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Severe Reversible Cerebral Vasoconstriction Syndrome with Large Posterior Cerebral Infarction
Reversible cerebral vasoconstriction syndrome is characterized by thunderclap headache and multifocal cerebral vasoconstriction. Cerebral vasoconstriction is reversible, and most cases have good prognosis. However, clinical outcome is possibly severe when it is complicated by stroke, yet detailed reports on such a case are few. We experienced a case of severe reversible cerebral vasoconstriction syndrome in a 32-year-old woman with medical history of preeclampsia 3 years prior. She presented with sudden sharp headache followed by altered mental status and vasoconstriction of the bilateral posterior cerebral arteries.
Source: Journal of Stroke and Cerebrovascular Diseases - August 6, 2018 Category: Neurology Authors: Hiroki Yamada, Ryogo Kikuchi, Akiyoshi Nakamura, Hiromichi Miyazaki Source Type: research

Oral Dipyridamole-Associated Circulatory Collapse
Extended-release dipyridamole plus aspirin is widely used for secondary prevention of ischemic stroke, although the molecular pharmacodynamics of dipyridamole are not completely determined. Adverse effects of fixed-dose combination of aspirin and dipyridamole include headache, bleeding, and gastrointestinal events. Previously, intravenous infusion of dipyridamole in cardiac stress testing has been associated with cardiogenic shock and pulmonary edema. Herein, we report a case study of a 72-year-old man, presented with a transient ischemic attack who suffered a circulatory collapse after an oral dose of 200 mg extended-release dipyridamole.
Source: Journal of Stroke and Cerebrovascular Diseases - September 2, 2018 Category: Neurology Authors: Pasi Jolma, Jyrki Ollikainen, Ilkka Uurto Source Type: research

De Novo Renal Artery Stenosis Developed in Initially Normal Renal Arteries during the Long-Term Follow-Up of Patients with Moyamoya Disease
Moyamoya disease is a cerebrovascular disease of unknown origin causing progressive stenosis of the intracranial arteries in the circle of Willis.1,2 Stenoocclusive lesions and the subsequent hemodynamic compromise result in the formation of dilated, fragile collateral vessels at the base of the brain, which are termed moyamoya vessels. The presentation of patients with these lesions varies from asymptomatic to symptoms of headache, epilepsy, and ischemic and hemorrhagic stroke. Patients with moyamoya disease sometimes have concomitant extracranial arterial stenosis3; of all the extracranial arteries reported, the most com...
Source: Journal of Stroke and Cerebrovascular Diseases - March 27, 2020 Category: Neurology Authors: Shoko Hara, Kazuhide Shimizu, Tadashi Nariai, Mitsuhiro Kishino, Toshifumi Kudo, Tomoyuki Umemoto, Motoki Inaji, Taketoshi Maehara Tags: Case Report Source Type: research

Rules About Rules – The 6-h CT Rule For Subarachnoid Hemorrhage
In this issue of the Journal of Stroke and Cerebrovascular Diseases, Chakraborty and colleagues describe the cautionary tale of a patient who presented with a thunderclap headache concerning for a subarachnoid hemorrhage (SAH). A head computed tomographic scan (CT) done 4  h after the onset of the headache was interpreted as negative but the patient was ultimately found to have an aneurysmal SAH.1
Source: Journal of Stroke and Cerebrovascular Diseases - September 15, 2020 Category: Neurology Authors: Jonathan A. Edlow Source Type: research

A Novel Mutation Outside of the EGFr Encoding Exons of NOTCH3 Gene in a Chinese with CADASIL
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary cerebral small vascular disease caused by the mutations of the NOTCH3 gene. The NOTCH3 gene consists of 33 exons. The pathogenic mutations of the NOTCH3 gene in CADASIL are located in 2 –24 exons coding for the 34 EGFr (epidermal growth factor-like repeat) domains. The classical clinical manifestations are recurrent TIA or ischaemic stroke, migraine, cognitive disorder and affective disorder.
Source: Journal of Stroke and Cerebrovascular Diseases - October 30, 2020 Category: Neurology Authors: wan Wang, Zhixia Ren, yingying Shi, Jiewen Zhang Source Type: research

