Acute Ischemic Stroke in a 10-Month-Old Baby Recovered With Aspirin

2021 ◽  
Author(s):  
Seyed A. Hosseini ◽  
Mohammad H. Gharib ◽  
Seyed B. Mirheidari ◽  
Bahar Ghanbarzade ◽  
Parnian S. Hosseini
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Pediatric Population ◽  
Limb Weakness ◽  
Left Limb ◽  
Ct Head ◽  
Permanent Morbidity ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
Evidence Based Guidelines

AbstractAcute ischemic stroke is rare in children and often brings enduring and permanent morbidity in pediatric population. While there are numerous recommendations for initial treatment, evidence on effectiveness of different therapies among children is limited. Here, we describe a 10-month-old boy who presented with fever, restlessness, seizure and postictal left limb weakness. Examination revealed left hemiplegia and hemiparesthesia. Computed tomography (CT) head showed loss of gray–white matter distinction with diffuse hypodensity in the right temporoparietal lobes and right caudate nucleus. Magnetic resonance imaging (MRI) brain demonstrated diffusion restriction in favor of acute ischemic stroke in the right middle cerebral artery (MCA) territory. Brain MR angiography (MRA) demonstrated complete occlusion of proximal aspect of M1 segment of right MCA. Genetic testing determined a homozygous 4G/4G polymorphism of the PAI-1 gene. Antiplatelet therapy was started after diagnosis and continued for 8 days with antibiotic therapy. Stroke in children and infants is an infrequent condition associated with substantial morbidity and mortality that needs clinicians' care. This case highlights the significance of awareness about stroke in children and emphasizes on further research to compile evidence-based guidelines for acute stroke therapy in children.

scholarly journals Successive development of ischemic stroke and hemorrhagic stroke in a patient with essential thrombocythemia: a case report

2021 ◽  
Vol 49 (1) ◽  
pp. 030006052098771
Author(s):  
Xuhui Chen ◽  
Liming Cao ◽  
Hongye Feng ◽  
Xuming Huang
Keyword(s):  
Ischemic Stroke ◽  
Essential Thrombocythemia ◽  
Sinus Thrombosis ◽  
Stable Condition ◽  
Lower Limbs ◽  
Subdural Hemorrhage ◽  
Vascular Events ◽  
Limb Weakness ◽  
Left Limb ◽  
The Right

Patients with essential thrombocythemia (ET) can experience hemorrhagic or ischemic vascular events. The prevention of these complications is challenging, and the overall risk of vascular events caused by ET is often overlooked. A 34-year-old man was admitted for a 10-day history of weakness and numbness in his right limbs. He had been diagnosed with ET in 2008 but had stopped receiving treatment half a year before admission. Physical examination showed a superficial sense of disturbance in the right limbs and decreased muscle strength in the right upper and lower limbs (4/5). His platelet count (459 × 109/L) was elevated. Magnetic resonance imaging showed acute watershed infarction, and he was treated successfully. However, he was readmitted for headache and left limb weakness 14 months later. A head computed tomography scan revealed spontaneous subdural hemorrhage. He underwent subdural hematoma removal and decompressive craniectomy. Surgery and pathological investigation revealed no venous sinus thrombosis or vascular malformation. His condition improved, and he exhibited a stable condition 1 year after discharge. Successive development of ischemic stroke and spontaneous subdural hemorrhage is rare in a patient with ET. This case suggests that ET is not only a risk factor for stroke but can also cause highly heterogeneous strokes.

scholarly journals Approach to Ischemic Stroke

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Meaghan Wunder
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Unit ◽  
Limb Weakness ◽  
Basic Approach ◽  
Ct Head ◽  
Acute Stroke Unit ◽  
The Brain ◽  
Basic Medical ◽  
Rule Out

An approach to managing acute ischemic stroke includes recognition, investigations, treatment, and secondary prevention.  Firstly, facial drooping, limb weakness and slurred speech are some common signs that should raise the suspicion for stroke.  Upon presentation, investigations, including the national institute of health stroke scale and a CT head, should be done to rule out intracranial hemorrhage and diagnose an ischemic stroke. The treatment principles for an acute ischemic stroke focus on removing or dissolving the occlusion to maintain or reinstate perfusion of the brain.  Finally, patients suffering ischemic stroke should be admitted to the acute stroke unit and monitored for complications. Basic medical management of comorbidities should also be considered to prevent subsequent ischemic episodes. This article will explain each of these processes in more detail to help develop a basic approach to the management of an acute ischemic stroke.

scholarly journals Intravenous Thrombolysis After Reversal of Dabigatran With Idarucizumab in Acute Ischemic Stroke: A Case Report

