Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
  1. Home
  2. Search

Refine search

Refine search

Access:
Content type:
Publication date:
Apply   From and To filters
Subject: Show more
Journals Show more
Publishers: Show more
Societies Show more
Series: Show more
Collections: Show more

Actions for selected content:

Select all | Deselect all
  • View selected items
  • Export citations
  • Download PDF (zip)
  • Save to Kindle
  • Save to Dropbox
  • Save to Google Drive

Save Search

You can save your searches here and later view and run them again in "My saved searches".

Please provide a title, maximum of 40 characters.
Cancel
×

4 results

  • Neurologic complications of infective endocarditis in children

  • Marin Jacobwitz, Emmanuelle Favilla, Amisha Patel, Therese M. Giglia, Kimberly Taing, Chitra Ravishankar, J. William Gaynor, Daniel J. Licht, Jennifer L. McGuire, Lauren A. Beslow
  • Journal:
    Cardiology in the Young / Volume 33 / Issue 3 / March 2023
    Published online by Cambridge University Press:
    12 May 2022, pp. 463-472
    • Article
      • You have access
    • PDF
    • HTML
    • Export citation
  • Objectives:

    To define the frequency and characteristics of acute neurologic complications in children hospitalised with infective endocarditis and to identify risk factors for neurologic complications.

    Study Design:

    Retrospective cohort study of children aged 0–18 years hospitalised at a tertiary children’s hospital from 1 January, 2008 to 31 December, 2017 with infective endocarditis.

    Results:

    Sixty-eight children met Duke criteria for infective endocarditis (43 definite and 25 possible). Twenty-three (34%) had identified neurologic complications, including intracranial haemorrhage (25%, 17/68) and ischaemic stroke (25%, 17/68). Neurologic symptoms began a median of 4.5 days after infective endocarditis symptom onset (interquartile range 1, 25 days), though five children were asymptomatic and diagnosed on screening neuroimaging only. Overall, only 56% (38/68) underwent neuroimaging during acute hospitalisation, so additional asymptomatic neurologic complications may have been missed. Children with identified neurologic complications compared to those without were older (48 versus 22% ≥ 13 years old, p = 0.031), more often had definite rather than possible infective endocarditis (96 versus 47%, p < 0.001), mobile vegetations >10mm (30 versus 11%, p = 0.048), and vegetations with the potential for systemic embolisation (65 versus 29%, p = 0.004). Six children died (9%), all of whom had neurologic complications.

    Conclusions:

    Neurologic complications of infective endocarditis were common (34%) and associated with mortality. The true frequency of neurologic complications was likely higher because asymptomatic cases may have been missed without screening neuroimaging. Moving forward, we advocate that all children with infective endocarditis have neurologic consultation, examination, and screening neuroimaging. Additional prospective studies are needed to determine whether early identification of neurologic abnormalities may direct management and ultimately reduce neurologic morbidity and overall mortality.

  • Chapter 10 - Acute Anticoagulant Therapy for the Treatment of Acute Ischaemic Stroke and Transient Ischaemic Attack

  • from Part III - Acute Treatment of Ischaemic Stroke and Transient Ischaemic Attack
  • Edited by Jeffrey L. Saver, Graeme J. Hankey, University of Western Australia, Perth
  • Book:
    Stroke Prevention and Treatment
    Published online:
    15 December 2020
    Print publication:
    10 December 2020, pp 179-198

  • Summary

    In broad, relatively unselected patients with acute ischaemic stroke, immediate high-dose anticoagulation therapy to avert early stroke progression or recurrence reduces recurrent ischaemic stroke compared with control during the treatment period but this benefit is offset by an increase in intracranial haemorrhage (ICH) and extracranial haemorrhage (ECH). Immediate antiplatelet therapy has similarly efficacy as anticoagulation in averting early stroke progress or recurrence, and is safer when used as an immediate agent (see Chapter 9). In acute ischaemic stroke patients with atrial fibrillation, after start of antiplatelet therapy on presentation, early switchover to anticoagulation therapy 2 -14 days after stroke onset is reasonable, but caution should be taken in certain subgroups of patients with high risk of bleeding. In broad, relatively unselected ischaemic stroke patients, low-dose, venous prophylaxis anticoagulation compared with control reduces the occurrence of asymptomatic deep venous thrombosis (DVT) and shows a tendency to reduce pulmonary embolism, but also shows off-setting tendencies to increase ICH and ECH, without conferring a clear net clinical benefit. Low-molecular-weight heparins (LMWH) or heparinoids, compared with unfractionated heparin, appear to further decrease the occurrence of DVT and PE but potentially further increase ICH, but there are too few data to provide reliable information.

  • MP46: Clinically significant traumatic intracranial haemorrhage following minor head trauma in older adults: a retrospective cohort study

  • E. Mercier, T. O'Brien, B. Mitra, N. Le Sage, P. Tardif, M. Emond, M. D'Astous
  • Journal:
    Canadian Journal of Emergency Medicine / Volume 22 / Issue S1 / May 2020
    Published online by Cambridge University Press:
    13 May 2020, p. S59
    Print publication:
    May 2020
    • Article
      • You have access
    • PDF
    • Export citation

  • Introduction: The primary objective of this study was to determine the incidence of clinically significant traumatic intracranial haemorrhage (T-ICH) following minor head trauma in older adults. Secondary objective was to investigate the impact of anticoagulant and antiplatelet therapies on T-ICH incidence. Methods: This retrospective cohort study extracted data from electronic patient records. The cohort consisted of patients presenting after a fall and/or head injury and presented to one of five ED between 1st March 2010 and 31st July 2017. Inclusion criteria were age ≥ 65 years old and a minor head trauma defined as an impact to the head without fulfilling criteria for traumatic brain injury. Results: From the 1,000 electronic medical records evaluated, 311 cases were included. The mean age was 80.1 (SD 7.9) years. One hundred and eighty-nine (189) patients (60.8%) were on an anticoagulant (n = 69), antiplatelet (n = 130) or both (n = 16). Twenty patients (6.4%) developed a clinically significant T-ICH. Anticoagulation and/or antiplatelets therapies were not associated with an increased risk of clinically significant T-ICH in this cohort (Odds ratio (OR) 2.7, 95% CI 0.9-8.3). Conclusion: In this cohort of older adults presenting to the ED following minor head trauma, the incidence of clinically significant T-ICH was 6.4%.

  • 20 - Post-operative care of neurosurgical patients

  • from Section 4 - Neurointensive care
  • Edited by Basil F. Matta, David K. Menon, Martin Smith
  • Book:
    Core Topics in Neuroanaesthesia and Neurointensive Care
    Published online:
    05 December 2011
    Print publication:
    13 October 2011, pp 301-314

  • Summary

    This chapter discusses the role of structural imaging using CT and MRI, conventional angiography and CT angiography, and physiological imaging using CT perfusion, 131Xenon CT, MRI and magnetic resonance spectroscopy (MRS), single-photon emission computed tomography (SPECT) and positron emission tomography (PET) in the assessment, management and prediction of outcome neurological injury. Acute CT is useful in identifying those individuals in whom deterioration is as a result of a mass lesion and can demonstrate extradural, subdural or intracranial haemorrhage and midline shift, or subarachnoid haemorrhage and ventricular abnormality. Contrast-enhanced CT imaging is also used to produce CT angiography and perfusion imaging. MRI data are produced using powerful static magnetic fields and intermittent oscillating radiofrequency electromagnetic fields that elicit signals from the nuclei of certain atoms. Single-photon emission CT uses conventional gamma-emitting nuclear medicine isotopes with multiple detectors to generate tomographic images.