Childhood haemorrhagic stroke: a 7-year single-centre experience

BackgroundIn recent years, there has been increasing research interest in improving diagnostic and management protocols in childhood arterial ischaemic stroke (AIS). However, childhood stroke comprises, in approximately equal parts, both arterial ischaemic and haemorrhagic stroke (HS).ObjectiveThe aim of this study was to focus on the aetiology, clinical presentation, treatment and short-term outcome of children with spontaneous intracranial bleeding in a university hospital and elucidate differences to childhood AIS.DesignWe performed a retrospective analysis of electronic medical records of children (28 days–18 years) diagnosed with HS between 2010 and 2016.ResultsWe included 25 children (male child, n=11) with a median age of 8 years 1 month. The most common clinical presentations were vomiting (48%), headache (40%) and altered level of consciousness (32%). In more than half of the patients, HS was caused by vascular malformations. Other risk factors were brain tumour, coagulopathy and miscellaneous severe underlying diseases. Aetiology remained unclear in one child. Therapy was neurosurgical in most children (68%). Two patients died, 5 patients needed further (rehabilitation) treatment and 18 children could be discharged home.ConclusionsHS differs from AIS in aetiology (vascular malformations as number one risk factor), number of risk factors (‘mono-risk’ disease), clinical presentation (vomiting, headache and altered level of consciousness) and (emergency) therapy.

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Splenic Infarction and Infectious Diseases in Korea

10.21203/rs.3.rs-44746/v4 ◽

2020 ◽

Author(s):

Jae Hyoung Im ◽

Moon-Hyun Chung ◽

Hye-Jin Lee ◽

Hea Yoon Kwon ◽

JiHyeon Baek ◽

...

Keyword(s):

Risk Factors ◽

Immune Cells ◽

Clinical Presentation ◽

Scrub Typhus ◽

Systemic Infection ◽

Splenic Infarction ◽

University Hospital ◽

Radiological Findings ◽

Epstein Barr ◽

The Relationship

Abstract Background The spleen contains immune cells and exhibits a pattern of infarction different from other organs; as such, splenic infarction (SI) may provide important clues to infection. However, the nature of the relationship between SI and infectious disease(s) is not well understood. Accordingly, this retrospective study investigated the relationship between SI and infection. Methods Hospital records of patients with SI, who visited Inha University Hospital (Incheon, Republic of Korea) between January 2008 and December 2018, were reviewed. Patient data regarding clinical presentation, causative pathogens, risk factors, and radiological findings were collected and analyzed.Results Of 353 patients with SI, 101 with infectious conditions were enrolled in this study, and their data were analyzed to identify associations between SI and infection. Ten patients were diagnosed with infective endocarditis (IE), and 26 exhibited bacteremia without IE. Twenty-seven patients experienced systemic infection due to miscellaneous causes (negative result on conventional automated blood culture), including the following intracellular organisms: parasites (malaria [n =12], babesiosis [n =1]); bacteria (scrub typhus [n =5]); viruses (Epstein–Barr [n =1], cytomegalovirus [n =1]); and unidentified pathogen[s] (n =7). Splenomegaly was more common among patients with miscellaneous systemic infection; infarction involving other organs was rare. Thirty-eight patients had localized infections (e.g., respiratory, intra-abdominal, or skin and soft tissue infection), and most (35 of 38) had other risk factors for SI. Conclusions In this study, various infectious conditions were found to be associated with SI, and intracellular organisms were the most common causative pathogens. Further studies are needed to examine other possible etiologies and the underlying pathophysiological mechanisms.

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Spectrum of Intracerebral Hemorrhage in Children: A Report from PICU of a Resource Limited Country

Critical Care Research and Practice ◽

10.1155/2016/9124245 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Qalab Abbas ◽

Qurat ul Ain Merchant ◽

Bushra Nasir ◽

Anwar ul Haque ◽

Basit Salam ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Medical Records ◽

