Short Communications. Alcoholic Intracerebral Hemorrhage

Size: px
Start display at page:

Download "Short Communications. Alcoholic Intracerebral Hemorrhage"

Transcription

1 Short Communications 1565 Alcoholic Intracerebral Hemorrhage Leon A. Weisberg, MD Six alcoholic patients developed extensive cerebral hemispheric hemorrhages with both intraventricular and subarachnoid blood. All patients had evidence of liver damage, low platelet counts, and abnormal prothrombin and partial thromboplastin times. Four patients presented with seizures; in two of the four, these seizures were initially diagnosed as alcohol withdrawal seizures. Four patients were comatose with lateralizing neurologic deficit; two patients were comatose without lateralizing neurologic deficit, suggesting a metabolic encephalopathy. In one patient there was delayed neurologic deterioration. In all six patients, computed tomography showed large diffuse cerebral hemispheric hemorrhages, prominent intraventricular blood, and breakthrough into the subarachnoid spaces, which was confirmed by necropsy findings. There was marked mass effect but minimal surrounding edema. All six patients died. In three, autopsy showed no evidence of aneurysm, vascular malformation, neoplasm, or amyloid angiopathy and no arteriolar hypertensive changes. (Stroke 1988;19: ) A lcohol has known acute and chronic cardio- ZA vascular effects'- 4 that cause alcoholics to A JL be at risk for stroke. Chronic alcoholics have decreased concentrations of liver-produced coagulation factors and platelet abnormalities that predispose them to hemorrhagic stroke. Chronic alcoholism may cause hypertension, and acute alcoholic episodes may precipitate an acute hypertensive state with return to normotension when the subject stops drinking alcohol. Based on the potential for hypertension and impaired coagulation, hemorrhagic stroke develops with increased frequency in alcoholics. I describe six patients with alcoholic nonhypertensive intracerebral hemorrhages (ICHs) that may have occurred as a consequence of the chronic and/or acute alcoholic state. Case Reports Case 1. A 52-year-old chronic alcoholic woman developed headache and vomiting; she suddenly became unresponsive. Findings were stupor, hyperventilation, left hemiplegia, bilateral Babinski's signs, and a fixed dilated right pupil. Her hemoglobin was 10 g/dl; stool guaiacs were positive. Platelet count was 70,000/mm 3. Her prothrombin time was 14.5 (normal control 12) seconds and her partial thromboplastin time was 38 (normal range 23-34) seconds. She had impaired liver function (SGOT 300 From the Department of Neurology and Psychiatry, Tulane Medical School, the Department of Neurology, Veterans Administration Hospital, and the Department of Neurology, Charity Hospital, New Orleans, Louisiana. Address for correspondence: Leon A. Weisberg, MD, Department of Neurology and Psychiatry, 1430 Tulane Avenue, New Orleans, LA Received November 3, 1987; accepted July 6, IU, SGPT 450 IU, total bilirubin concentration 3.5 mg/dl, alkaline phosphatase value 190 IU). Computed tomography (CT) showed a massive right frontal-parietal hematoma with intraventricular and subarachnoid blood (Figure 1). Despite treatment with mannitol and corticosteroids, she did not improve neurologically; she developed pneumonia and died. Necropsy showed right intracerebral subarachnoid and intraventricular hemorrhage. There was no evidence of aneurysm, arteriovenous malformation, neoplasm, amyloid angiopathy, or hypertensive arteriolar vascular disease. The ICH had broken through into the subarachnoid spaces at multiple points, into the superficial frontal and parietal regions. Case 2. A 45-year-old chronic alcoholic man had been drinking heavily for 2 weeks. He stopped drinking because of abdominal pain. Three days later, he had a generalized seizure; following the seizure, he developed left-sided weakness and became lethargic. During 8 hours, he became comatose and developed left hemiplegia with a fixed dilated right pupil. Laboratory studies showed a hemoglobin concentration of 9.5 g/dl, a white blood cell count of 17,000/mm 3, a total bilirubin concentration of 4.2 mg/dl, a SGOT of 320 IU, a SGPT of 400 IU, and an alkaline phosphatase value of 135 IU. His prothrombin time was 16 (control 11.9) seconds and his partial thromboplastin time was 38 (normal range 23-34) seconds. During a previous admission, he had had a liver biopsy that showed fatty liver. CT showed an extensive right hemispheric hemorrhage (Figure 2) with both intraventricular and subarachnoid blood. He had two seizures, suffered a cardiopulmonary arrest, and died. Necropsy showed a diffuse right ICH. There was

2 1566 Stroke Vol 19, No 12, December 1988 FIGURE 1. Computed tomograms, 52-year-old chronic alcoholic woman (Case 1). Top left: right frontal-parietal hyperdense nonenhancing lesion with (top right) extension into and thalamic region. Bottom left: lateral ventricles are dilated with evidence of ventricular compression by extensive right hemispheric hematoma. Bottom right: intraventricular and cisternal blood. was no evidence of aneurysm, vascular malforma- tion, neoplasm, amyloid angiopathy, or hyperten- sive vascular disease. blood in the lateral ventricles breaking through into the cortical sulcal spaces in multiple regions. There was evidence of transtentorial herniation. There

3 Weisberg Alcoholic Intracerebral Hemorrhage 1567 FIGURE 2. Computed tomograms, 45-year-old chronic alcoholic man (Case 2). Top left: heterogeneous right hemispheric hematoma. Bottom: blood is seen in basal cisternal and sulcal space. Top right: marked right hemispheric mass effect with intraventricular blood. Summary of Clinical Findings The clinical and CT findings in these six patients are summarized in Table 1. Five patients were in their 40s. Five were men and one was a woman. None had a history of hypertension; none had elevated blood pressure when initially examined, and none were hypertensive during their hospital course. All six patients had biopsy evidence of fatty liver or cirrhosis. All were anemic with low platelet counts and abnormal prothrombin and partial thromboplastin times. Four patients initially had seizures; in two, this initial seizure was believed to be an

