Pub Date : 2023-09-01DOI: 10.1016/j.hest.2022.10.006
Cristian Deana , Luigi Vetrugno , Daniele Bagatto
{"title":"Correlation does not mean causation: Proofs of COVID-19 associated strokes!","authors":"Cristian Deana , Luigi Vetrugno , Daniele Bagatto","doi":"10.1016/j.hest.2022.10.006","DOIUrl":"10.1016/j.hest.2022.10.006","url":null,"abstract":"","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":"4 3","pages":"Pages 176-177"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9616474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40448691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.hest.2022.10.001
Josef Finsterer , Fulvio A. Scorza , Antonio-Carlos G. de Almeida
Pituitary apoplexy often manifests with a severe headache and is often caused by bleeding in a pituitary adenoma, which is common and often undiagnosed. The pituitary gland is damaged when the tumour suddenly enlarges due to bleeding. Bleeding into the pituitary can block blood supply to the pituitary gland. The larger the tumour, the higher the risk of a future pituitary apoplexy. Since only few cases have been reported, the SARS-CoV-2 vaccine is unlikely to cause pituitary apoplexy. Patients with new-type headache require neurological evaluation and may require cerebral imaging to rule out bleeding, ischemia, venous sinus thrombosis, meningitis, encephalitis, pituitary apoplexy, reversible cerebral vasoconstriction syndrome, dissection, or migraine.
{"title":"Spot the adenoma after pituitary apoplexy following a SARS-CoV-2 vaccination","authors":"Josef Finsterer , Fulvio A. Scorza , Antonio-Carlos G. de Almeida","doi":"10.1016/j.hest.2022.10.001","DOIUrl":"10.1016/j.hest.2022.10.001","url":null,"abstract":"<div><p>Pituitary apoplexy often manifests with a severe headache and is often caused by bleeding in a pituitary adenoma, which is common and often undiagnosed. The pituitary gland is damaged when the tumour suddenly enlarges due to bleeding. Bleeding into the pituitary can block blood supply to the pituitary gland. The larger the tumour, the higher the risk of a future pituitary apoplexy. Since only few cases have been reported, the SARS-CoV-2 vaccine is unlikely to cause pituitary apoplexy. Patients with new-type headache require neurological evaluation and may require cerebral imaging to rule out bleeding, ischemia, venous sinus thrombosis, meningitis, encephalitis, pituitary apoplexy, reversible cerebral vasoconstriction syndrome, dissection, or migraine.</p></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":"4 3","pages":"Pages 178-179"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9575575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40653034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.hest.2022.11.001
Luca Roncati, Antonio Manenti
It is news of 28 October 2022 that the Pharmacovigilance Risk Assessment Committee of the European Medicines Agency has recommended to add heavy menstrual bleeding among the side effects of unknown frequency inside the package insert of nucleoside-modified messenger ribonucleic acid vaccines to prevent coronavirus disease 2019 (COVID-19). The decision has been made in the light of the numerous reports of unexpected menstrual changes or abnormal uterine bleeding following COVID-19 vaccination. Here we advance a possible involvement of the particular adenohypophyseal microcirculation in these strange and still unexplained events.
{"title":"Apropos of menstrual changes and abnormal uterine bleeding after COVID-19 vaccination","authors":"Luca Roncati, Antonio Manenti","doi":"10.1016/j.hest.2022.11.001","DOIUrl":"10.1016/j.hest.2022.11.001","url":null,"abstract":"<div><p>It is news of 28 October 2022 that the Pharmacovigilance Risk Assessment Committee of the European Medicines Agency has recommended to add heavy menstrual bleeding among the side effects of unknown frequency inside the package insert of nucleoside-modified messenger ribonucleic acid vaccines to prevent coronavirus disease 2019 (COVID-19). The decision has been made in the light of the numerous reports of unexpected menstrual changes or abnormal uterine bleeding following COVID-19 vaccination. Here we advance a possible involvement of the particular adenohypophyseal microcirculation in these strange and still unexplained events.</p></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":"4 3","pages":"Pages 180-181"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9642033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40698656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.hest.2022.10.004
Josef Finsterer , Fulvio A. Scorza , Antonio-Carlos G. de Almeida
Cerebrovascular events are increasingly recognized as a complication of SARS-CoV-2 infections. They can be due to hypercoagulability, vasculopathy, cardiac involvement in the infection, or autonomic dysfunction. However, establishing a causal relationship between cerebrovascular events and viral infection is not always easy and requires thorough investigation and documentation of a close temporal relationship between SARS-CoV-2 infection and the onset of cerebral impairment. Establishing a causal relationship between SARS-CoV-2 infection and cerebrovascular events is desirable as it can guide therapeutic management and determine the outcome.
