Hemorrhaging is also known as bleeding or abnormal bleeding as a
result of blood loss due to internal.external leaking from blood
vessels or through the skin.
Pulmonary hemorrhage (P-Hem)
Pulmonary hemorrhage is defined as a acute condition of lung bleeding from the from the upper respiratory tract or the endotracheal tube of the lung with the mortality of 30 to 40%.
Complication
1. Leptospirosis
Leptospirosis is a widespread zooanthroponosis that is prevalent in tropical regions due to the
favorable environmental survival conditions of its etiologic agent (Leptospira)(12).
2. Fetomaternal complications
Antenatal diagnosis and treatment of women with hereditary hemorrhagic
telangectasia and pulmonary arteriovenous malformations might prevent
potentially lifethreatening fetomaternal complications(13).
3. Pulmonary infection and respiratory failure
In the study of spinal cord injury (SCI) rats, pulmonary edema and hemorrhage were occurred in the early stage of SCI while the other organs were almost normal. And the location of lung edema and hemorrhage were the same as that of pulmonary infection(14).
4. Etc.
E.4. Treatments
Treatments depend on the diagnosis of each patient, if the underlined
cause is due to medication, then medicine has to be stopped.
1. Immediate treatment
According to the Intensive Care Nursery House Staff Manual immediate
treatment of P-Hem should include tracheal suction, oxygen and positive
pressure ventilation. To assist in decreasing P-Hem, mean
airway pressure should be increased, either by a relatively high PEEP (i.e., 6 to 10
cmH2O) or by high frequency ventilation(15). In the infants, reserachers
at suggested that current management of PH in VLBW infants includes
ventilatory support using high
positive end expiratory pressure, transfusion of blood and blood
products to support the circulation and correct any hemostatic or
coagulation defects and evaluation and treatment for patent ductus
arteriousus (PDA). These strategies are often ineffective in preventing
a poor outcome. rFVIIa is effective in controlling life-threatening
hemorrhage in patients with hemophilia A and B with inhibitors,
and in nonhemophiliacs with a variety of inherited or acquired
hemostatic defects including platelet disorders, liver disease and von
Willebrand's disease.(15a)
2. Embolization - Interventional treatment of pulmonary arteriovenous malformations
Acording to the study of Dr. Andersen PE and Dr. Kjeldsen AD. at the Odense University Hospital " Pulmonary
arteriovenous malformations (PAVM) are congenital vascular
communications in the lungs. The generally accepted treatment strategy of first choice is
embolization of the afferent arteries to the arteriovenous
malformations. It is a minimally invasive procedure and at the same time
a lung
preserving treatment with a very high technical success, high
effectiveness and low morbidity and mortality. Embolization prevents
cerebral stroke and abscess as well as pulmonary haemorrhage
and further raises the functional level. Embolization is a
well-established method of treating PAVM, with a significant effect on
oxygenation of the blood. Screening for PAVM in patients at risk is
recommended, especially in patients with HHT(16).
3. Corticosteroids
There is a report of a patient suffered from acute
glomerulonephritis with modest renal impairment and life-threatening
pulmonary hemorrhage. The pulmonary hemorrhage caused severe hypoxia
that necessitated artificial ventilation. As a last resort, 1 g/day of
methylprednisolone was administered intravenously. Rapid cessation of
pulmonary hemorrhage ensued with clearing of the lungs fields. the
suggestion of large doses of glucocorticosteroids should be administered
to patients with life-threatening pulmonary hemorrhage before
considering bilateral nephrectomy, especially if the renal function is
still adequate. Bilateral nephrectomy is an irreversible approach and,
as with massive doses of steroids, has yet to be proved to be a
consistently effective mode of therapy(17).
4. Etc.
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Sources
(12) http://saithan.net/pulmonary%20and%20sys%20disease/Pulmonary%20complications%20of%20leptospirosis.pdf
(13) http://ape.med.miami.edu/Doc/Resident%20Web%20Site%20Articles/Other%20diseases/Hereditary%20Hemorrhagic%20Telangiectasias/OB%20article%20+%20pulmAVMs.pdf
(14) http://www.ncbi.nlm.nih.gov/pubmed/22683446
(15) http://www.ucsfbenioffchildrens.org/pdf/manuals/29_PulmHemorrhage.pdf
(15a) http://www.nature.com/jp/journal/v22/n8/full/7210787a.html
(16) http://www.ncbi.nlm.nih.gov/pubmed/21160695
(17) http://annals.org/article.aspx?articleid=689575
Monday, 2 December 2013
Hemorrhaging: Pulmonary hemorrhage (P-Hem) - The Symptoms and Diagnosis
Hemorrhaging is also known as bleeding or abnormal bleeding as a
result of blood loss due to internal.external leaking from blood
vessels or through the skin.
Pulmonary hemorrhage (P-Hem)
Pulmonary hemorrhage is defined as a acute condition of lung bleeding from the from the upper respiratory tract or the endotracheal tube of the lung with the mortality of 30 to 40%.
Symptoms
1. The onset of P-Hem is characterized by oozing of bloody fluid from the nose and mouth or endotracheal tube with associated rapid worsening of the respiratory status, cyanosis and, in severe cases, shock(7).
2. In the report of 3 cases of enterovirus 71 infection with pulmonary edema or pulmonary hemorrhage as the early clinical manifestation, found that pulmonary edema or pulmonary hemorrhage occurred in the 3 cases with EV71-infected infants. The initial presentation was often nonspecific with fever and vomiting, and sudden appearances of cyanosis, tachypnea, tachycardia, hypertension or hypotension, limb weakness may suggest pulmonary edema or hemorrhage. Excessive fluid resuscitation may deteriorate the illness, on the contrary, fluid restriction and inotropic agents, and early intubation with positive pressure mechanical ventilation may be the proper treatment(8).
