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Geers MS, van der Sar-van der Brugge S, van Norden AGW, van Hulst RA, De Backer ICF. [Cerebral arterial air embolism: the effect of hyperbaric oxygen therapy]. Ned Tijdschr Geneeskd 2023; 167:D7480. [PMID: 37994739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND Iatrogenic gas embolism is the presence of gas in vascular structures. Feared are those in coronary or cerebral arteries. These can result in cerebral or myocardial infarction. CASE DESCRIPTION A 79-year-old female underwent CT-guided biopsy of the lung. Minutes later she developed neurological symptoms. After administration of oxygen her symptoms initially improved, but later worsened. Based on her symptoms air embolism was suspected. She recovered fully after treatment with hyperbaric oxygen. CONCLUSION Air embolism is a potentially life-threatening complication of surgical, radiological or vascular interventions. Early recognition can lead to prompt treatment and better prognosis. If air embolism is suspected the patient should be treated according to ABCDE principles and oxygen should be administered. In case of neurological or circulatory symptoms a hospital that could provide hyperbaric oxygen therapy should be contacted as soon as possible.
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Affiliation(s)
- Marloes S Geers
- Erasmus MC, afd. Longgeneeskunde, Rotterdam
- Contact: Marloes S. Geers
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2
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Budrejko S, Królak T, Kempa M, Raczak G. Emergency mechanical thrombectomy to treat embolic stroke complicating catheter ablation of cardiac arrhythmia. Kardiol Pol 2021; 79:591-592. [PMID: 34125942 DOI: 10.33963/kp.15931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 11/23/2022]
Affiliation(s)
- Szymon Budrejko
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdańsk, Poland.
| | - Tomasz Królak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdańsk, Poland
| | - Maciej Kempa
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdańsk, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdańsk, Poland
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Binkley M, Kelly M, Hardy K. Cerebral arterial gas embolism in a patient with hypoplastic left heart syndrome treated with emergent hyperbaric oxygen: case report. Undersea Hyperb Med 2020; 47:431-434. [PMID: 32931669] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A 30-year-old female with a history of seizure disorder and hypoplastic left heart syndrome treated with a Norwood procedure in 1986 followed by a modified non-fenestrated Fontan (Left SVC to IVC to pulmonary arteries) with a known baffle leak presented to the emergency department. On day of presentation, the patient became unresponsive, with perioral cyanosis, rightward gaze and a left facial droop near the end of a platelet transfusion. An emergent non-contrast head CT revealed intracranial air in the right MCA distribution. She was taken to the hyperbaric chamber and was treated with a U.S. Navy Table 6 in a multiplace chamber with no extensions. Ten minutes into the treatment patient became more alert and spontaneously asked questions. The following day she was treated with a U.S. Navy Table 5. Patient had repeat CT of the head, which showed resolution of intracerebral gas and small areas of ischemia in right frontal lobe and right caudate. On hospital day five neurologic exam was normal, with 5/5 strength and no residual deficits. Treating the patient was a concern because patient has a single ventricle, in which the pulmonary artery is connected directly to the vena cava. There is very little data regarding the effects of hyperbaric oxygen (HBO2)therapy on single-ventricle physiology. Only two case reports of three pediatric patients treated with HBO2 for CAGE in a similar setting are known. In these cases the patients had improvements in their symptoms following HBO2. These cases and ours indicate HBO2 is feasible and indicated for CAGE in patients with cyanotic congenital heart disease.
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Affiliation(s)
- Mark Binkley
- Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania U.S
| | - Matthew Kelly
- Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania U.S
| | - Kevin Hardy
- Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania U.S
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Takao S, Masuda T, Yamada T, Yamaguchi K, Sakamoto S, Matsushima H, Horimasu Y, Nakashima T, Miyamoto S, Iwamoto H, Fujitaka K, Hamada H, Hattori N. Pulmonary arteriovenous malformation exhibiting recanalization >10 years after coil embolization: Two case reports. Medicine (Baltimore) 2020; 99:e18694. [PMID: 31914070 PMCID: PMC6959888 DOI: 10.1097/md.0000000000018694] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Some patients with pulmonary arteriovenous malformation (PAVM) present with hypoxemia and life-threatening complications, including stroke and cerebral abscess. Catheter embolization is currently the preferred treatment for PAVM. However, previous studies have revealed that the incidence of PAVM recanalization is approximately 10% 5 to 7 years after embolization. In contrast, there are no studies where recanalization has occurred over 10 years after embolization. PATIENT CONCERNS Herein, we report 2 cases diagnosed with cerebral embolism due to PAVM recanalization 13 years and 30 years after catheter treatment, in case I and II, respectively. DIAGNOSES Both cases were diagnosed with PAVM recanalization on chest computed tomography (CT) examination performed after cerebral embolism development. Furthermore, pulmonary artery angiography revealed blood flow from the pulmonary artery to the vein in the PAVM, confirming PAVM recanalization. INTERVENTIONS Coil re-embolization was performed for the all recanalized PAVM. OUTCOMES All the target lesions were successfully re-embolized in both cases. However, in case I, the second recanalization of embolized PAVM was confirmed 1 year after coil re-embolization. Consequently, the third embolization was performed in case I. In contrast to case I, the patient in case II was followed up without recanalization for 2 years after embolization. LESSONS We described the first 2 cases diagnosed with PAVM recanalization >10 years after the first catheter embolization. These cases suggest that patients with PAVMs should undergo life-long follow-up after catheter embolization.
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Affiliation(s)
- Shun Takao
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Minami-ku
| | - Takeshi Masuda
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Minami-ku
| | - Takahiro Yamada
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Minami-ku
| | - Kakuhiro Yamaguchi
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Minami-ku
| | - Shinjiro Sakamoto
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Minami-ku
| | - Hayato Matsushima
- Department of Neurology, Suiseikai Kajikawa Hospital, Naka-ku, Hiroshima, Japan
| | - Yasushi Horimasu
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Minami-ku
| | - Taku Nakashima
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Minami-ku
| | - Shintaro Miyamoto
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Minami-ku
| | - Hiroshi Iwamoto
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Minami-ku
| | - Kazunori Fujitaka
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Minami-ku
| | - Hironobu Hamada
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Minami-ku
| | - Noboru Hattori
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Minami-ku
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5
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Moon RE. Hyperbaric treatment of air or gas embolism: current recommendations. Undersea Hyperb Med 2019; 46:673-683. [PMID: 31683367] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Gas can enter arteries (arterial gas embolism, AGE) due to alveolar-capillary disruption (caused by pulmonary over-pressurization, e.g. breath-hold ascent by divers) or veins (venous gas embolism, VGE) as a result of tissue bubble formation due to decompression (diving, altitude exposure) or during certain surgical procedures where capillary hydrostatic pressure at the incision site is subatmospheric. Both AGE and VGE can be caused by iatrogenic gas injection. AGE usually produces stroke-like manifestations, such as impaired consciousness, confusion, seizures and focal neurological deficits. Small amounts of VGE are often tolerated due to filtration by pulmonary capillaries; however VGE can cause pulmonary edema, cardiac "vapor lock" and AGE due to transpulmonary passage or right-to-left shunt through a patient foramen ovale. Intravascular gas can cause arterial obstruction or endothelial damage and secondary vasospasm and capillary leak. Vascular gas is frequently not visible with radiographic imaging, which should not be used to exclude the diagnosis of AGE. Isolated VGE usually requires no treatment; AGE treatment is similar to decompression sickness (DCS), with first aid oxygen then hyperbaric oxygen. Although cerebral AGE (CAGE) often causes intracranial hypertension, animal studies have failed to demonstrate a benefit of induced hypocapnia. An evidence based review of adjunctive therapies is presented.
