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A 56-Year-Old Woman with Recurrent Strokes: A Clear Case with a Therapeutic Dilemma
A 56-year-old woman with a history of cerebral amyloid angiopathy (CAA) complicated by prior intracranial hemorrhage (ICH) was evaluated for an asymptomatic ischemic stroke discovered on screening brain MRI. On echocardiogram, she was found to have a mass on her mitral valve and strongly positive antiphospholipid antibodies. She was diagnosed with nonbacterial thrombotic (Libman-Sacks) endocarditis associated with the primary antiphospholipid syndrome (APS). The treatment decision was complicated by the history of CAA with ICH within the last year with very high risk for bleeding complications if on anticoagulation. A mult...
Source: Case Reports in Neurology - February 15, 2021 Category: Neurology Source Type: research

Recurrent Acute Ischemic Stroke after Infective Endocarditis Caused by Streptococcus Constellatus: First Case Report and Analysis of the Case Series
Acute ischemic stroke (AIS) is highly prevalent in patients with infective endocarditis (IE) and associated with high rates of death and disability. IE presenting as an acute ischemic stroke, especially recurrent concurrence of acute anterior and posterior circulation infarct, has rarely been reported. Herein, we report a case study of a 60-year-old man with a history of aortic valve replacement and was under warfarin, presented with recurrent acute ischemic stroke which was found to have no vegetation secondary to infective endocarditis caused by Streptococcus constellatus as the embolic source.
Source: Journal of Stroke and Cerebrovascular Diseases - April 26, 2018 Category: Neurology Authors: Yumin Wang, Weili Zhao, Jun Lu, Guoli Li, Bin Peng, Hongquan Wang Tags: Case Studies Source Type: research

Cancer-related Stroke due to Mural Thrombus in the Extracranial Carotid Artery.
Authors: Ando D, Kobayashi J, Kuroda H, Aoki M Abstract A 41-year-old man was admitted to our hospital because of a cancer-related stroke (CRS) caused by a thrombus of the extracranial carotid artery. He had undergone neoadjuvant radiochemotherapy for metastatic colorectal adenocarcinoma. The serum D-dimer values were within the normal range. We treated him with intravenous unfractionated heparin followed by warfarin. There were no recurrent stroke events over six months. The leading cause of a CRS is an embolism caused by hypercoagulopathy, mainly represented by non-bacterial thrombotic endocarditis. However, it w...
Source: Internal Medicine - June 4, 2016 Category: Internal Medicine Tags: Intern Med Source Type: research

A review of the role of anticoagulation for patients with infective endocarditis and embolic stroke
Key Clinical Message Stroke is a common embolic complication of infective endocarditis. The most important treatment to prevent stroke in endocarditis is the initiation of antibiotic therapy. It is unclear whether the initiation of de novo anticoagulation (i.e, warfarin) in patients with infective endocarditis is beneficial, since there are no large or randomized controlled trials in this area. However, this case report suggests, despite the limited evidence, that anticoagulation in this patient caused no harm and could suggest a hint of possible benefit. Stroke is a common embolic complication of infective endocarditis. ...
Source: Clinical Case Reports - April 12, 2016 Category: Journals (General) Authors: Arfah Hazel Preston, Stefan Williams, Judy Archer Tags: Case Report Source Type: research

CardioPulse Articles * Warfarin increases stroke risk in atrial fibrillation * Aspirin still overprescribed for stroke prevention in atrial fibrillation * Clinical Research in Cardiology: the official journal of the German Cardiac Society (Deutsche Gesellschaft fur Herz-/Kreislaufforschung) * Septic shock in infective endocarditis * Innovation in atrial fibrillation therapy
Source: European Heart Journal - June 7, 2014 Category: Cardiology Tags: CardioPulse Source Type: research

Heparin, grad students, a clinical revolution and giving credit where it's due
The story of a grad student who overcame remarkable odds only to be denied his moment of glory, or a tale of dark deceit and devilish doings? The story of heparin is as complicated as the chemistry itselfBlood is remarkable.A liquid that carries nutrients, waste products and the ever-vigilant cells of the immune system around the body, blood rapidly turns into a solid when it leaves its veins and arteries and becomes exposed to bodily tissues or the air outside. This process of solidification – clotting, or coagulation – is executed and controlled by a complex set of reactions and interactions primarily involving the e...
Source: Guardian Unlimited Science - September 4, 2013 Category: Science Authors: Richard P Grant Tags: theguardian.com Blogposts Science Source Type: news

Non-Bacterial Aortic Valve Vegetation
A 31 year-old man was referred to our hospital for management of a 2cm×2.3cm lesion seen on the left coronary cusp of his aortic valve on transoesophageal echocardiogram (, panel A and B). There was a mild gradient across the aortic valve (mean gradient of 17mmHg) and some mild eccentric aortic regugitation as a consequence of the lesion. Echocardiography had been performed after an ejection systolic murmur was noted by his local medical officer. He denied symptoms of infection or congestive cardiac failure. Routine initial investigations were unremarkable. Multiple sets of blood cultures were negative. Urgent antiphospho...
Source: Heart, Lung and Circulation - May 28, 2013 Category: Cardiology Authors: Sarah Gutman, Andrew Burns Tags: Images Source Type: research