scholarly journals Ischemic stroke with agraphestesia signal focus

2021 ◽  
Author(s):  
Ana Luísa Lopes Espínola da Costa Reis ◽  
Leonardo Henrique Gandolfi de Souza ◽  
Vitor Roberto Pugliesi Marques
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Parietal Lobe ◽  
Cerebral Arteries ◽  
Sudden Onset ◽  
Neurological Deficits ◽  
Motor Deficits ◽  
Ischemic Event ◽  
The Right ◽  
Sensory Ability

Introduction: The ischemic stroke is one of the main causes of death and disability in Brazil. Among the main risk factors are age, atrial fibrillation (AF), diabetes, dyslipidemia and physical inactivity. The main etiology of stroke is cardioembolic, resulting in obstruction of the cerebral arteries by a thrombus of cardiac origin. The artery most affected in ischemic strokes is the middle cerebral artery. The stroke has main characteristics, with emphasis on the sudden onset of symptoms, involvement of a focal area, ischemia caused by obstruction of a vessel and neurological deficits depending on the affected area. Graphesthesia is defined as a cutaneous sensory ability to recognize letters or numbers traced on the skin. The loss of this sensory ability is known as agraphesthesia. Case Report: M.A.F.O. female, 78a, arrived at the UPA complaining of mental confusion. Patient denies previous stroke. Personal history of systemic arterial hypertension. Upon physical examination, the patient was conscious, self and disoriented and inattentive. He was able to repeat and evoke words, without measurable motor déficits. Left upper limb with agraphestesia. Computed tomography was requested, which showed an extensive hypodense area in the right parietoccipital region, which leads to the erasure of the furrows between the adjacent gyres, which may correspond to a recent ischemic event. Magnetic resonance imaging, diffusion-restricted area with correspondence on the ADC map, located in the right temporoparietal region inferring an acute ischemic event. An electrocardiogram was also requested, which showed an irregular rhythm, characteristic of atrial fibrillation, resulting in a diagnostic hypothesis of cardioembolic ischemic stroke. Discussion: The involvement of post-central ischemic gyrus lesions may correspond to paresthesia, anesthesia, hypoesthesia; the involvement of secondary and terciary areas of sensitivity in the upper parietal lobe, especially in the active movements of the hand and in the modalities of integrated sensitivity, their lesions may be clinically affected by: apraxias, dysgraphias, hemineglect, agraphestesia, stereoagnosia and spacial disorientation.

Transluminal Angioplasty of Intracerebral Vessels for Cerebral Arterial Spasm: Reversal of Neurological Deficits after Delayed Treatment

Neurosurgery ◽  
1989 ◽  
Vol 25 (3) ◽  
pp. 424-429 ◽  
Author(s):  
Stanley L. Barnwell ◽  
Randall T. Higashida ◽  
Van V. Halbach ◽  
Christopher F. Dowd ◽  
Charles B. Wilson ◽  
...  
Keyword(s):  
Parietal Lobe ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Cerebral Arteries ◽  
Transluminal Angioplasty ◽  
Neurological Deficits ◽  
Delayed Treatment ◽  
Vascular Flow ◽  
Symptomatic Vasospasm ◽  
The Right ◽  
Risk Of Hemorrhage

Abstract We used intracerebral transluminal angioplasty to treat two episodes of symptomatic vasospasm in a patient recovering from an aneurysmal subarachnoid hemorrhage. The procedures were performed after medical therapies, intravascular volume expansion, and induced arterial hypertension failed to alleviate the patient's neurological condition. The first angioplasty, confined to the right middle cerebral and distal internal carotid arteries, took place more than 30 hours after the onset of left hemiplegia. Despite the subsequent discovery of a small parietal lobe infarct, it brought about a marked improvement in left motor function and may have also limited the spread of necrotic damage. The second angioplasty was necessitated when stenotic segments of the basilar and posterior cerebral arteries caused a 24-hour decline in the patient's mental status. Although delayed in relation to the onset of symptoms, it successfully reversed the patient's comatose state. The use of transluminal angioplasty for vasospasm is generally limited to cases where it can be performed shortly after the onset of neurological symptoms; delaying the procedure increases the risk of hemorrhage from reperfused areas of infarction. Our experience with this patient demonstrates that delayed angioplasty can improve vascular flow to ischemic territory, even after infarction, without complications and with resultant improvement in neurological function.

