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Middle Cerebral Artery Calcification: Association With Ischemic Stroke
This study retrospectively included 354 subjects with ischemic stroke in the MCA territory and 1518 control subjects who underwent computed tomography (CT) of the brain. We recorded major known risk factors for ischemic stroke, including age, gender, hypertension, diabetes mellitus, smoking, hyperlipidemia, and obesity, along with the MCA calcium burden, measured with the Agatston calcium scoring method. Univariate and modified logistic regression analyses were performed to examine the association between the MCA calcification and ischemic stroke. The univariate analyses showed significant associations of ischemic stroke w...
Source: Medicine - December 1, 2015 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Japanese encephalitis (JE) mimicking acute ischemic stroke: A case report
Conclusion: Diagnosis of JE that mimicked acute stroke at onset and with no fever can be challenging. Recognition of disease development, MRI and Japanese encephalitis virus immunoglobulinM findings are helpful in early definitive diagnosis.
Source: Medicine - November 6, 2020 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

A multiparameter model predicting in-hospital mortality in malignant cerebral infarction
Abstract: The early identification of patients with large hemisphere infarctions (LHIs) at risk of fatal brain edema may result in better outcomes. A quantitative model using parameters obtained at admission may be a predictor of in-hospital mortality from LHI. This prospective study enrolled all patients with LHI involving>50% of the middle cerebral artery (MCA) admitted to our neurological intensive care unit within 48 hours of symptom onset. Early clinical and radiographic parameters and the baseline CHADS2 score (congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke [double weight]) w...
Source: Medicine - July 1, 2017 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Posterior reversible encephalopathy syndrome in a postpartum hemorrhagic woman without hypertension: A case report
Rationale: Posterior reversible encephalopathy syndrome (PRES), which diagnosis is based on clinical symptoms and radiological features, is a neurotoxic disease characterized by a set of clinical manifestations, such as seizure, headache, visual, and/or consciousness disturbance. It is the first case of PRES followed by postpartum hemorrhage (PPH) without underlying disease. Patient concerns: A 37-year-old healthy woman had PPH after caesarean section. Six days after delivery, headache occurred suddenly, followed by episodes of clonus seizure. Diagnoses: Brain computed tomography showed ischemic stroke. However, magnetic...
Source: Medicine - April 1, 2017 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Reversible cerebral vasoconstriction syndrome with basilar artery stenosis: A case report
Conclusions: A headache in young patients with risk factors of atherosclerosis, such as smoking history, uncontrolled hypertension, and dyslipidemia may be caused by reversible cerebral vasoconstriction syndrome or ischemic stroke, which has fatal neurological complications. Therefore, reversible cerebral vasoconstriction syndrome or ischemic stroke should be suspected and appropriately evaluated in such patients, even if the headache is not the thunderclap type.
Source: Medicine - September 24, 2021 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Lithium intoxication presenting as altered consciousness and arrhythmia with cardiogenic shock: A case report
Rationale: Lithium has been used to treat bipolar disorder. Lithium has a narrow therapeutic index, with a therapeutic level between 0.6 and 1.5 mEq/L. The possible complications of lithium overdose include altered mental status, hand tremor, muscle weakness, nausea, vomiting, diarrhea, seizure, syncope, and arrhythmia. Lithium intoxication can be fatal and is difficult to diagnose in patients without a history of lithium intake. The occurrence of serious cardiac arrhythmias is rare in lithium intoxication. Patient concerns: An 81-year-old man was brought to the emergency department because of consciousness disturba...
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Acute onset bilateral hearing loss in dorsomedial pontine hemorrhage: A Case report
We report herein a rare case of acute onset bilateral hearing loss caused by nontraumatic pontine hemorrhage. Pontine hemorrhage is often associated with disturbance of consciousness; however, care is required as latent communication disorder due to impaired hearing is possible regardless of the state of consciousness.
Source: Medicine - August 1, 2019 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Posterior reversible encephalopathy syndrome (PRES) in a patient with moyamoya disease: A case report
Conclusion: This report suggests that patients with MMD may be susceptible to PRES. It highlights the importance of considering PRES as a differential diagnosis while providing care to MMD patients with concurrent acute neurological symptoms and a prompt intervention contributes to a favorable clinical prognosis.
Source: Medicine - August 6, 2021 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Basilar dolichoectasia with intermural hematoma accompanied by cerebral microbleeds and white matter hyperintensities: A case report
Rationale: The clinical manifestations of basilar dolichoectasia (BD) are variable. The diagnosis is based on imaging measurements. Digital subtraction angiography displays only the dilated vascular lumen and lacks visualization of the arterial wall. High-resolution Magnetic resonance imaging (MRI) can identify intramural hematoma; therefore, it may be more suitable for the imaging evaluation of BD. However, most of the existing literature pertaining to BD lacks vascular wall assessment. Patient concerns: A 65-year-old Chinese man perceived weakness of the left upper and lower limb, double vision, dizziness, nau...
Source: Medicine - August 20, 2021 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

54-Year-Old Woman With Altered Mental Status and Abdominal Pain
A 54-year-old woman was transferred to our medical center with altered mental status, abdominal pain, and hypotension. Her medical history included type 2 diabetes mellitus, hypertension, hyperlipidemia, active tobacco use, prior cholecystectomy, and a recent stroke. One month earlier, she presented to an outside facility with right-sided facial weakness and numbness. Brain magnetic resonance imaging (MRI) at that time revealed multiple small lacunar-type infarcts. Computed tomography (CT) angiography of the head and neck, 48-hour Holter monitoring, and transesophageal echocardiography did not reveal an embolic source.
Source: Mayo Clinic Proceedings - June 29, 2022 Category: Internal Medicine Authors: Caroline L. Matchett, Nikita Rafie, Jacob C. Jentzer Tags: Residents ’ Clinic Source Type: research

Cerebellopontine angle meningioma in a patient presented as acute cerebrovascular accident
CONCLUSION: Although stroke is the main cause of sudden onset ataxia in a patient with cerebrovascular risk factors, yet other less common causes may be found as in this case of CPA meningioma.PMID:37427233 | PMC:PMC10328571 | DOI:10.1097/MS9.0000000000000928
Source: Annals of Medicine - July 10, 2023 Category: Internal Medicine Authors: Mohamed Sheikh Hassan Ayhan K öksal Source Type: research

Natural History and Sequelae of Penetrating Aortic Ulcer
A man in his 70s with history of tobacco use and hypertension presented for transesophageal echocardiography after a recent diagnosis of ischemic stroke. This demonstrated a moderate right-to-left shunt on Valsalva release and no left atrial appendage thrombus. Assessment of the thoracic aorta revealed a complex penetrating aortic ulcer and saccular aneurysm with thrombus in the distal arch and proximal descending thoracic aorta (Figure). Computed tomography angiography confirmed the presence of multiple penetrating ulcerations with large saccular aneurysms.
Source: Mayo Clinic Proceedings - September 1, 2023 Category: Internal Medicine Authors: Raghav R. Julakanti, Prabhakar Shantha Rajiah, Krishnaswamy Chandrasekaran Tags: Medical image Source Type: research