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1.
Katherine P. Cabral Gilles L. Fraser Jennifer Duprey Beth A. Gibbons Timothy Hayes Jeffrey E. Florman David B. Seder 《Clinical neurology and neurosurgery》2013
Prothrombin complex concentrates (PCCs) offer a means for the rapid reversal of warfarin, particularly in the setting of life-threatening bleeding. We evaluated the effectiveness and safety of a PCC-based protocol in patients with warfarin-associated intracerebral hemorrhage (ICH), subdural hematoma (SDH), or subarachnoid hemorrhage (SAH). 相似文献
2.
目的 总结无蛛网膜下腔出血(SAH)的破裂脑动脉瘤的诊治经验.方法 对15例在起病后2 d内首次CT或MRI上表现为脑内出血(ICH),和(或)脑室内出血(IVH)、硬脑膜下血肿(SDH)和壁间出血(IMH)而无SAH的破裂脑动脉瘤患者的临床表现、影像学检查结果 、治疗方法 和预后进行回顾性分析.结果 本组首次CT或MRI检查表现为ICH者3例、IVH合并ICH者6例、SDH者1例、IVH者1例、IMH者3例和等高混合密度者1例.其中动脉瘤位于大脑中动脉6例、前交通动脉4例、后交通动脉3例、大脑前动脉1例和小脑后下动脉1例.开颅手术夹闭动脉瘤13例,血管内栓塞2例.出院时GOS评分:恢复良好8例、中残3例、重残3例和植物生存1例.本组15例占同期破裂脑动脉瘤的3.8%.结论 破裂脑动脉瘤首次CT扫描可表现为单纯ICH,和(或)IVH、SDH、IMH而无SAH,与CT扫描时间、动脉瘤的部位和指向以及出血量有关.早期控制颅内高压、及时诊断和有效处理破裂动脉瘤,是改善预后的关键. 相似文献
3.
目的探讨蛛网膜下腔出血(SAH)合并硬膜下血肿(SDH)的临床特点和机理。方法对16例经CT、脑血管造影、手术和11例尸解证实的颅内动脉瘤破裂致SAH合并SDH患者进行临床及病理特点分析。结果临床表现意识障碍12例,玻璃体下出血7例,死亡13例。导致SAH合并SDH的原因可能为:(1)动脉瘤破裂,大量血液破入蛛网膜下腔,撕破蛛网膜;(2)伴随的脑内血肿破入蛛网膜下腔并撕破蛛网膜;(3)发病时突发意识丧失、摔倒,致头部外伤。结论颅内动脉瘤致SAH可合并SDH,其预后不佳,病死率高,CT阴性者不能完全排除合并SDH的可能。 相似文献
4.
We report a rare case of simultaneous cranial subarachnoid and spinal subdural hematoma (SDH) in a 42-year-old man who was on Warfarin therapy after cardiac bypass surgery. Computed tomography at presentation revealed a cranial subarachnoid hemorrhage, and spinal Magnetic Resonance Imaging (MRI) showed a spinal SDH extending from the T6 to L5 segments. He had paraparesis due to spinal cord compression. The patient was managed conservatively due to his poor general condition and was infused with intravenous steroid therapy, but he experienced sudden cardiac arrest 5 hours later after being admitted to the hospital. This case is of interest because of its first presentation of spinal subdural hematoma and cranial subarachnoid hemorrhage simultaneously and it is also the second longest vertebral segmental spread in the literature. 相似文献
5.
Triantafyllopoulou A Beaumont A Ulatowski J Tamargo RJ Varelas PN 《Neurocritical care》2006,5(1):39-42
Introduction Acute subdural hematoma (SDH) is an infrequent complication after aneurysmal subarachnoid hemorrhage. SDH associated with
unruputed intracavernous aneurysm has never been reported.
Methods Single patient case report and review of relevent literature.
Results A 65-year-old woman with an unruptured, thrombosed giant intracavernous aneurysm developed an acute SDH 2 days after admission
for cavernous sinus syndrome. Despite emergent evacuation of the SDH, the patient never regained consciousness because of
brain herniation.
