Heparin-induced thrombocytopenia and thrombosis following subarachnoid hemorrhage

2000 ◽  
Vol 93 (1) ◽  
pp. 136-139 ◽  
Author(s):  
Ian F. Parney ◽  
David E. Steinke
Keyword(s):  
Platelet Count ◽  
Subarachnoid Hemorrhage ◽  
Large Body ◽  
Artery Aneurysm ◽  
Left Middle Cerebral Artery ◽  
Cerebral Angiogram ◽  
Related Disorder ◽  
Heparin Induced Thrombocytopenia ◽  
Content Type ◽  
Fine Print

U The authors present a case of heparin-induced thrombocytopenia and thrombosis (HITT) that occurred after aneurysmal subarachnoid hemorrhage (SAH), and they review the relevant literature. An immune-mediated syndrome, HITT is characterized by moderate thrombocytopenia and paradoxical vascular thromboses. Although it has been estimated in prospective studies that HITT occurs in between 1 and 3% of patients receiving heparin, it is underrecognized in the neurosurgical literature. In the present case, a 49-year-old woman underwent clipping of a right posterior communicating artery aneurysm after suffering a Hunt and Hess Grade III SAH. She had an uncomplicated postoperative course with good clip positioning and no vasospasm observed on a cerebral angiogram obtained on Day 7.On Day 23, the patient developed a right hemiparesis and experienced a grand mal seizure. A head computerized tomography scan revealed a hemorrhagic infarct in the left middle cerebral artery distribution. Repeated cerebral angiograms did not show vasospasm. She was thrombocytopenic (platelet count as low as 46 × 109/L on Day 28 compared with 213 × 109/L on Day 1) and had been receiving heparin flushes to maintain intravenous catheter patency. An assay for HITT-associated antibodies was positive. The heparin flushes were discontinued and the platelet count recovered (121 × 109/L). She improved neurologically, but was left with a significant right hemiparesis at discharge. This patient had assay-proven heparin-induced thrombocytopenia despite minimal exposure to heparin. Because there was no evidence of vasospasm or other factors to account for her delayed hemorrhagic infarction, an HITT-related disorder seemed most likely. Despite a large body of literature describing HITT in nonneurosurgical patients, only three previous neurosurgical cases have been published. This case report may serve to heighten awareness of this disorder.

Paradoxical aggravation of vasospasm with papaverine infusion following aneurysmal subarachnoid hemorrhage

1996 ◽  
Vol 84 (4) ◽  
pp. 690-695 ◽  
Author(s):  
Brent L. Clyde ◽  
Andrew D. Firlik ◽  
Anthony M. Kaufmann ◽  
MichaelP. Spearman ◽  
Howard Yonas
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Artery ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Left Middle Cerebral Artery ◽  
Xenon Ct ◽  
Content Type ◽  
Symptomatic Vasospasm ◽  
Fine Print

✓ Reports of intraarterial papaverine infusion as treatment for cerebral vasospasm are few and documented complications are uncommon. The authors report the case of a patient with paradoxical aggravation of cerebral arterial narrowing during selective intraarterial papaverine infusion intended to treat vasospasm following aneurysmal subarachnoid hemorrhage (SAH). A 48-year-old man presented to the authors' service with symptomatic vasospasm 10 days after experiencing an SAH. The ruptured anterior communicating artery aneurysm was surgically obliterated the following day, and thereafter maximum hypervolemic and hypertensive therapies were used. However, the patient remained lethargic, and a stable xenon—computerized tomography (CT) cerebral blood flow (CBF) study revealed CBF to be 15 cc/100 g/minute in the left anterior cerebral artery (ACA) and 25 cc/100 g/minute in the right ACA territories. Cerebral arteriography demonstrated diffuse severe left ACA and mild left middle cerebral artery (MCA) vasospasm. In response intraarterial papaverine was infused into the internal carotid artery just proximal to the ophthalmic artery. During the infusion the patient became aphasic and exhibited right hemiplegia. Arteriography performed immediately after the intraarterial papaverine infusion revealed diffuse exacerbation of vasospasm in the distal ACA and MCA territories. A repeat xenon—CT CBF study showed that CBF in the left ACA and the MCA had drastically decreased (2 cc/100 g/minute and 10 cc/100 g/minute, respectively). Despite aggressive management, infarction ultimately developed. This is the first clinical case to illustrate a paradoxical effect of intraarterial papaverine treatment for vasospasm following aneurysmal SAH. The possible mechanisms of this paradoxical response and potential therapeutic reactions are reviewed.

