Brain Hemorrhage Research Articles

CORTICAL BLINDNESS DUE TO BILATERAL STROKES – A CASE REPORT OF ANTON SYNDROME

Background: Blindness (anopia) is a functional loss of vision, which could be due either to ophthalmological or neurological conditions. Blindness may be congenital or acquired. The main causes of blindness in adults are cataracts, uncorrected ametropia (myopia, astigmatism), glaucoma, macular dystrophy, cortical ischemic strokes, etc. In less than 10% of the patients, the reason for cortical blindness is bilateral occipital strokes, one of them hemorrhagic. Case Description: In the current case report, we present a 75-year-old patient with complaints of headache and visual loss. The patient has a history of a left PCA (posterior cerebral artery) distal ischemic stroke. The CT scan reveals a hypodense cerebral lesion in the left medial occipital cortex and subcortex (lingual gyri and cuneus) and a hyperdense cerebral lesion in the right medial occipital cortex and subcortex (lingual gyri and cuneus). The neurological examination shows only bilateral visual loss without motor deficits. The patient has visual anosognosia and confabulation in the setting of obvious visual loss and cortical blindness(Anton-Babinski syndrome, also known as ABS or Anton syndrome). However, performing cerebellar tests (dysdiadochokinesis, finger-to-nose test, heel-to-shin test, cerebellar ataxia) was not done because of the visual loss. After being consulted by a neurologist and neurosurgeon with the preliminary diagnosis of brain hemorrhage, the patient was admitted to the Neurology Clinic of UMHAT D-r "Georgi Stranski", Pleven, Bulgaria. Conclusion: Occipital infarction must be considered in all cases with sudden onset of isolated visual loss. Early diagnosis and treatment of stroke reduce mortality and morbidity. The prognosis depends on the extension of the visual cortex damage.

CD4+ T cells aggravate hemorrhagic brain injury.

Leukocyte infiltration accelerates brain injury following intracerebral hemorrhage (ICH). Yet, the involvement of T lymphocytes in this process has not been fully elucidated. Here, we report that CD4+ T cells accumulate in the perihematomal regions in the brains of patients with ICH and ICH mouse models. T cells activation in the ICH brain is concurrent with the course of perihematomal edema (PHE) development, and depletion of CD4+ T cells reduced PHE volumes and improved neurological deficits in ICH mice. Single-cell transcriptomic analysis revealed that brain-infiltrating T cells exhibited enhanced proinflammatory and proapoptotic signatures. Consequently, CD4+ T cells disrupt the blood-brain barrier integrity and promote PHE progression through interleukin-17 release; furthermore, the TRAIL-expressing CD4+ T cells engage DR5 to trigger endothelial death. Recognition of T cell contribution to ICH-induced neural injury is instrumental for designing immunomodulatory therapies for this dreadful disease.

Quamdiu? Time to proficiency in endoscope-assisted minimally invasive clot evacuation

IntroductionSpontaneous intraparenchymal brain hemorrhages are a devastating disease associated with significant disability or death. Minimally invasive clot evacuation (MICE) techniques can reduce mortality. We reviewed our experience with learning endoscope-assisted MICE to determine whether adequate results could be obtained in less than 10 cases. MethodsWe performed a retrospective chart review of patients undergoing endoscope-assisted MICE at a single institution by a single surgeon from January 1, 2018 to January 1, 2023 using a neuro-endoscope, a commercial clot evacuation device, and frameless stereotaxis. Demographic data was collected along with surgical results and complications. Image analysis using software determined the degree of clot removal. Hospital length of stay and functional outcomes were assessed using the Glasgow Coma Scale score (GCS) and Glasgow Outcome Score (extended) (GOS-E). ResultsEleven patients were identified: average age 60.82 years old, 64 % male, all had hypertension. There was a clear improvement in IPH evacuation over the series. By case #7, greater than 80 % of clot volume was evacuated consistently. All patients remained neurologically stable or improved following surgery. In long-term follow-up, four patients (36.4 %) had good outcomes (GOS-E ≥ 6) and 2 patients had fair outcomes (GOS-E = 4) (18 %). There were no surgical mortalities, re-hemorrhages, or infections. ConclusionsWith an experience of less than 10 cases, it is possible to obtain results comparable to most published series of endoscope-assisted MICE. Benchmarks such as greater than 80 % volume removal, less than 15 mL residual, and 40 % good functional outcomes can be obtained.

