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Clinical Medicine (London, England) Apr 2018Intracerebral haemorrhage causes 1 in 10 strokes, but has the worst overall outcomes of all stroke subtypes. Baseline haematoma volume is a key prognostic factor and... (Review)
Review
Intracerebral haemorrhage causes 1 in 10 strokes, but has the worst overall outcomes of all stroke subtypes. Baseline haematoma volume is a key prognostic factor and early complications - such as haematoma expansion, obstructive hydrocephalus and perihaematomal oedema - may worsen outcome. There is evidence that withdrawal of care may occur more often in intracerebral haemorrhage than ischaemic stroke independent of premorbid health and stroke severity. However, recent evidence shows that reversal of anticoagulants, intensive blood pressure lowering and surgery in carefully selected cases may improve outcomes. Ongoing research may also provide evidence for new medical treatments and minimally invasive approaches to surgery. Effective implementation of evidence-based care to intracerebral haemorrhage patients can be difficult but quality improvement methodology can help to achieve maximal benefit.
Topics: Anticoagulants; Brain; Cerebral Hemorrhage; Critical Care; Hematoma; Humans; Hypertension; Prognosis
PubMed: 29700086
DOI: 10.7861/clinmedicine.18-2-s9 -
Laeknabladid Jun 2023A 50-year old male presented to our emergency department with sudden abdominal pain. Upon arrival he was diaphoretic, pale and tachycardic. A CT showed retroperitoneal...
A 50-year old male presented to our emergency department with sudden abdominal pain. Upon arrival he was diaphoretic, pale and tachycardic. A CT showed retroperitoneal hemorrhage with suspected tumor at the left adrenal gland. He was quickly stabilized with intravenous fluids and blood transfusion. Rebleed occurs roughly a week after discharge and a new CT showed a visceral pseudoaneurysm from the left middle adrenal artery. The pseudoaneurysm was embolized and the patient discharged in good condition. Follow-up MRI depicted reabsorption of the hematoma and no adrenal tumor. Thus, the etiology of the previous retroperitonal hemorrhage is considered spontaneous.
Topics: Male; Humans; Middle Aged; Aneurysm, False; Retroperitoneal Space; Hemorrhage; Hematoma; Adrenal Glands
PubMed: 37233620
DOI: 10.17992/lbl.2023.05.744 -
The Neuroradiology Journal Jun 2015Cerebral arteriovenous malformation (AVM) in pregnancy is a complex situation and there is no agreement on its hemorrhage risk and treatment. Although studies on... (Review)
Review
Cerebral arteriovenous malformation (AVM) in pregnancy is a complex situation and there is no agreement on its hemorrhage risk and treatment. Although studies on bleeding risk of cerebral AVMs in pregnancy are very few, and they provide different results, pregnancy will increase the hemorrhagic risk of AVM and ruptured cerebral AVM in pregnancy should be actively treated. After intracranial hemorrhage, cerebral angiography should be performed for pregnant women shielded correctly. Cerebral angiography could clearly demonstrate the characteristics of cerebral AVM. Results from the literature show that the radiation dose of endovascular and stereotactic radiotherapy for cerebral AVM in pregnancy was below the safety value and was safe. For an unruptured AVM in pregnancy, if there are no bleeding factors, e.g. no coexisting aneurysm, smooth venous drainage, no venous ectasia, or high risk of treatment, then it should be observed conservatively.
Topics: Cerebral Angiography; Decompression, Surgical; Embolization, Therapeutic; Encephalocele; Endovascular Procedures; Female; Hematoma; Humans; Intracranial Arteriovenous Malformations; Intracranial Hemorrhages; Pregnancy; Pregnancy Complications, Cardiovascular; Radiosurgery
PubMed: 26246089
DOI: 10.1177/1971400915589692 -
Journal of Medicine and Life 2015A developed society is usually also characterized by an elderly population, which has a continuous percentage growth. This population frequently presents a cumulus of... (Review)
Review
UNLABELLED
A developed society is usually also characterized by an elderly population, which has a continuous percentage growth. This population frequently presents a cumulus of medical pathologies. With the development of the medication and surgical treatment of different affections, the life span has increased and the pathology of an old patient has diversified as far as the cumulus of various pathological diseases in the same person is concerned. Chronic subdural pathologies represent an affection frequently met in neurosurgery practice. Any neurosurgeon, neurologist and not only, has to be aware of the possibility of the existence of a chronic subdural haematoma, especially when the patient is old and is subjected to an anticoagulant or antiaggregant treatment, these 2 causes being by far the etiological factors most frequently met in chronic subdural haematomas. With an adequate diagnosis and treatment, usually surgical, the prognosis is favorable. Although the surgical treatment presents a categorical indication in most of the cases, the fact that there are many surgical techniques, a great relapse rate, as well as the numerous studies, which try to highlight the efficiency of a technique as compared to another, demonstrate that the treatment of these haematomas is far from reaching a consensus among the neurosurgeons. The latest conservatory treatment directions are still being studied and need many years to be confirmed.
