Medical Management of Patients with Subarachnoid or Intracranial Hemorrhage and Increased Intracranial Pressure

2019 ◽  
pp. 30-56
Author(s):  
Ahmad Sweid ◽  
Pascal M. Jabbour ◽  
Sage P. Rahm ◽  
Stavropoula Tjoumakaris ◽  
M. Reid Gooch ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Hemorrhage ◽  
Medical Management ◽  
Medical Intervention ◽  
Subdural Hemorrhage ◽  
Arachnoid Membrane ◽  
Anatomical Localization ◽  
Intracerebral Hemorrhages ◽  
Epidural Hemorrhage ◽  
Bridging Vein

Intracranial hemorrhage requires an understanding of etiology and prompt management for an improved outcome. Intracranial hemorrhage is classified into four subcategories: epidural hemorrhage, subdural hemorrhage, subarachnoid hemorrhage, and intracerebral or intraparenchymal hemorrhage, according to the anatomical localization of the bleed. If it occurs in the space between the dura and the skull, then this is epidural hemorrhage, which usually traumatic and requires emergent surgical intervention. A subdural hematoma is localized between the dura and the arachnoid membrane. Usually, this entity occurs in elderly patients following trauma or a tear of a cortico-dural bridging vein. Hematoma evacuation in specific indications is the treatment of choice. Both epidural and subdural hematomas have a minimal role for medical intervention; thus this chapter focuses on the other two entities; subarachnoid hemorrhage and intracerebral hemorrhage. Studies have shown that early and specialized multidisciplinary management improves outcomes. This chapter discusses the etiology, presentation, and medical management of both subarachnoid and intracerebral hemorrhages.

scholarly journals Are there mortality differences between men and women in all types of intracranial hemorrhages: subarachnoid, intraparenchymal and subdural? An analysis of the Spanish population

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Fernandez De Bobadilla Osorio ◽  
J.R Rey-Blas ◽  
N Gonzalez-Aguado ◽  
B Fuentes ◽  
P Masedo ◽  
...  
Keyword(s):  
Gender Differences ◽  
Subarachnoid Hemorrhage ◽  
Intracranial Hemorrhage ◽  
Epidemiological Data ◽  
Spanish Population ◽  
Subdural Hemorrhage ◽  
Men And Women ◽  
Mediterranean Countries ◽  
Gender And Age ◽  
Relationship Of

Abstract Objectives There are 3 types of intracranial hemorrhage (ICH): 1) subarachnoid hemorrhage (SAH), CIE10:I60; 2) intraparenchymal hemorrhage (IPH), I61 and 3) subdural hemorrhage (SDH) I62. Epidemiological data on this field are scarce in Mediterranean countries. Our goal was to determine whether the relationship of ICH mortality with gender and age was different for the 3 types of HIC. Methods Data were retrospectively obtained from the Spanish National Institute of Statistics. Deaths/100.000 population of SAH, IPH and SDH were assessed for the entire Spanish population since 2008 to 2017 (n=46,527,039). Year 2017 was the last available for analysis. Incidence was analyzed for men and women and for age strata (<1 years of age, 2–10, 11–20, 21–30, 31–40, 41–50, 51–60, 61–70, 71–80; >80). Results In order to fit in the abstract space, only data of 2017 are presented, although years 2008 to 2017 were also analyzed and results were similar. Mortality/100,000 of IPH stayed very low under 40 years of age and then grew exponentially in both, men and women, and was significantly higher for men for all age strata. Mortality of SDH was much lower but behaved in a similar way: exponential growth since 40s and lower incidence in women. SAH behaved differently: it started to be significant since 20 years of age and there were no gender differences. Conclusion Mortality of intraparenchymal and subdural hemorrhage increases exponentially since 40 years of age and is lower in women. On the contrary, mortality of subarachnoid hemorrhage increases earlier and there are no gender differences. Death/100.000 intracranial hemorrhage Funding Acknowledgement Type of funding source: None

scholarly journals Intracranial Hemorrhage and Pneumocephaly After Cervical Epidural Injection

2019 ◽  
Vol 3 (4) ◽  
pp. 369-371
Author(s):  
Nishit Mehta
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Neck Pain ◽  
Intracranial Hemorrhage ◽  
Epidural Injection ◽  
Subdural Hemorrhage ◽  
Epidural Injections

Cervical epidural injections are commonly used to treat patients with radicular neck pain. The following is a description of a case of subarachnoid hemorrhage, subdural hemorrhage, and pneumocephaly following cervical epidural injection.

