Prevalence of risk factors in spontaneous intracerebral hemorrhage and aneurysmal subarachnoid hemorrhage

OBJECTIVE: To evaluate whether differences exist in the occurrence of modifiable risk factors between aneurysmal subarachnoid hemorrhage and spontaneous intracerebral hemorrhage, since these stroke subtypes have frequently been combined in epidemiological studies and labeled hemorrhagic stroke. DESIGN: Cross-sectional survey. SETTING: Helsinki University Central Hospital in Helsinki, Finland. PATIENTS: One hundred fifty-six consecutive patients with spontaneous intracerebral hemorrhage aged 16 to 60 years (96 males and 60 females) and 281 patients with aneurysmal subarachnoid hemorrhage (145 males and 136 females) who were admitted to an emergency department. MAIN OUTCOME MEASURES: Prevalence of several health habits, previous diseases, and medication of patients with spontaneous intracerebral hemorrhage were compared with that of patients with subarachnoid hemorrhage using multiple logistic regression. RESULTS: Hypertension (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.6-4.3), diabetes mellitus (OR, 26.4; 95% CI, 3.1-221.6), alcohol intake within the preceding week (for 1-150 g of alcohol: OR, 2.0; 95% CI, 1.1-3.6; for 151-300 g of alcohol: OR, 1.7; 95% CI, 0.8-3.8; and for > 300 g of alcohol: OR, 4.4; 95% CI, 2.1-9.1), and anticoagulant treatment (OR, 21.8; 95% CI, 2.3-207.3) were all significantly more common, but current cigarette smoking (OR, 0.3; 95% CI, 0.2-0.5) was less common in patients with intracerebral hemorrhage than in those with subarachnoid hemorrhage simultaneously after adjustment for sex, age, and body mass index. In males, hypertension (OR, 2.3; 95% CI, 1.1-4.5) and alcohol intake (for > 300 g/wk: OR, 5.8; 95% CI, 2.2-15.7) were more common, but current smoking (OR, 0.2; 95% CI, 0.1-0.4) was less common in patients with intracerebral hemorrhage than in those with subarachnoid hemorrhage after adjustment for age, body mass index, and diabetes mellitus. In females, hypertension (OR, 2.9; 95% CI, 1.4-5.8) and anticoagulant treatment (OR, 10.0; 95% CI, 1.0-100.2) were more common in patients with intracerebral hemorrhage after adjustment for age and body mass index. In univariate statistics, patients with intracerebral hemorrhage were also older, more often had previous symptoms of cerebral ischemia, and had higher values for body mass index and gamma-glutamyltransferase than did those with subarachnoid hemorrhage. CONCLUSIONS: Hypertension, diabetes mellitus, anticoagulant treatment, and amount of alcohol taken within 1 week seem more commonly to be associated with intracerebral hemorrhage than with subarachnoid hemorrhage, which is, however, associated more frequently with cigarette smoking.     

Gastric duplication-colonic fistula with colonic ulceration and bleeding

An 11-month-old girl had massive rectal bleeding. A midabdominal mass was palpated. Ultrasound scan showed a large cystic mass with diffusely echogenic contents; Tc-99M radionuclide scan confirmed a duplication. Exploratory surgery and pathology examination showed a gastric duplication with formation of a fistula into the transverse colon with a colonic ulcer and hemorrhage. This combination of findings is presented as a rare cause of lower gastrointestinal hemorrhage in infancy.     

Spontaneous cerebellar hemorrhage in children and adolescents

Spontaneous cerebellar hemorrhage is infrequently reported in children, although this disorder account for roughly 10% of nontraumatic intracranial hemorrhages in adults. We studied three cases that demonstrated the clinical features, radiological findings, pathological features, and outcome in this condition. A review of the literature uncovered 21 additional cases. The most commonly encountered cause of hemorrhage found in 62% of the cases was a vascular abnormality. Of the 24 patients, 15 underwent surgery and 14 of these survived. No patient survived without surgery. Computerized tomography has increased the diagnostic yield while decreasing diagnostic morbidity, and early surgical intervention provided dramatic improvement in many patients. The diagnosis of spontaneous cerebellar hemorrhage must always be considered in the examination of a patient with symptoms and signs suggesting an acute onset of a posterior fossa mass lesion.     

