Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0023380 (lethargy)
 5,697 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Twenty patients underwent a regimen of stereotactic puncture and consecutive local lysis with recombinant tissue plasminogen activator (rt-PA) for their spontaneous intracerebral hemorrhage (ICH). Rt-PA was administered via a stereotactically placed silicone catheter according to a hematoma-size-related formula. There was no extensive intraoperative hematoma aspiration so that the capacity of rt-PA for blood-clot lysis could be investigated. Fifteen patients were somnolent/stuporous on admission and 5 comatose, the hematoma-size ranging from 3 x 3 x 4 cm up to 7 x 4 x 4 cm (mean: 5.1 x 3.9 x 3.5 cm). Control computed tomography (CT) was performed on a daily basis, and in 19 patients the hematoma showed complete or almost complete resolution on CT within 4 days. The rt-PA dosage necessary ranged from 5 to 14 (mean: 8.5) mg. Rt-PA application was performed once in 1 patients, twice in 7, three times in 11 and four times in 1 patient. On follow-up after a mean of 7.2 months 3 patients had died (Glasgow Outcome Score--GOS I). Another was GOS II, 10 GOS III, 5 GOS IV and 1 had made an excellent recovery (GOS V). Patients who were somnolent or stuporous on admission or who exhibited secondary deterioration of their level of consciousness benefitted from the treatment protocol. Early postoperative mobilization and thereby reduction of secondary complications during the patient's stay in the intensive care unit appear to be possible. Comatose patients did not benefit from this treatment and those should be treated conservatively.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Local thrombolytic treatment of spontaneous intracerebral hemorrhage with plasminogen activator (rt-PA). Indications and limits]. 778 14

In the last few years, left ventricular assist devices (LVADs) have moved to the forefront in the management of patients with advanced heart failure. Pumps have gradually become smaller and more efficient and have clearly demonstrated survival benefits and improvement in functional status and quality of life in patients with advanced heart failure. Despite impressive advances in device technology, risk of severe complications remains, such as device thrombosis. A 62-year-old man who underwent HeartWare LVAD implantation as a bridge to cardiac transplant was admitted 18 days after device implantation with severe shortness of breath, fatigue and lethargy; he was found to have increased pump flows with high power demands and evidence of cardiogenic shock. An echocardiogram showed an echo density at the inflow cannula that was suggestive of thrombosis. Laboratory data showed evidence of hemolysis. He was treated successfully with intraventricular tissue plasminogen activator with rapid resolution of his symptoms and return of LVAD flow and power consumption to baseline. The patient was discharged with no complications or recurrence of thrombosis and received a successful transplant 1 month later.
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PMID:Successful treatment of early thrombosis of HeartWare left ventricular assist device with intraventricular thrombolytics. 2352 25

Intraventricular recombinant tissue plasminogen activator (IVT rt-PA) has improved outcomes for intraventricular hemorrhage (IVH). Patients with suspected or untreated arteriovenous malformations (AVMs) have been excluded from clinical trials. We present a patient with IVH secondary to a ruptured AVM safely treated with IVT rt-PA. A 48-year-old Hispanic male with a history of dermatomyositis presented to the emergency department with sudden left-sided weakness. En route to computed tomography (CT), he became lethargic. Computed tomography revealed extensive IVH with acute hydrocephalus, which was treated with the placement of external ventricular drain with clinical improvement. Computed tomography angiogram performed did not reveal AVM. Cerebral digital subtraction angiogram (DSA) was planned due to suspicion of AVM. Prior to DSA, patient became acutely lethargic. Computed tomography imaging revealed worsening hydrocephalus. External ventricular drain was noted to be draining. Repeat CT revealed improved hydrocephalus but with left lateral ventricle dilatation. Risks and benefits of IVT rt-PA were discussed with the family and a decision was made to treat. Three doses of 1 mg IVT rt-PA were administered with resolution of midline blood and lateral ventricular dilatation with clinical improvement. Digital subtraction angiogram revealed early draining vein on right internal carotid artery injection draining into the inferior sagittal sinus representing ruptured AVM without clear nidus. Repeat DSA with possible embolization was planned after discharge. In spite of additional in-hospital complications, the patient gradually improved and was ultimately discharged home. Our case supports the idea that the use of IVT rt-PA following an IVH caused by an underlying AVM could be further explored in carefully designed clinical trials.
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PMID:Safety of Intraventricular rt-PA for Pan-Ventricular IVH Caused by a Ruptured AVM: A Case Report. 2897 5