[Neuroradiological pattern of peripartum cerebro vascular disease medicating transfer to determine care unit]

Pregnancy and puerperium are considered a period of a high risk of stroke responsible in a part of the morbidity and mortality in women. Imaging is the pivotal tool to diagnostics and care. To investigate the clinical and imaging features cerebrovascular complications during pregnancy and in post partum period. We report a retrospective analysis of forty four patients [November 2002 - October 2010] admitted in the intensive car department of the national institute of neurology for cerebro-vascular complications during pregnancy and in post partum period. Cerebro-vascular imaging modalities included cerebral computed tomography [CCT] with and without contrast in 94% of cases, magnetic resonance imaging [MRI] in 30.6% of cases completed by venous angiography MRI in 27.2% of cases and angiography MRI of Willis polygon in 11.3% of cases and by cerebral angiography in 13.6% of cases. Posterior reversible encephalopathy syndrome [PRES] is diagnosed in 61.4% of cases followed by meningo-cerebral haemorrhage [MCH] in 29.5% and finally cerebral venous thrombosis [CVT] and arterial ischemia in 4.5% of cases each one. The cerebro-vascular complications are revelled in 86.3% of the cases during the postpartum and were associated with the eclampsia or preeclampsia in 90.9% of the cases [n=40]. CCT showed typical lesions of PRES in 23 patients. It confirms the presence of hematoma in the 13 patients with MCH and find hypodense lesion in one case with ischemic stroke. CCT show direct [delta sign] and indirect signs of CVT. MRI confirms the diagnostic of PRES, when done [11 of 12 cases] and show cortical sub cortical hyper signal on T2 and FLAIR and hypo signal on T1 sequences. MRI was normal in one case. It shows hemorrhagic lesion in the 2 cases of MCH, thrombosis in the cases of CVT and ischemic lesion in the cases of ischemic stroke. CCT and MRI done within 48 hours from admission were decisive for early diagnostic and for fast and adequate care. Early recognition of stroke in peri partum by cerebral imaging is of paramount importance for prompt diagnosis and treatment to improve maternal morbidity and mortality

Cardiac injury in traumatic subarachnoid hemorrhagea: prospective study in 35 patients

Various electrocardiographic abnormalities have been noted since 1954 in patients with head trauma complicated by subarachnoid hemorrhage [SAH]. However, very few studies have interested to these ECG modifications in the case of post traumatic SAH [t-SAH]. To assess the incidence of ECG abnormalities during the first five days after admission and the predictive value of these cardiac complications on the mortality in t-SAH. This prospective study included 35 patients out of 125 with traumatic SAH diagnosed in the emergency unit in Rabta's hospital [2001-2009]. Patients with cardio vascular history, thoracic trauma, non neurological coma and vascular-related neurological coma were excluded. An electrocardiogram monitoring was performed. A brain CT scan was performed in admission, 48 h after and case of neurological aggravation. Serum cardiac troponin 1C levels were determined on hospital admission and then on the third and fifth days of hospitalization. The statistical analysis was based on the non-parametric variance test of Kruskal-Wallis to compare the means; on the chi 2 and Fisher tests to compare percentage, with a significant result at 0.05 percentile and on the Odds ratio non-parametric factors for death. Association between 2 quantitative variables have been analyzed by Pearson coefficient of correlation. Mean age of the 35 patients was 39 +/- 17 years. Sex ratio was 4 in favor of men. The prevalence of electrocardiographic changes was of 57% [20 patients] Serum Troponin I level showed a peak on the 3rd day then it decreased. The majority of electrical abnormalities occurred during the third after admission and are associated to a markedly increased Troponin I plasma level and to the highest rate of mortality. Statistical analysis showed a significant correlation between T wave changes and the increase of serum Tn 1C level [p= 0; 0002]. The relative risk of mortality was higher than 7.2 times in cases with increase serum Tnlc level. We demonstrated that ECG changes were common in patients with t SAH and the major predictive factors of mortality were the increase of serum TnIC and T wave changes Subarachnoid hemorrhage [SAH] is a complication of head trauma inducing frequently cerebral vasospasm and even cerebral infarct. Various electrocardiographic abnormalities have been noted in patients with head trauma complicated by subarachnoid hemorrhage [1-5]. They are considered to be secondary to the massive catecholamine discharge in systemic circulation [6, -9]. Serum cardiac troponin I [Tnl] was considered a highly sensitive and specific marker of myocardial cell lesion and might be regularly performed in these patients to detect early myocardial ischemia. We carried out a prospective study in 35 patients with traumatic SAH [tSAH] in order to assess the incidence of coronary complications during the first five days after admission and to demonstrate the interest of troponin le blood assay in the diagnosis of coronary abnormalities