagreb, Zagreb School of Medicine, University of Zagreb, Croatia (B.M.)
| | - Teresa Mesquita
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal (T.M., J.P.M.)
| | | | - Hany Mohamed Aref
- Department of Neurology, Ain Shams University, Cairo, Egypt (H.M.A.)
| | - Zeinab Mohseni Afshar
- Infection Disease Research Center, Kermanshah University of Medical Sciences, Iran (Z.M.A.)
| | - Jusun Moon
- Department of Neurology, National Medical Center, Seoul, South Korea (J. Moon)
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University and Helsinki University Hospital, Finland (M.N., B.R.J.)
| | - Behnam Rezai Jahromi
- Department of Neurosurgery, Helsinki University and Helsinki University Hospital, Finland (M.N., B.R.J.)
| | - Lawrence Nolan
- Department of Neurology, Albany Medical Center, NY (L.L., L.N., K.T.)
| | - Abhi Pandhi
- Department of Neurology, University of Tennessee (N.G., A.P., S.A.)
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, South Korea (J.-H.P.)
| | - João Pedro Marto
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal (T.M., J.P.M.)
| | - Francisco Purroy
- Department of Neurology, Hospital Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida, Universitat de Lleida, Spain (F.P., N.R.C.)
| | - Sakineh Ranji-Burachaloo
- Iranian Center of Neurological Research, Neuroscience Institute (G.F., S.R.-B., M. Ghabaee, M.H.H.), Tehran University of Medical Sciences, Iran
| | - Nuno Reis Carreira
- Department of Internal Medicine (N.E.C.), Hospital de Santa Maria, University of Lisbon, Portugal.,Department of Neurology, Hospital Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida, Universitat de Lleida, Spain (F.P., N.R.C.)
| | - Manuel Requena
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron Barcelona, Spain (M. Requena, M. Rubiera).,Department de Medicina, Universitat Autònoma de Barcelona, Spain (M. Requena, M. Rubiera)
| | - Marta Rubiera
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron Barcelona, Spain (M. Requena, M. Rubiera).,Department de Medicina, Universitat Autònoma de Barcelona, Spain (M. Requena, M. Rubiera)
| | - Seyed Aidin Sajedi
- Department of Neurology, Neuroscience Research Center, Golestan University of Medical Sciences, Iran (S.A.S.)
| | - João Sargento-Freitas
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal (J.S.-F.)
| | - Vijay K Sharma
- Division of Neurology, University Medicine Cluster, National University Health System, Singapore (V.K.S.)
| | - Thorsten Steiner
- Department of Neurology, Klinikum Frankfurt Höchst, Germany (T.S.).,Department of Neurology, Heidelberg University Hospital, Germany (T.S.)
| | - Kristi Tempro
- Department of Neurology, Albany Medical Center, NY (L.L., L.N., K.T.)
| | - Guillaume Turc
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, France (B.G., G. Turc)
| | | | - Mostafa Almasi-Dooghaee
- Divisions of Vascular and Endovascular Neurosurgery (M.A.-D., M. Ghorbani), Firoozgar Hospital, Iran University of Medical Sciences, Tehran.,Neurology (M.A.-D.), Firoozgar Hospital, Iran University of Medical Sciences, Tehran.,Divisions of Vascular and Endovascular Neurosurgery (M.A.-D.), Rasoul-Akram Hospital, Iran University of Medical Sciences, Tehran.,Neurology (M.A.-D.), Rasoul-Akram Hospital, Iran University of Medical Sciences, Tehran
| | | | - Arefeh Babazadeh
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Iran (A.B.)
| | - Humain Baharvahdat
- Neurosurgical Department, Ghaem Hospital, Mashhad University of Medical Sciences, Iran (H.B.)
| | | | - Apoorva Dev
- PES University, Bangaluru, Karnataka, India (F. Khodadadi, A.D.)
| | - Mohammad Ghorbani
- Divisions of Vascular and Endovascular Neurosurgery (M.A.-D., M. Ghorbani), Firoozgar Hospital, Iran University of Medical Sciences, Tehran
| | - Ava Hamidi
- Neurology Ward, Gheshm Hospital, Iran (A.H.)
| | - Zeynab Sadat Hasheminejad
- Department of Neurology, Imam Hosein Hospital, Shahid Beheshti Medical University, Tehran, Iran (Z.S.H., M. Sepehrnia)
| | | | - Fariborz Khorvash
- Neurology Department, Isfahan University of Medical Sciences, Iran (F. Khorvash)
| | - Firas Kobeissy
- Neurosciences Research Center, Lebanese University/Medical School, Beirut, Lebanon (M. Sabra, F. Kobeissy).,Program of Neurotrauma, Neuroproteomics and Biomarker Research, University of Florida (F. Kobeissy)
| | | | | | - Debdipto Misra
- Steele Institute of Health and Innovation, Geisinger Health System, PA (D.M.)
| | - Ali Reza Noorian
- Department of Neurology, Southern California Permanente Medical Group, Irvine, CA (A.R.N.)
| | | | - Sepideh Paybast
- Department of Neurology, Bou Ali Hospital, Qazvin University of Medical Sciences, Iran (S.P.)
| | - Leila Poorsaadat
- Department of Neurology, Arak University of Medical Sciences, Iran (L.P.)
| | - Mehrdad Roozbeh
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran (M. Roozbeh)
| | - Behnam Sabayan
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (B.S.)