{"title":"Establishing causality between SARS-CoV-2 and stroke/bleeding requires a temporal relationship and plausible pathophysiology","authors":"Josef Finsterer , Fulvio A. Scorza , Antonio-Carlos G. de Almeida","doi":"10.1016/j.hest.2022.10.004","DOIUrl":"10.1016/j.hest.2022.10.004","url":null,"abstract":"<div><p>Cerebrovascular events are increasingly recognized as a complication of SARS-CoV-2 infections. They can be due to hypercoagulability, vasculopathy, cardiac involvement in the infection, or autonomic dysfunction. However, establishing a causal relationship between cerebrovascular events and viral infection is not always easy and requires thorough investigation and documentation of a close temporal relationship between SARS-CoV-2 infection and the onset of cerebral impairment. Establishing a causal relationship between SARS-CoV-2 infection and cerebrovascular events is desirable as it can guide therapeutic management and determine the outcome.</p></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":"4 3","pages":"Pages 174-175"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9575563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40653033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cognitive impairments, pain, and motor dysfunction are daunting challenges for stroke survivors, clinicians, and caregivers during rehabilitation programmes. There is a dearth of studies investigating the effectiveness of combining neurodevelopmental technique telerehabilitation-based exercises with transcranial direct current stimulation (tDCS) for stroke survivors with mild cognitive impairments post-stroke.
Objectives
The primary aim of this study is to investigate and compare the effects of Telerehabilitation-Based Exercises with or without Transcranial Direct Current Stimulation (tDCS) on pain, motor and cognitive function in older adults with mild cognitive impairments post-stroke.
Methods
A multi-arm parallel-group (three groups) randomized controlled trial study involving a minimum of 87 participants (29 per group) will be conducted. Participants will be randomized into either telerehabilitation programmes with tDCS, telerehabilitation programmes alone or conventional physiotherapy programmes. All participants will be treated 3 times weekly for 8 weeks (45 min of intervention per session).
Discussion
The findings in this study are expected to guide the provision of effective and affordable rehabilitation for stroke survivors with mild cognitive impairment.
{"title":"Telerehabilitation-based exercises with or without transcranial direct current stimulation for pain, motor and cognitive function in older adults with mild cognitive impairments post-stroke: A multi-arm parallel-group randomized controlled trial study protocol","authors":"Tolulope Adeniji , Thayananthee Nadasan , Oladapo Michael Olagbegi , Olumide Dada","doi":"10.1016/j.hest.2023.01.004","DOIUrl":"https://doi.org/10.1016/j.hest.2023.01.004","url":null,"abstract":"<div><h3>Background</h3><p>Cognitive impairments, pain, and motor dysfunction are daunting challenges for stroke survivors, clinicians, and caregivers during rehabilitation programmes. There is a dearth of studies investigating the effectiveness of combining neurodevelopmental technique telerehabilitation-based exercises with transcranial direct current stimulation (tDCS) for stroke survivors with mild cognitive impairments post-stroke.</p></div><div><h3>Objectives</h3><p>The primary aim of this study is to investigate and compare the effects of Telerehabilitation-Based Exercises with or without Transcranial Direct Current Stimulation (tDCS) on pain, motor and cognitive function in older adults with mild cognitive impairments post-stroke.</p></div><div><h3>Methods</h3><p>A multi-arm parallel-group (three groups) randomized controlled trial study involving a minimum of 87 participants (29 per group) will be conducted. Participants will be randomized into either telerehabilitation programmes with tDCS, telerehabilitation programmes alone or conventional physiotherapy programmes. All participants will be treated 3 times weekly for 8 weeks (45 min of intervention per session).</p></div><div><h3>Discussion</h3><p>The findings in this study are expected to guide the provision of effective and affordable rehabilitation for stroke survivors with mild cognitive impairment.</p></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":"4 3","pages":"Pages 122-128"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49746186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Physiotherapy rehabilitation of patients with stroke is challenging for the patient, their informal caregivers and the therapist involved. A telerehabilitation programme combined with transcranial direct current stimulation (tDCS) may be the more appealing approach that may save rehabilitation time and improve treatment outcomes. This study performs a scoping review on the effect of telerehabilitation-based exercises plus tDCS among older adults with stroke.
