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.

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.

Abstract TP217: Association Between Thrombophilia and Chronic Cerebrovascular Disease in Young Adults With Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Marialaura Simonetto ◽  
Sara Shams ◽  
Xian Wu ◽  
Ivan Diaz ◽  
Setareh Salehi Omran ◽  
...  
Keyword(s):  
Young Adults ◽  
Ischemic Stroke ◽  
White Matter ◽  
Cerebrovascular Disease ◽  
Acute Ischemic Stroke ◽  
Brain Mri ◽  
Mean Difference ◽  
Small Vessel ◽  
Robust Estimator ◽  
Multivariable Analyses

Introduction: Thrombophilias are a known cause of acute ischemic stroke (AIS) in the young. We hypothesized that thrombophilias would be associated with an increased burden of chronic cerebrovascular disease in these patients. Methods: We included patients enrolled in the prospective Cornell AcutE Stroke Academic Registry (CAESAR) who were 18-65 years of age, diagnosed with AIS by brain MRI between 2011-2015, and had thrombophilia testing within 6 months of their stroke. The exposure variable was thrombophilia, defined as at least one positive thrombophilia test according to standard criteria. The primary outcome was the total Age-Related White Matter Changes (ARWMC) score (0-15). Secondary outcomes were the Fazekas score (0-3) and the number of chronic small vessel (subcortical) cerebral infarcts. Outcomes were determined by a single radiologist blinded to thrombophilia status using clinically-performed brain MRIs at the time of index stroke. Doubly robust estimator analyses were used to test the association between an underlying thrombophilia and outcomes. Models were adjusted for age, gender, race, and vascular risk factors. Results: Among 177 patients meeting eligibility criteria, mean age was 47 (SD, 10) years and 50% were women. Thrombophilia was detected in 77 patients (44%). The mean total ARWMC score, Fazekas score, and number of chronic small vessel infarcts were 1.90 (SD, 1.74), 0.91 (SD, 0.69), and 0.16 (SD, 0.63) in patients with thrombophilia and 2.16 (SD, 1.64), 1.07 (SD, 0.69) and 0.35 (SD, 0.81) in patients without thrombophilia. In multivariable analyses, there was no difference in the total ARWMC score (mean difference -0.05, 95% CI -0.43 to 0.33, p=0.80) or Fazekas score (mean difference -0.05, 95% CI -0.21 to 0.11, p=0.52) between patients with thrombophilia and those without. However, in multivariable analyses, the number of chronic infarcts (mean difference -0.22, 95% CI -0.42 to -0.01, p=0.01) was lower in patients with thrombophilia than in those without. Conclusions: In a single-center study of young adults with AIS, underlying thrombophilia was not associated with white matter disease burden. However, contrary to our hypothesis, it was inversely associated with the number of chronic small vessel infarcts.

scholarly journals Effects of White Matter Hyperintensities on 90-Day Functional Outcome after Large Vessel and Non-Large Vessel Stroke

2020 ◽  
Vol 49 (4) ◽  
pp. 419-426
Author(s):  
Christoph Johannes Griessenauer ◽  
David McPherson ◽  
Andrea Berger ◽  
Ping Cuiper ◽  
Nelson Sofoluke ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
White Matter ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Brain Mri ◽  
Large Vessel ◽  
Favorable Outcome ◽  
White Matter Hyperintensity ◽  
Vessel Occlusion ◽  
Brain Extraction

