Cerebral Infarction Hemorrhage Research Articles

Adenomyosis Accompanied by Multiple Hemorrhagic Cerebral Infarction: A Case Report

Adenomyosis Accompanied by Multiple Hemorrhagic Cerebral Infarction: A Case Report

Hemorrhagic cerebral venous infarction after vein injury during intraoperative lesion resection: incidence, hemorrhagic stages, risk factors and prognosis.

Cerebral venous infarction (CVI) after vein injury during intraoperative lesion resection is associated with intracranial hemorrhage. We conducted this study to identify the incidence, clinical and imaging features, and prognosis of hemorrhage CVI. We performed a retrospective analysis of patients with confirmed CVI after vein injury who underwent craniotomy in our hospital. Postoperative clinical symptoms were observed, and imaging features were compared between patients with and without intracranial hemorrhages through CT examination. Variables were analyzed using univariate and multivariate regression analyses. Among 2,767 patients who underwent craniotomy, 93 cases of injured veins were identified intraoperatively. Hemorrhagic CVI was found in 38% (35/93). Multivariate analysis revealed that midline approach, meningioma, postoperative seizures, disorders of consciousness and interval in hours < 72 h were identified as predictors of hemorrhagic CVI. After 3 months of follow-up, the prognosis was poor in 15 cases (16%, 15/93), including death (two cases), vegetative survival (four cases), and severe disability (nine cases). Hemorrhagic CVI, as a critical complication after venous injury, can have disastrous consequences. Do not injure known veins intraoperatively. In case of injury, requisite remedial measures should be adopted during and after surgery.

Feasibility and safety of intracranial carotid implantation with covered stents for advanced head and neck squamous cell carcinoma involving the carotid artery: A preliminary investigation

AbstractObjectiveThe aim of this study was to assess the feasibility and safety of implanting covered stents in cases of advanced head and neck squamous cell carcinoma (ASCCHN) where the carotid artery was involved.MethodsA total of 30 patients (29 males and one female) were included in this study, with ages ranging from 40 to 79 years. Among these patients, 28 patients had received radiotherapy and 17 received subsequent adjuvant therapy, while one was receiving treatment for the first time. Eighteen were treated with covered stent implantation in conjunction with surgery, and the remaining 12 received stent implantation alone. The study evaluated and compared the stent implantation's success rate, overall survival (OS), and associated complications.ResultsSuccessful implantation of covered stents was achieved in all 30 cases. No instances of significant hemorrhage or thromboembolic cerebral infarction occurred during surgery. Of the patients in the salvage surgical group, 15 underwent complete tumor resection with a success rate of 83.3% (15/18), of which four experienced tumor recurrence with a local recurrence rate of 26.7% (4/15). The OS rates at 6 months for all patients, the salvage surgical group, the 15 patients with complete tumor resection, and the nonsurgical group were 64.0%, 66.8%, 75.5%, and 58.6%, respectively. At 12 months, the OS rates were 21.4%, 29.3%, 43.2%, and 11.8%, respectively. Notably, the OS of the 15 patients who underwent complete tumor resection was significantly higher than that of the 12 patients who received stent implantation alone (p = 0.044). All cerebrovascular accidents occurred in patients with radiotherapy history, and subsequent adjuvant therapy had no significant effect on the OS time in the salvage surgical and nonsurgical groups (p = 0.935; p = 0.526).ConclusionIn cases of ASCCHN involving the carotid artery, the implantation of covered stents is a safe and feasible procedure.

Extracorporeal membrane oxygenation treatment for severe asthma had unexpected adverse effects: a case report

Asthma, a chronic respiratory ailment, affects millions worldwide. Extracorporeal membrane oxygenation (ECMO) has gained traction as a life-saving intervention for patients with severe asthma who are unresponsive to conventional treatments. However, complications associated with ECMO, including electrolyte imbalances and hemorrhage, can have significant clinical implications. This case report highlights a 49 years-old male patient with severe asthma who developed pronounced hypokalemia and hemorrhage following venovenous ECMO (VVECMO) therapy. Despite potassium supplementation, serum potassium levels continued declining before normalizing after 24 h. The patient subsequently experienced gastrointestinal bleeding, cerebral hemorrhage, and extensive cerebral infarction, ultimately resulting in a deep coma. Hypokalemia during ECMO therapy can result from a rapid reduction of carbon dioxide, β-receptor agonist use, corticosteroid use, and diuretic administration. Hemorrhage is another common ECMO complication, often linked to heparin anticoagulation therapy. Clinicians should be aware of potential complications and adopt appropriate prevention and management strategies when using ECMO in patients with severe asthma.

