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 Infant Stroke Associated With Left Atrial Thrombus and Supraventricular Tachycardia

2021 ◽  
Vol 8 ◽  
pp. 2329048X2199529
Author(s):  
Rachel Pauley ◽  
Elise L. Mercier ◽  
Ashutosh Kumar ◽  
William H. Trescher ◽  
Gayatra Mainali
Keyword(s):  
Supraventricular Tachycardia ◽  
Left Atrial ◽  
Focal Epilepsy ◽  
Anticoagulation Therapy ◽  
Left Middle Cerebral Artery ◽  
Atrial Thrombus ◽  
Increased Risk ◽  
Ischemic Infarct ◽  
The Brain ◽  
Left Middle

We report a rare case of cardioembolic stroke in the setting of supraventricular tachycardia (SVT) in an infant. After a week of irritability, a 10-week-old male presented to the emergency department with SVT requiring treatment with adenosine. He developed right-sided hemiparesis and focal motor seizures. Imaging of the brain showed ischemic infarct in the left middle cerebral artery (MCA) territory. Echocardiogram showed a newly formed large left atrial intracardiac thrombus. A coagulopathy workup was negative. He was treated with beta-blocker and anticoagulation therapy. He had mild residual right hemiparesis. During childhood, he developed medically refractory focal epilepsy from the left hemisphere, requiring epilepsy surgery at age 10. A child presenting with sustained SVT can be at increased risk for intracardiac thrombi and stroke.

scholarly journals Adverse Outcome of Early Recurrent Ischemic Stroke Secondary to Atrial Fibrillation after Repeated Systemic Thrombolysis

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Luciano A. Sposato ◽  
Valeria Salutto ◽  
Diego E. Beratti ◽  
Paula Monti ◽  
Patricia M. Riccio ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Neurological Outcome ◽  
Left Middle Cerebral Artery ◽  
Cerebrovascular Event ◽  
Middle Cerebral Artery Infarction ◽  
Systemic Thrombolysis ◽  
Left Middle

Background. Recurrent ischemic stroke is associated with adverse neurological outcome in patients with atrial fibrillation. There is very scarce information regarding the neurological outcome of atrial fibrillation patients undergoing repeated systemic thrombolysis after early recurrent ischemic stroke.Clinical Case and Discussion. We describe a case of a 76-year-old woman with known paroxysmal atrial fibrillation who was admitted because of an acute right middle cerebral artery ischemic stroke and who underwent repeated systemic thrombolysis within 110 hours. The patient underwent systemic thrombolysis after the first ischemic stroke with almost complete neurological recovery. On the fourth day after treatment, an acute left middle cerebral artery ischemic stroke was diagnosed and she was treated with full-dose intravenous recombinant tissue plasminogen activator. A hemorrhagic transformation of the left middle cerebral artery infarction was noted on follow-up cranial computed tomographic scans. The patient did not recover from the second cerebrovascular event and died 25 days after admission.Conclusion. To the best of our knowledge, this is the second case reporting the adverse neurological outcome of a patient with diagnosis of atrial fibrillation undergoing repeated systemic thrombolysis after early recurrent ischemic stroke. Our report represents a contribution to the scarce available evidence suggesting that repeated systemic thrombolysis for recurrent ischemic stroke should be avoided.

scholarly journals Effect of Middle Cerebral Artery Compression on Pial Artery Pressure, Blood Flow, and Electrophysiological Function of Cerebral Cortex of Cat

1984 ◽  
Vol 4 (4) ◽  
pp. 593-598 ◽  
Author(s):  
H. Date ◽  
K.-A. Hossmann ◽  
T. Shima
Keyword(s):  
Blood Flow ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Experimental Situation ◽  
Vascular Occlusion ◽  
Left Middle Cerebral Artery ◽  
Cortical Blood Flow ◽  
Artery Pressure ◽  
Pial Artery ◽  
Left Middle

In 20 cats, the left middle cerebral artery was gradually compressed with a microdriven vascular occluder implanted by a transorbital approach. Pial artery pressure, cortical blood flow, segmental vascular resistance, electrocorticogram, and cortical steady potentials were measured in the territory of the left middle cerebral artery and correlated with the degree of vascular stenosis. Pial artery pressure began to decrease when the lumen of the middle cerebral artery was reduced to 200 μm. Cortical blood flow and EEG power declined when pial artery pressure fell below 35–40 mm Hg; cortical steady potential started to shift toward negativity at a pressure below 25–30 mm Hg; and both hemodynamic and electrophysiological changes were maximal at a pressure below 10 mm Hg. When the vascular occlusion was released within 5 min after the onset of ischemia, a pial artery pressure of only 18 mm Hg was necessary to restore normal blood flow. After 1-h occlusion, normalization of flow occurred at a pressure of 30 mm Hg. Since this pressure is still substantially below normal pial artery pressure, no-reflow does not seem to be of significance in this experimental situation.

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.

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