Introduction: White matter hyperintensity (WMH) burden is a critically important cerebrovascular phenotype related to the diagnosis and prognosis of acute ischemic stroke. The effect of WMH burden on functional outcome in large vessel occlusion (LVO) stroke has only been sparsely assessed, and direct LVO and non-LVO comparisons are currently lacking. Material and Methods: We reviewed acute ischemic stroke patients admitted between 2009 and 2017 at a large healthcare system in the USA. Patients with LVO were identified and clinical characteristics, including 90-day functional outcomes, were assessed. Clinical brain MRIs obtained at the time of the stroke underwent quantification of WMH using a fully automated algorithm. The pipeline incorporated automated brain extraction, intensity normalization, and WMH segmentation. Results: A total of 1,601 acute ischemic strokes with documented 90-day mRS were identified, including 353 (22%) with LVO. Among those strokes, WMH volume was available in 1,285 (80.3%) who had a brain MRI suitable for WMH quantification. Increasing WMH volume from 0 to 4 mL, age, female gender, a number of stroke risk factors, presence of LVO, and higher NIHSS at presentation all decreased the odds for a favorable outcome. Increasing WMH above 4 mL, however, was not associated with decreasing odds of favorable outcome. While WMH volume was associated with functional outcome in non-LVO stroke (p = 0.0009), this association between WMH and functional status was not statistically significant in the complete case multivariable model of LVO stroke (p = 0.0637). Conclusion: The burden of WMH has effects on 90-day functional outcome after LVO and non-LVO strokes. Particularly, increases from no measurable WMH to 4 mL of WMH correlate strongly with the outcome. Whether this relationship of increasing WMH to worse outcome is more pronounced in non-LVO than LVO strokes deserves additional investigation.

Association between acute ischemic stroke etiology and macroscopic aspect of retrieved clots: is a clot’s color a warning light for underlying pathologies?

2019 ◽  
Vol 11 (12) ◽  
pp. 1197-1200 ◽  
Author(s):  
Alessandro Sgreccia ◽  
Zoé Duchmann ◽  
Jean Philippe Desilles ◽  
Bertrand Lapergue ◽  
Julien Labreuche ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Infective Endocarditis ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Case Reports ◽  
Patient Characteristics ◽  
Study Groups ◽  
Double Blind ◽  
Stroke Etiology

BackgroundFew case reports have considered the chromatic aspect of retrieved clots and the possible association with their underlying etiology.ObjectiveThe aim of our study was to analyze the frequency of the TOAST ischemic stroke typical (atrial fibrillation, dissection, atheroma) and atypical (infective endocarditis, cancer-related, valve-related thrombi) etiologies depending on the chromatic aspect of retrieved clots.MethodsA total of 255 anonymized and standardized clot photos of consecutive patients treated by mechanical thrombectomy for acute ischemic stroke were included. A double-blind evaluation was performed by two senior interventional neuroradiologists, who classified the visual aspects of the clots into two main patterns: red/black or white. Main patient characteristics, distribution of underlying stroke etiologies, and outcomes were compared between the two study groups.ResultsThe inter-reader agreement for clot colors was excellent (k=0.78). Two hundred and thirty-three patients were classified as having red/black clots and 22 as having white clots. A statistically significant association (p=0.001) between atypical etiologies and white clots was observed.ConclusionsWhite clots were significantly associated with atypical etiologies in this cohort,in particular, with infectious endocarditis.

scholarly journals Catheter based selective hypothermia reduces stroke volume during focal cerebral ischemia in swine

2015 ◽  
Vol 8 (4) ◽  
pp. 418-422 ◽  
Author(s):  
Thomas K Mattingly ◽  
Lynn M Denning ◽  
Karen L Siroen ◽  
Barb Lehrbass ◽  
Pablo Lopez-Ojeda ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cerebral Ischemia ◽  
Stroke Volume ◽  
Acute Ischemic Stroke ◽  
Brain Mri ◽  
Global Cerebral Ischemia ◽  
Moderate Hypothermia ◽  
Stroke Model ◽  
Stroke Treatment ◽  
Endovascular Cooling