Reversible Cerebral Vasoconstriction Syndrome with Posterior Leucoencephalopathy after Oral Contraceptive Pills

Cephalalgia ◽  
2009 ◽  
Vol 30 (1) ◽  
pp. 42-45 ◽  
Author(s):  
Y Soo ◽  
AB Singhal ◽  
T Leung ◽  
S Yu ◽  
H Mak ◽  
...  
Keyword(s):  
Oral Contraceptive ◽  
Cerebral Arteries ◽  
Haemorrhagic Stroke ◽  
Sudden Onset ◽  
Reproductive Hormones ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Neurological Deficits ◽  
Oral Contraceptive Pills ◽  
Cerebral Vasoconstriction ◽  
Contraceptive Pills

Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by sudden-onset recurrent ‘thunderclap’ headaches with reversible multifocal narrowing of the cerebral arteries, often associated with focal neurological deficits from ischaemic or haemorrhagic stroke. It has been associated with exposure to vasoconstrictive drugs, pregnancy, migraine, and a variety of other conditions. Whereas the pathophysiology of RCVS remains unclear, changes in the levels of female hormones are considered important because RCVS predominantly affects women and is frequently associated with pregnancy. We report a patient with angiographically confirmed RCVS whose MRI showed reversible brain oedema, suggesting an overlap between RCVS and the reversible posterior leucoencephalopathy syndrome. The only identified risk factor was oral contraceptive pills started 1 month prior to onset, supporting a role for female reproductive hormones in precipitating this overlap syndrome.

scholarly journals Overview of The Head CT-Scan in Stroke Patients who was Treated at Muhammadiyah Hospital Palembang

2021 ◽  
Vol 2 (1) ◽  
pp. 24
Author(s):  
Pratrisna Yusastra ◽  
Indriyani Indriyani ◽  
Budi Utama
Keyword(s):  
Ischemic Stroke ◽  
Ct Scan ◽  
Hemorrhagic Stroke ◽  
Right Hemisphere ◽  
Clinical Symptoms ◽  
Neurological Deficits ◽  
Thalamic Lesion ◽  
Stroke Patients ◽  
Head Ct ◽  
The Right

Background: Stroke is a collection of symptoms of neurological deficits due to sudden acute disturbance of brain function, both focal and global, caused by blockage or rupture of arteries and veins and proven by imaging and/or reflex pathology. Using CT-Scan, the description of acute phase stroke can be easier and can determine the appropriate treatment criteria for stroke. Purposes: To determine characteristic Head CT-Scan image of stroke patients hospitalized in Muhammadiyah Palembang Hospital. Methods: This study was conducted in a retrospective descriptive manner and obtained a sample of 41 stroke patients according to the inclusion and exclusion criteria using total sampling. Result: In this study, there were 28 patients (68.2%) with ischemic stroke and 13 patients (31.7%) with hemorrhagic stroke. Head CT-Scan image of ischemic stroke shows basal ganglia lesion (28.5%) and the right hemisphere lesions (57.1%) as the most predominant area. Head CT-Scan image of hemorrhagic stroke (58.3%) had intracerebral hemorrhage with the dominant thalamic lesion area (66.6%) and the right hemisphere (58.3%) had the most lesions with 8 patients (66, 6%) had a midline shift. Stroke patients were treated as experienced by the elderly (90.2%) and were dominated by the female sex (63.4%) and are dominated by clinical symptoms of hemiparesis (29.2%). Conclusion: Stroke patients at Muhammadiyah Palembang hospital dominated by ischemic stroke and on head CT Scan image predominantly shows lesions on the right cerebral hemisphere.

Adenosine-Induced Cardiac Arrest for Transvenous Embolization of Midbrain Arteriovenous Malformation

2019 ◽  
Vol 18 (6) ◽  
pp. E184-E190 ◽  
Author(s):  
Jaims Lim ◽  
Hussain Shallwani ◽  
Kunal Vakharia ◽  
Adnan H Siddiqui
Keyword(s):  
Arteriovenous Malformation ◽  
Transarterial Embolization ◽  
Posterior Wall ◽  
Sudden Onset ◽  
High Flow ◽  
Neurological Deficits ◽  
Transvenous Embolization ◽  
Blurred Vision ◽  
Systemic Hypotension ◽  
The Right