3. Etc.
E.3. Diagnosis
1. The computed tomography (CT) scans and chest radiograph
In the study of the computed tomography (CT) scans and chest radiograph of seven patients with bronchoscopic or pathologically proven cases of pulmonary hemorrhage to determine the appearance and value of each modality, showed that CT revealed the presence and location in all cases while chest radiographs were falsely negative in two cases. The CT pattern was always an alveolar pattern while the pattern was more variable on chest radiographs. By providing better pattern definition than the chest radiographs, CT is the study of choice in detecting the presence of a suspected pulmonary hemorrhage(9).
2. Bronchoalveolar lavage (BAL)
Bronchoalveolar lavage (BAL) is a medical procedure to collect and examine the lung fluid with the use of a bronchoscope, passing through the mouth or nose into the lungs. In the study to investigate the efficacy of bronchoalveolar lavage (BAL) in diagnosing pulmonary hemorrhage in 51 immunosuppressed patients with new pulmonary infiltrates, showed that Severe pulmonary hemorrhage was ultimately diagnosed in 14 cases, and a mild degree of hemorrhage was found in an additional 19 cases. Thrombocytopenia and invasive fungal infections were statistically associated with severe hemorrhage, as was an increased percentage of alveolar macrophages in the BAL sample(10).
3. CT-guided transthoracic lung biopsy
Higher rates of complications are significantly found with multiple punctures (pneumothorax risk multiplied by 7.4), longer intra-parenchymal needle tract (5 and 7% higher risk of pneumothorax and hemorrhage for every 1 mm increase in depth), and with smaller lesions (2 and 5% lower risk respectively for pneumothorax and hemorrhage for every 1 cm increase in lesion size). The presence of an interposing rib is associated with a higher rate of hemorrhage(11).
4. Etc.
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Sources
(7) http://www.ucsfbenioffchildrens.org/pdf/manuals/29_PulmHemorrhage.pdf
(8) http://www.ncbi.nlm.nih.gov/pubmed/19099810
(9) http://www.sciencedirect.com/science/article/pii/089970719390021E
(10) http://www.ncbi.nlm.nih.gov/pubmed/3605828
(11) http://www.ncbi.nlm.nih.gov/pubmed/22645895
Pulmonary hemorrhage (P-Hem)
Pulmonary hemorrhage is defined as a acute condition of lung bleeding from the from the upper respiratory tract or the endotracheal tube of the lung with the mortality of 30 to 40%.
Symptoms
1. The onset of P-Hem is characterized by oozing of bloody fluid from the nose and mouth or endotracheal tube with associated rapid worsening of the respiratory status, cyanosis and, in severe cases, shock(7).
2. In the report of 3 cases of enterovirus 71 infection with pulmonary edema or pulmonary hemorrhage as the early clinical manifestation, found that pulmonary edema or pulmonary hemorrhage occurred in the 3 cases with EV71-infected infants. The initial presentation was often nonspecific with fever and vomiting, and sudden appearances of cyanosis, tachypnea, tachycardia, hypertension or hypotension, limb weakness may suggest pulmonary edema or hemorrhage. Excessive fluid resuscitation may deteriorate the illness, on the contrary, fluid restriction and inotropic agents, and early intubation with positive pressure mechanical ventilation may be the proper treatment(8).
3. Etc.
E.3. Diagnosis
1. The computed tomography (CT) scans and chest radiograph
In the study of the computed tomography (CT) scans and chest radiograph of seven patients with bronchoscopic or pathologically proven cases of pulmonary hemorrhage to determine the appearance and value of each modality, showed that CT revealed the presence and location in all cases while chest radiographs were falsely negative in two cases. The CT pattern was always an alveolar pattern while the pattern was more variable on chest radiographs. By providing better pattern definition than the chest radiographs, CT is the study of choice in detecting the presence of a suspected pulmonary hemorrhage(9).
2. Bronchoalveolar lavage (BAL)
Bronchoalveolar lavage (BAL) is a medical procedure to collect and examine the lung fluid with the use of a bronchoscope, passing through the mouth or nose into the lungs. In the study to investigate the efficacy of bronchoalveolar lavage (BAL) in diagnosing pulmonary hemorrhage in 51 immunosuppressed patients with new pulmonary infiltrates, showed that Severe pulmonary hemorrhage was ultimately diagnosed in 14 cases, and a mild degree of hemorrhage was found in an additional 19 cases. Thrombocytopenia and invasive fungal infections were statistically associated with severe hemorrhage, as was an increased percentage of alveolar macrophages in the BAL sample(10).
3. CT-guided transthoracic lung biopsy
Higher rates of complications are significantly found with multiple punctures (pneumothorax risk multiplied by 7.4), longer intra-parenchymal needle tract (5 and 7% higher risk of pneumothorax and hemorrhage for every 1 mm increase in depth), and with smaller lesions (2 and 5% lower risk respectively for pneumothorax and hemorrhage for every 1 cm increase in lesion size). The presence of an interposing rib is associated with a higher rate of hemorrhage(11).
4. Etc.
Chinese Secrets To Fatty Liver And Obesity Reversal
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Optimal Health And Loose Weight
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Back to General health http://kylejnorton.blogspot.ca/p/general-health.html
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Sources
(7) http://www.ucsfbenioffchildrens.org/pdf/manuals/29_PulmHemorrhage.pdf
(8) http://www.ncbi.nlm.nih.gov/pubmed/19099810
(9) http://www.sciencedirect.com/science/article/pii/089970719390021E
(10) http://www.ncbi.nlm.nih.gov/pubmed/3605828
(11) http://www.ncbi.nlm.nih.gov/pubmed/22645895
Hemorrhaging: Pulmonary hemorrhage (P-Hem) - The Causes and Risk Factors
Hemorrhaging is also known as bleeding or abnormal bleeding as a
result of blood loss due to internal.external leaking from blood
vessels or through the skin.
Pulmonary hemorrhage (P-Hem)
Pulmonary hemorrhage is defined as a acute condition of lung bleeding from the from the upper respiratory tract or the endotracheal tube of the lung with the mortality of 30 to 40%.