Conclusion Acute SDH is a rare complication of ruptured, giant intracavernous aneurysms. Erosion of the cavernous sinus wall by acute
enlargement of the aneurysm after thrombosis is the proposed mechanism for development of the SDH. 相似文献
6.
A 26-year-old male presented with a rare cerebellar pilocytic astrocytoma with multicompartmental subarachnoid metastases. Cerebrospinal fluid dissemination of low grade astrocytoma at presentation is rare in adults. In the present patient, clinical and neuroradiological follow-up at 4 years, without adjuvant treatment, revealed non progression of tumors. The occurrence of benign dormancy, low grade tumor histology and multifocal involvement of the neuraxis is rare. Close clinical observation is the best approach for management of such a patient. The relevant literature is discussed. 相似文献
7.
M. R. Germans F. A. Pennings M. E. S. Sprengers W. P. Vandertop 《Journal of neurology》2008,255(12):1910-1915
Objective
In patients with non-traumatic subarachnoid hemorrhage (SAH) and no evidence for a cerebral aneurysm on angiography, a frequent
cause of the hemorrhage is perimesencephalic hemorrhage or other cerebral vascular pathology. In some patients no cause is
found. The exact incidence of a spinal vascular malformation (SVM) as the origin for the SAH is not known. We assessed the
occurrence of SVM in angiogram-negative, non-perimesencephalic subarachnoid hemorrhage (NPSAH).
Methods
47 patients (from a consecutive cohort of 632) were identified with an angiogramnegative, non-perimesencephalic subarachnoid
hemorrhage and 42 of these were analyzed by performing MR-imaging of the complete spinal neuraxis with additional spinal angiography
on indication.
Results
In four patients a spinal vascular malformation was identified as the cause of the SAH, indicating an incidence of 9 % of
SVM in NPSAH, and an incidence of 1 % of SVM in all patients with SAH.
Interpretation
Systematic analysis of angiogram-negative, non-perimesencephalic subarachnoid hemorrhage by MR imaging of the complete spinal
neuraxis yields a higher incidence of SVM than previously documented. We recommend MR imaging of the complete spinal neuraxis
in patients with a non-perimesencephalic subarachnoid hemorrhage in whom no cause for the hemorrhage has been found. 相似文献
8.
Shingo Ohno Yukio Ikeda Toshiaki Onitsuka Satoshi Nakajima Jo Haraoka 《Brain and nerve》2004,56(8):701-704
A 33-year-old man was admitted to our hospital with a sudden severe headache five days after the onset CT scan showed a slight high-density area in the basal cistern, mimicking subarachnoid hemorrhage (SAH), and diffuse brain swelling. However, conventional cerebral angiography and CT angiography failed to demonstrate aneurysms and vascular malformations. MRI showed bilateral subdural hematoma, but no SAH. Irrigation of liquefied subdural hematoma, causing high intracranial pressure, was carried out. Postoperative course was uneventful and his headache resolved within a day. The author presented a case of bilateral chronic subdural hematoma who presented with a sudden severe headache mimicking a SAH. Hyper attenuation in the basal cistern and subarachnoid space in CT, don't always indicate SAH. MRI, including fluid-attenuated inversion recovery (FLAIR) sequences, is useful in differentiating the "pseudo" SAH from "true" SAH, and lead to the right diagnosis. 相似文献
9.
Andrew M. Naidech Ali Shaibani Rajeev K. Garg Isis M. Duran Storm M. Liebling Sarice L. Bassin Bernard R. Bendok Richard A. Bernstein H. Hunt Batjer Mark J. Alberts 《Neurocritical care》2010,13(3):313-320
Background and Purpose
In patients with subarachnoid hemorrhage (SAH), higher hemoglobin (HGB) has been associated with better outcomes, but packed red blood cell (PRBC) transfusions with worse outcomes. We performed a prospective pilot trial of goal HGB after SAH. 相似文献10.
