Acute Ischemic Stroke in a Young Child and Its Association with SARS-CoV-2 Infection

2021 ◽  
Author(s):  
Nivya Shree ◽  
Anitha Kommalur ◽  
Lakshmi M. ◽  
Mallesh Kariyappa ◽  
Sahana Devadas ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Neurological Complications ◽  
Deficiency Anemia ◽  
Nasopharyngeal Swab ◽  
Left Middle Cerebral Artery ◽  
Rt Pcr ◽  
Cerebrovascular Complications ◽  
Acute Infarct ◽  
Stroke In The Young

AbstractThe coronavirus disease 2019 (COVID-19) in children has been shown to have lower morbidity and mortality in children as compared with adults. The neurological complications related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are increasingly reported in children, yet the cerebrovascular complications are rare. We report a case of a toddler who presented with right-sided hemiparesis and motor aphasia, with an antecedent history suggestive of COVID-19 infection. The child tested negative on the nasopharyngeal swab for real-time reverse transcription-polymerase chain reaction (RT-PCR), but the serology for anti-SARS-CoV-2 IgG assay was positive. The neuroimaging showed an acute infarct in the left middle cerebral artery territory. A detailed evaluation for causes of childhood stroke was unrevealing, except for the presence of severe iron deficiency anemia (IDA). The child was diagnosed as acute ischemic stroke (AIS) most probably secondary to mild COVID-19 infection. The objective of this case report is to explain the possibility of AIS after a mild COVID-19 infection, complicated by the underlying severe IDA. Therefore, an association between COVID-19 and stroke in children needs to be emphasized and RT-PCR for SARS-CoV-2 as well as serological assay must be included in the workup of stroke in the young.

scholarly journals Healthcare Worker With Large Vessel Acute Ischemic Stroke Likely Related to Mild SARS-CoV-2 Infection

2020 ◽  
pp. 194187442096684
Author(s):  
Carlos Castillo-Pinto ◽  
Guillaume Lamotte ◽  
Amit Mehta ◽  
Rajiv Sonti ◽  
Gianluca Di Maria ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Healthcare Worker ◽  
Ct Perfusion ◽  
Glycosylated Hemoglobin ◽  
Large Vessel ◽  
Closure Device ◽  
Nasopharyngeal Swab ◽  
Left Middle Cerebral Artery ◽  
Stroke Work

We report the case of a healthcare worker who presented with a large vessel acute ischemic stroke in setting of a mild SARS-CoV-2 infection and provide a review of the emerging literature on COVID-related stroke. A 43-year-old female presented with right-sided hemiparesis, aphasia and dysarthria. She had a nonproductive of cough for 1 week without fever, fatigue or dyspnea. A CT Head, CT angiography and CT perfusion imaging revealed a M1 segment occlusion of the left middle cerebral artery requiring transfer from a primary to a comprehensive stroke center. A nasopharyngeal swab confirmed SARS-CoV-2 infection prior to arrival at the accepting center. During the thrombectomy a 3 cm thrombus was removed. Thrombus was also evident in the 8 French short sheath during closure device placement so a hypercoagulable state was suspected. Stroke work-up revealed a glycosylated hemoglobin of 8.7%, elevation of inflammatory markers and an indeterminate level of lupus anticoagulant IgM. On discharge home, she had near complete neurological recovery. This case highlights suspected mechanisms of hypercoagulability in SARS-CoV-2 infection and the importance of optimizing stroke care systems during the COVID-19 pandemic.

A CASE OF INFECTIVE ENDOCARDITIS COMPLICATED BY ACUTE ISCHEMIC STROKE

2021 ◽  
pp. 1-2
Author(s):  
Aneri Patel ◽  
Nirmit Patel
Keyword(s):  
Ischemic Stroke ◽  
Infective Endocarditis ◽  
Acute Ischemic Stroke ◽  
Brain Mri ◽  
Endothelial Lining ◽  
High Grade Fever ◽  
Cerebrovascular Complications ◽  
Septic Embolization ◽  
Acute Infarct ◽  
Mitral Area

