scholarly journals Chemical thrombolysis with extended 15-hour window in a patient undergoing perfusion CT scan with Rapid CT protocol: a case report

2021 ◽  
Author(s):  
Hendrick Henrique Fernandes Gramasco ◽  
Maria Clara Foloni ◽  
Rebeca Aranha Barbosa Sousa ◽  
Yasmim Nadime José Frigo ◽  
Mateus Felipe dos Santos ◽  
...  
Keyword(s):  
Case Report ◽  
Acute Stroke ◽  
Cerebral Artery ◽  
Ct Perfusion ◽  
Reperfusion Therapy ◽  
Tertiary Hospital ◽  
Perfusion Ct ◽  
Left Middle Cerebral Artery ◽  
Ct Protocol ◽  
The Right

Context: Recently, with the advance of neuroimaging modalities, the windows of reperfusion therapy in patients with acute stroke have been reviewed and extended, especially for mechanical thrombectomy. Case report: 81 year old patient, previously hypertensive and dyslipidemic, fully functional (modified Rankin scale = 0), admitted to the emergency room of a tertiary hospital with global aphasia, right hemiparesis, right homonymous hemianopsia and severe hypoesthesia of the right upper limb, scoring 26 on the NIHSS, with report of having contacted family members for the last time 15 hours before admission. She was treated according to the institution’s acute stroke protocol, and underwent non-contrast brain computed tomography (CT), perfusion CT with Rapid CT protocol and cerebral artery + neck angio-CT, which ruled out bleeding and showed an ASPECTS of 8, an estimated ischemic core volume of 17 mL, and an area with hypoperfusion of 118 mL (perfusional mismatch of 101 mL), besides occlusion of the M1 segment of the left middle cerebral artery. Thus, she was submitted to chemical thrombolysis, with a decrease in NIHSS score to 15 and evolving without complications upon hospitalization. Conclusions: In patients with uncertain ictus, the use of advanced neuroimaging modalities, such as perfusion tomography with Rapid CT protocol, may assist in the indication of reperfusion therapies safely.

scholarly journals Acute Stroke due to Electrocution: Uncommon or Unrecognized?

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Laxmi Kokatnur ◽  
Mohan Rudrappa
Keyword(s):  
Acute Stroke ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Parietal Lobe ◽  
Frontal Lobes ◽  
Organ Damage ◽  
Left Middle Cerebral Artery ◽  
Anterior Circulation ◽  
Daily Lives ◽  
The Right

The growing dependence on electricity in our daily lives has increased the incidence of electrocution injuries. Although several neurological injuries have been described previously, acute stroke due to electrocution is rare. Our patient, a previously healthy man, was electrocuted after he grabbed a “live” high-voltage wire. Although he was hemodynamically stable, he remained confused with language defects. MRI of the brain showed acute stroke in the bilateral anterior cerebral artery territory and watershed regions of the left middle cerebral artery territory. MR angiogram incidentally showed A1 segment aplasia of the right anterior cerebral artery. Electrocution is known to cause vasospasm leading to end-organ damage similar to that seen in stroke. In our patient, vasospasm of the left anterior circulation likely led to watershed infarcts in the left parietal lobe and bilateral frontal lobes. Due to aplasia of the A1 segment on the right side, perfusion to both frontal lobes was solely from the left anterior cerebral artery.

scholarly journals Microsurgical Treatment of Posterior Cerebral Artery Aneurysm (P2P Segment): Case Report and Review of the Literature

2018 ◽  
Vol 37 (04) ◽  
pp. 343-348
Author(s):  
Lucas Meguins ◽  
Antônio Spotti ◽  
Jean de Oliveira ◽  
Carlos Pereira ◽  
Ronaldo Fernandes ◽  
...  
Keyword(s):  
Case Report ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Artery Aneurysm ◽  
Saccular Aneurysm ◽  
Neurological Deficits ◽  
Uneventful Recovery ◽  
Cerebral Peduncle ◽  
Vast Number ◽  
The Right