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Affiliation(s)
- Richard E Moon
- Depts. of Anesthesiology and Medicine, Center for Hyperbaric Medicine and Environmental Physiology, Duke University Medical Center, Durham, North Carolina U.S
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Abstract
Fat embolism syndrome (FES) is a rare syndrome caused by embolization of fat particles into multiple organs including the brain. It typically manifests with petechial rash, deteriorating mental status, and progressive respiratory insufficiency, usually occurring within 24-48 h of trauma with long-bone fractures or an orthopedic surgery. The diagnosis of FES is based on clinical and imaging findings, but requires exclusion of alternative diagnoses. Although there is no specific treatment for FES, prompt recognition is important because it can avoid unnecessary interventions and clarify prognosis. Patients with severe FES can become critically ill, but even comatose patients with respiratory failure may recover favorably. Prophylactic measures, such as early stabilization of fractures and certain intraoperative techniques, may help decrease the incidence and severity of FES.
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Affiliation(s)
- Daniel Agustín Godoy
- Neurointensive Care Unit, Sanatorio Pasteur, Chacabuco 675, 4700, Catamarca, Argentina.
- Intensive Care Unit, Hospital San Juan Bautista, Catamarca, Argentina.
| | - Mario Di Napoli
- Neurological Service, San Camillo de' Lellis General Hospital, Rieti, Italy
- Neurological Section, SMDN-Center for Cardiovascular Medicine and Cerebrovascular Disease Prevention, Sulmona, L'Aquila, Italy
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7
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Wihlborg H, Wiklund S, Styring E. [Respiratory failure and neurological impairment in a child with Duchenne muscular dystrophy following minor trauma]. Lakartidningen 2019; 116:FI6F. [PMID: 31237663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Fat Embolism Syndrome (FES) is a rare and often lethal condition, associated with trauma or surgery. It is more serious than a typical fat embolism seen after a fracture in a long bone. FES is a triad of symtoms, including respiratory failure, abnormal neurology and petechial bleeding. FES is a diagnosis of exclusion. The incidence of FES is higher among adults compared to children. One possible explanation for this is the greater proportion of fat in the adult bone marrow. Children with Duchennes muscular dystrophy have a significantly increased risk of FES compared to both other children and adults. There is no specific treatment. Treatment is supportive until the respiratory and cardiovasculatory symtoms pass.
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Affiliation(s)
- Helena Wihlborg
- Skånes universitetssjukhus - Barnnarkos och barnintensivvård Lund, Sweden Skånes universitetssjukhus - Barnnarkos och barnintensivvård Lund, Sweden
| | - Sven Wiklund
- Skånes universitetssjukhus - Barnneurologiska kliniken Lund, Sweden Skånes universitetssjukhus - Barnneurologiska kliniken Lund, Sweden
| | - Emelie Styring
- Skånes universitetssjukhus - Ortopedkliniken Lund, Sweden Skånes universitetssjukhus - Ortopedkliniken Lund, Sweden
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Takeuchi Y, Nakahara K, Nakajima M, Inoue Y, Matsumura R, Yamaguchi M, Katabuchi H, Ando Y. A 23-Year-Old Woman with Sudden-Onset Blindness of the Right Eye. J Stroke Cerebrovasc Dis 2019; 28:e12-e13. [PMID: 30638937 DOI: 10.1016/j.jstrokecerebrovasdis.2018.12.031] [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] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 12/19/2018] [Accepted: 12/22/2018] [Indexed: 11/19/2022] Open
Abstract
A 23-year-woman was presented for sudden-onset monocular blindness. Branch retinal artery occlusion in the right eye and multiple brain embolism were detected. Trousseau syndrome due to bilateral ovarian cancer was diagnosed; no embolic events were observed after anticoagulant therapy and surgical resection.
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Affiliation(s)
- Yosuke Takeuchi
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Keiichi Nakahara
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Makoto Nakajima
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
| | - Yasuteru Inoue
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Riyo Matsumura
- Department of Ophthalmology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Munekage Yamaguchi
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hidetaka Katabuchi
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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9
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Dilip M, Bielawski A, Owen E. Hyperbaric oxygen therapy for cerebral air gas embolism following orthotopic heart transplant: case report. Undersea Hyperb Med 2018; 45:685-688. [PMID: 31158937] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Air gas embolism (AGE) is a rare complication of cardiac surgery, with high morbidity and mortality. We present a case of suspected AGE following orthotopic heart transplant. The patient received hyperbaric oxygen therapy with near-complete resolution of symptoms at follow-up. This case exemplifies the difficulty in diagnosis of AGE, the considerations involved in the treatment of a critical care patient in a hyperbaric chamber, and utility in treating a patient for AGE even after a delay in diagnosis.
