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Application of transcranial direct current stimulation in cricopharyngeal dysfunction with swallowing apraxia caused by stroke: A case report
Rationale: Dysphagia is a common complication after stroke. The 2 types of dysphagia with cricopharyngeal dysfunction and swallowing apraxia after stroke are relatively rare and difficult to treat; however, there are few clinical case reports of cricopharyngeal dysfunction and swallowing apraxia after stroke. Patient concerns: A case of cricopharyngeal dysfunction and swallowing apraxia due to cerebral infarction caused by atrial fibrillation in a 63-year-old woman who was followed up for 1 year. Diagnoses: The patient was diagnosed with cricopharyngeal dysfunction and swallowing apraxia caused by strok...
Source: Medicine - December 3, 2021 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Interventional treatment for acute cerebral infarction with large vessel occlusion combined with aortic arch interruption: A case report
Rationale: Aortic arch interruption is a type of congenital vascular malformation that is often observed in childhood. Most children die of congestive heart failure due to rapid deterioration. Children can only survive to adulthood if they have extremely rich collateral circulation. Cases of acute cerebral infarction with large vessel occlusion receiving interventional treatment in adult patients with interrupted aortic arch have not been reported. Patient concerns: A 55-year-old man with a history of atrial fibrillation and smoking but without a family history of stroke was admitted to our hospital with a 5-hou...
Source: Medicine - November 19, 2021 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Intracardiac thrombus in a patient with mitral bioprosthesis and atrial fibrillation treated with direct oral anticoaugulant: A case report
Rationale: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with increased morbidity, especially stroke and heart failure. There is also increasing awareness that atrial fibrillation is a major cause of embolic events which in 75% of cases are complicated by cerebrovascular accidents. Patient concerns: A 50-year-old woman with mitral bioprosthesis under warfarin for nonvalvular atrial fibrillation was referred to our Coronary Intensive Care Unit due to acute myocardial infarction without evidence of significant coronary artery stenosis. Diagnoses: Cardiovascular examination...
Source: Medicine - June 11, 2021 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

A novel nonsense mutation in TNNT2 in a Chinese pedigree with hypertrophic cardiomyopathy: A case report
Rationale: Hypertrophic cardiomyopathy (HCM) is an inherited myocardial disease and a common cause of sudden cardiac death, heart failure, atrial fibrillation and stroke. In families affected by HCM, genotyping is useful for identifying susceptible relatives. In the present study, we investigated the disease-causing mutations in a three-generation Chinese family with HCM using whole exome sequencing (WES). Patient concerns: The proband, a 50-year-old man, was diagnosed with HCM at the age of 41 years. He presented with an asymmetric hypertrophic interventricular septum and a maximum interventricular septum thickness o...
Source: Medicine - August 21, 2020 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Successful dabigatran reversal after subdural hemorrhage using idarucizumab in a mobile stroke unit: A case report
Rationale: Idarucizumab is a specific reversal agent for patients with bleeding related to the anticoagulant dabigatran. There are no prior descriptions of Idarucizumab administration in the prehospital setting for intracranial hemorrhage. Patient concerns: An 82-year-old woman treated with dabigatran for atrial fibrillation developed acute focal weakness. This led to activation of emergency medical services and assessment in the mobile stroke unit (MSU). Diagnosis: Computed tomography of the brain performed in the MSU revealed an acute subdural hematoma. Interventions: The patient was treated with Idarucizumab ...
Source: Medicine - May 1, 2020 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Thrombolysis in an acute ischemic stroke patient with rivaroxaban anticoagulation: A case report
Rationale: Whether intravenous recombinant tissue plasminogen activator (r-TPA) therapy can be administered in acute ischemic stroke patients treated with novel oral anticoagulants (NOACs), including rivaroxaban, remains controversial. Patient concerns: A 76-year-old woman with nonvalvular atrial fibrillation, who had been receiving 15 mg rivaroxaban once daily, was brought to the emergency department with right-side hemiparesis and aphasia. The onset of neurological deficits occurred 8 hours after the last dose of rivaroxaban administration. Diagnosis: The patient was diagnosed with acute ischemic stroke. Int...
Source: Medicine - February 1, 2019 Category: Internal Medicine Tags: Research Article: Clinical Case Report 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

Dabigatran as an alternative for atrial thrombosis resistant to rivaroxaban: A case report
Rationale: Anti-thrombosis therapy for atrial fibrillation (AF) management and stroke prevention is an important aspect of disease management. Novel oral anticoagulants (NOACs) are recommended by guidelines for AF management. However, if one can switch one NOAC to another when the former showed a poor effect has not been fully determined. Patient concerns: A 52-year-old man was admitted to our center for heart failure and AF with a thrombus in the left atrium. Diagnoses: Cardiomyopathy was diagnosed by cardiac magnetic resonance (CMR) and echocardiography. Interventions: He was prescribed rivaroxaban (20 mg da...
Source: Medicine - December 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

A case report of parenchymal hematoma after intravenous thrombolysis in a rivaroxaban-treated patient: Is it a true rivaroxaban hemorrhagic complication?
AbstractRationale:To date, the only treatment approved for acute ischemic strokes is thrombolysis. Whether intravenous thrombolysis may be safe in patients taking direct oral anticoagulants (DOACs) is currently a matter of debate.Patient concerns:A 74-year-old woman, who was on rivaroxaban 20 mg/d for nonvalvular atrial fibrillation, was admitted to our stroke unit with left-sided hemiparesis and aphasia. The onset of neurologic deficits had occurred 5 hours after the last rivaroxaban dose.Diagnosis:An acute ischemic stroke was diagnosed.Interventions:The patient was administered thrombolytic treatment with intravenous r...
Source: Medicine - December 1, 2017 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

WATCHMAN device-related thrombus successfully treated with apixaban: A case report
Rationale: Among atrial fibrillation patients with high risk of bleeding, left atrial appendage occlusion has emerged as an alternative to long-term oral anticoagulation therapy for stroke prevention. Device-related thrombus remains a major concern because it may result in recurrent embolic events. To date, there is no consensus on the optimal method of treating device-related-thrombus. Patient concerns: A 78-year-old man with atrial fibrillation had an episode of intracranial hemorrhage while taking warfarin. He subsequently underwent percutaneous placement of a 30-mm Watchman device to the left atrial appendage. He ...
Source: Medicine - November 1, 2017 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Utility of Duranta, a wireless patch-type electrocardiographic monitoring system developed in Japan, in detecting covert atrial fibrillation in patients with cryptogenic stroke: A case report
Rationale: Subcutaneous implantable electrocardiographs are highly effective in detecting covert atrial fibrillation (AF) in cryptogenic stroke. However, these invasive devices are not indicated for all cryptogenic stroke patients, and noninvasive improvements over conventional Holter-type ambulatory electrocardiography are needed. We evaluated the clinical application and effectiveness of Duranta (ImageONE Co., Ltd.), a wireless patch-type electrocardiographic monitoring system developed in Japan for chronically ill patients or home-based patients at the end of life. A Duranta device was used to detect covert AF in patien...
Source: Medicine - February 1, 2017 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research