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.

TRANSCORTICAL SENSORY APHASIA AS A MANIFESTATION OF ISCHEMIC STROKE WITH INTRACARDIAC THROMBUS

2021 ◽  
pp. 86-86
Author(s):  
Aziz Ahizoune ◽  
Ahmed Bourazza
Keyword(s):  
Language Impairment ◽  
Brain Mri ◽  
Semantic Knowledge ◽  
Sudden Onset ◽  
Left Middle Cerebral Artery ◽  
Intracardiac Thrombus ◽  
Auditory Comprehension ◽  
Sensory Aphasia ◽  
History Of ◽  
Left Middle

Transcortical sensory aphasia is characterized by impaired auditory comprehension, with intact repetition and uent speech. A 44-year-old right-handed patient with a history of hypertension on amlodipine and ischemic heart disease on aspirin was admitted to the neurology department for sudden onset of language impairment that started 2 days ago. The patient had features of transcortical sensory aphasia. Brain MRI showed an infarct in the territory of the left middle cerebral artery involving the tempo-parietal region. An apical thrombus was observed in the left ventricle on transthoracic echocardiography. This language impairment is thought to be caused by a disconnection between sensory language processes and semantic knowledge of objects. The prognosis is generally guarded and depends on the etiology and severity of the presentation

Conus Perimedullary Arteriovenous Fistula with Intracranial Drainage: Case Report

Neurosurgery ◽  
2001 ◽  
Vol 49 (2) ◽  
pp. 457-462 ◽  
Author(s):  
G. Edward Vates ◽  
Alfredo Quiñones-Hinojosa ◽  
Van V. Halbach ◽  
Michael T. Lawton
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Artery Aneurysm ◽  
Venous Drainage ◽  
Sudden Onset ◽  
Clinical Findings ◽  
Left Middle Cerebral Artery ◽  
Lower Extremity Weakness ◽  
Posterior Laminectomy ◽  
Cerebral Artery Aneurysm ◽  
Left Middle

Abstract OBJECTIVE AND IMPORTANCE Perimedullary arteriovenous fistulae (AVFs) do not commonly present with subarachnoid hemorrhage or intracranial venous drainage causing neurological symptoms. We present a case with both of these features. The patient was inadvertently treated for an unruptured intracranial aneurysm before his true problem was recognized. CLINICAL PRESENTATION A 65-year-old man presented with sudden-onset lower-extremity weakness, diplopia, nausea, and dysarthria on the day of admission. A lumbar puncture documented subarachnoid hemorrhage, and imaging studies revealed a left middle cerebral artery aneurysm. It was noted during surgery that this aneurysm was unruptured, and the patient did not exhibit improvement after surgery. INTERVENTION Spinal angiography demonstrated a spinal perimedullary AVF feeding from the left T12 radicular artery; venous drainage extended rostrally into the posterior fossa venous system. The AVF was surgically occluded via a posterior laminectomy at the level of the AVF. After surgery, the patient's symptoms began to abate. CONCLUSION Conus perimedullary AVFs can have venous drainage that extends as far as intracranial veins, which can lead to confusing clinical findings because the symptoms may suggest an intracranial process, although the lesion is in the spine. Surgeons must be aware of this confusing presentation.

Catecholamine content of cerebral tissue after occlusion or manipulation of middle cerebral artery in cats

1975 ◽  
Vol 43 (1) ◽  
pp. 32-36 ◽  
Author(s):  
Harold P. Cohen ◽  
Arthur G. Waltz ◽  
Ronald L. Jacobson
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Neurological Deficits ◽  
Left Middle Cerebral Artery ◽  
Cerebral Infarcts ◽  
Cerebral Tissue ◽  
Vasoactive Agents ◽  
Content Type ◽  
Catecholamine Content ◽  
Left Middle

