1
|
Zhang P, Yang X, Fu MZ, Gao CL, Fang X, Xia ZK. Risk Factors and Clinical Outcomes of Renal Thrombotic Microangiopathy in Children with Lupus Nephritis in Terms of Pathological and Clinical Features. Nephron Clin Pract 2024:1-9. [PMID: 38852577 DOI: 10.1159/000538240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 03/05/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Thrombotic microangiopathy (TMA) is an important risk factor for the prognosis of lupus nephritis (LN). Patients with LN complicated with TMA tend to be critically ill with high mortality and poor prognosis. In the present study, we retrospectively analyzed the clinical manifestations, laboratory results, renal pathological manifestations, and prognosis of children with LN-TMA and analyzed the risk factors for end-stage renal disease (ESRD) in children with LN-TMA. METHODS Seventy-four patients with LN and renal TMA (rTMA) were selected and compared to 128 LN controls without TMA (1:2 ratio) matched according to demographics, pathological type and treatments. RESULTS The mean values of systolic blood pressure, diastolic blood pressure (DBP), lactate dehydrogenase (LDH), blood urea nitrogen (BUN), urinary protein quantitation (PRO), urine red blood cells, N-acetyl-β-D-glucosidase (NAG), retinol-binding protein, systemic lupus erythematosus disease activity score (SLEDAI), and activity index (AI) scores in the TMA group were all higher than those in the non-TMA group (p < 0.05 and p < 0.01). The mean values of complement C3, hemoglobin, platelets, estimated glomerular filtration rate, and chronic index (CI) score in the TMA group were all lower than those in the non-TMA group (p < 0.05 and p < 0.01). The number of cases of glomerular crescent, fibrous crescent, endocapillary proliferation, tubular atrophy, interstitial fibrosis, C3 and C1q deposition in the TMA group was higher than that in the non-TMA group (p < 0.05 and p < 0.01). The 3-year and 5-year renal survival rates in the TMA group (88.93% vs. 97.00%, p < 0.05) and TMA group (61.41% vs. 82.31%, p < 0.05) were significantly lower than those in the non-TMA group. Multivariate Cox regression analysis showed that serum creatinine before treatment (≥110 μmol/L), TMA and interstitial fibrosis were independent risk factors for the development of ESRD in LN children. CONCLUSION The general condition of children with TMA is critical, and the prognosis is poor. Early detection, early treatment and the development of new treatments are key to improving LN-TMA outcomes in children.
Collapse
Affiliation(s)
- Pei Zhang
- Department of Pediatrics, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China,
| | - Xiao Yang
- Department of Pediatrics, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China
| | - Meng-Zhen Fu
- Department of Pediatric Nephrology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
| | - Chun-Lin Gao
- Department of Pediatrics, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Xiang Fang
- Department of Pediatrics, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Zheng-Kun Xia
- Department of Pediatrics, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China
- Department of Pediatrics, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| |
Collapse
|
2
|
Kim J, Young GS. Neuroimaging of COVID-19. Semin Neurol 2023; 43:205-218. [PMID: 37379850 DOI: 10.1055/s-0043-1767771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
We review the wide variety of common neuroimaging manifestations related to coronavirus disease 2019 (COVID-19) and COVID therapies, grouping the entities by likely pathophysiology, recognizing that the etiology of many entities remains uncertain. Direct viral invasion likely contributes to olfactory bulb abnormalities. COVID meningoencephalitis may represent direct viral infection and/or autoimmune inflammation. Para-infectious inflammation and inflammatory demyelination at the time of infection are likely primary contributors to acute necrotizing encephalopathy, cytotoxic lesion of the corpus callosum, and diffuse white matter abnormality. Later postinfectious inflammation and demyelination may manifest as acute demyelinating encephalomyelitis, Guillain-Barré syndrome, or transverse myelitis. The hallmark vascular inflammation and coagulopathy of COVID-19 may produce acute ischemic infarction, microinfarction contributing to white matter abnormality, space-occupying hemorrhage or microhemorrhage, venous thrombosis, and posterior reversible encephalopathy syndrome. Adverse effects of therapies including zinc, chloroquine/hydroxychloroquine, antivirals, and vaccines, and current evidence regarding "long COVID" is briefly reviewed. Finally, we present a case of bacterial and fungal superinfection related to immune dysregulation from COVID.
