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Total 172 results found since Jan 2013.

Thrombolysis-related Multiple Lobar Hemorrhaging in Cerebral Amyloid Angiopathy with Extensive Strictly Lobar Cerebral Microbleeding.
Authors: Eriguchi M, Yakushiji Y, Tanaka J, Nishihara M, Hara H Abstract A hemi-paralyzed 86-year-old man was diagnosed with ischemic stroke and underwent thrombolysis. Pre-thrombolysis brain magnetic resonance imaging revealed extensive strictly lobar cerebral microbleeding (CMB). Post-thrombolytic computed tomography revealed asymptomatic multiple intracerebral hemorrhaging (ICH). His age, CMB topography, and decreased cerebral spinal fluid amyloid-β 40 and 42 levels were compatible with a diagnosis of cerebral amyloid angiopathy (CAA). There is no consensus on the safety of thrombolysis for acute stroke patient...
Source: Internal Medicine - July 20, 2017 Category: Internal Medicine Tags: Intern Med Source Type: research

Acute evaluation of the acute vestibular syndrome – differentiating posterior circulation stroke from acute peripheral vestibulopathies
Abstract This review article aims to provide an evidence‐based approach to evaluating the patient who presents with acute prolonged, spontaneous vertigo in the context of the acute vestibular syndrome (AVS). Differentiation of posterior circulation stroke presenting as an acute vestibular syndrome has been regarded as an important diagnostic challenge for physicians involved in acute care. Current evidence suggests that a targeted approach to history taking and physical examination with emphasis on the oculomotor examination, more specifically the HINTS (Head Impulse/ Nystagmus/Test‐of‐skew) examination battery, yiel...
Source: Internal Medicine Journal - July 11, 2017 Category: Internal Medicine Authors: Benjamin Kwok ‐Tung Tsang, Alex Siew‐Kar Chen, Mark Paine Tags: Review Source Type: research

Late emergence of macular sparing in a stroke patient: Clinical Case Report
We report a case of HH with a dramatic improvement in central vision several days after an occipital infarction. To our knowledge, this is the first case to show macular sparing developing after several days.
Source: Medicine - July 1, 2017 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Clinical predictors for the manifestation of late gadolinium enhancement after acute myocardial infarction
We examined 136 patients after first ST-elevated myocardial infarction by CMR after a median of 4 days (range: 2–7). Patients with manifestation of LGE were matched to patients without LGE by means of age and gender. Clinical follow-up with a combined primary endpoint including myocardial reinfarction, congestive heart failure, stroke, death and development of left ventricular thrombus was reported after 24 months. Patients with manifestation of LGE had a significant longer time of symptom-to-intervention, a higher prevalence of anterior AMI, and more proximal culprit lesions. Furthermore, left ventricular ejection frac...
Source: Medicine - May 1, 2017 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Posterior reversible encephalopathy syndrome in a postpartum hemorrhagic woman without hypertension: A case report
Rationale: Posterior reversible encephalopathy syndrome (PRES), which diagnosis is based on clinical symptoms and radiological features, is a neurotoxic disease characterized by a set of clinical manifestations, such as seizure, headache, visual, and/or consciousness disturbance. It is the first case of PRES followed by postpartum hemorrhage (PPH) without underlying disease. Patient concerns: A 37-year-old healthy woman had PPH after caesarean section. Six days after delivery, headache occurred suddenly, followed by episodes of clonus seizure. Diagnoses: Brain computed tomography showed ischemic stroke. However, magnetic...
Source: Medicine - April 1, 2017 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Vertebrobasilar system computed tomographic angiography in central vertigo
This article reveals the opportunity to diagnose posterior circulation abnormalities causing central vertigo with a feasible method such as CTA.
Source: Medicine - March 1, 2017 Category: Internal Medicine Tags: Research Article: Diagnostic Accuracy Study Source Type: research

