Nontraumatic Intracranial Hemorrhage Research Articles

P5138Resuming anticoagulation in patients with atrial fibrillation experiencing hemorrhage stroke or nontraumatic intracranial hemorrhage

P5138Resuming anticoagulation in patients with atrial fibrillation experiencing hemorrhage stroke or nontraumatic intracranial hemorrhage

Intracerebral Hemorrhage in Women: A Review with Special Attention to Pregnancy and the Post-Partum Period

Non-traumatic intracranial hemorrhage includes subarachnoid hemorrhage, subdural hemorrhage, and intracerebral hemorrhage (ICH), which can be classified as primary or secondary. Primary ICH is due to arterial hypertension or cerebral amyloid angiopathy, and secondary ICH is due to cerebral vascular malformations, coagulopathies, infectious complications, brain tumors, and illicit stimulant drug use. This review explores the epidemiology and management of non-traumatic ICH in women, with a focus on pregnancy and the post-partum period, defined as 6weeks post-delivery.

Safety and effectiveness of Factor Eight Inhibitor Bypassing Activity for direct oral anticoagulant-related hemorrhage reversal

BackgroundThe incidence of patients who present with life-threatening bleeding complications has been increasing as the use of direct oral anticoagulation (DOAC) has increased. Therefore, effective reversal agents are urgently needed. Current guidelines recommend the use of prothrombin complex concentrates (PCCs) and activated PCCs (aPCC) for reversal of DOAC anticoagulant activity in the setting of traumatic and non-traumatic intracranial hemorrhage (ICH). However, little data is available. ObjectiveHerein, we investigated the safety and effectiveness of Factor Eight Inhibitor Bypassing Activity [FEIBA (an aPCC)] in a population of patients who required emergent reversal of DOAC for hemorrhage or urgent surgical interventions. MethodsThis is a case series study. Medical records from patients who required emergent reversal of DOAC for life threatening hemorrhage or urgent surgical interventions were collected from February 1, 2014, to April 1, 2017 and reviewed. Data, including demographics as well as safety, outcomes, and dosing of FEIBA for reversal of DOAC effects were collected and descriptive statistics were obtained. ResultsForty-two patients who received FEIBA were included in the study. The rates of thrombotic events (10%), hemorrhage progression (10%), and observed mortality (29%) were similar to rates previously published in the limited literature evaluating aPCC use in this population. ConclusionThis case series suggests that FEIBA administration is relatively safe and effective to reverse DOACs in the setting of hemorrhage or need for urgent surgical procedures. Until target-specific reversal agents are available, future studies are warranted to evaluate the effectiveness of aPCC administration for DOAC-associated hemorrhagic complications.

Relevance of Abusive Head Trauma to Intracranial Hemorrhages and Bleeding Disorders.

Bleeding disorders and abusive head trauma (AHT) are associated with intracranial hemorrhage (ICH), including subdural hemorrhage (SDH). Because both conditions often present in young children, the need to screen for bleeding disorders would be better informed by data that include trauma history and are specific to young children. The Universal Data Collection database contains information on ICH in subjects with bleeding disorders, including age and trauma history. Study objectives were to (1) characterize the prevalence and calculate the probabilities of any ICH, traumatic ICH, and nontraumatic ICH in children with congenital bleeding disorders; (2) characterize the prevalence of spontaneous SDH on the basis of bleeding disorder; and (3) identify cases of von Willebrand disease (vWD) that mimic AHT. We reviewed subjects <4 years of age in the Universal Data Collection database. ICH was categorized on the basis of association with trauma. Prevalence and probability of types of ICH were calculated for each bleeding disorder. Of 3717 subjects, 255 (6.9%) had any ICH and 206 (5.5%) had nontraumatic ICH. The highest prevalence of ICH was in severe hemophilia A (9.1%) and B (10.7%). Of the 1233 subjects <2 years of age in which the specific location of any ICH was known, 13 (1.1%) had spontaneous SDH (12 with severe hemophilia; 1 with type 1 vWD). The findings in the subject with vWD were not congruent with AHT. In congenital bleeding disorders, nontraumatic ICH occurs most commonly in severe hemophilia. In this study, vWD is not supported as a "mimic" of AHT.

