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      Convexity Subarachnoid Hemorrhage, Pseudomonas Aeruginosa (PA) Infective Endocarditis and Left Atrial Appendage Occluder (LAAO) Device Infection. A Case Report

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          Abstract

          An 83 year-old-man with left atrial appendage occluder (LAAO) developed Pseudomonas Aeruginosa (PA) infective endocarditis. MRI at day 3 of onset showed distal small infarcts in both middle cerebral arteries and left postero-inferior cerebellar artery territories. MRI at day 6 revealed two sites of convexity subarachnoid hemorrhage (cSAH). MRA and CTA failed to reveal a Mycotic aneurysm.

          The radiologic findings favor the assumption of necrosis of distal branches of mca or of pial arteries wall.

          This case present three unusual features: the presence of localized cSAH after initiation of antibiotherapy without mycotic aneurysm being individualized; the late occurrence of infective endocarditis after LAAO implantation; the very rare occurrence of PA in prosthetic infections.

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          Hemorrhage in posterior reversible encephalopathy syndrome: imaging and clinical features.

          H.M. Hefzy, W.S. Bartynski, J.F. Boardman … (2009)
          Hemorrhage is known to occur in posterior reversible encephalopathy syndrome (PRES), but the characteristics have not been analyzed in detail. The purpose of this study was to evaluate the imaging and clinical features of hemorrhage in PRES. Retrospective assessment of 151 patients with PRES was performed, and 23 patients were identified who had intracranial hemorrhage at toxicity. Hemorrhage types were identified and tabulated, including minute focal hemorrhages ( 116 mm Hg). The overall incidence of hemorrhage was 15.2%, with borderline statistical significance noted between the observed clinical associations (P = .07). Hemorrhage was significantly more common (P = .02) after allogeneic bone marrow transplantation (allo-BMT) than after solid-organ transplantation. The 3 hemorrhage types were noted with equal frequency. A single hemorrhage type was found in 16 patients, with multiple types noted in 7. Patients undergoing therapeutic anticoagulation were statistically more likely to develop hemorrhage (P = .04). No difference in hemorrhage incidence was found among the 3 blood pressure subgroups (range, 14.9%-15.9%). Three distinct types of hemorrhage (minute hemorrhage, sulcal subarachnoid hemorrhage, hematoma) were identified in PRES with equal frequency. The greatest hemorrhage frequency was seen after allo-BMT and in patients undergoing therapeutic anticoagulation. Hemorrhage rate was independent of the toxicity blood pressure.
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            Hemorrhagic manifestations of reversible cerebral vasoconstriction syndrome: frequency, features, and risk factors.

            Raphael Porcher, Christian Stapf, U Fiedler … (2010)
            Reversible cerebral vasoconstriction syndrome (RCVS), characterized by severe headaches and reversible constriction of cerebral arteries, may be associated with ischemic and hemorrhagic strokes. The aim of this study was to describe the frequency, patterns, and risk factors of intracranial hemorrhages in RCVS. We analyzed prospective data on 89 consecutive patients with RCVS, of which 8 were postpartum and 46 used vasoactive substances. Standard bivariate and multivariate statistical tests were applied to compare patients with and without hemorrhage. Thirty patients (34%), of which 5 were postpartum and 12 used vasoactive substances, developed at least 1 type of intracranial hemorrhage, including cortical subarachnoid (n = 27), intracerebral (n = 11), and subdural hemorrhage (n=2). Patients with hemorrhage had an older age (46.6 versus 41.6 years, P = 0.049) and were more frequently females (90% versus 51%, P = 0.0017) or were migrainers (43% versus 19%, P = 0.022) than those without hemorrhage. Multivariate testing identified 2 independent risk factors of hemorrhage in RCVS: female gender (OR, 4.05; 95% CI, 1.46 to 11.2) and migraine (OR, 2.34; 95% CI, 1.06 to 5.18). Patients with hemorrhage had a greater risk of persistent focal deficits (30% versus 2%, P = 0.0002), cerebral infarction (13% versus 2%, P = 0.039), posterior reversible encephalopathy syndrome (17% versus 3%, P = 0.041) at the acute stage, and of inability to resume normal activities at 6 months (27% versus 0%, P < 0.0001). In RCVS, women and migrainers seem to be at higher risk of intracranial hemorrhage. Overall, intracranial hemorrhages are frequent in RCVS and are associated with a more severe clinical spectrum.
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              Atraumatic convexal subarachnoid hemorrhage: clinical presentation, imaging patterns, and etiologies.

