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Quiz case: a clinical reasoning challenge in the emergency stroke setting
AbstractA right-handed woman in her 80s was admitted to the emergency department 1 h after sudden-onset global aphasia and right-sided hemiparesis. Medical history included arterial hypertension, dyslipidemia, hyperuricemia, aortic stenosis, osteoporosis, and recent pulmonary embolism. Medication consisted of apixaban, bisoprolol, hydrochlorothiazide, allopurinol, fenofibrate, and vitamin D. Vital parameters (blood pressure, heart rate, body temperature, oxygen saturation) and glycemia were all within normal range. Electrocardiogram showed a first-degree atrioventricular block. The patient was promptly transported to the e...
Source: Neurological Sciences - August 5, 2023 Category: Neurology Source Type: research

Optimizing  The Timing of Stereotactic Minimally Invasive Drainage for Hypertensive Intracerebral Hemorrhage
ConclusionsCustomized timing of stereotactic drainage may be superior to conventional fixed timing (within 12  h post-hemorrhage) in reducing post-surgery complications and promoting recovery, which supports the potential use of customized timing of stereotactic minimally invasive drainage as a new convention in clinics.
Source: Neurology and Therapy - April 18, 2023 Category: Neurology Source Type: research

Building Evidence on Safety of Thrombolysis for Patients Receiving Direct Oral Anticoagulants
Nearly 20% of patients with acute ischemic stroke (AIS) are undergoing direct oral anticoagulant (DOAC) treatment at the time of their stroke. Common indications for DOACs among these patients include stroke prevention from atrial fibrillation, treatment of venous and pulmonary thrombosis, and coronary and peripheral atherosclerotic disease. Novel indications for DOAC use are expected to emerge and may increase the proportion of patients with AIS who are undergoing treatment with DOACs. Current US and European acute stroke treatment guidelines recommend withholding intravenous thrombolysis (thrombolysis), a morbidity- and ...
Source: JAMA Neurology - January 3, 2023 Category: Neurology Source Type: research

Sixteen-Syndrome in a Young Patient with Systemic Lupus Erythematosus
This report describes a case of 16 syndrome in systemic lupus erythematosus (SLE). A 28 year old woman with underlying lupus was presented with sudden left side body weakness and diplopia. Examination showed features of 16 syndrome with one and a half syndrome, facial diplegia and left hemiparesis. Neuroimaging revealed an acute infarct of bilateral dorsal pons. The patient was placed on antiplatelet therapy. However, she developed left leg deep vein thrombosis and pulmonary embolism after one week. She was then given subcutaneous low molecular weight heparin, followed by warfarin and cycles of cyclophosphamide. Her hemipa...
Source: Neurology India - October 21, 2022 Category: Neurology Authors: Masnon Nurul Ain Teo Shee Kiang Wan Hazabbah Wan Hitam Hui Jan Tan Rabani Remli Wan Zaidi Wan Asyraf Othmaliza Othman Source Type: research

The Development of Pulmonary Edema after Recombinant Tissue Plasminogen Activator in Acute Ischemic Stroke Patient; Neurogenic or Non-Neurogenic?
In this study, we reported four cases of post-thrombolytic ischemic stroke patients who suffer from pulmonary edema with different symptoms and onset times as well as we discuss the possible explanation behind these different outcomes.Case Rep Neurol 2022;14:348 –358
Source: Case Reports in Neurology - August 30, 2022 Category: Neurology Source Type: research

A Review of the Current Literature and Updates on Embolic Stroke of Undetermined Source (ESUS)
AbstractPurpose of ReviewThe initial ESUS construct presumed that atrial fibrillation (AF) would be detected in a substantial percentage of patients, but subsequent studies have determined that the rate of AF detection is much lower than anticipated, thereby highlighting other potential causes of ESUS. To date, there is no clear consensus supporting PFO closure or anticoagulation in ESUS patients. In this review, we discuss the recent studies on potential causes of ESUS and related work-up as well as report the recent trials on the treatment of ESUS.Recent FindingsSome of the potential causes of ESUS are undetected AF, pat...
Source: Current Treatment Options in Neurology - August 6, 2022 Category: Neurology Source Type: research

A Nationwide Analysis of Aneurysmal Subarachnoid Hemorrhage Mortality, Complications, and Health Economics in the USA
In conclusion, patients with aSAH have high post-operative complication ra tes and costs. Development of novel interventions to reduce complications and improve outcomes is crucial.
Source: Translational Stroke Research - July 26, 2022 Category: Neurology Source Type: research

Artery of Percheron Occlusion in China: A Case Report and Chinese Literature Review
Conclusion: Our report suggests that unusual mood disorder and language disorder of aged patients might indicate the AOP occlusion, and cerebral imaging of magnetic resonance imaging (better with magnetic resonance angiography) should be performed to establish the diagnosis of AOP occlusion. The fast and accurate diagnosis of stroke because of AOP occlusion could best benefit the patients.
Source: The Neurologist - July 1, 2022 Category: Neurology Tags: Case Report/Case Series Source Type: research

