Transient ischemic attack post craniectomy: A case report and review of sinking skin flap syndrome

Background: The symptoms of stroke in the pediatric population are less evaluated than in adults. Although certain indicators are characteristic of stroke – acute drooping of the mouth corners, hemiparesis, and headache – they are not pathognomonic. Other diseases may manifest with similar symptoms, such as the first episode of hemiplegic migraine, and should be differentiated from stroke at an emergency department. Aim of the study: We present the differential diagnosis between stroke, transient ischemic attack, and first episode of hemiplegic migraine in a teenager with alarming focal symptoms. Case report: We present a case of 15-year-old patient with acute headache, drooping of the right mouth corners, and hemiparesis of the right upper and lower limb. He was brought by ambulance to the emergency department under suspicion of a stroke. A series of diagnostic tests performed at the Emergency Department did not reveal any vascular incident. Further diagnosis was performed at the Neurology Department. The patient was discharged from the hospital with a suspicion of first attack of hemiplegic migraine or transient ischemic attack. Conclusions: Differentiating stroke from other conditions in young patients is a significant challenge. The stroke diagnostic process in children requires further research to support accurate diagnosis and, if necessary, treatment as rapidly as possible.

Download Full-text

Ticagrelor in unstable carotid stenosis - a case report

Medicinski pregled ◽

10.2298/mpns2104127p ◽

2021 ◽

Vol 74 (3-4) ◽

pp. 123-126

Author(s):

Aleksandra Ilic ◽

Vladimir Galic ◽

Dmitar Vlahovic ◽

Tamara Rabi-Zikic ◽

Mirjana Jovicevic ◽

...

Keyword(s):

Case Report ◽

Platelet Aggregation ◽

Carotid Stenosis ◽

Antiplatelet Therapy ◽

Transient Ischemic Attack ◽

Dual Antiplatelet Therapy ◽

Transient Ischemic Attacks ◽

Suitable Alternative ◽

Ischemic Attack ◽

Aggregation Analysis

Introduction. Ticagrelor is an oral, reversible, direct-acting inhibitor of adenosine diphosphate receptor P2Y12, which has a faster onset of action and stronger inhibition of platelet aggregation than clopidogrel. Case Report. This case report describes a 54-year-old male patient with repeated, transient ischemic attacks due to ipsilateral, significant carotid stenosis registered by carotid duplex ultrasound. In addition to aspirin, clopidogrel and rosuvastatin were added to the therapy. Despite optimal treatment, the patient was continuously unstable with frequent but transient neurological symptoms. A magnetic resonance imaging of the brain showed acute, cortical-subcortical ischemic lesions in the left frontal and parietal lobes, while the computed tomography angiography of the endocranium showed progression of findings and occlusion of the left common carotid artery. Subsequently, laboratory platelet aggregation analysis confirmed aspirin resistance and poor response to clopidogrel. Episodes of transient ischemic attacks were stabilized after the exclusion of dual antiplatelet therapy and introduction of ticagrelor. After that, the patient?s symptoms did not recur and he remained stable. Conclusion. The incidence of resistance to antiplatelet therapy in patients with stroke or transient ischemic attack varies greatly and ranges from 3% to 85% for aspirin, and 28% to 44% for clopidogrel. Our case showed that platelet aggregation analysis is reasonable if patients with transient ischemic attack or minor acute ischemic stroke are neurologically unstable, despite optimal medical treatment and when other therapeutic options, such as carotid revascularization, are not indicated. In such situations, ticagrelor may be a suitable alternative to dual antiplatelet therapy.

Download Full-text