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Affiliation(s)
- Monisha Dilip
- University of California, San Diego, School of Medicine, La Jolla, California U.S
| | - Anthony Bielawski
- University of California, San Diego, Department of Emergency Medicine, Division of Hyperbaric and Undersea Medicine, San Diego, California U.S
| | - Elizabeth Owen
- University of California, San Diego, Department of Emergency Medicine, Division of Hyperbaric and Undersea Medicine, San Diego, California U.S
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10
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Bembenek JP, Karlinski MA, Kurkowska-Jastrzebska I, Czlonkowska A. Embolic strokes of undetermined source in a cohort of Polish stroke patients. Neurol Sci 2018; 39:1041-1047. [PMID: 29556872 PMCID: PMC5966493 DOI: 10.1007/s10072-018-3322-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/09/2018] [Indexed: 11/27/2022]
Abstract
We aimed to provide a descriptive analysis of embolic stroke of undetermined etiology (ESUS) population based on a long-term prospective stroke registry. We retrospectively analyzed data collected in a detailed registry regarding consecutive patients admitted for first-ever ischemic stroke (IS) between January 2001 and December 2015. We used Org 10172 in Acute Stroke Treatment classification supplemented with ESUS criteria proposed by the Cryptogenic Stroke/ESUS International Working Group. Within the ESUS group, we additionally compared patients ≤ 60 and > 60 years of age. During the study period, there was a total of 3008 (1615 females and 1393 males) admissions of first-ever strokes. The most frequent cause was undetermined (38.7%), followed by cardioembolic (27.7%), large artery atherosclerosis (18.2%), small vessel disease (11.9%), and other determined (3.6%). We identified 326 patients as ESUS, which accounted for 10.8% of all strokes and 28% of strokes of undetermined etiology. ESUS patients were the youngest. Compared to all types of stroke but for those with small vessel disease, ESUS patients were most often independent before stroke and had the least severe neurological deficit at admission and the best outcome at discharge. ESUS patients ≤ 60 years were more frequently independent at discharge than ESUS patients > 60 years. Approximately 11% of patients from our registry met ESUS criteria. ESUS patients were younger when compared to all other stroke etiologies, suffered less severe strokes, and had more favorable outcome at discharge than other groups except for those with small vessel disease strokes.
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Affiliation(s)
- Jan Pawel Bembenek
- 2nd Department of Neurology, Institute of Psychiatry and Neurology, ul. Sobieskiego 9, 02-957, Warsaw, Poland.
| | - Michal Adam Karlinski
- 2nd Department of Neurology, Institute of Psychiatry and Neurology, ul. Sobieskiego 9, 02-957, Warsaw, Poland
| | - Iwona Kurkowska-Jastrzebska
- 2nd Department of Neurology, Institute of Psychiatry and Neurology, ul. Sobieskiego 9, 02-957, Warsaw, Poland
| | - Anna Czlonkowska
- 2nd Department of Neurology, Institute of Psychiatry and Neurology, ul. Sobieskiego 9, 02-957, Warsaw, Poland
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
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11
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Caplan LR. Atrial Fibrillation, Past and Future: From a Stroke Non-Entity to an Over-Targeted Cause. Cerebrovasc Dis 2018; 45:149-153. [PMID: 29587270 DOI: 10.1159/000488063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 03/01/2018] [Indexed: 11/19/2022] Open
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12
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Yasaka M, Koretsune Y, Yamashita T, Oda E, Matsubayashi D, Ota K, Kobayashi M, Matsushita Y, Kaburagi J, Ibusuki K, Takita A, Iwashita M, Yamaguchi T. Recurrent Stroke and Bleeding Events after Acute Cardioembolic Stroke-Analysis Using Japanese Healthcare Database from Acute-Care Institutions. J Stroke Cerebrovasc Dis 2017; 27:1012-1024. [PMID: 29246672 DOI: 10.1016/j.jstrokecerebrovasdis.2017.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/22/2017] [Accepted: 11/02/2017] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND To understand the reality of patients who experienced a cardioembolic stroke (CES) is important because of the high incidence of recurrent stroke and the need to account for bleeding risk in relation to the need for anticoagulation treatment. We elucidated the current real-world medical care in patients who had a CES and identified the risk factors for recurrent stroke. METHODS AND RESULTS The study comprised 9804 patients who were diagnosed with CES between April 2008 and September 2013 as identified in a healthcare database used by acute-care institutions in Japan. We analyzed the incidence and risk factors of stroke and bleeding events in CES patients. The incidence of stroke was 10.3% during the median observation period of 68 days, mainly consisting of recurrent CES (8.5%). The incidence of bleeding events and intracranial bleeding was 10.3% and 7.0%, respectively. The recurrence of ischemic stroke was significantly lower, and brain hemorrhage was significantly higher in the anticoagulation treatment group. The factors related to an increased risk of stroke were a history of cerebral infarction or transient ischemic attack, diabetes, and increase of CHA2DS2-VASc and CHADS2 scores. The risk factors for bleeding events were hypertension, renal dysfunction, and use of proton pump inhibitors (PPIs). CONCLUSIONS The patients who experienced CES had a high rate of recurrent stroke or CES, mainly consisting of recurrent CES. Although anticoagulation may be beneficial for reducing recurrence of ischemic stroke, careful management is required given consideration of increased risk of brain hemorrhage during anticoagulation treatment, especially for patients with hypertension, renal dysfunction, and use of PPIs.
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Affiliation(s)
- Masahiro Yasaka
- Department of Cerebrovascular Medicine and Neurology, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan.
| | | | | | - Eisei Oda
- Medical TOUKEI Corporation, Tokyo, Japan
| | | | - Kaori Ota
- Medical Data Vision Co., Ltd., Tokyo, Japan
| | | | - Yasuyuki Matsushita
- EU Biostatistics & Data Management, Daiichi Sankyo Europe GmbH, Munich, Germany
| | - Jumpei Kaburagi
- Medical Science Department, Daiichi Sankyo Co., Ltd., Tokyo, Japan
| | - Kei Ibusuki
- Medical Science Department, Daiichi Sankyo Co., Ltd., Tokyo, Japan
| | - Atsushi Takita
- Safety and Risk Management Department, Daiichi Sankyo Co., Ltd., Tokyo, Japan
| | - Mikio Iwashita
- Medical Science Department, Daiichi Sankyo Co., Ltd., Tokyo, Japan
| | - Takuhiro Yamaguchi
- Department of Biostatistics, Graduate School of Medicine, Tohoku University, Miyagi, Japan
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13
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Feng GH, Li HP, Li QL, Fu Y, Huang RB. Red blood cell distribution width and ischaemic stroke. Stroke Vasc Neurol 2017; 2:172-175. [PMID: 28989807 PMCID: PMC5628378 DOI: 10.1136/svn-2017-000071] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/28/2017] [Accepted: 05/07/2017] [Indexed: 12/14/2022] Open
Abstract
The red blood cell distribution width (RDW) is a measure of red blood cell (RBC) size heterogeneity, which is easily calculated by dividing the SD of erythrocyte volumes for the mean corpuscular volume. Recent reporter suggested that, besides haematological diseases and anaemia, many human disorders may be closely associated with the elevated RDW. A literature review has revealed the RDW may be closely related to the development of ischaemic stroke, carotid artery atherosclerosis and cerebral embolism. Higher RDW could independently predict adverse outcomes in patients in these conditions.