✓ The authors determined by fluorimetry the norepinephrine-epinephrine content (NE-E) of cerebral tissue from 38 cats, to ascertain whether constriction of hypersensitive arterial vessels by vasoactive agents in ischemic cerebral tissue could cause extension of cerebral infarcts and worsening of neurological deficits. Twenty-three cats had the left middle cerebral artery (MCA) occluded transorbitally, and 10 cats had sham operations. Five cats had only the surgical procedures necessary for obtaining tissue; mean NE-E content was 0.30 µg/gm (SD = 0.041). For the other 33 cats, including those with sham operations, values were variable, ranging from 0.07 to 0.60 µg/gm. Low values usually were obtained for ischemic hemispheres 24 hours and 7 days after MCA occlusion, but at other times values could be high or low on either side. Many factors unrelated to tissue damage, including arterial manipulation, influence the catecholamine content of cerebral tissue.

scholarly journals Triggered by Covid-19? Large Vascular Occlusion Resulting in Cytokine Storm Syndrome and Kounis Syndrome: A Case Report

2021 ◽  
Vol 2 (1) ◽  
pp. 030-033
Keyword(s):  
Vascular Occlusion ◽  
Left Middle Cerebral Artery ◽  
Cytokine Storm ◽  
Kounis Syndrome ◽  
Vessel Occlusion ◽  
Middle Cerebral Artery Infarction ◽  
Increased Risk ◽  
Thorax Ct ◽  
The Brain ◽  
Left Middle

It has been widely reported that infections caused by coronaviruses, especially SARS-CoV-2 (Covid-19), can result in cytokine storm syndrome, one of the causes of acute cerebrovascular disease and ‘kounis syndrome’. An 87-year-old male patient, who did not have any chronic diseases apart from hypertensions, was admitted to our emergency department with mental fog and right-sided weakness in the absence of the typical symptoms of Covid-19 (such as fever, cough). In addition to evidence of left middle cerebral artery infarction in Computerized Tomography (CT) of the brain, there were infiltrative findings compatible with Covid-19 in thorax CT. Here, we discuss this case in the light of the literature, assuming that inflammation (cytokine storm) and hypercoagulopathy induced by Covid-19 may have presented with large vessel occlusion and kounis syndrome as a result of increased risk of arterial thrombosis.

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 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 Herpes Simplex Viral Encephalitis Masquerading as a Classic Left MCA Stroke

2015 ◽  
Vol 2015 ◽  
pp. 1-5
Author(s):  
Peter A. Abdelmalik ◽  
Timothy Ambrose ◽  
Rodney Bell
Keyword(s):  
Herpes Simplex ◽  
Viral Encephalitis ◽  
Ct Perfusion ◽  
Altered Mental Status ◽  
Acute Onset ◽  
Left Middle Cerebral Artery ◽  
Vessel Occlusion ◽  
Epileptiform Discharges ◽  
Ct Angiogram ◽  
Show Evidence

Objective. Stroke is a clinical diagnosis, with a history and physical examination significant for acute onset focal neurological symptoms and signs, often occurring in patients with known vascular risk factors and is frequently confirmed radiographically.Case Report. A 79-year-old right-handed woman, with a past medical history of hypertension, hyperlipidemia, and prior transient ischemic attack (TIA), presented with acute onset global aphasia and right hemiparesis, in the absence of fever or prodrome. This was initially diagnosed as a proximal left middle cerebral artery (MCA) stroke. However, CT perfusion failed to show evidence of reduced blood volume, and CT angiogram did not show evidence of a proximal vessel occlusion. Furthermore, MRI brain did not demonstrate any areas of restricted diffusion. EEG demonstrated left temporal periodic lateralized epileptiform discharges (PLEDs). The patient was empirically loaded with a bolus valproic acid and started on acyclovir, both intravenously. CSF examination demonstrated a pleocytosis and PCR confirmed the diagnosis of herpes simplex viral encephalitis (HSVE).Conclusions. HSVE classically presents in a nonspecific fashion with fever, headache, and altered mental status. However, acute focal neurological signs, mimicking stroke, are possible. A high degree of suspicion is required to institute appropriate therapy and decrease morbidity and mortality associated with HSVE.

scholarly journals Meningioma: An Important Stroke Mimic

2021 ◽  
pp. 47
Author(s):  
Seng Wee Cheo ◽  
Tee Tat Khoo ◽  
Qin Jian Low ◽  
Yuen Kang Chia
Keyword(s):  
Facial Asymmetry ◽  
Clinical Problem ◽  
Haemorrhagic Stroke ◽  
Sudden Onset ◽  
Left Middle Cerebral Artery ◽  
Large Artery ◽  
Vessel Occlusion ◽  
Stroke Mimics ◽  
Stroke Mimic ◽  
Toast Classification