Giant Vertebrobasilar Fusiform Aneurysm Mass Effect Heralds Rapid in Situ Thrombosis and Ischemic Stroke in the Setting of Ulcerative Colitis
Here we describe a case of brainstem infarction secondary to rapid thrombus formation in a giant vertebrobasilar fusiform aneurysm (GVBFA) that was preceded clinically by several months of headaches and dizziness initially attributable to mass effect. Less than a month after initial identification of the aneurysm, a large partially-occluding thrombus formed leading to infarction of the brainstem. Interestingly, this patient also had ulcerative colitis, which has been associated with acquired hypercoagulability.
Source: Journal of Stroke and Cerebrovascular Diseases - February 10, 2021 Category: Neurology Authors: Keith J. Kincaid, Ju Yu, Franklin D. Echevarria, Alexis N. Simpkins Tags: Case Report Source Type: research

Pediatric Case of Life-Threatening Stroke Caused by Reversible Cerebral Vasoconstriction Syndrome with Spontaneous Cervical Internal Carotid Artery Vasospasm: A Case Report
Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by acute and severe headache, referred to as thunderclap, and transient segmental cerebral arterial vasoconstriction. The diagnostic criteria include 1) thunderclap headache with or without neurological deficits or seizures, 2) uniphasic course without new symptoms lasting for more than a month after clinical onset, 3) no evidence of aneurysmal subarachnoid hemorrhage, 4) normal or near-normal cerebrospinal fluid analysis findings, 5) multifocal segmental cerebral artery vasoconstriction on either catheter angiography or, indirectly, computed tomography ...
Source: Journal of Stroke and Cerebrovascular Diseases - August 12, 2021 Category: Neurology Authors: Yu Fujii, Yoshiki Hanaoka, Toshihiro Ogiwara, Jun-ichi Koyama, Tetsuyoshi Horiuchi Tags: Case Report Source Type: research

First Report: Rare RNF213 Variant Associated with Familial Moyamoya Disease in an African American Family
Moyamoya disease (MMD) is a rare progressive idiopathic cerebrovasculopathy. Symptoms include headache, seizures, and ischaemic or haemorrhagic stroke. In contrast, the vasculopathy in moyamoya syndrome is secondary to an inciting event or systemic disease. MMD has a bimodal distribution, peaking around ages 10 and 40.
Source: Journal of Stroke and Cerebrovascular Diseases - October 16, 2021 Category: Neurology Authors: N. Abimbola Sunmonu, Naveen Kumar Ambati, Matthew J. Thomas, Robin D. Ulep, Bradford Worrall Tags: Short Communication Source Type: research

Ischemic stroke is a potential complication of uncontrolled inflammation in mevalonate kinase deficiency – A case report
Mevalonate kinase deficiency (MKD) is an autosomal recessive monogenic autoinflammatory disease (AID) characterized by recurrent antigen-independent systemic inflammation attacks, interleukin-1beta hypersecretion, fever and pain.1 Neurological manifestations include headaches, fatigue, retinal dystrophy, ataxia and development delay.2
Source: Journal of Stroke and Cerebrovascular Diseases - October 12, 2022 Category: Neurology Authors: Justine Blais, Didier Bonneville-Roussy, Hannah Laure Elfassy, Sylvain Lanthier Tags: Case Report Source Type: research

Angiogram-Negative Subarachnoid Hemorrhage: Outcomes Data and Review of the Literature
We report data for 31 patients who presented to our institution from 2006 to the present. We performed a retrospective chart review, and report outcome data that include rates of rehemorrhage, hydrocephalus, vasospasm, permanent ischemic deficits, headaches, and outcomes based on modified Rankin Scale scores. We also performed a review of the literature and meta-analysis of the data therein. We compared rates of complications in the PMH subgroup and the diffuse-type hemorrhage subgroup. The chart review revealed no poor outcomes and no rehemorrhages in the patients with PMH. In the diffuse hemorrhage subgroup, 1 patient ha...
Source: Journal of Stroke and Cerebrovascular Diseases - April 1, 2012 Category: Neurology Authors: Scott Boswell, William Thorell, Steve Gogela, Elizabeth Lyden, Dan Surdell Tags: Original Articles Source Type: research