Infective endocarditis is an infectious and inammatory process involving endothelial lining of heart structures and valves. Cerebrovascular complications (CVCs) frequently occur in patients who are in the active stage of infective endocarditis (IE), and result from cerebral septic embolization of an endocardial vegetation. Acute stroke due to septic emboli is a particularly dreaded complication , with a frequency of 25-35%. Here we present a case of 32 year old male patient, who comes to the ER with high grade fever and palpitations since 9 days. On examination we found hyperdynamic impulse with decrescendo type systolic murmur at mitral area and we decided to do a blood workup and also requested a 2D ECHO. Blood culture and 2D ECHO showed different species of streptococci and mitral regurgitation respectively. Based on the investigations we started the patient on antibiotics, However, on the day 7 of treatment, patient developed slurring of speech and hemiparesis followed by motor aphasia. We sent the patient for brain MRI that showed acute infarct in left central semioval, left corona radiata and left perisylvian region. Acute ischemic stroke is the complication of the infective endocarditis and we started tpAalong with intravenous antibiotics after which he experienced signicant clinical improvement in few days.

Bivalirudin for Endovascular Intervention in Acute Ischemic Stroke: Case Report

Neurosurgery ◽  
2004 ◽  
Vol 54 (1) ◽  
pp. 218-223 ◽  
Author(s):  
Mark R. Harrigan ◽  
Elad I. Levy ◽  
Bernard R. Bendok ◽  
L. Nelson Hopkins
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Scale Score ◽  
Intracranial Hemorrhage ◽  
National Institutes Of Health ◽  
Left Middle Cerebral Artery ◽  
Computed Tomographic ◽  
Left Middle ◽  
Arterial Thrombolysis

Abstract OBJECTIVE AND IMPORTANCE Intra-arterial thrombolysis has been demonstrated to improve recanalization and outcomes among patients with acute ischemic stroke. However, thrombolytic agents have limited effectiveness and are associated with a significant risk of bleeding. Bivalirudin is a direct thrombin inhibitor that has been demonstrated in the cardiology literature to have a more favorable efficacy and bleeding profile than other antithrombotic medications. We report the use of bivalirudin during endovascular treatment of acute stroke, when hemorrhagic complications are not uncommon. CLINICAL PRESENTATION A 71-year-old woman with atrial fibrillation presented with right hemiparesis and aphasia and was found to have a National Institutes of Health Stroke Scale score of 10. Computed tomographic scans revealed no evidence of intracranial hemorrhage, aneurysm, or ischemic stroke. Cerebral angiography revealed thromboembolic occlusion of the superior division of the left middle cerebral artery. INTERVENTION For anticoagulation, a loading dose of bivalirudin was intravenously administered before the interventional procedure, followed by continuous infusion. Attempts to remove the clot with an endovascular snare failed to induce recanalization of the vessel. Bivalirudin was then administered intra-arterially. Immediate postprocedural angiography demonstrated restoration of flow in the left middle cerebral artery. Repeat computed tomographic scans demonstrated no intracranial hemorrhage. The patient's hemiparesis and aphasia were nearly resolved and her National Institutes of Health Stroke Scale score was 2 at the time of her discharge 5 days later. CONCLUSION To our knowledge, this is the first report of the use of bivalirudin for treatment of acute ischemic stroke. Bivalirudin may be a useful agent for intravenous anticoagulation and intra-arterial thrombolysis in this setting.

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.

What is the impact of head movement on automated CT perfusion mismatch evaluation in acute ischemic stroke?

2021 ◽  
pp. neurintsurg-2021-017510
Author(s):  
Arne Potreck ◽  
Fatih Seker ◽  
Matthias Anthony Mutke ◽  
Charlotte Sabine Weyland ◽  
Christian Herweh ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Head Movement ◽  
Ct Perfusion ◽  
Treatment Decision ◽  
Brain Perfusion ◽  
Left Middle Cerebral Artery ◽  
Ct Scanner ◽  
Infarct Core ◽  
The Impact

ObjectivesAutomated CT perfusion mismatch assessment is an established treatment decision tool in acute ischemic stroke. However, the reliability of this method in patients with head motion is unclear. We therefore sought to evaluate the influence of head movement on automated CT perfusion mismatch evaluation.MethodsUsing a realistic CT brain-perfusion-phantom, 7 perfusion mismatch scenarios were simulated within the left middle cerebral artery territory. Real CT noise and artificial head movement were added. Thereafter, ischemic core, penumbra volumes and mismatch ratios were evaluated using an automated mismatch analysis software (RAPID, iSchemaView) and compared with ground truth simulated values.ResultsWhile CT scanner noise alone had only a minor impact on mismatch evaluation, a tendency towards smaller infarct core estimates (mean difference of −5.3 (−14 to 3.5) mL for subtle head movement and −7.0 (−14.7 to 0.7) mL for strong head movement), larger penumbral estimates (+9.9 (−25 to 44) mL and +35 (−14 to 85) mL, respectively) and consequently larger mismatch ratios (+0.8 (−1.5 to 3.0) for subtle head movement and +1.9 (−1.3 to 5.1) for strong head movement) were noted in dependence of patient head movement.ConclusionsMotion during CT perfusion acquisition influences automated mismatch evaluation. Potentially treatment-relevant changes in mismatch classifications in dependence of head movement were observed and occurred in favor of mechanical thrombectomy.

