The clinical profile of patients with intracerebral hemorrhage after receiving acute coronary syndrome regimen in a tertiary hospital: A case series

@#Coronary heart disease, which includes acute coronary syndromes (ACS) is a major cause of death and morbidity. Treatment for this condition includes dual anti-platelet treatment combined with an anti-coagulant and an anti-dyslipidemic. Bleeding complications may occur and one fatal adverse event is intracerebral hemorrhage (ICH). ACS cases in a tertiary hospital for the years 2014-2018 showed that there were 7 patients who presented with symptomatic ICH after treatment administration that accounts for 0.01% of a total of 1,097 patients. These patients were over the age of 50, but with no sex predilection. Common comorbidities were hypertension and malignancy. All patients presented with acute onset neurologic deficits within 1-4 days after administration of ACS regimen, with ICH scores of 3-4 signifying a high mortality rate of 72-90%. 6 out 7 patients had significant volume of ICH with mass effects, and 1 with subarachnoid hemorrhage. This lead to poor outcome in all patients with 6 out of 7 mortalities and 1 left with substantial disability. It was found that given the total number of patients administered with the said treatment, there is a low incidence of ICH.

Las complicaciones neurológicas centrales tempranas post-trasplante cardíaco se asocian a mayor mortalidad intrahospitalaria / Early central neurologic complications after heart transplantation are associated with higher intra-hospital mortality

Resumen Las complicaciones neurológicas posteriores al trasplante cardíaco representan una causa importante de morbimortalidad. La meta del presente estudio fue evaluar las complicaciones neurológicas (CN) en la evolución clínica de pacientes sometidos a trasplante cardíaco. Se evaluaron retrospectivamente todos los trasplantados cardíacos en el Hospital Italiano de Buenos Aires de noviembre del 2014 hasta agosto del 2018. Se evaluaron variables demográficas y clínicas, y se compararon entre los pacientes con y sin CN. Se incluyeron 193 adultos (edad ≥ 18 años). La edad media fue de 51±12 años, y 74% (n = 143) fueron varones. Las dos causas más frecuentes que llevaron a la indicación de trasplante fueron la miocardiopatía idiopática en 34% (n = 65) y la isquémica en 29% (n = 56). El 92% (n = 176) presentó inestabilidad hemodinámica al momento del trasplante. El 12% (n = 23) presentó CN centrales en la primer semana post-trasplante. Las más frecuentes fueron encefalopatía (5%), hematoma subdural (2%), hemorragia subaracnoidea (2%), convulsiones (2%), y accidente cerebrovascular isquémico (1%). En 4% se observó neuropatía periférica. La mortalidad hospitalaria fue del 11%, y 88% de los pacientes fueron dados de alta a domicilio. Los que presentaron CN centrales tuvieron mayor mortalidad intrahospitalaria en comparación a quienes no las presentaron (32% vs. 9%, p = 0.002).

Abstract Neurological complications in orthotopic heart transplantation represent amajor cause of morbidity and mortality despite successful transplantation. The aim of our study was to evaluate neurological complications on the outcome of patients with heart transplantation. We retrospectively studied 193 adult patients (aged ≥ 18 years) who underwent heart transplant at Hospital Italiano in Buenos Aires from November 2014 to August 2018. We evaluated demographic and clinical variables and outcome of patients with and without neurological complications. We included 193 patients with a mean age of 51 ± 12 years of which 74% (n = 143) were men. The two most frequent causes that led to heart transplantation were idiopathic cardiomyopathy in 34% (n = 65) and ischemic cardiomyopathy in 29% (n = 56). Hemodynamic instability was present at the moment of transplant in 92% (n = 176) of the cases. Central neurological complications in the first week post-transplant occurred in 12% (n = 23). The most frequent were: encephalopathy (5%), subdural hematoma (2%), subarachnoid hemorrhage (2%), seizures (2%) and ischemic stroke (1%). Peripheral neuropathy was observed in 4% of cases. Hospital mortality was 11% (n = 22) and 88% (n = 170) was discharged at home. Those who presented central neurological complications had higher in-hospital mortality compared to those who did not (32% vs. 9%, p = 0.002).

