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Acute cerebral infarction with acute myocardial infarction due to patent foramen ovale: A case report
Rationale: Patent foramen ovale (PFO) is not considered to be the main cause of stroke and is classified as the infarction of undetermined cause. The relationship between PFO and cerebral embolism is still unclear and cerebral embolism accompanied with coronary artery embolization in PFO patient is rare. In this case, we reported a patient with PFO suffered acute cerebral and myocardial infarction simultaneously, and analyzed the source of emboli and potential pathogenesis. Patient concerns: A 53-year-old female presented with chief complaints of intermittent palpitations and chest tightness for 6 years, aggravated fo...
Source: Medicine - May 1, 2020 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Management of paradoxical embolism in a patient with coexisting patent foramen ovale and masked pulmonary arteriovenous fistula: A case report
Rationale: Paradoxical embolism (PE) is an important cause of cryptogenic stroke, particularly in young patients, which usually have a relation with an unexpected route in circulation. Here we report a rare case of cryptogenic stroke carried 2 uncommon malformations. Patient concerns: A 48-year-old female experienced double neurological events in just 2 months. Diagnosis: Patent foramen ovale was diagnosed with transesophageal echocardiography and successfully occluded in the first admission due to stroke. In the second admission, chest tomographic angiography found a chordae shadow in the right middle lobe, was th...
Source: Medicine - April 1, 2020 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Cerebral sinovenous thrombosis in a child with ulcerative colitis: A case report
Rationale: Cerebral sinovenous thrombosis (CVT) associated with inflammatory bowel disease (IBD) is infrequent, but clinically nonnegligible due to its high disability and fatality rates. Patient concerns: A 12-year-old child with newly developed ulcerative colitis (UC) suffered from a sudden left-sided hemiparesis and numbness. Diagnoses: Cerebral sinovenous thrombosis due to ulcerative colitis was diagnosed in this girl. Interventions: The patient was treated with blood transfusion and anticoagulation therapy. Digital subtraction angiography (DSA) and urokinase thrombolysis were implemented followed. Outcomes...
Source: Medicine - January 1, 2020 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Blood Cell-Bound C4d as a Marker of Complement Activation in Patients With the Antiphospholipid Syndrome
In conclusion the detection of complement activation products on circulating erythrocytes and platelets using a highly sensitive and specific assay further supports the view that APS is a complement-mediated disorder. Increased EC4d and PC4d percentages are associated with the active inflammatory disease in SLE. It is difficult to translate this finding to APS which is a non-acute inflammatory disorder. We failed to find an association with both the classification and non-classification criteria, including thrombocytopenia. However, we believe that this sensitive tool to evaluate complement activation may offer more inform...
Source: Frontiers in Immunology - April 11, 2019 Category: Allergy & Immunology Source Type: research

Accidental Rivaroxaban Intoxication in a Boy: Some Lessons in Managing New Oral Anticoagulants in Children
We report a child who presented abnormal coagulation tests after unintended ingestion of 4 tablets of rivaroxaban. The patient was treated with fresh frozen plasma as well as admitted to intensive care and improved several hours later. We discuss his presentation and review of the literature on this topic.
Source: Pediatric Emergency Care - March 1, 2019 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

Resolution of left ventricular thrombus by edoxaban after failed treatment with warfarin overdose: A case report
Rationale: Although novel oral-anticoagulants are widely used in patients with atrial fibrillation (AF) for stroke prevention, there was only limited evidence for their use in left ventricular (LV) thrombus. Patient concerns: A 41-year-old man who presented with acute onset of right-hand clumsiness and aphasia even under high international normalized ratio (INR: 7.64) from warfarin use. He was previously treated with warfarin for the LV thrombus and non-valvular AF. Brain magnetic resonance imaging (MRI) showed multiple acute infarction in the cortex of the bilateral frontal lobes, left parietal lobe, and bilateral ce...
Source: Medicine - January 1, 2019 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

