The Experts below are selected from a list of 519 Experts worldwide ranked by ideXlab platform
Adnan Khan - One of the best experts on this subject based on the ideXlab platform.
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Ruptured spinal arteriovenous malformation: Presenting as stunned myocardium and Neurogenic Shock.
Surgical neurology international, 2015Co-Authors: Tasneem H. Mehesry, Nissar Shaikh, Mohammad F. Malmstrom, Marco A. E. Marcus, Adnan KhanAbstract:Neurogenic pulmonary edema (NPE) is a clinical syndrome usually defined as an acute pulmonary edema occurring shortly after a central neurologic insult. NPE was identified 100 years ago, but it is still underappreciated in the clinical setup. NPE usually appears within minutes to hours after the injury. It has a high mortality rate if not recognized early and treated appropriately. Similarly, Neurogenic Shock is a known complication of spinal cord injury reported incidence is more than 20% in isolated upper cervical spinal injury. But NPE is rare to occur, and stunned myocardium (SM) is not reported in spinal arteriovenous malformation (AVM) rupture. SM is a reversible cardiomyopathy resulting in transient left ventricular dysfunction which has been described to occur in the setting of catecholamine release during situations of physiologic stress. We report a case of high spinal AVM rupture presenting as SM, NPE, and Neurogenic Shock. A 32-year-old male who presented with sudden onset of pain and weakness in upper limbs. Imaging studies showed AVM rupture by imaging techniques. Initially, the patient had severe hypertension, respiratory distress requiring intubation and ventilation, then he developed hypotension, bradycardia, and asystole, which required immediate cardiopulmonary resuscitation and atropine. He remained with quadriplegia and suffered from frequent episodes of bradycardia and asystole. Spinal AVM rupture can present as Neurogenic Shock, stunned myocardium, and pulmonary edema. Early recognition of AVM rupture and prompt surgical intervention, as well as aggressive treatment of Shock, may enhance recovery and decrease the long-term morbidity.
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Ruptured spinal arteriovenous malformation: Presenting as stunned myocardium and Neurogenic Shock.
Surgical Neurology International, 2015Co-Authors: Tasneem H. Mehesry, Nissar Shaikh, Mohammad F. Malmstrom, Marco A. E. Marcus, Adnan KhanAbstract:Background: Neurogenic pulmonary edema (NPE) is a clinical syndrome usually defined as an acute pulmonary edema occurring shortly after a central neurologic insult. NPE was identified 100 years ago, but it is still underappreciated in the clinical setup. NPE usually appears within minutes to hours after the injury. It has a high mortality rate if not recognized early and treated appropriately. Similarly, Neurogenic Shock is a known complication of spinal cord injury reported incidence is more than 20% in isolated upper cervical spinal injury. But NPE is rare to occur, and stunned myocardium (SM) is not reported in spinal arteriovenous malformation (AVM) rupture. SM is a reversible cardiomyopathy resulting in transient left ventricular dysfunction which has been described to occur in the setting of catecholamine release during situations of physiologic stress. We report a case of high spinal AVM rupture presenting as SM, NPE, and Neurogenic Shock. Case Description: A 32‑year‑old male who presented with sudden onset of pain and weakness in upper limbs. Imaging studies showed AVM rupture by imaging techniques. Initially, the patient had severe hypertension, respiratory distress requiring intubation and ventilation, then he developed hypotension, bradycardia, and asystole, which required immediate cardiopulmonary resuscitation and atropine. He remained with quadriplegia and suffered from frequent episodes of bradycardia and asystole. Conclusions: Spinal AVM rupture can present as Neurogenic Shock, stunned myocardium, and pulmonary edema. Early recognition of AVM rupture and prompt surgical intervention, as well as aggressive treatment of Shock, may enhance recovery and decrease the long‑term morbidity.
Tasneem H. Mehesry - One of the best experts on this subject based on the ideXlab platform.
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Ruptured spinal arteriovenous malformation: Presenting as stunned myocardium and Neurogenic Shock.
