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1.
BMJ Case Rep ; 14(2)2021 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-33563669

RESUMO

Primary intraventricular haemorrhage (PIVH) is an uncommon type of intracerebral haemorrhage, accounting for only 0.31% of all strokes and 3.1% of all intracerebral haemorrhages. Due to the low incidence of PIVH, little is known about its clinical characteristics, risk factors, aetiologies, prognosis and treatment. Acute hydrocephalus is common and is associated with a poor prognosis. External ventricular drainage (EVD) could promptly reduce intracranial pressure by diverting cerebrospinal fluid and intraventricular blood; however, the incidence of complications such as central nervous system infection, catheter occlusion and rebleeding are relatively common. Despite being an invasive procedure, frontal minicraniotomy is an available therapeutic option to avoid complications of EVD. The authors report a case of a PIVH managed with frontal minicraniotomy and perform a literature review about epidemiological data, clinical features and treatment of PIVH.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/cirurgia , Ventrículos Cerebrais , Craniotomia/métodos , Adulto , Drenagem/métodos , Humanos , Masculino
2.
BMJ Case Rep ; 14(1)2021 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-33504534

RESUMO

A 47-year-old woman with history of seizure disorder (semiology of seizure unknown), not well controlled with antiepileptic drugs since last 30 years presented with 1-year history of intermittent throbbing headache. On the day prior to admission, she experienced worst headache, followed by loss of consciousness. On regaining consciousness, she had neck pain without any focal neurological deficit, but examination was marked by positive meningeal signs. She had history of oral ulceration, photosensitivity and small joints pain for which no medical consultancy was sought until. Following relevant investigations, this case came out to be moyamoya angiopathy secondary to underlying systemic lupus erythematosus. She was put on immunosuppressive and immunomodulator as per recommendations. Among neurological symptoms, headache improved dramatically without any further seizure recurrence till the 6 months of follow-up.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/diagnóstico , Doença de Moyamoya/diagnóstico por imagem , Albuminúria , Angiografia Digital , Anticorpos Antinucleares/imunologia , Anticonvulsivantes/uso terapêutico , Antirreumáticos/uso terapêutico , Angiografia Cerebral , Hemorragia Cerebral/etiologia , Epilepsia/complicações , Epilepsia/tratamento farmacológico , Feminino , Glucocorticoides/uso terapêutico , Humanos , Hidroxicloroquina/uso terapêutico , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/imunologia , Angiografia por Ressonância Magnética , Pessoa de Meia-Idade , Doença de Moyamoya/complicações , Tomografia Computadorizada por Raios X
3.
Am J Case Rep ; 22: e927011, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33384403

RESUMO

BACKGROUND Pandemic coronavirus disease 2019 (COVID-19) originated in Wuhan, China, and is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Severe respiratory symptoms are a hallmark of the disease, which may also include complications related to a hypercoagulable state and central nervous system involvement. These complications can occur during either the acute or the recovery phase. The cerebral involvement typically manifests as intracranial hypertension, intracerebral hemorrhage, diffuse encephalopathy, or cerebral venous thrombosis. The hemorrhagic form of cerebral venous thrombosis can be a diagnostic challenge and is treated by anticoagulation therapy, despite the existence of an intracerebral hemorrhage. This report describes a case of superficial cerebral venous thrombosis and intracerebral hematoma in a 48-year-old man weeks after recovering from the acute phase of SARSCoV-2 infection. CASE REPORT A 48-year-old man with a past medical history of SARS-CoV-2 infection confirmed by SARS-CoV-2 reverse-transcription polymerase chain reaction presented with left upper-limb numbness, weakness, and impaired positional sensorium. After initial stabilization, noncontrast computerized tomography and magnetic resonance imaging confirmed an intracerebral hemorrhage with underlying cerebral venous thrombosis. The patient was successfully treated with enoxaparin anticoagulation therapy, and symptoms improved over the following 12 days. CONCLUSIONS Central nervous system venous thrombosis is an atypical presentation of the hypercoagulable state primarily seen in younger patients, and it can occur in a delayed fashion after recovery from mild forms of COVID-19.


