PubMed Health⌕ Search

Biomedical subjects

Edward M Manno

Publications and source records attributed to Edward M Manno.

At least 19 recordsLinked to original sources
PubMed2006

Progression of warfarin-associated intracerebral hemorrhage after INR normalization with FFP.

To identify hematoma progression in patients with warfarin-associated intracerebral hemorrhage (ICH) despite international normalized ratio (INR) normalization with fresh-frozen plasma (FFP), we reviewed 45 patients with warfarin-associated ICH given FFP. The median time for door to INR normalization was 30 hours (14 to 49.5), with 4 patients' hematomas enlarging after INR normalization. FFP is associated with substantial time delay to actual administration and pulmonary edema and may not prevent progression of ICH despite INR normalization.

Aged↗
PubMed2006

Expanding the treatment window with mechanical thrombectomy in acute ischemic stroke.

INTRODUCTION: Acute ischemic stroke is a common disease associated with high mortality and significant long-term disability. Treatment options for acute ischemic stroke continue to evolve and include pharmaceutical and mechanical therapies. With the recent US Food and Drug Administration approval of a new device for mechanical thrombectomy, the options available for treatment of acute ischemic stroke have been expanded. Thrombolytic therapy is generally given intravenously in the first 3 h and up to 6 h via the intraarterial route for pharmacological clot disruption. The maximum time-frame for mechanical thrombectomy devices has yet to be determined. METHODS: A 78-year-old female presented to the emergency room with a dense right hemiparesis, leftward gaze preference and dense global aphasia. Eight hours after symptom onset, left carotid angiography confirmed a left internal carotid artery terminus occlusion. A single pass was made through the clot with an X6 Merci Retriever device. RESULTS: After a single pass, the vessel was reopened and normal flow in the left internal carotid artery was demonstrated. At the time of discharge, her neurological deficits had improved significantly. Furthermore, the final infarct area, as demonstrated on magnetic resonance imaging, was probably much smaller than it would have been if the vessel had not been recanalized. CONCLUSION: We report the use of a new mechanical thrombectomy device 8 h after onset of ischemic symptoms, with substantial subsequent improvement in neurological outcome. In selected cases, use of the Merci Retriever can result in improved outcomes beyond the traditional 6-h window used for intraarterial pharmacological thrombolysis.

Aged↗
PubMed2006

The declaration of death and the withdrawal of care in the neurologic patient.

Intensive care technologies have led to an increase in patients who are neurologically devastated and deceased. The practical, moral, and ethical situations encountered can be varied and challenging to manage. Decisions and discussions surrounding withdrawal of care, death by neurologic criteria, and organ donation require significant knowledge of the prognosis, ancillary testing, and definitions of these processes. Experience and skill are often required on the part of physicians and staff to guide families through these most difficult of circumstances.

Apnea↗
PubMed2006

Gliomatosis cerebri angiographically mimicking central nervous system angiitis: case report.

OBJECTIVE: The diagnosis of isolated central nervous system angiitis often requires both cerebral angiography and biopsy for diagnosis. CLINICAL PRESENTATION: We present a case of gliomatosis cerebri with demonstrated angiographic changes suggestive of a central nervous system vasculitis. INTERVENTION: A 47-year-old woman presented with a 2-week history of worsening headache and progressive drowsiness. Magnetic resonance imaging scans revealed confluent nonenhancing T2-weighted hyperintensity involving the frontal white matter bilaterally, hypothalamus, and both thalami. A four-vessel angiogram revealed diffuse arterial beading with stenoses of a right frontal middle cerebral artery branch and the distal posterior cerebral artery and anterior cerebral artery branches, bilaterally. The biopsy revealed a Grade 2 fibrillary astrocytoma consistent with gliomatosis cerebri. CONCLUSION: Gliomatosis cerebri can mimic central nervous system vasculitis angiographically. Perivascular infiltration by tumor cells may be responsible for these changes.

Angiography, Digital Subtraction↗
PubMed2006

A review of red cell transfusion in the neurological intensive care unit.

