Rupture of Intracranial Aneurysms during Cerebral Angiography

Neurosurgery ◽  
1979 ◽  
Vol 5 (3) ◽  
pp. 314-324 ◽  
Author(s):  
George H. Koenig ◽  
William H. Marshall ◽  
Joseph G. Poole ◽  
Richard A. Kramer
Keyword(s):  
Statistical Analysis ◽  
Subarachnoid Hemorrhage ◽  
Critically Ill ◽  
Cerebral Angiography ◽  
Critically Ill Patients ◽  
Intracranial Aneurysms ◽  
Internal Carotid ◽  
Recent Trend ◽  
Review Of The Literature ◽  
Angiographic Technique

Abstract Ten new cases of intracranial aneurysms that ruptured during cerebral angiography, obtained from four local hospitals and the practices of eight angiographers, are detailed. A review of the literature reveals 28 other well-documented cases. An analysis of this clinical material shows that internal carotid injections are not necessarily more dangerous than common carotid injections. Although critically ill patients are at higher risk and must be treated with caution, there is not enough evidence to warrant a delay in angiography to avoid rupture. The recent trend toward early angiography in cases of subarachnoid hemorrhage is reflected in the statistical analysis. A plea for meticulous angiographic technique is advanced.

scholarly journals A comparative review of the literature surrounding complications associated with percutaneous dilatational tracheostomy versus open surgical tracheostomy

2018 ◽  
Vol 8 (1) ◽  
pp. 5-11
Author(s):  
Holly  Newton ◽  
Shadaba Ahmed
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Surgical Procedure ◽  
Percutaneous Dilatational Tracheostomy ◽  
Review Of The Literature ◽  
Surgical Tracheostomy ◽  
Dilatational Tracheostomy ◽  
Comparative Review ◽  
Open Surgical Tracheostomy

In this structured review, I aim to discuss the principle of tracheostomies including what they are and why we perform them. My main objective is to explore the literature surrounding whether or not there is a better option between open surgical and percutaneous dilatational tracheostomy, based on the complications with which they are associated. Simply put, a tracheostomy is a common surgical procedure performed on critically ill patients in order to facilitate their breathing. I will discuss the two main types of tracheostomy: open surgical (OST) and percutaneous dilatational (PDT), along with their accompanying impediments. 

Neonatal intracranial aneurysms: case report and review of the literature

2018 ◽  
Vol 21 (5) ◽  
pp. 471-477 ◽  
Author(s):  
Jeewaka E. Mohotti ◽  
Nicole S. Carter ◽  
Victor Jia Wei Zhang ◽  
Leon T. Lai ◽  
Christopher Xenos ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Time Of Flight ◽  
Review Of The Literature ◽  
Microsurgical Treatment ◽  
Enhanced Mri ◽  
Contrast Enhanced ◽  
Mca Aneurysm ◽  
Contrast Enhanced Mri

Intracranial aneurysms in the neonate, presenting in the first 4 weeks of life, are exceedingly rare. They appear to have characteristics, including presentation and location, that vary from those found in adults. The authors present a case of a 28-day-old neonate with a ruptured distal middle cerebral artery (MCA) aneurysm. Initial noninvasive imaging with transfontanelle ultrasound and CT confirmed intraparenchymal and subarachnoid hemorrhage. Contrast-enhanced MRI revealed a 14-mm ruptured fusiform MCA aneurysm that was not identified on time-of-flight magnetic resonance angiography (MRA). Microsurgical treatment was performed with partial neurological recovery. A comprehensive review of the literature from 1949 to 2017 revealed a total of 40 aneurysms in 37 neonates, including the present case. The most common presenting symptom was seizure. Although subarachnoid hemorrhage was the most common form of hemorrhage, 40% had intraparenchymal hemorrhage. The median aneurysm size was 10 mm (range 2–30 mm) and the most common location was the MCA, with two-thirds of cases involving the distal intracranial vasculature. Over the last 10 years, there has been a trend of increasing noninvasive diagnosis of ruptured cerebral aneurysms in neonates, with CT angiography and contrast-enhanced MRI being the most useful diagnostic modalities. The use of contrast-enhanced MRI may improve sensitivity over time-of-flight MRA. Microsurgical treatment was the most common treatment modality overall, with increased use of endovascular treatment in the last decade. Most patients underwent microsurgical vessel ligation or endovascular parent vessel occlusion. There were high rates of neurological recovery after microsurgical or endovascular treatment, particularly for patients with distal aneurysms.

scholarly journals Evaluating probiotics for the prevention of ventilator-associated pneumonia: a randomised placebo-controlled multicentre trial protocol and statistical analysis plan for PROSPECT

