scholarly journals Acute Ischaemic Stroke Successfully Treated with Thrombolytic Therapy and Endovascular Thrombectomy with Non-Contrast Computed Tomography and Computed Tomography Angiogram Protocol

2020 ◽  
Vol 12 (Suppl. 1) ◽  
pp. 15-21
Author(s):  
Tsun-Haw Toh ◽  
Khairul Azmi Abdul Kadir ◽  
Mei-Ling Sharon Tai ◽  
Kay Sin Tan
Keyword(s):  
Computed Tomography ◽  
Signs And Symptoms ◽  
Left Internal Carotid Artery ◽  
Left Middle Cerebral Artery ◽  
Endovascular Thrombectomy ◽  
Nihss Score ◽  
Ct Angiogram ◽  
Improved Outcomes ◽  
Computed Tomography Angiogram ◽  
Left Middle

Early endovascular thrombectomy leads to improved outcomes for patients with proximal occlusions when started within 6 h from onset of symptoms. We present a case illustrating the flow of events for a patient who underwent endovascular thrombectomy in our centre after conventional imaging – a brain non-contrast computed tomography (NCCT) and CT angiogram (CTA) – achieving a door-to-groin time of 195 min. The patient is a 65-year-old who presented with signs and symptoms of a left middle cerebral artery (MCA) territory infarct. His National Institute of Health Stroke Scale (NIHSS) score was 15 on presentation and his brain NCCT showed an Alberta Stroke Programme Early CT Score (ASPECTS) of 8. His CTA showed a left MCA distal M1 occlusion with focal calcification and stenosis of the proximal left internal carotid artery. He was subsequently thrombosed and underwent thrombectomy successfully, with a door-to-groin-puncture time of 195 min. A TICI 2b reperfusion was achieved. His NIHSS score improved to 9 over the next 2 days. For cases with straightforward NCCT and CTA with no contraindications, endovascular thrombectomy should be pursued without delay. A review of the current available literature for the usage of NCCT and CTA as well as the importance of ASPECTS scoring in patient selection for endovascular thrombectomy was included.

scholarly journals Left internal carotid artery agenesis in a patient with headache

2014 ◽  
pp. 25-27
Author(s):  
Inês Alice Teixeira Leão ◽  
C. H. Rezende ◽  
J. B. L. Gomes ◽  
R. F. Almeida
Keyword(s):  
Computed Tomography ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Rare Case ◽  
Internal Carotid ◽  
Left Internal Carotid Artery ◽  
Left Middle Cerebral Artery ◽  
Clinical Neurology ◽  
Structural Lesion ◽  
Left Middle

Sometimes in clinical neurology, we diagnose a very rare case. We report on a patient who presented with crisis of headache and vomiting (clinically diagnose as migraine). Computed tomography (CT) scan of the head did not reveal any structural lesion. Magnetic resonance angiography showed absence of left internal carotid artery associated with absence of the left middle cerebral artery (MCA).

Pre-thrombectomy intravenous thrombolytics are associated with increased hospital bills without improved outcomes compared with mechanical thrombectomy alone

2019 ◽  
Vol 11 (12) ◽  
pp. 1187-1190 ◽  
Author(s):  
Ameer E Hassan ◽  
Hari Kotta ◽  
Leeroy Garza ◽  
Laurie Preston ◽  
Wondwossen Tekle ◽  
...  
Keyword(s):  
Average Length ◽  
Length Of Hospital Stay ◽  
Functional Independence ◽  
Multivariate Statistical ◽  
Capture Process ◽  
Endovascular Thrombectomy ◽  
Nihss Score ◽  
Intravenous Tissue Plasminogen Activator ◽  
Improved Outcomes ◽  
Iv Tpa