2021 ◽  
Vol 13 ◽  
Author(s):  
Dan Xie ◽  
Xuefan Wang ◽  
Yao Li ◽  
Ruiling Chen ◽  
Yingying Zhao ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Case Report ◽  
Acute Ischemic Stroke ◽  
Time Window ◽  
Case Reports ◽  
Intravenous Thrombolysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Limb Weakness ◽  
Left Limb

Background: As there is a growing concern about the cerebral embolism events secondary to non-valvular atrial fibrillation (NVAF), novel oral anticoagulant (NOAC) has been more and more widely used as an anticoagulation treatment for the prevention of stroke. However, in the face of life-threatening bleeding or emergency surgery/treatment, NOAC-related antagonists such as idarucizumab need to be urgently used to reverse the NOAC. Using recombinant tissue plasminogen activator (rt-PA) intravenous thrombolysis for acute ischemic stroke requires a time window of 4.5 h. This case reports rt-PA intravenous thrombolysis after reversal of dabigatran anticoagulation with idarucizumab in patients with acute ischemic stroke.Case Presentation: We report the case of 62-year-old Chinese female with NVAF treated with dabigatran 110 mg twice daily, and missed a dose on the eve of the stroke. The patient presented with acute ischemic stroke causing the angle of mouth deviated to right side and left limb weakness in the early morning of the next day. However, the last dosing time of dabigatran was between 24 and 48 h, the patients were given rt-PA intravenous thrombolysis after reversal of dabigatran anticoagulation with idarucizumab, while any potential relative contraindication had been excluded by means of laboratory test and CT scan in the hospitalization services. National Institute of Health stroke scale (NIHSS) score was reduced from 4 to 1, and the patient was discharged after 2 weeks.Conclusion: Our case report adds to the evidence that idarucizumab administration is safe and effective in the setting of patients with atrial fibrillation treated with dabigatran who develop acute ischemic stroke requiring rt-PA intravenous thrombolysis.

scholarly journals Intravenous Thrombolysis after Reversal of Dabigatran with Idarucizumab in Acute Ischemic Stroke: A Case Report

2020 ◽  
Author(s):  
DAN XIE ◽  
Xuefan Wang ◽  
Yao Li ◽  
Ruiling Chen ◽  
Yingying Zhao ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Case Report ◽  
Acute Ischemic Stroke ◽  
Time Window ◽  
Case Reports ◽  
Intravenous Thrombolysis ◽  
Nonvalvular Atrial Fibrillation ◽  
Limb Weakness ◽  
Left Limb

Abstract Background: As there is a growing concern about the cerebral embolism events secondary to non-valvular atrial fibrillation, direct oral anticoagulant (DOAC) has been more and more widely used as an anticoagulation treatment for prevention of stroke. However, in the face of life-threatening bleeding or emergency surgery/treatment, doac-related antagonists such as idarucizumab need to be urgently used to reverse the DOAC. Using rt-PA intravenous thrombolysis for acute ischemic stroke requires a time window of 4.5 hours. This case reports rt-PA intravenous thrombolysis after reversal of dabigatran anticoagulation with idarucizumab in patients with acute ischemic stroke. Case presentation: We report the case of 62-year-old Chinese female with nonvalvular atrial fibrillation treated with dabigatran 110mg twice daily, and missed a dose on the eve of the stroke. The patient presented with acute ischemic stroke causing the angle of mouth deviated to right side and left limb weakness in the early morning of the next day. Due to the last dosing time of dabigatran was between 24-48 hours, the patients were given rt-PA intravenous thrombolysis after reversal of dabigatran anticoagulation with idarucizumab, while all contraindications had been excluded by laboratory test and CT scan. NIHSS score was reduced from 4 to 1, and the patient was discharged after 2 weeks. Conclusion: Our case report adds to the evidence that idarucizumab administration is safe and effective in the setting of patients with atrial fibrillation treated with dabigatran who develop acute ischemic stroke requiring rt-PA intravenous thrombolysis.

scholarly journals Making a case for the right ‘-ase’ in acute ischemic stroke: alteplase, tenecteplase, and reteplase

2019 ◽  
Vol 18 (2) ◽  
pp. 87-96
Author(s):  
Katleen Wyatt Chester ◽  
Megan Corrigan ◽  
J. Megan Schoeffler ◽  
Michelle Shah ◽  
Florence Toy ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
The Right

ISCHEMIC STROKE IN COVID-19 PATIENT: A RARE CASE REPORT.