| | - Saeideh Salehizadeh
- Neurology Department, Salahadin Ayubi Hospital, Baneh, Iran (S. Salehizadeh)
| | - Alia Saberi
- Neurology Department, Poursina Hospital, Rasht, Guilan, Iran (S.A.S.N., A.S.)
| | - Mercedeh Sepehrnia
- Department of Neurology, Imam Hosein Hospital, Shahid Beheshti Medical University, Tehran, Iran (Z.S.H., M. Sepehrnia)
| | - Fahimeh Vahabizad
- Imam Khomeini Hospital, and Neurology Department, Sina Hospital (G.B., F.V.), Tehran University of Medical Sciences, Iran
| | | | - Mojdeh Ghabaee
- Iranian Center of Neurological Research, Neuroscience Institute (G.F., S.R.-B., M. Ghabaee, M.H.H.), Tehran University of Medical Sciences, Iran.,Neurology Department (G.F., A.V.F., M. Ghabaee), Tehran University of Medical Sciences, Iran
| | - Nasrin Rahimian
- Department of Neurology, Yasrebi Hospital, Kashan, Iran (N.R.)
| | - Mohammad Hossein Harirchian
- Iranian Center of Neurological Research, Neuroscience Institute (G.F., S.R.-B., M. Ghabaee, M.H.H.), Tehran University of Medical Sciences, Iran
| | | | | | - Rohan Arora
- Department of Neurology, Long Island Jewish Forest Hills, Queens, NY (R.A.)
| | - Saeed Ansari
- Department of Neurology, University of Tennessee (N.G., A.P., S.A.)
| | - Venkatesh Avula
- Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA (V. Avula, V. Abedi, J.L.)
| | - Jiang Li
- Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA (V. Avula, V. Abedi, J.L.).,Biocomplexity Institute, Virginia Tech, Blacksburg, VA (J.L., V. Abedi)
| | - Vida Abedi
- Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA (V. Avula, V. Abedi, J.L.).,Biocomplexity Institute, Virginia Tech, Blacksburg, VA (J.L., V. Abedi)
| | - Ramin Zand
- Neurology Department, Neuroscience Institute, Geisinger Health System, PA (S. Shahjouei, A. Mowla, D.C., C.J.G., R.Z.)
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Chaudhari PP, Pineda JA, Bachur RG, Khemani RG. Trends and variation in repeat neuroimaging for children with traumatic intracranial hemorrhage. J Am Coll Emerg Physicians Open 2021; 2:e12400. [PMID: 33733248 PMCID: PMC7936793 DOI: 10.1002/emp2.12400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/22/2021] [Accepted: 02/12/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES We aimed to determine trends and institutional variation in repeat neuroimaging in children with traumatic intracranial hemorrhage and to identify factors associated with neuroimaging modality (subsequent magnetic resonance imaging [MRI] vs computed tomography [CT]). METHODS We conducted a retrospective cross-sectional study of 35 hospitals in the Pediatric Health Information System database. We included children <18 years of age hospitalized from 2010-2019 with intracranial hemorrhage and who underwent a brain CT. We calculated repeat neuroimaging rates by modality and used regression analyses to examine temporal trends. We used hierarchical logistic regression to identify factors associated with subsequent MRI versus repeat CT, controlling for hospital. RESULTS We identified 12,714 children with intracranial hemorrhage, of which 5072 with repeat neuroimaging were studied. Of the 5072 children with repeat neuroimaging, repeat CT was performed in 67.6% (n = 3429) and subsequent MRI in 32.4% (n = 1643). Overall repeat neuroimaging with either a CT or MRI remained similar from 2010-2019 (P = 0.431); however, repeat CT scans significantly decreased (P = 0.001); whereas, MRIs significantly increased (P < 0.001). Repeat neuroimaging by hospital ranged from 20%-80%. After controlling for institution, subsequent MRI was more likely to be used in younger children and children who did not receive hyperosmotic agents, neurosurgical interventions, or intensive care unit admission (all P-values <0.001). CONCLUSIONS We found that repeat neuroimaging rates for children with intracranial hemorrhage vary substantially by institution. We also found that although MRI was increasingly used to re-image these children, overall repeat neuroimaging rates (CT or MRI) have not decreased over the past decade. Future work to implement optimal utilization of neuroimaging in these children is needed.
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Affiliation(s)
- Pradip P. Chaudhari
- Division of Emergency and Transport MedicineChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
- Keck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Jose A. Pineda
- Keck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA
- Department of Anesthesia and Critical Care MedicineChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
| | - Richard G. Bachur
- Division of Emergency MedicineBoston Children's Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Robinder G. Khemani
- Keck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA
- Department of Anesthesia and Critical Care MedicineChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
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39
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Kumar S, Kale HA. Remote cerebellar haemorrhage: A case report. Indian J Radiol Imaging 2021; 30:521-523. [PMID: 33737786 PMCID: PMC7954161 DOI: 10.4103/ijri.ijri_123_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/28/2020] [Accepted: 09/01/2020] [Indexed: 12/03/2022] Open
Abstract
Intracranial haemorrhage after supra-tentorial craniotomies can occur in a typical pattern and location which may suggest the diagnosis of remote cerebellar haemorrhage (RCH) which is quite a rare occurrence. The ‘Zebra Sign’ refers to a pattern of hyperdensity indicative of blood and hypodensity indicative of normal cerebellar parenchyma in a curvilinear, stripe-like fashion along the cerebellar folia and is a characteristic imaging finding in RCH. RCH in general doesn't require surgical treatment, however in cases of significant hydrocephalus or progressive deterioration of consciousness surgical treatment may be warranted. The knowledge of this condition is important as it can pre-empt unnecessary further investigations and biopsy. Although imaging appearance may be striking, close imaging follow-up and clinical monitoring are often enough for the management of this entity.
