Severe brain trauma to the fetus in a car accident: Literature review and a clinical case

Car accidents are the main cause of trauma during pregnancy. Even a non-severe accident is associated with a high risk of injury and unfavorable outcome for the fetus, especially in the event of placental abruption. Major agents leading to a trauma could also include safety belt and safety airbags. Blunt abdominal trauma during a car accident is associated with such type of intrauterine injury as fetal skull fractures and various intracranial hemorrhages. Despite a common viewpoint on relatively high death rates in this population, it is not infrequent that fetal trauma has a favorable outcome without any clinically significant neurological deficiency. The paper presents an analysis of the main outcomes of intrauterine brain injury and associated factors. As an illustration, we describe a case of a car accident related brain injury to a fetus at 38 week of gestation, with skull fracture, brain contusion, and subarachnoidal, epidural and subdural, parenchymal and intraventricular hemorrhages induced by the safety belt, with the mother being virtually uninjured. After treatment, the patient was discharged from the hospital in a satisfactory state, without clinically significant neurological symptoms and signs. A 8-months follow-up of the infant showed some delay in brain maturation manifesting as benign epileptiform discharges of childhood and magnetic resonance imaging patterns. It is highly likely, that the leading factors ensuring a favorable outcome of a intrauterine severe brain trauma (without fatal trauma to the mother and fetus) are as follows: correct obstetric strategy, late gestational age and absence of a massive parenchymal and/or intraventricular bleeding. After the short-term clinical recovery from a severe intrauterine brain trauma and in addition to it, proper follow-up of the child is essential because of a high risk of long-term cerebral and functional abnormalities, mostly paroxysmal, behavioral and cognitive.

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Residual Pituitary Function after Brain Injury-Induced Hypopituitarism: A Prospective 12-Month Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2005-0504 ◽

2005 ◽

Vol 90 (11) ◽

pp. 6085-6092 ◽

Cited By ~ 224

Author(s):

Gianluca Aimaretti ◽

Maria Rosaria Ambrosio ◽

Carolina Di Somma ◽

Maurizio Gasperi ◽

Salvatore Cannavò ◽

...

Keyword(s):

Brain Injury ◽

High Risk ◽

Gh Deficiency ◽

Pituitary Function ◽

Brain Injured ◽

Injured Patients ◽

The Brain ◽

Over Time

Abstract Context: Traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH) are conditions at high risk for the development of hypopituitarism. Objective: The objective of the study was to clarify whether pituitary deficiencies and normal pituitary function recorded at 3 months would improve or worsen at 12 months after the brain injury. Design and Patients: Pituitary function was tested at 3 and 12 months in patients who had TBI (n = 70) or SAH (n = 32). Results: In TBI, the 3-month evaluation had shown hypopituitarism (H) in 32.8%. Panhypopituitarism (PH), multiple (MH), and isolated (IH) hypopituitarism had been demonstrated in 5.7, 5.7, and 21.4%, respectively. The retesting demonstrated some degree of H in 22.7%. PH, MH, and IH were present in 5.7, 4.2, and 12.8%, respectively. PH was always confirmed at 12 months, whereas MH and IH were confirmed in 25% only. In 5.5% of TBI with no deficit at 3 months, IH was recorded at retesting. In 13.3% of TBI with IH at 3 months, MH was demonstrated at 12-month retesting. In SAH, the 3-month evaluation had shown H in 46.8%. MH and IH had been demonstrated in 6.2 and 40.6%, respectively. The retesting demonstrated H in 37.5%. MH and IH were present in 6.2 and 31.3%, respectively. Although no MH was confirmed at 12 months, two patients with IH at 3 months showed MH at retesting; 30.7% of SAH with IH at 3 months displayed normal pituitary function at retesting. In SAH, normal pituitary function was always confirmed. In TBI and SAH, the most common deficit was always severe GH deficiency. Conclusion: There is high risk for H in TBI and SAH patients. Early diagnosis of PH is always confirmed in the long term. Pituitary function in brain-injured patients may improve over time but, although rarely, may also worsen. Thus, brain-injured patients must undergo neuroendocrine follow-up over time.

