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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

Examining Disparities and Excess Cardiovascular Mortality Before and During the COVID-19 Pandemic
To investigate the patterns and demographics of cardiovascular (CVD) death and subtypes myocardial infarction (MI), stroke, and heart failure (HF) in the pre-COVID-19 era (2018-2019) vs during COVID-19 pandemic (2020-2021) in the United States.
Source: Mayo Clinic Proceedings - July 20, 2022 Category: Internal Medicine Authors: Scott E. Janus, Mohamed Makhlouf, Nicole Chahine, Issam Motairek, Sadeer G. Al-Kindi Tags: Original Article Source Type: research

Left Atrial Appendage Occlusion, A Misnomer?
The importance of the left atrial appendage (LAA) as the source of thromboembolism including stroke in patients with nonvalvular atrial fibrillation is well documented, with more than 90% of ischemic strokes related to a LAA thrombus. Although oral anticoagulation has been the standard of care, approximately 50% to 60% of patients either have contraindications to oral anticoagulation or do not continue the medication beyond the first year. This led to the development of local site-specific therapy to occlude the LAA by either surgical or transcatheter means.
Source: Mayo Clinic Proceedings - August 1, 2022 Category: Internal Medicine Authors: David R. Holmes, Trevor J. Simard, Ammar M. Killu, Mohamad A. Alkhouli Tags: Review Source Type: research

86-Year-Old Woman With Fever, New-Onset Dysarthria, and Ataxia
An 86-year-old woman with a medical history of hypertension, hyperlipidemia, permanent atrial fibrillation receiving anticoagulation, and chronic venous stasis causing recurrent leg cellulitis presented to the emergency department for new-onset dysarthria and imbalance, which began earlier that morning. She denied a history of stroke, chills, unintentional weight loss, diarrhea, dysuria, frequency, or recent head trauma. The patient endorsed taking her anticoagulation as prescribed without skipped doses.
Source: Mayo Clinic Proceedings - August 1, 2023 Category: Internal Medicine Authors: Nikita Jhawar, Abdallah El Sabbagh Tags: Residents ’ Clinic Source Type: research

Safeguarding Against Stroke Risk by Statins
Whereas mighty prospective randomized trials —and meta-analyses of these—rightly command the data used to drive guidelines and daily clinical practice, careful long-term follow-up of closely monitored cohorts can generate crucial discoveries not anticipated in a 5-year study. As just one example, findings from lifelong follow-up in the Ame rican Framingham studies and the Whitehall cohorts in the United Kingdom show a strong association between blood pressure in middle years and dementia in later life.
Source: Mayo Clinic Proceedings - September 1, 2023 Category: Internal Medicine Authors: Adrian J.B. Brady Tags: Editorial Source Type: research

Hypertriglyceridemia-Induced Pseudo –High Anion Gap Metabolic Acidosis Manifesting as Ischemic Stroke
Hypertriglyceridemia is a metabolic disorder characterized by elevated levels of triglycerides in the bloodstream.1 The underlying causes are multifactorial and range from metabolic syndrome and genetic predisposition to lifestyle choices.1 The management of hypertriglyceridemia usually involves a combination of lifestyle modifications, control of low-density lipoprotein and high-density lipoprotein levels, and pharmacotherapy when necessary.1 The clinical presentation is predominantly asymptomatic; however, some patients present with abdominal pain, nausea, vomiting, and pancreatitis.
Source: Mayo Clinic Proceedings - September 1, 2023 Category: Internal Medicine Authors: Abdul R. Akkawi, Mason Fawcett, Abhiram Challa, Timothy Nguyen, Jennifer Jackson, Richard Muraga Tags: Letter to the editor 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

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