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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

Recurrent Hemorrhagic Venous Infarctions Caused by Thrombosis of a Pontine Developmental Venous Anomaly and Protein S Mutation
A 34-year-old man presented with an acute onset of upbeat nystagmus, slurred speech, and limb and truncal ataxias. The patient had a history of limb ataxia and gait disturbance previously treated as brainstem encephalitis with corticosteroids 3 years previously. Brain magnetic resonance imaging showed pontine developmental venous anomaly (DVA) and hemorrhagic infarction within the drainage territory of the DVA. Three months later, the patient exhibited recurrent limb ataxia, double vision, and numbness of the left side of the body.
Source: Journal of Stroke and Cerebrovascular Diseases - September 18, 2016 Category: Neurology Authors: Yuri Nakamura, Kei-ichiro Takase, Takuya Matsushita, Satoshi Yoshimura, Ryo Yamasaki, Hiroyuki Murai, Kazufumi Kikuchi, Jun-ichi Kira Tags: Case Studies Source Type: research

Multiple Cerebral Infarctions in a Patient with Adenomyosis on Hormone Replacement Therapy: A Case Report
A 59-year-old woman was admitted to our hospital because of repeated episodes of bilateral hand weakness. She had a 10-year history of combined estrogen –progestin therapy for menopausal symptoms. Magnetic resonance imaging on admission showed multiple hyperintense lesions in bilateral cerebral and cerebellar cortices on diffusion-weighted imaging. Transesophageal echocardiography showed thrombus formation on the aortic valve and moderate aortic i nsufficiency. Laboratory test demonstrated elevated CA125 (334.8 U/mL) and D-dimer (7.0 µg/mL) levels.
Source: Journal of Stroke and Cerebrovascular Diseases - August 8, 2016 Category: Neurology Authors: Nanako Hijikata, Yuki Sakamoto, Chikako Nito, Noriko Matsumoto, Arata Abe, Akane Nogami, Takahiro Sato, Hiroyuki Hokama, Seiji Okubo, Kazumi Kimura Tags: Case Studies Source Type: research

A Case of Recurrent Ischemic Stroke Involving Subacute, Progressive Intracranial Cerebral Arterial Sclerosis Prior to Diagnosis with -mutated Polycythemia Vera
A 58-year-old man presenting with no vascular risk factors visited our hospital with right hemiparesis and total aphasia. Diffusion-weighted magnetic resonance imaging of the brain showed multiple hyperintensities in watershed distributions in the left hemisphere. Magnetic resonance angiography (MRA) revealed stenosis of the middle cerebral artery, despite normal MRA findings 2 months prior. One year after the first stroke, the patient experienced a recurrent ischemic stroke involving the left anterior choroidal artery, pulmonary embolism, and deep venous thrombosis.
Source: Journal of Stroke and Cerebrovascular Diseases - September 29, 2015 Category: Neurology Authors: Tomohisa Nezu, Shiro Aoki, Kazuhide Ochi, Sayaka Sugihara, Tetsuya Takahashi, Naohisa Hosomi, Hirofumi Maruyama, Masayasu Matsumoto Tags: Case Studies Source Type: research

Fatal Intracranial Hemorrhage after Intravenous Thrombolytic Therapy for Acute Ischemic Stroke Associated with Cancer-related Nonbacterial Thrombotic Endocarditis
Nonbacterial thrombotic endocarditis (NBTE) is associated with hypercoagulability in patients with inflammatory states such as cancer and autoimmune diseases. Cardiac vegetations caused by NBTE often lead to life-threatening systemic thromboembolism that most frequently affects the brain, spleen, and kidneys. A 54-year-old woman diagnosed with ovarian cancer suddenly developed back pain and left hemiparesis. Although intravenous alteplase (rt-PA) therapy was administered to treat hyperacute ischemic infarction detected by magnetic resonance imaging, intracranial hemorrhage occurred in the left hemisphere several hours late...
Source: Journal of Stroke and Cerebrovascular Diseases - August 11, 2014 Category: Neurology Authors: Takuya Yagi, Kie Takahashi, Mariko Tanikawa, Morinobu Seki, Takato Abe, Norihiro Suzuki Tags: Case Reports Source Type: research

