Archive for the ‘CCT Notfall’ Category

Atlantoaxiale Dislokation

Dienstag, 05. Dezember 2017

Alaria_atlantoaxiale_Dislokation

AAD

AAD_Ligament_Densaxis

Anatomie_Axis_dens

Vasokonstriktionssyndrom (RZVS)

Donnerstag, 28. September 2017

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Stroke

Dienstag, 04. Juli 2017

CT- Stroke:

  1. Blutung oder andere Diagnose
  2. Frühzeichen eines Infarktes(Hyperdenses Arterienzeichen,Hypodenses oder verwaschene Hirngewebe Kontur)
  3. Infarktgroesse (ASPECTS)
  4. Mittels CT-Angiographie kann Indikation zur CT-Endovask. Therapie geprüft werden auch bei Antikoagulation.
ASPECTS:                       M1 - M3 inferior______________________________(3)

                               M4 - M6 superior______________________________(3)

Extrapyramidal_________________N. caud/ Linsenkern/Capsula int./ Insel_______(4)

Score 10 normal, Score 0 am schlechtesten._______________________________Sum.(10)

 

CT-Endovask. Therapie: Innerhalb von 6 Std. (Leitlinien 2018: Bis zu 16-24 Std. nach Infarkt. Siehe unten (*))

  1. Kollateral Status + (CTA und 4D MIP) KM prox. u. dist. der Arterien Occlusion
  2. ASPECTS (8-10)
  3. Prox. intracran. Arterien Occlusion

CT-Perfusion Infarkt:  MTT erhoet, CBV erniedrigt (CBV bei Tumor nicht erniedrigt)

MECHANISCHE_THROMBEKTOMIE_STROKE 

Thrombolyse_CAVE

[gss columns=1 link=file gss=0 ids=4023,4024,4021,4020,4019,4018,4017,4016,4353,3010,4010,3003 carousel="fx=carousel" name=2993]

 

(*)What’s different from previous recommendations is that patients who are ineligible for intravenous (IV) tissue plasminogen activator (tPA) may now be selected for mechanical thrombectomy within 6 hours.

 

(*)This new recommendation is a level 1A. (28.01.2018)

In light of the new results from DEFUSE-3, and a second study called DAWN, published January 4 also in NEJM, the new guidelines recommend thrombectomy in eligible patients 6 to 16 hours after a stroke (another level 1A recommendation).

And on the basis of the DAWN results, the procedure is „reasonable“ in patients 16 to 24 hours after a stroke (level IIa-B-R).

 

IV alteplase or thrombolysis remains the cornerstone of stroke therapy,“ Dr Powers said at a media briefing. „Everyone who is eligible for this should get it, and it should not be delayed to determine if they’re eligible for another treatment.“ Innerhalb 4,5 Std. nach Stroke.

 

Mechanical thrombectomy and tPA „are not mutually exclusive,“ and patients can receive both interventions, he said.

 

Some patients who are not eligible for tPA — for example, those on blood thinners like warfarin — may still be eligible for mechanical thrombectomy, noted Dr Powers.

 

 

 

 

 

Conclusions—Swollen cerebral and cerebellar infarcts are critical conditions that warrant immediate, specialized
neurointensive care and often neurosurgical intervention. Decompressive craniectomy is a necessary option in many
patients. Selected patients may benefit greatly from such an approach, and although disabled, they may be functionally
independent. (Stroke. 2014;45:00-00.)

juveniler_stroke

Hirn_Gefäßerkrankungen

Stroke-2014-Wijdicks-01.str.0000441965.15164.d6

The Role of Imaging in Acute Ischemic Stroke

ischaemie_Lyse_mech._Thrombektomie

 

rtpaLyse (2)

Bestimmung des frühen Zeitintervalls:

MismatchDWI_Flair

 

 

MalignentEdema

Thrombolyse_CAVE

 

Sinusthrombose CCT nativ Guidelines

Montag, 19. Juni 2017

Hohe Dichte Sinus sag. nativ CCT linearer venoeser Infarkt

Hohe Dichte Sinus sag. nativ CCT

Flow void Sinus links

 

