Intracranial hemorrhage in primary immune thrombocytopenia (ITP): 20 years’ experience in pediatrics

Elalfy, Mohsen Saleh; Eltonbary, Khadiga; Ghamry, Islam Reda El; Elalfy, Omar; Wahid, Marwa; Badr, Mohamed; Hassan, Tamer; Mansour, Ahmed; Meabed, Mohamed H.; El-Hawy, Mahmoud A.; Youssry, Ilham; Elhady, Marwa Abd; El-Shanshory, Mohamed; Elsayh, Khalid I; Hassab, Hoda

doi:10.1007/s00431-020-03923-x

Cited by 10 publications

(13 citation statements)

References 30 publications

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“…In the present study, a positive correlation was found between night-time disorders and medial temporal atrophy; nonetheless, other structures involved in arousal regulation, as the hypothalamic suprachiasmatic nucleus (SCN), was previously correlated to sleep disruption (Lyketsos et al, 2007). It was proposed that MTA may induce dysfunction of the SCN and/or its downstream effector systems, and that, in turn, the fragmented and irregular rhythms of activity may aggravate the neuropathological process responsible for the MTA, according to a negative feed-forward cycle (Musiek et al, 2015;Van Someren et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

Correlation of Frontal Atrophy and CSF Tau Levels With Neuropsychiatric Symptoms in Patients With Cognitive Impairment: A Memory Clinic Experience

Ramusino

Perini

Vaghi

et al. 2021

Front. Aging Neurosci.

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Background: Behavioral and psychological symptoms of dementia (BPSD) are a distressful condition. We aimed to investigate the BPSD distribution in subjects with cognitive impairment, and the potential correlations between BPSD and neurodegeneration in terms of cerebrospinal fluid (CSF) tau and brain atrophy.Methods: One-hundred patients with mild cognitive impairment (MCI) or dementia (Alzheimer’s disease, AD; Lewy-body disease, LBD; frontotemporal dementia, FTD; vascular dementia, VD) underwent a complete diagnostic workup, including 3T-MRI and/or CT and CSF. Cortical atrophy was assessed with medial temporal atrophy (MTA), posterior atrophy (PA), and global cortical atrophy-frontal lobe (GCA-F) scales. BPSD were rated using the Neuropsychiatric Inventory (NPI), and BPSD clusters were defined according to the European Alzheimer Disease Consortium.Results: Delusions, hallucinations, and psychosis cluster were differently distributed among the diagnostic groups (p < 0.05, p < 0.001, and p < 0.05), with LBD patients showing higher scores for hallucinations (vs. MCI, p < 0.001, and AD, p < 0.05) and psychosis cluster (vs. MCI, p < 0.05). In primary dementias, we found a negative correlation between NPI total score and tau levels (p = 0.08), confirmed by beta regression (p < 0.01), while a positive non-significant relationship was observed in MCI. Higher GCA-F scores were associated with delusions and apathy (p < 0.05, on both hemispheres) and hallucinations (left: p < 0.01, right: p < 0.05). GCA-F scores were positively correlated with psychosis cluster (right: p < 0.05), and agitation/aggression (left: p < 0.05). Conversely, nighttime disturbances were positively correlated with both GCA-F and MTA scores (left: p < 0.01; right: p < 0.05).Conclusion: Our results suggest that psychotic symptoms are significantly more represented in LBD patients and that CSF tau and frontal atrophy are associated with the occurrence and severity of BPSD in clinical practice. Longitudinal studies are however required to ascertain their actual predictive value.

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Section: Discussionmentioning

confidence: 99%

Correlation of Frontal Atrophy and CSF Tau Levels With Neuropsychiatric Symptoms in Patients With Cognitive Impairment: A Memory Clinic Experience

Ramusino

Perini

Vaghi

et al. 2021

Front. Aging Neurosci.

