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Fetal and Neonatal Alloimmune Thrombocytopenia
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
The most serious complication is the 10–30% risk of intracranial hemorrhage. Approximately 75% occur antenatally, with more than half developing prior to 28 weeks. The neonatal mortality from intracranial hemorrhage (ICH) is 5–13%.
Assessment of fetal brain abnormalities
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Intracranial hemorrhage includes subdural hemorrhage, primary subarachnoid hemorrhage, intracerebellar hemorrhage, intraventricular hemorrhage, and intraparenchymal hemorrhage other than cerebellar hemorrhage (63). Hydro-cephalus, hydranencephaly, porencephaly, and/or microcephaly are possible secondary complications, which are often detectable by imaging studies. Unilateral ventriculomegaly due to cerebral hemorrhage and fresh intracerebral hemorrhage is shown in Figure 10. The hyperechoic lesion is changing into porencephaly in a short period.
Translating the Medical Record
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
Other special diagnostic studies include the electroencephalogram (EEG), which measures and records electrical impulses from the cortex of the brain. This is used for several purposes, such as to assist in diagnosing epilepsy, narcolepsy, and Alzheimer's disease. It is used to evaluate brain tumors, abscesses, subdural hematomas, cerebral infarcts, and intracranial hemorrhages. This procedure is also used to determine electrocerebral silence or "brain death." Terms associated with EEG include auditory brain stem response (ABR), visual-evoked response (VES), and somatosensory-evoked response (SER). EEG recording techniques are used in combination with computer data processing to evaluate electrophysiologic integrity of these pathways.
Predictors of neurosurgical intervention in complicated mild traumatic brain injury patients: a retrospective cohort study
Published in Brain Injury, 2021
Jean-Nicolas Tourigny, Véronique Paquet, Émile Fortier, Christian Malo, Éric Mercier, Jean-Marc Chauny, Gregory Clark, Pierre-Gilles Blanchard, Valérie Boucher, Pierre-Hugues Carmichael, Jean-Luc Gariépy, Marcel Émond
The risk of clinical and radiological deteriorations leading to a neurosurgical intervention varies depending on the type of intracranial hemorrhage. A recent meta-analysis found that patients with isolated subarachnoid hemorrhage (SAH) have a 0.0017% risk of needing neurosurgical intervention (4). This very low risk puts into question the common practice of transferring the majority of patients with mTBI with isolated SAH to a level 1 trauma center for neurosurgical consultation. An important clinical equipoise exists concerning treatment, observation, repeat head CT and interhospital transfers of patients with complicated mTBI. Currently in our province, guidelines for the management of complicated mTBIs provide a list of significant lesions on initial head CT that should warrant transfer to a neurotrauma center (5). However, these criteria are not routinely used and, to our knowledge, have not been validated in our population.
The potential for immune checkpoint modulators in cerebrovascular injury and inflammation
Published in Expert Opinion on Therapeutic Targets, 2021
Jennifer E. Kim, Kisha Patel, Christopher M. Jackson
Additional challenges lie in the heterogeneity of neuroinflammatory disorders. For example, CNS vasculitides encompass primary and secondary angiitis, the latter of which includes all CNS manifestations of a heterogenous group of systemic autoimmune pathologies with widely variable etiologies, pathomechanisms, and clinical presentations. Intracranial hemorrhage may be secondary to trauma, hypertensive vasculopathy, hemorrhagic conversion of an ischemic stroke, amyloid angiopathy, or ruptured vascular malformations or aneurysms. The translatability of checkpoint modulating therapies across various pathologies is contingent on the shared role of immune checkpoints as critical gatekeepers of inflammation. We believe that PD-1+ inflammatory monocytes, discovered as a mediator of cerebral vasospasm, may be an example of one such unifying target. Most of the studies discussed above offer hope that checkpoint modulators could revolutionize the treatment of neuroinflammatory disorders, just as they have done in the treatment of human cancers. Further investigations of the roles that immune checkpoints play, and their interactions with other checkpoints (i.e. tiered, reciprocal, synergistic, and/or antagonistic) will be needed to best harness their potential as therapeutic targets.
Apoplexy in Richard Bright’s (1789–1858) reports of medical cases
Published in Journal of the History of the Neurosciences, 2021
Bright’s ability to describe brain diseases accurately and in a felicitous prose constitutes a major contribution to the development of neurology. In a previous communication (Schutta 2017), I endeavored to show, by including extensive quotations of his observations, that Bright had a good grasp of the symptomatology of brain diseases. The observations under discussion enhanced the understanding of intracranial hemorrhages. Bright stands out among scholarly physicians in the early-nineteenth century and participated creditably in a process that created new concepts of disease by describing “typical condition of many patients,” rather than “disorderly condition of a particular patient.” This process—initiated by Morgagni and fine-tuned by Rochoux, Bright, and their contemporaries—was a necessary groundwork for the next step in the advance of medicine: the “counting and comparing” that led to the development of effective medicine (Wootton 2006, 145).