Abstract BACKGROUND AND IMPORTANCE Few studies describe the use of adenosine-induced cardiac systole for treatment of cerebrovascular pathologies. We describe a midbrain arteriovenous malformation (AVM) treated with transvenous embolization using adenosine-induced asystole to achieve transient systemic hypotension with the purpose of furthering discussion on the technique and operative considerations for adenosine use in endovascular AVM treatments. CLINICAL PRESENTATION A 29-yr-old man presented with sudden onset of severe bilateral headache, blurred vision, and numbness on the right side of his face and tongue. Noncontrast head computed tomography revealed fourth ventricle hemorrhage. Diagnostic cerebral angiography revealed a high-flow midbrain AVM with a posterior wall perforator from the basilar artery terminus and a draining vein into the straight sinus. Transarterial AVM embolization was successful. The patient was discharged with no residual neurological deficits but returned 1 wk later with slurred speech and left-sided dysmetria. Repeat angiography revealed partial AVM filling. Attempts at transarterial embolization were unsuccessful. Thus, transvenous AVM embolization with adenosine-induced cardiac asystole and systemic hypotension was performed. A total of 60 mg of adenosine was administered, followed by 2 additional doses of 60 and 40 mg; and complete cardiac asystole with a mean arterial pressure of 40 mmHg was maintained, resulting in successful embolization of the AVM. No residual filling was visualized on postembolization arterial angiography runs. The patient was neurologically stable and discharged on postoperative day 2. CONCLUSION With appropriate and safe dosing, adenosine-induced asystole and systemic hypotension may be a feasible, safe option to reduce flow and assist endovascular transvenous embolization of high-flow AVMs.

scholarly journals Fluctuations in Moyamoya Vasculopathy Associated with Basedow Disease Depending on Thyroid Hormone Status

2020 ◽  
Vol 12 (2) ◽  
pp. 140-147
Author(s):  
Masaoki Hidaka ◽  
Masato Osaki ◽  
Shinya Yamaguchi ◽  
Tetsuro Sayama ◽  
Shuji Arakawa ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Magnetic Resonance ◽  
Thyroid Function ◽  
Cerebral Arteries ◽  
Sudden Onset ◽  
Parietal Lobes ◽  
Middle Cerebral Arteries ◽  
Hormone Status ◽  
Intracranial Artery Stenosis ◽  
The Right

A 31-year-old woman presented with sudden onset of weakness in her left upper limb. Magnetic resonance imaging revealed acute cerebral infarctions in the right frontal and parietal lobes. Magnetic resonance angiography showed stenosis in the proximal portions of the bilateral middle cerebral arteries and terminal portions of the bilateral internal carotid arteries. The patient also complained of thyrotoxic symptoms, such as tachycardia, goiter, and fine finger tremor. She was diagnosed with acute ischemic stroke due to moyamoya vasculopathy (MMV) associated with Basedow disease. The patient’s thyroid hormone status normalized and intracranial artery stenosis gradually improved. However, after 6 months, she developed transient left hemiparesis during the 7th week of gestation. Her thyroid function deteriorated, and MMV progressed. Then, MMV improved again with the normalization of her thyroid function. This case shows that MMV associated with Basedow disease could worsen or improve depending on the thyroid hormone status.

Republished: Monorail microsnare retrieval of cardiac microcatheter tip embolised to the middle cerebral artery after attempted cardiac ablation procedure

2020 ◽  
Vol 12 (7) ◽  
pp. e6-e6
Author(s):  
Michael Young ◽  
Ryan Johnson ◽  
Hamad Farhat
Keyword(s):  
Atrial Fibrillation ◽  
Mitral Valve ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Complete Recovery ◽  
Neurological Deficits ◽  
Ablation Procedure ◽  
Cardiac Ablation ◽  
The Right

We present a case of a 52-year-old man with previous mitral valve replacement who presented to an outside hospital for planned cardiac ablation for atrial fibrillation. During the procedure, while advancing the microcatheter across the mitral valve, the microcatheter was sheared embolising into the right middle cerebral artery. This retained cardiac microcatheter tip was successfully retrieved with the monorail microsnare technique. The patient made a complete recovery without any neurological deficits or evidence of infarct on follow-up imaging.