A case report of left atrial myxoma-induced acute myocardial infarction and successive stroke
Rationale: Left atrial myxoma is a common primary cardiac tumor, however, due to poor image quality or atypical myxoma images, it is often misdiagnosed by echocardiograph. A case of left atrial myxoma being misdiagnosed as a thrombus, which successively caused acute myocardial infarction (AMI) and stroke, is very rare. Contrast-enhanced echocardiography can play an important role in definitive diagnosis. Patient concerns: A 44-year-old woman was diagnosed AMI because of chest pain with no significant stenosis in the coronary arteries. One month later, the patient was suddenly found unconscious, magnetic resonance imag...
Source: Medicine - December 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Dabigatran as an alternative for atrial thrombosis resistant to rivaroxaban: A case report
Rationale: Anti-thrombosis therapy for atrial fibrillation (AF) management and stroke prevention is an important aspect of disease management. Novel oral anticoagulants (NOACs) are recommended by guidelines for AF management. However, if one can switch one NOAC to another when the former showed a poor effect has not been fully determined. Patient concerns: A 52-year-old man was admitted to our center for heart failure and AF with a thrombus in the left atrium. Diagnoses: Cardiomyopathy was diagnosed by cardiac magnetic resonance (CMR) and echocardiography. Interventions: He was prescribed rivaroxaban (20 mg da...
Source: Medicine - December 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Early ST-segment elevation acute myocardial infarction after thrombolytic therapy for acute ischemic stroke: A case report
We report a case of STEMI occurring 40 minutes after thrombolytic therapy for AIS and discuss the possible mechanisms and therapeutic approaches. Patient concerns: A 87-year-old woman with a history of arterial hypertension was admitted for acute onset of right-sided limb weakness 2 hours before arrival at the emergency department. Forty minutes after intravenous recombinant tissue plasminogen activator (i.v. rtPA) administration for AIS, STEMI occurred (signaled by a third-degree atrioventricular block). Diagnoses: The diagnoses were AIS and STEMI. Coronary angiography confirmed right coronary artery occlusion. ...
Source: Medicine - December 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Cerebral venous sinus thrombosis presenting with multifocal intracerebral hemorrhage and subarachnoid hemorrhage: A case report
Rationale: Multifocal cerebral hemorrhage refers to the cerebral hemorrhage in 2 or more lesions at the same time or 48 h in the brain caused by various causes, which has an acute onset, high mortality rate, and poor clinical treatment effect. Subarachnoid hemorrhage (SAH) is caused by the direct flow of blood into the subarachnoid cavity due to the rupture of the diseased vessels at the base or surface of the brain. Cerebral venous sinus thrombosis (CVST) affects approximately 5 people per million and accounts for approximately 1% of all stroke events. CVST with both SAH and multifocal intracerebral hemorrhage (ICH) a...
Source: Medicine - December 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Emicizumab for the Treatment of Acquired Hemophilia_A: Lessons Learned from 4 Very Different Cases
In conclusion, emiczumab seems to be an effective hemostatic therapy also for AHA, which offers several advantages: subcutaneous weekly therapy, good hemostatic efficacy, possible outpatient therapy, the option to reduce the intensity of immunosuppressive therapy to avoid side effects (as the patients are protected from bleeding), and seems even to be more cost effective than bypassing agents. However, special attention is necessary on the use of appropriate lab assays (chromogenic FVIII assays), the artificial effects on APTT and Bethesda assays, the recognition of the remission, and to avoid the concomitant use of APCC. ...
Source: Blood - November 21, 2018 Category: Hematology Authors: Knoebl, P., Sperr, W. R., Schellongowski, P., Staudinger, T., Jilma-Stohlawetz, P., Quehenberger, P., Koder, S., Ay, C., Gleixner, K. V. Tags: 322. Disorders of Coagulation or Fibrinolysis: Poster II Source Type: research

A case report of parenchymal hematoma after intravenous thrombolysis in a rivaroxaban-treated patient: Is it a true rivaroxaban hemorrhagic complication?
AbstractRationale:To date, the only treatment approved for acute ischemic strokes is thrombolysis. Whether intravenous thrombolysis may be safe in patients taking direct oral anticoagulants (DOACs) is currently a matter of debate.Patient concerns:A 74-year-old woman, who was on rivaroxaban 20 mg/d for nonvalvular atrial fibrillation, was admitted to our stroke unit with left-sided hemiparesis and aphasia. The onset of neurologic deficits had occurred 5 hours after the last rivaroxaban dose.Diagnosis:An acute ischemic stroke was diagnosed.Interventions:The patient was administered thrombolytic treatment with intravenous r...
Source: Medicine - December 1, 2017 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

WATCHMAN device-related thrombus successfully treated with apixaban: A case report
Rationale: Among atrial fibrillation patients with high risk of bleeding, left atrial appendage occlusion has emerged as an alternative to long-term oral anticoagulation therapy for stroke prevention. Device-related thrombus remains a major concern because it may result in recurrent embolic events. To date, there is no consensus on the optimal method of treating device-related-thrombus. Patient concerns: A 78-year-old man with atrial fibrillation had an episode of intracranial hemorrhage while taking warfarin. He subsequently underwent percutaneous placement of a 30-mm Watchman device to the left atrial appendage. He ...
Source: Medicine - November 1, 2017 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Device used to close small hole in heart may protect against recurrent stroke
A device used to close a small hole in the heart may benefit certain stroke patients by providing an extra layer of protection for those facing years of ongoing stroke risk, according to the results of a large clinical trial led by UCLA researchers.“It is a major new treatment option for some people,” said Dr. Jeffrey Saver, director of theUCLA Comprehensive Stroke Center and lead author of the study. However, he added, “Using the device is going to have to be a considered clinical decision between the doctor and the patient about who’s the right person to get it.”Thefindings appear in the Sept. 14 New England Jo...
Source: UCLA Newsroom: Health Sciences - September 14, 2017 Category: Universities & Medical Training Source Type: news

Dissection extending from extra- to intracranial arteries: A case report of progressive ischemic stroke
We reported a rare case of 33-year-old patient with progressive ischemic stroke due to dissection from an intimal tear in the right proximal internal carotid artery to distal middle cerebral artery. Diagnoses: 3D fat-saturated T1 VISTA imaging, owing to its comprehensive neck and head coverage, high spatial resolution, enables the reader to have several sections with good contrast covering the dissected arterial segment, even in the rare dissection involving extra- and intra-cranial arteries referred in this article. Interventions: Clopidogrel 75mg daily was prescribed, also the patient was given rehabilitation training....
Source: Medicine - May 1, 2017 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

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