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Intracranial Hemorrhage Diagnosed with Transcranial Ultrasound in a Comatose, Postliver Transplant Patient
We report a case of an intracranial hemorrhage first suspected during a trans-cranial Doppler assessment of a postorthotopic liver transplant patient. The patient was at considerable risk of bleeding, due to a primary graft nonfunction, but he had also elevated ammonium levels, justifying the comatose state, and no focal neurological deficits.
Source: Journal of Stroke and Cerebrovascular Diseases - September 4, 2019 Category: Neurology Authors: Amedeo Bianchini, Rocco D'Andrea, Berin Lepic, Lorenzo Querci, Cristiana Laici, Antonio Siniscalchi Tags: Case Report Source Type: research

Intraoperative Aneurysm Rupture during Resection for Presumed Metastasis
A 54-year-old male with metastatic melanoma, including a presumed brain metastasis underwent elective surgery when there was sudden onset of extensive bleeding upon resection. An emergent cerebral angiogram revealed a fusiform left posterior cerebral artery aneurysm. Malignant melanoma commonly metastasizes to the brain and has shown to assume a wide variety of appearances with involvement of almost any intracranial structures. The unexpected intraoperative finding required immediate action and strategic rethinking.
Source: Journal of Stroke and Cerebrovascular Diseases - August 8, 2019 Category: Neurology Authors: Anna L. K ühn, Katyucia de Macedo Rodrigues, Ajit S. Puri Tags: Case Report Source Type: research

Comparing Outcomes of Patients With Idiopathic Subarachnoid Hemorrhage by Stratifying Perimesencephalic Bleeding Patterns
Background: To determine the clinical outcomes of perimesencephalic subarachnoid hemorrhages based on the computed tomography (CT) bleeding patterns. Methods: This retrospective cohort study included: (1) patients ( ≥18 years) admitted to a comprehensive stroke center (January 2015-May 2018), (2) with angiography-negative, nontraumatic subarachnoid hemorrhage in a perimesencephalic or diffuse bleeding pattern, and (3) had CT imaging performed in less than rqual to 72 hours of symptom onset. Patients were stra tified by location of bleeding on CT: Peri-1: focal prepontine hemorrhage; Peri-2: prepontine with suprasellar ci...
Source: Journal of Stroke and Cerebrovascular Diseases - July 11, 2019 Category: Neurology Authors: Benjamin Atchie, Constance McGraw, Kathryn McCarthy, Rebecca van Vliet, Donald Frei, Alicia Bennett, Russell Bartt, Alessandro Orlando, Jeffrey Wagner, David Bar-Or Source Type: research

A Narrative Review of Nonvitamin K Antagonist Oral Anticoagulant Use in Secondary Stroke Prevention
The prevalence of atrial fibrillation (AF), the most common cardiac arrhythmia, increases with age, predisposing elderly patients to an increased risk of embolic stroke. With an increasingly aged population the number of people who experience a stroke every year, overall global burden of stroke, and numbers of stroke survivors and related deaths continue to increase. Anticoagulation with vitamin K antagonists (VKAs) reduces the risk of ischemic stroke in patients with AF; however, increased bleeding risk is well documented, particularly in the elderly.
Source: Journal of Stroke and Cerebrovascular Diseases - July 4, 2019 Category: Neurology Authors: Valeria Caso, Florian Masuhr Tags: Review Article Source Type: research

Cerebral Hemorrhage of a 50-Year-Old Female Patient with Polycythemia Vera
Polycythemia vera is a chronic myeloproliferative neoplasm, which is primarily characterized by elevated erythrocyte count with the risk of thrombosis, hemorrhage, and vasomotor symptoms. More common reported about bleeding events are gastrointestinal, mucosal, and cutaneous bleeding. Spontaneous cerebral hemorrhage/bleeding is seldom reported. Here, we report the case of a 50-year-old female with polycythemia vera who developed a spontaneous cerebral hemorrhage. She improved significantly after hydroxyurea agent and red cell apheresis, and the hematocrit decreased from 74% to 40%.
Source: Journal of Stroke and Cerebrovascular Diseases - May 20, 2019 Category: Neurology Authors: Lei Chen, Han Xiao, Zhiping Hu Tags: Case Report Source Type: research