Left Atrial Size and Ischemic Events after Ischemic Stroke or Transient Ischemic Attack in Patients with Nonvalvular Atrial Fibrillation

2020 ◽  
Vol 49 (6) ◽  
pp. 619-624
Author(s):  
Keisuke Tokunaga ◽  
Masatoshi Koga ◽  
Sohei Yoshimura ◽  
Yasushi Okada ◽  
Hiroshi Yamagami ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Left Atrial ◽  
Nonvalvular Atrial Fibrillation ◽  
Ischemic Event ◽  
Increased Risk ◽  
Ischemic Attack ◽  
Ischemic Events

<b><i>Background:</i></b> The present study aimed to clarify the association between left atrial (LA) size and ischemic events after ischemic stroke or transient ischemic attack (TIA) in patients with nonvalvular atrial fibrillation (NVAF). <b><i>Methods:</i></b> Acute ischemic stroke or TIA patients with NVAF were enrolled. LA size was classified into normal LA size, mild LA enlargement (LAE), moderate LAE, and severe LAE. The ischemic event was defined as ischemic stroke, TIA, carotid endarterectomy, carotid artery stenting, acute coronary syndrome or percutaneous coronary intervention, systemic embolism, aortic aneurysm rupture or dissection, peripheral artery disease requiring hospitalization, or venous thromboembolism. <b><i>Results:</i></b> A total of 1,043 patients (mean age, 78 years; 450 women) including 1,002 ischemic stroke and 41 TIA were analyzed. Of these, 351 patients (34%) had normal LA size, 298 (29%) had mild LAE, 198 (19%) had moderate LAE, and the remaining 196 (19%) had severe LAE. The median follow-up duration was 2.0 years (interquartile range, 0.9–2.1). During follow-up, 117 patients (11%) developed at least one ischemic event. The incidence rate of total ischemic events increased with increasing LA size. Severe LAE was independently associated with increased risk of ischemic events compared with normal LA size (multivariable-adjusted hazard ratio, 1.75; 95% confidence interval, 1.02–3.00). <b><i>Conclusion:</i></b> Severe LAE was associated with increased risk of ischemic events after ischemic stroke or TIA in patients with NVAF.

scholarly journals Drug-induced ischemic stroke

2021 ◽  
pp. 42-49
Author(s):  
T. M. Ostroumova ◽  
O. D. Ostroumova ◽  
Yu. A. Filippova
Keyword(s):  
Ischemic Stroke ◽  
Drug Prescription ◽  
Cerebral Arteries ◽  
Sudden Onset ◽  
Prevention Measures ◽  
Drug Induced ◽  
The Central Nervous System ◽  
Acute Disturbance ◽  
Inflammatory Drugs ◽  
High Doses

Stroke is an acute disturbance of the blood supply to the brain, characterized by the sudden onset of focal neurological symptoms, which persists for more than 24 hours or leads to the death of the patient in a shorter period of time due to cerebrovascular pathology. In the world and in Russia, stroke remains one of the leading causes of death and disability. At the same time, ischemic stroke (IS) is more common – about 80% of cases. Many classes of drugs, such as oral contraceptives, nonsteroidal anti-inflammatory drugs, and various psychoactive substances, can contribute to the development of drug-induced IS (DI IS). Data upon the frequency of DI IS is limited. In part, this reflects the problem of identifying and confirming the causal relationship between drug prescription and the development of IS. DI IS risk factors include: abuse of caffeine and alcohol, older age, smoking, drug addiction, high doses of drugs containing provoking agents, the simultaneous use of several drugs, the presence of comorbid diseases. Adverse drug reactions develop due to the following pathophysiological mechanisms: cerebral embolism, vasoconstriction of cerebral arteries, vasculitis of the central nervous system, orthostatic hypotension. The management of a patient with a DI IS does not differ significantly from the management of a patient with IS of a different etiology and includes thrombolysis or mechanical thromboextraction (in the absence of contraindications), as well as rational methods of secondary prevention. It is necessary to completely cancel or reduce the dose of the drug, the use of which led to the development of a stroke. DI IS prevention measures include the choice of drugs with the lowest risk of its occurrence and the use of modern scales for assessing the risk of this phenomenon.

scholarly journals Case Report: Brain Metastasis Confined to the Infarcted Area Following Stroke

