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Cerebral Bleed

Giovanni Malferrari, Domenico Laterza, Franco Valzania, Daniela Monaco, Mauro Silingardi, Attilia Maria Pizzini
Antiplatelet agents and vitamin K antagonists (VKA) are usually used in the treatment of cervical (carotid or vertebral) artery dissections (CADs); however, data about the use of direct oral anticoagulants (DOACs) in these conditions are very limited. DOACs have proven to be effective in stroke reduction in non-valvular atrial fibrillation and, when possible, they are preferred to warfarin because of their better safety profile. We describe four cases of CADs and, firstly in literature, cervico-cerebral (CCADs) in young patients (average age of 42 years) treated with rivaroxaban 20 mg daily...
April 12, 2019: Neurological Sciences
Stefan H Hohnloser, John Camm, Riccardo Cappato, Hans-Christoph Diener, Hein Heidbüchel, Lluís Mont, Carlos A Morillo, Khalid Abozguia, Massimo Grimaldi, Heiko Rauer, Paul-Egbert Reimitz, Rüdiger Smolnik, Christoph Mönninghoff, Josef Kautzner
AIMS: Edoxaban is a direct factor Xa inhibitor approved for stroke prevention in atrial fibrillation (AF). Uninterrupted edoxaban therapy in patients undergoing AF ablation has not been tested. METHODS AND RESULTS: The ELIMINATE-AF trial, a multinational, multicentre, randomized, open-label, parallel-group study, was conducted to assess the safety and efficacy of once-daily edoxaban 60 mg (30 mg in patients indicated for dose reduction) vs. vitamin K antagonists (VKAs) in AF patients undergoing catheter ablation...
April 11, 2019: European Heart Journal
Safoura Sheikh Rezaei, Martina Mittlböck, Bertholdt Reichardt, Michael Wolzt
OBJECTIVES: Non-vitamin K oral anticoagulants (NOAC) or vitamin-K antagonists (VKA) are used for the prophylaxis and treatment of thromboembolic events. A potential drug-drug interaction and increased bleeding events have been reported with co-medication of selective serotonin receptor inhibitors (SSRI) and VKA. The aim of this study was to investigate the bleeding risk of a co-prescription of NOAC or VKA with SSRI. METHODS: Patients with prescription of NOAC or VKA and an antidepressant drug therapy (ADTx) were selected from the drug reimbursement database of 13 Austrian health insurance funds...
April 9, 2019: International Journal of Geriatric Psychiatry
Xiangping Luo, Shunqing He, Zhaowei Lin, Zhian Li, Chao Huang, Qi Li
Background: Intertrochanteric fragility fracture (IFF) treated with proximal femoral nail anti-rotation (PFNA) is associated with significant hidden blood loss and high blood transfusion rate. The purpose of the present study was to evaluate the efficacy and safety of tranexamic acid (TXA) in reducing blood loss in these patients. Materials and Methods: Consecutive eligible patients were recruited and randomly assigned to a TXA group or a control group. The TXA group received 15 mg/kg body weight of TXA intravenously 15 min before incision and the same dose 3 h later...
March 2019: Indian Journal of Orthopaedics
Ye Zhang, Hong Deng, Yang Hu, Chao Pan, Guofeng Wu, Qi Li, Zhouping Tang
Adipose-derived mesenchymal stromal cells (ADSCs) exhibited high potential in tissue repair and regeneration, and it has been proved that ADSCs could protect brain cells from apoptosis and maintaining blood-brain barrier stability after cerebral vascular disease. In this study, we evaluated the therapeutic potential and mechanism of ADSCs stereotactic transplantation in intracerebral hemorrhage (ICH) mice model and hemin-treated astrocytes. Mice were divided into three groups: sham group, ICH + PBS group, and ICH + ADSC group...
April 8, 2019: Journal of Cellular Biochemistry
Yan'gang Wang, Yang Wang, Junjie Zhang, Shunli Du, Jiabin Wu
For malignant cerebral venous sinus thrombosis (CVST) complicated with cerebral hernia, decompressive craniectomy may be life-saving, and thrombectomy combined with thrombolysis may obtain better outcomes. This report describes an approach performed on 2 patients diagnosed with CVST combined both thrombectomy and thrombolysis with decompressive craniectomy through incising the superior sagittal sinus. The general procedure of the operation is as follows. The anterior part of the superior sagittal sinus was exposed firstly...
April 5, 2019: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Hannes Nordmeyer, René Chapot, Patrick Haage
BACKGROUND:  Intracranial atherosclerotic stenosis (ICAS) causes 5 - 10 % of all ischemic strokes in the European population. Indication for endovascular treatment is a special challenge and the selection of material as well as interventional techniques essentially differs from the treatment of extracranial stenoses. According to recent studies patient selection became evidence based; however the method should not be abandoned. New technical approaches can contribute to avoid complications...
