scholarly journals Rare Bilateral Caudate Infarction in a Patient with a Common Circle of Willis Variant

2019 ◽  
Vol 46 (5) ◽  
pp. 593-594
Author(s):  
Mimma G. Anello ◽  
Timothy L. Miao ◽  
Sachin K. Pandey ◽  
Jennifer L. Mandzia
Keyword(s):  
Atrial Fibrillation ◽  
Left Middle Cerebral Artery ◽  
Past Medical History ◽  
Acute Therapy ◽  
Ct Angiogram ◽  
Level Of Consciousness ◽  
Middle Cerebral Artery Stroke ◽  
Artery Disease ◽  
Acute Aphasia ◽  
Left Middle

A 62-year-old male presented to hospital with acute aphasia. His past medical history was significant for a previous left middle cerebral artery stroke, from which he fully recovered, hypertension, dyslipidemia, coronary artery disease, one episode of atrial fibrillation postoperatively, and thalidomide exposure in utero. Although initially he was thought to be aphasic, on further examination, he demonstrated significant abulia. His level of consciousness was normal, and neurological examination was otherwise unremarkable. A CT angiogram of the head and neck was performed. The patient was not a candidate for acute therapy, as he had established stroke on imaging, and the time of onset was unclear.

scholarly journals Adverse Outcome of Early Recurrent Ischemic Stroke Secondary to Atrial Fibrillation after Repeated Systemic Thrombolysis

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Luciano A. Sposato ◽  
Valeria Salutto ◽  
Diego E. Beratti ◽  
Paula Monti ◽  
Patricia M. Riccio ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Neurological Outcome ◽  
Left Middle Cerebral Artery ◽  
Cerebrovascular Event ◽  
Middle Cerebral Artery Infarction ◽  
Systemic Thrombolysis ◽  
Left Middle

Background. Recurrent ischemic stroke is associated with adverse neurological outcome in patients with atrial fibrillation. There is very scarce information regarding the neurological outcome of atrial fibrillation patients undergoing repeated systemic thrombolysis after early recurrent ischemic stroke.Clinical Case and Discussion. We describe a case of a 76-year-old woman with known paroxysmal atrial fibrillation who was admitted because of an acute right middle cerebral artery ischemic stroke and who underwent repeated systemic thrombolysis within 110 hours. The patient underwent systemic thrombolysis after the first ischemic stroke with almost complete neurological recovery. On the fourth day after treatment, an acute left middle cerebral artery ischemic stroke was diagnosed and she was treated with full-dose intravenous recombinant tissue plasminogen activator. A hemorrhagic transformation of the left middle cerebral artery infarction was noted on follow-up cranial computed tomographic scans. The patient did not recover from the second cerebrovascular event and died 25 days after admission.Conclusion. To the best of our knowledge, this is the second case reporting the adverse neurological outcome of a patient with diagnosis of atrial fibrillation undergoing repeated systemic thrombolysis after early recurrent ischemic stroke. Our report represents a contribution to the scarce available evidence suggesting that repeated systemic thrombolysis for recurrent ischemic stroke should be avoided.

034 The susceptibility vessel sign: a clinical-radiological case of propagating left MCA thrombus with resolving neurological deficits

2018 ◽  
Vol 89 (6) ◽  
pp. A14.2-A14
Author(s):  
Benjamin Nham ◽  
Simon Hawke
Keyword(s):  
Sudden Onset ◽  
Neurological Deficits ◽  
Left Middle Cerebral Artery ◽  
List Type ◽  
Radiological Sign ◽  
Vessel Occlusion ◽  
Ct Angiogram ◽  
Gradient Echo Imaging ◽  
Haemoglobin Content ◽  
Left Middle

