Journal articles on the topic 'Intracranial hypertension (ICH)'
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Mrozek, Ségolène, Laurent Lonjaret, Aude Jaffre, Anne-Christine Januel, Nicolas Raposo, Sergio Boetto, Jean-François Albucher, Olivier Fourcade, and Thomas Geeraerts. "Reversible Cerebral Vasoconstriction Syndrome with Intracranial Hypertension: Should Decompressive Craniectomy Be Considered." Case Reports in Neurology 9, no. 1 (January 24, 2017): 6–11. http://dx.doi.org/10.1159/000455090.
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Background: Reversible cerebral vasoconstriction syndrome (RCVS) is a rare cause of intracerebral hemorrhage (ICH) causing intracranial hypertension. Methods: Case report. Results: We report a case of RCVS-related ICH leading to refractory intracranial hypertension. A decompressive craniectomy was performed to control intracranial pressure. We discuss here the management of RCVS with intracranial hypertension. Decompressive craniectomy was preformed to avoid the risky option of high cerebral perfusion pressure management with the risk of bleeding, hemorrhagic complications, and high doses of norepinephrine. Neurological outcome was good. Conclusion: RCVS has a complex pathophysiology and can be very difficult to manage in cases of intracranial hypertension. Decompressive craniectomy should probably be considered.
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Petrayevsky, A. V., K. S. Trishkin, and I. A. Gndoyan. "Idiopathic Intracranial Hypertension: Current Neuroophthalmologic Points." Ophthalmology in Russia 18, no. 4 (December 28, 2021): 791–800. http://dx.doi.org/10.18008/1816-5095-2021-4-791-800.
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Idiopathic intracranial hypertension (ICH) is a neuroophophthalmologic syndrome, the main ophthalmologic symptoms of which are vision loss and bilateral swelling of optic nerve disks (OD). The article provides a review covering various aspects of ICH. Epidemiology: ICH occurs mainly in women aged 20–45 years with body overweight. In this group of patients world incidence is 12–20 per 100 000 of population per year. In the total population it represents 0.5–2 cases per 100 000 of population per year. The eightfold gender predominance of women with ICH is observed. Etiology is not fully known until present time. The reliable connection between obesity in childbearing age women and menstrual cycle disorders as evidences of hormonal changes has been established. The probable mechanisms of increase of ICP are supposed: hyperproduction of and disturbances of its absorption, CSF mechanical pressure on the optic nerve sheath; restriction of venous outflow from the brain due to the pathology of venous sinuses; stimulating effect of abundant vitamin A in diet resulting in the fat tissue formation with the development of obesity; expression of the protein aquaporin, involved in the regulation of body mass and water metabolism in the subarachnoid space. Clinical manifestations. Ophthalmologic symptoms of ICH: transient visual impairment, sustained loss of visual acuity, photopsy, retrobulbar pain, diplopia. Non-ophthalmologic symptoms: headache, throbbing tinnitus, hearing loss, dizziness. Diagnostics. The valuable diagnostic data can be obtained by visual field investigation, ophthalmoscopic examination with revealing of bilateral OD-edema, OD and retinal optical coherent tomography, orbital ultrasound examination, brain MRI with venography. Treatment. Non-drug therapy: weight loss, lowcalorie diet with limited water and salt intake. Drug therapy: long-term oral use of carbonic anhydrase inhibitors (acetazolamide, topiramate). High doses of steroids (methylprednisone) are used for short-term treatment of patients with fulminant disease type before surgery. Surgery: bypass surgery, cerebral venous sinus stenting and fenestrations of the optic nerve sheath: bariatric surgery with reducing of stomach volume.
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Basali, Ayman, Edward J. Mascha, Iain Kalfas, and Armin Schubert. "Relation between Perioperative Hypertension and Intracranial Hemorrhage after Craniotomy." Anesthesiology 93, no. 1 (July 1, 2000): 48–54. http://dx.doi.org/10.1097/00000542-200007000-00012.
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Background Previous data suggest that systemic hypertension (HTN) is a risk factor for postcraniotomy intracranial hemorrhage (ICH). The authors examined the relation between perioperative blood pressure elevation and postoperative ICH using a retrospective case control design. Methods The hospital's database of all patients undergoing craniotomy from 1976 to 1992 was screened. Coagulopathic and unmatchable patients were excluded. There were 69 evaluable patients who developed ICH postoperatively (n = 69). A 2-to-1 matched (by age, date of surgery, pathologic diagnosis, surgical procedure, and surgeon) control group without postoperative ICH was assembled (n = 138). Preoperative, intraoperative, and postoperative blood pressure records (up to 12 h) were examined. Incidence of perioperative HTN (blood pressure > or = 160/90 mmHg) and odds ratios for ICH were determined. Results Of the 11,214 craniotomy patients, 86 (0.77%) suffered ICH, and 69 fulfilled inclusion criteria. The incidence of preoperative HTN was similar in the ICH (34%) and the control (24%) groups. ICH occurred 21 h (median) postoperatively, with an interquartile range of 4-52 h. Sixty-two percent of ICH patients had intraoperative HTN, compared with only 34% of controls (P < 0.001). Sixty-two percent of the ICH patients had prehemorrhage HTN in the initial 12 postoperative hours versus 25% of controls (P < 0.001), with an odds ratio of 4.6 (P < 0.001) for postoperative ICH. Hospital stay (median, 24.5 vs. 11.0 days), and mortality (18.2 vs. 1.6%) were significantly greater in the ICH than in the control groups. Conclusions ICH after craniotomy is associated with severely prolonged hospital stay and mortality. Acute blood pressure elevations occur frequently prior to postcraniotomy ICH. Patients who develop postcraniotomy ICH are more likely to be hypertensive in the intraoperative and early postoperative periods.
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Amarenco, Pierre, Jong S. Kim, Julien Labreuche, Hugo Charles, Maurice Giroud, Philippa C. Lavallée, Byung-Chul Lee, et al. "Intracranial Hemorrhage in the TST Trial." Stroke 53, no. 2 (February 2022): 457–62. http://dx.doi.org/10.1161/strokeaha.121.035846.
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Background and Purpose: Although statins are effective in secondary prevention of ischemic stroke, they are also associated with an increase risk of intracranial hemorrhage (ICH) in certain conditions. In the TST trial (Treat Stroke to Target), we prespecified an exploration of the predictors of incident ICH. Methods: Patients with ischemic stroke in the previous 3 months or transient ischemic attack within the previous 15 days and evidence of cerebrovascular or coronary artery atherosclerosis were randomly assigned in a 1:1 ratio to a target LDL (low-density lipoprotein) cholesterol of <70 mg/dL or 100±10 mg/dL, using statin or ezetimibe. Results: Among 2860 patients enrolled, 31 incident ICH occurred over a median follow-up of 3 years (18 and 13 in the lower and higher target group, 3.21/1000 patient-years [95% CI, 2.38–4.04] and 2.32/1000 patient-years [95% CI, 1.61–3.03], respectively). While there were no baseline predictors of ICH, uncontrolled hypertension (HR, 2.51 [95% CI, 1.01–6.31], P =0.041) and being on anticoagulant (HR, 2.36 [95% CI, 1.00–5.62], P =0.047)] during the trial were significant predictors. On-treatment low LDL cholesterol was not a predictor of ICH. Conclusions: Targeting an LDL cholesterol of <70 mg/dL compared with 100±10 mg/dL in patients with atherosclerotic ischemic stroke nonsignificantly increased the risk of ICH. Incident ICHs were not associated with low LDL cholesterol. Uncontrolled hypertension and anticoagulant therapy were associated with ICH which has important clinical implications. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01252875; EUDRACT identifier: 2009-A01280-57.
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Richmond, Therese S. "Intracranial Pressure Monitoring." AACN Advanced Critical Care 4, no. 1 (February 1, 1993): 148–60. http://dx.doi.org/10.4037/15597768-1993-1012.
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Intracranial pressure monitoring (ICP) is a technology that assists critical care nurses in the assessment, planning, intervention, and evaluation of care. The physiologic basis of intracranial hypertension (ICH) and ICP monitoring are reviewed. Types of monitors arc described. Advantages, disadvantages, and complications of fluid-filled versus fiberoptic systems are explored. Priorities in nursing care of the patient with an ICP monitor are examined
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Araújo, Marx, Benjamim Vale, Irapua Ricarte, Lívio de Macêdo, Anderson Rodrigues, and Tomásia Monteiro. "Ultrasonographic Evaluation of the Optic Nerve Sheath in the Diagnosis of Idiopathic Intracranial Hypertension." Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 38, no. 01 (November 22, 2016): 073–76. http://dx.doi.org/10.1055/s-0036-1594234.
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AbstractIntracranial hypertension (ICH) is a life-threatening condition that can be observed in several diseases. Its clinical presentation is variable, with headache, nausea, vomiting, visual disturbances, papilledema, and alterations in the level of consciousness. The gold standard for the diagnosis of ICH is still the intracranial implantation of invasive devices. Non-invasive techniques, such as ultrasonography of the optic nerve sheath (USONS), have emerged in recent years with promising clinical results. The authors report the case of a patient with progressive headache associated with visual impairment and papilledema, and the eventual diagnosis of idiopathic intracranial hypertension using USONS.
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Carney, Brian J., Erik J. Uhlmann, Maneka Puligandla, Charlene Mantia, Griffin M. Weber, Donna S. Neuberg, and Jeffrey I. Zwicker. "Recurrent Intracranial Hemorrhage and Venous Thromboembolism Following Initial Intracranial Hemorrhage in Patients with Brain Tumors on Anticoagulation." Blood 134, Supplement_1 (November 13, 2019): 2438. http://dx.doi.org/10.1182/blood-2019-126027.
