Acute haemorrhage rate in 28,000 Out-of-Hours CT heads

Objectives: The aim of this paper is to assess the acute haemorrhage rate in patients who had CT head investigation out-of-hours with and without trauma and compare the rates of haemorrhage between warfarin and DOACs, at a busy teritary teaching hospital. Methods: All CT heads performed between January 2008 and December 2019 were identified from the radiology information system (RIS) at Sheffield Teaching Hospitals (STH), with the requesting information being available from January 2015. The clinical information was assessed for the mention of trauma or anticoagulation and the reports were categorised into acute and non-acute findings. Results: Between 2008 and 2019 the number of scans increased by 63%, with scans performed out of hours increasing by 278%. Between 2015 and 2019, the incidence of acute ICH was similar over the 5 year period, averaging at 6.9% and ranging from 6.1 to 7.6%. The rate of detection of acute haemorrhage following trauma was greater in those not anticoagulated (6.8%), compared with patients on anticoagulants such as warfarin (5.2%) or DOACs (2.8%). Conclusions: Over 12 years, there has been a significant increase in the number of CT heads performed at STH. The rate of ICH has remained steady over the last 5 years indicating a justified increase in imaging demand. However the incidence of ICH in patients prescribed DOACs is lower than the general population and those on warfarin. Advances in knowledge: : This finding in a large centre should prompt discussion of the risk of bleeding with DOACs in relation to CT head imaging guidelines.

Case Report: Giant Thyroid Cyst with Critical Airway Compresion

Thyroid nodules with cystic component are common and the vast majority of them do not cause symptoms. Their neck location, close to airway and vascular structures, makes them a potentially life-threating condition if they become bigger or suffer from an acute haemorrhage. In this case report we expose the case of a twenty-two year old man who went to our emergency service suffering from odynophagia and neck swelling. He was diagnosed with giant thyroid cyst and critical tracheal compression. Initially, in order to relieve symptoms, we carried out two ultrasound-guided aspirations; later, as final treatment, the patient underwent thyroid lobectomy. He progressed successfully without postoperative complications. In our experience, surgery is an effective and definitive treatment to consider in cases for big thyroid cyst in young patients.

Is Fahr’s disease a saviour for intracranial hypertensive bleeds? - A review

Fahr’s disease (FD) is a rare disorder characterised by abnormal deposition of calcium in different parts of brain especially in basal ganglia, thalamus and dentate nucleus. Association of FD with ischemic stroke has been described in past but very less literature available showing association of FD with haemorrhagic stroke. We present here a case of 70 years old hypertensive male patient suffering from FD with left thalamic acute haemorrhage. Although basal ganglia is a common site for hypertensive bleed, but in this hypertensive patient, basal ganglia was spared. We assume that this could be due to presence of calcification within vessel walls of basal ganglia that strengthen the walls and hence act as a saviour for basal ganglia bleed in this case.

Evidence of motor injury due to damaged corticospinal tract following acute hemorrhage in the basal ganglia region

The integrity of the corticospinal tract (CST) is significantly affected following basal ganglia haemorrhage. We aimed to assess the local features of CST and to effectively predict motor function by diffusion characteristics of CST in patients with motor injury following acute haemorrhage in the acute basal ganglia region. We recruited 37 patients with paresis of the lateral limbs caused by acute basal ganglia haemorrhage. Based on the automated fiber quantification method to track CST, assessed the character of each CST segment between the affected and contralateral sides, and correlated these with the Fugl–Meyer (FM) and Barthel Index (BI) scores at 6 months after onset. The fractional anisotropy (FA) values of the injured side of CST showed a significantly lower FA than the contralateral side along the tract profiles (p < 0.05, corrections for multiple comparisons). The FA values of each site at the internal capsule, closed corona radiata were positively correlated with the FM and BI score at 6 months after onset (p < 0.001, respectively). Our findings assessed the character of CST vividly in detail and dementated the primary sites of CST can predict the long-term outcome of motor function. This study may facilitate future clinical and cognitive studies of acute haemorrhage.

Sudden death due to ruptured oesophageal varices – autopsy-based case report

Acute haemorrhage from ruptured oesophageal varices is a serious consequence of portal hypertension in cirrhotic patients. It represents a medical emergency with a high morbidity and mortality rate. Studies over the years have shown a direct link with chronic alcoholism in the development of such complications. Although the gastrointestinal system accounts for a few numbers of sudden deaths, bleeding through ruptured varices represent a life-threatening condition. The role of forensic pathologist is vital in dealing with sudden deaths. Here, we report a case of a 46-year-old man who died suddenly following the rupture of oesophageal varices.

Pituitary tumour apoplexy due to pituitary adenoma in a dog: clinical, 3T MRI and CT features

Pituitary apoplexy (PA) is a neurological syndrome resulting from sudden infarction/haemorrhage within a normal or tumoural pituitary gland. Prompt imaging is essential to correlate haemorrhagic/ischaemic changes with clinical signs. The purpose of this report is to describe the clinical, CT and 3T MRI findings of PA in a 13-year-old dog previously diagnosed with pituitary-dependent hyperadrenocorticism. Neurological examination revealed an anxious-compulsive behaviour, internal ophthalmoplegia and bilaterally reduced menace response. Brain MRI showed a pituitary mass with two focal well-defined areas. The first was T2 weighted (T2w) and T1 weighted (T1w) hyperintense, FLAIR hypointense to the grey matter, and mildly contrast-enhancing with signal void artefact in GE-T2*, compatible with late/subacute haemorrhage; the second was T2w hypointense, T1w, FLAIR and GE-T2* isointense/hypointense to the grey matter and moderately enhancing, compatible with acute haemorrhage. The dog recovered after 24 hours, but internal ophthalmoplegia remained. To the authors’ knowledge, this is the first report describing MRI findings in a dog with PA.

Adapted Intraoperative Program Infusion-Transfusion Therapy in Critical Light Bleeding

The paper presents data on the evaluation of the effectiveness of intraoperative infusion–transfusion therapy for critical luminal blood loss in patients. The data on the clinical picture of a number of patients were used. A comparative analysis of different types of treatment was performed. In conclusion, it is concluded that patients who had profuse bleeding and acute haemorrhage of the III degree and who performed the operation in the early stages, according to active surgical tactics, the chances of a favorable outcome of the operation increased by 60%. The risk level of an adverse outcome in case of delayed surgery (expectant management) increased by 15%.