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Um convite à escrita: a história de um (não) disléxico (An invitation for written: The history of a (no) dyslexic )

Estudos da língua(gem) ◽

10.22481/el.v6i2.1072 ◽

2008 ◽

Vol 6 (2) ◽

pp. 193

Author(s):

Fernanda Maria Pereira Freire

Keyword(s):

High School ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Junior High School ◽

Neurological Disorders ◽

Seventh Grade ◽

Writing Ability ◽

History Of ◽

Car Accident

O artigo discute dados de escrita de um homem de 27 anos (AL) que foi diagnosticado como disléxico na 7ª série do ensino fundamental – razão pela qual abandonou os estudos – e que sofreu, aos 23 anos, um traumatismo crânio-encefálico devido a um acidente automobilístico, o que ocasionou um quadro de Síndrome Frontal. O acompanhamento longitudinal, baseado nos pressupostos teórico-metodológicos da Neurolingüística Discursiva, mostra que: (1) ALnunca foi disléxico, (2) mesmo apresentando dificuldades decorrentes do quadro neurológico, ALé capaz de reconstruir a sua relação com a escrita.PALAVRAS-CHAVE: Neurolingüística. Síndrome Frontal. Escrita. Dislexia.ABSTRACT The article discusses writing datas of a 27 year-old-man (AL) who was diagnosed as dyslexic on the seventh grade of junior-high school – the reason he left his studies - and suffered a traumatic brain injury, when he was 23, due to a car accident, which led a Frontal Syndrome picture. The longitudinal follow-up - based on the theoretic referential theoretical of Discursive Neurolinguistics - shows that: (1) AL was never dyslexic, (2) AL is able to rebuild his relationship with the writing ability despite his neurological disorders. KEYWORDS: Neurolinguistic. Frontal Syndrome. Writing, Dyslexia.

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Measuring the impact and sustainability of a statewide program for identifying minority and underserved clients at risk for hereditary breast and ovarian cancer (HBOC): An eight-year follow up including transitions during the COVID pandemic.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18546 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18546-e18546

Author(s):

Alice S. Kerber ◽

Sheryl G. A. Gabram ◽

Diane Durrence ◽

Janet Y. Shin ◽

Nancy M. Paris ◽

...

Keyword(s):

Public Health ◽

Genetic Testing ◽

High Risk ◽

Surveillance Data ◽

Health Centers ◽

Care Providers ◽

Underserved Women ◽

Clinically Significant ◽

The Impact

e18546 Background: The Georgia Breast Cancer Genomics Program was created with 2011-2014 funding from the Centers for Disease Control and Prevention and the Georgia Department of Public Health (GDPH). In collaboration with GDPH and the Georgia Center for Oncology Research and Education (Georgia CORE), the goal of the program has been to reduce disparities among high-risk minority and underserved women. The objective of this study is to report the 8-year surveillance data for women at increased risk for HBOC in statewide public health centers. The effect of the COVID pandemic on the program and sustainability is also reported. Methods: From 11/1/2012-12/31/2020, the program provided education, outreach and collected surveillance data using an online genetics referral screening tool as recommended by USPSTF. Providers in 159 counties and health centers across Georgia were educated in cancer family history collection and appropriate referral to genetics. When an individual was found to be at high risk, she was referred to the Georgia CORE Genetics Advanced Practice Nurse for additional education, genetic testing and follow-up. Results: Online screenings attributable to GDPH totaled 29,087 with 1,656 positive screens. 28 % of clients were less than 25 years of age and 56 % ranged from 25-54. Race: 33 % white, 41 % black, 15 % Hispanic and 11 % other or N/A. 92 % of referrals were uninsured. Genetic testing was started or completed on 430 clients. 36 individuals declined testing after counseling (reconsideration, insurance, unknown reasons) and were provided with contact information. 47 (11%) pathogenic, clinically significant mutations were identified including 37 (79 %) HBOC related mutations and 10 (21 %) Lynch related mutations. Variants of uncertain significance were identified in 90 (21 %) clients, with multiple variants in 40 of those. 27 clients have been served through GDPH for physician consultation and surveillance. 13 were referred to area resources: one diagnosed with cancer, and 7 chose referral to other health care providers. Because of the pandemic, the program transitioned to telecommunications and remote access to testing in 5/2020. From 5/2020-12/2020, 34 clients completed testing (41% minority, all uninsured). 10 (29%) clinically significant mutations were identified and heightened surveillance initiated. Conclusions: The GDPH and Georgia CORE collaborative genomics program has served clients over the past 8 years, adjusting to changing resources while reaching a significant number of minority and underserved women. The program successfully converted to remote services during the COVID pandemic. Lessons learned from this transition have been incorporated into planning for future program sustainability.