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Affiliation(s)
- Gang-Hua Feng
- Department of Neurology, The First People’s Hospital of Chenzhou, University of South China, Chenzhou, China
| | - Hai-Peng Li
- Department of Neurology, The First People’s Hospital of Chenzhou, University of South China, Chenzhou, China
| | - Qiu-Li Li
- Department of Neurology, The First People’s Hospital of Chenzhou, University of South China, Chenzhou, China
| | - Ying Fu
- Thyroid Medicine Department/Radionuclide Therapy Department (Ward 31), Hunan Provincial Tumor Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Ren-Bin Huang
- Department of Neurology, The First People’s Hospital of Chenzhou, University of South China, Chenzhou, China
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14
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Hirano T. [Embolic Stroke of Undetermined Source]. Brain Nerve 2017; 69:651-656. [PMID: 28596467 DOI: 10.11477/mf.1416200796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A new clinical construct, embolic stroke of undetermined source (ESUS) was established as a therapeutically relevant entity, which are defined as a non-lacunar infarction without proximal arterial stenosis or cardioembolic sources, with a clear indication for anticoagulation, especially with direct oral anticoagulant (DOAC). The possible embolic sources include covert atrial fibrillation, arterial stenosis with <50%, low-risk emboligenic cardiac sources, aortic plaque, cancer-associated, and paradoxical embolism. As its diagnosis is based on exclusive process, ESUS comprises heterogeneous pathologies. Though current Japanese guideline recommends antiplatelets for non-cardioembolic stroke, ESUS may benefits from anticoagulants. Randomized trials testing DOAC for the secondary prevention of ESUS are currently ongoing.
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Affiliation(s)
- Teruyuki Hirano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University Faculty of Medicine
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15
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Radecka E, Stjernqvist P, Nyren S, Nekludov M. [Iatrogenic cerebral arterial gas embolism after lung biopsy]. Lakartidningen 2017; 114:D93A. [PMID: 28350416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Eva Radecka
- Thoraxradiologiska kliniken - PhD, Specialist i radiologi, ÖL, Karolinska Universitetssjukhuset Solna Stockholm, Sweden Thoraxradiologiska kliniken, Karolinska Universitetsjukhuset Solna - Stockholm, Sweden
| | - Paula Stjernqvist
- ANOPIVA kliniken - ST-läkare, Karolinska Universitetssjukhuset Solna Stockholm, Sweden ANOPIVA kliniken, Karolinska Universitetssjukhuset Solna - Stockholm, Sweden
| | - Sven Nyren
- Thoraxradiologiska kliniken - docent, ÖL, Karolinska Universitetssjukhuset Solna Stockholm, Sweden Thoraxradiologiska kliniken, Karolinska Universitetssjukhuset Solna - Stockholm, Sweden
| | - Michael Nekludov
- ANOPIVA kliniken - PhD, Specialist i anestesiologi, specialist i hyperbarmedicin, BÖL, Karolinska Universitetssjukhuset Solna Stockholm, Sweden - ANOPIVA kliniken Stockholm, Sweden
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16
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Joob B, Wiwanitkit V. Cerebral arterial gas embolism, ingestion of hydrogen peroxide and flight. Diving Hyperb Med 2017; 47:65-66. [PMID: 28357828] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We read with interest the recent report by Smedley et al. on an interesting case of cerebral arterial gas embolism (CAGE) after pre-flight ingestion of hydrogen peroxide (H₂O₂). The authors discuss the safety of aero-medical transfer following H₂O₂ ingestion. We agree with the possible problems but the concern on the other side of the coin needs to be mentioned; can transfer be delayed is the big question? Indeed, as reported by others, ingestion of even a small amount of concentrated H₂O₂ can result in CAGE. Hence, whether aero-medical transfer proceeds or not, severe, life-threatening embolism can occur. Since it was reported that "complete neurologic recovery occurred quickly with hyperbaric therapy", this supports the contention that the fastest transfer of the patient for hyperbaric treatment should be the primary focus.
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Affiliation(s)
- Beuy Joob
- Sanitation 1 Medical Academic Center, Bangkok, Thailand,
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Verspohl E. [In process]. Med Monatsschr Pharm 2016; 39:542. [PMID: 29979525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Covington D, Bielawski A, Sadler C, Latham E. A favorable outcome despite a 39-hour treatment delay for arterial gas embolism: case report. Undersea Hyperb Med 2016; 43:457-461. [PMID: 28763175] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Cerebral arterial gas embolism (CAGE) occurs when gas enters the cerebral arterial vasculature. CAGE can occur during sitting craniotomies, cranial trauma or secondary to gas embolism from the heart. A far less common cause of CAGE is vascular entrainment of gas during endoscopic procedures. We present the case of a 49-year-old male who developed a CAGE following an esophagoduodenoscopy (EGD) biopsy. Due to a delay in diagnosis, the patient was not treated with hyperbaric oxygen (HBO₂) therapy until 39 hours after the inciting event. Despite presenting to our institution non-responsive and with decorticate posturing, the patient was eventually discharged to a rehabilitation facility, with only mild left upper extremity weakness. This delay in HBO₂ treatment represents the longest delay in treatment to our knowledge for a patient suffering from CAGE secondary to EGD. In addition to the clinical case report, we discuss the etiology of CAGE and the evidence supporting early HBO₂ treatment, as well as the data demonstrating efficacy even after considerable treatment delay.
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Affiliation(s)
- Derek Covington
- University of California San Diego (UCSD), San Diego, California U.S
| | - Anthony Bielawski
- University of California San Diego (UCSD), San Diego, California U.S
| | - Charlotte Sadler
- University of California San Diego (UCSD), San Diego, California U.S
| | - Emi Latham
- University of California San Diego (UCSD), San Diego, California U.S
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Moon RE. Iatrogenic cerebral gas embolism. Diving Hyperb Med 2016; 46:119. [PMID: 27335001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Richard E Moon
- Center for Hyperbaric Medicine and Environmental Physiology, Duke University Medical Center, Durham, USA E-mail:
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Affiliation(s)
- Geoff Frawley
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Prahran, Victoria, Australia E-mail:
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Smedley BL, Gault A, Gawthrope IC. Cerebral arterial gas embolism after pre-flight ingestion of hydrogen peroxide. Diving Hyperb Med 2016; 46:117-119. [PMID: 27335000] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 03/11/2016] [Indexed: 06/06/2023]
Abstract
Cerebral arterial gas embolism (CAGE) is a feared complication of ambient depressurisation and can also be a complication of hydrogen peroxide ingestion. We present an unusual case of CAGE in a 57-year-old woman exposed to both of these risk factors. We describe her subsequent successful treatment with hyperbaric oxygen, despite a 72-hour delay in initial presentation and diagnosis, and discuss the safety of aero-medical transfer following hydrogen peroxide ingestions.
