Introduction: Brain metastases are the most common intracranial neoplasm in adult patients, and one of the fearsome complications proves to be intratumoral hemorrhage. The neurosurgical management of patients harboring a bleeding brain metastasis is not fully established and there is still today an ongoing debate on the optimal management of these patients. The aim of this article is to provide the neurosurgeons with practical tools to assist in their decision-making process in the management of BMs.
Methods: We conducted a literature review of the relevant Pubmed, Cochrane, and Google scholar-indexed articles published between 2000 and 2019. The following key words were entered in the Pubmed search engine: [metastasis], [metastases], [brain metastases], [brain metastasis], [hemorrhage], [hematoma], [blood clot], [intracerebral hemorrhage], [intracranial hemorrhage]. The review was performed in accordance with the PRISMA recommendations.
Results: Based on PubMed, Cochrane, and Google scholar, 459 articles were retained, 392 were then removed because of their non-adequacy with the topic and, 9 articles were removed because they were not written in English language. So, 58 articles were analyzed. Radiological evaluation is crucial, but few traps exist. The frequency of overall brain tumor-related with intracranial hematoma is 7.2%, with a higher frequency for secondary tumors. The local recurrence rate after resection of a hemorrhagic metastasis seems to be better probably because of an easier "en bloc" resection thanks to the hematoma. An atypical presentation is reported in up to 4% in patients with chronic or acute subdural hematoma. Patients with subarachnoid hemorrhage and epidural hematoma are rare. A clear-cut correlation between the incidence of bleeding event in brain mets and prior stereotactic radiosurgery was not established.
Conclusion: The current literature pertaining to the neurosurgical management of acute bleeding in brain metastasis is scant and the level of evidence remains low (experts 'opinions; class C). Herein we suggest a flowchart to assist in dealing with those difficult patients.
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http://dx.doi.org/10.1016/j.neuchi.2020.11.005 | DOI Listing |
Z Evid Fortbild Qual Gesundhwes
January 2025
Institut für Medizinmanagement und Gesundheitswissenschaften (IMG) der Universität Bayreuth, Bayreuth, Deutschland.
Introduction: Unmet health care needs are seen as a key indicator of equity in access to health care. With younger people, they can lead to poorer health outcomes in adulthood, and in older people they can be associated with an increased risk of mortality. The presence of a disability is considered a risk factor for unmet needs.
View Article and Find Full Text PDFRes Social Adm Pharm
January 2025
Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, Ontario, M5T 3M6, Canada; Research & Innovation, North York General Hospital, 4001 Leslie Street, Toronto, Ontario, M2K 1E1, Canada.
Purpose: Diversion or theft of controlled substances is a recognized problem affecting healthcare systems globally. The purpose of this study was to develop a framework for identifying and characterizing system factors leading to vulnerabilities for diversion within hospitals.
Methods: We applied a qualitative framework method, which involved 1) compiling a list of critical diversion vulnerabilities through observations and proactive risk analyses in the inpatient pharmacy, emergency department and intensive care unit of two Canadian hospitals; 2) coding the vulnerabilities into deductively and inductively derived themes and subthemes; and 3) building a conceptual framework.
J Hand Ther
January 2025
Venture Rehabilitation Sciences Group, Saskatoon, SK, Canada; School of Rehabilitation Science, University of Saskatchewan, Saskatoon, SK, Canada. Electronic address:
Background: Stenosing tenosynovitis, or trigger finger, is a common cause of hand disability. This study outlines a trigger finger management protocol that redirects referrals for surgical consultations to conservative management first.
Purpose: The primary outcome variable was the protocol endpoint based on the resolution of trigger finger symptoms (i.
Transplant Proc
January 2025
Department of Nephrology, La Paz University Hospital, Madrid, Spain.
The management of anticoagulation and antiplatelet therapy in stage V chronic kidney disease (CKD) patients undergoing renal transplantation remains controversial. Some centers advocate for the use of reversal agents or procoagulants preoperatively, while others suggest that transplantation can proceed safely without halting these treatments. This study aims to evaluate the incidence of hemorrhagic and thrombotic complications in the first 72 hours post-transplant in patients receiving anticoagulant or antiplatelet therapy compared to a control group without such treatments.
View Article and Find Full Text PDFJ Prosthet Dent
January 2025
Professor, Department of Ophthalmology, Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Bilateral anophthalmia, a clinical condition characterized by the absence of globe and ocular tissues from both the orbits, presents considerable challenges to a patient's daily routine and use of prostheses. The patient's inability to orientate custom ocular prostheses (COPs) 3-dimensionally is understandable, and they typically rely on caregivers to manage the prostheses and prevent inadvertent injury to the socket. This clinical report describes the successful integration of braille script into COPs as a solution to these challenges by improving prosthesis management, decreasing caregiver dependence, and encouraging independence.
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