Factors Influencing the Development of Gastrointestinal Complications after Neurosurgery: Results of Multivariate Analysis

Chan, Kwan-Hon; Mann, Kirpal S.; Lai, Edward C. S.; Ngan, John; Tuen, Henry H.; Yue, Chung P.

doi:10.1227/00006123-198909000-00010

Cited by 25 publications

(20 citation statements)

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“…In the study period, 16 612 patients with ischemic or hemorrhagic strokes were admitted to the hospital or developed in-hospital stroke; therefore, our study patients represent 0.1% of the total population. Of the 17 patients with gastrointestinal hemorrhage, 14 patients had a CT scan-documented ischemic stroke (lacuna [1 patient]; middle cerebral artery upper or lower division [7]; middle cerebral artery stem [3]; posterior cerebral artery territory [1]; and basilar artery territory [2]). An intracerebral hemorrhage was seen in 3 patients (putamen [1] and subdural localization [2]).…”

Section: Resultsmentioning

confidence: 99%

Gastrointestinal bleeding in stroke.

Wijdicks

Fulgham

Batts

1994

Stroke

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Background and Purpose Patients-with ischemic or hemorrhagic stroke are at risk for systemic complications. The reasons why gastrointestinal bleeding occurs after stroke are unknown and have intuitively been attributed to stress ulcers. No study to date has addressed causes of gastrointestinal hemorrhage in stroke.Methods Between 1976 and 1994, 17 patients identified from the Mayo Clinic medical record system as having gastrointestinal hemorrhage and ischemic stroke (n=14) or intracerebral hemorrhage (n=3) were reviewed for presentation, associated causes, and outcome. Results of the endoscopic procedures were compiled, and available gastric biopsies were reviewed.Results In 17 patients with gastrointestinal bleeding after stroke, sudden hematemesis, a decrease in hemoglobin level, or orthostatic hypotension was found as a presenting feature.

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Section: Resultsmentioning

confidence: 99%

Gastrointestinal bleeding in stroke.

Wijdicks

Fulgham

Batts

1994

Stroke

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“…The pathophysiology of stroke-related stress ulcers may develop from vagal hyperactivity, resulting in increased gastric acid secretion, or from mucosal ischemia [102,104]. Experimental models have shown that stress activates the hypothalamus, resulting in cholinergic stimulation to the stomach.…”

Section: Gastrointestinal Dysfunctionmentioning

confidence: 99%

Autonomic nervous system disorders in stroke

Korpelainen

Sotaniemi

Myllylä

1999

Clinical Autonomic Research

130

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Disturbances of the autonomic nervous system are common in patients with various cerebrovascular diseases. They are attributed to damage of the central autonomic network, particularly in the frontoparietal cortical areas and in the brain stem, or to a disruption of the autonomic pathways descending from the hypothalamus via the mesencephalon, pons, and medulla to the spinal cord. The most common clinical problems include abnormalities in heart rate and blood pressure regulation, reflecting cardiovascular autonomic dysfunction, and asymmetric sweating with cold hemiplegic limbs, reflecting changes in the sudomotor and vasomotor regulatory systems. Bladder and bowel dysfunction and impotence are also frequent complaints after stroke, but the present knowledge concerning their prevalence and clinical significance is still limited. Cardiovascular autonomic dysfunction, which is mainly related to increased sympathetic activity, is most evident in the acute phase of stroke, whereas other autonomic disorders, such as abnormal sweating, are long-standing or even irreversible. In addition to the well-established sympathetic hyperfunction, abnormalities of the parasympathetic nervous system may also contribute to the autonomic imbalance after stroke. Reliable recognition of autonomic dysfunction using quantitative analysis methods is important, because these disturbances are not only subjectively disabling and uncomfortable, but they may also be prognostically unfavorable. Moreover, quantitative measurements also form the ground for successive treatment of various stroke-related autonomic disorders.

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“…Recent work has implicated a spiral enteric pathogen, Carnpylobacter pylori, in gastritis and ulcer disease, but the relationship of this with stress ulcer is unclear [43]. Factors associated with stress ulcers include coma, inappropriate secretion of antidiuretic hormone, pyogenic infections of the central nervous system, and other postoperative complications [44]. Peptic ulcer disease in children is uncommon, and it is therefore striking that there appears to be such a predilection for gastrointestinal hemorrhage in the setting of posterior fossa tumors in this group, especially in the setting of tumor involvement of the lower brainstem [40].…”

Section: Intraoperative and Postoperative Complicationsmentioning

confidence: 99%

Surgical management of medulloblastoma

1996

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Recent technological aids and understanding of pathophysiology has made the surgery of medulloblastoma safer. The guiding principle for the neurosurgeon remains removal of bulky disease, but there is no justification for removal of small amounts of tumor from critical locations. Post-operative complications include hydrocephalus, hematoma, mutism, asceptic meningitis, gastroinstestinal hemorrhage, and cervical instability. Staging is best done preoperatively with MRI, and presence of dissemination remains the most important prognostic factor in this disease. Postoperative surveillance imaging is of questionable value.

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Factors Influencing the Development of Gastrointestinal Complications after Neurosurgery: Results of Multivariate Analysis

Cited by 25 publications

References 0 publications

Gastrointestinal bleeding in stroke.

Gastrointestinal bleeding in stroke.

Autonomic nervous system disorders in stroke

Surgical management of medulloblastoma

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