Neurocritical care
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Case Reports
Management of recurrent cerebral arterial occlusion in a patient with cardiac decompensation.
We describe a woman with congestive heart failure who presented with acute cardiac decompensation followed by ischemic stroke. The management of the patient posed unique challenges for thrombolytic treatment (due to existing coagulopathy) and subsequent optimization of hemodynamic status. Issues related to rethrombosis and use of platelet glycoprotein IIB/IIIA inhibitors are also discussed.
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Subarachnoid hemorrhages caused by intracranial dissections are rare. The management of dissections in these cases not clear. ⋯ Basilar artery dissection can present with subarachnoid hemorrhage. No guidelines are available for management of basilar artery dissections and treatment should be tailored to the individual patient.
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A 44-year-old man developed a right middle cerebral artery territory stroke due to a large fat embolism after an aortic valve repair. We briefly review the phenomenon of fat embolism and discuss the salient radiographic (CT) finding in this case--a "hypodense artery sign."
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Case Reports
Endovascular treatment of inadvertent cannulation of the vertebro-subclavian arterial junction.
Inadvertent arterial cannulation at a noncompressible site is a highly risky complication of central venous line placement. ⋯ Due to the complex site of cannulation, and the patient being fully anticoagulated, the use of a percutaneous closure device was not attempted. Open vascular surgery was not a treatment option due to high surgical risk. After determining left VA dominance, the right VA was occluded distal to the catheter entry point with platinum coils. Subsequently, a covered stent was placed into the SCA across the origin of the VA. The sheath was then removed safely without complications. A minor leak was initially present, which was stopped by repeating balloon inflation within the stent above nominal pressure.
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Case Reports
Successful endovascular treatment of a ruptured mycotic intracavernous carotid artery aneurysm in an AIDS patient.
As the medical treatment for human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) continues to advance, the HIV-related aneurysms may pose a clinical problem of increasing magnitude. The authors report on a successfully treated ruptured mycotic intracavernous carotid artery aneurysm case in an AIDS patient. ⋯ The cerebral aneurysms in HIV/AIDS patients can be generally categorized into two groups: the mycotic aneurysms from bacterial or fungal infections and the HIV-associated aneurysms as a distinct entity. To plan appropriate interventions, a high degree of clinical suspicion must be exercised to promptly recognize the mycotic nature of many HIV-related aneurysms.