Ischemic infarcts and hemorrhages are uncommon but dangerous complications of pregnancy. Their etiology is related to physiological changes during pregnancy. The majority of strokes are seen in the third trimester and postpartum and are etiologically related to three conditions: reversible cerebral vasoconstriction syndrome, preeclampsia/eclampsia and cerebral venous thrombosis. The first two conditions are etiologically connected and can lead to ischemic and hemorrhagic events, whereas cerebral sinus thrombosis is mainly related to hypercoagulation and causes venous infarcts and brain hemorrhages. MRI and CT scans are safe to use for diagnosis of stroke in pregnancy, although use of iodine-based contrast may affect thyroid function of the neonate. Management of stroke in pregnancy is specific to cause and depends on management of blood pressure and delivery in preeclampsia/eclampsia, expected management or calcium channel blockers in reversible cerebral vasoconstriction syndrome, and anticoagulation for cerebral sinus thrombosis.
Study Design: Retrospective data analysis. Objectives: To determine prevalence of orthostatic hypotension (OH) in patients with spinal cord injury (SCI) during the acute rehabilitation period. Setting: Quaternary care spinal unit, Vancouver General Hospital, British Columbia, Canada Methods: Eighty-nine patients with acute SCI stratified by neurological level (cervical, 55 (62%); upper thoracic, 12 (13%); lower thoracic, 22 (25%)), and graded by American Spinal Injury Association standards. Non-invasive measurement of systolic and diastolic blood pressure and heart rate were made at baseline and 3 min following an orthostatic challenge test administered during the first month after SCI. Results: Patients with cervical or upper thoracic motor complete SCI more frequently experienced OH (Po0.01). OH persisted during the first month following SCI in 74% of cervical and only 20% of upper thoracic motor complete SCI patients. Conclusion: Patients with cervical and upper thoracic motor complete SCI are more likely to experience persistent OH than those with lower level or motor incomplete SCI during the first month of rehabilitation.
Hyperglycemia on admission has been associated with poor outcome after intracerebral hemorrhage (ICH). However, the mechanistic links between hyperglycemia and poor outcome are not fully elucidated. We sought to determine the relationship between the serum glucose levels during the first 72 h after ICH, and evolution of hematoma and perihematomal edema (PHE), and functional outcome at 3 months and performed a retrospective review of prospectively collected data from 135 consecutive ICH patients. Patients were divided into two groups based on their mean glucose level-high (≥150 mg/dl) vs. controlled (<150 mg/dl). We used Chi-square test and multiple logistic regressions to assess the relationship between glucose level and outcome variables, including hematoma expansion (HE), PHE growth, and modified Rankin Scale (mRS) score at 3 months. The mean 72-h glucose level was 123 ± 16 for the controlled group and 190 ± 48 mg/dl for the high-glucose group. The corresponding rates of HE were 23.4 vs. 25.9 % (unadjusted p = 0.80; adjusted p = 0.08); PHE growth, 31.3 vs. 29.6 % (unadjusted p = 0.88; adjusted p = 0.39); and poor outcome at 3 months, defined as mRS score of ≥3, was 54 vs. 71 % (unadjusted p = 0.06; adjusted p = 0.89). On multivariate analyses, the ICH score emerged as the major predictor for poor outcome, but not glucose. In conclusion, we found a trend for an association between mean 72 h glucose levels and poor outcome at 3 months, but this effect attenuated after adjusting for the ICH score. High glucose was not associated with HE or PHE growth. More preclinical and clinical studies are needed to elucidate the role of hyperglycemia in ICH before embarking on large and costly clinical trials of tight glucose control in ICH patients.
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