2021 ◽  
pp. 72-73
Author(s):  
Atul Kaushik ◽  
Showkat Nazir Wani ◽  
Anish Garg ◽  
Dev Kumar
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Rare Case ◽  
Cardiovascular Complications ◽  
Left Middle Cerebral Artery ◽  
Early Evaluation ◽  
Rare Case Report ◽  
Ct Head ◽  
Left Middle ◽  
Middle Cerebral Artery Infarct

Background: COVID-19 is shown to be associated with hypercoagulable state which may cause neurological and cardiovascular complications. COVID-19 has been represented as an independent risk factor for acute ischemic stroke. Objective:We report a case of acute ischemic stroke as a COVID-19 complication. Material and methods: A 62-year-old known hypertensive male was diagnosed with COVID-19. He developed neurological symptoms 10 days after being tested positive. On doing an NC-CT head, a large acute ischemic stroke involving left Middle Cerebral Artery infarct was detected. Result and Conclusion: Our case represents the development of acute ischemic stroke as a neurological manifestation in patient with COVID-19. Early evaluation for acute neurological changes and timely management may reduce morbidity and mortality in such cases.

Abstract 1122‐000122: The Role of the Venous System in Infarct Burden in Patients with Acute Ischemic Stroke

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Shail S Thanki ◽  
Elliot Pressman ◽  
Shail S Thanki ◽  
John D Mayfield ◽  
Maximilian J Rabil ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
False Negative ◽  
Transverse Sinus ◽  
Sigmoid Sinus ◽  
Venous Sinus ◽  
Post Stroke ◽  
Number Of Patients ◽  
Ct Head

Introduction : Acute ischemic stroke (AIS) is a leading cause of disability internationally. Most therapies focus on intra‐arterial treatment to improve post‐stroke deficits and neurologic status. However, if a relationship between venous anatomy and post‐stroke deficits or infarct size can be shown, then venous augmentation strategies represent a possibility for future interventions as an adjunct to intra‐arterial treatment. Methods : We retrospectively reviewed all ischemic infarcts at our institution that underwent thrombectomy from January 2018 – October 2020. From these, we selected cases that were demonstrated as M1 occlusions on intra‐procedural angiogram and those who had a CT Head obtained within six hours of the patient’s last known normal (LKN). Patients without a CT Head or CT Angiogram of their head were excluded. Using axial and sagittal reconstructed views of 0.9mm slices, cross‐sectional area measurements were taken of the superior sagittal sinus 1cm above the Torcula, in three locations of the ipsilateral and contralateral transverse sinus, in three locations of the ipsilateral and contralateral sigmoid sinus, and of the ipsilateral and contralateral internal jugular vein (IJV) at the external surface of the skull. For the transverse and sigmoid sinuses, the three measurements were averaged together. These measurements were then compared against patient’s Alberta Stroke Program Early CT Score (ASPECTS). Results : 77 patients were identified in the study period. Average ASPECTS was 8.9, ranging from 5–10. There were three patients included with ASPECTS < 6. Average ipsilateral transverse sinus area was 34.4mm ± 3.34, average ipsilateral sigmoid sinus area was 32.8mm ± 2.74, average ipsilateral IJV area was 46.9 mm ± 5.00. Correlation tests to identify relationships between venous sinus area and ASPECTS was unremarkable (ipsilateral transverse sinus p = 0.574, ipsilateral sigmoid sinus p = 0.548, ipsilateral IJV p = 0.798). When assessed as a ratio of ipsilateral venous sinus area to contralateral sinus area to assess correlation with ASPECTS, results were unremarkable (transverse sinus p = 0.891, sigmoid sinus p = 0.292, IJV p = 0.499). Conclusions : Venous sinus size was not found to be predictive or associated with predominantly favorable ASPECTS for strokes found within six hours. We believe this may be due to our cohort lacking significant numbers of patients with low ASPECTS, yielding a false negative result. We are currently expanding this project to include a comparable number of patients with ASPECTS < 6 to determine the role of venous collateral system in infarct progression.

scholarly journals Inadvertent Central Arterial Catheterization: An Unusual Cause of Ischemic Stroke

2018 ◽  
Vol 09 (01) ◽  
pp. 155-158 ◽  
Author(s):  
Nakul Katyal ◽  
Amanda Korzep ◽  
Christopher Newey
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Low Dose ◽  
Venous Catheter ◽  
Interventional Cardiology ◽  
Heparin Infusion ◽  
Intravenous Drugs ◽  
Arterial Catheterization ◽  
The Right ◽  
Low Dose Heparin

ABSTRACTCentral venous catheter (CVC) insertion is extensively utilized in Intensive Care Units for evaluation of hemodynamic status, administration of intravenous drugs, and for providing nutritional support in critically ill patients. Unfortunately, CVC use is associated with complications including lung injury, bleeding, infection, and thrombosis. We present a patient with an acute ischemic stroke from an inadvertently placed CVC into the right common carotid artery. A 57-year-old male presented to our institution for left hemiplegia and seizures 2 days after a CVC was placed. He was found to have a right frontal ischemic stroke on computed tomography (CT). CT angiography noted that the catheter was arterial and had a thrombosis around it. He was started on a low-dose heparin infusion. A combination of cardiothoracic surgery and interventional cardiology was required to safely remove the catheter. Central arterial catheterization is an unusual cause for acute ischemic stroke and presents management challenges.

