Cerebral lipiodol embolisation

2021 ◽  
pp. practneurol-2021-002952
Author(s):  
Lisa Batcheller ◽  
Mark Thaller ◽  
Ben Wright
Keyword(s):  
Intensive Care ◽  
Basal Ganglia ◽  
Ct Scan ◽  
Thoracic Duct ◽  
Muscle Tone ◽  
Talc Pleurodesis ◽  
Chyle Leak ◽  
Cognitive Limitations ◽  
Double Incontinence ◽  
Conscious Level

Cerebral lipiodol embolisation is a rare but serious complication of lymphangiography. A man in his seventies had undergone lymphangiography for a refractory chyle leak following oesophagectomy. The day after lymphangiography, his conscious level dropped with bilaterally miotic pupils, increased muscle tone and double incontinence. CT scan of the head showed patchy high density throughout basal ganglia, cortex and cerebellum but no infarct, in keeping with lipiodol embolisation. He was managed initially in intensive care and subsequently underwent thoracoscopy with clipping and suturing of the left thoracic duct, and later a talc pleurodesis. At 3 months, he had some cognitive limitations and was walking with a stick.

scholarly journals Observational study of thrombosis and bleeding in COVID-19 VV ECMO patients

2021 ◽  
pp. 039139882198906
Author(s):  
Brianda Ripoll ◽  
Antonio Rubino ◽  
Martin Besser ◽  
Chinmay Patvardhan ◽  
William Thomas ◽  
...  
Keyword(s):  
Intensive Care ◽  
Ct Scan ◽  
Thrombotic Event ◽  
Area Under The Curve ◽  
Whole Body ◽  
Bleeding Events ◽  
Heparin Resistance ◽  
Increased Risk ◽  
Thrombotic Complications ◽  
Clinically Significant

Introduction: COVID-19 has been associated with increased risk of thrombosis, heparin resistance and coagulopathy in critically ill patients admitted to intensive care. We report the incidence of thrombotic and bleeding events in a single center cohort of 30 consecutive patients with COVID-19 supported by veno-venous extracorporeal oxygenation (ECMO) and who had a whole body Computed Tomography Scanner (CT) on admission. Methodology: All patients were initially admitted to other hospitals and later assessed and retrieved by our ECMO team. ECMO was initiated in the referral center and all patients admitted through our CT scan before settling in our intensive care unit. Clinical management was guided by our institutional ECMO guidelines, established since 2011 and applied to at least 40 patients every year. Results: We diagnosed a thrombotic event in 13 patients on the initial CT scan. Two of these 13 patients subsequently developed further thrombotic complications. Five of those 13 patients had a subsequent clinically significant major bleeding. In addition, two patients presented with isolated intracranial bleeds. Of the 11 patients who did not have baseline thrombotic events, one had a subsequent oropharyngeal hemorrhage. When analyzed by ROC analysis, the area under the curve for % time in intended anticoagulation range did not predict thrombosis or bleeding during the ECMO run (0.36 (95% CI 0.10–0.62); and 0.51 (95% CI 0.25–0.78); respectively). Conclusion: We observed a high prevalence of VTE and a significant number of hemorrhages in these severely ill patients with COVID-19 requiring veno-venous ECMO support.

Neurotransmitters in the Basal Ganglia and Motor Thalamus: Their Role for the Regulation of Muscle Tone

1987 ◽  
pp. 185-202 ◽  
Author(s):  
T. Klockgether ◽  
M. Schwarz ◽  
L. Turski ◽  
C. Ikonomidou-Turski ◽  
K. Ossowska ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Muscle Tone ◽  
Motor Thalamus

scholarly journals Post-thyroidectomy hypocalcemia exacerbated by chyle leak

2015 ◽  
Vol 2015 ◽  
Author(s):  
Naweed Alzaman ◽  
Anastassios G Pittas ◽  
Miriam O'Leary ◽  
Lisa Ceglia
Keyword(s):  
Total Thyroidectomy ◽  
Thoracic Duct ◽  
Treatment Options ◽  
Oral Intake ◽  
Neck Surgery ◽  
List Type ◽  
Chyle Leak ◽  
Thoracic Duct Injury ◽  
Extensive Lymph Node ◽  
Learning Points

Summary Transient hypocalcemia after thyroidectomy is not uncommon and the risk increases with the extent of neck surgery. We report a case of severe and prolonged hypocalcemia after total thyroidectomy complicated by thoracic duct injury. Hypoparathyroidism and thoracic duct injury are potential complications following total thyroidectomy with extensive lymph node dissection. This case suggested that having both conditions may complicate treatment of hypoparathyroid-induced hypocalcemia by way of losses of calcium and vitamin D in the chyle leak. Learning points This report highlights chyle leak as an uncommon cause of prolonged hypocalcemia in patients who have undergone extensive neck surgery. Chyle has an electrolyte concentration similar to that of plasma. Medical treatment options for a chyle leak include fat-free oral diet or parenteral nutrition without oral intake, pharmacological treatment (primarily octreotide).