2021 ◽  
Vol 11 ◽  
Author(s):  
Dong-Seok Gwak ◽  
Yang-Ha Hwang ◽  
Yong-Won Kim
Keyword(s):  
Ischemic Stroke ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Metastatic Cancer ◽  
Brain Magnetic Resonance Imaging ◽  
Neurological Deficits ◽  
Nasolabial Fold ◽  
Apparent Diffusion Coefficient Values ◽  
Index Stroke ◽  
The Right

Background: Ischemic stroke and cancer are frequent in the elderly and are the two common causes of death and disability. They are related to each other, and cancer may lead to ischemic stroke and vice versa. If patients with cancer exhibited recurrent acute neurological deficits after index stroke, a cancer-related stroke could be considered. However, a brain metastasis is another common cause of neurological complications and has a poor prognosis in patients with ischemic stroke and comorbid cancer. Here, we report a rare case of metastatic cancer that occurred after index stroke in a patient with renal cell carcinoma (RCC) and unusual imaging findings. Through the case, we discuss the pathophysiology and probable predisposing factors for metastatic disease in areas of infarction.Case Presentation: A 48-year-old man presented with sudden onset of left facial palsy and hemiparesis. He had a history of hypertension and RCC with pulmonary metastases treated with radical nephrectomy and chemotherapy. Brain magnetic resonance imaging (MRI) revealed multiple scattered acute infarctions in the right insular, frontal, parietal, and left occipital cortices. There were no definite sources of embolism. Eight months after the index stroke, he presented with subacute onset of progressive left hemiparesis. He had no focal neurological deficits except left-sided weakness and left nasolabial fold blunting. MRI scan demonstrated partial diffusion restriction on the right frontotemporal cortices without decline of apparent diffusion coefficient values on the corresponding lesions and T1 hypointensities and T2 hyperintensities with perilesional vasogenic edema on the right insular, frontal, parietal, and left occipital cortices, indicative of brain metastases confined to the area of previous infarctions.Conclusions: Cerebral infarctions can cause neovascularization and disruption of the blood–brain barrier. Moreover, the compartmentalized cavity formed by the ischemic injury may accept a large volume of metastatic tumor cells. Such an altered microenvironment of infarcted tissue would be suitable for the colonization and proliferation of metastatic seed. Further, brain metastases should be considered, in addition to recurrence, when new focal neurological deficits develop in patients with ischemic stroke and comorbid cancer.

scholarly journals Dramatic Intracerebral Hemorrhagic Presentations of Reversible Cerebral Vasoconstriction Syndrome: Three Cases and a Literature Review

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Joel M. Stary ◽  
Bonnie H. Wang ◽  
Seong-Jin Moon ◽  
Huan Wang
Keyword(s):  
Cerebral Arteries ◽  
Sudden Onset ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Neurological Deficits ◽  
Midline Shift ◽  
Cerebral Vasoconstriction ◽  
Uncomplicated Pregnancy ◽  
Pregnancy And Delivery ◽  
Intervention Patient ◽  
Prompt Diagnosis

Reversible cerebral vasoconstriction syndrome (RCVS) refers to a number of disorders characterized by severe and sudden-onset (“thunderclap”) headaches and angiographic features of reversible, segmental, multifocal vasoconstriction of cerebral arteries. Although RCVS generally resolves without significant sequelae, a rare and possibly underrecognized hemorrhagic presentation has a worse potential course. We report three cases of hemorrhagic RCVS and review the literature. Three females (42, 54, and 33 years old, resp.) presented with severe headache, neurological deficits, and dramatic intracerebral hemorrhage (ICH). Patient 1 presented comatose with a 9 × 4 × 6.6 cm left deep intraparenchymal hemorrhage (IPH) and 1 cm midline shift. She underwent emergent surgical intervention. Patient 2 had a 3.3 × 1.5 cm left superior frontal IPH that enlarged to 4 × 2.5 cm within 12 hours with worsening headache and neurological deficits. She was successfully managed nonoperatively. Patient 3, after uncomplicated pregnancy and delivery, presented with a 1.5 cm left superior parietal IPH on postpartum day 7. Two days later, she acutely developed right hemiplegia. Repeat CT demonstrated a new 3.3 × 1.7 cm left frontal IPH. She was also successfully managed nonoperatively. Many diverse conditions are grouped within the category of RCVS. Dramatic ICH remains a rare and possibly underrecognized presenting feature. Prompt diagnosis and management are essential for obtaining the best outcome.

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