Assuntos
/complicações , Hemorragia Cerebral/diagnóstico por imagem , Hematoma/diagnóstico por imagem , Trombose Intracraniana/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Anticoagulantes/uso terapêutico , Hemorragia Cerebral/virologia , Enoxaparina/uso terapêutico , Hematoma/virologia , Humanos , Trombose Intracraniana/tratamento farmacológico , Trombose Intracraniana/virologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Trombose Venosa/tratamento farmacológico , Trombose Venosa/virologia
4.
Clin Imaging ; 69: 75-78, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32683139

RESUMO

Acute stroke patients transferred to thrombectomy capable centers (TCC), undergo a CT head exam upon arrival at the TCC to evaluate for ASPECTS decay and intracranial hemorrhage. In patients who received iodinated contrast prior to transfer, parenchymal enhancement may simulate hemorrhage on this post-transfer CT. We report two cases utilizing CT spectral imaging to differentiate between parenchymal contrast enhancement and hemorrhage in this setting. TCC may consider dual-energy or dual-layer (spectral) imaging for this patient cohort.


Assuntos
Hemorragia Cerebral , Acidente Vascular Cerebral , Hemorragia Cerebral/diagnóstico por imagem , Meios de Contraste , Humanos , Acidente Vascular Cerebral/diagnóstico por imagem , Trombectomia , Tomografia Computadorizada por Raios X
6.
J Stroke Cerebrovasc Dis ; 30(2): 105527, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33310072

RESUMO

We report herein a case of intraventricular silicone oil migration, a rare complication of intraocular silicone oil tamponade, mimicking a hemorrhage during antithrombotic therapy for ischemic stroke. A 62-year-old male patient with a history of diabetic retinopathy was admitted for right hemiparesis and dysarthria. Brain magnetic resonance imaging on admission showed an acute left-sided ventral medullary infarction, and antithrombotic therapy was started. Head computed tomography done on the next day after admission showed an area of high-density resembling a hematoma in the lateral ventricle. Additional magnetic resonance imaging in the supine and lateral recumbent positions confirmed migration of the lesion within the ventricles by position, indicating intraventricular silicone oil migration. Several facilities in Japan perform magnetic resonance imaging instead of computed tomography as the first step in assessing stroke in the emergency clinical setting. While the silicone oil used in internal tamponade appears high-density on computed tomography, it does not register as an abnormality on diffusion-weighted imaging, thus creating a pitfall to diagnosis based on this modality.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Ventrículos Cerebrais/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Fibrinolíticos/administração & dosagem , Migração de Corpo Estranho/diagnóstico por imagem , Óleos de Silicone/efeitos adversos , Tomografia Computadorizada por Raios X , Hemorragia Cerebral/induzido quimicamente , Erros de Diagnóstico , Fibrinolíticos/efeitos adversos , Migração de Corpo Estranho/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Óleos de Silicone/administração & dosagem , Resultado do Tratamento
7.
BMJ Case Rep ; 13(12)2020 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-33318267

RESUMO

A 75-year-old female patient presented with signs and symptoms of a right hemispheric syndrome. A CT scan of the brain with angiogram showed an acute infarct in the right middle cerebral artery (MCA) territory secondary to thromb-occlusion of the M1 segment of the right MCA. A follow-up CT scan 2 weeks later showed a large hyperdense region in the infarcted area. With the aid of a dual-energy CT scan, this was eventually shown to be due to contrast staining from an earlier administration of iodinated contrast on the same day, rather than frank haemorrhagic conversion of the recent right MCA infarct.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Meios de Contraste , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Iodo
8.
J Clin Neurosci ; 79: 275-276, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33070912

RESUMO

Since the outbreak with novel corona virus in December 2019, a myriad of different neurological manifestations in patients with COVID-19 infection have been reported. We present a case of non-traumatic intracranial hemorrhage in the olfactory gyrus in a patient who tested positive for SARS-COV-2. The area of hemorrhage is not a common location for spontaneous hemorrhage. Given that loss of smell is considered a relatively common symptom of this pandemic, it is an intriguing association of COVID-19 and olfactory gyrus ICH for neurotropism of SARS-CoV2 for olfactory bulb and glia cells through nasal mucosa. Future studies will need to elucidate the exact mechanism of anosmia from COVID-19 and potential mechanisms leading to ICH.


