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Biomedical subjects

E F Wijdicks

Publications and source records attributed to E F Wijdicks.

178 records · Page 10Linked to original sources
PubMed1988

Long-term follow-up of 71 patients with thunderclap headache mimicking subarachnoid haemorrhage.

Seventy-one patients with sudden, severe, and unusual headache, but with normal computerised tomographic scan and cerebrospinal fluid, were followed for an average of 3.3 years. Twelve patients (17%) had identical recurrences, but again without evidence of subarachnoid haemorrhage. Findings on cerebral angiography, performed in four patients after the first attack and in two patients after recurrent episodes, were normal. Thirty-one (44%) of the seventy-one patients subsequently had regular episodes of tension headache or common migraine. If the computerised tomographic scan and cerebrospinal fluid findings are normal, this type of headache can be regarded as a benign symptom, and cerebral angiography is not indicated.

Adolescent↗
PubMed1988

Warning headache in aneurysmal subarachnoid hemorrhage. A case-control study.

Thirty consecutive patients with aneurysmal subarachnoid hemorrhage (SAH), 20 patients with ischemic stroke, and 100 controls were extensively interviewed about previous episodes of sudden headache, according to a standard pro forma. Thirteen patients with SAH (43%) had a history of a forewarning headache, compared with only one of the patients with ischemic stroke and none of the controls. The interval from the warning headache to the admission rupture was between one week and two months in all patients but one with SAH. Only half of the 13 patients with a warning headache consulted their physician. The outcome was slightly worse in patients with a warning headache, but the differences did not reach statistical significance. These data emphasize the frequent occurrence of warning headaches in SAH. Measures to increase the recognition of sudden headaches should be considered.

Diagnostic Errors↗
PubMed1988

The effect of fludrocortisone acetate on plasma volume and natriuresis in patients with aneurysmal subarachnoid hemorrhage.

In order to prevent hypovolemia fludrocortisone acetate treatment was started on admission in 39 consecutive patients with CT evidence of subarachnoid hemorrhage. In 28 patients an aneurysm was proven or probable, and in 21 of these the effects of fludrocortisone acetate on sodium balance and on plasma volume could be studied. In the first five days plasma volume decreased more than 10% in four patients, decreased less than 10% in five and increased in 12. The cumulative sodium balance measured over five days was negative in seven of the 21 patients. Plasma renin values were measured in 15 of the 21 patients and also in stored samples of 18 patients who were not treated with fludrocortisone acetate. Plasma renin values were less high in patients treated with fludrocortisone acetate, regardless of the presence of a negative sodium balance. In three of the 39 patients signs of pulmonary edema developed, and low serum potassium values were observed in four of the 21 patients. In comparison with previous studies, these findings suggest that fludrocortisone acetate is an effective method of decreasing the incidence of volume depletion and negative sodium balance.

Blood Volume↗
PubMed1988

Enlargement of the third ventricle and hyponatraemia in aneurysmal subarachnoid haemorrhage.

Hyponatraemia following aneurysmal subarachnoid haemorrhage is associated with an increased risk of cerebral infarction. Whether the development of hyponatraemia was related to enlargement of the third ventricle on the admission CT scan was investigated in a consecutive series of 133 patients who were seen within 72 hours of aneurysmal haemorrhage. Hyponatraemia occurred significantly more often in patients with enlargement of the third ventricle (with or without dilatation of the lateral ventricles) than in patients with a normal ventricular system (20/41 versus 24/92, p = 0.016). After ventricular drainage, the sodium levels returned to normal in two patients in whom the size of the third ventricle decreased and not in four patients with persistent enlargement of the third ventricle. The significant relationship between enlargement of the third ventricle and hyponatraemia remained after adjustment for the amount of cisternal blood, but not after adjustment for the amount of intraventricular blood. These results suggest that the size of the third ventricle is an important but not the only factor in the relationship between acute hydrocephalus and hyponatraemia in patients with aneurysmal subarachnoid haemorrhage.

Cerebral Angiography↗
PubMed1987

Digoxin-like immunoreactive substance in patients with aneurysmal subarachnoid haemorrhage.

Digoxin was measured by radioimmunoassay in the plasma of 25 patients with aneurysmal subarachnoid haemorrhage who had not received digoxin treatment. After heating the plasma an endogenous substance cross reacting with antibodies to digoxin was identified in 18 cases. The presence of this substance was significantly related to the total amount of blood and to the presence of blood in the frontal interhemispheric fissure and could not be explained by hypertension or intake of water and sodium. A negative sodium balance and volume depletion occurred more often in patients who were positive for digoxin, but this relation did not reach statistical significance. It is concluded that a digoxin-like natriuretic factor is released in response to a subarachnoid haemorrhage, probably as a result of hypothalamic damage.

Aged↗
PubMed1985

Hyponatremia and cerebral infarction in patients with ruptured intracranial aneurysms: is fluid restriction harmful?