Perioperative risk factors of stent-assisted coiling for acute ruptured intracranial aneurysm / 第二军医大学学报

Objective To explore the influencing risk factors of perioperative technical complications and clinical prognosis of stent-assisted coiling (SAC) for acute (≤28 d) ruptured intracranial aneurysm (RIA). Methods Acute RIA patients, who received SAC treatment in Changhai Hospital of Naval Medical University (Second Military Medical University) between Jan. 2012 and Jun. 2018, were retrospectively enrolled. The clinical and imaging data were analyzed using univariable analysis and multivariate logistic regression analysis to identify the potential risk factors of perioperative technical complications and clinical prognosis. Results A total of 509 acute RIA patients (170 males and 339 females), who underwent SAC treatment and received 30-d follow-up, were included in this study. Perioperative ischemic complications occurred in 28 cases (5.5%), and multivariate regression analysis showed that the location of aneurysms at the bifurcation of blood vessels was an independent risk factor of ischemic complications (odds ratio [OR]＝4.108, P＝0.001). Perioperative hemorrhagic complications occurred in 25 cases (4.9%), and multivariate regression analysis showed that age60 years was an independent risk factor of hemorrhagic complications (OR＝3.574, P＝0.014). The modified Rankin scale (mRS) scores of 81 patients (15.9%) ranged from 3 to 5 at discharge, 27 patients (5.3%) died with mRS score of 6, and the poor prognosis (mRS score2) rate was 21.2% (108/509). Multivariate regression analysis showed that age≥80 years, Hunt-Hess 3-5 class, perioperative ischemic complications, perioperative hemorrhagic complications and poor Glasgow coma scale (GCS) score were independent risk factors of poor prognosis (all P0.01). Conclusion For the acute RIA patients treated with SAC, the location of aneurysms at the vascular bifurcation is an independent risk factor of perioperative ischemic complications; age60 years is an independent risk factor for hemorrhagic complications; and the patients with poor GCS score at admission have a poor prognosis at discharge, and perioperative ischemic and hemorrhagic complications are independent risk factors of poor prognosis.

Preoperative evaluation value of carotid and cerebral arteries by CT angiography in acute type A aortic dissection / 医疗卫生装备

Objective To investigate the feasibility of combined CT angiography(CTA)of head,neck and aorta in acute type A aortic dissection (ATAAD) and whether the incremental craniocervical information benefits the surgeon and leads to improved clinical outcomes.Methods One hundred and twenty ATAAD patients in a CAC group underwent combined aortic CTA and 123 ATAAD patients in a control group underwent conventional aortic CTA.In the CAC group,the image quality was analyzed and critical CTA findings in craniocervical arteries were determined for further surgery procedure.The radiation dose,intraoperative cerebral protection method,and postoperative intensive care units(ICU)time,in-hospital time,neurologic dysfunction(ND)and all-cause mortality were compared between the two groups.Results The CAC group had all the carotid and cerebral arteries diagnosed successfully. There were 13 patients replaced conventional unilateral antegrade selective cerebral perfusion with bilateral one according to the head and neck CTA images in the CAC group. The CAC group had effective radiation dose,postoperative ND,ICU time and in-hospital time significantly lower than those of the control group (P<0.05).There were no statistical differences between the all-cause morbidities of the two groups (P>0.05).Conclusion A combined CTA of head, neck and aorta in ATAAD is feasible. The incremental craniocervical information may lead to improved clinical outcomes.

A Review of Complications and Outcomes following Vertebral Column Resection in Adults

The correction of rigid spinal deformities in adult patients can require a three-column osteotomy (pedicle subtraction osteotomy [PSO] or vertebral column resection [VCR]) to obtain spinal balance. Unfortunately, the existing adult deformity literature frequently reports the outcomes and complications of these procedures together even though VCR is a more extensive procedure with potentially higher rates of complications. We sought to address this shortcoming and provide clinicians with an overview of the existing literature regarding VCR in adult patients. The goals of this review are: to determine the rate of overall and neurologic complications following VCR, the rate of complications with VCR compared to PSO, and the impact of VCR on clinical and radiographic outcomes. An electronic literature search was used to identify studies reporting outcomes or complications following VCR in adult patients. Raw data on patient demographics, case information, radiographic outcomes, complications and clinical outcomes were extracted. Data were pooled to report a rate of overall complications and neurologic complications. A pooled relative risk of complications following PSO vs. VCR was also calculated. Eleven retrospective studies (Level IV) met our inclusion criteria. The overall rate of complications was 69.2%. The reoperation rate was 9.6%. The rate of neurologic complications was 13.3% (range, 6.3% to 15.8%) with most cases being transient. The rate of permanent neurologic deficits was 2.0%. We found a significantly higher rate of all complications with VCR compared to PSO (relative risk, 1.36; 95% confidence interval, 1.24-1.49; p<0.001). All studies reporting clinical outcomes showed significant improvements in functional outcome postoperatively.

