scholarly journals Posterior spinal artery aneurysm as an unlikely culprit for perimesencephalic pattern subarachnoid hemorrhage: illustrative case

2021 ◽  
Vol 1 (22) ◽  
Author(s):  
Armaan K. Malhotra ◽  
Jerry C. Ku ◽  
Vitor M. Pereira ◽  
Ivan Radovanovic
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Clinical Decision Making ◽  
Artery Aneurysm ◽  
Clinical Decision ◽  
Vascular Imaging ◽  
Treatment Modalities ◽  
Illustrative Case ◽  
Multiple Treatment ◽  
Posterior Spinal Artery ◽  
Negative Results

BACKGROUND Angiogram-negative nontraumatic subarachnoid hemorrhage (SAH) can be diagnostically challenging, and a broad differential diagnosis must be considered. Particular attention to initial radiographic hemorrhage distribution is essential to guide adjunctive investigations. Posterior spinal artery aneurysms are rare clinical entities with few reported cases in the literature. An understanding of isolated spinal artery aneurysm natural history, diagnosis, and management is evolving as more cases are identified. OBSERVATIONS Isolated thoracic posterior spinal artery aneurysm can be the culprit lesion in perimesencephalic distribution SAH. Embolization resulted in complete aneurysm occlusion and did not result in periprocedural morbidity. At the 1-year follow-up, the patient was neurologically intact with no recurrence on magnetic resonance angiography. LESSONS This case report highlighted the presentation, diagnostic workup, clinical decision-making, and endovascular intervention for a woman who presented with SAH secondary to posterior spinal artery aneurysm. After initially negative results on vascular imaging, dedicated spinal vascular imaging revealed the location of the aneurysm. Multiple treatment modalities exist for isolated spinal artery aneurysms and must be selected on the basis of patient- and lesion-specific characteristics.

Management of thoracic aortic lesions - the future is endovascular

VASA ◽  
2012 ◽  
Vol 41 (3) ◽  
pp. 163-176 ◽  
Author(s):  
Weidenhagen ◽  
Bombien ◽  
Meimarakis ◽  
Geisler ◽  
A. Koeppel
Keyword(s):  
Thoracic Aorta ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Clinical Decision ◽  
Clinical Results ◽  
Treatment Modalities ◽  
Traumatic Rupture ◽  
Descending Thoracic Aorta ◽  
New Treatment ◽  
Aneurysm Dissection

Open surgical repair of lesions of the descending thoracic aorta, such as aneurysm, dissection and traumatic rupture, has been the “state-of-the-art” treatment for many decades. However, in specialized cardiovascular centers, thoracic endovascular aortic repair and hybrid aortic procedures have been implemented as novel treatment options. The current clinical results show that these procedures can be performed with low morbidity and mortality rates. However, due to a lack of randomized trials, the level of reliability of these new treatment modalities remains a matter of discussion. Clinical decision-making is generally based on the experience of the vascular center as well as on individual factors, such as life expectancy, comorbidity, aneurysm aetiology, aortic diameter and morphology. This article will review and discuss recent publications of open surgical, hybrid thoracic aortic (in case of aortic arch involvement) and endovascular repair in complex pathologies of the descending thoracic aorta.

Dissecting Aneurysm of the Posterior Spinal Artery

Neurosurgery ◽  
2012 ◽  
Vol 71 (3) ◽  
pp. E749-E756 ◽  
Author(s):  
Hyun Jeong Kim ◽  
In Sup Choi
Keyword(s):  
Abdominal Pain ◽  
Subarachnoid Hemorrhage ◽  
Arteriovenous Malformations ◽  
Intracranial Aneurysms ◽  
Clinical Presentation ◽  
Artery Aneurysm ◽  
Dissecting Aneurysm ◽  
Posterior Spinal Artery ◽  
Spinal Subarachnoid Hemorrhage ◽  
Distal Flow