An elderly case of malignant small cell glioma with hemorrhage coexistent with a calcified pilocytic astrocytoma component in the cerebellar hemisphere
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Yuhei Sangatsuda Nobuhiro Hata Satoshi O. Suzuki Yojiro Akagi Ryusuke Hatae Daisuke Kuga Koji Yoshimoto Seiya Momosaki Toru Iwaki Koji Iihara 《Neuropathology》2018,38(5):493-497
Pilocytic astrocytoma is a less aggressive form of glial tumor that commonly occurs in the pediatric population, and its malignant transformation is extremely rare. Here, we report an elderly case of malignant small cell glioma with hemorrhage coexistent with a calcified pilocytic astrocytoma component. An 80‐year‐old male was found to have a right cerebellar non‐enhanced tumor with hematoma adjoining a calcified nodule. The lesion was surgically removed, and a histological examination verified that the tumor was a malignant small cell glioma with hemorrhagic change and the calcified nodule showed features of pilocytic astrocytoma. Genetic analyses revealed no glioma‐relevant genetic alterations such as IDH and BRAF mutations. Although calcification is generally observed in slowly growing gliomas, the aggressive clinical course of calcified cerebellar pilocytic astrocytoma has been previously reported. Our extremely rare case shows that careful follow‐up is necessary even for calcified pilocytic astrocytomas. 相似文献
11.
Sang Hoon Chang Seung-Ho Yang Byung Chul Son Sang Won Lee 《Journal of Korean Neurosurgical Society》2009,46(6):592-595
Cerebellar hemorrhage is an unusual complication of supratentorial neurosurgery. To the best of our knowledge, only three case reports have described the occurrence of cerebellar hemorrhage after burr hole drainage for the treatment of chronic subdural hematoma (SDH). We present the case of a patient with this rare postoperative complication of cerebellar hemorrhage after burr hole drainage of a chronic SDH. Although burr hole drainage for the treatment of chronic SDH is rare complication, it is necessary to be aware of the possibility of cerebellar hemorrhage after supratentorial surgery, even with limited surgery such as burr hole drainage of a chronic SDH. 相似文献
12.
Spontaneous spinal subdural hematoma is reported at a rare level of incidence, and is frequently associated with underlying coagulopathy or those receiving anticoagulant or antiplatelet agents; some cases accompany concomitant intracranial hemorrhage. The spontaneous development of spinal subdural hemorrhage (SDH) is a neurological emergency; therefore, early diagnosis, the discontinuation of anticoagulant, and urgent surgical decompression are required to enable neurological recovery. In this report, we present a simultaneous spinal subdural hematoma and cranial subarachnoid hemorrhage, which mimicked an aneurysmal origin in a female patient who had been taking warfarin due to aortic valve replacement surgery. 相似文献
13.
Taraszewska A Czernicki Z Andrychowski J 《Folia neuropathologica / Association of Polish Neuropathologists and Medical Research Centre, Polish Academy of Sciences》2005,43(3):172-177
The pilocytic astrocytoma is only rarely associated with gross intratumoral hemorrhage despite rich vasculature and blood vessel changes, accompanied often by perivascular depots of hemosiderin. We report an unusual case of pigmented cerebellar pilocytic astrocytoma presenting with posttraumatic hemorrhage in a 38-year-old man with no history related to the tumor. CT and MRI examination after head injury demonstrated unexpectedly the cystic lesion of 2 cm in diameter in the region of the right cerebellar hemisphere and vermis. The lesion was associated with hematoma and it was surgically removed 3 weeks after trauma. Histopathological examination revealed pilocytic astrocytoma tissue with broad hemorrhagic changes and with an unusual pattern of massive pigmentation of the cytoplasm of pilocytic astrocytes, consistent with hemosiderosis. Positive stains for iron and ferritin and ultrastructural study confirmed deposition of hemosiderin granules in the tumour cells. There was no evidence of melanin or melanosomes. This finding of hemosiderin accumulation in the cytoplasm of neoplastic astroglia seems to be analogous to post-hemorrhagic pigmentation of the normal Bergmann glia and subpial astrocytes. In the literature, the examples of neuroepithelial tumors with hemosiderin pigmentation of tumor cells have been rarely documented. To our knowledge, this is the first reported case of pigmented pilocytic astrocytoma exhibiting extensive intracellular hemosiderin deposition. 相似文献
14.
