Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Nov 2012
Case ReportsIntravenous recombinant tissue plasminogen activator thrombolysis in acute ischemic stroke due to middle cerebral artery dissection.
Beneficial effect of recombinant tissue plasminogen activator (rtPA) in cerebral arterial dissection is controversial. We experienced a 45-year-old man with acute ischemic stroke due to middle cerebral artery dissection, who was treated with rtPA. Characteristic vascular findings indicating dissection became evident only in subsequent angiographic examinations. Our case indicates that serial angiographic examinations should be essential after acute thrombolytic therapy, especially in young patients who are at a high risk of cerebral arterial dissection.
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J Stroke Cerebrovasc Dis · Nov 2012
Case ReportsMultistage indocyanine green videoangiography for the convexity dural arteriovenous fistula with angiographically occult pial fistula.
Recently, intraoperative indocyanine green (ICG) videoangiography has become a common technique for treating cerebrovascular diseases. We report a case of dural arteriovenous fistula (AVF) treated with direct surgery using intraoperative ICG videoangiography. A 41-year-old man with right hemiplegia caused by a left subcortical hemorrhage was transferred to our hospital. ⋯ Accurate detection of all fistular points and complete resection, including the dura mater and pial vessels, are necessary to avoid rebleeding caused by the residual dural AVF due to incomplete obliteration of the fistular points. Intraoperative ICG videoangiography could provide information on angiographically occult vascular malformation, such as pial fistulas, that cannot be detected by preoperative DSA. Our findings suggest that multistage intraoperative ICG videoangiography can be quite useful for complete resection of a dural AVF with angiographically occult pial fistula.
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J Stroke Cerebrovasc Dis · Nov 2012
Case ReportsCerebellar infarction originating from vertebral artery stenosis caused by a hypertrophied uncovertebral joint.
We report a case of cerebellar infarction originating from vertebral artery stenosis caused by a hypertrophied uncovertebral joint. A 38-year-old man presented with sudden onset of headache, dizziness, and dysarthria. The magnetic resonance imaging scan of the brain revealed acute infarction in the right cerebellar hemisphere in the territory of the posterior inferior cerebellar artery (PICA) and superior cerebellar artery (SCA). ⋯ C5-C6 anterior discectomy and fusion were performed together with direct uncovertebral joint decompression. Postoperative 3-dimensional computed tomographic angiography revealed improvement in antegrade filling in the right vertebral artery. The imaging findings for this patient and the pathogenesis of cerebellar infarction for our patient are discussed.
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J Stroke Cerebrovasc Dis · Nov 2012
Type of preadmission antidiabetic treatment and outcome among patients with ischemic stroke: a nationwide follow-up study.
We examined whether the preadmission use of sulfonylureas is associated with improved clinical outcome compared with other antidiabetic treatments after hospitalization with ischemic stroke. ⋯ Preadmission use of sulfonylureas appeared not to be associated with an overall improved clinical outcome among type 2 diabetic patients admitted with ischemic stroke.
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J Stroke Cerebrovasc Dis · Nov 2012
Blood pressure management and evolution of thrombolysis-associated intracerebral hemorrhage in acute ischemic stroke.
There is limited knowledge on the radiographic features of thrombolysis-induced hemorrhage. The factors that influence early hematoma expansion have not been elucidated. ⋯ Once diagnosed, thrombolysis-induced symptomatic ICH undergoes significant early expansion in size. Systolic BP may play a role in hematoma expansion.