Introduction Aneurysms of the posterior cerebral artery (PCA) represent ∼ 1% of all intracranial aneurysms and usually present with subarachnoid hemorrhage. Objective The aim of the present study is to describe the case of an adult man presenting a saccular aneurysm of the right PCA at the posterior half of the postcommunicating (P2P) segment, and to discuss the technical nuances of the approach and of the clipping process. Case Report An investigation of a chronic headache in a 55-year-old man found a saccular aneurysm located just posterior to the most lateral portion of the right cerebral peduncle. A digital subtraction arteriography revealed a 7.8 mm × 5.6 mm × 4.8 mm posterior-medial projecting aneurysm of the right PCA at the P2P segment. A subtemporal approach was performed with partial aspiration of the right parahippocampal gyrus for a better exposure of the vascular structures. A proximal temporary occlusion of the PCA was performed at the anterior half of the postcommunicating P2A segment. The aneurysm was clipped with two semi-curved clips. The patient presented an uneventful recovery and was discharged from the hospital on the third postoperative day without any additional neurological deficits. Conclusion Aneurysms of the PCA are an uncommon vascular disease that challenges the ability of the neurosurgeons due to their many anatomical nuances, to their vast number of perforators, and to the risk of bleeding. However, the operative management of aneurysms of the PCA is technically feasible, safe and effective when performed respecting microsurgical principles.

scholarly journals Interpreting CT perfusion in stroke

2018 ◽  
Vol 19 (2) ◽  
pp. 136-142 ◽  
Author(s):  
Stevan Christopher Wing ◽  
Hugh S Markus
Keyword(s):  
Acute Stroke ◽  
Perfusion Imaging ◽  
Treatment Time ◽  
Ct Perfusion ◽  
Time Windows ◽  
Onset Time ◽  
Brain Perfusion ◽  
Reperfusion Therapy ◽  
Imaging Protocol ◽  
Stroke Imaging

CT perfusion images can be rapidly obtained on all modern CT scanners and easily incorporated into an acute stroke imaging protocol. Here we discuss the technique of CT perfusion imaging, how to interpret the data and how it can contribute to the diagnosis of acute stroke and selection of patients for treatment. Many patients with acute stroke are excluded from reperfusion therapy if the onset time is not known or if they present outside of traditional treatment time windows. There is a growing body of evidence supporting the use of perfusion imaging in these patients to identify patterns of brain perfusion that are favourable for recanalisation therapy.

scholarly journals Radiological CT findings and time evolution in acute stroke: case report

2021 ◽  
Vol 8 (2) ◽  
pp. 76-79
Author(s):  
Laio Bastos de Paiva Raspante ◽  
Laura Filgueiras Mourão Ramos ◽  
Uedson Tazinaffo
Keyword(s):  
Artificial Intelligence ◽  
Case Report ◽  
Emergency Room ◽  
Acute Stroke ◽  
Cerebral Perfusion ◽  
Imaging Finding ◽  
Clinical Suspicion ◽  
Perfusion Study ◽  
The Right ◽  
Optimized Treatment

Case report of a 95-year-old female patient that was admitted to the emergency room with a sudden weakness on the right who underwent propaedeutic imaging with cerebral perfusion study by CT using artificial intelligence (AI) software for clinical suspicion of acute stroke. The case illustrates a frequent and specific imaging finding for stroke and its disappearance in the control exam even without optimized treatment.

scholarly journals Recurrent transient heading disorientation heralding acute posterior cerebral artery (PCA) infarction

2019 ◽  
Vol 1 (1) ◽  
pp. e000009
Author(s):  
Yong Chuan Chee ◽  
Beng Hooi Ong
Keyword(s):  
Case Report ◽  
Cerebral Infarction ◽  
Cerebral Artery ◽  
Transient Ischaemic Attack ◽  
Posterior Cerebral Artery ◽  
Underlying Mechanism ◽  
Unusual Presentation ◽  
Topographical Disorientation ◽  
Ischaemic Attack ◽  
The Right

ObjectiveHeading disorientation is a type of pure topographical disorientation. Reported cases have been very few and its underlying mechanism remains unclear. We report an unusual presentation of a 60-year-old man with recurrent transient heading disorientation heralding an acute posterior cerebral artery infarction.DesignCase report.ConclusionAcquired injury to the right retro-splenial region can result in a specific variant of topographical disorientation known as heading disorientation that may present as an atypical transient ischaemic attack-like symptom heralding acute cerebral infarction.

scholarly journals Urgent Middle Cerebral Artery Embolectomy of Calcified Embolus After Intravenous Thrombolysis: 2-Dimensional Operative Video

2019 ◽  
Vol 17 (2) ◽  
pp. E54-E55 ◽  
Author(s):  
Jiri Fiedler ◽  
Svatopluk Ostry ◽  
Martin Bombic ◽  
Ludek Sterba ◽  
Petr Kostal
Keyword(s):  
Informed Consent ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Ct Perfusion ◽  
Intravenous Thrombolysis ◽  
Complete Recovery ◽  
Clinical Findings ◽  
Left Middle Cerebral Artery ◽  
Initial Flow ◽  
Ct Perfusion Imaging

