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Radiologe. 2002 Nov;42(11):871-9.
[Subarachnoid hemorrhage without aneurysm]
[Article in German]
Muller-Forell W, Welschehold S, Kohler J, Schicketanz KH.
Institut fur Neuroradiologie des Universitatsklinikums Mainz, Germany.
The rupture and bleeding of intracranial aneurysms is the most common cause of a spontaneous, non-traumatic subarachnoid hemorrhage (SAH). In up to 20% of these patients, no aneurysm is found, but the prognosis of these patients is known to be better than in those with aneurysms. The retrospective evaluation of the initial CT- and angiographic findings of 773 patients with spontaneous SAH, who underwent (up to three) 4-vessel DSA, brought a percentage of 12.4% with negative angiography. We found the favourable prognosis of these patients with negative angiography not only to be dependent from the distribution of the hemorrhage, with preference to perimesencephalic pattern, but the initial clinical state. 85% of our patients, who presented with perimesencephalic blood pattern and even 80% of those patients with additional intraventricular hemorrhage but the good clinical condition of Hunt-Hess I/II were discharged without neurological deficits. We recommend the obligatory 4-vessel catheter-angiography (DSA) in all patients with spontaneous SAH, independent of the blood pattern on initial CT, and one control in the presence of other than perimesencephalic subarachnoid hemorrhage, CTA might be reserved for additional controls.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12458439&dopt=Abstract hemorrhage
Radiologe. 2002 Nov;42(11):892-7.
[CT-angiographic evaluation of intracranial aneurysms - a review of the literature and first experiences with 4- and 16-slice multi detector CT scanners]
[Article in German]
Ertl-Wagner B, Hoffmann RT, Bruning R, Reiser MF.
Institut fur Klinische Radiologie, Klinikum der Universitat Munchen, Grosshadern, Germany.
Intracranial aneurysms are a common pathology faced by the diagnostic radiologist in daily practice. They can present as symptomatic aneurysms with a subarachnoid hemorrhage or as an incidental finding in another radiological study. Moreover, clipped or coiled aneurysms sometimes require a postinterventional work-up to exclude residual perfusion.Previous studies assessing the value of CT angiography in the diagnosis of intracranial aneurysms have been conducted using single slice spiral CT-scanners. They have shown a limited sensitivity in the diagnosis of small aneuryms with a diameter of equal to or smaller than 3 mm.Presently, there is only limited experience regarding the use of multi-detector row CT (MDCT) in the diagnosis of intracranial aneurysms. We have examined eight patients with a total of eleven aneurysms with MDCT technology, five patients with a 4-slice MDCT and three with a 16-slice MDCT. Of these, five were untreated aneurysms and six posttherapeutic with a status post surgical clipping. The mean diameter of the aneurysms was 5 mm (range 2 to 13 mm, median 3 mm). Of the treated aneuryms, two showed residual perfusion of the aneurysmal neck with a diameter of 2 and 6 mm respectively. In all cases, MDCT-angiography was in full agreement with the DSA diagnosis.Studies on larger patient populations will need to demonstrate the value of CTA in the diagnosis of intracranial aneurysms compared to the reference standard DSA.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12458442&dopt=Abstract hemorrhage
Pediatr Infect Dis J. 2002 Nov;21(11):1088-90.
Cerebral hemorrhage associated with vitamin K deficiency in congenital tuberculosis treated with isoniazid and rifampin.
Kobayashi K, Haruta T, Maeda H, Kubota M, Nishio T.
Department of Pediatrics, Kobe City General Hospital, Japan.
We report a male infant with congenital tuberculosis who developed cerebral hemorrhage associated with vitamin K deficiency during treatment with isoniazid and rifampin. Despite an absence of risk factors for vitamin K deficiency, the severe hemorrhagic disorder occurred at 4 months of age. We speculate that vitamin K deficiency in the present case may have resulted from a synergic effect of antituberculosis agents and immaturity of vitamin K metabolism and/or its absorption.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12458578&dopt=Abstract hemorrhage
Neurosurgery. 2003 Feb;52(2):276-81; discussion 281-2.