Efficacy and safety of bridging therapy and direct mechanical thrombectomy in large vessel occlusions: a meta-analysis.

Efficacy and safety of bridging therapy and direct mechanical thrombectomy in large vessel occlusions: a meta-analysis.

Multidisciplinary treatment for infective endocarditis complicated with systemic multiple abscess due to Panton-Valentine leukocidin producing community-acquired methicillin-resistant Staphylococcus aureus and Candida albicans: a case report

BackgroundInfective endocarditis resulting from community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is a rare, but often fatal heart disorder. Here, we report a case of multidisciplinary treatment for infective endocarditis with systemic multiple abscesses due to Panton-Valentine leukocidin (PVL) producing CA-MRSA and Candida albicans.Case presentationThe patient suffered from infective endocarditis, destructive thyroiditis, hemorrhagic cerebral infarction due to mycotic embolism, lung abscess, multiple skeletal muscle abscess, and disseminate intravascular coagulopathy. Aggressive medical treatment as well as mechanical circulatory support was required before the curative surgical treatment. Blood cultures were positive for MRSA and Candida albicans. Genomic analysis of MRSA revealed Staphylococcal Cassette Chromosome mec IVc and also the virulence gene encoding PVL.ConclusionsCA-MRSA strains have higher pathogenicity and are more destructive to tissue than healthcare-associated MRSA strains because of the toxins they produce, including PVL. Multidisciplinary treatment including aggressive surgery was required to rescue the patient.

P194 DESTRUCTIVE AORTIC VALVE ENDOCARDITIS WITH INVOLVEMENT OF THE MITRO–AORTIC CURTAIN: A SUCCESSFUL “UFO” PROCEDURE

Abstract Infective endocarditis is a relatively rare disease with an estimated mean incidence of 3.6–7.0 cases per 100,000 subject–years. Aortic bicuspid disease, the most frequent congenital anomaly, is one of the main risk factors. Heart failure, uncontrolled infection (fistulas, abscesses, persistently positive blood cultures) and systemic embolization are among the most feared complications of endocarditis: these cases constitute an indication for emergency/urgent cardiac surgery. An example of extremely demolitive surgery is the Commando or "UFO" procedure, which consists in the double replacement of the aortic valve and the mitral valve with reconstruction of the mitro–aortic junction. The clinical case concerns a 36–year–old man who went to the emergency room for high fever with shivering. Having been found positive blood cultures for MSSA and having emerged mitro–aortic vegetation by echocardiogram, a diagnosis of infective endocarditis was made. During hospitalization, multi–organ cardioembolic phenomena (e.g. splenic, cerebral) with hemorrhagic cerebral infarction occurred: therefore, in accordance with current guidelines, a conservative treatment was temporarily opted for. However, in the following days the deterioration of the clinical–haemodynamic picture was such as to require emergency cardiac surgery. The patient was thus subjected to Commando or UFO procedure with reconstruction of the mitral–aortic junction. Severe bi–ventricular dysfunction was found for the first time at post–operative echocardiographic control, with the need for mechanical support to the circulation (AV ECMO, Impella). The remainder of the hospitalization was characterized by a progressive recovery of ventricular function (LVEF 16% to 44%), therefore patient was discharged in discrete hemodynamic compensation, despite the multiorgan sequelae (hepatic, neurological, renal).

564 The Influence of Presenting Glucose and Glycated Hemoglobin on Outcomes Following Mechanical Thrombectomy for Anterior Circulation Large Vessel Occlusion