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e025228 ◽  
Author(s):  
Jennie Johnstone ◽  
Diane Heels-Ansdell ◽  
Lehana Thabane ◽  
Maureen Meade ◽  
John Marshall ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Controlled Trial ◽  
Statistical Analysis Plan ◽  
Hospital Length Of Stay ◽  
Sensitivity Analyses ◽  
Ventilator Associated Pneumonia ◽  
Increased Risk ◽  
The Impact

IntroductionVentilator-associated pneumonia (VAP) is the most common healthcare-associated infection in critically ill patients. Prior studies suggest that probiotics may reduce VAP and other infections in critically ill patients; however, most previous randomised trials were small, single centre studies. The Probiotics: Prevention of Severe Pneumonia and Endotracheal Colonization Trial (PROSPECT) aims to determine the impact of the probioticLactobacillus rhamnosusGG on VAP and other clinically important outcomes in critically ill adults.MethodsPROSPECT is a multicentre, concealed, randomised, stratified, blinded, controlled trial in patients ≥18 years old, anticipated to be mechanically ventilated ≥72 hours, in intensive care units (ICUs) in Canada, the USA and Saudi Arabia. Patients receive either 1×1010 colony forming units ofL. rhamnosusGG twice daily or an identical appearing placebo. Those at increased risk of probiotic infection are excluded. The primary outcome is VAP. Secondary outcomes are other ICU-acquired infections includingClostridioides difficileinfection, diarrhoea (including antibiotic-associated diarrhoea), antimicrobial use, ICU and hospital length of stay and mortality. The planned sample size of 2650 patients is based on an estimated 15% VAP rate and will provide 80% power to detect a 25% relative risk reduction.Ethics and disseminationThis protocol and statistical analysis plan outlines the methodology, primary and secondary analyses, sensitivity analyses and subgroup analyses. PROSPECT is approved by Health Canada (#9427-M1133-45C), the research ethics boards of all participating hospitals and Public Health Ontario. Results will be disseminated via academic channels (peer reviewed journal publications, professional healthcare fora including international conferences) and conventional and social media. The results of PROSPECT will inform practice guidelines worldwide.Trialregistration numberNCT02462590; Pre-results.

scholarly journals Proximity to the Treating Centre and Outcomes Following Subarachnoid Hemorrhage

2011 ◽  
Vol 38 (1) ◽  
pp. 36-40 ◽  
Author(s):  
Cian J. O'Kelly ◽  
Julian Spears ◽  
David Urbach ◽  
M. Christopher Wallace
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Survival Benefit ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Mortality Rates ◽  
Limited Resources ◽  
Early Complications ◽  
The Impact ◽  
The Relationship

Abstract:Background:In the management of subarachnoid hemorrhage (SAH), the potential for early complications and the centralization of limited resources often challenge the delivery of timely neurosurgical care. We sought to determine the impact of proximity to the accepting neurosurgical centre on outcomes following aneurysmal SAH.Methods:Using administrative data, we analyzed patients undergoing treatment for aneurysmal subarachnoid hemorrhage at neurosurgical centres in Ontario between 1995 and 2004. We compared mortality for patients receiving treatment at a centre in their county (in-county) versus those treated from outside counties (out-of-county). We also examined the impact of distance from the patient's residence to the treating centre.Results:The mortality rates were significantly lower for in-county versus out-of-county patients (23.5% vs. 27.6%, p=0.009). This advantage remained significant after adjusting for potential confounders (HR=0.84, p=0.01). The relationship between distance from the treating centre and mortality was biphasic. Under 300km, mortality increased with increasing distance. Over 300km, a survival benefit was observed.Conclusions:Proximity to the treating neurosurgical centre impacts survival after aneurysmal SAH. These results have significant implications for the triage of these critically ill patients.

Rhythmical and Periodic EEG Patterns Do Not Predict Short-term Outcome in Critically Ill Patients With Subarachnoid Hemorrhage

2013 ◽  
Vol 30 (3) ◽  
pp. 247-254 ◽  
Author(s):  
Amy Z. Crepeau ◽  
John F. Kerrigan ◽  
Paula Gerber ◽  
Gunjan Parikh ◽  
Heidi Jahnke ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Short Term ◽  
Term Outcome ◽  
Short Term Outcome

Thrombocytopenia in critically ill patients: A review of the literature

2011 ◽  
Vol 1 (4) ◽  
pp. 199-202 ◽  
Author(s):  
Anis Chaari ◽  
Fatma Medhioub ◽  
Mohamed Samet ◽  
Kamilia Chtara ◽  
Rania Allala ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Review Of The Literature

scholarly journals Body temperature abnormalities in non-neurological critically ill patients: a review of the literature