Assuntos
Betacoronavirus , Hemorragia Cerebral/etiologia , Infecções por Coronavirus/complicações , Lobo Parietal/diagnóstico por imagem , Pneumonia Viral/complicações , Hemorragia Cerebral/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Transtornos do Olfato/etiologia , Pandemias , Olfato
9.
Pediatrics ; 146(5)2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33115795

RESUMO

BACKGROUND: Perinatal stroke encompasses multiple disease-specific cerebrovascular syndromes that cause lifelong neurodevelopmental morbidity for millions worldwide. Acute presentations include neonatal arterial ischemic stroke (NAIS), neonatal cerebral sinovenous thrombosis, and neonatal hemorrhagic stroke (NHS). Delayed presentations include arterial presumed perinatal ischemic stroke, periventricular venous infarction, and presumed perinatal hemorrhagic stroke. Our objective was to define the birth prevalence of all subtypes of perinatal stroke by using a population-based cohort. METHODS: The Alberta Perinatal Stroke Project is a research cohort established in 2008 in southern Alberta, Canada, with prospective (2008-2017) and retrospective (1990-2008) enrollment leveraging universal health care at a single tertiary care pediatric center. The primary outcome was the estimated birth prevalence of each perinatal stroke syndrome, secondary outcomes were birth prevalence over time, sex ratios, and change in age at diagnosis. Analysis included Poisson regression, Wilcoxon rank test, and Fisher exact test. RESULTS: The overall estimated birth prevalence of term-born perinatal stroke was 1:1100. The estimated birth prevalence was 1:3000 for NAIS, 1:7900 for arterial presumed perinatal ischemic stroke, 1:6000 for periventricular venous infarction, 1:9100 for cerebral sinovenous thrombosis, 1:6800 for NHS, and 1:65000 for presumed perinatal hemorrhagic stroke. The apparent birth prevalence of NAIS and NHS increased over time. There were more males affected than females. The age at diagnosis decreased for late-presenting stroke types. CONCLUSIONS: The estimated birth prevalence of term perinatal stroke is higher than previous estimates, which may be explained by population-based sampling of disease-specific states. This emphasizes the need for further studies to better understand the disease-specific pathophysiology to improve treatment and prevention strategies.


Assuntos
Acidente Vascular Cerebral/epidemiologia , Fatores Etários , Alberta/epidemiologia , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/epidemiologia , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/epidemiologia , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/epidemiologia , Estudos de Coortes , Feminino , Hospitais Pediátricos , Humanos , Recém-Nascido , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/epidemiologia , Masculino , Distribuição de Poisson , Prevalência , Estudos Prospectivos , Estudos Retrospectivos , Distribuição por Sexo , Estatísticas não Paramétricas , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Centros de Atenção Terciária
10.
Cerebrovasc Dis ; 49(5): 556-562, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33011723