Intraventricular Hemorrhage in Premature Infants

1980 ◽  
Vol 2 (5) ◽  
pp. 145-153
Author(s):  
Joseph J. Volpe
Keyword(s):  
Intensive Care ◽  
Subarachnoid Hemorrhage ◽  
Premature Infant ◽  
Intracranial Hemorrhage ◽  
Premature Infants ◽  
Intraventricular Hemorrhage ◽  
Neonatal Intensive Care ◽  
Survival Rates ◽  
Clinical Importance ◽  
Subdural Hemorrhage

Four major varieties of intracranial hemorrhage can be recognized in the neonatal period: (1) subdural hemorrhage, (2) primary subarachnoid hemorrhage, (3) intracerebellar hemorrhage, and (4) periventricular-intraventricular hemorrhage.1 Subdural hemorrhage, often related to obstetrical trauma, now is an uncommon lesion in most medical centers. Primary subarachnoid hemorrhage, although very common, is rarely of major clinical importance, because of its venous origin and self-limited course. Intracerebellar hemorrhage, commonly observed at postmortem examination of the small premature infant but rarely documented during life, is of uncertain clinical significance. Periventricular-intraventricular hemorrhage is the most common and serious variety of neonatal intracranial hemorrhage. The enormous importance of this lesion is linked to the remarkable improvements in recent years in neonatal intensive care and, as a consequence, in survival rates for small premature infants. Because periventricular-intraventricular hemorrhage is characteristic of the premature infant (particularly the infant less than approximately 32 weeks gestation), the lesion has reached nearly epidemic proportions in modern neonatal intensive care facilities. INCIDENCE The remarkably high incidence of periventricular-intraventricular hemorrhage is demonstrated dramatically by studies in which premature infants were subjected to computed tomography (CT) scan routinely within the first week of life (Table 1). Thus, 40% to 45% of all such infants exhibited periventricular-intraventricular hemorrhage.2,3

Intravenous Tranexamic Acid for Subdural and Epidural Intracranial Hemorrhage: Randomized, Double‐Blind, Placebo-Controlled Trial

2019 ◽  
Vol 14 (4) ◽  
pp. 286-291 ◽  
Author(s):  
Pouya Ebrahimi ◽  
Javad Mozafari ◽  
Reza Bahrami Ilkhchi ◽  
Mohammad Ghasem Hanafi ◽  
Maryam Mousavinejad
Keyword(s):  
Tranexamic Acid ◽  
Intracranial Hemorrhage ◽  
Controlled Trial ◽  
Controlled Clinical Trial ◽  
Subdural Hemorrhage ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Significant Difference ◽  
Epidural Hemorrhage ◽  
And Control

Background: Recovery of patients with traumatic brain injury largely depends on the reduction in secondary brain damage. The present study aims at investigating the effect of Tranexamic Acid (TXA) administration within the first hours of brain trauma in the emergency department (ED). Methods: This randomized, double-blind, placebo-controlled clinical trial was carried out in patients with subdural and epidural hemorrhage. Patients with any type of bleeding were assigned into two groups of TXA and 0.9% normal saline as placebo. The rate of intracranial hemorrhage after surgery was assessed by CT-scan and amount of hemoglobin (Hb) was measured immediately before surgery and after 6 hours of surgery. Results: A total of 80 participants were randomly assigned into four groups of 20 people. There was a significant difference in the mean of intraoperative bleeding during surgery in patients receiving TXA and placebo in both SDH (Subdural hematoma) and EDH (Epidural Hemorrhage) groups (P= 0.012). The Hb drop amount had no significant difference with placebo (P< 0.0001). No complications were observed in any of the intervention and control groups during the study as well. Conclusion: The use of TXA may reduce bleeding, however, based on the results of this study, such effect was not statistically significant in controlling the epidural and subdural hemorrhage, but clinical trials with a higher sample size are suggested for further investigation in this regard.