Hypomagnesemia after aneurysmal subarachnoid hemorrhage.
van den Bergh WM, Algra A, van der Sprenkel JW, Tulleken CA, Rinkel GJ.
Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands. w.m.vandenbergeuro.azu.nl
OBJECTIVE: Hypomagnesemia frequently occurs in hospitalized patients, and it is associated with poor outcome. We assessed the frequency and time distribution of hypomagnesemia after aneurysmal subarachnoid hemorrhage (SAH) and its relationship to the severity of SAH, delayed cerebral ischemia (DCI), and outcome after 3 months. METHODS: Serum magnesium was measured in 107 consecutive patients admitted within 48 hours after SAH. Hypomagnesemia (serum magnesium <0.70 mmol/L) at admission was related to clinical and initial computed tomographic characteristics by means of the Mann-Whitney U test. Hypomagnesemia at admission and during the DCI onset period (Days 2-12) was related to the occurrence of DCI and hypomagnesemia at admission, and hypomagnesemia that occurred any time during the first 3 weeks after SAH was related to outcome. RESULTS: Hypomagnesemia at admission was found in 41 patients (38%) and was associated with more cisternal (P = 0.006) and ventricular (P = 0.005) blood, a longer duration of unconsciousness (P = 0.007), and a worse World Federation of Neurosurgical Societies scale score at admission (P = 0.001). The crude hazard ratio for DCI with hypomagnesemia at admission was 2.4 (95% confidence interval, 1.0-5.6), and after multivariate adjustment it was 1.9 (95% confidence interval, 0.7-4.7). The hazard ratio of hypomagnesemia from Days 2 to 12 for patients with DCI was 3.2 (range, 1.1-8.9) after multivariate adjustment. The crude odds ratio for poor outcome (Glasgow Outcome Scale score, 1-3) with hypomagnesemia at admission was 2.5 (range, 1.1-5.5). Hypomagnesemia at admission did not contribute to the prediction of outcome in the multivariate model. CONCLUSION: Hypomagnesemia is frequently present after SAH and is associated with severity of SAH. Hypomagnesemia occurring between Days 2 and 12 after SAH predicts DCI.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12535355&dopt=Abstract hemorrhage
J Am Vet Med Assoc. 2002 Nov 15;221(10):1430-6, 1419.
Percutaneous arterial embolization and chemoembolization for treatment of benign and malignant tumors in three dogs and a goat.
Weisse C, Clifford CA, Holt D, Solomon JA.
Section of Small Animal Surgery, Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104-6010, USA.
The term bland arterial embolization refers to catheter-directed delivery of particulate material for the purpose of embolizing selected arteries. This technique is used in humans to treat a number of conditions, including arteriovenous malformations, uterine fibroids, and epistaxis. The term chemoembolization refers to selective intra-arterial delivery of chemotherapeutic agents in conjunction with particulate material for the purpose of embolizing arteries supplying blood to a tumor. Compared with traditional modes of drug delivery, chemoembolization increases local concentration and dwell time of the chemotherapeutic agent, augments tumor ischemia, and minimizes systemic toxic effects. In humans, the technique has shown encouraging results in the treatment of a variety of nonresectable tumors. The present report describes techniques for percutaneous bland arterial embolization and chemoembolization in dogs and goats and results of these techniques in 3 dogs and a goat. Bland arterial embolization was performed in 2 dogs and the goat. The goals of treatment included pain palliation, reduction of tumor growth, and control of hemorrhage, and each animal was considered to have benefited from the procedure on the basis of the preprocedural goals. Chemoembolization was performed in 1 dog for treatment of a nonresectable hepatocellular carcinoma. Unfortunately, this dog did not live long enough to identify any response to treatment. Results for animals studied illustrate the feasibility of bland arterial embolization and chemoembolization in veterinary patients and suggest that embolization may provide an alternative method of treatment for animals with inoperable lesions.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12458612&dopt=Abstract hemorrhage
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