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Predictive value of free fatty acid levels in embolic stroke of undetermined source: A retrospective observational study
The present study aimed to investigate the predictive value of free fatty acid (FFA) in embolic stroke of undetermined source (ESUS) according to the presence of potential embolic sources (PES) after extensive etiologic evaluation. This was a retrospective observational study based on a single-center registry from January 2011 to July 2017. Stroke subtypes were determined through laboratory findings, brain, and angiographic imaging, carotid ultrasonography, transthoracic echocardiography, and 24-hour Holter monitoring. If ESUS was suspected, transesophageal echocardiography was additionally performed. Patients were classi...
Source: Medicine - October 2, 2020 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Acute basilar artery occlusion with recurrent shivering: A case report
Rationale: Shivering is an important physiological response of the body that causes muscle tremors to maintain temperature homeostasis. Traumatic brain injuries that affect the hypothalamus cause hypothermia, and physical removal of suprasellar tumors causes thermoregulation imbalance. However, no study has reported shivering due to ischemic stroke. Patient concerns: A 58-year-old male patient was admitted to our emergency department to evaluate severe stenosis of the basilar artery. While waiting for further examination, he exhibited coarse shivering and severe dysarthria. Diagnosis: Brain computed tomography angi...
Source: Medicine - September 25, 2020 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Hemichorea-hemiballismus as the initial manifestation of symptomatic middle cerebral artery dissection: A case report
Conclusion: Prompt recognition of acute onset hemichorea-hemiballismus as the manifestation of acute ischemic stroke in appropriate clinical setting may reduce diagnostic delay. Multiple imaging techniques including cerebral digital subtraction angiography and HR-MRI can be applied to diagnosis and further clarify the mechanism of stroke, which facilitate in selection of secondary prevention therapies.
Source: Medicine - September 4, 2020 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

The resolution of carotid arterial thrombus by oral anticoagulation after IV thrombolysis for chemotherapy-induced stroke: A case report
Rationale: Cancer-related stroke has been regarded as an emerging subtype of ischemic event. Acute treatment for this subtype may include the antiplatelet agents, anticoagulants, or endovascular intervention. Patient concerns: A 63-year-old woman with sudden-onset right hemiparesis and conscious change was sent to our emergency department. The patient had underlying sigmoid adenocarcinoma and received chemotherapy FOLFIRI (FOL, folinic acid; F, fluorouracil; and IRI, irinotecan) with targeted therapy cetuximab following lower anterior resection since the diagnosis was made. Diagnoses: Brain magnetic resonance angio...
Source: Medicine - August 28, 2020 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Bilateral pontine infarction with basilar artery fenestration: A case report
Rationale: Basilar artery (BA) fenestration is a congenital anomaly with duplicated BA, which can cause ischemic stroke. However, the stroke mechanism is not clearly verified in patients with BA fenestration. Patient concerns: Here, we report a case of 64-year-old man with well-controlled hypertension admitted with dysarthria, only. Diagnoses: Diffusion weighted image showed a bilateral symmetric pontine infarction sparing the midline. BA fenestration was observed from magnetic resonance angiography. Intervention: High-resolution magnetic resonance image (MRI) and 4D flow MRI was performed to verify the mechanis...
Source: Medicine - August 7, 2020 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Microcatheter infusion of bolus-dose tirofiban for acute ischemic stroke due to distal intracranial artery occlusion
The utility of endovascular thrombectomy for acute occlusion of the distal intracranial artery (A2/A3/M2/M3/P2/P3) is unclear, and aspiration and stent thrombectomy are associated with risk of bleeding. We analyzed patients with acute occlusion of the distal intracranial artery to assess the safety and efficacy of microcatheter-based tirofiban infusion. We retrospectively reviewed data of the endovascular thrombectomy registry of our center between January 2018 and June 2019. Patients with distal intracranial artery occlusion who underwent endovascular thrombectomy with microcatheter-based infusion of tirofiban were recru...
Source: Medicine - July 24, 2020 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Mechanical thrombectomy for a 12-year-old boy with acute ischemic stroke: A case report
Conclusions: Mechanical thrombectomy can be performed safely for children with AIS, but needs a further research with large samples.
Source: Medicine - July 24, 2020 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Plaque features and vascular geometry in basilar artery atherosclerosis
Hemodynamic changes occurring at the segments of arterial bifurcations, up and down stream of stenotic vessels appear to play a critical role in the development of atherosclerosis. Therefore, we hypothesized that basilar artery (BA) geometry may be related to the distribution of atherosclerotic plaque. In this retrospective cross-sectional study, all patients hospitalized with ischemic stroke and intracranial atherosclerotic disease were sifted from March 2017 to October 2017. Sixty-seven patients with intracranial atherosclerotic disease (39 with and 28 without BA atherosclerosis) were analyzed. Magnetic resonance imagin...
Source: Medicine - May 1, 2020 Category: Internal Medicine Tags: Research Article: Observational Study 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