Causes and Rick factors
A. Causes
1. Pulmonary Embolism
In the study to determine the characteristics of the history, physical examination, chest radiograph, electrocardiogram, and the ventilation/perfusion lung scan probability in elderly patients with pulmonary embolism who present with the syndrome of pulmonary infarction or hemorrhage, found that although a few clinical features of the pulmonary hemorrhage/infarction syndrome of pulmonary embolism in elderly patients differ from patients less than 40 years of age, in general, the clinical characteristics are comparable to younger patients(1).
2. Bacteria infection
Enterovirus 71 (EV71) infection with pulmonary edema or pulmonary hemorrhage as a fulminant and often fatal illness(2). Others report a case of a 63-year-old woman treated by intensive chemotherapy for acute myeloid leukemia (AML) who presented while severely neutropenic and thrombocytopenic a Sm pulmonary infection with hemoptysis leading to death in 48 h, according to the study of Lethal pulmonary hemorrhage caused by a fulminant Stenotrophomonas maltophilia respiratory infection in an acute myeloid leukemia patient(3).
3. Lung cancer
In the study to investigate the risk factors associated with fatal pulmonary hemorrhage (PH) in patients with locally advanced non-small cell lung cancer (NSCLC), treated with chemoradiotherapy, showed that f the 583 patients, 2.1% suffered a fatal PH. The numbers of patients with minimum, minor, and major cavitations were 13, 11, and 14, respectively. Among the 38 patients with tumor cavitation, all 3 patients who developed fatal PH had major cavitations. On multivariate analysis, the presence of baseline major cavitation (odds ratio, 17.878), and a squamous cell histology (odds ratio, 5.491) proved to be independent significant risk factors for fatal PH. Interestingly, all patients with fatal PH and baseline major cavitation were found to have tumors with squamous cell histology, and the occurrence of fatal PH in patients having both risk factors was 33.3%(4).
4. Pneumonia
In the review of the epidemiological, clinical and diagnosis findings of pneumonia and pulmonary hemorrhage observed in patients with leptospirosis in the period January 2007 to October 2009. A 64% (20/31) of patients diagnosed with leptospirosis presented pneumonia. Fifteen of them (75%) had severe pneumonia, of which seven (35%) were pulmonary hemorrhage. In ten patients (32%) reason for consultation and clinical early stage was a secretory gastroenteritis with fever and abdominal pain. Jaundice was only expressed in eleven patients (35%)(5).
5. Etc.
B. Risk factors
1. Extreme Exercise
There is a report of Exercise-induced pulmonary hemorrhage (EIPH) occurs in horses that race at high speeds(6)
2. Hereditary hemorrhagic telangiectasia and others
Hereditary hemorrhagic telangiectasia (Osler-Weber- Rendu disease) is inherited as an autosomal dominant trait with an incidence as high as 1:2300, according to the study of Hereditary hemorrhagic telangiectasia with pulmonary arteriovenous malformations. Prematurity is the factor most commonly associated with P-Hem; other associated factors are those that predispose to perinatal asphyxia or bleeding disorders, including toxemia of pregnancy, maternal cocaine use, erythroblastosis fetalis, breech delivery, hypothermia, infection, Respiratory Distress Syndrome, administration of exogenous surfactant (in some studies) and ECMO(7).
3. Etc.
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Optimal Health And Loose Weight
Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer
Back to General health http://kylejnorton.blogspot.ca/p/general-health.html
Back to Kyle J. Norton Home page http://kylejnorton.blogspot.ca
Sources
(1) http://www.ncbi.nlm.nih.gov/pubmed/11416457
(2) http://www.ncbi.nlm.nih.gov/pubmed/19099810
(3) http://www.ncbi.nlm.nih.gov/pubmed/15360016
(4) http://www.ncbi.nlm.nih.gov/pubmed/22260460
(5) http://www.ncbi.nlm.nih.gov/pubmed/21550928
(6) http://www.ker.com/library/proceedings/04/EIPH_p95.pdf
(7) http://www.ucsfbenioffchildrens.org/pdf/manuals/29_PulmHemorrhage.pdf
Pulmonary hemorrhage (P-Hem)
Pulmonary hemorrhage is defined as a acute condition of lung bleeding from the from the upper respiratory tract or the endotracheal tube of the lung with the mortality of 30 to 40%.
Causes and Rick factors
A. Causes
1. Pulmonary Embolism
In the study to determine the characteristics of the history, physical examination, chest radiograph, electrocardiogram, and the ventilation/perfusion lung scan probability in elderly patients with pulmonary embolism who present with the syndrome of pulmonary infarction or hemorrhage, found that although a few clinical features of the pulmonary hemorrhage/infarction syndrome of pulmonary embolism in elderly patients differ from patients less than 40 years of age, in general, the clinical characteristics are comparable to younger patients(1).
2. Bacteria infection
Enterovirus 71 (EV71) infection with pulmonary edema or pulmonary hemorrhage as a fulminant and often fatal illness(2). Others report a case of a 63-year-old woman treated by intensive chemotherapy for acute myeloid leukemia (AML) who presented while severely neutropenic and thrombocytopenic a Sm pulmonary infection with hemoptysis leading to death in 48 h, according to the study of Lethal pulmonary hemorrhage caused by a fulminant Stenotrophomonas maltophilia respiratory infection in an acute myeloid leukemia patient(3).
3. Lung cancer
In the study to investigate the risk factors associated with fatal pulmonary hemorrhage (PH) in patients with locally advanced non-small cell lung cancer (NSCLC), treated with chemoradiotherapy, showed that f the 583 patients, 2.1% suffered a fatal PH. The numbers of patients with minimum, minor, and major cavitations were 13, 11, and 14, respectively. Among the 38 patients with tumor cavitation, all 3 patients who developed fatal PH had major cavitations. On multivariate analysis, the presence of baseline major cavitation (odds ratio, 17.878), and a squamous cell histology (odds ratio, 5.491) proved to be independent significant risk factors for fatal PH. Interestingly, all patients with fatal PH and baseline major cavitation were found to have tumors with squamous cell histology, and the occurrence of fatal PH in patients having both risk factors was 33.3%(4).