Cerebellar Hemorrhage Following an Uncomplicated Lumbar Spine Surgery: Case Report
We present a case of remote cerebellar hemorrhage following uncomplicated lumbar spinal decompression and fusion without CSF leakage.
Source: Journal of Stroke and Cerebrovascular Diseases - May 14, 2019 Category: Neurology Authors: Ryan C. Hofler, Michael P. Wemhoff, Stephen J. Johans, Russ P. Nockels Tags: Case Report Source Type: research

Paradoxical Brain Embolism Caused by Isolated Pulmonary Arteriovenous Fistula Successfully Treated with Recombinant Tissue Plasminogen Activator
Pulmonary arteriovenous fistula (PAVF), a vessel malformation connecting the pulmonary circulation to the systemic circulation while bypassing the pulmonary capillaries, can cause paradoxical cerebral infarction. It is often associated with hereditary hemorrhagic telangiectasia (HHT), a genetic disease characterized by multiple dermal, mucosal, and visceral telangiectasia causing recurrent bleeding. Paradoxical cerebral embolism caused by PAVF without HHT is rare. Here, we report a patient with isolated PAVF who experienced an ischemic stroke caused by a paradoxical embolism from deep venous thrombosis; the patient was suc...
Source: Journal of Stroke and Cerebrovascular Diseases - April 17, 2019 Category: Neurology Authors: Itsuki Hasegawa, Takato Abe, Toshikazu Mino, Kousuke Okamoto, Akitoshi Takeda, Yoshiaki Itoh Tags: Case Report Source Type: research

Thrombolysis in Ischemic Stroke Patients with Isolate Pulmonary Arteriovenous Malformations
Pulmonary arteriovenous malformations are rare cause for ischemic stroke. British Thoracic Society Clinical Statement considered insufficient evidence of safety or clinical benefit to recommend thrombolysis for stroke with pulmonary arteriovenous malformations. For pulmonary arteriovenous malformations with hereditary hemorrhagic telangiectasia, bleeding risk after thrombolysis is high, while for isolate pulmonary arteriovenous malformations, bleeding risk is much lower. We here present 2 cases of ischemic stroke with isolate pulmonary arteriovenous malformations treated with thrombolysis.
Source: Journal of Stroke and Cerebrovascular Diseases - March 28, 2019 Category: Neurology Authors: Gaoping Lin, Peng Jiang, Min Lou Tags: Case Report Source Type: research

Efficacy of Direct Revascularization Surgery for Hemorrhagic Moyamoya Syndrome As a Late Complication of Cranial Irradiation for Childhood Craniopharyngioma
Moyamoya syndrome (MMS) is an uncommon late complication after cranial irradiation. Its hemorrhagic presentation from the associated pseudo-aneurysm is extremely rare, and the optimal management strategy is undetermined. We herein report a 36-year-old man who developed intraventricular hemorrhage from a pseudo-aneurysm at the extended left anterior choroidal artery as an abnormal collateral of MMS 30 years after surgical removal and cranial irradiation for childhood craniopharyngioma. Catheter angiography confirmed the diagnosis of MMS, and multiple pseudo-aneurysms were evident at the ipsilateral abnormal choroidal collat...
Source: Journal of Stroke and Cerebrovascular Diseases - February 13, 2019 Category: Neurology Authors: Yuya Kato, Miki Fujimura, Kenichi Sato, Hidenori Endo, Teiji Tominaga Tags: Case Report Source Type: research

Catastrophic Secondary Infarctions with Onset Seizure Following Tissue Plasminogen Activator Therapy
Fatalities following intravenous recombinant tissue-type plasminogen activator therapy have been reported. Major fatal complications following intravenous recombinant tissue-type plasminogen activator therapy include intracranial hemorrhage, aortic dissection, and extracranial bleeding. However, the possibility that intravenous recombinant tissue-type plasminogen activator therapy itself paradoxically induces synchronized multiple cerebral novel infarctions has never been considered. We herein report the first case of bilateral internal carotid artery infarction with onset seizure following intravenous recombinant tissue-t...
Source: Journal of Stroke and Cerebrovascular Diseases - January 14, 2019 Category: Neurology Authors: Kosuke Matsuzono, Lisa Nagaoka, Masayuki Suzuki, Younhee Kim, Tadashi Ozawa, Takafumi Mashiko, Haruo Shimazaki, Reiji Koide, Shigeru Fujimoto Tags: Case Report Source Type: research