Collapse
Affiliation(s)
- Jisoo Kim
- Division of Neuroradiology, Department of Radiology, Harvard Medical School & Brigham and Women's Hospital, Boston, Massachusetts
| | - Geoffrey S Young
- Division of Neuroradiology, Department of Radiology, Harvard Medical School & Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|
3
|
Incidental DWI Lesions in Patients with Recent Small Subcortical Infarctions. J Stroke Cerebrovasc Dis 2022; 31:106304. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/02/2022] [Indexed: 01/16/2023] Open
|
4
|
The Spectrum of Neuroimaging Findings on CT and MRI in Adults With COVID-19. AJR Am J Roentgenol 2021; 217:959-974. [DOI: 10.2214/ajr.20.24839] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
5
|
Physiopathological implications of abnormal Arterial Spin Labeling perfusion in thrombotic microangiopathy. THROMBOSIS UPDATE 2021. [DOI: 10.1016/j.tru.2021.100045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
6
|
Osmotic Demyelination Syndrome: A New Mime in the Circus of Neurology. Can J Neurol Sci 2021; 49:270-271. [PMID: 33845937 DOI: 10.1017/cjn.2021.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
7
|
Lee JY, Lee KM, Yeon EK, Lee EH, Kim EJ. Fulminant Course of Acute Necrotizing Encephalopathy Followed by Serial MRI: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:1274-1280. [PMID: 36238398 PMCID: PMC9432353 DOI: 10.3348/jksr.2020.0173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/18/2021] [Accepted: 01/26/2021] [Indexed: 12/04/2022]
Abstract
Acute necrotizing encephalopathy (ANE) is a rare but distinctive type of influenza-associated encephalopathy characterized by symmetric multiple lesions with an invariable thalamic involvement. Although the exact pathogenesis of ANE remains unclear, the most prevalent hypothesis is the “cytokine storm,” which results in blood-brain-barrier breakdown. We present the case of a 10-year-old boy with fulminant ANE confirmed with serial MRI studies, including diffusion-weighted imaging and susceptibility-weighted imaging. A comparison of these serial images demonstrated detailed and longitudinal changes in MRI findings during the clinical course corresponding to pathophysiological changes. Our case clarifies the pathogenesis of ANE brain lesions using serial imaging studies and suggests that early immunomodulatory therapy reduces brain damage.
Collapse
Affiliation(s)
- Ji Young Lee
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Kyung Mi Lee
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Eung Koo Yeon
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Eun Hye Lee
- Department of Pediatrics, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Eui Jong Kim
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea
| |
Collapse
|
8
|
Hernández-Fernández F, Sandoval Valencia H, Barbella-Aponte RA, Collado-Jiménez R, Ayo-Martín Ó, Barrena C, Molina-Nuevo JD, García-García J, Lozano-Setién E, Alcahut-Rodriguez C, Martínez-Martín Á, Sánchez-López A, Segura T. Cerebrovascular disease in patients with COVID-19: neuroimaging, histological and clinical description. Brain 2020; 143:3089-3103. [PMID: 32645151 PMCID: PMC7454411 DOI: 10.1093/brain/awaa239] [Citation(s) in RCA: 193] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/30/2020] [Accepted: 06/30/2020] [Indexed: 12/19/2022] Open
Abstract
Since the appearance of the first case of coronavirus disease 2019 (COVID-19) a pandemic has emerged affecting millions of people worldwide. Although the main clinical manifestations are respiratory, an increase in neurological conditions, specifically acute cerebrovascular disease, has been detected. We present cerebrovascular disease case incidence in hospitalized patients with SARS-CoV-2 infection. Patients were confirmed by microbiological/serological testing, or on chest CT semiology. Available data on comorbidity, laboratory parameters, treatment administered, neuroimaging, neuropathological studies and clinical evolution during hospitalization, measured by the modified Rankin scale, were analysed. A bivariate study was also designed to identify differences between ischaemic and haemorrhagic subtypes. A statistical model of binary logistic regression and sensitivity analysis was designed to study the influence of independent variables over prognosis. In our centre, there were 1683 admissions of patients with COVID-19 over 50 days, of which 23 (1.4%) developed cerebrovascular disease. Within this group of patients, cerebral and chest CT scans were performed in all cases, and MRI in six (26.1%). Histological samples were obtained in 6/23 cases (two brain biopsies, and four arterial thrombi). Seventeen patients were classified as cerebral ischaemia (73.9%, with two arterial dissections), five as intracerebral haemorrhage (21.7%), and one leukoencephalopathy of posterior reversible encephalopathy type. Haemorrhagic patients had higher ferritin levels at the time of stroke (1554.3 versus 519.2, P = 0.004). Ischaemic strokes were unexpectedly frequent in the vertebrobasilar territory (6/17, 35.3%). In the haemorrhagic group, a characteristic radiological pattern was identified showing subarachnoid haemorrhage, parieto-occipital leukoencephalopathy, microbleeds and single or multiple focal haematomas. Brain biopsies performed showed signs of thrombotic microangiopathy and endothelial injury, with no evidence of vasculitis or necrotizing encephalitis. The functional prognosis during the hospital period was unfavourable in 73.9% (17/23 modified Rankin scale 4–6), and age was the main predictive variable (odds ratio = 1.5; 95% confidence interval 1.012–2.225; P = 0.043). Our series shows cerebrovascular disease incidence of 1.4% in patients with COVID-19 with high morbidity and mortality. We describe pathological and radiological data consistent with thrombotic microangiopathy caused by endotheliopathy with a haemorrhagic predisposition.