ObjectiveTo investigate whether significant differences exist in hospital bills and patient outcomes between patients who undergo endovascular thrombectomy (EVT) alone and those who undergo EVT with pretreatment intravenous tissue plasminogen activator (IV tPA).MethodsWe retrospectively grouped patients in an EVT database into those who underwent EVT alone and those who underwent EVT with pretreatment IV tPA (EVT+IV tPA). Hospital encounter charges (obtained via the hospital’s charge capture process), final patient bills (ie, negotiated final bills as per insurance/Medicare rates), demographic information, existing comorbidities, admission and discharge National Institutes of Health Stroke Scale (NIHSS) score, and functional independence data (modified Rankin Scale score 0–2) were collected. Univariate and multivariate statistical analyses were performed.ResultsOf a total of 254 patients, 96 (37.8%) underwent EVT+IV tPA. Median NIHSS score at admission was significantly higher in the EVT+IV tPA group than in the EVT group (p=0.006). After adjusting for NIHSS admission score, patient bills and encounter charges in the EVT+IV tPA group were still found to be $3861.64 (95% CI $658.84 to $7064.45, p=0.02) and $158 071.29 (95% CI $134 641.50 to $181 501.08, p < 0.001) greater than in the EVT only group respectively. The EVT+IV tPA group had a higher complication rate of intracranial hemorrhage (ICH) (p=0.005). The EVT and EVT+IV tPA groups did not differ significantly in median discharge NIHSS score (p=0.56), functional independence rate at 90 days (p=0.96), or average length of hospital stay (p=0.21).ConclusionPatients treated with EVT+IV tPA have greater hospital encounter charges and final hospital bills as well as higher rates of ICH than patients who undergo treatment with EVT only.

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.

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.

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 Neurofibromatosis type 1 with subarachnoid hemorrhage due to multiple and de novo aneurysms: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Tatsuya Uchida ◽  
Kenichi Amagasaki ◽  
Atsushi Hosono ◽  
Hiroshi Nakaguchi
Keyword(s):  
Computed Tomography ◽  
Subarachnoid Hemorrhage ◽  
Neurofibromatosis Type 1 ◽  
Intracranial Aneurysms ◽  
De Novo ◽  
Neurofibromatosis Type ◽  
Left Middle Cerebral Artery ◽  
Short Period ◽  
Left Middle

Abstract Background Neurofibromatosis type 1 causes various lesions in many organs including the skin, and the incidence of complications with intracranial aneurysms is 9–11%. Here we report a case of neurofibromatosis type 1 with subarachnoid hemorrhage due to multiple and de novo aneurysms. Case presentation The patient was a 49-year-old Japanese woman with a history of neurofibromatosis type 1. She was transported to our hospital owing to disturbance of consciousness and was diagnosed with subarachnoid hemorrhage by computed tomography. Computed tomography angiography revealed multiple, small intracranial aneurysms, and we suspected that one of them in the peripheral branch of the left middle cerebral artery was the source of hemorrhage based on the distribution of hematoma. The patient underwent emergency surgery. Because it was difficult to identify an aneurysm in the most peripheral part of the left middle cerebral artery in the initial surgery, only one aneurysm was clipped. Later, a peripheral aneurysm was clipped using the navigation system. Because both aneurysms were small intracranial aneurysms (< 2 mm), either of them could be the source of hemorrhage. The postoperative course was good, and the patient was discharged in healthy condition. Because brain magnetic resonance imaging performed in the previous year did not find aneurysms at the same site, she was diagnosed with rupture of a de novo aneurysm. Neurofibromatosis type 1 might have caused the rupture of multiple intracranial aneurysms in a short period in this patient. Conclusion Neurofibromatosis type 1 may be complicated by the formation of multiple intracranial aneurysms in a short period.

Acute stroke in pituitary adenomas complicated by pituitary apoplexy

2016 ◽  
Vol 21 (3) ◽  
pp. 136-139
Author(s):  
Miralim M. Azizov
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Apoplexy ◽  
Clinical Signs ◽  
Pituitary Tumors ◽  
Clinical Syndrome ◽  
Left Internal Carotid Artery ◽  
Left Middle Cerebral Artery ◽  
Ischemic Brain ◽  
Left Middle ◽  
Visual Disturbances

Pituitary apoplexy is a clinical syndrome that is manifested by headache, visual disturbances, ophthalmoplegia or impaired consciousness. It can develop as a result of necrosis or hemorrhage in the pituitary gland or in cases of pituitary tumors. A favorable prognosis is possible if early diagnosis and timely surgical treatment. Pituitary apoplexy complicated by the disorder of the cerebral circulation occurs relatively rare. We observed the female patient aged of 51 year with pituitary adenoma, clinical signs of which were sudden depression of consciousness, right hemiparesis and left-sided ptosis. Signs of pituitary apoplexy were revealed after performed examinations. The sharp increase in the size of the tumor resulted in a compression of supraclinoid portion of the left internal carotid artery, which was the cause of ischemic brain damage in the pool left middle cerebral artery. After 2 weeks of conservative treatment, the patient was undergone to the surgery via transsphenoidal access. Histological examination confirmed the hemorrhage and necrosis of the pituitary adenoma. Complication developed 3 months after surgery partially regressed. Taking into account the relatively rare occurrence of pituitary apoplexy complicated with cerebrovascular ischemic type, clinicians should be alert to this complication. The method of choice is transsphenoidal delayed adenomectomy with conservative therapy.