We studied retrospectively the relationship between hyponatremia and cerebral infarction in 134 consecutive patients with aneurysmal subarachnoid hemorrhage. In 44 patients sodium levels fell below 135 mmol/L on at least two consecutive days between the second and the tenth day after the hemorrhage. Twenty-five of these patients fulfilled the criteria for the syndrome of inappropriate secretion of antidiuretic hormone. Cerebral infarction developed in 27 of the 44 patients with hyponatremia and in 19 of the 90 patients with normal serum sodium levels (p less than 0.001). Cerebral infarctions were more often fatal in patients with hyponatremia (p less than 0.01). Twenty-six of the 44 patients had been treated with fluid restriction to correct the serum sodium levels, and infarctions developed in 21. Fluid restriction to correct hyponatremia appears to be potentially dangerous in patients with aneurysmal subarachnoid hemorrhage.

Cerebral Infarction↗
PubMed1985

Volume depletion and natriuresis in patients with a ruptured intracranial aneurysm.

We studied the sodium balance and changes in plasma volume by an isotope dilution technique in the first week after an aneurysmal subarachnoid hemorrhage in 21 patients. In 11 of the patients, the plasma volume decreased by more than 10%. This was accompanied by a negative sodium balance and hyponatremia in 6 patients, a negative sodium balance without hyponatremia in 4 patients, and a positive sodium balance in 1 patient. Together with a decrease in plasma volume, blood urea nitrogen content increased and body weight decreased. Three patients developed hyponatremia without a decrease in plasma volume. Serum vasopressin was measured in 14 of the 21 patients. The values were elevated on admission and declined in the first week, regardless of the presence of hyponatremia. These findings indicate that natriuresis and hyponatremia in aneurysmal subarachnoid hemorrhage reflect salt wasting and not inappropriate secretion of antidiuretic hormone and that these changes should be corrected by fluid replacement rather than by fluid restriction.

Arginine Vasopressin↗
PubMed1985

Acute hydrocephalus after aneurysmal subarachnoid hemorrhage.

Hydrocephalus, defined as a bicaudate index above the 95th percentile for age, was found in 34 (20%) of 174 prospectively studied patients with subarachnoid hemorrhage (SAH) who survived the first 24 hours and who underwent computerized tomography (CT) scanning within 72 hours. The occurrence of acute hydrocephalus was related to the presence of intraventricular blood, and not to the extent of cisternal hemorrhage. The level of consciousness was depressed in 30 of the 34 patients. Characteristic clinical features were present in 19 patients, including a gradual obtundation after the initial hemorrhage in 16 patients and small nonreactive pupils in nine patients (all with a Glasgow Coma Scale score of 7 or less). In the remaining 15 patients (44%), the diagnosis could be made only by CT scanning. After 1 month, 20 of the 34 patients had died: six from rebleeding (four after shunting), 11 from cerebral infarction (eight after an initial improvement), and three from other or mixed causes. Only one of nine patients in whom a shunt was placed survived, despite rapid improvement in all immediately after shunting. The mortality rate among patients with acute hydrocephalus was significantly higher than in those without, with the higher incidence caused by cerebral infarction (11 of 34 versus 12 of 140 cases, respectively; p less than 0.001). Death from infarction could not be attributed to the extent of cisternal hemorrhage, the use of antifibrinolytic drugs, or failure to apply surgical drainage, but could often be explained by the development of hyponatremia, probably accompanied by hypovolemia.

Acute Disease↗
PubMedDate not supplied

Cerebral venous thrombosis complicated by hemorrhagic infarction: factors affecting the initiation and safety of anticoagulation.

BACKGROUND AND PURPOSE: Anticoagulation (AC) may improve outcome in cerebral venous thrombosis (CVT), even when complicated by pretreatment hemorrhagic infarction (HI). The HI characteristics which affect the decision to initiate AC therapy and its outcome are unknown. We reviewed our experience with AC treatment for patients with CVT and HI. METHODS: Retrospective study. RESULTS: Two groups of patients were compared: those who received AC (n = 6) and those who did not (n = 6). Hemorrhage volumes ranged from petechial to large (93 cm3) hematoma with mass effect. Anticoagulated patients received treatment a mean of 11.3 days after symptom onset. Each had exclusively extratemporal HI without midline shift and had stable hemorrhage volumes and clinical status for at least 24 h prior to AC. AC did not increase HI volume or worsen clinical outcome. All 6 non-AC patients had enlarging hematomas. Four of these 6 patients had temporal HI; and two required hematoma resection. CONCLUSIONS: AC therapy was avoided in CVT patients with HI that were located in the temporal lobe, caused midline shift or were enlarging. AC was safely initiated within several days in clinically stable patients with non-temporal-lobe HI of unchanging volume. We suggest that the location and unchanged volume on serial CT may be important factors influencing the safety of AC therapy in patients with CVT and HI.

Adolescent↗
PubMedDate not supplied

Percutaneous endoscopic gastrostomy after acute stroke: complications and outcome.