ST-Segment Elevation in a Young Woman with a Brain Bleed

ST-Segment Elevation in a Young Woman with a Brain Bleed

Disrupted neurogenesis, gliogenesis, and ependymogenesis in the Ccdc85c knockout rat for hydrocephalus model

Coil-coiled domain containing 85c (Ccdc85c) is a causative gene for congenital hydrocephalus and subcortical heterotopia with frequent brain hemorrhage. We established Ccdc85c knockout (KO) rats and investigated the roles of CCDC85C and intermediate filament protein expression, including nestin, vimentin, GFAP, and cytokeratin AE1/AE3 during the lateral ventricle development in KO rats to evaluate the role of this gene. We found altered and ectopic expression of nestin and vimentin positive cells in the wall of the dorso-lateral ventricle in the KO rats during development from the age of postnatal day (P) 6, whereas both protein expression became faint in the wild-type rats. In the KO rats, there was a loss of cytokeratin expression on the surface of the dorso-lateral ventricle with ectopic expression and maldevelopment of ependymal cells. Our data also revealed disturbed GFAP expression at postnatal ages. These findings indicate that lack of CCDC85C disrupts the proper expression of intermediate filament proteins (nestin, vimentin, GFAP, and cytokeratin), and CCDC85C is necessary for normal neurogenesis, gliogenesis, and ependymogenesis.

Neurological Involvement in Dengue: An Autopsy Study

ABSTRACT Dengue is a mosquito-borne disease that is a public health concern and outbreaks have increased in India. The virus produces fever, hemorrhagic fever, and shock syndrome. Dengue may cause encephalopathy. Few autopsies in individuals with neurological complaints have been documented. Our paper reports on an adult with dengue and neurological symptoms with postmortem findings. Thirty-six-year-old presented with a 2-day fever. He was febrile with a normal systemic exam. By evening, he was stuporous. His platelet count was moderately decreased to about 80,000/cumm. His serum and cerebrospinal fluid (CSF) were positive for dengue non-structural (NS) 1 antigen (Ag). He deteriorated and succumbed on day 4. An autopsy was performed to determine the cause of death. On examination, the brain was edematous with frontoparietal, internal capsule, and brain stem hemorrhages. Microscopy showed vascular congestion, edema, multiple hemorrhages, and liquefactive necrosis. In India, diagnostic testing is limited. This patient’s platelet count was not too low, but postmortem findings of brain hemorrhages highlight the necessity of recognizing its uncommon manifestations.

PEDS6: Brain MRI Outcomes Following Carotid Reconstruction vs Ligation in Neonatal Patients Decannulated from VA-ECMO

Background: There is a paucity of data to guide carotid artery management during veno-arterial extracorporeal membrane oxygenation (VA-ECMO) decannulation. In our institution, carotid reconstruction is routinely performed by some surgeons, whereas others prefer ligation. We aimed to compare the radiographic outcomes of the different surgical techniques in our neonatal VA-ECMO survivors. Methods: We performed a single-center retrospective analysis of neonates (<28 days old) in our neonatal intensive care unit (NICU) who survived VA-ECMO decannulation between 6/2009 and 9/2022. Our institutional practice was to obtain daily screening head ultrasounds (HUS) on neonates while on ECMO and a brain MRI once clinically stable following decannulation. Patients who did not have a brain MRI following decannulation were excluded from the study. Carotid reconstruction was only performed on ECMO patients cannulated for less than 10 days, thus all patients cannulated for greater than 10 days were also excluded. The primary outcome parameter was arterial infarcts visualized on brain MRI. Secondary outcomes included extra-axial and intra-axial brain hemorrhage. Results: 82 patients met inclusion criteria for this study, including 38 (46%) that had carotid reconstruction and 44 (54%) that had carotid ligation. The two groups had similar demographics including patient characteristics, ECMO indication and duration, HUS abnormalities on ECMO and survival to hospital discharge. 21 patients (26%) had parenchymal echogenicity or intra-ventricular hemorrhage (IVH) on screening HUS while on ECMO, whereas 43 patients (52%) had either ischemic or hemorrhagic brain injury on post-ECMO MRI. There was no difference in arterial infarcts (24% vs. 27%, p=0.71) and extra-axial hemorrhage (18% vs. 21%, p=0.82) on brain MRI between the reconstructed and ligated patients. However, there was a greater number of patients with intra-axial hemorrhage with carotid reconstruction compared to ligation (45% vs. 16%, p<0.01). Conclusions: Neonates that survive VA-ECMO have multiple risk factors for brain injury. We found no difference in arterial infarcts or extra-axial brain hemorrhage following carotid reconstruction. However, there was a greater number of intra-axial hemorrhagic brain injury in patients with carotid reconstruction. Further studies are needed to discern the mechanisms underlying these radiographic differences and the effects on long-term neurocognitive outcomes.

