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1.
Medicine (Baltimore) ; 98(44): e17785, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689850

RESUMO

INTRODUCTION: Cerebrovascular imaging is the gold standard for diagnosis of intracranial aneurysms. Rupture of intracranial aneurysm is rare in cerebrovascular angiography, especially in unruptured intracranial aneurysm. PATIENT CONCERNS: A 74-year-old woman was admitted to the hospital for sudden onset of left eyelid ptosis for 1 day with no obvious inducement. The patient had a history of hypertension. Physical examination revealed that she had clear consciousness and normal speech, but the left eyelid drooped. The left pupil diameter was 5 mm and light reflex was absent. The left eyeball could not move, and the right eye examinations were normal. The limb muscle strength and muscle tension were normal. DIAGNOSIS: Bilateral internal carotid artery posterior communicating aneurysm, severe stenosis of the origin of left carotid artery, and right oculomotor nerve palsy. INTERVENTIONS: After the hospital, the aneurysm ruptured and hemorrhaged during radiography, and the patient improved after immediate rescue and treatment. On the third day after angiography, the patient's the condition gradually stabilized. Under the general anesthesia, left carotid artery stenosis stent implantation and left posterior communicating artery aneurysm stent assisted coil embolization were performed successfully. On the second day after embolization, the patient's head computed tomography (CT) showed subarachnoid hemorrhage with hydrocephalus. The patient underwent external ventricular drainage. A month later, the patient underwent ventriculoperitoneal shunt. OUTCOMES: Six months later, the patient visited our hospital for a follow-up, and she was clear-headed, aphasia, right limb hemiplegia with muscle strength grade II, left side autonomous activities, and the GOS score was 2 points. Head CT showed the ventricles were normal. CONCLUSIONS: Acute oculomotor palsy may be a risk factor for rupture of ipsilateral unruptured aneurysms, but more basic research and clinical trial evidence of intracranial aneurysms are needed to confirm this.


Assuntos
Aneurisma Roto/etiologia , Lesões das Artérias Carótidas/etiologia , Artéria Carótida Interna/diagnóstico por imagem , Angiografia Cerebral/efeitos adversos , Aneurisma Intracraniano/diagnóstico por imagem , Idoso , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Feminino , Humanos , Aneurisma Intracraniano/complicações , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/etiologia , Doenças do Nervo Oculomotor/diagnóstico por imagem , Doenças do Nervo Oculomotor/etiologia
2.
Medicine (Baltimore) ; 98(46): e17670, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725609

RESUMO

This study aims to identify predictive factors related to clinical outcome, reoperation, and complications in patients with brain abscess.Patients with a diagnosis of brain abscess at discharge at the Second Affiliated Hospital of Zhejiang University School of Medicine between 2008 and 2018 were reviewed. Logistic regression was used to identify predictive factors associated with Glasgow Outcome Scale (GOS) at discharge, GOS at 1 year after discharge, reoperation and complications.Among 183 patients enrolled into the study, 142 patients had a good outcome at discharge (GOS ≥ 4) and 41 had a poor outcome (GOS ≤ 3). During the follow-up period, 20 additional patients had a good outcome. A total of 156 patients were treated by open craniotomy excision (n = 72) and aspiration (n = 84), 10 of whom underwent reoperation. Complications in surgical patients for brain abscess occurred in 54 patients. Poor outcome was related to Glasgow coma scale (P = .007) and ventricular proximity (P = .001). Surgical method was associated with reoperation (P = .04) and complications (P < .001). Seizure at admission was related to epilepsy (P < .001). Surgical method was related to postoperative intracranial hemorrhage (P = .02).Glasgow coma scale (GCS) and ventricular proximity were associated with poor outcome. Further, patients who underwent aspiration were more likely to experience reoperation, while open craniotomy excision (OCE) was related to complications. Patients presenting seizure at admission were more likely to develop epilepsy. Patients who underwent OCE tended to experience postoperative intracranial hemorrhage.


