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Cardiac myxoma and ischemic stroke
We report a case of intra-arterial tirofiban administration in a patient with acute ischemic stroke due to left atrial myxoma. Our purpose is to increase awareness at evaluation of secondary causes of ischemic stroke and provide a treatment option.Cardiac myxoma, which is most commonly found in the left atrium, is a rare etiology of cardioembolic stroke.1 The diagnosis of cardiac myxoma is seldom found at the onset of cerebral embolism when considering emergency endovascular treatment. We present a case of a 52-year-old Chinese male who had an ischemic stroke caused by left atrial myxoma, followed by an obvious recovery af...
Source: QJM - March 6, 2020 Category: Internal Medicine Source Type: research

Central venous catheter use increases ischemic stroke risk: a nationwide population-based study
ConclusionCVC placement increases ischemic stroke risk, particularly in those aged ≤35 years; this trend warrants further investigation.
Source: QJM - June 21, 2019 Category: Internal Medicine Source Type: research

Septic cerebral emboli as a risk factor for thrombolysis-related haemorrhagic transformation
For the sake of completeness the risk factors enumerated by Wanget al. for haemorrhagic transformation of acute cerebral infarcts after intravenous thrombolysis (IVT)1 ought to include infective endocarditis (IE)-related septic emboli.2 In the latter study, which covered the period 2002 –10, 222 patients (mean age 69; 46% female) were identified who were treated with IVT for acute ischaemic stroke associated with IE. These patients were compared with 134 048 counterparts (mean age 69; 49% female) treated with IVT in the absence of IE. The rate of IVT-related intracerebral haemorr hage was significantly (P = 0.006) hi...
Source: QJM - January 25, 2019 Category: Internal Medicine Source Type: research

Reply: Septic cerebral emboli as a risk factor for thrombolysis-related haemorrhagic transformation
We appreciate the opportunity to respond to Dr. Jolobe ’s letter titled ‘Septic cerebral emboli as a risk factor for thrombolysis-related hemorrhagic transformation’. Dr. Jolobe made a nice comment on our article titled ‘Risk factors of hemorrhagic transformation after intravenous thrombolysis with rt-PA in acute cerebral infarction’.1 We agree that septic cerebral emboli was a risk factor for thrombolysis-related hemorrhagic transformation as demonstrated in an early study.2 In fact, it was based on this early study and the following studies that intravenous thrombolysis is not recommended for patients with acut...
Source: QJM - January 25, 2019 Category: Internal Medicine Source Type: research

Epidemiology, risk factors and characteristics of pediatric stroke: a nationwide population-based study
Conclusions and implicationsInfants younger than 2  years, boys and children in lower socioeconomic status have a significantly higher risk of stroke. Hemorrhagic stroke has a significantly higher mortality rate than ischemic stroke. More than half of the children with stroke had underlying diseases and the causes of hemorrhagic stroke are signifi cantly different from ischemic stroke.
Source: QJM - April 10, 2018 Category: Internal Medicine Source Type: research

Hypovolemia due to cerebral salt wasting may contribute to stroke in tuberculous meningitis
ConclusionIn TBM, stroke occurred in 39.5% of the patients, 50% of whom had CSW. Volume contraction due to CSW may contribute to stroke.
Source: QJM - April 9, 2018 Category: Internal Medicine Source Type: research

The disappearing basal ganglia sign
A 55-year-old male with previous stroke presented with right sided facial paralysis and body weakness, after falling at home. Neurological examination revealed an upper motor neuron lesion. Cranial computed tomography (CT) showed disappearing basal ganglia sign affecting the left basal ganglia (Figure  1A). Repeat CT (Figure  1B) depicted an acute left middle cerebral artery (MCA) infarct. Appropriate management was instituted; however, patient passed away. The disappearing basal ganglia sign is a CT sign of early MCA infarction.1 One study reported a sensitivity of 77% and specificity of 100% for early CT signs within t...
Source: QJM - December 7, 2017 Category: Internal Medicine Source Type: research

Transcatheter aortic valve implantation (TAVI) for severe aortic incompetence
A 38-year-old woman with Marfan ’s syndrome presented with a 1-day history of left-sided weakness due to thromboembolic occlusion of the right distal middle cerebral artery (MCA). National Institute of Health Stroke Scale (NIHSS) score was 11-points. She complained of progressively worsening exertional dyspnoea during the last 1  month.
Source: QJM - October 23, 2017 Category: Internal Medicine Source Type: research

Acute ocular ischemic syndrome
Learning points for cliniciansOcular ischemic syndrome (OIS) is a sight-threatening condition due to ocular hypoperfusion subsequent to severe stenosis or occlusion of the carotid arteries. Acute OIS occurring simultaneously with stroke is rare. It is necessary for clinicians to be familiar with OIS and its underlying etiology to make an accurate diagnosis and initiate appropriate treatment.
Source: QJM - August 2, 2017 Category: Internal Medicine Source Type: research

The potential impact of sleep-related movement disorders on stroke risk: a population-based longitudinal study
ConclusionsPatients with SRMD were found to have an increased risk of all-cause stroke along with a higher possibility of hemorrhagic stroke over ischemic stroke.
Source: QJM - May 8, 2017 Category: Internal Medicine Source Type: research

Cardiac troponin-I as a predictor of mortality in patients with first episode acute atrial fibrillation
ConclusionsElevated cardiac Troponin I is a significant predictor of mortality and a composite endpoint of mortality, stroke or heart failure in patients presenting with first episode acute AF.
Source: QJM - March 11, 2017 Category: Internal Medicine Source Type: research

New-onset atrial fibrillation-related ischemic stroke occurring after hospital discharge in septicemia survivors
Conclusion: The middle-aged and elderly septicemia survivors suffered from new-onset AF had increased incidence of IS within three months. New-onset AF was a mediator factor of IS in septicemia survivors of Asian population.
Source: QJM - February 8, 2017 Category: Internal Medicine Source Type: research

Underuse of screening in Osler –Weber–Rendu syndrome
<span class="paragraphSection">According to the view expressed by the authors the management of Hereditary Haemorrhagic Telangiectasia (HHT) should include prevention of complications of vascular lesions.<a href="#hcw221-B1" class="reflinks">¹</a> Accordingly, the opportunity should have been taken to screen the patient for pulmonary arteriovenous malformations (PAVM), the latter a feature in 15 –50% of patients with HHT.<a href="#hcw221-B2" class="reflinks">²</a> With transthoracic contrast echocardiography as the imaging modality, the Internati...
Source: QJM - January 12, 2017 Category: Internal Medicine Source Type: research

Pregnancy increases stroke risk up to 1 year postpartum and reduces long-term risk
Conclusion: The risk of stroke was elevated during the first year postpartum, but lower in subsequent years. Stroke risk increased in multiparous ( ≥3) women. Physicians should be on alert for pregnancy complications and ensure appropriate management to prevent postpartum stroke.
Source: QJM - January 9, 2017 Category: Internal Medicine Source Type: research

Antipsychotic prescription amongst hospitalized patients with dementia
Conclusion: Antipsychotic medications are commonly prescribed for hospitalized patients with dementia in Ireland. Ward environments and dementia-related governance structures are suboptimal.
Source: QJM - September 18, 2016 Category: Internal Medicine Authors: Gallagher, P., Curtin, D., de Siun, A., OShea, E., Kennelly, S., ONeill, D., Timmons, S. Tags: Original papers Source Type: research

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