4. Pneumonia
In the review of the epidemiological, clinical and diagnosis findings of pneumonia and pulmonary hemorrhage observed in patients with leptospirosis in the period January 2007 to October 2009. A 64% (20/31) of patients diagnosed with leptospirosis presented pneumonia. Fifteen of them (75%) had severe pneumonia, of which seven (35%) were pulmonary hemorrhage. In ten patients (32%) reason for consultation and clinical early stage was a secretory gastroenteritis with fever and abdominal pain. Jaundice was only expressed in eleven patients (35%)(5).
5. Etc.
B. Risk factors
1. Extreme Exercise
There is a report of Exercise-induced pulmonary hemorrhage (EIPH) occurs in horses that race at high speeds(6)
2. Hereditary hemorrhagic telangiectasia and others
Hereditary hemorrhagic telangiectasia (Osler-Weber- Rendu disease) is inherited as an autosomal dominant trait with an incidence as high as 1:2300, according to the study of Hereditary hemorrhagic telangiectasia with pulmonary arteriovenous malformations. Prematurity is the factor most commonly associated with P-Hem; other associated factors are those that predispose to perinatal asphyxia or bleeding disorders, including toxemia of pregnancy, maternal cocaine use, erythroblastosis fetalis, breech delivery, hypothermia, infection, Respiratory Distress Syndrome, administration of exogenous surfactant (in some studies) and ECMO(7).
3. Etc.
Chinese Secrets To Fatty Liver And Obesity Reversal
Use The Revolutionary Findings To Achieve
Optimal Health And Loose Weight
Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer
Back to General health http://kylejnorton.blogspot.ca/p/general-health.html
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Sources
(1) http://www.ncbi.nlm.nih.gov/pubmed/11416457
(2) http://www.ncbi.nlm.nih.gov/pubmed/19099810
(3) http://www.ncbi.nlm.nih.gov/pubmed/15360016
(4) http://www.ncbi.nlm.nih.gov/pubmed/22260460
(5) http://www.ncbi.nlm.nih.gov/pubmed/21550928
(6) http://www.ker.com/library/proceedings/04/EIPH_p95.pdf
(7) http://www.ucsfbenioffchildrens.org/pdf/manuals/29_PulmHemorrhage.pdf
Upper head hemorrhaging: Subarachnoid hemorrhage (SAH) - The Treatments
Hemorrhaging is also known as bleeding or abnormal bleeding as a
result of blood loss due to internal.external leaking from blood
vessels or through the skin.
Subarachnoid hemorrhage (SAH)
Subarachnoid hemorrhage (SAH) is defined as a condition of the presence of blood within the subarachnoid space (the area between the brain and the thin tissues that cover the brain).
Treatments
1. Surgery
a. Clipping
In the study of the data of patients with SAH who underwent aneurysmal clipping at the Kartal Training and Research Hospital between 1999 and 200, showed that early surgery is advantageous over late surgery in patients with SAH with lower post-operative vasospasm and mortality rates(22).
b. Coiling
In the study of 15 patients with high-risk intracranial saccular aneurysms treated using electrolytically detachable coils introduced via an endovascular approach. The patients ranged in age from 21 to 69 years. The most frequent clinical presentation was subarachnoid hemorrhage (eight cases). Considerable thrombosis of the aneurysm (70% to 100%) was achieved in all 15 patients, and preservation of the parent artery was obtained in 14. Although temporary neurological deterioration due to the technique was recorded in one patient, no permanent neurological deficit was observed in this series and there were no deaths. It is believed that this new technology is a viable alternative in the management of patients with high-risk intracranial saccular aneurysms. It may also play an important role in the occlusion of aneurysms in the acute phase of subarachnoid hemorrhage(23).
c. Fenestration of the lamina terminalis and removal of cisternal clots
In the study to investigate the effects of clot removal on multiple outcome variables following the clipping of ruptured anterior communicating aneurysms, showed that vasospasm affected 5 of 17 (29%) in group A and 8 of 13 (61.5%) in group B (p < 0.05). Endovascular treatment for vasospasm was required in one patient in group A (5.8% of 17, 20% of 5) and in five from group B (38.4% of 13, 62.5% of 8) (p < 0.05). Mortality was observed in one case in group A (5.8% of 17, 20% of 5) and in two cases in group B (15.3% of 13, 25% of 8) and was related to vasospasm after SAH. Ventriculoperitonal shunt (VPS) was required in one case in group A (5.8%) and in five cases in group B (38.4%). Conclusions: Fenestration of the lamina terminalis and removal of cisternal clots significantly decreased the incidence of post-SAH hydrocephalus and was associated with better outcomes(24).
2. Other Treatments
The preference of medication with poor clinical evidence, such as magnesium sulfate, aspirin, statins, and anti-fibrinolytics was lower than 10%. The use of intravenous nimodipine and systemic glucocorticoids was as high as 31%. The availability of endovascular therapy was 69%. The indication for treatment of patients with unruptured intracranial aneurysms that required intervention was less than 13.8%. In patients with ruptured or unruptured intracranial aneurysms, coiling was the preferred method for exclusion, according to a a sample of members from the Colombian Association of Neurosurgery(25)
3. Etc.
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Optimal Health And Loose Weight
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Sources
(22) http://www.ncbi.nlm.nih.gov/pubmed/22368972
(23) http://thejns.org/doi/abs/10.3171/jns.1991.75.1.0008
(24) http://www.ncbi.nlm.nih.gov/pubmed/22890652
(25) http://www.ncbi.nlm.nih.gov/pubmed/22059120
Subarachnoid hemorrhage (SAH)
Subarachnoid hemorrhage (SAH) is defined as a condition of the presence of blood within the subarachnoid space (the area between the brain and the thin tissues that cover the brain).