Rapid Stroke is a common clinical problem. Stroke can be broadly divided into ischaemic and haemorrhagic stroke. Ischaemic stroke can be further classified by TOAST classification into large-artery atherosclerosis, cardioembolism, small vessel occlusion, the stroke of other determined aetiology and stroke of undetermined aetiology. Importantly, we need to be wary of important stroke mimics such as brain tumour, demyelination, intoxication as they can lead to changes in clinical management. Here, we would like to illustrate a case of meningioma which clinically mimics a stroke. This patient is a 78-year-old lady who initially presented with sudden onset right-sided body weakness associated with slurred speech and facial asymmetry. An urgent plain computed tomography (CT) of the brain showed hypodensities at the left middle cerebral artery territory. However, re-evaluation noted her to have a normal Glasgow Coma Scale without any cortical signs, cerebellar sign or dysphasia. In view of these, stroke mimics was suspected. A contrasted CT brain was done which confirmed the diagnosis of meningioma. She was offered surgical intervention for meningioma but she was not keen on it. In conclusion, this case highlighted the importance of clinical evaluation in recognising stroke mimics.

Abstract 59: Extending the Time for Thombolysis in Emergency Neurological Deficits (EXTEND) - High Prevalence of Intracranial Vessel Occlusion in Wake-up-stroke Patients

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Henry Ma ◽  
Bruce C Campbell ◽  
Mark W Parsons ◽  
Christopher Levi ◽  
Atte Meretoja ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cerebral Artery ◽  
Stroke Onset ◽  
Phase Iii ◽  
Neurological Deficits ◽  
Lesion Volume ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Intracranial Vessel ◽  
Ct Angiogram

Background: EXTEND is an investigator-initiated, randomised, double-blind and placebo-controlled Phase III trial of intravenous alteplase vs placebo in patients with ischemic stroke 4.5-9 hours from stroke onset or wake-up-stroke (WUS). The prevalence of intra-cranial vessel occlusion in WUS patients remains to be determined and can guide the development of optimal therapy for this unique group of stroke patients. Objective: To study the prevalence and characteristics of intra-cranial vessel occlusion in this WUS cohort. Methods: Ischemic stroke patients within 4.5-9 hours from stroke onset or with WUS (time of WUS onset defined as the midpoint between time to sleep and awakening with the stroke symptoms) are eligible for enrollment. Criteria for entry into the trial include perfusion-diffusion mismatch using a perfusion threshold of Tmax>6sec and a perfusion:diffusion lesion volume ratio of >1.2. Diffusion lesion volume must be <70mL based on assessment by automated RAPID software. Intra-cranial vessel occlusion was assessed on MR or CT angiogram performed at randomisation and 24 later. Two expert readers assessed these images independently. Results: 97 patients had images with adequate quality, including 63 (65%) in the WUS group with median age of 77.0 yrs (IQR 67.0, 81.0) and NIHSS of 14.0 (9.0, 19.0). 62 of 63 patients (98%) had vessel occlusion with 44.4% involving M1 of the middle cerebral artery, 17.5% M2, 4.8% M3, 25.4% both internal carotid artery (ICA) and M1, 4.8% ICA alone and 3.1% the posterior cerebral artery. The median ischemic core volume was 15.0 ml (6.5, 31.5), Tmax>6 volume 88.5ml (58.0, 122.0), mismatch volume 65.5ml (42.8, 92.0), and ratio of 4.8 (2.5, 8.7). 19 patients (30%) demonstrated recanalization on follow-up imaging. Conclusion: In WUS patients there is a very high rate of intracranial vessel occlusion with relatively large volumes of salvageable penumbral tissue. Intravenous thrombolytic therapy followed by thrombectomy in selected cases may be an appropriate therapeutic option with safety and efficacy remaining to be established in randomized controlled trials.

Sign in / Sign up

Export Citation Format

Share Document