Collapse
Affiliation(s)
| | | | | | - Rosa Collado-Jiménez
- Department of Radiology, Hospital General Universitario de Albacete, Albacete, Spain
| | - Óscar Ayo-Martín
- Department of Neurology, Hospital General Universitario de Albacete, Albacete, Spain
| | - Cristina Barrena
- Department of Neurosurgery, Hospital General Universitario de Albacete, Albacete, Spain
| | | | - Jorge García-García
- Department of Neurology, Hospital General Universitario de Albacete, Albacete, Spain
| | - Elena Lozano-Setién
- Department of Radiology, Hospital General Universitario de Albacete, Albacete, Spain
| | | | | | - Antonio Sánchez-López
- Anaesthesia Intensive Care Unit, Hospital General Universitario de Albacete, Albacete, Spain
| | - Tomás Segura
- Department of Neurology, Hospital General Universitario de Albacete, Albacete, Spain
| |
Collapse
|
9
|
Alwan F, Mahdi D, Tayabali S, Cipolotti L, Lakey G, Hyare H, Scully M. Cerebral MRI findings predict the risk of cognitive impairment in thrombotic thrombocytopenic purpura. Br J Haematol 2020; 191:868-874. [DOI: 10.1111/bjh.17126] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Ferras Alwan
- Department of Haematology University College London Hospital London UK
| | - Dina Mahdi
- Department of Haematology University College London Hospital London UK
| | - Sarrah Tayabali
- Department of Haematology University College London Hospital London UK
| | - Lisa Cipolotti
- Department of Neuropsychology National Hospital for Neurology and Neurosurgery UCLH NHS Trust London UK
| | - Grace Lakey
- Department of Neuropsychology National Hospital for Neurology and Neurosurgery UCLH NHS Trust London UK
| | - Harpreet Hyare
- Department of Radiology University College London Hospital London UK
| | - Marie Scully
- Department of Haematology University College London Hospital London UK
- Cardiometabolic Programme‐NIHR UCLH/UCL BRC London UK
| |
Collapse
|
10
|
Gulko E, Oleksk ML, Gomes W, Ali S, Mehta H, Overby P, Al-Mufti F, Rozenshtein A. MRI Brain Findings in 126 Patients with COVID-19: Initial Observations from a Descriptive Literature Review. AJNR Am J Neuroradiol 2020; 41:2199-2203. [PMID: 32883670 DOI: 10.3174/ajnr.a6805] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/28/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Recently, numerous investigational studies, case series, and case reports have been published describing various MR imaging brain findings in patients with COVID-19. The purpose of this literature review was to compile and analyze brain MR imaging findings in patients with COVID-19-related illness. MATERIALS AND METHODS Literature searches of PubMed, publicly available Internet search engines, and medical journal Web sites were performed to identify articles published before May 30, 2020 that described MR imaging brain findings in patients with COVID-19. RESULTS Twenty-two articles were included in the analysis: 5 investigational studies, 6 case series, and 11 case reports, encompassing MR imaging of the brain in 126 patients. The articles originated from 7 different countries and were published in 14 medical journals. MR imaging brain findings included specific diagnoses (such as acute infarct, posterior reversible encephalopathy syndrome) or specific imaging features (such as cortical FLAIR signal abnormality, microhemorrhages). CONCLUSIONS The most frequent diagnoses made on brain MR imaging in patients with COVID-19 were acute and subacute infarcts. Other common findings included a constellation of leukoencephalopathy and microhemorrhages, leptomeningeal contrast enhancement, and cortical FLAIR signal abnormality.
