Acute Hemorrhage and Trauma

Abstract BACKGROUND Flow diverters have become an important tool in the treatment of intracranial aneurysms, especially when dealing with difficult-to-treat or complex aneurysms. The p64 is the only fully resheathable and mechanically detachable flow diverter available for clinical use. OBJECTIVE To evaluate the safety and effectiveness of p64 for the treatment of intracranial saccular unruptured aneurysms arising from the anterior circulation over a long-term follow-up period. METHODS We retrospectively reviewed our prospectively maintained database to identify all patients who underwent treatment for an intracranial saccular (unruptured or beyond the acute hemorrhage phase) aneurysm arising from the anterior circulation with ≥1 p64 between December 2011 and December 2019. Fusiform aneurysms and dissections were excluded. Aneurysms with prior or concomitant saccular treatment (eg, coiling and clipping) were included. Aneurysms with parent vessel implants other than p64 were excluded. Anatomic features, intraprocedural complications, clinical outcome, as well as clinical and angiographic follow-ups were all recorded. RESULTS In total, 530 patients (388 females; median age 55.9 yr) with 617 intracranial aneurysms met the inclusion criteria. The average number of devices used per aneurysm was 1.1 (range 1-3). Mean aneurysm dome size was 4.8 mm (range 1-27 mm). Treatment-related morbimortality was 2.4%. Early, mid-term, and long-term angiographic follow-up showed complete or near-complete aneurysm occlusion in 76.8%, 89.7%, and 94.5%, respectively. CONCLUSION Treatment of intracranial saccular unruptured aneurysms of the anterior circulation using p64 is a safe and effective treatment option with high rate of occlusion at long-term follow-up and low morbimortality.

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CT and MR presentation of acute hemorrhage in a spinal schwannoma

Surgical Neurology ◽

10.1016/s0090-3019(97)90029-x ◽

1998 ◽

Vol 50 (3) ◽

pp. 219-220 ◽

Cited By ~ 12

Author(s):

Kazuya Uemura ◽

Akira Matsumura ◽

Eiki Kobayashi ◽

Yuji Tomono ◽

Tadao Nose

Keyword(s):

Acute Hemorrhage ◽

Spinal Schwannoma

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Hyperperfusion Syndrome: Toward a Stricter Definition

Neurosurgery ◽

10.1227/01.neu.0000088738.80838.74 ◽

2003 ◽

Vol 53 (5) ◽

pp. 1053-1060 ◽

Cited By ~ 126

Author(s):

◽

Shelagh B. Coutts ◽

Michael D. Hill ◽

William Y. Hu ◽

Garnette R. Sutherland

Keyword(s):

Carotid Artery ◽

Intracerebral Hemorrhage ◽

Carotid Endarterectomy ◽

Clinical Presentation ◽

Imaging Techniques ◽

Neurological Deficits ◽

Acute Hemorrhage ◽

Motor Weakness ◽

Hyperperfusion Syndrome ◽

Angioplasty And Stenting

Abstract OBJECTIVE Hyperperfusion syndrome is a rare and potentially devastating complication of carotid endarterectomy or carotid artery angioplasty and stenting. With the advent of new imaging techniques, we reviewed our experience with this phenomenon. METHODS This report is a retrospective review of 129 consecutive cases of carotid endarterectomy performed between June 1, 2000, and May 31, 2002, and 44 consecutive cases of carotid artery angioplasty and stenting performed between January 1, 1997, and May 31, 2002. We specifically searched for examples of patients who developed postprocedural nonthrombotic neurological deficits that typified the hyperperfusion syndrome. RESULTS Seven cases of hyperperfusion syndrome occurred, four after endarterectomy (3.1% of carotid endarterectomy cases) and three after stenting (6.8% of stenting cases). The cases of hyperperfusion were classified as presenting with 1) acute focal edema (two cases with stroke-like presentation, attributable to edema immediately after revascularization), 2) acute hemorrhage (two cases of intracerebral hemorrhage immediately after stenting and one case immediately after endarterectomy), or 3) delayed classic presentation (two cases with seizures, focal motor weakness, and/or late intracerebral hemorrhage at least 24 hours after endarterectomy). CONCLUSION Hyperperfusion syndrome may be more common and more variable in clinical presentation than previously appreciated.

