1/13. Massive cerebral embolization: successful treatment with retrograde perfusion.stroke is an unpredictable and morbid complication of cardiac operations. We report a patient who suffered massive bilateral cerebral embolization during aortic cannulation for coronary bypass. This was treated successfully with hypothermic circulatory arrest and high flow retrograde cerebral perfusion. The patient suffered only minimal neurologic impairment and improved rapidly. She was discharged home on postoperative day 7 neurologically intact.- - - - - - - - - - ranking = 1keywords = coronary (Clic here for more details about this article) |
2/13. Detection of acute thalamo-mesencephalic infarction: diffusion abnormality precedes T2 hyperintensity.OBJECTIVE: To examine the time course of signal changes in diffusion-weighted magnetic resonance imaging (DW-MRI) and T2-weighted MRI in a case of cerebral infarction in the posterior circulation territory. MATERIALS AND methods: diffusion- and T2-weighted MRI and comparison of signal changes in these sequences at 4 h, 1 day and 4 days after the onset of clinical symptoms caused by acute thalamo-mesencephalic infarction. RESULTS: Four hours after the onset of symptoms, signal changes in DW-MRI revealed an infarction in the territory of the posterior perforating thalamic artery, whereas no signal changes were detected in T2-weighted MRI. In follow-up MRI 1 and 4 days after infarction, however, a marked hyperintensity matching the location of the diffusion deficit could be identified in T2 images. CONCLUSION: Signal changes in DW-MRI precede T2 hyperintensity after infarction in the posterior circulation territory after hemispheric infarction.- - - - - - - - - - ranking = 174.9471233174keywords = circulation (Clic here for more details about this article) |
3/13. Electrical storm: case series and review of management.Electrical storm is defined as a recurrent episode of hemodynamically destabilizing ventricular tachyarrhythmia that usually requires electrical cardioversion or defibrillation. We describe three cases presenting with electrical storm under differing circumstances: (1) a 57-year-old man with ST-elevation myocardial infarction within 1 week of a posterior circulation stroke who developed refractory sustained ventricular tachycardia 10 days after an acute myocardial infarction; (2) a 65-year-old man who developed polymorphic ventricular tachycardia and ventricular fibrillation following dobutamine echocardiography; and (3) a 20-year-old woman who developed intractable ventricular fibrillation following an overdose of a weight-reduction pill. The management of electrical storm is discussed, and evolving literature supporting the routine use of intravenous amiodarone and beta-blockers in place of intravenous lidocaine is critically examined.- - - - - - - - - - ranking = 87.473561658698keywords = circulation (Clic here for more details about this article) |
4/13. Multifocal varicella-zoster virus vasculopathy without rash.A 51-year-old woman with crest syndrome (calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia) developed stepwise progressive focal neurological deficits without zoster rash. Multifocal ischemic infarcts were seen on magnetic resonance imaging, and cerebral angiography revealed focal stenosis of arteries affecting the intracranial circulation. A brain biopsy was nondiagnostic. Virological etiology of the disease was verified by the detection of varicella-zoster virus antibody in cerebrospinal fluid and by reduced serum-cerebrospinal fluid varicella-zoster virus IgG ratios (compared with normally high ratios of total IgG and albumin). Treatment with intravenous acyclovir stabilized but did not significantly improve her neurological deficits.- - - - - - - - - - ranking = 87.473561658698keywords = circulation (Clic here for more details about this article) |
5/13. Simultaneous ischemic and neurotoxic brain damage after coronary angiography.Transient cortical blindness following intra-arterial catheter angiography is a known rare complication. We report the case of a 56-year-old man who suffered from transient cortical blindness and neuropsychological deficits after coronary angiography. Serial CT scans revealed reversible pathologic parenchymal contrast enhancement of the right occipital lobe as well as left middle cerebral artery infarction at the same time. CT changes and time course of clinical symptoms are presented and discussed for both lesions of presumably different etiology.- - - - - - - - - - ranking = 5keywords = coronary (Clic here for more details about this article) |
6/13. Cerebellar infarction in adolescent males associated with acute marijuana use.OBJECTIVE: To demonstrate the clinical characteristics, radiologic findings, and neuropathological features of tetrahydrocannabinol-related posterior fossa ischemic stroke in adolescent patients. DESIGN: A retrospective case and chart review of 3 cases encountered at a tertiary care institution over a span of 5 years. SETTING: Inpatient and intensive care hospitalization units managing children and adolescents. SUBJECTS: male adolescent patients with ischemic cerebellar stroke after use of marijuana. DIAGNOSTIC INVESTIGATIONS: Computed tomography brain scans (3 subjects), magnetic resonance imaging brain study (1 subject), cerebral arteriography (1 subject), cerebellar biopsy (1 subject), and necropsy (2 subjects). RESULTS: Three adolescent males had similar presentations of headache, fluctuating level of consciousness or lethargy, visual disturbance, and variable ataxia after self-administration of marijuana. They developed primary cerebellar infarctions within days after the exposure that could not be attributed to supratentorial herniation syndromes and only minimally involved brainstem structures. CONCLUSIONS: Episodic marijuana use may represent a risk factor for stroke in childhood, particularly in the posterior circulation. Early recognition of the cerebellar stroke syndrome may allow prompt neurosurgical intervention, reducing morbidity.- - - - - - - - - - ranking = 87.473561658698keywords = circulation (Clic here for more details about this article) |