4 1568 Stroke Vol 19, No 12, December 1988 TABLE 1. Clinical and Computed Tomography Findings in Six Patients With Alcoholic Intracerebral Hemorrhage Liver Platelet PT/PTPT Neurologic Case/sex/age dysfunction count (mm" 3 ) (in sec) Seizures deficit l/f/52 Fatty degeneration 70, /38 No Coma, hemiplegia, fixed dilated pupil 2/M/45 3/M/48 4/M/42 5/M/43 6/M/46 Fatty degeneration 80,000 95,000 91,000 15/38 Coma and hemiparesis, delayed progression with dilated pupil 16/40 Coma, hemiplegia 16/40 Coma, no lateralizing signs 110, /37 Coma, no lateralizing signs 130,000 14/37 No Coma, hemiplegia PT/PTPT, prothrombin and partial thromboplastin times; F, female; M, male. Computed tomography findings Parenchymal Ventricular Subarachnoid hematoma blood blood Frontal-parietal, thalamic, Temporal, parietal-frontal Temporal, parietal, frontal, parietal,, thalamic parietal, temporal, temporal, parietal No No alcohol withdrawal seizure, but both patients showed a decreasing level of consciousness with focal deficit. Four of the six patients were comatose without focal deficit, pupillary abnormalities, or abnormal eye movements, suggesting a metabolic encephalopathy. In only one of the six patients was there delayed (8 hours later) neurologic deterioration, which included findings consistent with transtentorial herniation. In this patient necropsy showed evidence of transtentorial herniation and intraventricular bleeding. CT showed a characteristic pattern consisting of widespread cerebral hemispheric hemorrhage that appeared as a mottled, heterogeneous, high-density lesion. There was prominent cortical sulcal space and basal cisternal blood. The subarachnoid space hemorrhage was quite prominent and diffuse. Intraventricular blood was seen in four patients. The hemispheric hemorrhage was associated with marked mass effect. There were CT findings consistent with subfalcine and transtentorial herniation. All six patients died. Autopsy was performed in three patients and showed diffuse and extensive cerebral hemispheric hemorrhage without evidence of an underlying aneurysm, vascular malformation, neoplasm, amyloid angiopathy, or hypertensive disease. Discussion Previous studies have reported that alcohol may predispose to hemorrhagic stroke 5-7 ; chronic alcohol ingestion is associated with hypertension. One study reported that the association of alcohol with stroke is reduced after adjusting for hypertension 8 ; however, in another study alcohol was a major risk factor for ICH despite blood pressure control. 9 The risk of hemorrhagic stroke was directly correlated with the amount of alcohol consumed, and the relation held for subarachnoid hemorrhage and ICH. 510 If alcohol consumption is decreased, the risk of hemorrhagic stroke is reduced. None of these six patients had a history of hypertension or were hypertensive when the ICH developed. My clinical data do not allow me to quantify alcohol consumption with the coagulation disturbances or to compare the risk of hemorrhagic stroke with a control group. If hypertension is not implicated as a major risk factor for hemorrhagic stroke, it is likely that the impaired coagulation mechanism (low platelet count with abnormal prothrombin and partial thromboplastin times) was related to the ICH. The reduced number of platelets and impaired platelet function would weaken the blood vessel wall, and combined with impaired coagulation factors, this predisposes alcoholics to ICH. All these patients had low platelet counts and abnormal prothrombin and partial thromboplastin times. In alcoholics with hepatic damage, there may be decreased concentrations of clotting factors, increased fibrinolysis, and laboratory evidence of disseminated intravascular coagulation." In patients with hypertensive ICH, the characteristic locations include the putamen, thalamus, pons, or cerebellum 12 ; the intracranial bleeding does not usually break through into the subarachnoid space, whereas in nonhypertensive patients with ICH (e.g., aneurysm, vascular malformation, amyloid angiopathy) the hemorrhage is more commonly located in

5 Weisberg Alcoholic Intracerebral Hemorrhage 1569 the subcortical hemispheric white matter and breaks through into the subarachnoid spaces In hypertensive ICH, CT shows a homogeneous hyperdense nonenhancing lesion, usually with a surrounding hypodense region representing edema. Although many patients with ICH have erythrocytes in the cerebrospinal fluid, CT rarely shows subarachnoid blood. All six alcoholic patients with cerebral hemispheric hemorrhage showed cisternal and cortical sulcal blood; however, autopsy showed no other identifiable cause of the ICH. In one patient there was delayed neurologic deterioration consistent with transtentorial herniation. Without an early CT at the time the initial neurologic dysfunction developed and a repeat CT after the delayed neurologic deterioration, I could not precisely determine the mechanism of the delayed deterioration. Potential pathologic mechanisms include worsening of the edema, herniation, and intraventricular extension of the bleeding. The infrequent finding of delayed neurologic deterioration in these six alcoholic patients is consistent with the low incidence reported in ICH series Based on the location, size, and the CT pattern of the alcoholic hemorrhage, it is most unlikely that this represented a hemorrhagic contusion or a traumatic ICH. The CT pattern was also not consistent with a hemorrhagic cerebral infarction. The intracranial blood was widely dispersed within the subarachnoid spaces. There was blood in the superficial cortical and subcortical white matter, with extension into the basal ganglia and thalamus. Despite the large size and prominent mass effect (with evidence of subfalcine and transtentorial herniation), surrounding hypodense areas representing edema were not seen. This lack of CT-visualized edema is contrasted with the findings of prominent edema in other large nonalcohol-related ICHs. None of these six alcoholic patients showed multiple ICHs. I suggest that chronic alcohol exposure may lead to massive cerebral hemorrhage. Other studies using large sample sizes and quantitative features of alcohol ingestion and coagulation may settle the significance of this finding. References 1. Gorelick PB: Alcohol and stroke. Stroke 1987;18: Arkwright PD, Beilin LJ, Rouse 1, Armstrong BK, Vandongen R: Effects of alcohol use and other aspects of lifestyle on blood pressure levels and prevalence of hypertension in a working population. Circulation 1982;66: Gill JS, Zezulka AV, Shipley MJ, Gill SK, Beevers DG: Stroke and alcohol consumption. N Engl J Med 1986; 315: Kagan A, Popper JS, Rhoads GG: Dietary and other risk factors for stroke in Hawaiian Japanese men. Stroke 1985; 16: Donahue RP, Abbott RD, Reed DM.Yano K: Alcohol and hemorrhagic stroke: The Honolulu Heart Program. JAMA 1986;255: Hillbom M, Kaste M: Alcohol intoxication: A risk factor for primary subarachnoid hemorrhage. Neurology 1982; 32: Hillbom M, Kaste M: Does alcohol intoxication precipitate aneurysmal subarachnoid hemorrhage? J Neurol Neurosurg Psychiatry 1981 ;44: Stokes GS: Hypertension and alcohol: Is there a link? J Chronic Dis 1982 ;35: Kozararevic D, Vojvodic N, Dawbir N, McGee D, Racic Z, Gordon T, Zukel W: Frequency of alcohol consumption and morbidity and mortality. The Yugoslavia Cardiovascular Disease Study. Lancet 1980;l: Kagan A, Popper JS, Rhoads GG: Factors related to stroke incidence in Hawaii Japanese men: The Honolulu Heart Study. Stroke 1980;l 1: Cowan DH: Effects of alcoholism on hemostasis. Semin Hematol \9$0;\l: Weisberg LA: Computerized tomography in intracerebral hemorrhage. Arch Neurol 1979;36: McCormick WF, Rosenfield DB: Massive brain hemorrhage: A review of 144 cases and an examination of their causes. Stroke 1973;4: Weisberg LA: Subcortical lobar intracerebral hemorrhage: Clinical-computed tomographic correlations. J Neurol Neurosurg Psychiatry 1985;48: Weisberg LA: Primary putaminal hemorrhage: Clinical-CT correlations (abstract). Neurology 1988;38(suppl 1): 149 KEY WORDS alcoholism cerebral hemorrhage blood coagulation blood platelets