Collapse
Affiliation(s)
- E Gulko
- From the Department of Radiology (E.G., W.G., S.A., H.M.), Division of Neuroradiology
| | - M L Oleksk
- New York Medical College (M.L.O.), Valhalla, New York
| | - W Gomes
- From the Department of Radiology (E.G., W.G., S.A., H.M.), Division of Neuroradiology
| | - S Ali
- From the Department of Radiology (E.G., W.G., S.A., H.M.), Division of Neuroradiology
| | - H Mehta
- From the Department of Radiology (E.G., W.G., S.A., H.M.), Division of Neuroradiology
| | | | - F Al-Mufti
- Department of Neurology (F.A.M.), Westchester Medical Center, Valhalla, New York
| | - A Rozenshtein
- Department of Radiology (A.R.), Division of Cardiothoracic Imaging, Westchester Medical Center, Valhalla, New York
| |
Collapse
|
11
|
Cavalcanti DD, Raz E, Shapiro M, Dehkharghani S, Yaghi S, Lillemoe K, Nossek E, Torres J, Jain R, Riina HA, Radmanesh A, Nelson PK. Cerebral Venous Thrombosis Associated with COVID-19. AJNR Am J Neuroradiol 2020; 41:1370-1376. [PMID: 32554424 PMCID: PMC7658892 DOI: 10.3174/ajnr.a6644] [Citation(s) in RCA: 158] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/14/2020] [Indexed: 12/23/2022]
Abstract
Despite the severity of coronavirus disease 2019 (COVID-19) being more frequently related to acute respiratory distress syndrome and acute cardiac and renal injuries, thromboembolic events have been increasingly reported. We report a unique series of young patients with COVID-19 presenting with cerebral venous system thrombosis. Three patients younger than 41 years of age with confirmed Severe Acute Respiratory Syndrome coronavirus 2 (SARS-Cov-2) infection had neurologic findings related to cerebral venous thrombosis. They were admitted during the short period of 10 days between March and April 2020 and were managed in an academic institution in a large city. One patient had thrombosis in both the superficial and deep systems; another had involvement of the straight sinus, vein of Galen, and internal cerebral veins; and a third patient had thrombosis of the deep medullary veins. Two patients presented with hemorrhagic venous infarcts. The median time from COVID-19 symptoms to a thrombotic event was 7 days (range, 2-7 days). One patient was diagnosed with new-onset diabetic ketoacidosis, and another one used oral contraceptive pills. Two patients were managed with both hydroxychloroquine and azithromycin; one was treated with lopinavir-ritonavir. All patients had a fatal outcome. Severe and potentially fatal deep cerebral thrombosis may complicate the initial clinical presentation of COVID-19. We urge awareness of this atypical manifestation.
Collapse
Affiliation(s)
- D D Cavalcanti
- From the Departments of Radiology (D.D.C., E.R., M.S., S.D., R.J., A.R., P.K.N.)
| | - E Raz
- From the Departments of Radiology (D.D.C., E.R., M.S., S.D., R.J., A.R., P.K.N.)
| | - M Shapiro
- From the Departments of Radiology (D.D.C., E.R., M.S., S.D., R.J., A.R., P.K.N.)
| | - S Dehkharghani
- From the Departments of Radiology (D.D.C., E.R., M.S., S.D., R.J., A.R., P.K.N.)
| | - S Yaghi
- Neurology (S.Y., K.L., J.T.)
| | | | - E Nossek
- Neurosurgery (E.N., H.A.R.), NYU Grossman School of Medicine, New York, New York
| | | | - R Jain
- From the Departments of Radiology (D.D.C., E.R., M.S., S.D., R.J., A.R., P.K.N.)
| | - H A Riina
- Neurosurgery (E.N., H.A.R.), NYU Grossman School of Medicine, New York, New York
| | - A Radmanesh
- From the Departments of Radiology (D.D.C., E.R., M.S., S.D., R.J., A.R., P.K.N.)
| | - P K Nelson
- From the Departments of Radiology (D.D.C., E.R., M.S., S.D., R.J., A.R., P.K.N.)
| |
Collapse
|
12
|
Abstract
PURPOSE OF REVIEW This article discusses the epidemiology, diagnosis, treatment, and prevention of neurologic complications of common and rare blood cell disorders. RECENT FINDINGS A growing number of preventive treatment options are available for stroke in sickle cell disease. Paroxysmal nocturnal hemoglobinuria and immune thrombocytopenia can lead to stroke. Thrombotic thrombocytopenic purpura frequently causes neurologic symptoms and should be considered in the differential diagnosis of a patient with neurologic symptoms, thrombocytopenia, and hemolytic anemia. Polycythemia vera and essential thrombocythemia are rare causes of stroke. SUMMARY This article discusses sickle cell disease and the most recent advances in stroke preventive therapy as well as neurologic complications of paroxysmal nocturnal hemoglobinuria, immune thrombocytopenia, thrombotic thrombocytopenic purpura, polycythemia vera, and essential thrombocythemia.
