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Kim Y, Koutsouras GW, Bourdages G, Beutler T. Insidious onset of spontaneous spinal epidural hematoma in immune thrombocytopenic purpura: a case-based review. Childs Nerv Syst 2023; 39:1903-1909. [PMID: 37126139 DOI: 10.1007/s00381-023-05963-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/16/2023] [Indexed: 05/02/2023]
Abstract
INTRODUCTION Spontaneous spinal epidural hematoma (SSEH) can result from various etiologies with a variable degree of neurological deficits. Here, we describe a rare case of SEH secondary to immune thrombocytopenic purpura (ITP) in a child and review the literature of SSEH caused by ITP. CASE REPORT A 9-year-old female who presented with rapid neurological decline, including bowel and bladder incontinence and paraparesis. A SSEH was observed extending from C2 to T6, causing a mass effect on the spinal cord. Her platelet count was only 7000/µL. Multidisciplinary care was established with neurosurgery, pediatric hematology, and pediatric surgery. The patient was managed emergently with splenectomy and surgical evacuation, with multilevel laminectomy and laminoplasty for evacuation of the hematoma. After a short course of rehabilitation, the patient regained all neurological function. CONCLUSION We report the first case of cervicothoracic SSEH secondary to ITP in a child managed with emergent splenectomy and surgical evacuation with multilevel lamoplasty. We also described the methods of timely diagnosis, urgent management, and overall prognosis of patients with this condition.
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Affiliation(s)
- YeonSoo Kim
- Department of Neurosurgery, SUNY Upstate University Hospital, Syracuse, NY, USA
| | - George W Koutsouras
- Department of Neurosurgery, SUNY Upstate University Hospital, Syracuse, NY, USA.
| | - George Bourdages
- Department of Neurosurgery, SUNY Upstate University Hospital, Syracuse, NY, USA
| | - Timothy Beutler
- Department of Neurosurgery, SUNY Upstate University Hospital, Syracuse, NY, USA
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Kufel WD, Abouelhassan Y, Steele JM, Gutierrez RL, Perwez T, Bourdages G, Nicolau DP. Plasma and cerebrospinal fluid concentrations of cefiderocol during successful treatment of carbapenem-resistant Acinetobacter baumannii meningitis. J Antimicrob Chemother 2022; 77:2737-2741. [DOI: 10.1093/jac/dkac248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/24/2022] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
To date, no real-world data are available to describe cefiderocol use in carbapenem-resistant Acinetobacter baumannii (CRAB) meningitis. Furthermore, cefiderocol pharmacokinetic (PK) data to support CNS penetration in human subjects are limited. These gaps pose a significant concern for clinicians who are faced with treating such infections when considering cefiderocol use.
Objectives
To describe cefiderocol CSF and plasma PK and pharmacodynamic (PD) data from two different dosing regimens [2 g IV q6h (regimen 1) and 2 g IV q8h (regimen 2)] during treatment of CRAB meningitis.
Patients and methods
A 61-year-old woman with CRAB meningitis was treated with cefiderocol and intraventricular gentamicin. Steady-state plasma and CSF cefiderocol concentrations were evaluated on Day 19 (regimen 1) and Day 24 (regimen 2) during the cefiderocol treatment course.
Results
CSF AUC was 146.49 and 118.28 mg·h/L, as determined by the linear-log trapezoidal method for regimens 1 and 2, respectively. Penetration into CSF estimated as the AUCCSF/AUCfree plasma ratio was 68% and 60% for regimens 1 and 2, respectively. Estimated free plasma and CSF concentrations exceeded the MIC of the isolate for 100% of the dosing interval. Microbiological and clinical cure were achieved, and no cefiderocol-associated adverse effects were observed.
Conclusions
Cefiderocol, when given as 2 g q8h and 2 g q6h, attained CSF concentrations that exceeded the organism-specific MIC and the CLSI susceptible breakpoint (≤4 mg/L) for 100% of the dosing interval.
