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ECG Changes in Intracranial Hemorrhage ECG changes are fairly common in intracranial hemorrhage. Giant T inversions with QT interval prolongation may be seen in intracranial hemorrhage even without associated myocardial damage [1]. But the number of persons with lobar hemorrhage in that study was only 17%. Am Heart J.
Approximately 30% of aneurysmal subarachnoid hemorrhage (aSAH) patients who survive the rupture develop delayed cerebral ischemia (DCI) 4 to 10 days following aSAH. Stroke, Volume 56, Issue Suppl_1 , Page AWP370-AWP370, February 1, 2025.
Neutrophils are reported to be critical mediators of to poor outcome after subarachnoid hemorrhage (SAH). Following SAH, neutrophils cause vascular occlusion via neutrophil extracellular traps (NETs) and NETs have been identified as a therapeutic target to prevent delayed cerebral ischemia in mice (DCI) with SAH.
Neutrophils are reported to be critical mediators of to poor outcome after subarachnoid hemorrhage (SAH). In this study, our hypothesis was that NETs cause vascular occlusion leading to delayed cerebral ischemia (DCI) and worse outcome after SAH.
Subarachnoid hemorrhage is a critical neurological condition accounting for about 5% of all strokes, and survivors experience long-term cognitive deterioration and increased risk of dementia. Genetic predispositions have been associated with post-subarachnoid hemorrhage cognitive outcomes and emphasize a role for personalized care strategies.
Secondary analyses included the distinction of ischemic from hemorrhagic strokes, and the accuracy with which the lesion location and site of vessel occlusion were identified. The accuracy to identify ischemia compared with hemorrhage was 0.91 (0.870.93).
Background:Several studies have shown that tranexamic acid (TXA), an anti-fibrinolytic agent, may reduce hematoma expansion (HE) in intracerebral hemorrhage (ICH), but its therapeutic time window is unclear. We excluded trials that used TXA for longer than 3 days which causes delayed vasospasm, increasing the risk of cerebral ischemia.
Background:Enteral nimodipine is the most evidence-based and widely used drug for the treatment of delayed cerebral ischemia and is known to have various neuroprotective functions. Herein, we studied the effect of enteral nimodipine on endothelial apoptosis after subarachnoid hemorrhage (SAH).Methods:SAH
BACKGROUND:Arteriovenous malformations (AVMs) are characteristic of hereditary hemorrhagic telangiectasia. Loss-of-function mutations in the activin receptorlike kinase 1 (Alk1) are linked to hemorrhagic telangiectasia type 2.METHODS:Endothelial-specific Ischemia assays were used to examine the cell capacity for vascular malformation.
Introduction:Delayed cerebral ischemia (DCI) is a leading cause of morbidity and mortality in aneurysmal subarachnoid hemorrhage (aSAH). The proportion of patients with functional independence was significantly higher in the LD group compared to the EVD group 1-month post-hemorrhage (BI p = 0.04; GOS p = 0.04)Conclusions:In
Intracerebral Hemorrhagic (ICH) stroke is the second most common type of stroke and its aftermath is often more severe than ischemia. Stroke, Volume 56, Issue Suppl_1 , Page AWP213-AWP213, February 1, 2025. Recent population data has shown increasing trends of ICH in middle aged people, contributing to the economic burden of society.
She had multiple rib fractures as well as serious hemorrhage and underwent massive transfusion. Either could be a result of myocardial contusion There is some minimal ST depression -- this could represent ischemia What else is there that could use therapy immediately? ng/mL, and an ECG was recorded: There are no P-waves visible.
Introduction:Oxidative stress plays an important role in both early brain injury and delayed cerebral ischemia after subarachnoid hemorrhage (SAH). Stroke, Volume 56, Issue Suppl_1 , Page AWP368-AWP368, February 1, 2025.
Introduction:Elevated levels of Interleukin-6 (IL-6) levels in cerebrospinal fluid (CSF) have been correlated with delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH). Stroke, Volume 55, Issue Suppl_1 , Page AWP152-AWP152, February 1, 2024.