INTRODUCTION: Elevated presenting glucose and glycated hemoglobin (HbA1C) values may be associated with worse outcomes following mechanical thrombectomy (MT) for anterior circulation large vessel occlusion (ACLVO). METHODS: All patients who underwent MT for ACLVO between 2015 – 2021 at a single institution were reviewed. The outcomes included favorable functional status (modified Rankin Scale [mRS] 0 – 2) at 90 days, any intracranial hemorrhage (ICH), parenchymal hemorrhage, and malignant middle cerebral artery infarction (MMI). Multivariate logistic regression analyses adjusting for age, premorbid mRS, admission NIHSS, ASPECTS, collateral score, tPA administration, onset to reperfusion time, and TICI grade were performed. Youden’s index was used to identify thresholds for glucose and HbA1C that optimized area under the receiving operator characteristic curve for predicting outcomes. RESULTS: A total of 332 patients were included. The mean (SD) age was 70.9 years (15.1), 50.3% of patients were female, and 26.9% of patients had a history of diabetes. The median (IQR) presenting glucose, SGR, and HbA1C values were 118 mg/dL (40), 1.0 (0.35), and 5.7% (1.0), respectively. Presenting glucose was associated with any ICH (OR 1.38, 95% 1.08 – 1.80) and MMI (OR 1.48, 95% CI 1.06 – 2.03), but not functional status. SGR was not associated with any outcome. Presenting HbA1C was associated with MMI (OR 1.43, 95% 1.02 – 2.02) but not functional status or ICH. The optimal threshold among glucose values for predicting ICH and MMI were 167 mg/dL and 128 mg/dL, respectively. For HbA1c, the threshold for predicting MMI was 6.0. CONCLUSIONS: Presenting glucose and HbA1C were associated with MMI, and glucose was associated with ICH after MT for ACLVO. Improved glucose control prior to admission could decrease the odds of these events.

Corroborating evidence for the correlation between the MTHFR C677T single nucleotide variant and smoking in Croatian subjects independent of ischemic stroke

Hyperhomocysteinaemia is a risk factor for ischemic stroke development. Single nucleotide variation in the methylenetetrahydrofolate reductase gene (MTHFR, C677T polymorphism, T allele) causes a Ala222Val mutation that is associated with hyperhomocysteinemia, cardiovascular disease and stroke. The homozygous TT genotype of MTHFR may also be linked to tobacco smoking in patients from distinct demographic groups. This study evaluated the association of T allele with smoking in a cohort of 301 Croatian adults, including 187 healthy controls and 114 patients with ischemic stroke (IS) and proven ischemic cerebral infarction based on Computed Tomography (CT). Exclusion criteria were hemorrhagic cerebral infarction on CT scan, medical history of diabetes mellitus, and age (>60 years). Cholesterol, triglycerides (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL) and C-reactive protein (CRP) were biochemically analyzed. A positive correlation between the TT genotype of MTHFR and smoking was observed within our entire study cohort (p = 0.011). In the control group, the relative frequency of the TT genotype in smokers is complemented by the prevalence of the CC genotype among non-smokers. Hence, our study with Croatian subjects corroborates previous studies indicating that the TT MTHFR variant is linked to smoking. This positive correlation between the TT genotype and smoking represents a confounding parameter that must be accounted for to permit evaluation of statistical associations with stroke and biochemical markers in blood and single nucleotide variations in the MTHFR gene.

Clinical application and comparison of serum lipoprotein (a) particle concentration and mass concentration in stroke patients and healthy adults: a prospective cohort study

Serum Lp(a) is routinely detected by mass concentration in clinical laboratory, but the results of which cannot be standardized. On the other hand, particle concentration detection has gained increasing popularity and facilitated the standardization of Lp(a) testing in clinical practice. This study aimed to compare the Lp(a) mass concentration and particle concentration between patients with stroke and healthy controls. The participants admitted in the Third Hospital of Hebei Medical University between January 2021 and October 2021 were assigned to hemorrhagic stroke, cerebral infarction and healthy control group. Serum Lp(a) particle and mass concentration were detected by using the Shenzhen Mindray BS-2000I and Beckman AU5821 detection system, respectively. The primary study endpoint was the difference between Lp(a) mass concentration and particle concentration among the 3 groups. There was no statistically significant difference in age and gender among the 3 groups. Serum Lp(a) mass concentration [227.7 (113.1-447.1) mg/L vs. 117.1 (59.8-210.7) mg/L, P=0.001] and particle concentration [30.1 (12.9-72.3) nmol/L vs. 13.5 (6.8-29.9) nmol/L, P=0.001] in the cerebral infarction group were significantly higher than those in the healthy control group. The areas under the receiver operating characteristic (ROC) curve (AUC) of Lp(a) mass concentration and particle concentration for the diagnosis of cerebral infarction were 0.67 and 0.66, respectively, and the cut-off value was 181.1 mg/L and 15.6 nmol/L, respectively. There was no statistically significant difference in the efficacy of the two parameters for the diagnosis of cerebral infarction (Z=0.88, P=0.38). The conversion factors for the two concentrations were not significantly different between gender nor age subgroups, and decreased as mass concentrations increased. Compared with healthy control group, the positive rate of Lp(a) mass concentration (37.8% vs. 17.5%, P<0.01) and the positive rate of particle concentration (24.4% vs. 10.8%, P=0.005) were significantly increased in the cerebral infarction group. The particle concentration detection of Lp(a) has significant clinical relevance in patients with ischemic stroke. The mass concentration test results may overestimate the actual serum Lp(a) content in stroke patients.