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Resumption of anticoagulant therapy after major bleeding and recurrence of hemorrhagic complications in patients with atrial fibrillation with a high risk of stroke and thromboembolism (based on the results of 20 years of observation)

Terapevticheskii arkhiv ◽

10.26442/00403660.2020.09.000655 ◽

2020 ◽

Vol 92 (9) ◽

pp. 15-23

Author(s):

A. I. Mironova (Staroverova) ◽

E. P. Panchenko ◽

E. S. Kropacheva ◽

O. A. Zemlyanskaya

Keyword(s):

High Risk ◽

Anticoagulant Therapy ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Recurrent Bleeding ◽

Hemorrhagic Complication ◽

Hemorrhagic Complications ◽

Ulcerative Lesions ◽

Clinically Significant

Aim.To analyze the frequency of resumption of anticoagulant therapy (ACT) after major and clinically significant bleeding among AF patients who received oral anticoagulants and were observed in the Department of clinical problems of atherothrombosis from 1999 to 2019 within the retro-prospective register Regata-2, and to search for clinical factors associated with recurrence of hemorrhagic complications among patients who resumed anticoagulant therapy after a bleeding episode. Materials and methods.In cohort study of patients with high-risk AF with absolute indications for ACT we enrolled 290 AF patients (130 women and 160 men) aged 32 to 85 years (the average age was 65.188.89 years). During the follow-up period, 92 patients developed hemorrhagic complications, and 73 of them resumed ACT. 35 of the 73 patients who resumed ACT developed a relapse of major/clinically significant bleeding. Results.The frequency of resuming ACT after the first hemorrhagic complication increased over time from 75% in the period from 19992003 to 90% in the period 20152019. We were not able to establish an exact relationship between the presence of concomitant pathology and the decision to resume the ACT after bleeding. The only reliable reason for refusing to resume the ACT was the patients categorical reluctance. Among patients who had recurrent hemorrhagic complications, the total score on the Charleson comorbidity scale was significantly higher (4.232.01vs3.521.43;p=0.0425). Patients with recurrent bleeding were significantly more likely to suffer from CKD with a decrease in GFR less than 60 ml/min/1.73 sq. m, and also had a history of erosive and ulcerative lesions of the gastrointestinal tract. There was also a significant Association of recurrent bleeding with the use of proton pump inhibitors. Subgroups of patients who switched from warfarin to taking direct oral anticoagulants after the first bleeding and subsequent recurrent bleeding did not differ in basic clinical characteristics from patients without bleeding after changing the anticoagulant. According to multiple regression analysis, NSAIDs showed a tendency to develop a relapse of B/C bleeding on the background of direct oral anticoagulants in patients who underwent GO on the background of warfarin therapy (b=0.4524,p=0.0530). Conclusion.During the 20-year follow-up, the frequency of all major and clinically significant bleeding was 2.6/100 patients-years, the frequency of first bleeding was 5.86/100 patients-years, while the frequency of repeated hemorrhagic complications was 7.06/100 patients-years. Patients with a high thromboembolic risk should receive anticoagulants, provided that the modifiable risk factors for bleeding are carefully corrected.

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Abstract WMP119: Short Term Use of Direct Oral Anticoagulants is Not Associated With Decreased Bleeding in High Risk Patients Following Percutaneous Left Atrial Appendage Closure

Stroke ◽

10.1161/str.51.suppl_1.wmp119 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Salman Farhat ◽

Demilade Adedinsewo ◽

Susie Sennhauser ◽

Jeffrey Winder ◽

Najiyah Salwa ◽

...

Keyword(s):

High Risk ◽

Left Atrial ◽

Left Atrial Appendage ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Left Atrial Appendage Closure ◽