Treatments
1. Surgery
a. Clipping
In the study of the data of patients with SAH who underwent aneurysmal clipping at the Kartal Training and Research Hospital between 1999 and 200, showed that early surgery is advantageous over late surgery in patients with SAH with lower post-operative vasospasm and mortality rates(22).
b. Coiling
In the study of 15 patients with high-risk intracranial saccular aneurysms treated using electrolytically detachable coils introduced via an endovascular approach. The patients ranged in age from 21 to 69 years. The most frequent clinical presentation was subarachnoid hemorrhage (eight cases). Considerable thrombosis of the aneurysm (70% to 100%) was achieved in all 15 patients, and preservation of the parent artery was obtained in 14. Although temporary neurological deterioration due to the technique was recorded in one patient, no permanent neurological deficit was observed in this series and there were no deaths. It is believed that this new technology is a viable alternative in the management of patients with high-risk intracranial saccular aneurysms. It may also play an important role in the occlusion of aneurysms in the acute phase of subarachnoid hemorrhage(23).
c. Fenestration of the lamina terminalis and removal of cisternal clots
In the study to investigate the effects of clot removal on multiple outcome variables following the clipping of ruptured anterior communicating aneurysms, showed that vasospasm affected 5 of 17 (29%) in group A and 8 of 13 (61.5%) in group B (p < 0.05). Endovascular treatment for vasospasm was required in one patient in group A (5.8% of 17, 20% of 5) and in five from group B (38.4% of 13, 62.5% of 8) (p < 0.05). Mortality was observed in one case in group A (5.8% of 17, 20% of 5) and in two cases in group B (15.3% of 13, 25% of 8) and was related to vasospasm after SAH. Ventriculoperitonal shunt (VPS) was required in one case in group A (5.8%) and in five cases in group B (38.4%). Conclusions: Fenestration of the lamina terminalis and removal of cisternal clots significantly decreased the incidence of post-SAH hydrocephalus and was associated with better outcomes(24).
2. Other Treatments
The preference of medication with poor clinical evidence, such as magnesium sulfate, aspirin, statins, and anti-fibrinolytics was lower than 10%. The use of intravenous nimodipine and systemic glucocorticoids was as high as 31%. The availability of endovascular therapy was 69%. The indication for treatment of patients with unruptured intracranial aneurysms that required intervention was less than 13.8%. In patients with ruptured or unruptured intracranial aneurysms, coiling was the preferred method for exclusion, according to a a sample of members from the Colombian Association of Neurosurgery(25)
3. Etc.
Chinese Secrets To Fatty Liver And Obesity Reversal
Use The Revolutionary Findings To Achieve
Optimal Health And Loose Weight
Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer
Back to General health http://kylejnorton.blogspot.ca/p/general-health.html
Back to Kyle J. Norton Home page http://kylejnorton.blogspot.ca
Sources
(22) http://www.ncbi.nlm.nih.gov/pubmed/22368972
(23) http://thejns.org/doi/abs/10.3171/jns.1991.75.1.0008
(24) http://www.ncbi.nlm.nih.gov/pubmed/22890652
(25) http://www.ncbi.nlm.nih.gov/pubmed/22059120
Upper head hemorrhaging: Subarachnoid hemorrhage (SAH) - The Complications and diseases associated with SAH
Hemorrhaging is also known as bleeding or abnormal bleeding as a
result of blood loss due to internal.external leaking from blood
vessels or through the skin.
Subarachnoid hemorrhage (SAH)
Subarachnoid hemorrhage (SAH) is defined as a condition of the presence of blood within the subarachnoid space (the area between the brain and the thin tissues that cover the brain).
Complications and diseases associated with SAH
1. Changes in coagulative and fibrinolytic activities
Both coagulative and fibrinolytic activities were altered after the onset of SAH. These results demonstrate that the coagulative/fibrinolytic cascade might be activated via different mechanisms in different types of stroke(18).
2. Terson's Syndrome
TS was diagnosed in 20 of 155 SAH patients (30 eyes), and detected in 16 (14.16%) of 113 patients with aneurysmal SAH and four (9.52%) of 42 patients with traumatic SAH. No correlations were found between state-of-consciousness, GCS scores, and presence of TS in patients with traumatic SAH. Among patients suffering from aneurysmal SAH, however, significant relationships were observed between state-of-consciousness, GCS scores, Hunt-Hess grades, and incidence of TS (p < 0.01). No statistically significant difference was observed between men and women with regard to the incidence of TS (χ(2) = 0.821, p = 0.365)(19).
3. Fahr's Disease
there is a report of a case of an acute IBCG presentation in which the cause of the deterioration was an aneurysmal subarachnoid hemorrhage(20).
4. Hydrocephalus
Hydrocephalus, also known as "water in the brain" is defined as complex and multifactorial neurological disorders of accumulation of cerebrospinal fluid (CSF) in the cavity of brain of that can lead to intracranial pressure inside the side, resulting of brain trauma, stroke, infection, tumor, etc. Acute hydrocephalus is present in 20% of patients with subarachnoid hemorrhage. One third of them may be asymptomatic on admission; 50% of those who have clinical hydrocephalus recover spontaneously within the first 24 h. The presence of acute hydrocephalus after subarachnoid hemorrhage is associated with additional morbidity and higher mortality secondary to rebleeding(21).
5. Etc.
Chinese Secrets To Fatty Liver And Obesity Reversal
Use The Revolutionary Findings To Achieve
Optimal Health And Loose Weight
Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer
Back to General health http://kylejnorton.blogspot.ca/p/general-health.html
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Sources
(18) http://www.ncbi.nlm.nih.gov/pubmed/16671428
(19) http://www.ncbi.nlm.nih.gov/pubmed/22913767
(20) http://www.ncbi.nlm.nih.gov/pubmed/22754741
(21) http://www.ncbi.nlm.nih.gov/pubmed/9586937
Subarachnoid hemorrhage (SAH)
Subarachnoid hemorrhage (SAH) is defined as a condition of the presence of blood within the subarachnoid space (the area between the brain and the thin tissues that cover the brain).
Complications and diseases associated with SAH
1. Changes in coagulative and fibrinolytic activities
Both coagulative and fibrinolytic activities were altered after the onset of SAH. These results demonstrate that the coagulative/fibrinolytic cascade might be activated via different mechanisms in different types of stroke(18).
