Clinical Program for Cerebrovascular Disorders Mount Sinai Medical Center Intraventricular Hemorrhage and TPA Clinical Case Presentation Clara Raquel Epstein,

Slides:



Advertisements
Similar presentations
THE CLINICAL EFFICACY OF REPEAT BRAIN CT IN PATIENTS WITH TRAUMATIC INTRACRANIAL HAEMORRHAGE WITHIN 24 HRS AFTER BLUNT HEAD INJURY.
Advertisements

Radiology Slideshow CT & MRI Ian Anderson, 2007.
Q? Neuroradiology This would be best described as a Spetzler grade: 1
Management of Ruptured Cerebral Aneurysms with Poor Grade SAH (Grade IV and V) Prof. Dr. Leónidas M. Quintana Prof. Dr. Leónidas M. Quintana Department.
Mechanical Injuries Of Brain and Meniges.
Mallika Khwanmuang Phatcharapol Udomluck Jitsupa Litleangdej th year medical students.
The Brain Lecture 2 Ali B Alhailiy.
Treatment of hydrocephalus at the Wessex Neurological Centre
B.A.P.E.T Brain Attack Protocol & Emergency Treatment By: Nicole Florentine, Christina Lauderman Erin Patrick, & Kara Sharp.
Figures 8.1 through 8.5 represent 5 patients who presented with focal neurological deficits and acute change in mental status Non-contrast CT Brain.
What is a Stroke? Lumen ventricle A stroke is an injury to the brain caused by interruption of its blood flow, or by bleeding into or around the brain.
Neuroradiology DR. Sharifa AL-Duraibi.
Dr. VASHDEV KHIMANI ASSISTANT PROFESSOR DEPT. OF NEUROSURGERY LUMHS JAMSHORO.
Clinical Program for Cerebrovascular Disorders Mount Sinai Medical Center Intracerebral Hemorrhage and A Comprehensive Overview of the Malignant Gliomas.
Sudden Headache and Unresponsiveness in a 10 year-old boy Sudden Headache and Unresponsiveness in a 10 year-old boy J. Stephen Huff, MD, FACEP Emergency.
Journal Club: The ED Management of Intracerebral Hemorrhage Patients Journal Club: The ED Management of Intracerebral Hemorrhage Patients Nils G. Wahlgren,
SPECT imaging in cerebrovascular disease Measurement of regional cerebral blood flow (rCBF) Sensitive indicator of perfusion Diagnosis and prognosis of.
Grand Rounds Brooke LW Nesmith, M.D., J.D.
Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology Intracranial mass presenting with hemorrhage and respiratory.
Author(s):Ross, Ian B. MD; Fratkin, Jonathan D. MD Issue:Volume 63(2), August 2007, pp E47-E50 Publication Type:[Case Report] Publisher:© 2007 Lippincott.
Brain Single-Photon Emission CT With HMPAO and Safety of Thrombolytic Therapy in Acute Ischemic Stroke Proceedings of the Meeting of the SPECT Safe Thrombolysis.
Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical.
Seeing a Stroke Developed by: K. Banasky, RN, BSN Educator GCH Emergency Services.
GAL-INT-6 The safety and efficacy of galantamine in patients with Vascular dementia or AD with cerebrovascular disease Sean Lilienfeld MD, FCP, MMed Janssen.
Done by : Abdulgadir F. Bugdadi Ahmed Al-Shinkiti Hassan Al-Fadda Blind Ventricular Catheter Placement in Experienced Hands: How Optimal is it?
Consultant Neuroradiologist
MedPix Medical Image Database COW - Case of the Week Case Contributor: Wendy Smoker Affiliation: University of Iowa Health Care.
Dr Kneale Metcalf Stroke Physician (NNUHFT)
IN THE NAME OF ALLAH THE MOST MERCIFUL, THE MOST KIND “Blessed is He in Whose hand is the Sovereignty, and He is Able to do all things Who hath created.
Malignant MCA Infarction and Hemicraniectomy