The Clinical Outcomes in Children with Status Epilepticus: a Single Centered, Comparative Study during the Period between 1990s and 2000s

PURPOSE: Status epilepticus(SE) is one of the most common neurologic emergencies in children, which might result in significant morbidity and mortality. The aim of this study was to evaluate the changes of etiology and prognosis, clinical outcomes in children with status epilepticus during the period between the 1990s and 2000s at a single institution. METHODS: We retrospectively reviewed and analyzed the records of two groups (group A and B) of children with SE at the Department of Pediatrics of our institution. Group A consisted of 98 children aged between 2 months and 15 years and admitted from January, 1992 to December, 1998. Group B consisted of 79 children at the same age and admitted from November, 2008 to July, 2011. We compared age distribution, etiology, duration, abnormality of EEG and Brain CT/MRI, and neurologic complications between the two groups. RESULTS: Compared with group A, the mortality rate of SE in group B improved from 7.1% to 1.3%. Neurological complication rates also improved from 21.4% (group A) to 18.3% (group B). Duration of SE decreased from 71.4+/-82.6 minutes (group A) to 42.0+/-53.8 minutes (group B). Etiologies of SE between two periods were not significantly different, but the duration of SE decreased, and mortality and neurologic outcomes improved (P<0.001). The duration of SE was significantly correlated with neurologic complications (R2=0.214, P<0.001). CONCLUSION: This study showed decreased mortality and neurologic complication rates in SE over the last decade. The Decrease of mortality and neurologic complication rates may be due to the decreased duration of SE and more immediate visit of patients to the hospital than in the past.

Curso de reumatologia: aula 7: manifestações neurológicas nas colagenoses / Course of rheumatology: class 7: neurologic manifestations in collagenosis

O propósito deste artigo é focar as principais manifestações neurológicas das doenças difusas do tecido conjuntivo, com ênfase nas suas manifestações clínicas. Os autores discutem as várias complicações do sistema nervoso central e periférico na doença muscular inflamatória (polimiosite e dermatomiosite), policondrite recidivante, esclerose sistêmica, artrite reumatoide, síndrome de Sjõgren, doença mista do tecido conjuntivo (doença de Sharp), lúpus eritematoso sistêmico e síndrome do anticorpo antifosfolipide.

The purpose of this article is to focus on the major nervous system manifestations in connective tissue diseases, with emphasis on their clinica findings. Authors discuss several complications in inflammatory muscle disease (polymyositis an dermatomyositis), relapsing polychondritis, systemic sclarosis, rheumatoid arthritis, Sjõgren syndorme, mixed connective tissue (Sharp disease), systemic lupus erythematosus and antiphospholipid syndrome.

Risk factors of postoperative delirium following liver transplantation / 대한마취과학회지

BACKGROUND: Postoperative delirium (POD) after liver transplantation is a serious complication. This study investigated the incidence and the risk factors of POD in liver transplantation recipients. METHODS: Three hundred and sixty eight adult recipients who had undergone liver transplantation were included. We reviewed medical records and the POD was determined by either psychiatric consultation or established diagnostic criteria. Recipients were divided into two groups according to the occurrence of POD: POD group (n = 150) and non-POD group (n = 218), and risk factors were assessed. RESULTS: One hundred fifty (40.8%) of the 368 recipients developed POD after liver transplantation. History of alcohol consumption and alcoholic liver disease, history of hepatic encephalopathy, preoperative mental status changes, ventilator care, dialysis, hypotension, and ICU care were significantly higher in the POD group. In the preoperative laboratory test, sodium was lower while bilirubin, PT (INR) and MELD score were higher in the POD group. Postoperative variables including dialysis, ventilator care duration, ICU stay, hospital stay, glucose and ammonia were significantly higher in the POD group. Three variables were identified as independent predictors of POD in a multiple regression analysis: history of alcohol consumption (odds ratio, 2.04; 95% confidence interval [CI], 1.12-3.72; P = 0.02), history of hepatic encephalopathy (odds ratio, 2.54; 95% CI, 1.46-4.41, P<0.01), and MELD score (odds ratio, 1.03; 95% CI, 1.00-1.06; P = 0.02). CONCLUSIONS: The development of POD and related morbidity and mortality would be reduced if we identified the recipients with risk factors preoperatively and applied early intervention.