Assuntos
Abscesso Encefálico/cirurgia , Escala de Resultado de Glasgow , Hemorragias Intracranianas/etiologia , Complicações Pós-Operatórias/etiologia , Reoperação/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Abscesso Encefálico/patologia , Criança , Pré-Escolar , Craniotomia/efeitos adversos , Craniotomia/métodos , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
3.
J Clin Neurosci ; 69: 1-6, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31521472

RESUMO

Thrombolysis-induced haemorrhagic transformation is the most challenging preventable complication in thrombolytic therapy. This condition is often associated with poor functional outcome and long-term disease burden. Statins, or 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors, are controversially suggested to either increase or decrease the odds of better primary outcomes compared to treatment without statins after thrombolysis in patients or animals; statins are thought to act by influencing lipid levels, the inflammatory response, blood brain barrier permeability and cell apoptosis. Statins are the cornerstone of secondary prevention of cardiovascular and cerebrovascular diseases. However, the role of statins in acute phase stroke, and the necessity of their use, remains unclear. Currently, whether statins can increase the risk of haemorrhagic transformation is of great concern for patients treated with tissue plasminogen activator (t-PA). Herein, we thoroughly summarize the recent advances that address whether the administration of statins in ischaemic stroke increases haemorrhagic transformation in patients or animals who received thrombolysis at an early stage and the related mechanisms. This review will provide more clinical and preclinical evidence to address questions regarding the exercise of caution in the use of high dose statins in patients who received thrombolysis and if low dose statins may be beneficial in decreasing thrombolysis-induced haemorrhagic transformation.


Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Hemorragias Intracranianas/etiologia , Acidente Vascular Cerebral/etiologia , Terapia Trombolítica/efeitos adversos , Animais , Relação Dose-Resposta a Droga , Acidente Vascular Cerebral/patologia , Terapia Trombolítica/métodos , Ativador de Plasminogênio Tecidual/efeitos adversos
4.
World Neurosurg ; 132: e21-e27, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31521754

RESUMO

BACKGROUND: To investigate role of Low-dose, Early Fresh frozen plasma Transfusion (LEFT) therapy in preventing perioperative coagulopathy and improving long-term outcome after severe traumatic brain injury (TBI). METHODS: A prospective, single-center, parallel-group, randomized trial was designed. Patients with severe TBI were eligible. We used a computer-generated randomization list and closed opaque envelops to randomly allocate patients to treatment with fresh frozen plasma (5 mL/kg body weight; LEFT group) or normal saline (5 mL/kg body weight; NO LEFT group) after admission in the operating room. RESULTS: Between January 1, 2018, and November 31, 2018, 63 patients were included and randomly allocated to LEFT (n = 28) and NO LEFT (n = 35) groups. The final interim analysis included 20 patients in the LEFT group and 32 patients in the NO LEFT group. The study was terminated early for futility and safety reasons because a high proportion of patients (7 of 20; 35.0%) in the LEFT group developed new delayed traumatic intracranial hematoma after surgery compared with the NO LEFT group (3 of 32; 9.4%) (relative risk, 5.205; 95% confidence interval, 1.159-23.384; P = 0.023). Demographic characteristics and indexes of severity of brain injury were similar at baseline. CONCLUSIONS: LEFT therapy was associated with a higher incidence of delayed traumatic intracranial hematoma than normal fresh frozen plasma transfusion in patients with severe TBI. A restricted fresh frozen plasma transfusion protocol, in the right clinical setting, may be more appropriate in patients with TBIs.


Assuntos
Transfusão de Sangue/métodos , Lesões Encefálicas Traumáticas/terapia , Plasma , Idoso , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/cirurgia , Craniotomia , Método Duplo-Cego , Feminino , Hematoma Subdural Agudo/cirurgia , Hematoma Subdural Agudo/terapia , Humanos , Hemorragia Intracraniana Traumática/complicações , Hemorragias Intracranianas/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Prevenção Secundária , Resultado do Tratamento
5.
World Neurosurg ; 132: e169-e177, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31505291