Adrenal hemorrhage complicating ACTH therapy in Crohn's disease

Huge dose ACTH therapy is used in some severely ill patients with inflammatory bowel disease. We report a teenage girl with Crohn's disease who developed an acute abdomen following ACTH therapy. CT revealed the mass to be a hemorrhagic adrenal gland; the opposite adrenal gland was hypertrophied but without signs of hemorrhage.     

Hypothalamic pilocytic astrocytoma presenting with intratumoral and subarachnoid hemorrhage

A 45-year-old male presented with sudden onset of severe headache. Computed tomography and magnetic resonance imaging demonstrated an irregularly enhanced suprasellar mass with intratumoral and subarachnoid hemorrhage. The mass was removed in two operations. Histological examination of the tumor revealed pilocytic astrocytoma. The relatively rich vascularity and perivascular tumor cell proliferation observed in this benign lesion were probably the causes of this extremely rare association.     

Solitary fibrous tumor of the adrenal gland

Solitary fibrous tumors are rare neoplasms, most commonly involving the pleura, recently described in various other locations. We report a solitary fibrous tumor of the right adrenal gland in a 42-year-old woman, discovered incidentally during abdominopelvic ultrasonographic examination. Pathologic and immunohistologic features of the tumor were identical to those of other solitary fibrous tumors. Three-quarters of this unencapsulated infiltrating tumoral mass presented foci of hemorrhage and were made of small, round, epithelioid-like cells that expressed the CD34 antigen more weakly than do the typical spindle cells usually observed in solitary fibrous tumors. Despite hemorrhage and poor limitation, the tumor behaved in a innocuous manner; the mass remaining unchanged for more than 5 years before the patient agreed to surgical intervention, which was recommended because of a sudden enlargement of the mass.     

Thrombus distribution and changes in aneurysm size following endovascular aortic aneurysm repair

Microvascular lesions, also called varices or capillary ectasias, in contrast to vocal fold polyps with telangiectatic vessels, are relatively small lesions arising from the microcirculation of the vocal fold. Varices are most commonly seen in female professional vocalists and may be secondary to repetitive trauma, hormonal variations, or repeated inflammation. Microvascular lesions may either be asymptomatic or cause frank dysphonia by interrupting the normal vibratory pattern, mass, or closure of the vocal folds. They may also lead to vocal fold hemorrhage, scarring, or polyp formation. Laryngovideostroboscopy is the key in determining the functional significance of vocal fold varices. Management of patients with a varix includes medical therapy, speech therapy, and occasionally surgical vaporization. Indications for surgery are recurrent hemorrhage, enlargement of the varix, development of a mass in conjunction with the varix or hemorrhage, and unacceptable dysphonia after maximal medical and speech therapy due to a functionally significant varix.     

Prenatally detected cystic neuroblastoma

A case of adrenal cystic neuroblastoma (NB) detected by prenatal ultrasonography (US) is presented. The suprarenal mass initially showed pure cystic features on a variety of imaging studies such as US, computed tomography, and magnetic resonance imaging. Tumor markers were negative. The mass was suspected to be an adrenal hemorrhage rather than a NB. Three months later, although the diameter was unchanged, the thickness of the cyst wall seemed to have slightly increased. Surgical exploration revealed an adrenal cystic tumor and histology showed a NB in situ. Forty-five infants with prenatally detected NB were found in the English literature; about one-half of them were cystic NBs, and most had a favorable outcome.     

Retroperitoneal hemorrhage due to a ruptured adrenal myelolipoma. A case report

Adrenal myelolipomas are usually small and asymptomatic tumors discovered incidentally. In a small number of cases, acute pain may develop secondary to intratumoral and/or retroperitoneal bleeding. We observed a large, surgically and histologically confirmed, myelolipoma of the right adrenal gland with spontaneous internal and external hemorrhage. CT demonstrated heterogeneity of the mass, obliteration of the surrounding fat planes, and retroperitoneal blood dissection. A literature review produced only 5 reports of ruptured myelolipoma with external hemorrhage.     