Why adult patients with acute leukemias are dying in the developing world: The other side of the coin.

e19035 Background: Majority of the patients with acute leukemias can reach complete remission (CR) in case of appropriate therapy and many of those in CR are expected to remain in remission for several years, which could be considered a cure. Because of progress in recent decades, less and less patients in the developed world are dying. In the developing world the situation is different and with the current work we would like to report the state of leukemias in Armenia and significant disparities, which affect the treatment outcomes of those patients. Methods: We analyzed the medical records of all expired adult patients diagnosed with acute leukemia at the Hematology Center of Armenia from 01/01/2016 until 12/31/2020. Hematology Center is the only institution in Armenia treating leukemias, meaning the data is a countrywide report. Death dates were taken from the United Information System of Electronic Healthcare in the Republic of Armenia. Results: Over the five-year period, 431 patients were diagnosed with AL, of which 310 (71.9%) died. 244 medical records were available for further analysis. The median age of patients at the time of diagnosis was 59 (18-85), 45.9% (112) were female. 23.8% (58) of patients died before starting chemotherapy, of which 44.8% (26) refused the treatment, the others died from different complications due to disease progression. 33.6% (82) patients reached CR of which 29.3% (24) died in first remission: 3 pts from acute heart failure, 1 from COVID-19, 3 from septic shock, 1 from pulmonary aspergillosis, 2 from acute respiratory failure, in 14 patients the causes of death were unknown. 58(70.7%) of those patients, who developed relapse, only 12% (7) of them reached 2nd remission. In 82.8% (48) of patients the death was because of disease progression. One patient died from acute kidney failure, 1 from acute respiratory failure, 1 from COVID-19,1 from septic shock. 50 patients died during induction therapy, form which 58% (29) was due to disease progression, the other reasons were: septic shock, acute heart failure, brain hemorrhage, acute respiratory failure, mesenteric venous thrombosis, multiple organ failure. 30 patients were resistant to the first line therapy and refused further therapy. In 24 patients it was not possible to clarify if they have developed remission and what were the death causes. Conclusions: In our analyzed cohort 23% of all patients refused the treatment, almost half of which did not even start the treatment. It should also be mentioned that because of stigma about cancer, some of those patients did not know their diagnosis and the decisions were made by the relatives. Other reasons for such high abandonment rates are mostly financial and social.