Vascular Malformations ◽

Pediatric Intensive Care ◽

Conventional Angiography ◽

Altered Level ◽

Vascular Intervention ◽

Resource Limited ◽

Level Of Consciousness ◽

Gender Presentation

Intracerebral hemorrhage (ICH) in children is a rare but disabling disease that accounts for almost half cases of stroke. We report our experience of ICH in children. Retrospective review of medical records of children (1 month-16 years) admitted in Pediatric Intensive Care Unit between January 2007 and December 2014 was done. Data collected included age, gender, presentation, examination findings, neuroimaging done (CT, MRI, and angiography) management (conservative/intervention), and outcome. Results are presented as frequency and percentages. Of the total 50 patients, 58% were male and 26% were <1 year. On presentation 44% had vomiting, 42% had seizures, and GCS < 8 while 40% had altered level of consciousness. Single bleed was present in 88%, 94% had supratentorial bleed, and 32% had intraventricular extension. 72% had bleed volume of <30 mL and 8% had >60 mL. CT scan was done in 98% patients and MRI in 34%, while 6% underwent conventional angiography. 60% patients were managed conservatively, 36% underwent neurosurgical intervention, and 6% underwent radiological vascular intervention. Hematologic causes were identified in 52% patients and vascular malformations in 14% and in 26% no cause could be identified. 26% of patients expired.

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Subacute Thyroiditis: Clinical Presentation and Long Term Outcome

International Journal of Endocrinology ◽

10.1155/2014/794943 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 16

Author(s):

Assim A. Alfadda ◽

Reem M. Sallam ◽

Ghadi E. Elawad ◽

Hisham AlDhukair ◽

Mossaed M. Alyahya

Keyword(s):

Clinical Presentation ◽

Thyroid Stimulating Hormone ◽

Subacute Thyroiditis ◽

University Hospital ◽

Term Outcome ◽

Long Term Outcome ◽

Thyroid Uptake ◽

Inflammatory Drugs ◽

And Gender

Few studies have been reported from the Kingdom of Saudi Arabia (SA) to describe the clinical presentation and long term outcomes of subacute thyroiditis (SAT). Our aim was to review the demographic, anthropometric, clinical presentation, laboratory results, treatment, and disease outcome in Riyadh region and to compare those with results from different regions of the Kingdom and different parts of the world. We reviewed the medical files of patients who underwent thyroid uptake scan during an 8-year period in King Khalid University Hospital. Only 25 patients had confirmed diagnosis of thyroiditis. Age and gender distribution were similar to other studies. Most patients presented with palpitation, goiter, and weight change. Elevated thyroid hormones, suppressed thyroid-stimulating hormone, and elevated ESR were reported. Among those, 7 cases of SAT were recorded.β-Blockers were prescribed to 57% and nonsteroidal anti-inflammatory drugs to 29% of SAT. Long follow-up demonstrated that 85.7% of SAT cases recovered, while 14.3% developed permanent hypothyroidism. In conclusion, SAT is uncommon in the central region of SA. Compared to the western region, corticosteroid is not commonly prescribed, and permanent hypothyroidism is not uncommon. A nation-wide epidemiological study to explain these interprovincial differences is warranted.

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Clinical Characteristics of Influenza in Season 2017/2018 in a German Emergency Department: A Retrospective Analysis

Microbiology Insights ◽

10.1177/1178636119890302 ◽

2019 ◽

Vol 12 ◽

pp. 117863611989030 ◽

Cited By ~ 4

Author(s):

Sonia Mohammad ◽

Klaus Korn ◽

Barbara Schellhaas ◽

Markus F Neurath ◽

Ruediger S Goertz

Keyword(s):