RESUMO

INTRODUCTION: Intracerebral hemorrhage (ICH) is the most fatal type of stroke worldwide. Herein, we aim to develop a predictive model based on computed tomography (CT) markers in an ICH cohort and validate it in another cohort. METHODS: This retrospective observational cohort study was conducted in 3 medical centers in China. The values of CT markers, including hypodensities, hematoma density, blend sign, black hole sign, island sign, midline shift, baseline hematoma volume, and satellite sign, in predicting poor outcome were analyzed by logistic regression analysis. A nomogram was developed based on the results of multivariate logistic regression analysis in development cohort. Area under curve (AUC) and calibration plot were used to assess the accuracy of nomogram in this development cohort and validate in another cohort. RESULTS: A total of 1,498 patients were included in this study. Multivariate logistic regression analysis indicated that hypodensities, black hole sign, island sign, midline shift, and baseline hematoma volume were independently associated with poor outcome in development cohort. The AUC was 0.75 (95% confidence interval [CI]: 0.73-0.76) in the internal validation with development cohort and 0.74 (95% CI: 0.72-0.75) in the external validation with validation cohort. The calibration plot in development and validation cohort indicated that the nomogram was well calibrated. CONCLUSIONS: CT markers of hypodensities, black hole sign, and island sign might predict poor outcome of ICH patients within 90 days.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Técnicas de Apoio para a Decisão , Nomogramas , Tomografia Computadorizada por Raios X , Idoso , Hemorragia Cerebral/terapia , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
12.
Clin Imaging ; 68: 239-241, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32911311

RESUMO

Neurologic complications of COVID-19 infection have been recently described and include dizziness, headache, loss of taste and smell, stroke, and encephalopathy. Brain MRI in these patients have revealed various findings including ischemia, hemorrhage, inflammation, and demyelination. In this article, we report a case of critical illness-associated cerebral microbleeds identified on MRI in a patient with severe COVID-19 infection and discuss the potential etiologies of these neuroimaging findings.


Assuntos
Infecções por Coronavirus , Estado Terminal , Pandemias , Pneumonia Viral , Acidente Vascular Cerebral , Betacoronavirus , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/etiologia , Humanos , Imagem por Ressonância Magnética , Acidente Vascular Cerebral/epidemiologia
13.
J Stroke Cerebrovasc Dis ; 29(10): 105159, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912495

RESUMO

OBJECTIVE: This study aimed to establish and verify a model for predicting death within 2 days after spontaneous cerebral hemorrhage based on the patient's characteristics at the time of admission. METHODS: During 2015-2017, the records of a cohort of 397 patients with clinically diagnosed cerebral hemorrhage were collected for model development. Minimum absolute contraction and the selection operator (lasso) regression model were used to determine factors that most consistently and correctly predicted death after cerebral hemorrhage. Discrimination and calibration were used to evaluate the performance of the resulting nomogram. After internal validation, the nomogram was further assessed during 2017-2018 using a different cohort of 200 consecutive subjects. RESULTS: The nomogram included four predictors from the lasso regression analysis: Glasgow Coma Scale, hematoma location, hematoma volume, and primary intraventricular hemorrhage. The nomogram showed good discrimination and good calibration for both training and verification cohorts. Decision curve analysis showed that the prediction nomogram was clinically useful. CONCLUSION: This prediction model can be used for early, simple, and accurate prediction of early death following cerebral hemorrhage.


Assuntos
Hemorragia Cerebral/mortalidade , Hemorragia Cerebral Intraventricular/mortalidade , Mortalidade Hospitalar , Nomogramas , Idoso , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral Intraventricular/diagnóstico por imagem , Feminino , Escala de Coma de Glasgow , Hematoma/diagnóstico por imagem , Hematoma/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Tomografia Computadorizada por Raios X
14.
J Stroke Cerebrovasc Dis ; 29(10): 105069, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912497

RESUMO

Hemorrhagic stroke associated with essential thrombocythemia (ET) is very infrequent. Herein, we report a case of a 33-year-old woman with a 2-year history of ET who developed intracerebral and subarachnoid hemorrhage. Angiography demonstrated severe vessel irregularity in the bilateral cerebral arteries. Molecular genetic testing revealed a calreticulin mutation. To our knowledge, hemorrhagic stroke has been reported in only six other patients with ET, and this is the first report of hemorrhagic stroke in an ET patient with a calreticulin mutation. We review the current literature and discuss the possible underlying mechanisms.


