Intracranial hemorrhage and infarction in anticoagulated patients with prosthetic heart valves.

Lieberman, Arnold L.; Hass, William K.; Pinto, Rita Del; Isom, Wayne; Kupersmith, Mark J.; Bear, George; Chase, Randolph M.

doi:10.1161/01.str.9.1.18

Cited by 92 publications

(29 citation statements)

References 44 publications

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“…Cerebral venous thrombosis has been proposed as an etiology of HI in leukemic patients. 13 Chemotherapy-induced thrombocytopenia may have contributed to hemorrhage in one of our patients with leukemia and one with myeloma. Heparin-induced thrombocytopenia, although reported in association with intracerebral hemorrhage, 16 did not play a role in any of our patients.…”

Section: Discussionmentioning

confidence: 89%

The clinical spectrum of hemorrhagic infarction.

Ott¹,

Zamani²,

Kleefield³

et al. 1986

Stroke

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SUMMARYThe hospital records and head CT scans of 44 patients with hemorrhagic infarction were retrospectively analyzed. The majority of cases (73%) were embolic or possibly embolic In etiology, and 55% were not associated with anticoagulant therapy. Adverse prognosis was most clearly related to infarct size, underlying systemic illness, and symptomatic hemorrhage. Of the nineteen patients hi whom serial CT scans documented conversion from bland to hemorrhagic infarction, 12 exhibited no clinical worsening at the tune that hemorrhagic infarction was observed; the remaining seven, all of whom worsened, were receiving anticoagulant therapy at the tune of documented conversion. Fourteen patients hi whom anticoagulant therapy was used despite the findings of hemorrhagic infarction remained stable or improved during bospitalization. Stroke Vol 17, No 4, 1986HEMORRHAGIC INFARCTION (HI) has long been recognized as a potential complication of embolic stroke. Fisher and Adams postulated that downstream migration of the embolus after its initial impact leads to extravasation of blood via reflow into damaged vessels of the proximally infarcted zone. 1The exact role of anticoagulants in the causation of hemorrhage into infarcted brain tissue remains unknown. Moreover, recent studies have emphasized the efficacy of early anticoagulation (AC) in the prevention of recurrent embolic stroke. Serial CT scanning allows direct observation of the effect of AC on the evolution of embolic infarcts.We have retrospectively analyzed our experience with patients in whom the diagnosis of HI was made by CT during a period of two years. The study sought to clarify the roles of anticoagulation and embolism in producing HI and to explore the clinical significance of hemorrhagic transformation of bland infarction. MethodsThe CT scan reports of all patients studied during the years 1983 and 1984 in two tertiary hospitals were surveyed, and the hospital records reviewed for all cases in whom the diagnosis of HI was made. All scans were reviewed again by one of two neuroradiologists without knowledge of the clinical picture and a neurologist to verify the original diagnosis and tabulate the characteristics of each HI.The radiologic diagnosis of HI was defined as an area of low attenuation conforming to a vascular territory within which a single non-homogeneous area or multiple areas of high attenuation were present with characteristic blood density. Infarct size was described as large if the entire vascular territory of a major vessel (anterior, middle, or posterior cerebral artery) was involved; moderate if a major division of that territory was involved; and small if only a minor branch territory was involved. The extent of hemorrhage was described as severe if greater than 50% of the infarct was of blood density; mild if having the appearance of scattered punctate hemorrhages; and moderate for those of intermediate degree.Cases were classified as "probably cardiac embolism" if: 1) the symptoms appeared suddenly and rapidly achieved maximal inte...

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Section: Discussionmentioning

confidence: 89%

The clinical spectrum of hemorrhagic infarction.

Ott¹,

Zamani²,

Kleefield³

et al. 1986

Stroke

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“…ICH was found in all autopsy cases, and hemorrhagic infarct was found on brain CT examination in the surgery case (case 14). Parenchymal hematomas were found in 12 patients (cases 1-12), hemorrhagic infarcts in four (cases 12-15), and primary subarachnoid hemorrhages in two (cases [15][16]. Figure 1 shows the macroscopic appearance of representative cases with parenchymal hematomas.…”

Section: Resultsmentioning

confidence: 99%

“…16 " 19 Cardiac surgery after acute embolic stroke increases the risk of secondary bleeding into the ischemic region; the mechanisms underlying this bleeding are discussed elsewhere. 15 Of the 16 patients examined in this report, four had hemorrhagic infarcts and an additional five patients experienced antecedent ischemic episodes that led subsequently to parenchymal hematomas.…”

Section: Discussionmentioning

confidence: 99%

Histopathological analysis of the mechanisms of intracranial hemorrhage complicating infective endocarditis.