Collapse
|
13
|
Sharma R, Dearaugo S, Infeld B, O'Sullivan R, Gerraty RP. Cerebral amyloid angiopathy: Review of clinico-radiological features and mimics. J Med Imaging Radiat Oncol 2018; 62:451-463. [PMID: 29604173 DOI: 10.1111/1754-9485.12726] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/01/2018] [Indexed: 01/02/2023]
Abstract
Cerebral amyloid angiopathy (CAA) is an important cause of lobar intracerebral haemorrhage (ICH) in the elderly, but has other clinico-radiological manifestations. In the last two decades, certain magnetic resonance imaging (MRI) sequences, namely gradient-recalled echo imaging and the newer and more sensitive susceptibility-weighted imaging, have been utilised to detect susceptibility-sensitive lesions such as cerebral microbleeds and cortical superficial siderosis. These can be utilised sensitively and specifically by the Modified Boston Criteria to make a diagnosis of CAA without the need for 'gold-standard' histopathology from biopsy. However, recently, other promising MRI biomarkers of CAA have been described which may further increase precision of radiological diagnosis, namely chronic white matter ischaemia, cerebral microinfarcts and lobar lacunes, cortical atrophy, and increased dilated perivascular spaces in the centrum semiovale. However, the radiological manifestations of CAA, as well as their clinical correlates, may have other aetiologies and mimics. It is important for the radiologist to be aware of these clinico-radiological features and mimics to accurately diagnose CAA. This is increasingly important in a patient demographic that has a high prevalence for use of antiplatelet and antithrombotic medications for other comorbidities which inherently carries an increased risk of ICH in patients with CAA.
Collapse
Affiliation(s)
- Rohit Sharma
- Department of Medicine, Monash University, The Alfred Hospital, Melbourne, Victoria, Australia
- Epworth HealthCare, Richmond, Victoria, Australia
| | - Stephanie Dearaugo
- Department of Medicine, Monash University, The Alfred Hospital, Melbourne, Victoria, Australia
- Epworth HealthCare, Richmond, Victoria, Australia
| | - Bernard Infeld
- Department of Medicine, Monash University, The Alfred Hospital, Melbourne, Victoria, Australia
- Epworth HealthCare, Richmond, Victoria, Australia
| | - Richard O'Sullivan
- Department of Medicine, Monash University, The Alfred Hospital, Melbourne, Victoria, Australia
- Healthcare Imaging Services, Melbourne, Victoria, Australia
| | - Richard P Gerraty
- Department of Medicine, Monash University, The Alfred Hospital, Melbourne, Victoria, Australia
- Epworth HealthCare, Richmond, Victoria, Australia
| |
Collapse
|
14
|
Kim PPC, Nasman BW, Kinne EL, Oyoyo UE, Kido DK, Jacobson JP. Cerebral Microhemorrhage: A Frequent Magnetic Resonance Imaging Finding in Pediatric Patients after Cardiopulmonary Bypass. J Clin Imaging Sci 2017; 7:27. [PMID: 28781924 PMCID: PMC5523507 DOI: 10.4103/jcis.jcis_29_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 05/26/2017] [Indexed: 12/13/2022] Open
Abstract
Objectives: This study was undertaken to estimate the incidence and burden of cerebral microhemorrhage (CM) in patients with heart disease who underwent cardiopulmonary bypass (CPB), as detected on susceptibility-weighted imaging (SWI), a magnetic resonance (MR) sequence that is highly sensitive to hemorrhagic products. Materials and Methods: With Institutional Review Board waiver of consent, MR imaging (MRI) of a cohort of 86 consecutive pediatric patients with heart failure who underwent heart transplantation evaluation were retrospectively reviewed for CM. A nested case–control study was performed. The CPB group consisted of 23 pediatric patients with heart failure from various cardiac conditions who underwent CPB. The control group was comprised of 13 pediatric patients with similar cardiac conditions, but without CPB history. Ten patients in the CPB group were female (age: 5 days to 16 years at the time of the CPB and 6 days to 17 years at the time of the MRI). The time interval between the CPB and MRI ranged from 11 days to 4 years and 5 months. Six patients in the control group were female, age range of 2 days to 6 years old. The number of CM on SWI was counted by three radiologists (PK, EK and DK). The differences in number of CM between groups were tested for significance using Mann–Whitney U-test, α = 0.05. Using the univariate analysis of variance model, the differences in number of CM between groups were also tested with adjustment for age at MRI. Results: There are statistically significant differences in CM on SWI between the CPB group and control group with more CM were observed in the CPB group without and with adjustment for age at MRI (P < 0.001). Conclusions: Exposure of CPB is associated with increased prevalence and burden of CM among pediatric patients with heart failure.
