No abstract available.
Basal Ganglia Hemorrhage ; Basal Ganglia ; Catheters ; Drainage ; Status Epilepticus

No abstract available.
Brain ; Tuberculoma

BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is classically characterized by symmetric vasogenic edema in the parietooccipital areas, but may occur at other sites with varying imaging appearances. CASE REPORT: A 55-year old female with chronic kidney disease (CKD) was admitted to the emergency room, presenting with nausea, vomiting and seizure. The initial blood pressure was 145/90 mmHg. Fluid attenuated inversion recovery demonstrated diffuse vasogenic edema in the bilateral cortical and subcortical white matters involving the frontal lobes. Perfusion magnetic resonance imaging (MRP) showed no hyper- or hypoperfusion at blood pressure levels of 140/50 mmHg. A follow-up magnetic resonance imaging at 3 weeks later demonstrated complete resolution of previous lesions. CONCLUSIONS: Earlier reports have demonstrated that PRES can occur in cases of atypical distributions, and features of imaging findings and normotensive settings. It is important to note that PRES is a dynamic process. As a result, we suggest that MRP must be considered in the appropriate temporal framework, to avoid misinterpretation of the other diseases, especially in CKD patients.
Blood Pressure ; Edema ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Frontal Lobe ; Humans ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Nausea ; Perfusion Imaging ; Perfusion ; Posterior Leukoencephalopathy Syndrome ; Renal Insufficiency, Chronic ; Seizures ; Vomiting ; White Matter

BACKGROUND: Medical management of patients presenting with spontaneous intracerebral hemorrhage (ICH) is focused on blood pressure (BP) management. However, the BP goal to prevent ICH expansion remains controversial. Recent clinical trials have suggested that aggressive BP control is safe but may not have the previously thought benefits. CASE REPORT: We present an example of aggressive BP control in the setting of hypertensive ICH, in accordance to previously established protocols. This resulted in adverse effects in the form of acute kidney injury and watershed infarcts, which impeded the patients' recovery and prolonged his hospitalization. CONCLUSIONS: Hypertensive individuals have altered cerebral autoregulation curves shifted to the right and require higher arterial pressures to maintain adequate cerebral blood flow. Hence, aggressive BP reduction may result in cerebral hypoperfusion as well as other forms of end-organ damage.
Acute Kidney Injury ; Arterial Pressure ; Blood Pressure ; Cerebral Hemorrhage ; Cerebral Infarction ; Cerebrovascular Circulation ; Homeostasis ; Hospitalization ; Humans

BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is a neurological complication caused by cerebral hyperperfusion. CASE REPORT: A 46-year-old male presented with decreased mental status, left facial palsy, and left-sided weakness after video-assisted thoracoscopic surgery for a solitary pulmonary nodule. During the surgery, phenylephrine was infused intravenously for general anesthesia-induced hypotension. High signal intensity at the right parietooccipital lobe was noted on fluid-attenuated inversion recovering imaging and diffusion-weighted imaging. His neurological symptoms improved two days after initial presentation. Follow-up diffusion-weighted imaging showed resolution of the brain lesions 10 days after the surgery. CONCLUSIONS: We report a patient who presented with PRES after administration of phenylephrine during resection of a solitary pulmonary nodule. PRES should be considered for patients presented with acute neurologic symptoms following surgical procedures.
Brain ; Facial Paralysis ; Follow-Up Studies ; Humans ; Hypertension ; Hypotension ; Male ; Middle Aged ; Neurologic Manifestations ; Phenylephrine ; Posterior Leukoencephalopathy Syndrome ; Solitary Pulmonary Nodule ; Thoracic Surgery, Video-Assisted

BACKGROUND: Various etiologies are the causative agents for sciatic neuropathy. We present here a case of ischemic sciatic neuropathy in a patient with liposarcoma. CASE REPORT: A 55-year-old woman presented with severe pain and weakness of the left leg. She had a history of recurred retroperitoneal liposarcoma, and was being administered chemotherapy. Examination revealed weakness in ankle dorsiflexion, plantar flexion and hamstring. Complaints also included dysesthesia, and numbness in the sole and dorsum of the foot. Nerve conduction study showed low compound muscle action potentials and slow motor conduction velocity of left peroneal and tibial nerves, with indiscernible sensory nerve action potentials of the left superficial peroneal and sural nerves. Computed tomography angiography revealed occlusion of the left common iliac artery. Commencement of intravenous infusion of heparin resulted in skin color change and progression of the weakness. Hence, the patient underwent an emergency thrombectomy. CONCLUSIONS: Ischemia should be considered as a cause of sciatic neuropathy in cancer patients, which requires management with timely treatment.
Action Potentials ; Angiography ; Ankle ; Drug Therapy ; Emergencies ; Female ; Foot ; Heparin ; Humans ; Hypesthesia ; Iliac Artery ; Infusions, Intravenous ; Ischemia ; Leg ; Liposarcoma ; Middle Aged ; Neural Conduction ; Paresthesia ; Sciatic Neuropathy ; Skin Pigmentation ; Sural Nerve ; Thrombectomy ; Tibial Nerve

