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Diagnostic, Medical, and Surgical Approaches to Stroke Management
Published in Mary C. Singleton, Eleanor F. Branch, Physical Therapy and the Stroke Patient: Pathologic Aspects and Clinical Management, 2014
Intraparenchymal hemorrhage. Hemorrhage into a cerebral infarction can be a complication of stroke in anticoagulated patients. This type of intraparenchymal hemorrhage is different from the hemorrhagic cerebral infarction seen in stroke patients with embolic occlusions and can sometimes be determined from the pattern on CT scan. Either type of hemorrhage can produce cerebral edema and hemisphere swelling and represents a serious complication of stroke.
Oral examinations
Published in Deepak Subedi, Marialena Gregoriades, En Hsun Choi, John T Murchison, Graham McKillop, A Complete Guide to the Final FRCR 2B, 2011
Deepak Subedi, Marialena Gregoriades, En Hsun Choi, John T Murchison, Graham McKillop
The possible causes of subarachnoid haemorrhage are trauma, rupture of a berry aneurysm, arteriovenous malformation, blood dyscrasia or bleeding into tumours. Leakage of blood into the subarachnoid space can also occur as a result of intraparenchymal haemorrhage. Repeat angiography may be necessary in patients with angiographically negative subarachnoid haemorrhage, as sometimes the initial angiography may be falsely negative secondary to spasm. Non-aneurysmal perimesencephalic haemorrhage has a benign clinical course. Rebleeding, hydrocephalus and vasospasm leading to infarction are the acute complications of subarachnoid haemorrhage.
Complications of Shock Wave Lithotripsy
Published in Kevin R. Loughlin, Complications of Urologic Surgery and Practice, 2007
Nicole L. Miller, James E. Lingeman
The pattern of injury seen in human kidneys as a result of SWL corresponds to that demonstrated in animal studies. The most common clinical sign of renal trauma is gross hematuria (27). Computed tomography (CT) and magnetic resonance imaging (MRI) have demonstrated renal injury, including enlargement of the kidney, loss of corticomedullary junction demarcation, low signal intensity changes in the perirenal fat and hematomas in 63% to 85% of patients treated with SWL (Fig. 3) (28–35). As demonstrated in animal studies, hemorrhage can be intraparenchymal, subcapsular, or perirenal (36). While perirenal collections have been shown to resolve in a few days (37), subcapsular hematomas may take six weeks to six months or longer to resolve (28). Intraparenchymal hemorrhage is preferentially located at the corticomedullary junction which may be more susceptible to injury as a result of differing tissue densities in this location (38). The thin-walled arcuate veins located in the corticomedullary junction are especially vulnerable to shock wave injury.
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
Initial CT findings that should be considered significant, and therefore should alert the clinician to the need for neurosurgical consultation are subdural hemorrhage (especially ≥ 4 mm width) and midline shift. In fact, half of patients who underwent neurosurgery had subdural hemorrhage or midline shift as indication for surgery. Moreover, almost all mTBI-related deaths had subdural hemorrhage. Therefore, like many previous studies (21–24), we support the fact that subdural hemorrhage should be considered as a predicting factor for neurosurgical intervention. Conversely, the sole presence of a subarachnoid hemorrhage, an intraventricular hemorrhage, an intraparenchymal hemorrhage, multiple hemorrhages or any skull fracture type were not associated with a greater risk of neurosurgical intervention in our cohort. Most of the patients with a normal neurological exam and presenting one of these isolated findings did not require neurosurgical intervention and had a favorable evolution. Therefore, we hypothesize that a subset of patients with mTBI could be managed in their original center without being transferred to a center with neurosurgical capacities, providing neurosurgical teleconsultation is available.
Flow-diverting stent and delayed intracranial bleeding: the case for discussing acquired von Willebrand disease
Published in Platelets, 2021
The mechanism of delayed intraparenchymal hemorrhage, however, still remains elusive. More than 80% of delayed intraparenchymal bleeding occurs within vascular territory harboring that of treated aneurysms [18]. After FDS implantation, some patients have new ipsilateral ischemic lesions on diffusion-weighted imaging (DWI) and microhemorrhages on susceptibility-weighted imaging in the brain magnetic resonance imaging [19]. Interestingly nearly all microhemorrhages arise from the previous DWI lesions, confirming a temporal/causative association between ischemic DWI lesions and microhemorrhage after FDS implantation [20]. We have just shown reduced global vWF activity after FDS implantation especially in patients with relatively large intracranial aneurysms [5], a typical laboratory finding of high-shear-generating vascular device-related type 2A AvWD [8,9,13]. Taken together, a shear-induced sustained increase in vWF activity (i.e., elongated multimers of vWF) coming from a downstream stented vessel appears to be responsible for the initiation of a series of events leading to microthrombus formation in the ipsilateral microcirculation of the brain with subsequent hemorrhagic transformation [5].
Intracranial hemorrhage in the setting of posterior reversible encephalopathy syndrome: two case reports and a review
Published in Hospital Practice, 2018
Manveer Garcha, Keithan Sivakumar, Mohammed El-Hunjul, Shweta Varade, Hussam A. Yacoub
PRES was described in 1996 by Hinchey et al. [1] in a report of 15 patients whose symptoms included the constellation of seizures, altered mental status, visual loss, and white matter edema seen on neuroimaging, specifically in the parietal and occipital subcortical white matter. In their initial report, these authors did not describe any patients with intraparenchymal hemorrhage associated with PRES [1]. However, the investigators selected only patients with white-matter abnormalities who had resolution of clinical symptoms. These criteria may have excluded patients with atypical radiological findings such as intracranial hemorrhage (ICH). All 15 patients had resolution of their symptoms; thus, the condition was referred to as ‘posterior leukoencephalopathy syndrome.’ Due to the presence of vasogenic edema in the parietal and occipital lobes, the syndrome became more popularly known as PRES [3].