Risk of Thrombolysis

Images Otitis Media

Fig. 11.8a Initial noncontrast head CT of this patient shows very subtle edema of the basal ganglia on the left, indicating infarction that has led to an acute right-sided hemiparesis. There was definitely no hemorrhage present at the time of diagnosis. b Regional thrombolysis initiated immediately after the head CT was complicated by massive hemorrhage extending into the ventricle and a subsequent CSF flow obstruction. See the blood in the right posterior horn of the lateral ventricle. There is extreme midline shift. This patient did not survive.

Fig. 11.8a Initial noncontrast head CT of this patient shows very subtle edema of the basal ganglia on the left, indicating infarction that has led to an acute right-sided hemiparesis. There was definitely no hemorrhage present at the time of diagnosis. b Regional thrombolysis initiated immediately after the head CT was complicated by massive hemorrhage extending into the ventricle and a subsequent CSF flow obstruction. See the blood in the right posterior horn of the lateral ventricle. There is extreme midline shift. This patient did not survive.

neighboring ventricles widening to compensate for the loss of tissue (Fig. 11.10c).

Sinus thrombosis: Thromboses of the venous sinuses can cause brain infarctions owing to congestion and outflow obstruction. They occur in a number of disease entities: if oral contraceptives are used or as a complication of septic intracranial processes. Clinically they manifest with varying uncharacteristic neurological symptoms and epileptic seizures. It is crucial for the clinician to consider them in the differential of not so typical acute CNS problems! The diagnosis is verified by MRI (Fig. 11.11). The "empty delta sign" is pathognomonic: thrombus surrounded by contrast-enhanced blood is seen within the venous confluence.

^ Diagnosis: Giufeng calls Greg and also gets in touch with the neurologist. She thinks Mrs. Peabody-Smith has a fresh stroke without a hemorrhagic component. She sees some loss of gray-white matter differentiation in the right basal ganglia compared with the contralateral side: the right internal capsule, the caudate head, and the globus pallidum cannot be differentiated. Thrombolysis is a real option in this case, but inherent risks have to be considered. Whether the therapy is going to be administered intravenously by the neurologists or regionally into the feeding artery by the interventional neuroradiologist must be decided now. But that is definitely something for Gregory to manage.

I Subacute Stroke

I Subacute Stroke

Genue Right Internal Capsule

Fig. 11.9a This patient came to the hospital with cortical blindness of two days' duration. The head CT shows an already well-demarcated infarction in the left occipital lobe. b In another patient, reperfusion of the infarcted territory has led to secondary parenchymal hemorrhage—a hemorrhagic infarction. c Such hemorrhage can also occur in infarcted gray matter.

Fig. 11.9a This patient came to the hospital with cortical blindness of two days' duration. The head CT shows an already well-demarcated infarction in the left occipital lobe. b In another patient, reperfusion of the infarcted territory has led to secondary parenchymal hemorrhage—a hemorrhagic infarction. c Such hemorrhage can also occur in infarcted gray matter.

I Old Stroke

I Old Stroke

Stroke Head

Fig. 11.10a The precontrast head CT shows circumscribed hypodensity in the left frontal region. b After contrast administration, accumulation of contrast in the cortex indicates increased vascularity in this area during resorption of the necrotic tissue. c This stroke in the posterior vascular territory of the right medial cerebral artery has been all but completely resorbed. In response there is impressive ex-vacuo dilatation of the posterior horn of the right lateral ventricle.

Fig. 11.10a The precontrast head CT shows circumscribed hypodensity in the left frontal region. b After contrast administration, accumulation of contrast in the cortex indicates increased vascularity in this area during resorption of the necrotic tissue. c This stroke in the posterior vascular territory of the right medial cerebral artery has been all but completely resorbed. In response there is impressive ex-vacuo dilatation of the posterior horn of the right lateral ventricle.

0 0

Post a comment