Emergency Free-Hand Bedside Catheter Evacuation of Large Intracerebral Hematomas Following Thrombolysis for Ischemic Stroke: A Case Series

AbstractIntroductionSymptomatic intracerebral hemorrhage (sICH) following systemic thrombolysis for ischemic stroke is often devastating, and open surgical evacuation is considered dangerous due to the increased risk of perioperative bleeding, and stereotactic placement of a catheter is too time-consuming. We therefore evaluated the feasibility of a free-hand bedside catheter technique for emergency hematoma evacuation.MethodsPatients who had a supratentorial sICH after thrombolysis, a hematoma volume  >  30 ml, and an ensuing reduction in vigilance were consecutively treated with acute minimally invasive catheter hematoma evacuation. Catheter insertion and trajectory were planned via 3D-reconstructed computed tomography (CT) scan, and free-hand insertion of an external ventricular catheter into the core of the hematoma was performed bedside, followed by careful blood aspiration. Cranial CT was used to verify catheter position and residual hematoma volume. In cases, where the residual volume exceeded 15 ml, urokinase (5000 IE) was administered into the clot every 6 h until the volume dec reased to 
Source: Neurocritical Care - Category: Neurology Source Type: research

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Emilio Rodríguez-Castro1,2, Manuel Rodríguez-Yáñez1,2, Susana Arias1,2, María Santamaría1,2, Iria López-Dequidt1,2, Ignacio López-Loureiro1, Manuel Rodríguez-Pérez1, Pablo Hervella1, Tomás Sobrino1, Francisco Campos1, José Castillo1* and Ramón Iglesias-Rey1* 1Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain2Stroke Unit, Department of Neurology, Hospital Clínico Universitario, Santiago...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Johannes Schurig1,2*, Karl Georg Haeusler1,2,3, Ulrike Grittner4,5, Christian H. Nolte1,2, Jochen B. Fiebach1,2, Heinrich J. Audebert1,2, Matthias Endres1,2,5,6 and Andrea Rocco1,2 1Center for Stroke Research Berlin, Charité–Universitätsmedizin Berlin, Berlin, Germany 2Department of Neurology, Charité–Universitätsmedizin Berlin, Berlin, Germany 3Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany 4Insitute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, Berlin, Germany 5Berlin Institute of Heal...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Conclusion: Defining the vascular pathology by CTA directly at the emergency site may be beneficial in triaging patients with various cerebrovascular diseases to the most appropriate target hospital and specialized treatment.Cerebrovasc Dis 2017;44:338 –343
Source: Cerebrovascular Diseases - Category: Neurology Source Type: research
Objective:We sought to determine the safety of Intravenous (IV) recombinant tissue plasminogen activator (rtPA) in patients who received IV rtPA for acute ischemic stroke (AIS) and had a platelet count less than 100,000 /mm3.Background:A platelet count
Source: Neurology - Category: Neurology Authors: Tags: Thrombolysis and Acute Evaluation in Ischemic Stroke Source Type: research
J Mocco, MD, MS Professor and Vice Chair for Education Director, Cerebrovascular Center Residency Program Director Department of Neurological Surgery Mount Sinai Health System Intracerebral Hemorrhage: The 'Other' Stroke A recent patient of mine, 48-year-old "Joe" (not his real name), was eating with his family at an Italian restaurant. Suddenly, he stood up, cursed, and collapsed. They brought him to the hospital, and he could not talk, move, or do anything we asked him to do. It turned out that Joe had suffered the second-most common, but deadliest, form of stroke: intracerebral hemorrhage. When people hea...
Source: Healthy Living - The Huffington Post - Category: Consumer Health News Source Type: news
AbstractDirect oral anticoagulants (DOACs) are superior to warfarin in reduction of the intracranial bleeding risk. The aim of the present study was to assess whether early DOAC introduction (1 –3 days after onset) in stroke patients with non-valvular atrial fibrillation (nVAF) may be safe and effective, compared with DOAC introduction after 4–7 days. We conducted a prospective analysis based on data collected from 147 consecutive nVAF patients who started DOAC within 7 days after stro ke onset. In all patients, we performed pre-DOAC CT scan 24–36 h after onset and follow-up CT scan at 7 days after D...
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research
Conclusions— WMLs visible on computed tomography are associated with a more than doubled risk of sICH in patients treated with intravenous thrombolysis for acute ischemic stroke.
Source: Stroke - Category: Neurology Authors: Tags: Computerized tomography and Magnetic Resonance Imaging, Thrombolysis Clinical Sciences Source Type: research
Conclusions VHL/PBRM1 mutations confirmed 3rd subtype identified and under review but appears to be mis-classified tumors.  Shows value of molecular methods rather than new mechanistic insights. Integration with survival outcome—suggests molecular detailing can be prognostic Full integrative analysis in process Preliminary data can be found at http://tcga-data.nci.hih.gov/tcga/ FoxO Transcription Factors in mTORC1- Activated Renal Tumorigenesis:  Implications for the RCC Treatment Boyi Gan, MD Anderson Cancer Center FoxO Family Transcription Factors:  mammals possess FoxO...
Source: Kidney Cancer Association - Category: Urology & Nephrology Source Type: news
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