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Introduction Both venous thromboembolism (VTE) and intracranial hemorrhage (ICH) are common potentially life-threatening complications of primary and metastatic brain tumors. Despite emerging evidence regarding the safety of anticoagulation in patients with brain tumors, there is little evidence on appropriate management of VTE following an ICH. Potential management options after an ICH in patients with brain tumors include resumption of full or modified dose anticoagulation or cessation of anticoagulant therapy with or without placement of an inferior vena cava (IVC) filter. We evaluated rates of recurrent VTE and ICH following an initial ICH occurring on anticoagulant therapy. Methods A retrospective cohort study was performed using a hospital-based online medical record database (CQ2) which links ICD-9 and ICD-10 codes with prescription medication records. Cases were identified based on coding for primary brain tumors or brain metastases, after which charts were manually reviewed for a diagnosis of ICH. A blinded review of radiographic imaging was performed, and the initial ICH was categorized as either trace, measurable, or major. Measurable intracranial hemorrhages were those defined as greater than 1 mL in volume and major intracranial hemorrhages were defined as greater than 10 mL in volume, symptomatic, or requiring surgical intervention. The electronic medical record was reviewed to ascertain longitudinal anticoagulation status after the initial ICH. The primary endpoints of the study were recurrent ICH and venous thromboembolism (VTE) within 12 months from the initial ICH. Gray's test was used to compare the cumulative incidence of recurrent ICH and VTE between the groups, with death as a competing risk. Results A total of 79 patients with primary brain tumors or brain metastases and confirmed ICH were included in the study. Fifty-four patients (68.4%) restarted anticoagulation after ICH and 25 patients discontinued anticoagulation entirely. The cohorts were well-matched for tumor diagnosis, age, and comorbidities that portend an increased risk of ICH such as hypertension, chronic kidney disease, and concomitant aspirin use (Table 1). The cumulative incidence of recurrent ICH (95% CI) at one year was 6.1% (1.5 - 15.3) in the restart cohort compared to 4.2% (0.3 - 18.3) in patients who did not restart anticoagulation. Median time from anticoagulation restart to recurrent ICH was 36 days. A total of 16 of 31 patients with major ICH restarted anticoagulation and among these patients two developed subsequent ICH (cumulative incidence 14.5%, 95% CI 2.1 - 38.3). Among the 15 patients with a major ICH who did not restart anticoagulation, the cumulative incidence was 6.7% (0.3 - 27.5). Eleven of 15 patients with measurable ICH restarted anticoagulation and among these patients one subsequently developed ICH (cumulative incidence 0.1%, 95% CI 0.0 - 0.3). No recurrent ICH events were observed in 33 patients with trace initial hemorrhages regardless of restart status. All recurrent ICH events met criteria for classification as a major hemorrhage on the basis of clinical symptoms, and 30-day mortality after recurrent ICH was 100%. The cumulative incidence of recurrent VTE was significantly lower in the restart cohort compared to cohort of patients who did not restart anticoagulation (8.1 vs. 35.3, P=0.003, Figure 1). There were a total of five VTE events in the restart cohort, three deep vein thrombi (DVT) and two pulmonary emboli (PE). Two of the DVT were associated with an IVC filter. There were a total of nine VTE events in patients who did not restart anticoagulation, seven DVT and two PE. Five of the DVT were associated with an IVC filter. The two PE were both submassive events requiring ICU admission. Conclusions Recurrent VTE events are less frequent and less severe in patients who restart anticoagulation following ICH in patients with brain tumors on anticoagulation. Restarting anticoagulation after smaller ICH (trace or measurable) appears safe. However, approximately 1 in 7 patients with major initial ICH who restarted anticoagulation subsequently developed recurrent major ICH that was associated with a very high mortality rate. This raises serious questions as to the safety of restarting therapeutic anticoagulation following major hemorrhage in the setting of brain tumors. Disclosures Neuberg: Pharmacyclics: Research Funding; Madrigal Pharmaceuticals: Equity Ownership; Celgene: Research Funding. Zwicker:Quercegen: Research Funding; Daiichi: Consultancy; Seattle Genetics: Consultancy; Parexel: Consultancy; Incyte: Research Funding; Bayer: Consultancy; Portola: Consultancy.
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de Lima Oliveira, Marcelo, Angela Macedo Salinet, Ricardo de Carvalho Nogueira, Alessandro Rodrigo Belon, Wellingson Silva Paiva, Brasil Chian Ping Jeng, Manoel Jacobsen Teixeira, and Edson Bor-Seng-Shu. "The Effects of Induction and Treatment of Intracranial Hypertension on Cerebral Autoregulation: An Experimental Study." Neurology Research International 2018 (June 25, 2018): 1–8. http://dx.doi.org/10.1155/2018/7053932.
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Background. This study aimed to analyse cerebral autoregulation (CA) during induction and treatment of intracranial hypertension (ICH) in an experimental model. Materials and Methods. Landrace and Duroc piglets were divided into mild and severe ICH groups. Four or seven millilitres of saline solution was infused into paediatric bladder catheter inserted in the parietal lobe (balloon inflation). After 1.5 h, a 3% saline solution was infused via venous catheter, and 30 min later, the bladder catheter balloon was deflated (surgery). The cerebral static autoregulation (sCA) index was evaluated using cerebral blood flow velocities (CBFV) obtained with Doppler ultrasound. Results. Balloon inflation increased ICP in both groups. The severe ICH group showed significantly lower sCA index values (p=0.001, ANOVA) after balloon inflation (ICH induction) and a higher sCA index after saline injection (p=0.02) and after surgery (p=0.04). ICP and the sCA index were inversely correlated (r=−0.68 and p<0.05). CPP and the sCA index were directly correlated (r=0.74 and p<0.05). Conclusion. ICH was associated with local balloon expansion, which triggered CA impairment, particularly in the severe ICH group. Moreover, ICP-reducing treatments were associated with improved CA in subjects with severe ICH.
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Yang, Chunhui, Yiqing Qiu, Jiali Wang, Yina Wu, Xiaowu Hu, and Xi Wu. "Intracranial hemorrhage risk factors of deep brain stimulation for Parkinson’s disease: a 2-year follow-up study." Journal of International Medical Research 48, no. 5 (December 29, 2019): 030006051985674. http://dx.doi.org/10.1177/0300060519856747.
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Objective This study aimed to analyze the risk factors of intracranial hemorrhage (ICH) after deep brain stimulation (DBS) for idiopathic Parkinson’s disease (PD). Methods Patients who received DBS from March 2014 to December 2016 were retrospectively analyzed. The hemorrhage index was derived by combining the hemorrhagic volume and clinical manifestations of ICH. All patients with IHC were followed up for 2 years. Results Computed tomography showed 13 events of ICH in 11 patients (nine cases in the subthalamic nucleus), including eight cases with symptomatic hemorrhage (seven cases in the subthalamic nucleus). Hemorrhage was characterized by intracranial hematoma in the electrode puncture tract. Male sex and hypertension were significant risk factors for ICH. Hemorrhage in the preferred puncture side was significantly higher than that in the non-preferred puncture side. The mean hemorrhage index was 2.23 ± 0.83 in 11 patients, and no permanent neurological impairment was found during the 2-year follow-up. The effect of DBS on motor symptoms was similar in patients with and without ICH. Conclusion Male sex and hypertension are risk factors of ICH after DBS in PD. The risk of hemorrhage on the first puncture site is significantly higher than that on the second puncture site.
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Qdaisat, Aiham, Sai-Ching J. Yeung, Cristhiam H. Rojas Hernandez, Pavani Samudrala, Mona Kamal, Ziyi Li, and Adriana H. Wechsler. "Characteristics and Outcomes of Intracranial Hemorrhage in Cancer Patients Visiting the Emergency Department." Journal of Clinical Medicine 11, no. 3 (January 27, 2022): 643. http://dx.doi.org/10.3390/jcm11030643.
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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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Gaynetdinova, D. D., and D. F. Galeeva. "SYNDROME OF INTRACRANIAL HYPERTENSION AND IRON DEFICIENCY IN INFANTS WITH CEREBRAL ISCHEMIA IN THE NEONATAL PERIOD." Pediatria. Journal named after G.N. Speransky 100, no. 1 (February 15, 2021): 36–41. http://dx.doi.org/10.24110/0031-403x-2021-100-1-36-41.
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Objective of the research: to study the relationship between severity of clinical manifestations of intracranial hypertension (ICH) syndrome of perinatal genesis and red blood counts in infants who underwent cerebral ischemia (CI) at birth. Materials and methods: 94 children with ICH syndrome of perinatal posthypoxic genesis at the age of 6 months of corrected age were examined: 1st group – with normal hemoglobin (Hb) level, 32 children (34%); 2nd group – with reduced Hb level, 62 children (66%). Researchers used anamnestic, clinico-neurological (assessment of the somatic and neurological status with objectification of ICH severity using a specially developed 60-point «Assessment of intracranial hypertension severity» (AIHS) scale in children aged 1 month to 1 year), laboratory study of Hb level on an automated hematological analyzer Sysmex XE2100, Sysmex, Germany, and ferritin level on a modular analytical system Сobas8000, Roche, Denmark) and statistical methods of research. Results: 77% of children (72 children) were diagnosed with mild ICH, 22% (21 children) had moderate severity, and one child (1%) had severe ICH. A strong negative relationship was obtained between the severity of ICH syndrome (the number of points on AIHS scale) and the Hb level (R=–0,72): the lower the Hb level, the more pronounced the clinical manifestations of the ICH syndrome. The ferritin content turned out to be reduced in 83% (78 children), an average negative correlation was found between the severity of the ICH syndrome (the number of points on AIHS scale and ferritin values (R=–0,55): the lower the ferritin content in the blood, the more severe the clinical manifestations of ICH syndrome. Conclusion: in infants with ICH syndrome in the residual period of neonatal IC, a relationship was found between the severity of clinical and instrumental manifestations of ICH syndrome with red blood parameters (Hb and serum ferritin). In this regard, the participation of latent iron deficiency in the pathophysiological processes of the formation and course of ICH syndrome in infants is not excluded.
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Leyssens, K., T. Mortelmans, T. Menovsky, D. Abramowicz, Marcel Th B. Twickler, and L. Van Gaal. "The Cushing Reflex: Oliguria as a Reflection of an Elevated Intracranial Pressure." Case Reports in Nephrology 2017 (2017): 1–3. http://dx.doi.org/10.1155/2017/2582509.
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Oliguria is one of the clinical hallmarks of renal failure. The broad differential diagnosis is well known, but a rare cause of oliguria is intracranial hypertension (ICH). The actual knowledge to explain this relationship is scarce. Almost all literature is about animals where authors describe the Cushing reflex in response to ICH. We hypothesize that the Cushing reflex is translated towards the sympathetic nervous system and renin-angiotensin-aldosterone system with a subsequent reduction in medullary blood flow and oliguria. Recently, we were confronted with a patient who had complicated pituitary surgery and displayed multiple times an oliguria while he developed ICH.
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Rufai, Sohaib R., Noor ul Owase Jeelani, and Rebecca J. McLean. "Detection of intracranial hypertension in children using optical coherence tomography: a systematic review protocol." BMJ Open 10, no. 7 (July 2020): e037833. http://dx.doi.org/10.1136/bmjopen-2020-037833.
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IntroductionIntracranial hypertension (ICH) in children can have deleterious effects on the brain and vision. It is notoriously difficult to estimate intracranial pressure (ICP) in children and existing methods deliver suboptimal diagnostic accuracy to be used as screening tools. Optical coherence tomography (OCT) may represent a valuable, non-invasive surrogate measure of ICP, as has been demonstrated in a number of associated conditions affecting adults. More recently, OCT has been employed within the paediatric age group. However, the role of OCT in detecting ICH in children has not been rigorously assessed in a systematic review for all relevant conditions. Here, we propose a systematic review protocol to examine the role of OCT in the detection of ICH in children.Methods and analysisElectronic searches in the Cochrane Central Register of Controlled Trials, Medline, Embase, Web of Science and PubMed will identify studies featuring OCT in detecting ICH in children. Two independent screeners will identify studies for inclusion using a screening questionnaire. The systematic search and screening will take place between 2 April 2020 and 1 June 2020, while we aim to complete data analysis by 1 September 2020. Quality assessment will be performed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The primary outcome measure is the sensitivity and specificity of OCT in detecting ICH in children. Secondary outcomes measures include conditions associated with ICH per study, direct ICP monitoring, sensitivity and specificity of other measures for ICP and OCT parameters used.Ethics and disseminationEthical approval is not required for the proposed systematic review as no primary data will be collected. The findings will be disseminated through presentations at scientific meetings and peer-reviewed journal publication.PROSPERO registration numberCRD42019154254.
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Yanishevsky, S. N. "Intracranial hemorrhage in patients taking oral anticoagulants. Current possibilities for therapy." Neurology, Neuropsychiatry, Psychosomatics 11, no. 3S (June 24, 2019): 82–88. http://dx.doi.org/10.14412/2074-2711-2019-3s-82-88.
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The paper reviews an update on the possibilities of providing care for patients with spontaneous non-traumatic intracranial hemorrhage (ICH) developing in patients with atrial fibrillation who use oral anticoagulants. The incidence of ICH is shown to be considerably lower when nonvitamin K-dependent anticoagulants (NOACs) are used, but the hematoma evolution scenarios do not differ between the groups of patients receiving vitamin K antagonists or NOACs. The results of studies assessing hypertension therapy in patients with ICH are compared. The possibilities of using various reversal agents for various oral anticoagulants are also discussed. Since one of the main problems associated with increased mortality and severe disabilities is the progression rate of ICH, the possibility of using a specific antagonist can determine the choice of an anticoagulant for the primary prevention of ischemic stroke in a patient with atrial fibrillation.