Internal Medicine ◽

Risk Factors ◽

Emergency Department ◽

Influenza A ◽

Clinical Presentation ◽

Clinical Symptoms ◽

Influenza Infection ◽

University Hospital ◽

Influenza B ◽

Younger Patients

Introduction: Influenza infection is a viral disease with significant morbidity and mortality during the cold months. Clinical presentation typically includes cough, fever, and pain. Influenza disease is hardly diagnosed only on the basis of clinical symptoms due to similar clinical presentation of other diseases such as a typical cold or other flu-like diseases. We evaluated patients with proven influenza who presented at an emergency department of internal medicine in a university hospital according to the clinical presentation and different age groups. Materials and Methods: From October 2017 to April 2018, 723 reverse transcription-polymerase chain reaction (RT-PCR) tests for influenza were performed in the emergency department on patients with suspected influenza diagnosed clinically. A total of 240 influenza-positive patients were retrospectively assessed for documented main symptoms, vital parameters, risk factors for an unfavorable course, hospitalization, and death. Results: The mean age of influenza patients was 65 years. Overall, 30 patients were aged 18 to 39 years, 48 patients 40 to 59 years, and 162 patients ⩾60 years. Influenza B in 168 (70%) was predominant to 72 influenza A (mostly H1N1). In only 30% of the patients all three typical symptoms (cough, fever, and headache/myalgia) were documented. Headache or myalgia (with 34%) was rather uncommon in influenza B. Sudden onset was cited in only 5.4%; 57% of all influenza patients were in hospital for a mean of 7.1 days, and 5.8% of all influenza patients died. Patients aged above 60 years had more risk factors, showed typical symptoms less frequently, and were hospitalized longer than younger patients (<60 and <40 years). Conclusions: At an emergency department of internal medicine, influenza-diseased patients are of higher age, show an increased number of comorbidities, and are more likely to have milder symptoms documented. Elderly patients with influenza have a higher hospitalization rate with a longer hospital stay as compared with younger patients.

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Splenic Infarction and Infectious Diseases in Korea

10.21203/rs.3.rs-44746/v2 ◽

2020 ◽

Author(s):

Jae Hyoung Im ◽

Moon-Hyun Chung ◽

Hye-Jin Lee ◽

Hea Yoon Kwon ◽

JiHyeon Baek ◽

...

Keyword(s):

Risk Factors ◽

Immune Cells ◽

Clinical Presentation ◽

Scrub Typhus ◽

Systemic Infection ◽

Splenic Infarction ◽

University Hospital ◽

Radiological Findings ◽

Epstein Barr ◽

The Relationship

Abstract BackgroundThe spleen contains immune cells and exhibits a pattern of infarction different from other organs; as such, splenic infarction (SI) may provide important clues to infection. However, the nature of the relationship between SI and infectious disease(s) is not well understood. Accordingly, this retrospective study investigated the relationship between SI and infection. MethodsHospital records of patients with SI, who visited Inha University Hospital (Incheon, Republic of Korea) between January 2008 and December 2018, were reviewed. Patient data regarding clinical presentation, causative pathogens, risk factors, and radiological findings were collected and analyzed.ResultsOf 353 patients with SI, 101 with infectious conditions were enrolled in this study, and their data were analyzed to identify associations between SI and infection. Ten patients were diagnosed with infective endocarditis (IE), and 26 exhibited bacteremia without IE. Twenty-seven patients experienced systemic infection due to miscellaneous causes (negative result on conventional automated blood culture), including the following intracellular organisms: parasites (malaria [n =12], babesiosis [n =1]); bacteria (scrub typhus [n =5]); viruses (Epstein–Barr [n =1], cytomegalovirus [n =1]); and unidentified pathogen[s] (n =7). Splenomegaly was more common among patients with miscellaneous systemic infection; infarction involving other organs was rare. Thirty-eight patients had localized infections (e.g., respiratory, intra-abdominal, or skin and soft tissue infection), and most (35 of 38) had other risk factors for SI. ConclusionsIn this study, various infectious conditions were found to be associated with SI, and intracellular organisms were the most common causative pathogens. Further studies are needed to examine other possible etiologies and the underlying pathophysiological mechanisms.

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The Etiologies of Altered Level of Consciousness in the Emergency Department: Before versus after Coronavirus Disease-19

Journal of the Korean Neurological Association ◽

10.17340/jkna.2021.3.5 ◽

2021 ◽

Vol 39 (3) ◽

pp. 141-149

Author(s):

Dong Hwan Kim ◽

Jae Cheon Jeon ◽

In-Cheol Kim ◽

Yaerim Kim ◽

Yong Won Cho ◽

...

Keyword(s):