Postendarterectomy heparin-induced thrombocytopenia

1988 ◽  
Vol 69 (4) ◽  
pp. 632-634 ◽  
Author(s):  
Larry A. Rogers
Keyword(s):  
Platelet Count ◽  
Vascular Surgery ◽  
Carotid Endarterectomy ◽  
Potential Problem ◽  
Anticoagulation Therapy ◽  
Massive Bleeding ◽  
Drug Induced ◽  
Heparin Induced Thrombocytopenia ◽  
Content Type ◽  
Fine Print

✓ Two episodes of massive bleeding from a sutured arteriotomy were observed within 30 hours after carotid endarterectomy. The patient had received anticoagulation therapy with heparin for 72 hours prior to surgery. A platelet count of 93,000/cu mm was demonstrated following the second hemorrhage. The potential problem of drug-induced thrombocytopenia following vascular surgery is discussed.

Decrease in platelet count as an independent risk factor for symptomatic vasospasm following aneurysmal subarachnoid hemorrhage

2005 ◽  
Vol 102 (5) ◽  
pp. 882-887 ◽  
Author(s):  
Yutaka Hirashima ◽  
Hideo Hamada ◽  
Masanori Kurimoto ◽  
Hideki Origasa ◽  
Shunro Endo
Keyword(s):  
Platelet Count ◽  
Subarachnoid Hemorrhage ◽  
Blood Cells ◽  
White Blood Cells ◽  
Experimental Studies ◽  
Content Type ◽  
Symptomatic Vasospasm ◽  
Cell Counts ◽  
Fisher Grade ◽  
Fine Print

Object. Increased platelet consumption is expected in patients with cerebral vasospasm, according to data from clinical and experimental studies. The authors investigated sequential changes in platelet counts in patients with subarachnoid hemorrhage (SAH) and the difference in platelet consumption between patients with and those without symptomatic vasospasm (SV). Variables related to platelet count as well as other clinical and radiological variables were analyzed as independent predictors of SV. Methods. One hundred consecutive patients who had undergone surgery within 48 hours after SAH onset were entered in the study. Clinical and radiological variables and blood cell counts, including red blood cells, white blood cells, and platelets, after SAH were retrospectively examined. Twenty of these variables were entered into univariate and multivariate analyses to determine predictors for SV. After SAH, the platelet count decreased to a minimum and then increased rapidly to levels greater than those recorded on admission. This change was specific to SAH, and platelet consumption was more severe in patients with SV than in those without. There were three independent predictors of SV: a ratio of the lowest platelet count and the admission count greater than 0.7 (odds ratio [OR] 0.322, 95% confidence interval [CI] 0.124–0.834, p = 0.0196) and a history of hypertension (OR 0.338, 95% CI 0.126–0.906, p = 0.0311) were negatively significant (that is, decreases the occurrence of SV), and a Fisher Grade 3 (OR 4.42, 95% CI 1.48–13.2, p = 0.0077) was positively significant (that is, increases the occurrence of SV). Conclusions. The association between a decrease in platelet count and the occurrence of SV indicates the important role of platelets in the pathophysiology of vasospasm following SAH.

Direct surgical obliteration of a persistent trigeminal artery aneurysm

1974 ◽  
Vol 40 (2) ◽  
pp. 249-251 ◽  
Author(s):  
Glenn Morrison ◽  
William M. Hegarty ◽  
Charles C. Brausch ◽  
Theodore J. Castele ◽  
Rorert J. White
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Operative Treatment ◽  
Artery Aneurysm ◽  
Persistent Trigeminal Artery ◽  
Fusiform Aneurysm ◽  
Trigeminal Artery ◽  
Content Type ◽  
Fine Print

✓ A woman with a fusiform aneurysm of a persistent trigeminal artery sustained a subarachnoid hemorrhage and presented with hypalgesia in the distribution of the maxillary and mandibular nerves. The first successful direct operative treatment of this rare aneurysm is reported.