Collapse
Affiliation(s)
- Paggie P C Kim
- Department of Radiology, Section of Neuroradiology and Pediatric Radiology, Loma Linda University Medical Centre, Loma Linda, CA, USA
| | - Benjamin W Nasman
- Department of Radiology, Section of Neuroradiology and Pediatric Radiology, Loma Linda University Medical Centre, Loma Linda, CA, USA
| | - Erica L Kinne
- Department of Radiology, Section of Neuroradiology and Pediatric Radiology, Loma Linda University Medical Centre, Loma Linda, CA, USA
| | - Udochukwu E Oyoyo
- Department of Radiology, Section of Neuroradiology and Pediatric Radiology, Loma Linda University Medical Centre, Loma Linda, CA, USA
| | - Daniel K Kido
- Department of Radiology, Section of Neuroradiology and Pediatric Radiology, Loma Linda University Medical Centre, Loma Linda, CA, USA
| | - J P Jacobson
- Department of Radiology, Section of Neuroradiology and Pediatric Radiology, Loma Linda University Medical Centre, Loma Linda, CA, USA
| |
Collapse
|
15
|
Chang J, Arani K, Chew S, Frosch MP, Gonzalez RG, Maza N, Romero JM. Susceptibility Etching on MRI in Patients with Microangiopathy. J Neuroimaging 2016; 27:43-49. [PMID: 27539492 DOI: 10.1111/jon.12384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 07/11/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND We detected a novel imaging sign, which consists of a specific imaging pattern of diffuse susceptibility effect, delineating the cortical-subcortical junction on high-resolution susceptibility-weighted images (SWIs). We describe magnetic resonance imaging findings in 10 patients with "susceptibility etching" and possible association with their abnormal coagulation profile. MATERIALS/METHODS A retrospective case series study with a search for cases that demonstrated susceptibility effect at the cortical-subcortical junction on SWI sequences was performed. The patients' respective coagulation profiles including prothrombin time, partial thromboplastin time, fibrinogen, D-dimer values, and platelet counts were reviewed. In addition, clinical history and neurological deficits were recorded. RESULTS We identified 10 patients with the "susceptibility etching" pattern at the cortical-subcortical junction. All patients were acutely ill and had a significantly elevated D-dimer (4,309 mcg/L to >10,000 mcg/L) with variably reduced platelet count. Two patients had reduced fibrinogen and 5 patients had prolonged international normalized ratio. Of the 10 patients, 4 died during hospitalization, within a few days of imaging. Pathology of 1 patient at autopsy demonstrated findings suggestive of a microvascular thrombotic or embolic event without overt parenchymal microhemorrhage. CONCLUSION In this preliminary case series, we describe patients with "susceptibility etching" on SWI who were also found to have profound coagulation impairment. While other comorbities may also contribute to this novel sign, we suggest that a possible etiology may be secondary to microvascular in situ formation of fine thrombi and/or emboli lodged into an area of vascular caliber reduction and maybe related to thrombotic microangiopathy.
Collapse
Affiliation(s)
- Jennifer Chang
- Department of Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Keerthi Arani
- Department of Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Sheena Chew
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Matthew P Frosch
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - R Gilberto Gonzalez
- Department of Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Noor Maza
- Department of Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Javier M Romero
- Department of Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
16
|
Ginat DT, Christoforidis GA. Retinal and intracranial hemorrhage in acute leukemic disseminated intravascular coagulation. Neurology 2015; 85:107-8. [PMID: 26150592 DOI: 10.1212/wnl.0000000000001723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Daniel Thomas Ginat
- From the Department of Radiology, Pritzker School of Medicine, University of Chicago, Chicago, IL.
