P115 Subarachnoid haemorrhage with negative initial vascular imaging: a single unit experience

2019 ◽  
Vol 90 (3) ◽  
pp. e52.2-e52
Author(s):  
F Rasul ◽  
G Silva ◽  
T Fitzpatrick ◽  
S Derakshani ◽  
A Ghosh ◽  
...  
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Clinical Outcomes ◽  
Vascular Imaging ◽  
Electronic Database ◽  
Single Centre ◽  
Vascular Abnormality ◽  
Cerebral Angiogram ◽  
Vascular Abnormalities ◽  
Ct Angiogram ◽  
Age Range

ObjectivesTo investigate the incidence of vascular abnormality and clinical outcomes in a group of patients presenting with spontaneous subarachnoid haemorrhage (SAH) and negative initial vascular investigation.DesignSingle centre prospective cohort study.SubjectsAll adult patients with SAH admitted to our unit over a 12 month period.MethodsProspective collection of data on secure electronic database. Information pertaining to gender, age, mode of initial and subsequent vascular investigations was acquired. Details regarding clinical outcomes at 30 days and complications were documented.Results118 consecutive patients with SAH were admitted to our unit over the 12 month study period. 37 patients had negative initial vascular imaging (37/118=31.4%). M:F=19:18, age range 26–76 years. 32 patients underwent a high quality CT angiogram as initial vascular investigation, 5 patients underwent catheter cerebral angiogram (DSA). The most common modality of further vascular imaging was DSA. 5 vascular abnormalities were detected on subsequent vascular imaging (5/37=13.5%). Hydrocephalus and vasospasm were the commonest complications. Clinical outcomes were very good; all patients had a GOS of 5 at 30 days.ConclusionsPatients with SAH and negative initial vascular investigation are an important subset of patients with SAH. There is no uniformity in the type of subsequent vascular investigations selected. Our experience is consistent with previously published studies.

Abstract TP299: Lone Intraventricular Hemorrhage Frequently Harbors Vascular Malformations And Has Better Clinical Outcomes Than When Associated With Small Parenchymal Component

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Ather Taqui ◽  
Lauren Koffman ◽  
Muhammad S Hussain ◽  
Ken Uchino
Keyword(s):  
Clinical Outcomes ◽  
Intraventricular Hemorrhage ◽  
Clinical Presentation ◽  
Past History ◽  
Anticoagulation Therapy ◽  
Case Series ◽  
Cerebral Angiogram ◽  
Ct Angiogram ◽  
Significant Difference ◽  
Early Clinical Outcomes

Background: Primary intraventricular hemorrhage (PIVH) is an uncommon neurological event which can cause significant morbidity. The current literature comprises of small case series that include two types of PIVH: 1) blood restricted to the ventricular system only 2) predominant IVH plus a small parenchymal component. Hypothesis: We hypothesized that these two types represent different clinical entities and have key differences in their clinical, diagnostic and prognostic profiles. Methods: We performed a retrospective chart review over last 3 years from our center’s database. Neuroradiology reports of initial CT scans from all cases of intracranial hemorrhage (ICH) were reviewed to capture patients. Then CT images were reviewed and classified into pure IVH or IVH with small intraparenchymal hemorrhage within 15mm of the ventricular wall (IVH/sICH). Exclusion criteria included presence of subarachnoid hemorrhage and head trauma. Results: Out of 846 ICH patients, 25 patients (3%) were identified as pure IVH and 26 (3.1%) as IVH/sICH. Median ages were 72 and 61 years, and females were 17 (68%) and 14 (54%) without significant difference. Pure IVH was found to have significantly higher rate of cerebral angiogram performance (60% vs 26.9%, p=0.02), more frequent etiology of arteriovenous malformations (AVM) or arteriovenous fistula (32% vs 3.8%, p=0.01), better early clinical outcomes measured by median modified Rankin score at discharge (4 vs 5, p=0.05) and lower in-hospital mortality (0% vs 23.1%, p=0.02). IVH/sICH group was found to have significantly higher rate of focal findings on presentation (p=0.02) and past history of HTN (p=0.02). No significant differences were found between the groups in clinical presentation, admission blood pressure, pre-admission antiplatelet and anticoagulation therapy, severity of IVH on CT, CT angiogram findings, and in-hospital complication and treatment. Conclusion: Clinical presentation was not different between pure IVH and IVH with small parenchymal component. Pure IVH patients received a more aggressive diagnostic approach, had more frequent diagnosis of vascular malformation, and had better early clinical outcomes.

