Left Intracerebral Hemorrhage Research Articles

Pediatric Air Gunshot Penetrating Head Injury with Good Outcome: A Case Report

Abstract: Ball bearing (BB) and pellet guns are non-power guns but their related injuries have been reported worldwide. They represent a significant cause of injury especially among children and teenagers. Their potentially harmful and lethal effects have been well documented in the medical literature since the early 1980s. Fatality rate is closely related to the damaged part of the brain and the level of the damage. In this Case Report we documented a 6-years-old girl was getting shot at the head by herself, who initially want to play around, using her neighbour’s Air gun rifle. The pellet trajectory passed through the left frontal lobe, left temporal lobe, left posterior putamen, posteriorly left crus posterior of internal capsule, left occipital horn of lateral ventricle, left occipital lobe, and ended at left cerebral falx between both medial surfaces of occipital lobes. Directional slope of the pellet was medially upward, with its tracking left Intracerebral Hemorrhage (ICH) with perifocal edema and Intraventricular Hemorrhage (IVH) dominant in the left lateral ventricle. After 8 days management, the patient was discharged from our hospital with stable condition, GCS 15 without any significant neurological deficits. Intracranial intracerebral pellet due to air gun shot injury, may have fatal and lethal manifestation if the pellet damage the eloquent area and/or deep area of the brain (hypothalamus, thalamus and brain stem). If accessible the foreign body or pellet should be removed immediately for better outcome. Keywords: Head Injury, Air Gun Shot, Intracerebral Haemorrhage

Functional Long-Term Outcome after Left- versus Right-Sided Intracerebral Hemorrhage

Background and Purpose: Hemispheric location might influence outcome after intracerebral hemorrhage (ICH). INTERACT suggested higher short-term mortality in right hemispheric ICH, yet statistical imbalances were not addressed. This study aimed at determining the differences in long-term functional outcome in patients with right- vs. left-sided ICH with a priori-defined sub-analysis of lobar vs. deep bleedings. Methods: Data from a prospective hospital registry were analyzed including patients with ICH admitted between January 2006 and August 2014. Data were retrieved from institutional databases. Outcome was assessed using the modified Rankin Scale (mRS) score. Outcome measures (long-term mortality and functional outcome at 12 months) were correlated with ICH location and hemisphere, and the imbalances of baseline characteristics were addressed by propensity score matching. Results: A total of 831 patients with supratentorial ICH (429 left and 402 right) were analyzed. Regarding clinical baseline characteristics in the unadjusted overall cohort, there were differences in disfavor of right-sided ICH (antiplatelets: 25.2% in left ICH vs. 34.3% in right ICH; p < 0.01; previous ischemic stroke: 14.7% in left ICH vs. 19.7% in right ICH; p = 0.057; and presence/extent of intraventricular hemorrhage: 45.0% in left ICH vs. 53.0% in right ICH; p = 0.021; Graeb-score: 0 [0-4] in left ICH vs. 1 [0-5] in right ICH; p = 0.017). While there were no differences in mortality and in the proportion of patients with favorable vs. unfavorable outcome (mRS 0-3: 142/375 [37.9%] in left ICH vs. 117/362 [32.3%] in right ICH; p = 0.115), patients with left-sided ICH showed excellent outcome more frequently (mRS 0-1: 64/375 [17.1%] in left ICH vs. 43/362 [11.9%] in right ICH; p = 0.046) in the unadjusted analysis. After adjusting for confounding variables, a well-balanced group of patients (n = 360/hemisphere) was compared showing no differences in long-term functional outcome (mRS 0-3: 36.4% in left ICH vs. 33.9% in right ICH; p = 0.51). Sub-analyses of patients with deep vs. lobar ICH revealed also no differences in outcome measures (mRS 0-3: 53/151 [35.1%] in left deep ICH vs. 53/165 [32.1%] in right deep ICH; p = 0.58). Conclusion: Previously described differences in clinical end points among patients with left- vs. right-hemispheric ICH may be driven by different baseline characteristics rather than by functional deficits emerging from different hemispheric functions affected. After statistical corrections for confounding variables, there was no impact of hemispheric location on functional outcome after ICH.