A true mycotic (Aspergillus) aneurysm leading to fatal subarachnoid hemorrhage in a patient with hereditary hemorrhagic telangiectasia

1971 ◽  
Vol 35 (1) ◽  
pp. 71-76 ◽  
Author(s):  
Peter Davidson ◽  
David M. Robertson
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Basilar Artery ◽  
Hereditary Hemorrhagic Telangiectasia ◽  
Artery Aneurysm ◽  
Content Type ◽  
Intracranial Involvement ◽  
Basilar Artery Aneurysm ◽  
Fine Print

✓ A mycotic basilar artery aneurysm, in which Aspergillus was identified histologically, was found to be the cause of a massive subarachnoid hemorrhage in a 75-year-old man who suffered from hereditary hemorrhagic telangiectasia; there was no evidence of intracranial involvement by the latter disorder.

Subarachnoid hemorrhage possibly caused by a saccular carotid artery aneurysm within the cavernous sinus

1990 ◽  
Vol 73 (2) ◽  
pp. 301-304 ◽  
Author(s):  
Tatsuya Nishioka ◽  
Akinori Kondo ◽  
Ikuhiro Aoyama ◽  
Kiyoshi Nin ◽  
Jun Takahashi
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Surgical Approach ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Content Type ◽  
Carotid Artery Aneurysm ◽  
Fine Print

✓ Aneurysms arising from the intracavernous portion of the internal carotid artery very rarely rupture. A patient is presented in whom rupture of an aneurysm wholly within the cavernous sinus caused a subarachnoid hemorrhage. The aneurysm was successfully clipped via a direct surgical approach. The possible mechanism by which subarachnoid hemorrhage occurred is briefly discussed.

Reduced platelet function in subarachnoid hemorrhage

1986 ◽  
Vol 64 (6) ◽  
pp. 907-910 ◽  
Author(s):  
Sotirios A. Tsementzis ◽  
Jaswinder S. Gill ◽  
Edward R. Hitchcock ◽  
Jennifer A. Hartley ◽  
Surinder K. Gill ◽  
...  
Keyword(s):  
Platelet Count ◽  
Subarachnoid Hemorrhage ◽  
Platelet Aggregation ◽  
Platelet Function ◽  
Maximum Rate ◽  
Adenosine Diphosphate ◽  
Platelet Adhesiveness ◽  
Content Type ◽  
Aneurysmal Rupture ◽  
Fine Print

✓ The hypothesis that abnormalities of platelet function may relate to the occurrence or recurrence of subarachnoid hemorrhage (SAH) has been examined. Seventy patients with SAH and 65 control individuals were studied. The adenosine diphosphate (ADP) threshold for secondary platelet aggregation was significantly higher in the SAH group than in the controls. In tests using 4.0 µg/ml ADP, the percent platelet aggregation (at 2 minutes) and the maximum rate of platelet aggregation (over 20 seconds) were significantly lower in the SAH patients. There was no difference in total platelet count between the two groups. Platelet adhesiveness was lower in the SAH patients when compared to controls. Circulating microaggregates did not differ between the two groups. The results indicate that reduced platelet function does relate to SAH and may either contribute to aneurysmal rupture in cases of SAH or be a consequence of it.