ISCHEMIC STROKE AFTER CORONARY BYPASS SURGERY IN PATIENTS WITH TYPE 2 DIABETES, HYPERTENSION, AND TRIPLE VESSEL DISEASE

Objective: We want to investigate this case, what are the various Risk factors for Ischaemic stroke as a major complication, and how to reduce this life-threatening complication in high-risk patients with diabetes, hypertension, and triple vessel disease. Design and method: A 55-year-old patient with TVD Tripple vessel disease without acute MI (myocardial infarction) needed CABG. His angiographic score and uncontrolled diabetes suggested open heart surgery. He did not have carotid or aortic plaque or other issues during the pre-op examination. He underwent on-pump CABG, cardiac aortic bypass with two saphenous veins (on the RCA and OM1), and anastomosis of the left internal thoracic artery on the LAD. The pumping duration was 150 minutes. The patient was weaned from the pump, the surgery was completed, the sternum was closed, and the patient was transferred to the intensive care unit. When we decided to extubate the patient after 12 hours, we noticed his limb movement was not symmetrical. He was paralyzed on the left side. There was significant left hemisphere ischemia on brain CT, which was consistent with CVA. Once brain hemorrhage was excluded, the neurologists started administering heparin to treat the ischemic stroke. Results: Patients with severe stenosis and 3VD require intervention or CABG treatment; however, in this instance, the areas of stenosis were not appropriate for stenting, and the patient's uncontrolled diabetes was another reason suggestive of open-heart surgery. Three crucial aspects have shocked us and that all surgeons may find challenging. Uncontrolled diabetes can significantly contribute to the damage of medium and small blood vessels, and chronic hypertension can cause micro tears and blood clots in the vessels. These three variables can result in tiny damage. Long pump time and these two variables contributed to blood stagnation in the patient. In addition, the patient may have been more vulnerable to ischemic attacks. Conclusions: We may have avoided this complication by administering the following measures

Ferrostatin‐1 and z‐VAD‐FMK Potentially Attenuated Iron‐mediated Neurotoxicity and Rescued Cognitive Function in Iron‐overloaded Rats

AbstractBackgroundOur study indicated that iron‐overloaded condition induced neurotoxicity in rats and cognitive impairment (1). Furthermore, neuronal deaths caused by apoptosis and ferroptosis, have been identified as one of the underlying mechanisms of neurotoxicity in iron‐overloaded condition (1, 2). Recently, a ferroptosis inhibitor; ferrostatin‐1 and a pan‐caspase inhibitor; z‐VAD‐FMK exerted neuroprotection in traumatic brain injury and intracerebral hemorrhagic brain. Nonetheless, the comparative efficacy of these cell death inhibitors on brain parameters and cognitive function in iron‐overloaded rats has not yet been investigated.MethodThirty male Wistar rats were divided into 2 groups to receive an intraperitoneal injection with 10% dextrose in normal saline solution (NSS) as a control group (n = 6) or 100 mg/kg iron dextran as an iron‐overloaded group (n = 24). After 4 weeks of injection, iron‐overloaded group was subdivided into 4 groups (n = 6/ group) to subcutaneously receive with the pharmacological interventions including 1) vehicle (10% DMSO in NSS), 2) deferoxamine (25 mg/kg), 3) ferrostatin‐1 (2 mg/kg), and 4) z‐VAD‐FMK (1 mg/kg). In contrast, rats in the control group were received vehicle. Those mice were received the assigned treatment for further 2 weeks. Behavioral tests including the Morris water maze test (hippocampal‐dependent memory) and novel object recognition test (hippocampal‐independent memory), were performed. At the end of experiments, systemic iron overload and brain parameters including blood‐brain tight junction proteins, brain iron, synaptic markers, and brain ferroptosis/apoptosis were determined.ResultNot only systemic iron overload, but iron‐overloaded rats exhibited blood‐brain barrier breakdown, brain iron overload, iron‐mediated brain toxicity including brain oxidative stress, loss of synaptic proteins, and brain ferroptosis/apoptosis, leading to cognitive impairment. Treatment with deferoxamine attenuated rats from systemic iron overload, brain pathologies, and hippocampal‐independent memory (Figure 1A), but failed to rescue hippocampal‐dependent memory in iron‐overloaded rats (Figure 1B). Interestingly, cell death inhibitors including ferrostatin‐1 and z‐VAD‐FMK provided superior neuroprotection than deferoxamine by attenuating loss of synaptic proteins and restoring cognitive function in hippocampal‐dependent and hippocampal‐independent manners (Figure 1A‐1C).ConclusionFerrostatin‐1 and z‐VAD‐FMK exerted neuroprotective effects and cognitive restoration in rats under iron‐overloaded condition, suggesting the novel therapeutic strategy using cell death inhibitors in brain following iron‐overloaded condition.

