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Malignant Middle Cerebral Artery Infarction Resulting from Dissection of Middle Cerebral Artery
A 30-year-old man presented with headache, left hemiparesis, and uncal herniation. Magnetic resonance imaging showed acute infarction in the right middle cerebral artery (MCA). Lifesaving craniotomy proceeded because of the uncal herniation. Assessment of brain tissue led to a diagnosis of MCA dissection. His skin biopsy showed ultrastructural abnormalities of dermal connective tissue. This is the unique case that dissection was diagnosed from both a biopsy specimen of the MCA and the dermal connective tissue.
Source: Journal of Stroke and Cerebrovascular Diseases - August 13, 2015 Category: Neurology Authors: Kenichi Sakuta, Renpei Sengoku, Hidetaka Mitsumura, Yu Kono, Issei Kan, Shogo Kaku, Yasuyuki Iguchi Tags: Case Report Source Type: research

Case of Cerebral Amyloid Angiopathy-Related Inflammation – Is the Absence of Cerebral Microbleeds A Good Prognostic Sign?
Objective: The aim of this study is to describe a case of pathologically proven cerebral amyloid angiopathy-related inflammation (CAA-I) without cerebral microbleeds (CMBs) and its clinical course. Background: CAA-I is an uncommon variant of cerebral amyloid angiopathy. Keys to diagnosis rely on the physician's awareness of this entity, CMBs on magnetic resonance imaging (MRI), an often favorable response to immunosuppression, and ultimately brain biopsy. CAA-I with no CMBs is rarely reported. Results: A 76-year-old woman presented with 4 weeks of headaches and was found to have visual neglect on the left part of the visual field.
Source: Journal of Stroke and Cerebrovascular Diseases - September 1, 2015 Category: Neurology Authors: John W. Liang, Wei Zhang, Jonathan Sarlin, Irene Boniece Tags: Case Report Source Type: research

Report of Dramatic Improvement after a Lumboperitoneal Shunt Procedure in a Case of Anticoagulation Therapy-Resistant Cerebral Venous Thrombosis
Cerebral venous thrombosis (CVT), which typically progresses from either acute or subacute onset, presents with symptoms related to intracranial hypertension (e.g., headache and papilledema) and brain parenchymal lesions (e.g., aphasia and hemiplegia). Anticoagulation therapy is generally accepted as a treatment for CVT and often leads to good clinical outcomes. However, we experienced a case of CVT with an uncommon clinical course. The patient was a 63-year-old man who presented with headache, papilledema, visual loss, and diplopia; his condition gradually deteriorated, and he was diagnosed with CVT via cerebral angiography.
Source: Journal of Stroke and Cerebrovascular Diseases - November 30, 2015 Category: Neurology Authors: Sadaharu Torikoshi, Yoshinori Akiyama Tags: Case Studies Source Type: research

Percutaneous Transluminal Angioplasty Improved Posterior Reversible Encephalopathy Syndrome due to Renovascular Hypertension
A 51-year-old man was admitted to our hospital complaining of preceding throbbing headache and tonic convulsions. Headache and convulsive seizure disappeared and his consciousness recovered to alert within 2 hours after onset. Neurological examination showed no abnormal findings. Laboratory examinations revealed high low-density lipoprotein cholesterol (179 mg/dL), renin (42 ng/mL/hour), aldosterone (265 pg/mL), noradrenaline (1031 pg/mL), and dopamine (79 pg/mL). In brain magnetic resonance imaging (MRI), fluid-attenuated inversion recovery, but not the diffusion-weighted image, showed high signal intensities in...
Source: Journal of Stroke and Cerebrovascular Diseases - November 30, 2015 Category: Neurology Authors: Atsushi Mizuma, Maiko Kouchi, Taira Nakayama, Shunya Takizawa Tags: Case Studies Source Type: research