High-frequency radio-wave ablation of osteoid osteoma in the lumbar spine

This report describes a presumed choroidal granuloma with vitreous hemorrhage resembling choroidal melanoma. A healthy 31-year-old man, who had progressive vision loss in the right eye during 1 month, was found to have a yellow-white juxtapapillary choroidal mass. Fluorescein angiography demonstrated a choroidal neovascular membrane over the lesion. There was focal persistent hypofluorescence in the late phase of fluorescein angiography. The thickness of the lesion increased from 3.0 mm to 7.1 mm during 1 month. Subretinal and vitreous hemorrhage developed. The patient was suspected to have a choroidal granuloma and choroidal neovascular membrane, and was treated with oral steroids. Ten months later, the vitreous blood cleared completely with an attached retina. Control of inflammation may have a role in the treatment of idiopathic choroidal granulomas and some choroidal neovascular membranes secondary to ocular inflammation.     

Idiopathic adrenal hemorrhage: a case report

A 77-year-old man with a low grade fever persisting for 30 days consulted a local physician. A computed tomographic scan of the abdomen showed a mixed density mass on the left adrenal gland. He was referred to our hospital for further examination. Hormonal assay demonstrated a slightly high level of noradrenalin in the serum (18 pg/ml) and vanillyl mandelic acid in the urine (6.2 ng/ml). Magnetic resonance imaging revealed a heterogeneous mass lesion 3 cm in diameter with a high signal intensity on both T1 and T2 weighted images. Angiography showed a hypovascular mass in the supra-renal region suggesting an adrenal tumor or malignancy. Left adrenalectomy combined with en bloc nephrectomy was performed because of severe adhesion. Histologic evaluation showed hematoma without malignant cells due to idiopathic adrenal hemorrhage.     

Fatal hemorrhage from rupture of the intracranial internal carotid artery caused by aspergillus arteritis

To the best of our knowledge, this is the first reported case of combined intracranial and extracranial hemorrhage due to aspergillus cerebral arteritis. Knowledge of the imaging and the importance of early diagnosis and treatment are emphasized. A 78 year old man developed progressive right-sided visual impairment and diplopia. Magnetic resonance imaging demonstrated a mass lesion located in the right orbital apex, with extension to the cavernous sinus and the right middle cranial fossa. Cerebral angiography showed no aneurysmal dilatation. He was scheduled for transnasal biopsy. However, the patient died of massive epistaxis and intracranial hemorrhage. Postmortem examination revealed an aspergillus granuloma of the orbit and the skull base involving the intracranial and extracranial internal carotid artery. Aspergillus fumigatus was identified by culture. The characteristic feature of the fungal infection is a low-intensity signal on T2-weighted magnetic resonance images. This finding may be useful in diagnosing fungal infection.     

The lymphatic circulation plays a dynamic role in blood volume and plasma protein restitution after hemorrhage

The purpose of this study was to determine the contribution of the lymphatic circulation to blood volume and plasma protein restitution after hemorrhage. Splenectomized sheep were prepared with thoracic duct and vascular catheters. The day after surgery, thoracic duct lymph flow, thoracic duct lymph protein, plasma protein, mean arterial pressure, and blood volume were measured. After 12 h, awake sheep were either bled 25% of blood volume over 5 min (HEM; n = 6) or observed (SHAM; n = 5) and measurements were recorded for 48 h. In HEM, the thoracic duct protein return rate and thoracic duct lymph flow transiently decreased (0-.5 h) but were then equal to or greater than that in SHAM. In HEM, there was restitution of both blood volume and plasma protein mass approximately 12 h after hemorrhage. Both thoracic duct lymph flow and protein return rate are significant contributors to blood volume and plasma protein restitution after hemorrhage. These findings and the prior demonstration by the authors that lymphatic vessel pumping is increased after hemorrhage suggest a dynamic role for the lymphatic circulation in blood volume homeostasis after hemorrhage.     

Lymphoepithelioma-like carcinoma of the ureter

We reported a case of the biliary cystadenoma of the liver. The cystic mass had lobulation and septation and showed marked hyperintensity on T1-weighted images and hypointensity on T2-weighted images; MR findings were very unusual for cystadenoma. The content of the cystic mass was jelly-like, thick mucinous fluid without intracystic hemorrhage. We concluded that these unusual signal intensities of the cyst were due to hyperproteinous mucinous fluid.     

Endocrine approach to male fertility control by steroid hormone combination in rat Rattus norvegicus L

We describe a case of an adrenal incidentalomas in the setting of congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency. The adrenal mass was shown to be a cavernous hemangioma. Such neoplasms are rare but have the risk of retroperitoneal hemorrhage and may be difficult to differentiate from malignant adrenal tumors. The main consideration brought up by this case was that the simultaneous occurrence of an endocrinologically active disease such as CAH in association with a likely incidentalomas may lead to surgical intervention, due to the impossibility of being certain of its nonsecretory nature. Laparoscopic adrenalectomy allowed safe resection with no morbidity and a short hospitalization.     