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Affiliation(s)
- Sachin Kumar
- Department of Radiology, Kokilaben Dhirubhai Ambani Hopsital and Research Institute, Mumbai, Maharashtra, India
| | - Hrishikesh A Kale
- Department of Radiology, Kokilaben Dhirubhai Ambani Hopsital and Research Institute, Mumbai, Maharashtra, India
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40
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Affiliation(s)
- Erik Freitag
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Germany (E.F., M.K., J.E.W., H.J.A.)
| | - Maximilian Kaffes
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Germany (E.F., M.K., J.E.W., H.J.A.)
| | - Joachim E Weber
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Germany (E.F., M.K., J.E.W., H.J.A.)
- Berlin Institute of Health (BIH), Berlin, Germany (J.E.W.)
| | - Heinrich J Audebert
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Germany (E.F., M.K., J.E.W., H.J.A.)
- Centre for Stroke Research Berlin, Germany (J.E.W., H.J.A.)
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41
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Haga M, Itoh K, Horikoshi T, Namba F, Kabe K. Severe Consumptive Coagulopathy in an Extremely-Low-Birth-Weight Infant with Intra-Abdominal Umbilical Vein Varix: A Case Report. AJP Rep 2021; 11:e76-e79. [PMID: 34055464 PMCID: PMC8159582 DOI: 10.1055/s-0041-1727288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/15/2021] [Indexed: 10/27/2022] Open
Abstract
Recent studies have shown favorable outcomes for intra-abdominal umbilical vein varices (IUVVs) in term neonates who have no other complications. Little is known, however, about the prognosis of IUVVs in preterm neonates. We encountered a case of IUVV in an extremely low-birth-weight infant who developed severe consumptive coagulopathy after birth. The patient's coagulation test normalized as the varix spontaneously obstructed. Although life-threatening hemorrhagic complications were avoided, a cerebellum hemorrhage was found in the brain magnetic resonance imaging at the term-equivalent age. In a literature survey, coagulopathy was reported in 4 out of 15 infants with IUVVs born before 34 weeks of gestation, including our present case. Preterm infants with IUVVs may develop coagulopathy because of the prematurity of their coagulation-fibrinolysis systems. Attention should be given to the coagulation status of preterm neonates with IUVVs.
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Affiliation(s)
- Mitsuhiro Haga
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Kanako Itoh
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Tsuguhiro Horikoshi
- Maternal and Fetal Medicine, Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Fumihiko Namba
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Kazuhiko Kabe
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
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42
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Wallau CAK, Costa-Nobre DT, Leslie ATFS, Guinsburg R. Impact of bundle implementation on the incidence of peri/intraventricular hemorrhage among preterm infants: a pre-post interventional study. SAO PAULO MED J 2021; 139:251-258. [PMID: 33978129 PMCID: PMC9625011 DOI: 10.1590/1516-3180.2020.0412.r1.28012021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 01/28/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Peri/intraventricular hemorrhage (PIVH) is a frequent cause of death and morbidity among preterm infants. Few studies have addressed the use of bundles for preventing PIVH. OBJECTIVE To evaluate the efficacy of a bundle of interventions designed to decrease the incidence of intraventricular hemorrhage at hospital discharge among preterm infants. DESIGN AND SETTING Pre-post interventional study with retrospective and prospective data collection performed before and after bundle implementation in the neonatal intensive care unit of a university hospital. METHODS Infants with gestational age < 32 weeks without malformations, who survived > 6 days were included. The bundle consisted of the following actions during the first 72 hours of life: maintenance of head in neutral position with the body in supine position, minimal handling, including delay of lumbar puncture until after 72 hours and absence of respiratory therapy maneuvers. Cranial ultrasound was performed on days 3, 7 and 28, or later if needed. The effect of the bundle was analyzed through logistic regression and results were adjusted for confounding variables. RESULTS 167 infants met the inclusion criteria; 146 (87%) were analyzed. Bundle implementation was associated with decreased chances of PIVH at hospital discharge (odds ratio 0.29; 95% confidence interval 0.13-0.65). Cerebrospinal fluid collection within the first 72 hours increased the odds of PIVH of any grade during the hospital stay fourfold, after adjustment for all variables included in the model. CONCLUSION Implementation of a bundle of interventions to avoid intraventricular hemorrhage was effective for decreasing the incidence of all grades of PIVH in preterm infants.
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Affiliation(s)
- Cristiane Akemi Koyama Wallau
- MSc. Postgraduate Student. Neonatal Division, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo (SP), Brazil
| | - Daniela Testoni Costa-Nobre
- MD, PhD. Adjunct Professor, Neonatal Division, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo (SP), Brazil
| | - Ana Teresa Figueiredo Stochero Leslie
- MD, MSc, PhD. Adjunct Professor, Neonatal Division, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo (SP), Brazil
| | - Ruth Guinsburg
- MD, PhD. Full Professor, Neonatal Division, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo (SP), Brazil
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43
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Greenway MRF, Erben Y, Huang JF, Siegel JL, Lamb CJ, Badi MK, Sakusic A, Gopal N, Meschia JF, Lin MP. Yield of Head Imaging in Ambulatory and Hospitalized Patients With SARS-CoV-2: A Multi-Center Study of 8675 Patients. Neurohospitalist 2020; 11:221-228. [PMID: 34155446 PMCID: PMC7746954 DOI: 10.1177/1941874420980622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background and Purpose: To describe the neurological and cerebrovascular findings in patients who
tested positive for SARS-CoV-2 and underwent head imaging in ambulatory and
inpatient settings. Methods: Consecutive patients aged ≥18 years with SARS-CoV-2 infection diagnosed or
treated at Mayo Clinic sites from 3/11/2020 to 7/23/2020 with head CT or
brain MRI within 30 days of SARS-CoV-2 diagnosis were included.