IntroductionThe susceptibility vessel sign (SVS) is a radiological sign on the SWI sequence of MRI that can predict cardioembolic source and increased recanalisation rates in stroke.1 We present a case of an 86 year old female with resolving neurological deficits from a propagating left MCA thrombus with positive SVS on imaging.CaseAn 86 year old female presented with sudden onset right sided weakness and expressive aphasia in the context of new atrial fibrillation. Her NIHSS was 4. Initial CT angiogram showed complete occlusion of the proximal M1 segment of the left middle cerebral artery. She was within the thrombolysis window but her deficits largely resolved (NHISS 0) before thrombolysis could be administered. A repeat CT angiogram one hour after the first scan showed complete resolution of the MCA occlusion. An MRI brain showed curvilinear gradient signal hypointensity in the distal left M2 segment of the MCA (positive SVS) with a small area of infarction and restricted diffusion. She was discharged on apixaban without neurological deficit. This is a unique case of a stroke patient, with proximal large vessel occlusion, presenting with neurological deficits that self-resolved within minutes without thrombolysis or thrombectomy. There was a positive SVS on MRI. This radiological sign allows direct visualisation of the hypointense thrombo-embolus on the SWI sequence. It occurs as there is a higher level of deoxy-haemoglobin content in the thrombo-embolus and is predictive of a cardioembolic source as cardioembolic thrombi are rich in erythrocytes1.ConclusionOur case demonstrated interesting clinical-radiological-pathological correlation in cardioembolic stroke with resolving neurological deficits. The patient’s clinical improvement matched the radiological improvement and corresponded to the pathophysiological course of thrombus from embolization, propagation, occlusion, dissolution and then recanalisation. The SVS is a useful radiological sign to predict cardioembolic sources of stroke and is associated with higher vessel re-canalisation rates.Reference. Cho KH, Kim JS, Kwon SU, et al. Significance of susceptibility vessel sign on T2*-weighted gradient echo imaging for identification of stroke subtypes. Stroke2005;36:2379–2383.

A Case of Abulia From Left Middle Cerebral Artery Stroke in an Adolescent Treated Successfully With Short Duration Olanzapine

2020 ◽  
Vol 43 (3) ◽  
pp. 86-89
Author(s):  
Andrew T. Connor ◽  
Alex Crawford ◽  
Rebecca J. Levy ◽  
Lauren M. Schneider ◽  
Seth A. Hollander ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Short Duration ◽  
Cerebral Artery ◽  
Left Middle Cerebral Artery ◽  
Middle Cerebral Artery Stroke ◽  
Left Middle

scholarly journals Simultaneous treatment of ischaemic bowel and ischaemic stroke with intravenous thrombolysis therapy

2018 ◽  
Vol 11 (1) ◽  
pp. e227126
Author(s):  
Lucia Y Chen ◽  
Charlotte Ainscough ◽  
Mohamed Sayed ◽  
Maneesh Bhargava
Keyword(s):  
Ischaemic Stroke ◽  
Intravenous Thrombolysis ◽  
Abdominal Distension ◽  
Artery Occlusion ◽  
Left Middle Cerebral Artery ◽  
Simultaneous Treatment ◽  
Systemic Thrombolysis ◽  
Ct Angiogram ◽  
Stroke Team ◽  
Left Middle

Novel treatment of simultaneous mesenteric and cerebral ischaemia with systemic thrombolysis. A 75-year-old man presented to the acute stroke team with aphasia, right-sided weakness and distressed with a pain he was unable to localise. He was treated with intravenous thrombolysis with tissue plasminogen activator for a left middle cerebral artery stroke. Decompensation on the ward during thrombolysis with worsening abdominal distension and pain, hypotension and tachycardia prompted a CT angiogram scan, which displayed proximal inferior mesenteric artery occlusion. Thrombolysis treatment resulted in excellent improvement of both his dysphasia and weakness from the left cerebral ischaemic stroke and reperfusion of the ischaemic bowel, without surgical intervention.

scholarly journals Does the side of middle cerebral artery compromise matters in the mortality after thrombolysis in ischemic stroke?

