intracranial hemorrhages
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2022 ◽  
Vol Publish Ahead of Print ◽  
Benjamin Seeliger ◽  
Michael Doebler ◽  
Daniel Andrea Hofmaenner ◽  
Pedro D. Wendel-Garcia ◽  
Reto A. Schuepbach ◽  

Stroke ◽  
2022 ◽  
pp. 1100-1111.e4
Georgios A. Maragkos ◽  
Ajith J. Thomas ◽  
Christopher S. Ogilvy

Emi Nomura ◽  
Yuko Kawahara ◽  
Yoshio Omote ◽  
Yoshiaki Takahashi ◽  
Namiko Matsumoto ◽  

2021 ◽  
Vol 15 (4) ◽  
pp. 36-43
Vladimir G. Dashyan ◽  
Ivan M. Godkov ◽  
Leonid V. Prokop’ev ◽  
Andrey A. Grin ◽  
Vladimir V. Krylov

Study aim. To analyse the surgical outcomes in patients with haemorrhagic stroke depending on the timing of surgery. Materials and methods. We performed a retrospective analysis of 500 patients (335 (67%) men and 165 (33%) women), who underwent surgical treatment of hypertensive intracranial hemorrhages at the N.V. Sklifosovsky Research Institute for Emergency Medicine between 1997 and 2020. The mean patient age was 53.1 12.2 years. The mean time until surgery was 3.3 2.6 days. Outcomes were assessed on day 30 from disease onset using the modified Rankin Scale (mRS). Results. In the total sample, outcomes as measured by the mRS were as follows: type 0 84 (16.8%) patients, type 1 37 (7.4%), type 2 46 (9.2%), type 3 38 (7.6%), type 4 43 (8.6%), type 5 142 (28.4%) and type 6 110 (22.0%). Treatment results were better when surgery was delayed (2 = 64.4; p 0.00001). Mortality was 36.4% after surgery conducted in the first day after haemorrhage, while mRS scores of 02 made up 18.6%. Mortality was 20.4% after surgery conducted on the second or third day, and mRS scores of 02 made up 29.6%. Mortality was 17.4% after surgery conducted on day 47, and mRS scores of 02 outcomes were present in 49.0% of subjects. Mortality was 8.8% when surgery was performed on day 8 or later, and favourable outcomes were present in 48.5% of patients. Conclusion. Intracerebral haematoma excision on day 23 leads to better outcomes in patients with reduced levels of alertness up to sopor, while surgery after day 3 leads to better results in alert patients and those with obtundation.

2021 ◽  
Vol 2 (24) ◽  

BACKGROUND Traumatic aneurysms at the superior cerebellar arteries after head injury are extremely rare and may be overlooked. Rupture of these aneurysms can cause fatal intracranial hemorrhages; thus, early identification of the entity helps prevent detrimental outcomes. OBSERVATIONS A patient suffered from sudden severe headache and decreased consciousness level several weeks after a blunt head injury. He received surgery to remove a progressive enlarging subdural hematoma. The diagnosis of a traumatic aneurysm at the superior cerebellar artery was delayed, made only after a recurrent subdural hemorrhage occurred. He received another surgery to obliterate the aneurysm. LESSONS The patient could have been treated earlier if traumatic aneurysm had been suspected in the beginning. In addition to the case, the authors also reviewed the literature to clarify the pathophysiology, clinical presentation, diagnosis, and management of the disease.

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260560
Almut Kundisch ◽  
Alexander Hönning ◽  
Sven Mutze ◽  
Lutz Kreissl ◽  
Frederik Spohn ◽  

Background Highly accurate detection of intracranial hemorrhages (ICH) on head computed tomography (HCT) scans can prove challenging at high-volume centers. This study aimed to determine the number of additional ICHs detected by an artificial intelligence (AI) algorithm and to evaluate reasons for erroneous results at a level I trauma center with teleradiology services. Methods In a retrospective multi-center cohort study, consecutive emergency non-contrast HCT scans were analyzed by a commercially available ICH detection software (AIDOC, Tel Aviv, Israel). Discrepancies between AI analysis and initial radiology report (RR) were reviewed by a blinded neuroradiologist to determine the number of additional ICHs detected and evaluate reasons leading to errors. Results 4946 HCT (05/2020-09/2020) from 18 hospitals were included in the analysis. 205 reports (4.1%) were classified as hemorrhages by both radiology report and AI. Out of a total of 162 (3.3%) discrepant reports, 62 were confirmed as hemorrhages by the reference neuroradiologist. 33 ICHs were identified exclusively via RRs. The AI algorithm detected an additional 29 instances of ICH, missed 12.4% of ICH and overcalled 1.9%; RRs missed 10.9% of ICHs and overcalled 0.2%. Many of the ICHs missed by the AI algorithm were located in the subarachnoid space (42.4%) and under the calvaria (48.5%). 85% of ICHs missed by RRs occurred outside of regular working-hours. Calcifications (39.3%), beam-hardening artifacts (18%), tumors (15.7%), and blood vessels (7.9%) were the most common reasons for AI overcalls. ICH size, image quality, and primary examiner experience were not found to be significantly associated with likelihood of incorrect AI results. Conclusion Complementing human expertise with AI resulted in a 12.2% increase in ICH detection. The AI algorithm overcalled 1.9% HCT. Trial registration German Clinical Trials Register (DRKS-ID: DRKS00023593).

