Cerebral microhemorrhages in a patient with mycotic aneurysm: relevance of T2-GRE imaging in SBE.
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Adult↗
Biomedical subjects
Suresh Subramaniam
Publications and source records attributed to Suresh Subramaniam.
Cerebral microhemorrhages predict new disabling or fatal strokes in patients with acute ischemic stroke or transient ischemic attack.
BACKGROUND AND PURPOSE: Cerebral microhemorrhages (MHs) are common among patients presenting with acute ischemic stroke and may predict both subsequent ischemic and hemorrhagic strokes. METHODS: We prospectively studied patients with and without MHs presenting within 12 hours of their ischemic stroke or transient ischemic attack (TIA). A magnetic resonance (MR) scan was performed within 24 hours of symptom(s) onset. The primary outcome was disabling or fatal stroke at 18 months. RESULTS: An MR scan was done in 236 patients with acute ischemic stroke or TIA. Forty-five (19.1%) patients had an MH on a baseline MR scan. Patients with MHs were 2.8x (10.8% versus 4.0%; P=0.036) more likely to have a subsequent disabling or fatal stroke than patients without an MH. The risk of symptomatic intracerebral hemorrhage was not statistically significant among MH and non-MH patients (3.3% versus 0.8%; P=0.31). CONCLUSIONS: The presence of cerebral MH(s) in patients with acute ischemic stroke or TIA predicts recurrent disabling and fatal strokes. This risk is mainly assumed by recurrent ischemic strokes.
Age Factors↗
Massive cerebral infarction.
BACKGROUND: Massive cerebral infarcts cause brain edema with midline shifts and impingement on vital structures producing coma and death. The mortality rate is estimated at 80% with standard medical treatment. Surgical decompression with hemicraniectomy has proved to be life saving, but the impact on functional outcomes is largely unknown. The focus of this review is to discuss the treatment options for massive cerebral infarcts. REVIEW SUMMARY: Neurologic deterioration following massive cerebral infarct needs to be recognized early enough for medical and surgical interventions. Medical management includes monitoring in a neurologic intensive care unit, hyperosmolar agents, and hyperventilation. Surgical management includes decompressive hemicraniectomy and duraplasty with resection of infarcted tissue in some instances. CONCLUSION: Hemicraniectomy is emerging as a promising treatment of patients with massive cerebral infarcts, but only select patients benefit from this procedure. Further information from randomized controlled trials is required to elucidate the best treatment options for this kind of stroke.
Blood Pressure↗
Controversies in medical management of intracerebral hemorrhage.
Intracerebral hemorrhage (ICH) is a devastating form of stroke that is associated with a very high mortality rate. Both medical therapies to control blood pressure, blood sugar, temperature, and surgical therapies to remove or contain clot remain controversial. The decision when to offer medical versus surgical treatment is very challenging and uncertain. Novel therapies are currently being developed and may be successful in containing the neurological injury associated with ICH. This review will highlight the controversies underlying medical management of ICH and the current ongoing research in the field.
Cerebral Hemorrhage↗