April 4, 2019: RöFo: Fortschritte Auf Dem Gebiete der Röntgenstrahlen und der Nuklearmedizin
Kenichiro Uchida, Tetsuro Nishimura, Hiromasa Yamamoto, Yasumitsu Mizobata
BACKGROUND: Blunt traumatic aortic injury (BTAI) patients are severely ill, with high mortality and morbidity. As 60% of BTAIs occur in the distal arch, left subclavian artery (LSCA) management is determined without knowing posterior cerebral or left arm circulation in emergent cases. Because we perform thoracic endovascular aortic repair (TEVAR) + debranching technique for thoracic BTAI, we assessed efficacy and safety of debranching TEVAR in BTAI patients. METHODS: We retrospectively reviewed vital signs on arrival, injury mechanism, characteristics, clinical time-series, concomitant injuries, injury description, operative procedures, and results from patient records...
April 3, 2019: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Young-Ji Kim, Jong-Woo Jeong, Youngshin Song, Tae-Sung Koo
Purpose: The purpose of this study was to investigate the effects of the type of formulation on the efficacy of warfarin. Materials and methods: The electronic medical records of patients with cerebral infarction, who were administered tablet or powder formulations of warfarin from 2013-2015, were retrospectively analyzed. Clinical data, changes in the international normalized ratio (INR), the warfarin dose, and the time to reach the plasma warfarin concentration that could induce an adverse effect, such as bleeding, were evaluated...
2019: Clinical Pharmacology: Advances and Applications
Laurent Puy, Charlotte Cordonnier
Sporadic cerebral amyloid angiopathy (CAA) is a small vessel disease caused by vascular deposits of Aß-amyloid peptides in the walls of cortical and leptomeningeal vessels. Advancing age is the strongest known clinical risk factor for developing CAA. This devastating disease occurs frequently in elderly people, and is a frequent cause of symptomatic lobar intracerebral hemorrhage (ICH), cognitive impairment and transient focal neurological episodes. Typical cerebral MRI findings include lobar intracerebral hemorrhages and neuroimaging biomarkers of CAA (lobar cerebral microbleeds, cortical superficial siderosis, white matter hyperintensities, dilated perivascular spaces and microinfarcts)...
March 1, 2019: Gériatrie et Psychologie Neuropsychiatrie du Vieillissement
Masahiko Mihara, Yasunobu Tamaki, Nariaki Nakura, Satoshi Takayanagi, Akira Saito, Shunsuke Ochiai, Kazuo Hirakawa
BACKGROUND: Pulmonary thromboembolism (PTE) and deep vein thrombosis (DVT) are serious complications after total hip arthroplasty (THA). Aspirin has been considered a safe and cost-effective prophylaxis for venous thromboembolism (VTE), and there have been some reports about the incidence of PTE (0%-0.57%) and DVT (0.1%-0.35%) with low-dose aspirin for prophylaxis after THA. The aim of this study was to investigate the incidence of postoperative symptomatic VTE in our hospital and to evaluate the clinical efficacy of our prophylactic regimen...
March 19, 2019: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
Tommaso Sciortino, Bethania Fernandes, Marco Conti Nibali, Lorenzo G Gay, Marco Rossi, Egesta Lopci, Anna E Colombo, Maria G Elefante, Federico Pessina, Lorenzo Bello, Marco Riva
BACKGROUND: Stereotactic biopsy is consistently employed to characterize cerebral lesions in patients who are not suitable for microsurgical resection. In the past years, technical improvement and neuroimaging advancements contributed to increase the diagnostic yield, the safety, and the application of this procedure. Currently, in addition to histological diagnosis, the molecular analysis is considered essential in the diagnostic process to properly select therapeutic and prognostic algorithms in a personalized approach...
March 20, 2019: Acta Neurochirurgica
Gerhard Pichler, Sigrid Baumgartner, Marlene Biermayr, Eugene Dempsey, Hans Fuchs, Tom G Goos, Gianluca Lista, Laila Lorenz, Lukasz Karpinski, Souvik Mitra, Lilijana Kornhauser-Cerar, Alexander Avian, Berndt Urlesberger, Georg M Schmölzer
BACKGROUND: Transition immediately after birth is a complex physiological process. The neonate has to establish sufficient ventilation to ensure significant changes from intra-uterine to extra-uterine circulation. If hypoxia or bradycardia or both occur, as commonly happens during immediate transition in preterm neonates, cerebral hypoxia-ischemia may cause perinatal brain injury. The primary objective of the COSGOD phase III trial is to investigate whether it is possible to increase survival without cerebral injury in preterm neonates of less than 32 weeks of gestation by targeting cerebral tissue oxygen saturation (crSO2 ) using specified clinical treatment guidelines during the immediate transition period after birth (the first 15 min) in addition to the routine monitoring of arterial oxygen saturation (SpO2 ) and heart rate (HR)...
