scholarly journals 304: INTRACRANIAL HEMORRHAGE DURING THE USE OF VENOVENOUS ECMO IN COVID 19: A CASE SERIES

2021 ◽  
Vol 50 (1) ◽  
pp. 138-138
Author(s):  
AMREETA SHARMA ◽  
Jayna gardner-Gray ◽  
GINA HURST
Keyword(s):  
Intracranial Hemorrhage ◽  
Case Series ◽  
Venovenous Ecmo

scholarly journals Neurologically Devastating Intraparenchymal Hemorrhage in COVID-19 Patients on Extracorporeal Membrane Oxygenation: A Case Series

Neurosurgery ◽  
2020 ◽  
Vol 87 (2) ◽  
pp. E147-E151 ◽  
Author(s):  
Sabrina M Heman-Ackah ◽  
YouRong Sophie Su ◽  
Michael Spadola ◽  
Dmitriy Petrov ◽  
H Isaac Chen ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Intracranial Hemorrhage ◽  
Case Reports ◽  
Case Series ◽  
Therapeutic Modality ◽  
Membrane Oxygenation ◽  
Resource Setting ◽  
Therapeutic Algorithms ◽  
Successful Recovery ◽  
Vv Ecmo

Abstract BACKGROUND AND IMPORTANCE Extracorporeal membrane oxygenation (ECMO) represents a life-saving therapy in cases of refractory hypoxia and has been utilized in patients suffering from the most severe forms of coronavirus disease 2019 (COVID-19). A strikingly high mortality rate of 94% was described in early reports of patients with COVID-19 transitioned to ECMO. Later case reports and series demonstrating successful recovery from COVID-19 after ECMO have revived interest in this therapeutic modality, including the recent approval of ECMO for COVID-19 patients by the Food and Drug Administration (FDA). Here, we present the first reports of devastating intracranial hemorrhage as a complication of veno-venous (VV) ECMO in two COVID-19 patients. CLINICAL PRESENTATION We performed a retrospective analysis of 2 cases of devastating intracranial hemorrhage in patients on VV-ECMO for the treatment of COVID-19. Collected data included clinical history, laboratory results, treatment, and review of all available imaging. Both patients demonstrated activated partial thromboplastin times (aPTT) within an appropriate therapeutic range. No risk factors that clearly predicted likelihood of this complication were identified. CONCLUSION Understanding the complications of ECMO in this cohort and developing therapeutic algorithms to aid in optimal patient selection will be critical in the limited resource setting experienced as a result of global pandemic. We propose the use of head computed tomography (CT) to identify devastating neurological complications as early as possible, aiding in the resource allocation of ECMO machines to the most appropriately selected patients.

scholarly journals The e-merging e-pidemic of e-scooters

2019 ◽  
Vol 4 (1) ◽  
pp. e000337 ◽  
Author(s):  
Leslie M Kobayashi ◽  
Elliot Williams ◽  
Carlos V Brown ◽  
Brent J Emigh ◽  
Vishal Bansal ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Intracranial Hemorrhage ◽  
Injury Severity ◽  
Case Series ◽  
Operative Intervention ◽  
Facial Fractures ◽  
Helmet Use ◽  
Drug And Alcohol Use ◽  
Drug And Alcohol ◽  
Over Time

IntroductionSince their release in 2017, standing electric motorized scooters (eScooters) have risen in popularity as an alternative mode of transportation. We sought to examine the incidence of injury, injury patterns, prevalence of helmet and drug and alcohol use in eScooter trauma.MethodsThis was a multi-institutional retrospective case series of patients admitted for injuries related to operation of an eScooter following the widespread release of these devices in September 2017 (September 1, 2017 to October 31, 2018). Demographics, drug and alcohol use, helmet use, admission vitals, injuries, procedures, hospital and intensive care unit length of stay (LOS), death, and disposition were analyzed.Results103 patients were admitted during the study period, and monthly admissions increased significantly over time. Patients were young men (mean age 37.1 years; 65% male), 98% were not wearing a helmet. Median LOS was 1 day (IQR 1–3). 79% of patients were tested for alcohol and 48% had a blood alcohol level >80 mg/dL. 60% of patients had a urine toxicology screen, of which 52% were positive. Extremity fractures were the most frequent injury (42%), followed by facial fractures (26%) and intracranial hemorrhage (18%). Median Injury Severity Score was 5.5 (IQR 5–9). One-third of patients (n=34) required an operative intervention, the majority of which were open fixations of extremity and facial fractures. No patients died during the study. The majority of patients were discharged home (86%).ConclusioneScooter-related trauma has significantly increased over time. Alcohol and illicit substance use among these patients was common, and helmet use was extremely rare. Significant injuries including intracranial hemorrhage and fractures requiring operative intervention were present in over half (51%) of patients. Interventions aimed at increasing helmet use and discouraging eScooter operation while intoxicated are necessary to reduce the burden of eScooter-related trauma.Level of evidenceLevel IV.