Abstract BACKGROUND AND IMPORTANCE: Because of their rarity, the pathogenesis and clinical features of isolated spinal artery aneurysms are still unclear, and their diagnoses and treatments are challenging. We report a case of an isolated posterior spinal artery aneurysm and review previous reports thoroughly to identify the general features of isolated spinal aneurysms. CLINICAL PRESENTATION: A 52-year-old man presented with abdominal pain followed by back pain and radiculopathy from subarachnoid hemorrhage in the spinal canal. The spinal angiogram demonstrated the presence of a dissecting aneurysm of the posterior spinal artery. He was treated by endovascular occlusion of the origin of the radiculopial artery and recovered completely. CONCLUSION: Isolated spinal artery aneurysms are very rare lesions; however, they should be considered in patients with intracranial or spinal subarachnoid hemorrhage without evidence of arteriovenous malformations. Spinal aneurysms have different etiologies compared with intracranial aneurysms. Cervical aneurysms have worse outcomes than thoracolumbar aneurysms. The etiology and location of the lesion and distal flow to the lesion should be taken into consideration when planning the treatment.

DECISION MAKING IN PEDIATRIC SPINAL DEFORMITY

Neurosurgery ◽  
2008 ◽  
Vol 63 (suppl_3) ◽  
pp. A54-A68 ◽  
Author(s):  
Justin S. Smith ◽  
Christopher I. Shaffrey ◽  
Mark F. Abel ◽  
Christopher P. Ames
Keyword(s):  
Decision Making ◽  
Spinal Deformity ◽  
Pediatric Patients ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Nonoperative Treatment ◽  
Treatment Modalities ◽  
Decision Making Process ◽  
History Of ◽  
Diagnosis And Classification

ABSTRACT OBJECTIVE To review the concepts involved in the decision-making process for management of pediatric patients with spinal deformity. METHODS The literature was reviewed in reference to pediatric deformity evaluation and management. RESULTS Pediatric spinal deformity includes a broad range of disorders with differing causes, natural histories, and treatments. Appropriate categorization of pediatric deformities is an important first step in the clinical decision-making process. An understanding of both nonoperative and operative treatment modalities and their indications is requisite to providing treatment for pediatric patients with spinal deformity. The primary nonoperative treatment modalities include bracing and casting, and the primary operative treatments include nonfusion instrumentation and fusion with or without instrumentation. In this article, we provide a review of pediatric spinal deformity classification and an overview of general treatment principles. CONCLUSION The decision-making process in pediatric deformity begins with appropriate diagnosis and classification of the deformity. Treatment decisions, both nonoperative and operative, are often predicated on the basis of the age of the patient and the natural history of the disorder.

scholarly journals Successfully Treated Isolated Posterior Spinal Artery Aneurysm Causing Intracranial Subarachnoid Hemorrhage: Case Report

2015 ◽  
Vol 55 (12) ◽  
pp. 915-919 ◽  
Author(s):  
Yoshinobu HORIO ◽  
Toshiro KATSUTA ◽  
Kazuhiro SAMURA ◽  
Naoki WAKUTA ◽  
Kenji FUKUDA ◽  
...  
Keyword(s):  
Case Report ◽  
Subarachnoid Hemorrhage ◽  
Artery Aneurysm ◽  
Posterior Spinal Artery

The Elderly Psychiatric Patient with Positive Syphilis Serology: The Problem of Neurosyphilis

1998 ◽  
Vol 28 (3) ◽  
pp. 333-339 ◽  
Author(s):  
Ishwer L. Bharwani ◽  
Charles O. Hershey
Keyword(s):  
Elderly Patients ◽  
Clinical Decision Making ◽  
Relevant Literature ◽  
Clinical Decision ◽  
The Elderly ◽  
Illustrative Case ◽  
Positive Serology ◽  
Important Indicator ◽  
Syphilis Serology ◽  
Latent Syphilis

Objective: Older patients have a high prevalence of neurological and psychiatric disorders. They also have a baseline prevalence of late latent syphilis or positive syphilis serology. Thus the clinical question arises as to whether a neuropsychiatric disorder in a geriatric patient is neurosyphilis or if the positive serology is incidental. Method: An illustrative case example is used to illustrate this dilemma. The relevant literature is reviewed. Results: The cerebrospinal fluid (CSF) protein is an important indicator of inflammatory activity in the central nervous system and is used as a clinical guide in the diagnosis. Elderly patients have higher values of normal CSF protein than younger patients. Conclusions: Given the importance of CSF protein in the diagnosis of neurosyphilis, physicians must include this knowledge, that elderly patients have higher CSF protein values, in their clinical decision making in the differentiation between neurosyphilis and late latent syphilis in the elderly patient.