Ferdinand K. Hui Luis M. Tumialán Tomoko Tanaka C. Michael Cawley Y. Jonathan Zhang 《Neurocritical care》2009,11(1):64-70
Objective To identify prognostic factors for vasospasm, hydrocephalus, and clinical outcomes in patients with angiographically negative,
non-traumatic, diffuse subarachnoid hemorrhage (d-SAH).
Methods Retrospective review of patients who experienced angiographically negative SAH at our institution over the past 6 years was
undertaken. The patients were stratified based on grade at presentation, severity, and pattern of SAH on initial non-enhanced,
computed tomography (CT) of the head into perimesencephalic and diffuse subtypes. The patients were further differentiated
based on the development of vasospasm, hydrocephalus and required treatments, and clinical outcomes. Patients were excluded
if a causative lesion was discovered subsequently.
Results Ninety-four patients with angiographically negative SAH were identified. A total of 31 patients were considered to have the
perimesencephalic (p-SAH) subtype, while 63 patients fit criteria for the diffuse (d-SAH) subtype. Compared to the p-SAH subtype,
those patients with d-SAH subtype had significantly higher risk for complications related to SAH with an increased incidence
of hydrocephalus (50.8% vs. 9.6%), requirement for external ventricular drainage (41% vs. 9.6%), and for the hydrocephalus
requiring eventual permanent cerebrospinal fluid diversion (20.6% vs. 0%). Patients with d-SAH were also at an increased risk
for symptomatic vasospasm (28.6% vs. 9.6%). Ultimately, only 76% of d-SAH patients achieved complete recovery and independent
living, compared to 96.7% of p-SAH patients.
Conclusion The angiographically negative d-SAH pattern is associated with worse presentations and outcome. These patients are at increased
risk for vasospasm and hydrocephalus requiring aggressive treatment and should therefore be cared for with a higher level
of surveillance. 相似文献
15.
Mansoor Foroughi Glenda Hendson Michael A. Sargent Paul Steinbok 《Child's nervous system》2011,27(4):671-679
Introduction
Spontaneous regression of pilocytic astrocytoma after incomplete resection is well recognized, especially for cerebellar and optic pathway tumors, and tumors associated with Neurofibromatosis type-1 (NF1). The purpose of this report is to document spontaneous regression of pilocytic astrocytomas of the septum pellucidum and to discuss the possible role of cannabis in promoting regression. 相似文献16.
Fisher LA Ko N Miss J Tung PP Kopelnik A Banki NM Gardner D Smith WS Lawton MT Zaroff JG 《Neurocritical care》2006,5(3):180-185
Introduction
Abnormalities of serum sodium are common after subarachnoid hemorrhage (SAH) and have been linked to poor outcome. This study analyzed whether abnormal serum sodium levels are associated with cardiac outcomes and mortality after subarachnoid hemorrhage (SAH). 相似文献17.
Basal subarachnoid hemorrhage by rupture of arteriovenous malformation at the cerebellopontine angle
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Mio Takayama Masayuki Kashiwagi Kenji Hara Aya Matsusue Brian Waters Natsuki Ikematsu Shin‐ichi Kubo 《Neuropathology》2017,37(5):441-445
A man in his late forties had lived as a recluse for more than ten years. He was found dead in his room. At autopsy, subarachnoid hemorrhage (SAH) was detected at the base of the brain, which weighed 1333 g. The cerebellar tonsil was swollen. The cerebral ventricle was enlarged and filled with blood. A hematoma was observed in the upper part of the left side of the cerebellar hemisphere. The location and size of SAH in this case indicated that the rupture of a cerebral aneurysm (CA) had occurred; however, CA was not detected. A mass of blood vessels buried in the hematoma was observed at the left cerebellopontine angle (CPA). The vascular lesion showed round‐shaped blood vessels as well as flat‐shaped vessels with the appearance of veins, but with elastic fibers indicative of arteries. The lesion was considered to be the nidus and was 5–8 mm in size. Feeding arteries appeared to be from the anterior inferior cerebellar artery (AICA). However, the draining vein and anastomotic parts of the artery and vein were not confirmed. Based on these histopathological features, this vascular lesion was diagnosed as arteriovenous malformation (AVM). A differential diagnosis between AVM at CPA and CA is needed in order to identify the source of non‐traumatic SAH. 相似文献
18.