Demographics, medical history, indication for SARS-CoV-2 testing, neurologic
symptoms, indication for brain imaging, neuroimaging findings, etiology of
cerebrovascular events, and hospital course were abstracted from medical
records. Results: Of 8,675 patients with SARS-CoV-2, 180 (2.07%) had head imaging. Mean age of
the entire cohort was 42 ± 18 years, whereas mean age of those with head
imaging was 62 ± 19 years. Common indications for imaging were headache
(34.4%), encephalopathy (33.4%), focal neurologic symptom (16.7%), and
trauma (13.9%). While 86.1% of patients who underwent head imaging had
normal exams, cerebrovascular events occurred in 18 patients (0.21% of the
total cohort). Of patients with cerebrovascular events, 8 (44.5%) had acute
infarct; 6 (33.3%), acute intracranial hemorrhage; 5 (2.8%), subacute
infarct; and 1 (0.6%) posterior reversible encephalopathy syndrome. In the
thirteen patients with ischemic stroke, 6 (46.2%) had cryptogenic stroke; 3
(23.1%), other defined causes; 2 (15.4%), small vessel stroke; 1 (7.7%),
large vessel stroke; and 1 (7.7%) cardioembolic stroke. Conclusion: In ambulatory and hospitalized patients with SARS-CoV-2 infection, the rate
of head imaging is low, with common indications of encephalopathy and
headache. Cerebrovascular events occurred rarely, and cryptogenic stroke was
the most common stroke mechanism.
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Affiliation(s)
| | - Young Erben
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | - Jason L Siegel
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.,Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA.,Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Christopher J Lamb
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.,Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Mohammed K Badi
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.,Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Amra Sakusic
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.,Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Neethu Gopal
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Michelle P Lin
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
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Pérez-García C, Moreu M, Rosati S, Simal P, Egido JA, Gomez-Escalonilla C, Arrazola J. Mechanical Thrombectomy in Medium Vessel Occlusions: Blind Exchange With Mini-Pinning Technique Versus Mini Stent Retriever Alone. Stroke 2020; 51:3224-3231. [PMID: 33070712 DOI: 10.1161/strokeaha.120.030815] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Mechanical thrombectomy techniques for intracranial medium vessel occlusions (MeVOs) have evolved in recent years, although the optimal approach is still unclear. The aim of this study was to investigate the effectiveness and safety of mechanical thrombectomy in MeVOs using mini (0.017 inches microcatheter compatible) stent retrievers combined with low-profile (0.035 inches distal inner diameter) distal aspiration catheters through the blind exchange/mini-pinning (BEMP) technique compared with mini stent retrievers alone. METHODS Retrospective review of a prospectively maintained database of patients treated with the BEMP technique or mini stent retriever alone for intracranial MeVOs from 2017 to 2020 in a comprehensive stroke center. Both groups were compared about baseline characteristics, occlusion site, clinical presentation, clot cause, procedural outcomes (MeVO first-pass and final expanded Thrombolysis in Cerebral Ischemia score, the mini stent retriever used, number of passes with the front-line approach, and need of rescue therapy), safety outcomes (emboli to unwanted territories and hemorrhagic complications), and clinical outcomes at 90 days. Multivariable logistic regression analysis was performed with potential predictors of vessel recanalization to find independent variables associated with MeVO first-pass expanded Thrombolysis in Cerebral Ischemia 2c/3 recanalization. RESULTS We reviewed 102 patients/106 MeVOs treated with the BEMP technique (n=56) or mini stent retriever (n=50). There was a higher rate of MeVO first-pass expanded Thrombolysis in Cerebral Ischemia 2c/3 recanalization (57% versus 34%, P=0.017), lower need of rescue therapy (7.1% versus 22%, P=0.028), and lower rate of emboli to new territory (1.8% versus 12%, P=0.035) and symptomatic intracranial hemorrhage (1.9% versus 12.8%, P=0.038) with the BEMP technique. After multivariable analysis, the sole independent factor associated to MeVO first-pass expanded Thrombolysis in Cerebral Ischemia 2c/3 recanalization was the BEMP technique (odds ratio, 2.72 [95% CI, 1.19-6.22]; P=0.018). CONCLUSIONS In the setting of MeVOs, the BEMP technique may lead to higher rates of the first-pass recanalization and a lower incidence of symptomatic intracranial hemorrhage than mini stent retrievers alone.