Assuntos
Hemorragia Cerebral/etiologia , Acidente Vascular Cerebral/etiologia , Hemorragia Subaracnóidea/etiologia , Trombocitemia Essencial/complicações , Adulto , Calreticulina/genética , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/cirurgia , Craniotomia , Feminino , Predisposição Genética para Doença , Humanos , Mutação , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/cirurgia , Trombocitemia Essencial/diagnóstico , Trombocitemia Essencial/genética , Resultado do Tratamento
15.
J Stroke Cerebrovasc Dis ; 29(10): 105111, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912557

RESUMO

INTRODUCTION: Since the emergence of Coronavirus Disease 19 (COVID-19) pandemic, multiple neurologic complications in infected patients have been reported. Despite these reports, the mechanism of COVID-19 nervous system injury is not well understood. We report the case of a COVID-19 patient with diffuse microhemorrhages on brain MRI, positive anticardiolipin antibodies, and purpuric rash with biopsy showing a thrombotic vasculopathy, all features suggestive of secondary microangiopathy. CASE REPORT: A 69-year-old male with history of hypertension, chronic kidney disease, and hypothyroidism presented with one week of dyspnea, cough, diarrhea, and fevers. Chest x-ray demonstrated bibasilar consolidations and nasopharyngeal reverse transcriptase polymerase chain reaction confirmed SARS-CoV-2 infection. He had subsequent respiratory decline requiring intubation the day after admission. He developed a truncal morbilliform rash and diffuse purpura, a biopsy of which showed small dermal blood vessels with intraluminal microthrombi consistent with thrombotic vasculopathy. He was found to have elevated aCL IgM and IgG and equivocal lupus anticoagulant study. Brain MRI obtained for persistent encephalopathy showed innumerable areas of susceptibility weighted imaging changes throughout the bilateral juxtacortical white matter, corpus callosum, basal ganglia, and brainstem, as well as multiple small areas of FLAIR hyperintensities, consistent with microhemorrhage DISCUSSION: While there have been several reported cases of neurologic manifestations of COVID-19, the pathophysiology may not be related to neurotropism of the virus itself. The new development of antiphospholipid antibodies and thrombotic vasculopathy in dermal blood vessels in this patient suggest a secondary microangiopathy potentially related to a virally-induced inflammatory state.


Assuntos
Betacoronavirus/patogenicidade , Hemorragia Cerebral/virologia , Doenças de Pequenos Vasos Cerebrais/virologia , Infecções por Coronavirus/virologia , Pneumonia Viral/virologia , Púrpura/virologia , Idoso , Betacoronavirus/isolamento & purificação , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/terapia , Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem , Doenças de Pequenos Vasos Cerebrais/terapia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Progressão da Doença , Evolução Fatal , Interações Hospedeiro-Patógeno , Humanos , Masculino , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Púrpura/diagnóstico , Púrpura/terapia
16.
Neurologia ; 35(9): 621-627, 2020.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32912745

RESUMO

INTRODUCTION: We analysed the neurological complications of patients with severe SARS-CoV-2 infection who required intensive care unit (ICU) admission. PATIENTS AND METHODS: We conducted a retrospective, observational, descriptive study of consecutive patients admitted to the ICU due to severe respiratory symptoms secondary to SARS-CoV-2 infection between 1 April and 1 June 2020. RESULTS: We included 30 patients with neurological symptoms; 21 were men (72.40%), and mean age (standard deviation [SD]) was 57.41 years (11.61). The mean duration of ICU stay was 18.83 days (14.33). The neurological conditions recorded were acute confusional syndrome in 28 patients (93.33%), neuromuscular disease in 15 (50%), headache in 5 (16.66%), cerebrovascular disease in 4 (13.33%), and encephalopathies/encephalitis in 4 (13.33%). CSF analysis results were normal in 6 patients (20%). Brain MRI or head CT showed alterations in 20 patients (66.6%). EEG was performed in all patients (100%), with 8 (26.66%) showing abnormal findings. In 5 of the 15 patients with clinical myopathy, diagnosis was confirmed with electroneuromyography. We found a correlation between older age and duration of ICU stay (P=.002; 95%CI: 4.032-6.022; OR: 3,594). CONCLUSIONS: Severe COVID-19 mainly affects men, as observed in other series. Half of our patients presented acute myopathy, and almost all patients left the ICU with acute confusional syndrome, which fully resolved; no correlation was found with EEG or neuroimaging findings. Older age is associated with longer ICU stay.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Estado Terminal , Doenças Musculares/etiologia , Doenças do Sistema Nervoso/etiologia , Pandemias , Pneumonia Viral/complicações , Doença Aguda , Adulto , Fatores Etários , Idoso , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/epidemiologia , Hemorragia Cerebral/etiologia , Confusão/epidemiologia , Confusão/etiologia , Infecções por Coronavirus/epidemiologia , Cuidados Críticos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças Musculares/epidemiologia , Doenças do Sistema Nervoso/epidemiologia , Neuroimagem , Pneumonia Viral/epidemiologia , Estudos Retrospectivos , Espanha/epidemiologia
17.
Yonsei Med J ; 61(8): 736-738, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32734739