Determining the risk of development of cranial pathology in patients with minor head injury using antiagregan-anticoagulants

Background: Patients use antiplatelet/anticoagulant drug which is increasing bleeding tendency is increasing with age. These patients can be admitted to the emergency room with minor head trauma and some ambiguities which may occur in the management of emergency services We undertook this study to determine the factor of intracranial hemorrhage in anticoagulated patients and patients on antiplatelet therapy and its impact on clinical management, identify predictors of positive imaging findings and their outcomes. Methods: ın a prospective analysis, All patients who had minor head trauma between June 1, 2014 and May 1 2015 were included in this study. They should be evaluated by doctors in the ED; no interference will be made during diagnosis and treatment. We reviwed medications, mechanism of injury, head CT results and outcomes. Demografic data, symptoms, clinical examinations were recorded. Results: 606 patients with minor head trauma were admitted to the emergency department. The average age of patients was 48.6 ± 22.6 and 57% (n = 345) were men, 43% (n = 261) were female. 30% of them (n:182) were taking antiplatelet/anticoagulant. Patients who use antiplatelet/anticoagulat is older then patients who didn’t use antiplatelet/anticoagulat therapy. Patients had CT scanned and they had 14,6% pathological finding. But this wasn’t statistically significant (p=0,762). Similarly, there was no statistically significant difference between 68 users antiplatelet and anticoagulant therapy (p = 0.865). Nausea was statistically significant in patients with pathology in the head CT (p=0,045). Conclusion: Minor head trauma in patients may die or have brain hemorrhage who use ASA with klopidogrel. However, symptoms of the patient, physical examination and laboratory data are insufficient to predict the risk of intracranial pathology.

A case of intravenous iron administration resulting in cerebral edema expansion

BackgroundIron plays an important role in the development of perihematomal edema (PHE) in the setting of intracerebral hemorrhage (ICH). Cerebral iron is increased via direct hemoglobin release in ICH, and several studies have investigated the use of iron-chelating agents to mitigate its toxicity. However, the effect of systemic iron administration, corroborating the reverse concept, has never been investigated or reported clinically. We report the first case of systemic iron administration in the setting of hemorrhagic traumatic brain injury (TBI).Case presentationA 46-year-old woman was admitted to the hospital with acute moderate-to-severe TBI. Her head computed tomography (CT) scan showed bifrontal hemorrhagic contusions with mild PHE. She was started on hypertonic saline 3% continuous infusion and her condition remained stable initially. She was found to be anemic and was given intravenous iron sucrose. Shortly after iron administration, her mental status declined, and left pupil became dilated and sluggish. Repeat CT demonstrated significantly worsening PHE. This prompted maximum hyperosmolar therapy and external ventricular drain (EVD) placement which both were weaned off slowly due to liable ICPs. She was discharged home after a 25-day hospital stay.ConclusionsWe believe this is the first report of exacerbating PHE accompanied by clinical decline after intravenous iron administration in the setting of acute hemorrhagic brain contusions. Though the effects of systemic iron administration on brain edema and the treatments targeting cerebral iron are poorly understood, the administration of systemic iron in acute TBI seems to be detrimental. More research is needed to address iron toxicity in TBI. Our case adds to the growing evidence for such a pathway in the treatment of ICH and TBI.

Automated screening of computed tomography using weakly supervised anomaly detection.

Current artificial intelligence studies for supporting CT screening tasks depend on either supervised learning or detecting anomalies. However, the former involves a heavy annotation workload owing to requiring many slice-wise annotations (ground truth labels); the latter is promising, but while it reduces the annotation workload, it often suffers from lower performance. This study presents a novel weakly supervised anomaly detection (WSAD) algorithm trained based on scan-wise normal and anomalous annotations to provide better performance than conventional methods while reducing annotation workload. Based on surveillance video anomaly detection methodology, feature vectors representing each CT slice were trained on an AR-Net-based convolutional network using a dynamic multiple-instance learning loss and a center loss function. The following two publicly available CT datasets were retrospectively analyzed: the RSNA brain hemorrhage dataset (normal scans: 12,862; scans with intracranial hematoma: 8882) and COVID-CT set (normal scans: 282; scans with COVID-19: 95). Anomaly scores of each slice were successfully predicted despite inaccessibility to any slice-wise annotations. Slice-level area under the curve (AUC), sensitivity, specificity, and accuracy from the brain CT dataset were 0.89, 0.85, 0.78, and 0.79, respectively. The proposed method reduced the number of annotations in the brain dataset by 97.1% compared to an ordinary slice-level supervised learning method. This study demonstrated a significant annotation reduction in identifying anomalous CT slices compared to a supervised learning approach. The effectiveness of the proposed WSAD algorithm was verified through higher AUC than existing anomaly detection techniques.