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Affiliation(s)
- Ben L Smedley
- Rockingham General Hospital, Rockingham, Western Australia
| | - Alan Gault
- Sir Charles Gairdner Hospital, Nedlands, Western Australia
- Western Australia and New South Wales Poisons Information Centre, Australia
| | - Ian C Gawthrope
- Sir Charles Gairdner Hospital, Nedlands, Western Australia
- Western Australia and New South Wales Poisons Information Centre, Australia
- Fiona Stanley Hyperbaric Unit, 11 Robin Warren Drive, Murdoch, 6150, Western Australia, E-mail:
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Beevor H, Frawley G. Iatrogenic cerebral gas embolism: analysis of the presentation, management and outcomes of patients referred to The Alfred Hospital Hyperbaric Unit. Diving Hyperb Med 2016; 46:15-21. [PMID: 27044457] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 02/08/2016] [Indexed: 06/05/2023]
Abstract
INTRODUCTION The aim of this study was to review patients with iatrogenic cerebral gas embolism (CGE) referred to The Alfred Hospital hyperbaric unit to determine whether hyperbaric oxygen treatment (HBOT) reduced morbidity and mortality. METHODS This is a retrospective cohort study with a contemporaneous comparison group of patients referred between January 1998 and December 2014. The primary end point was good neurological outcome at the time of discharge from hospital or rehabilitation facility as assessed by the Glasgow Outcome Scale (GOS-E). RESULTS Thirty-six patients were treated with HBOT for CGE and nine patients were diagnosed with CGE but did not receive HBOT. Thirty-two patients developed CGE from an arterial source and 13 from a venous source. The mean time from recognition of the event to institution of HBOT was 15 hours. Four of 45 patients (8.9%) died. Good neurological outcomes (defined as GOS-E 7 or 8) occurred in 27 patients and moderate disability in 13. The only independent factor that was associated with good neurological outcome was time to first HBOT (OR 0.94, 0.89-0.99; P = 0.05). Hemiplegia as the first presenting sign, however, was associated with poor outcome (OR 0.27, 0.06-1.08; P = 0.05). The source of embolus (arterial versus venous), hyperbaric treatment table used and patient age did not affect outcome. CONCLUSION Appropriate treatment of CGE with hyperbaric oxygen was found to be impeded by delays in diagnosis and subsequent transfer of patients. Better neurological outcome was associated with HBOT within eight hours of CGE.
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Affiliation(s)
- Harriet Beevor
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Geoff Frawley
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, 55 Commercial Rd, Prahran, Victoria 3181 Australia, Phone: +61-(0)3-9076-2269, E-mail:
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David M, Loftsgaarden M, Chukwudelunzu F. Embolic Stroke Caused by Staphylococcus lugdunensis Endocarditis Complicating Vasectomy in a 36-Year-Old Man. Tex Heart Inst J 2015; 42:585-7. [PMID: 26664319 DOI: 10.14503/thij-14-4566] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Staphylococcus lugdunensis is part of the native flora in the inguinal region of the body. Inguinal surgeries, such as vasectomy, place carriers of this aggressive pathogen at risk for contamination. Native-valve endocarditis caused by coagulase-negative S. lugdunensis has a rapid and complicated clinical course. The pathogenicity of this organism is not limited to cardiac valvular destruction. We report the case of a 36-year-old man who presented with S. lugdunensis endocarditis, dysarthria, and hemiparesis 5 weeks after a vasectomy. To our knowledge, this is the first report of embolic stroke caused by S. lugdunensis endocarditis. In addition, we discuss the relevant medical literature.
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Affiliation(s)
- Jurjan Aman
- Department of Intensive Care, Sint Antonius Ziekenhuis, Nieuwegein, Netherlands; Department of Internal Medicine, Sint Antonius Ziekenhuis, Nieuwegein, Netherlands.
| | - Laurien van Koppenhagen
- Department of Intensive Care, Sint Antonius Ziekenhuis, Nieuwegein, Netherlands; Department of Anaesthesiology, Sint Antonius Ziekenhuis, Nieuwegein, Netherlands
| | - Alexander M Snoek
- Department of Radiology, Sint Antonius Ziekenhuis, Nieuwegein, Netherlands
| | | | - Ary-Jan van der Lely
- Department of Intensive Care, Sint Antonius Ziekenhuis, Nieuwegein, Netherlands; Department of Anaesthesiology, Sint Antonius Ziekenhuis, Nieuwegein, Netherlands
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Harlan NP, Davies LH, Weaver LK, Cloward TV, Churchill S, Deru K, Yanase L. Spontaneous cerebral gas embolism and pulmonary arteriovenous malformation: a case report. Undersea Hyperb Med 2015; 42:425-428. [PMID: 26591982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Pulmonary barotrauma can cause cerebral arterial gas embolism (CAGE) from pulmonary overdistension of alveoli forcing gas into the pulmonary vasculature. We report a case of CAGE in a man found to have occult pulmonary arteriovenous malformation (PAVM) and undiagnosed obstructive sleep apnea (OSA). A 46-year-old man was admitted to the hospital for an acute seizure and left-sided weakness, with telangiectasias on his lower lip and tongue. Brain-computed tomography (CT) showed gas emboli in the right hemisphere. Chest CT revealed a 1.8-cm PAVM in the posterior right costophrenic sulcus. A transthoracic echocardiogram showed no intracardiac shunt or patent foramen ovale. He was treated with phenytoin, lidocaine and hyperbaric oxygen. The PAVM was occluded with a detachable balloon followed by coil embolization. Polysomnography revealed severe obstructive sleep apnea, which was treated with CPAP. Seven years later, the patient was functioning at his pre-event baseline. We propose the CAGE was caused by high negative intrathoracic pressures while breathing against an obstructed upper airway, with air entrainment into the PAVM and subsequent arterialization.
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Abstract
Background:Patent foramen ovale (PFO) is present in 40% of patients with cryptogenic stroke and may be associated with paradoxical emboli to the brain. Therapeutic options include antiplatelet agents, anticoagulation, percutaneous device and surgical closure. We assessed the hypothesis that there are differences in rates of recurrent TIA or stroke between patients in the four treatment groups.Methods:Patients presenting from January 1997 with cryptogenic stroke or TIA and PFO were followed prospectively until June 2003. Treatment choice was made on an individual case basis. The primary outcome was recurrent stroke. The secondary outcome was a composite of stroke, TIA, and vascular death.Results:Baseline. Our cohort consisted of 121 patients; 64 (53%) were men. Median age was 43 years. Sixty-nine percent presented with stroke and 31% with TIA. One or more vascular risk factor was present in 40%. Atrial septal aneurysm (ASA) was present in 24%. Treatment consisted of antiplatelet agents (34%), anticoagulation (17%), device (39%) and surgical closure (11%). Follow-up. Recurrent events occurred in 16 patients (9 antiplatelet, 3 anticoagulation, 4 device closure); 7 were strokes, 9 were TIA. Comparing individual treatments there was a trend toward more strokes in the antiplatelet arm (p=0.072); a significant difference was seen for the composite endpoint (p=0.012). Comparing closure versus combined medical therapy groups, a significant difference was seen for primary (p=0.014) and secondary (p=0.008) outcomes, favoring closure. Age and pre-study event predicted outcome.Conclusion:Patent foramen ovale closure was associated with fewer recurrent events. Complications of surgical and device closure were self-limited.