RESUMO

BACKGROUND: We proposed a novel prognostic tool for the prediction of in-hospital mortality based on a combination of hemodynamic parameters and biomarkers in patients with traumatic brain injury (TBI). We hypothesized that a combination of shock index (SI) with high sensitive troponin T (HsTnT), the Bio-Shock Index (Bio-SI), has better prognostic power than its individual components. METHODS: A retrospective chart review was conducted (2011-2018) for patients with TBI. Patients were categorized into 2 groups (low and high Bio-SI) based on the receiver operating characteristic curve. RESULTS: A total of 2619 patients were admitted with TBI, and 1471 fulfilled the inclusion criteria and 73% had high Bio-SI (≥10). High Bio-SI values were associated with more intraventricular hemorrhage (P = 0.001), brain edema (P = 0.001), and had lower mean arterial pressure (P = 0.001), admission Glasgow Coma Scale score (P = 0.001), and higher SI (P = 0.001), serum lactate (P = 0.001), HsTnT values (P = 0.001), and Rotterdam score (P = 0.03). Patients with high Bio-SI had a prolonged hospital (P = 0.003) and intensive care unit stay (P = 0.001); longer ventilatory days (P = 0.001) and had higher rates of pneumonia (P = 0.001), sepsis (P = 0.001), and in-hospital mortality (P = 0.001). The Bio-SI showed high sensitivity and negative predictive value (91.4% and 94.4%, respectively) as compared with elevated SI (50.2% and 87.6%, respectively) and positive troponin (79.7% and 93.7%, respectively). CONCLUSIONS: The Bio-SI is potentially a better tool than its individual components to predict in-hospital mortality among patients with TBI; however, HsTnT alone outperforms SI. Prospective studies and multicenter trials studying troponin levels and SI in all patients with TBI with the inclusion of outcome scores will prove or disprove the predictability of the new index.


Assuntos
Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/mortalidade , Adulto , Biomarcadores , Lesões Encefálicas Traumáticas/complicações , Feminino , Escala de Coma de Glasgow , Hemodinâmica , Mortalidade Hospitalar , Humanos , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/mortalidade , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Troponina T/sangue , Adulto Jovem
6.
Am Surg ; 85(8): 821-829, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31560301

RESUMO

Anticoagulated older adults suffering ground-level falls are a specialty trauma population at risk for intracranial hemorrhage (ICH). Delays in diagnosis or initiation of anticoagulation reversal can lead to increased morbidity/mortality. A novel "Headstrike" protocol was implemented to improve the treatment efficacy and disposition of these patients. The study objective was to determine effectiveness of the "Headstrike" protocol in providing these patients with timely treatment and disposition, while maintaining positive outcomes. A trauma performance improvement database was queried for all "Headstrike" activations for a 12-month period after implementation. Demographics, patient care, and health data were collected. Descriptive statistics were used for cohort analysis. Five hundred fifteen patients were activated as a "Headstrike" during the study period. Thirty eight patients were diagnosed with ICH (7.4%), 35 of whom were identified on initial imaging. Anticoagulation reversal was ordered for 84.6 per cent of these patients. Of the patients with negative initial CT, only three patients (0.8%) were found to have a delayed ICH on routine follow-up imaging. No anticoagulant/antiplatelet agent was associated with a significantly higher risk of ICH. Implementation of the "Headstrike" protocol resulted in trauma service line resources being used more efficiently, while ensuring high-quality, expeditious care to this population.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Anticoagulantes/administração & dosagem , Protocolos Clínicos , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/terapia , Idoso , Feminino , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Masculino , Melhoria de Qualidade , Estudos Retrospectivos , Centros de Traumatologia , Resultado do Tratamento
7.
Acta Neurol Scand ; 140(6): 435-442, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31505028

RESUMO

OBJECTIVES: One of the most important prognostic factors of cerebral venous sinus thrombosis (CVST) is intracranial hemorrhage (ICH). We studied the risk factors, clinical, and radiologic characteristics of early, delayed, and expanded ICH in Iranian patients with CVST. MATERIALS AND METHODS: In a retrospective study, from August 2012 to September 2016, all adult patients with a confirmed diagnosis of CVST were recruited. Demographic, clinical, and radiologic characteristics of the patients were recorded. The predictors of early, delayed, and expanded ICH were assessed through logistic regression analysis. RESULTS: Among 174 eligible patients, 35.1% of the patients had early ICH. Delayed and expanded hemorrhage occurred in 5% and 7.4% of the patients, respectively. Higher age was a risk factor (odds ratio [OR] = 1.038, 95% confidence interval [CI] = 1.008-1.069), and involvement of multiple sinuses/veins was associated with lower risk of early ICH (OR = 0.432, CI = 0.226-0.827). The risk of delayed ICH was higher in the patients with early hemorrhage (OR = 4.44, CI: 0.990-19.94), men (OR = 4.18, CI: 0.919-19.05), and those with a focal neurologic deficit on admission (OR = 16.05, CI: 1.82-141.39). Acute onset was the predictor of the expansion of early ICH (OR = 8.92, CI: 1.81-43.77), whereas female gender-related conditions were associated with a lower risk of hemorrhage expansion (OR = 0.138, CI: 0.025-0.770). Administration of anticoagulants was associated with neither delayed (P value = .140) nor expanded hemorrhage (P-value = .623). CONCLUSIONS: Male gender, early hemorrhages, acute onset, and presence of focal neurologic deficit are the risk factors for delayed and/or expanded hemorrhages in the patients with CVST.


