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1. Perioperative Hypothermia (33°C) Does Not Increase the Occurrence of Cardiovascular Events in Patients Undergoing Cerebral Aneurysm Surgery

Author

D. Chartrand, Michael Beven, C. Salem, W. Burnett, S. Jackson, G. Downey, Michael T. Lawton, S. Lownie, R. Tack, E. Dy, Tord D. Alden, David R. McIlroy, Lis Evered, K. Lukitto, L. Kirby, Thomas A. Moore, R. Popovic, N. Robertson, Patrick W. Hitchon, A. Ashtari, R. Elbe, N. F. Kassell, D. Dulli, A. Wyss, G. Ghazali, S. Rice, Gavin W. Britz, P. Bennett, Karen B. Domino, A. Shahen, D. Dehring, Robert Greif, Argye E. Hillis, L. Meng, D. Fishback, Fred Gentili, Mark Buckland, B. Schaefer, H. Madder, C. Weasler, Anish Bhardwaj, E. Thomson, Ramez W. Kirollos, Basil F. Matta, Kevin H. Siu, H. Machlin, W. Pfisterer, A. Freymuth, N. Badner, R. Wilson, R. Grauer, Zhiyi Zuo, A. McAllister, Z. Sha, A. Rushton, D. Hill, William T. Clarke, L. Jensen, G. Heard, L. Clark, D. Chatfield, J. Haartsen, Jing Wang, S. Nobles, Renee Testa, P. D'Urso, Hossam El-Beheiry, David J. Stone, James C. Torner, Michael J. Souter, A. Meyer, Marek A. Mirski, Marlan R. Hansen, W. Jenkins, L. Pobereskin, J. Walkes, M. Quigley, R. Struthers, James H McMahon, Howard A. Riina, Behnam Badie, P. Heppner, Simon Jones, R. Silbergleit, Thomas N. Pajewski, T. Broderick, Katherine Harris, P. Smythe, N. Duggal, J. Quaedackers, J. Mason, P. E. Bickler, P. McNeill, V. Roelfsema, I. Gibmeier, C. Chambers, H. Gramke, D. Campbell, T. Novick, O. Moise, J. Woletz, Lorri A. Lee, H. Van Aken, Adrian W. Gelb, A. Kane, B. Rapf, Martin S. Angst, S. Shaikh, D. Sirhan, C. Miller, B. Hodkinson, D. Leggett, F. Johnson, Harry J. M. Lemmens, M. Langley, Y. Young, Jeffrey V. Rosenfeld, C. Moy, W. Hamm, C. Hall, G. Henry, R. Burnstein, Lisa Hannegan, A. Buchmann, R. Schatzer, Bruce P. Hermann, John E. McGillicuddy, Bruno Giordani, John C. VanGilder, Keith H. Berge, D. Sage, L. Sternau, N. Page, Marc R. Mayberg, B Thompson, T. Hartman, Laurel E. Moore, S. Bhatia, Richard A. Jaffe, G. Seever, D. Cowie, Jonathan G. Zaroff, C. Duffy, Deborah A. Rusy, Elana Farace, H R Winn, Paul H. Ting, R. Spinka, J. Marler, Patricia H. Petrozza, S. Harding, Lauren C. Berkow, E. Cunningham, D. Bisnaire, D. Wilhite, P. Blanton, S. Laurent, O. Odukoya, Issam A. Awad, P. Chery, C. Lind, B. Bauer, D. Lindholm, K. Kieburtz, J. Ormrod, Michael