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Pearls & Oy-sters: Cerebral venous air embolism after central catheter removal: Too much air can kill
A 95-year-old woman with a history of hypertension presented from a long-term care facility for altered mental status in the context of dehydration and hypoglycemia. Multiple attempts to obtain a peripheral IV failed, and a triple lumen catheter was placed into the right internal jugular vein using the Seldinger technique under ultrasound guidance. No complications followed the procedure. The patient was then rehydrated and given multiple ampules of D50, leading to prompt resolution of the hypoglycemia and improvement in her mental status. After resolution of symptoms, the central line was removed, with the head of the bed...
Source: Neurology - March 30, 2015 Category: Neurology Authors: Bartolini, L., Burger, K. Tags: MRI, All Clinical Neurology, All Cerebrovascular disease/Stroke, Embolism RESIDENT AND FELLOW SECTION Source Type: research

Cryptogenic Stroke Following Abdominal Free Flap Breast Reconstruction Surgery
Conclusion Surgeons and cardiologists should be aware of this cerebrovascular complication secondary to PFO following major reconstructive surgery such as microvascular breast reconstruction. It also serves to challenge microvascular surgeons to reconsider routine use of central venous pressure lines in free flap patients who might otherwise have good peripheral vessels for postoperative fluids and antibiotic administration.
Source: International Journal of Surgery Case Reports - November 11, 2014 Category: Surgery Source Type: research

Teaching NeuroImages: Hyperdense posterior cerebral artery sign
A 38-year-old man presented to the emergency department with right-sided weakness, sensory loss, and hemianopsia. CT head showed a left hyperdense posterior cerebral artery sign (HPCAS) (figure 1). CT angiogram of the head confirmed a left posterior cerebral artery (PCA) occlusion (figure 2). MRI demonstrated a left PCA infarct. Transesophageal echocardiogram revealed an atrial septal aneurysm and patent foramen ovale. He was treated with antiplatelet therapy. The HPCAS has been considered a marker for acute ischemia in the PCA territory.1 Recognizing the HPCAS on CT in acute stroke may help in the diagnosis and treatment ...
Source: Neurology - November 10, 2014 Category: Neurology Authors: Capampangan, D. J., Lee-Ianotti, J. K., Riordan, K. C., Kramer, C. L. Tags: CT, All Cerebrovascular disease/Stroke RESIDENT AND FELLOW SECTION Source Type: research

Amusia: Unique Presentation of Stroke (P6.261)
CONCLUSIONS:Even though music and speech are similar in principle and execution they are functions of different hemispheres of the brain. Unlike aphasia, anatomical localization of amusia has not been established but it is known that right non dominant hemisphere is concerned with musical ability. Impairment of musical ability in the presence of intact speech can be the only presenting finding in stroke. Their identification is the key to early and appropriate treatment.Study Supported by:NoneDisclosure: Dr. Ramchandani has nothing to disclose. Dr. Alsmaan has nothing to disclose. Dr. Schwarz has nothing to disclose. Dr. A...
Source: Neurology - April 9, 2014 Category: Neurology Authors: Ramchandani, C., Alsmaan, F., Schwarz, H., Alkhoury, Z. Tags: Cerebrovascular Disease and Interventional Neurology: Case Reports Source Type: research

Simultaneous onset of myocardial infarction and ischemic stroke in a patient with atrial fibrillation: Multiple territory injury revealed on angiography and magnetic resonance
An 84-year-old man with a history of hypertension and paroxysmal atrial fibrillation (AF) who received no anticoagulant drugs experienced acute chest pain and transient loss of consciousness. He was transferred to our emergency room. His initial electrocardiogram showed sinus rhythm with ST-segment elevation in the I, aVL, and V1–V6 leads. His blood pressure was 158/92mmHg and his pulse was regular at 70beats per minute. A chest radiograph showed increased heart size and pulmonary vascular congestion. His troponin T level was elevated (more than 0.1ng/mL). He was diagnosed with ST-elevation myocardial infarction (MI) and...
Source: International Journal of Cardiology - February 4, 2014 Category: Cardiology Authors: Osamu Hashimoto, Kozo Sato, Yohei Numasawa, Joji Hosokawa, Masahiro Endo Tags: Online Letters to the Editor Source Type: research

Patent Foramen Ovale Closure Challenged by Left Atrial Chord
In a 22-year-old woman suffering from ischemic stroke affecting the posterior cerebral artery, clinical work-up ruled out cardiovascular and neurological pathologies except patent foramen ovale (PFO) with septal aneurysm and complete bubble filling of the left atrium as demonstrated by echocardiography. The patient was scheduled for transcatheter PFO closure. Peri-interventional 3-dimensional transesophageal echocardiography revealed a PFO tunnel and a left atrial chord keeping the PFO open, with consequent continuous left to right shunting (A to C; Online Video 1). Balloon sizing demonstrated a tunnel diameter of 16 mm (D...
Source: Journal of the American College of Cardiology: Cardiovascular Imaging - February 3, 2014 Category: Radiology Source Type: research

Imaging Characteristics of Ischemic Strokes Related to Patent Foramen Ovale Clinical Sciences
Conclusions— A PFO-stroke usually appears as a single cortical or multiple small ischemic lesions in the vertebrobasilar circulation without any visible vessel occlusion on angiography. The recanalization rate is significantly lower than in AF-stroke. These imaging characteristics of PFO-stroke may help to diagnose the mechanism and determine the treatment strategy.
Source: Stroke - November 25, 2013 Category: Neurology Authors: Kim, B. J., Sohn, H., Sun, B. J., Song, J.-K., Kang, D.-W., Kim, J. S., Kwon, S. U. Tags: Pediatric and congenital heart disease, including cardiovascular surgery, Acute Cerebral Infarction, Computerized tomography and Magnetic Resonance Imaging Clinical Sciences Source Type: research

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