1/15. Post transplanted infective endocarditis.The patient, a 51-year-old man, was receiving immunosuppressants for 2 yr after renal allotransplantation. He had heart failure with aortic regurgitation, fever, anemia and a history of odontectomy on admission. He was resistant to medical treatments and died from cerebral emboli. On autopsy, vegetation of the aortic valve was identified. Progression of atherosclerosis, which may have been due to steroids and chronic rejection, was prominent. This report is the first case of infective endocarditis following organ transplantation in japan. Such complications as infective endocarditis and atherosclerosis will be on the rise with the increase of numbers or organ transplantations.- - - - - - - - - - ranking = 1keywords = sclerosis (Clic here for more details about this article) |
2/15. The neurological complications of cardiac transplantation.review of the neurological complications encountered in 83 patients who received cardiac homografts over a seven-year period leads to the following conclusions: (1) Neurological disorders are common in transplant recipients, occurring in over 50 per cent of patients. (2) infection was the single most frequent cause of the neurological dysfunction, being responsible for one-third of all CNS complications. (3) The infective organisms were typically those considered to be usually of low pathogenicity: fungi, viruses, protozoa and an uncommon bacterial strain. (4) Other clinical neurological syndromes were related to vascular lesions, often apparently from cerebral ischaemia or infarction occurring during the surgical procedure, metabolic encephalopathies, cerebral microglioma, acute psychotic episodes and back pain from vertebral compression fractures. (5) The infectious complications and probably the development of neoplasms de novo, are related to immunosuppressive therapy which impairs virtually all host defence mechanisms and alters the nature of the host's response to infective agents or other foreign antigens. (6) Because neurological symptoms and signs were usually those of behavioural changes or deterioration in intellectual performance, the neurological examination was often of little value in diagnosing the nature or even the anatomical site of the neuropathological process. (7) The possibility of an infectious origin of the neurological manifestations must be aggressively pursued even in the absence of fever and a significantly abnormal spinal fluid examination. The diagnostic error made most frequently was to ascribe neurological symptoms erroneously to metabolic disturbances or to "intensive care unit psychosis" when they were in fact due to unrecognized CNS infection. (8) maintenance of mean cardiopulmonary bypass pressures above 70 mmHg, particularly in patients with known arteriosclerosis, may reduce operative morbidity. (9) Though increased diagnostic accuracy is possible with routine use of a variety of radiological and laboratory techniques, two further requirements probably must be met before a significant reduction in the frequency of neurological complications will occur: the advent of greater immunospecificity in suppressing rejection of the grafted organ while preserving defences against infection; and a more effective armamentarium of antiviral and antifungal drugs.- - - - - - - - - - ranking = 0.5keywords = sclerosis (Clic here for more details about this article) |
3/15. Strokes in tuberous sclerosis: are rhabdomyomas a cause?Abnormalities of the cerebral arteries and the aorta are more common in young patients with tuberous sclerosis than in the rest of the population. Strokes have been reported but there is no confirmation that embolization of cerebral arteries by fragments of cardiac rhabdomyoma plays a role in the higher incidence of strokes in these patients.- - - - - - - - - - ranking = 2.5keywords = sclerosis (Clic here for more details about this article) |
4/15. Clinical presentations of vascular malformations of the brain stem: comparison of angiographically positive and negative types.Clinical and radiographic features of 63 patients with a vascular malformation of the brain stem are described. On radiological grounds they were divided into two groups: one with angiographically visible lesions (AVAVMs), the other with lesions not seen angiographically, that is, occult (AOVMs). In the first group the initial clinical manifestation was due to haemorrhage in 20 of the 33 cases and consisted of a progressive neurological deficit in 12. In the second group 29 of the 30 initially presented with a brain stem haemorrhage. The latter was often characterised by development of symptoms over two days or more (16 cases), absence of headache (48 cases) and tendency to recurrence (20 cases). Clinical diagnosis was difficult in many cases especially in the AOVM group. Several of the patients were misdiagnosed as having multiple sclerosis. Clinical data in conjunction with magnetic resonance imaging were helpful in determining the nature of these lesions.- - - - - - - - - - ranking = 0.5keywords = sclerosis (Clic here for more details about this article) |