P. Murphy, Timothy G. Short, Y. Painchaud, R. Peters, Peter C. Whitfield, D. Bain, B. Hindman, A. Shelton, A. Morris, D. Milovan, L. Salvia, William L. Young, S. Wallace, W. Lilley, H. Yi, R. Chelliah, David W. Newell, R. Deam, John Laidlaw, P. Mak, J. Woelfer, K. Graves, Peter M. C. Wright, D. Van Alstine, M. Hemstreet, Phillip A. Scott, Steven D. Chang, S. Poustie, M. Clausen, I. Herrick, Daniel H. Kim, Vladimir Zelman, John L.D. Atkinson, Marcel E. Durieux, Alessandro Olivi, G. Smith, James R. Munis, F. Vasarhelyi, S. Olson, C. Greiner, C. Hoenemann, G. Kleinpeter, J. Kish, Daniel K. Resnick, J. Lang, Dhanesh K. Gupta, E. Knosp, N. Monteiro de Oliveira, D. Moskopp, Carin A. Hagberg, J. Howell, Klaus Hahnenkamp, Gregory M. Davis, T. Phan, Paul S. Myles, C. Beven, F. Salevsky, Maria Matuszczak, E. Mee, David L. Bogdonoff, P. Berklayd, J. Freyhoff, P. Tanzi, A. Law, Barbara A. Dodson, Z. Thayer, R. Govindaraj, Alex Konstantatos, Ralph F. Frankowski, Pirjo H. Manninen, David G. Piepgras, K. Willmann, E. Babayan, Donald S. Prough, Leslie C. Jameson, John A. Wilson, Mary Pat McAndrews, M. Abou-Madi, Steven S. Glazier, Vincent C. Traynelis, Derek A. Taggard, Fredric B. Meyer, C. Bradfield, Hoang P. Nguyen, Mary L. Marcellus, J. Ogden, M. Maleki, M. Lotto, Michael A. Olympio, C. Merhaut, D. Nye, K. Webb, Richard Leblanc, Nichol McBee, William L. Lanier, A. Molnar, Peter J. Lennarson, S. Wadanamby, H. Hulbert, Christopher R. Turner, H. Fraley, Kevin K. Tremper, Sesto Cairo, J. Shafer, J. Krugh, D. Blair, L. Coghlan, P. Schmid, K. O'Brien, K. Littlewood, T. Anderson, R. Eliazo, S. Wirtz, Carol B. Applebury, Jennifer O. Hunt, S. Hickenbottom, Hendrik Freise, Gary D. Steinberg, M. Woodfield, Robert J. Dempsey, Kirk J. Hogan, M. Harrison, H. Stanko, Teresa Bell-Stephens, N. Merah, T. Blount, J. Sanders, J. Biddulph, Tsutomu Sasaki, F. Mensink, P. Balestrieri, Lisa D. Ravdin, H. Lohmann, M. Todd, James Gebel, Lawrence Litt, Christoph Schul, B. White, Bradley J. Hindman, S. Salerno, A. James, D. Manke, Mvon Lewinski, D. Luu, Michael M. Todd, A. Drnda, S. Salsbury, J. Palmisano, L. Connery, Michael Tymianski, E. Tuffiash, Cynthia A. Lien, R. Sawyer, A. Sills, D. Sinclair, J. Bramhall, Ira J. Rampil, David M. Colonna, M. Geraghty, Steven W. Anderson, V. Petty, S. Pai, J. Sheehan, S. Black, K. English, N. Scurrah, Diana G. McGregor, P. Davies, P. Doyle-Pettypiece, H. Bone, Neal