P-140 Clinical outcomes following pharyngolaryngectomy reconstruction: a 20-year single centre study

Oral Oncology ◽  
2021 ◽  
Vol 118 ◽  
pp. 9
Author(s):  
Thomas Layton ◽  
Rachel Thomas ◽  
Carol Harris ◽  
Samantha Holmes ◽  
Priy Silva ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Single Centre ◽  
Centre Study ◽  
Single Centre Study

Abstract TP226: Vertebral Artery Dissection is More Common Than Carotid Artery Dissection and More Difficult to Detect on Non-invasive Imaging

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Mohammad O Nakawah ◽  
John Volpi
Keyword(s):  
Tertiary Care ◽  
Vertebral Artery Dissection ◽  
Clinical Manifestations ◽  
Carotid Artery Dissection ◽  
Vascular Imaging ◽  
Noninvasive Testing ◽  
Artery Dissection ◽  
Care Hospital ◽  
Anterior Circulation ◽  
Cerebral Angiogram

Background: Cervical artery dissections (CAD) are among the most common causes of stroke in young and middle-aged adults. In contrast to carotid dissections (CD) and anterior circulation ischemia, the clinical manifestations of vertebral dissections (VD) and posterior circulation ischemia are often nonspecific (e.g. dizziness and ataxia), and thus a high index of suspicion is necessary for diagnosis. Therefore, the reported incidence of VD in the medical literature is likely to be an underestimation. Methods: With IRB approval, we conducted a retrospective chart review study using the Neurology Database of Houston Methodist Neurological Institute to identify all patients diagnosed with CAD between August 2011 and March 2015. All patients presented with cerebral ischemia (TIA or stroke). The diagnosis of CAD was made by a stroke neurologist and was based on clinical presentation and appropriate vascular imaging studies. Patients with incidental CAD and those with questionable diagnosis of CAD clinically and radiographically were excluded. Over the studied period (32 months), a total of 677 TIA patients and 3230 stroke patients were admitted to our tertiary-care hospital. Results: Of 52 patients with CAD-related TIA or ischemic stroke, there were 34 patients (65.4%) with VD and 18 patients (34.6%) with CD. The average age of presentation is 47 years (range: 18 to 75 years) for VD patients and 51 years (range: 34 to 78 years) for CD patients. CAD was slightly more common in males, with 18 VD patients (52.9%) and 10 CD patients (55.5%) in our studied population were males. Out of 30 patients with VD who underwent both noninvasive vascular imaging (MRA or CTA) and cerebral angiogram, dissection was detected on noninvasive imaging in 10 patients (33.3%). On the other hand, out of 13 patients with CD who had both types of imaging modalities, dissection was detected on noninvasive testing in 8 patients (61.5%). Conclusions: VD was detected approximately twice as frequently as CD in our study. Both conditions are slightly more common in men with an average age of presentation is about 50 years. In addition, our data suggest that noninvasive testing is more likely to diagnose carotid dissection (in two-third of cases) than vertebral dissection (in one-third of cases).

Abstract 1122‐000187: Acute Stroke, Subarachnoid Hemorrhage, VZV vasculopathy, and Carotid Dissection: An Interesting Case

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Hashaam Arshad ◽  
Zhenhua Gui ◽  
Dakota Owens ◽  
Binod Wagle ◽  
Charles Donohoe
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Lumbar Puncture ◽  
Internal Carotid ◽  
Acute Encephalopathy ◽  
Igg Antibody ◽  
Cerebral Angiogram ◽  
Ct Angiogram ◽  
The Right