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Affiliation(s)
- Carlos Pérez-García
- Department of Interventional Neuroradiology (C.P.-G., M.M., S.R.), Hospital Clínico San Carlos, Madrid, Spain
| | - Manuel Moreu
- Department of Interventional Neuroradiology (C.P.-G., M.M., S.R.), Hospital Clínico San Carlos, Madrid, Spain
| | - Santiago Rosati
- Department of Interventional Neuroradiology (C.P.-G., M.M., S.R.), Hospital Clínico San Carlos, Madrid, Spain
| | - Patricia Simal
- Department of Neurology (P.S., J.A.E., C.G.-E.), Hospital Clínico San Carlos, Madrid, Spain
| | - Jose Antonio Egido
- Department of Neurology (P.S., J.A.E., C.G.-E.), Hospital Clínico San Carlos, Madrid, Spain
| | | | - Juan Arrazola
- Department of Radiology (J.A.), Hospital Clínico San Carlos, Madrid, Spain
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45
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Warad D, Ismail M, Rusk D, Rodriguez V, Pruthi RK. Risk of perinatal intracranial hemorrhage and role of prenatal genetic testing in individuals with type 3 von Willebrand disease. J Thromb Haemost 2020; 18:2779-2780. [PMID: 33460294 DOI: 10.1111/jth.15000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Deepti Warad
- Special Coagulation Laboratory, Division of Hematopathology, Mayo Clinic, Rochester, Minnesota, USA
- Division of Pediatric Hematology Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Maryama Ismail
- Mayo Medical School, Mayo Clinic, Rochester, Minnesota, USA
| | - Dawn Rusk
- Division of Pediatric Hematology Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Vilmarie Rodriguez
- Division of Pediatric Hematology Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rajiv K Pruthi
- Special Coagulation Laboratory, Division of Hematopathology, Mayo Clinic, Rochester, Minnesota, USA
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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46
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Copelan A, Drocton G, Caton MT, Smith ER, Cooke DL, Nelson J, Abla AA, Fox C, Amans MR, Dowd CF, Halbach VV, Higashida RT, Lawton MT, Kim H, Fullerton HJ, Gupta N, Hetts SW. Brain Arteriovenous Malformation Recurrence After Apparent Microsurgical Cure: Increased Risk in Children Who Present With Arteriovenous Malformation Rupture. Stroke 2020; 51:2990-2996. [PMID: 32912090 DOI: 10.1161/strokeaha.120.030135] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Do children have an increased risk for brain arteriovenous malformation (AVM) recurrence compared with adults and does this risk vary depending on initial presentation with AVM rupture? METHODS We retrospectively studied 115 patients initially presenting with brain AVM under age 25 years who underwent complete surgical resection of the AVM as documented by digital subtraction angiography (DSA) and had delayed follow-up DSA to evaluate for AVM recurrence after apparent initial cure. RESULTS The mean time from baseline DSA to follow-up DSA was 2.3 years, ranging from 0 to 15 years. Twelve patients (10.4% of the 115 patient cohort and 16.7% of 72 patients with hemorrhage at initial presentation) demonstrated AVM recurrence on follow-up DSA. All patients with recurrence initially presented with intracranial hemorrhage, and intracranial hemorrhage was a significant predictor of recurrence (log rank P=0.037). Among patients with initial hemorrhage, the 5-year recurrence rate was 17.8% (95% CI, 8.3%-35.7%). All recurrences occurred in patients who were children at the time of their initial presentation; the oldest was 15 years of age at the time of initial AVM surgery. The 5-year recurrence rate for children (0-18 years of age) with an initial presentation of hemorrhage was 21.4% (95% CI, 10.1%-41.9%). Using Cox regression, we found the risk of AVM recurrence decreased by 14% per each year increase in age at the time of initial surgical resection (hazard ratio=0.86 [95% CI, 0.75-0.99]; P=0.031). CONCLUSIONS There is a high rate of recurrence of apparently cured brain AVMs in children who initially present with AVM rupture. Imaging follow-up is warranted to prevent re-rupture.
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Affiliation(s)
- Alexander Copelan
- Division of Neurointerventional Radiology, Department of Radiology and Biomedical Imaging (A.C., G.D., M.T.C., E.R.S., D.L.C., M.R.A., C.F.D., V.V.H., R.T.H., S.W.H.), University of California, San Francisco
| | - Gerald Drocton
- Division of Neurointerventional Radiology, Department of Radiology and Biomedical Imaging (A.C., G.D., M.T.C., E.R.S., D.L.C., M.R.A., C.F.D., V.V.H., R.T.H., S.W.H.), University of California, San Francisco
| | - M Travis Caton
- Division of Neurointerventional Radiology, Department of Radiology and Biomedical Imaging (A.C., G.D., M.T.C., E.R.S., D.L.C., M.R.A., C.F.D., V.V.H., R.T.H., S.W.H.), University of California, San Francisco
| | - Eric R Smith