J. Naff, M. Lenaerts, James Mitchell, K. Pedersen, Matthew A. Howard, M. Angliss, Daniel Tranel, Bongin Yoo, M. Irons, Emine O. Bayman, C. Skilbeck, Nicholas G. Bircher, Wendy C. Ziai, S. Micallef, Chuanyao Tong, Kathryn Chaloner, Mark T. Wallace, John Moloney, Gavin Fabinyi, P. Sutton, Edward C. Nemergut, Elizabeth Richardson, C. McCleary, M. Graf, Mrinalini Balki, P. Porter, James J. Evans, A. Prabhu, L. Kim, R. Hendrickson, A. Dashfield, V. Portman, Michel T. Torbey, J. Kruger, Donna L. Auer, J. Sorenson, Patricia H. Davis, John A. Walker, M. Mosier, H. Smith, J. Heidler, Andrew Silvers, P. Fogarty-Mack, William F. Chandler, F. Shutway, F. Rasulo, S. Alatakis, Stephen Samples, A. Wray, Henry H. Woo, John A. Ulatowski, Steven L. Giannotta, D. Chandrasekara, J. Sturm, S. Crump, Peter A. Rasmussen, Max R. Trenerry, D. Novy, Wink S. Fisher, N. Quinnine, F. Bardenhagen, M. Angle, W. Ng, G. Ferguson, A. Blackwell, Christopher M. Loftus, James H. Fitzpatrick, David S. Warner, E. Tuerkkan, W. Kutalek, Ferenc E. Gyulai, D. Daly, Helen Fletcher, J. Smith, Mazen A. Maktabi, Howard Yonas, J. Sneyd, M. Menhusen, Johnny E. Brian, K. Smith, R. Watson, T. Weber, D. Greene-Chandos, M. Wichman, Peter Szmuk, J. Birrell, Pekka Talke, J. Jane, L. Atkins, J. Smart, T. Han, B. O'Brien, R. Mattison, Bermans J. Iskandar, J. Ridgley, S. Dalrymple, L. Lindsey, D. Anderson, Julie B. Weeks, M. Felmlee-Devine, P. Deshmukh, D. Ellegala, L. Moss, A. Mathur, F. Lee, F. Sasse, H. Macgregor, R. Peterson, Margaret R. Weglinski, Karen Lane, Daniele Rigamonti, L. Carriere, Mark Wilson, R. Morgan, T. Costello, C. Thien, Arthur M. Lam, H. Bybee, C. Salmond, Robert E. Breeze, Peter Karzmark, Monica S. Vavilala, S. Yantha, Philip E. Stieg, Guy L. Clifton, Kenneth Manzel, D. Papworth, Rafael J. Tamargo, Rosemary A. Craen, Harold P. Adams, B. Radziszewska, Y. Kuo, Satwant K. Samra, B. Frankel, R. Fry, T. Cunningham, M. Mosa, M. McTaggart, F. Steinman, Alex Abou-Chebl, Michael J. Link, Rona G. Giffard, N. Lapointe, C. Meade, Robert F. Bedford, J. Cormack, Robert P. From, J. Reynolds, Paul A. Leonard, K. Quader, N. Subhas, C. Lothaller, S. Ryan, J. Winn, H. Brors, Amin B. Kassam, A. Gelb, J. Zaroff, Gregory M. Malham, A. Redmond, Gordon J. Chelune, J. Findlay, Zeyd Ebrahim, L. Forlano, Mark E. Shaffrey, C. Chase, Peter J. Kirkpatrick, Armin Schubert, L. Koller, Jana E. Jones, P. Li, and B. Chen