Background:We have previously identified that hemoglobin decrements and new-onset anemia during an intracerebral hemorrhage (ICH) hospitalization is frequent, rapid, and associates with poor outcome. Though this association may be related to impaired cerebral oxygen delivery, it is unclear whether these changes relate to cerebral ischemia.
Background:We identified that major ABO incompatible platelet transfusions are associated with poor intracerebral hemorrhage (ICH) outcomes, yet the driver for this relationship is unknown and does not appear to be related to impaired hemostasis. Stroke, Volume 55, Issue Suppl_1 , Page AWP173-AWP173, February 1, 2024. 217.94, p = 0.03).Conclusions:Major
Introduction:Supratentorial intracerebral hemorrhage (ICH) is a devastating stroke subtype with high mortality and morbidity, and hematoma clearance is a critical therapeutic target. Stroke, Volume 56, Issue Suppl_1 , Page A48-A48, February 1, 2025.
We summarized the current clinical evidence on the use of dual‐energy computed tomography for identifying early cerebral ischemia, detecting and predicting hemorrhagic transformations, and characterizing clots and stenotic plaques.
Side note: The differential of sudden persistent loss of consciousness with adequate hemodynamics is relatively short: seizure, intracranial hemorrhage, basilar artery occlusion. We have also shown several cases in which atrial flutter hides true, active ischemia. There was again no intracranial hemorrhage.
Introduction:Tenecteplase (TNK) is becoming the preferred thrombolytic for acute brain ischemia. Median door-to-needle (DTN), door-to-puncture (DTP), thrombolytic utilization and symptomatic hemorrhage rates were recorded at five primary (P) and a comprehensive stroke center (C).Results:During Symptomatic hemorrhage occurred in 0.0%(P),
Alternation in ST segment appearance ( or in the amount of ST elevation or depression ) — is often linked to ischemia. Repolarization Alternans — entails beat-to-beat variation in the ST segment and/or T wave. Conduction and Refractoriness Alternans — entails variance of impulse propagation along some par t of the conduction system.
CTA head and neck were obtained and showed no evidence of intracranial hemorrhage, large vessel occlusion stroke (what a helpful and apt name for an acute arterial occlusion paradigm, by the way.), or basilar ischemia. Blood glucose was not low at 162 mg/dL. EKG on arrival to the ED is shown below: What do you think?
Osborn waves have been reported with hypercalcemia, brain injury, subarachnoid hemorrhage, Brugada syndrome, cardiac arrest from VFib — and — severe, acute ischemia resulting in acute MI ( See My Comment in the November 22, 2019 post on Dr. Smith’s Blog ). Rituparna et al — as well as Chauhan and Brahma ( Int.
This highlights one of the most important complications of Eisenmenger syndrome, that is airway hemorrhage. Airway hemorrhage can occur in those who ascend to high altitude and during air travel. But if you go by the statistics, majority of the hemorrhages occur at sea level or ordinary level of height.
In this study, we tested the hypothesis that small extracellular vesicles (sEVs) derived from healthy human VSMCs (VSMC-sEVs) reduce diabetes- and ischemia-neurovascular damage.Methods and Results:VSMC-sEVs were characterized.
His response: “subendocardial ischemia. Smith : It should be noted that, in subendocardial ischemia, in contrast to OMI, absence of wall motion abnormality is common. With the history of Afib, CTA abdomen was ordered to r/o mesenteric ischemia vs ischemic colitis vs small bowel obstruction. Anything more on history?
Secondary outcomes included a composite of periprocedural hemorrhagic/ischemia‐related complications and favorable functional outcome.RESULTSThe study included 104 patients treated with WEB and 107 patients treated with BAC. P= 0.180) and hemorrhagic events (WEB: 3.8% Of the patients, 60.5% versus BAC: 2.8%;P= versus BAC: 7.5%;P=
Peripheral blood gene expression profiles can distinguish ischemic stroke from intracerebral hemorrhage and controls. Stroke, Volume 55, Issue Suppl_1 , Page AWP313-AWP313, February 1, 2024. However, it can be difficult to clinically distinguish “mimics” of transient ischemic attacks (TIA) and minor strokes from true TIAs and minor strokes.