Association of Iron Deficiency Anemia with Stroke Severity in patients with Acute Ischemic Stroke

2021 ◽  
Vol 15 (11) ◽  
pp. 3004-3006
Author(s):  
Rabia Rathore ◽  
Nasir Farooq Butt ◽  
Adil Iqbal ◽  
Hina Latif ◽  
Mariam Azeem ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Iron Deficiency ◽  
Acute Ischemic Stroke ◽  
Iron Deficiency Anemia ◽  
Descriptive Study ◽  
World Health ◽  
Deficiency Anemia ◽  
P Value ◽  
Stroke Severity ◽  
Cross Sectional

Aim: To study the relationship of Iron Deficiency anemia (IDA) with severity of acute ischemic stroke. Study Design: A cross-sectional descriptive study. Place & Duration of Study: Department of Medicine, Mayo Hospital, Lahore from March 2020 to February 2021 Methods: A descriptive study of cross-sectional type was done on 200 individuals who had acute ischemic stroke (AIS) and were hospitalized at Mayo Hospital Lahore. Consecutive non-probability convenience sampling method was used to gather the data. Severity of stroke was assessed at the time of admission using the National Institute of Health Stroke Scale, (NIHSS) at the same time blood complete examination along with peripheral blood film was done to diagnose anemia in these patients. Iron studies were done to diagnose iron deficiency anemia (IDA). P-value less than 0.05 was taken as significant. Results: About 200individuals presenting with AIS were enrolled in the research work. Anemia according to World Health Organization was seen in 80(40%) and was not present in 120(60%) patients. Among the subjects who had anemia, 16(20%) had a minor AIS, 23(28.75%) had a moderately severe AIS, and 41(51.25%) reported with a severe AIS, according to NIHSS criteria. A notable relationship was found to exist between anemia and stroke severity, (P-value 0.000). Conclusion: Anemia was a commonly found in individuals with acute stroke due to ischemia and had direct relation with severity of stroke. Keywords: Iron deficiency Anemia, severity, ischemic stroke.

scholarly journals An acute ischemic stroke after multiple bee stings in an elderly patient

2013 ◽  
Vol 4 (2) ◽  
pp. 55-58
Author(s):  
Niranjan Mambally Rachaiah ◽  
Rajashekar Hirisave Kalegowda ◽  
Rashmi Bhadravathy Krishnaswamy
Keyword(s):  
Computed Tomography ◽  
Elderly Patient ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Neurological Complications ◽  
Neurologic Deficit ◽  
Allergic Reactions ◽  
Medical Sciences ◽  
Wasp Stings ◽  
Focal Neurologic Deficit

Although bee stings can cause local and systemic allergic reactions, neurological complications are rare. There are few reports of stroke following bee or wasp stings. We report a 70-year-old healthy man developed a focal neurologic deficit 5 hours after multiple bee stings, which was confirmed to be an acute ischemic stroke on computed tomography (CT) scan.DOI: http://dx.doi.org/10.3126/ajms.v4i2.7892Asian Journal of Medical Sciences 4(2013) 55-58

scholarly journals A Case of Acute Ischemic Stroke Associated with Hookworm Anemia.