2021 ◽  
pp. 489-500
Lucas P. Carlstrom ◽  
Eelco F. M. Wijdicks

Traumatic brain injury (TBI) continues to be a leading cause of long-term morbidity and death worldwide. Each year, an estimated 1.7 million persons in the United States sustain TBIs, leading to 275,000 hospitalizations and 52,000 deaths annually. In addition to high personal costs, the direct and indirect societal expenditures are estimated to be $60 billion per year. This chapter reviews the diagnostic approach to head trauma and prognosis in brain injury and addresses specific conditions, such as concussions and intracranial hemorrhages.

Abdallah Amireh ◽  
Muhammad Nagy ◽  
Hassan Ali ◽  
Siddhart Mehta ◽  
Haralabos Zacharatos ◽  

Introduction : The 2019 AHA/ASA updated Guidelines for the Early Management of Patients with Acute Ischemic Stroke mention tenecteplase (TNK) as a reasonable therapy in patients without contraindications for IV fibrinolysis who are also eligible to undergo mechanical thrombectomy. We describe a case of acute left MCA ischemic stroke treated with IV TNK (IV bolus of 0.25 mg/kg) followed by mechanical thrombectomy with subsequent multicompartmental intracranial hemorrhages unrelated to area of infraction. Methods : A retrospective review at a single center university hospital was performed for all intravenous TNK administrations outside of a clinical trial setting from October 2020 to July 2021. Results : A 61‐year‐old male with history of HTN and cardiomyopathy (EF<20%). Presented with sudden onset right sided weakness, aphasia and left gaze. Presenting NIHSS was 28. CT head with hyperdense left MCA sign and ASPECTS score of 10. CTA confirmed proximal left MCA M1 segment occlusion. IV TNK was given within 01:23 hours of symptoms onset. Subsequently, patient underwent emergent mechanical thrombectomy for disabling large vessel occlusion stroke. Spontaneous near complete recanalization of left MCA occlusion was noted on initial angiography run with small non flow limiting distal thrombi visualized in the distal MCA territories. Immediate post procedure CT head was negative for any intracranial hemorrhage. Patient’s exam was noted to improve to NIHSS of 2. Approximately 6 hours after the TNK administration, patient became acutely unresponsive with NIHSS of 26. With Glasgow Coma Scale 7 patient required emergent intubation. CT head revealed bilateral cerebellar intraparenchymal hemorrhages, extensive subarachnoid hemorrhage in basal cisterns and within the sulci in bilateral frontotemporal regions, as well as subdural hemorrhages along the falx and tentorial dural folds. Hypertonic saline was administered followed by emergent extraventricular drain placement. Tranexamic acid 1000 mg was given as emergent reversal, fibrinogen level was 155 mg/dL. Despite aggressive medical management and over following 24 hours, exam worsened with loss of pupillary reflexes. Patient was terminally extubated 2 days after initial presentation in accordance with his advance directives. Conclusions : Tenecteplase was a reasonable choice in this case given LVO and disabling stroke. The patient’s neurological exam improved significantly after TNK with evidence of spontaneous recanalization. However, patient’s multicompartmental intracranial hemorrhages unrelated to area of infraction were unusual in the absence of any vascular lesions to predispose hemorrhage based on CT and conventional angiography. Further observational studies are warranted to evaluate similar complications of Tenecteplase administration and their occurrence rates.

2021 ◽  
Vol 20 (3) ◽  
pp. 92-101
E. V. Suntsova ◽  
M. N. Sadovskaya ◽  
O. V. Spichak ◽  
S. S. Ozerov ◽  
S. P. Khomyakova ◽  

Primary immune thrombocytopenia is a benign and self-limiting process in the majority of children. Severe life-threatening hemorrhages, including intracranial, develop rarely. Risk factors predisposing for development of severe hemorrhagic complications have not been determined. In order to decrease the severity of neurological consequences and mortality in intracranial hemorrhages, timely combined urgent therapy is neсessary. There are four clinical cases of intracranial hemorrhage in immune thrombocytopenia in children with different outcomes in this article. The parents of the patients agreed to use the information, including photos of children, in scientific research and publications.

2021 ◽  
pp. 1-2
Kirill Alekseyev ◽  

Coronavirus disease 2019 (COVID-19) is a pandemic that began in December 2019 as a result of the global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We frequently associate COVID-19 with symptoms of fever, shortness of breath, and pneumonia; however, we are slowly uncovering the fact that systems other than the respiratory are being affected. We present a 60-year-old female who presented with altered mental status and was found to have COVID-19 induced subdural hematoma. Although intracranial hemorrhages are extremely rare in the setting of COVID-19, it is known that the affinity of SARS-CoV-2 to the angiotensin-converting enzyme 2 receptors, in addition to the cytokine storm, predisposes infected individuals to intracranial hemorrhages. Thus, it is crucial to consider intracranial hemorrhage as a possible cause of altered mental status in patients infected with COVID-19 and weigh the potential risk versus benefits of utilizing anticoagulants when managing the thrombotic complications of this virus.

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