scholarly journals Intracranial hemorrhage from dural arteriovenous fistulas: clinical features and outcome

2013 ◽  
Vol 34 (5) ◽  
pp. E15 ◽  
Author(s):  
David J. Daniels ◽  
Ananth K. Vellimana ◽  
Gregory J. Zipfel ◽  
Giuseppe Lanzino
Keyword(s):  
Clinical Features ◽  
Intracranial Hemorrhage ◽  
Case Series ◽  
Venous Drainage ◽  
Sudden Onset ◽  
Residual Symptoms ◽  
Arteriovenous Fistulas ◽  
Common Location ◽  
Dural Arteriovenous Fistulas

Object In this paper the authors' goal was to review the clinical features and outcome of patients with intracranial dural arteriovenous fistulas (DAVFs) who presented with hemorrhage. Methods A retrospective study of 28 patients with DAVFs who presented with intracranial hemorrhage to 2 separate institutions was performed. The information reviewed included clinical presentation, location and size of hemorrhage, angiographic features, treatment, and clinical and radiologically documented outcomes. Clinical and radiological follow-up were available in 27 of 28 patients (mean follow-up 17 months). Results The vast majority of patients were male (86%), and the most common presenting symptom was sudden-onset headache. All DAVFs had cortical venous drainage, and about one-third were associated with a venous varix. The most common location was tentorial (75%). Treatment ranged from endovascular (71%), surgical (43%), Gamma Knife surgery (4%), or a combination of modalities. The majority of fistulas (75%) were completely obliterated, and most patients experienced excellent clinical outcome (71%, modified Rankin Scale score of 0 or 1). There were no complications in this series. Conclusions Case series, including the current one, suggest that the vast majority of patients who present with intracranial hemorrhage from a DAVF are male. The most common location for DAVFs presenting with hemorrhage is tentorial. Excellent outcomes are achieved with individualized treatment, which includes various therapeutic strategies alone or in combination. Despite the hemorrhagic presentation, almost two-thirds of patients experience a full recovery with no or minimal residual symptoms.

757: Andexanet Alfa After 4-Factor PCC Administration for Intracranial Hemorrhage: A Case Series

2020 ◽  
Vol 49 (1) ◽  
pp. 375-375
Author(s):  
Paige Bradshaw ◽  
Shaun Keegan ◽  
Madeline Foertsch
Keyword(s):  
Intracranial Hemorrhage ◽  
Case Series ◽  
Andexanet Alfa

Intracranial hemorrhage after spine surgery

2013 ◽  
Vol 19 (3) ◽  
pp. 370-380 ◽  
Author(s):  
Paul E. Kaloostian ◽  
Jennifer E. Kim ◽  
Ali Bydon ◽  
Daniel M. Sciubba ◽  
Jean-Paul Wolinsky ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intracranial Hemorrhage ◽  
Spinal Surgery ◽  
Rare Complication ◽  
Case Series ◽  
Early Postoperative Period ◽  
Csf Leak ◽  
Drain Removal ◽  
Outcome Information ◽  
Csf Leakage

Object The authors describe the largest case series of 8 patients with intracranial hemorrhage (ICH) after spinal surgery and identify associated pre-, intra-, and postoperative risk factors in relation to outcome. Methods The authors retrospectively reviewed the cases of 8 patients treated over 16 years at a single institution and also reviewed the existing literature and collected demographic, treatment, and outcome information from 33 unique cases of remote ICH after spinal surgery. Results The risk factors most correlated with ICH postoperatively were the presence of a CSF leak intraoperatively and the use of drains postoperatively with moderate hourly serosanguineous output in the early postoperative period. Conclusions Intracranial hemorrhage is a rare complication of spinal surgery that is associated with CSF leakage and use of drains postoperatively, with moderate serosanguinous output. These associations do not justify a complete avoidance of drains in patients with CSF leakage but may guide the treating physician to keep in mind drain output and timing of drain removal, while noting any changes in neurological examination status in the meantime. Additionally, continued and worsening neurological symptoms after spinal surgery may warrant cranial imaging to rule out intracranial hemorrhage, usually within the first 24 hours after surgery. The presence of cerebellar hemorrhage and hydrocephalus indicated a trend toward worse outcome.