| | - Gregory A Christoforidis
- From the Department of Radiology, Pritzker School of Medicine, University of Chicago, Chicago, IL
| |
Collapse
|
17
|
Yazici S, Karahan O, Oral MK, Bayramoğlu Z, Unal M, Caynak B, Sagbas E. Comparison of Renoprotective Effect of Dabigatran With Low-Molecular-Weight Heparin. Clin Appl Thromb Hemost 2015; 22:361-5. [PMID: 25681331 DOI: 10.1177/1076029615571629] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The susceptibility of tissue to ischemia-reperfusion (I/R) injury is a major obstacle to tissue regeneration and cellular survival. In this study, we investigated the possible renoprotective effect of dabigatran in an experimental renal I/R model. METHOD A total of 25 rats were randomly divided into 5 equal groups. The control group was used to obtain basal values of oxidant and antioxidant biomarkers. The sham group was used to obtain renal prolidase and malondialdehyde (MDA) levels after renal ischemia (for 45 minutes) and reperfusion (for 1 hour). A standard diet was followed. Oral 15 mg/kg dabigatran etexilate was administrated to group I, intraperitoneal 250 U/kg enoxaparin sodium was administrated to group II, and intraperitoneal 250 U/kg bemiparin sodium was administrated to group III for 1 week before the renal I/R was performed. Renal tissue samples were obtained during the first hour of reperfusion to detect renal prolidase and MDA levels in these groups, after which the rats were euthanized. RESULTS Renal prolidase levels were significantly higher in the sham group compared with the control group (1834.2 ± 982.3 U/g protein vs 238.8 ± 43.6U/g protein; P = .001). Lower prolidase levels were observed in groups II (838.7 ± 123.8 U/g protein) and III (1012.9 ± 302.3 U/g protein), and the lowest prolidase levels occurred in group I (533.8 ± 96.2 U/g protein; P < .05) when compared with the sham group. The MDA levels were significantly lower (P < .05) in groups I, II, and III (163.9 ± 41.5, 185.4 ± 51.0, and 138.2 ± 22.6 μmol/g protein, respectively) compared with the sham group. CONCLUSION Dabigatran etexilate, a univalent direct thrombin inhibitor, may protect the renal tissue more effectively when compared to low-molecular-weight heparins.
Collapse
Affiliation(s)
- Suleyman Yazici
- Department of Cardiovascular Surgery, Medical School of Bilim University, Florence Nightingale Hospital, İstanbul, Turkey
| | - Oguz Karahan
- Department of Cardiovascular Surgery, Medical School of Dicle University, Diyarbakir, Turkey
| | - Mehmet Kerem Oral
- Department of Cardiovascular Surgery, Medical School of Bilim University, Florence Nightingale Hospital, İstanbul, Turkey
| | - Zehra Bayramoğlu
- Department of Cardiovascular Surgery, Medical School of Bilim University, Florence Nightingale Hospital, İstanbul, Turkey
| | - Mehmet Unal
- Department of Cardiovascular Surgery, Medical School of Bilim University, Florence Nightingale Hospital, İstanbul, Turkey
| | - Baris Caynak
- Department of Cardiovascular Surgery, Medical School of Bilim University, Florence Nightingale Hospital, İstanbul, Turkey
| | - Ertan Sagbas
- Department of Cardiovascular Surgery, Medical School of Bilim University, Florence Nightingale Hospital, İstanbul, Turkey
| |
Collapse
|
18
|
Katsetos CD, Poletto E, Kasmire KE, Walleigh D, Kumar I, Pascasio JM, Legido A, Goldsmith DP. Childhood primary angiitis of the central nervous system with metachronous hemorrhagic infarcts: a postmortem study with clinicopathologic correlation. Semin Pediatr Neurol 2014; 21:184-94. [PMID: 25149960 DOI: 10.1016/j.spen.2014.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This neuropathologic case study illustrates the discovery of metachronous hemorrhagic infarcts insinuating round mass-like lesions by magnetic resonance imaging in the setting of childhood primary angiitis of the central nervous system (cPACNS) raising diagnostic awareness of this unusual presentation in a clinical and neuroimaging context. The report underscores the importance of recurrent vasculitis-induced ischemic brain damage as a pathologic correlate of relapsing cPACNS and offers a critical reappraisal of common imitators as well as a clinicopathologic approach to differential diagnosis. Attention is drawn to the caveat that although magnetic resonance imaging findings at initial presentation may not be typical for stroke, they later exhibit attributes of cerebral infarction at both the subacute and chronic stages. A pattern of cPACNS characterized predominantly by multiple petechial-like cortical hemorrhages with pathologic features of hemorrhagic infarcts is recognized. The present study lends credence to the practice of a rigorous autopsy-based approach aimed at a better understanding of the anatomic pathology and biology of cPACNS and at facilitating prospective neuroimaging and biopsy-based surgical pathology correlations, ultimately enhancing diagnostic accuracy in clinical settings. Although PACNS is, by definition, a diagnosis of exclusion, it should be considered from the outset in the differential diagnosis of ischemic stroke or hemorrhagic stroke or of unusual and relapsing intra-axial mass-like CNS lesions in children, necessitating appropriate pathologic evaluation of brain biopsy specimens.
