scholarly journals Unrecognized Ruptured Intracranial Aneurysm Presenting as Cerebral Vasospasm-Induced Ischemic Stroke: A Case Report

2021 ◽  
Author(s):  
Joong-Goo Kim ◽  
Chul-Hoo Kang ◽  
Jay Chol Choi ◽  
Jong-Kook Rhim
Keyword(s):  
Ischemic Stroke ◽  
Saccular Aneurysm ◽  
Left Middle Cerebral Artery ◽  
Digital Subtraction ◽  
Middle Cerebral Artery Territory ◽  
Resonance Imaging ◽  
Ruptured Intracranial Aneurysm ◽  
Acute Confusion ◽  
Subarachnoid Hemorrhages ◽  
Left Middle

A 44-year-old woman presented with acute confusion, apparently due to a clinically silent subarachnoid hemorrhage followed by vasospasm, which in turn led to an ischemic stroke. During the initial evaluation, an acute ischemic stroke in the left middle cerebral artery territory was observed. Magnetic resonance imaging revealed a late subacute hemorrhage in the left basal cistern. Digital subtraction angiography indicated the presence of a small saccular aneurysm that had recently ruptured, as well as vasospasm in the left circle of Willis. Balloon angioplasty and balloon-assisted coil embolization were performed for the vasospasm and saccular aneurysm, respectively. This case demonstrates that clinically silent subarachnoid hemorrhages resulting in ipsilateral vasospasm and infarction can occur as complications of a ruptured aneurysm.

Bivalirudin for Endovascular Intervention in Acute Ischemic Stroke: Case Report

Neurosurgery ◽  
2004 ◽  
Vol 54 (1) ◽  
pp. 218-223 ◽  
Author(s):  
Mark R. Harrigan ◽  
Elad I. Levy ◽  
Bernard R. Bendok ◽  
L. Nelson Hopkins
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Scale Score ◽  
Intracranial Hemorrhage ◽  
National Institutes Of Health ◽  
Left Middle Cerebral Artery ◽  
Computed Tomographic ◽  
Left Middle ◽  
Arterial Thrombolysis

Abstract OBJECTIVE AND IMPORTANCE Intra-arterial thrombolysis has been demonstrated to improve recanalization and outcomes among patients with acute ischemic stroke. However, thrombolytic agents have limited effectiveness and are associated with a significant risk of bleeding. Bivalirudin is a direct thrombin inhibitor that has been demonstrated in the cardiology literature to have a more favorable efficacy and bleeding profile than other antithrombotic medications. We report the use of bivalirudin during endovascular treatment of acute stroke, when hemorrhagic complications are not uncommon. CLINICAL PRESENTATION A 71-year-old woman with atrial fibrillation presented with right hemiparesis and aphasia and was found to have a National Institutes of Health Stroke Scale score of 10. Computed tomographic scans revealed no evidence of intracranial hemorrhage, aneurysm, or ischemic stroke. Cerebral angiography revealed thromboembolic occlusion of the superior division of the left middle cerebral artery. INTERVENTION For anticoagulation, a loading dose of bivalirudin was intravenously administered before the interventional procedure, followed by continuous infusion. Attempts to remove the clot with an endovascular snare failed to induce recanalization of the vessel. Bivalirudin was then administered intra-arterially. Immediate postprocedural angiography demonstrated restoration of flow in the left middle cerebral artery. Repeat computed tomographic scans demonstrated no intracranial hemorrhage. The patient's hemiparesis and aphasia were nearly resolved and her National Institutes of Health Stroke Scale score was 2 at the time of her discharge 5 days later. CONCLUSION To our knowledge, this is the first report of the use of bivalirudin for treatment of acute ischemic stroke. Bivalirudin may be a useful agent for intravenous anticoagulation and intra-arterial thrombolysis in this setting.

ISCHEMIC STROKE IN COVID-19 PATIENT: A RARE CASE REPORT.