Subjects
medicine.medical_specialty, Subarachnoid hemorrhage, Interventional cardiology, business.industry, Vascular disease, Perioperative, Hypothermia, medicine.disease, Preoperative care, Anesthesiology and Pain Medicine, Aneurysm, Anesthesia, Anesthesiology, Medicine, medicine.symptom, business
Abstract

Background Perioperative hypothermia has been reported to increase the occurrence of cardiovascular complications. By increasing the activity of sympathetic nervous system, perioperative hypothermia also has the potential to increase cardiac injury and dysfunction associated with subarachnoid hemorrhage. Methods The Intraoperative Hypothermia for Aneurysm Surgery Trial randomized patients undergoing cerebral aneurysm surgery to intraoperative hypothermia (n = 499, 33.3 degrees +/- 0.8 degrees C) or normothermia (n = 501, 36.7 degrees +/- 0.5 degrees C). Cardiovascular events (hypotension, arrhythmias, vasopressor use, myocardial infarction, and others) were prospectively followed until 3-month follow-up and were compared in hypothermic and normothermic patients. A subset of 62 patients (hypothermia, n = 33; normothermia, n = 29) also had preoperative and postoperative (within 24 h) measurement of cardiac troponin-I and echocardiography to explore the association between perioperative hypothermia and subarachnoid hemorrhage-associated myocardial injury and left ventricular function. Results There was no difference between hypothermic and normothermic patients in the occurrence of any single cardiovascular event or in composite cardiovascular events. There was no difference in mortality (6%) between groups, and there was only a single primary cardiovascular death (normothermia). There was no difference between hypothermic and normothermic patients in postoperative versus preoperative left ventricular regional wall motion or ejection fraction. Compared with preoperative values, hypothermic patients had no postoperative increase in cardiac troponin-I (median change 0.00 microg/l), whereas normothermic patients had a small postoperative increase (median change + 0.01 microg/l, P = 0.038). Conclusion In patients undergoing cerebral aneurysm surgery, perioperative hypothermia was not associated with an increased occurrence of cardiovascular events.