PS02.056: TIMELY LIGATION OF THORACIC DUCT IN POST ESOPHAGECTOMY CHYLE LEAK: KEY TO SUCCESSFUL MANAGEMENT

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 136-136
Author(s):  
Sanjeev Parshad ◽  
Parvinder Sandu ◽  
Shekar Gogna ◽  
Abhijeet Beniwal ◽  
Rajendra Karwasra
Keyword(s):  
Mortality Rate ◽  
Thoracic Duct ◽  
Conflicts Of Interest ◽  
Surrounding Tissue ◽  
Chyle Leak ◽  
Threatening Condition ◽  
Life Threatening ◽  
Carcinoma Esophagus ◽  
Esophagectomy For Cancer

Abstract Background Chyle leak after esophagectomy for carcinoma esophagus is a rare but life threatening condition with reported an incidence of 1–6%. Mortality rate of up to 50% have been reported. Management of chyle leak is controversial. We reviewed our experience with iatrogenic chylothorax after esophagectomy for carcinoma esophagus. Methods From 2003 to 2017, 560 patients underwent esophagectomy for cancer at our department of oncosurgery. Eight patients developed post operative chyle leak. Transthoracic or transabdominal ligation of duct was done in six patients with in first week. 100 ml of cream was given 30 min before induction to visualize the leak intraoperatively. We used 4–0 prolene pledgeted suture to ligate the duct. Results Six patients who underwent early ligation could be salvaged and the two who were managed conservatively succumbed. Oringer et al. pointed towards conservative treatment having little place in the management of chylothorax in nutritionally depleted patients. Hence, prompt ligation of thoracic duct decreases morbidity and mortality of chylothorax. Thus the role of early surgery needs to stressed. There is a wide difference of mortality rate of conservative management of 82% with respect to the mortality rate of surgery of 10–16%. Though no conclusion data are available regarding the indication and time point of surgical ligation of the thoracic duct, it is important not to procrastinate while the condition deteriorates to a level at which surgery would be detrimental.Administration of cream to the patient (through feeding jejunostomy) around half an hour before surgery makes identification of site of leak simpler.The importance of pledgeted sutures cannot be denied as the thoracic duct is paper thin and chyle contains no fibrin. Thus non pledgeted sutures will tear it further. Infact, stitching should not be done through the duct but into the surrounding tissue around the duct and should allow the pledgets to close the duct. Conclusion Disclosure All authors have declared no conflicts of interest.

scholarly journals Oesophagectomy with en bloc resection of the thoracic duct: risk factors for post-operative chyle leak and current management

2019 ◽  
Vol 2 ◽  
pp. 13-13
Author(s):  
Brian Ip ◽  
Ka Ting Ng ◽  
Simon Packer ◽  
Simon Paterson-Brown ◽  
Graeme Couper
Keyword(s):  
Risk Factors ◽  
Thoracic Duct ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Current Management ◽  
En Bloc ◽  
Chyle Leak

scholarly journals Bilateral basal ganglia calcifications visualised on CT scan.

1980 ◽  
Vol 43 (5) ◽  
pp. 403-406 ◽  
Author(s):  
T S Brannan ◽  
A A Burger ◽  
M Y Chaudhary
Keyword(s):  
Basal Ganglia ◽  
Ct Scan

scholarly journals Diagnostic errors in paediatric cardiac intensive care

2018 ◽  
Vol 28 (5) ◽  
pp. 675-682 ◽  
Author(s):  
Priya N. Bhat ◽  
John M. Costello ◽  
Ranjit Aiyagari ◽  
Paul J. Sharek ◽  
Claudia A. Algaze ◽  
...  
Keyword(s):  
Intensive Care ◽  
Nurse Practitioners ◽  
Diagnostic Errors ◽  
Physician Assistants ◽  
Cognitive Limitations ◽  
Data Assessment ◽  
Medication Side ◽  
Viral Illness ◽  
Psychiatric Conditions ◽  
Cardiac Intensive Care

AbstractIntroductionDiagnostic errors cause significant patient harm and increase costs. Data characterising such errors in the paediatric cardiac intensive care population are limited. We sought to understand the perceived frequency and types of diagnostic errors in the paediatric cardiac ICU.MethodsPaediatric cardiac ICU practitioners including attending and trainee physicians, nurse practitioners, physician assistants, and registered nurses at three North American tertiary cardiac centres were surveyed between October 2014 and January 2015.ResultsThe response rate was 46% (N=200). Most respondents (81%) perceived that diagnostic errors harm patients more than five times per year. More than half (65%) reported that errors permanently harm patients, and up to 18% perceived that diagnostic errors contributed to death or severe permanent harm more than five times per year. Medication side effects and psychiatric conditions were thought to be most commonly misdiagnosed. Physician groups also ranked pulmonary overcirculation and viral illness to be commonly misdiagnosed as bacterial illness. Inadequate care coordination, data assessment, and high clinician workload were cited as contributory factors. Delayed diagnostic studies and interventions related to the severity of the patient’s condition were thought to be the most commonly reported process breakdowns. All surveyed groups ranked improving teamwork and feedback pathways as strategies to explore for preventing future diagnostic errors.ConclusionsPaediatric cardiac intensive care practitioners perceive that diagnostic errors causing permanent harm are common and associated more with systematic and process breakdowns than with cognitive limitations.

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