Collapse
Affiliation(s)
- Christos D Katsetos
- Department of Pediatrics, Drexel University College of Medicine, St. Christopher׳s Hospital for Children, Philadelphia, PA; Department of Pathology and Laboratory Medicine, Drexel University College of Medicine, St. Christopher׳s Hospital for Children, Philadelphia, PA; Department of Neurology, Drexel University College of Medicine, Philadelphia, PA.
| | - Erica Poletto
- Department of Pediatrics, Drexel University College of Medicine, St. Christopher׳s Hospital for Children, Philadelphia, PA; Department of Radiology, Drexel University College of Medicine, St. Christopher׳s Hospital for Children, Philadelphia, PA
| | - Kathryn E Kasmire
- Department of Pediatrics, Drexel University College of Medicine, St. Christopher׳s Hospital for Children, Philadelphia, PA
| | - Diana Walleigh
- Department of Pediatrics, Drexel University College of Medicine, St. Christopher׳s Hospital for Children, Philadelphia, PA
| | - Indira Kumar
- Department of Pediatrics, Drexel University College of Medicine, St. Christopher׳s Hospital for Children, Philadelphia, PA
| | - Judy Mae Pascasio
- Department of Pediatrics, Drexel University College of Medicine, St. Christopher׳s Hospital for Children, Philadelphia, PA; Department of Pathology and Laboratory Medicine, Drexel University College of Medicine, St. Christopher׳s Hospital for Children, Philadelphia, PA
| | - Agustin Legido
- Department of Pediatrics, Drexel University College of Medicine, St. Christopher׳s Hospital for Children, Philadelphia, PA; Department of Neurology, Drexel University College of Medicine, Philadelphia, PA
| | - Donald P Goldsmith
- Department of Pediatrics, Drexel University College of Medicine, St. Christopher׳s Hospital for Children, Philadelphia, PA
| |
Collapse
|
19
|
Löbel U, Eckert B, Simova O, Meier-Cillien M, Kluge S, Gerloff C, Röther J, Magnus T, Fiehler J. Cerebral magnetic resonance imaging findings in adults with haemolytic uraemic syndrome following an infection with Escherichia coli, subtype O104:H4. Clin Neuroradiol 2013; 24:111-9. [PMID: 23811994 DOI: 10.1007/s00062-013-0231-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 06/12/2013] [Indexed: 11/27/2022]
Abstract
PURPOSE Infections with Enterohaemorrhagic Escherichia coli typically occur in children causing haemolytic uraemic syndrome (HUS) and neurological symptoms in 20-50 %. Little information is available on the morphology of brain manifestations in adults. The purpose of this study was to identify a characteristic magnetic resonance imaging (MRI) pattern during the outbreak of a novel mutation of Escherichia coli O104:H4. METHODS Patients were recruited from two hospitals between May and July 2011. The MRI protocol included standard anatomical, diffusion-weighted, and susceptibility-sensitive sequences. RESULTS A total of 104 MRIs of 57 (32 female, 25 male) patients (mean 45.5 ± 18.4 years) showed abnormal signal intensity on 51 MRIs (49 %). Bilateral thalamus (39 %), bilateral pons (35 %), centrum semiovale and splenium of corpus callosum (33 %) were most often involved. Acute lesions were reversible in 81 % of cases. There was no statistically significant association between symptom onset and the MRI findings (P = 0.2). CONCLUSIONS Neuroimaging findings in this adult patient cohort were non-specific and similar to previous findings in children. A characteristic neuroimaging pattern of an infection with Escherichia coli O104:H4 was not identified. However, bilateral symmetric T2 hyperintense lesions of the thalami and dorsal pons characterized by restricted diffusion suggest a metabolic toxic effect of the disease on the brain.
Collapse
Affiliation(s)
- U Löbel
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany,
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Benseler S, Pohl D. Childhood central nervous system vasculitis. HANDBOOK OF CLINICAL NEUROLOGY 2013; 112:1065-78. [DOI: 10.1016/b978-0-444-52910-7.00024-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
|