1/85. Nonaneurysmal thunderclap headache with diffuse, multifocal, segmental, and reversible vasospasm.OBJECTIVE: To highlight the clinical profiles and angiographic findings of two patients with recurrent thunderclap headache (TCH) without subarachnoid hemorrhage (SAH) and to present modified diagnostic criteria for this unusual syndrome. BACKGROUND: TCH may be a benign recurrent headache disorder or it may represent a serious underlying process such as SAH or venous sinus thrombosis. The pathophysiology of this disorder in the absence of underlying pathology is not well understood and its potential angiographic features are not well appreciated. methods: Two case descriptions with illustrative angiography. RESULTS: Both cases demonstrated the potential for reversible intracranial vasospasm without intracranial aneurysm or SAH and a benign clinical outcome. CONCLUSIONS: Primary TCH has a distinctive clinical and angiographic profile and must be distinguished from central nervous system vasculitis and SAH.- - - - - - - - - - ranking = 1keywords = thrombosis (Clic here for more details about this article) |
2/85. plasma antithrombin iii deficiency in ischaemic stroke in the young.A deficiency of plasma antithrombin III has been identified as a potential risk factor for thrombosis. In a pilot study of 56 patients aged less than 40 years who presented with ischaemic stroke of unknown etiology, we detected only one case of plasma antithrombin iii deficiency. Antithrombin III activity was estimated by a chromogenic assay. Hence, antithrombin iii deficiency, though rare, should be considered while evaluating young patients with stroke of unknown etiology.- - - - - - - - - - ranking = 1keywords = thrombosis (Clic here for more details about this article) |
3/85. Transient ischaemic attacks related to carotid stenosis precipitated by straining, bending, and sneezing.Three patients are described in whom one or more carotid territory transient ischaemic attacks (TIAs) were preceded by sneezing, straining, or bending over. It is argued that the mechanism involved dislodgment of embolic material from the site of carotid atheroma. This mechanism should be considered as an alternative to paradoxical embolism when TIAs are precipitated by such physiological manoeuvres. Furthermore, TIAs should be added to the list of medical hazards associated with such events.- - - - - - - - - - ranking = 1.4318341368296keywords = embolism (Clic here for more details about this article) |
4/85. Homozygous prothrombin gene mutation and ischemic cerebrovascular disease: a case report.We report the case of a 31-year-old woman who, at the age of 26 suffered from an episode of superficial thrombophlebitis in the left leg, experienced two episodes of transient ischemic attacks at the age of 30 and had an ischemic stroke with left-sided hemiparesis at the age of 31 years. A cerebral CT scan showed an ischemic lesion in the right sylvian area involving the opercular and nucleocapsular regions. Her father had had an ischemic stroke at the age of 54 years and died at the age of 58; her mother had had a myocardial infarction at the age of 48 years and died at 51 years from breast cancer. Laboratory investigation of the patient demonstrated high levels of fibrinogen, F II, F VII, F 1 2, FPA and ACA-IgG with low levels of HDL cholesterol associated with homozygosity for the 20210 A genotype. There were no other genetic or acquired prothrombotic defects. In conclusion, this case strongly suggests a clinically significant role ot the prothrombin gene mutation in both arterial and venous thrombosis.- - - - - - - - - - ranking = 1keywords = thrombosis (Clic here for more details about this article) |
5/85. Iliofemoral vein thrombosis and pulmonary embolism associated with a transient ischemic attack in a patient with antiphospholipid syndrome.Several clinical conditions, such as deep vein thrombosis, cerebral infarct, pulmonary infarct, skin ulcers, renal failure, and habitual abortion, are thought to be associated with the antiphospholipid syndrome. The authors describe a 32-year-old woman who had characteristics of the antiphospholipid syndrome including increased immunoglobulin g-cardiolipin antibody titers, iliofemoral vein thrombosis, pulmonary embolism, headache, visual disturbances, and habitual abortion. During hospitalization, she suddenly experienced right-sided weakness. A Tc-99m HMPAO brain scan showed the probability of a transient ischemic attack in the left frontotemporal cortex.- - - - - - - - - - ranking = 13.159170684148keywords = embolism, thrombosis (Clic here for more details about this article) |
6/85. The successful surgical treatment of a paradoxical embolus to the carotid bifurcation.Paradoxical embolism is a rare cause of ischemic stroke. We report the case of a 67-year-old man who had a saddle embolus to the carotid bifurcation successfully treated with emergency embolectomy. Transesophageal echocardiogram revealed a large patent foramen ovale and an easily demonstrable right-to-left shunt. Subsequent investigations revealed proximal deep venous thrombosis in the left femoral and popliteal veins and multiple pulmonary emboli. Long-term anticoagulation was instituted for the diagnosis of paradoxical embolism. The patient's recovery was uneventful, and he remained neurologically intact. A literature review emphasizes the role of transesophageal echocardiography and suggests that paradoxical embolism may be a more common cause of stroke than previously thought.- - - - - - - - - - ranking = 5.2955024104887keywords = embolism, thrombosis (Clic here for more details about this article) |