Isolated Posterior Spinal Artery Aneurysm Presenting with Spontaneous Thrombosis After Subarachnoid Hemorrhage

2020 ◽  
Vol 134 ◽  
pp. 544-547 ◽  
Author(s):  
Kento Takebayashi ◽  
Tomomi Ishikawa ◽  
Masato Murakami ◽  
Takayuki Funatsu ◽  
Tasuya Ishikawa ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Artery Aneurysm ◽  
Spontaneous Thrombosis ◽  
Posterior Spinal Artery

Compression hosiery for venous disorders and oedema: a question of balance

2020 ◽  
Vol 25 (Sup9) ◽  
pp. S26-S32
Author(s):  
Jeanette Muldoon ◽  
Sylvie Hampton ◽  
Sarah Gray ◽  
Trish Cosham
Keyword(s):  
Clinical Decision Making ◽  
Compression Therapy ◽  
Clinical Decision ◽  
Self Management ◽  
Treatment Modalities ◽  
Treatment Pathway ◽  
Compression Bandages ◽  
New Type ◽  
Venous Disorders

Compression therapy for venous and lymphatic conditions may be delivered via a range of treatment modalities using many different technologies, depending on the patient's condition and needs. Clinical decision-making relies on accurate assessment of the patient, their presenting and underlying clinical condition, skill and training of the applier and the available resources. However, changes in the patient's condition or lifestyle may necessitate re-evaluation of the treatment pathway. Generally, compression bandages and Velcro wraps are used in the intensive acute phase of treatment, with self-management using compression hosiery or wraps being used for long-term maintenance to prevent recurrence. Although guidelines recommend the highest class of compression hosiery for maximum effectiveness, clinical evidence shows practical challenges associated with application and tolerance of higher pressures and stiffness. An audit of a new type of compression garment was conducted, and it showed that incorporating stiffness into circular knitted hosiery helped overcome some of these challenges with improvements in limb size, skin softening and wound size. Additionally, self-management was facilitated by the ease of donning and doffing.

Abstract P547: Cardiac Arrest in Patients Who Present With Subarachnoid Hemorrhage is Associated With Worse Outcomes

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Gurkamal Kaur ◽  
Jose Dominguez ◽  
Rosa Semaan ◽  
Leanne Fuentes ◽  
Jonathan Ogulnick ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Subarachnoid Hemorrhage ◽  
Large Scale ◽  
Clinical Decision Making ◽  
Population Data ◽  
Clinical Decision ◽  
Small Sample ◽  
P Value ◽  
Dismal Prognosis ◽  
Scale Population

Introduction: Subarachnoid hemorrhage (SAH) can be a devastating neurologic condition that leads to cardiac arrest (CA), and ultimately poor clinical outcomes. Existing literature on this subject reveal a dismal prognosis when analyzing relatively small sample sizes. We aimed to further elucidate the incidence, mortality rates, and outcomes of CA patients with SAH using large-scale population data. Methods: A retrospective cohort study was conducted using the National Inpatient Sample (NIS) database. Patients included in the study met criteria using International Classification of Diseases (ICD) codes 9th and 10th edition of: non-traumatic SAH, CA cause unspecified, and CA due to other underlying conditions between 2008 and 2014. For all regression analyses, a p-value of <0.05 was considered statistically significant. Results: We identified 170,869 patients hospitalized for non-traumatic SAH. Within these, there was a 3.17% incidence of CA. The mortality rate in CA with SAH was 82% (vs non-CA 18.4%, p< 0.001). Of the survivors of CA with SAH, 15.7% were discharged to special facilities and services (vs non-CA 37.6%, p<0.0001). The remaining 2.3% were discharged home (vs non-CA 44.0%, p<.0001). Higher NIS SAH severity score (NIS-SSS) was a predictor of CA in SAH patients (p <.0001). Patients treated with aneurysm clipping and coiling had lower odds ratio of CA (p <.0001). Conclusion: The study confirms the poor prognosis of patients with CA and SAH using large-scale population data. Patients that underwent aneurysm treatment show lower association with CA. Findings presented here provide useful data for clinical decision making and guiding goals of care discussion with family members. Further studies may identify interventions and protocols for treatment of these severely ill patients.