Surgical neurology international, 2015Co-Authors: Tasneem H. Mehesry, Nissar Shaikh, Mohammad F. Malmstrom, Marco A. E. Marcus, Adnan KhanAbstract:Neurogenic pulmonary edema (NPE) is a clinical syndrome usually defined as an acute pulmonary edema occurring shortly after a central neurologic insult. NPE was identified 100 years ago, but it is still underappreciated in the clinical setup. NPE usually appears within minutes to hours after the injury. It has a high mortality rate if not recognized early and treated appropriately. Similarly, Neurogenic Shock is a known complication of spinal cord injury reported incidence is more than 20% in isolated upper cervical spinal injury. But NPE is rare to occur, and stunned myocardium (SM) is not reported in spinal arteriovenous malformation (AVM) rupture. SM is a reversible cardiomyopathy resulting in transient left ventricular dysfunction which has been described to occur in the setting of catecholamine release during situations of physiologic stress. We report a case of high spinal AVM rupture presenting as SM, NPE, and Neurogenic Shock. A 32-year-old male who presented with sudden onset of pain and weakness in upper limbs. Imaging studies showed AVM rupture by imaging techniques. Initially, the patient had severe hypertension, respiratory distress requiring intubation and ventilation, then he developed hypotension, bradycardia, and asystole, which required immediate cardiopulmonary resuscitation and atropine. He remained with quadriplegia and suffered from frequent episodes of bradycardia and asystole. Spinal AVM rupture can present as Neurogenic Shock, stunned myocardium, and pulmonary edema. Early recognition of AVM rupture and prompt surgical intervention, as well as aggressive treatment of Shock, may enhance recovery and decrease the long-term morbidity.
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Ruptured spinal arteriovenous malformation: Presenting as stunned myocardium and Neurogenic Shock.
Surgical Neurology International, 2015Co-Authors: Tasneem H. Mehesry, Nissar Shaikh, Mohammad F. Malmstrom, Marco A. E. Marcus, Adnan KhanAbstract:Background: Neurogenic pulmonary edema (NPE) is a clinical syndrome usually defined as an acute pulmonary edema occurring shortly after a central neurologic insult. NPE was identified 100 years ago, but it is still underappreciated in the clinical setup. NPE usually appears within minutes to hours after the injury. It has a high mortality rate if not recognized early and treated appropriately. Similarly, Neurogenic Shock is a known complication of spinal cord injury reported incidence is more than 20% in isolated upper cervical spinal injury. But NPE is rare to occur, and stunned myocardium (SM) is not reported in spinal arteriovenous malformation (AVM) rupture. SM is a reversible cardiomyopathy resulting in transient left ventricular dysfunction which has been described to occur in the setting of catecholamine release during situations of physiologic stress. We report a case of high spinal AVM rupture presenting as SM, NPE, and Neurogenic Shock. Case Description: A 32‑year‑old male who presented with sudden onset of pain and weakness in upper limbs. Imaging studies showed AVM rupture by imaging techniques. Initially, the patient had severe hypertension, respiratory distress requiring intubation and ventilation, then he developed hypotension, bradycardia, and asystole, which required immediate cardiopulmonary resuscitation and atropine. He remained with quadriplegia and suffered from frequent episodes of bradycardia and asystole. Conclusions: Spinal AVM rupture can present as Neurogenic Shock, stunned myocardium, and pulmonary edema. Early recognition of AVM rupture and prompt surgical intervention, as well as aggressive treatment of Shock, may enhance recovery and decrease the long‑term morbidity.
Andrei V. Krassioukov - One of the best experts on this subject based on the ideXlab platform.
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Incidence and Natural Progression of Neurogenic Shock after Traumatic Spinal Cord Injury
Journal of neurotrauma, 2017Co-Authors: Ian A. Ruiz, Jordan W. Squair, Aaron A. Phillips, Christine D Lukac, Dayan Huang, Patrick Oxciano, Dong Yan, Andrei V. KrassioukovAbstract:Abstract Neurogenic Shock, a distributive type of circulatory Shock after spinal cord injury (SCI), results in profound hypotension. The consequent hemodynamic instability complicates clinical management, delays surgical intervention, and impacts neurological outcome. Moreover, the reported incidence of this condition varies significantly. We establish the true incidence of Neurogenic Shock by comparing the most common clinical definitions used to diagnose the condition. Further, we characterize the acute progression and recovery of Neurogenic Shock. Daily blood pressure, heart rate, and fluid management as well as vasopressor therapy and neurologic status were collected over 30 days from 84 adults admitted to our tertiary trauma center after cervical (n = 56) and thoracic (n = 28) SCI. We found that the reported incidence of Neurogenic Shock varied greatly depending on which clinical definition was applied. By using a novel combination of hemodynamic and laboratory criteria to define Neurogenic Shock, th...