BackgroundTotal body hypothermia is an established neuroprotectant in global cerebral ischemia. The role of hypothermia in acute ischemic stroke remains uncertain. Selective application of hypothermia to a region of focal ischemia may provide similar protection with more rapid cooling and elimination of systemic side effects. We studied the effect of selective endovascular cooling in a focal stroke model in adult domestic swine.MethodsAfter craniotomy under general anesthesia, a proximal middle cerebral artery branch was occluded for 3 h, followed by 3 h of reperfusion. In half of the animals, selective hypothermia was induced during reperfusion using a dual lumen balloon occlusion catheter placed in the ipsilateral common carotid artery. Following reperfusion, the animals were sacrificed. Brain MRI and histology were evaluated by experts who were blinded to the intervention.Results25 animals were available for analysis. Using selective hypothermia, hemicranial temperature was successfully cooled to a mean of 26.5°C. Average time from start of perfusion to attainment of moderate hypothermia (<30°C) was 25 min. Mean MRI stroke volumes were significantly reduced by selective cooling (0.050±0.059 control, 0.005±0.011 hypothermia (ratio stroke:hemisphere volume) (p=0.046). Stroke pathology volumes were reduced by 42% compared with controls (p=0.256).ConclusionsSelective moderate hypothermia was rapidly induced using endovascular techniques in a clinically realistic swine stroke model. A significant reduction in stroke volume on MRI was observed. Endovascular selective hypothermia can provide neuroprotection within time frames relevant to acute ischemic stroke treatment.

scholarly journals Accuracy of Brain MRI Interpretation of Emergency Medicine Specialists versus Radiologist and Neurologist in Suspected Acute Ischemic Stroke Patients; a Diagnostic Accuracy Study

2021 ◽  
Vol 8 (2) ◽  
Author(s):  
Atefeh Abdollahi ◽  
Sepideh Aarabi ◽  
Arash Safaie ◽  
Abdorreza Naser Moghadasi ◽  
Mohammad Sadegh Vahedi ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Ischemic Stroke ◽  
Diagnostic Accuracy ◽  
Acute Ischemic Stroke ◽  
Gold Standard ◽  
Medical Center ◽  
Brain Mri ◽  
Brain Magnetic Resonance Imaging ◽  
Diagnostic Accuracy Study ◽  
Accuracy Study

Background: Despite numerous brain magnetic resonance imaging (MRI) utilization in the emergency department (ED), certainly, imaging alone is not enough, and it is necessary to have a correct interpretation by a physician who has sufficient skills in this regard. Objectives: Here, we decided to investigate the accuracy of interpreting brain MRI of suspected acute ischemic stroke (AIS) patients conducted by emergency medicine physicians (EMPs) in comparison with a radiologist and a neurologist. Methods: This diagnostic accuracy study was conducted from April to November 2019 in Tehran, Iran. All attending EMPs of one major educational, medical center, a radiologist, and a neurologist also participated. A set of brain MRI stereotypes related to patients suspected of having a AIS was randomly selected. By reviewing the brain MRI interpretation of EMPs, once in comparison with the radiologist and once in comparison with the neurologist, misinterpretations (presence or absence of findings compatible with the diagnosis of AIS) were extracted. Results: Brain MRI stereotypes of 287 suspected AIS patients were interpreted of these patients, 160 cases (55.7%) were male. The mean age of the study patients was 65.0 ± 14.1 (range of 18 to 98) years. The value of the agreement for diagnosis between EMPs and neurologists was 0.684 (95% CI: 0.580 to 0.787). Considering the neurologist as the gold standard, the accuracy of AIS diagnosis by the EMPs was 0.85% (95% CI: 79.3 to 89.6). The agreement value for diagnosis between EMPs and radiologist was 0.673 (95% CI: 0.553 to 0.794). Considering the radiologist as the gold standard, the accuracy of AIS diagnosis by the EMPs was 86.3% (95% CI: 79.8 to 91.3). The agreement value for diagnosis in these two groups was 0.752 (95% CI: 0.627 to 0.877). Conclusions: The findings of the current study revealed that the accuracy of brain MRI interpretation performed by the EMPs, compared with both neurologist and radiologist was proper.