The treatment of anemia in critically ill patients has changed significantly in the past decade with a major shift toward restrictive blood-transfusion strategy. There is a paucity of studies regarding the approach toward anemia in the neurological critical care population. Anemia is a complex problem in this group of patients because of the extreme sensitivity of brain tissue to changes in the cerebral perfusion pressure and oxygen deficit. Most of the evidence regarding management of anemia and optimal hematocrit threshold is based on animal experiments and observational studies. Recent studies have shown a mixed response in the local oxygen saturations and patient outcomes after blood transfusion in neurological critically ill patients. Although there is little reason to suspect that restrictive transfusion protocols would be detrimental, further studies are needed to determine optimal transfusion threshold in this population.

Anemia↗
PubMed2006

Prolonged coma from refractory status epilepticus.

OBJECTIVE: Status epilepticus is a life-threatening medical condition. In its most severe form, refractory status epilepticus (RSE) seizures may not respond to first and second-line anti-epileptic drugs. RSE is associated with a high mortality and significant medical complications in survivors with prolonged hospitalizations. METHODS: We describe the clinical course of RSE in the setting of new onset lupus in a 31-year-old male who required prolonged barbiturate coma. RESULTS: Seizure stopped on day 64 of treatment. Prior to the resolution of seizures, discussion around withdrawal of care took place between the physicians and patient's family. Medical care was continued because of the patient's age, normal serial MRI studies, and the patient's reversible medical condition. CONCLUSION: Few evidence-based data exist to guide management of RSE. Our case emphasizes the need for continuous aggressive therapy when neuroimaging remains normal.

Adult↗
PubMed2006

Pulmonary complications after intracerebral hemorrhage.

OBJECTIVE: There are no data on pulmonary complications in an selected population of patients with intracerebral hemorrhages (ICH). At present, most data is extrapolated from series of patients with stroke that combine patients with both ischemic and hemorrhagic strokes. The purpose of this study was to determine the frequency, types of pulmonary complications in patients with ICH, their association with clinical variables, and contribution to hospital stay. MATERIALS AND METHODS: A total of 144 consecutive patients with ICH between January 1999 and October 2003 were analyzed for pulmonary complications such as pneumonia, pulmonary edema, pulmonary embolism, or miscellaneous complications. RESULTS: Overall, 41 patients (28%, 95% confidence interval, 22-36%) developed pulmonary complications. The most common events were pneumonia (19%) and pulmonary edema (8%). Complications were most often encountered immediately after the onset of ICH (63% detected on the day of admission). Pulmonary complications lengthened the duration of hospital stay among survivors. CONCLUSIONS: Our study provides data on pulmonary complications after acute ICH. Almost one-third of patients with ICH develop pulmonary complications. Pulmonary complications increased morbidity, mortality, and duration of hospital stay. Aggressive management of these complications can potentially reduce the morbidity, mortality, duration of hospital stay, and financial expenditure incurred in this group of patients.

Aged↗
PubMed2006

Tako-tsubo cardiomyopathy in aneurysmal subarachnoid hemorrhage: an underappreciated ventricular dysfunction.

OBJECT: Neurogenic stunned myocardium in aneurysmal subarachnoid hemorrhage (SAH) is associated with a wide spectrum of reversible left ventricular wall motion abnormalities and includes a subset of patients with a pattern of apical akinesia and concomitant sparing of basal segments called "tako-tsubo cardiomyopathy". METHODS: After obtaining institutional review board approval, the authors retrospectively identified among all patients admitted to the Mayo Clinic's Neurological Intensive Care Unit between January 1990 and January 2005 those with aneurysmal SAH who had met the echocardiographic criteria for tako-tsubo cardiomyopathy. Among 24 patients with SAH-induced reversible cardiac dysfunction, the authors identified eight with SAH-induced tako-tsubo cardiomyopathy. All eight patients were women with a mean age of 55.5 years (range 38.6-71.1). Seven patients presented with a poor-grade SAH, reflected by a Hunt and Hess grade of III or IV. Four patients underwent aneurysm clip application, and four underwent endovascular coil occlusion. The initial mean ejection fraction (EF) was 38% (range 25-55%), and the mean EF at recovery was 55% (range 40-68%). Cerebral vasospasm developed in six patients, but cerebral infarction developed in only three patients. CONCLUSIONS: The authors describe the largest cohort with aneurysmal SAH-induced tako-tsubo cardiomyopathy. In the SAH population, tako-tsubo cardiomyopathy predominates in postmenopausal women and is often associated with pulmonary edema, prolonged intubation, and cerebral vasospasm. Additional studies are warranted to understand the complex mechanism involved in tako-tsubo cardiomyopathy and its intriguing relationship to neurogenic stunned myocardium.

