Cases reported "Cerebral Infarction"

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1/19. early diagnosis of central nervous system aspergillosis with combination use of cerebral diffusion-weighted echo-planar magnetic resonance image and polymerase chain reaction of cerebrospinal fluid.

    We treated a patient diagnosed as central nervous system (CNS) aspergillosis with the combined use of cerebral diffusion-weighted echo-planar magnetic resonance imaging (DWI) and polymerase chain reaction of the cerebrospinal fluid (CSF-PCR). DWI, a cutting-edge imaging modality to reveal the earliest changes of cerebral infarction, detected cerebral fungal embolization when the conventional computed tomographic scan and magnetic resonance imaging failed to reveal it. CSF-PCR demonstrated the presence of aspergillus-specific dna in the specimen, when the conventional examination and culture of CSF were nonspecific or negative. These diagnostic methods could be useful in the early diagnosis of CNS aspergillosis.
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2/19. Unexpected childhood death due to hemolytic uremic syndrome.

    Two cases of unexpected childhood death due to hemolytic uremic syndrome are reported. A 21-month-old girl who was discovered dead in bed following a short illness was found at autopsy to have overwhelming sepsis resulting from transmural colitis. escherichia coli serotype 0157A was isolated from the intestine, and renal changes of hemolytic uremic syndrome were found. A 4-year-old girl died suddenly in hospital from intracranial hemorrhage while being treated for hemolytic uremic syndrome-related renal failure. culture of urine and feces grew verocytotoxin producing E. coli. These cases demonstrate that hemolytic uremic syndrome may be a rare cause of unexpected childhood death and that the diagnosis may not be established prior to autopsy. Postmortem culture of tissues and fluids in cases of suspected sepsis in children may be essential in establishing this diagnosis, because histologic evaluation may be compromised by profound sepsis and tissue putrefaction. Accuracy in diagnosis may have significant public health and medicolegal consequences.
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3/19. Neurological symptoms in patients whose cerebrospinal fluid is culture- and/or polymerase chain reaction-positive for mycoplasma pneumoniae.

    We describe 13 patients with neurological signs and symptoms associated with mycoplasma pneumoniae infection. M. pneumoniae was isolated from the cerebrospinal fluid (CSF) of 9 patients: 5 with meningoencephalitis, 2 with meningitis, and 1 with cerebrovascular infarction. One patient had headache and difficulties with concentration and thinking for 1 month after the acute infection. M. pneumoniae was detected, by means of PCR, in the CSF of 4 patients with negative culture results. Two had epileptic seizures, 1 had blurred vision as a consequence of edema of the optic disk, and 1 had peripheral nerve neuropathy.
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4/19. cavernous sinus thrombosis and cerebral infarction caused by fusobacterium nucleatum infection.

    We report an unusual case of fusobacterial infection with secondary intracranial invasion. The condition was complicated by a cavernous sinus thrombosis and ischemic stroke. The patient was a 63-year-old woman with no history of systemic disease who had undergone a tooth extraction before the onset of symptoms. She initially suffered from sphenomaxillary sinusitis and a cavernous sinus thrombosis, and subsequently developed meningitis. cerebrospinal fluid examination suggested a pyogenic infection. Anaerobic culture revealed fusobacterium nucleatum. However, despite immediate antibiotic therapy, her condition remained unstable over the next few days, and she eventually developed an ischemic stroke. We describe our experience in the management of this case of anaerobic meningitis and the unusual complication of ischemic stroke; this case suggests that more aggressive therapy in addition to empirical antibiotics may be warranted.
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5/19. mitral valve endocarditis caused by a serum-resistant strain of escherichia coli.

    endocarditis due to escherichia coli is rare. The case of a 79-year-old woman with E. coli bacteremia and multiple hemorrhagic cerebral infarcts is reported. A two-dimensional echocardiogram showed no evidence of a vegetation. While she was receiving antimicrobial therapy, bacteremia, hematuria, conjunctival petechiae, and a mitral regurgitant murmur occurred. The patient died, and at autopsy a large (2.2 x 2.0 x 0.7 cm) necrotic vegetation on the anterior leaflet of the mitral valve and several hemorrhagic infarcts of the brain were noted. An in vitro study with use of pooled human serum was performed and demonstrated that the patient's infecting strain of E. coli was serum resistant, in contrast to a serum-sensitive control strain of E. coli that was isolated from the cultures of blood from a patient with pyelonephritis. Including our case, 19 well-described cases of E. coli endocarditis from 1945 to 1990 have been reported. E. coli can cause endocarditis of both sides of the heart. More cases of endocarditis of host valves than of prosthetic valves have been documented.
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6/19. Aldolase C/zebrin II is released to the extracellular space after stroke and inhibits the network activity of cortical neurons.