PE finding: Left side extremities mild weakness No traumatic wound No bloody otorrhea, nor rhinorrhea

PE finding: Left side extremities mild weakness No traumatic wound No bloody otorrhea, nor rhinorrhea Case report A 82-year-old man was suffered from sudden onset spasm of extremities then he fell down to the ground with loss of consciousness. He recovered his consciousness 7-8 mins later but his conscious

More information

Approximately 70-80% of all strokes are ischemic and 20-30% are hemorrhagic Hemorrhagic stroke is defined as an acute neurologic injury resulting from bleeding in the brain There are two distinct types

More information

Ischaemic stroke 85% (85 in every 100 strokes)

Ischaemic stroke 85% (85 in every 100 strokes) UNDERSTANDING STROKE DUE TO INTRACEREBRAL HAEMORRHAGE This factsheet provides information for people who have had a stroke due to an intracerebral (bleed in the brain) and for their families and carers.

More information

DIAGNOSTIC CRITERIA OF STROKE

DIAGNOSTIC CRITERIA OF STROKE DIAGNOSTIC CRITERIA OF STROKE Diagnostic criteria are used to validate clinical diagnoses. Here below MONICA diagnostic criteria are reported. MONICA - MONItoring trends and determinants of CArdiovascular

More information

What Is an Arteriovenous Malformation (AVM)?

What Is an Arteriovenous Malformation (AVM)? What Is an Arteriovenous Malformation (AVM)? From the Cerebrovascular Imaging and Intervention Committee of the American Heart Association Cardiovascular Council Randall T. Higashida, M.D., Chair 1 What

More information

Emerging therapies for Intracerebral Hemorrhage

Emerging therapies for Intracerebral Hemorrhage Emerging therapies for Intracerebral Hemorrhage Chitra Venkat, MBBS, MD, MSc. Associate Professor of Neurology and Neurological Sciences Stroke and Neurocritical Care. Stanford University Learning objectives

More information

Acute Care of Patients with Intracerebral Hemorrhage

Acute Care of Patients with Intracerebral Hemorrhage Acute Care of Patients with Intracerebral Hemorrhage Cyrus K. Dastur, MD Assistant Professor Director, Neurocritical Care Departments of Neurology and Neurological Surgery UC Irvine None Declarations Definitions

More information

Head Injury. Dr Sally McCarthy Medical Director ECI

Head Injury. Dr Sally McCarthy Medical Director ECI Head Injury Dr Sally McCarthy Medical Director ECI Head injury in the emergency department A common presentation 80% Mild Head Injury = GCS 14 15 10% Moderate Head Injury = GCS 9 13 10% Severe Head Injury

More information

Types of Brain Injury

Types of Brain Injury Types of Brain Injury The bones of your skull are hard and they protect your brain. Your brain is soft, like firm Jell-O. When your head moves, your brain moves inside your skull. When your head is hit

More information

Discovery of an Aneurysm Following a Motorcycle Accident. Maya Babu, MSIII Gillian Lieberman, M.D.

Discovery of an Aneurysm Following a Motorcycle Accident. Maya Babu, MSIII Gillian Lieberman, M.D. Discovery of an Aneurysm Following a Motorcycle Accident Maya Babu, MSIII Gillian Lieberman, M.D. Patient CC: July 2004 65 yo male transferred to the BI from an OSH s/p motorcycle crash w/o a helmet CC

More information

The Clinical Evaluation of the Comatose Patient in the Emergency Department

The Clinical Evaluation of the Comatose Patient in the Emergency Department The Clinical Evaluation of the Comatose Patient in the Emergency Department patients with altered mental status (AMS) and coma. treat patients who present to the Emergency Department with altered mental

More information

FERNE / EMRA 2009 Mid-Atlantic Emergency Medicine Medical Student Symposium: ABCs of Head CT Interpretation; Heather M. Prendergast MD, MPH.

FERNE / EMRA 2009 Mid-Atlantic Emergency Medicine Medical Student Symposium: ABCs of Head CT Interpretation; Heather M. Prendergast MD, MPH. ABCs of Head CT Interpretation in the Emergency Department: CT Interpretation Workshop Guide Heather M. Prendergast, MD, MPH, FACEP Associate Professor Department of Emergency Medicine University of Illinois

More information

CLOSED HEAD INJURY IN PEDIATRICS

CLOSED HEAD INJURY IN PEDIATRICS CLOSED HEAD INJURY IN PEDIATRICS 1. Background... 1 2. Diagnosis... 1 a) Types of closed head injuries... 1 3. Questions to Ask... 2 4. Physical examination... 3 a) Primary survey... 3 b) Secondary Survey...

More information

STROKE PREVENTION AND TREATMENT MARK FISHER, MD PROFESSOR OF NEUROLOGY UC IRVINE

STROKE PREVENTION AND TREATMENT MARK FISHER, MD PROFESSOR OF NEUROLOGY UC IRVINE STROKE PREVENTION AND TREATMENT MARK FISHER, MD PROFESSOR OF NEUROLOGY UC IRVINE CASE REPORT: ACUTE STROKE MANAGEMENT 90 YEAR OLD WOMAN, PREVIOUSLY ACTIVE AND INDEPENDENT, CHRONIC ATRIAL FIBRILLATION,

More information

Using the Pupillometer in Clinical Practice

Using the Pupillometer in Clinical Practice Using the Pupillometer in Clinical Practice Claude Hemphill MD M.A.S. chmephill@sfgh.ucsf.edu Kathy Johnson RN, MSN KJOHNSON@queens.org Mary Kay Bader RN, MSN, CCNS Badermk@aol.com Pupillometry: How It

More information

Pseudoabducens palsy: When a VI nerve palsy is not a VI nerve palsy

Pseudoabducens palsy: When a VI nerve palsy is not a VI nerve palsy Pseudoabducens palsy: When a VI nerve palsy is not a VI nerve palsy Emily S. Birkholz, MD, and Michael Wall, MD December 30, 2009 CC: 44 year old male with diplopia HPI: This 44 year old man with a history

More information

Head Injury. Michael Bruce Horowitz, M.D.