RESUMO

Remote intracerebral hemorrhage (ICH) is defined as an ICH that occurs at a distant site from the treated lesion and is a considerable post-neurointerventional complication. Because such a life-threatening complication should not be neglected, we report our experience with delayed remote ICH in a patient with symptomatic intracranial atherosclerotic stenosis (ICAS) treated by Wingspan stenting following on-label usage guidelines. A middle-aged person suffered a lobar-type subcortical hemorrhage on the left temporal lobe 22 days after Wingspan stenting in the left internal carotid artery. The present case seemed to correspond with a previous report in which remote ICH tended to occur as an ipsilateral lobar-type hemorrhage in patients with unruptured intracranial aneurysm on the internal carotid artery undergoing treatment with stents or flow diverters. Delayed remote ICH should be considered as a potential risk of using a Wingspan stent covering the carotid siphon for ICAS.


Assuntos
Artéria Carótida Interna/patologia , Artéria Carótida Interna/cirurgia , Estenose das Carótidas/cirurgia , Hemorragia Cerebral/etiologia , Stents/efeitos adversos , Idoso , Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Hemorragia Cerebral/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Resultado do Tratamento
18.
Stroke ; 51(9): 2649-2655, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32755456

RESUMO

BACKGROUND AND PURPOSE: We conducted this study to investigate the prevalence and distribution of cerebral microbleeds and leukoencephalopathy in hospitalized patients with coronavirus disease 2019 (COVID-19) and correlate with clinical, laboratory, and functional outcomes. METHODS: We performed a retrospective chart review of 4131 COVID-19 positive adult patients who were admitted to 3 tertiary care hospitals of an academic medical center at the epicenter of the COVID-19 pandemic in New York City from March 1, 2020, to May 10, 2020, to identify patients who had magnetic resonance imaging (MRI) of the brain. We evaluated the MRIs in detail, and identified a subset of patients with leukoencephalopathy and/or cerebral microbleeds. We compared clinical, laboratory, and functional outcomes for these patients to patients who had a brain MRI that did not show these findings. RESULTS: Of 115 patients who had an MRI of the brain performed, 35 (30.4%) patients had leukoencephalopathy and/or cerebral microbleeds. Patients with leukoencephalopathy and/or cerebral microbleeds had neuroimaging performed later during the hospitalization course (27 versus 10.6 days; P<0.001), were clinically sicker at the time of brain MRI (median GCS 6 versus 14; P<0.001), and had higher peak D-dimer levels (8018±6677 versus 3183±3482; P<0.001), lower nadir platelet count (116.9±62.2 versus 158.3±76.2; P=0.03), higher peak international normalized ratio (2.2 versus 1.57; P<0.001) values when compared with patients who had a brain MRI that did not show these findings. They required longer ventilator support (34.6 versus 9.1 days; P<0.001) and were more likely to have moderate and severe acute respiratory distress syndrome score (88.6% versus 23.8%, P<0.001). These patients had longer hospitalizations (42.1 versus 20.9 days; P<0.001), overall worse functional status on discharge (mRS 5 versus 4; P=0.001), and higher mortality (20% versus 9%; P=0.144). CONCLUSIONS: The presence of leukoencephalopathy and/or cerebral microbleeds is associated with a critical illness, increased mortality, and worse functional outcome in patients with COVID-19.


