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Survivor gives us a lens into regional systems of care for acute ischemic stroke in North Dakota
I just got back from the North Dakota Mission: Lifeline STEMI and Acute Stroke Conference in Bismark, ND. I had a great time and I learned a lot. I often get asked to speak in various venues about acute STEMI and 12-lead ECG interpretation, but for this conference they wanted me to talk mostly about stroke. That turned out to be a good thing because it forced me to read the 2013 AHA / ASA Guildelines for the Early Management of Patients With Acute Ischemic Stroke to make sure I was asking intelligent questions during the panel discussion (which I moderated) and also giving accurate information for the class I taught about ...
Source: EMS 12-Lead - May 31, 2013 Category: Cardiology Authors: Tom Bouthillet Tags: ems-topics patient-management North Dakota Mission Lifeline Stroke Source Type: research

Reduced Smoke-like Echo and Resolved Thrombus in the Left Atrium with Rivaroxaban Therapy in an Acute Cardioembolic Stroke Patient
We report a case of a nonvalvular atrial fibrillation (NVAF) patient with acute cardioembolic stroke in whom rivaroxaban, an oral direct factor Xa inhibitor, reduced a smoke-like echo in the left atrium and resolved a thrombus in the left atrial appendage. A 71-year-old man was admitted because of the sudden onset of right hemiplegia and aphasia and was diagnosed with acute cardioembolic stroke associated with NVAF. The patient had not been treated with warfarin before admission, and rivaroxaban therapy (15 mg once daily) was initiated. Transesophageal echocardiography was performed on day 8 and a mobile thrombus was foun...
Source: Journal of Stroke and Cerebrovascular Diseases - April 11, 2014 Category: Neurology Authors: Shin Saito, Hirofumi Tomita, Yoshihiro Kimura, Hiroshi Shiroto, Joji Hagii, Norifumi Metoki, Hiroyasu Hitomi, Takaatsu Kamada, Tomohiro Osanai, Ken Okumura, Minoru Yasujima Tags: Case Reports Source Type: research

Repeated Episodes of Ischemic Stroke over a Short Period in a Patient with Essential Thrombocythemia on Anticoagulant Therapy
A 69-year-old man who had essential thrombocythemia, for which he was taking no medications, suddenly developed aphasia and right hemiplegia and was admitted to the hospital. He was thought to have had an embolic stroke and was initially treated with warfarin. Although the international normalized ratio was in the therapeutic range, he had 3 additional ischemic stroke episodes with the same symptoms after the index stroke. Magnetic resonance angiographic examinations revealed serial changes in middle cerebral artery stenosis. After administration of an antiplatelet agent and hydroxyurea, he had no additional strokes.
Source: Journal of Stroke and Cerebrovascular Diseases - August 14, 2012 Category: Neurology Authors: Masaki Naganuma, Kazuya Isoda, Shinsuke Nishi, Kiyotaka Ito, Teruyuki Hirano Tags: Case Reports Source Type: research

Is intravenous thrombolysis safe for acute ischemic stroke patients taking warfarin with INR 1.9?: A case report
Conclusion: The clinical guidelines are still the main reference for guiding clinical practice, and the main thrombolytic standards and contraindications for treatment still need to be conformed. On this basis, for individualized patients, clinicians must accurately judge the cause of acute stroke, to make optimal choice, reduce disability and mortality, and improve quality of life of patients.
Source: Medicine - March 1, 2020 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

The Case Files: Traumatic Carotid Dissection
By Hsiao, Jonie MD   A 30-year-old man who was right-hand dominant presented 10 days after sustaining left-sided face and head trauma from a fall from a skateboard at an unknown speed. He lost consciousness for several seconds, and initially developed a headache with nausea and vomiting. A non-contrast head CT performed at another hospital done two days after the incident was reportedly negative.   He now presents primarily with concerns about the appearance of his left eye. He has notable anisocoria and a droopy eyelid. His left pupil is notably smaller, 2 mm, compared with the right eye, 5 mm. Both are reactive. The re...
Source: The Case Files - June 4, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research