Microcatheter-guided compartment packing of acutely ruptured complex intracerebral aneurysms (ARCIAs): Preliminary experience and technical note.

We present our initial experience using the microcatheter-guided compartment packing (MCP) technique for endovascular embolization of acutely ruptured complex intracerebral aneurysms (ARCIAs) and evaluate the safety, feasibility, and efficiency of this technique. This retrospective, single-center study included 28 patients who underwent coil embolization using the MCP technique for ARCIAs at our institution between January 2021 and January 2022. The MCP technique was the placement of microcatheters in different compartments within the aneurysm to deploy the coils simultaneously or sequentially. Patient demographics, aneurysm characteristics, procedural parameters, grade of occlusion, complications, and clinical results were analyzed. The clinical outcomes were evaluated with modified Rankin Scale (mRS) scores. Of the 28 patients successfully treated with the MCP technique, 24 (85.7%) aneurysms were considered as complete occlusions (Raymond I) based on the immediate postembolization angiogram results. Complications occurred in 2/28 treatments, including guidewire perforation with subarachnoid hemorrhage and cerebral vasospasm-related cerebral infarction. An angiography follow-up demonstrated complete occlusion in 25/28 aneurysms. Twenty-six (92.9%) patients had favorable 90-day outcomes (mRS 0-2) after the endovascular coil embolization. The MCP technique is simple, safe, and effective, achieving good packing density and initial occlusion rate when used to treat ARCIAs.

Aortic repair following initial decompressive craniectomy for acute type A aortic dissection complicated with extensive hemorrhagic cerebral infarction: a case report

A 69-year-old woman presented with acute type A aortic dissection complicated by extensive hemorrhagic cerebral infarction due to brain malperfusion. Emergency decompressive craniectomy was initially performed, with an initial diagnosis of hemorrhagic cerebral infarction. The patient was referred for surgical management following a diagnosis of acute type A aortic dissection. After stabilizing the neurological condition with medical treatment for nine weeks, hemiarch replacement was performed electively. The postoperative course was uneventful, with no new neurological disorders. Subsequently, she recovered sufficiently to have daily conversations and attend hospital appointments using a wheelchair.

Early isolated subarachnoid hemorrhage versus hemorrhagic infarction in cerebral venous thrombosis.

BackgroundCerebral venous thrombosis (CVT) is a rare cerebral vascular disease, the presentation of which is highly variable clinically and radiologically. A recent study demonstrated that isolated subarachnoid hemorrhage (iSAH) in CVT is not as rare as thought previously and may have a good prognostic significance. Hemorrhagic venous infarction, however, is an indicator of an unfavorable outcome. We therefore hypothesized that patients who initially suffered iSAH would have a better clinical outcome than those who suffered hemorrhagic cerebral infarction.Patients and methodsWe selected patients hospitalized due to CVT, who presented either with isolated SAH or cerebral hemorrhagic infarction at admission or during the following 24 hours: 23 (10 men) aged 22–73 years. The data were extracted from hospital admission records, our computer data system, and the hospital radiological database.ResultsThe iSAH group consisted of 8 (6 men) aged 49.3 ± 16.2 and the hemorrhagic infarction group included 15 (4 men) aged 47.9 ± 16.8. Despite having a significantly greater number of thrombosed venous sinuses/deep veins (Mann-Whitney Rank Sum Test, p = 0.002), the isolated SAH group had a significantly better outcome on its modified Rankin Score (mRs) than the hemorrhagic infarction group (Mann-Whitney Rank Sum Test, p = 0.026). Additional variables of significant impact were edema formation (p = 0.004) and sulcal obliteration (p = 0.014).ConclusionsThe patients who suffer iSAH initially had a significantly better outcome prognosis than the hemorrhagic infarction patients, despite the greater number of thrombosed sinuses/veins in the iSAH group. A possible explanation might include patent superficial cerebral communicating veins.

