scholarly journals Blunt Cerebrovascular Injury with Severe Head Injury

2021 ◽  
Vol 4 (4) ◽  
Keyword(s):  
Head Injury ◽  
Treatment Guidelines ◽  
Spinous Process ◽  
Anticoagulation Therapy ◽  
Morbidity And Mortality ◽  
Definitive Treatment ◽  
Blunt Cerebrovascular Injury ◽  
Decompressive Hemicraniectomy ◽  
The Road ◽  
Cerebrovascular Injury

Blunt Cerebrovascular Injury (BCVI) are rare and comprises of less than 1% of total head injury in our tertiary neurocenter. This leads to significant morbidity and mortality of patient. This case report is to focus on the BCVI with head injury. Because of rarity of this disease, there’s no treatment guidelines. However whatever the treatment we have is based on the experience of the surgeons/physician our case came to our Emergency Room with alleged history of lying along the road side in pool of blood .He was evaluated in peripheral hospital and he was later transferred to our center. Patient on evaluation was found to have transaction of Right ICA just distal to right Common carotid artery bifurcation. There was associated fracture of spinous process C5, C6. Probable mechanism of injury was sudden hyperextension of neck. Patient presented with delayed stroke following BCVI. He was managed with Right Decompressive hemicraniectomy and anticoagulation therapy was started for Right ICA injury. Thus early diagnosis and treatment of Blunt Cerebrovascular injury is essential in traumatic brain injury patients with risk factors for BCVI for definitive treatment of vascular injury with either stenting or surgery and thereby limiting morbidity and mortality of the patient.

scholarly journals Blunt cerebrovascular injury in the geriatric population

2020 ◽  
Vol 49 (4) ◽  
pp. E10
Author(s):  
Diana T. Le ◽  
Kinsey A. Barhorst ◽  
James Castiglione ◽  
George L. Yang ◽  
Sanjit J. Shah ◽  
...  
Keyword(s):  
Motor Vehicle ◽  
Adult Population ◽  
The Elderly ◽  
Morbidity And Mortality ◽  
Categorical Variables ◽  
Clinical Implications ◽  
Blunt Cerebrovascular Injury ◽  
Geriatric Population ◽  
Discharge Disposition ◽  
Cerebrovascular Injury

OBJECTIVEBlunt cerebrovascular injury (BCVI) is associated with high rates of neurological morbidity and mortality. The detection and management of BCVI has improved with advances in imaging and sensitive screening protocols. Few studies have explored how these injuries specifically affect the geriatric population. The purpose of this retrospective analysis was to investigate the presentation and prognosis of BCVI in the elderly population and to assess its clinical implications in the management of these patients.METHODSAll patients presenting to the University of Cincinnati (UC) level I trauma center between February 2017 and December 2019 were screened for BCVI and entered into the prospectively maintained UC Neurotrauma Registry. Patients with BCVI confirmed by CT angiography underwent retrospective chart reviews to collect information regarding demographics, positive screening criteria, cause of injury, antithrombotic agent, injury location, Denver Grading Scale, hospital and ICU length of stay, and discharge disposition. Patients were divided into geriatric (age ≥ 65 years) and adult (age < 65 years) subgroups. Continuous variables were analyzed using the Student t-test and categorical variables with the Pearson chi-square test.RESULTSOf 124 patients with BCVI, stratification by age yielded 23 geriatric and 101 adult patients. Injury in the geriatric group was associated with significantly higher mortality (p = 0.0194). The most common cause of injury in the elderly was falls (74%, 17/23; p < 0.0001), whereas motor vehicle accidents were most common in the adult group (38%, 38/100; p = 0.0642). With respect to the location of injury, carotid (p = 0.1171) and vertebral artery (p = 0.6981) injuries did not differ significantly for the geriatric group. The adult population presented more often with Denver grade I injuries (p < 0.0001), whereas the geriatric population presented with grade IV injuries (p = 0.0247). Elderly patients were more likely to be discharged to skilled nursing facilities (p = 0.0403) and adults to home or self-care (p = 0.0148).CONCLUSIONSThis study is the first to characterize BCVI to all cervical and intracranial vessels in the geriatric population. Older age at presentation is significantly associated with greater severity, morbidity, and mortality from injury, with no preference for the particular artery injured. These findings carry important clinical implications for adapting practice in an aging population.