scholarly journals Warfarin Reinitiation After Intracranial Hemorrhage: A Case Series of Heart Valve Patients

2019 ◽  
Vol 47 (2) ◽  
pp. 237-241 ◽  
Author(s):  
Andrea Wan ◽  
Ken Butcher ◽  
Mathew Hodgson ◽  
Karen Schultz ◽  
Tammy J. Bungard
Keyword(s):  
Intracranial Hemorrhage ◽  
Heart Valves ◽  
Case Series ◽  
International Normalized Ratio ◽  
Limited Data ◽  
Long Term Outcomes ◽  
Thrombotic Risk ◽  
Thromboembolic Risk

ABSTRACT:Patients with mechanical heart valves are at high thrombotic risk and require warfarin. Among those developing intracranial hemorrhage, limited data are available to guide clinicians with antithrombotic reinitiation. This 13-patient case series of warfarin-associated intracranial hemorrhages found the time to reinitiate antithrombotic therapy (17 days, interquartile range 21.5 days), and changes to international normalized ratio targets were variable and neither correlated with the type, location, or etiology of bleed, nor the valve and associated thromboembolic risk. The initial presentation significantly impacted prognosis, and diligent assessment and follow-up may support positive long-term outcomes.

scholarly journals Severe bleeding complications other than intracranial hemorrhage in neonatal alloimmune thrombocytopenia: a case series and review of the literature

Transfusion ◽  
2016 ◽  
Vol 56 (5) ◽  
pp. 1230-1235 ◽  
Author(s):  
Dian Winkelhorst ◽  
Marije M. Kamphuis ◽  
Liselotte C. de Kloet ◽  
Jaap Jan Zwaginga ◽  
Dick Oepkes ◽  
...  
Keyword(s):  
Intracranial Hemorrhage ◽  
Case Series ◽  
Bleeding Complications ◽  
Severe Bleeding ◽  
Review Of The Literature ◽  
Alloimmune Thrombocytopenia

Endoscopic Third Ventriculostomy for Hydrocephalus Secondary to Extraventricular Obstruction in Thalamic Hemorrhage: A Case Series

2020 ◽  
Vol 19 (4) ◽  
pp. 384-392
Author(s):  
Hussein A Zeineddine ◽  
Antonio Dono ◽  
Ryan Kitagawa ◽  
Sean I Savitz ◽  
Huimahn Alex Choi ◽  
...  
Keyword(s):  
Intracranial Hemorrhage ◽  
Endoscopic Third Ventriculostomy ◽  
Case Series ◽  
External Ventricular Drainage ◽  
Tube Placement ◽  
Third Ventriculostomy ◽  
Shunt Placement ◽  
Cerebrospinal Fluid Diversion ◽  
Thalamic Hemorrhage ◽  
Gastrostomy Tube Placement

Abstract BACKGROUND Intracranial hemorrhage carries significant morbidity and mortality, particularly if associated with hydrocephalus. Management of hydrocephalus includes temporary external ventricular drainage, with or without shunting. Thalamic location is an independent predictor of mortality and increases the likelihood of shunt dependence. OBJECTIVE To determine whether endoscopic third ventriculostomy (ETV) can avoid the need for shunt placement and expedite recovery. METHODS We prospectively identified thalamic intracranial hemorrhage patients who developed acute hydrocephalus requiring cerebrospinal fluid diversion by extraventricular drain placement from November 2017 to February 2019. Patients who failed an extraventricular drain clamping trial were then evaluated for eligibility for an ETV procedure. Patients who underwent ETV were then followed up for the development of hydrocephalus, need for shunting, and length of stay in the intensive care unit. RESULTS Eight patients (7 males, 1 female) were prospectively enrolled. All patients underwent an ETV successfully. None of the patients required shunting. ETV was performed despite the presence of other factors that would have prevented shunt placement, including fever, leukocytosis, and gastrostomy tube placement. Seven patients who underwent ETV were evaluated at 3-mo follow-up and did not require shunting. CONCLUSION ETV is a safe and effective technique for the management of hydrocephalus resulting from an extraventricular obstruction in thalamic hemorrhage. It can avoid the need for permanent shunting in this patient population. Larger studies should be conducted to validate and further analyze this intervention.

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