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BackgroundDelayed cerebral ischemia represents a significant contributor to death and disability following aneurysmal subarachnoid hemorrhage. In murine studies (n=30), the endovascular perforation model was predominantly used, while rat studies primarily employed intracisternal blood injection to mimic subarachnoid hemorrhage.
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.
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.
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.
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).
IntroductionAcute spinal cord ischemia syndrome (ASCIS) is a rare disease that is thought to comprise roughly only 1.2% The use of recreational cocaine in young adults is well known to be responsible for acute ischemic and hemorrhagic strokes in individuals who lack other vascular risk factors. of all strokes [1, 2].
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.
Subarachnoid hemorrhage (SAH), commonly caused by a ruptured aneurysm, carries a high rate of disability and death. Preclinical studies demonstrate SAH induces dysregulation of the cerebrovasculature and increases neuroinflammation, which contributes to early brain injury and delayed cerebral ischemia.
Introduction:Subarachnoid hemorrhage (SAH) is the deadliest form of hemorrhagic stroke. Post-SAH vasospasm induces brain tissue hypoxia-ischemia resulting in brain injury and functional impairments. Stroke, Volume 55, Issue Suppl_1 , Page ATP303-ATP303, February 1, 2024.
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.
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.
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.
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),
This ECG is diagnostic of diffuse subendocardial ischemia. Because the patient had asystole, was resuscitated without difficulty, and had no neurologic function, suspected a cerebral hemorrhage was suspected as the etiology of the arrest, specifically subarachnoid hemorrhage. What is the utility of a head CT in cardiac arrest?
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.
The secondary outcomes included intracranial hemorrhage, major bleeding, systemic thromboembolism, and all‐cause death. A nonsignificantly higher incidence rate of intracranial hemorrhage was observed in the DOAC‐change group compared with the DOAC‐retain group (0.75 versus 0.53 per 100‐person‐years; HR, 1.49 [95% CI, 0.78–2.83]).
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.
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.
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.
in other 2 external test cohorts), distinguish ischemia and hemorrhage (100.0% in the internal validation dataset, 95.5% in validation dataset, 99.1% in other test cohorts), LVO identification (80.0% in validation dataset, 88.6% in other test cohorts), and screening patients eligible for IVT (89.4% in validation dataset, 60.0%
Background and objectives:Remote ischemic conditioning during cerebral ischemia ( PerRIC ) represents a new protection paradigm. Stroke, Volume 56, Issue Suppl_1 , Page AWMP7-AWMP7, February 1, 2025. We present the safety and efficacy analysis of the entire patient cohort of the multicenter double-blind REMOTECAT trial (.Methods:Patients
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.
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