Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Nov 2012
Influence of COX-inhibiting analgesics on the platelet function of patients with subarachnoid hemorrhage.
Platelet function of patients with subarachnoid hemorrhage (SAH) may play an important part in both rebleeding and delayed cerebral ischemia, but little is known about aggregation pathways during the acute phase of stroke. Analgesics are used regularly in the first days after bleeding, and some can potentially inhibit the cyclooxygenase (COX) enzyme. We examined the platelet function of patients with SAH in order to describe their basal situation and determine whether the administration of intravenous nonsteroidal antiinflammatory drugs (NSAIDs) affected platelet aggregation. ⋯ The administration of COX-inhibiting analgesics leads to an hypoaggregability state in the first days of SAH. Further insight into their impact on complications such as rebleeding and delayed cerebral ischemia is needed in order to optimize the headache treatment of SAH.
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J Stroke Cerebrovasc Dis · Nov 2012
Case ReportsA case of embolic stroke imitating atherothrombotic brain infarction before massive hemorrhage from an infectious aneurysm caused by Streptococci.
Early detection followed by treatment with antibiotics in conjunction with direct or endovascular surgery is integral in the management of patients with intracranial infectious aneurysms. These aneurysms often manifest as massive intracranial hemorrhages, which severely deteriorate the outcome. ⋯ We present a case of α-Streptococcus-provoked infectious aneurysm in a patient without infective endocarditis, initially presenting as atherothrombotic-like brain infarction, before massive intracranial hemorrhage. The present case alerts clinicians to keep in mind possible development of infectious aneurysms, even in patients who appear to be suffering from atherothrombotic stoke, especially in patients presenting with signs of infection.
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J Stroke Cerebrovasc Dis · Nov 2012
Previous antiplatelet use is associated with hematoma expansion in patients with spontaneous intracerebral hemorrhage.
Patients with intracerebral hemorrhage (ICH) often report the use of antiplatelet medications, even more commonly than the use of anticoagulants. The effect of antiplatelet drugs on the course of ICH is controversial. In this study, our aim was to determine the effects of previous antiplatelet therapy on admission hematoma volume and hematoma expansion in patients with spontaneous ICH. ⋯ Previous antiplatelet use significantly contributes to hematoma expansion in patients with ICH.
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J Stroke Cerebrovasc Dis · Nov 2012
Case ReportsA patient with deep cerebral venous sinus thrombosis in whom neuroendovascular therapy was effective.
A 63-year-old man presented with aphasia. A computed tomographic scan of the head revealed hemorrhagic infarction in the left temporal lobe. Magnetic resonance venography (MRV) revealed no flow from the straight sinus and left transverse sinus to the sigmoid sinus, indicating cerebral venous sinus thrombosis (CVST). ⋯ In Western countries, neuroendovascular therapy is often aggressively performed in patients with worsening symptoms despite anticoagulation. However, in Japan, such reports are extremely rare. We recommend neuroendovascular therapy for deep CVST resistant to anticoagulant therapy.
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J Stroke Cerebrovasc Dis · Nov 2012
Case ReportsAcute ischemic stroke treated with intravenous tissue plasminogen activator in a patient taking dabigatran with radiographic evidence of recanalization.
Dabigatran etexelate is a new oral direct thrombin inhibitor that has been approved by the US Food and Drug Administration to prevent stroke in patients with nonvalvular atrial fibrillation. A 51-year-old man with a history of atrial fibrillation who was taking dabigatran presented with an acute ischemic stroke. ⋯ Recanalization of the middle cerebral artery with intravenous tissue plasminogen activator was apparent on digital subtraction angiography, and there was no evidence of intracerebral hemorrhage on the repeat computed tomographic scan. This is the first report of a patient who was taking dabigatran etexilate and who had an ischemic stroke caused by a middle cerebral artery occlusion, with an elevated thrombin time and radiographic recanalization with intravenous tissue plasminogen activator without evidence of hemorrhagic transformation.