Resolution of left ventricular thrombus by edoxaban after failed treatment with warfarin overdose: A case report
Rationale: Although novel oral-anticoagulants are widely used in patients with atrial fibrillation (AF) for stroke prevention, there was only limited evidence for their use in left ventricular (LV) thrombus. Patient concerns: A 41-year-old man who presented with acute onset of right-hand clumsiness and aphasia even under high international normalized ratio (INR: 7.64) from warfarin use. He was previously treated with warfarin for the LV thrombus and non-valvular AF. Brain magnetic resonance imaging (MRI) showed multiple acute infarction in the cortex of the bilateral frontal lobes, left parietal lobe, and bilateral ce...
Source: Medicine - January 1, 2019 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

E-248 Postpartum vertebral artery dissections: a report of 7 cases and literature review
ConclusionA limited cohort of 33 ppVADs exist in the literature. This study contributes 7 additional cases and suggests that, despite heterogenous management of ppVAD, the resulting outcomes were favorable.Disclosures V. Lazarov: None. A. Monteiro: None. F. Almayman: None. M. Waqas: None. J. Cappuzzo: None. E. Levy: None. A. Siddiqui: None.
Source: Journal of NeuroInterventional Surgery - July 23, 2022 Category: Neurosurgery Authors: Lazarov, V., Monteiro, A., Almayman, F., Waqas, M., Cappuzzo, J., Levy, E., Siddiqui, A. Tags: SNIS 19th annual meeting electronic poster abstracts Source Type: research

Case report: MELAS and concomitant presumed antiphospholipid antibody syndrome in an adult woman
Mitochondrial encephalomyopathy, lactic acidosis, stroke-like episodes, and other features (short stature, headaches, seizures, and sensorineural hearing loss) constitute characteristics of MELAS syndrome. MELAS is a rare condition due to mutations in maternally inherited mitochondrial DNA with levels of heteroplasmy possibly related to late adulthood presentation. A previously reported MELAS case coexisted with presumed Antiphospholipid Antibody Syndrome (APLAS), but the connection between MELAS and a potential APLAS is unclear. A 29-year-old woman presented with mild right-sided sensorimotor symptoms and mixed aphasia in...
Source: Frontiers in Neurology - December 14, 2022 Category: Neurology Source Type: research

Aortic Sarcoma Mimicking a Thrombus Filling Vascular Lumen: A Rare Cause of Cerebral Infarction (P4.364)
Conclusion- Primary aortic sarcoma is an extremely rare cause of stroke. This sarcoma may be misinterpreted as a thrombus filling vascular lumen on CT angiography, but no elevation of D-dimer is incompatible with a large thrombus. The final diagnosis can be made by surgical biopsy.Disclosure: Dr. Kim has nothing to disclose. Dr. Jeon has nothing to disclose. Dr. Park has nothing to disclose. Dr. Kim has nothing to disclose. Dr. Kim has nothing to disclose. Dr. Kwon has nothing to disclose.
Source: Neurology - April 3, 2016 Category: Neurology Authors: Kim, H., Jeon, S.-B., Park, K.-W., Kim, H., Kim, B. J., Kwon, S. Tags: Cerebrovascular Case Reports Source Type: research

Clinical Reasoning: A 68-year-old man with a history of lung cancer presenting with right-sided weakness and aphasia
A 68-year-old man with paroxysmal atrial fibrillation on warfarin, left subclavian thrombosis treated with carotid-subclavian bypass, and lung adenocarcinoma treated with pneumonectomy, chemotherapy, and prophylactic cranial irradiation and in remission since 1987 was admitted to our neurocritical care unit with acute onset of right-sided weakness, expressive aphasia, and lethargy. On admission his temperature was 101.7°F, and initial blood pressure was 140/60 mm Hg. There was no nuchal rigidity. He was alert and mute with impaired comprehension. He had left gaze preference. Vision was impaired in the right field. Ther...
Source: Neurology - October 5, 2015 Category: Neurology Authors: Gupta, A., Etherton, M. R., McKee, K., Baker, J. M., Izzy, S., Feske, S. K. Tags: All Cerebrovascular disease/Stroke, Radiation therapy-tumor, All Epilepsy/Seizures RESIDENT AND FELLOW SECTION Source Type: research