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).

scholarly journals Pseudo-colour with K-means Clustering Algorithm for Acute Ischemic Stroke Lesion Segmentation in Brain MRI

2021 ◽  
Vol 29 (2) ◽  
Author(s):  
Abang Mohd Arif Anaqi Abang Isa ◽  
Kuryati Kipli ◽  
Ahmad Tirmizi Jobli ◽  
Muhammad Hamdi Mahmood ◽  
Siti Kudnie Sahari ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Acute Ischemic Stroke ◽  
Clustering Algorithm ◽  
Brain Mri ◽  
Segmentation Algorithm ◽  
Automated Segmentation ◽  
Resonance Imaging ◽  
Greyscale Image

Segmentation of an acute ischemic stroke from a single modality of a greyscale magnetic resonance imaging (MRI) is an essential and challenging task. Recently, there are several numbers of related works on the automatic segmentation of infarct lesion from the input image and give a high accuracy in extraction of infarct lesion. Still, limited works have been reported in isolating the penumbra tissues and infarct core separately. The segmentation of the penumbra tissues is necessary because that region has the potential to recover. This paper presented an automated segmentation algorithm on diffusion-weighted magnetic resonance imaging (DW-MRI) image utilizing pseudo-colour conversion and K-means clustering techniques. A greyscale image contains only intensity information and often misdiagnosed due to overlap intensity of an image. Colourization is the method of adding colours to greyscale images which allocate luminance or intensity for red, green, and blue channels. The greyscale image is converted to pseudo-colour is to intensify the visual perception and deliver more information. Then, the algorithm segments the region of interest (ROI) using K-means clustering. The result shows the potential of automated segmentation to differentiate between the healthy and lesion tissues with 90.08% in accuracy and 0.89 in dice coefficient. The development of an automated segmentation algorithm was successfully achieved by entirely depending on the computer with minimal interaction.

scholarly journals Patients With Acute Ischemic Stroke Who Receive Brain Magnetic Resonance Imaging Demonstrate Favorable In‐Hospital Outcomes

2020 ◽  
Vol 9 (20) ◽  
Author(s):  
Hwan Lee ◽  
Yifeng Yang ◽  
Baoqiong Liu ◽  
Simon A. Castro ◽  
Tiantian Shi
Keyword(s):  
Magnetic Resonance Imaging ◽  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Hospital Stay ◽  
Acute Ischemic Stroke ◽  
Brain Mri ◽  
Brain Magnetic Resonance Imaging ◽  
Control Group ◽  
Inpatient Mortality ◽  
Resonance Imaging

Background Use of inpatient brain magnetic resonance imaging (MRI) in patients with acute ischemic stroke is highly institution dependent and has been associated with increased length and cost of hospital stay. We examined whether inpatient brain MRI in patients with acute ischemic stroke is associated with improved clinical outcomes to justify its resource requirements. Methods and Results The National Inpatient Sample database was queried retrospectively to find 94 003 patients who were admitted for acute ischemic stroke and then received inpatient brain MRI between 2012 and 2014. Multivariable regression analysis was performed with respect to a control group to assess for differences in the rates of inpatient mortality and complications, as well as the length and cost of hospital stay based on brain MRI use. Inpatient brain MRI was independently associated with lower rates of inpatient mortality (1.67% versus 3.09%; adjusted odds ratio [OR], 0.60; 95% CI, 0.53–0.68; P <0.001), gastrostomy (2.28% versus 2.89%; adjusted OR, 0.82; 95% CI, 0.73–0.93; P <0.001), and mechanical ventilation (1.97% versus 2.82%; adjusted OR, 0.68; 95% CI, 0.60–0.77; P <0.001). Brain MRI was independently associated with ≈0.32 days (8%) and $1131 (11%) increase in the total length ( P <0.001) and cost ( P <0.001) of hospital stay, respectively. Conclusions Inpatient brain MRI in patients with acute ischemic stroke is associated with substantial decrease in the rates of inpatient mortality and complications, at the expense of marginally increased length and cost of hospitalization.

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