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Frol, Senta, and Janja Pretnar Oblak. "Early Outcome after Intracranial Hemorrhage Related to Non-Vitamin K Oral Anticoagulants." Interventional Neurology 7, no. 1-2 (October 11, 2017): 19–25. http://dx.doi.org/10.1159/000480524.
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Background: Intracranial hemorrhage (ICH) is a serious, life-threatening, but fortunately rare complication of non-vitamin K oral anticoagulant (NOAC) therapy. There are limited data on NOAC-related ICH prognosis. Methods: All consecutive patients admitted to a single center due to acute NOAC-related ICH from September 2012 until the beginning of 2017 were included. Risk factors, type of NOAC, and location of ICH were evaluated. Risk for ischemic and bleeding events and clinical status upon admission and at discharge were evaluated using standard scales. Results: Thirty-four patients aged 77.8 ± 8.3 years with NOAC-related ICH were included. The main predisposing risk factors were age and arterial hypertension. The median CHA2DS2-VASc score was 3.4 and the median HAS-BLED score was 1.8. Eighteen patients were treated with rivaroxaban, 11 with dabigatran, and 5 with apixaban. Ten patients (29%) had a favorable outcome with a modified Rankin Scale score ≤2 and 13 patients (38%) died. The location of the ICH was mainly intraparenchymal and subdural. Conclusions: Our retrospective single-center study shows that the mortality rate with NOAC-related ICH is <40%, which makes it comparable to that with vitamin K antagonist-related ICH.
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Cooper, Shannon, Cino Bendinelli, Andrew Bivard, Mark Parsons, and Zsolt J. Balogh. "Abnormalities on Perfusion CT and Intervention for Intracranial Hypertension in Severe Traumatic Brain Injury." Journal of Clinical Medicine 9, no. 6 (June 25, 2020): 2000. http://dx.doi.org/10.3390/jcm9062000.
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The role of invasive intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (STBI) remain unclear. Perfusion computed tomography (CTP) provides crucial information about the cerebral perfusion status in these patients. We hypothesised that CTP abnormalities would be associated with the severity of intracranial hypertension (ICH). To investigate this hypothesis, twenty-eight patients with STBI and ICP monitors were investigated with CTP within 48 h from admission. Treating teams were blind to these results. Patients were divided into five groups based on increasing intervention required to control ICH and were compared. Group I required no intervention above routine sedation, group II required a single first tier intervention, group III required multiple different first-tier interventions, group IV required second-tier medical therapy and group V required second-tier surgical therapy. Analysis of the results showed demographics and injury severity did not differ among groups. In group I no patients showed CTP abnormality, while patients in all other groups had abnormal CTP (p = 0.003). Severe ischaemia observed on CTP was associated with increasing intervention for ICH. This study, although limited by small sample size, suggests that CTP abnormalities are associated with the need to intervene for ICH. Larger scale assessment of our results is warranted to potentially avoid unnecessary invasive procedures in head injury patients.
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MUMINOV, M. D. "Neuroimaging monitoring of acute transient hydrocephalus of traumatic genesis." Practical medicine 20, no. 4 (2022): 66–70. http://dx.doi.org/10.32000/2072-1757-2022-4-66-70.
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The paper shows the possibility of non-invasive computed tomographic monitoring (CT) of intracranial pressure (ICP) as a classifier of intracranial hypertension (ICH). To determine the prevalence of parenchymal or hydrocephalic hypertension syndrome, we calculated the correlation coefficient of the optic nerve width (dON) and the size of the 3rd ventricle, using their CT imaging. 312 patients with isolated crania-cerebral injury (CCI) were examined. In 170 (54.5%) cases, hypertension syndrome was detected without signs of acute hydrocephalus. In 142 (45.5%) patients, the correlation of the width of the dON and the size of the 3rd ventricle revealed mainly hydrocephalic syndrome against the background of the development of acute transient hydrocephalus (ATHC). CT monitoring and the determination of the correlation between the width of the retroorbital part of the optic nerve and the size of the 3rd ventricle allowed determining the development of an acute form of transient hydrocephalus, which in turn led to the further implementation of invasive methods for measuring, monitoring and correcting the traumatic ICH.
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Chong, Boon-Hor, Koon-Ho Chan, Vincent Pong, Kui-Kai Lau, Yap-Hang Chan, Ming-Liang Zuo, Wai-Man Lui, et al. "Use of aspirin in Chinese after recovery from primary intracranial haemorrhage." Thrombosis and Haemostasis 107, no. 02 (2012): 241–47. http://dx.doi.org/10.1160/th11-06-0439.
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SummaryIntracranial haemorrhage (ICH) accounts for ~35% of all strokes in Chinese. Anti-platelet agent is often avoided after an index event due to the possibility of recurrent ICH. This single-centered observational study included 440 consecutive Chinese patients with a first spontaneous ICH surviving the first month performed during 1996–2010. The subjects were identified, and their clinical characteristics, anti-platelet therapy after ICH, and outcomes including recurrent ICH, ischaemic stroke, and acute coronary syndrome were checked from hospital records. Of these 440 patients, 56 patients (12.7%) were prescribed aspirin (312 patient-aspirin years). After a follow-up of 62.2 ± 1.8 months, 47 patients had recurrent ICH (10.7%, 20.6 per 1,000 patient years). Patients prescribed aspirin did not have a higher risk of recurrent ICH compared with those not prescribed aspirin (22.7 per 1,000 patient-aspirin years vs. 22.4 per 1,000 patient years, p=0.70). Multivariate analysis identified age > 60 years (hazard ratio [HR]: 2.0, 95% confidence interval [CI]: 1.07–3.85, p=0.03) and hypertension (HR: 2.0, 95% CI: 1.06–3.75, p=0.03) as independent predictors for recurrent ICH. In a subgroup analysis including 127 patients with standard indications for aspirin of whom 56 were prescribed aspirin, the incidence of combined vascular events including recurrent ICH, ischaemic stroke, and acute coronary syndrome was statistically lower in patients prescribed aspirin than those not prescribed aspirin (52.4 per 1,000 patient-aspirin years, vs. 112.8 per 1,000 patient-years, p=0.04). In conclusion, we observed in a cohort of Chinese post-ICH patients that aspirin use was not associated with an increased risk for a recurrent ICH.
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Wakisaka, Yoshinobu, Jordan D. Miller, Yi Chu, Gary L. Baumbach, Saul Wilson, Frank M. Faraci, Curt D. Sigmund, and Donald D. Heistad. "Oxidative Stress through Activation of NAD(P)H Oxidase in Hypertensive Mice with Spontaneous Intracranial Hemorrhage." Journal of Cerebral Blood Flow & Metabolism 28, no. 6 (February 27, 2008): 1175–85. http://dx.doi.org/10.1038/jcbfm.2008.7.
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We have developed an experimental model of spontaneous intracranial hemorrhage (ICH) in transgenic mice expressing human renin and human angiotensinogen (R+/A+) treated with high-salt diet and Nω-nitro-l-arginine methyl ester (l-NAME). We investigated whether oxidative stress is associated with spontaneous ICH in R+/A+ mice. R+/A+ mice on high-salt diet and l-NAME presented neurologic signs 57±13 (mean±s.e.m.) days after the start of treatment. Intracranial hemorrhage was shown with histologic examination. Levels of superoxide in brain homogenate were significantly increased in R+/A+ mice with ICH (118±10 RLU per sec per mg; RLU, relative light unit) compared with age-matched control mice (19±1) and R+/A+ mice without ICH (53±3). NAD(P)H oxidase activity was significantly higher in R+/A+ mice with ICH (34,933±2,420 RLU per sec per mg) than in control mice (4,984±248) and R+/A+ mice without ICH (15,069±917). These results suggest that increased levels of superoxide are due, at least in part, to increased NAD(P)H oxidase activity. Increased NAD(P)H oxidase activity preceded signs of ICH, and increased further when R+/A+ mice developed ICH. These findings suggest that oxidative stress may contribute to spontaneous ICH in chronic hypertension.
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Neupane, Bishomber, Ipsa Shakya, Rajiv Neupane, Babita Khanal, Prakash Kafle, and Edmond Jonathan Gandham. "Concurrent Eloquent Area Bleeds in a Patient with Uncontrolled Hypertension." Journal of Nobel Medical College 11, no. 2 (December 31, 2022): 79–81. http://dx.doi.org/10.3126/jonmc.v11i2.50906.
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Uncontrolled hypertension being the most important risk factor for intracerebral hemorrhage (ICH) often leads to solitary hematoma whereas multiple spontaneous simultaneous ICH is not common, and occurrence of bilateral hemorrhage is a rare entity with normal bleeding parameters with very few case reports so far. Here, we report a 67-year-old man with a past medical history of uncontrolled hypertension who was brought to the emergency department due to severe headache, worsening confusion for 1 day. An urgent non-contrast brain Computed Tomography (CT) performed immediately revealed bilateral intracerebral hemorrhage (ICH) of the same age in the right putamen and left thalamus. Our patient had a non-traumatic ICH, with low GCS (5/15) at presentation. He was managed conservatively with antihypertensives and antiedema measures. He was discharged in stable condition GCS 14/15 with left hemiparesis (3/5). At last follow up he was recovering well.Due to the rarity of spontaneous intracranial bleed in patient with normal bleeding parameters, it is particularly interesting to report this rare case presentation.
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Zanon, Ezio, Samantha Pasca, Francesco Demartis, Annarita Tagliaferri, Cristina Santoro, Isabella Cantori, Angelo Claudio Molinari, et al. "Intracranial Haemorrhage in Haemophilia Patients Is Still an Open Issue: The Final Results of the Italian EMO.REC Registry." Journal of Clinical Medicine 11, no. 7 (April 1, 2022): 1969. http://dx.doi.org/10.3390/jcm11071969.
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Background: Intracranial hemorrhage (ICH) is a highly serious event in patients with haemophilia (PWH) which leads to disability and in some cases to death. ICH occurs among all ages but is particularly frequent in newborns. Aim: The primary aim was to assess the incidence and mortality due to ICH in an Italian population of PWH. Secondary aims were to evaluate the risk factors for ICH, the role of prophylaxis, and the clinical management of patients presenting ICH. Methods: A retrospective-prospective registry was established in the network of the Italian Association of Haemophilia Centers to collect all ICHs in PWH from 2009 to 2019 reporting clinical features, treatments, and outcomes. Results: Forty-six ICHs were collected from 13 Centers. The ICHs occurred in 15 children (10 < 2 years), and in 31 adults, 45.2% of them with mild hemophilia. Overall, 60.9% patients had severe haemophilia (15/15 children). Overall ICH incidence (×1000 person/year) was 0.360 (0.270–0.480 95% CI), higher in children <2 years, 1.995 (1.110–3.442 95% CI). Only 7/46 patients, all with severe haemophilia, had received a prophylactic regimen before the ICH, none with mild. Inhibitors were present in 10.9% of patients. In adult PWHs 17/31 suffered from hypertension; 85.7% of the mild subjects and 29.4% of the moderate/severe ones (p < 0.05). ICH was spontaneous in the 69.6% with lower rate in children (46.7%). Surgery was required in 21/46 patients for cerebral hematoma evacuation. Treatment with coagulation factor concentrates for at least three weeks was needed in 76.7% of cases. ICH was fatal in 30.4% of the cases. Of the survivors, 50.0% became permanently disabled. Only one-third of adult patients received long term prophylaxis after the acute treatment. Conclusion: The results from our Registry confirm the still high incidence of ICH in infants <2 years and in adults, particularly in mild PWHs presenting hypertension and its unfavorable outcomes. The majority of PWHs were treated on-demand before ICH occurred, suggesting the important role of prophylaxis in preventing such life-threatening bleeding.