Methods
This scoping adopts the Joana Briggs Institute guidelines for conducting a scoping review. Using Keywords and related MeSH terms to telerehabilitation-based exercises and tDCS among older adults with stroke, the following databases were searched: Cochrane, PubMed, Scopus, and Web of Science. Additional seven other databases (Academic Search Complete; PsycInfo; Health Source-Consumer Edition; Health Source: Nursing/Academic Edition; MEDLINE with Full Text; Academic Search Ultimate) were searched via EBSCOhost. The articles identified were imported to Mendeley for deduplication and then to Rayyan for further deduplication, title and abstract screening.
Results
Out of 216 total articles retrieved, 6 met the study’s inclusion criteria and were extracted for this study. The evidence shows that the telerehabilitation-based exercise intervention with tDCS improves upper limb motor function among older adult patients with stroke.
Discussion & conclusion
Most of the evidence found focused on a combination of virtual reality-based exercises plus tDCS, and none of the telerehabilitation exercise interventions follows the neurorehabilitation techniques such as the Brunnstrom approach and Bobath technique. While it can be concluded that the evidence points towards improving upper limb motor functions with virtual reality and tDCS for stroke rehabilitation among older adults, there is no evidence of its effect on non-motor symptoms such as pain and cognitive functions possibly due to unavailability of relevant studies. There is also a dearth of evidence for t he telerehabilitation programme that uses neurodevelopmental techniques such as Brunnstrom and Bobath approaches with tDCS. This is paramount in providing effective care to older adult patients with stroke.
目的脑卒中患者的物理治疗康复对患者、其非正式护理人员和相关治疗师来说都是一项挑战。远程康复计划与经颅直流电刺激(tDCS)相结合可能是更具吸引力的方法,可以节省康复时间并改善治疗结果。本研究对基于远程康复的锻炼加tDCS在老年中风患者中的影响进行了范围审查。方法本范围界定采用Joana Briggs研究所指南进行范围界定审查。使用Keywords和相关的MeSH术语在老年中风患者中进行基于远程康复的锻炼和tDCS,检索了以下数据库:Cochrane、PubMed、Scopus和Web of Science。另外七个其他数据库(学术搜索完成;PsycInfo;健康来源消费者版;健康来源:护理/学术版;MEDLINE全文;学术搜索终极版)通过EBSCOhost进行搜索。将确定的文章导入Mendeley进行重复数据消除,然后导入Rayyan进行进一步的重复数据消除、标题和摘要筛选。结果在检索到的216篇文章中,有6篇符合本研究的纳入标准,并被提取用于本研究。有证据表明,基于远程康复的tDCS运动干预改善了老年中风患者的上肢运动功能。讨论&;结论大多数证据集中在基于虚拟现实的锻炼加tDCS的组合上,并且没有一种远程康复锻炼干预遵循神经康复技术,如Brunnstrom方法和Bobath技术。虽然可以得出结论,有证据表明,虚拟现实和tDCS有助于改善老年人中风康复的上肢运动功能,但没有证据表明其对疼痛和认知功能等非运动症状有影响,这可能是由于缺乏相关研究。也缺乏证据表明远程康复计划使用神经发育技术,如Brunnstrom和Bobath方法和tDCS。这对于为老年中风患者提供有效的护理至关重要。
{"title":"Effectiveness of telerehabilitation-based exercises plus transcranial direct current stimulation for stroke rehabilitation among older adults: A scoping review","authors":"Tolulope Adeniji , Oladapo M. Olagbegi , Thayananthee Nadasan , Olumide Dada","doi":"10.1016/j.hest.2022.11.002","DOIUrl":"https://doi.org/10.1016/j.hest.2022.11.002","url":null,"abstract":"<div><h3>Objective</h3><p>Physiotherapy rehabilitation of patients with stroke is challenging for the patient, their informal caregivers and the therapist involved. A telerehabilitation programme combined with transcranial direct current stimulation (tDCS) may be the more appealing approach that may save rehabilitation time and improve treatment outcomes. This study performs a scoping review on the effect of telerehabilitation-based exercises plus tDCS among older adults with stroke.</p></div><div><h3>Methods</h3><p>This scoping adopts the Joana Briggs Institute guidelines for conducting a scoping review. Using Keywords and related MeSH terms to telerehabilitation-based exercises and tDCS among older adults with stroke, the following databases were searched: Cochrane, PubMed, Scopus, and Web of Science. Additional seven other databases (Academic Search Complete; PsycInfo; Health Source-Consumer Edition; Health Source: Nursing/Academic Edition; MEDLINE with Full Text; Academic Search Ultimate) were searched via EBSCOhost. The articles identified were imported to Mendeley for deduplication and then to Rayyan for further deduplication, title and abstract screening.</p></div><div><h3>Results</h3><p>Out of 216 total articles retrieved, 6 met the study’s inclusion criteria and were extracted for this study. The evidence shows that the telerehabilitation-based exercise intervention with tDCS improves upper limb motor function among older adult patients with stroke.