    cell death after stroke involves apoptotic, autophagocytic and necrotic mechanisms which may cause the release of cytosolic proteins to the extracellular space. Aldolase C (AldC) is the brain specific isoform of the glycolytic enzyme fructose-1,6-bisphosphate aldolase. According to its characteristic striped expression pattern in the adult cerebellum AldC is also termed zebrin II. Here, we demonstrate release of AldC into the cerebrospinal fluid (CSF) after stroke in vivo. Studies with cell cultures confirmed that AldC is released to the extracellular space after hypoxia. Moreover, addition of purified recombinant AldC to networks of cortical neurons plated on multielectrode arrays reversibly inhibited the spontaneous generation of action potentials at AldC concentrations which can be expected to occur after lesions of the human cerebral cortex. This mechanism could be relevant in the pathogenesis of the electrophysiological changes in the penumbra region after stroke.
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7/19. endarterectomy for persistent primitive hypoglossal artery--case report.

    Persistent primitive hypoglossal artery, an anastomosis between the carotid artery and the vertebrobasilar system, is found in about 0.05% of cerebral angiograms. Though usually asymptomatic, it may occasionally cause ischemic disease. A 62-year-old male presented with left hemiparesis. Right carotid angiograms demonstrated a primitive hypoglossal artery originating from the internal carotid artery at the 2nd cervical spine. This artery supplied almost all blood to the basilar artery system. A marked stenosis extended from the origin of the internal carotid artery to the primitive hypoglossal artery. An endarterectomy of the internal carotid and primitive hypoglossal arteries was performed using a special internal shunt 46 days after the onset. Sudden arterial bleeding from the incised part of the internal carotid artery occurred 12 days after the operation. The carotid artery was resutured. The rupture of the carotid artery appeared to be caused by an infection of pseudomonas aeruginosa, which was detected by culture of the chronic ear discharge. rupture of the vessel wall due to infection is an important complication after endarterectomy. This is the second reported endarterectomy of the primitive hypoglossal artery.
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8/19. fusobacterium necrophorum sepsis with cerebral infarction.

    We have described the case of a 23-month-old female child in whom Fusobacterium sepsis progressed to cerebral infarction despite therapy with intravenous chloramphenicol and ampicillin. Some clinical improvement was noted upon addition of metronidazole to the treatment regimen. The child survived, but has severe neurologic sequelae. physicians should suspect anaerobic infection in children who have signs of severe neurologic infection and in whom cultures are negative for aerobes. In selected cases, early treatment with metronidazole may be helpful.
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9/19. cerebral infarction due to systemic necrotizing vasculitis in a patient with rheumatic heart disease, subacute bacterial endocarditis and status epilepticus.

    Systemic necrotizing vasculitis involving cerebral blood vessels is described in a 30-year-old man with rheumatic heart disease and subacute bacterial endocarditis. Fever, anaemia, splenomegaly and positive blood cultures for gram-negative bacteria were found on admission. The fever resolved with antibiotic therapy on the third hospital day but he then developed hemiplegia and multifocal seizures. The seizures progressed to uncontrollable status epilepticus accompanied by congestive heart failure and the patient died 20 d after admission. At autopsy, exudative and necrotizing vasculitis involving medium- to small-sized arteries was seen in the brain, the heart and the skeletal muscles. Rheumatic myocarditis and endocarditis and old rheumatic mitral valve deformities were also present. In addition, verrucous endocarditis in the mitral valve and Lohlein's focal glomerulonephritis were noted. We discuss the possible mechanism of the systemic necrotizing vasculitis in relation to rheumatic fever.
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10/19. Cerebral and myocardial infarction induced by nonbacterial thrombotic endocarditis in a patient with ovarian cancer: report of a case.

    A 40-year-old woman was admitted to our hospital because of left hemiplegia. She was affected with myocardial infarction and cerebral infarction. Echocardiogram revealed that the aortic and mitral valves had thick and uneven echoes suggesting vegetations. Judging from the finding that repeated blood cultures were negative, we had considered in her lifetime that myocardial and cerebral infarctions were due to embolization associated with nonbacterial thrombotic endocarditis (NBTE). At autopsy, histological diagnosis was made as ovarian cancer with disseminated intravascular coagulation. From the clinical course and the histological findings, we diagnosed this patient as NBTE.
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