Head Injury. Michael Bruce Horowitz, M.D. Neurosurgical Aspects of Closed Head Injury Michael Bruce Horowitz, M.D. Definition of Closed Head Injury Insult rendered to the brain following a traumatic event that does not create an opening in the

More information

CADASIL. MRI Films and results. For CADASIL Together We Have Hope Non Profit Organization (Foundation) to assist doctors in understanding CADSAIL

CADASIL. MRI Films and results. For CADASIL Together We Have Hope Non Profit Organization (Foundation) to assist doctors in understanding CADSAIL CADASIL MRI Films and results For CADASIL Together We Have Hope Non Profit Organization (Foundation) to assist doctors in understanding CADSAIL Figure 1. MRI in two CADASIL patients MRI in two patients

More information

Therapeutic Management Options for. Acute Ischemic Stroke Anna Rosenbaum, MD

Therapeutic Management Options for. Acute Ischemic Stroke Anna Rosenbaum, MD Therapeutic Management Options for Acute Ischemic Stroke Anna Rosenbaum, MD Epidemiology Epidemiology 4 th leading cause of death in the United States 1 Leading cause of disability Increase in projected

More information

The Treatment of Brain Ischemia With Vasopressor Drugs

The Treatment of Brain Ischemia With Vasopressor Drugs The Treatment of Brain Ischemia With Vasopressor Drugs BY GARY WISE, M.D., ROBERT SUTTER, M.D., AND JAMES BURKHOLDER, M.D. Abstract: The Treat me nl of Brain Ischemia With Vasopressor Drugs Vasopressor

More information

CHAPTER 12 HEAD TRAUMA

CHAPTER 12 HEAD TRAUMA Essentials of Clinical Neurology: Head Trauma 12-1 CHAPTER 12 HEAD TRAUMA Head trauma from motor vehicle accidents, industrial mishaps, falls, and physical assault has become a significant part of medical

More information

Bleeding in the brain haemorrhagic stroke

Bleeding in the brain haemorrhagic stroke Stroke Helpline: 0303 3033 100 Website: stroke.org.uk Bleeding in the brain haemorrhagic stroke Most strokes are caused by a blockage in an artery leading to the brain an ischaemic stroke. However, about

More information

Evidence-Based Management of Pediatric Head Trauma. Mariann Nocera, MD Siraj Amanullah, MD, MPH November 13, 2014

Evidence-Based Management of Pediatric Head Trauma. Mariann Nocera, MD Siraj Amanullah, MD, MPH November 13, 2014 Evidence-Based Management of Pediatric Head Trauma Mariann Nocera, MD Siraj Amanullah, MD, MPH November 13, 2014 Objectives Discuss the types and mechanisms of blunt head trauma in children Discuss the

More information

TRAUMATIC BRAIN INJURY (TBI)

TRAUMATIC BRAIN INJURY (TBI) Background: Traumatic Brain Injury (TBI) is one of the leading causes of trauma related disability and death in the U.S. TBIs can occur as either blunt, penetrating, or a combination of both depending

More information

APPENDIX A NEUROLOGIST S GUIDE TO USING ICD-9-CM CODES FOR CEREBROVASCULAR DISEASES INTRODUCTION

APPENDIX A NEUROLOGIST S GUIDE TO USING ICD-9-CM CODES FOR CEREBROVASCULAR DISEASES INTRODUCTION APPENDIX A NEUROLOGIST S GUIDE TO USING ICD-9-CM CODES FOR CEREBROVASCULAR DISEASES INTRODUCTION ICD-9-CM codes for cerebrovascular diseases is not user friendly. This presentation is designed to assist

More information

The State of the Liver in the Adult Patient after Fontan Palliation

The State of the Liver in the Adult Patient after Fontan Palliation The State of the Liver in the Adult Patient after Fontan Palliation Fred Wu, M.D. Boston Adult Congenital Heart Service Boston Children s Hospital/Brigham & Women s Hospital 7 th National Adult Congenital

More information

1. Describe the mechanisms by which the brain is injured following closed-head injury.

1. Describe the mechanisms by which the brain is injured following closed-head injury. Objectives: 1. Describe the mechanisms by which the brain is injured following closed-head injury. 2. List delayed sequelae/complications of CNS trauma. 3. Compare hemorrhage into epidural, subdural and

More information

THE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT

THE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT THE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT Stroke Prevention in Atrial Fibrillation Gregory Albers, M.D. Director Stanford Stroke Center Professor of Neurology and Neurological

More information

Acute Myocardial Infarction (the formulary thrombolytic for AMI at AAMC is TNK, please see the TNK monograph in this manual for information)

Acute Myocardial Infarction (the formulary thrombolytic for AMI at AAMC is TNK, please see the TNK monograph in this manual for information) ANNE ARUNDEL MEDICAL CENTER CRITICAL CARE MEDICATION MANUAL DEPARTMENT OF NURSING AND PHARMACY Guidelines for Use of Intravenous Alteplase (Tissue Plasminogen Activator (t-pa)), Activase in the Treatment

More information

Surgical Treatments of Cerebral Arteriovenous Malformations: Reduction in Bleeding Risks and Seizure Control

Surgical Treatments of Cerebral Arteriovenous Malformations: Reduction in Bleeding Risks and Seizure Control 31 Surgical Treatments of Cerebral Arteriovenous Malformations: Reduction in Bleeding Risks and Seizure Control Kazuhiko NOZAKI, M.D., Nobuo HASHIMOTO, M.D, Susumu MIYAMOTO, M.D., and Akiyo SADATO, M.D.