Diagnostic Value of Image Features of Magnetic Resonance Imaging in Intracranial Hemorrhage and Cerebral Infarction.

This study aimed to investigate the differential diagnosis value of routine magnetic resonance imaging (MRI) and magnetic resonance diffusion-weighted imaging (DWI) in hyperacute intracranial hemorrhage (HICH) and hyperacute cerebral infarction (HCI). Fifty-five patients with HICH were set as group A, and 55 patients with HCI were selected as group B. All the patients underwent routine MRI and DWI examinations. The morphological distribution and signal characteristics (low, high, or mixed) of the lesions in the two groups were recorded. The diagnostic accuracy, sensitivity, and specificity of routine MRI and DWI were compared for distinguishing HICH and HCI. The results suggested that the lesions in patients with HICH were mainly manifested as mixed signals (40 cases), while those in patients with HCI showed high signals (48 cases). HICH occurred in the basal ganglia in 44 cases, in the brain stem in 6 cases, in the cerebellum in 4 cases, in the cerebral cortex in 0 cases, and in the corpus callosum in 1 case. HCI occurred in the basal ganglia area, brain stem, cerebellum, cerebral cortex, and corpus callosum in 5, 3, 35, 12, and 0 cases, respectively. The diagnostic accuracy, specificity, and sensitivity of DWI for HICH and HCI were significantly higher than those of routine MRI (P < 0.05). It was indicated that compared with routine MRI, DWI was more effective in the diagnosis of HICH and HCI, with clearer and more accurate images and better diagnostic performance.

Cardiac Function Assessment By Echocardiography In Ischemic Stroke/Non Hemorrhagic Cerebral Infarction

Background: Every year, more than half a million people in the world suffer from acute cerebrovascular events, including ischemic stroke, intracerebral and subarachnoid hemorrhage, giving a mortality of nearly 20%. Acute strokes, especially subarachnoid hemorrhage is frequently accompanied by a variety of electrocardiographic (ECG) abnormalities. Objective: To find out the cardiac function assessment by echocardiography in ischemic stroke/non hemorrhagic cerebral infarction. Material and Methods: An observational study was conducted in Department of Medicine and Cardiology, Sher-E-Bangla Medical College Hospital, Bangladesh from July to December-2019. 51 patients of ischemic stroke were taken and 2D transthoracic echocardiography was done to find potential cardioembolic abnormalities. Results: 74.5% of patients had echocardiographic abnormalities and 41.1% had potential cardioembolic abnormalities, out of which most common were ventricular wall hypokinesia, calcific aortic valve, rheumatic heart disease and dilated cardiomyopathy. The prevalence was almost similar in different age groups and both the sexes. Conclusion: Prevalence of potential cardioembolic abnormalities is high (41.1%) in ischemic stroke patients and 2D echocardiography is therefore recommended in the management and secondary prevention of cardioembolicstroke, which has a higher mortality and more chances of recurrence than atherothrombotic type of ischemicstroke.

Imaging of COVID-19 vasculopathy from head to toe: Egyptian collective experience after 2 years of the pandemic

BackgroundCOVID-19 vasculopathy is a critical condition that impacts the disease prognosis including vasculitis and thromboembolic complications. This study aimed to provide the Egyptian experience about the COVID-19 vasculopathy during the past two years of the pandemic and to collectively include the different modalities and imaging techniques for the diagnosis of cerebrovascular, pulmonary, gastrointestinal, and peripheral arterial vascular complications.ResultsThis is a multi-center retrospective analysis of 3500 PCR-proved COVID-19 infection between March 2020 and December 2021. A cohort of 282 consecutive patients with COVID-19 vasculopathy was considered for inclusion. They included 204 males and 78 females (72:28%). The mean age was 68 years, and age ranged from 48 to 90 years. Five radiologists evaluated the different imaging examinations in consensus including computed tomography (CT), CT-angiography (CTA), CT-perfusion (CTP), magnetic resonance imaging (MRI), MR-arteriography (MRA), and MR-venography (MRV). 244/282 (86.5%) patients suffered from non-hemorrhagic cerebral ischemic infarctions. 13/282 (4.6%) patients suffered from hemorrhagic cerebral infarctions. 5/282 (1.8%) patients suffered from cerebral vasculitis. Pulmonary vascular angiopathy was detected in 10/282 (3.5%) patients, including pulmonary embolism in 10/10 patients, pulmonary infarctions in 8/10 patients, pulmonary vascular enlargement in 5/10 patients, and vascular "tree-in-bud" sign in 2/10 patients. Intestinal ischemia and small bowel obstruction were detected in 3/282 patients (1%) while GIT bleeding was encountered in 4/282 patients (1.4%). Lower limb arterial ischemia was found in 3/282 patients (1%). Additionally; 39/282 (13.8%) patients developed peripheral deep venous thrombosis (DVT) due to prolonged ICU recumbence while 28/282 (10%) patients developed jugular vein thrombosis sequel to prolonged catheterization. A p value (0.002) and (r) = 0.8 statistically proved strong significant relation between COVID-19 vasculopathy and D-dimer levels.ConclusionsMulti-system vasculopathy was a serious complication of COVID-19 which impacted the patients' morbidity and mortality. An Egyptian experience about the COVID-19 vasculopathy during the past two years of the pandemic was provided. It encountered the different modalities and imaging techniques for the diagnosis of cerebrovascular, pulmonary, gastrointestinal, and peripheral arterial COVID-19 vascular complications.

