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

Intracardiac Thrombus ◽

Auditory Comprehension ◽

Sensory Aphasia ◽

History Of ◽

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 ◽

10.1097/00006123-200108000-00038 ◽

2001 ◽

Vol 49 (2) ◽

pp. 457-462 ◽

Cited By ~ 3

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 ◽

Lower Extremity Weakness ◽

Posterior Laminectomy ◽

Cerebral Artery Aneurysm ◽

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.

Reconstruction of the MCA bifurcation after excision of a giant aneurysm

Journal of Neurosurgery ◽

10.3171/jns.1988.68.6.0974 ◽

1988 ◽

Vol 68 (6) ◽

pp. 974-977 ◽

Cited By ~ 19

Author(s):

W. Michel Bojanowski ◽

Robert F. Spetzler ◽

L. Philip Carter

Keyword(s):

Doppler Ultrasonography ◽

Operative Procedure ◽

Giant Aneurysm ◽

Content Type ◽

History Of ◽

Microsurgical Techniques ◽

Left Middle ◽

Good Flow ◽

Fine Print

✓ A patient with a giant aneurysm of the left middle cerebral artery (MCA) presented with a history of subarachnoid hemorrhage and ischemic symptoms. When the aneurysm was explored, its base was found to be very firm and atherosclerotic. Temporary clips were applied to the MCA, the aneurysm was excised, and the MCA bifurcation was reconstructed using microsurgical techniques. Good flow in the reconstructed MCA trunk was demonstrated by intracranial Doppler ultrasonography. A description of the operative procedure is presented.

034 The susceptibility vessel sign: a clinical-radiological case of propagating left MCA thrombus with resolving neurological deficits

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2018-anzan.33 ◽

2018 ◽

Vol 89 (6) ◽

pp. A14.2-A14

Author(s):

Benjamin Nham ◽

Simon Hawke

Keyword(s):

Sudden Onset ◽

Neurological Deficits ◽

List Type ◽

Radiological Sign ◽

Vessel Occlusion ◽

Ct Angiogram ◽

Gradient Echo Imaging ◽

Haemoglobin Content ◽

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.

Luxury Perfusion Producing Sensory Aphasia

Case Reports in Neurology ◽

10.1159/000511955 ◽

2021 ◽

pp. 46-49

Author(s):

Daiki Sakai ◽

Ryuji Sakakibara ◽

Fuyuki Tateno ◽

Yosuke Aiba

Keyword(s):

Brain Injury ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Middle Cerebral Artery ◽

Internal Carotid ◽

Sensory Aphasia ◽

Luxury Perfusion ◽

Old Japanese ◽

We describe the case of an 86-year-old Japanese man who, by luxury perfusion after spontaneous recanalization of the left middle cerebral artery/internal carotid artery, produced acute transient sensory aphasia. This rare phenomenon is thought to be caused by reperfusion brain injury.

A RARE CASE OF RUPTURED ANEURYSM AT THE ORIGIN OF INFERIOR PART OF DUPLICATED MIDDLE CEREBRAL ARTERY

MNJ (Malang Neurology Journal) ◽

10.21776/ub.mnj.2021.007.02.13 ◽

2021 ◽

Vol 7 (2) ◽

pp. 146-148

Author(s):

Achmad Firdaus Sani ◽

Dedy Kurniawan

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Internal Carotid ◽

Anatomical Variation ◽

Ruptured Aneurysm ◽

Endovascular Coiling ◽

History Of ◽

Head Computed Tomography ◽

Duplicated middle cerebral artery (DMCA) is an anomalous vessel arises from the internal carotid artery (ICA). This anatomical variation is rare. Aneurysm with this anatomical variation and unusual form was very rare. Even though this kind of aneurysm is rare, it was often ruptured. In this paper, we report a case of 40-years old female with abrupt decreased of consciousness as a chief complaint, along with severe headache one day earlier, no history of head trauma, and there was nuchal rigidity. She didn’t had history of hypertension before. Head computed tomography showed subarachnoid hemmorrhage (SAH) mostly on the left sylvian fissure with Hunt and Hess scale was 3 and Fisher scale was 2, while the cerebral angiography showed duplication of the left middle cerebral artery in which the inferior part of the MCA duplication has ruptured aneurysm at the origin. Treatment option for this aneurysm is endovascular coiling with preserved of the inferior part of duplicated MCA. Result of this treatment shows a good outcome.

