fibrin and Subarachnoid-Hemorrhage

Fibrin and fibrinogen degradation products in the cerebrospinal fluid (CSF-FDP) were first studied in a group of 29 patients observed during the first and the second week after subarachnoid hemorrhage (SAH), then in a second group of 26 patients for a total of 55 patients. In the latter group only the first FDP value obtained as soon as possible after SAH was taken in consideration. In the whole series of 55 patients several noteworthy factors were found: 1) FDP determination should be performed as soon as possible after SAH; 2) CSF-FDP at or above 40, 80 micrograms/ml was found both in the patients with severe neurological deficits and in those with cerebral ischemia (statistically significant); 3) the significance of CSF-FDP in patients who rebled was also evaluated. In conclusion CSF-FDP could be considered useful in predicting cerebral ischemia.

Topics: Aneurysm, Ruptured; Biomarkers; Brain Ischemia; Cerebrospinal Fluid Proteins; Consciousness Disorders; Convalescence; Fibrin; Fibrin Fibrinogen Degradation Products; Fibrinolysis; Humans; Intracranial Aneurysm; Ischemic Attack, Transient; Recurrence; Rupture, Spontaneous; Severity of Illness Index; Subarachnoid Hemorrhage

Dating the traumatic event is usually done on subdural hematoma (SDH). After infant deaths due to Abusive head trauma (AHT) without SDH available, the magistrates still ask experts to date the traumatic event. To do so, the expert only has tools based on adult series of AHT. We aimed to develop a subarachnoid hemorrhage (SAH) and retinal hemorrhage (RH) dating system applicable to infants aged under 3 years.. We studied a retrospective multicenter collection of 235 infants who died between the ages of 0 and 36 months, diagnosed with SAH and/or RH by forensic pathological examination and with known posttraumatic interval (PTI). Two pathologists assessed blindly and independently 12histomorphological features in 83 infants (35 girls, 48 boys) whose median age was 3.8 months. For SAH, histopathological changes were significantly correlated with PTI for the appearance of red blood cells, of fibrino-plaquetted organization, the quantity of lymphocytes and macrophages and the presence or absence of siderophages, collagen and fibroblast formation and presence or absence of neovascularization. For RH, histopathological changes were significantly correlated with PTI for the appearance of red blood cells, the presence or absence of siderophages and sclerosis of the retina.. Our HAS dating system improves the precision and reliability of forensic pathological expert examination of AHT, when SDH are not available, for age estimation in infants. The study of RH histomorphological changes does not allow for reliable dating.

Topics: Blood Platelets; Child Abuse; Child, Preschool; Collagen; Erythrocytes; Female; Fibrin; Fibroblasts; Forensic Pathology; Humans; Infant; Infant, Newborn; Lymphocytes; Macrophages; Male; Neovascularization, Physiologic; Postmortem Changes; Retina; Retinal Hemorrhage; Retrospective Studies; Sclerosis; Subarachnoid Hemorrhage

Aneurysmal subarachnoid hemorrhage (aSAH) has been reported to actuate blood coagulation. Rotational thromboelastometry (ROTEM) is a dynamic hemostatic test that can differentiate various coagulation abnormalities. For example, increased coagulation activity can be detected as a wider amplitude of tracing (maximal clot firmness [MCF]). ROTEM had not been used to evaluate coagulation changes after aSAH. We evaluated the on-going coagulation process in patients with aSAH in a prospective, observational study to compare their ROTEM assay results with the control values obtained from patients undergoing clipping of nonruptured aneurysms.. ROTEM analyses were performed at 12, 24, 48, and 72 hours after the onset of aSAH and compared with the preoperative analyses from the control group. A total of 17 patients with aSAH treated in the intensive care unit and 16 control patients were enrolled.. At 72 hours, EXTEM-MCF was significantly greater in patients with aSAH compared with the baseline values of the control group (68.0 mm [interquartile range (IQR), 66.0-71.0] versus 64.5 mm [IQR, 59.5-66.8]; P = 0.024). This was mainly due to increased fibrin formation and fibrin polymerization. The same comparison in the FIBTEM-MCF analysis yielded similar results (aSAH group, 23.0 mm [IQR, 19.0-25.0] vs. control group, 15.4 mm [IQR, 12.5-17.8], respectively; P = 0.001).. Blood coagulation is activated at 72 hours after aSAH onset, which can be detected by ROTEM EXTEM-MCF analysis. Also, the FIBTEM-MCF was elevated, implying that the relative contribution of fibrin formation and fibrin polymerization is essential.

Topics: Adult; Aged; Blood Coagulation; Female; Fibrin; Humans; Intracranial Aneurysm; Male; Middle Aged; Prospective Studies; Retrospective Studies; Subarachnoid Hemorrhage; Thrombelastography; Time Factors

Rupture of cerebral aneurysms results in subarachnoid hemorrhage. In many cases, bleeding from aneurysms spontaneously arrests. Although bleeding from cerebral aneurysms has been reported to arrest from outside, bleeding from some aneurysms can arrest in different ways.. Between April 2002 and March 2004, we prospectively investigated mechanisms of spontaneous hemostasis in ruptured aneurysms by macroscopic examination when performing craniotomy and clipping surgeries.. Hemostatic mechanisms were investigated in 247 patients with ruptured aneurysm (77 men, 170 women; age range, 25-95 years). Hemostatic mechanisms were divided into 3 different patterns. In the most common pattern (79.4%), the surface of the aneurysm rupture point was sealed from the outside by a platelet plug or fibrin net (outside-arrest pattern). In some aneurysms (10.1%), a thrombus or platelet plug was attached to the rupture point from inside the aneurysm (inside-arrest pattern). In a very small number of aneurysms (1.6%), a naked thrombus covered the hole made on the arterial wall or small remnant of the aneurysmal dome (bursting pattern) The mechanism remained unclear in the remaining 8.9% of aneurysms. Multivariate analysis revealed that alert consciousness on admission (WFNS grade I) significantly associated with usual hemostasis (outside arrest pattern: OR, 3.8; 95% CI, 1.4-10.0; P = .008). Borderline association with usual hemostasis was found in aneurysms with a size of 5 or smaller than 5 mm (OR, 2.6; 95% CI, 0.99-7.1; P = .052).. The present preliminary study revealed that arrest of bleeding from a ruptured cerebral aneurysm does not always occur from outside the aneurysm. Unusual mechanisms of hemostasis are seen in approximately 12% of ruptured aneurysm. The outside-arrest-pattern aneurysm was more common for smaller aneurysms, and these patients tended to be of better grade. Further studies are necessary to explore the mechanism of hemostasis for ruptured cerebral aneurysms.