Montreal Cognitive Assessment of cognitive dysfunction after basal ganglia stroke

ObjectiveThe Montreal Cognitive Assessment (MoCA) was used to evaluate cognitive dysfunction after basal ganglia stroke, and factors affecting total MoCA score were examined.MethodsData were retrospectively analyzed for 30 patients with basal ganglia intracerebral hemorrhage or basal ganglia cerebral infarction, who were admitted to The Second Affiliated Hospital of Fujian Traditional Medical University (Fujian, China) from January 2017 to March 2020. Cognitive impairment was assessed using the MoCA, and potential correlations were explored between clinicodemographic characteristics (sex, age, stroke location and etiology) and MoCA dimensions or total MoCA score.ResultsUnivariate linear regression showed that the total MoCA score was significantly associated with sex, age, executive function, naming, attention, abstract generalization ability, memory ability, and visuospatial orientation. However, multivariate linear regression identified only executive function, naming, attention, memory ability, and visuospatial orientation as significantly associated with the total MoCA score.ConclusionsWe showed that the MoCA test can be used for patients with basal ganglia stroke. The total MoCA score of basal ganglia stroke was significantly associated with impairments in executive function, naming, attention, memory ability, and visuospatial orientation.

A Review of Remote Intracerebral Hemorrhage after Chronic Subdural Hematoma Evacuation.

Remote intracerebral hemorrhage (RICH) is a severe complication following chronic subdural hematoma (cSDH) drainage, and only case reports and small case series have been reported to date. The authors present an emblematic patient affected by RICH following cSDH drainage. A systematic review of the literature on diagnosis and management of patients affected by RICH following cSDH evacuation has also been performed. A literature search according to the PRISMA statement was conducted using PubMed and Scopus databases with the following Mesh terms: [(remote) AND (intracerebral hemorrhage or cerebral hematoma or cerebral infarction or cerebellar hemorrhage or cerebellar hematoma or cerebellar infarction) AND (chronic subdural hematoma)]. The literature search yielded 35 results, and 25 articles met our inclusion criteria: 22 articles were case reports and 3 were case series including three to six patients. Overall, 37 patients were included in the study. Age was reported in all 37 patients, 26 males (70.3%) and 11 females (29.7%), with a male-to-female ratio of 2.4:1. The mean age at diagnosis was 64.6 years (range: 0.25-86 years). Only in 5 cases (13.5%) did the ICH occur contralaterally to the previously drained cSDH. The rapidity of drainage can lead to several types of intracranial hemorrhages, caused by a too rapid change in the cerebral blood flow (CBF) and/or tears of bridging veins. The average time interval between cSDH drainage and neurologic deterioration was 71.05 hours (range: 0-192 hours). RICH following cSDH represents a rare occurrence and a serious complication, associated with elevated morbidity. Careful monitoring of drain speed after cSDH evacuation surgery is recommended, and minimally invasive techniques such as twist drill craniostomy are suggested, especially for massive cSDHs.