2021 ◽  
Author(s):  
Jiang-qiong Ke ◽  
Huicong Huang ◽  
Guangyao Zhou ◽  
Yan Li ◽  
Shengmin Shao ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Ischemic Stroke ◽  
Iron Deficiency ◽  
Cerebral Infarction ◽  
Acute Ischemic Stroke ◽  
Iron Deficiency Anemia ◽  
Deficiency Anemia ◽  
Cerebral Stroke ◽  
Parasitic Diseases ◽  
Normal Brain

Abstract Background: Hookworm disease discovered in a patient presenting with cerebral infarction due to severe iron-deficiency anemia and confirmed by gastroduodenoscopy has not been reported especially with negative stool routine. Case presentation: We report a male patient who presented himself to us with acute cerebral stroke verified as hookworm disease. Routine laboratory tests revealed low Hemoglobin (Hb) concentration but stool routine and occult blood test were normal. Brain magnetic resonance imaging (MRI) showed left-sided parietal-occipital lobe and centrum semiovale (“watershed”) infarction verified the diagnosis of acute ischemic stroke. Bone marrow aspiration showed proliferative bone marrow image with obvious red system hyperplasia. Gastroduodenoscopy discovered adult hematophagic hookworms in the bulb and descending part of duodenum of the patient. A series of conservative drug treatment was initiated and the patient was subsequently treated with albendazole after the gastroduodenoscopy. Twenty-five days later, the patient's physical function improved gradually and he was discharged without neurological deficit. Conclusion: Hookworm disease could be manifest in acute ischemic stroke. It was concluded that patients with severe iron-deficiency anemia should also be examined for rare intestinal parasitic diseases. Screening for these intestinal parasitic diseases in patients presenting with cerebral infarction and anemia could effectively avoid misdiagnosis and make increase the efficacy of treatment.

scholarly journals 655: A CASE OF ACUTE ISCHEMIC STROKE IN A TODDLER WITH SEVERE IRON DEFICIENCY ANEMIA

2021 ◽  
Vol 50 (1) ◽  
pp. 320-320
Author(s):  
Yezan Abderrahman ◽  
Niranjan Vijayakumar ◽  
Aditya Badheka ◽  
Madhuradhar Chegondi
Keyword(s):  
Ischemic Stroke ◽  
Iron Deficiency ◽  
Acute Ischemic Stroke ◽  
Iron Deficiency Anemia ◽  
Deficiency Anemia

scholarly journals Management of infective endocarditis in patients with post-stroke brain damages

2019 ◽  
pp. 84-96
Author(s):  
V. V. Fedko ◽  
S. P. Spysarenko ◽  
T. O. Malysheva ◽  
D. V. Pochynock
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Ischemic Stroke ◽  
Cardiopulmonary Bypass ◽  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Neurological Impairment ◽  
Neurological Complications ◽  
Cerebrovascular Complications ◽  
Management Protocol

This study evaluated the effectiveness of anesthesiological management in sur-gical treatment of infective endocarditis with cerebrovascular complications. The aim of the study was to decrease neurological complications and hospital mortality after surgical inter-ventions with the use of cardiopulmonary bypass in patients with infective endocarditis. The main preoperative risk factors of endocardit-associated cerebrovascular complications, which influenced the immediate results of cardiac surgery were: sepsis, systemic inflammatory response, disorders of systemic hemodynamics, high risk of recurrent cerebrovascular events, anemia and carbohydrate disorders. New anesthesiological management protocol was de-veloped and improved. Intraoperative risk factors for hospital mortality were associated with: total protein at the end of surgery less than 49 g/l; maximum blood glucose during surgery more than 10.7 mmol/l; anemia and hemodilution – hemoglobin level less than 58.8 g/l in the period of complete bypass and less than 79.4 g/l at the end of the surgery; positive water balance at the end of the operation. Determination of preoperative blood S100? protein level may be recommended to determine the prognosis of postoperative neurological complications, since the level above 0.13 µg/l was associated with postoperative neurological impairment. The implemented changes in the anesthetic management permitted to decrease neuro-logical complication rate from 22.2% to 9.6% and thirty-day mortality from 19.0% to 2.7% after surgical treatment of infective endocarditis with the use of cardiopulmonary bypass in patients with cerebrovascular complications. In order to achieve maximum effectiveness of anesthesiological management and to re-duce the level of postoperative neurological complications the optimal timing for surgery was 2–3 days after development of cerebrovascular impairment. In case of ischemic stroke in the most acute phase of the course (the first 72 hours), emergency cardiac surgery was advisable (except the cases of brain coma or total volume of myocardial infarction exceeding 31.5 cm3). In the case of ischemic stroke, more than 72 hours after the onset, and in the absence of progression of acute heart failure, the recommended timing for cardiac surgery was 4 weeks after the manifestation of cerebrovascular impairment. In the case of hemorrhagic or mixed type of neurological impairment, cardiac surgery was postponed for 1.4–2 months (since the development of the stroke).

Sign in / Sign up

Export Citation Format

Share Document