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“…22,23 The diagnosis of ICH was based on imaging evidence from CT or MRI. Impairment of consciousness on admission was evaluated by the Glasgow coma scale (GCS): mild (13)(14), moderate (9)(10)(11)(12), or severe (3)(4)(5)(6)(7)(8). 24 Previous infections referred to infections occurring one month before ICH or at the last follow-up.…”

Section: Definitions and Evaluationsmentioning

confidence: 99%

“…[9][10][11][12] According to previous reports, ICH occurs in approximately 1% of ITP patients with a mortality of 24.0%-31.2%. 9,[13][14][15] Lower platelet count, prior bleeding events, and antecedent head trauma have been shown to be associated with the development of ICH in pediatric and adult patients. [13][14][15][16][17] Meanwhile, prior hemorrhagic events and newly diagnosed ITP were related to death in a cohort of 40 children.…”

Section: Introductionmentioning

confidence: 99%

“…9,[13][14][15] Lower platelet count, prior bleeding events, and antecedent head trauma have been shown to be associated with the development of ICH in pediatric and adult patients. [13][14][15][16][17] Meanwhile, prior hemorrhagic events and newly diagnosed ITP were related to death in a cohort of 40 children. 14 However, to date, risk factors for death from ICH in adults with ITP remain unclear.…”

Section: Introductionmentioning

confidence: 99%

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Developing and validating a mortality prediction model for ICH in ITP: a nationwide representative multicenter study

et al. 2022

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Intracranial hemorrhage (ICH) is a rare and life-threatening hemorrhagic event in patients with immune thrombocytopenia (ITP). However, its mortality and related risk factors remain unclear. Herein, we conducted a nation-wide multicenter real-world study of ICH in adult ITP patients. According to data from 27 centers in China during 2005-2020, the mortality rate from ICH was 33.80% in ITP adults (48/142). We identified risk factors by logistic univariate and multivariate logistic regression for 30-day mortality in a training cohort of 107 patients as follows: intraparenchymal hemorrhage (IPH), platelet count ≤10×109/L at ICH, a combination of serious infections, grade of preceding bleeding events and Glasgow coma scale (GCS) level on admission. Accordingly, a prognostic model of 30-day mortality was developed based on the regression equation. Then, we evaluated the performance of the prognostic model through a bootstrap procedure for internal validation. Furthermore, an external validation with data from a test cohort with 35 patients from 11 other centers was conducted. The areas under the receiver operating characteristic curves for the internal and external validation were 0.954 (95% CI: 0.910~0.998) and 0.942 (95% CI: 0.871~1.014), respectively. Both calibration plots illustrated a high degree of consistency in the estimated and observed risk. In addition, the decision curve analysis showed a considerable net benefit for patients. Thus, an application (47.94.162.105:8080/ich/) was established for users to predict 30-day mortality when ICH occurred in adult patients with ITP.

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“…Most children with recently diagnosed ITP have a benign, self-limiting condition which usually recovers spontaneously, with minimal morbidity and mortality ( 4 , 5 ). The frequency of severe hemorrhage episodes in childhood is ~1/800 ( 1 ), the intracranial hemorrhage being the most important, thought rare complication ( 4 , 5 ), occurring in both newly diagnosed and in persistent/chronic ITP patients ( 6 ); 40% of children with ITP progress toward persistent ITP exhibiting a low platelet count and hemorrhage episodes beyond 3 months, and 10–20% goes toward chronicity.…”

Section: Introductionmentioning

confidence: 99%

The Use of Clinical Scores in the Management of Immune Thrombocytopenic Purpura in Children

Roșu

Spoială²,

Roşu³

et al. 2022

Front. Pediatr.

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While the majority of children with recently diagnosed ITP have a benign, self-limiting condition, most often with a spontaneously recovery, 40% of children with ITP progress toward persistent ITP and 10–20% goes toward chronicity. Several clinical scores have been developed with the aim to perform a better monitoring outcome or to differentiate transient vs. persistent ITP (e.g., Donato score). Our paper aims to describe and to compare the most important scores used in the management of ITP in children: bleeding severity scores and chronicity prediction scores. These scores include a combination of different already known risk factors: age, gender, presence of a previous infections or vaccination, bleeding grade, type of onset, platelet count at diagnosis. The real utility of these scores has been a matter of debate and no consensus has been reached so far as to their necessity to be implemented as compulsory tool in the care of children with ITP.

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Intracranial hemorrhage in primary immune thrombocytopenia (ITP): 20 years’ experience in pediatrics

Cited by 10 publications

References 30 publications

Correlation of Frontal Atrophy and CSF Tau Levels With Neuropsychiatric Symptoms in Patients With Cognitive Impairment: A Memory Clinic Experience

Correlation of Frontal Atrophy and CSF Tau Levels With Neuropsychiatric Symptoms in Patients With Cognitive Impairment: A Memory Clinic Experience

Developing and validating a mortality prediction model for ICH in ITP: a nationwide representative multicenter study

The Use of Clinical Scores in the Management of Immune Thrombocytopenic Purpura in Children

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