scholarly journals Intracranial Hemorrhage and Pneumocephaly After Cervical Epidural Injection

2019 ◽  
Vol 3 (4) ◽  
pp. 369-371
Author(s):  
Nishit Mehta
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Neck Pain ◽  
Intracranial Hemorrhage ◽  
Epidural Injection ◽  
Subdural Hemorrhage ◽  
Epidural Injections

Cervical epidural injections are commonly used to treat patients with radicular neck pain. The following is a description of a case of subarachnoid hemorrhage, subdural hemorrhage, and pneumocephaly following cervical epidural injection.

scholarly journals Are there mortality differences between men and women in all types of intracranial hemorrhages: subarachnoid, intraparenchymal and subdural? An analysis of the Spanish population

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Fernandez De Bobadilla Osorio ◽  
J.R Rey-Blas ◽  
N Gonzalez-Aguado ◽  
B Fuentes ◽  
P Masedo ◽  
...  
Keyword(s):  
Gender Differences ◽  
Subarachnoid Hemorrhage ◽  
Intracranial Hemorrhage ◽  
Epidemiological Data ◽  
Spanish Population ◽  
Subdural Hemorrhage ◽  
Men And Women ◽  
Mediterranean Countries ◽  
Gender And Age ◽  
Relationship Of

Abstract Objectives There are 3 types of intracranial hemorrhage (ICH): 1) subarachnoid hemorrhage (SAH), CIE10:I60; 2) intraparenchymal hemorrhage (IPH), I61 and 3) subdural hemorrhage (SDH) I62. Epidemiological data on this field are scarce in Mediterranean countries. Our goal was to determine whether the relationship of ICH mortality with gender and age was different for the 3 types of HIC. Methods Data were retrospectively obtained from the Spanish National Institute of Statistics. Deaths/100.000 population of SAH, IPH and SDH were assessed for the entire Spanish population since 2008 to 2017 (n=46,527,039). Year 2017 was the last available for analysis. Incidence was analyzed for men and women and for age strata (<1 years of age, 2–10, 11–20, 21–30, 31–40, 41–50, 51–60, 61–70, 71–80; >80). Results In order to fit in the abstract space, only data of 2017 are presented, although years 2008 to 2017 were also analyzed and results were similar. Mortality/100,000 of IPH stayed very low under 40 years of age and then grew exponentially in both, men and women, and was significantly higher for men for all age strata. Mortality of SDH was much lower but behaved in a similar way: exponential growth since 40s and lower incidence in women. SAH behaved differently: it started to be significant since 20 years of age and there were no gender differences. Conclusion Mortality of intraparenchymal and subdural hemorrhage increases exponentially since 40 years of age and is lower in women. On the contrary, mortality of subarachnoid hemorrhage increases earlier and there are no gender differences. Death/100.000 intracranial hemorrhage Funding Acknowledgement Type of funding source: None

Intraventricular Hemorrhage in Premature Infants

1980 ◽  
Vol 2 (5) ◽  
pp. 145-153
Author(s):  
Joseph J. Volpe
Keyword(s):  
Intensive Care ◽  
Subarachnoid Hemorrhage ◽  
Premature Infant ◽  
Intracranial Hemorrhage ◽  
Premature Infants ◽  
Intraventricular Hemorrhage ◽  
Neonatal Intensive Care ◽  
Survival Rates ◽  
Clinical Importance ◽  
Subdural Hemorrhage

Four major varieties of intracranial hemorrhage can be recognized in the neonatal period: (1) subdural hemorrhage, (2) primary subarachnoid hemorrhage, (3) intracerebellar hemorrhage, and (4) periventricular-intraventricular hemorrhage.1 Subdural hemorrhage, often related to obstetrical trauma, now is an uncommon lesion in most medical centers. Primary subarachnoid hemorrhage, although very common, is rarely of major clinical importance, because of its venous origin and self-limited course. Intracerebellar hemorrhage, commonly observed at postmortem examination of the small premature infant but rarely documented during life, is of uncertain clinical significance. Periventricular-intraventricular hemorrhage is the most common and serious variety of neonatal intracranial hemorrhage. The enormous importance of this lesion is linked to the remarkable improvements in recent years in neonatal intensive care and, as a consequence, in survival rates for small premature infants. Because periventricular-intraventricular hemorrhage is characteristic of the premature infant (particularly the infant less than approximately 32 weeks gestation), the lesion has reached nearly epidemic proportions in modern neonatal intensive care facilities. INCIDENCE The remarkably high incidence of periventricular-intraventricular hemorrhage is demonstrated dramatically by studies in which premature infants were subjected to computed tomography (CT) scan routinely within the first week of life (Table 1). Thus, 40% to 45% of all such infants exhibited periventricular-intraventricular hemorrhage.2,3