More information

6.0 Management of Head Injuries for Maxillofacial SHOs

6.0 Management of Head Injuries for Maxillofacial SHOs 6.0 Management of Head Injuries for Maxillofacial SHOs As a Maxillofacial SHO you are not required to manage established head injury, however an awareness of the process is essential when dealing with

More information

Preoperative Laboratory and Diagnostic Studies

Preoperative Laboratory and Diagnostic Studies Preoperative Laboratory and Diagnostic Studies Preoperative Labratorey and Diagnostic Studies The concept of standardized testing in all presurgical patients regardless of age or medical condition is no

More information

Anoxic Brain Injury and Neural Damage: Three Case Reports

Anoxic Brain Injury and Neural Damage: Three Case Reports Anoxic Brain Injury and Neural Damage: Three Case Reports Abstract Anoxic brain injury (ABI) is common and can occur in a wide variety of disorders. This neural injury is associated with significant and

More information

The most serious symptoms of this stage are:

The most serious symptoms of this stage are: The Natural Progression of Hepatitis C The natural history of hepatitis C looks at the likely outcomes for people infected with the virus if there is no medical intervention. However, the process of trying

More information

Hepatitis C. Laboratory Tests and Hepatitis C

Hepatitis C. Laboratory Tests and Hepatitis C Hepatitis C Laboratory Tests and Hepatitis C If you have hepatitis C, your doctor will use laboratory tests to check your health. This handout will help you understand what the major tests are and what

More information

Guidelines for the Triage and Transfer of Patients with Brain Injury to The Queen s Medical Center. April 2007. Revised September 2007

Guidelines for the Triage and Transfer of Patients with Brain Injury to The Queen s Medical Center. April 2007. Revised September 2007 Guidelines for the Triage and Transfer of Patients with Brain Injury to The Queen s Medical Center April 2007 Revised September 2007 Reviewed March 2012 2 The Queen s Medical Center (QMC) is the only trauma

More information

Blood Can Be Very Bad: CT Interpretation Course Guide. Andrew D. Perron, MD, FACEP

Blood Can Be Very Bad: CT Interpretation Course Guide. Andrew D. Perron, MD, FACEP Blood Can Be Very Bad: CT Interpretation Course Guide EM Residency Program Director Department of Emergency Medicine Maine Medical Center Portland, ME I. Course Description: Recently published data indicates

More information

JHS Stroke Program. 2016 JHS Annual Mandatory Education

JHS Stroke Program. 2016 JHS Annual Mandatory Education JHS Stroke Program 2016 JHS Annual Mandatory Education Learner Objectives At the conclusion of this module learners will be able to: State the definition of stroke Discuss the pathophysiology of stroke

More information

Small vessel disease, microbleeds and intracerebral haemorrhage

Small vessel disease, microbleeds and intracerebral haemorrhage Small vessel disease, microbleeds and intracerebral haemorrhage Andreas Charidimou Clinical Research Fellow UCL Institute of Neurology Queen Square London The clinical question What is the best anticoagulation

More information

Parts of the Brain. Chapter 1

Parts of the Brain. Chapter 1 Chapter 1 Parts of the Brain Living creatures are made up of cells. Groups of cells, similar in appearance and with the same function, form tissue. The brain is a soft mass of supportive tissues and nerve

More information

DISCLOSURES RISK ASSESSMENT. Stroke and Heart Disease -Is there a Link Beyond Risk Factors? Daniel Lackland, MD

DISCLOSURES RISK ASSESSMENT. Stroke and Heart Disease -Is there a Link Beyond Risk Factors? Daniel Lackland, MD STROKE AND HEART DISEASE IS THERE A LINK BEYOND RISK FACTORS? D AN IE L T. L AC K L AN D DISCLOSURES Member of NHLBI Risk Assessment Workgroup RISK ASSESSMENT Count major risk factors For patients with

More information

It has been demonstrated that postmortem MDCT, or virtual

It has been demonstrated that postmortem MDCT, or virtual ORIGINAL RESEARCH A.B. Smith G.E. Lattin, Jr. P. Berran H.T. Harcke Common and Expected Postmortem CT Observations Involving the Brain: Mimics of Antemortem Pathology BACKGROUND AND PURPOSE: Postmortem

More information

Acute Pancreatitis. Questionnaire. if yes: amount (cigarettes/day): since when (year): Drug consumption: yes / no if yes: type of drug:. amount:.

Acute Pancreatitis. Questionnaire. if yes: amount (cigarettes/day): since when (year): Drug consumption: yes / no if yes: type of drug:. amount:. The physical examination has to be done AT ADMISSION! The blood for laboratory parameters has to be drawn AT ADMISSION! This form has to be filled AT ADMISSION! Questionnaire Country: 1. Patient personal

More information

Ischemia and Infarction

Ischemia and Infarction Harvard-MIT Division of Health Sciences and Technology HST.035: Principle and Practice of Human Pathology Dr. Badizadegan Ischemia and Infarction HST.035 Spring 2003 In the US: ~50% of deaths are due to

More information

Traumatic Head Injuries

Traumatic Head Injuries Traumatic Brain Injury (TBI) Traumatic Head Injuries Major contributing cause of trauma deaths Many survivors have permanent disability Commonly occurs in young adults (mostly males) Spokane County EMS

More information

Stroke And Multiple Sclerosis. 2013 ACOI Internal Medicine Review Course Scott Spradlin D.O. FACOI

Stroke And Multiple Sclerosis. 2013 ACOI Internal Medicine Review Course Scott Spradlin D.O. FACOI Stroke And Multiple Sclerosis 2013 ACOI Internal Medicine Review Course Scott Spradlin D.O. FACOI Stroke 3 rd Leading cause of Death Acute brain injury due to a vascular cause Sudden onset Persist at least

More information

SUBSTANCE USE DISORDER SOCIAL DETOXIFICATION SERVICES [ASAM LEVEL III.2-D]

SUBSTANCE USE DISORDER SOCIAL DETOXIFICATION SERVICES [ASAM LEVEL III.2-D] SUBSTANCE USE DISORDER SOCIAL DETOXIFICATION SERVICES [ASAM LEVEL III.2-D] I. Definitions: Detoxification is the process of interrupting the momentum of compulsive drug and/or alcohol use in an individual

More information

Cardiovascular diseases. pathology

Cardiovascular diseases. pathology Cardiovascular diseases pathology Atherosclerosis Vascular diseases A disease that results in arterial wall thickens as a result of build- up of fatty materials such cholesterol, resulting in acute and

More information

Both clinical condition and treatment criteria must be met to qualify for critical care coding.

