middle cerebral artery territory
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2021 ◽  
Vol 14 (11) ◽  
pp. e240693
Author(s):  
Shivakumar K Masaraddi ◽  
Rohan J Desai ◽  
Swanit Hemant Deshpande ◽  
Sameet Patel

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.


2021 ◽  
Vol 59 (239) ◽  
Author(s):  
Biraj Pokhrel ◽  
Shambhu Khanal ◽  
Parikshit Chapagain ◽  
Gopal Sedain

Cerebral infarction is a rare complication of pituitary apoplexy, which can result in significant morbidity if not treated on time. Pituitary apoplexy mostly occurs in pre-existing adenoma, which can remain undiagnosed until symptoms arise. Here, we present a case of a 26-year-old man with undiagnosed acromegaly who presented with left retro-orbital pain, diminished vision of the left eye, and right hemiparesis. Neuroimaging revealed large hemorrhagic sellar mass and ischemic infarction in the left middle cerebral artery territory. Emergency transcranial tumor excision was done, which resulted in significant neurological recovery.


2021 ◽  
Author(s):  
Kilian Fröhlich ◽  
Gabriela Siedler ◽  
Svenja Stoll ◽  
Kosmas Macha ◽  
Thomas M. Kinfe ◽  
...  

Abstract Purpose Endovascular therapy (EVT) of large-vessel occlusion in acute ischemic stroke (AIS) may be performed in general anesthesia (GA) or conscious sedation (CS). We intended to determine the contribution of ischemic cerebral lesion sites on the physician’s decision between GA and CS using voxel-based lesion symptom mapping (VLSM). Methods In a prospective local database, we sought patients with documented AIS and EVT. Age, stroke severity, lesion volume, vigilance, and aphasia scores were compared between EVT patients with GA and CS. The ischemic lesions were analyzed on CT or MRI scans and transformed into stereotaxic space. We determined the lesion overlap and assessed whether GA or CS is associated with specific cerebral lesion sites using the voxel-wise Liebermeister test. Results One hundred seventy-nine patients with AIS and EVT were included in the analysis. The VLSM analysis yielded associations between GA and ischemic lesions in the left hemispheric middle cerebral artery territory and posterior circulation areas. Stroke severity and lesion volume were significantly higher in the GA group. The prevalence of aphasia and aphasia severity was significantly higher and parameters of vigilance lower in the GA group. Conclusions The VLSM analysis showed associations between GA and ischemic lesions in the left hemispheric middle cerebral artery territory and posterior circulation areas including the thalamus that are known to cause neurologic deficits, such as aphasia or compromised vigilance, in AIS-patients with EVT. Our data suggest that higher disability, clinical impairment due to neurological deficits like aphasia, or reduced alertness of affected patients may influence the physician’s decision on using GA in EVT.


2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Hussen Abdu ◽  
Fentaw Tadese ◽  
Girma Seyoum

Background. Distinguishing the category of stroke plays a vital role in planning patient care. Simple clinical findings help distinguish the type of stroke. However, there is a need for diagnostic imaging. In Ethiopia, stroke is the most common neurological condition in patients admitted to hospitals. Yet, there are limited data on comparisons of stroke subtypes. Thus, this study was designed to determine the prevalence of stroke and to compare ischemic and hemorrhagic strokes. Methods. A retrospective cross-sectional study design was employed. Medical records containing complete information and confirmed diagnosis using imaging techniques were included. The data were entered into SPSS version 24.0 for analysis. Results with a P value of <0.05 were considered statistically significant. Results. From a total of 312 stroke patients, 204 (65.4%) patients were admitted due to ischemic stroke. More females, 59 (18.9%), were admitted for hemorrhagic stroke than males. In both ischemic, 175 (56.1%) and hemorrhagic, 91 (29.2%) stroke cases, most of the patients were 45 years and above. Middle cerebral artery territory was the most common site of arterial territory infarctions in ischemic stroke, 158 (50.7%). Middle cerebral artery territory also was the most common site of hematoma in hemorrhagic stroke, 91 (29.2%). Infarctions in more than one lobe of the cerebrum (16.4%) and intracerebral hemorrhage in multiple areas of the cerebrum (7.4%) were observed in ischemic as well as hemorrhagic stroke cases. Most of the ischemic, 124 (39.8%), and hemorrhagic, 39 (12.5%), stroke patients presented loss of sensation and weakness of body parts. Hypertension was observed in 124 (39.8%) ischemic and 73 (23.4%) hemorrhagic stroke patients. The mortality rate of ischemic stroke, 47 (15.3%), was two times higher than hemorrhagic stroke, 20 (6.5%). Hypertension was the most common predictor of death in both ischemic and hemorrhagic stroke cases. Conclusions. Ischemic stroke is a common type of stroke in the medical ward of the study hospital. More females were affected by hemorrhagic stroke than males. Middle cerebral artery territory was the most affected area of the brain in both ischemic and hemorrhagic strokes. Most ischemic and hemorrhagic stroke patients were admitted due to loss of sensation and weakness of body parts. Hypertension was the most common risk factor of stroke as well as a predictor of stroke-related deaths. Identification of the stroke subtypes may be important in the management of stroke. Thus, health professionals, government officials, community leaders, and the population at large could be involved in creating awareness about antecedent risk factors and clinical presentations of stroke subtypes.


