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Brain Stem Hemorrhage

Brainstem Hemorrhage


Presentation

  • A 38-year-old hypertensive woman presented with acute onset of cranial nerve and long tract signs referable to a lesion in the right dorsolateral pons. A hemorrhage in the suspected area was demonstrated by CT.[ncbi.nlm.nih.gov]
  • The authors present a case of a 29-year-old man who developed rapidly progressive cranial nerve palsies and a right hemiparesis secondary to a pontine hemorrhage.[ncbi.nlm.nih.gov]
  • A 76-year-old man presented with brain stem hemorrhage after burr-hole drainage for bilateral chronic subdural hematomas.[ncbi.nlm.nih.gov]
  • April 05, 2016 ; 86 (16 Supplement) April 16, 2016 First published April 8, 2015, Abstract Objective: We present a case of Superior Colliculi hemorrhage that was incidentally discover on head CT scan with the only presenting symptom of left hemi-body[neurology.org]
  • Secondary occipital lobe infarction was present in 3.5% of the patients. It is concluded that secondary brain stem hemorrhage is a common major contribution to the cause of death in stroke.[ncbi.nlm.nih.gov]
Hyperacusis
  • We report a 43 year old gentleman who’s only presenting symptom to his primary care provider was left body, mainly facial paresthesia, mild left facial droop and hyperacusis. The only risk factor in this case was, Tobacco use.[neurology.org]
Miosis
  • The fulminating malignant course is characterised by rapid onset of coma, miosis, tetraplegia and respiratory disturbances. Three quarters of all patients die within 24 hours ( 8 , 13 , 25 ).[link.springer.com]

Workup

Neurofibrillary Tangle
  • We report findings from an autopsy of a male in his 40s who died of a brain stem hemorrhage associated with cerebral amyloid angiopathy (CAA), senile plaques (SPs) and neurofibrillary tangles (NFTs), which are histopathological changes associated with[ncbi.nlm.nih.gov]

Treatment

  • He recovered after conservative treatment. Asymmetrical and rapid decompression, which leads to vascular disruption and/or sudden increase in cerebral blood flow, was probably responsible for the secondary brain stem hemorrhage.[ncbi.nlm.nih.gov]
  • One patient died on the second day and the other on the third day after onset despite supportive treatment. These cases of brain stem hemorrhage with fulminant hyperthermia should be distinguished from those with simple hyperthermia.[ncbi.nlm.nih.gov]
  • […] evaluation of clipping versus coiling 211 Preliminary report of the clot lysis evaluating accelerated resolution of intraventricular hemorrhage CLEARIVH clinical trial 216 Leptin plays a role in ruptured human brain arteriovenous malformations 221 Novel treatments[books.google.de]
  • Recognizing the signs of stroke quickly is critical because the treatments are time sensitive.[massgeneral.org]
  • Ongoing treatment will depend on the type of stroke experienced.[guidedoc.com]

Prognosis

  • CT indicates a more favorable prognosis for brain stem hemorrhage than has been previously suspected.[ncbi.nlm.nih.gov]
  • . • MRI may provide further detail and aid prognosis. • Surgery is reserved for select cases in which specific expertise is available.[medlink.com]
  • XenonCT study of regional cerebral blood flow around hematoma in patients with basal ganglia hemorrhage 160 Preliminary application of pyramidal tractography in evaluating prognosis of patients with hypertensive intracerebral hemorrhage 165 Experimental[books.google.de]
  • The prognosis has been reported to be highly dependent on the clinical severity at presentation and the presence of certain radiological markers.[ncbi.nlm.nih.gov]
  • Prognosis for Stroke Patients The prognosis for stroke patients varies dramatically between individuals. The most important factor in a patient’s brain stem stroke prognosis is time.[guidedoc.com]

Etiology

  • MRI is frequently needed to make a specific diagnosis and to separate vascular etiologies from tumor and other structural injuries. The pattern of sensory disturbance may be helpful.[dizziness-and-balance.com]
  • "Comparison of CTA to DSA in determining the etiology of spontaneous ICH". Canadian Journal of Neurological Sciences . 36 (2): 176–180. doi : 10.1017/s0317167100006533 . Greenberg, Mark S. (2016). Handbook of Neurosurgery . ISBN 9781626232419 .[en.wikipedia.org]

Epidemiology

  • There is racial variation in the incidence of bleeding into the brain substance; Asians, Latin American, Mexican American, Native American and African American patients have a greater risk according to epidemiological data.[minneapolisclinic.com]
  • A maximal score (score 100) indicates full independence for all items, whereas a minimal score (score 0) indicates that the patient is fully dependent for all items. 21 Statistical Analysis A descriptive analysis of the epidemiologic characteristics of[ajnr.org]
  • […] by 30 days after the insult, [7] and half of the deaths occur in the first 2 days. [29] Even though the majority of deaths occurs in the first days after ICH, survivors have a long term excess mortality of 27% compared to the general population. [30] Epidemiology[en.wikipedia.org]
Sex distribution
Age distribution

Pathophysiology

  • . * A comprehensive source that thoroughly examines the neurological manifestations of stroke * A guide to highly studied topics, including stroke complications, syndromes, and stroke related psychiatric disorders * A better understanding of the pathophysiological[books.google.com]
  • In Barnet HJM (and others, Eds), Stroke: Pathophysiology, Diagnosis and Management. New York: Chrchill-Livingstone, pp 549-619, 1986 Dai, A. I. and M. Wasay (2006). "Wernekink comissure syndrome: a rare midbrain syndrome secondary to stroke."[dizziness-and-balance.com]

Prevention

  • Therefore, simultaneous and bilateral decompression with a slow rate of evacuation of massive bilateral chronic subdural hematomas is recommended to prevent serious complications such as secondary intracranial hematoma.[ncbi.nlm.nih.gov]
  • […] manifestations of stroke * A guide to highly studied topics, including stroke complications, syndromes, and stroke related psychiatric disorders * A better understanding of the pathophysiological basis of strokes that will help practitioners better diagnose, prevent[books.google.com]
  • Surgical excision may prevent recurrences. Rarely, small hemorrhages may be secondary to lacunar disease (type II lacunae) ( Challa and Moody 1989 ).[medlink.com]
  • Management or prevention of these conditions can significantly decrease your risk.[winchesterhospital.org]

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