</p></div><div><h3>Discussion & conclusion</h3><p>Most of the evidence found focused on a combination of virtual reality-based exercises plus tDCS, and none of the telerehabilitation exercise interventions follows the neurorehabilitation techniques such as the Brunnstrom approach and Bobath technique. While it can be concluded that the evidence points towards improving upper limb motor functions with virtual reality and tDCS for stroke rehabilitation among older adults, there is no evidence of its effect on non-motor symptoms such as pain and cognitive functions possibly due to unavailability of relevant studies. There is also a dearth of evidence for t he telerehabilitation programme that uses neurodevelopmental techniques such as Brunnstrom and Bobath approaches with tDCS. This is paramount in providing effective care to older adult patients with stroke.</p></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":"4 3","pages":"Pages 136-146"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49758537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.hest.2023.02.003
Yuanwei Li , Devin W. McBride , Yingxin Tang , Desislava Doycheva , John H. Zhang , Zhouping Tang
Stroke, a cerebrovascular disease with a high mortality rate, is categorized as either ischemic or hemorrhagic. Current existing therapies have limitations, including a narrow time window for treatment. As stroke induces a rapid and large immune response, immune cells and inflammatory mediators have become promising therapeutic targets for both ischemic and hemorrhagic strokes. In recent years, T cells have been investigated for their role in the pathogenesis of secondary injury and their therapeutic potential after stroke. And regulatory T cells, as one of the subpopulations of T cells, have been proved neuroprotective at both acute and recovery stages. In this review, we summarize the existing roles of Tregs in stroke and the various methods available for Treg intervention, and then provide a perspective for the future of immunotherapy in stroke.
{"title":"Immunotherapy as a treatment for Stroke: Utilizing regulatory T cells","authors":"Yuanwei Li , Devin W. McBride , Yingxin Tang , Desislava Doycheva , John H. Zhang , Zhouping Tang","doi":"10.1016/j.hest.2023.02.003","DOIUrl":"https://doi.org/10.1016/j.hest.2023.02.003","url":null,"abstract":"<div><p>Stroke, a cerebrovascular disease with a high mortality rate, is categorized as either ischemic or hemorrhagic. Current existing therapies have limitations, including a narrow time window for treatment. As stroke induces a rapid and large immune response, immune cells and inflammatory mediators have become promising therapeutic targets for both ischemic and hemorrhagic strokes. In recent years, T cells have been investigated for their role in the pathogenesis of secondary injury and their therapeutic potential after stroke. And regulatory T cells, as one of the subpopulations of T cells, have been proved neuroprotective at both acute and recovery stages. In this review, we summarize the existing roles of Tregs in stroke and the various methods available for Treg intervention, and then provide a perspective for the future of immunotherapy in stroke.</p></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":"4 3","pages":"Pages 147-153"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49746800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hematoma expansion is associated with unfavourable neurological outcomes in intracranial haemorrhage. We aimed to study association of red blood cell (RBC) indices, platelet indices, and their ratios with hematoma expansion, detected by serial computed tomography (CT).
Methods
Hospital-based observational study of 88 patients with intracerebral hematoma referred for serial CT head with patients grouped as having progression/ no change/ resolution of hematoma. Baseline hematological indices and ratios were analysed.
Results
40 patients (45.5 %) had resolution, 20 patients (22.7 %) had no change and 28 patients (31.8 %) had progression of hematoma. RBC distribution width (RDW) (p value 0.001) and Plateletcrit (p-value 0.009) showed statistically significant difference among the groups. RBC distribution width (RDW) to PC ratio (RPR) showed statistically significant increase (p < 0.001) in patients with progression. Receiver operating characteristic curve with RPR as test variable in predicting progression of hematoma showed cut-off value as 0.0615 (64.3 % sensitivity, 63.3 % specificity). Patients with RPR > 0.0615 had greater chances of hematoma progression {OR 3.1 (95 % CI 1.22 to 7.91); p = 0.0174}
Conclusion
Raised RPR was most significant parameter with higher RDW, lower plateletcrit values in patients with progression of intra-parenchymal hematoma. These readily available indices can aid in prompt prognostication of intracerebral haemorrhage cases.
