ABSTRACT
BACKGROUND AND PURPOSE: Diffusion-weighted imaging (DWI) commonly detects acute ischaemic lesions in patients with acute intracerebral hemorrhage (ICH), especially with cerebral amyloid angiopathy (CAA). We investigated the relationship between cortical superficial siderosis (cSS), a neuroimaging marker of CAA, and DWI lesions in patients with acute ICH. METHODS: We conducted a retrospective analysis of prospectively collected data from consecutive patients with acute supratentorial ICH who underwent brain magnetic resonance imaging within 10 days after symptom onset. Magnetic resonance imaging scans were analyzed for DWI lesions, cSS and other markers for small-vessel disease. Univariate and multivariate analyses were performed to assess the association between cSS and DWI lesions. RESULTS: Among 246 ICH survivors (mean age 71.4 ± 12.6 years) who were enrolled, 126 had lobar ICH and 120 had deep ICH. Overall, DWI lesions were observed in 38 (15.4%) patients and were more common in patients with lobar ICH than deep ICH (22.2% vs. 8.3%; P = 0.003). In multivariate logistic regression analysis, the extent of white matter hyperintensities [odds ratio (OR), 1.29; 95% confidence interval (CI), 1.05-1.58; P = 0.02] and cSS severity (focal cSS: OR, 3.54; 95% CI, 1.28-9.84; disseminated cSS: OR, 4.41; 95% CI, 1.78-10.97; P = 0.001) were independently associated with the presence of DWI lesions. CONCLUSIONS: Diffusion-weighted imaging lesions are more frequently observed in patients with acute lobar ICH than in those with deep ICH. cSS severity and white matter hyperintensity extent are independent predictors for the presence of DWI lesions, suggesting that CAA may be involved in the pathogenesis of DWI lesions associated with acute ICH.
Subject(s)
Brain Ischemia/diagnostic imaging , Brain/diagnostic imaging , Cerebral Hemorrhage/diagnostic imaging , Siderosis/diagnostic imaging , Aged , Aged, 80 and over , Brain Ischemia/complications , Cerebral Amyloid Angiopathy/complications , Cerebral Hemorrhage/complications , Diffusion Magnetic Resonance Imaging , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Neuroimaging , Retrospective StudiesABSTRACT
Traumatic injury of the thoracic aorta remains the leading cause of death in multiple trauma patients and it requires urgent management. Computed tomography has a key diagnostic role and allows the clinician to choose an appropriate treatment strategy. The development of new classifications, based on a better understanding of the mechanisms of these injuries, has clarified the indications for treatment. Advances in techniques, especially in endovascular management, have contributed to improving prognosis for patients. Interventional radiology, which usually consists of endovascular placement of a covered stent, now constitutes the gold standard treatment in these injuries. Due to the potentially grave prognosis of these patients, it is crucial to know how to detect these injuries and to describe the imaging signs of serious damage.
Subject(s)
Aorta, Thoracic/injuries , Emergency Medical Services , Thoracic Injuries/therapy , Wounds, Nonpenetrating/therapy , Accidents, Traffic , Aneurysm, False/diagnosis , Aneurysm, False/therapy , Aortic Rupture/diagnosis , Aortic Rupture/therapy , Aortography , Blood Vessel Prosthesis Implantation , Early Medical Intervention , Endovascular Procedures/methods , Humans , Prognosis , Stents , Thoracic Injuries/diagnosis , Tomography, X-Ray Computed , Wounds, Nonpenetrating/diagnosisABSTRACT
Several mechanisms predispose to bleeding in neoplastic disease. This is all the more serious as it often occurs on a background of medically vulnerable patients and the magnitude of the bleed may lead to hemorrhagic shock or acute respiratory distress as a result of hemoptysis. It often carries a poor prognosis, even if the acute episode has been controlled, as bleeding due to rupture of a tumor often indicates an advanced stage of the disease, and also because tumor rupture carries a risk of metastatic spread including peritoneal carcinomatosis. The risk of recurrent bleeding is also not insignificant. In most cases, endovascular hemostatic embolization is the first line palliative treatment.