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Alterations in cardiac autonomic control in spinal cord injury
Autonomic neuroscience : basic & clinical, 2017Co-Authors: Fin Biering-sørensen, Tor Biering-sørensen, Nan Liu, Lasse Malmqvist, Jill M. Wecht, Andrei V. KrassioukovAbstract:A spinal cord injury (SCI) interferes with the autonomic nervous system (ANS). The effect on the cardiovascular system will depend on the extent of damage to the spinal/central component of ANS. The cardiac changes are caused by loss of supraspinal sympathetic control and relatively increased parasympathetic cardiac control. Decreases in sympathetic activity result in heart rate and the arterial blood pressure changes, and may cause arrhythmias, in particular bradycardia, with the risk of cardiac arrest in those with cervical or high thoracic injuries. The objective of this review is to give an update of the current knowledge related to the alterations in cardiac autonomic control following SCI. With this purpose the review includes the following subheadings: 2. Neuro-anatomical plasticity and cardiac control 2.1 Autonomic nervous system and the heart 2.2 Alteration in autonomic control of the heart following spinal cord injury 3. Spinal Shock and Neurogenic Shock 3.1 Pathophysiology of spinal Shock 3.2 Pathophysiology of Neurogenic Shock 4. Autonomic dysreflexia 4.1 Pathophysiology of autonomic dysreflexia 4.2 Diagnosis of autonomic dysreflexia 5. Heart rate/electrocardiography following spinal cord injury 5.1 Acute phase 5.2 Chronic phase 6. Heart rate variability 6.1 Time domain analysis 6.2 Frequency domain analysis 6.3 QT-variability index 6.4 Nonlinear (fractal) indexes 7. Echocardiography 7.1 Changes in cardiac structure following spinal cord injury 7.2 Changes in cardiac function following spinal cord injury 8. International spinal cord injury cardiovascular basic data set and international standards to document the remaining autonomic function in spinal cord injury.
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hemodynamic parameters and timing of surgical decompression in acute cervical spinal cord injury
Journal of Spinal Cord Medicine, 2007Co-Authors: Sagun Tuli, Jayshree Tuli, William P Coleman, Fred H Geisler, Andrei V. KrassioukovAbstract:Background/objectives To evaluate the relationship between the severity of cervical spinal cord injury (SCI) (American Spinal Injury Association [ASIA] grade), presence of Neurogenic Shock, and timing of surgical intervention. This is a post-hoc analysis from the Sygen multicenter randomized controlled trial. Methods Blood pressure (BP) and heart rate (HR) data were collected when patients were first assessed in the emergency room (Time A) and at the time of randomization (Time B). Individuals were subdivided by ASIA grade and by the level of the systolic BP (SBP). Results Only individuals with cervical SCI from the Sygen trial (n = 577) were evaluated. Severe complete SCI (ASIA grade = A) was established in 57% of these patients. A total of 74 (13%) patients with Neurogenic Shock (SBP or = 90 mmHg (P = 0.025). Multivariable analysis after adjusting for confounders revealed a statistically significant difference in the time to surgical intervention based on SBP for ASIA A (P = 0.026), yet not for ASIA B or C/D. Conclusions The presence of Neurogenic Shock was associated with a delay in the timing of surgical intervention in patients with cervical SCI. Detailed evaluation of autonomic dysfunctions following SCI including cardiovascular instability could improve our understanding of the complexities of clinical presentations and possible neurological outcomes.