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Vasilieva, Yu P., N. V. Skripchenko, A. V. Klimkin, M. A. Bedova, and O. A. Levina. "Novel approach to comprehensive diagnosis of intracranial hypertension in children with neuroinfections." Voprosy praktičeskoj pediatrii 17, no. 5 (2022): 90–100. http://dx.doi.org/10.20953/1817-7646-2022-5-90-100.
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Objective. To develop an algorithm of structural and functional non-invasive diagnosis of different stages of intracranial hypertension (ICH) in children with acute meningitis and encephalitis. Patients and methods. We examined 115 patients aged 1 month to 17 years. We used neurosonography (NSG), transcranial duplex scanning (TCD), ultrasound examination of the optic nerve (ON), and fundus examination by an ophthalmologist. We have developed a comprehensive structural and functional diagnostic algorithm for different ICH stages in children with suspected neuroinfections. This algorithm should be applied within a day upon admission to the intensive care unit and includes NSG, TCD, ON ultrasound, and fundus examination by an ophthalmologist. The exact diagnostic criteria were developed for each method. NSG: clear contours of the brain stem; lateral ventricles between 12 and 16 mm in size; bone-brain diastasis between 1 and 4 mm. TCD: systolic flow rate in the middle cerebral artery between 60 and 180 cm/s; systolic flow rate in the veins of Rosenthal between 10 and 20 cm/s; arterial resistance index up to 0.8; venous resistance index up to 0.5. ON ultrasound: ON thickness up to 5.5 mm in children aged 1 month to 5 years and up to 5.8 mm in children aged 5–17 years. Fundus examination: dilated veins in the fundus. Decompensated ICH: deformed brain stem pattern; lateral ventricles up to 11 mm, bone-brain diastasis <1 mm; systolic flow rate in the middle cerebral artery up to 60 mm/s; systolic flow rate in the veins of Rosenthal up to 10 mm/s; reverberation pattern; ON thickness 6.5 ± 0.43 mm with unclear ON contours; stagnant disk of the optic nerve. We provide clinical examples that illustrate the effectiveness of the new algorithm, as well as the effectiveness of comprehensive therapy with cytoflavin during acute disease. Cytoflavin has multiple effects on the organism, improves cerebral hemodynamics and metabolism. Key words: intracranial hypertension, children, duplex, optic nerve, meningitis, neurosonography, ultrasound, encephalitis, cytoflavin
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Reddy, Subhash, Rohit Sharma, Jonathan Grotts, Lisa Ferrigno, and Stephen Kaminski. "Incidence of Intracranial Hemorrhage and Outcomes after Ground-level Falls in Geriatric Trauma Patients Taking Preinjury Anticoagulants and Antiplatelet Agents." American Surgeon 80, no. 10 (October 2014): 975–78. http://dx.doi.org/10.1177/000313481408001014.
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Antiplatelet and anticoagulant medication increases the risk of intracranial hemorrhage (ICH) after a fall in geriatric patients. We sought to determine whether there were differences in ICH rates and outcomes based on type of anticoagulant or antiplatelet agent after a ground-level fall (GLF). Our institutional trauma registry was used to identify patients 65 years old or older after a GLF while taking warfarin, clopidogrel, or aspirin over a 2-year period. Rates and types of ICH and patient outcomes were evaluated. Of 562 patients who met inclusion and exclusion criteria, 218 (38.8%) were on warfarin, 95 (16.9%) were on clopidogrel, and 249 (44.3%) were on aspirin. Overall ICH frequency was 15 per cent with no difference in ICH rate, type of ICH, need for craniotomy, mortality, or intensive care unit or hospital length of stay between groups. Patients with ICH were more likely to present with abnormal Glasgow Coma Score, history of hypertension, and/or loss of consciousness.
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Dias, Mark S., and Laligam N. Sekhar. "Intracranial Hemorrhage from Aneurysms and Arteriovenous Malformations during Pregnancy and the Puerperium." Neurosurgery 27, no. 6 (December 1, 1990): 855–66. http://dx.doi.org/10.1227/00006123-199012000-00001.
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Abstract Intracranial hemorrhage (ICH) from an intracranial aneurysm or arteriovenous malformation is a grave complication of pregnancy and is responsible for 5 to 12% of all maternal deaths. We critically analyzed 154 cases of verified ICH during pregnancy from an identified intracranial lesion, including 2 patients treated at our institution and 152 cases previously reported in the literature in English. Aneurysms were responsible for ICH in 77% of patients, and arteriovenous malformations in 23%. Hemorrhage occurred antepartum in 92% of patients and postpartum in 8%. Women with angiomatous hemorrhage were younger than those with aneurysmal hemorrhage; however, in contrast to previous reports, we found no differences between angiomatous and aneurysmal hemorrhage with respect to parity or gestational age at the time of the initial hemorrhage. Hypertension and/or albuminuria were present at some time during the pregnancy in 34% of patients with documentation, which sometimes made it difficult to differentiate angiomatous or aneurysmal ICH from that associated with eclampsia. In a logistic regression analysis, surgical management of aneurysms, but not arteriovenous malformations, was associated with significantly lower maternal and fetal mortality, independent of other covariants. For those patients with a lesion not operated on, cesarean delivery afforded no better maternal or fetal outcome than did vaginal delivery. We conclude that the decision to operate after ICH during pregnancy should be based upon neurosurgical principles, whereas the method of delivery should be based upon obstetrical considerations. The perioperative and anesthetic management of the pregnant patient with a neurosurgical complication is discussed.
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de Wit, K., M. Mercuri, C. Varner, S. Parpia, S. McLeod, N. Clayton, C. Kearon, and A. Worster. "PL03: Prevalence and clinical predictors of intracranial hemorrhage in seniors who have fallen." CJEM 21, S1 (May 2019): S5—S6. http://dx.doi.org/10.1017/cem.2019.42.
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Introduction: The Canadian population is aging and an increasing proportion of emergency department (ED) patients are seniors. ED visits among seniors are frequently instigated by a fall at home. Some of these patients develop intracranial hemorrhage (ICH) because of falling. There has been little research on the frequency of ICH in elderly patients who fall, and on which clinical factors are associated with ICH in these patients. The aim of this study was to identify the incidence of ICH, and the clinical features which are associated with ICH, in seniors who present to the ED having fallen. Methods: This was a prospective cohort study conducted in three EDs. Patients were included if they were age >65 years, and presented to the ED within 48 hours of a fall on level ground, off a bed/chair/toilet or down one step. Patients were excluded if they fell from a height, were knocked over by a vehicle or were assaulted. ED physicians recorded predefined clinical findings (yes/no) before any head imaging was done. Head imaging was done at the ED physician's discretion. All patients were followed for 6 weeks (both by telephone call and chart review at 6 weeks) for evidence of ICH. Associations between baseline clinical findings and the presence of ICH were assessed with multivariable logistic regression. Results: In total, 1753 patients were enrolled. The prevalence of ICH was 5.0% (88 patients), of whom 74 patients had ICH on the ED CT scan and 14 had ICH diagnosed during follow-up. 61% were female and the median age was 82 (interquartile range 75-88). History included hypertension in 76%, diabetes in 29%, dementia in 27%, stroke/TIA in 19%, major bleeding in 11% and chronic kidney disease in 11%. 35% were on antiplatelet therapy and 25% were on an anticoagulant. Only 4 clinical variables were independently associated with ICH: bruise/laceration on the head (odds ratio (OR): 4.3; 95% CI 2.7-7.0), new abnormalities on neurological examination (OR: 4.4; 2.4-8.1), chronic kidney disease (OR: 2.4; 1.3-4.6) and reduced GCS from baseline (OR: 1.9; 1.0-3.4). Neither anticoagulation (OR: 0.9; 0.5-1.6) nor antiplatelet use (OR: 1.1; 0.6-1.8) appeared to be associated with ICH. Conclusion: This prospective study found a prevalence of ICH of 5.0% in seniors after a fall, and that bruising on the head, abnormal neurological examination, abnormal GCS and chronic kidney disease were predictive of ICH.
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Zheng, Haiping, Chunli Chen, Jie Zhang, and Zhiping Hu. "Mechanism and Therapy of Brain Edema after Intracerebral Hemorrhage." Cerebrovascular Diseases 42, no. 3-4 (2016): 155–69. http://dx.doi.org/10.1159/000445170.
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Background: Intracerebral hemorrhage (ICH) is a subtype of stroke with a severe high mortality and disability rate and accounts for about 10-15% of all strokes. The oppression and destruction by hematoma to brain tissue cause the primary brain injury. The inflammation and coagulation response after ICH would accelerate the formation of brain edema around hematoma, resulting in a more severe and durable injury. Currently, treatments for ICH are focusing on the primary injury including reducing intracranial hypertension, blood pressure control, and rehabilitation. There is a short-of-effective medical treatment for secondary inflammation and reducing brain edema in ICH patients. So, it is very important to study on the relationship between brain edema and ICH. Summary: Many molecular and cellular mechanisms contribute to the formation and progress of brain edema after ICH; inhibition of brain edema provides favorable outcome of ICH. Key Messages: This review mainly discusses the pathology and mechanism of brain edema, the effects of brain edema on ICH, and the methods of treating brain edema after ICH.
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Listratov, A. I., T. M. Ostroumova, A. I. Kochetkov, and O. D. Ostroumova. "Drug-induced intracerebral hemorrhage." Kachestvennaya Klinicheskaya Praktika = Good Clinical Practice, no. 2 (August 2, 2022): 55–68. http://dx.doi.org/10.37489/2588-0519-2022-2-55-68.
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Intracerebral hemorrhage (ICH), which is a form of hemorrhagic stroke, is an extremely serious disease. This pathology is characterized by very high levels of disability and mortality. Despite the improvement in the treatment of those diseases that can lead to ICH, its frequency is currently increasing, which is largely due to the use of drugs, in which case the term «drug-induced intracerebral hemorrhage» (DI ICH) is used. One of the main reasons for drug-induced ICH is an increase in the frequency of prescribing anticoagulant therapy for the prevention of ischemic stroke in atrial fibrillation, as well as dual antithrombotic therapy. In addition to anticoagulants, thrombolytic drugs can lead to the development of this pathology. According to the literature, an increase in the risk of developing ICH is also associated with therapy with antidepressants from the group of selective serotonin reuptake inhibitors, as well as high doses of statins. Risk factors for this adverse reaction are age, smoking, hypertension, and thrombocytopenia. Treatment of DI ICH is an extremely difficult task and includes the withdrawal of the culprit medication, antihypertensive therapy, correction of intracranial hypertension, and, in some cases, the administration of antidotes. The main method of prevention is the use of antiplatelet drugs and other drugs, the use of which is associated with an increased risk of developing DI ICH, in strict accordance with modern protocols and recommendations.
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Mantha, Simon, Ann M. Pianka, and Nicholas P. Tsapatsaris. "Determinants of Intracranial Hemorrhage Incidence in Patients on Oral Anticoagulation Followed at the Lahey Clinic." Blood 116, no. 21 (November 19, 2010): 1101. http://dx.doi.org/10.1182/blood.v116.21.1101.1101.