 

 

 

 

 

 

 

Differenzierung Duraler Sinusvenenzysten und Thrombosen

Durale_Sinusvenenzyste

He summarized the main highlights of the new guidelines as follows:

Diagnostic Recommendations

  • The diagnostic recommendations are based on the impact of diagnostic procedures on patient outcome and not on process indicators.
  • For the diagnosis of CVT, computed tomographic venography, magnetic resonance venography, or intra-arterial venography can be used because these techniques have similar accuracies.
  • Prothrombotic and cancer screening are not recommended as a routine.

Therapeutic Recommendations

  • All patients with acute CVT should be anticoagulated parentally, preferably with low-molecular-weight heparin (LMWH).
  • Patients with large hemisphere lesions with impending herniation should be offered decompressive surgery.
  • Seizure prophylaxis with anticonvulsants is indicated in patients who experience an acute symptomatic seizure and have a venous infarct or hemorrhage.
  • Non–vitamin K anticoagulants (novel oral anticoagulants) are not recommended, particularly in the acute phase, because of the limited experience and unknown safety.
  • No recommendations could be made regarding acute endovascular treatment because of the very low quality of available evidence, pending the publication of the final results of the TO-ACT trial, which was prematurely terminated for futility this year.
  •  Pregnancy is not contraindicated after CVT, and subcutaneous LMWH is suggested during pregnancy to prevent recurrent venous thrombotic events.

NOAK/Antikoagulation

Montag, 05. September 2016

SOP Orale Antikoagulation_2016.compressed

Dabigatran_Antidot

Wechselwirkung_NOAK

Direkte orale Antikoagulanzien in der traumatologischen Notaufnahme:

NOAK_Trauma_Blutung

Therapieversager bei LE unter NOAK Therapie wurden beschrieben, eigener Fall in der Erfahrung.

Nach Wechsel auf  Warfarin Besserung der Symptomatik und Auflösung der Thromben

im CT.

 

Trombophilie

Freitag, 18. Dezember 2015

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DWI-Flair mismatch bei Insult

Freitag, 05. September 2014

DWI-FLAIR mismatch for the identification of patients with acute ischaemic stroke within 4·5 h of symptom onset (PRE-FLAIR): a multicentre observational study

http://www.thelancet.com/journals/laneur/article/PIIS1474-4422%2811%2970192-2/abstract

Interpretation

Patients with an acute ischaemic lesion detected with DWI but not with FLAIR imaging are likely to be within a time window for which thrombolysis is safe and effective. These findings lend support to the use of DWI-FLAIR mismatch for selection of patients in a future randomised trial of thrombolysis in patients with unknown time of symptom onset.

Sinus cavernosus Thrombose

Samstag, 30. August 2014

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Intracran. Hämatom_ICH

Freitag, 04. Juli 2014

CT spot sign predicts hematoma expansion in stroke patients:

CCT_ICH

Fingolimod zur Bejhandlung:

ICH_Fingolimod ICH_Fingolimod

ICH_Fingolimod

Kopfschmerz/Neurologischer Notfall

Sonntag, 20. April 2008

CCT CMRT bei akuten u. subakuten Kopfschmerzen und neurologischen Notfällen

Kopfschmerz

Hirn_Gefäßerkrankungen

Kopfschmerzen_CCT_CMRT

neurolognotfaelle

shtradiologe

Imaging „Worst Headache of My Life“

Subarachnoid Hemorrhage
(78 % haben Blutung, ein Prozent Unselektiert unch. Headache.)
lumbar puncture is still recommended in cases of clinically suspected SAH with a negative CT.In 80% of cases, the etiology is a ruptured aneurysm.
CT angiography (CTA), or less commonly, magnetic resonance angiography (MRA) is mandatory for definitively localizing the aneurysm.
132 Patienten (6,2%) hatten eine SAH. Die Entscheidungsregel aus Alter ab 40 Jahren, Nackenschmerzen oder -steife und bezeugter Bewusstseinsverlust oder Symptombeginn bei Anstrengung hatte eine Sensitivität für eine SAH von 98% und eine Spezifität von 28%. Wurden zudem die Parameter „Donnerschlagkopfschmerz“ (plötzlicher, sehr starker Kopfschmerz) und „limitierte Nackenbeugung bei der Untersuchung“ berücksichtigt, so hatte diese als Ottawa SAH Rule bezeichnete Entscheidungsregel eine Sensitivität von 100% bei einer Spezifität von 15%.