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Effect of vasopressin on portal pressure during volume replacement after acute hemorrhage

World Journal of Surgery ◽

10.1007/bf01561286 ◽

1979 ◽

Vol 3 (2) ◽

pp. 241-246 ◽

Cited By ~ 10

Author(s):

William P. Skivolocki ◽

Kenneth R. Sirinek ◽

William G. Pace

Keyword(s):

Portal Pressure ◽

Volume Replacement ◽

Acute Hemorrhage

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Acute Hemorrhage and Oxygen Free Radicals

Angiology ◽

10.1177/000331978803901201 ◽

1988 ◽

Vol 39 (12) ◽

pp. 1005-1013 ◽

Cited By ~ 10

Author(s):

Kailash Prasad ◽

Jawahar Kalra ◽

Greg Buchko

Keyword(s):

Free Radicals ◽

Oxygen Free Radicals ◽

Acute Hemorrhage

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Hemorrhagic and nonhemorrhagic Rathke cleft cysts mimicking pituitary apoplexy

Journal of Neurosurgery ◽

10.3171/jns/2008/108/01/0003 ◽

2008 ◽

Vol 108 (1) ◽

pp. 3-8 ◽

Cited By ~ 46

Author(s):

Mandy J. Binning ◽

James K. Liu ◽

John Gannon ◽

Anne G. Osborn ◽

William T. Couldwell

Keyword(s):

Mr Imaging ◽

Pituitary Tumor ◽

Pituitary Apoplexy ◽

Pituitary Tumors ◽

Imaging Features ◽

Mr Images ◽

Acute Hemorrhage ◽

Consistent Finding ◽

Imaging Characteristics ◽

Intracystic Hemorrhage

Object Rathke cleft cysts (RCCs) are infrequently symptomatic, and apoplexy is one of the most unusual presentations. Only a few cases of apoplexy associated with RCCs have been reported, and their clinical, imaging, surgical, and pathological features are poorly understood. In the cases that have been reported, intracystic hemorrhage has been a consistent finding. The authors report 6 cases of RCCs in which the presenting clinical and imaging features indicated pituitary apoplexy, both with and without intracystic hemorrhage. Methods The authors retrospectively reviewed charts and magnetic resonance (MR) imaging studies obtained in patients who underwent transsphenoidal surgery for RCC. Six patients were identified who presented with symptoms and MR imaging characteristics consistent with pituitary apoplexy but were found intraoperatively to have an RCC. All 6 patients presented with a sudden headache, 2 with visual loss, and 1 with diplopia. Review of the preoperative MR images demonstrated mixed signal intensities in the sellar masses suggestive of a hemorrhagic pituitary tumor. In all patients there was a presumed clinical diagnosis of pituitary tumor apoplexy and an imaging-documented diagnosis of hemorrhagic pituitary tumor. Results All 6 patients underwent transsphenoidal resection to treat the suspected pituitary apoplexy. Intraoperative and histopathological findings were consistent with the diagnosis of an RCC in all cases. Only 2 cases showed evidence of hemorrhage intraoperatively. In all cases, an intracystic nodule was found within the RCC at surgery, and this intracystic nodule was present on the initial MR imaging when retrospectively reviewed. The imaging characteristics of the intracystic nodules were similar to those of acute hemorrhage seen in cases of pituitary apoplexy. Conclusions The clinical and imaging features of RCCs appear similar to those of hemorrhagic pituitary tumors, making them often indistinguishable from pituitary apoplexy.

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Effect of Acute Hemorrhage on Transcutaneous, Subcutaneous, Intramuscular, and Arterial Oxygen Tensions

PEDIATRICS ◽

10.1542/peds.65.5.881 ◽

1980 ◽

Vol 65 (5) ◽

pp. 881-883

Author(s):

Frederick A. Matsen ◽

Craig R. Wyss ◽

Racheal V. King ◽

Charles W. Simmons

Keyword(s):

Arterial Oxygen ◽

Peripheral Blood Flow ◽

Danger Signal ◽

Close Approximation ◽

Monitoring Method ◽

Acute Hemorrhage ◽

Tissue Po2 ◽

Oxygen Tensions ◽

Arterial Po2 ◽

Transcutaneous Po2

Although transcutaneous Po2 is a close approximation of arterial Po2 in most neonates, infants in shock often show lower transcutaneous than arterial Po2 values. For a better understanding of this discrepancy, we investigated the effect of acute hemorrhage on transcutaneous, tissue, and arterial Po2 in rabbits. With progressive hemorrhage, transcutaneous and tissue Po2 values declined steeply while arterial Po2 values did not. We speculate that the progressive decrement in transcutaneous and tissue Po2 values with hemorrhage is produced by diminished peripheral blood flow. Rather than representing a failure of the transcutaneous Po2 monitoring method, we speculate that transcutaneous hypoxia with shock may be a clinically valuable danger signal.

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