Stroke as a rare consequence of scorpion sting and scorpion ingestion: A case report from South East Nigeria

Stroke following scorpion stings is rare and potentially fatal. Some case reports have been documented, especially in the Indian subcontinent. There is no published report of stroke as a complication of scorpion envenomation from South East Nigeria. Presented is the profile of an elderly woman with hemorrhagic stroke as a complication of a sting from a scorpion which was killed and thereafter ingested. A review of relevant literature is also made. An 83-year-old woman from a rural community was admitted in August 2011 at the University of Nigeria Teaching Hospital, Enugu with dysphasia, altered sensorium and right hemiparesis occurring 4 h after a scorpion sting to the left leg 2 weeks before presentation. Preceding the neurological deficits she had local pain and restlessness. She was not a known hypertensive or diabetic, but had been stung on two previous occasions by scorpions. It was customary to eat the scorpion if killed which was the case here. Systemic examination was remarkable only for drowsiness with a Glasgow Coma Scale of 11/15, mild right facial nerve palsy with ipsilateral spastic hemiplegia. Brain computed tomography scan done about 4 weeks after the ictus showed features consistent with a left intracerebral hemorrhage. She was managed conservatively and recovered motor functions over 3 weeks necessitating discharge. Since there was no other detectable risk factor, we can conclude that the patient suffered a stroke as a result of the vasculotoxic actions of the scorpion venom.

Electrocardiographic Abnormalities and Elevated cTNT at Admission for Intracerebral Hemorrhage: Predictors for Survival?

Cerebrovascular lesions are often associated with electrocardiographic (ECG) abnormalities. The main purpose of this work was to investigate the prognostic value of ECG abnormalities and/or elevated cardiac troponin (cTNT) on admission in patients with nontraumatic intracerebral hemorrhage (ICH). Ninety-seven consecutive patients with ICH were included. The predictive value of ECG abnormalities and increased TNT on survival were evaluated using Cox proportional hazard model. The most frequently observed ECG abnormalities were the presence of a Q wave (39.6%), followed by prolonged QTc (>0.44 s; 35.4%), which was an independent predictor for long-term mortality (P = 0.019). No difference in QTc was observed between patients with right versus left ICH. Increased cTNT levels at admission had no prognostic value. Various ECG changes were common in patients presenting with an ICH, but only prolonged QTc was found to be an independent predictor of poor survival during follow-up after ICH.

Rare Presentations of Delayed Radiation Injury: A Lobar Hematoma and a Cystic Space-occupying Lesion Appearing More Than 15 Years after Cranial Radiotherapy: Report of Two Cases

Radiation vasculopathy and radionecrosis, constituting delayed radiation injury, are rare but recognized complications of radiation therapy occurring at a peak incidence of 3 years after treatment. Little information is available about these complications occurring more than 15 years after radiotherapy and presenting as other than solid intracranial masses. We describe two patients who presented with space-occupying cerebral lesions. Patient 1 presented as an emergency with a sudden loss of consciousness. Computed tomography revealed a large left intracerebral hemorrhage; cerebral angiography disclosed nothing abnormal, and a primary spontaneous hemorrhage was presumed. Twenty-seven years earlier, this patient had received adjuvant whole-brain and spine radiotherapy and concomitant chemotherapy after excision of a vermis medulloblastoma. Patient 2 presented with a left frontal cystic lesion (presumed malignant glioma) as the cause of personality and behavioral changes for some months. She had previously received external beam radiation for a basal cell epithelioma, which had been excised from her left forehead 19 years earlier. Both patients recovered well after undergoing craniotomies and removal of their lesions; they were discharged home with no neurological deficit. Even after long intervals after radiotherapy, it is important to consider radiation vasculopathy and radionecrosis as differential diagnoses of more common conditions. Histological confirmation of a delayed radiation injury in the absence of any evidence of neoplasia or vascular abnormality has allowed appropriate prognosis and management to be formulated with confidence in each of these patients.