Simultaneous Onset of Anterior and Middle Cerebral Artery Dissections with an Old Vertebral Artery Dissection
We report a patient with infarctions caused by simultaneous arterial dissections in the right anterior cerebral artery and the left middle cerebral artery and discuss the characteristic feature of this vascular disorder. A 53-year-old woman presented with a severe headache and a mild aphasia. Magnetic resonance imaging revealed multiple acute cerebral infarctions in the left temporal and right frontal lobes. The initial angiographic findings revealed arterial dissections of the anterior cerebral, left middle cerebral, and right vertebral arteries. The follow-up angiographic examination found improvement of the stenosis in ...
Source: Journal of Stroke and Cerebrovascular Diseases - April 16, 2012 Category: Neurology Authors: Tatsuya Kato, Takashi Yagi, Hideyuki Yoshioka, Masakazu Ogiwara, Toru Horikoshi, Hiroyuki Kinouchi Tags: Original Articles Source Type: research

Clinical and Radiological Management and Outcome of Pregnancies Complicated by Cerebral Venous Thrombosis: A Review of 19 Cases
Conclusions: If magnetic resonance imaging is available, it should be used for the detection of CVT in all pregnant patients instead of computed tomography. Patients with parenchymal lesions, thrombophilia, and antiphospholipid syndrome had a greater risk of being left with neurologic sequelae. For pregnant patients with CVT, low molecular weight heparin in full anticoagulant doses should be continued throughout the pregnancy. Anticoagulant therapy did not appear to predispose patients to further intracranial hemorrhage.
Source: Journal of Stroke and Cerebrovascular Diseases - August 17, 2012 Category: Neurology Authors: Caner Feyzi Demir, Mehmet Fatih İnci, Fuat Özkan, Mustafa Yıldız, Hasan Özdemir Tags: Original Articles Source Type: research

Nonaneurysmal Subarachnoid Hemorrhage after Udenafil Intake
We report a 67-year-old man who presented with severe headache after taking 50 mg of udenafil, a new phosphodiesterase 5 inhibitor. Computed tomographic imaging of the brain revealed a small amount of acute subarachnoid hemorrhage localized around basal cisterns (anterior to midbrain and pons). There were no aneurysms in the cerebral arteries, although vein of Galen stenosis was suspected after magnetic resonance venography. This case anecdotally suggests that phosphodiesterase 5 inhibition might trigger perimesencephalic subarachnoid hemorrhage with venous hypertension possibly associated with vein of Galen stenosis.
Source: Journal of Stroke and Cerebrovascular Diseases - May 6, 2013 Category: Neurology Authors: Eun-Kee Bae, Jong-Hyeon Ahn, Jeong-Jin Park Tags: Case Reports Source Type: research

Ipsilateral Sensorimotor Deficits in Lateral Medullary Infarction: A Case Report
The patient, a 32-year-old man, presented with sudden onset of occipital headache, vertigo, dysarthria, gait ataxia, right Horner syndrome, numbness of the right hand, and mild right hemiparesis. On magnetic resonance imaging, an acute small infarction was located on the right side of the caudal medulla extending dorsomedially. Magnetic resonance angiography showed severe right vertebral artery stenosis. Lateral medullary infarction associated with ipsilateral sensorimotor deficits in the limb is very rare, and the lesion probably involved the ipsilateral dorsal column or decussating lemniscal fibers and corticospinal fibe...
Source: Journal of Stroke and Cerebrovascular Diseases - December 10, 2012 Category: Neurology Authors: Tetsuro Sameshima, Akio Morita, Yumiko Yamaoka, Yasumitsu Ichikawa Tags: Case Reports Source Type: research

A Ruptured Aneurysm Arising at the Leptomeningeal Collateral Circulation from the Extracranial Vertebral Artery to the Posterior Inferior Cerebellar Artery Associated with Bilateral Vertebral Artery Occlusion
We report an extremely rare case of a small ruptured aneurysm of the leptomeningeal collateral circulation from the vertebral artery (VA) to the posterior inferior cerebellar artery (PICA); this aneurysm was associated with bilateral VA occlusion. A 72-year-old woman with sudden headache, nausea, and subarachnoid hemorrhage (SAH) was admitted to our hospital. On admission, no evidence of cerebral signs or cranial nerve palsy was found. Computed tomography imaging showed SAH predominantly in the posterior fossa, and digital subtraction angiography revealed bilateral VA occlusion and the left VA aneurysm located proximal to ...
Source: Journal of Stroke and Cerebrovascular Diseases - December 9, 2013 Category: Neurology Authors: Masashi Chonan, Shinjitu Nishimura, Naoto Kimura, Masayuki Ezura, Hiroshi Uenohara, Teiji Tominaga Tags: Case Reports Source Type: research

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