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Abstract Abstract 1101 Background: oral anticoagulation with warfarin is used to treat venous and arterial thromboembolic disease. Its administration is associated with a risk of intracranial hemorrhage (ICH), a devastating complication which usually results in death or severe disability. The international normalized ratio (INR) is one of the factors which can help determine the risk of ICH in a given individual (Singer DE et al, Circ Cardiovasc Qual Outcomes 2009). Materials and methods: using the DoseResponse® patient database at our institution, we carried out a retrospective nested matched case-control study to identify patient characteristics associated with the occurrence of ICH. The database was queried for the years 2007 to 2009. Each case was matched by month to 4 control patients having a routine INR determination for the monitoring of chronic anticoagulation. The following characteristics were captured: INR, age, sex, systolic and diastolic blood pressure, hemoglobin, creatinine, history of pertinent medical conditions (hypertension, diabetes, heart failure, gastrointestinal bleeding, ischemic stroke, active cancer, substance abuse, cirrhosis), indication for anticoagulation (non-valvular atrial fibrillation, valvular atrial fibrillation, venous thromboembolism or other) and intake of antiplatelet agent. Blood pressure for cases was obtained from a medical encounter occurring before the bleeding event. The relationship between those risk factors and the odds ratio of ICH was determined with conditional logistic regression, using the SAS® 9.2 software platform. The initial approach consisted of stepwise regression with forward selection and backward elimination. Results: 31 cases of ICH were retrieved; they were matched to 124 controls. In the univariate analysis, the two groups differed significantly only in terms of their hemoglobin: 12.8 versus 13.5 g/dL for cases and controls, respectively (p=0.048). As for the INR, the mean value was 3.0 for cases vs 2.5 for controls. The distribution of this parameter was normal albeit more markedly skewed to the right for cases, with 3 values of 5.0 or more, compared to only one instance of this for controls. Most cases of ICH occurred in the setting of a therapeutic INR. The odds ratio (OR) of ICH (using the interval 2.01 to 2.50 as the reference) started increasing above an INR of 3.50, reaching its highest level in individuals with an INR value greater than 4.50 (OR=5.78, 95% CI=1.10-30.48). Mean blood pressures were similar between the two groups: 92 vs 89 mmHg for cases vs controls, respectively (p=0.252). The variables retained in the final regression model on the basis of statistical significance and clinical pertinence are shown in the table. The OR of ICH was 1.50 for increments of 1.0 in INR value (p=0.021), while it was 1.56 for increments of 10 mmHg in mean blood pressure (p=0.032). The presence of cancer, anemia and heart failure appeared to contribute to the risk of an event but the associations for those factors were not statistically significant. Conclusion: the INR is an important predictor for the incidence of ICH, but a supratherapeutic measurement is found only in a minority of cases; the risk of an event increases markedly with an INR above 3.5. Mean blood pressure is another important determinant of the risk of ICH in individuals on chronic warfarin therapy. Previous studies have shown that a diagnosis of hypertension is associated with an increased risk of ICH in the anticoagulated patient population (Berwaerts J et al, QJM 2000; Atrial Fibrillation Investigators, Arch Intern Med 1994; Singer DE et al, Ann Intern Med 2009), but to the knowledge of this author there has been no report describing the variation in this risk over the spectrum of mean blood pressures. This lends support to the generally accepted practice of aggressively treating arterial hypertension in patients on chronic oral anticoagulation. Multivariable Analysis Disclosures: No relevant conflicts of interest to declare.
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Pastor Escartín, Felix, Vicent Quilis Quesada, Pau Capilla Guasch, Diego Tabarés Palacín, Esteban Vega Torres, Fernando Talamantes Escribá, and Evandro De Oliveira. "Chiari I - Idiopathic Intracranial Hypertension Association After Failed Posterior Fossa Surgery. Case Report." JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA 30, no. 3 (March 3, 2019): 252–60. http://dx.doi.org/10.22290/jbnc.v30i3.1852.
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Objectives: Several papers have been published relating the Idiopathic Intracranial Hypertension Syndrome (HTII) to the Arnold Chiari type I malformation (AC1M). Both entities have clinical and demographic similarities, a poorly defined etiology and, sometimes common therapeutic posibilities. A correlation between both entities has been suggested, especially in a subgroup of patients in whom posterior fossa decompression surgery fails. With regard to a case, we reviewed the literature and proposed our hypothesis about the origin of Chiari-HTII syndrome and its therapeutic possibilities. Case presentation: A 41year-old patient with mild obesity, menstrual abnormalities and empty Sella Turcicae, was operated on with an AC1M associating basilar impression and syringomyelia causing all together a centromedullary syndrome. After posterior fossa decompression surgery and successful arthrodesis, she improved in the immediate postoperative period. Nevertheless, she soon developed symptoms of intracranial hypertension (ICH), and showed increased opening pressure in lumbar puncture compatible with HTII syndrome. A ventriculoperitoneal shunt (VPS) was implanted with clinical improvement and 12 months later the syringomyelia was absent on in the magnetic resonance (MRI). Conclusion: The Chiari I-HTII syndrome is described as the coexistence of ICH symptoms after failed posterior fossa surgery, in patients with no flow MRI anomalies, and increased opening pressure at the lumbar puncture. In our experience, both entities seem to overlap in a common syndrome and must be taken into account, especially in patients with atypical onset of symptoms or patients in whom conservative treatment fails.
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Andreytseva, M. I., S. S. Petrikov, L. T. Khamidova, and A. A. Solodov. "The ultrasound study of the optic canal for detecting raised intracranial pressure (a literature review and critical analysis)." Russian Sklifosovsky Journal "Emergency Medical Care" 7, no. 4 (January 30, 2019): 349–56. http://dx.doi.org/10.23934/2223-9022-2018-74-349-356.
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Intracranial hypertension (ICH) is a frequent and serious complication that occurs in pa-tients with severe traumatic brain injury (TBI) and nontraumatic brain damage. Persistent ICH significantly worsens the prognosis of the disease course and increases the risk of adverse outcomes. In this regard, one of the main tasks of intensive care of patients with intracranial bleeding (ICB) is diagnosis and timely management of ICH. The gold standard is invasive intracranial pressure (ICP) monitoring. The advantages of direct measurement of ICP include accuracy and continuity of registration. The disadvantages are the invasiveness of the method, high cost, the risk of developing infectious and hemorrhagic complications and possible dislocation of sensors. It is necessary to search for a method of non-invasive assessment of the level of ICH most correlated with the data of direct measurement of ICP. Ultrasonography of the optic nerve structures can be such an alternative cheap way to assess ICP. Its advantages are the possibility of repeated dynamic use, no need for surgical intervention, simplicity and high accuracy of measurement. However, the results obtained with ultrasound vary, since this method is operator dependent and requires precise adherence to the technique of the study. When the optic nerve ultrasound is performed, a contact gel for ultrasound examinations is applied to the anterolateral surface of the closed upper eyelid, and a scanning plane is displayed behind the eyeball for visualization in the central part of the ultrasound image of the optic nerve, lens and retina. To visualize the vertical course of the ophthalmic artery (and the vertical course of the optic nerve), the color flow Doppler mode is used. The study includes measuring the diameter of the optic nerve and the optic nerve sheath diameter (ONSD). There is subarachnoid space with cerebrospinal fluid between the optic nerve and its sheath. With an increase in intracranial pressure, the expansion of this space occurs, ONSD grows as well. This article contains an analysis of the literature describing the anatomy of the optic nerve and various ultrasound techniques, as well as data from various authors on the threshold value of the optic nerve sheath diameter.
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Grayck, Eva Nozik, Jon N. Meliones, Frank H. Kern, Doug R. Hansell, Ross M. Ungerleider, and William J. Greeley. "Elevated Serum Lactate Correlates With Intracranial Hemorrhage in Neonates Treated With Extracorporeal Life Support." Pediatrics 96, no. 5 (November 1, 1995): 914–17. http://dx.doi.org/10.1542/peds.96.5.914.
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Objectives. To correlate the initial and maximal lactate levels with the occurrence of intracranial hemorrhage (ICH) and survival in patients treated with extracorporeal life support (ECLS). Design. Retrospective chart review. Setting. Pediatric intensive care unit. Patients. Eighty-two neonatal patients placed on ECLS for respiratory failure due to sepsis, meconium aspiration, or persistent pulmonary hypertension of the newborn. Measurements. The initial lactate level measured within 6 hours of initiating ECLS and the maximal lactate level measured throughout the ECLS course were collected. Lactate levels were described as mean lactate ± SE (mM). Head ultrasound reports and survival were reviewed. Platelet counts and activated clotting times (ACTs) were examined. Results. The mean initial and maximal lactate levels were higher in ECLS patients who developed ICH (initial: 10 ± 1.7 mM vs 6.4 ± 0.8 mM, p = .05 and maximal: 12.4 ± 2.5 mM vs 7.9 ± 0.8 mM, p = .04). Initial and maximal lactate levels were also elevated in nonsurvivors (initial: 11.7 ± 3 mM vs 6.4 ± 0.7 mM, p = .01 and maximal: 14.8 ± 3.3 mM vs 7.8 ± 0.8 mM, P < .01). Platelet counts and ACT did not differ in patients with and without ICH. Conclusions. Lactate is a useful marker for the development of ICH in ECLS patients. In addition, elevated lactates during ECLS identify a subgroup of patients with poor outcome. Prospective studies are needed to determine whether the incorporation of this information into pre-ECLS and ECLS management will decrease the occurrence of ICH and improve survival.
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Alanazi, Abdulaziz H., Mir S. Adil, Xiaorong Lin, Daniel B. Chastain, Andrés F. Henao-Martínez, Carlos Franco-Paredes, and Payaningal R. Somanath. "Elevated Intracranial Pressure in Cryptococcal Meningoencephalitis: Examining Old, New, and Promising Drug Therapies." Pathogens 11, no. 7 (July 10, 2022): 783. http://dx.doi.org/10.3390/pathogens11070783.
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Despite the availability of effective antifungal therapy, cryptococcal meningoencephalitis (CM) remains associated with elevated mortality. The spectrum of symptoms associated with the central nervous system (CNS) cryptococcosis is directly caused by the high fungal burden in the subarachnoid space and the peri-endothelial space of the CNS vasculature, which results in intracranial hypertension (ICH). Management of intracranial pressure (ICP) through aggressive drainage of cerebrospinal fluid by lumbar puncture is associated with increased survival. Unfortunately, these procedures are invasive and require specialized skills and supplies that are not readily available in resource-limited settings that carry the highest burden of CM. The institution of pharmacologic therapies to reduce the production or increase the resorption of cerebrospinal fluid would likely improve clinical outcomes associated with ICH in patients with CM. Here, we discuss the potential role of multiple pharmacologic drug classes such as diuretics, corticosteroids, and antiepileptic agents used to decrease ICP in various neurological conditions as potential future therapies for CM.
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VASILIEVA, YU P., N. V. SKRIPCHENKO, A. V. KLIMKIN, M. A. BEDOVA, O. A. LEVINA, and B. V. OSTAPENKO. "Comprehensive structural and functional approach to the noninvasive diagnosis of intracranial hypertension and its degree in meningitis and encephalitis in children." Practical medicine 20, no. 1 (2022): 56–66. http://dx.doi.org/10.32000/2072-1757-2022-1-56-66.
