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Specialty: Internal Medicine
Source: Mayo Clinic Proceedings
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Total 82 results found since Jan 2013.
Hypertriglyceridemia-Induced Pseudo –High Anion Gap Metabolic Acidosis Manifesting as Ischemic Stroke
Hypertriglyceridemia is a metabolic disorder characterized by elevated levels of triglycerides in the bloodstream.1 The underlying causes are multifactorial and range from metabolic syndrome and genetic predisposition to lifestyle choices.1 The management of hypertriglyceridemia usually involves a combination of lifestyle modifications, control of low-density lipoprotein and high-density lipoprotein levels, and pharmacotherapy when necessary.1 The clinical presentation is predominantly asymptomatic; however, some patients present with abdominal pain, nausea, vomiting, and pancreatitis.
Source: Mayo Clinic Proceedings - September 1, 2023 Category: Internal Medicine Authors: Abdul R. Akkawi, Mason Fawcett, Abhiram Challa, Timothy Nguyen, Jennifer Jackson, Richard Muraga Tags: Letter to the editor Source Type: research
Natural History and Sequelae of Penetrating Aortic Ulcer
A man in his 70s with history of tobacco use and hypertension presented for transesophageal echocardiography after a recent diagnosis of ischemic stroke. This demonstrated a moderate right-to-left shunt on Valsalva release and no left atrial appendage thrombus. Assessment of the thoracic aorta revealed a complex penetrating aortic ulcer and saccular aneurysm with thrombus in the distal arch and proximal descending thoracic aorta (Figure). Computed tomography angiography confirmed the presence of multiple penetrating ulcerations with large saccular aneurysms.
Source: Mayo Clinic Proceedings - September 1, 2023 Category: Internal Medicine Authors: Raghav R. Julakanti, Prabhakar Shantha Rajiah, Krishnaswamy Chandrasekaran Tags: Medical image Source Type: research
Safeguarding Against Stroke Risk by Statins
Whereas mighty prospective randomized trials —and meta-analyses of these—rightly command the data used to drive guidelines and daily clinical practice, careful long-term follow-up of closely monitored cohorts can generate crucial discoveries not anticipated in a 5-year study. As just one example, findings from lifelong follow-up in the Ame rican Framingham studies and the Whitehall cohorts in the United Kingdom show a strong association between blood pressure in middle years and dementia in later life.
Source: Mayo Clinic Proceedings - September 1, 2023 Category: Internal Medicine Authors: Adrian J.B. Brady Tags: Editorial Source Type: research
86-Year-Old Woman With Fever, New-Onset Dysarthria, and Ataxia
An 86-year-old woman with a medical history of hypertension, hyperlipidemia, permanent atrial fibrillation receiving anticoagulation, and chronic venous stasis causing recurrent leg cellulitis presented to the emergency department for new-onset dysarthria and imbalance, which began earlier that morning. She denied a history of stroke, chills, unintentional weight loss, diarrhea, dysuria, frequency, or recent head trauma. The patient endorsed taking her anticoagulation as prescribed without skipped doses.
Source: Mayo Clinic Proceedings - August 1, 2023 Category: Internal Medicine Authors: Nikita Jhawar, Abdallah El Sabbagh Tags: Residents ’ Clinic Source Type: research
Oral Anticoagulation in Patients With Advanced Chronic Kidney Disease and Atrial Fibrillation: Beyond Anticoagulation
The optimal approach to prevent stroke and systemic embolism in patients with advanced chronic kidney disease (CKD) and atrial fibrillation remains unresolved. We conducted a narrative review to explore areas of uncertainty and opportunities for future research. First, the relationship between atrial fibrillation and stroke is more complex in patients with advanced CKD than in the general population. The currently employed risk stratification tools do not adequately discriminate between patients deriving a net benefit and those suffering a net harm from oral anticoagulation.
Source: Mayo Clinic Proceedings - April 5, 2023 Category: Internal Medicine Authors: Sofie A.M. Dhaese, An S. De Vriese Tags: Review Source Type: research
Ischemic Stroke in Patients With Malignancy
Approximately one-quarter to one-third of patients with ischemic stroke have an embolic stroke of undetermined source (ESUS). An estimated 5% to 10% of patients with ESUS have an active cancer diagnosis. Presence of cancer potentially increases the risk of acute ischemic stroke through various mechanisms such as cancer-related hypercoagulability, intracranial tumors leading to an arterial compression, or intracardiac tumors leading to cardioembolism. Certain cancer therapeutics can also contribute to risk of ischemic stroke.
Source: Mayo Clinic Proceedings - November 1, 2022 Category: Internal Medicine Authors: Ugur Sener, Zafer Keser Tags: Concise review Source Type: research
Left Atrial Appendage Occlusion, A Misnomer?
The importance of the left atrial appendage (LAA) as the source of thromboembolism including stroke in patients with nonvalvular atrial fibrillation is well documented, with more than 90% of ischemic strokes related to a LAA thrombus. Although oral anticoagulation has been the standard of care, approximately 50% to 60% of patients either have contraindications to oral anticoagulation or do not continue the medication beyond the first year. This led to the development of local site-specific therapy to occlude the LAA by either surgical or transcatheter means.