Inflammation and rehabilitation outcomes in patients with nontraumatic intracranial haemorrhage.

Systemic inflammation and its impact on rehabilitation for patients with non-traumatic haemorrhagic injury (HBI) sequelae has not yet been adequately documented. We therefore considered 31 patients with HBI, to determine the serum levels of inflammatory markers (C-Reactive Protein, CRP and or interleukine-6, IL-6) to establish their impact on functional status (Functional Independence Measure, FIM: 18 indicating the worst performance and 126, a normal score). The results showed an inflammation prevalence (CRP >0.5 mg/dl and/or IL 6 >7 pg/ml) of 74.2% at admission to Rehab. FIM reduction was more pronounced in inflamed compared to non-inflamed subjects (p < 0.05) and significantly correlated with blood variables sensitive to inflammation, such as alpha 1 globulin (r = - 0.565) and neutrophil/ lymphocyte ratio (r = - 0.52), CRP (r = - 0.365). At discharge from Rehab, the inflammation rate diminished. Inflamed patients showed similar gains in FIM score as their controls. In the entire population, the FIM gain was significantly associated with a gain in serum albumin, only (r = +0.56). We conclude that systemic inflammation is prevalent in HBI patients and contributes to reduce patient functional status. However, during the Rehab stage, inflammation does not hinder the improvement rate of functional capacity.

Inflammation and rehabilitation outcomes in patients with nontraumatic intracranial haemorrhage.

Systemic inflammation and its impact on rehabilitation for patients with non-traumatic haemorrhagic injury (HBI) sequelae has not yet been adequately documented. We therefore considered 31 patients with HBI, to determine the serum levels of inflammatory markers (C-Reactive Protein, CRP and or interleukine-6, IL-6) to establish their impact on functional status (Functional Independence Measure, FIM: 18 indicating the worst performance and 126, a normal score). The results showed an inflammation prevalence (CRP >0.5 mg/dl and/or IL 6 >7 pg/ml) of 74.2% at admission to Rehab. FIM reduction was more pronounced in inflamed compared to non-inflamed subjects (p < 0.05) and significantly correlated with blood variables sensitive to inflammation, such as alpha 1 globulin (r = - 0.565) and neutrophil/ lymphocyte ratio (r = - 0.52), CRP (r = - 0.365). At discharge from Rehab, the inflammation rate diminished. Inflamed patients showed similar gains in FIM score as their controls. In the entire population, the FIM gain was significantly associated with a gain in serum albumin, only (r = +0.56). We conclude that systemic inflammation is prevalent in HBI patients and contributes to reduce patient functional status. However, during the Rehab stage, inflammation does not hinder the improvement rate of functional capacity.

Computed tomography angiography in the diagnosis of arteriovenous malformations

Introduction: The most common cause of intracranial bleeding in younger patients and children are vascular anomalies. Digital subtractions angiography presents a gold standard in diagnostics of aneurisms and vascular malformations. Our aim is to present our experience in using computed tomography angiography in diagnosing arteriovenous malformations.&#x0D; Methods: We included 150 patients with acute non-traumatic intracranial hemorrhage diagnosed by non-contrast CT examination, after which they were subjected to CT angiography of the cerebral vessels, and then underwent maximum intense projection and volume rendering reconstruction.&#x0D; Results: Out of 150 patients with non-traumatic intracranial hemorrhage, in 121 (81%) a diagnosis of aneurysm was rendered, while in 8 (5%) arteriovenous malformation was found. In 29 (14%) patients cause of bleeding was not identified. Patients with arteriovenous malformations, were age 17-77 years, with mean age 42.75 years. Five (62.5%) of them were female patients and three (37.5%) were male.&#x0D; Conclusion: Spontaneous non-traumatic intracranial hemorrhage is a significant cause of morbidity and mortality. Computed tomography angiography is sufficiently specific and sensitive in diagnosis of arteriovenous malformations in our experience.