Manifestações neurológicas da anemia perniciosa: [carta ao editor] / Neurologic manifestations of pernicious anemiaNeurologic manifestations of pernicious anemia: [letter to editor]

Neurologic alterations form part of the classical manifestations of megaloblastic anemias, with pernicious anemia being the prototype. Subacute combined degeneration of the spinal cord with involvement of the posterior and lateral columns, axonal or demyelinating sensorimotor neuropathy, Lhermitte's syndrome, neuropsychiatric manifestations and degeneration of the autonomic innervation of the bladder and the Auerbach and Meissner plexuses being among the most important features. Of great importance is the possible absence of macrocytosis or even anemia in cases of neurologic manifestations. Otherwise, the multisegmentation of neutrophils may be an important indication for the correct diagnosis, particularly when the serum levels of vitamin B12 and methylmalonic acid are not available.

Síntomas neurológicos de las enfermedades reumáticas / Neurologic symptoms of rheumatic diseases

Una de las más importantes pero la menos común de las manifestaciones de enfermedad autoinmune la constituye la vasculitis, la cual modifica la historia de la enfermedad, dependiendo del órgano afectado. Esta revisión incluye las más importantes manifestaciones y complicaciones de los sistemas nerviosos central y periférico que se desarrollan por vasculitis en las enfermedades reumáticas, ya sea como una primera manifestación de enfermedad o como acompañante de enfermedad sistémica. También hacemos una revisión de la inmunopatogénesis, los principales hallazgos radiológicos, hallazgos en las biopsias de tejido cerebral o de nervio periférico, en las biopsias de músculo, con los posibles diagnósticos diferenciales conocidos.

The vasculitis is one of the most common manifestations of autoimmune diseases, it will change the medical evolution depending on the affected organ. This review includes the most important manifestations and complications in the central and peripheral nervous system, due to vasculitis developed in the setting of rheumatic diseases, as a primary manifestation or as a part of other symptoms, as well. Also, an up date in immunopathogenesis, radiology, peripheral and central nervous biopsy, muscle biopsy findings, and differential diagnosis is made.

A Case of Aseptic Meningitis with Herpes Zoster

Herpes zoster is not a common disease in healthy children. Neurologic complications can occur to herpes zoster patients but rare in immunocompetent children. It usually affects patients with immunocompromised or impaired cellular immunity. Aseptic meningitis is especially rare in the various neurologic complications that are induced by varicella-zoster virus. We experienced a case of herpes zoster meningitis in a previously healthy child.

Neurologic complications after open-heart surgery in children

Neurologic complications after open-heart surgery are not only relatively common but also often fatal. In order to know the clinical characteristics and causative risk factors, we carried out the retrospective study on 655 patients who had been admitted and undergone OHS at Seoul National University Children's Hospital during 2-year period from July 1990 to June 1992. The results were as follows; 1) The incidence of neurologic complications after OHS was 4.7% (31 cases) of the total 655 cases. 2) In the viewpoint of the pre-op diagnosis, neurologic complications developed in 20 cases (7.8%) among cyanotic congenital heart disease and in 11 cases (2.9%J among acyanotic CHD. 3) In the viewpoint of the type of operation, the incidence of neurologic complications was 33.3% in Jatene procedure and 12.1% in Fontan procedure. 4) Compared with the group who didn't develp neurologic complications (624 cases), cardiopulmonary bypass time, aorta cross clamp time, and total arrest time were longer and the degree of hypothermia was lower in the group who had neurologic complications (31 cases), which are statistically significant each other(p<0.01). 5) In 25 cases (80.6%), neurologic complications occurred within 72 hours after OHS. 6) Clinical manifestations of neurologic complications were seizures (26 cases, 84%), consciousness change (13 cases, 42%), hemiplegia (1 case), and decreased muscle tone (1 case). 7) Of the 31 cases, 16 cases showed more than one abnormal finding among EEG, Brain CT, or Brain MRI. 8) The possible etiologies of neurologic complications were diffuse hypoxic ischemic encephalopathy (16 cases, 51.6%), focal or multiple ischemic stoke that was thought to be due to microembolisms (3 cases, 9.7%), electrolyte or acid-base imbalance (8 cases, 25.8%), and the remainders were unknown (4 cases. 12.9%) 9) In the course of neurologic complications, 11 cases (35.5%) expired, 14 cases(45.2%) recovered at discharge, 3 cases (9.7%) were controlled at discharge, and 2 cases (6.5%) had long-term sequela(one spastic quadriplegia and one hemiparesis). 10) The cause of death among mortality cases were mainly due to brain damage (7 cases), while 4 cases had other direct causes such as heart failure, respiratory failure, or sepsis.