Correlation of Bleeding Volume and Cognitive Function Impairment in Hemorrhage Traumatic Brain Injury

Background/aim: Traumatic Brain Injury (TBI) is a neurological emergency. When a traumatic brain injury occurs, there will be short-term and long-term effects that will affect the brain. This study was aimed to determine the correlation of bleeding volume and cognitive function impairment in hemorrhagic traumatic brain injury. Method: This study uses data collection methods in the form of interviews with samples which will later be presented in the form of analytical observational study. Consecutive data collection on TBI patients in poly and unit room medical neurosurgery at Sanglah Hospital from August – Oktober 2021. The questionnaire used to cognitive function impairment with Montreal Cognitive Assessment version Indonesia (MoCA-INA). Data analysis using SPSS Version 23 for windows. Results: A total of 42 subjects were divided into normal and decreased cognitive function The patients’ mean age was average 29 (17-49) years old, Man 62%, cases epidural hemorrhagic 50 %, subdural 38% and intracerebral 12%, and their mean Glasgow Coma Scale score at admission was 11.5 ± 1.7 and significant with OR = 0.1 (95% CI = (0.02-0.4; p = 0.003) were. Lesions were predominantly localized to the frontal (14 lesions) and temporal (10 lesions) lobes. Lobe lesion volume did not correlate with cognitive function. The volume bleeding average 10.43 (1-40) significant with p= 0.016 (OR 5.2 (95% CI (1.3-19.7). Conclusion: Bleeding volume in hemorrhagic TBI increased five times in volume &gt; 10 mL and GCS 9-13 first times came emergency room significant increased 0.1 times decreased function cognitive. Keywords: sleep quality, non-vegetarian, diet, serotonin, vegetarian

POST ISCHEMIC STROKE IMAGING AND ITS CLINICAL RELEVANCE: A SYSTEMATIC REVIEW

Stroke is a focal or global functional brain disorder that starts suddenly and lasts longer than 24 hours and is caused by changes in cerebral blood flow. It is not caused by transient cerebral circulatory abnormalities, brain tumors, or secondary strokes as a result of trauma or infection. Strokes can develop in any part of the brain. Ischemia or brain hemorrhage are also potential causes of a stroke that occurs suddenly and leads in neurologic impairments. Strokes are classified into two types: bleeding and non-bleeding. Both are potentially fatal. Several studies have found that imaging is required before treating an acute ischemic stroke. The importance of imaging after stroke treatment, on the other hand, is less obvious. Bleeding, particularly cerebral haemorrhage, is the most feared complication in people who have had acute ischemic stroke treatment. As a result, the AHA/ASA IV-tPA guidelines recommend that a non-contrast computed tomography (NCCT) brain scan be performed at least 24 hours after therapy. Non-contrast CT (NCCT) is still the cheapest, quickest, most generally available, and simplest method for diagnosing intracerebral bleeding after an ischemic stroke. However, MRI with the right sequences may be able to detect the same thing. The NCCT may frequently detect hyperdense regions following treatment for acute ischemic stroke. Magnetic resonance imaging (MRI) is one of the most commonly used imaging methods both before and after stroke treatment due to the wealth of information it gives. Finally, post-ischemic stroke imaging is becoming increasingly essential because it can provide both specific clinical guidance and a better knowledge of the processes that occur after such a severe impact on the brain. It may aid in the prediction of long-term outcomes and, in the future, may assist clinicians in tailoring and optimizing rehabilitation efforts for specific patients.