Subdural and Primary Subarachnoid Hemorrhages: A Case Study

2007 ◽  
Vol 26 (3) ◽  
pp. 143-151 ◽  
Author(s):  
Stacie Barker
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Hemorrhage ◽  
Intracranial Bleeding ◽  
Subdural Hemorrhage ◽  
Neonatal Nurses ◽  
Life Threatening ◽  
Subarachnoid Hemorrhages

Subdural hemorrhage (SDH) and primary subarachnoid hemorrhage (SAH) are two forms of intracranial bleeding that can be encountered in infants. These events can be life threatening to the infant and devastating to his family. Neonatal nurses need to have an understanding of these unfortunate, yet not uncommon, types of intracranial hemorrhage. This article explains the etiology, the diagnosis, and the treatment of SDH and SAH, concluding with a case study.

scholarly journals Terson's syndrome: report of a case with favorable outcome

1998 ◽  
Vol 56 (1) ◽  
pp. 133-136
Author(s):  
GIULIO CESARE PINNOLA ◽  
SÉRGIO MURILO CORRÊA ◽  
SÔNIA BEATRIZ F. RIBEIRO ◽  
ALFREDO LEBOREIRO-FERNANDEZ ◽  
JAIME OLAVO MARQUEZ
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Early Diagnosis ◽  
Intracranial Hemorrhage ◽  
Vitreous Hemorrhage ◽  
Medical Intervention ◽  
Favorable Outcome ◽  
Favorable Prognosis ◽  
Terson’S Syndrome ◽  
Terson's Syndrome ◽  
Syndrome Report

Terson's syndrome is characterized by the presence of a subarachnoid hemorrhage accompanied by retinal and vitreous hemorrhage leading to a not very favorable prognosis. We describe a case with a good outcome, probably because of a early diagnosis and medical intervention. We emphasize the routine optician's check up as very important in the evaluation of a prognosis in the cases of a suspect intracranial hemorrhage .

Clinical-neurosonographic parallels of intracranial hemorrhagies in early childhood

2019 ◽  
Vol 22 (6) ◽  
pp. 116-122
Author(s):  
Sh. Sh. Shamansurov ◽  
Sh. H. Saidazizova ◽  
S. O. Nazarova
Keyword(s):  
Early Childhood ◽  
Comparative Analysis ◽  
Subarachnoid Hemorrhage ◽  
Left Hemisphere ◽  
Intracranial Hemorrhage ◽  
Intraventricular Hemorrhage ◽  
Detailed Examination ◽  
Intracranial Hemorrhages ◽  
Risk Of Hemorrhage ◽  
Neurological State

Objective. Conduct a comparative analysis of clinical and neurosonographic indicators of intracranial hemorrhage in infants.Materials and methods. In the clinical part of the study, 68 patients took part in the acute / acute periods of intracranial hemorrhage, which we took for the study on the basis of the Tashkent City Children's Clinical Hospital No1. Gender ratios of which were 69.1% boys (47 children) and 30.9% girls (21 children), from birth to 2 months of life (average age at the time of hemorrhage is 36.28 ± 9.85 days). Diagnostic examination included neurosonography (NSG) of all children in the first 24 hours of the implementation of intracranial hemorrhages on admission to the clinic.Results. According to our study of 68 children with intracranial hemorrhage, it turned out that the average age of morbidity was 36.28 ± 9.85 days (p < 0.001) Neurosonographic indicators stated the presence of parenchymal hemorrhage (right and left hemisphere), SAH (subarachnoid hemorrhage), hemorrhage into the trunk, IVH (intraventricular hemorrhage) II, IVH III. According to neurosonography, parenchymal hemorrhage (right-16 or left hemisphere-21) was observed in 37 patients, SAH and IVH-II 21 (30.9%) patients, IVH III – in 17 (25%) patients, hemorrhage in 3 (4.4%) brain stem of patientsConclusion. Analysis of the implementation of hemorrhage showed that not always small gestational age is the risk of hemorrhage. Cases of less severe changes (27%) on NSG with a coarser clinical picture and vice versa (15%), necessitate (taking into account the severity of the neurological state), a more detailed examination, including visualization (CT, MRI).

Anti-epileptic Drug (AED) Use in Subarachnoid Hemorrhage (SAH) and Intracranial Hemorrhage (ICH)

2018 ◽  
Vol 23 (42) ◽  
pp. 6446-6453
Author(s):  
Rui Feng ◽  
Justin Mascitelli ◽  
Alexander G. Chartrain ◽  
Konstantinos Margetis ◽  
J. Mocco
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Hemorrhage ◽  
Anti Epileptic Drug

Transfer Learning of The ResNet-18 and DenseNet-121 Model Used to Diagnose Intracranial Hemorrhage in CT Scanning

