Predictors of Cerebral Venous Thrombosis and Arterial Ischemic Stroke in Young Asian Women

Background and Purpose— Focal cerebral arteriopathy is monophasic inflammatory stenosis of the distal internal carotid artery or the proximal segment of the middle cerebral artery. It is one of the most common causes of acute arterial ischemic stroke in young children but is a less familiar entity for adult neurologists. Methods— We retrospectively reviewed stroke service radiology records at a tertiary referral center from January 2013 to December 2014. Focal cerebral arteriopathy was defined as nonprogressive unifocal and unilateral stenosis/irregularity of the distal internal carotid artery or its proximal branches. Only patients aged 16 to 55 years with stroke were included. Results— There were 5 cases of focal cerebral arteriopathy: 2 males and 3 females. Three cases were from the cohort of 123 acute presentations of young stroke, and 2 cases were outpatient referrals. The mean age (range) was 43 (32–55) years. The majority presented with recurrent transient ischemic attacks/minor strokes within a single vascular territory over days to weeks. All cases had characteristic radiological features. Interval imaging demonstrated resolution in 1 case and improvement in 3 cases. Functional outcome was excellent with discharge modified Rankin Scale score ranging from 0 to 1. Recurrence occurred in 1 case. Conclusions— Focal cerebral arteriopathy is a rare cause of arterial ischemic stroke in young adults. Follow-up intracranial imaging is essential to differentiate from progressive arteriopathies. Evidence-based treatment warrants further investigation. Prognosis is favorable.

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Cerebral hemorrhagic infarction as the initial manifestation of deep venous thrombosis in a child with patent foramen ovale

Global Cardiology Science and Practice ◽

10.21542/gcsp.2018.17 ◽

2018 ◽

Vol 2018 (2) ◽

Author(s):

Dimitrios Panagopoulos ◽

Sofia Loukopoulou ◽

Evagelos Karanasios ◽

Gerorgia Grigoriadou ◽

Nikolaos Eleftherakis

Keyword(s):

Ischemic Stroke ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Patent Foramen Ovale ◽

Anticoagulation Therapy ◽

Unknown Etiology ◽

Foramen Ovale ◽

Arterial Ischemic Stroke ◽

Radiological Investigation ◽

Ultrasound Study

Arterial ischemic stroke (AIS), with an estimated incidence of 1.1–4.3 per 100,000, is an important cause of morbidity and mortality in children and the risk of recurrence is high. We present the case of an 11-year-old child who presented with a symptomatology of acute ischemic stroke of unknown etiology. The radiological investigation did not reveal any underlying brain abnormality that could cause the event. The diagnostic work up included an echocardiogram, which revealed a thrombus in the right atrium, in conjunction with a patent foramen ovale. The patient was initiated immediately on anticoagulation therapy with low molecular weight heparin and warfarin, but two days later she suffered pulmonary emboli, diagnosed with spiral thorax computed tomography (CT) scan. An ultrasound study of the vessels of the lower extremities revealed deep venous thrombosis (DVT), which was considered to be the underlying causative mechanism.

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