European guidelines on perioperative venous thromboembolism prophylaxis: Neurosurgery.

: Although there are numerous publications addressing venous thromboembolism and its prevention in neurosurgery, there are relatively few high-quality studies to guide decisions regarding thromboprophylaxis. In patients undergoing craniotomy, we recommend that if intermittent pneumatic compression (IPC) is used, it should be applied before the surgical procedure or on admission (Grade 1C). In craniotomy patients at particularly high risk for venous thromboembolism, we suggest considering the initiation of mechanical thromboprophylaxis with IPC preoperatively with addition of low molecular weight heparin (LMWH) postoperatively when the risk of bleeding is presumed to be decreased (Grade 2C). In patients with non-traumatic intracranial haemorrhage, we suggest thromboprophylaxis with IPC (Grade 2C). For patients who have had non-traumatic intracranial haemorrhage, we suggest giving consideration to commencement of LMWH or low-dose unfractionated heparin when the risk of bleeding is presumed to be low (Grade 2C). We suggest continuing thromboprophylaxis until full mobilisation of the patient (Grade 2C). For patients undergoing spinal surgery with no additional risk factors, we suggest no active thromboprophylaxis intervention apart from early mobilisation (Grade 2C). For patients undergoing spinal surgery with additional risk factors, we recommend starting mechanical thromboprophylaxis with IPC (Grade 1C), and we suggest the addition of LMWH postoperatively when the risk of bleeding is presumed to be decreased (Grade 2C).

European Guidelines on perioperative venous thromboembolism prophylaxis: Executive summary.

European Guidelines on perioperative venous thromboembolism prophylaxis: Executive summary.

Causes of death in hospitalized children younger than 12\xa0years of age in a Chinese hospital: a 10\xa0year study

BackgroundIn China, the majority (77%) of urban children die in hospitals. Hospital-based review could provide insight leading to improvements in clinical practice and increase the survival of critically ill children. The aim of the present study is to identify the trends of immediate causes and chronic underlying diseases associated with deaths of children at one of the largest teaching hospitals in China over a period of 10 years (2006–2015).MethodsA retrospective analysis of data of all children aged 1 month to 11 years who died at Xinhua Hospital between 2006 and 2015. Demographic details, main causes of deaths, and chronic underlying diseases were reviewed.ResultsCase fatality rate was 0.55% (510/93,443) and it represented 0.41–0.80% deaths per year. Overall, the most common immediate causes of deaths in hospitalized children were pneumonia (36.7%), sepsis (13.5%), tumour (11.4%), followed by nontraumatic intracranial or gastrointestinal hemorrhage (10.6%) and cardiac shock (9.6%). Over 70% of the deaths in children were complicated with chronic underlying diseases. Congenital abnormality was the most frequent chronic underlying disease observed in infants (60.3%) and tumour was the main chronic underlying disease in toddlers (31.1%) and older children (44%).ConclusionsInfectious diseases, especially pneumonia, were the major immediate causes of deaths, and the mortality in the study population decreased with age. Tumour and other noninfectious disease accounted for more deaths in older children. Chronic underlying diseases were found in most deaths of children.

Сравнительная оценка эффективности хирургического лечения больных с нетравматическими внутричерепными кровоизлияниями

Сравнительная оценка эффективности хирургического лечения больных с нетравматическими внутричерепными кровоизлияниями

Treatment of Atrial Fibrillation in Patients with Dementia: A Cohort Study from the Swedish Dementia Registry.