Seizure syndrome as a first manifestation of solitary tumor-like mass lesion of PACNS: Two case reports
Rationale: Primary angiitis of the central nervous system (PACNS) is an inflammatory disease involving cerebrovascular and parenchymal, and solitary tumor-like mass lesion of PACNS (TLML-PACNS) is frequently misdiagnosed as neoplastic or other inflammatory diseases. However, seizure syndrome as a first manifestation of TLML-PACNS has rarely reported before. Patient concerns: Here, we report 2 cases of seizure syndrome, which was the first sign that presented prior to the diagnosis of TLML-PACNS by brain biopsy. Diagnoses: A mass lesion in the white and gray matters was detected by magnetic resonance imaging. The patholog...
Source: Medicine - March 1, 2017 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Utility of Duranta, a wireless patch-type electrocardiographic monitoring system developed in Japan, in detecting covert atrial fibrillation in patients with cryptogenic stroke: A case report
Rationale: Subcutaneous implantable electrocardiographs are highly effective in detecting covert atrial fibrillation (AF) in cryptogenic stroke. However, these invasive devices are not indicated for all cryptogenic stroke patients, and noninvasive improvements over conventional Holter-type ambulatory electrocardiography are needed. We evaluated the clinical application and effectiveness of Duranta (ImageONE Co., Ltd.), a wireless patch-type electrocardiographic monitoring system developed in Japan for chronically ill patients or home-based patients at the end of life. A Duranta device was used to detect covert AF in patien...
Source: Medicine - February 1, 2017 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Use of susceptibility-weighted imaging in assessing ischemic penumbra: A case report
We reported a 65-year-old man complained of paroxysmal hemiplegia of his right limbs and anepia for 2 days, whereas the symptoms lasted for about 12 hours when he admitted to the hospital. Diagnosis: We diagnosed it as acute ischemic stroke caused by the left middle cerebral artery stenosis. Interventions: Susceptibility-weighted imaging (SWI), multimodal magnetic resonance imaging (MRI) work-up which includes conventional MRI sequences (T1WI, T2WI, and FLAIR), DWI, PWI. Outcomes: His DWI-SWI mismatch was comparable to that of DWI-PWI at admission, suggesting that DWI-SWI could predict ischemic penumbra in patient wit...
Source: Medicine - February 1, 2017 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Stroke in the acute setting
Acute stroke and transient ischaemic attack (TIA) are focal neurological syndromes of vascular origin and should be treated as medical emergencies. Brain imaging with computed tomography or magnetic resonance imaging is required to distinguish ischaemic stroke from intracerebral haemorrhage, recognize non-stroke pathologies that mimic stroke and guide investigation into the underlying mechanism. Acute interventions of benefit in ischaemic stroke include intravenous thrombolysis with alteplase given within 4.5 hours of onset, endovascular thrombectomy within 6 hours of onset in selected patients, stroke unit care and aspirin.
Source: Medicine - January 22, 2017 Category: Internal Medicine Authors: Keith W. Muir Tags: Acute medicine II Source Type: research

Stroke mimic: Perfusion magnetic resonance imaging of a patient with ictal paralysis
H OnderJournal of Postgraduate Medicine 2017 63(1):60-61
Source: Journal of Postgraduate Medicine - January 10, 2017 Category: Internal Medicine Authors: H Onder Source Type: research

Reply to Letter to Editor regarding the article, " Stroke mimic: Perfusion magnetic resonance imaging of a patient with ictal paralysis "
D Sanghvi, C Goyal, J ManiJournal of Postgraduate Medicine 2017 63(1):61-62
Source: Journal of Postgraduate Medicine - January 10, 2017 Category: Internal Medicine Authors: D Sanghvi C Goyal J Mani Source Type: research

Intracranial dermoid cyst rupture-related brain ischemia: Case report and hemodynamic study
Rationale: Spontaneous rupture of intracranial dermoid cyst is a rare but serious clinical event that can result in cerebral ischemia. Cerebral vasospasm and vasculitis are considered as potential mechanisms of dermoid cyst rupture-related cerebral ischemia. However, the hemodynamic mechanisms between cerebral ischemia and dermoid cyst rupture are not well known. Patient concerns: A 55-year-old, right-handed man was admitted to our hospital with sudden receptive aphasia and right-sided hypoalgesia. Brain magnetic resonance imaging (MRI) revealed a ruptured dermoid cyst and watershed infarcts in the left hemisphere. Then b...
Source: Medicine - January 1, 2017 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Fatal antiphospholipid syndrome following endoscopic transnasal-transsphenoidal surgery for a pituitary tumor: A case report
Conclusion: If patients have a history of cerebral stroke in their early life, such as a young stroke, the APS and higher risk of developing fatal APS after major surgery should be considered. The optimal management of APS remains controversial. The best treatment strategies are only early diagnosis and aggressive therapies combing of anticoagulant, corticosteroid, and plasma exchange. The intravenous immunoglobulin is prescribed for patients with refractory APS.
Source: Medicine - January 1, 2017 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Posterior Reversible Encephalopathy Syndrome with Extensive Deep White Matter Lesions Including the Temporal Pole.
We report the case of a 55-year-old man with atypical PRES, who had malignant hypertension and renal dysfunction. Magnetic resonance imaging of the brain revealed extensive vasogenic edema in the deep white matter including the temporal pole, as well as in the brainstem and cerebellum. Antihypertensive therapy and hemodialysis contributed to both clinical and radiological improvement. Involvement of the deep white matter including the temporal pole, which is rarely affected in an ischemic stroke, should be recognized as a potential sign of PRES. PMID: 27904123 [PubMed - in process]
Source: Internal Medicine - December 3, 2016 Category: Internal Medicine Tags: Intern Med Source Type: research