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Intracranial hypertension is a factor complicating the course of neuroinfections and determining its outcomes. The original article describes the results of the examination of 115 patients with meningitis and encephalitis. The purpose — to develop a comprehensive structural and functional approach to noninvasive diagnosis of intracranial hypertension (ICH) and its degree in meningitis and encephalitis. Methods: neurosonography (NSG); transcranial duplex scanning (TCDS); optic nerve sheath diameter (ONSD); ocular fundus. Results. A technique of ICH diagnostics is proposed. All patients suspected for neuroinfection with the clinical manifestations of general infection and meningeal syndrome during the first day at hospital, without preliminary preparation, undergo NSG, optic nerve sheath diameter estimation, TCDS, and ocular fundus exammination. The characteristic features for ICH in the stage of compensation are: clear contours of the brain stem, lateral ventricles from 12 to 16 mm, bone-marrow diastasis from 1 mm to 4 mm; systolic blood flow velocity in the middle cerebral artery from 60 cm/s to 180 cm/s, the Rosenthal’s veins — from 10 cm/s to 20 cm/s, an increase in the resistance index in the arteries up to 0.8, in the veins up to 0.5; ONSD: in children aged 1 month 5 years up to 5.5 mm, in children aged 5 to 17 years up to 5.8 mm; expansion of the veins in the fundus. The characteristic features for ICH in the stage of decompensation are: the deformation of the brain stem, lateral ventricles up to 11 mm, bone-marrow diastasis size less than 1 mm; systolic blood flow velocity in the middle cerebral artery up 60 cm/s, the Rosenthal’s veins up to 10 cm/s, detection of a reverberation pattern; ONSD: 6.5 ± 0.43 mm with a loss of clarity of the contours; stagnation of ON disk in the fundus.
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Evangelisti, Maria Antonietta, Giovanni Carta, Giovanni P. Burrai, Maria Luisa Pinna Parpaglia, Francesca Cubeddu, Isabella Ballocco, Antonella Puggioni, and Maria Lucia Manunta. "Repeatability of ultrasound examination of the optic nerve sheath diameter in the adult cat: comparison between healthy cats and cats suffering from presumed intracranial hypertension." Journal of Feline Medicine and Surgery 22, no. 10 (January 22, 2020): 959–65. http://dx.doi.org/10.1177/1098612x19898006.
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Objectives The objectives of this study were to test: (1) the repeatability of ultrasonographic examination of the optic nerve sheath diameter (ONSD) in the cat; (2) the association between the ONSD and age, sex and body weight in healthy cats; and (3) the difference in the ONSD between healthy cats and those suffering from presumed intracranial hypertension (ICH). Methods This study had a prospective, blinded, observational cross-sectional study design. Two groups of animals were considered: healthy cats (group A) and cats with a diagnosis of presumed ICH (group B). The ONSD was evaluated, measured and compared between the two groups via an ultrasonographic transpalpebral approach. Repeatability of the procedure was evaluated through the intraclass correlation coefficient (ICC). Data were statistically compared using the Student’s t-test and linear regression analysis. Results A strong inter- and intraobserver ICC indicating good repeatability was observed. The interobserver ICC was 0.965 ( P <0.05) for the right eye and 0.956 ( P <0.05) for the left eye. The intraobserver ICC was 0.988 ( P <0.05) and 0.984 ( P <0.05) for the right and left eyes, respectively. In healthy cats the mean ± SD ONSD was 1.23 ± 0.11 mm (range 1–1.47 mm) and 1.23 ± 0.10 (range 1–1.4 mm) for right and left eyes, respectively. The ONSD was not related to sex or weight; a weak relationship was observed with age. In group B, the mean ONSD was 1.68 ± 0.13 mm (range 1.5–1.9 mm) and 1.61 ± 0.15 mm (range 1.4–1.9 mm) for the right and left eyes, respectively. In group B, the ONSD was statistically significantly larger than in group A, the healthy cats ( P <0.001). Conclusions and relevance The transpalpebral ultrasonographic technique is a non-invasive, feasible and reproducible method to measure ONSD both in healthy cats and in cats suffering from suspected ICH.
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Biesbroek, J. Matthijs, Gabriel J. E. Rinkel, Ale Algra, and Jan Willem Berkelbach van der Sprenkel. "Risk Factors for Acute Subdural Hematoma From Intracranial Aneurysm Rupture." Neurosurgery 71, no. 2 (April 2, 2012): 264–69. http://dx.doi.org/10.1227/neu.0b013e318256c27d.
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Abstract BACKGROUND: An acute subdural hematoma (aSDH) is a rare complication of aneurysmal subarachnoid hemorrhage (SAH) and is associated with poor clinical condition on admission and poor outcome. Risk factors for the development of an aSDH from aneurysmal rupture are unknown and may help our understanding of how an aSDH develops. OBJECTIVE: To identify risk factors for the development of an aSDH from intracranial aneurysm rupture. METHODS: Patients were selected from our prospectively collected single-center SAH database. From all 1757 patients fulfilling prespecified inclusion criteria, 63 had an aSDH. We assessed sex, age, smoking, hypertension, history of SAH, sentinel headache, location of the ruptured aneurysm, and intracerebral hemorrhage (ICH) as risk factors for an aSDH. Univariable and multivariable risk ratios with corresponding 95% confidence intervals (CIs) were calculated for characteristics with Poisson regression. RESULTS: Multivariable risk ratios were 1.021 (95% CI: 1.001-1.042) for each year increase in age, 2.3 (95% CI: 1.3-3.8) for posterior communicating artery aneurysms, 3.0 (95% CI: 1.5-6.0) for sentinel headache, and 5.2 (95% CI: 3.1-8.9) for ICH. None of the 95 patients (0%; 95% CI: 0%-3.8%) with a ruptured vertebrobasilar aneurysm had an aSDH, which was statistically significantly lower than at other sites (P = .02 for basilar aneurysm; P = .04 for vertebral aneurysm). None of the other studied characteristics had a statistically significant association with an aSDH. CONCLUSION: Increasing age, sentinel headache, ICH, and aneurysms at the posterior communicating artery are independent risk factors for an aSDH. Patients with a basilar or vertebral aneurysm have a low risk of an aSDH.
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Assoumane, Ibrahim, Mahdia Touati, Harissou Adamou, Nadia Lagha, Ibrahim Baaré, Samuila Sanoussi, Abderahmanne Sidi Said, and Abdelhalim Morsli. "Management of Idiopathic Intracranial Hypertension: Experience of a North African Center." Indian Journal of Neurosurgery 9, no. 02 (June 15, 2020): 085–88. http://dx.doi.org/10.1055/s-0040-1710107.
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Abstract Background The idiopathic intracranial hypertension (IIH) is characterized by elevation of intracranial pressure (ICP) in the absence of intracerebral space occupation or venous sinus thrombosis. It usually occurs in obese young women but is very rare in childhood. Materials and Methods We conducted a retrospective study in the neurosurgical department of Bab El Oued teaching hospital of Algiers over a period of 8 years from January 2008 to December 2015. We analyzed clinical data of 10 patients with IIH diagnosis, and the surgical technique consisted of an insertion of a lumbo-peritoneal shunt. Results In our study, 80% were women with sex ratio M/F of 0.25; the mean age was 32 years and 60% of our patients were obese. For most of our patients, the postoperative outcome was marked by the disappearance of the headache immediately, disappearance of strabismus and diplopia in the following week, followed by improvement of visual function. Conclusion The IIH is predominantly a disease of women in the childbearing age; surgical treatment is a good option for patients who resisted medication or did not tolerate it as well as for ICH fulminous in emergency cases.
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van de Beeten, Stephanie D. C., Martijn J. Cornelissen, Renee M. van Seeters, Marie-Lise C. van Veelen, Sarah L. Versnel, Sjoukje E. Loudon, and Irene M. J. Mathijssen. "Papilledema in unicoronal synostosis: a rare finding." Journal of Neurosurgery: Pediatrics 24, no. 2 (August 2019): 139–44. http://dx.doi.org/10.3171/2019.3.peds18624.
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OBJECTIVEUnicoronal synostosis results in frontal plagiocephaly and is preferably treated before the patient is 1 year of age to prevent intracranial hypertension (ICH). However, data on the prevalence of ICH in these patients is currently lacking. This study aimed to establish the prevalence of preoperative and postoperative signs of ICH in a large cohort of patients with unicoronal synostosis and to test whether there is a correlation between papilledema and occipitofrontal head circumference (OFC) curve stagnation in unicoronal synostosis.METHODSThe authors included all patients with unicoronal synostosis treated before 2 years of age at a single center between 2003 and 2013. The presence of ICH was evaluated by routine fundoscopy. The OFC growth curve was analyzed for deflection and in relationship to signs of ICH.RESULTSIn total, 104 patients were included in this study, 84 (81%) of whom were considered to have nonsyndromic unicoronal synostosis. Preoperatively, none of the patients had papilledema as determined by fundoscopy (mean age at surgery 11 months). Postoperatively, 5% of patients with syndromic synostosis and 3% of those with nonsyndromic synostosis had papilledema, and this was confirmed by optical coherence tomography. Raised intracranial pressure was confirmed in 1 patient with syndromic unicoronal synostosis. Six of 78 patients had OFC stagnation, which was not significantly correlated to papilledema (p = 0.22). One child with syndromic unicoronal synostosis required repeated surgery for ICH (0.96%).CONCLUSIONSPapilledema was not found in patients with unicoronal synostosis when they underwent surgery before the age of 1 year and was also very rare during follow-up. There was no relationship between papilledema and OFC stagnation.
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Al-Saadi, Tariq, Yahya Al-Kindi, Moosa Allawati, and Hatem Al-Saadi. "Intracranial Hemorrhage following Spinal Surgery: A Systematic Review of a Rare Complication." Surgery Journal 08, no. 01 (January 2022): e98-e107. http://dx.doi.org/10.1055/s-0042-1743525.
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Abstract Introduction Intracranial hemorrhage (ICH) is a potentially severe complication of spinal surgeries. The occurrence of such complications causes deterioration of the patient's clinical status and delayed discharge from the hospital. Although no specific etiological factors were identified for this complication, but multiple risk factors might play role in its development, they include the use of anticoagulants, presence of uncontrolled hypertension, and perioperative patient positioning. Aim A systematic review of the literature to investigate the prevalence of different types of intracranial hemorrhages in patients who underwent spinal surgeries. Methods A literature review was conducted using multiple research databases. Data were extracted using multiple variables that were formulated incongruent with the study aim and then further analyzed. Results A total of 79 studies were included in our analysis after applying the exclusion criteria and removing of repeated studies, 109 patients were identified where they were diagnosed with intracranial hemorrhage after spine surgery with a mean age of 54 years. The most common type of hemorrhage was cerebellar hemorrhage (56.0%) followed by SDH and intraparenchymal hemorrhage; 23.9 and 17.4%, respectively. The most common spine surgery was laminectomy (70.6%), followed by fixation and fusion (50.5%), excision of spinal lesions was done in 20.2% of the patient, and discectomy (14.7%). Conclusion The data in this study showed that out of 112 patients with ICH, cerebellar hemorrhage was the most common type. ICH post–spine surgery is a rare complication and the real etiologies behind this complication are still unknown, cerebrospinal fluid drain and durotomy were suggested.
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Fan, Jun-Yu, Catherine Kirkness, Paolo Vicini, Robert Burr, and Pamela Mitchell. "An Approach to Determining Intracranial Pressure Variability Capable of Predicting Decreased Intracranial Adaptive Capacity in Patients With Traumatic Brain Injury." Biological Research For Nursing 11, no. 4 (March 24, 2010): 317–24. http://dx.doi.org/10.1177/1099800409349164.