- Division of Neurointerventional Radiology, Department of Radiology and Biomedical Imaging (A.C., G.D., M.T.C., E.R.S., D.L.C., M.R.A., C.F.D., V.V.H., R.T.H., S.W.H.), University of California, San Francisco
| | - Daniel L Cooke
- Division of Neurointerventional Radiology, Department of Radiology and Biomedical Imaging (A.C., G.D., M.T.C., E.R.S., D.L.C., M.R.A., C.F.D., V.V.H., R.T.H., S.W.H.), University of California, San Francisco.,Center for Cerebrovascular Research (D.L.C., J.N., A.A.A., C.F., M.R.A., C.F.D., V.V.H., R.T.H., H.K., H.J.F., N.G., S.W.H.), University of California, San Francisco.,Pediatric Brain Center (D.L.C., A.A.A., C.F., M.R.A., C.F.D., V.V.H., R.T.H., H.J.F., S.W.H.), University of California, San Francisco
| | - Jeffrey Nelson
- Center for Cerebrovascular Research (D.L.C., J.N., A.A.A., C.F., M.R.A., C.F.D., V.V.H., R.T.H., H.K., H.J.F., N.G., S.W.H.), University of California, San Francisco
| | - Adib A Abla
- Center for Cerebrovascular Research (D.L.C., J.N., A.A.A., C.F., M.R.A., C.F.D., V.V.H., R.T.H., H.K., H.J.F., N.G., S.W.H.), University of California, San Francisco.,Pediatric Brain Center (D.L.C., A.A.A., C.F., M.R.A., C.F.D., V.V.H., R.T.H., H.J.F., S.W.H.), University of California, San Francisco.,Division of Cerebrovascular Neurosurgery, Department of Neurological Surgery (A.A.A., C.F.D., V.V.H., R.T.H.), University of California, San Francisco
| | - Christine Fox
- Center for Cerebrovascular Research (D.L.C., J.N., A.A.A., C.F., M.R.A., C.F.D., V.V.H., R.T.H., H.K., H.J.F., N.G., S.W.H.), University of California, San Francisco.,Pediatric Brain Center (D.L.C., A.A.A., C.F., M.R.A., C.F.D., V.V.H., R.T.H., H.J.F., S.W.H.), University of California, San Francisco.,Departments of Neurology and Pediatrics (C.F., H.J.F.), University of California, San Francisco
| | - Matthew R Amans
- Division of Neurointerventional Radiology, Department of Radiology and Biomedical Imaging (A.C., G.D., M.T.C., E.R.S., D.L.C., M.R.A., C.F.D., V.V.H., R.T.H., S.W.H.), University of California, San Francisco.,Center for Cerebrovascular Research (D.L.C., J.N., A.A.A., C.F., M.R.A., C.F.D., V.V.H., R.T.H., H.K., H.J.F., N.G., S.W.H.), University of California, San Francisco.,Pediatric Brain Center (D.L.C., A.A.A., C.F., M.R.A., C.F.D., V.V.H., R.T.H., H.J.F., S.W.H.), University of California, San Francisco
| | - Christopher F Dowd
- Division of Neurointerventional Radiology, Department of Radiology and Biomedical Imaging (A.C., G.D., M.T.C., E.R.S., D.L.C., M.R.A., C.F.D., V.V.H., R.T.H., S.W.H.), University of California, San Francisco.,Center for Cerebrovascular Research (D.L.C., J.N., A.A.A., C.F., M.R.A., C.F.D., V.V.H., R.T.H., H.K., H.J.F., N.G., S.W.H.), University of California, San Francisco.,Pediatric Brain Center (D.L.C., A.A.A., C.F., M.R.A., C.F.D., V.V.H., R.T.H., H.J.F., S.W.H.), University of California, San Francisco.,Division of Cerebrovascular Neurosurgery, Department of Neurological Surgery (A.A.A., C.F.D., V.V.H., R.T.H.), University of California, San Francisco.,Department of Anesthesia and Perioperative Care (C.F.D., V.V.H., R.T.H., H.K.), University of California, San Francisco
| | - Van V Halbach
- Division of Neurointerventional Radiology, Department of Radiology and Biomedical Imaging (A.C., G.D., M.T.C., E.R.S., D.L.C., M.R.A., C.F.D., V.V.H., R.T.H., S.W.H.), University of California, San Francisco.,Center for Cerebrovascular Research (D.L.C., J.N., A.A.A., C.F., M.R.A., C.F.D., V.V.H., R.T.H., H.K., H.J.F., N.G., S.W.H.), University of California, San Francisco.,Pediatric Brain Center (D.L.C., A.A.A., C.F., M.R.A., C.F.D., V.V.H., R.T.H., H.J.F., S.W.H.), University of California, San Francisco.,Division of Cerebrovascular Neurosurgery, Department of Neurological Surgery (A.A.A., C.F.D., V.V.H., R.T.H.), University of California, San Francisco.,Department of Anesthesia and Perioperative Care (C.F.D., V.V.H., R.T.H., H.K.), University of California, San Francisco
| | - Randall T Higashida
- Division of Neurointerventional Radiology, Department of Radiology and Biomedical Imaging (A.C., G.D., M.T.C., E.R.S., D.L.C., M.R.A., C.F.D., V.V.H., R.T.H., S.W.H.), University of California, San Francisco.,Center for Cerebrovascular Research (D.L.C., J.N., A.A.A., C.F., M.R.A., C.F.D., V.V.H., R.T.H., H.K., H.J.F., N.G., S.W.H.), University of California, San Francisco.,Pediatric Brain Center (D.L.C., A.A.A., C.F., M.R.A., C.F.D., V.V.H., R.T.H., H.J.F., S.W.H.), University of California, San Francisco.,Division of Cerebrovascular Neurosurgery, Department of Neurological Surgery (A.A.A., C.F.D., V.V.H., R.T.H.), University of California, San Francisco.,Department of Anesthesia and Perioperative Care (C.F.D., V.V.H., R.T.H., H.K.), University of California, San Francisco
| | - Michael T Lawton
- Division of Pediatric Neurosurgery, Department of Neurological Surgery (N.G.), University of California, San Francisco.,Division of Neurovascular Surgery, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (M.T.L.)