2015 ◽  
Vol 73 (8) ◽  
pp. 644-647 ◽  
Author(s):  
Renata Dal-Prá Ducci ◽  
Marcos Christiano Lange ◽  
Carla Heloísa Moro ◽  
Rodrigo Harger ◽  
Alexandre Luiz Longo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Univariate Analysis ◽  
Intravenous Thrombolysis ◽  
Left Middle Cerebral Artery ◽  
Affected Side ◽  
The Impact ◽  
Left Middle

The impact of the side in middle cerebral artery (MCA) ischemic stroke is not well established. Our aim was to analyze the differences between right (RMCA) and left middle cerebral artery (LMCA) stroke in patients submitted to intravenous thrombolysis and the influence of the affected side in the patient’s mortality after 3 months. Method Patients with MCA ischemic stroke submitted to intravenous thrombolysis from March 2010 to December 2011 at two Brazilian Stroke Centers were included. Differences between patients with RMCA and LMCA stroke were identified by univariate analysis. Results Forty-five patients with RMCA stroke and 67 with LMCA stroke were analyzed. Patients with LMCA had a higher incidence of atrial fibrillation (p = 0.031), although patients with RMCA more often had a previous ischemic stroke (p = 0.034). The mortality over 3 months was similar for either side (OR = 1.20 ;0.37 - 4.29, p = 0.772). Conclusion The side of the MCA ischemic stroke did not influence the patients mortality.

scholarly journals Propranolol for Paroxysmal Sympathetic Hyperactivity with Lateralizing Hyperhidrosis after Stroke

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Jason W. Siefferman ◽  
George Lai
Keyword(s):  
Low Dose ◽  
Cortical Inhibition ◽  
Left Middle Cerebral Artery ◽  
Sympathetic Hyperactivity ◽  
Paroxysmal Sympathetic Hyperactivity ◽  
System Activation ◽  
Middle Cerebral Artery Stroke ◽  
Sympathetic Nervous ◽  
Left Middle ◽  
Sympathetic Nervous System Activation

Brain injury can lead to impaired cortical inhibition of the hypothalamus, resulting in increased sympathetic nervous system activation. Symptoms of paroxysmal sympathetic hyperactivity may include hyperthermia, tachycardia, tachypnea, vasodilation, and hyperhidrosis. We report the case of a 41-year-old man who suffered from a left middle cerebral artery stroke and subsequently developed central fever, contralateral temperature change, and hyperhidrosis. His symptoms abated with low-dose propranolol and then returned upon discontinuation. Restarting propranolol again stopped his symptoms. This represents the first report of propranolol being used for unilateral dysautonomia after stroke. Propranolol is a lipophilic nonselective beta-blocker which easily crosses the blood-brain barrier and may be used to treat paroxysmal sympathetic hyperactivity.

scholarly journals Acute ischaemic stroke-related choreoathetosis treated with arterial thrombectomy

2019 ◽  
Vol 12 (1) ◽  
pp. e226035 ◽  
Author(s):  
Ali Muhammad ◽  
Egidija Bielskute ◽  
Paul C Guyler ◽  
Iris Q Grunwald
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Emergency Department ◽  
Rare Case ◽  
Intravenous Thrombolysis ◽  
Caucasian Woman ◽  
Left Middle Cerebral Artery ◽  
Ct Head ◽  
The Right ◽  
Left Middle

A rare case of acute choreoathetosis after acute stroke is presented. This 66-years-old, right-handed Caucasian woman presented with weakness of her right arm and right leg with dysarthria, which resolved by the time she arrived in the emergency department. No obvious focal sign apart from the abnormal choreoathetoid movement of the right arm and leg and of the neck was present. Her medical history included atrial fibrillation without anticoagulation. CT head was nil acute (Alberta Stroke Program Early CT Score of 10). CT angiography of the carotids showed a hyperdense M2 segment of the left middle cerebral artery. Intravenous thrombolysis immediately followed by thrombectomy was decided. Using the Penumbra aspiration device (ACE 68) two clots were removed with two aspirations. A small distal clot remained but partial recanalisation (Thrombolysis in Myocardial Infarction/Thrombolysis in Cerebral Infarction 2b) was achieved. 30 seconds after restoring blood flow, the choreoathetoid movements ceased. The patient was brought to intensive care for further monitoring, which was uneventful.

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