7/85. The role of thrombolysis in the management of left-sided prosthetic valve thrombosis: a study of 85 cases diagnosed by transesophageal echocardiography.BACKGROUND AND AIM OF THE STUDY: Treatment strategies of prosthetic valve thrombosis (PVT) are controversial. The aim of this study was to compare the efficacy and safety of thrombolysis, surgery and heparin therapy in patients with either obstructive or non-obstructive PVT. methods: Between 1993 and 2000, 85 episodes of PVT were found (82 in the mitral position, three in the aortic) in 59 patients (22 males, 37 females; mean age 53 years; range: 28-80 years) by multiplane transesophageal echocardiography (TEE). Obstructive PVT was defined as restricted leaflet (occluder) motion with increased gradient, even if thrombus was not seen by TEE; non-obstructive PVT was considered as normal leaflet motion, irrespective of the gradients. Thrombolysis was given in 43 episodes (streptokinase, n = 37) by standard dosage protocols, surgery was performed in 20, and i.v. heparin was used in 22. recurrence rate was calculated in 26 survivors of successful thrombolysis based on six months to six years follow up. Treatment with thrombolysis and heparin was monitored using TEE. RESULTS: There were 54 cases of obstructive PVT and 31 cases of non-obstructive PVT. Anticoagulation was inadequate in 82% of cases. Thrombolysis was completely successful in 37 cases (86% success rate); in 27 of 32 patients with obstructive PVT (in both cases of aortic location), and in 10 of 11 non-obstructive PVT. heparin was successful in only nine of 18 non-obstructive PVT, and in none of four obstructive cases. Nine patients died, all with obstructive PVT, and all but one were in NYHA class IV; two were treated by thrombolysis (5% mortality), six by surgery (30% mortality) and one with heparin (5% mortality). Complications of thrombolysis included two strokes and two transient ischemic attack episodes (9%), and bleeding in one case (2%). There were six complications due to heparin treatment: newly developed obstruction in five patients and stroke in one patient. recurrence was diagnosed in eight episodes in six patients with obstructive PVT after successful thrombolysis (22%); rethrombolysis was successful in four of five cases. CONCLUSION: Thrombolysis was shown to be superior to surgery in obstructive PVT, especially in NYHA class IV patients. Severe complications of thrombolysis were noted only in the critically ill. As heparin treatment appeared ineffective and unsafe for the treatment of PVT, thrombolysis appeared to be the optimal therapeutic choice in this condition.- - - - - - - - - - ranking = 5keywords = thrombosis (Clic here for more details about this article) |
8/85. Patent foramen ovale transcatheter closure device thrombosis.The role of patent foramen ovale (PFO) in patients with cryptogenic stroke (stroke of unknown cause) remains controversial, although an association seems likely in younger patients with atrial septal aneurysms and PFO. The mechanism of cryptogenic stroke in these patients is presumed to be paradoxical embolism via right-to-left shunt across the PFO. The available options for treatment include medical therapy with antiplatelet or anticoagulant therapy or closure of the PFO surgically or with use of transcatheter PFO closure devices. We describe 2 cases of bilateral device thrombosis associated with use of a transcatheter PFO closure device (CardioSEAL). To our knowledge, only 1 other case of thrombosis associated with use of this device has been reported.- - - - - - - - - - ranking = 7.4318341368296keywords = embolism, thrombosis (Clic here for more details about this article) |
9/85. Transient postoperative occlusion of the superficial temporal--middle cerebral artery branch anastomosis: spasm, swelling, or thrombosis.Ten superficial temporal-middle cerebral artery branch anastomoses were followed by postoperatvie angiograms. The early angiograms revealed patent anastomosis in six patients. In two patients the superficila temporal artery was severely narrowed and tapered and the cerebral arteries were not visualized. In one the superficial temporal artery was not significantly narrowed but was only patent extracranically. In the remaining patient, the superficial temporal artery was completely occluded. The late angiograms showed the patency of the six originally patent anastomoses, and also complete patency of the three anastomoses in which the cerebral arteries were not visualized.- - - - - - - - - - ranking = 4keywords = thrombosis (Clic here for more details about this article) |
10/85. Intra-arterial thrombin injection of an ascending aortic pseudoaneurysm complicated by transient ischemic attack and rescued with systemic abciximab.Thrombin injection as a means of inducing thrombus formation has recently received wide attention as an alternative treatment for pseudoaneurysm. We present a case of a 67-year-old man in whom a large mycotic pseudoaneurysm developed in the ascending aorta because of sternal osteomyelitis and mediastinitis after coronary artery bypass grafting. Transcatheter intra-arterial thrombin injection was performed, and it successfully induced pseudoaneurysm thrombosis. However, the procedure was complicated by a sudden transient ischemic attack caused by thrombus propagation into the cerebral circulation. Complete thrombus dissolution in the cerebral circulation with the resolution of neurologic symptoms was achieved by means of intravenous abciximab.- - - - - - - - - - ranking = 1keywords = thrombosis (Clic here for more details about this article) |
| | Next -> |