Source: Mayo Clinic Proceedings - August 1, 2022 Category: Internal Medicine Authors: David R. Holmes, Trevor J. Simard, Ammar M. Killu, Mohamad A. Alkhouli Tags: Review Source Type: research
Effectiveness and Safety of Clopidogrel vs Aspirin in Elderly Patients With Ischemic Stroke
To evaluate the risks of recurrent stroke and major bleeding events with clopidogrel and aspirin use among patients aged 80 years or older.
Source: Mayo Clinic Proceedings - August 1, 2022 Category: Internal Medicine Authors: Hsin-Yi Huang, Shin-Yi Lin, Aaron J. Katz, Jau-Jiuan Sheu, Fang-Ju Lin, Chi-Chuan Wang, Chung-Hsuen Wu Tags: Original article Source Type: research
Examining Disparities and Excess Cardiovascular Mortality Before and During the COVID-19 Pandemic
To investigate the patterns and demographics of cardiovascular (CVD) death and subtypes myocardial infarction (MI), stroke, and heart failure (HF) in the pre-COVID-19 era (2018-2019) vs during COVID-19 pandemic (2020-2021) in the United States.
Source: Mayo Clinic Proceedings - July 20, 2022 Category: Internal Medicine Authors: Scott E. Janus, Mohamed Makhlouf, Nicole Chahine, Issam Motairek, Sadeer G. Al-Kindi Tags: Original Article Source Type: research
64-Year-Old Woman With Aphasia and Troponin Elevation
A 64-year-old right-handed woman presented to the emergency department with aphasia of 20 hours' duration, for which a stroke code was activated. She was unable to state her name; her speech was effortful, with many paraphasic errors, but some intact automatic phrases (sorry, yes, no). The family stated that her last known well was 20 hours ago. Additional history suggested several months of decline consisting of punctuated episodes of mild memory, attention, concentration, and language difficulty.
Source: Mayo Clinic Proceedings - June 29, 2022 Category: Internal Medicine Authors: Bryce Kalei Chang, Jana Wieland, Christopher J. Klein Tags: Residents ’ clinic Source Type: research
54-Year-Old Woman With Altered Mental Status and Abdominal Pain
A 54-year-old woman was transferred to our medical center with altered mental status, abdominal pain, and hypotension. Her medical history included type 2 diabetes mellitus, hypertension, hyperlipidemia, active tobacco use, prior cholecystectomy, and a recent stroke. One month earlier, she presented to an outside facility with right-sided facial weakness and numbness. Brain magnetic resonance imaging (MRI) at that time revealed multiple small lacunar-type infarcts. Computed tomography (CT) angiography of the head and neck, 48-hour Holter monitoring, and transesophageal echocardiography did not reveal an embolic source.
Source: Mayo Clinic Proceedings - June 29, 2022 Category: Internal Medicine Authors: Caroline L. Matchett, Nikita Rafie, Jacob C. Jentzer Tags: Residents ’ Clinic Source Type: research
28-Year-Old Man With Joint Pain
A 28-year-old man presented to the emergency department with right shoulder pain that radiated to the right arm as well as pain of the right hip and lower back. His medical history is significant for sickle cell disease (SCD) with the HbSS genotype (homozygous for the S globin). He had a hemorrhagic stroke in the setting of venous sinus thrombosis 2 years earlier with no persisting neurologic deficits as well as osteonecrosis of bilateral hips and right knee requiring right total hip arthroplasty and right total knee arthroplasty.
Source: Mayo Clinic Proceedings - June 1, 2022 Category: Internal Medicine Authors: Emily B. Butts, Albert Bui, Razvan M. Chirila Tags: Residents ’ clinic Source Type: research
Outcomes of Patients With Type 2 Myocardial Infarction Complicating Acute Ischemic Stroke
To study the patient profiles and the prognostic impact of type 2 myocardial infarction (MI) on outcomes of acute ischemic stroke (AIS).
Source: Mayo Clinic Proceedings - April 26, 2022 Category: Internal Medicine Authors: Salik Nazir, Robert W. Ariss, Abdul Mannan Khan Minhas, Keerat Rai Ahuja, Hani Jneid, George V. Moukarbel Tags: Original Article Source Type: research
Risk Factors for Silent Brain Infarcts and White Matter Disease in a Real-World Cohort Identified by Natural Language Processing
To assess the frequency of silent brain infarcts (SBIs) and white matter disease (WMD) and associations with stroke risk factors (RFs) in a real-world population.
Source: Mayo Clinic Proceedings - April 26, 2022 Category: Internal Medicine Authors: Lester Y. Leung, Yichen Zhou, Sunyang Fu, Chengyi Zheng, Patrick H. Luetmer, David F. Kallmes, Hongfang Liu, Wansu Chen, David M. Kent Tags: Original article Source Type: research
Craniocervical Artery Dissections: A Concise Review for Clinicians
Craniocervical artery dissection (CAD), although uncommon, can affect the young and lead to devastating complications, including stroke and subarachnoid hemorrhage. It starts with a tear in the intima of a vessel with subsequent formation of an intramural hematoma. Most CAD occurs spontaneously or after minor trauma. Patients with CAD may exhibit isolated symptoms of an underlying subclinical connective tissue disorder or have a clinically diagnosed connective tissue disorder. Emergent evaluation and computed tomography angiography or magnetic resonance imaging/angiography of the head and neck are required to screen for and to diagnose CAD.
Source: Mayo Clinic Proceedings - April 1, 2022 Category: Internal Medicine Authors: Zafer Keser, James F. Meschia, Giuseppe Lanzino Tags: Concise review Source Type: research
