The use of recombinant activated factor VII to reverse warfarin-induced anticoagulation in patients with hemorrhages in the central nervous system: preliminary findings

2003 ◽  
Vol 98 (4) ◽  
pp. 737-740 ◽  
Author(s):  
Julian Lin ◽  
William C. Hanigan ◽  
Michael Tarantino ◽  
John Wang
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Fresh Frozen Plasma ◽  
Factor Vii ◽  
Hemostatic Agent ◽  
Recombinant Activated Factor Vii ◽  
Content Type ◽  
Activated Factor Vii ◽  
The Central Nervous System ◽  
Fine Print

Object. In this report the authors describe the use of the hemostatic agent recombinant activated factor VII (rFVIIa) in the perioperative treatment of hemorrhages in the central nervous system that are associated with warfarin therapy. Methods. Two patients sustained hemorrhages within the spinal canal, and the other two had acute intracranial subdural hematomas. All patients had normal platelet counts, activated partial thromboplastin times, and fibrinogen levels, and all received fresh frozen plasma in conjunction with rFVIIa. The initial international normalized ratios (INRs) ranged from 1.9 to 5.6. Each dose of rFVIIa was 1200 µg, ranging from 16 to 22 µg/kg of body weight. Two patients received two perioperative doses of rFVIIa; the others required just one dose before surgery. The INR normalized within 2 hours of administration of rFVIIa in all patients. There were no thromboembolic complications, and surgical blood loss was less than 100 ml for all operations. Conclusions. This clinical experience indicates that rFVIIa may be safe and effective as the initial hemostatic agent for rapid reversal of orally administered anticoagulation medications in patients who require urgent neurosurgical intervention.

Recombinant activated factor VII for cerebral injury—induced coagulopathy in pediatric patients

2003 ◽  
Vol 98 (3) ◽  
pp. 611-616 ◽  
Author(s):  
John David Morenski ◽  
Joseph D. Tobias ◽  
David F. Jimenez
Keyword(s):  
Injured Patient ◽  
Fresh Frozen Plasma ◽  
Cerebral Injury ◽  
Factor Vii ◽  
Recombinant Activated Factor Vii ◽  
Content Type ◽  
Activated Factor Vii ◽  
Fresh Frozen ◽  
Repeated Doses ◽  
Fine Print

✓ Brain injury remains one of the leading causes of death and disability in children. Appropriate therapy involves aggressive management of intracranial pressure (ICP) and cerebral perfusion pressure, which often requires placement of an intraparenchymal ICP monitor or intraventricular catheter. These potentially life-saving interventions require normal coagulation function; however, several factors may lead to coagulopathy in the head-injured patient. Standard therapies, which often include multiple doses of fresh frozen plasma (FFP), have a number of drawbacks when used in the pediatric population. The use of FFP requires time to type and crossmatch, thaw, and administer. It imposes a significant volume load on a child in whom cerebral edema remains a problem. Success in using recombinant activated factor VII (rFVIIa) in the hemophiliac population suggests an alternative therapy. Three patients suffered severe coagulopathy after cerebral injury. One patient received rFVIIa after repeated doses of FFP had failed to correct the coagulopathy; the other two patients received rFVIIa as the initial therapy. Treatment with rFVIIa consisted of a bolus of 90 µg/kg. Recombinant activated factor VII rapidly corrected the patients' coagulopathies, which allowed placement of intraparenchymal fiberoptic lines and intraventricular catheters to monitor ICP. The patients suffered no complication from the placement of ICP monitoring devices, as demonstrated on computerized tomography scans obtained within 24 hours after placement. Brain injury—induced coagulopathy may lead to significant secondary injury and delays the invasive monitoring necessary for the aggressive management of intracranial hypertension. Fresh frozen plasma takes time to administer, may require repeated doses of significant volume for the pediatric patient, and may ultimately fail. Preliminary data indicated that rFVIIa provides a rapid and successful correction of coagulopathy in the head-injured patient.

scholarly journals Safety of Recombinant Activated Factor VII in Patients With Warfarin-Associated Hemorrhages of the Central Nervous System