Both clinical condition and treatment criteria must be met to qualify for critical care coding. Yale Compliance Department CRITICAL CARE FACT SHEET 99291 - Critical care, evaluation and management; first 30-74 minutes + 99292 - Critical care, evaluation and management, each additional 30 minutes

More information

Level III Stroke Center Data Collection Requirements

Level III Stroke Center Data Collection Requirements Who? Level III Stroke Center Data Collection Requirements All LERN Level III Stroke Centers. LERN Level I and II Stroke Centers have reporting requirements to The Joint Commission or other Board approved

More information

โครงการ ศ นย ความเป นเล ศโรคลมช กรามาธ บด (Rama Epilepsy Excellent Center)

โครงการ ศ นย ความเป นเล ศโรคลมช กรามาธ บด (Rama Epilepsy Excellent Center) โครงการ ศ นย ความเป นเล ศโรคลมช กรามาธ บด (Rama Epilepsy Excellent Center) Difficult issues in managing seizures in the critically ill patients Apisit Boongird, MD Seizures in the critically ill patients

More information

E x p l a i n i n g Stroke

E x p l a i n i n g Stroke Explaining Stroke Introduction Explaining Stroke is a practical step-by-step booklet that explains how a stroke happens, different types of stroke and how to prevent a stroke. Many people think a stroke

More information

Ischemic Stroke Diagnosis and Medical Management. Richard M. Zweifler, MD System Chair of Neurology Ochsner Health System

Ischemic Stroke Diagnosis and Medical Management. Richard M. Zweifler, MD System Chair of Neurology Ochsner Health System Ischemic Stroke Diagnosis and Medical Management Richard M. Zweifler, MD System Chair of Neurology Ochsner Health System Stroke Epidemiology Nearly 800,000 Americans suffer stroke annually Fourth leading

More information

Intracranial pressure monitoring in neurosurgery department in Iasi latest developments

Intracranial pressure monitoring in neurosurgery department in Iasi latest developments Romanian Neurosurgery (2012) XIX 1 Intracranial pressure monitoring in neurosurgery department in Iasi latest developments lin Iordache 1, Raluca Munteanu 2, Mihaela Cosman 2, Dana-Mihaela Turliuc 1 1

More information

What You Should Know About Cerebral Aneurysms

What You Should Know About Cerebral Aneurysms What You Should Know About Cerebral Aneurysms From the Cerebrovascular Imaging and Interventions Committee of the American Heart Association Cardiovascular Radiology Council Randall T. Higashida, M.D.,

More information

Liver Enzymes. AST and ALT (Transaminases)

Liver Enzymes. AST and ALT (Transaminases) Liver Enzymes Four separate liver enzymes are included on most routine laboratory tests. They are- aspartate aminotransferase (AST or SGOT) and alanine aminotransferase (ALT or SGPT), which are known together

More information

Pathology ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Pathology and Top 25 codes

Pathology ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Pathology and Top 25 codes Pathology ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Pathology and Top 25 codes Chapter 2 Neoplasms (C00-D49) Classification improvements Code expansions Significant expansions or revisions

More information

NCD for Lipids Testing

NCD for Lipids Testing Applicable CPT Code(s): NCD for Lipids Testing 80061 Lipid panel 82465 Cholesterol, serum or whole blood, total 83700 Lipoprotein, blood; electrophoretic separation and quantitation 83701 Lipoprotein blood;

More information

Nervous System Pathology

Nervous System Pathology Nervous System Pathology Nervous System Central Nervous System CNS Brain & Spinal cord Nervous System Peripheral Nervous System PNS Spinal and cranial nerves CNS Close relationship with endocrine system

More information

Stuart B Black MD, FAAN Chief of Neurology Co-Medical Director: Neuroscience Center Baylor University Medical Center at Dallas

Stuart B Black MD, FAAN Chief of Neurology Co-Medical Director: Neuroscience Center Baylor University Medical Center at Dallas Billing and Coding in Neurology and Headache Stuart B Black MD, FAAN Chief of Neurology Co-Medical Director: Neuroscience Center Baylor University Medical Center at Dallas CPT Codes vs. ICD Codes Category

More information

Home Health Care ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Home Health Care and Top 20 codes

Home Health Care ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Home Health Care and Top 20 codes Home Health Care ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Home Health Care and Top 20 codes Chapter 4: Endocrine, Nutritional and Metabolic Diseases (E00-E99) ICD-10-CM diabetes mellitus

More information

Survey of Canadian Physicians Use of anti-thrombotic therapy for Atrial Fibrillation

Survey of Canadian Physicians Use of anti-thrombotic therapy for Atrial Fibrillation Survey of Canadian Physicians Use of anti-thrombotic therapy for Atrial Fibrillation On the following pages are a number of questions asking about the conditions under which you would prescribe anticoagulation

More information

09/05/2014. Painting pictures of the brain with numbers. Overview

09/05/2014. Painting pictures of the brain with numbers. Overview Painting pictures of the brain with numbers Neurology for Insurers Dr Ian Cox & Adele Groyer (Gen Re) Overview Critical Illness Product Background Why should we be interested in neurology? Consult our

More information

Let s talk about: Stroke

Let s talk about: Stroke Let s talk about: Stroke February 20 th 2013 Laura Wilson Christine Stables Questions 1. Why is knowing about stroke important? 2. What exactly is a stroke and what are the symptoms? 3. What should I do

More information

National Cancer Institution (NCI) Toxicity Criteria

National Cancer Institution (NCI) Toxicity Criteria National Cancer Institution (NCI) Toxicity Criteria Toxicity Grade 0 1 2 3 4 Blood/Bone Marrow WBC?4.0 3.0-3.9 2.0-2.9 1.0-1.9

More information

ICTUS CEREBELOSOS. Carlos S. Kase, M.D. Department of Neurology Boston University Boston, MA

ICTUS CEREBELOSOS. Carlos S. Kase, M.D. Department of Neurology Boston University Boston, MA ICTUS CEREBELOSOS Carlos S. Kase, M.D. Department of Neurology Boston University Boston, MA CEREBELLAR STROKES CEREBELLAR INFARCTION CEREBELLAR HEMORRHAGE Distribution of Pathologically Confirmed Cerebellar

More information

Alcohol: The good, the bad and

Alcohol: The good, the bad and Alcohol: The good, the bad and the Clare Wilhelm, Ph.D. Portland VA Medical Center Oregon Health & Science University Supported by VA Career Development Grant (BX001294) Overview Alcohol statistics the

More information

A First Class Emergency: Headache in Flight. David Bordo, MD

A First Class Emergency: Headache in Flight. David Bordo, MD A First Class Emergency: Headache in Flight A 41 year-old flight attendant boarded a plane in London to return to Chicago, complaining of her typical migraine headache. A co-worker gave her a sumatriptan

More information

LONG-TERM SEIZURE OUTCOME AFTER EPILEPSY SURGERY

LONG-TERM SEIZURE OUTCOME AFTER EPILEPSY SURGERY LONG-TERM SEIZURE OUTCOME AFTER EPILEPSY SURGERY Prakash Kotagal, M.D. Head, Pediatric Epilepsy Cleveland Clinic Epilepsy Center LEFT TEMPORAL LOBE ASTROCYTOMA SEIZURE OUTCOME 1 YEAR AFTER EPILEPSY SURGERY