Fazit: Bei nicht traumatischen Patienten mit starken, plötzlich entstandenen Kopfschmerzen ohne neurologische Ausfälle (vorläufig nur in diesem Setting!) werden mit der Ottawa SAH Rule nahezu alle Patienten mit SAH erfasst.

Parenchymal Hemorrhage

Hydrocephalus

distinguishing ex vacuo dilation of the ventricles (ie, dilation due to parenchymal volume loss) from true hydrocephalus.communicating or noncommunicating?
Communicating hydrocephalus, by contrast, shows dilation of the entire ventricular system.

Ischemia

Posterior reversible encephalopathy syndrome (PRES).

multifocal areas of edema usually involving the parieto-occipital white matter, seizures, visual disturbances, and alteration of consciousness.
commonly observed in conjunction with particular disease states, especially hypertension, eclampsia/preeclampsia, immunosuppression, chemotherapy, and autoimmune diseases

Brain Tumor

isolated headache was the clinical presentation in only 8% of patients.

Dural Sinus Thrombosis

Occasionally the headache is accompanied by altered mentation, decreased level of consciousness, and papilledema.On initial inspection, venous infarction may mimic the appearance of arterial infarction. Importantly, however, venous infarctions will not be confined to the usual arterial vascular territories, which may provide a clue to the correct diagnosis.

Arterial Dissection

Headache is present in approximately 70% of patients with dissection of the carotid or vertebral artery (co-called cervicocephalic arterial dissection).[possibility of dissection include the presence of neck or facial pain, orbital pain, or Horner syndrome.

Meningitis

diagnosis of meningitis is established by cerebrospinal fluid (CSF) analysis and clinical symptoms.When an abnormality is present, it usually takes the form of mild, transient hydrocephalus. Occasionally, leptomeningeal enhancement can be seen on postcontrast imaging , the absence of such enhancement does not exclude meningitis.Complications of severe meningitis can include ventriculitis, extra-axial fluid collections (empyemas and subdural effusions), parenchymal infection (cerebritis or abscess), and secondary infectious vasculitis.[7] Imaging with CT or MR may help to identify these complications.

Pituitary Apoplexy

Pituitary apoplexy is an uncommon cause of worst headache of life, and denotes symptomatic hemorrhage within the pituitary gland,usually into a pituitary adenoma.

Disorders of CSF Pressure

In some patients with headache, CSF pressure may be too high, as in the case of idiopathic intracranial hypertension (IIH, aka, pseudotumor cerebri), or too low, as in the case of intracranial hypotension.IIH They most commonly are young, obese women.On physical exam, these patients may have papilledema as a result of the increased intracranial pressure
Once thrombosis is excluded, one sign suggesting the presence of IIH that may be visible on venous sinus imaging is narrowing at the junction of the transverse and sigmoid sinuses.
On MRI, other potentially subtle findings associated with IIH include flattening of the posterior globe, dilation, and tortuosity of the optic nerve sheath, and an empty sella.
ultimately the diagnosis is established by lumbar puncture with measurement of opening pressure.
Bilateral subdural hygromas or hematomas may also accompany intracranial hypotension, and can be identified on the initial scan.Diffuse smooth dural enhancement is the most suggestive MR imaging feature.  Other variably present findings include crowding of the basilar cisterns due to brain sagging, pituitary enlargement, cerebellar tonsillar ectopia, and distension of the venous sinuses.


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