Gestational Trophoblastic Neoplasia
Pat Price, Karol Sikora in Treatment of Cancer, 2020
These patients usually present without a history of molar pregnancy and may or may not have had histology showing either choriocarcinoma or PSTT/ETT. Such individuals may have widespread disease involvement and need extensive investigation beyond just simple blood tests, hCG, pelvic Doppler ultrasound, and CXR. Additional tests should include contrast-enhanced computed tomography (CT) of chest/abdomen (Figure 23.7), MRI of pelvis and brain (Figure 23.8), and biopsy if this can be obtained without precipitating life-threatening hemorrhage. Genetic analysis may be required to determine whether the disease is gestational and if so, from which previous pregnancy it has arisen, as this can guide management. Fluorodeoxyglucose positron emission tomography (FDG)-PET-CT scanning is usually not required but may be helpful later in the disease course for identifying active disease sites suitable for resection. All high-risk patients with a negative MRI of brain should have a CSF:serum hCG ratio measured to look for occult disease (see later section on CNS disease).
Rheology of Paraproteinemias and Leukemias
Gordon D. O. Lowe in Clinical Blood Rheology, 2019
These are also common in HVS and include headaches, dizziness, vertigo, visual disturbances (e.g., diplopia), nystagmus, ataxia, deafness, tinnitus, psychiatric syndromes, pyramidal lesions, myelopathy, peripheral neuropathy (Bing-Neel syndrome), myopathy, drowsiness, seizures, and coma.8 Fatal cerebral hemorrhage may occur. As with retinopathy, RSV is usually greater than 4.0 in patients with neurological symptoms. Again, however, there is much interindividual variation in the “symptomatic threshold” of hyperviscosity.3,8,31 Blood viscosity, measured at a low shear rate, also correlated with neurological symptoms.24 One patient with WM had a fatal neurological syndrome with a relatively low RSV (3.6) but high calculated high-shear blood viscosity (13.2 mPa sec).32 Plasmapheresis again appears rapidly effective in treatment of neurological features.3,8,31
Diagnostic, Medical, and Surgical Approaches to Stroke Management
Mary C. Singleton, Eleanor F. Branch in Physical Therapy and the Stroke Patient: Pathologic Aspects and Clinical Management, 2014
Subarachnoid hemorrhage differs from other forms of stroke in its presentation. Depending on the severity and location of the bleeding, the clinical symptoms can vary from severe headache, mild confusion, and little neurological deficit to coma and death. The diagnosis of subarachnoid hemorrhage is made by demonstrating blood in the cerebrospinal fluid at the time of lumbar puncture. Computerized tomography examination will often detect subarachnoid blood, but rare cases have been described where normal CT scans were found when subarachnoid hemorrhage was present. Therefore, evaluation of suspected subarachnoid hemorrhage requires a CT scan but a lumbar puncture should be done when there is a strong suspicion.
The rare manifestations in tuberculous meningoencephalitis: a review of available literature
Published in Annals of Medicine, 2023
Rong li He, Yun Liu, Quanhui Tan, Lan Wang
Subarachnoid haemorrhage refers to the blood flowing into the subarachnoid space after the blood vessels at the bottom of the brain or on the surface of the brain break, leading to the corresponding clinical symptoms. Subarachnoid haemorrhage is rare in tuberculous meningoencephalitis. Only a few literatures have reported this phenomenon. The main clinical manifestation is sudden severe headache, with or without nausea, vomiting and other symptoms [14]. At present, the aetiology of TBM with SAH is still unclear. At present, its pathogenesis is considered to be related to TBM vasculitis and late inflammatory reaction, which may lead to subarachnoid haemorrhage [15]. Pathological examination also showed that subarachnoid haemorrhage may be related to the rupture of inflammatory tuberculoma or fungal aneurysm [16]. The diagnosis of subarachnoid haemorrhage mainly depends on the clinical manifestations. Cranial CT is the first choice for imaging diagnosis, and the positive rate is about 85%. Head CT shows diffuse high-density images of basal cistern, ventricular system and convexity of brain. Intracranial arterial lesions can also be detected by digital subtraction DSA of the whole cranial artery and MRA of the intracranial artery magnetic resonance angiography. The main causes of subarachnoid haemorrhage are aneurysm rupture and haemorrhage [17]. The clinical manifestations of patients with nodular encephalopathy suddenly appear in the course of the disease, which can be diagnosed in combination with the corresponding changes of head CT.
Synergistic deterioration of prognosis associated with decreased grip strength and hyporesponse to erythropoiesis-stimulating agents in patients undergoing hemodialysis
Published in Renal Failure, 2022
Shizuka Kobayashi, Kentaro Tanaka, Junichi Hoshino, Shigeko Hara, Akifumi Kushiyama, Yoshihide Tanaka, Shuta Motonishi, Ken Sakai, Takashi Ozawa
All causes of death were defined as all-cause mortality. Cardiovascular disease was defined as ischemic cardiovascular events (angina, myocardial infarction, arteriosclerosis obliterans, cerebral hemorrhage, and cerebral infarction), or nonischemic heart disease events (heart failure). In the survival analysis, if a patient experienced both events, the first event took precedence. The observation period was 2 years. In our study, we observed events with a composite endpoint. However, we performed a separate multivariate analysis for all-cause mortality and cardiovascular disease. Angina pectoris and myocardial infarction were diagnosed using coronary angiography and myocardial scintigraphy, while arteriosclerosis obliterans was screened with ankle-brachial index (ABI) and diagnosed by a specialist using lower extremity ultrasound, contrast-enhanced computed tomography (CT), or magnetic resonance imaging (MRI). Cerebral hemorrhage and infarction were diagnosed based on imaging findings, such as CT and MRI.
Characteristics of Nontrauma Patients Receiving Prehospital Blood Transfusion with the Same Triggers as Trauma Patients: A Retrospective Observational Cohort Study
Published in Prehospital Emergency Care, 2022
Susanne Ångerman, Hetti Kirves, Jouni Nurmi
The nontrauma group consisted of patients with various etiologies of hemorrhage (Figure 2). The most common reason for massive hemorrhage was gastrointestinal bleeding (n = 15, 42%). Patients with vascular catastrophes (n = 9, 25%) were suspected to suffer from a ruptured abdominal aortic aneurysm except for one case of suspected aortic dissection. Postoperative complications (n = 6, 17%) involved three patients suffering from late postoperative bleeding after major vascular surgery, two post-tonsillectomy bleedings and one patient with bleeding from the microvascular free flap in the lower limb. Gynecologic/obstetric hemorrhage (n = 4, 11%) was caused only by pregnancy-related reasons – for example, uterine rupture and extrauterine pregnancy. Other indications for PHBT were one case of severe epistaxis and one case of anemic point-of-care test finding in a patient resuscitated from pulseless electrical activity.
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