Adult↗
PubMed2006

Clinical importance of cardiac troponin release and cardiac abnormalities in patients with supratentorial cerebral hemorrhages.

OBJECTIVE: To determine the Incidence of cardiac troponin T (cTnT) elevation, electrocardiographic (ECG) changes, and arrhythmias in supratentorial intracerebral hemorrhage (ICH) and their association with early mortality. PATIENTS AND METHODS: Patients with supratentorial ICHs admitted to Mayo Clinic, Rochester, Minn, from March 1998 to October 2003 were studied. We excluded moribund patients with ICHs who died within 12 hours of hospital admission. Cardiac troponin T levels measured on admission and day 2 were determined by a third-generation enzyme-linked immunosorbent assay. Continuous ECG monitoring was performed In all patients. Computed tomographic scans were graded and correlated with abnormal cardiac variables. RESULTS: Peak levels of cTnT were elevated at 0.035 to 1.2 microg/L (mean +/- SD, 0.27 +/- 0.38 microg/L) in 10 (20%) of 49 patients and were not associated with changes in creatine kinase MB fraction or ECG results. The cTnT levels did not correlate with location or side of hemorrhage or mortality at 30 days. Seventy (64%) of 110 patients displayed ECG abnormalities. The ECG changes did not correlate with the location or side of ICH, hydrocephalus, midline shift, or extension to the ventricles. CONCLUSION: The cTnT elevations in survivors of acute ICH are frequent but without confirmatory ECG changes that suggest mild myocardial injury. One-month mortality is not influenced by such cTnT elevations. In addition, ECG abnormalities are common but likely benign in patients with supratentorial ICH who survive the initial insult.

Adult↗
PubMed2005

Gadolinium encephalopathy in a patient with renal failure.

Gadolinium chelates are extensively used in MRI studies. Neurotoxicity due to gadolinium chelates is minimal and uncommon. A 57-year-old woman in renal failure developed a subacute encephalopathy after inadvertent repetitive gadolinium contrast administration. An unusual MRI appearance with CSF hyperintensity due to gadolinium diffusion into the CSF is also shown.

Amnesia, Retrograde↗
PubMed2005

Validation of a new coma scale: The FOUR score.

The Glasgow Coma Scale (GCS) has been widely adopted. Failure to assess the verbal score in intubated patients and the inability to test brainstem reflexes are shortcomings. We devised a new coma score, the FOUR (Full Outline of UnResponsiveness) score. It consists of four components (eye, motor, brainstem, and respiration), and each component has a maximal score of 4. We prospectively studied the FOUR score in 120 intensive care unit patients and compared it with the GCS score using neuroscience nurses, neurology residents, and neurointensivists. We found that the interrater reliability was excellent with the FOUR score (kappa(w) = 0.82) and good to excellent for physician rater pairs. The agreement among raters was similar with the GCS (kappa(w) = 0.82). Patients with the lowest GCS score could be further distinguished using the FOUR score. We conclude that the agreement among raters was good to excellent. The FOUR score provides greater neurological detail than the GCS, recognizes a locked-in syndrome, and is superior to the GCS due to the availability of brainstem reflexes, breathing patterns, and the ability to recognize different stages of herniation. The probability of in-hospital mortality was higher for the lowest total FOUR score when compared with the lowest total GCS score.

Aged↗
PubMed2005

Cardiac pathology in status epilepticus.

Massive catecholamine release resulting in the formation of cardiac contraction bands may represent the cause of death in status epilepticus (SE). We reviewed the cardiac pathology of patients who died during SE to asses for contraction bands. Eight of 11 patients who died during SE had identifiable myocardial contraction bands compared with 5 of 22 control patients (p < 0.05, Fisher's exact t test). These findings delineate a pathological substrate and provide compelling evidence that excessive catecholamine release is the mechanism responsible for death in SE.

Adolescent↗
PubMed2005

The management of large hemispheric cerebral infarcts.

Large hemispheric cerebral infarcts have significant morbidity and mortality. Our understanding of this pathophysiological process involved with secondary neurological deterioration in large hemispheric infarctions has increased in the past few decades. New experimental strategies designed to improve outcome are reviewed.

Critical Care↗