Subdural and Primary Subarachnoid Hemorrhages: A Case Study

2007 ◽  
Vol 26 (3) ◽  
pp. 143-151 ◽  
Author(s):  
Stacie Barker
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Hemorrhage ◽  
Intracranial Bleeding ◽  
Subdural Hemorrhage ◽  
Neonatal Nurses ◽  
Life Threatening ◽  
Subarachnoid Hemorrhages

Subdural hemorrhage (SDH) and primary subarachnoid hemorrhage (SAH) are two forms of intracranial bleeding that can be encountered in infants. These events can be life threatening to the infant and devastating to his family. Neonatal nurses need to have an understanding of these unfortunate, yet not uncommon, types of intracranial hemorrhage. This article explains the etiology, the diagnosis, and the treatment of SDH and SAH, concluding with a case study.

Medical Management of Patients with Subarachnoid or Intracranial Hemorrhage and Increased Intracranial Pressure

2019 ◽  
pp. 30-56
Author(s):  
Ahmad Sweid ◽  
Pascal M. Jabbour ◽  
Sage P. Rahm ◽  
Stavropoula Tjoumakaris ◽  
M. Reid Gooch ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Hemorrhage ◽  
Medical Management ◽  
Medical Intervention ◽  
Subdural Hemorrhage ◽  
Arachnoid Membrane ◽  
Anatomical Localization ◽  
Intracerebral Hemorrhages ◽  
Epidural Hemorrhage ◽  
Bridging Vein

Intracranial hemorrhage requires an understanding of etiology and prompt management for an improved outcome. Intracranial hemorrhage is classified into four subcategories: epidural hemorrhage, subdural hemorrhage, subarachnoid hemorrhage, and intracerebral or intraparenchymal hemorrhage, according to the anatomical localization of the bleed. If it occurs in the space between the dura and the skull, then this is epidural hemorrhage, which usually traumatic and requires emergent surgical intervention. A subdural hematoma is localized between the dura and the arachnoid membrane. Usually, this entity occurs in elderly patients following trauma or a tear of a cortico-dural bridging vein. Hematoma evacuation in specific indications is the treatment of choice. Both epidural and subdural hematomas have a minimal role for medical intervention; thus this chapter focuses on the other two entities; subarachnoid hemorrhage and intracerebral hemorrhage. Studies have shown that early and specialized multidisciplinary management improves outcomes. This chapter discusses the etiology, presentation, and medical management of both subarachnoid and intracerebral hemorrhages.

Clinical-neurosonographic parallels of intracranial hemorrhagies in early childhood

2019 ◽  
Vol 22 (6) ◽  
pp. 116-122
Author(s):  
Sh. Sh. Shamansurov ◽  
Sh. H. Saidazizova ◽  
S. O. Nazarova
Keyword(s):  
Early Childhood ◽  
Comparative Analysis ◽  
Subarachnoid Hemorrhage ◽  
Left Hemisphere ◽  
Intracranial Hemorrhage ◽  
Intraventricular Hemorrhage ◽  
Detailed Examination ◽  
Intracranial Hemorrhages ◽  
Risk Of Hemorrhage ◽  
Neurological State

Objective. Conduct a comparative analysis of clinical and neurosonographic indicators of intracranial hemorrhage in infants.Materials and methods. In the clinical part of the study, 68 patients took part in the acute / acute periods of intracranial hemorrhage, which we took for the study on the basis of the Tashkent City Children's Clinical Hospital No1. Gender ratios of which were 69.1% boys (47 children) and 30.9% girls (21 children), from birth to 2 months of life (average age at the time of hemorrhage is 36.28 ± 9.85 days). Diagnostic examination included neurosonography (NSG) of all children in the first 24 hours of the implementation of intracranial hemorrhages on admission to the clinic.Results. According to our study of 68 children with intracranial hemorrhage, it turned out that the average age of morbidity was 36.28 ± 9.85 days (p < 0.001) Neurosonographic indicators stated the presence of parenchymal hemorrhage (right and left hemisphere), SAH (subarachnoid hemorrhage), hemorrhage into the trunk, IVH (intraventricular hemorrhage) II, IVH III. According to neurosonography, parenchymal hemorrhage (right-16 or left hemisphere-21) was observed in 37 patients, SAH and IVH-II 21 (30.9%) patients, IVH III – in 17 (25%) patients, hemorrhage in 3 (4.4%) brain stem of patientsConclusion. Analysis of the implementation of hemorrhage showed that not always small gestational age is the risk of hemorrhage. Cases of less severe changes (27%) on NSG with a coarser clinical picture and vice versa (15%), necessitate (taking into account the severity of the neurological state), a more detailed examination, including visualization (CT, MRI).