Assuntos
Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/patologia , Trombose dos Seios Intracranianos/complicações , Adulto , Feminino , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
8.
World Neurosurg ; 132: e66-e75, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31518746

RESUMO

BACKGROUND: The health care expenditure in Vietnam is equivalent to 1% of that in the United States. For most patients with brain arteriovenous malformations (AVM), surgery is the only available treatment modality. This study reports on the outcomes on AVM microsurgery in this resource-restricted environment. METHODS: This is a prospectively collected, retrospectively analyzed case series of consecutive patients who underwent surgical resection of AVM by a single surgeon in Vietnam. All surgeries were performed in a 3-year period in Hanoi. The primary endpoints were obliteration of the AVM and surgical morbidity (modified Rankin Scale [mRS] > 1). RESULTS: There were 86 patients and 62% presented with hemorrhage. Only 2 patients had preoperative embolization, and 47 patients (54%) had preoperative digital subtraction angiography. All patients underwent microsurgical resection of their AVM. Excluding the 4 patients who died, the AVM obliteration rate was 98%. The mean follow-up was 20.1 months. Before surgery, 36% of patients had at least some disability (mRS > 1). Postoperatively, this was reduced to 10% (McNemar P = 0.007). For the overall cohort, neurologic status was improved from initial encounter to final assessment (P = 0.001). Because of resource restrictions, some patients with hemorrhage experienced delays in treatment. There was no difference in outcome between patients who were admitted before or after 24 hours post ictus (P = 0.6). The days spent waiting for surgery did not correlate with final mRS in univariate regression (R2 = 0.01). CONCLUSIONS: Notwithstanding the limitation in health care resources in Vietnam, surgery for AVMs was successful in eliminating the malformation, with obliteration rates and morbidity comparable with international standards.


Assuntos
Revascularização Cerebral/métodos , Malformações Arteriovenosas Intracranianas/cirurgia , Adolescente , Adulto , Idoso , Angiografia Digital , Criança , Embolização Terapêutica , Determinação de Ponto Final , Feminino , Seguimentos , Humanos , Malformações Arteriovenosas Intracranianas/complicações , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Ruptura , Tempo para o Tratamento , Resultado do Tratamento , Vietnã , Adulto Jovem
9.
J Stroke Cerebrovasc Dis ; 28(11): 104357, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31495670

RESUMO

Transcranial ultrasound is a well validated diagnostic technique used to assess cerebral perfusion or to detect structural damage in intensive care unit patients. We report a case of an intracranial hemorrhage first suspected during a trans-cranial Doppler assessment of a postorthotopic liver transplant patient. The patient was at considerable risk of bleeding, due to a primary graft nonfunction, but he had also elevated ammonium levels, justifying the comatose state, and no focal neurological deficits. The clinical conditions were unstable, making the transportation to the radiology suite at elevated risk. The hemorrhage was identified by B-mode ultrasound before the development of focal neurological signs or alterations in the middle cerebral artery Doppler flow and optical nerve sheath diameter. We suggest that transcranial B-mode ultrasound may prove useful as a monitoring tool in selected patients, also providing early clinical suspicion for the onset of intracranial hemorrhage even before the development of intracranial hypertension or focal neurological deficits.