Puerperal Extracranial Vertebral Artery Dissection and Nonaneurysmal Subarachnoid Hemorrhage
Previously reported only a few times before, we present a case of extracranial vertebral dissection and spontaneous frontoparietal subarachnoid hemorrhage (SAH) in the puerperium, discussing possible mechanisms and difficulties in management. A 35-year-old woman presented 10 days postcaesarean section with neck pain and vertigo with normal initial investigations. Following recurrent vertigo, headache, and ataxia, imaging revealed a frontoparietal SAH and vertebral artery dissection. The patient was consequently treated with aspirin, and then following a return of symptoms 3 weeks later, warfarin therapy was continued for 6 months.
Source: Journal of Stroke and Cerebrovascular Diseases - December 14, 2015 Category: Neurology Authors: James W. Garrard, Renata F. Simm, Edson Bor-Seng-Shu, Ricardo C. Nogueira Tags: Case Studies Source Type: research

A Case of Unexpected Symptomatic Vasospasm after Clipping Surgery for an Unruptured Intracranial Aneurysm
We report a case of a 62-year-old woman who presented with symptomatic vasospasm 11 days after clipping surgery for an unruptured aneurysm. We could not predict the existence of vasospasm until ischemic symptoms developed. We retrospectively found mild vasospasm in the computed tomography angiogram taken 8 days after the operation. The patient complained of a prolonged unexpected headache 1 week after the operation.
Source: Journal of Stroke and Cerebrovascular Diseases - December 24, 2015 Category: Neurology Authors: Hiroaki Hashimoto, Masahiro Kameda, Takao Yasuhara, Isao Date Tags: Case Studies Source Type: research

Atypical Presentation of Aneurysmal Subarachnoid Hemorrhage: Incidence and Clinical Importance
The symptoms of sudden severe headache and/or diminished consciousness characterize the onset of aneurysmal subarachnoid hemorrhage (SAH). However, several studies have suggested that some patients show an atypical presentation at the onset: symptoms lacking sudden headache and diminished consciousness. The aim of this study was to investigate the incidence and clinical features of cases with atypical onset.
Source: Journal of Stroke and Cerebrovascular Diseases - February 26, 2016 Category: Neurology Authors: Yukari Ogasawara, Katsuhiro Ito, Hiroki Ohkuma Source Type: research

Concurrence of Aneurysmal Subarachnoid Hemorrhage and Stanford Type A Acute Aortic Dissection
We report a rare case of concurrent aneurysmal subarachnoid hemorrhage (SAH) and acute aortic dissection (AAD). A 38-year-old man visited our hospital complaining of severe headache, and brain computed tomography (CT) revealed the presence of SAH. Thoracic to neck computed tomography angiography (CTA), performed in addition to brain CTA, suggested a tear in the aortic arch, and subsequent CT aortography established the diagnosis of Stanford type A AAD. The AAD in our patient, who reported no episodes of chest or back pain, was detected incidentally by thoracic to neck CTA.
Source: Journal of Stroke and Cerebrovascular Diseases - April 11, 2016 Category: Neurology Authors: Joji Inamasu, Takeya Suzuki, Akira Wakako, Akiyo Sadato, Yuichi Hirose Tags: Case Studies Source Type: research

Cerebral Venous Thrombosis Associated with Intracranial Hemorrhage and Timing of Anticoagulation after Hemicraniectomy
We present a case of CVT where timing of anticoagulation was unclear by current guidelines.
Source: Journal of Stroke and Cerebrovascular Diseases - June 15, 2016 Category: Neurology Authors: Michael A. Pizzi, David A. Alejos, Jason L. Siegel, Betty Y.S. Kim, David A. Miller, William D. Freeman Source Type: research

Multiple Dural and Pial Arteriovenous Fistulae in a Twenty-Four-Year-Old Woman in the Setting of Superior Sagittal Sinus Thrombosis: Case Report and Review of Literature
A 24-year-old woman presented with headache, nausea, and vomiting, and was found to have chronic superior sagittal sinus (SSS) thrombosis and multiple dural arteriovenous fistulae (dAVFs). Despite anticoagulant therapy and successful recanalization of her sinus, her fistulae persisted, and she developed additional separate pial arteriovenous fistulae (pAVFs). Her fistulae were treated with staged endovascular embolization, open clipping, and gamma knife radiosurgery over the course of 10 months.
Source: Journal of Stroke and Cerebrovascular Diseases - August 17, 2016 Category: Neurology Authors: Farhan A. Mirza, Justin F. Fraser Tags: Case Studies Source Type: research