Background:Patients with dementia might have higher risk for hemorrhagic complications with anticoagulant therapy prescribed for atrial fibrillation (AF).Objective:This study assesses the risks and benefits of warfarin, antiplatelets, and no treatment in patients with dementia and AF.Methods:Of 49,792 patients registered in the Swedish Dementia Registry 2007–2014, 8,096 (16%) had a previous diagnosis of AF. Cox proportional hazards models were used to calculate the risk for ischemic stroke (IS), nontraumatic intracranial hemorrhage, any-cause hemorrhage, and death.Results:Out of the 8,096 dementia patients with AF, 2,143 (26%) received warfarin treatment, 2,975 (37%) antiplatelet treatment, and 2,978 (37%) had no antithrombotic treatment at the time of dementia diagnosis. Patients on warfarin had fewer IS than those without treatment (5.2% versus 8.7%; p < 0.001) with no differences compared to antiplatelets. In adjusted analyses, warfarin was associated with a lower risk for IS (HR 0.76, CI 0.59–0.98), while antiplatelets were associated with increased risk (HR 1.25, CI 1.01–1.54) compared to no treatment. For any-cause hemorrhage, there was a higher risk with warfarin (HR 1.28, CI 1.03–1.59) compared to antiplatelets. Warfarin and antiplatelets were associated with a lower risk for death compared to no treatment.Conclusions:Warfarin treatment in Swedish patients with dementia is associated with lower risk of IS and mortality, and a small increase in any-cause hemorrhage. This study supports the use of warfarin in appropriate cases in patients with dementia. The low percentage of patients on warfarin treatment indicates that further gains in stroke prevention are possible.

Вплив інтраопераційного розриву аневризм головного мозку на результати хірургічного лікування в ранній післяопераційний період

Objective – to study features of clinical neurological manifestations of intraoperative rupture of arterial aneurysms (AA) in the early postoperative period. Materials and methods. A retrospective study of the results of surgical treatment of 69 patients (31 (44.9 %) men and 38 (55.1 %) women) with acute cerebrovascular disorder in the hemorrhagic type was performed, due to the breakdown of brain aneurysm, in which there was an intraoperative rupture of arterial aneurysm. Age of patients from 21 to 65 years, the average age is (42.2 ± 14.2) year. In all cases the disease manifested itself as a clinic of non-traumatic intracranial hemorrhage as a result of the rupture of AA. The primary gap was observed in 57 (82.6 %) patients, repeated – in 12 (17.4 %) patients. The formation of intrahepatic hematoma was observed in 36 (52.2 %) patients. During hospitalization all patients underwent computer tomography of the brain to verify hemorrhage, cerebral edema, ischemic lesions and hydrocephalus expansion of the ventricular system. Diagnosis and determination of the degree of angiospasm were performed using transcranial dopplerography. The diagnosis of cerebral aneurysms was established using cerebral angiography and multispiral computer angiography. Intraoperative doppler screening was used to assess the radicalization of the aneurysm exclusion from the bloodstream. The Hunt-Hess scale, the World Federation of Neurological Surgeon Grading System for Subarachnoid Hemorrhage (WFNS SAH grading scales), Glasgow scale, was used to assess the clinical state of patients. Results. In the acute period 47 (68.12 %) patients were operated, in the subacute and cold period – 22 (31.9 %). In 63 patients, the intraoperative aneurysm rupture occurred during the allocation of aneurysms from arachnoidal adhesions, 2 at the time of aspiration of the intracerebral hematoma, 3 in the approach to aneurysm during to retraction of spatulas, 1 – noncontact aneurysm rupture during the trepanation stage. Temporary occlusion with a clip of an arterial carrier aneurysms as a measure of prevention of intraoperative rupture of brain aneurysms was aplicated in 66 (95.65 %) cases. Persistent neurological disorders arose in 15 (21.74 %) patients. 48 patients were discharge from the hospital in satisfactory condition. Six (8.7 %) patients (3 women and 3 men from 22 to 53 years old) died: 3 – due to the rupture of the aneurysm of anterior cerebral artery-anterior communicating artery on the left, 2 – aneurysms of anterior cerebral artery-anterior communicating artery on the right, 1 – the aneurysms of anterior inferior cerebellar artery on the right. In acute period operated 4 patients, in the distant period – 2. Conclusions. Intraoperative rupture of cerebral aneurysm – the most often intraoperative complications of clipping brain aneurysms, the appearance of which worsens the general condition of the patient, leads to the formation of persistent focal deficiency and increases the likelihood of postoperative lethality. The application of adequate surgical access to the optimal position of the patient on the operating table, induced arterial hypotension, temporary occlusion of the artery carrier aneurysms are reliable methods of preventing the onset of intraoperative ruptures of arterial aneurysms. Surgical tactics with an intraoperative rupture of aneurysm depends on the stage at which the bleeding from aneurysm occurred, its intensity and on anatomic-topographic features of aneurysms and arterial links of blood supply to the brain.

