Post-traumatic intracranial pseudo-aneurysms of posterior circulation: a comprehensive review of an under-diagnosed and rare entity

AbstractTraumatic aneurysms are rare and the total number of cases involving the posterior circulation (TIPC) is even smaller. Traumatic brain injury (TBI) may be responsible not only of rupture in brain aneurysm (BrA) pre-existing to trauma, but it has been identified also as a possible pathogenetic cause of TIPC formation in patients not affected by intracranial vascular lesions. A complete literature review was performed of all reported cases regarding rupture of BrA with SAH resulting from TIPC not previously identified at the first radiological screening. A representative case of a left posterior inferior cerebellar artery (PICA) pseudo-aneurysm caused by left vertebral artery’s dissection is reported. We show a unique complete collection of all 34 cases. Despite their rarity, TIPCs are associated with a significant morbidity and mortality rate, as high as 40–60%. Of the 22 patients with good neurological status (64.7%), we did not notice a significant correlation with regard to the location of the aneurysm, type of treatment, or clinical onset. Early recognition of a pseudo-aneurysm and adequate treatment seem to be the most important prognostic factor for these patients. Despite their rarity, TIPCs are associated with a significant morbidity and mortality rate. A TIPC should be suspected in case of delayed deterioration in head‐injured patient and should be investigated with angiography. Conservative management is worsened by poor prognosis and the goal of treatment is to exclude the aneurysm from circulation with surgical or endovascular methods as soon as possible.

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Beware of Nihilism: Favorable Outcome despite Poor Admission Status in Posterior Circulation Aneurysms after Aneurysmal Subarachnoid Hemorrhage

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0040-1719142 ◽

2021 ◽

Author(s):

Nina Brawanski ◽

Sepide Kashefiolasl ◽

Sae-Yeon Won ◽

Joachim Berkefeld ◽

Elke Hattingen ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Mortality Rate ◽

Cerebral Artery ◽

Coil Embolization ◽

Posterior Inferior Cerebellar Artery ◽

Posterior Circulation ◽

Anterior Circulation ◽

Ruptured Aneurysms ◽

Admission Status ◽

Posterior Circulation Aneurysms

Abstract Objective As shown in a previous study, aneurysm location seems to influence prognosis in patients with subarachnoid hemorrhage (SAH). We compared patients with ruptured aneurysms of anterior and posterior circulation, undergoing coil embolization, concerning differences in outcome and prognostic factors. Methods Patients with SAH were entered into a prospectively collected database. We retrospectively identified 307 patients with aneurysms of the anterior circulation (anterior cerebral artery, carotid bifurcation, and middle cerebral artery) and 244 patients with aneurysms of the posterior circulation (aneurysms of the basilar artery, posterior inferior cerebellar artery, posterior communicating artery and posterior cerebral artery). All patients underwent coil embolization. The outcome was assessed using the modified Rankin Scale (mRS; favorable [mRS 0–2] vs. unfavorable [mRS 3–6]) 6 months after SAH. Results In interventionally treated aneurysms of the anterior and posterior circulation, statistically significant risk factors for poor outcome were worse admission status and severe cerebral vasospasm. If compared with patients with ruptured aneurysms of the anterior circulation, patients with aneurysms of the posterior circulation had a significantly poorer admission status, and suffered significantly more often from an early hydrocephalus. Nonetheless, there were no differences in outcome or mortality rate between the two patient groups. Conclusion Patients with a ruptured aneurysm of the posterior circulation suffer more often from an early hydrocephalus and have a significantly worse admission status, possibly related to the untreated hydrocephalus. Nonetheless, the outcome and the mortality rate were comparable between ruptured anterior and posterior circulation aneurysms, treated by coil embolisation. Therefore, despite the poorer admission status of patients with ruptured posterior circulation aneurysms, treatment of these patients should be considered.

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“Air” on the side of caution: The importance of early recognition and intervention in Ludwig’s angina

Case Reports in Internal Medicine ◽

10.5430/crim.v5n3p40 ◽

2018 ◽

Vol 5 (3) ◽

pp. 40

Author(s):

Sallie M. Long ◽

Talha Demirci ◽

Stacy R. Kruse

Keyword(s):

Surgical Intervention ◽

Early Recognition ◽

Morbidity And Mortality ◽

Deep Neck Infection ◽

Airway Compromise ◽

Significant Morbidity ◽

Neck Infection ◽

Ludwig’S Angina ◽

Basic Treatment ◽

Ludwig's Angina

Ludwig’s angina is a deep neck infection of the supramylohyoid and inframylohyoid spaces. Without prompt recognition and intervention, it can progress to airway compromise with significant morbidity and mortality. Although otolaryngologists and oral surgeons are well-versed in this condition, it is vital that physicians across all specialties are knowledgeable about the presentation and basic treatment of this potentially fatal condition. Here we report a case of Ludwig’s angina in a 29-year-old male that was successfully managed with both medical and surgical intervention. We also aim to describe the presentation and treatment of Ludwig’s angina in order to increase awareness in non-surgical fields.