Ashley R. Catalano H. R. Winn Errol Gordon Jennifer A. Frontera 《Neurocritical care》2012,17(3):324-333
Background
Interhospital transfer of patients with intracranial hemorrhage can offer improved care, but may be associated with complications.Methods
A prospective single-center study was conducted between 2/2008 and 6/2010 of patients with subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH) and subdural hemorrhage (SDH), admitted to the neuro-ICU at a tertiary-care academic hospital. Admission demographics, complications and 3-month functional outcomes were compared between directly admitted and transferred patients. The effect of transfer time on complications and outcomes was assessed.Results
Of 257 total patients, 120 (47%) were transferred and 137 (53%) were directly admitted. About 86 (34%) had SAH, 80 (31%) had ICH and 91 (35%) had SDH. The median transfer time was 190?min (46?C1,446). Transferred patients were significantly less educated, less likely to be insured and more frequently had SAH as a diagnosis than directly admitted patients (all P?<?0.05), though admission neurological and cognitive status was similar. Complications did not differ between transferred and directly admitted patients; however, among transferred patients, longer transfer time was associated with aneurysm rebleed (7.3 vs. 1.8%, P?=?0.007) and tracheostomy (20 vs. 17.5%, P?=?0.013). In multivariate analysis, after adjusting for other predictors, transferred patients had worse cognitive outcome at 3-months (adjusted OR 12.4, 95% CI 1.2?C125.2, P?=?0.033) compared to direct admits, though there were no differences in death, disability or length of stay (LOS).Conclusions
Transferred patients had similar rates of death, disability and LOS as directly admitted patients, though worse 3-month cognitive outcomes. Prolonged time to interhospital transfer was associated with an increased risk of aneurysm rerupture and tracheostomy. 相似文献19.
Daniel Shepherd Joseph Kapurch Sudhir Datar Giuseppe Lanzino Eelco F. M. Wijdicks 《Neurocritical care》2014,20(3):489-493
Background
Aneurysm rupture presenting as an isolated or pure subdural hematoma (SDH) without subarachnoid hemorrhage is an extremely rare radiographic presentation. We present a case of a ruptured internal carotid artery aneurysm with a pure SDH and concurrent sphenoid sinus hemorrhage.Methods
Case report and review of the literature.Results
We describe a case of a 48-year-old right-handed woman found comatose brought by emergency medical services to an outside hospital. A non-contrast head CT scan demonstrated bilateral acute SDHs without evidence of intraparenchymal or subarachnoid hemorrhage. A CT angiogram of the head showed a focal hyperdensity in the distal left internal carotid artery (ICA) and was confirmed by conventional cerebral angiography to be a 7-mm left supraclinoid ICA aneurysm. On repeat CT scan a new hemorrhage was seen in the sphenoid sinus indicating a re-bleeding. The aneurysm was treated with coil embolization and complete occlusion was confirmed with subsequent angiograms. The patient had an eventful hospital course complicated by a Takotsubo cardiomyopathy and pulmonary edema. She was medically treated with successful recovery of her cardiopulmonary function. She remained markedly disabled and was transferred to an inpatient rehabilitation center for continued convalescence.Conclusions
Acute subdural hematoma may be due to a ruptured clinoid carotid aneurysm. Acute hemorrhage into the sphenoid sinus can be an important clue. 相似文献20.
Matthieu Vinchon Sabine de Foort-Dhellemmes Marie Desurmont Isabelle Delestret 《Child's nervous system》2010,26(5):637-645