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Affiliation(s)
- Leanne Casaubon
- University Health Network, Toronto General Hospital, ON, Canada
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Zheng Z, Guo G, Xu L, Lei L, Wei X, Pan Y. Left atrial myxoma with versus without cerebral embolism: length of symptoms, morphologic characteristics, and outcomes. Tex Heart Inst J 2014; 41:592-5. [PMID: 25593521 DOI: 10.14503/thij-13-3862] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The aim of this study was to evaluate the embolic sequelae of left atrial myxomas and their influence on diagnosis, treatment, and prognosis. Seventy-eight patients were retrospectively investigated. According to their symptoms and neurologic-imaging findings, these patients were classified into 2 groups: embolism (15 patients, 19%) and nonembolism (63 patients, 81%). The time from the first onset of symptoms to diagnosis (that is, the duration of symptoms) was significantly longer in the embolism group than in the nonembolism group (105 ± 190 vs 23 ± 18 d; P <0.01). The myxomas were divided into 2 types on the basis of clinicopathologic findings: type 1, with an irregular or villous surface and a soft consistency, and type 2, with a smooth surface and a compact consistency. There were 42 patients with type 1 myxoma and 36 with type 2. Type 1 myxoma was more frequently found in the embolism group (12 patients, 29%) than was type 2 myxoma (3 patients, 8%). The difference was significant (P=0.04). There were 2 perioperative deaths in the nonembolism group. No recurrence of cardiac myxoma or death was recorded in either group during follow-up. In the embolism group, neurologic symptoms were relieved by surgery, and no subsequent neurologic event was reported. Because surgical resection is highly effective in left atrial myxoma, we should strive for early diagnosis in order to shorten the duration of symptoms and to avoid worse neurologic damage in patients in whom an embolic event is the initial manifestation.
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Rahme R, Yeatts SD, Abruzzo TA, Jimenez L, Fan L, Tomsick TA, Ringer AJ, Furlan AJ, Broderick JP, Khatri P. Response. J Neurosurg 2014; 121:1352-1353. [PMID: 25584368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Dubrava J, Vulev I, Richter D. Isolated pulmonary arteriovenous fistulas with massive right-to-left shunt as a rare cause of cryptogenic stroke in a young woman. Isr Med Assoc J 2014; 16:320-321. [PMID: 24979842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Weenink RP, Hollmann MW, Zomervrucht A, van Ooij PJAM, van Hulst RA. A retrospective cohort study of lidocaine in divers with neurological decompression illness. Undersea Hyperb Med 2014; 41:119-126. [PMID: 24851549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Lidocaine is the most extensively studied substance for adjuvant therapy in neurological decompression illness (DCI), but results have been conflicting. In this retrospective cohort study, we compared 14 patients who received adjuvant intravenous lidocaine for neurological decompression sickness and cerebral arterial gas embolism between 2001 and 2011 against 21 patients who were treated between 1996 and 2001 and did not receive lidocaine. All patients were treated with hyperbaric oxygen (HBO2) therapy according to accepted guidelines. Groups were comparable for all investigated confounding factors, except that significantly more control patients had made an unsafe dive (62% vs. 14%, p = 0.007). Groups had comparable injury severity as measured by Dick and Massey score (lidocaine 2.7 +/- 1.7, control 2.0 +/- 1.6), an adapted version of the Dick and Massey score, and the Blatteau score. Number of HBO2 sessions given was comparable in both groups (lidocaine 2.7 +/- 2.3, control 2.0 +/- 1.0). There was neither a positive nor a negative effect of lidocaine on outcome (relative risk for objective neurological signs at follow-up in the lidocaine group was 1.8, 95% CI 0.2-16). This is the first retrospective cohort study of lidocaine in neurological DCI. Since our study is under-powered to draw definitive conclusions, a prospective multicenter study remains the only way to reliably determine the effect of lidocaine in neurological decompression illness.
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Bothma PA, Heij REA. Despite animal studies, HBOT is the treatment of choice for cerebral gas embolism. Diving Hyperb Med 2013; 43:249. [PMID: 24510336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Pieter A Bothma
- Consultant in anaesthesia, London Hyperbaric Unit, James Paget University Hospital, Gorleston, United Kingdom, E-mail:
| | - Robin E A Heij
- Registrar in anaesthsia, East of England Hyperbaric Unit, Addenbrooke's Hospital, Cambridge, UK
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Pérez-Nellar J, Scherle-Matamoros C. [Sonothrombolysis in a case of occlusion of the middle cerebral artery secondary to an angiographic complication]. Rev Neurol 2013; 57:478-479. [PMID: 24203672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Vanderloo JPFH. Aloha, I'm back. J Miss State Med Assoc 2013; 54:314-316. [PMID: 24400475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- John P F H Vanderloo
- Department of Family Medicine, University of Mississippi School of Medicine, USA.
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Sun XZ, Tian XY, Liu J. [One case of left atrial myxoma complicated with systemic multiple vascular thrombosis]. Zhonghua Er Ke Za Zhi 2013; 51:548. [PMID: 24267142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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35
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Kenedi C, Sames C, Paice R. A systematic review of factitious decompression sickness. Undersea Hyperb Med 2013; 40:267-274. [PMID: 23789561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We present a case of factitious decompression sickness (DCS) involving a patient emergently treated at a hyperbaric medicine facility in New Zealand. Patients with factitious disorder feign illnesses such as DCS in order to receive care and attention despite the lack of an underlying illness. Other studies have suggested that 0.6% to as many as 9.3% of hospital admissions are factitious in nature. Therefore we believe that factitious DCS is occurring more often than hyperbaric clinicians suspect. DCS can be life-threatening, and hyperbaric medicine clinicians will almost always "err on the side of caution" when patients are referred with symptoms of DCS. Because DCS can be diagnosed based on subjective symptoms and self-reported history, there are opportunities for factitious patients to receive hyperbaric therapy. The costs associated with factitious DCS include transport, staff resources and preventing patients with treatable conditions from accessing the hyperbaric chamber. We performed a systematic review of the literature and found eight additional reported cases of confirmed or suspected factitious DCS. We report our findings and recommendations for hyperbaric medicine specialists regarding the recognition and management of factitious DCS.
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Affiliation(s)
- Christopher Kenedi
- Department of General Medicine, Auckland City Hospital, Auckland, New Zealand.