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DRESS syndrome in the setting of oxacillin therapy—a call for better patient preparedness: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-03202-9 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Hawa Ozien Abu ◽

Sajjadh M. J. Ali ◽

Anil Phuyal ◽

Akil Sherif ◽

Gregory T. Williams ◽

...

Keyword(s):

Emergency Department ◽

Staphylococcus Aureus ◽

Drug Reaction ◽

Early Recognition ◽

Elevated Serum ◽

Morbidity And Mortality ◽

Significant Morbidity ◽

Drug Induced ◽

Life Threatening ◽

Systemic Symptoms

Abstract Background Drug reaction with eosinophilia and systemic symptoms syndrome is a rare but severe and potentially life-threatening hypersensitivity reaction, with significant morbidity and mortality. The clinical presentation of drug reaction with eosinophilia and systemic symptoms may include extensive skin rash, fever, lymphadenopathy, internal organ involvement, eosinophilia, and atypical lymphocytosis, most commonly due to drug-induced reaction. Our case is a rare occurrence of drug reaction with eosinophilia and systemic symptoms syndrome in the setting of oxacillin therapy. Case presentation A 55-year-old Caucasian male presented to the emergency department on account of acute onset, 2-day history of generalized pruritic rash with associated fever, occurring 3 weeks after commencing therapy with intravenous oxacillin for methicillin-sensitive Staphylococcus aureus bacteremia. He had no known drug allergies. Two days prior to hospitalization, he had a telehealth visit with the infectious diseases specialist on account of his rash, and was recommended to use oral diphenhydramine. However, with the onset of fever and persistence of his rash, he was advised to discontinue the oxacillin and present to the emergency department. On examination, he was febrile at 101.2 °F and had a generalized blanchable maculopapular and morbilliform rash involving the face, trunk, upper and lower extremities, but sparing the palms, soles, and oral mucosa. He had palpable nontender lymph nodes in the cervical and inguinal regions bilaterally. Laboratory studies revealed atypical lymphocytosis, eosinophilia, neutrophilia, and elevated serum transaminases. He was started on intravenous diphenhydramine and admitted to the in-patient medical service. On the second day of hospitalization, his fever resolved. However, his rash was persistent and generalized, as well as elevated transaminases and an abnormal cell count on the second day of hospitalization. To complete his 6-week course of antibiotics for methicillin-sensitive Staphylococcus aureus bacteremia, he was switched to an alternative therapy with cefazolin, and he was scheduled for weekly follow-up assessments following hospital discharge. Conclusions Healthcare providers should increasingly be aware of the significant morbidity and mortality attributable to drug reaction with eosinophilia and systemic symptoms syndrome and the potential medications which may incite such life-threatening reactions. Early recognition of drug reaction with eosinophilia and systemic symptoms syndrome and prompt institution of management strategies can promote improved clinical outcomes. Enhanced patient–provider communication strategies should be implemented to better prepare patients for the likelihood of such drug reactions, with the goal of improving patient-centered care and adherence with treatment strategies.

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Open and laparoscopic surgeries are associated with comparable 90 day morbidities and mortalities following ERAS protocols- A retrospective Study. (Preprint)

10.2196/preprints.19313 ◽

2020 ◽

Author(s):

BHAVIN VASAVADA ◽

Hardik Patel

Keyword(s):

Multivariate Analysis ◽

Retrospective Study ◽

Mortality Rate ◽

Operative Time ◽

Univariate Analysis ◽

Morbidity And Mortality ◽

Morbidity Rate ◽

Blood Products ◽

Asa Score

UNSTRUCTURED All the gastrointestinal surgeries performed between April 2016 to march 2019 in our institution have been analysed for morbidity and mortality after ERAS protocols and data was collected prospectively. We performed 245 gastrointestinal and hepato-biliary surgeries between April 2016 to march 2019. Mean age of patients was 50.96 years. 135 were open surgeries and 110 were laparoscopic surgeries. Mean ASA score was 2.40, mean operative time was 111 minutes, mean CDC grade of surgery was 2.56. 40 were emergency surgeries and 205 were elective surgeries. Overall 90 days mortality rate was 8.5% and over all morbidity rate was around 9.79% . On univariate analysis morbidity was associated significantly with higher CDC grade of surgeries, higher ASA grade, more operative time, more blood products use, more hospitalstay, open surgeries,HPB surgeries and luminal surgeries(non hpb gastrointestinal surgeries) were associated with higher 90 days morbidity. On multivariate analysis no factors independently predicted morbidity. On univariate analysis 90 days mortality was predicted by grade of surgeries, higher ASA grade, more operative time, more blood products use, open surgeries and emergency surgeries. However on multivariate analysis only more blood products used was independently associated with mortality There is no difference between 90 day mortality and moribidity rates between open and laparoscopic surgeries.