2021 ◽  
pp. 72-73
Author(s):  
Atul Kaushik ◽  
Showkat Nazir Wani ◽  
Anish Garg ◽  
Dev Kumar
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Rare Case ◽  
Cardiovascular Complications ◽  
Left Middle Cerebral Artery ◽  
Early Evaluation ◽  
Rare Case Report ◽  
Ct Head ◽  
Left Middle ◽  
Middle Cerebral Artery Infarct

Background: COVID-19 is shown to be associated with hypercoagulable state which may cause neurological and cardiovascular complications. COVID-19 has been represented as an independent risk factor for acute ischemic stroke. Objective:We report a case of acute ischemic stroke as a COVID-19 complication. Material and methods: A 62-year-old known hypertensive male was diagnosed with COVID-19. He developed neurological symptoms 10 days after being tested positive. On doing an NC-CT head, a large acute ischemic stroke involving left Middle Cerebral Artery infarct was detected. Result and Conclusion: Our case represents the development of acute ischemic stroke as a neurological manifestation in patient with COVID-19. Early evaluation for acute neurological changes and timely management may reduce morbidity and mortality in such cases.

Bee sting leading to stroke: a case report and review of the literature

2021 ◽  
Vol 14 (11) ◽  
pp. e240693
Author(s):  
Shivakumar K Masaraddi ◽  
Rohan J Desai ◽  
Swanit Hemant Deshpande ◽  
Sameet Patel
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Diffusion Mri ◽  
Left Middle Cerebral Artery ◽  
Acute Pulmonary Oedema ◽  
Middle Cerebral Artery Territory ◽  
Review Of The Literature ◽  
Bee Sting ◽  
Local Reactions ◽  
Left Middle

In India, bee stings are very common, seen mainly in farmers and honey collectors. Usually, it presents with local reactions and anaphylaxis. It rarely requires urgent hospitalisation. Other major complications seen are acute renal failure, intravascular coagulation, rhabdomyolysis and acute pulmonary oedema. Stroke as a presentation is uncommon. We report a case of a 45-year-old man presenting with right-sided hemiplegia and aphasia due to multiple bee stings. Diffusion MRI showed left middle cerebral artery territory hyperacute infarct.

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.

Arterial Spin Labeling Magnetic Resonance Imaging Can Identify the Occlusion Site and Collateral Perfusion in Patients with Acute Ischemic Stroke: Comparison with Digital Subtraction Angiography

2019 ◽  
Vol 48 (1-2) ◽  
pp. 70-76 ◽  
Author(s):  
Yoichi Morofuji ◽  
Nobutaka Horie ◽  
Yohei Tateishi ◽  
Minoru Morikawa ◽  
Susumu Yamaguchi ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Acute Ischemic Stroke ◽  
Digital Subtraction Angiography ◽  
Arterial Spin Labeling ◽  
Spin Labeling ◽  
Collateral Flow ◽  
Digital Subtraction ◽  
Resonance Imaging

Background and Objectives: Determining the occlusion site and collateral blood flow is important in acute ischemic stroke. The purpose of the current study was to test whether arterial spin labeling (ASL) magnetic resonance imaging (MRI) could be used to identify the occlusion site and collateral perfusion, using digital subtraction angiography (DSA) as a gold standard. Method: Data from 521 consecutive patients who presented with acute ischemic stroke at our institution from January 2012 to September 2014 were retrospectively reviewed. Image data were included in this study if: (1) the patient presented symptoms of acute ischemic stroke; (2) MRI was performed within 24 h of symptom onset; and (3) DSA following MRI was performed (n = 32 patients). We defined proximal intra-arterial sign (IAS) on ASL as enlarged circular or linear bright hyperintense signal within the occluded artery and distal IAS as enlarged circular or linear bright hyperintense signals within arteries inside or surrounding the affected region. The presence or absence of the proximal IAS and distal IAS were assessed, along with their inter-rater agreement and consistency with the presence of occlusion site and collateral flow on DSA images. Results: The sensitivity and specificity for identifying occlusion site with ASL were 82.8 and 100%, respectively. Those for identifying collateral flow with ASL were 96.7 and 50%, respectively. The inter-rater reliability was excellent for proximal IAS (κ = 0.92; 95% CI 0.76–1.00) and substantial for distal IAS detection (κ = 0.78; 95% CI 0.38–1.00). Conclusions: Proximal IAS and distal IAS on ASL imaging can provide important diagnostic clues for the detection of arterial occlusion sites and collateral perfusion in patients with acute ischemic stroke.