March 20, 2019: Trials
Richard Blythe, Azza Ismail, Aaizza Naqvi
Intravenous recombinant tissue-plasminogen-activator (rtPA) and mechanical-thrombectomy (MT) are currently the only approved treatments for acute ischemic stroke. Their effectiveness was demonstrated in several clinical trials, and is therefore standard of care. Pregnant women were not included in these studies and consequently the effectiveness and safety in this group are unclear. We present a rare case of a patient in the third-trimester of pregnancy that underwent MT. A 29-year-old woman of 39 weeks' gestation presented with left facial-paresis, hemiparesis, and neglect...
March 13, 2019: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Hormuzdiyar H Dasenbrock, Robert F Rudy, Timothy R Smith, William B Gormley, Nirav J Patel, Kai U Frerichs, M Ali Aziz-Sultan, Rose Du
OBJECTIVEThe complex decision analysis of unruptured intracranial aneurysms entails weighing the benefits of aneurysm repair against operative risk. The goal of the present analysis was to build and validate a predictive scale that identifies patients with the greatest odds of a postsurgical adverse event.METHODSData on patients who underwent surgical clipping of an unruptured aneurysm were extracted from the prospective National Surgical Quality Improvement Program registry (NSQIP; 2007-2014); NSQIP does not systematically collect data on patients undergoing intracranial endovascular intervention...
March 15, 2019: Journal of Neurosurgery
David A Warrell
Louse-borne relapsing fever (LBRF) is an epidemic disease with a fascinating history from Hippocrates' times, through the 6th century 'Yellow Plague', to epidemics in Ireland, Scotland and England in the 19th century and two large Afro-Middle Eastern pandemics in the 20th century. An endemic focus persists in Ethiopia and adjacent territories in the Horn of Africa. Since 2015, awareness of LBRF in Europe, as a re-emerging disease, has been increased dramatically by the discovery of this infection in dozens of refugees arriving from Africa...
January 2019: Epidemiology and Infection
Sarah H O'Brien, Danshi Li, Lesley G Mitchell, Thomas Hess, Pamela Zee, Donald L Yee, Jane W Newburger, Lillian Sung, Vilmarie Rodriguez
Venous thromboembolic (VTE) complications in children and adolescents with acute lymphoblastic leukaemia (ALL) and T or B cell lymphoblastic lymphoma (T/B cell LL) can result not only in life-threatening acute complications but also contribute to significant long-term sequelae. The PREVAPIX-ALL study is an open-label randomized controlled study comparing outcomes of treatment with prophylactic dose apixaban versus no anticoagulation (standard of care) in children and adolescents with ALL and T/B cell LL receiving standard induction chemotherapy with asparaginase and the presence of a central venous access device...
March 12, 2019: Thrombosis and Haemostasis
Toshikazu Kimura, Chikayuki Ochiai, Kensuke Kawai, Akio Morita, Nobuhito Saito
OBJECTIVETo investigate the risk of bleeding from unruptured cerebral aneurysms (UCAs), previous studies have used Kaplan-Meier analyses without treating the definitive treatment as a competing risk event, which may underestimate the rupture rate. The authors analyzed the survival of patients with UCAs alongside the occurrence of aneurysm bleeding and its competing risk events.METHODSA retrospective analysis was conducted on 722 patients diagnosed with UCAs in the period from 2000 to 2009 using an institution's electronic medical records and telephone interviews...
March 8, 2019: Journal of Neurosurgery
Takanori Ohta, Hiroshi Imanaga, Seidou Oku, Hirotake Kusumoto, Yasuhiro Sugio, Sadafumi Tamiya, Yasutaka Kubo, Ryosuke Ogawa, Kenji Hikosaka, Kazumi Norose, Yuju Ohno
A 57-year-old man with high-risk myelodysplastic syndrome underwent umbilical cord blood transplantation. He began receiving steroids on day 14 for acute graft-versus-host disease, and experienced dizziness on day 75 during gradual dose reduction. Multiple hemorrhages were observed in the cerebrum, cerebellum, and brainstem. His bleeding increased, and he underwent a brain biopsy on day 91. Subsequently, he was diagnosed with central nervous system vasculitis (CNSV) on the basis of the observed aggregation of mature CD3+ lymphocytes around small vessels and vascular wall invasion by lymphocytes and macrophages...
2019: [Rinshō Ketsueki] the Japanese Journal of Clinical Hematology
Allan Hall, Roddy O'Kane
The management of hypertension in SAH patients within the Pre-Aneurysmal treatment period remains ambiguous. This is in part due to the lack of high level evidence-based guidelines. Despite this there are current recommendations which offer guidance regarding certain parameters such as MAP and systolic BP. However managing hypertension within this critical period is difficult since a fine balance must be achieved between lowering BP enough to minimize the risk of re-bleeding, and preventing reduced cerebral perfusion and subsequent ischaemic damage...
February 27, 2019: World Neurosurgery
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