Anti-epileptic Drug (AED) Use in Subarachnoid Hemorrhage (SAH) and Intracranial Hemorrhage (ICH)

2018 ◽  
Vol 23 (42) ◽  
pp. 6446-6453
Author(s):  
Rui Feng ◽  
Justin Mascitelli ◽  
Alexander G. Chartrain ◽  
Konstantinos Margetis ◽  
J. Mocco
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Hemorrhage ◽  
Anti Epileptic Drug

Cervical Interlaminar Epidural Injections In The Treatment Of Cervical Disc Herniation, Post Surgery Syndrome, Or Discogenic Pain: Cost Utility Analysis From Randomized Trials

2019 ◽  
Vol 5 (22;5) ◽  
pp. 421-431
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Neck Pain ◽  
Disc Herniation ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Cervical Disc Herniation ◽  
Cervical Disc ◽  
Utility Analysis ◽  
Discogenic Pain ◽  
Epidural Injections ◽  
Post Surgery

Background: Neck pain is one of the major conditions attributing to overall disability in the United States. There have been multiple publications assessing clinical and cost effectiveness of multiple modalities of interventions in managing chronic neck pain. Even then, the literature has been considered sparse in relation to cervical interlaminar epidural injections in managing chronic neck pain. In contrast, cost utility studies of lumbar interlaminar injections, caudal epidural injections, cervical and lumbar facet joint nerve blocks, percutaneous adhesiolysis demonstrated costs of less than $3,500 for quality-adjusted life year (QALY). Objectives: To assess the cost utility of cervical interlaminar epidural injections in managing chronic neck and/or upper extremity pain secondary to cervical disc herniation, post-surgery syndrome in neck, and axial or discogenic neck pain. Study Design: Analysis based on 3 previously published randomized trials of the effectiveness of cervical interlaminar epidural injections assessing their role in disc herniation, cervical post-surgery syndrome, and axial or discogenic pain. Setting: A contemporary, private, specialty referral interventional pain management center in the United States. Methods: Cost utility of cervical interlaminar epidural injections with or without steroids in managing cervical disc herniation, cervical post-surgery syndrome, and cervical discogenic or axial neck back pain was conducted with data derived from 3 randomized controlled trials (RCTs) that included a 2-year follow-up, with inclusion of 356 patients. The primary outcome was significant improvement defined as at least 50% in pain reduction and disability status. Direct payment data from all carriers from 2018 was utilized for the assessment of procedural costs. Overall costs, including drug costs, were determined by multiplication of direct procedural payment data by a factor of 1.67 to accommodate for indirect payments respectively for disc herniation, discogenic pain, and cervical post-surgery syndrome. Results: The results of the 3 RCTs showed direct cost utility for one year of QALY of $2,412.31 for axial or discogenic pain without disc herniation, $2,081.07 for disc herniation, and $2,309.20 for post surgery syndrome, with an average cost per one year QALY of $2,267.57, with total estimated overall costs with addition of indirect costs of $3,475.38, $4,028.55, $3,856.36, and $3,785.89 respectively. Limitations: The limitation of this cost utility analysis includes that it is a single center evaluation. Indirect costs were extrapolated. Conclusion: This cost utility analysis of cervical interlaminar epidural injections in patients nonresponsive to conservative management in the treatment of disc herniation, post surgery syndrome and axial or discogenic neck pain shows $2,267.57 for direct costs with a total cost of $3,785.89 per QALY. Key words: Cervical interlaminar epidural injections, chronic neck pain, cervical disc herniation, cervical discogenic pain, post surgery syndrome, cost utility analysis, cost effectiveness analysis, quality-adjusted life years

Transfer Learning of The ResNet-18 and DenseNet-121 Model Used to Diagnose Intracranial Hemorrhage in CT Scanning