Topics: Adult; Aged; Aged, 80 and over; Aneurysm, Ruptured; Blood Coagulation; Blood Platelets; Cerebral Angiography; Cerebral Arteries; Embolization, Therapeutic; Female; Fibrin; Hemostasis; Humans; Intracranial Aneurysm; Male; Middle Aged; Neurosurgical Procedures; Prospective Studies; Subarachnoid Hemorrhage; Subarachnoid Space; Surgical Instruments; Treatment Outcome; Vascular Surgical Procedures

The incidence of chronic hydrocephalus was studied in 39 patients with subarachnoid hemorrhage, who underwent perivascular coating with fibrin glue of cerebral arteries after clipping of aneurysm. A use was made of this procedure in order to prevent vasospasm by keeping the main cerebral arteries away from direct contact with subarachnoid clots. Most cases in this series belonged to group 3 of Fisher's CT grade (33/39, 84.6%). As a result, despite the high CT grade, the incidence of chronic hydrocephalus was as low as 17.9% (7/39), almost in agreement with those of the previous literature. In conclusion, (1) coating with fibrin glue did not increase the incidence of chronic hydrocephalus and (2) intrathecal application of fibrin glue is a promising method in the field of clinical neurosurgery.

Topics: Adhesives; Adult; Aged; Aged, 80 and over; Cerebral Arteries; Chronic Disease; Female; Fibrin; Follow-Up Studies; Humans; Hydrocephalus; Intracranial Aneurysm; Ischemic Attack, Transient; Male; Middle Aged; Subarachnoid Hemorrhage; Time Factors; Tissue Adhesives; Tomography, X-Ray Computed

We report experimental studies showing the relationship of the reflectivity of blood clot to both the red cell mass and the fibrin mesh. The highest amplitude echoes are returned by the fibrin mesh. These studies are compared with clinical examples of the different types of neonatal intracranial haemorrhage, as demonstrated by ultrasound. We conclude that the typical high-amplitude echoes characteristic of intracerebral haemorrhage are primarily due to the amount of fibrin mesh present, and not to the intact red cell mass, as has been previously suggested.

Topics: Blood Coagulation; Cerebral Hemorrhage; Cerebral Ventricles; Chronic Disease; Erythrocyte Volume; Fibrin; Hematoma, Subdural; Humans; Infant, Newborn; Subarachnoid Hemorrhage; Ultrasonography

Topics: Adolescent; Adult; Age Factors; Aged; Animals; Blood Coagulation; Body Temperature; Cerebral Hemorrhage; Cerebrospinal Fluid; Child; Child, Preschool; Dogs; Female; Fibrin; Fibroblasts; Haplorhini; Hematoma, Subdural; Humans; Infant; Intracranial Pressure; Male; Middle Aged; Osmotic Pressure; Sex Factors; Subarachnoid Hemorrhage; Subdural Space

Topics: Adult; Bone and Bones; Central Nervous System; Female; Fibrin; Humans; Infant, Newborn; Infant, Newborn, Diseases; Placenta; Polyhydramnios; Pregnancy; Respiratory Distress Syndrome, Newborn; Subarachnoid Hemorrhage; Syndrome

Topics: Aminocaproates; Blood Coagulation Tests; Fibrin; Fibrinolysin; Fibrinolysis; Humans; Intracranial Aneurysm; Subarachnoid Hemorrhage

Topics: Female; Fibrin; Fibrinogen; Fibrinolysis; Humans; Middle Aged; Subarachnoid Hemorrhage; Time Factors

Topics: Adult; Aged; Antifibrinolytic Agents; Blood Cell Count; Cerebral Angiography; Cyclohexanecarboxylic Acids; Factor IX; Factor V; Factor VII; Factor X; Female; Fibrin; Fibrinogen; Fibrinolytic Agents; Humans; Hydralazine; Intracranial Aneurysm; Male; Methyldopa; Middle Aged; Phenytoin; Prothrombin; Recurrence; Subarachnoid Hemorrhage

Topics: Blood-Brain Barrier; Chemical Precipitation; Cyclohexanecarboxylic Acids; Depression, Chemical; Electrophoresis, Paper; Fibrin; Fibrinolysis; Humans; Injections, Intravenous; Intracranial Aneurysm; Methods; Rupture; Subarachnoid Hemorrhage; Time Factors

Topics: Autopsy; Blood Cell Count; Blood Coagulation Factors; Blood Coagulation Tests; Blood Platelets; Blood Vessels; Cerebral Hemorrhage; Disseminated Intravascular Coagulation; Erythroblastosis, Fetal; Female; Fibrin; Fibrinogen; Hemoglobins; Hemorrhage; Humans; Infant, Newborn; Liver; Lung; Pregnancy; Retrospective Studies; Subarachnoid Hemorrhage; Thrombin; Thromboplastin