Masuda

Yutani

Waki

et al. 1992

Stroke

129

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Background and Purpose:We conducted the present study to elucidate the pathological mechanisms leading to intracranial hemorrhage complicating infective endocarditis.Methods: Neurological, neuroradiological, and histopathological analyses were performed in 16 patients (one surgical and 15 autopsy cases), 12 men and four women 26-68 years of age, who had demonstrated central nervous system complications during the course of infective endocarditis.Results: Intracranial hemorrhage was found in all cases; parenchymal hematomas were found in 12 cases, hemorrhagic infarcts in four cases, and primary subarachnoid hemorrhages in two cases. Chronological analysis of neurological examination and computed tomographic scan of the brain confirmed that antecedent cerebral ischemic events had occurred in five of 12 patients showing parenchymal hematomas at autopsy. Hemorrhagic infarct, indicated by petechial or diffuse hemorrhages within the infarct, was seen in another four patients, so that hemorrhagic transformation of the ischemic infarct was confirmed in nine patients. Although mycotic aneurysms were found in five patients, only three of these were ruptured; the other two were occluded with septic emboli. Pyogenic arteritis without aneurysm was found to be distributed in the small cortical arterial branches located in the spaces of cortical sulci, with rupture occurring in five patients.Conclusions: These results suggest that hemorrhagic transformation of the ischemic infarct due to septic emboli is the most frequent mechanism leading to intracerebral hemorrhage encountered in patients dying of infective endocarditis and that rupture of pyogenic arteritis may be responsible for such hemorrhage in many cases, with ruptures of mycotic aneurysms as an alternative mechanism. (Stroke 1992^3:843-850) KEY WORDS • cerebral hemorrhage • embolism • endocarditis, bacterial

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“…Lieberman et al reported significant hemorrhage in 9.4% of patients treated with anticoagulants during an 8 year study period. The overall frequency of fatal hemorrhage is 1.0% (10). Most of the bleeds are minor, involving the genito-urinary or gastrointestinal tract; serious or fatal intracranial bleeds represent the major therapeutic problem.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous cranial subarachnoid hemorrhage and spinal subdural hematoma

Mete

Erkutlu²,

Akcali³

2010

Turkish Neurosurgery

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We report a rare case of simultaneous cranial subarachnoid and spinal subdural hematoma (SDH) in a 42-year-old man who was on Warfarin therapy after cardiac bypass surgery. Computed tomography at presentation revealed a cranial subarachnoid hemorrhage, and spinal Magnetic Resonance Imaging (MRI) showed a spinal SDH extending from the T6 to L5 segments. He had paraparesis due to spinal cord compression. The patient was managed conservatively due to his poor general condition and was infused with intravenous steroid therapy, but he experienced sudden cardiac arrest 5 hours later after being admitted to the hospital. This case is of interest because of its first presentation of spinal subdural hematoma and cranial subarachnoid hemorrhage simultaneously and it is also the second longest vertebral segmental spread in the literature. ÖZBiz bu makalede kardiak by-pass cerrahisi sonrası Warfarin tedavisi alan 42 yaşında erkek bir hastada, eş zamanlı gelişen kranial subaraknoid kanama ve spinal subdural hematom bulgularını bildiriyoruz. Hastanın başvuru kranial bilgisayarlı tomografisinde subaraknoid kanama ve sonrasında yapılan spinal manyetik rezonans görüntülemesinde T6 vertebra düzeyinden başlayıp L5 vertebra düzeyine dek uzanan spinal subdural hematom gözlendi. Hastada spinal kord kompresyonuna bağlı paraparezi mevcut idi. Genel durum bozukluğundan dolayı hasta konservatif olarak intravenöz steroid infüzyon tedavisi ile gözlenirken, hastaneye başvurusundan 5 saat sonra ani kardiak arrest gelişti. Bu olgu literatürde ilk defa eş zamanlı olarak gelişen kranial subaraknoid kanama ve ikinci en uzun segmentte gelişen spinal subdural hematom olması itibariyle ilgi çekicidir.AnAhtAR sÖZCÜKleR: Spinal subdural hematom, Kranial subaraknoid kanama, MRG, Spinal kord kompresyonu

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Intracranial hemorrhage and infarction in anticoagulated patients with prosthetic heart valves.

Cited by 92 publications

References 44 publications

The clinical spectrum of hemorrhagic infarction.

The clinical spectrum of hemorrhagic infarction.

Histopathological analysis of the mechanisms of intracranial hemorrhage complicating infective endocarditis.

Simultaneous cranial subarachnoid hemorrhage and spinal subdural hematoma

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