2. Terson's Syndrome
TS was diagnosed in 20 of 155 SAH patients (30 eyes), and detected in 16 (14.16%) of 113 patients with aneurysmal SAH and four (9.52%) of 42 patients with traumatic SAH. No correlations were found between state-of-consciousness, GCS scores, and presence of TS in patients with traumatic SAH. Among patients suffering from aneurysmal SAH, however, significant relationships were observed between state-of-consciousness, GCS scores, Hunt-Hess grades, and incidence of TS (p < 0.01). No statistically significant difference was observed between men and women with regard to the incidence of TS (χ(2) = 0.821, p = 0.365)(19).
3. Fahr's Disease
there is a report of a case of an acute IBCG presentation in which the cause of the deterioration was an aneurysmal subarachnoid hemorrhage(20).
4. Hydrocephalus
Hydrocephalus, also known as "water in the brain" is defined as complex and multifactorial neurological disorders of accumulation of cerebrospinal fluid (CSF) in the cavity of brain of that can lead to intracranial pressure inside the side, resulting of brain trauma, stroke, infection, tumor, etc. Acute hydrocephalus is present in 20% of patients with subarachnoid hemorrhage. One third of them may be asymptomatic on admission; 50% of those who have clinical hydrocephalus recover spontaneously within the first 24 h. The presence of acute hydrocephalus after subarachnoid hemorrhage is associated with additional morbidity and higher mortality secondary to rebleeding(21).
5. Etc.
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Sources
(18) http://www.ncbi.nlm.nih.gov/pubmed/16671428
(19) http://www.ncbi.nlm.nih.gov/pubmed/22913767
(20) http://www.ncbi.nlm.nih.gov/pubmed/22754741
(21) http://www.ncbi.nlm.nih.gov/pubmed/9586937
Upper head hemorrhaging: Subarachnoid hemorrhage (SAH) - The Diagnosis
Hemorrhaging is also known as bleeding or abnormal bleeding as a
result of blood loss due to internal.external leaking from blood
vessels or through the skin.
Subarachnoid hemorrhage (SAH)
Subarachnoid hemorrhage (SAH) is defined as a condition of the presence of blood within the subarachnoid space (the area between the brain and the thin tissues that cover the brain).
Diagnosis
1. Computed tomography (CT) scan or multidetector CT angiography
If your doctor suspects the bleeding is within the brain itself, then CT scan is the best choice. Computed tomography (CT) is the standard diagnostic tool uses X-rays to make detailed pictures of structures inside the skull to check for fractures and bleeding, specially in case of trauma. Scheduled repeat head computed tomography after mild traumatic brain injury has been shown to have limited use for predicting the need for an intervention. CT scan has correctly identified over 95% of cases—especially on the first day after the onset of bleeding. Others suggested that multidetector CT angiography can be used as a primary examination tool in the diagnostic work-up of patients with SAH(15).
2. A Lumbar puncture
If CT scan can not identify the diagnosis, your doctor may suggest a lumbar puncture (spinal tap). In the study to evaluate the Differentiation of early subarachnoid hemorrhage from traumatic lumbar puncture, showed that the 0.3 to 7% hemolysis which occurred was relatively independent both of the time following SAH and of the number of red blood cells (rbc) in the cerebrospinal fluid (CSF). There was, on the other hand, a significant and time-dependent increase in CSF lactate concentration early after SAH, suggesting the potential clinical value of the detection of increased lactate with a relatively normal lactate/pyruvate ratio in hemorrhagic CSF. Until this can be evaluated in human subjects, however, determination of the rbc counts or total hemoglobin concentrations in serially collected samples of CSF remains the best clinical method(16).
3. ECG
ECG is found to be important in differetiating of SAH. In the study to evaluate all patients admitted to a 31-bed department of intensive care between 1993 and 2000 with acute aneurysmal SAH documented by cerebral angiography or autops, indicated that of 159 patients (49.6 years [range: 20-75]) with acute SAH, 106 (66.7%) had abnormal ECGs (classified by an observer blinded to the patients' clinical course and outcome. Conduction abnormalities were present in 7.5%. Arrhythmias occurred in 30.2%. By univariate analysis, the presence of ST depression was related to outcome as assessed by the Glasgow Outcome Scale (GOS) (15% poor outcome [GOS 4-5] vs. 1% good outcome [GOS 1-3], p<0.05)(17).
4. Etc.
Chinese Secrets To Fatty Liver And Obesity Reversal
Use The Revolutionary Findings To Achieve
Optimal Health And Loose Weight
Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer
Back to General health http://kylejnorton.blogspot.ca/p/general-health.html
Back to Kyle J. Norton Home page http://kylejnorton.blogspot.ca
Sources
(14a) http://www.ncbi.nlm.nih.gov/pubmed/22135608
(15) http://www.ncbi.nlm.nih.gov/pubmed/20935079
(16) http://www.ncbi.nlm.nih.gov/pubmed/906062
(17) http://www.ncbi.nlm.nih.gov/pubmed/15301889
Subarachnoid hemorrhage (SAH)
Subarachnoid hemorrhage (SAH) is defined as a condition of the presence of blood within the subarachnoid space (the area between the brain and the thin tissues that cover the brain).
Diagnosis
1. Computed tomography (CT) scan or multidetector CT angiography
If your doctor suspects the bleeding is within the brain itself, then CT scan is the best choice. Computed tomography (CT) is the standard diagnostic tool uses X-rays to make detailed pictures of structures inside the skull to check for fractures and bleeding, specially in case of trauma. Scheduled repeat head computed tomography after mild traumatic brain injury has been shown to have limited use for predicting the need for an intervention. CT scan has correctly identified over 95% of cases—especially on the first day after the onset of bleeding. Others suggested that multidetector CT angiography can be used as a primary examination tool in the diagnostic work-up of patients with SAH(15).
