ABSTRACT
Intracerebral hemorrhage (ICH) is associated with high mortality in patients on oral anticoagulant treatment. The normalization of hemostatic balance usually requires slow-acting or risky treatments, such as vitamin K, fresh frozen plasma or prothrombin complex concentrates, which have narrow therapeutic windows particularly in cardiopathic patients like those with mechanical heart valves. Recombinant activated factor VII (rFVIIa) seems useful in patients with normal or pathologic coagulation who have an ICH. We report of a patient on acenocumarol for mitro-aortic valve replacement, referred for headache and found at computerized tomography scanning to have a parietal hemorrhage with ventricular invasion. International normalized ratio was 3.22. The patient was treated with vitamin K and with a bolus of 80 mug/kg of rFVIIa, with correction of the international normalized ratio within 15 min. Sequential computerized tomographies showed progressive reduction of the hematoma and normalization of ventricular spaces and the patient fully recovered. No valvular dysfunctions or cardiac thrombi were found at sequential echocardiograms. Neurological examination at 3 months follow-up visit was completely normal. To our knowledge, this is the first report of the safe and successful use of rFVIIa to treat ICH in a patient on oral anticoagulants for prosthetic heart valves.
Subject(s)
Cerebral Hemorrhage/drug therapy , Factor VII/therapeutic use , Heart Valve Prosthesis , Factor VIIa , Female , Humans , Middle Aged , Recombinant Proteins/therapeutic use , Recovery of Function , Stress, Mechanical , Tomography Scanners, X-Ray Computed , Treatment Outcome , Vitamin K/therapeutic useABSTRACT
The authors report a case of associated bilateral asymmetrical microphthalmia and osseous choristoma of the choroid in a seventeen year old young woman. This association, to the author's knowledge, has not been previously reported in the literature. The bone choristoma was present in the eye's posterior poles and the clinical features were studied by electroretinography, fluorescein angiography, A-B scan ultrasonography, computerized axial tomography and nuclear magnetic resonance. The authors hypothesize that a choroid developmental tumor was produced by exposure to the rubella virus during embryonic life.
Subject(s)
Choroid Neoplasms/complications , Microphthalmos/complications , Osteoma , Adolescent , Female , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Tomography, X-Ray Computed , UltrasonographyABSTRACT
Because of the frequency and seriousness of side effects observed after radiculography, due to, among the other things, the amount of contrast medium, the authors describe a method that gives diagnostically satisfactory results using a low dose of contrast and a tangent-beam technique. Among 106 patients undergoing radiculography with a tangent-beam technique and Iopamidol, only 4 developed mild side effects, namely headache in three cases and headache with nausea in one.
Subject(s)
Intervertebral Disc Displacement/diagnostic imaging , Spinal Nerve Roots/diagnostic imaging , Contrast Media/adverse effects , Female , Headache/etiology , Humans , Iopamidol , Iothalamic Acid/adverse effects , Iothalamic Acid/analogs & derivatives , Male , Methods , Middle Aged , Nausea/etiology , RadiographyABSTRACT
We report a case of bilateral orbital sarcoidosis without other systemic lesions. Steroid therapy did not improve the clinical status of the patient.
Subject(s)
Orbital Diseases/diagnostic imaging , Sarcoidosis/diagnostic imaging , Humans , Male , Middle Aged , Tomography, X-Ray ComputedSubject(s)
Brain Diseases/diagnostic imaging , Cerebral Ventricle Neoplasms/diagnostic imaging , Cerebral Ventriculography , Contrast Media , Glioma/diagnostic imaging , Iothalamic Acid/analogs & derivatives , Adolescent , Adult , Aged , Cerebral Hemorrhage/diagnostic imaging , Child , Child, Preschool , Contrast Media/administration & dosage , Echinococcosis/diagnostic imaging , Female , Humans , Hydrocephalus/diagnostic imaging , Iopamidol , Iothalamic Acid/administration & dosage , Male , Middle AgedABSTRACT
610 sacrorodiculographic and myelographic examinations were carried out injecting at lumbar level Iopamidol at 200, 300 and 370 mg I/ml concentrations. Immediate and early complications have been noticed in 18,52% of cases, i.e. sensation of pain during contrast injection, headache, nausea, vomit, neck stiffness, photophobia, epilepsy. In sacrorodiculographic examinations, side effects especially occurred by using 370 mg I/ml concentrations; in lumbar and thoracic myelographies, incidence of complications did not statistically differ by uing 300 or 370 mg I/ml concentrations. Side effects have occurred most frequently in cervical myelographies carried out with 370 mg I/ml concentration. Analysis of complications as well as radiographic results suggest to use Iopamidol at 300 mg I/ml concentration in sacrorodiculographics, in lower thoracic myelographies and in studies of narrowed, stenosed or obstructed canals; Iopamidol at 370 mg I/ml concentration may be used in upper thoracic studies and cervical myelographies.
Subject(s)
Contrast Media/adverse effects , Iothalamic Acid/analogs & derivatives , Myelography/adverse effects , Spinal Nerve Roots/diagnostic imaging , Adult , Age Factors , Contrast Media/administration & dosage , Female , Humans , Iopamidol , Iothalamic Acid/administration & dosage , Iothalamic Acid/adverse effects , Male , Middle Aged , Sex Factors , Time FactorsABSTRACT
A case of epilepsy is reported during ventriculography with hydrosoluble triiodate contrast (methylglutamine iotalamate). The cysternal interhemispheric cavities of the midline were flooded. This complication, which could have been lethal was treated with thiopental sodium salt, 6 methylprednisolone, mannitol, curare, trans-larynx intubation, ventilation with oxygen and nitrous oxide. The AA. conclude that the presence of an anaesthetist-resuscitator is essential during ventriculography with triiodate hydrosoluble contrast medium.
Subject(s)
Cerebral Ventriculography/adverse effects , Epilepsy/chemically induced , Iothalamate Meglumine/adverse effects , Adolescent , Cerebellar Neoplasms/complications , Epilepsy/therapy , Female , Humans , Hydrocephalus/etiology , Medulloblastoma/complications , Subarachnoid Space/diagnostic imagingABSTRACT
Three patients with calcification of the posterior longitudinal ligament with myelopathy are reported and discussed. This condition which is frequent in Japan is rarely described in the western population. Such calcification is not only a radiographic finding but is a progressing phenomenon which may extend to compressive lesions of the spinal cord. All patients with calcification of the posterior longitudinal ligament should be fully studied neurologically and followed up.
Subject(s)
Calcinosis/diagnostic imaging , Ligaments , Spinal Diseases/diagnostic imaging , Calcinosis/complications , Female , Humans , Male , Middle Aged , Radiography , Spinal Cord Compression/etiology , Spinal Diseases/complicationsABSTRACT
From 53 cases of thrombosis of the internal carotid artery in the neck, collateral circulation through external carotid branches was angiographically demonstrated in 34 subjects. Anastomosis between external and intracranial circulations was seen to take place through three ways formed by internal maxillary, superficial temporal and facial arteries. The role of internal maxillary artery is emphasised as the most important pathway in the connections between the two circles.