Young-onset stroke complicating ulcerative colitis

2022 ◽  
pp. practneurol-2021-003106
Author(s):  
Su Yin Lim ◽  
Mohamed Sayed ◽  
Soma Banerjee ◽  
Neil Rane ◽  
Dheeraj Kalladka
Keyword(s):  
Ulcerative Colitis ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Low Molecular Weight ◽  
Arterial Segment ◽  
Heparin Infusion ◽  
Intravenous Heparin ◽  
Inflammatory Bowel ◽  
The Right ◽  
Proximal Occlusion

A 16-year-old girl developed a proximal occlusion of the right middle cerebral artery during a flare-up of acute ulcerative colitis. Although mechanical thrombectomy led to successful middle cerebral artery recanalisation, she required an immediate second thrombectomy due to reocclusion of the same arterial segment. She developed a second ischaemic event 7 days later despite intravenous heparin infusion, later switched to low-molecular-weight heparin, and a third event after 3 days despite the addition of aspirin. We discuss stroke risks in people with inflammatory bowel disease and the uncertainties around anticoagulation and antiplatelet regimens in such cases.

Republished: Successful treatment of ruptured multiple fusiform middle cerebral artery aneurysms with silk vista baby flow diverter in a 10-months-old infant

2021 ◽  
pp. neurintsurg-2021-017554.rep
Author(s):  
Giovanni Barchetti ◽  
Loris Di Clemente ◽  
Mauro Mazzetto ◽  
Mariano Zanusso ◽  
Paola Ferrarese ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Successful Treatment ◽  
Expectant Management ◽  
Flow Diverter ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Microsurgical Clipping ◽  
Parent Artery Occlusion ◽  
The Right

We report the successful treatment of multiple ruptured fusiform middle cerebral artery (MCA) aneurysms in a 10-month-old girl. This previously healthy infant presented with subarachnoid haemorrhage and was found to have multiple irregular dilatations of the superior division branch of the right MCA. Cerebral angiography was performed and confirmed the presence of multiple fusiform aneurysms of the MCA. After multidisciplinary team discussion, it was decided to treat the aneurysms with endovascular approach, using a flow-diverter. Microsurgical clipping was deemed risky because of the high likelihood of parent artery occlusion and expectant management was also considered inappropriate because of the risk of re-bleeding. Dual antiplatelet therapy was started, and a flow-diverter was successfully delivered in the superior division branch of the right MCA. The post-operative course was uneventful, MRI at 12 months did not show any sign of recurrence and at 3 years of age the patient had a normal neurological examination.

scholarly journals Effect of heparin on recanalization in acute stroke patients with intra-arterial thrombi

2015 ◽  
Vol 7 (2) ◽  
Author(s):  
Bijal K. Mehta ◽  
Haris Kamal ◽  
Aaron McMurtray ◽  
Mohammed Shafie ◽  
Ping Li
Keyword(s):  
Acute Stroke ◽  
Cerebral Artery ◽  
Demographic Data ◽  
Patient Characteristics ◽  
Stroke Patients ◽  
Intraluminal Thrombus ◽  
Heparin Infusion ◽  
Intravenous Heparin ◽  
Stroke Center ◽  
Infusion Protocol

