Intracranial hemorrhage

Changing the hemodialysis prescription for hemodialysis patients with subdural and intracranial hemorrhage

Authors: Davenport A.

Although continuous modalities of renal replacement therapy offer an advantage to the patient with compromised cerebral perfusion and intracranial hypertension, they are generally limited to the intensive care unit setting. Many hemodialysis patients admitted with strokes and subdural hematoma are managed on general wards. As such, these patients are generally treated by intermittent hemodialysis, and their dialysis prescription should be altered to minimize changes in serum osmolality, and fall in blood pressure during dialysis. Such patients require more frequent but shorter dialysis sessions, using minimally bioincompatible small surface area dialyzers with lower blood flows, in combination with higher sodium and cooled dialysate. In patients at risk of intracranial hemorrhage and those with invasive intracranial monitoring, systemic anticoagulants should be avoided, choosing no anticoagulation protocols or regional anticoagulants.

Intracranial hemorrhage due to intracranial hypertension caused by the superior vena cava syndrome

Authors: Bartek J Jr, Abedi-Valugerdi G, Liska J, Nyström H, Andresen M, Mathiesen T.

We report a patient with intracranial hemorrhage secondary to venous hypertension as a result of a giant aortic pseudoaneurysm that compressed the superior vena cava and caused obstruction of the venous return from the brain. To our knowledge, this is the first patient reported to have an intracranial hemorrhage secondary to a superior vena cava syndrome. The condition appears to be caused by a reversible transient rise in intracranial pressure, as a result of compression of the venous return from the brain. Treatment consisted of surgery for the aortic pseudoaneurysm, which led to normalization of the intracranial pressure and resorption of the intracranial hemorrhage.

Catastrophic Intracranial Hemorrhage as a Presenting Feature of Juvenile Polyarteritis Nodosa

Authors: Srinivasaraghavan R, Krishnamurthy S, Mahadevan S.

Intracranial hemorrhage has been rarely reported during the course of polyarteritis nodosa. We describe a 6-year-old boy who presented with fever, altered sensorium, skin rash, hypertension, and catastrophic intracranial hemorrhage. After surgical evacuation of the intracranial hematoma, he underwent a computerized tomography angiogram that showed narrowing of the right anterior cerebral artery. Skin biopsy showed small vessel vasculitis. Nerve conduction studies were suggestive of mononeuritis multiplex. He was diagnosed as polyarteritis nodosa and managed with immunosuppressants, to which he responded favorably. The most interesting aspect of the child's presentation was the catastrophic onset of altered sensorium with raised intracranial pressure, which was a diagnostic challenge. The mechanisms of intracranial hemorrhage in polyarteritis nodosa and a review of the literature are discussed. The authors emphasize that it is important to recognize intracranial hemorrhage as a life-threatening complication in children with polyarteritis nodosa to institute timely therapy.

A supratentorial primitive neuroectodermal tumor presenting with intracranial hemorrhage in a 42-year-old man: a case report and review of the literature

Authors: Papadopoulos EK, Fountas KN, Brotis AG, Paterakis KN.

INTRODUCTION: We report on a very rare case of a supratentorial primitive neuroectodermal tumor in an adult, which presented with intracerebral hemorrhage, and review the relevant medical literature.
CASE PRESENTATION: A 42-year-old Caucasian man complained of a sudden headache and nausea-vomiting. Our patient rapidly deteriorated to coma. An emergency computed tomography scan showed an extensive intraparenchymal hemorrhage that caused significant mass effect and tonsilar herniation. During surgery, an increased intracranial pressure was recorded and extensive bilateral decompressive craniectomies were performed. A cherry-like intraparenchymal lesion was found in his right frontal lobe and resected. Our patient died in the intensive care unit after approximately 48 hours. The resected lesion was identified as a central nervous system primitive neuroectodermal tumor.
CONCLUSION: Supratentorial primitive neuroectodermal tumors must be considered in the differential diagnosis of space-occupying lesions in adults. Spontaneous supratentorial hemorrhage due to primitive neuroectodermal tumors is an extremely rare but potentially lethal event.

Variability of ICU Use in Adult Patients With Minor Traumatic Intracranial Hemorrhage

Authors: Nishijima DK, Haukoos JS, Newgard CD, Staudenmayer K, White N, Slattery D, Maxim PC, Gee CA, Hsia RY, Melnikow JA, Holmes JF.

STUDY OBJECTIVE: Patients with minor traumatic intracranial hemorrhage are frequently admitted to the ICU, although many never require critical care interventions. To describe ICU resource use in minor traumatic intracranial hemorrhage, we assess (1) the variability of ICU use in a cohort of patients with minor traumatic intracranial hemorrhage across multiple trauma centers, and (2) the proportion of adult patients with traumatic intracranial hemorrhage who are admitted to the ICU and never receive a critical care intervention during hospitalization. In addition, we evaluate the association between ICU admission and key independent variables.

Multiple intracranial hemorrhages after cervical spinal surgery

Authors: Takahashi Y, Nishida K, Ogawa K, Yasuhara T, Kumamoto S, Niimura T, Tanoue T.

A 69-year-old woman presented with a rare case of multiple supra- and infratentorial intracranial hemorrhages after cervical laminoplasty for cervical spondylotic myelopathy without intraoperative liquorrhea. A wound drainage tube under negative pressure was placed with subsequent 380 ml of drainage in the first 12 hours. She had no complaint of headache and nausea at that time. Computed tomography of the brain obtained at 15 hours after surgery demonstrated cerebellar hemorrhage, acute subdural hemorrhage, subarachnoid hemorrhage, supratentorial intraparenchymal hemorrhage, and pneumocephalus. She was treated medically without consequent neurological deficits other than right hemianopsia. Overdrainage of cerebrospinal fluid through an occult dural tear might cause severely low intracranial pressure with subsequent multiple intracranial hemorrhages. Wound drainage should be controlled thoroughly even in patients without intraoperative liquorrhea.

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