ABBREVIATIONS
CT = computerized tomography, MRI = magnetic resonance imaging.
Topics: Hematoma, Subdural, Chronic; Humans; Magnetic Resonance Imaging; Tomography, X-Ray Computed
PubMed: 26351527
DOI: No ID Found -
Diagnostic and Interventional Imaging 2015Spontaneous muscle hematomas are a common and serious complication of anticoagulant treatment. The incidence of this event has increased along with the rise in the... (Review)
Review
Spontaneous muscle hematomas are a common and serious complication of anticoagulant treatment. The incidence of this event has increased along with the rise in the number of patients receiving anticoagulants. Radiological management is both diagnostic and interventional. Computed tomography angiography (CTA) is the main tool for the detection of hemorrhage to obtain a positive, topographic diagnosis and determine the severity. Detection of an active leak of contrast material during the arterial or venous phase is an indication for the use of arterial embolization. In addition, the interventional radiological procedure can be planned with CTA. Arterial embolization of the pedicles that are the source of the bleeding is an effective technique. The rate of technical and clinical success is 90% and 86%, respectively.
Topics: Abdominal Muscles; Aged; Angiography; Anticoagulants; Embolization, Therapeutic; Extravasation of Diagnostic and Therapeutic Materials; Female; Hematoma; Humans; Male; Muscular Diseases; Psoas Muscles; Risk Factors; Tomography, X-Ray Computed
PubMed: 26066549
DOI: 10.1016/j.diii.2015.03.014 -
Transfusion Aug 2022Transfusion of defective platelets could contribute to the inefficiency of platelet transfusion in preventing or stopping bleeding.
BACKGROUND
Transfusion of defective platelets could contribute to the inefficiency of platelet transfusion in preventing or stopping bleeding.
STUDY DESIGN AND METHODS
This single-center prospective study aimed to determine the prevalence of functional platelet abnormalities in a population of blood donors with a clinical history of bleeding diathesis or with history of hematoma (>4 cm) during blood donation. Donors with positive bleeding screening questionnaire were referred to the reference center for rare platelet diseases at La Timone University Hospital (Marseille) to confirm the bleeding tendency using a more extensive bleeding questionnaire (MCMDMscore) and to assess hemostasis, including a comprehensive platelet analysis.
RESULTS
One hundred and ninety-five donors identified based on a history of hematoma and 2434 blood donors were included in the study. Eighty-eight donors (3.6%) had a bleeding score indicating a potential bleeding disorder. Five donors with a history of hematoma (2.5%) and 15 (17%) donors with a confirmed bleeding score underwent hemostatic analysis, including two men and 18 women with average age of 33.9 years. Minor hemostatic abnormalities were observed in three donors. Two donors exhibited accelerated fibrinolysis with reduced euglobulin lysis time and increased D-dimer levels in serum. Two donors had a platelet granule defect, without identification of genetic abnormality.
CONCLUSION
The bleeding questionnaire proved to be a valuable tool to screen blood donors for potential platelet defects. Platelet dysfunction was rare in the blood donor population assessed. Additional studies are necessary to understand the clinical impact that the transfusion of platelets with qualitative defects has on recipients.
Topics: Adult; Blood Coagulation Disorders; Blood Donors; Blood Platelet Disorders; Blood Platelets; Female; Hematoma; Hemorrhage; Hemorrhagic Disorders; Hemostasis; Hemostatics; Humans; Male; Prospective Studies
PubMed: 35748562
DOI: 10.1111/trf.16990 -
Cerebrovascular Diseases (Basel,... 2013Intracerebral hemorrhage (ICH), the most devastating form of stroke, has no specific therapy proven to improve outcome by randomized controlled trial. Location and... (Review)
Review
Intracerebral hemorrhage (ICH), the most devastating form of stroke, has no specific therapy proven to improve outcome by randomized controlled trial. Location and baseline hematoma volume are strong predictors of mortality, but are nonmodifiable by the time of diagnosis. Expansion of the initial hematoma is a further marker of poor prognosis that may be at least partly preventable. Several risk factors for hematoma expansion have been identified, including baseline ICH volume, early presentation after symptom onset, anticoagulation, and the CT angiography spot sign. Although the biological mechanisms of hematoma expansion remain unclear, accumulating evidence supports a model of ongoing secondary bleeding from ruptured adjacent vessels surrounding the initial bleeding site. Several large clinical trials testing therapies aimed at preventing hematoma expansion are in progress, including aggressive blood pressure reduction, treatment with recombinant factor VIIa guided by CT angiography findings, and surgical intervention for superficial hematomas without intraventricular extension. Hematoma expansion is so far the only marker of outcome that is amenable to treatment and thus a potentially important therapeutic target.
