Search results for " hemorrhage"
showing 10 items of 355 documents
Intravenous Thrombolysis in Patients Dependent on the Daily Help of Others Before Stroke
2016
Background and Purpose— We compared outcome and complications in patients with stroke treated with intravenous thrombolysis (IVT) who could not live alone without help of another person before stroke (dependent patients) versus independent ones. Methods— In a multicenter IVT-register–based cohort study, we compared previously dependent (prestroke modified Rankin Scale score, 3–5) versus independent (prestroke modified Rankin Scale score, 0–2) patients. Outcome measures were poor 3-month outcome (not reaching at least prestroke modified Rankin Scale [dependent patients]; modified Rankin Scale score of 3–6 [independent patients]), death, and symptomatic intracranial hemorrhage. Unadjusted an…
The risk of intravenous thrombolysis-induced intracranial hemorrhage in Taiwanese patients with unruptured intracranial aneurysm.
2017
Background The presence of an intracranial aneurysm is contraindicated to recombinant tissue plasminogen activator (r-tPA) treatment for acute ischemic stroke. However, it is difficult to exclude asymptomatic intracranial aneurysms by using conventional, noncontrast head computed tomography (CT), which is the only neuroimaging suggested before r-tPA. Recent case reports and series have shown that administering r-tPA to patients with a pre-existing aneurysm does not increase the bleeding risk. However, Asians are known to have a relatively higher bleeding risk, and little evidence is available regarding the risk of using r-tPA on Asian patients with intracranial aneurysms. Methods Medical re…
Evolution Over Time of Ventilatory Management and Outcome of Patients With Neurologic Disease
2021
OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need fo…
Safety of endovascular treatment in acute stroke patients taking oral anticoagulants
2017
International journal of stroke 12(4), 412-415 (2017). doi:10.1177/1747493016677986
Spontaneous Cortical Spreading Depression and Intracranial Pressure Following Acute Subdural Hematoma in a Rat
2012
Acute subdural hemorrhage (ASDH) is a frequent and devastating consequence of traumatic brain injury. Tissue damage develops rapidly and makes treatment even more difficult. Management of increased intracranial pressure (ICP) due to extravasated blood volume and brain swelling is often insufficient to control all adverse effects of ASDH. In addition to sheer volume, spontaneously triggered cortical spreading depression (CSD) that leads to cell death following ischemia or trauma may contribute to injury development after ASDH. Therefore, we explored the occurrence of CSD by tissue impedance (IMP) measurement in a rat model subjected to ASDH. IMP and intraventricular and mean arterial pressur…
Utilization of mechanical power and associations with clinical outcomes in brain injured patients: a secondary analysis of the extubation strategies …
2023
Background: There is insufficient evidence to guide ventilatory targets in acute brain injury (ABI). Recent studies have shown associations between mechanical power (MP) and mortality in critical care populations. We aimed to describe MP in ventilated patients with ABI, and evaluate associations between MP and clinical outcomes. Methods: In this preplanned, secondary analysis of a prospective, multi-center, observational cohort study (ENIO, NCT03400904), we included adult patients with ABI (Glasgow Coma Scale ≤ 12 before intubation) who required mechanical ventilation (MV) ≥ 24 h. Using multivariable log binomial regressions, we separately assessed associations between MP on hospital day (H…
FLOW DIVERTER DEVICE IN THE ACUTE SETTING OF RUPTURED BLISTER LIKE ANEURYSM: A CASE REPORT
2021
Blister-like aneurysms (BLA) are a rare half-dome-shaped aneurysm, with a broad-based appearance, originating more often from a non-branching site of the supraclinoid internal carotid artery (ICA). They are sometimes difficult to recognize due to their morphological changes and high tendency to rupture. BLAs are often undiagnosed and may be detected only after repeated angiograms in the case of acute subarachnoid hemorrhage (SAH). BLA are life-threatening and no consensus has so far been reached on the best management strategy. We describe a patient with a BLA in the left ICA successfully treated by flow-diverting device using intraoperative abciximab bolus, with successful results. Recentl…
Sevoflurane Impairs Cerebral Blood Flow Autoregulation in Rats: Reversal by Nonselective Nitric Oxide Synthase Inhibition
2005
UNLABELLED In this study, we investigated the effects of 1.0 and 2.0 minimum alveolar anesthetic concentration (MAC) sevoflurane on cerebral blood flow (CBF) autoregulation before and after nonselective inhibition of nitric oxide (NO) synthase in rats. Rats were randomly assigned as follows: Group 1 (n = 8): 1.0 MAC sevoflurane; Groups 2 and 3 (n = 8 per group): 2.0 MAC sevoflurane. Assessment of autoregulation within a mean arterial blood pressure range of 140-60 mm Hg was performed by graded hemorrhage before and after administration of l-arginine methyl ester (l-NAME, 30 mg/kg IV, Groups 1 and 2) or during hypocapnia (Group 3). In 10 additional animals, brain tissue NO(2)(-) concentratio…
Acute Subdural Hematoma in Pigs: Role of Volume on Multiparametric Neuromonitoring and Histology
2008
Traumatic brain injury (TBI) is often complicated by acute subdural hemorrhage (ASDH) with a high mortality rate. The pathophysiological mechanisms behind such an injury type and the contribution of blood to the extent of an injury remain poorly understood. Therefore, the goals of this study were to establish a porcine ASDH model in order to investigate pathomechanisms of ASDH and to compare effects induced by blood or sheer volume. Thus, we infused 2, 5, and 9 mL of blood (up to 15% of intracranial volume), and we compared a 5-mL blood and paraffin oil volume to separate out effects of extravasated blood on brain tissue. An extended neuromonitoring was applied that lasted up to 12 h after …
Microsurgical Management of Intracranial Aneurysms After Flow Diversion Failure
2019
Subarachnoid hemorrhage (SAH) occurring after an intracranial aneurysm rupture has an incidence of 10.5 per 100,000 person-years and accounts for about 5% of strokes. The resulting outcome depends on several factors including the severity of the initial hemorrhage, rebleeding, perioperative medical management, and the timing and technical success for aneurysm treatment. The overall mortality rates from 32%−67% with 10%–20% of patients with long-term dependence due to brain damage. It is well known that 12% of patients die before achieving medical treatment and 25% die within the first 24 hours. Again, 40%–60% mortality rate occurs within 30 days. Among the surviving patients, about one thir…