Injuries related to sauna bathing

PurposeAwareness of well-being and health issues have contributed to increased popularity of sauna bathing. However, little is known about potential risks and injuries. The aim of this study was to identify the causes for injuries, the affected body regions and to define recommendations for prevention. MethodsA retrospective chart data analysis was conducted among patients treated for an injury related to sauna bathing at the local trauma centre of the Medical University of Innsbruck between January 1, 2005 and December 31, 2021. Patients’ demographics, the cause for the injury, the diagnosis, the body region of the trauma and the treatment methods were collected. ResultsTwo hundred and nine patients with injuries related to sauna bathing (83 female [39.7%] and 126 male [60.3%]) were identified. Fifty-one patients showed more than one injuries leading to a total of 274 diagnosis: contusions/distorsions (113; 41.2%), wounds (79; 28.8%), fractures (42; 15.3%), ligament injuries (17; 6.2%), concussions (15; 5.5%), burns (4; 1.5%) and brain bleeding (3; 1.1%). The most common cause for an injury was a slip/fall (157; 57.5%) followed by dizziness/syncope (82; 30.0%). Interestingly, head and face injuries were mostly caused by dizziness/syncope, whereas slip/fall was the leading cause for injuries of foot, hand, forearm and wrist. Nine patients(4.3%) needed surgical treatment mainly due to fractures. Eight patients got injured by wood splinters. One patient sustained grade IIB-III burns lying unconscious with an alcohol intoxication of 3.6‰ in the sauna. ConclusionThe main causes for injuries during sauna bathing were slip/falls and dizziness/syncopes. The latter one might be prevented by improved of the personal behaviour (e.g. drink enough water before and after each sauna bathing), whereas slip/falls might be prevented by the revision of safety regulations, particularly the obligation to wear slip resistant slippers. Thus, everyone himself as well as the operators can contribute to reduce injuries related sauna bathing.

Safety of low-dose anticoagulation in extracorporeal membrane oxygenation using the Permanent Life Support System: a retrospective observational study.

Bleeding and thrombosis are major complications associated with high mortality in extracorporeal membrane oxygenation (ECMO) management. Anticoagulant therapy should be adequate to reduce thrombosis. However, related studies are limited. We retrospectively reviewed all patients supported with ECMO at a single institution between January 2014 and July 2022 and included those on all types of ECMO using the Permanent Life Support System. Patients were classified into two groups according to their measured mean activated partial thromboplastin time (aPTT) during ECMO management: a high-anticoagulation (AC) group (aPTT, ≥55 seconds; n=52) and a low-AC group (aPTT, <55 seconds; n=79). The primary outcome was thrombotic or bleeding events during ECMO. We identified 10 patients with bleeding; significantly more of these patients were in the high-AC group (n=8) than in the low-AC group (15.4% vs. 2.5%, p=0.01). However, thrombus events and oxygenator change-free times were not significantly different between the two groups. Four patients in the high-AC group died of bleeding complications (brain hemorrhage, two; hemopericardium, one; and gastrointestinal bleeding, one). One patient in the low-AC group developed a thrombus and died of ECMO dysfunction due to circuit thrombosis. Heparin did not significantly improve thrombotic outcomes. However, maintaining an aPTT of ≥55 seconds was a significant risk factor for bleeding events, especially those associated with mortality.

P393 EDOXABAN: NEW PERSPECTIVE IN A PATIENT WITH CANCER–ASSOCIATED THROMBOSIS COMPLICATED BY BRAIN METASTASES. A RARE CLINICAL CASE