scholarly journals Intraarterial Thrombolysis with r-tPA for Treatment of Anterior Circulation Acute Ischemic Stroke

2003 ◽  
Vol 9 (3) ◽  
pp. 273-282
Author(s):  
F. Baltacioğlu ◽  
N. Afşar ◽  
G. Ekinci ◽  
N. Tuncer-Elmaci ◽  
N Çagatay Çimşit ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Recombinant Tissue Plasminogen Activator ◽  
Neurological Status ◽  
Treatment Modalities ◽  
Anterior Circulation ◽  
Main Trunk ◽  
History Of ◽  
The Right

To investigate factors effecting the safety and recanalization efficacy of local intraarterial (IA) recombinant tissue plasminogen activator (r-tPA) delivery in patients with acute ischemic stroke. Eleven patients with anterior circulation acute ischemic stroke were treated. The neurological status of the patients were graded with the Glasgow Coma Scale (GCS) and National Institute of Health Stroke Scale (NIHSS). All patients underwent a computed tomography (CT) examination at admission. In addition four patients had diffusion-weighted and one patient had a perfusion magnetic resonance (MR) examinations. Patients were treated within six hours from stroke onset. Immediate, six hours, and 24 hours follow-up CT examinations were performed in order to evaluate the haemorrhagic complications and the extent of the ischemic area. The Rankin Scale (RS) was used as an outcome measure. Two of the 11 patients had carotid “T” occlusion (CTO), nine had middle cerebral artery (MCA) main trunk occlusion. Four patients had symptomatic haemorrhage with a large haematoma rupturing into the ventricles and subarachnoid space. Of these, three patients died within 24 hours. The remaining seven patients had asymptomatic haematomas that were smaller compared to symptomatic ones, and showed regression in size and density on follow-up CTs. At third month five patients had a good outcome and three patients had a poor outcome. In acute ischemic stroke, local IA thrombolysis is a feasible treatment when you select the right patient. Haemorrhage rate does not seem to exceed that occuring in the natural history of the disease and in other treatment modalities.

scholarly journals Pediatric Acute Ischemic Stroke by Age-Group: A Systematic Review and Meta-Analysis of Published Studies and Hospitalization Records

2021 ◽  
pp. 1-11
Author(s):  
Denise M. Oleske ◽  
Xianbin Cheng ◽  
Anna Jeong ◽  
Thomas J. Arndt
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Incidence Rate ◽  
Pediatric Population ◽  
Meta Analysis ◽  
Geographic Region ◽  
Incidence Rates ◽  
Childhood Development ◽  
Age Group ◽  
Specific Data

<b><i>Background:</i></b> Although stroke is rare among the pediatric population, it is nevertheless associated with serious or life-threatening consequences. The etiologic factors of acute ischemic stroke (AIS) are likely to vary over the course of childhood development. The incidence rates of AIS, not previously systematically examined by pediatric age subgroup, could guide studies of its etiology. <b><i>Objective:</i></b> The aim of this study is to evaluate the incidence rate of AIS by age-group in the pediatric population (aged 0–17/18 years) and identify any common trends or sources of variability across different countries. <b><i>Methods:</i></b> Rates of pediatric AIS were collated from a systematic literature review of published studies globally (1983–2020) and hospitalization records from Europe and the USA (2015–2018). Records that were included in the analysis reported the code or description used for AIS diagnosis and age-specific data for children aged 0–17/18 years. AIS incidence rates were summarized by age-group, data source, country, and geographic region. A meta-analysis was conducted to assess the heterogeneity of AIS rates in neonates. <b><i>Results:</i></b> The pooled AIS incidence rate was 5.6 per 100,000 children across all records. When only records reporting the AIS incidence rates for children across the full age range (0–17/18 years) were analyzed, the pooled AIS incidence rate was 4.6 per 100,000 children and ranged from 7.0 per 100,000 (Germany) to 1.3 per 100,000 (Denmark). The highest pooled rates were observed in the 0–28-day age-group (24.6 per 100,000 live births), declining to the lowest rates in the 5–9-year age-group, and rising again in the 10–17/18-year age-group. AIS rates were the most heterogeneous in the 0–28-day age-group and across European countries. Significantly higher AIS rates in neonates were observed from hospital databases (35.9 per 100,000) than in the literature (19.4 per 100,000). AIS rates may be underestimated as pediatric AIS events are rare and challenging to diagnose, and limited age-specific data are available. <b><i>Conclusions:</i></b> Incidence rates of pediatric AIS by age-groups followed a consistent overall pattern of a reverse J-shaped curve, with the highest rates in neonates, across predominantly European and North American countries. Further research is warranted to examine if this pattern is observed in other geographic regions and to identify AIS risk factors specific to different phases of childhood development.

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