Stroke ◽  
2010 ◽  
Vol 41 (7) ◽  
pp. 1459-1463 ◽  
Author(s):  
Maisha T. Robinson ◽  
Alejandro A. Rabinstein ◽  
James F. Meschia ◽  
William D. Freeman
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Factor Vii ◽  
Recombinant Activated Factor Vii ◽  
Activated Factor Vii ◽  
The Central Nervous System

Cerebral sparganosis

1990 ◽  
Vol 73 (1) ◽  
pp. 147-150 ◽  
Author(s):  
Andrew Mitchell ◽  
Bernd W. Scheithauer ◽  
Patrick J. Kelly ◽  
Glenn S. Forbes ◽  
Jon E. Rosenblatt
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Surgical Removal ◽  
Asian Countries ◽  
Content Type ◽  
Chronic Abscess ◽  
The Central Nervous System ◽  
Cerebral Sparganosis ◽  
Tapeworm Infection ◽  
Fine Print

✓ The tapeworm Spirometra mansonoides infects man worldwide, particularly in Asian countries. Rarely, the central nervous system is involved; such a case is presented here. In the total of 12 reported cases, including the case described, the worm presented clinically as a mass suspicious for neoplasm or chronic abscess cavity. Surgical removal was invariably curative in each case. Although infrequent, the possibility of tapeworm infection should be entertained in the evaluation of intracranial masses in patients who have visited exotic locales.

Central nervous system mesenchymal chondrosarcoma

1984 ◽  
Vol 61 (2) ◽  
pp. 375-381 ◽  
Author(s):  
Griffith R. Harsh ◽  
Charles B. Wilson
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Vascular Tumor ◽  
Mesenchymal Chondrosarcoma ◽  
Content Type ◽  
Meningeal Tumor ◽  
The Central Nervous System ◽  
Initial Resection ◽  
Mesenchymal Chondrosarcomas ◽  
Fine Print

✓ Local recurrence developed 6 years after the initial resection of an intraspinal meningeal tumor that originally was thought to be an angioblastic meningioma. Histological review of the pathology led to a change of that diagnosis to one of mesenchymal chondrosarcoma. The recurrent vascular tumor was embolized, then totally excised. Because this tumor had malignant features, the patient received irradiation and chemotherapy. No evidence of regrowth has been observed during a period of more than 4 years. Mesenchymal chondrosarcomas of the central nervous system and their treatment are reviewed.

Epidermoid and dermoid cysts

1977 ◽  
Vol 47 (1) ◽  
pp. 12-18 ◽  
Author(s):  
Beniamino Guidetti ◽  
Franco M. Gagliardi
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Postoperative Complications ◽  
Clinical Data ◽  
Late Results ◽  
Content Type ◽  
Operating Technique ◽  
The Central Nervous System ◽  
Fine Print

✓ The authors report on the clinical data, operating technique, postoperative complications, and late results in a series of 31 epidermoid and 21 dermoid cysts of the central nervous system.

Cerebral hemangioma with glial neoplasia (angioglioma?)

1982 ◽  
Vol 56 (3) ◽  
pp. 430-434 ◽  
Author(s):  
Edwin G. Fischer ◽  
Ana Sotrel ◽  
Keasley Welch
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
The Other ◽  
Content Type ◽  
Growth Reference ◽  
Biological Potential ◽  
Cavernous Hemangiomas ◽  
The Central Nervous System ◽  
Mass Lesions ◽  
Fine Print

✓ Two patients are reported who had intracerebral mass lesions composed of hemangioma and glial neoplasm. After excision, one recurred as an oligodendroglioma, and the remnant of the other remained static over a 5-year period. These lesions may represent a subgroup of cerebral hemangiomas that have the biological potential for future glial neoplastic growth. Reference is made to experimental work with polyoma virus which can induce cavernous hemangiomas in the central nervous system in mice, and which is a papovavirus. Other papovaviruses can induce ependymomas in hamsters.

Cerebellar metastasis from a prolactinoma during treatment with bromocriptine

1981 ◽  
Vol 55 (4) ◽  
pp. 615-619 ◽  
Author(s):  
Neil A. Martin ◽  
Martha Hales ◽  
Charles B. Wilson
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Pituitary Adenoma ◽  
Pituitary Tumors ◽  
Metastatic Tumor ◽  
Metastatic Spread ◽  
Content Type ◽  
The Central Nervous System ◽  
Cerebellar Metastasis ◽  
Fine Print

✓ A 31-year-old woman developed a cerebellar metastasis from an invasive prolactin-secreting pituitary adenoma while undergoing treatment with bromocriptine. The metastatic tumor was totally excised. Metastatic spread of pituitary tumors within the central nervous system is reviewed briefly.