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Affiliation(s)
- Wesley D Kufel
- Department of Pharmacy Practice, Binghamton University School of Pharmacy and Pharmaceutical Sciences , Binghamton, NY , USA
- Division of Infectious Diseases, Department of Medicine, State University of New York Upstate Medical University , Syracuse, NY , USA
- Department of Pharmacy, State University of New York Upstate University Hospital , Syracuse, NY , USA
| | - Yasmeen Abouelhassan
- Center for Anti-Infective Research and Development, Hartford Hospital , Hartford, CT , USA
| | - Jeffrey M Steele
- Division of Infectious Diseases, Department of Medicine, State University of New York Upstate Medical University , Syracuse, NY , USA
- Department of Pharmacy, State University of New York Upstate University Hospital , Syracuse, NY , USA
| | - Ramiro L Gutierrez
- Division of Infectious Diseases, Department of Medicine, State University of New York Upstate Medical University , Syracuse, NY , USA
| | - Talha Perwez
- Division of Infectious Diseases, Department of Medicine, State University of New York Upstate Medical University , Syracuse, NY , USA
| | - George Bourdages
- Department of Neurosurgery, State University of New York Upstate Medical University , Syracuse, NY , USA
| | - David P Nicolau
- Center for Anti-Infective Research and Development, Hartford Hospital , Hartford, CT , USA
- Division of Infectious Diseases, Hartford Hospital , Hartford, CT , USA
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Goren O, Bourdages G, Schirmer CM, Weiner G, Dalal SS, Griessenauer CJ. Intraoperative 3-Dimensional Rotational Angiography in Cerebrovascular Surgery: A Case Series. World Neurosurg 2020; 141:e736-e742. [PMID: 32535054 DOI: 10.1016/j.wneu.2020.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/30/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Intraoperative imaging is critical in cerebrovascular surgery to assess the technical success of the operation. This case series aimed to evaluate the safety and efficacy of 3-dimensional rotational angiogram (3D-RA) in addition to 2-dimensional intraoperative angiography (2D-IOA) during cerebrovascular surgery in the hybrid operating room. METHODS All consecutive patients who underwent open cerebrovascular surgery and intraoperative 2D-IOA with 3D-RA in a hybrid operating room at 2 academic centers between August 2018 and December 2019 were identified from a prospectively maintained institutional database. Medical charts and operative videos including intraoperative angiography were reviewed, and clinical and angiographic outcomes assessed. RESULTS A total of 40 cerebrovascular surgeries in 39 patients (mean age, 53 ± 13 years; 51% female) were carried out with the addition of 3D-RA to 2D-IOA in the hybrid operating room. After 3D-RA in addition to 2D-IOA, 1 (2.5%) surgical alteration occurred in an aneurysm clipping. Other procedures were not altered with the addition of 3D-RA to 2D-IOA. There were no complications from the addition of 3D-RA to 2D-IOA. CONCLUSIONS Using a combination of 3D-RA and 2D-IOA in the hybrid operating room may enhance the likelihood of achieving an optimal result when employing microsurgical cerebrovascular surgery and avoid unanticipated incomplete outcomes, complications, and returns to the operating room. Whereas the addition of 3D-RA elucidated residual aneurysm not otherwise visualized on the 2D-IOA, in other cerebrovascular procedures studied, there was no additional value of the 3D-RA over the 2D-IOA.
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Affiliation(s)
- Oded Goren
- Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA.
| | - George Bourdages
- Geisinger Commonwealth School of Medicine, Danville, Pennsylvania, USA
| | - Clemens M Schirmer
- Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA; Department of Neurosurgery, Geisinger, Wyoming-Valley, Pennsylvania, USA; Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Gregory Weiner
- Department of Neurosurgery, Geisinger, Wyoming-Valley, Pennsylvania, USA
| | - Shamsher S Dalal
- Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA; Department of Radiology, Geisinger, Danville, Pennsylvania, USA
| | - Christoph J Griessenauer
- Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA; Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
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Sadighi A, Wasko L, DiCristina H, Wagner T, Wright K, Capone K, Monczewski M, Kester M, Bourdages G, Griessenauer C, Zand R. Long-term outcome of resuming anticoagulation after anticoagulation-associated intracerebral hemorrhage. eNeurologicalSci 2020; 18:100222. [PMID: 32123759 PMCID: PMC7037578 DOI: 10.1016/j.ensci.2020.100222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 01/07/2020] [Accepted: 01/13/2020] [Indexed: 12/22/2022] Open
Abstract
Introduction The risk and benefit of restarting oral anticoagulation (OAC) therapy among patients with atrial fibrillation or flutter (AF) and an episode of anticoagulation-associated intracerebral hemorrhage (ICH) remain unclear. Whether or not to resume OAC after an OAC-associated ICH will remain an unanswered clinical question until we have sufficient data through randomized clinical trials. Here, we analyzed the long-term outcome of patients with AF who did or did not resume OAC after an OAC-associated ICH. Patients and methods We studied consecutive patients with AF who were discharged from our institution after an OAC-associated ICH event between 2010 and 2017. Baseline characteristics of patients, past medical history, and history or OAC use were recorded. Outcome measures in our study included recurrent ICH, ischemic stroke or systemic emboli, and death. Results Out of 115 patients with AF and OAC-associated ICH, 93 patients (mean age 76.2 ± 10.3 years [44–91 years old], 54.3% men) were included in this study. Thirty-eight (40.9%) patients resumed OAC after the episode of OAC-associated ICH. More than 70% of patients had resumed OAC within two months of ICH (mean delay 56.0 ± 52.5 days). There was no significant difference between the group who resumed OAC and the group who did not in terms of mean follow-up duration (1.9 vs. 2.4 years), the type of initial ICH, as well as history of hypertension, diabetes, previous ischemic stroke, congestive heart failure, coronary artery disease, and tobacco use. There was no significant difference between the two groups considering the incidence rate of recurrent ICH (relative risk 2.9; 95% CI, 0.3–30.8). There was also no significant difference between the two groups regarding the incidence rate of ischemic stroke or systemic emboli (relative risk 0.9; 95% CI, 0.3–2.7). There was no significate difference between patients who did and did not resume OAC was 96 and 121 per 1000 patient-years, respectively (relative risk 0.8; 95% CI, 0.3–1.9). Conclusions We did not observe any significant difference between the group of patients who resumed OAC and the patients who did not in terms of recurrent ICH, ischemic stroke or systemic emboli, and death. However, there was a tendency toward a higher long-term risk of recurrent ICH among patients who resumed OAC. Outcome of AF patients who did/did not resume OAC after an OAC-ICH was studied. No significant difference between two groups in terms of recurrent ICH and death. Tendency toward a higher long-term risk of recurrent ICH in patients who resumed OAC.