A Case of Hypertensive Encephalopathy with Enlarged Optic Nerve Sheath Measured by Transorbital Sonography
This case report describes our experience in using transorbital sonography to evaluate pathological changes in the central nervous system in hypertensive encephalopathy. A 49-year-old man with nausea, headache, and mild confusion was diagnosed with hypertensive encephalopathy by brain magnetic resonance imaging (MRI), which revealed vasogenic edema in the bilateral thalamus and the brain stem. Lumbar puncture showed no severe intracranial hypertension. Transorbital sonography showed an increase in the optic nerve sheath diameter (ONSD).
Source: Journal of Stroke and Cerebrovascular Diseases - November 8, 2016 Category: Neurology Authors: Takaya Kitano, Tomohisa Nezu, Tomoya Mukai, Jyunichi Uemura, Yuko Wada, Yoshiki Yagita Tags: Case Studies Source Type: research

Venous Infarcts Mimicking Large Vessel Arterial Disease: Watershed Lesions in Deep Cerebral Venous Thrombosis
We read with interest the recent report by Washida et  al on multiple deep white matter hyperintensities seen in diffusion-weighted imaging (DWI) in a patient with straight sinus thrombosis.1 We would like to report a similar instance of a 30-year-old female who presented to us with a 4-day history of headache, vomiting, and progressive drowsiness; on examination, she was drowsy and had left hemiparesis. Her initial magnetic resonance imaging demonstrated thalamic and basal ganglia signal changes and bilateral centrum semiovale punctate infarcts (Fig 1, A,B) that suggested possible deep cerebral venous sinus thrombosis a...
Source: Journal of Stroke and Cerebrovascular Diseases - December 7, 2016 Category: Neurology Authors: Ravinder-Jeet Singh, Jitender Saini, Vikram V. Holla, Nitish Kamble Tags: Letter to the Editor Source Type: research

Herbal Supplements Association with Reversible Cerebral Vasoconstriction Syndrome: A Case Report
Reversible cerebral vasoconstriction syndrome (RCVS) is a clinico-radiologic syndrome characterized by thunderclap headache and reversible multifocal arterial constrictions that resolves within 3 months. RCVS can be either spontaneous or related to a trigger; vasoactive drugs including over-the-counter medicine are common culprits. Nevertheless, there are sparse data on the association of herbal supplements in the genesis of unexplained RCVS.
Source: Journal of Stroke and Cerebrovascular Diseases - December 26, 2016 Category: Neurology Authors: Isabel Costa, Marcelo D. Mendon ça, Vera Cruz e Silva, Sofia Calado, Miguel Viana-Baptista Tags: Case Report Source Type: research

Progressive Bilateral Vertebral Artery Dissection in a Case of Osteogenesis Imperfecta
A 32-year-old woman with osteogenesis imperfecta (OI) was admitted to the hospital because of a right-sided occipital headache and facial paresthesia. She was diagnosed with lateral medullary syndrome due to right vertebral artery (VA) dissection. She was treated conservatively without antithrombotic therapy. She developed subarachnoid hemorrhage because of contralateral VA dissection 18 days later. This clinical course may reflect the underlying weakness of the vessel wall in OI. In patients with OI, occlusion of a unilateral VA could cause dissection and subsequent rupture of the contralateral VA.
Source: Journal of Stroke and Cerebrovascular Diseases - January 11, 2017 Category: Neurology Authors: Yuji Kato, Harumitsu Nagoya, Tetsuya Abe, Takeshi Hayashi, Masanori Yasuda, Akira Uchino, Norio Tanahashi, Masaki Takao Tags: Case Studies Source Type: research

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