Bilateral intracerebral hemorrhage following CPR

doi:10.22514/sv72.102012.10

Cited by 3 publications

(3 citation statements)

References 13 publications

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“…The most common cause is hematologic abnormalities [1]. Other etiologies include concomitant anticoagulant use, novel antithrombotic drug treatment, venous sinus thrombosis, vasculitis, cerebral metastasis and cardiopulmonary resuscitation [35,59,60,61]. …”

Section: Discussionmentioning

confidence: 99%

Primary Multiple Simultaneous Intracerebral Hemorrhages between 1950 and 2013: Analysis of Data on Age, Sex and Outcome

Laiwattana

Sangsawang

2014

Cerebrovasc Dis Extra

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Background: Primary multiple simultaneous intracerebral hemorrhages (MSICHs) are quite rare. Although occasional reports have been found, there have been no systematic reviews. The published case reports and case series contain overlapping data, leading to erroneous information about MSICHs. This is the first extensive review of accessible studies published in English on MSICHs. Our primary objective was to analyze the demographic data on age, sex, outcome and prognosis with regard to primary MSICHs. Summary: A PubMed search without language restriction for articles with results from human studies and registered between January 1950 and September 2013 yielded 677 articles. The following inclusion criteria were applied: (1) reported case(s) or case series on primary MSICHs; (2) text partly or fully in English, and (3) text contains identifiable data on age, sex and outcome of patients. A total of 24 articles met all the inclusion criteria. The reference lists of these 24 articles were inspected for additional relevant articles, which yielded another 20 articles. In all, 248 cases were identified; 143 cases were excluded for various reasons: 52 duplicate cases, 18 cases of multiple nonsimultaneous intracerebral hemorrhages, 25 cases of secondary MSICHs, and 48 cases with incomplete data on age, sex and outcome. The remaining 105 cases were analyzed. MSICHs were found to be more common in bilateral cases (53.33%): there were bilateral basal ganglia hemorrhages (33.33%), bilateral thalamic hemorrhages (18.10%), bilateral lobar hemorrhages (0.95%) and bilateral cerebellar hemorrhages (0.95%). Nonbilateral MSICHs were found in 46.67% of the cases. The hematomas were commonly distributed in the basal ganglia (45.83%), thalamus (30.56%) and cerebellum (10.19%). MSICHs were more frequently encountered in males (60.95%; average age: 59.13 ± 12.49 years). The average age of the female patients was higher (63.89 ± 13.11 years). Patients with primary MSICHs had a survival rate of 56.20%. There was a favorable outcome of primary MSICHs in 18.10% of all the cases, the highest proportion of which was in the nonbilateral MSICH group. The remaining 38.10% had unfavorable outcomes. Death occurred in 43.80% of all cases, the highest proportion being found in the bilateral basal ganglia hemorrhage group. Primary MSICHs share features with solitary intracerebral hemorrhage regarding age, sex, and the location and distribution of hematomas, but they have a poorer outcome (p < 0.05). Key Messages: Primary MSICHs are rare and share features with solitary intracerebral hemorrhage regarding age and the location and distribution of hematomas. Patients have a poorer prognosis but higher favorable outcome rates in case of survival. This information adds to the awareness of clinicians that higher rates of favorable outcomes can be achieved for MSICHs.

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Section: Discussionmentioning

confidence: 99%

Primary Multiple Simultaneous Intracerebral Hemorrhages between 1950 and 2013: Analysis of Data on Age, Sex and Outcome

Laiwattana

Sangsawang

2014

Cerebrovasc Dis Extra

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“…Subarachnoid hemorrhage after CPR is reported. There is also single previous report of intracerebral hemorrhage as complication of CPR 2,3 . In both conditions, reperfusion injury was suggested as the mechanism.…”

Section: Discussionmentioning

confidence: 91%

“…A single previous case reported intracerebral hemorrhage after CPR in which a brain computed tomography scan taken 1 day after cardiac arrest showed no evidence of intracerebral hemorrhage but second brain computed tomography taken 7 days after resuscitation showed hemorrhage of bilateral basal ganglia and thalami. The newfound hemorrhage suggested CPR after global cerebral ischemia as the cause 2 . The proposed mechanism of reperfusion injury begins with a period of hypoxia that results in oxidative stress leading to dysfunction of ATP-dependent ionic pumps.…”