Published
2010
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2. No Association between Intraoperative Hypothermia or Supplemental Protective Drug and Neurologic Outcomes in Patients Undergoing Temporary Clipping during Cerebral Aneurysm Surgery

Author

John A. Ulatowski, Steven L. Giannotta, J. Sturm, D. Cowie, D. Novy, N. Quinnine, James H. Fitzpatrick, David S. Warner, Ferenc E. Gyulai, D. Daly, S. Rice, H. Machlin, William T. Clarke, Philip E. Bickler, H. Van Aken, M. Langley, M. von Lewinski, G. Kleinpeter, J. Freyhoff, A. Morris, L. Salvia, Peter M. C. Wright, Wolfgang K. Pfisterer, K. English, M. Lenaerts, Nicholas G. Bircher, Simon Jones, L. Jensen, Issam A. Awad, P. Chery, B. Schaefer, S. Wallace, F. Johnson, H. Smith, J. Biddulph, T. Cunningham, N. Monteirode Oliveira, R. Watson, A. McAllister, D. Moskopp, Patricia H. Petrozza, B. Hindman, A. Shelton, D. Manke, F. Steinman, D. Luu, Alex Abou-Chebl, J. Birrell, M. Irons, J. Ridgley, Gavin Fabinyi, S. Alatakis, Basil F. Matta, James J. Evans, A. Prabhu, Rona G. Giffard, H. Gramke, Hendrik Freise, K. Graves, P. Fogarty-Mack, L. Clark, Wink S. Fisher, K. Smith, Renee Testa, P. D'Urso, A. Freymuth, James C. Torner, M. Wallace, R. Struthers, Howard A. Riina, Z. Thayer, Daniel Tranel, E. Knosp, E. Dy, Tord D. Alden, Henry H. Woo, Bruce P. Hermann, John C. VanGilder, Douglas Campbell, N. Lapointe, Gavin W. Britz, J. Sheehan, C. Meade, M. Balki, C. Bradfield, Alessandro Olivi, P. Doyle-Pettypiece, Robert F. Bedford, F. Bardenhagen, M. Angle, Donald S. Prough, John E. McGillicuddy, A. Drnda, M. Abou-Madi, S. Black, David R. McIlroy, Lis Evered, S. Poustie, J. Cormack, J. Sneyd, M. Menhusen, William L. Lanier, M. Maleki, T. Phan, D. Nye, M. Graf, Michael A. Olympio, N. Robertson, Teresa Bell-Stephens, E. Tuerkkan, N. Merah, S. Olson, L. Kirby, L. Moss, Peter Heppner, Thomas A. Moore, J. Bramhall, H. Madder, Christopher R. Turner, H. Fraley, James Mitchell, K. Pedersen, M. Angliss, Robert P. From, Y. Painchaud, Gary D. Steinberg, J. Woelfer, K. Littlewood, T. Anderson, J. Palmisano, M. Clausen, Paul H. Ting, Lisa D. Ravdin, H. Lohmann, R. Burnstein, R. Popovic, T. Hartman, D. Anderson, Julie B. Weeks, H. Macgregor, Kirk J. Hogan, D. Chatfield, Daniel H. Kim, James R. Munis, J. Lang, J. Reynolds, Michael M. Todd, F. Mensink, L. Pobereskin, J. Walkes, Mary Pat McAndrews, A. Sills, Bongin Yoo, P. Balestrieri, S. Micallef, Mary L. Marcellus, J. Wang, Kathryn Chaloner, Patrick W. Hitchon, Paul A. Leonard, C. McCleary, Lawrence Litt, N. Subhas, Wendy C. Ziai, James H McMahon, V. Petty, P. Smythe, G. Heard, Michael J. Souter, R. Hendrickson, A. Dashfield, V. Portman, Edward C. Nemergut, Patricia H. Davis, W. Burnett, M. Lotto, Y. Young, S. Jackson, J. Quaedackers, S. Ryan, Helen Fletcher, A. Ashtari, N. F. Kassell, Anish Bhardwaj, E. Thomson, Ramez W. Kirollos, Margaret R. Weglinski, Karen Lane, Daniele Rigamonti, J. Winn, Bradley J. Hindman, S. Salerno, L. Kim, R. Sawyer, Peter J. Lennarson, S. Wadanamby, Zhiyi Zuo, William F. Chandler, F. Shutway, P. Bennett, C. Merhaut, D. Hill, J. Haartsen, N. Badner, T. Weber, Rafael J. Tamargo, D. Fishback, Rosemary A. Craen, Michel T. Torbey, O. Odukoya, D. Chartrand, J. Jane, Michael T. Lawton, A. Buchmann, Richard A. Jaffe, P. Berklayd, T. Blount, J. Sanders, J. Marler, L. Meng, R. Grauer, Y. Kuo, O. Moise, P. Tanzi, R. Govindaraj, Alex Konstantatos, D. Greene-Chandos, G. Downey, M. Wichman, D. Chandrasekara, Amin B. Kassam, Max R. Trenerry, R. Elbe, A. Wyss, R. Peterson, D. Sirhan, C. Miller, Marek A. Mirski, Stephen Samples, H. Brors, Michael