Successful recanalization was defined as modified Thrombolysis in Cerebral Ischemia Score≥ 2b. Secondary outcomes were symptomatic intracranial hemorrhage and intracranial hemorrhage within 24 hours and mortality at 90 days. The primary outcome was a 90-day modified Rankin Scale (mRS) of 0-3.
Secondary outcomes included favorable functional outcome and periprocedural hemorrhagic/ischemia‐related complications. vs. BAC: 2.8%, p = 0.180) and hemorrhagic events (WEB: 3.8% The primary effectiveness outcome was complete aneurysm occlusion at the final imaging follow‐up using the Raymond‐Roy (RR) occlusion classification.
More often, tachycardia with ST segment abnormalities (elevation or depression) is due to an underlying illness (PE, sepsis, hemorrhage, dehydration, hypoxia, respiratory failure, etc.). Then ACS (STEMI) might be primary; this might be cardiogenic shock. One must clearly rule out these processes before jumping on the ACS diagnosis.
BACKGROUNDSteroids have pleiotropic neuroprotective actions including the regulation of inflammation and apoptosis which may influence the effects of ischemia on neurons, glial cells, and blood vessels. Stroke: Vascular and Interventional Neurology, Ahead of Print.
The primary outcome measure was successful recanalization defined as modified Thrombolysis in Cerebral Ischemia (mTICI) score of 2b or higher. 90-day modified Rankin score (mRS) 0-2, mortality and symptomatic hemorrhage were used as secondary outcomes.
The primary efficacy end point was achievement of modified Thrombolysis in Cerebral Ischemia (mTICI) reperfusion scores of ≥2b on first pass. There were no differences in distal emboli, or symptomatic intracranial hemorrhage. The total cohort was trichotomized into 3 groups (A, B, C) based on M1 tortuosity tertiles. and 26.5%, p=0.003.
307 (12.3%) cases had large vessel occlusions (LVOs) detected, and 77 (3.1%) had intracerebral hemorrhage (ICH). Conclusion:This is the largest cohort of CTP studies done in the pediatric/ young adult population for suspected acute cerebral ischemia. The ICH group was significantly younger than the total cohort: 18.8+/-5.1 vs 20.0+/-3.9
Introduction:CT perfusion maps (CTP) can estimate the ischemic core in acute ischemic stroke based on distinctive cerebral blood flow (CBF) thresholds.
intraluminal floating thrombus, intracardiac thrombus, acute coronary syndrome, acute limb ischemia, DVT and PE) within 3 days of symptom onset. The primary outcome was the incidence of intracranial hemorrhage (ICH) between both groups.
The protective effect of NO donors has been shown to prevent ischemia-reperfusion injury through reduction of reactive oxygen species formation in cardiovascular studies. Eligible patients were randomized to receive 800μg GTN or same volume of normal saline through the catheter after recanalization.
The anti-angiogenic impact of neutrophil elastase clouded the understanding of the role of neutrophils in promoting neovascularization (NV) and fibrinolysis in patients with chronic limb-threatening ischemia (CLTI). No hemorrhage occurred over the 30 day course. Segmental arterial recanalization indicated fibrinolysis.
The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia. Massive Transfusion for Motorcycle Collision with Hemorrhage, Troponin Elevated. Chest trauma was suspected on initial exam. Here is his initial ECG around 1330: What do you think?
Additionally, patients undergoing stenting were less likely to have symptomatic intracranial hemorrhage (sICH) (OR 0.34, 95% CI [0.17 ‐ 0.67]; p = 0.002). ConclusionPTAS appears to be an effective and safe treatment for ICAD after MT in the posterior circulation both improving likelihood of good outcomes and overall survival.
The primary outcome was successful reperfusion defined as a Modified Treatment in Cerebral Ischemia (mTICI) score of 2b or greater at the end of the procedure. Safety measures included rates of symptomatic intracranial hemorrhage (sICH) and mortality at 90 days.ResultsAmong 9 patients who met our criteria, the median age was 63 (51‐69.5)
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