Section: Discussionmentioning

confidence: 99%

Unilateral Thalamic Hemorrhages After Cardiopulmonary Resuscitation

Krieger

Pippin

Robak

et al. 2021

Am J Forensic Med Pathol

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A young adult man with no known medical or family history was found floating in lake after snowmobiling, presumably after going through ice. Subsequent resuscitation efforts included use of LUCAS device, defibrillation, and intubation. The decedent was pronounced dead several hours after being removed from water, with a spontaneous heart rate briefly recovered after resuscitation.Microscopic examination of the lung revealed occasional alveoli with numerous neutrophils within airspaces. The decedent's brain was edematous and sections revealed a 2.5-cm area of punctate hemorrhages in medial portion of right thalamus (Figs. 1 and 2). Microscopic examination of the thalamus revealed amorphous areas of extravasated blood not contained within vascular channels and condensed, eosinophilic neuronal cell bodies (Figs. 3 and 4). No evidence of ischemic injury was identified at autopsy, specifically that gross examination did not reveal any discoloration of the colon at the cecum or splenic flexure or discoloration of the watershed regions of the cerebral hemispheres and microscopic examination did not reveal centrilobular necrosis of the liver. No evidence of injuries was identified. Toxicology revealed a blood ethanol concentration of 0.212 g/dL. The cause of death was certified as drowning associated with acute ethanol intoxication. The manner of death was accident.

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Bilateral basal ganglia hemorrhage: a systematic review of etiologies, management strategies, and clinical outcomes

et al. 2023

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Bilateral basal ganglia hemorrhages (BBGHs) represent rare accidents, with no clear standard of care currently defined. We reviewed the literature on BBGHs and analyzed the available conservative and surgical strategies. PubMed, Scopus, Web of Science, and Cochrane were searched following the PRISMA guidelines to include studies reporting patients with BBGHs. Clinical characteristics, management, and outcomes were analyzed. We included 64 studies comprising 75 patients, 25 (33%) traumatic and 50 (67%) non-traumatic. Traumatic cases affected younger patients (mean age 35 vs. 46 years, p =0.014) and males (84% vs. 71%, p =0.27) and were characterized by higher proportion of normal blood pressures at admission (66% vs. 13%, p =0.0016) compared to non-traumatic cases. Most patients were comatose at admission (56%), with a mean Glasgow Coma Scale (GCS) score of 7 and a higher proportion of comatose patients in the traumatic than in the non-traumatic group (64% vs. 52%, p =0.28). Among the traumatic group, motor vehicle accidents and falls accounted for 79% of cases. In the non-traumatic group, hemorrhage was most associated with hypertensive or ischemic (54%) and chemical (28%) etiologies. Management was predominantly conservative (83%). Outcomes were poor in 56% of patients with mean follow-up of 8 months. Good recovery was significantly higher in the traumatic than in the non-traumatic group (48% vs. 17%, p =0.019). BBGHs are rare occurrences with dismal prognoses. Standard management follows that of current intracerebral hemorrhage guidelines with supportive care and early blood pressure management. Minimally invasive surgery is promising, though substantial evidence is required to outweigh the potentially increased risks of bilateral hematoma evacuation. Supplementary Information The online version contains supplementary material available at 10.1007/s10143-023-02044-x.

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Bilateral intracerebral hemorrhage following CPR

Abstract: Intracranial hemorrhage is an extremely rare complication following cardiopulmonary resuscitation (CPR). Only a few cases

Cited by 3 publications

References 13 publications

Primary Multiple Simultaneous Intracerebral Hemorrhages between 1950 and 2013: Analysis of Data on Age, Sex and Outcome

Primary Multiple Simultaneous Intracerebral Hemorrhages between 1950 and 2013: Analysis of Data on Age, Sex and Outcome

Unilateral Thalamic Hemorrhages After Cardiopulmonary Resuscitation

Bilateral basal ganglia hemorrhage: a systematic review of etiologies, management strategies, and clinical outcomes

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