Beven, M. Woodfield, William L. Young, D. Leggett, A. Wray, Karen B. Domino, Robert Greif, Argye E. Hillis, Gary G. Ferguson, Steven S. Glazier, J. Shafer, J. Krugh, I. Gibmeier, G. Ghazali, W. Ng, R. Tack, R. Schatzer, B. O'Brien, Bermans J. Iskandar, B. Bauer, C. Lind, C. Weasler, Michael Tymianski, E. Tuffiash, W. Hamm, C. Hall, L. Sternau, N. Page, Marc R. Mayberg, B Thompson, Richard Leblanc, A. Shahen, Laurel E. Moore, S. Bhatia, Nichol McBee, P. Davies, James Gebel, Cynthia A. Lien, J. Ormrod, David M. Colonna, D. Dehring, A. Rushton, P. Blanton, C. Lothaller, Diana G. McGregor, S. Harding, Lauren C. Berkow, D. Van Alstine, M. Hemstreet, A. Blackwell, Christopher M. Loftus, Klaus Hahnenkamp, J. Woletz, D. Lindholm, K. Kieburtz, M. Geraghty, Steven W. Anderson, D. Dulli, M. McTaggart, Fred Gentili, Johnny E. Brian, R. Peters, C. Greiner, Marlan R. Hansen, W. Jenkins, T. Broderick, Katherine Harris, B. Radziszewska, Maria Matuszczak, David L. Bogdonoff, K. Quader, Pekka Talke, B. Hodkinson, C. Hoenemann, C. Duffy, Deborah A. Rusy, R. Silbergleit, J. Findlay, Gregory M. Davis, J. Ogden, Adrian W. Gelb, A. Kane, Satwant K. Samra, E. Babayan, S. Dalrymple, Harry J. M. Lemmens, Tsutomu Sasaki, Lisa Hannegan, R. Eliazo, B. Frankel, D. Bisnaire, F. Salevsky, Michael J. Link, Jeffrey V. Rosenfeld, D. Sage, D. Sinclair, Keith H. Berge, D. Wilhite, Steven D. Chang, J. Kish, Carin A. Hagberg, Matthew A. Howard, Elizabeth Richardson, Peter C. Whitfield, D. Bain, Barbara A. Dodson, S. Crump, David G. Piepgras, John A. Wilson, David W. Newell, R. Deam, John Laidlaw, K. Willmann, J. Heidler, Vincent C. Traynelis, K. Webb, P. Li, A. Mathur, S. Hickenbottom, S. Wirtz, L. Lindsey, H. Stanko, Mark Wilson, S. Salsbury, L. Connery, Robert J. Dempsey, Edward W. Mee, R. Morgan, Ira J. Rampil, V. Roelfsema, Christoph Schul, B. White, A. James, N. Scurrah, C. Thien, Arthur M. Lam, P. Mak, Behnam Badie, Guy L. Clifton, R. Wilson, J. Kruger, Donna L. Auer, M. Mosier, S. Nobles, David J. Stone, A. Law, Timothy G. Short, W. Lilley, H. Yi, Marcel E. Durieux, Daniel K. Resnick, Dhanesh K. Gupta, Paul S. Myles, C. Beven, Thomas N. Pajewski, J. Mason, P. McNeill, F. Lee, Bruno Giordani, Leslie C. Jameson, G. Seever, Stephen P. Lownie, Fredric B. Meyer, P. Porter, K. O'Brien, Vladimir Zelman, John L.D. Atkinson, A. Molnar, H. Hulbert, S. Pai, Neal J. Naff, S. Shaikh, M. Mosa, Pirjo H. Manninen, Derek A. Taggard, Ian A. Herrick, Mark E. Shaffrey, Carol B. Applebury, C. Chase, Neil Duggal, Mark Buckland, M. Quigley, D. Milovan, Michael J. Harrison, Peter J. Kirkpatrick, Armin Schubert, R. Mattison, Ralph F. Frankowski, R. Chelliah, Jana E. Jones, J. Howell, H. Bone, Emine O. Bayman, P. Deshmukh, C. Skilbeck, P. Sutton, B. Chen, L. Carriere, J. Sorenson, Andrew Silvers, F. Sasse, F. Rasulo, Gordon J. Chelune, Zeyd Ebrahim, L. Forlano, Chuanyao Tong, John Moloney, Michael P. Murphy, S. Yantha, W. Kutalek, Kevin K. Tremper, C. Chambers, Sesto Cairo, Robert E. Breeze, A. Meyer, Monica S. Vavilala, C. Salem, H. El-Beheiry, Gregory M. Malham, A. Redmond, L. Koller, Kenneth Manzel, D. Papworth, C. Moy, G. Henry, Elana Farace, H R Winn, E. Cunningham, B. Rapf, J. Smith, Mazen A. Maktabi, Howard Yonas, D. Ellegala, Kevin H. Siu, Lorri A. Lee, Phillip A. Scott, K. Lukitto, Jennifer O. Hunt, D. Blair, P. Schmid, M. Felmlee-Devine, Peter A. Rasmussen, Peter Szmuk, L. Atkins, J. Smart, T. Han, T. Costello, H. Bybee, C. Salmond, Peter Karzmark, Philip E. Stieg, Harold P. Adams, T. Novick, Z. Sha, Martin S. Angst, S. Laurent, G. Smith, F. Vasarhelyi, R. A. Fry, and John A. Walker

