Articles: subarachnoid-hemorrhage.
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Septic cavernous sinus thrombosis (SCST) is a rare infectious thrombophlebitic disease. The infection often arises from the tissues surrounding the cavernous sinus as well as the cavernous sinus drainage. Early symptoms of SCST include fever, headache, proptosis, ptosis, bulbar conjunctival edema, and limited eye movement. The complications include venous sinus thrombosis, intracerebral abscess, and subdural empyema. Aneurysmal subarachnoid hemorrhage combined with acute cerebral infarction has not been reported. ⋯ We report a case of SCST mainly presenting as acute cerebral infarction and aneurysmal subarachnoid hemorrhage, with an acute onset and ultimately a poor prognosis. This complication is extremely rare and have not yet reported according existing literatures but can be life-threatening if not recognized and treated promptly. Early antibiotic administration and early sinus drainage may alter the patient's prognosis. By describing this unusual the case we hope to raise awareness of the need of early illness detection and treatment in order to avoid catastrophic consequences. It also exemplifies the mechanism of acute inflammatory disorders and aneurysm development.
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The associations of neutrophil to lymphocyte ratio (NLR) and red cell distribution width (RDW) with the prognosis of aneurysmal subarachnoid hemorrhage (aSAH) patients were confirmed in a few studies. But NLR and RDW levels in most of these studies were on admission. Here we carried 1 retrospective study including 150 patients with aSAH who underwent surgeries in the First Affiliated Hospital of Yangtze University from January 2020 to February 2023 to explore the associations on the preoperative day, the first (1st), third (3rd), and seventh (7th) postoperative days. ⋯ Higher RDW on the 3rd postoperative day and NLR on the 7th postoperative day were possibly associated with poor prognosis of aSAH patients. We should pay attention to the RDW and NLR levels during different hospitalization periods, especially in the short postoperative period. Moreover, the cutoff values for predicting prognosis need to be validated in larger-sample studies.
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Observational Study
Myocardial dysfunction assessed by speckle-tracking in good-grade subarachnoid hemorrhage patients (WFNS 1-2): a prospective observational study.
Cardiac complications due to non-traumatic subarachnoid hemorrhage (SAH) are usually described using classical echocardiographic evaluation. Strain imaging appears to have better sensitivity than standard echocardiographic markers for the diagnosis of left ventricular dysfunction. The aim of this study was to determine the prevalence of cardiac dysfunction defined as a Global Longitudinal Strain (GLS) ≥ - 20% in patients with good-grade SAH (WFNS 1 or 2). ⋯ Strain imaging showed a higher prevalence (60.6%) of left ventricular dysfunction during the acute phase of good-grade SAH (WFNS 1 or 2) than previously described.
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Journal of neurotrauma · Nov 2023
Observational StudyOptic nerve diameter on non-contrast computed tomography and intracranial hypertension in patients with acute brain injury: A validation study.
Intracranial hypertension is a feared complication of acute brain injury that can cause ischemic stroke, herniation, and death. Identifying those at risk is difficult, and the physical examination is often confounded. Given the widespread availability and use of computed tomography (CT) in patients with acute brain injury, prior work has attempted to use optic nerve diameter measurements to identify those at risk of intracranial hypertension. ⋯ When used to identify those with intracranial hypertension (> 20 mm Hg), the area under the receiver operator curve (AUROC) was 0.68. Using a previously proposed threshold of 0.6 cm, the sensitivity was 81%, specificity 43%, positive likelihood ratio 1.4, and negative likelihood ratio 0.45. CT-derived optic nerve diameter using a threshold of 0.6 cm is sensitive but not specific for intracranial hypertension, and the overall correlation is weak.
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A 62-year-old man presented a diffuse and predominantly cisternal acute nonaneurysmal subarachnoid hemorrhage associated with hydrocephalus. An external ventricular drain was placed, followed by clinical deterioration after its removal. At this point, a heavily T2-weighted high-resolution sequence of a brain magnetic resonance imaging showed acute hydrocephalus recrudescence and multiple arachnoid adhesions in the supravermian and interpeduncular cisterns, creating a loculated/cystic appearance. ⋯ Fibrosis and adhesions at the subarachnoid spaces may follow, restricting cerebrospinal fluid circulation, particularly at the cranial base. Hydrocephalus probably resulted from the combination of subarachnoid hemorrhage and extensive scaring at the basal cisterns, precluding transdural and transvenous cerebrospinal fluid efflux. Heavily T2-weighted high-resolution magnetic resonance imaging sequences allow an exquisite depiction of arachnoiditis, displaying obstructive cisternal membranes, and contribute to better etiologic assessment and management of hydrocephalus.