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Nurses caring for traumatic brain injury (TBI) patients with intracranial hypertension (ICH) recognize that patients whose intracranial adaptive capacity is reduced are susceptible to periods of disproportionate increase in intracranial pressure (DIICP) in response to a variety of stimuli. It is possible that DIICP signals potential secondary brain damage due to sustained or intermittent ICH. However, there are few clinically accessible intracranial pressure (ICP) measurement parameters that allow nurses and other critical care clinicians to identify patients at risk of DIICP. The purpose of this study was to investigate whether there are specific minute-to-minute trends in ICP variability during the first 48 hr of monitoring that might accurately predict DIICP in patients with severe TBI. A total of 38 patients with severe TBI were sampled from the data set of a randomized controlled trial testing bedside monitoring displays and cerebral perfusion pressure management in individuals with TBI or sub-arachnoid hemorrhage. The investigators retrospectively examined the rates of change (slope) in mean, standard deviation, and variance of ICP on a 1-min basis for 30 consecutive min prior to a specified DIICP event. There was a significantly increasing linear and quadratic slope in mean ICP prior to the development of DIICP, compared with the comparison data set (p < .05). It is feasible to display moving averages in modern bedside monitoring. Such an arrangement may be useful to provide visual displays that provide immediate clinically relevant information regarding the patients with decreased adaptive capacity and therefore increased risk of DIICP.
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Rifkin, Stephen I., Ali R. Malek, and Reza Behrouz. "Use of Hypertonic Continuous Venovenous Hemodiafiltration to Control Intracranial Hypertension in an End-Stage Renal Disease Patient." International Journal of Nephrology 2010 (2010): 1–2. http://dx.doi.org/10.4061/2010/391656.
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Continuous venovenous hemodiafiltration (CVVHDF) using solutions designed to maintain hypernatremia is described in an end-stage renal disease (ESRD) patient with cerebral edema (CE) due to an intracerebral hemorrhage (ICH). Hypernatremia was readily achieved and maintained without complication. CVVHDF should be considered as an alternative treatment option in ESRD patients with cerebral edema who require hypertonic saline therapy.
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Ozsari, Emine, and Abdullah Demirhan. "Effect of bronchoscopy on intracranial hypertension during different regimen of sedation by optic nerve sheath diameter." Neurology Asia 26, no. 4 (September 2021): 795–800. http://dx.doi.org/10.54029/2021mtd.
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Objectives: Fiberoptic bronchoscopy (FOB) is a useful method for ventilator-associated pneumonia (VAP), aspiration, and atelectasis, especially in intensive care units. (ICU) We aimed to investigate the effect of FOB on intracranial pressure by ultrasonographic optic nerve sheath diameter (uONSD) during different sedation protocols in a tertiary ICU. Methods: Prospective randomized study included the patients with two groups as superficial (Group M; midazolam) and deep sedation (Group P; propofol). FOB was performed for VAP or aspiration and intracranial hypertension (ICH) was measured with uONSD, noninvasively. The values of uONSD were noted pre-procedure, on sedation, 1st – 5th, and 15th minute of the procedure. In addition, mean arterial pressures (MAP), oxygen saturation, and heart rate values were recorded from the monitor. Results: The mean age and indications of FOB for 33 patients as Group M (n=17) and Group P (n=16) were similar to each other. ONSD was increased with the procedure in both groups but in group P it was stabilized from the 5th minutes of FOB whereas became higher progressively in group M (p<0,001). Postoperative MAP values that may have an important role for ICH were also increased in Group M (MAP was 70.65 ± 16.18 at time of sedation in Group P and 75.63 ± 13.76 in Group M). Conclusion: This study showed that bronchoscopy results as a significant increase for OSND in both groups but that was less high in patients who had deep sedation with propofol and it returned to baseline after the procedure.
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Bunchorntavakul, Chalermrat. "Acute liver failure." Thai Journal of Hepatology 1, no. 1 (April 24, 2018): 1–13. http://dx.doi.org/10.30856/th.jhep2018vol1iss1_63.
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Acute liver failure (ALF) is a life threatening condition defined by the evidence of hepatic injury, jaundice, coagulopathy, and encephalopathy in a patient without preexisting cirrhosis and with an illness duration of <26 weeks. The etiologies of ALF are heterogeneous: viral hepatitis being the most common in the East, whereas drug-induced, particularly acetaminophen, being the most common in the West. Over the past decades, the outcomes of ALF have been improving with early recognition and prompt initiation of etiology-specific therapy (especially N-acetylcysteine), complex intensive care protocols and urgent liver transplantation (LT). The most commonly used prognostic scoring systems include King’s College Criteria (more specific) and MELD (more sensitive). Cerebral edema and intracranial hypertension are reasons for high morbidity and mortality in the early phase; hypertonic saline is suggested for patients with high-risk for developing intracranial hypertension (ICH) and when ICH develops, mannitol is recommended as first-line therapy. Bacterial and fungal infections are very common necessitating strict preventive measures, careful surveillance and prompt aggressive antimicrobial therapy. Acute kidney injury develops in 50-70% of patients; mostly reversible in survivors and temporary dialysis is required in about 30% of cases. Overall 1-year survival after LT has been reported to be lower in patients with ALF as compared to those with cirrhosis; however following the first year this trend has been to be reversed and ALF patients have a better long-term survival. Extracorporeal liver support system, such as albumin dialysis and plasmapheresis, may serve as a bridge to LT and may increase LT-free survival in select cases.
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Koshman, I., A. G. Kalinichev, A. V. Shchegolev, and I. E. Shaludkin. "Traumatic intracranial hipertension correction in patients with intracranial hematomas during the early postoperative period with the use of systemic angioprotector." EMERGENCY MEDICAL CARE 22, no. 4 (January 19, 2022): 60–69. http://dx.doi.org/10.24884/2072-6716-2021-22-4-60-69.
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Post-traumatic brain edema is integral pathophysiological process in patients with severe traumatic brain injury, leading to increase of intracranial pressure (ICP). Intracranial hypertension (ICH), in turn, increases the number of deaths in this group of patients. The most important task in the treatment of victims in the early postoperative period after the removal of traumatic intracranial hematomas is correction of ICH syndrome.Purpose of the study. To evaluate the effect of the systemic angioprotector use on the treatment outcomes of patients with traumatic intracranial hematomas in the early postoperative period.Materials and methods. The study included 50 patients with traumatic intracranial hematomas. Group I — the main group (with the use of systemic angioprotector, n=24), group II — the comparison group (without the use of the medication, n=26). The effectiveness of treatment was compared — according to the following criteria: survival in the postoperative period (14 days), level of consciousness (at admission and average value during the day throughout the treatment), course of neurological status: meningeal signs, cranial nerve function, motor sphere, response to pain stimuli, autonomic system disorders (at admission and every day throughout the treatment), monitoring of ICP (before removal of the hematoma and average value throughout the measurement), changes in the multispiral computed tomogram of the head (at admission, on the 3rd, 7th, 14th day).Results. The study found that the mortality rate in the main group of patients with intracranial hematomas in the early postoperative period decreased by 21.5%. The average value of ICP for the entire period of measurement in group I is 15.0±7.6, in group II 17.3±8.4 mm Hg. The average value of points of the Glasgow com scale on the 14th day in group I is 9.2±1.9, in group II 7.5±0.7 points. The duration of intraventricular monitoring of ICP was less in the first group — 4.3±1.2 days, compared to the second group — 6.2±1.5 days.Conclusion. The use of systemic angioprotector in the complex treatment can reduce intracranial pressure (ICP) in patients with traumatic intracranial hematomas in the early postoperative period and improve intermediate outcomes.
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Jabbarli, Ramazan, Matthias Reinhard, Roland Roelz, Mukesch Shah, Wolf-Dirk Niesen, Klaus Kaier, Christian Taschner, Astrid Weyerbrock, and Vera Van Velthoven. "Intracerebral Hematoma Due to Aneurysm Rupture." Neurosurgery 78, no. 6 (November 25, 2015): 813–20. http://dx.doi.org/10.1227/neu.0000000000001136.
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Abstract BACKGROUND: Along with subarachnoid hemorrhage (SAH), a ruptured aneurysm may also cause an intracerebral hematoma (ICH), which negatively impacts the functional outcome of SAH. OBJECTIVE: To identify independent risk factors of aneurysmal ICH. METHODS: Six hundred thirty-two consecutive patients with aneurysmal SAH treated at our institution from January 2005 to December 2012 were eligible for this study. Demographic parameters and preexisting comorbidities of patients, as well as various clinical and radiographic characteristics of SAH were correlated with the incidence and volume of aneurysmal ICH. RESULTS: One hundred fifty-five patients (25%) had ICH on initial computed tomography with a mean volume of 26.7 mL (±26.8 mL). Occurrence and volume of ICH were associated with the location (distal anterior or middle cerebral artery >proximal anterior cerebral or internal carotid artery >posterior circulation, P < .001/P < .001) and size (>12 mm, P = .026/P < .001) of the ruptured aneurysm. Vascular risk factors independently increased the risk of ICH as well (arterial hypertension: odds ratio [OR] = 1.62, P = .032; diabetes mellitus: OR = 3.06, P = .009), while the use of aspirin (P = .037) correlated with the volume of ICH. The predictors of ICH were included into a risk score (0-9 points) that strongly predicted the occurrence of ICH (P = .01). Poor functional outcome after SAH was independently associated with the occurrence of ICH (P = .003, OR = 2.77) and its volume (P = .001, OR = 1.07 per-mL-increase). CONCLUSION: Aneurysmal ICH is strongly associated with poorer functional outcome and seems to be predictable even before the bleeding event. The proposed risk factors for aneurysmal ICH require further validation and may be considered for treatment decisions regarding unruptured intracranial aneurysms.
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Ordóñez-Rubiano, Edgar G., Luisa F. Figueredo, Carlos A. Gamboa-Oñate, Ivo Kehayov, Jorge A. Rengifo-Hipus, Ingrid J. Romero-Castillo, Angie P. Rodríguez-Medina, Javier G. Patiño-Gomez, and Oscar Zorro. "The reverse question mark and L.G. Kempe incisions for decompressive craniectomy: A case series and narrative review of the literature." Surgical Neurology International 13 (July 8, 2022): 295. http://dx.doi.org/10.25259/sni_59_2022.
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Background: Decompressive craniectomy (DC) is a lifesaving procedure, relieving intracranial hypertension. Conventionally, DCs are performed by a reverse question mark (RQM) incision. However, the use of the L. G. Kempe’s (LGK) incision has increased in the last decade. We aim to describe the surgical nuances of the LGK and the standard RQM incisions to treat patients with severe traumatic brain injury (TBI), intracranial hemorrhage (ICH), empyema, and malignant ischemic stroke. Furthermore, to describe, surgical limitations, wound healing, and neurological outcomes related to each technique. Methods: To describe a prospective acquired, case series including patients who underwent a DC using either an RQM or an LGK incision in our institution between 2019 and 2020. Results: A total of 27 patients underwent DC. Of those, ten patients were enrolled. The mean age was 42.1 years (26–71), and 60% were male. Five patients underwent DC using a large RQM incision; three had severe TBI, one ICH, and one ischemic stroke. The other five patients underwent DC using an LGK incision (one ICH, one subdural empyema, and one ischemic stroke). About 50% of patients presented severe headaches associated with vomiting, and six presented altered mental status (drowsy or stuporous). Motor deficits were present in four cases. In patients with ischemic or hemorrhagic stroke, symptoms were directly related to the stroke location. Hospital stays varied between 13 and 22 days. No readmissions were recorded, and no fatal outcome was documented during the follow-up. Conclusion: The utility of the LGK incision is comparable with the classic RQM incision to treat acute brain injuries, where an urgent decompression must be performed. Some of these cases include malignant ischemic strokes, ICH, and empyema. No differences were observed between both techniques in terms of prevention of scalp necrosis and general cosmetic outcomes.