More information

LECTURE 16 NEUROPATHOPHYSIOLOGY (HEAD INJURY)

LECTURE 16 NEUROPATHOPHYSIOLOGY (HEAD INJURY) LECTURE 16 Copyright 2000 by Bowman O. Davis, Jr. The approach and organization of this material was developed by Bowman O. Davis, Jr. for specific use in online instruction. All rights reserved. No part

More information

Chronic kidney disease and cerebral small vessel disease

Chronic kidney disease and cerebral small vessel disease Chronic kidney disease and cerebral small vessel disease M. Arfan Ikram, MD PhD Department of Epidemiology, Radiology, Neurology Erasmus MC Rotterdam, The Netherlands No disclosures Kidney-brain: Two pulsating

More information

STROKE April 2011 Dr Amer Jafar A delay in recognizing early warning signs (WS) and risk factors (RF) of ischemic stroke causes a delay in treatment Evaluated: knowledge of RF and WS and the impact of

More information

Alcohol and Opiate Fatalities. Michael Bell, MD Chief Medical Examiner Palm Beach County Medical Examiner s Office

Alcohol and Opiate Fatalities. Michael Bell, MD Chief Medical Examiner Palm Beach County Medical Examiner s Office Alcohol and Opiate Fatalities Michael Bell, MD Chief Medical Examiner Palm Beach County Medical Examiner s Office Opiates Opiates-Heroin diacetylmorphine Opiates Opiates Drug-Related Death Overdose or

More information

Cycling-related Traumatic Brain Injury 2011

Cycling-related Traumatic Brain Injury 2011 Cycling-related Traumatic Brain Injury 2011 The Chinese University of Hong Kong Division of Neurosurgery, Department of Surgery Accident & Emergency Medicine Academic Unit Jockey Club School of Public

More information

Scottish Clinical Coding

Scottish Clinical Coding Scottish Clinical Coding Standards Number 3 September 2013 Scottish Clinical Coding Standards - ICD10 Factor V Leiden Factor V Leiden is the name of a specific gene mutation that results in thrombophilia

More information

Stroke Coding Issues Presentation to: NorthEast Cerebrovascular Consortium

Stroke Coding Issues Presentation to: NorthEast Cerebrovascular Consortium Stroke Coding Issues Presentation to: NorthEast Cerebrovascular Consortium October 30, 2008 Barry Libman, RHIA, CCS, CCS-P President, Barry Libman Inc. Stroke Coding Issues Outline Medical record documentation

More information

Case Report. Central Neurocytoma. Fotis Souslian, MD; Dino Terzic, MD; Ramachandra Tummala, MD. Department of Neurosurgery, University of Minnesota

Case Report. Central Neurocytoma. Fotis Souslian, MD; Dino Terzic, MD; Ramachandra Tummala, MD. Department of Neurosurgery, University of Minnesota 1 Case Report Central Neurocytoma Fotis, MD; Dino Terzic, MD; Ramachandra Tummala, MD Department of Neurosurgery, University of Minnesota Case This is a previously healthy 20 year old female, with 3 months

More information

Introduction Hemophilia is a rare bleeding disorder in which the blood does not clot normally. About 1 in 10,000 people are born with hemophilia.

Introduction Hemophilia is a rare bleeding disorder in which the blood does not clot normally. About 1 in 10,000 people are born with hemophilia. Hemophilia Introduction Hemophilia is a rare bleeding disorder in which the blood does not clot normally. About 1 in 10,000 people are born with hemophilia. Hemophilia can be mild, moderate, or severe.

More information

Headache: Differential diagnosis and Evaluation. Raymond Rios PGY-1 Pediatrics

Headache: Differential diagnosis and Evaluation. Raymond Rios PGY-1 Pediatrics Headache: Differential diagnosis and Evaluation Raymond Rios PGY-1 Pediatrics You are evaluating a 9 year old male patient at the ED brought by his mother, who says that her son has had a fever, cough,

More information

The International Agenda for Stroke

The International Agenda for Stroke 1st Global Conference on Healthy Lifestyles and Noncommunicable Diseases Control Moscow, 28-29 April, 2011 The International Agenda for Stroke Marc Fisher MD, University of Massachusetts Editor-in-Chief,

More information

Introduction to Neuropsychological Assessment

Introduction to Neuropsychological Assessment Definitions and Learning Objectives Introduction to Neuropsychological Assessment Alan Sunderland Reader in Clinical Neuropsychology Neuropsychological assessment seeks to define cognitive disability in

More information

TPA, STROKE, & TELEMEDICINE. Improving utilization and improving outcomes in a constantly evolving field

TPA, STROKE, & TELEMEDICINE. Improving utilization and improving outcomes in a constantly evolving field TPA, STROKE, & TELEMEDICINE Improving utilization and improving outcomes in a constantly evolving field OVERVIEW tpa inclusion and exclusion evolution Challenges to tpa administration Target:Stroke Telemedicine

More information

UPDATED INCLUSION AND EXCLUSION CRITERIA FOR IV TPA ADMINISTRATION ACUTE STROKE TREATMENT: AN UPDATE GOALS OF TALK

UPDATED INCLUSION AND EXCLUSION CRITERIA FOR IV TPA ADMINISTRATION ACUTE STROKE TREATMENT: AN UPDATE GOALS OF TALK ACUTE STROKE TREATMENT: AN UPDATE James M. Gebel MD MS FAHA Medical Director Akron General Medical Center Cerebrovascular Center GOALS OF TALK Review changes to IV tpa administration as per new 2013 AHA

More information

Do We Need a New Definition of Stroke & TIA as Proposed by the AHA? Stroke & TIA need to Remain Clinical Diagnoses: to Change Would be Bonkers!