2021 ◽  
Vol 14 (6) ◽  
pp. e243193
Author(s):  
Budha O Singh ◽  
Prasan Kumar Panda ◽  
Rohit Walia

Cannabis is one of the most common illicit drugs and has been implicated with various complications which include stroke, acute myocardial infarction, arrhythmia and limb arteritis. We are reporting a case of a young man, who is a recreational cannabis smoker along with tobacco, who developed exertional progressive breathlessness for the last 4 months, mild cough for 2 months and acute left-sided hemiparesis along with ipsilateral facial palsy for 1 day that was attributed to an acute right middle cerebral artery territory infarct. There was also gangrene in his left forearm as a result of left radial artery thrombosis. Non-ischaemic-dilated cardiomyopathy was found in contrast-enhanced cardiac MRI and he was managed in the line of decompensated heart failure; the right-hand gangrene was later amputated in the subsequent follow-ups. Hence, cannabis can lead to cardiomyopathy and resulting cardioembolism. The mainstay of management remains supportive and avoidance of the offending agent. Social education is the need of the hour.


Author(s):  
Joong-Goo Kim ◽  
Chul-Hoo Kang ◽  
Jay Chol Choi ◽  
Jong-Kook Rhim

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.


2021 ◽  
Vol 12 ◽  
Author(s):  
Hai-Bin Xu ◽  
Yu-Fei Sun ◽  
Na Luo ◽  
Jia-Qi Wang ◽  
Guo-Can Chang ◽  
...  

Background and purpose: Previous studies have demonstrated that Net Water Uptake (NWU) is associated with the development of malignant edema (ME). The current study aimed to investigate whether NWU calculated in standardized and blindly outlined regions of the middle cerebral artery can predict the development of ME.Methods: We retrospectively included 119 patients suffering from large hemispheric infarction within onset of 24 h. The region of the middle cerebral artery territory was blindly outlined in a standard manner to calculate NWU. Patients were divided into two groups according to the occurrence of ME, which is defined as space-occupying infarct requiring decompressive craniotomy or death due to cerebral hernia in 7 days from onset. The clinical characteristics were analyzed, and the receiver operating characteristic curve (ROC curve) was used to assess the predictive ability of NWU and other factors for ME.Results: Multivariable analysis showed that NWU was an independent predictor of ME (OR 1.168, 95% CI 1.041–1.310). According to the ROC curve, NWU≥8.127% identified ME with good predictive power (AUC 0.734, sensitivity 0.656, specificity 0.862).Conclusions: NWU calculated in standardized and blindly outlined regions of the middle cerebral artery territory is also a good predictor for the development of ME in patients with large hemispheric infarction.


2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Ahmed Esmael ◽  
Mohammed Elsherief ◽  
Khaled Eltoukhy

Objectives. This study is aimed at correlating ASPECTS with mortality and morbidity in patients with acute middle cerebral artery territory infarction and at determining the cutoff value of ASPECTS that may predict the outcome. Methods. 150 patients diagnosed with acute middle cerebral artery territory infarction were involved in this study. Risk factors, initial NIHSS, and GCS were determined. An initial or follow-up noncontrast CT brain was done and assessed by ASPECTS. Outcomes were determined by mRS during the follow-up of cases after 3 months. Correlations of ASPECTS and outcome variables were done by Spearman correlation. Logistic regression analysis and ROC curve were done to detect the cutoff value of ASPECTS that predicts unfavorable outcomes. Results. The most common subtypes of ischemic strokes were lacunar stroke in 66 patients (44%), cardioembolic stroke in 39 patients (26%), and LAA stroke in 30 cases (20%). The cardioembolic stroke had a statistically significant lower ASPECT score than other types of ischemic strokes ( P < 0.05 ). Spearman correlation showed that lower ASPECTS values (worse outcome) were more in older patients and associated with lower initial GCS. ASPECTS values were inversely correlated with initial NIHSS, inpatient stay, inpatient complications, mortality, and mRS. The ASPECTS cutoff value determined for the prediction of unfavorable outcomes was equal to ≤7. The binary logistic regression analysis detected that patients with ASPECTS ≤ 7 were significantly associated with about fourfold increased risk of poor outcomes (OR 3.95, 95% CI 2.09–11.38, and P < 0.01 ). Conclusions. ASPECTS is a valuable and appropriate technique for the evaluation of the prognosis in acute ischemic stroke. Patients with high ASPECTS values are more likely to attain favorable outcomes, and the cutoff value of ASPECTS is a strong predictor for unfavorable outcomes. This trial is registered with ClinicalTrials.gov NCT04235920.


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