scholarly journals Bilateral cerebral infarction associated with severe arteriosclerosis in the A1 segment: a case report

2019 ◽  
Vol 47 (3) ◽  
pp. 1373-1377
Author(s):  
Jing Lin ◽  
Wenbiao Xian ◽  
Rong Lai ◽  
Jiaoxing Li ◽  
Yufang Wang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cerebral Infarction ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Anterior Communicating Artery ◽  
Left Middle Cerebral Artery ◽  
Large Artery ◽  
Anterior Circulation ◽  
The Right ◽  
Left Middle

Large artery atherosclerosis and cardioembolism are the two major subtypes of ischemic stroke. We herein describe a 75-year-old man with acute complete cerebral infarction in the typical territories of the bilateral anterior cerebral artery (ACA) and left middle cerebral artery. Brain magnetic resonance angiography showed that the right A1 segment of the ACA was affected by severe arteriosclerosis and that the right ACA other than the A1 segment was compensated by the left ACA through the anterior communicating artery. Acute cardioembolism only occluded the left anterior circulation but simultaneously blocked the right ACA due to decompensation. We presume that the bilateral cerebral infarctions were caused by chronic atherosclerosis and acute cardioembolism.

scholarly journals Does the side of middle cerebral artery compromise matters in the mortality after thrombolysis in ischemic stroke?

2015 ◽  
Vol 73 (8) ◽  
pp. 644-647 ◽  
Author(s):  
Renata Dal-Prá Ducci ◽  
Marcos Christiano Lange ◽  
Carla Heloísa Moro ◽  
Rodrigo Harger ◽  
Alexandre Luiz Longo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Univariate Analysis ◽  
Intravenous Thrombolysis ◽  
Left Middle Cerebral Artery ◽  
Affected Side ◽  
The Impact ◽  
Left Middle

The impact of the side in middle cerebral artery (MCA) ischemic stroke is not well established. Our aim was to analyze the differences between right (RMCA) and left middle cerebral artery (LMCA) stroke in patients submitted to intravenous thrombolysis and the influence of the affected side in the patient’s mortality after 3 months. Method Patients with MCA ischemic stroke submitted to intravenous thrombolysis from March 2010 to December 2011 at two Brazilian Stroke Centers were included. Differences between patients with RMCA and LMCA stroke were identified by univariate analysis. Results Forty-five patients with RMCA stroke and 67 with LMCA stroke were analyzed. Patients with LMCA had a higher incidence of atrial fibrillation (p = 0.031), although patients with RMCA more often had a previous ischemic stroke (p = 0.034). The mortality over 3 months was similar for either side (OR = 1.20 ;0.37 - 4.29, p = 0.772). Conclusion The side of the MCA ischemic stroke did not influence the patients mortality.

scholarly journals Unusual Evolution and Computerized Tomographic Appearance of a Gliosarcoma

1994 ◽  
Vol 21 (2) ◽  
pp. 141-145
Author(s):  
Mark C. Preul ◽  
Jose A. Espinosa ◽  
Donatella Tampieri ◽  
Stirling Carpenter
Keyword(s):  
Middle Cerebral Artery ◽  
Mass Effect ◽  
Left Middle Cerebral Artery ◽  
Low Grade ◽  
Post Mortem ◽  
Middle Cerebral Artery Territory ◽  
Entire Area ◽  
Central Calcification ◽  
The Brain ◽  
Left Middle

Abstract:A patient with a remote infarct, seizures, mild hemiparesis, and dysphasia became obtunded over four months and died. Computerized tomography (CT) over 5 years showed a consistent, large, wedge-shaped left hemisphere hypodensity with a central calcification, but without signs of mass effect. This was interpreted as an infarct of the left middle cerebral artery territory. Post-mortem examination of the brain revealed the entire area appearing as infarct on CT was a gliosarcoma. We suspect that the unusual CT appearance of the lesion was likely caused by multiple pathologies: a low grade glioma transforming into a gliosarcoma that was able to spread throughout the area of infarct encephalomalacia without revealing a typical CT appearance of mass effect. The patient's brief period of deterioration probably coincided with transformation of the tumor into a gliosarcoma. The variable CT characteristics of gliosarcomas are reviewed.

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