Abstract Herein, we present the case of a 58 y–o Caucasian man with unremarkable cardiovascular history and a strong family history for cancer. He was diagnosed with lung adenocarcinoma IVb (pleura, pleural effusion, lymph nodes), PDL1: 2% TPS and absence of actionable driver mutations on DNA and RNA NGS (only ERBB2 mutation). Started first–line chemotherapy with cisplatin–pemetrexed regimen and immunotherapy with pembrolizumab. He developed common/superficial femoral and popliteal deep vein thrombosis (DVT) and pulmonary embolism (PE). The patient started low–molecular–weight heparin (LMWH) namely enoxaparin 1 mg/kg x 2/d (weight: 65 Kg). After 1 mo, CT showed PE resolution. Due to DVT persistence and patient’s preference for oral administration, LMWH was replaced with direct oral anticoagulant (DOAC) namely edoxaban 60 mg 1 cp/d. After 2 mo, resolution of common femoral and popliteal vein thrombosis with partial recanalization of superficial femoral DVT were detected. However, he developed brain metastases treated with WB radiotherapy. We decided for edoxaban full dose long–term anticoagulant treatment with monthly cardioncological surveillance. After 6 mo since cancer diagnosis, the patient was still adherent to DOAC therapy, although in a maintenance combined regimen pemetrexed–pembrolizumab based, without both drug–drug interactions and brain bleeding. Conclusions Thromboembolism is the second leading cause of death in malignancy. In this clinical case, a man with advanced lung cancer developed extended cancer–associated thrombosis (CAT). However, the appearance of brain metastases has posed a clinical dilemma: to continue or to withdraw the anticoagulant therapy and, also, which drug to choose between LMWH and DOAC. Literature is limited on the use of DOACs in cancer patients with brain metastases. Besides, current guidelines neither advocate contraindication to DOAC, nor suggest caution as requested for gastrointestinal and genitourinary sites of cancer. We decided to proceed with edoxaban therapy, despite chemotherapy combined to immunotherapy were still ongoing and the concurrent appearance of brain metastases, with good results in efficacy, patient’s adherence and, mostly, safety. In conclusion, in regard to our clinical experience, we point out DOAC as a reliable and manageable therapeutical choice in CAT, also in active cancer patients with brain metastases receiving chemo–immunotherapy.

Exploring the Utility of Autonomic Nervous System Evaluation for Stroke Prognosis.

Stroke is a major cause of functional disability and is increasing in frequency. Therefore, stroke prognosis must be both accurate and timely. Among other biomarkers, heart rate variability (HRV) is investigated in terms of prognostic accuracy within stroke patients. The literature research of two databases (MEDLINE and Scopus) is performed to trace all relevant studies published within the last decade addressing the potential utility of HRV for stroke prognosis. Only the full-text articles published in English are included. In total, forty-five articles have been traced and are included in the present review. The prognostic value of biomarkers of autonomic dysfunction (AD) in terms of mortality, neurological deterioration, and functional outcome appears to be within the range of known clinical variables, highlighting their utility as prognostic tools. Moreover, they may provide additional information regarding poststroke infections, depression, and cardiac adverse events. AD biomarkers have demonstrated their utility not only in the setting of acute ischemic stroke but also in transient ischemic attack, intracerebral hemorrhage, and traumatic brain injury, thus representing a promising prognostic tool whose clinical application may greatly facilitate individualized stroke care.

A novel machine learning-based feature extraction method for classifying intracranial hemorrhage computed tomography images

One of the most serious forms of brain stroke is intracranial hemorrhage (ICH). When an artery bursts, the brain and the tissue around the artery start bleeding. This study proposes a joint feature selection strategy to classify computed tomography (CT) images of intracranial hemorrhage. The joint feature set is composed of transform and texture features. Joint features are constructed from a combination of grey level co-occurrence matrix (GLCM) features, discrete wavelet features (DWT), and discrete cosine features (DCT). Brain hemorrhage CT image classification uses ensemble-based machine learning (ML) techniques. On the training dataset, a Synthetic Minority Over-Sampling Technique (SMOTE) is applied to treat the problem of oversampling by adding fresh data. Additionally, the sequential forward feature selection technique is used to obtain feature subsets. The classification accuracy is further examined for varied feature vector sizes. Confusion matrix, precision, and recall in categorization are employed as performance evaluation measurements. The ML-based ensemble classifiers can produce highly accurate results with the aid of the proposed novel feature extraction mechanism. When taking into consideration a crucial feature set consisting of six features, it can be seen that Random Forest obtained the greatest accuracy, which is 87.22%.