Abstract 1122‐000202: Two World Wars, Two Pandemics and Then Stroke:Thrombectomy, Angioplasty and Stenting in a 110‐Year‐Old Patient

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000202 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Pouria Moshayedi ◽

Emily Chapman ◽

Mais Al‐Kawaz ◽

Jacopo Scaggiante ◽

Halima Tabani ◽

...

Keyword(s):

Acute Stroke ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Brain Mri ◽

Temporal Cortex ◽

Infarct Core ◽

Vessel Occlusion ◽

Stent Deployment ◽

Introduction : Endovascular thrombectomy (EVT) is the standard of care in patients with acute stroke due to large vessel occlusion. In an aging population it is important to know EVT outcomes in old age, despite patients over 80 years are mostly excluded from major trial. While the oldest reported patients undergoing EVT was 102 years old, we report a 110 years old patient as the oldest patient undergoing EVT for stroke reported in the literature, and discuss the technical details and outcome. Methods : n/a Results : A 110‐ year‐old patient presented with right side weakness and slurred speech and found to have left middle cerebral artery occlusion. She received tenecteplase and transferred to angio‐suite 1 hour and 35 minutes after onset of symptoms. Left middle cerebral artery underwent two passes with stentriever, balloon angioplasty and stent deployment resulting in thrombolysis in cerebral infarction (TICI) 3 reperfusion. Brain MRI showed infarction in the left basal ganglia and left temporal cortex. After thrombectomy she was able to hold right arm and leg against gravity and follow commands. However, patient developed aspiration pneumonia and passed away after family chose to focus care on her comfort and refused tracheostomy and gastric tube. Conclusions : Despite poor clinical outcome, this case presents technical success in good recanalization, resulting in small infarct core and immediate neurological improvement in the oldest reported acute stroke patient undergoing thrombectomy.

HIV Infection and Acute Stroke: A Case Report and a Review of the Literature

Case Reports in Medicine ◽

10.1155/2013/892054 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5

Author(s):

Hussein Assallum ◽

Mohammad Alkayem ◽

Nehad Shabarek

Keyword(s):

Hiv Infection ◽

Cardiovascular Events ◽

Brain Mri ◽

Young Patients ◽

The United States ◽

Sudden Onset ◽

Endothelial Damage ◽

Acute Infarction ◽

History Of ◽

The Relationship

Background. In the United States, ischemic stroke in HIV-infected patients has increased by 60%. However, unexpected cardiovascular events in relatively young patients have been observed.Clinical Vignette.A 31-year-old male who presented with a 5-hour history of sudden onset slurred speech and left hemiplegia. He has medical history of HIV infection for 2 years taking ARTs. On exam, a significant left hemiparesis was noticed. Brain MRI showed right anterior corona radiata and basal ganglia acute infarction.Discussion.Several mechanisms have been proposed for the relationship between HIV infection and cardiovascular risk. (i) HIV-associated dyslipidemia: HIV-infected patients tend to develop decrease in HDL-c and LDL-c levels. ART was associated with an increase in LDL-c but little change in HDL-c. (ii) Endothelial dysfunction: certain antiretroviral agents may independently contribute to endothelial damage. (iii) Hypertension: systolic blood pressure is higher in those using ART for greater than five years. (iv) Insulin resistance and diabetes have been noticed with ART. (v) Chronic inflammation. (vi) Hypercoagulability: decrease in proteins C and S was associated with HIV infection.Conclusion.Poorly controlled HIV infection and/or the introduction of ATR might be risk factors for cardiovascular events. More studies needed to address this medical dilemma.

Early detection of vertebral artery dissection

BMJ Case Reports ◽

10.1136/bcr-2018-226902 ◽

2018 ◽

Vol 11 (1) ◽

pp. e226902

Author(s):

Alice Morag MacArthur ◽

Syed Mehdi

Keyword(s):

Vertebral Artery ◽

Vertebral Artery Dissection ◽

Artery Aneurysm ◽

Sudden Onset ◽

Artery Dissection ◽

Ct Angiogram ◽

Neurology Clinic ◽

History Of ◽

Cerebral Artery Aneurysm

A 36-year-old female patient presented to hospital with a 1-week history of occipital headache. It was sudden onset following a fall into a swimming pool. Examination was unremarkable. CT angiogram brain scan showed right vertebral artery dissection with a 1 cm dissection flap and a 3 mm left middle cerebral artery aneurysm. She was discharged on aspirin, with outpatient neurology clinic follow-up.