Assuntos
Hemorragia Cerebral/complicações , Infecções por Coronavirus/complicações , Leucoencefalopatias/complicações , Pneumonia Viral/complicações , Idoso , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/epidemiologia , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/epidemiologia , Estado Terminal , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Hospitalização , Humanos , Coeficiente Internacional Normatizado , Tempo de Internação , Leucoencefalopatias/diagnóstico por imagem , Leucoencefalopatias/epidemiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Pandemias , Contagem de Plaquetas , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/epidemiologia , Prevalência , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento
19.
Stroke ; 51(9): 2795-2800, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32772685

RESUMO

BACKGROUND AND PURPOSE: Hemorrhages are a serious complication of brain surgery, and magnesium has shown hemostatic properties in hemorrhagic stroke and non-neurological surgeries. External ventricular drain (EVD) insertion is an advantageous model of emergency neurosurgical hemorrhage risk because it is common, standardized, and the operator is blinded to the outcome during the procedure. We tested the hypothesis that low magnesium is associated with risk of hemorrhagic complications from EVD insertion. METHODS: Patients with spontaneous intracerebral hemorrhage and aneurysmal subarachnoid hemorrhage were enrolled in a prospective, observational study. Demographic and clinical variables were prospectively recorded, including serum magnesium measurements. Catheter tract hemorrhage (CTH) was measured on postoperative head computed tomography within 48 hours of EVD insertion. RESULTS: We observed 50 CTH among 327 EVD procedures (15.3%) distributed similarly among intracerebral hemorrhage (21/116 [18.1%]) and subarachnoid hemorrhage (29/211 [13.7%]). Magnesium was lower in patients with CTH compared with those without (median 1.8 versus 2.0 mg/dL, P<0.0001). Higher magnesium was associated with lower odds of CTH (odds ratio 0.67 per 0.1 mg/dL magnesium [95% CI, 0.56-0.78], P<0.0001) after adjustment for other risk factors, with similar effect in the intracerebral hemorrhage and subarachnoid hemorrhage subgroups. Preprocedural increase in magnesium (odds ratio 0.68 [0.52-0.85]) and dose of preprocedural magnesium sulfate (odds ratio 0.67 [0.40-0.97]) were associated with reduced CTH risk after adjustment for initial magnesium and other risk factors. CONCLUSIONS: Lower magnesium at the time of EVD insertion was an independent predictor of hemorrhagic complications. Baseline risk was attenuated by preprocedural increases in magnesium, suggesting a therapeutic opportunity.


Assuntos
Hemorragia Cerebral/etiologia , Deficiência de Magnésio/complicações , Sulfato de Magnésio/uso terapêutico , Ventriculostomia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateteres/efeitos adversos , Hemorragia Cerebral/diagnóstico por imagem , Feminino , Humanos , Deficiência de Magnésio/sangue , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/farmacologia , Complicações Pós-Operatórias , Estudos Prospectivos , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico por imagem , Tomografia Computadorizada por Raios X
20.
Clin Imaging ; 68: 184-187, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32846364

RESUMO

Critical illness-associated cerebral microbleed (CICM) is a relatively rare and newly described condition. It can occur in critically ill ICU patients and can be secondary to many underlying etiologies. CICM is associated with high mortality and permanent neurologic deficits in surviving patients. Distribution of cerebral microhemorrhages in neuroimaging findings is critical for accurate diagnosis of this condition. Here, we present an ICU admitted patient with sickle cell disease crisis and CICM and will discuss their clinically and radiologically distinct phenomenon followed by a review of current literature.


Assuntos
Anemia Falciforme , Estado Terminal , Anemia Falciforme/complicações , Anemia Falciforme/diagnóstico por imagem , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/etiologia , Humanos , Neuroimagem
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