Assuntos
Coma , Hemorragias Intracranianas/diagnóstico por imagem , Hipertensão Intracraniana/diagnóstico por imagem , Transplante de Fígado/efeitos adversos , Ultrassonografia Doppler Transcraniana , Humanos , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/fisiopatologia , Hipertensão Intracraniana/etiologia , Hipertensão Intracraniana/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Resultado do Tratamento
10.
J Stroke Cerebrovasc Dis ; 28(11): 104328, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31471213

RESUMO

OBJECTIVE: Present study was aimed to precisely evaluate the angio-architectures in patients with asymptomatic moyamoya disease (MMD) by comparing with those with hemorrhagic stroke. METHODS: This study used the data set of cerebral angiography in Asymptomatic Moyamoya Registry (AMORE) Study and Japan Adult Moyamoya (JAM) Trial at enrollment. The development of 3 subtypes of collateral vessels, including lenticulostriate, thalamic, and choroidal anastomosis, was evaluated on cerebral angiography. Suzuki's angiographical stage and posterior cerebral artery (PCA) involvement were also assessed. These findings were compared between asymptomatic (AMORE) and hemorrhagic (JAM) groups. RESULTS: This study included 55 hemispheres of 35 patients in asymptomatic group and 75 hemispheres of 75 patients in hemorrhagic group. In asymptomatic group, thalamic anastomosis was less developed than in hemorrhagic group (P = .011), but there were no significant differences in the development of lenticulostriate and choroidal anastomosis between the 2 groups (P = .077 and P = .26, respectively). Suzuki's stage was more progressed and the prevalence of PCA involvement was significantly higher in hemorrhagic group than in asymptomatic group (P = .0033 and P = .016, respectively). CONCLUSIONS: This study reveals no significant differences in the development of choroidal anastomoses between asymptomatic and hemorrhagic-onset MMD. On the other hand, disease stage and PCA involvement were less advanced in asymptomatic MMD than in hemorrhagic-onset MMD. These findings strongly suggest a certain subgroup of asymptomatic patients with MMD is at potential risk for hemorrhagic stroke.


Assuntos
Angiografia Cerebral/métodos , Artérias Cerebrais/diagnóstico por imagem , Hemorragias Intracranianas/diagnóstico por imagem , Angiografia por Ressonância Magnética , Doença de Moyamoya/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Adolescente , Adulto , Idoso , Doenças Assintomáticas , Artérias Cerebrais/fisiopatologia , Circulação Cerebrovascular , Circulação Colateral , Estudos Transversais , Feminino , Humanos , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/fisiopatologia , Japão , Masculino , Pessoa de Meia-Idade , Doença de Moyamoya/complicações , Doença de Moyamoya/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Sistema de Registros , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/fisiopatologia , Adulto Jovem
12.
World Neurosurg ; 131: 116-119, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31398518

RESUMO

BACKGROUND: Occipital sinus (OS) dural arteriovenous fistula (DAVF) is extremely rare, and we are aware of no case accompanied by cerebral hemorrhage. We present a case of OS DAVF presenting with cerebellar hemorrhage, treated successfully by transvenous embolization. CASE DESCRIPTION: A 62-year-old female presented with headache and nausea of recent onset. Computed tomography revealed left cerebellar hemorrhage with perihematomal edema. Angiography showed OS DAVF fed by bilateral occipital and posterior meningeal arteries, with drainage into the left inferior hemispheric vein and right transverse sinus receiving the shunt flow from OS. The caudal side of the OS was occluded. The inferior hemispheric vein was dilated with 2 varices, and the junction between the OS and right transverse sinus was narrowed. Because the OS was not involved in normal cerebellar drainage, transvenous embolization of the OS was performed. The microcatheter was advanced to the OS from the transverse sinus during balloon occlusion at the confluence of sinuses. Coils were placed in the OS from the caudal to cranial side, and complete occlusion of the shunt was obtained. CONCLUSIONS: This is the first report of OS DAVF presenting with cerebellar hemorrhage. Transvenous embolization of the affected OS appears ideal when transvenous access is feasible, and the OS is not involved in normal venous drainage of the cerebellum.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Doenças Cerebelares/diagnóstico por imagem , Cavidades Cranianas/diagnóstico por imagem , Hemorragias Intracranianas/diagnóstico por imagem , Artérias Meníngeas/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/complicações , Malformações Vasculares do Sistema Nervoso Central/terapia , Doenças Cerebelares/etiologia , Angiografia Cerebral , Embolização Terapêutica , Feminino , Humanos , Hemorragias Intracranianas/etiologia , Pessoa de Meia-Idade
14.
J Stroke Cerebrovasc Dis ; 28(11): 104326, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31422006