Subjects
medicine.medical_specialty, business.industry, Vascular disease, Glasgow Outcome Scale, Odds ratio, Hypothermia, medicine.disease, law.invention, Surgery, Anesthesiology and Pain Medicine, Aneurysm, Randomized controlled trial, law, Anesthesia, Anesthesiology, Medicine, medicine.symptom, business, Prospective cohort study
Abstract

Background Although hypothermia and barbiturates improve neurologic outcomes in animal temporary focal ischemia models, the clinical efficacy of these interventions during temporary occlusion of the cerebral vasculature during intracranial aneurysm surgery (temporary clipping) is not established. Methods A post hoc analysis of patients from the Intraoperative Hypothermia for Aneurysm Surgery Trial who underwent temporary clipping was performed. Univariate and multivariate logistic regression methods were used to test for associations between hypothermia, supplemental protective drug, and short- (24-h) and long-term (3-month) neurologic outcomes. An odds ratio more than 1 denotes better outcome. Results Patients undergoing temporary clipping (n = 441) were assigned to intraoperative hypothermia (33.3 degrees +/- 0.8 degrees C, n = 208) or normothermia (36.7 degrees +/- 0.5 degrees C, n = 233), with 178 patients also receiving supplemental protective drug (thiopental or etomidate) during temporary clipping. Three months after surgery, 278 patients (63%) had good outcome (Glasgow Outcome Score = 1). Neither hypothermia (P = 0.847; odds ratio = 1.043, 95% CI = 0.678-1.606) nor supplemental protective drug (P = 0.835; odds ratio = 1.048, 95% CI = 0.674-1.631) were associated with 3-month Glasgow Outcome Score. The effect of supplemental protective drug did not significantly vary with temperature. The effects of hypothermia and protective drug did not significantly vary with temporary clip duration. Similar findings were made for 24-h neurologic status and 3-month Neuropsychological Composite Score. Conclusion In the Intraoperative Hypothermia for Aneurysm Surgery Trial, neither systemic hypothermia nor supplemental protective drug affected short- or long-term neurologic outcomes of patients undergoing temporary clipping.

Published
2010
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3. Traumatic Intracerebral Venous Thrombosis Associated With an Abnormal Golf Swing

Author

Stephen Samples, R. Philip Kinkel, and Russell P. Saneto

Subjects
Adult, Male, business.industry, Vascular disease, Deep vein, Headache, Sequela, medicine.disease, Thrombosis, Neck Injuries, Venous thrombosis, medicine.anatomical_structure, Intracranial Thrombosis, Neurology, Antibodies, Anticardiolipin, Anesthesia, Athletic Injuries, medicine, Factor V Leiden, Golf, Humans, Neurology (clinical), Vein, business
Abstract

Objectives.—To describe the occurrence of cerebral venous thrombosis in a 40-year-old man whose cerebral event was induced by a poor golf swing, to review the literature on possible mechanisms producing venous thrombosis, and to compare this case with the literature. Background.—Headache is the most frequent symptom in patients with cerebral venous thrombosis. However, patients presenting with a headache due to cerebral venous thrombosis are uncommon. The known risk factors for thrombosis include both acquired and genetic factors. When the interaction of these two groups occurs, the magnitude of this interaction is thought to produce a dynamic state that can favor thrombosis. Our case report illustrates that moderate levels of anticardiolipin antibodies together with the mild trauma of a golf swing can induce a cerebral venous thrombosis. This case also suggests that although headache is rarely due to cerebral venous thrombosis, it should be excluded by good medical acumen and testing. Results.—Minor trauma induced by a poor golf swing was chronologically related to the development of a progressive cerebral venous thrombosis. The patient had none of the risk factors associated with a predisposition to venous thrombosis: hypercoagulable state, concurrent infection, pregnancy/puerperium, collagen vascular disorder, malignancy, migraine, false-positive VDRL, previous deep vein thrombosis, renal disease, factor V Leiden, or a hematological disorder. There was no anatomical abnormality that would predispose the patient to a cerebral venous thrombosis. The only laboratory abnormality was a moderate anticardiolipin antibody level (25 GPL). The patient was placed on warfarin sodium therapy and is currently without clinical sequela from the venous thrombotic event. Conclusions.—Under certain circumstances, minor trauma can induce cerebral venous thrombosis. A review of the literature indicates that cerebral venous thrombosis in the presence of anticardiolipin antibodies and in the absence of systemic lupus erythematosus is a rare event. Previously, only major traumatic events have been reported to be associated with cerebral venous thromboses. The chronological development of cerebral venous thrombosis after a faulty golf swing strongly indicates that given a background of moderate levels of anticardiolipin antibodies, even minor trauma can induce a venous thrombotic event.

Published
2000
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