Short Term ◽

Device Placement ◽

Clinically Significant

Introduction: Percutaneous left atrial appendage closure is well established as an alternative to anticoagulation therapy for stroke prophylaxis among patients with non-valvular atrial fibrillation (NVAF) with relative or absolute contraindications to anticoagulation. Only the Watchman® (BSC) device has FDA approval for this indication. There are no current guidelines on the choice of short term antithrombotic therapy following placement of the Watchman® device. The landmark Watchman® clinical trials utilized warfarin and aspirin in the first 45 days to facilitate endothelialization; however these studies were started prior to direct oral anticoagulants (DOAC) becoming widely available. Our main objective was to compare bleeding outcomes with warfarin vs. DOACs following Watchman® device placement. Methods: We conducted a retrospective chart review of all patients who received a Watchman® device at all three Mayo Clinic sites (MN, FL, AZ) between January 2010 and December 2018 with follow up for outcomes at 45 days or 6 weeks following procedure. We conducted bivariate analysis using t-tests and chi-square tests as appropriate. A logistic regression model was constructed to evaluate the effect of anticoagulant choice on bleeding and thromboembolic outcomes. Clinically significant bleeding was defined as bleeding leading to interruption of anticoagulation regimen or requiring transfusion. Results: 232 patients were identified (33% female), mean age in years, CHADS2VASC score and HASBLED scores were 77, 5 and 4 respectively. Overall, 39% were initiated on non-warfarin therapies and 11% had a significant bleeding episode during follow up. There was no difference in clinically significant bleeding events (11% vs. 12%; OR 0.92, 95% CI: 0.32 – 2.65) with short term DOAC use compared to warfarin. Patients who received a Watchman® due to GI bleeding were more likely to have a bleeding event in the first 6 weeks following Watchman® (OR: 4.08, 95% CI: 1.30 – 12.75). Conclusion: This observational study demonstrates no significant difference in bleeding episodes with DOACs compared to warfarin during the first 6 weeks following Watchman® device placement in patients at high risk for bleeding. Larger prospective studies are needed.

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Management and outcome of pregnancies in women with red cell isoimmunization: a 15-year observational study from a tertiary care university hospital

BMC Pregnancy and Childbirth ◽

10.1186/s12884-019-2525-y ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

María Ángeles Sánchez-Durán ◽

María Teresa Higueras ◽

Cecilia Halajdian-Madrid ◽

Mayte Avilés García ◽

Andrea Bernabeu-García ◽

...

Keyword(s):

High Risk ◽

Observational Study ◽

Gestational Age ◽

Risk Group ◽

Perinatal Outcomes ◽

Low Risk ◽

Fetal Anemia ◽

Adverse Perinatal Outcomes ◽

Clinically Significant

Abstract Background The aims of this study were to determine the prevalence of the different anti-erythrocytic alloantibodies, to describe pregnancy outcomes according to a low-risk and high-risk classification for fetal anemia and to determine the factors that influence adverse perinatal outcomes. Methods This retrospective observational study included women referred to our center following the identification of maternal anti-erythrocytic alloantibodies between 2002 and 2017. Pregnancies were classified as high risk for fetal anemia in cases with clinically significant antibodies, no fetal-maternal compatibility and titers ≥1:16 or any titration in cases of Kell system incompatibility. In high-risk pregnancies, maternal antibody titration and the fetal middle cerebral artery peak systolic velocity (MCA-PSV) were monitored. Low-risk pregnancies underwent routine pregnancy follow-up. Results Maternal antibodies were found in 337 pregnancies, and 259 (76.9%) of these antibodies were clinically significant. The most frequent antibodies were anti-D (53%) and anti-K (19%). One hundred forty-three pregnancies were classified as low risk for fetal anemia, 65 (25%) cases were classified as no fetal-maternal incompatibility, 78 had clinically nonsignificant antibodies, 4 (2.8%) resulted in first-trimester pregnancy loss, and 139 (97.2%) resulted in livebirths. Of the 194 high-risk pregnancies, 38 had titers < 1:16 (resulting in 38 livebirths), and 156 had titers ≥1:16 or anti-K antibodies. In the last group, 6 cases miscarried before 18 weeks, 93 had a MCA-PSV < 1.5 multiples of the median (MoM), resulting in 3 perinatal deaths that were unrelated to fetal anemia, one termination and 89 livebirths; and 57 had a MCA-PSV > 1.5 MoM, resulting in 3 intrauterine deaths, 6 terminations and 48 livebirths. Ninety-two intrauterine transfusions were performed in 45 fetuses (87% anti-D). Adverse outcomes were related to a MCA-PSV > 1.5 MoM (p < 0.001), hydrops (p < 0.001) and early gestational age at first transfusion (p = 0.029) Conclusion Anti-D remains the most common antibody in fetuses requiring intrauterine transfusion. A low or high-risk classification for fetal anemia based on the type of antibody, paternal phenotype and fetal antigen allows follow-up of the pregnancy accordingly, with good perinatal outcomes in the low-risk group. In the high-risk group, adverse perinatal outcomes are related to high MCA-PSV, hydrops and early gestational age at first transfusion.

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