2. A Lumbar puncture
If CT scan can not identify the diagnosis, your doctor may suggest a lumbar puncture (spinal tap). In the study to evaluate the Differentiation of early subarachnoid hemorrhage from traumatic lumbar puncture, showed that the 0.3 to 7% hemolysis which occurred was relatively independent both of the time following SAH and of the number of red blood cells (rbc) in the cerebrospinal fluid (CSF). There was, on the other hand, a significant and time-dependent increase in CSF lactate concentration early after SAH, suggesting the potential clinical value of the detection of increased lactate with a relatively normal lactate/pyruvate ratio in hemorrhagic CSF. Until this can be evaluated in human subjects, however, determination of the rbc counts or total hemoglobin concentrations in serially collected samples of CSF remains the best clinical method(16).
3. ECG
ECG is found to be important in differetiating of SAH. In the study to evaluate all patients admitted to a 31-bed department of intensive care between 1993 and 2000 with acute aneurysmal SAH documented by cerebral angiography or autops, indicated that of 159 patients (49.6 years [range: 20-75]) with acute SAH, 106 (66.7%) had abnormal ECGs (classified by an observer blinded to the patients' clinical course and outcome. Conduction abnormalities were present in 7.5%. Arrhythmias occurred in 30.2%. By univariate analysis, the presence of ST depression was related to outcome as assessed by the Glasgow Outcome Scale (GOS) (15% poor outcome [GOS 4-5] vs. 1% good outcome [GOS 1-3], p<0.05)(17).
4. Etc.
Chinese Secrets To Fatty Liver And Obesity Reversal
Use The Revolutionary Findings To Achieve
Optimal Health And Loose Weight
Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer
Back to General health http://kylejnorton.blogspot.ca/p/general-health.html
Back to Kyle J. Norton Home page http://kylejnorton.blogspot.ca
Sources
(14a) http://www.ncbi.nlm.nih.gov/pubmed/22135608
(15) http://www.ncbi.nlm.nih.gov/pubmed/20935079
(16) http://www.ncbi.nlm.nih.gov/pubmed/906062
(17) http://www.ncbi.nlm.nih.gov/pubmed/15301889
Upper head hemorrhaging: Subarachnoid hemorrhage (SAH) - The Symptoms and Risk Factors
Hemorrhaging is also known as bleeding or abnormal bleeding as a
result of blood loss due to internal.external leaking from blood
vessels or through the skin.
Subarachnoid hemorrhage (SAH)
Subarachnoid hemorrhage (SAH) is defined as a condition of the presence of blood within the subarachnoid space (the area between the brain and the thin tissues that cover the brain).
Symptoms
1. Thunderclap headache, neck stiffness, psychosocial consequences
Classic signs and symptoms include sudden onset of 'thunderclap' headache but patients can present with atypical symptoms such as neck stiffness. For patients who survive SAH, the psychosocial consequences can be devastating and can affect their families or carers(11).
2. Head ache and Meningeal signs
In the study of 193 adult aSAH patients confirmed headache as well as meningeal signs as the most frequent symptom on presentation to the emergency department, and this was cited as the most common reason for seeking medical treatment(12).
3. Confusion, seizures. impairment of language ability and vasospasm
eizures are a recognized complication of subarachnoid hemorrhage (SAH). They can increase the cerebral metabolic demands and lead to cardiopulmonary compromise. This could be detrimental in the setting of delayed cerebral ischemia (DCI), when the brain tissue is vulnerable to further reductions in oxygen delivery or increases in demand. An association between seizures and worsening ischemia could influence the decision to use antiepileptic drug (AED) prophylaxis in patients with vasospasm(13).
4. Intracranial pressure (pressure inside the skull), drop of cerebral blood flowand Cushing reflex respons, brain edema formation, loss of hippocampal neurons, neurological dysfunction
SAH induced a sharp increase of intracranial pressure (ICP) from 5.1+/-1.2 to 78.5+/-9.3 mm Hg (mean+/-SD; p<0.05), a concomitant drop of cerebral blood flow (rCBF) by 81+/-4% (p<0.05), and a significant Cushing reflex response (p<0.05). rCBF measurements alone could not reliably detect SAH. SAH resulted in significant brain edema formation (brain water content increase at 72 h: 2.9+/-0.9%; p<0.05), loss of hippocampal neurons (CA1: -56%, CA2: -55%; CA3: -72%; 7 days; p<0.05), severe neurological dysfunction over 7 days, and a mortality of 30%.(14).
5. Other symptoms
There is a report of a 50-year-old male patient suffered from subarachnoid hemorrhage (SAH). No abnormal condition was found in intracranial vascular digital subtraction angiography (DSA). But, this patient presented with positive hantavirus-IgM and IgG, with typical clinical process, which lead to the diagnosis of EHF followed by SAH. Meticulous assessment of EHF patients with a serious condition had one or more central nervous system (CNS) abnormalities, such as sudden headache, vomiting, confusion, meningismus, and convulsions, which is necessary for diagnosing and giving timely treatment to improve the prognosis(14a).
Risk factors
a, Gene defect
In the study to evaluate whether genes influencing coagulation are associated with the occurrence of aneurysmal subarachnoid hemorrhage (SAH) and with secondary cerebral ischemia and rebleeding in patients with aneurysmal SAH, showed that aneurysmal SAH patients are more often carriers of the subunit B His95Arg factor XIII polymorphism compared to controls. This suggests that carriers of the subunit B His95Arg factor XIII polymorphism have an increased risk of aneurysmal SAH(7).
b. von Willebrand's disease
von Willebrand's disease is associated with the onset of subarachnoid hemorrhage (SAH)(8).
c. Vitamin K deficiency
Although late VKDB leads to significant morbidity and mortality, it can be avoided by providing vitamin K prophylaxis to all newborns. Administration of vitamin K (1 mg) at birth can prevent intracranial bleeding and other hemorrhagic manifestations, according to the study by Erciyes University, Talas, Kayseri, Turkey(9).
d. Factor XI deficiency
Aneurismal subarachnoid haemorrhage (SAH) is a devastating event affecting patients at a fairly young age and accounting for significant morbidity and mortality. Researchers at the National and Kapodistrian University of Athensm reported a unique case of aneurismal SAH in a patient with underlying coagulation FXI deficiency which was incidentally identified after patient's admission, as routine blood tests revealed increased activated partial thromboplastin time. Despite early successful treatment with coiling, the patient had a second episode of SAH a few months after his discharge, due to aneurysm revascularization and rupture(10).
d. Etc.