scholarly journals Role of combining anticoagulant and antiplatelet agents in COVID-19 treatment: a rapid review

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001628
Author(s):  
Kamal Matli ◽  
Raymond Farah ◽  
Mario Maalouf ◽  
Nibal Chamoun ◽  
Christy Costanian ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Anticoagulation Therapy ◽  
Antiplatelet Agents ◽  
Organ Damage ◽  
Multiple Organ ◽  
Rapid Review ◽  
Thromboembolic Events ◽  
Antithrombotic Agent ◽  
Heparin Resistance

Although primarily affecting the respiratory system, COVID-19 causes multiple organ damage. One of its grave consequences is a prothrombotic state that manifests as thrombotic, microthrombotic and thromboembolic events. Therefore, understanding the effect of antiplatelet and anticoagulation therapy in the context of COVID-19 treatment is important. The aim of this rapid review was to highlight the role of thrombosis in COVID-19 and to provide new insights on the use of antithrombotic therapy in its management. A rapid systematic review was performed using preferred reporting items for systematic reviews. Papers published in English on antithrombotic agent use and COVID-19 complications were eligible. Results showed that the use of anticoagulants increased survival and reduced thromboembolic events in patients. However, despite the use of anticoagulants, patients still suffered thrombotic events likely due to heparin resistance. Data on antiplatelet use in combination with anticoagulants in the setting of COVID-19 are quite scarce. Current side effects of anticoagulation therapy emphasise the need to update treatment guidelines. In this rapid review, we address a possible modulatory role of antiplatelet and anticoagulant combination against COVID-19 pathogenesis. This combination may be an effective form of adjuvant therapy against COVID-19 infection. However, further studies are needed to elucidate potential risks and benefits associated with this combination.

scholarly journals Treatment of asymptomatic blunt cerebrovascular injury (BCVI): a systematic review

2021 ◽  
Vol 6 (1) ◽  
pp. e000668
Author(s):  
Patrick B Murphy ◽  
Sarah Severance ◽  
Emma Holler ◽  
Laura Menard ◽  
Stephanie Savage ◽  
...  
Keyword(s):  
Systematic Review ◽  
Medical Management ◽  
Specific Treatment ◽  
Cochrane Library ◽  
Synthesis Methods ◽  
Low Grade ◽  
Significant Heterogeneity ◽  
Blunt Cerebrovascular Injury ◽  
Cerebrovascular Injury ◽  
Preventive Medication

BackgroundThe management of asymptomatic blunt cerebrovascular injury (BCVI) with respect to stroke prevention and vessel healing is challenging.ObjectivesThe aim of this systematic review was to determine if a specific treatment results in lower stroke rates and/or improved vessel healing in asymptomatic BCVI.Data sourcesAn electronic literature search of MEDLINE, EMBASE, Cochrane Library, CINAHL, SCOPUS, Web of Science, and ClinicalTrials.gov performed from inception to March 2020.Study eligibility criteriaStudies were included if they reported on a comparison of any treatment for BCVI and stroke and/or vessel healing rates.Participants and interventionsAdult patients diagnosed with asymptomatic BCVI(s) who were treated with any preventive medication or procedure.Study appraisal and synthesis methodsAll studies were systematically reviewed and bias was evaluated by the Newcastle-Ottawa Scale. No meta-analysis was performed secondary to significant heterogeneity across studies in patient population, screening protocols, and treatment selection. The main outcomes were stroke and healing rate.ResultsOf 8781 studies reviewed, 19 reported on treatment effects for asymptomatic BCVI and were included for review. Any choice of medical management was better than no treatment, but no specific differences between choice of medical management and stroke outcomes were found. Vessel healing was rare and the majority of healed vessels were following low-grade injuries.LimitationsMajority of the included studies were retrospective and at high risk of bias.Conclusions or implications of key findingsAsymptomatic BCVI should be treated medically using a consistent, local protocol. High-quality studies on the effect of individual antithrombotic agents on stroke rates and vessel healing for asymptomatic BCVI are required.

scholarly journals Blunt cerebrovascular injury in elderly fall patients: are we screening enough?