Levels of endothelin-I in bronchoalveolar fluid of patients with selected respiratory tract diseases

Clinical manifestations, clinical course and therapeutic schemes were studied in 37 patients with a surgical indication for biliary cysts of the liver observed in a surgery unit over 25 years. Cyst size varied from 2 to 30 cm and was greater than 10 cm in 12 cases. Yellowish-clear contents were observed in 23 cases and purulent or hemorrhagic contents in 3 each. Twenty-three patients were asymptomatic, 14 had pain and/or complications (hemorrhage 3, infection 3, compression 3, rupture 1). Therapy was abstention in 7 cases, puncture in 5, resection of the protruding dome in 17, complete exeresis in 5, and hepatectomy in 3. There were no deaths and morbidity reached 7%. Biliary cysts of the liver can be discovered fortuitously at surgery or imagery or in patients with abdominal pain, an abdominal mass or complications including compression, intraperitoneal rupture, intracystic hemorrhage, hemobilia, acute infection, torsion, cancerization. Diagnosis requires sonography and computed tomography. Therapeutic indications are: abstention for small asymptomatic cysts. For voluminous cysts, with complications or confirmed during a supramesocolic operation, the risk of recurrence or aggravation of the complications excludes puncture or injection of a sclerosing agent. Wide resection of the protruding part of the cyst with histology resection can be performed although prospective assessment is needed. Cystectomy is not indicated if there is a diagnostic doubt. Hepatectomy is an exceptional indication retained for patients with uncontrolable hemorrhage, intra-cystic tumors or voluminous cysts destroying the lobe.     

Ultrasonic evaluation of the vitreous and retina

Ultrasonic evaluation of the vitreous body augments and complements visual and clinical assessment in any condition in which some form of media opacity exists, eg, cornea, lens, hemorrhage, or subretinal mass. The appearance of the eye in hypotony, the presence of foreign material, the pattern of hemorrhage, and the presence of a detached retina or choroid are all identifiable and their diagnosis may be of critical importance to patient management. Patterns of diabetic retinopathy and ocular tumors are usually characteristic using conventional 10 MHz ultrasound. The use of Very High Frequency (VHF or UBM) ultrasound can identify ciliary body detachment or other retroiridal pathology, such as tumors and cysts.     

Intracerebroventricular injection of mu- and delta-opiate receptor antagonists block 60 Hz magnetic field-induced decreases in cholinergic activity in the frontal cortex and hippocampus of the rat

A 62-year-old male complaining of unilateral visual disturbance and pain in the involved eye had a small mass at the right orbital apex which was identified as an Aspergillus granuloma by transcranial biopsy. One month later, the patient became comatose because of fatal subarachnoid hemorrhage due to a newly developed aneurysm. Autopsy showed a ruptured aneurysm on the right internal carotid-posterior communicating artery. Histological examination demonstrated prominent Aspergillus invasion of the arterial wall. Aspergillus infection must be taken into consideration in patients with orbital apex syndrome, which may lead to serious cerebrovascular consequences. If sino-orbital lesions are detected by neuroimaging techniques, biopsy using an extradural approach should be performed to obtain a definitive diagnosis.     

A case of biliary cystadenoma with obstructive jaundice

Biliary cystadenoma is a rare cause of obstructive jaundice. We report a case of a 78-year-old Japanese man with biliary cystadenoma presenting repetitive abdominal pain and jaundice. Ultrasound sonography revealed a hyperechoic mass in the left lateral lobe of the liver. Histological examination revealed a biliary cystadenoma. Intracystic hemorrhage was assumed to be the cause of obstruction of the bile ducts.     

Neuroectodermal differentiation of embryonal carcinoma of the testis

Any pulsatile neck mass after extracorporeal membrane oxygenation (ECMO) must be viewed as a pseudoaneurysm of the carotid artery until proven otherwise. Prompt diagnosis is necessary utilizing ultrasound. Angiography may not be necessary. Carotid artery pseudoaneurysm requires urgent surgical intervention to prevent catastrophic hemorrhage. The utilization of cardiopulmonary bypass may facilitate safe repair.