7/13. Positional occlusion/stasis of vertebral arteries in a case of cervical rheumatoid arthritis presenting with multiple posterior circulation infarcts: a case report with angiographic demonstration.STUDY DESIGN: A case report of rheumatoid arthritis involving cervical spine, who presented with multiple posterior circulation infarcts, and pertinent literature review are presented. OBJECTIVE: To describe a rare positional occlusion/stasis of vertebral arteries, which resolved following application of cervical traction. The likely mechanism of above findings is proposed. SUMMARY OF BACKGROUND DATA: The mechanism of vertebrobasilar insufficiency with changes in head position in patients with rheumatoid arthritis can result from a number of causes; however, bilateral compromise of vertebral arteries during head extension had been described only once. There is no report of vertebral artery angiogram in any individual following application of traction and relief of compromise in extension. methods: A 45-year-old man had rheumatoid arthritis for the last 10 years and presented with symptoms of posterior circulation infarcts. Cervical spine radiographs revealed "mobile" atlantoaxial dislocation and atlantoaxial impaction. magnetic resonance imaging confirmed odontoid erosions, lateral masses destruction, atlantoaxial dislocation, and atlantoaxial impaction. Angiogram showed occlusion of the left vertebral artery and transient stasis of the right vertebral artery distal to foramen transversarium of C2 vertebra in extension position. The left vertebral artery had narrowing in the same segment in the neutral position. Following traction, repeat angiogram showed no occlusion or narrowing of either vertebral artery in any position. Transoral odontoidectomy and occipitocervical fusion were performed. RESULTS: The patient had no fresh deficits following surgery. CONCLUSIONS: We described a rare case of positional occlusion/stasis of vertebral arteries associated with rheumatoid arthritis, in which angiography following cervical traction showed complete resolution.- - - - - - - - - - ranking = 524.84136995219keywords = circulation (Clic here for more details about this article) |
8/13. The methylenetetrahydrofolate reductase (MTHFR) 677C-->T mutation and cardiovascular risk--A case of ischemic stroke and acute myocardial infarction.The authors report the case of a 39-year-old male patient who had an ischemic stroke (complete infarction of right anterior cerebral circulation) and an acute myocardial infarction during the same year. Molecular study revealed he was homozygous for the 677C-->T mutation in the gene coding for methylenetetrahydrofolate reductase, a key enzyme of folate metabolism; deficiency of this enzyme is associated with increased cardiovascular risk and neurological lesions. Some considerations are put forward about hyperhomocysteinemia and the MTHFR 677C-->T mutation as cardiovascular risk factors.- - - - - - - - - - ranking = 87.473561658698keywords = circulation (Clic here for more details about this article) |
9/13. Ischemic stroke associated with use of an ephedra-free dietary supplement containing synephrine.In response to concerns regarding the safety of ephedra-containing dietary supplements, manufacturers have marketed "ephedra-free" products. Many of these contain synephrine, a sympathomimetic amine from the plant citrus aurantium. synephrine is structurally similar to ephedrine and has vasoconstrictor properties. We describe a 38-year-old patient with ischemic stroke associated with an ephedra-free dietary supplement containing synephrine and caffeine. The patient presented with memory loss and unsteady gait after taking 1 or 2 capsules per day of a dietary supplement (Stacker 2 ephedra-Free) for 1 week. He had no notable medical history or major atherosclerotic risk factors and took no other medications. physical examination showed a mildly ataxic gait and substantial Impairment of both concentration and memory. Computed tomography and magnetic resonance imaging of the brain showed subacute infarctions in the left thalamus and left cerebellum in the distribution of the vertebrobasilar circulation. Other causes of ischemic stroke were evaluated, and findings were unremarkable; a vasospastic origin was considered most likely. The patient was discharged with nearly complete resolution of symptoms. synephrine, a sympathomimetic amine related to ephedrine, may be associated with Ischemic stroke. Consumers and clinicians need to be Informed about the potential risks of ephedra-free products.- - - - - - - - - - ranking = 87.473561658698keywords = circulation (Clic here for more details about this article) |
10/13. subclavian artery dissection and triple infarction of the nervous system.BACKGROUND: subclavian artery dissection is a rare entity. It is usually associated with anomalous aortic vasculature. Only with trauma or catheterization procedures is subclavian artery dissection with normal aortic vasculature reported. PATIENT: We describe a patient with intrascapular pain, an occipital headache, and 3 distinct infarctions in the nervous system. He had spontaneous subclavian artery dissection with normal aortic vasculature. CONCLUSION: subclavian artery dissections should be suspected in patients with intrascapular pain, occipital or cervical pain, and symptoms within the posterior circulation.- - - - - - - - - - ranking = 87.473561658698keywords = circulation (Clic here for more details about this article) |
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