{"title":"Hematological indices as predictors of intracerebral hematoma expansion detected on serial computed tomography","authors":"K. Suprasanna , H.B. Sridevi , S.R. Ravikiran , Ishank Jain , Varun Holla","doi":"10.1016/j.hest.2023.02.004","DOIUrl":"https://doi.org/10.1016/j.hest.2023.02.004","url":null,"abstract":"<div><h3>Objective</h3><p>Hematoma expansion is associated with unfavourable neurological outcomes in intracranial haemorrhage. We aimed to study association of red blood cell (RBC) indices, platelet indices, and their ratios with hematoma expansion, detected by serial computed tomography (CT).</p></div><div><h3>Methods</h3><p>Hospital-based observational study of 88 patients with intracerebral hematoma referred for serial CT head with patients grouped as having progression/ no change/ resolution of hematoma. Baseline hematological indices and ratios were analysed.</p></div><div><h3>Results</h3><p>40 patients (45.5 %) had resolution, 20 patients (22.7 %) had no change and 28 patients (31.8 %) had progression of hematoma. RBC distribution width (RDW) (p value 0.001) and Plateletcrit (p-value 0.009) showed statistically significant difference among the groups. RBC distribution width (RDW) to PC ratio (RPR)<!--> <!-->showed statistically significant increase (p < 0.001) in patients with progression.<!--> <!-->Receiver operating characteristic curve with RPR as test variable in predicting progression of hematoma showed cut-off value as 0.0615 (64.3 % sensitivity, 63.3 % specificity). Patients with RPR > 0.0615 had greater chances of hematoma progression {OR 3.1 (95 % CI 1.22 to 7.91); p = 0.0174}</p></div><div><h3>Conclusion</h3><p>Raised RPR was most significant parameter with higher RDW, lower plateletcrit values in patients with progression of intra-parenchymal hematoma. These readily available indices can aid in prompt prognostication of intracerebral haemorrhage cases.</p></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":"4 3","pages":"Pages 111-115"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49746901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.1016/j.hest.2023.01.002
Artur Eduardo Martio, Pedro de Moraes Rêgo Soares, Octávio Ruschel Karam, Wagner Lazaretto Padua, Luciano Bambini Manzato, Paulo Moacir Mesquita Filho
Objective
The present study seeks to overcome the lack of data on Covid-19 associated intracranial hemorrhage (ICH) in Brazil.
Methods
This is a retrospective, single-center case series of consecutive patients. It is a subanalysis of a larger study still in progress, which covers all neurological manifestations that occurred in patients admitted between March 1st, 2020 and June 1st, 2022, with active SARS-CoV-2 infection confirmed by polymerase chain reaction test. All patients with non-traumatic ICH were included.
Results
A total of 1675 patients were evaluated: 917 (54.75 %) had one or more neurological symptoms and 19 had non-traumatic ICH, comprising an incidence of 1.13 %. All patients had one or more risk factors for ICH. The presence of neurological manifestations before the ICH and ICU admission showed a statistically significant relationship with the occurrence of ICH (X2 = 6.734, p = 0.0095; OR = 4.47; CI = 1.3–15.4; and FET = 9.13; p = <0.001; OR = 9.15; CI = 3.27–25.5 respectively).
Conclusion
Our findings were largely congruent with the world literature. We believe that the assessment of risk factors can accurately predict the subgroup of patients at increased risk of ICH, but further studies are needed to confirm these hypotheses.