Superficial siderosis of the central nervous system after brachial plexus injury

1994 ◽  
Vol 80 (5) ◽  
pp. 931-934 ◽  
Author(s):  
Virginio Bonito ◽  
Cristina Agostinis ◽  
Stefano Ferraresi ◽  
Carlo Alberto Defanti
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Hearing Loss ◽  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Superficial Siderosis ◽  
Content Type ◽  
Initial Symptoms ◽  
The Central Nervous System ◽  
Fine Print

✓ Superficial siderosis is a rare condition characterized by deposition of hemosiderin in the leptomeninges and in the subpial layers of the brain and spinal cord. It is associated with cerebrospinal fluid abnormalities consistent with recurrent bleeding into the subarachnoid space. The usual symptoms are hearing loss, ataxia, spastic paraparesis, sensory and sphincter deficits, and mental deterioration. A case is presented of severe superficial siderosis of the central nervous system in a 51-year-old man who had suffered a brachial plexus injury at the age of 20 years. The diagnosis was made by means of magnetic resonance imaging 16 years after the initial symptoms, which comprised bilateral hearing loss and anosmia. Subarachnoid bleeding was due to traumatic pseudomeningocele of the brachial plexus, a very unusual cause of superficial siderosis. This case is interesting insofar as the surgical treatment prevented further bleeding and possibly progression of the disease.

Actinomycotic granuloma of the Gasserian ganglion with primary site in a dental root

1981 ◽  
Vol 54 (4) ◽  
pp. 553-555 ◽  
Author(s):  
Enrico Perna ◽  
R. Liguori ◽  
G. Petrone ◽  
E. Mannarino
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Special Reference ◽  
Unusual Case ◽  
Primary Site ◽  
Pathological Diagnosis ◽  
Gasserian Ganglion ◽  
Content Type ◽  
The Central Nervous System ◽  
Fine Print

✓ An unusual case of cerebral actinomycosis of the Gasserian ganglion is reported. The location and the pathological diagnosis of granuloma are both extremely rare. The literature is briefly reviewed with special reference to similar reports. The manner of spread and the course of the disease are described. The present case tends to confirm the opinion that primary cerebral actinomycosis is extremely rare and probably does not exist. The case also definitely indicates that the organism reaches the central nervous system by way of nerve or perineural pathways.

Primary malignant lymphoma of the central nervous system

1986 ◽  
Vol 65 (5) ◽  
pp. 600-607 ◽  
Author(s):  
Kevin Murray ◽  
Larry Kun ◽  
James Cox
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Malignant Lymphoma ◽  
Primary Tumor ◽  
Craniospinal Irradiation ◽  
Late Relapse ◽  
Prior History ◽  
Content Type ◽  
The Central Nervous System ◽  
Fine Print

✓ Eleven patients with primary malignant lymphoma of the central nervous system (CNS) were treated at the Medical College of Wisconsin Affiliated Hospitals between 1964 and 1984. Three patients had a prior history of immunosuppressive therapy following renal transplantation. All patients had biopsy-proven disease and 10 of the 11 were treated with external radiation therapy. The doses to the primary tumor ranged from 34 to 59.4 Gray (Gy). Actuarial (life-table) survival rate was 82% at 1 year and 43% at 3 years. No recurrence was seen after 13 months. Eighty-six reports totaling 693 cases of primary malignant lymphoma of the CNS were found in the literature. Of these, 308 cases were treated with a combination of surgery and irradiation. Overall survival at 5 years for those patients who received more than 50 Gy compared with less than 50 Gy to the primary tumor was 42.3% versus 12.8% (p < 0.05). Twenty-one patients survived longer than 5 years. Late relapse was notable, with 10 (47.6%) of 21 tumors recurring between 5 and 12.5 years after diagnosis. Based on this review, a minimum of 50 Gy radiation to the primary tumor is recommended. While no statement regarding the efficacy of craniospinal irradiation or chemotherapy can be made in view of the small numbers, the use of craniospinal irradiation and/or systemic chemotherapy should be considered for future trials.

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