              G Schlaug, D. Searls, Jeffrey Caplan … (2010)
              To identify patterns of clinical presentation, imaging findings, and etiologies in a cohort of hospitalized patients with localized nontraumatic convexal subarachnoid hemorrhage. Twenty-nine consecutive patients with atraumatic convexal subarachnoid hemorrhage were identified using International Classification of Diseases-9 code from 460 patients with subarachnoid hemorrhage evaluated at our institution over a course of 5 years. Retrospective review of patient medical records, neuroimaging studies, and follow-up data was performed. There were 16 women and 13 men between the ages of 29 and 87 years. Two common patterns of presentations were observed. The most frequent presenting symptom in patients 60 years (n = 13) usually had temporary sensory or motor symptoms (n = 7; 54%); brain MRI scans in these patients showed evidence of leukoaraiosis and/or hemispheric microbleeds and superficial siderosis (n = 9; 69%), compatible with amyloid angiopathy (n = 10; p < 0.0001). In a small group of patients, the presentation was more varied and included lethargy, fever, and confusion. Four patients older than 60 years had recurrent intracerebral hemorrhages in the follow-up period with 2 fatalities. Convexal subarachnoid hemorrhage is an important subtype of nonaneurysmal subarachnoid bleeding with diverse etiologies, though a reversible vasoconstriction syndrome appears to be a common cause in patients 60 years or younger whereas amyloid angiopathy is frequent in patients over 60. These observations require confirmation in future studies.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Open Neuroimag J
                Journal ID (iso-abbrev): Open Neuroimag J
                Journal ID (publisher-id): TONIJ
                Title: The Open Neuroimaging Journal
                Publisher: Bentham Open
                ISSN (Electronic): 1874-4400
                Publication date (Electronic): 22 May 2017
                Publication date Collection: 2017
                Volume: 11
                Pages: 26-31
                Affiliations
                [1 ]Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
                [2 ]Department of Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, INSERM Clinical Investigation Center 007, (S.T., X.D.) and INSERM U738, (C.L., X.D.) Université Paris Diderot, Sorbonne Paris Cité, France
                [3 ]Department of Radiology, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM U1148, Paris, France; University Paris 7, Bichat Hospital, Paris, France
                Author notes
                [* ]Address correspondence to this author at the Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, 46 rue Henri Huchard, 75018, Paris, France, Tel:+ 33624652932; Fax:+ 33140258305; E-mails: monique.boukobza@ 123456aphp.fr ; m.boukobza@ 123456orange.fr
                Article
                Publisher ID: TONIJ-11-26
                DOI: 10.2174/1874440001711010026
                PMC ID: 5470070
                SO-VID: 167cd7b3-b526-425f-a913-03525d165444
                Copyright © © 2017 Boukobza et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 18 January 2017
                Date revision received : 07 March 2017
                Date accepted : 20 April 2017
                Categories
                Subject: Article

                ScienceOpen disciplines: Neurosciences
                Keywords: infective endocarditis,convexity subarachnoid hemorrhage,t2-gre images,mycotic aneurysm,pseudomonas aeruginosa,left atrial appendage occluder
                Data availability:
                ScienceOpen disciplines: Neurosciences
                Keywords: infective endocarditis, convexity subarachnoid hemorrhage, t2-gre images, mycotic aneurysm, pseudomonas aeruginosa, left atrial appendage occluder

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