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Dhanabalan, Balaji, Anupam Dutta, Ajit Kumar Pegu, Bharath H. R, and Bhabani Sankar Dhal. "Study of Aetiological and Clinical Profile of Stroke Patients with Special Reference to Baseline Intracranial Haemorrhage Score in Haemorrhagic Stroke in North East India - A Hospital Based Cross-Sectional Study." Journal of Evolution of Medical and Dental Sciences 10, no. 13 (March 29, 2021): 947–51. http://dx.doi.org/10.14260/jemds/2021/204.
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BACKGROUND As defined by World Health Organization (WHO), stroke is accountable for 5 million deaths and 5 million disabled patients throughout the world. The prevalence of stroke is in rising trend in Indian subcontinent and therefore is a source of socioeconomic concern. This study was conducted to evaluate the aetiological and clinical profile in stroke patients with special reference to baseline intracranial haemorrhage (ICH) score in haemorrhagic stroke in North East India. METHODS The study was carried out among in-patients of Medicine Department at Assam Medical College and Hospital, Dibrugarh in North East India from March 2019 to February 2020. A total of 112 patients who presented with symptoms suggestive of stroke were assessed. Mean ± standard deviation was used to express continuous variables. Frequency and percentage were used to express categorical variables. Test of significance for qualitative data was assessed by chi-square test (for 2 x 2 tables). P-value less than 0.05 was taken as statistically significant. RESULTS In our study stroke was common in 40 – 60 years age group which comprised 50 % of total patients. Stroke was more common in males with a sex ratio of 1.24:1. 73.2 % of patients suffered haemorrhagic stroke and 22.3 % suffered ischemic stroke whereas 4.5 % suffered cardio-embolic stroke. Hypertension was the most prevalent and an important risk factor with 80.3 % (P = 0.001), followed by smoking with 39 % (P = 0.021), chronic alcohol consumption with 37 % (P = 0.028) and diabetes with 22 %. The most common site of haemorrhage was basal ganglia (28 %) followed by thalamus (24 %). Patients presenting with intraventricular extension, infratentorial location, low Glasgow Coma Scale (GCS) score (< 4) or having high ICH score (≥ 3) at the time of presentation were associated with increased mortality in haemorrhagic stroke (P = 0.010). CONCLUSIONS Haemorrhagic strokes (73.2 %) are the most common type. Hypertension is the most prevalent and an important risk factor (80.3 %). Basal ganglia (28 %) are the most common sites involved in haemorrhagic stroke; infratentorial location is associated with poor prognosis. Patients presenting with low GCS score (< 4) or having high ICH score (≥ 3) at the time of presentation are associated with increased mortality in haemorrhagic stroke. KEY WORDS Stroke, Hypertension, Basal Ganglia, GCS Score, ICH Score
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Dabrowski, Wojciech, Dorota Siwicka-Gieroba, Chiara Robba, Rafael Badenes, Katarzyna Kotfis, Todd T. Schlegel, and Andrzej Jaroszynski. "Decompressive Craniectomy Improves QTc Interval in Traumatic Brain Injury Patients." International Journal of Environmental Research and Public Health 17, no. 22 (November 21, 2020): 8653. http://dx.doi.org/10.3390/ijerph17228653.
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Background: Traumatic brain injury (TBI) is commonly associated with cardiac dysfunction, which may be reflected by abnormal electrocardiograms (ECG) and/or contractility. TBI-related cardiac disorders depend on the type of cerebral injury, the region of brain damage and the severity of the intracranial hypertension. Decompressive craniectomy (DC) is commonly used to reduce intra-cranial hypertension (ICH). Although DC decreases ICH rapidly, its effect on ECG has not been systematically studied. The aim of this study was to analyze the changes in ECG in patients undergoing DC. Methods: Adult patients without previously known cardiac diseases treated for isolated TBI with DC were studied. ECG variables, such as: spatial QRS-T angle (spQRS-T), corrected QT interval (QTc), QRS and T axes (QRSax and Tax, respectively), STJ segment and the index of cardio-electrophysiological balance (iCEB) were analyzed before DC and at 12–24 h after DC. Changes in ECG were analyzed according to the occurrence of cardiac arrhythmias and 28-day mortality. Results: 48 patients (17 female and 31 male) aged 18–64 were studied. Intra-cranial pressure correlated with QTc before DC (p < 0.01, r = 0.49). DC reduced spQRS-T (p < 0.001) and QTc interval (p < 0.01), increased Tax (p < 0.01) and changed STJ in a majority of leads but did not affect QRSax and iCEB. The iCEB was relatively increased before DC in patients who eventually experienced cardiac arrhythmias after DC (p < 0.05). Higher post-DC iCEB was also noted in non-survivors (p < 0.05), although iCEB values were notably heart rate-dependent. Conclusions: ICP positively correlates with QTc interval in patients with isolated TBI, and DC for relief of ICH reduces QTc and spQRS-T. However, DC might also increase risk for life-threatening cardiac arrhythmias, especially in ICH patients with notably prolonged QTc before and increased iCEB after DC.
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Derraz, Imad, Federico Cagnazzo, Nicolas Gaillard, Riccardo Morganti, Cyril Dargazanli, Raed Ahmed, Pierre-Henri Lefevre, et al. "Microbleeds, Cerebral Hemorrhage, and Functional Outcome After Endovascular Thrombectomy." Neurology 96, no. 13 (January 25, 2021): e1724-e1731. http://dx.doi.org/10.1212/wnl.0000000000011566.
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ObjectiveTo determine whether pretreatment cerebral microbleeds (CMBs) presence and burden are correlated with an increased risk of intracranial hemorrhage (ICH) or poor functional outcome following endovascular thrombectomy (EVT) for acute ischemic stroke (AIS).MethodsConsecutive patients treated by EVT for anterior circulation AIS were retrospectively analyzed. Experienced neuroradiologists blinded to functional outcomes rated CMBs on T2*-MRI using a validated scale. We investigated associations of CMB presence and burden with ICH and poor clinical outcome at 3 months (modified Rankin Scale score >2).ResultsAmong 513 patients, 281 (54.8%) had a poor outcome and 89 (17.3%) had ≥1 CMBs. A total of 190 (37%) patients experienced ICH; 66 (12.9%) were symptomatic. CMB burden was associated with poor outcome in a univariable analysis (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.03–1.36 per 1-CMB increase; p = 0.02), but significance was lost after adjustment for sex, age, stroke severity, hypertension, diabetes mellitus, atrial fibrillation, prior antithrombotic medication, IV thrombolysis, and reperfusion status (OR, 1.05; 95% CI, 0.92–1.20 per 1-CMB increase; p = 0.50). Results remained nonsignificant when taking into account CMB location or presumed underlying pathogenesis. CMB presence, burden, location, or presumed pathogenesis were not independently correlated with ICH.ConclusionsPoor functional outcome or ICH were not correlated with CMB presence or burden on pre-EVT MRI after adjustment for confounding factors. Excluding such patients from reperfusion therapies is unwarranted.Classification of EvidenceThis study provides Class II evidence that in patients with AIS undergoing EVT, after adjustment for confounding factors, the presence of CMBs is not significantly associated with clinical outcome or the risk of ICH.
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Stricker, Sarah, Grégoire Boulouis, Sandro Benichi, Marie Bourgeois, Florent Gariel, Lorenzo Garzelli, Jean-François Hak, et al. "Acute surgical management of children with ruptured brain arteriovenous malformation." Journal of Neurosurgery: Pediatrics 27, no. 4 (April 2021): 437–45. http://dx.doi.org/10.3171/2020.8.peds20479.
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OBJECTIVE Rupture of brain arteriovenous malformation (AVM) is the main etiology of intracerebral hemorrhage (ICH) in children. Ensuing intracranial hypertension is among the modifiable prognosis factors and sometimes requires emergency hemorrhage evacuation (HE). The authors aimed to analyze variables associated with HE in children with ruptured AVM. METHODS This study was a single-center retrospective analysis of children treated for ruptured AVM. The authors evaluated the occurrence of HE, its association with other acute surgical procedures (e.g., nidal excision, decompressive hemicraniectomy), and clinical outcome. Variables associated with each intervention were analyzed using univariable and multivariable models. Clinical outcome was assessed at 18 months using the ordinal King’s Outcome Scale for Childhood Head Injury. RESULTS A total of 104 patients were treated for 112 episodes of ruptured AVM between 2002 and 2018. In the 51 children (45.5% of cases) who underwent HE, 37 procedures were performed early (i.e., within 24 hours after initial cerebral imaging) and 14 late. Determinants of HE were a lower initial Glasgow Coma Scale score (adjusted odds ratio [aOR] 0.83, 95% CI 0.71–0.97 per point increase); higher ICH/brain volume ratio (aOR 18.6, 95% CI 13–26.5 per percent increase); superficial AVM location; and the presence of a brain herniation (aOR 3.7, 95% CI 1.3–10.4). Concurrent nidal surgery was acutely performed in 69% of Spetzler-Martin grade I–II ruptured AVMs and in 25% of Spetzler-Martin grade III lesions. Factors associated with nidal surgery were superficial AVMs, late HE, and absent alteration of consciousness at presentation. Only 8 cases required additional surgery due to intracranial hypertension. At 18 months, overall mortality was less than 4%, 58% of patients had a favorable outcome regardless of surgical intervention, and 87% were functioning independently. CONCLUSIONS HE is a lifesaving procedure performed in approximately half of the children who suffer AVM rupture. The good overall outcome justifies intensive initial management.
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Bunchorntavaku, Chalermrat l. "Acute liver failure." Thai Journal of Hepatology 1, no. 1 (April 27, 2018): 1–13. http://dx.doi.org/10.30856/th.jhep2018vol1iss1_001.
Full textAbstract:
Acute liver failure (ALF) is a life threatening condition defined by the evidence of hepatic injury, jaundice, coagulopathy, and encephalopathy in a patient without preexisting cirrhosis and with an illness duration of <26 weeks. The etiologies of ALF are heterogeneous: viral hepatitis being the most common in the East, whereas drug-induced, particularly acetaminophen, being the most common in the West. Over the past decades, the outcomes of ALF have been improving with early recognition and prompt initiation of etiology-specific therapy (especially N-acetylcysteine), complex intensive care protocols and urgent liver transplantation (LT). The most commonly used prognostic scoring systems include King’s College Criteria (more specific) and MELD (more sensitive). Cerebral edema and intracranial hypertension are reasons for high morbidity and mortality in the early phase; hypertonic saline is suggested for patients with high-risk for developing intracranial hypertension (ICH) and when ICH develops, mannitol is recommended as first-line therapy. Bacterial and fungal infections are very common necessitating strict preventive measures, careful surveillance and prompt aggressive antimicrobial therapy. Acute kidney injury develops in 50-70% of patients; mostly reversible in survivors and temporary dialysis is required in about 30% of cases. Overall 1-year survival after LT has been reported to be lower in patients with ALF as compared to those with cirrhosis; however following the first year this trend has been to be reversed and ALF patients have a better long-term survival. Extracorporeal liver support system, such as albumin dialysis and plasmapheresis, may serve as a bridge to LT and may increase LT-free survival in select cases.
Figure 1 CT brain ของผู้ป่วยเพศหญิง อายุ 22 ปี มีภาวะ ตับวายเฉียบพลันจากยา แรกรับมี encephalopathy grade III CT brain พบ mild cerebral edema with loss of sulci and gyri, blurring of grey - white junctions and mild narrowing of ventricles (A) 3 วันหลังเข้ารับการรักษา ในโรงพยาบาล ผู้ป่วยมีอาการแย่ลง encephalopathy grade IV, sluggish pupillary response to light both eyes: CT brain พบ progression of cerebral edema, loss of grey-white junctions and brain herniation (B)