Emergency Department ◽

South Korea ◽

Medical Records ◽

Clinical Characteristics ◽

Systemic Infection ◽

University Hospital ◽

Altered Level ◽

Level Of Consciousness ◽

Before And After ◽

Overall Mortality

Background: Altered level of consciousness (ALC) is a challenging condition in the emergency department (ED). We evaluated the clinical characteristics, causes, and prognosis of adult patients presenting with ALC at an ED of a university hospital.Methods: The medical records of patients with ALC who visited the ED of a university hospital from February 2019 to November 2020 were reviewed to compare before and after the outbreak of coronavirus disease-19 (COVID-19) in Daegu, South Korea. The cause of ALC, its classification, the patients’ destinations, and prognosis were carefully decided and compared.Results: A total of 1,851 patients with ALC in ED consisted of 1,068 before COVID-19 (BC; to February 17th, 2020) and 783 after COVID-19 (AC; from February 18th, 2020) were investigated. The all-time leading cause of ALC in ED was systemic infection (29.2% in BC, 25.0% in AC), followed by metabolic cause (21.0%) in BC and stroke (18.4%) in AC. Extra-cerebral etiologies of ALC were 1,206 (65.1%). The overall mortality of ALC in ED was 12.3%, consisting of 11.0% in BC and 14.2% in AC. During the daytime (07:00 to 18:59), patients in overall 1,179 patients (63.7%) with ALC visited ED, consisted of 665 (62.3%) in BC and 514 (65.5%) in AC.Conclusions: This study demonstrated the extra-cerebral etiologies as the major causes of ALC in the ED. And there have been shifts in the etiology of ALC in ED.

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Causes and epidemiology of agitation, confusion, and delirium in the ICU

10.1093/med/9780199600830.003.0226 ◽

2016 ◽

Author(s):

Eduard E. Vasilevskis ◽

E. Wesley Ely

Keyword(s):

Risk Factors ◽

Cognitive Disorder ◽

Modifiable Risk Factors ◽

Altered Level ◽

Psychomotor Activity ◽

Impaired Memory ◽

Adrenoceptor Agonist ◽

Level Of Consciousness ◽

Icu Delirium ◽

New Onset

Confusion is a non-specific, non-diagnostic term to describe a patient with disorientation, impaired memory, or abnormal thought process. Agitation describes an increased level of psychomotor activity, and anxious or aggressive behaviour. Many agitated patients may also be delirious, yet they only represent a minority of all delirious patients. ICU delirium is an acute cognitive disorder of both consciousness and content of thought. The hallmark of ICU delirium is a fluctuating mental status, inattention, and an altered level of consciousness. Delirium is the end product of a sequence of insults and injury that lead to a common measurable manifestation of end-organ brain injury. It does not have a single aetiology, but often has multiple different and potentially interacting aetiologies. Both non-modifiable and modifiable risk factors play important roles in the development of delirium. Importantly, the new onset of delirium should prompt the physician to investigate the underlying cause. Cognitive impairment and age are among the most important non-modifiable risk factors, whereas administration of benzodiazepines is the greatest. The alpha-2 adrenoceptor agonist dexmedetomidine shows promise as a sedative reducing the risk for delirium when compared with benzodiazepines.

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Splenic infarction and infectious diseases in Korea

BMC Infectious Diseases ◽

10.1186/s12879-020-05645-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Jae Hyoung Im ◽

Moon-Hyun Chung ◽

Hye-Jin Lee ◽

Hea Yoon Kwon ◽

Ji Hyeon Baek ◽

...

Keyword(s):

Risk Factors ◽

Immune Cells ◽

Clinical Presentation ◽

Scrub Typhus ◽

Systemic Infection ◽

Splenic Infarction ◽

University Hospital ◽

Radiological Findings ◽

Epstein Barr ◽

The Relationship

Abstract Background The spleen contains immune cells and exhibits a pattern of infarction different from other organs; as such, splenic infarction (SI) may provide important clues to infection. However, the nature of the relationship between SI and infectious disease(s) is not well understood. Accordingly, this retrospective study investigated the relationship between SI and infection. Methods Hospital records of patients with SI, who visited Inha University Hospital (Incheon, Republic of Korea) between January 2008 and December 2018, were reviewed. Patient data regarding clinical presentation, causative pathogens, risk factors, and radiological findings were collected and analyzed. Results Of 353 patients with SI, 101 with infectious conditions were enrolled in this study, and their data were analyzed to identify associations between SI and infection. Ten patients were diagnosed with infective endocarditis (IE), and 26 exhibited bacteremia without IE. Twenty-seven patients experienced systemic infection due to miscellaneous causes (negative result on conventional automated blood culture), including the following intracellular organisms: parasites (malaria [n = 12], babesiosis [n = 1]); bacteria (scrub typhus [n = 5]); viruses (Epstein–Barr [n = 1], cytomegalovirus [n = 1]); and unidentified pathogen[s] (n = 7). Splenomegaly was more common among patients with miscellaneous systemic infection; infarction involving other organs was rare. Thirty-eight patients had localized infections (e.g., respiratory, intra-abdominal, or skin and soft tissue infection), and most (35 of 38) had other risk factors for SI. Conclusions In this study, various infectious conditions were found to be associated with SI, and intracellular organisms were the most common causative pathogens. Further studies are needed to examine other possible etiologies and the underlying pathophysiological mechanisms.