Cerebral Dural Sinus Thrombosis Associated with Adenomyosis: A Case Report
This report emphasizes the possible relationship between CVT and adenomyosis.
Source: Journal of Stroke and Cerebrovascular Diseases - May 2, 2014 Category: Neurology Authors: Kenya Nishioka, Ryota Tanaka, Satoshi Tsutsumi, Kazuo Yamashiro, Mariko Nakahara, Hideki Shimura, Nobutaka Hattori, Takao Urabe Tags: Case Reports Source Type: research

In Vitro and In Vivo Evaluation of a Magnetic Resonance Imaging–guided Focused Ultrasound System for Dissolving Clots in Combination with Thrombolytic Drugs
Conclusions: The MRgFUS technique was proven successful in dissolving clots in vitro and in vivo. It was found that the volume of dissolved clot increases with acoustic intensity and beam size and decreases with frequency. With this system, it was possible to push ultrasound through a plastic phantom skull using a .5 MHz transducer. The beam of ultrasound through the phantom skull was monitored using the MRI technique of fast spoiled gradient. Finally, the thrombus in the in vivo model (ear artery) was successfully destroyed with the therapeutic protocols investigated in the in vitro models. This study shows that FUS ...
Source: Journal of Stroke and Cerebrovascular Diseases - May 1, 2014 Category: Neurology Authors: Christakis Damianou, Venediktos Hadjisavvas, Kleanthis Ioannides Tags: Original Articles Source Type: research

Alpha 1-Antitrypsin Therapy Mitigated Ischemic Stroke Damage in Rats
Our objective is to develop a new therapy for the treatment of stroke. Currently, the only effective therapy for acute ischemic stroke is the thrombolytic agent recombinant tissue plasminogen activator. α1-Antitrypsin (AAT), a serine proteinase inhibitor with potent anti-inflammatory, anti-apoptotic, antimicrobial, and cytoprotective activities, could be beneficial in stroke. The goal of this study is to test whether AAT can improve ischemic stroke outcome in an established rat model. Middle cerebral artery occlusion was induced in male rats via intracranial (i.c.) microinjection of endothelin-1. Five to 10 minutes after...
Source: Journal of Stroke and Cerebrovascular Diseases - March 3, 2014 Category: Neurology Authors: Huong L. Moldthan, Aaron C. Hirko, Jeffrey S. Thinschmidt, Maria B. Grant, Zhimin Li, Joanna Peris, Yuanqing Lu, Ahmed S. Elshikha, Michael A. King, Jeffrey A. Hughes, Sihong Song Tags: Original Articles Source Type: research

Recurrent Ischemic Stroke in a Patient with the Trousseau Syndrome Treated with Dabigatran
A 70-year-old man with multiple ischemic strokes was diagnosed with cardiac embolism and treated with dabigatran. Three months later, he suddenly developed vertigo and vomiting. Magnetic resonance imaging, showed recurrent lesions and blood tests revealed hypercoagulability, hypoproteinemia, and elevated cytokeratin 19 fragments that serve as a tumor marker of lung cancer. Chest computed tomography showed there were small nodules in bilateral lungs and swollen mediastinal lymph nodes. A conclusive diagnosis was impossible because the patient declined invasive procedures. We suspected primary lung cancer and diagnosed conco...
Source: Journal of Stroke and Cerebrovascular Diseases - February 21, 2014 Category: Neurology Authors: Kosuke Yoshida, Takashi Kimura, Yoko Aburakawa, Yasuhiro Suzuki, Kenji Kuroda, Osamu Yahara Tags: Case Reports Source Type: research

Cerebral Venous Thrombosis: Clinical Features, Risk Factors, and Long-term Outcome in a Tunisian Cohort
Conclusions: Our Tunisian population presented distinct risk factors profile with high frequency of thrombophilia, infections, and postpartum state. Oral contraceptive use is not a major risk factor in our population. The overall prognosis was good.
Source: Journal of Stroke and Cerebrovascular Diseases - January 24, 2014 Category: Neurology Authors: Youssef Sidhom, Malek Mansour, Mariem Messelmani, Hajer Derbali, Nejiba Fekih-Mrissa, Jamel Zaouali, Ridha Mrissa Tags: Original Articles Source Type: research