Abstract This video shows an urgent microsurgical embolectomy of the inferior division of the left middle cerebral artery in a patient treated by intravenous thrombolysis (IVT). Patient was eligible for endovascular mechanical thrombectomy1; however, the interventional radiologist was not comfortable performing the procedure given prior unsuccessful attempts to remove a calcified cerebral embolus.2 A 75-yr-old female presented with an acute ischemic stroke with isolated aphasia (NIHSS 9). Using the drip-and-ship concept, IVT (0.9 mg/kg rt-PA) was administered in a regional hospital. Fifty-five minutes after a complete recovery following IVT, multiple transient ischemic attacks of aphasia were observed. While the patient was a candidate for mechanical thrombectomy based on CT perfusion imaging, given the unsuccessful reports in the literature and the interventional radiologist's experience, the decision was made to offer microsurgical embolectomy of the calcified cerebral embolus.3 Informed consent for the procedure was obtained directly from the patient. Calcified, crumbly embolus was removed from a 5 mm longitudinal arteriotomy. The arteriotomy was sutured with interrupted 10-0 suture. Initial flow after the embolectomy was 6.5 mL/min. Upon inspection, a distal kink was found in the M2 and after repositioning, flow improved to 35 mL/min. Postoperative CT angiography documented complete recanalization. The clinical findings completely resolved (NIHSS 0) within 12 hr and remained unchanged at 3 mo and 1 yr. Informed consent was obtained from the patient for use of media for educational and publication purposes.

scholarly journals Dyke-Davidoff-Masson syndrome: case report of fetal unilateral ventriculomegaly and hypoplastic left middle cerebral artery

2013 ◽  
Vol 39 (1) ◽  
pp. 32 ◽  
Author(s):  
Ettore Piro ◽  
Maria Piccione ◽  
Gianluca Marrone ◽  
Mario Giuffrè ◽  
Giovanni Corsello
Keyword(s):  
Case Report ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Left Middle Cerebral Artery ◽  
Left Middle

scholarly journals Therapeutic challenges after successful thrombectomy in a patient with an antiphospholipid syndrome associated M1-occlusion: A case report

2015 ◽  
Vol 21 (5) ◽  
pp. 598-602 ◽  
Author(s):  
Katharina Stadler ◽  
Johannes S Mutzenbach ◽  
Gudrun Kalss ◽  
Johann Sellner ◽  
Abdul R Al-Schameri ◽  
...  
Keyword(s):  
Case Report ◽  
Antiphospholipid Syndrome ◽  
Stent Implantation ◽  
New Left ◽  
Anticoagulation Therapy ◽  
Blood Parameters ◽  
Left Middle Cerebral Artery ◽  
Systemic Thrombolysis ◽  
Magnetic Resonance Imaging Mri ◽  
The Right

Backround Stroke is a frequent disorder in patients with an antiphospholipid syndrome (APS). Due to a high risk for further thromboembolic events, appropriate anticoagulation therapy in patients with an APS-associated stroke seems mandatory but drug eluting and duration is a matter of debate. Case A 48-year-old female patient presented with Broca’s aphasia and mild hemiparesis on the right side. Diagnostic work-up revealed left middle cerebral artery (MCA) occlusion yet without diffusion-weighted lesions. Due to a thrombocytopenia (67.00 g/l) systemic thrombolysis was not indicated and endovascular treatment was initiated 150 min after symptom onset. After successful clot retrieval, recurrent re-occlusions lead to the necessity of stent implantation and anticoagulation, respectively. On day 5 she developed a new severe right-sided hemiparesis. The magnetic resonance imaging (MRI) showed a subtotal restenosis of the left MCA despite the regular anticoagulation regime leading to a new left MCA ischaemic stroke. In the meantime, the unknown aetiology, the patients’ age and the thrombocytopenia let to further diagnostic workup. Elevated blood parameters such as lupus anticoagulant (LA)-1, LA-ratio, positive anti-nuclear antibody (ANA), p-anti-neutrophil cytoplasmic antibodies (ANCA), c-ANCA confirmed the diagnosis of APS. Conclusion This case report showed the feasibility of mechanical clot retrieval and stent implantation in patients with APS. Due to the elevated risk of in-stent thrombosis a prolonged therapy with glycoprotein (GP)IIb/IIIa receptor antagonists in the initial postoperative period and further anticoagulation with coumarin derivate might be needed.

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