OBJECTIVE: To review the complications and outcome of percutaneous endoscopic gastrostomy placement (PEG) in 74 patients with acute stroke. PATIENTS AND METHODS: Medical record review and follow-up of patients with acute stroke admitted to a referral center. RESULTS: There were no immediate procedure-related complications. Late complications included aspiration pneumonia (11%), PEG occlusion and replacement (6%), accidental PEG removal (6%), wound infection (3%) and fatal gastrointestinal bleeding in 1 patient. In 18 patients (28%), PEG could be subsequently removed due to improvement in swallowing. CONCLUSION: PEG provides an effective alternative method of enteral feeding, but its impact on outcome remains uncertain. Late complications occurred in one third of the patients, but were seldom life threatening. Removal of the gastrostomy tube and resumption of oral feeding was possible in more than a quarter of the patients. All our patients who received PEG placement after acute stroke remained severely disabled; one third of the patients died from systemic complications of their stroke.

Acute Disease↗
PubMedDate not supplied

Clinician's biases toward surgery in cerebellar hematomas: an analysis of decision-making in 94 patients.

BACKGROUND AND PURPOSE: No studies have examined clinical decision-making in cerebellar hemorrhages. Clinical and CT features may influence surgery in patients with a spontaneous cerebellar hematoma. One commonly accepted adage is to remove a clot when 3 cm or larger in axial diameter on presentation CT scan. It is possible that certain preferences impact on outcome. METHODS: We analyzed 94 patients with spontaneous cerebellar hematomas between the years of 1973-1993. Thirty-one patients underwent suboccipital craniectomy and clot removal with or without ventriculostomy. Deterioration denoted worsening of consciousness, new brainstem signs, or presentation in coma. Statistical analysis was performed utilizing a tree-based model fitted by binary recursive partitioning. Ninety-five percent confidence intervals (CI) were calculated. RESULTS: The overall probability of surgical intervention was 33% (CI 23-43%). The chance of surgery in stable patients was 7% (CI 2-20%). Neurologic deterioration was seen in 54 patients (57%) and increased the prospects of a surgical procedure (52%, CI 38-66%). Surgery was performed in all deteriorating patients with small hematomas (size <3 cm), but large clots (size >3 cm) did not substantially influence surgical decision-making (45%, CI 30-60%) except in patients younger than 70 years old (57%, CI 41-82%). CONCLUSIONS: Clinicians at our institution usually wait for clinical deterioration to unfold prior to operating on patients with cerebellar hematomas. After deterioration occurs, they prefer small hematomas but will operate on large hematomas when patients are younger than 70, generally withholding surgery from older patients. These attitudes may impact on outcome and should be considered in future treatment trials.

Adult↗
PubMedDate not supplied

Thalamic hematoma from a ruptured posterior cerebral artery aneurysm.

BACKGROUND: The location of parenchymal hemorrhage often indicates the site of the aneurysm in subarachnoid hemorrhage. CASE REPORT: We present the first case of a thalamus hematoma associated with a small ruptured (P1) posterior cerebral artery aneurysm with rapid washout of subarachnoid blood mimicking a ganglionic hemorrhage. CONCLUSION: Thalamus hematoma with subarachnoid hemorrhage points at a ruptured proximal posterior circulation aneurysm.

Aneurysm, Ruptured↗
PubMedDate not supplied

Moyamoya-like vasculopathy from cocaine dependency.

We herein describe two cases of moyamoya vasculopathy occurring in two men who used alkaloidal cocaine for years. One patient presented with aneurysmal subarachnoid hemorrhage and one with infarction in both lobes. Particularly impressive was a significant degree of collateral development with lenticulostriate networks.

Adult↗
PubMedDate not supplied

Nonaneurysmal perimesencephalic subarachnoid hemorrhage: CT and MR patterns that differ from aneurysmal rupture.

We describe a characteristic distribution of cisternal blood in 52 patients with nonaneurysmal subarachnoid hemorrhage proved by a normal angiogram. On CT, the center of the bleeding was located immediately anterior to the brainstem in all patients, which was confirmed in four patients who were studied with MR imaging. Extension to the ambient cisterns or to the basal parts of the sylvian fissures was common, but the lateral sylvian or anterior interhemispheric fissures were never completely filled with blood. Rupture into the ventricular system did not occur. MR demonstrated downward extension of the blood anterior to the brainstem as far as the medulla, but failed to detect the source of hemorrhage. Our aim was to determine whether this so-called nonaneurysmal perimesencephalic hemorrhage could be distinguished from aneurysmal subarachnoid hemorrhage on early CT scans. Two neuroradiologists were shown a consecutive series of 221 CT scans of patients with subarachnoid hemorrhage who subsequently underwent angiography. Only one patient with a basilar artery aneurysm on angiography was incorrectly labeled by both observers as having a nonaneurysmal perimesencephalic pattern of hemorrhage. The high predictive value of the perimesencephalic pattern of hemorrhage for a normal angiogram (0.95 and 0.94, respectively, for the two observers) and the excellent interobserver agreement (kappa 0.87) demonstrate that nonaneurysmal perimesencephalic hemorrhage can be distinguished on CT in the majority of patients. Recognition of this pattern of hemorrhage is important as patients with this subset of subarachnoid hemorrhage have an excellent prognosis.

Adult↗