The Current State of Non-traumatic Intracranial Hemorrhage Treatment in Japan Using the Diagnosis Procedure Combination Data from 2014

The Current State of Non-traumatic Intracranial Hemorrhage Treatment in Japan Using the Diagnosis Procedure Combination Data from 2014

Cerebral Angiographic Findings in Non-Traumatic Intracranial Hemorrhage: A Single Center Experience in the West of Iran

Cerebral Angiographic Findings in Non-Traumatic Intracranial Hemorrhage: A Single Center Experience in the West of Iran

The Effect of Time to International Normalized Ratio Reversal on Intracranial Hemorrhage Evolution in Patients With Traumatic Brain Injury.

The incidence of geriatric traumatic brain injury (TBI) is increasing throughout the United States, with many of these patients taking anticoagulation (AC) medication. The purpose of this investigation was to determine the effect of time to international normalized ratio (INR) reversal on intracranial hemorrhage evolution in TBI patients taking prehospital AC medication. We hypothesized that rapid reversal of INR improves outcomes of head-injured patients taking AC medication. Admissions to a Level II trauma center between February 2011 and December 2013 were reviewed. Patients presenting with an initial INR of 2.0 or more, computed tomographic scan positive for intracranial hemorrhage, and INR reversal to less than 1.5 in hospital were included. Patients with nontraumatic intracranial hemorrhage were excluded. Reversal of INR was achieved using some combination of fresh frozen plasma, prothrombin complex concentrate, and vitamin K. A binary logistic regression model assessed the adjusted impact of rapid INR reversal on intracranial hemorrhage evolution. Significance was defined as p < .05. One hundred subjects were included. Four patients with nontraumatic intracranial hemorrhage were excluded, resulting in a final study population of 96 patients. The most common intracranial hemorrhage in the study population was subarachnoid hemorrhage (71.9%), followed by subdural hemorrhage (35.4%). Reversal of INR of less than 5 hr was not associated with intracranial hemorrhage evolution; however, reversal of less than 10 hr was found to be associated with a decreased odds ratio for intracranial hemorrhage evolution (p = .043). Rapid reversal of elevated INR levels (<10 hr) may decrease intracranial hemorrhage evolution in TBI patients taking prehospital AC medication.

295 Interhospital Transfer is Not a Predictor of In-Hospital Mortality for Patients With Nontraumatic Intracranial Hemorrhage

295 Interhospital Transfer is Not a Predictor of In-Hospital Mortality for Patients With Nontraumatic Intracranial Hemorrhage

Poster 322: Acute Non-Traumatic Intracranial Hemorrhage Due to Thrombocytopenia from Radiation for Prostate Cancer: A Case Report

PM&RVolume 9, Issue 9S1 p. S234-S234 Neurological Rehabilitation Poster Hall: Case Report Poster 322: Acute Non-Traumatic Intracranial Hemorrhage Due to Thrombocytopenia from Radiation for Prostate Cancer: A Case Report Varun Patibanda, Varun Patibanda Rutgers New Jersey Medical School Physic, Harrison, NJ, USASearch for more papers by this authorBenjamin Seidel DO, Benjamin Seidel DO Rutgers New Jersey Medical School Physic, Harrison, NJ, USASearch for more papers by this author Varun Patibanda, Varun Patibanda Rutgers New Jersey Medical School Physic, Harrison, NJ, USASearch for more papers by this authorBenjamin Seidel DO, Benjamin Seidel DO Rutgers New Jersey Medical School Physic, Harrison, NJ, USASearch for more papers by this author First published: 19 September 2017 https://doi.org/10.1016/j.pmrj.2017.08.262Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume9, Issue9S12017 AAPM&R Annual Assembly AbstractsSeptember 2017Pages S234-S234 RelatedInformation