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Superior Orbital Fissure Syndrome due to Sinusitis: Report of Two Cases

American Journal of Rhinology ◽

10.1177/194589240501900417 ◽

2005 ◽

Vol 19 (4) ◽

pp. 417-420 ◽

Cited By ~ 2

Author(s):

Fabio de Rezende Pinna ◽

Daniel L. Dutra ◽

Maura C. Neves ◽

Fabrizio Ricci Romano ◽

Richard L. Voegels ◽

...

Keyword(s):

Early Recognition ◽

Complete Recovery ◽

Ocular Motility ◽

Intravenous Antibiotic ◽

Superior Orbital Fissure ◽

Adequate Treatment ◽

Superior Orbital Fissure Syndrome ◽

Brain Involvement ◽

The Brain ◽

Anatomic Region

Background The potential morbidity and mortality of sphenoid sinus infectious processes are related to their proximity to vital structures within the orbit, such as the cavernous sinus and the brain. Involvement of the posterior orbit can result in superior orbital fissure syndrome, a rare entity affecting structures that cross this anatomic region. Early recognition of this syndrome is mandatory. Delays in adequate treatment may compromise the patient's prognosis. Methods We present two cases of incomplete superior orbital fissure syndrome due to infectious processes of the posterior ethmoid and sphenoid sinuses. Conclusions In our experience, endoscopic decompression of the lamina papyracea shows complete recovery of extrinsic ocular motility in these patients and should be combined with intravenous antibiotic therapy.

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Evaluation of an Electronic Dosing Calculator to Reduce Pediatric Medication Errors

Clinical Pediatrics ◽

10.1177/0009922818821871 ◽

2019 ◽

Vol 58 (4) ◽

pp. 413-416

Author(s):

Brian Murray ◽

Matthew J. Streitz ◽

Michael Hilliard ◽

Joseph K. Maddry

Keyword(s):

Patient Safety ◽

Medication Errors ◽

Prospective Cohort ◽

Pediatric Patients ◽

Cohort Analysis ◽

Morbidity And Mortality ◽

Patient Visit ◽

Significant Morbidity ◽

Potential Source ◽

Medication Dosage

Introduction. Adverse medication events are a potential source of significant morbidity and mortality in pediatric patients, where dosages frequently rely on weight-based formulas. The most frequent occurrence of medication errors occurs during the ordering phase. Methods. Through a prospective cohort analysis, we followed medication errors through patient safety reports (PSRs) to determine if the use of a medication dosage calculator would reduce the number of PSRs per patient visits. Results. The number of PSRs for medication errors per patient visit occurring due to errors in ordering decreased from 10/28 417 to 1/17 940, a decrease by a factor of 6.31, with a χ2 value of 4.063, P = .0463. Conclusion. We conclude that the use of an electronic dosing calculator is able to reduce the number of medication errors, thereby reducing the potential for serious pediatric adverse medication events.

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Pneumocephalus Following Self-Inflicted Penetrating Brain Injury

Case Reports in Otolaryngology ◽

10.1155/2017/7878646 ◽

2017 ◽

Vol 2017 ◽

pp. 1-3

Author(s):

Che-Fang Ho ◽

Yuan-Yun Tam ◽

Chia-Chen Wu

Keyword(s):

Rare Complication ◽

Bed Rest ◽

Morbidity And Mortality ◽

High Morbidity ◽

Adequate Treatment ◽

Cerebrospinal Fluid Rhinorrhea ◽

Intravenous Antibiotics ◽

Computed Tomography Scans ◽

Intravenous Hydration ◽

Prompt Diagnosis

Objective. Pneumocephalus is a rare complication that often occurs after traumatic skull base injury, leading to morbidity and mortality. Material and Method. We present the case of a 42-year-old healthy man who injured himself when he stuck a metal stick into his left nasal cavity to relieve prolonged nasal obstruction. Immediate cerebrospinal fluid rhinorrhea and subsequent meningitis and pneumocephalus occurred later. He was presented at our hospital with fever and meningeal signs. Result. Computed tomography scans revealed left rhinosinusitis and air collection in the subarachnoid space. The patient received the conservative treatment of bed rest, intravenous hydration, head elevation, and broad-spectrum intravenous antibiotics. Pneumocephalus and meningitis resolved without any surgery, and he experienced no other sequela or complication. Conclusion. Pneumocephalus is a rare incidence and can lead to high morbidity and mortality. Prompt diagnosis and adequate treatment of pneumocephalus and meningitis proved beneficial for our patient who recovered without any complication or surgery.