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ORIGINAL CONTRIBUTION Hemodynamic Parameters and Timing of Surgical Decompression in Acute Cervical Spinal Cord Injury
2007Co-Authors: Sagun Tuli, Jayshree Tuli, William P Coleman, Fred H Geisler, Andrei V. KrassioukovAbstract:Background/Objectives: To evaluate the relationship between the severity of cervical spinal cord injury (SCI) (American Spinal Injury Association [ASIA] grade), presence of Neurogenic Shock, and timing of surgical intervention. This is a post-hoc analysis from the Sygen multicenter randomized controlled trial. Methods: Blood pressure (BP) and heart rate (HR) data were collected when patients were first assessed in the emergency room (Time A) and at the time of randomization (Time B). Individuals were subdivided by ASIA grade and by the level of the systolic BP (SBP). Results: Only individuals with cervical SCI from the Sygen trial (n ¼ 577) were evaluated. Severe complete SCI (ASIA grade ¼ A) was established in 57% of these patients. A total o f 74 (13%) patients with Neurogenic Shock (SBP , 90 mmHg) at Time A were identified. The SBP increased significantly from Time A to Time B (P , 0.0001). The median time from SCI to surgical intervention, for ASIA A, was 80.9 hours for patients with initial SBP , 90 mmHg and 58 hours for patients with initial SBP � 90 mmHg (P ¼ 0.025). Multivariable analysis after adjusting for confounders revealed a statistically significant difference in the time to surgical intervention based on SBP for ASIA A (P ¼ 0.026), yet not for ASIA B or C/D. Conclusions: The presence of Neurogenic Shock was associated with a delay in the timing of surgical intervention in patients with cervical SCI. Detailed evaluation of autonomic dysfunctions following SCI including cardiovascular instability could improve our understanding of the complexities of clinical presentations and possible neurological outcomes. J Spinal Cord Med. 2007;30:482–490
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assessment of autonomic dysfunction following spinal cord injury rationale for additions to international standards for neurological assessment
Journal of Rehabilitation Research and Development, 2007Co-Authors: Andrei V. Krassioukov, Jill M. Wecht, Annkatrin Karlsson, Lisa Ann Wuermser, C J Mathias, Ralph J MarinoAbstract:We present a preliminary report of the discussion of the joint committee of the American Spinal Injury Association (ASIA) and the International Spinal Cord Society concerning the development of assessment criteria for general autonomic function testing following spinal cord injury (SCI). Elements of this report were presented at the 2005 annual meeting of the ASIA. To improve the evaluation of neurological function in individuals with SCI and therefore better assess the effects of therapeutic interventions in the future, we are proposing a comprehensive set of definitions of general autonomic nervous system dysfunction following SCI that should be assessed by clinicians. Presently the committee recommends the recognition and assessment of the following conditions: Neurogenic Shock, cardiac dysrhythmias, orthostatic hypotension, autonomic dysreflexia, temperature dysregulation, and hyperhidrosis.
Marco A. E. Marcus - One of the best experts on this subject based on the ideXlab platform.
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Ruptured spinal arteriovenous malformation: Presenting as stunned myocardium and Neurogenic Shock.
Surgical neurology international, 2015Co-Authors: Tasneem H. Mehesry, Nissar Shaikh, Mohammad F. Malmstrom, Marco A. E. Marcus, Adnan KhanAbstract:Neurogenic pulmonary edema (NPE) is a clinical syndrome usually defined as an acute pulmonary edema occurring shortly after a central neurologic insult. NPE was identified 100 years ago, but it is still underappreciated in the clinical setup. NPE usually appears within minutes to hours after the injury. It has a high mortality rate if not recognized early and treated appropriately. Similarly, Neurogenic Shock is a known complication of spinal cord injury reported incidence is more than 20% in isolated upper cervical spinal injury. But NPE is rare to occur, and stunned myocardium (SM) is not reported in spinal arteriovenous malformation (AVM) rupture. SM is a reversible cardiomyopathy resulting in transient left ventricular dysfunction which has been described to occur in the setting of catecholamine release during situations of physiologic stress. We report a case of high spinal AVM rupture presenting as SM, NPE, and Neurogenic Shock. A 32-year-old male who presented with sudden onset of pain and weakness in upper limbs. Imaging studies showed AVM rupture by imaging techniques. Initially, the patient had severe hypertension, respiratory distress requiring intubation and ventilation, then he developed hypotension, bradycardia, and asystole, which required immediate cardiopulmonary resuscitation and atropine. He remained with quadriplegia and suffered from frequent episodes of bradycardia and asystole. Spinal AVM rupture can present as Neurogenic Shock, stunned myocardium, and pulmonary edema. Early recognition of AVM rupture and prompt surgical intervention, as well as aggressive treatment of Shock, may enhance recovery and decrease the long-term morbidity.
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Ruptured spinal arteriovenous malformation: Presenting as stunned myocardium and Neurogenic Shock.
Surgical Neurology International, 2015Co-Authors: Tasneem H. Mehesry, Nissar Shaikh, Mohammad F. Malmstrom, Marco A. E. Marcus, Adnan KhanAbstract:Background: Neurogenic pulmonary edema (NPE) is a clinical syndrome usually defined as an acute pulmonary edema occurring shortly after a central neurologic insult. NPE was identified 100 years ago, but it is still underappreciated in the clinical setup. NPE usually appears within minutes to hours after the injury. It has a high mortality rate if not recognized early and treated appropriately. Similarly, Neurogenic Shock is a known complication of spinal cord injury reported incidence is more than 20% in isolated upper cervical spinal injury. But NPE is rare to occur, and stunned myocardium (SM) is not reported in spinal arteriovenous malformation (AVM) rupture. SM is a reversible cardiomyopathy resulting in transient left ventricular dysfunction which has been described to occur in the setting of catecholamine release during situations of physiologic stress. We report a case of high spinal AVM rupture presenting as SM, NPE, and Neurogenic Shock. Case Description: A 32‑year‑old male who presented with sudden onset of pain and weakness in upper limbs. Imaging studies showed AVM rupture by imaging techniques. Initially, the patient had severe hypertension, respiratory distress requiring intubation and ventilation, then he developed hypotension, bradycardia, and asystole, which required immediate cardiopulmonary resuscitation and atropine. He remained with quadriplegia and suffered from frequent episodes of bradycardia and asystole. Conclusions: Spinal AVM rupture can present as Neurogenic Shock, stunned myocardium, and pulmonary edema. Early recognition of AVM rupture and prompt surgical intervention, as well as aggressive treatment of Shock, may enhance recovery and decrease the long‑term morbidity.