5/15. thrombosis following desmopressin for uremic bleeding.An elderly patient with evidence of atherosclerosis and uremic bleeding diathesis developed two foci of cerebral thrombosis immediately after an infusion of desmopressin (DDAVP). Because large molecular weight multimers of von Willebrand factor (vWF) have been demonstrated to cause platelet aggregation under conditions of elevated fluid shear stress as occurs in atherosclerotic vessels, we investigated his plasma vWF at the time of the event and compared it to baseline values obtained 2 weeks later. Unusually large vWF multimers induced by the DDAVP infusion were present and likely contributed to the thrombotic process. Consequently, we believe DDAVP should be given with greater caution to patients with atherosclerosis.- - - - - - - - - - ranking = 1keywords = sclerosis (Clic here for more details about this article) |
6/15. Segmental duplication of the basilar artery with thrombosis.Duplication or fenestration of the basilar artery, a result of an embryologic malformation, has an incidence of up to 5.3% in the general population. The most common complication of this anomaly is the formation of aneurysms. thrombosis of a partially duplicated basilar artery developed in a 43-year-old man who complained of visual disturbances followed by seizures and coma, and who eventually died. autopsy showed a partially organized thrombus occluding both halves of a duplicated portion of the basilar artery, old infarcts in the calcarine cortices, and a recent large infarct in the basis pontis. There was only minimal atherosclerosis of other intracranial arteries, including the vertebral arteries. Hemodynamic disturbances and turbulent blood flow at the site of fenestration may be the cause of the thrombosis that occurred in this artery.- - - - - - - - - - ranking = 0.5keywords = sclerosis (Clic here for more details about this article) |
7/15. Cerebral embolism resulting from an intracardiac tumor in tuberous sclerosis.tuberous sclerosis was diagnosed in an infant girl during the first 3 days of life on the basis of electrocardiographic and cranial computed tomographic abnormalities. At 19 months of age, neurologic deterioration occurred and repeat computed tomography documented several new cortical lesions while the subaortic mass was markedly reduced in size. The sequence of events suggested cerebral embolization by the cardiac tumor.- - - - - - - - - - ranking = 2.5keywords = sclerosis (Clic here for more details about this article) |
8/15. Left ventricular tumor masquerading as multiple sclerosis.A 30-year-old man had relapsing and remitting neurologic symptoms, which had been diagnosed as multiple sclerosis for nine years. Eventually, an unusual left ventricular tumor was discovered. The pathologic diagnosis was cavernous angiectasia, which, to our knowledge, is a previously undescribed histologic entity. Embolization from cardiac tumors can mimic multiple sclerosis and multiple echocardiograms may be required for diagnosis.- - - - - - - - - - ranking = 3keywords = sclerosis (Clic here for more details about this article) |
9/15. tuberous sclerosis with cardiogenic cerebral embolism: magnetic resonance imaging.A girl with tuberous sclerosis and intracardiac masses had at least two episodes of cardiogenic cerebral embolization, the attacks characterized by acute onset of prolonged neurologic dysfunction arising from different vascular distributions in both cerebral hemispheres. Renal embolization was suggested by hematuria. magnetic resonance imaging (MRI) demonstrated ischemic lesions in cerebral locations predicted by the clinical signs. MRI also demonstrated extensive areas compatible with the dysmyelination of tuberous sclerosis.- - - - - - - - - - ranking = 3keywords = sclerosis (Clic here for more details about this article) |
10/15. Anterograde transneuronal degeneration in the limbic system: clinical-anatomic correlation.A 64-year-old man with diffuse atherosclerosis developed an organic mental syndrome, followed by hypothalamic symptoms. autopsy showed an old large cystic infarct involving the left temporal lobe including the hippocampus, and atrophy of the ipsilateral fornix, mammillary body, hypothalamus, mammillothalamic tract, and the anterior thalamic nucleus. The clinical deterioration and pathologic findings may be explained by anterograde transneuronal degeneration within the limbic system following the infarction.- - - - - - - - - - ranking = 0.5keywords = sclerosis (Clic here for more details about this article) |
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