Profile of Patients with Cerebral Venous Sinus Thrombosis with Cerebellar Involvement
Conclusions: Cerebellar involvement in CVT is very rare, and high index of suspicion is required for diagnosis. Imaging with CT and MRI will help in confirming the diagnosis. Conventional anticoagulation is effective in treatment. Mortality was 33%, and there was no disability in survivors.
Source: Journal of Stroke and Cerebrovascular Diseases - November 14, 2013 Category: Neurology Authors: Girish B. Kulkarni, Veerendrakumar Mustare, Mirza M. Abbas Tags: Original Articles Source Type: research

Thrombolytic Therapy Is an Only Determinant Factor for Stroke Evolution in Large Anterior Choroidal Artery Infarcts
Conclusions: Thrombolytic therapy is an only determinant factor for stroke evolution in large AChA infarcts, which reduced the risk of stroke evolution and improved functional outcome.
Source: Journal of Stroke and Cerebrovascular Diseases - October 16, 2013 Category: Neurology Authors: Meng-Chen Wu, Li-Kai Tsai, Chung-Chu Wu, Shin-Joe Yeh, Sung-Chun Tang, Yun-Ju Chen, Chien-Lin Chen, Jiann-Shing Jeng Tags: Original Articles Source Type: research

Ischemic Stroke in Evolution: Predictive Value of Perfusion Computed Tomography
Background: Various perfusion computed tomography (PCT) parameters have been used to identify tissue at risk of infarction in the setting of acute stroke. The purpose of this study was to examine predictive value of the PCT parameters commonly used in clinical practice to define ischemic penumbra. The patient selection criterion aimed to exclude the effect of thrombolysis from the imaging data.Methods: Consecutive acute stroke patients were screened and a total of 18 patients who initially underwent PCT and CT angiogram (CTA) on presentation but did not qualify to receive thrombolytic therapy were selected. The PCT images ...
Source: Journal of Stroke and Cerebrovascular Diseases - August 19, 2013 Category: Neurology Authors: Amir Kheradmand, Marc Fisher, David Paydarfar Tags: Original Articles Source Type: research

Cerebral Infarction in a Case of Parry-Romberg Syndrome
Our objective is to report a rare coexistence of Parry-Romberg disease and ischemic stroke. Here, we report the case of a 34-year-old woman with Parry-Romberg syndrome who developed cerebral infarction. This patient developed sudden left-sided weakness and was admitted to our hospital. Magnetic resonance imaging revealed acute cerebral infarction in the posterior limb of the right internal capsule. The patient had been diagnosed with Parry-Romberg syndrome at the age of 12, and she had a history of migraine without aura. Transesophageal echocardiography revealed a patent foramen ovale, but no atrial septal aneurysm or deep...
Source: Journal of Stroke and Cerebrovascular Diseases - May 9, 2013 Category: Neurology Authors: Yuji Tomizawa, Ryota Tanaka, Kiyoshi Sekiguchi, Yutaka Oji, Yasutaka Tanaka, Kazuo Yamashiro, Nobutaka Hattori Tags: Case Reports Source Type: research

Thrombosis of a Developmental Venous Anomaly in Inflammatory Bowel Disease: Case Report and Radiologic Follow-up
We describe the clinical and neuroradiologic follow-up of a 62-year-old man with a history of inflammatory bowel disease (IBD) presenting with new onset epilepsy and intracranial hemorrhage caused by thrombosis of a DVA who fully recovered after treatment with oral anticoagulant therapy. Patients with IBD have an increased risk of thrombosis because of inflammatory activity and the hypercoagulable state. Here we describe the first case of DVA thrombosis in a patient with IBD, and we show clinical and neuroradiologic follow-up after anticoagulant therapy.
Source: Journal of Stroke and Cerebrovascular Diseases - January 3, 2013 Category: Neurology Authors: Fabio Pilato, Rosalinda Calandrelli, Simona Gaudino, Paolo Profice, Matia Martucci, Giuseppe Esposito, Cesare Colosimo, Vincenzo Di Lazzaro Tags: Case Reports Source Type: research

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