Do We Need a New Definition of Stroke & TIA as Proposed by the AHA? Stroke & TIA need to Remain Clinical Diagnoses: to Change Would be Bonkers! Do We Need a New Definition of Stroke & TIA as Proposed by the AHA? No Stroke & TIA need to Remain Clinical Diagnoses: to Change Would be Bonkers! A/Prof Anne L. Abbott Neurologist School of Public Health

More information

Abdominal Emergency Cases. Jeff Dunkle, MD February 2011

Abdominal Emergency Cases. Jeff Dunkle, MD February 2011 Abdominal Emergency Cases Jeff Dunkle, MD February 2011 Case: Trauma Case: Trauma Dx? Dx: Shock Bowel Hypoperfusion complex Seen in patients with hypovolemic shock. Poor prognostic indicator. CT findings

More information

PROTOCOL. Management of Spontaneous Cerebellar Hematomas: A Prospective Treatment Protocol

PROTOCOL. Management of Spontaneous Cerebellar Hematomas: A Prospective Treatment Protocol PROTOCOL Management of Spontaneous Cerebellar Hematomas: A Prospective Treatment Protocol Ramez W. Kirollos, M.D., Atul K. Tyagi, F.R.C.S.(SN), Stuart A. Ross, M.Ch., Philip T. van Hille, F.R.C.S., Paul

More information

Novel oral Anticoagulants, stroke and intracerebral hemorrhage

Novel oral Anticoagulants, stroke and intracerebral hemorrhage Novel oral Anticoagulants, stroke and intracerebral hemorrhage David Seiffge and Philippe Lyrer on behalf of the Basel Stroke Research Team: Leo Bonati, Gian Marco De Marchis, Stefan Engelter, Henrik Gensicke,

More information

Effects of hypoglycemia on brain. Ji Hyun Kim Department of Neurology Korea University College of Medicine

Effects of hypoglycemia on brain. Ji Hyun Kim Department of Neurology Korea University College of Medicine Effects of hypoglycemia on brain Ji Hyun Kim Department of Neurology Korea University College of Medicine Glucose and brain The brain is dependent on glucose as its principal fuel Interruption of glucose

More information

LIPID PANEL CHOLESTEROL LIPOPROTEIN, ELECTROPHORETIC SEPARATION LIPOPROTEIN, DIRECT MEASUREMENT (HDL) LDL DIRECT TRIGLYCERIDES

LIPID PANEL CHOLESTEROL LIPOPROTEIN, ELECTROPHORETIC SEPARATION LIPOPROTEIN, DIRECT MEASUREMENT (HDL) LDL DIRECT TRIGLYCERIDES Test Code Test Name CPT CHOL Cholesterol, Serum 82465 HDL HDL, (High Density Lipoprotein) 83718 TRIG Triglycerides, Serum 84478 FTRIG Triglycerides (Fluid) 84478 LIPID Lipid Panel 80061 LDL LDL (Low Density

More information

Understanding Mortality Statistics: The Importance of Cause-of-Death Certification and Coding

Understanding Mortality Statistics: The Importance of Cause-of-Death Certification and Coding Understanding Mortality Statistics: The Importance of Cause-of-Death Certification and Coding Robert N. Anderson, PhD Arialdi M. Miniño, MPH Mortality Statistics Branch Division of Vital Statistics Centers

More information

Recognition and management of the end of life in stroke patients. Dr Victor Pace Consultant, St Christopher s Hospice London April 2010

Recognition and management of the end of life in stroke patients. Dr Victor Pace Consultant, St Christopher s Hospice London April 2010 Recognition and management of the end of life in stroke patients Dr Victor Pace Consultant, St Christopher s Hospice London April 2010 What we shall cover overview of stroke and dying LCP: advantages and

More information

New Onset Headache: Diagnosis and Management Michelle H. Biros, MD, MS

New Onset Headache: Diagnosis and Management Michelle H. Biros, MD, MS New Onset Headache: Diagnosis and Management ED Visit One A 20 year old Hispanic woman presented to the ED with a complaint of a severe headache present for three days. The headache woke her. Since that

More information

MEDICAL POLICY No. 91104-R7 DETOXIFICATION I. POLICY/CRITERIA

MEDICAL POLICY No. 91104-R7 DETOXIFICATION I. POLICY/CRITERIA DETOXIFICATION MEDICAL POLICY Effective Date: January 7, 2013 Review Dates: 1/93, 2/97, 4/99, 2/01, 12/01, 2/02, 2/03, 1/04, 1/05, 12/05, 12/06, 12/07, 12/08, 12/09, 12/10, 12/11, 12/12, 12/13, 11/14 Date

More information

The Electronic Medical Record in its entirety can be found on pages 39-54. The EMR is the reading tool that students will use as they complete The

The Electronic Medical Record in its entirety can be found on pages 39-54. The EMR is the reading tool that students will use as they complete The The Electronic Medical Record in its entirety can be found on pages 39-54. The EMR is the reading tool that students will use as they complete The Virtual Stroke Lab. The idea of the EMR was that students

More information

Diagnostic Information Available in University and Community Hospital Medical Records: Patients With Cerebrovascular Disease

Diagnostic Information Available in University and Community Hospital Medical Records: Patients With Cerebrovascular Disease Diagnostic Information Available in University and Community Hospital Medical Records: Patients With Cerebrovascular Disease BY ROBERT R. CARPENTER, M.D., KENNETH D. ROGERS, M.D., AND DAVID E. REED, M.D.

More information

Stroke Risk Scores. CHA 2 DS 2 -VASc. CHA 2 DS 2 -VASc Scoring Table 2

Stroke Risk Scores. CHA 2 DS 2 -VASc. CHA 2 DS 2 -VASc Scoring Table 2 Bleeding/Clotting Risk Evaluation Tools for Atrial Fibrillation Patients Before prescribing anticoagulants, providers should weigh the risk of thrombosis against the risk of bleeding. The tools below can

More information

GI Bleeding. Thomas S.Foster,Pharm.D. PHR 961 Integrated Therapeutics

GI Bleeding. Thomas S.Foster,Pharm.D. PHR 961 Integrated Therapeutics GI Bleeding Thomas S.Foster,Pharm.D. PHR 961 Integrated Therapeutics Overview Because GI bleeding is internal, it is possible for a person to have GI bleeding without symptoms. Important to recognize

More information

Epilepsy 101: Getting Started

Epilepsy 101: Getting Started American Epilepsy Society 1 Epilepsy 101 for nurses has been developed by the American Epilepsy Society to prepare professional nurses to understand the general issues, concerns and needs of people with

More information

Is this pt s brain dysfunction due to ischemia? Onset & progression of sx; location of deficit

Is this pt s brain dysfunction due to ischemia? Onset & progression of sx; location of deficit CEREBROVASCULAR ACCIDENTS & TIA s Maggie Kelly History: Onset of symptoms exact time Previous sxs suggestive of TIA s Progression of symptoms Headache? Medications Past history of CVA, clotting events

More information

Brain Cancer. This reference summary will help you understand how brain tumors are diagnosed and what options are available to treat them.

Brain Cancer. This reference summary will help you understand how brain tumors are diagnosed and what options are available to treat them. Brain Cancer Introduction Brain tumors are not rare. Thousands of people are diagnosed every year with tumors of the brain and the rest of the nervous system. The diagnosis and treatment of brain tumors

More information