Postoperative Intracranial Thrombolysis and Angioplasty

Interventional Neuroradiology ◽

10.1177/159101990100700408 ◽

2001 ◽

Vol 7 (4) ◽

pp. 325-330

Author(s):

O. Levrier ◽

J.M. Stordeur ◽

N. Bruder ◽

L. Manera ◽

P. Bouillot ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Language Impairment ◽

Artery Aneurysm ◽

Aneurysm Rupture ◽

Exclusion Criterion ◽

Intracranial Surgery ◽

Artery Thrombosis ◽

The case study involves a patient presenting middle cerebral artery thrombosis, related to a severe vasospasm following subarachnoid hemorrhage due to aneurysm rupture. The patient was treated initially by surgical clipping of the left middle cerebral artery aneurysm. After surgery, the neurological status of the patient was normal. Six days later, the patient presented right hemiplegia and aphasia that were related to the proximal left middle cerebral artery thrombosis. Despite recent open-skull surgery, in situ thrombolysis using urokinase and antiplatelet antibodies (abciximab) was performed. The thrombosed artery was reopened and a severe vasospasm was observed. The vasospasm was treated by transluminal angioplasty. No intracranial hemorrhage was noted after thrombolysis and angioplasty, whereas subcutaneous hemorrhage around the scalp incision was observed. The patient recovered from motor and language impairment. The only long-term symptom was a mild dysorthographia. Balance of risk/benefit is discussed for such aggressive thrombolytic therapy. In this particular case, effectiveness and uneventful use of abciximab was demonstrated despite very recent brain surgery that was considered a formal contra-indication for the use of such a powerful thrombolytic drug. Vessel thrombosis is an exceptional complication of cerebral vasospasm. In the early hours, intra-arterial thrombolysis may be considered, but recent intracranial surgery is usually an exclusion criterion to performing thrombolysis. We report the case of a patient who underwent thrombolysis and angioplasty in the postoperative period to treat this complication of vasospasm.

Human Herpesvirus 6 in the CSF of a Woman with New Onset Seizures – Encephalitis or Genomic Integration?

Neurology Clinical Practice ◽

10.1212/cpj.0000000000001024 ◽

2020 ◽

pp. 10.1212/CPJ.0000000000001024

Author(s):

Allyson M. Wenner ◽

Lisa Weitz ◽

Karoline Ostertag ◽

Stefan Hubmer ◽

Elisabeth Springer ◽

...

Keyword(s):

Ct Perfusion ◽

Human Herpesvirus ◽

Occipital Lobe ◽

Time Frame ◽

Sudden Onset ◽

Sensory Aphasia ◽

Headache Onset ◽

History Of ◽

Intravenous Alteplase ◽

Suspected Stroke

A 55-year-old female was referred to the Neurological Center Rosenhuegel with suspected stroke following sudden-onset sensory aphasia preceded by left-sided intermittent, pulsating ear- and headache, nausea, plus an elementary visual hallucination of bright, flashing, white lights. The ear- and headache began abruptly several days prior to arrival and were responsive to ibuprofen. The hallucinatory symptoms began suddenly after headache onset and lasted approximately five minutes. The patient also experienced aphasia immediately following the hallucinatory symptoms and was promptly transferred to the hospital. She had no known history of chronic illness, including migraines, stroke, seizures, or immunosuppression, and denied having fever or recent illness immediately prior to symptom onset. She had not been taking any regular medications, had not traveled recently, and denied alcohol and substance abuse. Family history was insignificant. Sensory aphasia was noted upon arrival at the hospital. A cranial CT-scan ruled out intracranial hemorrhage and CT-perfusion illustrated hyper-perfusion of the left occipital lobe (Figure 1). As the patient was within the appropriate time frame for thrombolytic therapy, she received intravenous alteplase due to suspected stroke and was asymptomatic the next day.