Introduction : A 51‐year‐old lady with a past medical history of Essential Hypertension, Hypothyroidism, prior Herpes Zoster infection 8 weeks ago was admitted with complaints of abdominal pain, bilateral flank pain, and restlessness. Her initial workup was significant for hyponatremia and hypokalemia. On the 3rd day of admission, she developed acute hypoxemic respiratory failure which led to intubation. At that time, CTA Chest was not done but CT Chest revealed prominent mucous plugging with left side glass ground opacities, Ultrasound of lower extremities revealed right common femoral vein DVT which led to concerns that she may have suffered from Pulmonary Embolism and led to starting Heparin drip. On the 6th day of admission, she developed Acute Encephalopathy, MRI Brain revealed acute infarcts in bilateral cerebral cortices and cerebella, CT Angiogram Head showed acute subarachnoid hemorrhage in the high posterior right parietal lobe, stenosis of the right high cervical internal carotid artery, and irregular, the appearance of the arterial vasculature throughout and CT Angiogram Neck abrupt change in caliber of the right ICA, 1.5 cm distal to the bifurcation with markedly severe narrowing of the majority of the extracranial right ICA throughout its course. A cerebral Angiogram was done which showed diffuse tandem segments of tandem cervical and intracranial portions of the right internal carotid artery and she was given nitroglycerin was administered as a therapeutic intervention. Lumbar Puncture showed WBC 2, RBC 7, Protein 162, Glucose 64, VZV PCR was negative, CSF VZV IgG Antibody positive at 303 IV (>165 IV indicative of current or past infection). Serum VZV IgG Antibody was positive at >4000 IV. Infectious Diseases were consulted after Lumbar Puncture, they initially started Acyclovir but once the Serum VZV IgG Antibody came back much higher than Serum VZV IgG Antibody levels, their assessment was that VZV vasculitis is unlikely and Acyclovir was discontinued. Eventually, the case was discussed at Neuroradiology which led to us getting a repeat MRA Neck without contrast which showed a concentric T1 and T2 hyperintensity along with a small and irregular caliber right cervical ICA consistent with dissection. She eventually completed a 21‐day course of Nimodipine due to underlying Subarachnoid Hemorrhage. Methods : NA Results : NA Conclusions : Our case demonstrates how it can become difficult to ascertain the etiology of stroke in certain patients. Our patient presented with multiple non‐specific symptoms initially and it was later on due to her Acute Encephalopathy that her Strokes and Subarachnoid Hemorrhage were discovered. It is still difficult to pinpoint whether the cause of strokes was dissection or VZV infection. Lumbar Puncture remains an essential tool to complete work up on uncommon etiologies of stroke.

scholarly journals Fusiform Lenticulostriate Artery Aneurysm with Subarachnoid Hemorrhage: The Role for Superselective Angiography in Treatment Planning

2010 ◽  
Vol 16 (3) ◽  
pp. 259-263 ◽  
Author(s):  
P.S. Kochar ◽  
W.F. Morrish ◽  
M.E. Hudon ◽  
J.H. Wong ◽  
M. Goyal
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Treatment Planning ◽  
Artery Aneurysm ◽  
Cerebral Angiogram ◽  
Perforating Artery ◽  
Ct Angiogram ◽  
Superselective Angiography ◽  
Lenticulostriate Artery ◽  
The Right ◽  
Exact Origin

Aneurysms of the lenticulostriatal perforating arteries are rare and either involve the middle cerebral artery-perforator junction or are located distally in basal ganglia. We describe a rare ruptured fusiform lenticulostriatal perforating artery aneurysm arising from a proximal M2 MCA branch, discerned on superselective microcatheter angiography, presenting solely with subarachnoid hemorrhage (SAH). A 50-year-old previously healthy man presented with diffuse SAH and negative CT angiogram. Cerebral angiogram demonstrated a 2 mm fusiform aneurysm presumably arising from the right lateral lenticulostriate perforator but the exact origin of the perforator was unclear. Superselective angiography was required to precisely delineate the aneurysm and its vessel of origin and directly influenced treatment planning (surgical trapping). Superselective microcatheter angiography provides both an option for endovascular therapy as well as more accurate delineation for surgical planning for these rare aneurysms.

Genetic variants of PEAR1 and ischemic clinical outcomes in coronary artery disease patients: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Xinyi Zhang ◽  
Sicong Li ◽  
Yuxuan Zhao ◽  
Ningjia Tang ◽  
Tong Jia ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Clinical Outcomes ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Electronic Database ◽  
Artery Disease ◽  
Relationship Of ◽  
The Relationship ◽  
Ischemic Events

Aim: The aim of this study was to assess the association between PEAR1 polymorphisms and ischemic clinical outcomes. Materials & methods: We searched the electronic database for articles on the relationship of PEAR1 SNPs and ischemic events in patients with coronary artery disease (CAD) up to October 2020. Results: A total of 9914 patients with CAD from six studies focusing on 12 SNPs of PEAR1 were included in this study. The A allele of rs12041331 were associated with ischemic events (odds ratio: 1.40; 95% CI: 1.04–1.88; p = 0.03). The AA homozygotes of rs2768759 was related to a higher risk of ischemic events than carriers of the C allele (odds ratio: 2.08; 95% CI: 1.09–3.97; p = 0.03). Conclusion: PEAR1 rs12041331 and rs2768759 are significantly associated with ischemic events in patients with CAD.

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