2014 ◽  
Vol 2 (1) ◽  
Author(s):  
Shigeki Kushimoto ◽  
Satoshi Yamanouchi ◽  
Tomoyuki Endo ◽  
Takeaki Sato ◽  
Ryosuke Nomura ◽  
...  
Keyword(s):  
Body Temperature ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Review Of The Literature

Bacterial intracranial aneurysms

1980 ◽  
Vol 53 (5) ◽  
pp. 633-641 ◽  
Author(s):  
John G. Frazee ◽  
Leslie D. Cahan ◽  
James Winter
Keyword(s):  
Cerebral Angiography ◽  
Intracranial Aneurysms ◽  
Elective Surgery ◽  
Bacterial Endocarditis ◽  
Severe Headache ◽  
High Dose ◽  
Review Of The Literature ◽  
Content Type ◽  
Neurological Signs ◽  
Fine Print

✓ The treatment of 13 patients with bacterial intracranial aneurysms is reported. The incidence of bacterial intracranial aneurysms was 4% of all patients admitted with intracranial aneurysms and 3% of all patients admitted with bacterial endocarditis. Each patient had neurological signs or symptoms suggestive of intracranial disease prior to the diagnosis of an aneurysm. Alpha Streptococcus was the most common infecting organism. All patients were treated with specific, high-dose antibiotics, and five patients underwent surgery as well. There were no surgical deaths. Six of eight nonsurgically treated patients died. A review of the literature confirms a high mortality for patients treated with only antibiotics, and a low mortality for elective surgery. The authors conclude that 1) patients with bacterial endocarditis, who develop sudden severe headache, focal neurological signs or symptoms, or seizures, should undergo serial cerebral angiography every 7 to 10 days throughout their hospitalization; 2) if an aneurysm is identified it should be excised whenever possible; and 3) patients with proximal or multiple aneurysms should be considered for surgery.

scholarly journals Endovascular Treatment of a “Blister-like” Aneurysm of the Internal Carotid Artery

2000 ◽  
Vol 27 (3) ◽  
pp. 247-250 ◽  
Author(s):  
P.D. McNeely ◽  
D.B. Clarke ◽  
B. Baxter ◽  
R.A. Vandorpe ◽  
I. Mendez
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Endovascular Therapy ◽  
Cerebral Angiography ◽  
Internal Carotid ◽  
Surgical Approaches ◽  
Detachable Coil ◽  
Aneurysm Neck ◽  
Guglielmi Detachable Coil

Backgound:“Blister-like” aneurysms of the supraclinoid internal carotid artery have recently been recognized as having unique pathological and clinical features. Little is known regarding their optimal treatment modality.Methods:We report a case of a “blister-like” aneurysm of the internal carotid artery treated with Guglielmi detachable coil (GDC) embolization. Case Report: A 55-year-old man presented with a Hunt & Hess grade II subarachnoid hemorrhage. Computed tomography revealed diffuse subarachnoid blood. Cerebral angiography demonstrated a broad-based bulge on the medial wall of the right distal internal carotid artery. The patient was taken to the operating room and underwent a right pterional craniotomy and wrapping of this unclippable aneurysm. On postoperative day 11, he developed signs of vasospasm, and repeat angiography showed remarkable growth of the aneurysm. The aneurysm was believed to be amenable to endovascular therapy and was treated by GDC embolization. The patient recovered well and remained neurologically intact on follow-up examinations. Repeat cerebral angiography was performed three and nine months following his initial presentation and revealed a significant aneurysm neck remnant. This neck remnant was treated by repeat GDC embolization 13 months following his subarachnoid hemorrhage.Conclusion:“Blister-like” aneurysms of the internal carotid artery are important to recognize and are difficult to manage using traditional surgical approaches. Early repeated cerebral angiography is indicated and, where appropriate, endovascular therapy should be considered in the management of these patients.

Multiple intracranial aneurysms in sickle cell anemia

1985 ◽  
Vol 62 (3) ◽  
pp. 430-434 ◽  
Author(s):  
M. Chris Overby ◽  
Allen S. Rothman
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Sickle Cell ◽  
Sickle Cell Anemia ◽  
Intracranial Aneurysms ◽  
Neurological Complications ◽  
Review Of The Literature ◽  
Hemoglobin S ◽  
Content Type ◽  
Multiple Intracranial Aneurysms ◽  
Fine Print

✓ Neurological complications of sickle cell anemia occur in 18% to 29% of patients with homozygous hemoglobin S disease. A review of the literature yielded reports of two cases, both treated conservatively, of multiple intracranial aneurysms occurring in patients with sickle cell anemia. The authors report two cases of subarachnoid hemorrhage secondary to multiple intracranial aneurysms in patients with sickle cell anemia. One of the two patients underwent three craniotomies for ablation of six intracranial aneurysms. The techniques used in the treatment of these patients are presented.

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