RESUMO

Endomyocarditis in Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare complication, commonly involving an apical mass compatible with a thrombus. However, no previous report has discussed mobile structures detected by echocardiography in a patient with EGPA. A 53-year-old man with asthma presented with low-grade fever, consciousness disturbance, and vomiting. Magnetic resonance imaging showed multiple acute infarctions in the bilateral cerebrum and cerebellum. Remarkable eosinophilia was observed, and transthoracic echocardiography showed multiple mobile structures originating from the left ventricular septum. The day after admission, he developed left partial hemianopia and intracranial hemorrhage was identified in his right occipital lobe. Skin biopsy showed infiltration of eosinophils in the arterial wall, and we diagnosed EGPA. Myocardial biopsy was performed from the right ventricular wall, and eosinophilic infiltration into the endocardium and myocardium was observed. Endomyocarditis secondary to EGPA was confirmed, and steroid therapy was immediately initiated. Ten days after steroid therapy, the mobile structures in the left ventricle disappeared completely. He suffered no recurrence of stroke with continued steroid therapy. Mobile structures in the left ventricle in patients with active EGPA could be treated conservatively with steroid therapy.


Assuntos
Síndrome de Churg-Strauss/tratamento farmacológico , Miocardite/tratamento farmacológico , Miocárdio/patologia , Esteroides/administração & dosagem , Administração Intravenosa , Infarto Encefálico/diagnóstico por imagem , Infarto Encefálico/etiologia , Síndrome de Churg-Strauss/complicações , Síndrome de Churg-Strauss/patologia , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/etiologia , Masculino , Pessoa de Meia-Idade , Miocardite/etiologia , Miocardite/patologia , Pulsoterapia , Resultado do Tratamento
16.
Hematology ; 24(1): 601-605, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31469059

RESUMO

OBJECTIVES: Congenital factor XIII (FXIII) deficiency is a rare severe bleeding disorder. Intracranial hemorrhage (ICH) is the leading cause of mortality and morbidity in FXIII deficiency. However, its pathogenesis is not well understood yet. In this study, we investigated the expression and CpG island methylation status of matrix metalloproteinase-2 (MMP-2) and MMP-9 in patients with FXIII deficiency and ICH. METHODS: Forty patients with FXIII deficiency including twenty patients with ICH, and twenty without ICH were recruited as case and control groups, respectively. Methylation status was determined by bisulfite sequencing polymerase chain reaction (PCR), and gene expression was assessed by quantitative real-time PCR. RESULTS AND DISCUSSION: We found an unmethylated pattern for both MMP-2 and MMP-9 genes in the case group. Both genes were partially methylated in the control group, while the percentage of methylated CpGs was significantly higher in MMP-9 than MMP-2 (P = 0.001). Furthermore, higher expression of MMP-9 (in both the mRNA and protein levels) was found in the case than control group (P = 0.008 and P = 0.009, respectively). On the other hand, there was no significant difference in MMP-2 expression level (neither mRNA nor protein) between the two groups (P = 0.12 and P = 0.25, respectively). CONCLUSION: Our findings indicated that MMP-9 over-expression might be related to ICH in FXIII deficiency, and gene methylation effectively regulates its expression. Future researches will expand our understanding of the pathogenesis of ICH in congenital FXIII deficiency.


Assuntos
Ilhas de CpG/genética , Deficiência do Fator XIII/complicações , Deficiência do Fator XIII/genética , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/genética , Metaloproteinase 2 da Matriz/genética , Metaloproteinase 9 da Matriz/genética , Adolescente , Criança , Feminino , Humanos , Hemorragias Intracranianas/patologia , Masculino
17.
Rev Soc Bras Med Trop ; 52: e20190115, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31340373

RESUMO

Snakebites were included by the World Health Organization in their list of neglected diseases. In Latin America, most snakebites are caused by species of the Viperidae family, notably by the genus Bothrops. Bothrops atrox accounts for 90% of the cases of envenoming in the Brazilian Amazon. In this report, we present a series of three cases of snakebites that evolved with hemorrhagic stroke due to delays in the access to antivenom in the Brazilian Amazon, being fundamental for diagnosis to validate the clinical suspicion and make decisions that would improve the treatment and prognosis of the patients.