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Congenital intestinal lymphangiectasia

Vojnosanitetski pregled ◽

10.2298/vsp1103270p ◽

2011 ◽

Vol 68 (3) ◽

pp. 270-273

Author(s):

Dusan Popovic ◽

Milan Spuran ◽

Tamara Alempijevic ◽

Miodrag Krstic ◽

Srdjan Djuranovic ◽

...

Keyword(s):

Early Recognition ◽

Clinical Manifestations ◽

Lymphatic Vessels ◽

High Protein Diet ◽

Intestinal Wall ◽

Intestinal Biopsy ◽

Intestinal Lymphangiectasia ◽

Laboratory Assessment ◽

Protein Losing Enteropathy ◽

Adequate Treatment

Background. Congenital intestinal lymphangiectasia is a disease which leads to protein losing enteropathy. Tortous, dilated lymphatic vessels in the intestinal wall and mesenterium are typical features of the disease. Clinical manifestations include malabsorption, diarrhea, steatorrhea, edema and effusions. Specific diet and medication are required for disease control. Case report. A 19-year old male patient was hospitalized due to diarrhea, abdominal swelling, weariness and fatigue. Physical examination revealed growth impairment, ascites, and lymphedema of the right hand and forearm. Laboratory assessment indicated iron deficiency anaemia, lymphopenia, malabsorption, inflammatory syndrome, and urinary infection. Enteroscopy and video capsule endoscopy demonstrated dilated lymphatic vessels in the small intestine. The diagnosis was confirmed by intestinal biopsy. The patient was put on high-protein diet containing medium-chain fatty acids, somatotropin and suportive therapy. Conclusion. Congenital intestinal lymphangiectasia is a rare disease, usually diagnosed in childhood. Early recognition of the disease and adequate treatment can prevent development of various complications.

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Recent Advances in the Management of Cardiogenic Shock

10.37191/mapsci-jccr-2(2)-029 ◽

2021 ◽

Author(s):

Christine M. Gasperetti

Keyword(s):

Mortality Rate ◽

Cardiogenic Shock ◽

Case Studies ◽

Mechanical Circulatory Support ◽

Early Recognition ◽

Dynamic State ◽

Circulatory Support ◽

Mechanical Support ◽

Recent Advances ◽

Definition Of

For decades, the cardiogenic shock has remained one of the cardiac illnesses with the highest mortality, as high as 50%. Recent advances have lowered this mortality rate by use of early recognition of shock as well as an increased understanding of both advanced mechanical support and the hemodynamics of myocardial support. Included are the new definition of shock, results of a study of inotropic medications in shock, description, and case studies of mechanical circulatory support, all providing a framework for the overall goal in the management of cardiogenic shock as one to recognize shock, follow its dynamic state, and maximize support to patients toward recovery.

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Pulmonary Hemorrhage in the Neonate

Neonatal Network The Journal of Neonatal Nursing ◽

10.1891/11-t-696 ◽

2021 ◽

Vol 40 (5) ◽

pp. 295-304

Author(s):

Megan Alexandra Welde ◽

Cassidy Brooke Sanford ◽

Melissa Mangum ◽

Christy Paschal ◽

Amy J. Jnah

Keyword(s):

Early Identification ◽

Diagnostic Testing ◽

Pulmonary Hemorrhage ◽

Underlying Disease ◽

Morbidity And Mortality ◽

Current Evidence ◽

Exogenous Surfactant ◽

Significant Morbidity ◽

Proactive Management ◽

Surfactant Administration

Pulmonary hemorrhage (PH) is a pathology associated with significant morbidity and mortality, particularly among preterm infants in the NICU. The diagnosis is made when hemorrhagic secretions are aspirated from the trachea concurrent with respiratory decompensation that necessitates intubation or escalated support. The implementation of mechanical ventilation and widespread exogenous surfactant administration have significantly reduced respiratory morbidities. However, when PH develops, death remains the most common outcome. Treatment for PH remains primarily supportive; thus, a thorough understanding of underlying disease processes, manifestations, diagnostic testing, and current evidence is vital to enable early identification and proactive management to reduce morbidity and mortality.

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