Anticoagulant use, such as heparin, is usually contraindicated in acute stroke patients. We present a study of patients, who were treated with intravenous heparin after a stroke that were also found to have an intraluminal thrombus. Prior studies imply that recanalization is achieved with heparin; however heparin should only prevent thrombus propagation. Therefore it is unclear whether and how IV heparin can achieve recanalization of intraluminal thrombi in acute stroke patients. A retrospective review of all acute stroke patients from a single stroke center who received a therapeutic IV heparin infusion from 5/2006 to 9/2011 were included in the study. We compared patients who had complete/partial recanalization and/or improved flow versus those that did not, with both these groups on a standard intravenous heparin infusion protocol. Demographic data was compared between the groups. Average partial thromboplastin time (PTT) during heparin infusion, time between computed tomography angiographies (CTAs), time from stroke onset to receiving IV heparin, and vessel occluded were also compared between groups. Forty-one patients (19 female, 22 male) were included in the study with a total of 55 vessels (either carotid, middle cerebral artery, anterior cerebral artery, posterior cerebral artery/posterior circulation) having intraluminal thrombi; 31 patients had 41 vessels with either partial or complete recanalization of effected vessels, while 10 patients had 14 vessels that did not have at least one vessel recanalize while on heparin. Using t-test we noted that the average PTT between the vessels that had partial/complete recanalization group (61.74) and non-recanalization group (66.30) was not statistical significantly different (P=0.37).The average time in days on heparin between vascular imaging studies (CTA/conventional angiogram) in the group of vessels with partial/complete recanalization (7.12 days) and the ones with no change (6.11 days) was not significantly different between the two groups (P=0.59). Patient’s vessels receiving heparin for &lt;24 hours <em>versus</em> those &gt;24 hours did not significantly differ either (P=0.17). This study compares patient characteristics associated with recanalization of intraluminal thrombi in acute stroke patients on heparin. Recanalization of intraluminal thrombi are not associated with average PTT or duration on heparin.

scholarly journals Ischemic Cardiomyopathy and Cerebral Infarction in a Young Patient Associated with Khat Chewing

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
T. J. Meulman ◽  
J. Bakker ◽  
E. J. van den Bos
Keyword(s):  
Cerebral Infarction ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Coronary Spasm ◽  
Systemic Hypertension ◽  
Vascular Territory ◽  
Khat Chewing ◽  
Enhanced Ct ◽  
Posterior Division ◽  
The Right

Khat is a stimulating agent used by many people in the Horn of Africa and the Arabian peninsula. Khat chewing is a known cardiovascular risk factor and is thought to cause vasoconstriction, systemic hypertension, and thrombogenicity. A 33-year-old Somalian man initially presented with loss of neurological function of the left arm, hazy vision, and headache. He smokes tobacco and chews two bundles of khat a week for more than 10 years. His ECG on admission showed a Q wave in V1 and V2 and 2 mm ST-elevations in V1, V2, and V3 and a terminal negative T wave in I, aVL, V2, V3, and V4, consistent with a recent, evolving anterior infarction. A noncontrast enhanced CT of the brain showed ischemia in the right middle cerebral artery vascular territory. An MRI showed recent ischemia in the vascular territory of the posterior division of the right middle cerebral artery. Coronary angiography showed a 70% stenosis with haziness of the proximal left anterior descending artery. Diagnostic tests and imaging are consistent with recent myocardial infarction in the LAD vascular territory because of coronary spasm and cerebral infarction in the middle cerebral artery vascular territory probably related to khat chewing.

Anastomosis of the anterior temporal artery to a secondary trunk of the middle cerebral artery for treatment of a giant M1 segment aneurysm

1992 ◽  
Vol 76 (5) ◽  
pp. 863-866 ◽  
Author(s):  
Joshua B. Bederson ◽  
Robert F. Spetzler
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Clinical Course ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Suture Line ◽  
Arterial Segment ◽  
Content Type ◽  
Proximal Middle Cerebral Artery

✓ The clinical course, operative technique, and angiographic outcome are reported for a patient with a giant intracranial aneurysm of the proximal middle cerebral artery (MCA) who presented with symptoms of ischemia. Treatment of the aneurysm required bypassing the involved MCA bifurcation, but the patient lacked a suitable donor superficial temporal artery. The involved arterial segment was therefore bypassed with a side-to-side anastomosis of the anterior temporal artery to one of the secondary trunks of the MCA. This bypass eliminated the need to harvest a vein graft and re-established flow using in situ intracranial vessels of similar diameter, minimal arterial dissection, and only one suture line.

scholarly journals Treatment of a Giant Aneurysm of the Right Middle Cerebral Artery with GDCs after Extracranial to Intracranial Bypass