Neglected elbow dislocation in a young man: treatment by open reduction and elbow fixator

A 22-year-old man fell 4 floors during a fire. He had 20% burns and multiple injuries. The Injury Severity Score on admission was 44. The Glasgow Coma Score was 11/15. He had a fractured pelvis and bilateral open fractures of the os calcis and required subsequent left belowknee amputation. He had also a left intracerebral hemorrhage resulting in a right hemiplegia and dysphasia. Several attacks of convulsions occurred. The patient presented to us 1 month after injury because of left elbow pain. The left elbow was posteriorly dislocated and was fixed in full extension. There was no nerve palsy in the left upper limb, particularly the ulnar nerve. Radiographs confirmed posterior dislocation of the left elbow with no fracture (Figure 1). Open reduction was performed by the posterior approach. The operative findings were as follows: dense fibrous tissue in the olecranon fossa, a contracted fibrotic triceps, contracted collateral ligaments, preserved articular cartilage, and a fairly normal-looking ulnar nerve. Reduction was achieved after excision of the fibrous tissue remnants of the capsule, release of both collateral ligaments, and clearance of the olecranon fossa. The reduction was concentric and not particularly difficult but with only fair stability. The ulnar nerve was inspected and decompressed at the cubital tunnel. The continuity of the triceps mechanism was carefully preserved, and there was limited flexion of the reduced elbow. The center of rotation of the elbow through the anteroinferior aspect of the medial epicondyle and the center of the lateral epicondyle was identified.2 A 2-mm Kirschner wire was inserted in the axis of rotation, with the position confirmed by image intensifier. The central connecting unit with the humeral and ulnar frames was slid over the wire, and the fixator used as its own template. Humeral screws (6/5 mm) were inserted from lateral to the mid humerus with care taken to avoid the radial nerve. Ulnar screws (4.5/3.5 mm) were applied from the dorsal side at the subcutaneous border so as to allow maximum forearm rotation. The elbow was then flexed and extended to confirm correct alignment and concentric reduction. The Kirschner wire was removed. The reduction was stable, and passive range was 0° to 70° because of limitation from the tight triceps. The postoperative regimen included active mobilization of the elbow and alternate passive stretching in flexion and extension by the compression-distraction device that accompanied the elbow fixator (Figure 2). This allowed slow stretching of the contracted triceps without the risk of overloading the articular cartilage of the elbow joint. The fixator was removed at 6 weeks, and active range on removal was 40° to 125°. The young man was well motivated and had active mobilization with passive stretching by therapists. He achieved 20° to 135° flexion range after 1 more month. At 1-year follow-up, the patient had full range in flexion/ extension and rotation (Figure 3). Radiographs of the left elbow did not show heterotopic ossification or degenerative changes (Figure 4). The Mayo elbow functional score8 was 100, and he was very satisfied, as he could use his left upper limb to maneuver his wheelchair single-handedly.

Vertical Transmission of Dengue

Dengue, an important mosquito-borne flavivirus infection, is endemic in Southeast Asia. We describe two mothers who had acute dengue 4 and 8 days before the births of their infants. One mother had worsening of her proteinuric pregnancy-induced hypertension, liver dysfunction, and coagulopathy and required multiple transfusions of whole blood, platelets, and fresh frozen plasma. Her male infant was ill at birth, developed respiratory distress and a large uncontrollable left intracerebral hemorrhage, and died of multiorgan failure on day 6 of life. Dengue virus type 2 was isolated from the infant's blood, and IgM antibody specific to dengue virus was detected in the mother's blood. The second mother had a milder clinical course; she gave birth to a female infant who was thrombocytopenic at birth and had an uneventful hospitalization. Dengue virus type 2 was recovered from the mother's blood, and IgM antibody specific to dengue virus was detected in the infant's blood. This report highlights not only the apparently rare occurrence of vertical transmission of dengue virus in humans but also the potential risk of death for infected neonates.