2021 ◽  
Vol 27 ◽  
Author(s):  
Qi Zhou ◽  
Wenjie Zhu ◽  
Fuchen Li ◽  
Mingqing Yuan ◽  
Linfeng Zheng ◽  
...  
Keyword(s):  
Deep Learning ◽  
Transfer Learning ◽  
Intracranial Hemorrhage ◽  
Intraventricular Hemorrhage ◽  
Learning Model ◽  
Normal Group ◽  
Subdural Hemorrhage ◽  
Model Assessment ◽  
Learning Models ◽  
Deep Learning Model

Objective: To verify the ability of the deep learning model in identifying five subtypes and normal images in noncontrast enhancement CT of intracranial hemorrhage. Method: A total of 351 patients (39 patients in the normal group, 312 patients in the intracranial hemorrhage group) performed with intracranial hemorrhage noncontrast enhanced CT were selected, with 2768 images in total (514 images for the normal group, 398 images for the epidural hemorrhage group, 501 images for the subdural hemorrhage group, 497 images for the intraventricular hemorrhage group, 415 images for the cerebral parenchymal hemorrhage group, and 443 images for the subarachnoid hemorrhage group). Based on the diagnostic reports of two radiologists with more than 10 years of experience, the ResNet-18 and DenseNet-121 deep learning models were selected. Transfer learning was used. 80% of the data was used for training models, 10% was used for validating model performance against overfitting, and the last 10% was used for the final evaluation of the model. Assessment indicators included accuracy, sensitivity, specificity, and AUC values. Results: The overall accuracy of ResNet-18 and DenseNet-121 models were 89.64% and 82.5%, respectively. The sensitivity and specificity of identifying five subtypes and normal images were above 0.80. The sensitivity of DenseNet-121 model to recognize intraventricular hemorrhage and cerebral parenchymal hemorrhage was lower than 0.80, 0.73, and 0.76 respectively. The AUC values of the two deep learning models were above 0.9. Conclusion: The deep learning model can accurately identify the five subtypes of intracranial hemorrhage and normal images, and it can be used as a new tool for clinical diagnosis in the future.

Deep Spinal Infection after Outpatient Epidural Injections for Pain: A Retrospective Sample Cohort Study Using a Claims Database in South Korea

2021 ◽  
Author(s):  
Chang-Soon Lee ◽  
Young Jae Park ◽  
Jee Youn Moon ◽  
Yong-Chul Kim
Keyword(s):  
Risk Factors ◽  
South Korea ◽  
Odds Ratio ◽  
Multivariable Analysis ◽  
Significant Risk ◽  
Epidural Injection ◽  
Spinal Infection ◽  
Single Shot ◽  
Epidural Injections ◽  
Spinal Infections

Background Deep spinal infection is a devastating complication after epidural injection. This study aimed to investigate the incidence of deep spinal infection primarily after outpatient single-shot epidural injection for pain. Secondarily, this study assessed the national trends of the procedure and risk factors for said infection. Methods Using South Korea’s National Health Insurance Service sample cohort database, the 10-yr national trend of single-shot epidural injections for pain and the incidence rate of deep spinal infection after the procedure with its risk factors were determined. New-onset deep spinal infections were defined as those occurring within 90 days of the most recent outpatient single-shot epidural injection for pain, needing hospitalization for at least 1 night, and receiving at least a 4-week course of antibiotics. Results The number of outpatient single-shot epidural injections per 1,000 persons in pain practice doubled from 40.8 in 2006 to 84.4 in 2015 in South Korea. Among the 501,509 injections performed between 2007 and 2015, 52 cases of deep spinal infections were detected within 90 days postprocedurally (0.01% per injection). In multivariable analysis, age of 65 yr or more (odds ratio, 2.91; 95% CI, 1.62 to 5.5; P = 0.001), living in a rural area (odds ratio, 2.85; 95% CI, 1.57 to 5.0; P &lt; 0.001), complicated diabetes (odds ratio, 3.18; 95% CI, 1.30 to 6.7; P = 0.005), multiple epidural injections (three times or more) within the previous 90 days (odds ratio, 2.34; 95% CI, 1.22 to 4.2; P = 0.007), and recent use of immunosuppressants (odds ratio, 2.90; 95% CI, 1.00 to 6.7; P = 0.025) were significant risk factors of the infection postprocedurally. Conclusions The incidence of deep spinal infection after outpatient single-shot epidural injections for pain is very rare within 90 days of the procedure (0.01%). The data identify high-risk patients and procedure characteristics that may inform healthcare provider decision-making. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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