2021 ◽  
Vol 27 ◽  
Author(s):  
Qi Zhou ◽  
Wenjie Zhu ◽  
Fuchen Li ◽  
Mingqing Yuan ◽  
Linfeng Zheng ◽  
...  
Keyword(s):  
Deep Learning ◽  
Transfer Learning ◽  
Intracranial Hemorrhage ◽  
Intraventricular Hemorrhage ◽  
Learning Model ◽  
Normal Group ◽  
Subdural Hemorrhage ◽  
Model Assessment ◽  
Learning Models ◽  
Deep Learning Model

Objective: To verify the ability of the deep learning model in identifying five subtypes and normal images in noncontrast enhancement CT of intracranial hemorrhage. Method: A total of 351 patients (39 patients in the normal group, 312 patients in the intracranial hemorrhage group) performed with intracranial hemorrhage noncontrast enhanced CT were selected, with 2768 images in total (514 images for the normal group, 398 images for the epidural hemorrhage group, 501 images for the subdural hemorrhage group, 497 images for the intraventricular hemorrhage group, 415 images for the cerebral parenchymal hemorrhage group, and 443 images for the subarachnoid hemorrhage group). Based on the diagnostic reports of two radiologists with more than 10 years of experience, the ResNet-18 and DenseNet-121 deep learning models were selected. Transfer learning was used. 80% of the data was used for training models, 10% was used for validating model performance against overfitting, and the last 10% was used for the final evaluation of the model. Assessment indicators included accuracy, sensitivity, specificity, and AUC values. Results: The overall accuracy of ResNet-18 and DenseNet-121 models were 89.64% and 82.5%, respectively. The sensitivity and specificity of identifying five subtypes and normal images were above 0.80. The sensitivity of DenseNet-121 model to recognize intraventricular hemorrhage and cerebral parenchymal hemorrhage was lower than 0.80, 0.73, and 0.76 respectively. The AUC values of the two deep learning models were above 0.9. Conclusion: The deep learning model can accurately identify the five subtypes of intracranial hemorrhage and normal images, and it can be used as a new tool for clinical diagnosis in the future.

Abstract P639: Cerebrovascular and Pathological Findings in Police Chokehold Fatalities

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Brian C Richardson ◽  
Johanna Rengifo ◽  
Michael Stanton ◽  
Neftali Nevarez ◽  
Cristina Román ◽  
...  
Keyword(s):  
Law Enforcement Officers ◽  
Single Subject ◽  
Subdural Hemorrhage ◽  
Middle Range ◽  
Autopsy Data ◽  
History Of ◽  
Epidural Hemorrhage ◽  
Artery Disease ◽  
Cervical Spine Fractures ◽  
Spinal Epidural

Introduction: A number of recent well publicized deaths from police chokeholds have focused attention on the use and safety of chokeholds by law enforcement officers (LEO). LEO chokeholds are depicted as a safe non-lethal restraint technique. Use of chokeholds by LEO is purported to be in the middle range of force options when compared to other tools of force available. LEO chokeholds are often likened to judo chokeholds which have a long history of safety and have not directly contributed to the death of a judoka since the sport of Judo was founded in Japan in 1882. Some have posited that chokeholds employed by LEO are especially likely to be safe in young adults, as they are less likely to have underlying cardiovascular diseases. Chokeholds applied by LEO can unfortunately be associated with severe medical and neurological sequelae, including death. Methods: We reviewed autopsy data of 29 deaths associated with LEO chokeholds. Results: Subjects ranged in age from 19 to 58. Reported chokehold duration ranged from 4 seconds to 3 minutes in length. In ten cases, chokeholds were applied multiple times to a single subject. In one case chokeholds were applied five times to a single subject. At autopsy, two subjects were found to have carotid artery intimal tears. Two subjects had epidural hemorrhages. One subject sustained a subdural hemorrhage. One subject was found to have had a subarachnoid hemorrhage. Five subjects had pathology typical of global cerebral anoxia. One subject sustained multiple cervical spine fractures with crush injury to the spinal cord as well as spinal epidural hemorrhage. Two subjects had evidence of hemorrhage involving the cervical anterior longitudinal ligament. Atherosclerotic heart disease was found in five subjects. Two subjects had severe occlusive coronary artery disease. Four of these subjects were between the ages of 28 and 35. Myocardial fibrosis was found in five subjects. Cardiomegaly was found at autopsy in six subjects. Conclusions: LEO chokeholds are not widely considered to constitute deadly force, however our review of autopsy data from 29 deaths caused by chokeholds applied by LEO revealed that they can be associated with death and severe cerebrovascular, and central nervous system sequela in both young and older subjects.

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