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36
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Gouicem D, Palcau L, Hello CL, Coffin O, Maiza D, Berger L. Gigantic clavicle osteochondroma with carotid compression as a rare cause of stroke. J Vasc Surg 2013; 57:845-7. [PMID: 23446126 DOI: 10.1016/j.jvs.2012.09.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Revised: 09/12/2012] [Accepted: 09/12/2012] [Indexed: 11/19/2022]
Abstract
We report the case of a 26-year-old woman who presented with embolic stroke from left common carotid artery compression by a gigantic clavicular osteochondroma. To our knowledge, this is the only such case described in the literature. The other particularity of this case is the delayed appearance of this childhood tumor. Surgery was successful, with a satisfying outcome.
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Affiliation(s)
- Djelloul Gouicem
- Department of Vascular Surgery, CHU Caen Côte de Nacre, Caen, France.
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Abstract
BACKGROUND AND AIM Cerebral infarction causes permanent neurological damage. Recently, the intravenous administration of bone marrow-derived mononuclear cells has been shown to improve functional recovery through enhanced angiogenesis in an experimental stroke model. Based on these observations, we have started a phase 1/2a clinical trial of cell-based therapy for patients with cardiogenic cerebral embolism. METHODS The major inclusion criterion was patients in whom severe cerebral embolism was diagnosed (more than 9 in the NIHSS score on day 7 after the onset of stroke) at age 75 or younger. The patients received 25 ml (low-dose group, n=6) or 50 ml (high-dose group, n=6) of bone marrow aspirate on days 7-10 after the onset of stroke. Autologous bone marrow-derived mononuclear cells were purified by the density gradient method and administered intravenously on the day of cell aspiration. The primary endpoint was safety and improvement of the NIHSS score compared with our historical control. RESULTS We treated 6 patients in the low-dose group and 4 patients in the high-dose group. No adverse effects were observed and most of the patients showed a significant improvement in neurological function at 6 months after cell transplantation. No enrolled patients showed worsening of the NIHSS score at 30 days after the treatment compared with the NIHSS score before the treatment. CONCLUSION Autologous bone marrow mononuclear cell transplantation is apparently safe and feasible, and it improves functional recovery.
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Affiliation(s)
- Akihiko Taguchi
- Department of Regenerative Medicine Research, Institute of Biomedical Research and Innovation
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Abstract
INTRODUCTION The pipeline embolization device (PED) is a new endovascular stent designed for the treatment of challenging intracranial aneurysms (IAs). Its use has been extended to nonruptured and ruptured IAs of a variety of configurations and etiologies in both the anterior and posterior circulations. METHODS We conducted a systematic review of ten eligible reports on its clinical efficacy and safety. RESULTS There were 414 patients with 448 IAs. The majority of the IAs were large (40.2 %), saccular or blister-like (78.3 %), and were located mostly in the anterior circulation (83.5 %). The regimens of antiplatelet therapy varied greatly between and within studies. The mean number of the PED used was 2.0 per IA. Deployment was successful in around 95 % of procedures. Aneurysm obliteration was achieved in 82.9 % of IAs at 6-month. The overall incidences of periprocedural intracranial vascular complication rate and mortality rate were 6.3 and 1.5 %, respectively. CONCLUSION The PED is a safe and effective treatment for nonruptured IAs. Its use in the context of acute subarachnoid hemorrhage (SAH) should be cautioned. Its main limitations include the need for prolonged antiplatelet therapy, as well as the potential risks of IA rupture and non-IA-related intracerebral hemorrhages (ICH). Future studies should aim at identifying factors that predispose to incomplete obliteration, delayed rupture, and thromboembolic complications.
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Affiliation(s)
- G K K Leung
- Division of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, China.
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Bothma PA, Brodbeck AE, Smith BA. Cerebral venous air embolism treated with hyperbaric oxygen: a case report. Diving Hyperb Med 2012; 42:101-103. [PMID: 22828820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 02/09/2012] [Indexed: 06/01/2023]
Abstract
We present a case of cerebral venous gas embolism. Our patient made a complete neurological recovery after hyperbaric oxygen therapy (HBOT). The principles of HBOT, compressing and eliminating air bubbles and decreasing Β-2 integrin function, thus improving microcirculation, can only be beneficial in a situation where neurological damage is likely. Retrograde cerebral venous gas embolism is a less well recognised variant of gas embolism than the arterial variant. Its existence as a different entity is better recognised in the forensic medicine and radiology literature than in other disciplines. There is evidence in the literature of patients dying from this complication and others seemingly experiencing very little effect. This case report highlights this condition, to encourage others to look out for it and report outcomes, and to serve as a reminder that peripheral lines may be a potential cause of gas embolism, although the portal of air entry in our case remains uncertain.
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Affiliation(s)
- Pieter A Bothma
- Department of Anaesthesia, James Paget University Hospitals NHS Foundation Trust, Norfolk, UK.
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Fernando RR, Koranne KP, Barker CM. AMPLATZER Septal Occluder failure resulting in paradoxical cerebral embolism. Tex Heart Inst J 2012; 39:647-652. [PMID: 23109759 PMCID: PMC3461693] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Patent foramen ovale and atrial septal defect are risk factors for paradoxical embolism and subsequent cerebral ischemic events. The transseptal passage of emboli from the right to the left cardiac chambers appears to play an important role. The therapeutic options are medical therapy (anti-aggregation or anticoagulation), surgical closure, or transcatheter closure. Transcatheter closure of atrial septal defects affords the advantage of closing an atrial defect without the associated morbidity of open-heart surgery and the bleeding sequelae of oral anticoagulation. After closure, however, the presence of a residual shunt is independently associated with an increased risk of recurrent ischemic events. Newer devices, such as the AMPLATZER Septal Occluder, have decreased the risk of residual shunting and thromboembolic events. In addition, they have a very low risk of device dislodgement, migration, and embolization.We describe the case of a 60-year-old woman with Ebstein anomaly and recurrent ischemic strokes who presented with acute ischemic infarcts and paradoxical embolism 3 years after undergoing transcatheter closure of an atrial septal defect. A right-to-left shunt through a displaced AMPLATZER Septal Occluder was detected. Pulmonary hypertension and resultant right ventricular failure and right atrial dilation could have contributed to the persistent shunting and paradoxical embolism.To our knowledge, the delayed dysfunction of an AMPLATZER Septal Occluder has not been reported. In addition to describing the patient's case, we review the relevant medical literature.