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ISCHEMIC STROKE

The Professional Medical Journal ◽

10.29309/tpmj/2016.23.04.1503 ◽

2016 ◽

Vol 23 (04) ◽

pp. 444-450

Author(s):

Mona Humaira ◽

Atif Sitwat Hayat ◽

Tariq Zaffar Shaikh ◽

Hanif Ghani ◽

Shoaib Ansari ◽

...

Keyword(s):

Ischemic Stroke ◽

Mortality Rate ◽

University Hospital ◽

Outcome Study ◽

Altered Level ◽

Factors Affecting ◽

Study Results ◽

Level Of Consciousness ◽

Medical Wards ◽

Study Setting

Objectives: Stroke is continued to rise in developing countries of the world.Early recognition and prompt treatment of poor prognostic factors would reduce mortality andmorbidity. The objective of our study was evaluation of factors affecting prognosis of ischemicstroke patients and to assess thirty days mortality and outcome. Study Design: Crosssectional,prospective study. Setting: Medical wards of Liaquat University Hospital Jamshoro/Hyderabad. Period: August 2009 to February 2011. Material and Methods: 150 patients wascarried out, patients having acute cerebral infarction of either gender, aged equal to or greaterthan 13 years were included while patients of stroke because of hemorrhage, space occupyinglesion and known diabetic were excluded from study. Results: 150 patients were selected,out of them 60% were male. Age of patients ranged from 13- 90 years with median age of51 years. At the end of one month mortality rate was 10% in our study. No improvement wasfound in 16% patients, partial improvement in 62% while only 12% recovered fully. Conclusion:Our study showed high mortality rate in ischemic stroke patients. Males at and after age of50 years develop ischemic stroke more commonly. Patients of ischemic stroke having fever,dysphagia, urinary incontinence, hyperglycemia and altered level of consciousness showedpoor prognosis.

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Incidence, indication and complications of postoperative reintubation after elective intracranial surgery

Sao Paulo Medical Journal ◽

10.1590/1516-3180.2013.1313440 ◽

2013 ◽

Vol 131 (3) ◽

pp. 158-165 ◽

Cited By ~ 7

Author(s):

Lucas Yutaka Hayashi ◽

Mariana Rodrigues Gazzotti ◽

Milena Carlos Vidotto ◽

Jose Roberto Jardim

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Preoperative Assessment ◽

Female Gender ◽

Pulmonary Complications ◽

University Hospital ◽

Altered Level ◽

Intracranial Surgery ◽

Level Of Consciousness ◽

Using Data

CONTEXT AND OBJECTIVE There are no reports on reintubation incidence and its causes and consequences during the postoperative period following elective intracranial surgery. The objective here was to evaluate the incidence of reintubation and its causes and complications in this situation. DESIGN AND SETTING Prospective cohort study, using data obtained at a tertiary university hospital between 2003 and 2006. METHODS 169 patients who underwent elective intracranial surgery were studied. Preoperative assessment was performed and the patients were followed up until hospital discharge or death. The rate of reintubation with its causes and complications was ascertained. RESULTS The incidence of reintubation was 12.4%, and the principal cause was lowered level of consciousness (71.5%). There was greater incidence of reintubation among females (P = 0.028), and greater occurrence of altered level of consciousness at the time of extubation (P < 0.0001). Reintubated patients presented longer duration of mechanical ventilation (P < 0.0001), longer stays in the intensive care unit (ICU) and in the hospital (P < 0.0001), greater incidence of pulmonary complications (P < 0.0001), greater need for reoperation and tracheostomy, and higher mortality (P < 0.0001). CONCLUSION The incidence of reintubation in these patients was 12.4%. The main cause was lowering of the level of consciousness. Female gender and altered level of consciousness at the time of extubation correlated with higher incidence of reintubation. Reintubation was associated with pulmonary complications, longer durations of mechanical ventilation, hospitalization and stay in the ICU, greater incidence of tracheostomy and mortality.

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