Complications of Shock Wave Lithotripsy
Kevin R. Loughlin in Complications of Urologic Surgery and Practice, 2007
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.
Head CT Analysis for Intracranial Hemorrhage Segmentation
Kayvan Najarian, Delaram Kahrobaei, Enrique Domínguez, Reza Soroushmehr in Artificial Intelligence in Healthcare and Medicine, 2022
Hemorrhage within the intracranial compartment has five subtypes depending on its anatomical location: epidural hemorrhage (EDH), subdural hematoma (SDH), subarachnoid hemorrhage (SAH), intraparenchymal hemorrhage (IPH), and intraventricular hemorrhage (IVH). IVH is defined as bleeding inside or around the ventricles in the brain, while IPH is defined as non-traumatic bleeding into the brain parenchyma (Naidech, 2011). Moreover, SAH refers to bleeding into the space between the pia and the arachnoid membranes (Naidech, 2011) while SDH refers to the accumulation of blood under the skull and outside of the brain arachnoid mater. As blood accumulates in the subdural region, it compresses brain tissue which can lead to unconsciousness or death; thus, its early detection and management are of utmost importance. The texture and so the attenuation of blood on a CT scan varies based on the age of blood. Thus, depending on the chronicity of SDH, this type of hematoma can be categorized into three main categories, including chronic, subacute, and acute, as well as a mixture of the three, each of which is represented with different attenuation of blood on a scan. Acute EDHs are identified on a CT scan as a hyperdense collection in the epidural space, located between the inner table of the skull and the dura mater (Kulesza et al., 2020).
Assessment of fetal brain abnormalities
Hung N. Winn, Frank A. Chervenak, Roberto Romero in 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.
Impact of helmet use in equestrian-related traumatic brain injury: a matched-pairs analysis
Published in British Journal of Neurosurgery, 2018
Georg Bier, Malte N. Bongers, Ahmed Othman, Johann-Martin Hempel, Volker Vieth, Walter Heindel, Ulrike Ernemann, Matthias C. Burg
In the helmet-group, both cases with ICH had subarachnoid hemorrhage, in one patient accompanied by a small intraparenchymal contusion. Correspondingly, in the no-helmet group, 6 patients (30%) had a subdural hemorrhage (p = .02), 7 (35%) a subarachnoid hemorrhage (p = .118), 7 (35%) intraparenchymal contusion bleedings (p = .022), and 2 patients (10%) presented with an intraventricular blood collection (p = .244; see Figure 4). The main localization for intraparenchymal hemorrhage was the frontal lobe (n = 6), followed by the temporal lobe (n = 4), and the parietal lobe (n = 1). In 2 cases (10%), more than one lobe was affected. An exemplarily image set of two patients, the unhelmeted one with severe subdural, subarachnoid and parenchymal hemorrhage is given in Figure 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].
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].
Related Knowledge Centers
- Death
- Disability
- Edema
- Parenchyma
- Subarachnoid Hemorrhage
- Stroke
- Brain
- Intracerebral Hemorrhage
- Intraventricular Hemorrhage
- Medical Emergency