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MESH Headings
- Brain Infarction/etiology
- Cardiac Catheterization/adverse effects
- Cardiac Catheterization/instrumentation
- Ebstein Anomaly/complications
- Echocardiography, Doppler, Color
- Echocardiography, Transesophageal
- Embolism, Paradoxical/diagnosis
- Embolism, Paradoxical/etiology
- Embolism, Paradoxical/physiopathology
- Embolism, Paradoxical/therapy
- Female
- Foreign-Body Migration/diagnosis
- Foreign-Body Migration/etiology
- Foreign-Body Migration/physiopathology
- Foreign-Body Migration/therapy
- Heart Septal Defects, Atrial/complications
- Heart Septal Defects, Atrial/diagnosis
- Heart Septal Defects, Atrial/physiopathology
- Heart Septal Defects, Atrial/therapy
- Humans
- Hypertension, Pulmonary/etiology
- Intracranial Embolism/diagnosis
- Intracranial Embolism/etiology
- Intracranial Embolism/physiopathology
- Intracranial Embolism/therapy
- Magnetic Resonance Angiography
- Middle Aged
- Prosthesis Design
- Prosthesis Failure
- Septal Occluder Device
- Ventricular Dysfunction, Right/etiology
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Affiliation(s)
- Rajeev R Fernando
- Division of Cardiology, University of Texas Health Science Center, Houston, Texas 77030, USA.
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Brito T, Pithan N, Martins G, Jessen B, Assumpção C, Porto T, Filho O, Siqueira-Filho A. Case reports: hyperbaric oxygen therapy for the treatment of cerebral air embolism. Undersea Hyperb Med 2011; 38:207-212. [PMID: 21721354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Cerebral air embolism is one of the most deleterious disorders that may affect divers, but it is also a possible complication of surgeries and medical procedures. We report our experience with iatrogenic cerebral air embolism and hyperbaric oxygen treatment.
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Affiliation(s)
- T Brito
- OHB-RIO Clinica Hiperbárica, Hospital Casa de Portugal, Rio de Janeiro, Brazil.
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Brockmeyer J, Johnson EK. Cerebral air embolism following removal of central venous catheter. Mil Med 2011; 176:i. [PMID: 21366069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
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Pandurangadu AV, Paul JAP, Barawi M, Irvin CB. A case report of cerebral air embolism after esophagogastroduodenoscopy: diagnosis and management in the emergency department. J Emerg Med 2011; 43:976-9. [PMID: 21236613 DOI: 10.1016/j.jemermed.2010.11.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 05/21/2010] [Accepted: 11/01/2010] [Indexed: 12/17/2022]
Abstract
BACKGROUND Esophagogastroduodenoscopy (EGD) is a rare cause of cerebral air embolism (CAE). To our knowledge, there are only eight previously reported such cases in the history of the procedure. OBJECTIVE To identify clinical causes of CAE that can present to the emergency department (ED) and to understand the appropriate management of CAE. CASE REPORT A 71-year-old man presented with new-onset left-sided hemiparesis and dysarthria 2h after undergoing an outpatient EGD. The patient was diagnosed with CAE in the ED after undergoing a computed tomography scan of the brain without contrast. CONCLUSION The diagnosis of CAE is based on a thorough history and obtaining urgent radiographic imaging of the brain. The definitive treatment of CAE involves hyperbaric oxygen.
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Affiliation(s)
- Ananda V Pandurangadu
- Department of Emergency Medicine, St. John Hospital and Medical Center, Detroit, Michigan, USA
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Singh A, Ramanakumar A, Hannan J. Simultaneous left ventricular and cerebral artery air embolism after computed tomographic-guided transthoracic needle biopsy of the lung. Tex Heart Inst J 2011; 38:424-426. [PMID: 21841875 PMCID: PMC3147210] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Air embolism is rare and potentially fatal. Its early recognition and prompt treatment can help to prevent life-threatening sequelae. Herein, we report the case of a 75-year-old man who underwent a computed tomographic-guided lung biopsy of a left-lower-lobe pulmonary nodule. A few minutes after the procedure, he experienced numbness and weakness in his right hand; this lasted for approximately 10 minutes and resolved on its own. Similar symptoms developed in his left hand and subsided in 5 minutes. His speech then became garbled. An urgent computed tomographic scan of the head showed no acute abnormality. Review of the chest computed tomographic scans that were performed during the biopsy revealed 10 cc of air in the left ventricular cavity. The patient was placed on 100% forced inspiratory oxygen and was kept in the Trendelenburg position on his left side. After 4 hours, computed tomography revealed that the air had been absorbed into the circulation. The patient had no residual neurologic deficits. In addition to reporting this case, we discuss possible causes of air embolism and the management of the condition after percutaneous lung biopsy.
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Affiliation(s)
- Aniruddha Singh
- Department of Medicine, Saint Vincent Hospital, Worcester, MA 01608, USA.
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Moon R, Butler FK. RE: Cerebral air embolism following removal of central venous catheter, published in [Mil Med 2009: 174(8): 878-81]. Mil Med 2010; 175:xvi. [PMID: 20882921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
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McCrary BF. RE: Cerebral air embolism following removal of central venous catheter, published in [Mil Med 2009: 174(8): 878-81]. Mil Med 2010; 175:xvi-xvii. [PMID: 20886694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
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Abstract
BACKGROUND There are limited data on the effectiveness of organized stroke care in different ischemic stroke subtypes in the real-world setting. We analyzed the effect of organized stroke care in all stroke subtypes in a longitudinal cohort study using data from the Registry of the Canadian Stroke Network. METHODS Between July 2003 and September 2007, there were 6,223 consecutive patients with ischemic stroke subtype information by Trial of Org 10172 in Acute Stroke Treatment criteria. Subtypes were categorized as large artery atherosclerotic disease, lacunar, cardioembolic, or other. The amount of organized stroke care was quantified using the previously published organized care index (OCI), graded 0-3 based on the presence or absence of occupational therapy or physiotherapy, stroke team assessment, and admission to a stroke unit. RESULTS Mortality at 30 days was associated with both stroke subtype and OCI. Higher OCI (defined as score 2-3 compared to 0-1) was strongly associated with lower odds of 30-day mortality in each ischemic stroke subtype (adjusted odds ratio estimates ranged from 0.16 to 0.43, p < 0.001, controlling for age, gender, stroke severity, and medical comorbidities by logistic regression). These estimates were essentially unchanged after excluding patients treated with palliative care. Numbers needed to treat, to prevent 1 death at 30 days, ranged from 4 to 9 across the subtypes. CONCLUSIONS A strong association between higher OCI and lower 30-day mortality was apparent in each ischemic stroke subtype. These data suggest that organized stroke care should be provided to stroke patients regardless of stroke subtype.
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Affiliation(s)
- E E Smith
- Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada T2N 2T9.
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McCrary BF. Re: Cerebral air embolism following removal of central venous catheter. Mil Med 2009; 174:xii-xiii. [PMID: 20058370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
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Moon R, Butler FK. Treatment of arterial gas embolism. Mil Med 2009; 174:xii. [PMID: 20055057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
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