The minor leak preceding subarachnoid hemorrhage

1987 ◽  
Vol 66 (1) ◽  
pp. 35-39 ◽  
Author(s):  
Richard Leblanc
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Lumbar Puncture ◽  
Computerized Tomography ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Content Type ◽  
A Minor ◽  
Fine Print

✓ Thirty-four of 87 consecutive patients with subarachnoid hemorrhage from a cerebral aneurysm had a premonitory minor leak. There were 12 men and 22 women, aged 25 to 73 years (mean 44.4 years). Twenty-two had a small and 12 had a large aneurysm located on the internal carotid artery (17 cases), anterior communicating artery (10 cases), middle cerebral artery (five cases), and pericallosal artery (two cases). Fifty-two percent of patients with a minor leak from an internal carotid artery aneurysm had ipsilateral, hemicranial, hemifacial, or periorbital pain. Half of the patients initially saw a physician, but in no case was the correct diagnosis made. Twenty-five patients had a major rupture within 24 hours to 4 weeks after findings suggesting a minor leak, with a mortality rate of 53%. Nine other patients were diagnosed by lumbar puncture or computerized tomography (CT) scanning after initial misdiagnosis and were operated on, without mortality, before a major rupture could occur. The CT scans were negative in 55% of patients with a minor leak, but lumbar puncture, when performed, was always positive. A minor leak prior to major aneurysmal rupture is a common occurrence and, if unrecognized, is associated with a high mortality. Computerized tomography scanning is unreliable in diagnosing this event, and lumbar puncture is the examination of choice once intracranial hypertension has been ruled out.

Cognition following subarachnoid hemorrhage from anterior communicating artery aneurysm: relation to timing of surgery

1999 ◽  
Vol 91 (3) ◽  
pp. 402-407 ◽  
Author(s):  
Nahal Mavaddat ◽  
Barbara J. Sahakian ◽  
Peter J. A. Hutchinson ◽  
Peter J. Kirkpatrick
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Temporal Lobe ◽  
Neurological Outcome ◽  
Artery Aneurysm ◽  
Timing Of Surgery ◽  
Anterior Communicating Artery ◽  
Content Type ◽  
Significant Difference ◽  
Favorable Neurological Outcome ◽  
Fine Print

Object. This study was conducted to define neuropsychological changes following operation for subarachnoid hemorrhage (SAH) caused by rupture of an anterior communicating artery (ACoA) aneurysm and to assess the influence of the timing of surgery to clip the aneurysm.Methods. Cognitive outcome was evaluated using the Cambridge Neuropsychological Test Automated Battery in patients with an ACoA aneurysm that had caused an SAH. Adult patients younger than 70 years of age who had achieved a favorable neurological outcome (Glasgow Outcome Scale scores of 4 or 5) were studied 6 to 24 months postsurgery. Patients were divided into early (Days 0–3) and late surgery groups (after Day 3) according to the timing of surgery after the ictus. Neuropsychological analysis was performed by reviewers who were blinded to the timing of surgery.Forty-seven patients whose mean age was 51.5 years were tested. They were compared with age- and intelligence quotient (IQ)—matched controls by using premorbid IQ as estimated on the National Adult Reading Test. Patients showed deficiencies in several tasks of verbal fluency, pattern recognition, and spatial working memory; this profile of deficits was similar to that seen in patients who underwent temporal lobe excisions. However, there was no significant difference in cognitive performance between the early and late surgery groups.Conclusions. After open surgery for ruptured ACoA aneurysms, patients who have achieved a favorable neurological outcome still exhibit significant cognitive deficits, primarily in tests sensitive to temporal lobe dysfunction. However, early surgery does not carry a higher risk of neuropsychological disability.

Disappearance and reappearance of cerebral aneurysm in serial arteriograms

1974 ◽  
Vol 41 (4) ◽  
pp. 508-510 ◽  
Author(s):  
Robert F. Spetzler ◽  
David Winestock ◽  
Hans T. Newton ◽  
Edwin B. Boldrey
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Aneurysm ◽  
Conservative Management ◽  
Artery Aneurysm ◽  
Content Type ◽  
Fine Print

✓ A case is reported in which a left frontopolar artery aneurysm was demonstrated, disappeared, and then reappeared in a series of angiographic studies obtained during the conservative management of two episodes of subarachnoid hemorrhage. Only 23 days separated the first and last angiograms; three days later the aneurysm was successfully clipped.

Sign in / Sign up

Export Citation Format

Share Document