Mohammad F. Malmstrom - One of the best experts on this subject based on the ideXlab platform.
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Ruptured spinal arteriovenous malformation: Presenting as stunned myocardium and Neurogenic Shock.
Surgical neurology international, 2015Co-Authors: Tasneem H. Mehesry, Nissar Shaikh, Mohammad F. Malmstrom, Marco A. E. Marcus, Adnan KhanAbstract:Neurogenic pulmonary edema (NPE) is a clinical syndrome usually defined as an acute pulmonary edema occurring shortly after a central neurologic insult. NPE was identified 100 years ago, but it is still underappreciated in the clinical setup. NPE usually appears within minutes to hours after the injury. It has a high mortality rate if not recognized early and treated appropriately. Similarly, Neurogenic Shock is a known complication of spinal cord injury reported incidence is more than 20% in isolated upper cervical spinal injury. But NPE is rare to occur, and stunned myocardium (SM) is not reported in spinal arteriovenous malformation (AVM) rupture. SM is a reversible cardiomyopathy resulting in transient left ventricular dysfunction which has been described to occur in the setting of catecholamine release during situations of physiologic stress. We report a case of high spinal AVM rupture presenting as SM, NPE, and Neurogenic Shock. A 32-year-old male who presented with sudden onset of pain and weakness in upper limbs. Imaging studies showed AVM rupture by imaging techniques. Initially, the patient had severe hypertension, respiratory distress requiring intubation and ventilation, then he developed hypotension, bradycardia, and asystole, which required immediate cardiopulmonary resuscitation and atropine. He remained with quadriplegia and suffered from frequent episodes of bradycardia and asystole. Spinal AVM rupture can present as Neurogenic Shock, stunned myocardium, and pulmonary edema. Early recognition of AVM rupture and prompt surgical intervention, as well as aggressive treatment of Shock, may enhance recovery and decrease the long-term morbidity.
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Ruptured spinal arteriovenous malformation: Presenting as stunned myocardium and Neurogenic Shock.
Surgical Neurology International, 2015Co-Authors: Tasneem H. Mehesry, Nissar Shaikh, Mohammad F. Malmstrom, Marco A. E. Marcus, Adnan KhanAbstract:Background: Neurogenic pulmonary edema (NPE) is a clinical syndrome usually defined as an acute pulmonary edema occurring shortly after a central neurologic insult. NPE was identified 100 years ago, but it is still underappreciated in the clinical setup. NPE usually appears within minutes to hours after the injury. It has a high mortality rate if not recognized early and treated appropriately. Similarly, Neurogenic Shock is a known complication of spinal cord injury reported incidence is more than 20% in isolated upper cervical spinal injury. But NPE is rare to occur, and stunned myocardium (SM) is not reported in spinal arteriovenous malformation (AVM) rupture. SM is a reversible cardiomyopathy resulting in transient left ventricular dysfunction which has been described to occur in the setting of catecholamine release during situations of physiologic stress. We report a case of high spinal AVM rupture presenting as SM, NPE, and Neurogenic Shock. Case Description: A 32‑year‑old male who presented with sudden onset of pain and weakness in upper limbs. Imaging studies showed AVM rupture by imaging techniques. Initially, the patient had severe hypertension, respiratory distress requiring intubation and ventilation, then he developed hypotension, bradycardia, and asystole, which required immediate cardiopulmonary resuscitation and atropine. He remained with quadriplegia and suffered from frequent episodes of bradycardia and asystole. Conclusions: Spinal AVM rupture can present as Neurogenic Shock, stunned myocardium, and pulmonary edema. Early recognition of AVM rupture and prompt surgical intervention, as well as aggressive treatment of Shock, may enhance recovery and decrease the long‑term morbidity.