| | - Helen Kim
- Center for Cerebrovascular Research (D.L.C., J.N., A.A.A., C.F., M.R.A., C.F.D., V.V.H., R.T.H., H.K., H.J.F., N.G., S.W.H.), University of California, San Francisco.,Department of Anesthesia and Perioperative Care (C.F.D., V.V.H., R.T.H., H.K.), University of California, San Francisco
| | - Heather J Fullerton
- Center for Cerebrovascular Research (D.L.C., J.N., A.A.A., C.F., M.R.A., C.F.D., V.V.H., R.T.H., H.K., H.J.F., N.G., S.W.H.), University of California, San Francisco.,Pediatric Brain Center (D.L.C., A.A.A., C.F., M.R.A., C.F.D., V.V.H., R.T.H., H.J.F., S.W.H.), University of California, San Francisco.,Departments of Neurology and Pediatrics (C.F., H.J.F.), University of California, San Francisco
| | - Nalin Gupta
- Center for Cerebrovascular Research (D.L.C., J.N., A.A.A., C.F., M.R.A., C.F.D., V.V.H., R.T.H., H.K., H.J.F., N.G., S.W.H.), University of California, San Francisco
| | - Steven W Hetts
- Division of Neurointerventional Radiology, Department of Radiology and Biomedical Imaging (A.C., G.D., M.T.C., E.R.S., D.L.C., M.R.A., C.F.D., V.V.H., R.T.H., S.W.H.), University of California, San Francisco.,Center for Cerebrovascular Research (D.L.C., J.N., A.A.A., C.F., M.R.A., C.F.D., V.V.H., R.T.H., H.K., H.J.F., N.G., S.W.H.), University of California, San Francisco.,Pediatric Brain Center (D.L.C., A.A.A., C.F., M.R.A., C.F.D., V.V.H., R.T.H., H.J.F., S.W.H.), University of California, San Francisco
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Johansson K, Johansson L, Pennlert J, Söderberg S, Jansson JH, Lind MM. Phosphatidylethanol Levels, As a Marker of Alcohol Consumption, Are Associated With Risk of Intracerebral Hemorrhage. Stroke 2020; 51:2148-2152. [PMID: 32543974 DOI: 10.1161/strokeaha.120.029630] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND PURPOSE Previous observational studies have shown a moderately increased risk of intracerebral hemorrhage (ICH) with high self-reported alcohol consumption. However, self-reported data tend to underestimate alcohol consumption. Phosphatidylethanol is a specific biomarker reflecting alcohol intake during the last month and correlates with the amount of alcohol consumed. The present study aimed to investigate the association between phosphatidylethanol levels and the risk of future ICH. METHODS This population-based nested case-referent study was conducted within the Northern Sweden Health and Disease Cohort. At baseline, all participants underwent a health examination, including a questionnaire with questions about alcohol consumption. A blood sample was collected and stored at -80°C, and phosphatidylethanol 16:0/18:1 levels were measured in packed erythrocytes. Cases (n=97) were diagnosed with a first-ever ICH between 1985 and 2007. Two referents (n=180) were matched to each case. RESULTS The mean age at baseline was 55 years, 39% of participants were women, and the mean time from blood sampling to ICH was 7.3 years. Only phosphatidylethanol and hypertension remained independently associated with ICH in a multivariable model. Participants with phosphatidylethanol >0.30 μmol/L had an increased risk of ICH compared with those with phosphatidylethanol <0.01 μmol/L (odds ratio, 4.64 [95% CI, 1.49-14.40]). CONCLUSIONS High blood concentrations of phosphatidylethanol were associated with an increased risk of future ICH. This association was independent of hypertension and other risk factors for ICH. Our findings suggest that phosphatidylethanol, as a marker of alcohol consumption, may be used as a risk marker of future ICH.
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Affiliation(s)
- Kristina Johansson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit (K.J., L.J., J.-H.J., M.M.L.), Umeå University, Sweden
| | - Lars Johansson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit (K.J., L.J., J.-H.J., M.M.L.), Umeå University, Sweden
| | - Johanna Pennlert
- Department of Public Health and Clinical Medicine (J.P., S.S.), Umeå University, Sweden
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine (J.P., S.S.), Umeå University, Sweden
| | - Jan-Håkan Jansson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit (K.J., L.J., J.-H.J., M.M.L.), Umeå University, Sweden
| | - Marcus M Lind
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit (K.J., L.J., J.-H.J., M.M.L.), Umeå University, Sweden
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48
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Benz AP, Eikelboom JW. Prothrombin Complex Concentrates for Intracranial Hemorrhage on Factor Xa Inhibitors. Circulation 2020; 141:1690-1692. [PMID: 32453664 DOI: 10.1161/circulationaha.120.046932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alexander P Benz
- Population Health Research Institute, Hamilton Health Sciences and McMaster University Hamilton, Ontario, Canada
| | - John W Eikelboom
- Population Health Research Institute, Hamilton Health Sciences and McMaster University Hamilton, Ontario, Canada
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49