Early Versus Delayed Initiation of Pharmacological Venous Thromboembolism Prophylaxis After an Intracranial Hemorrhage

Intracranial hemorrhage (ICH) accounts for up to 20% of all strokes with and carries an approximate 50% 30-day mortality. The risk of venous thromboembolism (VTE) is markedly higher in patients with ICH compared with ischemic strokes, but the optimal time to initiate pharmacological prophylaxis is ill-defined. Retrospective analysis. University-affiliated, tertiary care center. Patients admitted for a nontraumatic ICH who received pharmacological VTE prophylaxis during their first 30 hospital days. Of the 793 patients evaluated, 400 were included [142 (35.5%) early]. Rebleeding event rates were similar for early versus late [8 (5.6%) vs. 13 (5.0%), P=0.80] and rates of hospital-acquired VTEs were not statistically different [1 (0.7%) vs. 8 (3.1%), P=0.17]. The median time from admission to the first dose of pharmacological prophylaxis was similar in patients who experienced rebleeding versus those that did not [74 h (range, 38 to 110.5 h) vs. 63 h (range, 45 to 90.5 h), P=0.69]. There was a longer median time from admission to the first dose of pharmacological prophylaxis in patients who developed a VTE during the initial hospitalization versus those who did not [108 h (range, 73.3 to 187 h) vs. 63 h (range, 44.5 to 90 h), P=0.005]. Initiation of early pharmacological prophylaxis in ICH patients did not appear to increase the risk of rebleeding nor decrease the risk of VTE. Among those patients who did develop VTE during hospitalization, there was a longer median time from admission to the first dose of pharmacological prophylaxis.

Hypophosphatemia after nontraumatic intracranial hemorrhage.

The aim of this study was to assess the incidence and contributing factors of hypophosphatemia and the association with poor long-term outcome after nontraumatic intracranial hemorrhage. This was a prospective, observational study of patients with nontraumatic intracranial hemorrhage (i.e., aneurysmal or perimesencephalic subarachnoid hemorrhage, or spontaneous intracerebral or intraventricular hemorrhage) treated in the intensive care unit (ICU) at our university hospital. Plasma phosphate concentrations were measured serially in 2-day sections during the 6 day study period. The ICU mortality was recorded, 3-month and 1-year outcomes were assessed using the Glasgow Outcome Scale. One hundred patients were enrolled. The frequency of hypophosphatemia (Pi ≤ 0.65 mmol/l) was 70%. Chronic hypertension, acute hydrocephalus, and diffuse brain edema were more common in patients with hypophosphatemia compared with normophosphatemics (44% vs. 21%, P = 0.021; 59% vs. 33%, P = 0.021; and 43% vs. 13%, P = 0.004, respectively). Hypophosphatemic patients had higher maximum SOFA scores [10 (7-11) vs. 7.5 (5.75-10), P = 0.024]. Initial phosphate concentration correlated inversely with APACHE II score on admission (ρ = -0.304, P = 0.002) and SOFA score on the first ICU day (ρ = -0.269, P = 0.008). There was no difference in outcome between hypophosphatemic and normophosphatemic patients. In all five patients with severe hypophosphatemia (Pi < 0.32 mmol/l) the functional outcome was good. Hypophosphatemia was common in this patient population. The outcome was similar between hypophosphatemic and normophosphatemic patients. Chronic hypertension, acute hydrocephalus, diffuse brain edema and higher SOFA scores were more common in patients with hypophosphatemia.