Topics: Acute Disease; Cerebral Angiography; Cerebral Hemorrhage; Clinical Trials as Topic; Hematoma; Humans; Stroke
PubMed: 23466430
DOI: 10.1159/000346599 -
Stroke Oct 2023Spreading depolarizations (SDs) occur in all types of brain injury and may be associated with detrimental effects in ischemic stroke and subarachnoid hemorrhage. While...
BACKGROUND
Spreading depolarizations (SDs) occur in all types of brain injury and may be associated with detrimental effects in ischemic stroke and subarachnoid hemorrhage. While rapid hematoma growth during intracerebral hemorrhage triggers SDs, their role in intracerebral hemorrhage is unknown.
METHODS
We used intrinsic optical signal and laser speckle imaging, combined with electrocorticography, to investigate the effects of SD on hematoma growth during the hyperacute phase (0-4 hours) after intracortical collagenase injection in mice. Hematoma expansion, SDs, and cerebral blood flow were simultaneously monitored under normotensive and hypertensive conditions.
RESULTS
Spontaneous SDs erupted from the vicinity of the hematoma during rapid hematoma growth. We found that hematoma growth slowed down by >60% immediately after an SD. This effect was even stronger in hypertensive animals with faster hematoma growth. To establish causation, we exogenously induced SDs (every 30 minutes) at a remote site by topical potassium chloride application and found reduced hematoma growth rate and final hemorrhage volume (18.2±5.8 versus 10.7±4.1 mm). Analysis of cerebral blood flow using laser speckle flowmetry revealed that suppression of hematoma growth by spontaneous or induced SDs coincided and correlated with the characteristic oligemia in the wake of SD, implicating the vasoconstrictive effect of SD as one potential mechanism of action.
CONCLUSIONS
Our findings reveal that SDs limit hematoma growth during the early hours of intracerebral hemorrhage and decrease final hematoma volume.
Topics: Mice; Animals; Cortical Spreading Depression; Subarachnoid Hemorrhage; Electrocorticography; Cerebral Hemorrhage; Hematoma
PubMed: 37610105
DOI: 10.1161/STROKEAHA.123.042632 -
Journal of Cerebral Blood Flow and... Apr 2018Despite the absence of an intervention shown to improve outcomes in intracerebral hemorrhage, preclinical work has led to a greater understanding of the pathologic... (Review)
Review
Despite the absence of an intervention shown to improve outcomes in intracerebral hemorrhage, preclinical work has led to a greater understanding of the pathologic pathways of brain injury. Methods targeting hematoma clearance through both macroscopic (surgical) and microscopic (endogenous phagocytosis) means are currently under investigation, with multiple clinical trials ongoing. Macroscopic methods for removal involve both catheter- and endoscope-based therapies to remove the hematoma through minimally invasive surgery. Microscopic methods targeting hematoma clearance involve augmenting endogenous clearance pathways for red blood cells and altering the balance between phagocytosis and red blood cell lysis with the release of potentially harmful constituents (e.g. hemoglobin and iron) into the extracellular space.
Topics: Animals; Cerebral Hemorrhage; Hematoma; Humans; Minimally Invasive Surgical Procedures; Neurosurgical Procedures; Phagocytosis
PubMed: 29350086
DOI: 10.1177/0271678X17753590 -
International Journal of Surgery... Jan 2015Rectus sheath hematoma (RSH) is a relatively rare clinical condition, strongly associated among others, with abdominal trauma and anticoagulation. Although well... (Review)
Review
Rectus sheath hematoma (RSH) is a relatively rare clinical condition, strongly associated among others, with abdominal trauma and anticoagulation. Although well documented over the years, it still seems to be often misdiagnosed. Estimations of further increase in incidence are made, based on the increasing use of anticoagulants. Thus it was of interest to us to perform a literature review on the available literature of this entity with the aim to facilitate a better understanding and management in primary and secondary care settings. This review intends to present a synthesis on the main topics of this condition such as pathophysiology, epidemiology, predisposing factors, clinical presentation, diagnosis and basic treatment instructions. The initial search resulted in 146 articles. Additional citations from the reference list of the relevant publication were also included. Every physician in the field of primary/emergency medicine and surgery must be familiar with it, as misdiagnosis may lead to unnecessary laparotomy or death. In contrast, faster and more accurate diagnosis can lead to mortality rate reduction and cost containment.
Topics: Anticoagulants; Diagnosis, Differential; Hematoma; Humans; Muscular Diseases; Rectus Abdominis
PubMed: 25529279
DOI: 10.1016/j.ijsu.2014.12.015