2018 ◽  
Vol 13 (1) ◽  
Author(s):  
Vincent P. Anto ◽  
Joshua B. Brown ◽  
Andrew B. Peitzman ◽  
Brian S. Zuckerbraun ◽  
Matthew D. Neal ◽  
...  
Keyword(s):  
Blunt Cerebrovascular Injury ◽  
Cerebrovascular Injury

scholarly journals The Natural History of Indeterminate Blunt Cerebrovascular Injury

2016 ◽  
Vol 63 (3) ◽  
pp. 845-846
Author(s):  
J.D. Crawford ◽  
K.M. Allan ◽  
K.U. Patel
Keyword(s):  
Natural History ◽  
Blunt Cerebrovascular Injury ◽  
Cerebrovascular Injury ◽  
History Of

TAMI-01. BRAIN METASTASES: CURRENT LITERATURE REVIEW

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi198-vi198
Author(s):  
Ruchi Raval ◽  
Aadi Pandya ◽  
Jaspreet Behl ◽  
Sumul Raval
Keyword(s):  
Literature Review ◽  
Brain Metastases ◽  
Current Literature ◽  
Anticoagulation Therapy ◽  
Signs And Symptoms ◽  
The Body ◽  
Definitive Treatment ◽  
Cognitive Changes ◽  
Cancer Breast ◽  
The Brain

Abstract PURPOSE As more information is gathered about brain metastases, it still remains that the current prognosis of brain metastases is very poor. Due to this, it is imperative that physicians are aware of the most important components regarding brain metastases. This literature review will encompass the most current literature in order to highlight the most crucial information. METHODS All mentioned studies and literature reviews cited in the paper were obtained through various sites, and were published between 1996 and 2017. The main components that were required from the papers reviewed included where in the body the brain metastases originated from, where in the brain they tended to spread to, what the signs and symptoms typical of patients with brain metastases are, and what the options are in terms of treatment. RESULTS Using the results from a variety of studies performed within the past three decades, it is apparent that brain metastases most commonly originate from, in order of increasing frequency, lung cancer, breast cancer, melanoma, and colorectal cancer. In addition, it is reaffirmed that the magnetic resonance imaging (MRI) is the best diagnostic tool to be used when dealing with brain metastases. The most frequent signs and symptoms of a brain metastases include cognitive changes, headaches, weakness, and seizures. Finally, supportive treatment includes use of corticosteroids, antiepileptic drugs (AEDs), and anticoagulation therapy. Definitive treatment for brain metastases varies based on size, location, and prevalence in the brain, but the most effective options include chemotherapy, radiation therapy, and surgery. CONCLUSIONS The study’s results confirm the need for more research to be done regarding brain metastases, and better options to increase the survival of patients.

scholarly journals Improving Blood Pressure Control in Over-the-Road Truck Drivers: Is Provision of Medication Therapy Management by Pharmacists Feasible?

2015 ◽  
Vol 6 (1) ◽  
Author(s):  
Keri D. Hager ◽  
Benjamin D. Aronson ◽  
Reid C. Smith ◽  
David Parra ◽  
Michael Swanoski
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Medication Therapy Management ◽  
Truck Drivers ◽  
Morbidity And Mortality ◽  
Therapy Management ◽  
The Road ◽  
Medication Therapy ◽  
On The Road

Purpose This pilot sought to determine feasibility of studying the impact on hypertension in over-the-road truck drivers who met with pharmacists for Medication Therapy Management (MTM) compared to those who did not. Design/methodology/approach Drivers were randomly assigned to control or treatment (MTM) group for 52 weeks. Drivers assigned to the MTM arm could receive services in person or via secure videoconferencing technology located in a private space at the trucking company. All subjects were provided education and received a blood pressure monitor and log for recording daily blood pressures. Findings Eleven drivers enrolled and seven drivers completed the study. The primary barriers to participation included unpredictable driver schedules and lack of access to MTM provider while on the road. Research limitations/implications This pilot study was limited by small sample size. Pharmacists were not available to meet with truckers "on demand." Therefore, researchers are encouraged to test alternate opportunities to increase enrollment of drivers in studies and access to MTM services while drivers are on the road. Practical implications Hypertension is the second highest health-related cost burden, and over-the-road truck drivers have unique challenges that can make it difficult to attain blood pressure control. Pharmacist-provided MTM has been shown to improve blood pressure control. Improving access to MTM, perhaps using a national network of pharmacists or technology from the road, may decrease morbidity and mortality in drivers. Originality/value This paper fulfills an identified need to study how to improve driver access to care to reduce cardiovascular-related morbidity and mortality.   Type: Clinical Experience

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