Dr. Amer Jafar.  Previous studies showed that a positive family history of stroke (FHstroke) is an independent risk factor for lacunar stroke  The aim.
 69 y/o female with a 3 day history of posterior cervical pain and posterior headache.  On 8/13/15 at 2:30 PM she presented with sudden severe worsening.
Treatment of Ischaemic Stroke The American Heart Association American Stroke Association Guidelines Stroke. 2007;38:
AN UNUSUAL CASE OF SUBDURAL HAEMATOMA Theuns van Jaarsveld 28 January 2009.
Birth trauma in newborns Ass.prof. of hospital pediatric department.
Subarachnoid Hemorrhage. Etiology Spontaneous (primary) subarachnoid hemorrhage usually results from ruptured aneurysms. A congenital intracranial saccular.
Diagnosis and Treatment of Idiopathic Normal Pressure Hydrocephalus
Intracerebral Hemorrhage
Cerebrovascular diseases
CT BRAIN anatomy.
INTRAVENTRICULAR HEMORRHAGE IN THE NEONATE YURIDIA, KENNEDY RT-29 NEONATAL.
Normal Pressure Hydrocephalus
+ Praxis Patient Empowerment Post-Cerebrovascular Accident Allison Deighton NURS 484 Saginaw Valley State University.
Radiology Training Course. Timing of Imaging Studies.
HADJIGEORGIOU GF, MARKOGIANNAKIS G, PETROSYAN T, ZISAKIS A, PANTELI A, KELESIS C, HADJIGEORGIOU FG, VARSOS V DEPARTMENT OF NEUROSURGERY RED CROSS HOSPITAL,
Abstract No: eEdE-103 Submission Number: Disclosure There is no disclosure.
Neuroimaging Pearls For The Primary Care Provider Praveen Dayalu, MD Clinical Associate Professor Department of Neurology University of Michigan.
The impact of hyperacute blood pressure lowering on the early clinical outcome following intracerebral hemorrhage Ryo Itabashia, Kazunori Toyodaa,b, Masahiro.
IN THE NAME OF GOD Dr. h-kayalha Anesthesiologist.
J. Villanueva-Meyer, C. Glastonbury
Unilateral Manifestation of Deep Cerebral Vein Thrombosis
55 year-old man with acute headache and dizziness Teaching NeuroImages Neurology Resident and Fellow Section David Yen-Ting Chen, MD Ying-Chi Tseng, MD.
A 22 year old male with acute seizures and hemiparesis
A 9-year old girl with multi-compartmental intracranial hemorrhage
Increased Intracranial Pressure
Priorities for Clinical Research in Intracerebral Hemorrhage
Performance Improvement: Emergency Management in Acute Cerebrovascular Patients Current US Guidelines Lisa A. Shultz, MD Medical Director, Lourdes Stroke.
Rupture and spontaneous resolution of a P1 perforator pseudoaneurysm
Illustrative case 2.A, Nonenhanced CT scan shows subarachnoid hemorrhage and ventricular prominence.B, Right internal carotid artery angiogram, frontal.
Vasculitis. Vasculitis. This 16-year-old girl with systemic lupus erythematosus, chronic pancreatitis, nephritis, hypertension, cerebritis, and epilepsy.
Cerebrovascular disease
Surgical Decision Making for the Treatment of Intracranial Aneurysms
A 19-year-old woman presented with acute onset of headaches to the emergency department. A 19-year-old woman presented with acute onset of headaches to.
A 51-year-old man with a long history of headaches with associated nausea and vomiting. A 51-year-old man with a long history of headaches with associated.
Patient 16. Patient 16. Pre- and post-treatment images in a 13-year-old patient with a malignant hypothalamic glioma.A, Pretreatment FLAIR images (top.
Presentation transcript:

Clinical Program for Cerebrovascular Disorders Mount Sinai Medical Center Intraventricular Hemorrhage and TPA Clinical Case Presentation Clara Raquel Epstein, MD Fellow

Intraventricular Hemorrhage and TPA Clinical Case Presentation A 70 year old right handed Hispanic male with a history of hypertension, asthma, chronic renal insufficiency, s/p Bilroth I and s/p hypertensive basal ganglia hemorrhage on 10/28/98 presented on 11/9/99 with left upper extremity weakness, slurred speech, dizziness, vomiting, and blurred vision. Per history the patient ran out of his antihypertensive medications two weeks prior to admission and had complained of headaches for two days prior to presentation. On arrival to the emergency room the patients blood pressure was 246/120. In the ER, the patient was subsequently intubated in order to protect his airway from secretions.

Hospital Course On admission a CT scan was obtained which showed evidence of a right basal ganglia/thalamus hemorrhage with intraventricular extension. There was also enlargement of the ventricular system consistent with hydrocephalus. As compared with the previous MRI from 10/29/98, which demonstrated evidence of a focus of hemorrhage in the posterior limb of the right internal capsule, in the same location, it was suggested that this could represent an underlying vascular malformation such as a cavernous angioma.

Hospital Course Neurosurgery was consulted and on 11/10/99, a ventriculostomy was placed. The position of the catheter was re-adjusted on 11/11/99 for maximal placement considering the possibility of administering TPA. Pre and post CT scans confirmed adequate placement of the catheter to be relocated from the anterior third ventricle to the frontal horn of the right lateral ventricle. The ventricles were noted to be slightly smaller from the previous scan obtained 11/9/99.

Hospital Course The patients course in the NSICU is significant for difficulty controlling his blood pressure fluctuations, and respiratory distress with multiple intubations and extubations. The renal service was consulted and the patient has received multiple episodes of hemodialysis. In addition, on 11/16/99 the GI service was consulted for decreasing hemoglobin from the time of admission of 11.1 to 8.1. An EGD was performed and there was evidence of ulceration at the site of previous surgery.

Hospital Course Neurologically the patient improved in the first couple of days. He was able to follow commands. However, on 11/15/99, the patients neurologic status appeared to once again decline. It was initially thought that this change in status might be related to decreased CSF drainage from the ventriculostomy.

Hospital Course The current plan includes replacement of the ventriculostomy and to continue present management. The patient will continue to be evaluated for the need for placement of a ventriculoperitoneal shunt.

Adam Davis, MD Interventional Neuroradiology

Literature Review

Intraventricular hemorhage in adults: complications and treatment. Naff NJ; Tuhrim S New Horizons1997 Nov;5(4) : Intraventricular hemorrhage (IVH) frequently occurs in the setting of intracerebral and subarachnoid hemorrhage, and is an independent and significant contributor to morbidity and mortality in both conditions. Present therapy of IVH is directed at treating the associated complications of obstructive and communcating hydrocephalus. These therapies are often inadequate to treat the complications and do not remedy the underlying IVH. Intraventricular thrombolysis is a promising but unproven new therapy that directly addresses the IVH and my reduce the incidence of obstructive and communicating hydrocephalus.

Intraventricular hemorhage in adults: clinical-computed tomographic correlations. Weisberg LA, et al. Computed Medical Imaging Graph 1991 Jan-Feb;15(1):43-51 The clinical and CT findings in 100 consecutive adult nontraumatic intraventricular hemorrhage (IVH) cases were analyzed. There were 74 parenchymal brain hemorrhages with secondary ventricular extension. The ventricles were filled with blood and asymmetrically enlarged. If the hemorrhage involved putamen, cerebellum, pons or subcortical cerebral hemishpheric white matter, IVH was associated with large parenchymal hematomas; these patients had poor clinical outcome. With thalamic or caudate hematomas, IVH frequently occurred with large hematomas but may occur with small hematomas. The small hematomas were located directly contiguous to the ventricular walls and caused extensive ventricular blood. Patients with small thalamic and caudate hemorrhage with intraventricular blood had good clinical outcome; whereas patients with large hematomas had poor outcome. Primary IVH occurred in 24 cases. In these cases, blood was seen in all ventricular chambers. Aneurysms involving the anterior cerebral-anterior communicating artery region were the most common etiology for primary IVH.

Literature Review 1.Intraventricular streptokinase infusion in acute post-haemorrhagic hydrocephalus. 2.Fibrinolytic agents in the treatment of intraventricular hemorrhage in adults. 3.Recombinant tissue plasminogen activator for the treatment of spontaneous adult intraventricular hemorrhage. 4.Traumatic intraventricular hemorrhage treated with intraventricular recombinant-tissue plasminogen activator: technical case report. 5.Intraventricular urokinase for the treatment of posthemorrhagic hydrocephalus. 6.Fibrinolytic agents in the management of posthemorrhagic hydrocephalus in preterm infants: the evidence. 7.A cohort study of the safety and feasibility of intraventricular urokinase for nonaneurysmal spontaneous intraventricular hemorrhage. 8.Outcome in patients with large intraventricular haemorrhages: a volumetric study.