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Affiliation(s)
- Alireza Sadighi
- Department of Neurology, Geisinger Medical Center, Danville, PA, USA
| | - Lisa Wasko
- Department of Neurology, Geisinger Medical Center, Danville, PA, USA
| | | | - Thomas Wagner
- Department of Neurology, Geisinger Medical Center, Danville, PA, USA
| | - Kathryn Wright
- Department of Neurology, Geisinger Medical Center, Danville, PA, USA
| | - Kellie Capone
- Department of Neurology, Geisinger Medical Center, Danville, PA, USA
| | | | - Margaret Kester
- Department of Neurology, Geisinger Medical Center, Danville, PA, USA
| | - George Bourdages
- Department of Neurology, Geisinger Medical Center, Danville, PA, USA
| | | | - Ramin Zand
- Department of Neurology, Geisinger Medical Center, Danville, PA, USA
- Corresponding author at: Department of Neurology, Division of Cerebrovascular Diseases, Geisinger Medical Center, 100 N Academy Ave, Danville, PA 17822, USA.
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Beckett L, DiCristina H, Wagner T, Wright K, Capone K, Monczewski M, Kester M, Bourdages G, Zand R. Abstract WP457: Long-Term Outcome of Resuming Anticoagulation Treatment After Anticoagulation-Associated Intracerebral Hemorrhage. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.wp457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose:
The risk and benefit of restarting oral anticoagulation (OAC) therapy among patients with atrial fibrillation (AF) and an episode of anticoagulation-associated intracerebral hemorrhage (ICH) remain unclear. Many clinicians and patients prefer not to resume OAC after an OAC-associated ICH. Here, we analyzed the long-term outcome of patients with AF who did or did not resume OAC after an OAC-associated ICH.
Methods:
We studied consecutive patients with AF who were discharged from our institution after an OAC-associated ICH event between 2010 and 2017. Baseline characteristics of patients, past medical history, and history of OAC use were recorded. Outcome measures in our study included recurrent ICH, ischemic stroke or systemic emboli, and death.
Results:
Out of 115 patients with AF and OAC-associated ICH, 93 patients (mean age 76.2 ± 10.3 years [44-91 years old], 54.3% men) were included in this study. Thirty-eight (40.9%) patients resumed OAC after the episode of OAC-associated ICH. There was no significant difference among the group who resumed OAC and the patients who did not, in terms of mean follow-up duration (1.9 vs. 2.4 years), the type of initial ICH, as well as history of hypertension, diabetes, previous ischemic stroke, congestive heart failure, coronary artery disease, and tobacco use. Although the incidence rate of recurrent ICH was higher among patients who resumed OAC compared with those who did not (55 vs. 15 cases per 1000 patient-years), the difference was not significant (relative risk 2.9; 95% CI, 0.3-30.8). The incidence rate of ischemic stroke or systemic emboli was slightly lower among patients who had resumed OAC (69 vs. 76 cases per 1000 patient-years). However, the difference was not significant (relative risk 0.9; 95% CI, 0.3-2.7). The mortality rate among patient who did and did not resume OAC was 96 and 121 per 1000 patient-years, respectively (relative risk 0.8; 95% CI, 0.3-1.9).
Conclusions:
We did not observe any significant difference between the group of patients who resumed OAC and the patients who did not in terms of recurrent ICH, ischemic stroke or systemic emboli, and death. However, there was a tendency towards a higher long-term risk of recurrent ICH among patients who resumed OAC.
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Bourdages G, Yates B. Feedforward Mechanisms Adjust Cerebral Blood Flow During Anticipated Postural Changes. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.950.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Bill Yates
- Otolaryngology University of PittsburghPittsburghPAUnited States
- NeuroscienceUniversity of PittsburghPittsburghPAUnited States
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