scholarly journals Limited usefulness of routine head and neck CT angiogram in the imaging assessment of dizziness in the emergency department

2021 ◽  
pp. 197140092098866
Author(s):  
Angela Guarnizo ◽  
Kevin Farah ◽  
Daniel A Lelli ◽  
Darren Tse ◽  
Nader Zakhari
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Positive Predictive Value ◽  
Head And Neck ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Posterior Circulation ◽  
Emergency Department Presentation ◽  
Ct Angiogram ◽  
Computed Tomography Angiogram

Objective To assess the usefulness of head and neck computed tomography angiogram for the investigation of isolated dizziness in the emergency department in detecting significant acute findings leading to a change in management in comparison to non-contrast computed tomography scan of the head. Methods Patients presenting with isolated dizziness in the emergency department investigated with non-contrast computed tomography and computed tomography angiogram over the span of 36 months were included. Findings on non-contrast computed tomography were classified as related to the emergency department presentation versus unrelated/no significant abnormality. Similarly, computed tomography angiogram scans were classified as positive or negative posterior circulation findings. Results One hundred and fifty-three patients were imaged as a result of emergency department presentation with isolated dizziness. Fourteen cases were diagnosed clinically as of central aetiology. Non-contrast computed tomography was positive in three patients, all with central causes with sensitivity 21.4%, specificity 100%, positive predictive value 100%, negative predictive value 92.6% and accuracy 92.8%. Computed tomography angiogram was positive for angiographic posterior circulation abnormalities in five cases, and only two of them had a central cause of dizziness, with sensitivity 14.3%, specificity 97.7%, positive predictive value 40%, negative predictive value 91.46% and accuracy 92.1%. Conclusion Both non-contrast computed tomography and computed tomography angiogram of the head and neck have low diagnostic yield for the detection of central causes of dizziness, However, non-contrast computed tomography has higher sensitivity and positive predictive value than computed tomography angiogram, implying a lack of diagnostic advantage from the routine use of computed tomography angiogram in the emergency department for the investigation of isolated dizziness. Further studies are required to determine the role of computed tomography angiogram in the work-up of isolated dizziness in the emergency department.

scholarly journals Does Intravenous Thrombolysis Within 4.5 to 9 Hours Increase Clot Migration Leading to Endovascular Inaccessibility?

Stroke ◽  
2021 ◽  
Author(s):  
Jeremy C. Lim ◽  
Leonid Churilov ◽  
Andrew Bivard ◽  
Henry Ma ◽  
Richard J. Dowling ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Time Window ◽  
Intravenous Thrombolysis ◽  
Neurological Deficits ◽  
Magnetic Resonance Angiogram ◽  
Endovascular Thrombectomy ◽  
Treatment Groups ◽  
Significant Difference ◽  
Computed Tomography Angiogram

Background and Purpose: Distal clot migration is a recognized event following intravenous thrombolysis (IVT) in the setting of acute ischemic stroke. Of note, clots that were initially retrievable by endovascular thrombectomy may migrate to a distal nonretrievable location and compromise clinical outcome. We investigated the incidence of clot migration leading to clot inaccessibility following IVT in the time window of 4.5 to 9 hours. Methods: We performed a retrospective analysis of the EXTEND trial (Extending the Time for Thrombolysis in Emergency Neurological Deficits) data. Baseline and 12- to 24-hour follow-up clot location was determined on computed tomography angiogram or magnetic resonance angiogram. The incidence of clot migration leading to a change from retrievable to nonretrievable location was identified and compared between the two treatment groups (IVT versus placebo). Results: Two hundred twenty patients were assessed. Clot migration from a retrievable to nonretrievable location occurred in 37 patients: 21 patients (19.3%) in the placebo group and 16 patients (14.4%) in the IVT group. No significant difference was identified in the incidence of clot migration leading to inaccessibility between groups ( P =0.336). Conclusions: Our results did not show increased clot migration leading to clot inaccessibility in patients treated with IVT.

Sign in / Sign up

Export Citation Format

Share Document