Endovascular Treatment for Acute Ischemic Stroke After Video-Assisted Thoracoscopic Pulmonary Lobectomy in Patients With Lung Cancer: A Report of Four Cases and Literature Review
Postoperative cerebral embolic stroke is a serious complication of pulmonary lobectomy, occurring in 1.1% of patients undergoing lobectomy through video-assisted thoracoscopic surgery (VATS). The mechanism of this complication is thought to be embolic stroke caused by thrombus formed due to stagnation in the pulmonary vein stump after VATS lobectomy. There have been few reports demonstrating the utility of endovascular treatment (EVT) for cerebral embolic stroke after VATS lobectomy.
Source: Journal of Stroke and Cerebrovascular Diseases - June 10, 2022 Category: Neurology Authors: Hiroshi Ueno, Hiroto Yamaoka, Sakyo Hirai, Kyohei Fujita, Mariko Ishikawa, Shoko Fujii, Yuki Aizawa, Yosuke Ishii, Masataka Yoshimura, Kenji Yamada, Yoshikazu Yoshino, Morito Kurata, Katsutoshi Seto, Hironori Ishibashi, Kenichi Okubo, Shigeru Nemoto, Kazu Tags: Case Report Source Type: research

Cryptogenic, Embolic Stroke —Looking Backstage
Stroke is a common and devastating event and the majority of cases are caused by thromboembolism from the left atrium, left ventricle or left sided valves. This case report describes a case of embolic stroke with the origin of the thrombus from the left inferior pulmonary vein. The importance of this case is twofold. Firstly, it is the fourth case report of pulmonary venous thrombosis, a very rare condition, due to COVID-19 infection and secondly, it focuses attention on the fact that the left atrium is not the most proximal address of arterial thromboembolism —the pulmonary veins are.
Source: Journal of Stroke and Cerebrovascular Diseases - March 2, 2022 Category: Neurology Authors: Prof James Ker Tags: Case Report Source Type: research

Simultaneously Occurring Ischemic Stroke, Leg Artery Occlusion, and Pulmonary Embolism Induced by a Uterine Myoma
Paradoxical embolism from venous thrombosis through the patent foramen ovale is a rare but well-known cause of stroke in young adults. Here, we report a case of simultaneous middle cerebral artery infarction, multiple occlusions of the leg arteries, and pulmonary thromboembolism from the venous thrombus, all due to compression of the external iliac vein by a uterine leiomyoma.
Source: Journal of Stroke and Cerebrovascular Diseases - February 3, 2022 Category: Neurology Authors: Jean Hee Kim, Jaseong Koo, Kijeong Lee Tags: Case Report Source Type: research

Simultaneous Acute Pulmonary Thromboembolism and Stroke & #8211; A Management Dilemma
We report the case of a 52-year-old man with concurrent massive right middle cerebral artery AIS and acute PTE, who was successfully managed despite the contradictory guidelines to manage them simultaneously. The patient underwent decompression craniotomy followed by anticoagulant therapy. The current case report demonstrates that full-dose heparin, despite being relatively contraindicated in an AIS, can achieve a good outcome when given under close monitoring. The transesophageal echo with bubble contrast during the Valsalva maneuver demonstrated patent foramen ovale with a right to left shunt as a cause of AIS and PTE in this patient.
Source: Neurology India - October 30, 2021 Category: Neurology Authors: Sita Jayalakshmi Harsh Khandalia Sudhindra Vooturi PA Jiwani Subhash Kaul Source Type: research

Cryptogenic Stroke Caused by Pulmonary Arterial Venous Malformation with Massive Right-to-Left Shunt: A Case Report
ConclusionsPAVM is an important risk factor for PE and CS and should not be ignored as a possible etiology in stroke patients without any other risk factors. CTA of the pulmonary artery is the recommended gold standard for diagnosing and locating a PAVM. Thrombolytic therapy within the time window combined with transcatheter device occlusion of arteriovenous malformation and rehabilitation training may benefit the recovery of patients with CS caused by PE resulting from PAVM.
Source: Neurology and Therapy - September 3, 2021 Category: Neurology Source Type: research

Feasibility of the Big  5—Jena eCS Protocol
ConclusionThe implementation of an extended cardio-stroke protocol is feasible, no significantly time-consuming, acquiring assessable imaging, and maintaining radiation exposure acceptable. The Big  5—Jena eCS protocol was also able to detect some thrombi not reported by TTE or TEE; however, due to our data’s explorative character, a conclusive comparison with cardiac ultrasound is not possible. A prospective pilot study and clinical trials should be conducted to assess the diagnostic ac curacy of this protocol compared to echocardiography and determine the potential impact on diagnostic and treatment decisions.
Source: Clinical Neuroradiology - August 11, 2021 Category: Neurology Source Type: research

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