1999 ◽  
Vol 5 (1) ◽  
pp. 51-56 ◽  
Author(s):  
E. Castro ◽  
F. Fortea ◽  
F. Villoria ◽  
L. Muñoz ◽  
C Benito ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Giant Aneurysm ◽  
Endovascular Procedure ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Balloon Test Occlusion ◽  
Parent Vessel Occlusion ◽  
Detachable Coils ◽  
The Right

A case of a giant aneurysm of the right middle cerebral artery treated with Guglielmi detachable coils is reported. Extracranial to intracranial bypass had previously been performed and surgical trapping had been attempted. During the endovascular procedure, balloon test occlusion of the middle cerebral artery was performed in order to demonstrate clinical and angiographic tolerance to parent vessel occlusion. A previous occlusion test in the right common carotid artery did not show sufficient flow through the bypass to perform safe parent vessel occlusion. Diagnostic imaging, the endovascular procedure, and haemodynamic aspects in cases in which parent vessel occlusion is required after extracranial-intracranial bypass are described and the literature is reviewed.

Republished: A case of right middle cerebral artery ‘tendonectomy’ following mitral valve replacement surgery

2017 ◽  
Vol 9 (9) ◽  
pp. e35-e35 ◽  
Author(s):  
Mary C Thomas ◽  
Josser E Delgado Almandoz ◽  
Adam J Todd ◽  
Mark L Young ◽  
Jennifer L Fease ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Middle Cerebral Artery ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Cerebral Artery ◽  
Mechanical Thrombectomy ◽  
Chordae Tendineae ◽  
Replacement Surgery ◽  
The Right ◽  
Valve Replacement Surgery

Following mechanical mitral valve replacement surgery, a 69-year-old woman had an ischemic stroke in the right middle cerebral artery territory. Mechanical thrombectomy showed the embolus to be a piece of chordae tendineae excised during the valve replacement surgery.

scholarly journals Excessive closure of the right eye: a new sign of infarction in the territory of the ipsilateral right middle cerebral artery.

1993 ◽  
Vol 56 (8) ◽  
pp. 894-896 ◽  
Author(s):  
S Ohkawa ◽  
A Yamadori ◽  
K Maeda ◽  
M Tabuchi ◽  
Y Ohsumi ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
The Right

Effect of One Week Treatment with Ginkgo biloba Extract (EGb761) on Ischemia-Induced Infarct Volume in Gerbils

2003 ◽  
Vol 31 (04) ◽  
pp. 533-542 ◽  
Author(s):  
Shu-Ying Chung ◽  
Ming-Fu Wang ◽  
Jing-Ying Lin ◽  
Ming-Cheng Lin ◽  
Hui-Ming Liu ◽  
...  
Keyword(s):  
Locomotor Activity ◽  
Cerebral Ischemia ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Ginkgo Biloba ◽  
Focal Cerebral Ischemia ◽  
Infarct Volume ◽  
Control Group ◽  
Tetrazolium Chloride ◽  
The Right

The present study was designed to evaluate the neuroprotective effects of Ginkgo biloba leaf extract (EGb761) in male gerbils subjected to focal cerebral ischemia produced by permanent occlusion of the right middle cerebral artery. In this study, gerbils were fed standard chow with or without EGb761 (100 mg/kg/day, i.g.) prior to cerebral ischemia for 1 week. Gerbils were anesthetized and craniectomized to expose the right middle cerebral artery (MCA). The right MCA was constricted with an 8-0 suture to produce a permanent ligation. Infarct volume was assessed by TTC (2,3,5-triphenyl-tetrazolium chloride) staining 24 hours after initiation of cerebral ischemia. Results showed that the EGb761 group had significant reduction of infarct volume 4 and 6 mm from the frontal pole by 40% and 30%, respectively when compared to the control group ( p < 0.05). Mean locomotor activity of gerbils was reduced 24 hours after the occlusion of the MCA in both groups. However, there was no difference in locomotor activity between groups either 30 minutes before or 24 hours after the occlusion ( p < 0.05).

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