Oral Dipyridamole-Associated Circulatory Collapse
Extended-release dipyridamole plus aspirin is widely used for secondary prevention of ischemic stroke, although the molecular pharmacodynamics of dipyridamole are not completely determined. Adverse effects of fixed-dose combination of aspirin and dipyridamole include headache, bleeding, and gastrointestinal events. Previously, intravenous infusion of dipyridamole in cardiac stress testing has been associated with cardiogenic shock and pulmonary edema. Herein, we report a case study of a 72-year-old man, presented with a transient ischemic attack who suffered a circulatory collapse after an oral dose of 200 mg extended-release dipyridamole.
Source: Journal of Stroke and Cerebrovascular Diseases - September 2, 2018 Category: Neurology Authors: Pasi Jolma, Jyrki Ollikainen, Ilkka Uurto Source Type: research

Bilateral Caudate Nucleus Infarctions Following Upper Gastrointestinal Bleeding
A 75-year-old woman presented with consciousness disturbance accompanied by hematemesis. Brain imaging revealed ischemia in the bilateral caudate nuclei and right cerebral watershed area due to stenosis of the right anterior cerebral artery (ACA) and bilateral internal carotid arteries (ICA), and hypoperfusion in the right caudate nucleus. The patient's only symptom was abulia, which gradually resolved. Further brain scans showed that the ICA stenosis had improved, although the right ACA stenosis persisted.
Source: Journal of Stroke and Cerebrovascular Diseases - May 24, 2018 Category: Neurology Authors: Kensuke Daida, Nobukazu Miyamoto, Hiromi Takagi, Yuji Ueno, Kazuo Yamashiro, Ryota Tanaka, Nobutaka Hattori Tags: Case Studies Source Type: research

Direct Oral Anticoagulant Agents: Pharmacologic Profile, Indications, Coagulation Monitoring, and Reversal Agents
Vitamin K antagonists (VKAs), such as warfarin, have been used for thromboprophylaxis and for the treatment of thromboembolic events in patients with nonvalvular atrial fibrillation for over 60 years. The increasing use of direct oral anticoagulants (DOACs) in recent years has shown greater advantages and safer use over VKA, including reduced bleeding, fewer drug interactions, no food interactions, a quick onset and offset of activity, and predictable dose-response properties. Despite their advantages, there are a couple of major limitations that raise concerns among clinicians, including the need for more coagulation assa...
Source: Journal of Stroke and Cerebrovascular Diseases - May 9, 2018 Category: Neurology Authors: Deborah K. Rose, Barak Bar Tags: Review Article Source Type: research

Acute Intracranial and Spinal Subdural Hematoma Associated with Vardenafil
A 28-year-old healthy man was admitted to our hospital because of right-sided headache, vomiting, and lower back pain after the administration of vardenafil. Computed tomography and magnetic resonance imaging of the brain showed a small, right-sided, subdural hematoma. A lumbar magnetic resonance imaging showed a longitudinally extended subdural hematoma. He had no history of trauma. We speculated that vardenafil might have had an association with the bleeding. Several reports have suggested a relationship between phosphodiesterase-5 inhibitors and intracerebral or subarachnoid hemorrhage.
Source: Journal of Stroke and Cerebrovascular Diseases - May 2, 2018 Category: Neurology Authors: Takaaki Nakamura, Genya Watanabe, Ryuhei Harada, Emiko Kawasaki, Kenichi Tsukita, Yasushi Suzuki Tags: Case Studies Source Type: research

Spinal Cord Hemorrhage
Spinal cord hemorrhages are rare conditions that can be classified based on the primary location of bleeding into intramedullary (hematomyelia), subarachnoid hemorrhage (SAH), subdural hemorrhage, and epidural hemorrhage. We conducted a literature review to better understand the presenting symptoms, etiology, diagnosis, and treatment of spinal cord hemorrhages.
Source: Journal of Stroke and Cerebrovascular Diseases - March 16, 2018 Category: Neurology Authors: Amir Shaban, Toshio Moritani, Sami Al Kasab, Ali Sheharyar, Kaustubh S. Limaye, Harold P. Adams Tags: Review Article Source Type: research

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