{"title":"Intracranial hemorrhage and Covid-19: A retrospective analysis of 1675 hospitalized Covid-19 Brazilian patients","authors":"Artur Eduardo Martio, Pedro de Moraes Rêgo Soares, Octávio Ruschel Karam, Wagner Lazaretto Padua, Luciano Bambini Manzato, Paulo Moacir Mesquita Filho","doi":"10.1016/j.hest.2023.01.002","DOIUrl":"10.1016/j.hest.2023.01.002","url":null,"abstract":"<div><h3>Objective</h3><p>The present study seeks to overcome the lack of data on Covid-19 associated intracranial hemorrhage (ICH) in Brazil.</p></div><div><h3>Methods</h3><p>This is a retrospective, single-center case series of consecutive patients. It is a subanalysis of a larger study still in progress, which covers all neurological manifestations that occurred in patients admitted between March 1st, 2020 and June 1st, 2022, with active SARS-CoV-2 infection confirmed by polymerase chain reaction test. All patients with non-traumatic ICH were included.</p></div><div><h3>Results</h3><p>A total of 1675 patients were evaluated: 917 (54.75 %) had one or more neurological symptoms and 19 had non-traumatic ICH, comprising an incidence of 1.13 %. All patients had one or more risk factors for ICH. The presence of neurological manifestations before the ICH and ICU admission showed a statistically significant relationship with the occurrence of ICH (X<sup>2</sup> = 6.734, <em>p</em> = 0.0095; OR = 4.47; CI = 1.3–15.4; and FET = 9.13; <em>p</em> = <0.001; OR = 9.15; CI = 3.27–25.5 respectively).</p></div><div><h3>Conclusion</h3><p>Our findings were largely congruent with the world literature. We believe that the assessment of risk factors can accurately predict the subgroup of patients at increased risk of ICH, but further studies are needed to confirm these hypotheses.</p></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":"4 2","pages":"Pages 57-64"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9850839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9569839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.1016/j.hest.2022.10.003
Molly Monsour , Elliot Neal , Davide Marco Croci , Maxim Mokin , Waldo Guerrero , Kunal Vakharia , Siviero Agazzi , Harry Van Loveren
Objective
Giant aneurysms are infrequently complicated with obstructive hydrocephalus (HC), however, when concurrent, effective treatments are unestablished. There are incredibly few reports of HC due to basilar artery giant aneurysms and fewer reports regarding ventriculoperitoneal (VP) shunt complications in these patients.
Case presentation
We report the case of a gentleman in his 70 s who presented with a fusiform aneurysm of the entire basilar artery and mild intra-aneurysmal thrombosis. HC, secondary to the aneurysm, indicated VP shunt placement. Within 12 h following shunt placement, however, the patient deteriorated rapidly due to complete basilar artery occlusion and widespread brainstem ischemia. Endovascular intervention was unsuccessful due to extremely high clot burden. He unfortunately expired 2 days afterwards.
Conclusion
Hydrocephalus due to aneurysms is not uncommon, and VP shunt placement should be optimized to avoid unforeseen complications like the one described. We suspect that the shunt placement aggravated the already aberrant flow within the aneurysm, propagating a pro-thrombotic environment. With further reports of this complication, a standardized method to place VP shunts for patients with giant aneurysms while minimizing the risk of thrombotic occlusion could be established.
{"title":"Complete basilar artery occlusion following ventriculoperitoneal shunt placement for giant aneurysm complicated by concurrent obstructive hydrocephalus: A case report","authors":"Molly Monsour , Elliot Neal , Davide Marco Croci , Maxim Mokin , Waldo Guerrero , Kunal Vakharia , Siviero Agazzi , Harry Van Loveren","doi":"10.1016/j.hest.2022.10.003","DOIUrl":"https://doi.org/10.1016/j.hest.2022.10.003","url":null,"abstract":"<div><h3>Objective</h3><p>Giant aneurysms are infrequently complicated with obstructive hydrocephalus (HC), however, when concurrent, effective treatments are unestablished. There are incredibly few reports of HC due to basilar artery giant aneurysms and fewer reports regarding ventriculoperitoneal (VP) shunt complications in these patients.</p></div><div><h3>Case presentation</h3><p>We report the case of a gentleman in his 70 s who presented with a fusiform aneurysm of the entire basilar artery and mild intra-aneurysmal thrombosis. HC, secondary to the aneurysm, indicated VP shunt placement. Within 12 h following shunt placement, however, the patient deteriorated rapidly due to complete basilar artery occlusion and widespread brainstem ischemia. Endovascular intervention was unsuccessful due to extremely high clot burden. He unfortunately expired 2 days afterwards.</p></div><div><h3>Conclusion</h3><p>Hydrocephalus due to aneurysms is not uncommon, and VP shunt placement should be optimized to avoid unforeseen complications like the one described. We suspect that the shunt placement aggravated the already aberrant flow within the aneurysm, propagating a pro-thrombotic environment. With further reports of this complication, a standardized method to place VP shunts for patients with giant aneurysms while minimizing the risk of thrombotic occlusion could be established.</p></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":"4 2","pages":"Pages 72-76"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49744528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}