Abstract 11728: Common Primary Medical Conditions Associated With Secondary Takotsubo Cardiomyopathy

Introduction: Secondary Takotsubo cardiomyopathy (TCM) is considered a complication of the patient’s primary medical condition, such as medical, surgical or psychiatric conditions. More than one-third of TCM patients have primary medical conditions and tend to have a worse prognosis. However, there is no comprehensive study on the causes of TCM. Aim: We studied the common primary medical conditions in secondary TCM patients and their prognosis. Methods: We performed a retrospective analysis using the ICD-10-CM codes for a secondary diagnosis of TCM from the National Inpatient Sample database (2016-2018). We identified the primary medical condition represented by the ICD-10-CM diagnosis codes of secondary TCM patients and aggregated similar codes into clinically meaningful categories using the Clinical Classifications Software Refined. We then compared the mortality rate associated with each condition. Results: Of 14,816 patients admitted with secondary TCM, the common primary medical conditions included ‘Sepsis, unspecified organism’ (A419, 13.6%), ‘Chronic obstructive pulmonary disease with (acute) exacerbation’ (J441, 3.6%), ‘Acute respiratory failure with hypoxia’ (J9601, 2.8%), and ‘Pneumonia, unspecified organism’ (J189, 1.8%). After aggregating the individual codes into clinical categories, the common primary medical conditions included septicemia (19.1%), respiratory failure (6.4%), COPD and bronchiectasis (4.6%), hypertension with complications and secondary hypertension (4.2%), and cerebral infarction (3.1%). Primary medical conditions that yielded a higher mortality rate than the overall rate (8.5%) were septicemia (16.5%, P&lt;0.001), respiratory failure (10.7%, P=0.019), cerebral infarction (13.1%, P&lt;0.001), and acute hemorrhagic cerebrovascular disease (26.8%, P&lt;0.001). Conclusions: Sepsis is the most common primary medical condition of secondary TCM in admitted patients. Secondary TCM patients with a primary condition of acute hemorrhagic cerebrovascular disease, sepsis, respiratory failure, or cerebral infarction have higher in-hospital mortality than those with other primary medical conditions.

TO DEVELOP FORENSIC CRITERIA FOR THE DIFFERENTIAL DIAGNOSIS OF INTRACEREBRAL HEMORRHAGE OF TRAUMATIC AND NON-TRAUMATIC ORIGIN USING MUELLER-MATRIX MICROSCOPY OF LINEAR DICHROISM

Differential diagnosis of intracerebral hemorrhage due to traumatic and non-traumatic origin is a challenging issue, especially in the absence of visible body injuries and other signs of violence. For a forensic expert-practitioner, the main thing is objectivity, accuracy, and speed of obtaining the result, which could fully satisfy the methods of laser polarimetry in the case of differential diagnosis of hemorrhages of traumatic and non-traumatic origin in the human brain matter.&#x0D; The purpose: To develop forensic criteria for the differential diagnosis of intracerebral hemorrhage of traumatic and non-traumatic origin using Mueller-matrix microscopy of linear dichroism.&#x0D; Materials and methods: The object of the study was brain matter samples, collected in 115 corpses of both sexes aged 22 to 86 years with accurately known causes of death. The causes of death included coronary artery disease, traumatic brain hemorrhage, ischemic brain infarction, and non-traumatic brain hemorrhages. Brain matter samples have been frozen rapidly, and histological sections have been made using a freezing microtome. The slices have been evaluated using the method of azimuthal-invariant Mueller-matrix microscopy, followed by mathematical and statistical processing of the results. &#x0D; Results: significant topographic heterogeneity of Mueller-matrix invariants of brain matter samples linear dichroism maps among all research groups have been found. Individual and significant variations of dispersion, asymmetry, and kurtosis magnitude have confirmed the heterogeneity of Mueller-matrix invariants. The difference of images and histograms among groups is explained by the presence of necrotic changes in the case of ischemic brain necrosis and blood cells in the brain matter samples. For the set of central statistical moments of the 1st, 3rd, and 4th orders, which characterize the distributions of circular dichroism, the method of MM-microscopy in the differentiation of samples of non-hemorrhage and hemorrhage groups reaches a satisfactory level - 78% - 84%.&#x0D; Conclusions: Brain matter samples Muller-matrix microscopy of linear dichroism is effective for solving diagnostic problems of forensic medicine related to evaluating the cause of death from intracerebral hemorrhage of various origins. Diagnostic efficiency of Mueller-matrix mapping of polarization manifestations of linear dichroism method for intergroup differentiation of samples of deaths from traumatic hemorrhage (Group 2) and ischemic cerebral infarction (Group 3) reaches a satisfactory level of 79 - 84%.