Assuntos
Venenos de Crotalídeos/toxicidade , Hemorragias Intracranianas/etiologia , Mordeduras de Serpentes/complicações , Acidente Vascular Cerebral/etiologia , Adolescente , Adulto , Idoso , Animais , Antivenenos/uso terapêutico , Bothrops , Brasil , Feminino , Humanos , Masculino , Mordeduras de Serpentes/tratamento farmacológico , Adulto Jovem
18.
J Clin Neurosci ; 69: 224-229, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31327589

RESUMO

BACKGROUND: Atrial fibrillation (AF)-related stroke causes severe disability and poor prognosis. Adjunctive statin therapy has been recommended for atherosclerotic-related stroke but not AF-related stroke. This study investigated the effects of statin in AF patients who experienced acute ischemic stroke. METHODS: Data from patients with AF experiencing first-ever ischemic stroke between 2001 and 2010 were collected from the Taiwan National Health Insurance Research Database and categorized into non-statin and statin groups. The statin group was further divided into pre-stroke statin (those who began statin therapy before stroke) and post-stroke statin (those who began statin therapy after stroke) groups. The risks for recurrent ischemic stroke, coronary artery disease (CAD), intracranial hemorrhage (ICH), and 1-year mortality were compared among the groups. RESULTS: A total of 43,242 patients were in the non-statin, 2858 in the pre-stroke statin and 4640 in post-stroke statin groups. Comparing the risk for recurrent stroke and CAD among the three groups, the pre-stroke statin and post-stroke statin groups did not exhibit a significant difference compared with the non-statin group. In terms of ICH risk, the statin group had a lower risk for ICH (odds ratio [OR] 0.79, 95% confidence interval [CI] 0.68-0.90; p = 0.0007) compared with the non-statin group. The overall 1-year mortality in both statin subgroups was lower than that in the non-statin group (pre-stroke statin, OR 0.55 [95% CI 0.49-0.61]; p < 0.0001 versus post-stroke statin, OR 0.53 [95% CI 0.48-0.58]; p < 0.0001). CONCLUSIONS: Statin therapy reduced the risk of ICH and 1-year mortality in AF patients who experienced acute ischemic stroke.


Assuntos
Fibrilação Atrial/complicações , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hemorragias Intracranianas/epidemiologia , Acidente Vascular Cerebral/etiologia , Idoso , Isquemia Encefálica/etiologia , Feminino , Humanos , Hemorragias Intracranianas/etiologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Taiwan
20.
Cancer Treat Res ; 179: 179-189, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31317488

RESUMO

Venous thromboembolism is commonly diagnosed in patients with primary and secondary brain tumors. Anticoagulation management in the setting of brain tumors is complicated by the high background rate of spontaneous intracranial hemorrhage. Until recently, there was limited evidence to support the decision to administer therapeutic anticoagulation in the setting of brain metastases or primary brain tumors. The current evidence suggests that the safety profile of therapeutic low molecular weight heparin for the treatment of venous thromboembolism is contingent on whether the origin of brain tumor is primary (i.e., glioma) versus secondary. In patients with brain metastases, the rate of intracranial hemorrhage often exceeds 20% but is not influenced by the administration of low molecular weight heparin. In contrast, in primary brain tumors such as glioma, therapeutic anticoagulation is associated with an increased risk of intracranial hemorrhage that can negatively impact survival. This chapter reviews the underlying mechanisms contributing to thrombosis and hemorrhage in brain tumors and summarizes the current evidence and approaches in anticoagulation to treat venous thromboembolism.


Assuntos
Anticoagulantes/uso terapêutico , Neoplasias Encefálicas/complicações , Hemorragias Intracranianas/etiologia , Tromboembolia Venosa/tratamento farmacológico , Anticoagulantes/efeitos adversos , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/secundário , Humanos , Hemorragias Intracranianas/induzido quimicamente , Tromboembolia Venosa/etiologia
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