Review: Laboratory markers quantifying prothrombin activation and actions of thrombin in venous and arterial thrombosis do not accurately assess disease severity or the effectiveness of treatment

2006 ◽  
Vol 96 (11) ◽  
pp. 568-577 ◽  
Author(s):  
Frederick Ofosu
Keyword(s):  
Venous Thrombosis ◽  
Arterial Thrombosis ◽  
Cell Activation ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Thrombin Inhibitors ◽  
Treatment Modalities ◽  
Patients At Risk ◽  
Effective Drugs

SummaryThrombin is normally produced for hemostasis and physiological wound healing. Increased thrombin production in vivo, cell activation and inflammation mediated in part by thrombin are hallmarks of both arterial and venous thrombosis. Thrombin generates (pro) coagulant, mitogenic, inflammatory and anticoagulant responses by interacting witha variety of cells in vivo.Both direct and indirect thrombin inhibitors are effective drugs for preventing and treating the consequences of arterial and venous thrombosis. For these reasons, measurements of the production and activities of thrombin in vivo have the potential for gauging the extent of thromboembolism and the responses of patients to anticoagulant, antiplatelet and anti-inflammatory drugs. How-ever, a critical review of published information suggests that measurement of thrombin production and activity in patients at risk for and in patients with significant thrombosis generally does not provide information useful for clinical decision-making. This lack of clinical utility of levels of thrombin production in vivo may arise from two causes: the inability of the measurement to differentiate between physiological (hemostatic) and disease-related (pathological) sources and/or causes of thrombin production in vivo, and the inability of antithrombotic treatment modalities to permanently eliminate the stimuli that cause increased thrombin production evident in venous and arterial thrombosis.

scholarly journals Decision Support Systems in Prostate Cancer Treatment: An Overview

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Y. van Wijk ◽  
I. Halilaj ◽  
E. van Limbergen ◽  
S. Walsh ◽  
L. Lutgens ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Support ◽  
Clinical Decision Making ◽  
Decision Aids ◽  
External Beam Radiotherapy ◽  
Clinical Decision ◽  
Treatment Modalities ◽  
Patient Decision ◽  
Specific Advice ◽  
Support Tools

Background. A multifactorial decision support system (mDSS) is a tool designed to improve the clinical decision-making process, while using clinical inputs for an individual patient to generate case-specific advice. The study provides an overview of the literature to analyze current available mDSS focused on prostate cancer (PCa), in order to better understand the availability of decision support tools as well as where the current literature is lacking. Methods. We performed a MEDLINE literature search in July 2018. We divided the included studies into different sections: diagnostic, which aids in detection or staging of PCa; treatment, supporting the decision between treatment modalities; and patient, which focusses on informing the patient. We manually screened and excluded studies that did not contain an mDSS concerning prostate cancer and study proposals. Results. Our search resulted in twelve diagnostic mDSS; six treatment mDSS; two patient mDSS; and eight papers that could improve mDSS. Conclusions. Diagnosis mDSS is well represented in the literature as well as treatment mDSS considering external-beam radiotherapy; however, there is a lack of mDSS for other treatment modalities. The development of patient decision aids is a new field of research, and few successes have been made for PCa patients. These tools can improve personalized medicine but need to overcome a number of difficulties to be successful and require more research.

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