r-tPA with loading dose of clopidogrel and aspirin therapies for capsular warning syndrome attributed to middle cerebral artery atherosclerotic stenosis: A CARE-compliant case report
Rationale: The capsular warning syndrome (CWS) is a rare and special type of transient ischemic attacks (TIAs) syndrome. The pathophysiology of CWS is very complicate, and intracranial atherosclerotic stenosis (ICAS) is rare cause. Moreover, the effective and standard therapy has not yet been established. Patient concerns: A 47-year-old man experienced repeated and exacerbated TIAs of right hemiparesis and dysarthria. Fourteen hours after the first episode of TIAs, he developed more severe right hemiparesis and dysarthria, the National Institute of Health Stroke Scale (NIHSS) score was 12 points, and did not recover i...
Source: Medicine - February 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

Pulmonary arteriovenous malformation exhibiting recanalization >10 years after coil embolization: Two case reports
We described the first 2 cases diagnosed with PAVM recanalization>10 years after the first catheter embolization. These cases suggest that patients with PAVMs should undergo life-long follow-up after catheter embolization.
Source: Medicine - January 1, 2020 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Young male with syphilitic cerebral arteritis presents with signs of acute progressive stroke: A case report
Conclusion Progressive stroke was the initial symptom of the neurosyphilis. Disease progression is rapid and difficult to control with a single course of penicillin.
Source: Medicine - November 1, 2019 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

How to continue lipid-lowering therapy in patients with coronary heart disease and severe liver dysfunction?: A case report of plaque regression by a combination of Chinese and Western Medicine
Rationale: Atherosclerotic cardiovascular disease (ASCVD), including coronary heart disease (CHD), atherosclerotic stroke and peripheral vascular disease, has become the most deadly chronic noncommunicable disease throughout the world in recent decades, while plaque regression could reduce the occurrence of ASCVD. Traditional Chinese Medicine (TCM) has been widely used for prevention and treatment of these diseases. In the perspective of TCM, phlegm and blood stasis are considered to be leading pathogenesis for CHD. Hence, activating blood circulation and dissipating phlegm, which is of great benefit to regress plaque, h...
Source: Medicine - October 1, 2019 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Interventional recanalization as a treatment of carotid stump syndrome caused by right internal carotid artery occlusion: A case report
Rationale: Carotid stump syndrome is a cerebral infarction caused by an embolus formed subsequent to the vortex of blood flow from the occluded stump, which then moves through the collateral vessels into the brain. The covered stent and stent-assisted coil embolization stump are the effective interventions for the carotid artery stump. Patient concerns: A 71-year-old man twice experienced left limb weakness; diffusion weighted imaging confirmed the diagnosis of cerebral infarction. Cervical computed tomography angiography, intracranial magnetic resonance angiography, and digital subtraction angiography were conducted ...
Source: Medicine - September 1, 2019 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

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