Chinese Secrets To Fatty Liver And Obesity Reversal
Use The Revolutionary Findings To Achieve
Optimal Health And Loose Weight
Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer
Back to General health http://kylejnorton.blogspot.ca/p/general-health.html
Back to Kyle J. Norton Home page http://kylejnorton.blogspot.ca
Sources
(10) http://www.ncbi.nlm.nih.gov/pubmed/19367158
(11) http://www.ncbi.nlm.nih.gov/pubmed/20437757
(12) http://www.ncbi.nlm.nih.gov/pubmed/22578393
(13) http://www.ncbi.nlm.nih.gov/pubmed/21427775
(14) http://www.ncbi.nlm.nih.gov/pubmed/20457182
(14a) http://www.ncbi.nlm.nih.gov/pubmed/22135608
Subarachnoid hemorrhage (SAH)
Subarachnoid hemorrhage (SAH) is defined as a condition of the presence of blood within the subarachnoid space (the area between the brain and the thin tissues that cover the brain).
Symptoms
1. Thunderclap headache, neck stiffness, psychosocial consequences
Classic signs and symptoms include sudden onset of 'thunderclap' headache but patients can present with atypical symptoms such as neck stiffness. For patients who survive SAH, the psychosocial consequences can be devastating and can affect their families or carers(11).
2. Head ache and Meningeal signs
In the study of 193 adult aSAH patients confirmed headache as well as meningeal signs as the most frequent symptom on presentation to the emergency department, and this was cited as the most common reason for seeking medical treatment(12).
3. Confusion, seizures. impairment of language ability and vasospasm
eizures are a recognized complication of subarachnoid hemorrhage (SAH). They can increase the cerebral metabolic demands and lead to cardiopulmonary compromise. This could be detrimental in the setting of delayed cerebral ischemia (DCI), when the brain tissue is vulnerable to further reductions in oxygen delivery or increases in demand. An association between seizures and worsening ischemia could influence the decision to use antiepileptic drug (AED) prophylaxis in patients with vasospasm(13).
4. Intracranial pressure (pressure inside the skull), drop of cerebral blood flowand Cushing reflex respons, brain edema formation, loss of hippocampal neurons, neurological dysfunction
SAH induced a sharp increase of intracranial pressure (ICP) from 5.1+/-1.2 to 78.5+/-9.3 mm Hg (mean+/-SD; p<0.05), a concomitant drop of cerebral blood flow (rCBF) by 81+/-4% (p<0.05), and a significant Cushing reflex response (p<0.05). rCBF measurements alone could not reliably detect SAH. SAH resulted in significant brain edema formation (brain water content increase at 72 h: 2.9+/-0.9%; p<0.05), loss of hippocampal neurons (CA1: -56%, CA2: -55%; CA3: -72%; 7 days; p<0.05), severe neurological dysfunction over 7 days, and a mortality of 30%.(14).
5. Other symptoms
There is a report of a 50-year-old male patient suffered from subarachnoid hemorrhage (SAH). No abnormal condition was found in intracranial vascular digital subtraction angiography (DSA). But, this patient presented with positive hantavirus-IgM and IgG, with typical clinical process, which lead to the diagnosis of EHF followed by SAH. Meticulous assessment of EHF patients with a serious condition had one or more central nervous system (CNS) abnormalities, such as sudden headache, vomiting, confusion, meningismus, and convulsions, which is necessary for diagnosing and giving timely treatment to improve the prognosis(14a).
Risk factors
a, Gene defect
In the study to evaluate whether genes influencing coagulation are associated with the occurrence of aneurysmal subarachnoid hemorrhage (SAH) and with secondary cerebral ischemia and rebleeding in patients with aneurysmal SAH, showed that aneurysmal SAH patients are more often carriers of the subunit B His95Arg factor XIII polymorphism compared to controls. This suggests that carriers of the subunit B His95Arg factor XIII polymorphism have an increased risk of aneurysmal SAH(7).
b. von Willebrand's disease
von Willebrand's disease is associated with the onset of subarachnoid hemorrhage (SAH)(8).
c. Vitamin K deficiency
Although late VKDB leads to significant morbidity and mortality, it can be avoided by providing vitamin K prophylaxis to all newborns. Administration of vitamin K (1 mg) at birth can prevent intracranial bleeding and other hemorrhagic manifestations, according to the study by Erciyes University, Talas, Kayseri, Turkey(9).
d. Factor XI deficiency
Aneurismal subarachnoid haemorrhage (SAH) is a devastating event affecting patients at a fairly young age and accounting for significant morbidity and mortality. Researchers at the National and Kapodistrian University of Athensm reported a unique case of aneurismal SAH in a patient with underlying coagulation FXI deficiency which was incidentally identified after patient's admission, as routine blood tests revealed increased activated partial thromboplastin time. Despite early successful treatment with coiling, the patient had a second episode of SAH a few months after his discharge, due to aneurysm revascularization and rupture(10).
d. Etc.
Chinese Secrets To Fatty Liver And Obesity Reversal
Use The Revolutionary Findings To Achieve
Optimal Health And Loose Weight
Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer
Back to General health http://kylejnorton.blogspot.ca/p/general-health.html
Back to Kyle J. Norton Home page http://kylejnorton.blogspot.ca
Sources
(10) http://www.ncbi.nlm.nih.gov/pubmed/19367158
(11) http://www.ncbi.nlm.nih.gov/pubmed/20437757
(12) http://www.ncbi.nlm.nih.gov/pubmed/22578393
(13) http://www.ncbi.nlm.nih.gov/pubmed/21427775
(14) http://www.ncbi.nlm.nih.gov/pubmed/20457182
(14a) http://www.ncbi.nlm.nih.gov/pubmed/22135608
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