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Staged reconstruction of large skull defects with soft tissue infection after craniectomy using free flap and cranioplasty with a custom-made titanium mesh constructed by 3D-CT-guided 3D printing technology: Two case reports
Rationale: A craniectomy, which results in a large skull defect, is performed to decrease the intracranial pressure under conditions such as intracranial hemorrhage and ischemic stroke. When the patient's condition is stabilized, autologous cranioplasty using the bone flap previously removed in the craniectomy is performed. Bone flap infection after the autologous cranioplasty is not uncommon and is difficult to treat. After the infection is controlled, cranioplasty is needed to improve the head deformity and neurologic function. Cranioplasty with a titanium mesh can result in aesthetic improvement and a low infection ra...
Source: Medicine - February 1, 2019 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Discrepancy between perfusion- and diffusion-weighted images in ischemic stroke: A case report
Rationale: With the development of multi-slice computed tomography (CT) technology, perfusion CT angiography (p-CTA) is now widely used for the diagnosis of acute cerebral infarction. Although p-CTA has the advantage of distinguishing between an ischemic penumbra and an infarct core, more research is needed with respect to its clinical use. Patient concerns: A healthy 36-year-old man experienced sudden dizziness while swimming. His dizziness persisted irrespective of the change in position, and then improved during transport. He had no neurological abnormality when he arrived at the emergency room. Diagnoses: CT pe...
Source: Medicine - December 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

A case report on middle cerebral artery aneurysm treated by rapid ventricular pacing: A CARE compliant case report
Rationale: Cerebral aneurysm is a common cause of intracranial hemorrhage, stroke, and death. It is treated with vascular surgeries, such as coil embolism and artery clipping. However, surgery itself is a risk factor that may cause rupture of aneurysm, and leads to irreversible brain damage, and even death. Rapid ventricular pacing (RVP) is a procedure that temporarily lowers blood pressure by increasing heart rate and reducing ventricular filling time. RVP has been widely used to reduce blood vessel tension in many cardiovascular surgeries. Patient concerns: A 46-year-old man came to our hospital with intermittent ri...
Source: Medicine - November 1, 2018 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

Anterior and posterior diaphragm kinesio taping for intractable hiccups after ischemic stroke: A case report
Rationale: Pathophysiologic mechanisms of the central nervous system, such as stroke, can be associated with intractable hiccups. Intractable hiccups can be associated with potentially fatal consequences, thus requiring safe management in an inpatient rehabilitation facility (IRF) setting with a multidisciplinary team approach to optimize mobility and feeding. Patient Concerns: A 49-year-old male presented to the emergency department with complaints of vomiting and dizziness. Diagnoses: Head computed tomography revealed moderate acute inferior cerebellar infarct in the territory of the posterior inferior cerebellar...
Source: Medicine - August 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Angiography with the 256-multislice spiral computed tomography and its application in evaluating atherosclerotic plaque and cerebral ischemia
Ulceration of carotid arterial plaque is associated with cerebral events. Detection of ulcerated plaques will benefit patient from stroke and other ischemic events. The aim of this study was to evaluate morphology of atherosclerotic plaques in the carotid arteries and to assess its clinical impact in predicting cerebral events. A total of 386 patients were examined with 256-multislice spiral computed tomographic angiography (MSCTA). It was found that 356 of the 386 patients had cerebral ischemic symptoms. Specifically, 35 patients had amaurosis fugax (AmF), 178 had transient ischemic attack (TIA), and 143 had ischemic st...
Source: Medicine - July 1, 2018 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Preliminary study of time maximum intensity projection computed tomography imaging for the detection of early ischemic change in patient with acute ischemic stroke
This study aimed to assess the accuracy of time maximum intensity projection computed tomography technique (tMIP), which reflects the maximum value for the time phase direction from the dynamic volume data for each projected plane, for detection of EIC, against that of NCCT. Retrospective review of NCCT, cerebral blood volume in CT perfusion (CTP-CBV), and tMIP of 186 lesions from 280 regions evaluated by Alberta Stroke Program Early CT Score (ASPECTS) in 14 patients with acute middle cerebral artery stroke who had undergone whole-brain CTP using 320-row area detector CT was performed. Four radiologists reviewed EIC on NC...
Source: Medicine - March 1, 2018 Category: Internal Medicine Tags: Research Article: Quality Improvement Study Source Type: research

An overlooked cause in a patient with recurrent ischemic stroke: A case report
Rationale: The majority of ischemic strokes are due to cardioembolism, large vessel atherothromboembolism, small vessel occlusive disease, or other unusual mechanisms. In most clinical settings, many strokes without a well-defined etiology requires a thorough diagnostic evaluation, otherwise the underlying cause might be easily overlooked. Here we report on the rare cause of a patient with recurrent stroke. Patient concerns: A 50-year-old female patient had a 4-year history of recurrent acute onset of neurological deficits. Diagnoses: Contrast transcranial Doppler ultrasound detected a typical “curtain” appeara...
Source: Medicine - March 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

Usefulness of multiphase computed tomography angiography in a patient with transient ischemic attack in the hyperacute phase: A case report
We present a case of TIA, the cause of which was identified using multiphase computed tomography angiography (MCTA) in the hyperacute phase of the disease.Patient Concerns:The patient was a 57-year-old man who was admitted to the emergency department for right-side weakness persisting for 1 hour.Diagnoses:Occlusion of the proximal M3 segment of the left middle cerebral artery territory was found on the initial MCTA.Outcomes:The weakness completely resolved at 2 hours after symptom onset, and there was no acute infarction on the initial diffusion-weighted magnetic resonance imaging (MRI) on the same day. Follow-up MCTA ...
Source: Medicine - December 1, 2017 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Degeneration of paramedian nuclei in the thalamus induces Holmes tremor in a case of artery of Percheron infarction
Abstract Rationale: Holmes’ tremor is an uncommon neurologic disorder following brain insults, and its pathogenesis is undefined. The interruption of the dento-rubro-thalamic tract and secondary deterioration of the nigrostriatal pathway are both required to initiate Holmes’ tremor. We used nuclear medicine imaging tools to analyze a patient with concurrent infarction in different zones of each side of the thalamus. Finding whether the paramedian nuclear groups of the thalamus were injured was a decisive element for developing Holmes’ tremor. Patient concerns: A 36-year-old woman was admitted to our department d...
Source: Medicine - November 1, 2017 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

Cerebrovascular risk factors for patients with cerebral watershed infarction: A case–control study based on computed tomography angiography in a population from Southwest China
Abstract: To determine cerebrovascular risk factors for patients with cerebral watershed infarction (CWI) from Southwest China. Patients suffering from acute ischemic stroke were categorized into internal CWI (I-CWI), external CWI (E-CWI), or non-CWI (patients without CWI) groups. Clinical data were collected and degrees of steno-occlusion of all cerebral arteries were scored. Arteries associated with the circle of Willis were also assessed. Data were compared using Pearson chi-squared tests for categorical data and 1-way analysis of variance with Bonferroni post hoc tests for continuous data, as appropriate. Multivariate...
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

Vertebrobasilar system computed tomographic angiography in central vertigo
This article reveals the opportunity to diagnose posterior circulation abnormalities causing central vertigo with a feasible method such as CTA.
Source: Medicine - March 1, 2017 Category: Internal Medicine Tags: Research Article: Diagnostic Accuracy Study Source Type: research

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