BACKGROUND: The objective of the study was to evaluate the predictive value of plasma D-dimer at admission after acute ischemic stroke, and to assess its effect on short-term functional outcome. METHODS: Fasting plasma D-dimer was measured in 290 consecutive patients (61.7% men, mean age 67.0±12.3 years) within 3 days after the onset of acute ischemic stroke. The outcomes were measured at 3-months after stroke onset, by the modified Rankin Scale (mRS). RESULTS: Atrial fibrillation, hypertension, diabetes and involvement of the insular cortex, the levels of serum high sensitive C-reactive protein and D-dimer, as well as incidence of women and age, were all significantly higher in the poor outcome group (P<0.05). After the adjustment of National Institutes of Health Stroke Scale (NIHSS) scores on admission, the plasma D-dimer levels positively correlated with mRS (Spearman partial rho=0.247, P<0.001). The cut-off value of D-dimer level for prediction of poor outcomes was 0.35 mg/L (sensitivity 0.70, specificity 0.63, area under the curve 0.71). Furthermore, two multivariated logistic regression analysis models were performed. One model excluded the NIHSS score as an independent variable, and demonstrated that D-dimer (odds ratio, 1.24 for every 1.0 mg/L, P<0.05) was independently associated with poor functional outcome. Conversely, the other model which included the NIHSS score, did not show any such association. CONCLUSIONS: Plasma D-dimer level is a useful marker for short-term outcomes in acute ischemic stroke, and may have a role in risk stratification for predicting a poor outcome.
Atrial Fibrillation ; C-Reactive Protein ; Cerebral Cortex ; Cerebral Infarction ; Fasting ; Female ; Humans ; Hypertension ; Incidence ; Logistic Models ; Male ; National Institutes of Health (U.S.) ; Plasma ; Prognosis ; Sensitivity and Specificity ; Stroke

Kidney impairment due to acute kidney injury or chronic kidney disease is a potent risk factor for stroke which is a leading cause of morbidity and mortality worldwide. Patients with kidney impairment have various neurologic complications, including uremic encephalopathy, polyneuropathy, and cognitive impairment as well as higher rates of ischemic and hemorrhagic stroke and frequent seizures. Due to hypertension, coagulopathy, platelet dysfunction, and vascular disease, patients with kidney impairment are at high risk for types of catastrophic intracranial hemorrhages and strokes that typically lead to intracranial hypertension and cerebral herniation syndrome. Kidney impairment can alter drug pharmacokinetics and pharmacodynamics, and consequently patients with kidney impairment are at risk of experiencing adverse effects. Several central nervous system imaging modalities are not recommended in patients with compromised kidney function. Therefore, management of acute neurological conditions requires special attention in patients with kidney impairment. Given these common acute neurological conditions, physicians who care for patients with kidney impairment must be aware of evaluation and treatment of neurological diseases to achieve positive neurological outcomes.
Acute Kidney Injury ; Blood Platelets ; Brain Diseases ; Central Nervous System ; Cerebrovascular Disorders ; Cognition Disorders ; Humans ; Hypertension ; Intracranial Hemorrhages ; Intracranial Hypertension ; Kidney Diseases ; Kidney ; Mortality ; Pharmacokinetics ; Polyneuropathies ; Renal Insufficiency, Chronic ; Risk Factors ; Seizures ; Stroke ; Vascular Diseases

Patients admitted to the neuro-intensive care unit experience a number of cardiovascular complications. This is because of common risk factors exist between neurologic and cardiovascular diseases, and also the close interconnection between brain and heart, leading to an increased cardiovascular burden. Although the cardiovascular complications may or may not be clinically significant, the medical team should be aware of these instances, since such cardiac complications often result in fatal and irreversible outcomes. Particularly, unexpected cardiac arrest, acute myocardial infarction, uncontrolled atrial fibrillation, QT prolongation, and Takotsubo cardiomyopathy are common occurrences in the neuro-intensive care unit, and require careful attention. In this article, we review the incidence, clinical significance and management of such neuro-intensive care unit cardiac complications.
Atrial Fibrillation ; Brain ; Cardiovascular Diseases ; Death, Sudden, Cardiac ; Heart ; Heart Arrest ; Humans ; Incidence ; Intensive Care Units ; Myocardial Infarction ; Risk Factors ; Takotsubo Cardiomyopathy

Neurocritically ill patients are at an increased risk of other organ dysfunctions, especially lung injury. Major pulmonary complications, including acute respiratory distress syndrome, ventilator-associated pneumonia, and neurogenic pulmonary edema, are frequently caused by brain injury, and are associated with poor outcome. Brain and lung have strong interactions via complex pathways from the brain to the lung, and vice versa. Excessive release of catecholamines and systemic inflammatory responses play an integral role in the development of pulmonary dysfunction after brain injuries. Mechanical ventilation is commonly used to manage pulmonary dysfunctions associated with brain injury, and lung protective ventilation strategies reduce injuries to the lung and brain. This review focuses on the current knowledge regarding the epidemiology and pathophysiology of lung injuries in patients with neurocritical illness, and the various strategies of mechanical ventilation used to reduce lung injury.
Brain Injuries ; Brain ; Catecholamines ; Epidemiology ; Humans ; Lung Injury ; Lung ; Pneumonia, Ventilator-Associated ; Pulmonary Edema ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult ; Ventilation