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Yang W, Zhang L, Yao Q, Chen W, Yang W, Zhang S, He L, Li H, Zhang Y. Endovascular treatment or general treatment: how should acute ischemic stroke patients choose to benefit from them the most?: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e20187. [PMID: 32443338 PMCID: PMC7254577 DOI: 10.1097/md.0000000000020187] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Acute ischemic stroke due to large-vessel occlusion is a leading cause of death and disability, and therapeutic time window was limited to 4.5 hour when treated with intravenous thrombolysis. It has been acknowledged that endovascular treatment (EVT) is superior to general treatment (only medication, including intravenous recombinant tissue plasminogen activator (rt-PA)) in improving the outcome of AIS since 2015. However, the benefits were limited to improvement of functional outcomes and functional independence. Hence, this meta-analysis was conducted to summarize the benefits of EVT for acute ischemic stroke, explore underlying indications of EVT for AIS patients and suggest implications for clinical practice and future research. METHODS A search was performed to identify eligible studies in PubMed, Scopus and Web of Science updated to February 5, 2019. Functional outcomes, the modified Rankin Scale (mRS) 0-1, mRS 0-2, all-cause mortality, symptomatic intracerebral hemorrhage and asymptomatic intracerebral hemorrhage (aICH) at 90 days were selected as outcomes. Data was pooled to calculate the odds ratio (OR) and 95% confidence interval (CI). Heterogeneity, subgroup analysis, sensitivity analysis and publication bias were also performed in this meta-analysis. RESULTS Eighteen studies comprising 3831 patients were included and analyzed in this meta-analysis. In comparison with general treatment, improved functional outcomes (mRS 0-1: OR = 1.68, 95% CI = 1.43-1.97, inconsistency index [I = 57%, P < .00001; mRS 0-2: OR = 1.78, 95% CI = 1.55-2.03, I = 69%, P < .00001), reduced risk of all-cause mortality (OR = 0.82, 95% CI = 0.70-0.98, I = 27%, P = .03) but higher risk of aICH (OR = 1.43, 95% CI = 1.05-1.95, I = 0%, P = .02) at 90 days were found in AIS patients treated with EVT. Age < 70, National Institutes of Health Stroke Scale ≥20 and maximum delay for invention>5 hours could improve clinical outcomes following EVT. In sensitivity analysis, it showed that 2 studies had a great influence on the pooled ORs. No potential publication bias was found in this meta-analysis. CONCLUSION Taken together, EVT, which led to improved functional outcomes and decreased risk of death, is superior to general treatment for AIS patients with age < 70, National Institutes of Health Stroke Scale ≥20 and maximum delay for invention>5 hours. Moreover, it suggests that "with mechanical thrombectomy" is potential favorable factor for improving aICH in comparison with general treatment.
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Affiliation(s)
| | | | | | | | - Weiji Yang
- College of Life Sciences, Zhejiang Chinese Medical University
| | | | - Lan He
- Second Clinical Medical College
| | - Hong Li
- School of Stomatology, Zhejiang Chinese Medical University, Zhejiang, China
| | - Yuyan Zhang
- College of Life Sciences, Zhejiang Chinese Medical University
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50
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Chen CJ, Kearns KN, Ding D, Kano H, Mathieu D, Kondziolka D, Feliciano C, Rodriguez-Mercado R, Grills IS, Barnett GH, Lunsford LD, Sheehan JP. Stereotactic radiosurgery for arteriovenous malformations of the basal ganglia and thalamus: an international multicenter study. J Neurosurg 2020; 132:122-131. [PMID: 30641831 DOI: 10.3171/2018.8.jns182106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 08/31/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Arteriovenous malformations (AVMs) of the basal ganglia (BG) and thalamus are associated with elevated risks of both hemorrhage if left untreated and neurological morbidity after resection. Therefore, stereotactic radiosurgery (SRS) has become a mainstay in the management of these lesions, although its safety and efficacy remain incompletely understood. The aim of this retrospective multicenter cohort study was to evaluate the outcomes of SRS for BG and thalamic AVMs and determine predictors of successful endpoints and adverse radiation effects. METHODS The authors retrospectively reviewed data on patients with BG or thalamic AVMs who had undergone SRS at eight institutions participating in the International Gamma Knife Research Foundation (IGKRF) from 1987 to 2014. Favorable outcome was defined as AVM obliteration, no post-SRS hemorrhage, and no permanently symptomatic radiation-induced changes (RICs). Multivariable models were developed to identify independent predictors of outcome. RESULTS The study cohort comprised 363 patients with BG or thalamic AVMs. The mean AVM volume and SRS margin dose were 3.8 cm3 and 20.7 Gy, respectively. The mean follow-up duration was 86.5 months. Favorable outcome was achieved in 58.5% of patients, including obliteration in 64.8%, with rates of post-SRS hemorrhage and permanent RIC in 11.3% and 5.6% of patients, respectively. Independent predictors of favorable outcome were no prior AVM embolization (p = 0.011), a higher margin dose (p = 0.008), and fewer isocenters (p = 0.044). CONCLUSIONS SRS is the preferred intervention for the majority of BG and thalamic AVMs. Patients with morphologically compact AVMs that have not been previously embolized are more likely to have a favorable outcome, which may be related to the use of a higher margin dose.
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Affiliation(s)
- Ching-Jen Chen
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Kathryn N Kearns
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Dale Ding
- 2Department of Neurosurgery, University of Louisville, Louisville, Kentucky
| | - Hideyuki Kano
- 3Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
| | - David Mathieu
- 4Division of Neurosurgery, Centre de recherché du CHUS, University of Sherbrooke, Quebec, Canada
| | - Douglas Kondziolka
- 5Department of Neurosurgery, New York University Langone Medical Center, New York, New York
| | - Caleb Feliciano
- 6Section of Neurological Surgery, University of Puerto Rico, San Juan, Puerto Rico
| | | | - Inga S Grills
- 7Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan; and
| | - Gene H Barnett
- 8Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - L Dade Lunsford
- 3Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
| | - Jason P Sheehan
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
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