Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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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.
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J Stroke Cerebrovasc Dis · Nov 2012
Spectrum and potential pathogenesis of reversible posterior leukoencephalopathy syndrome.
Controversy still exists over the etiology and pathophysiology of reversible posterior leukoencephalopathy syndrome (RPLS). This large single-center case series aims to describe the clinical and imaging features of RPLS in an attempt to deduce the etiology of the disorder and the mechanisms of brain injury. ⋯ This study strongly suggests that hypertension-induced vasodilation rather than vasoconstriction-mediated hypoxia is likely the major mechanism responsible for the development of vasogenic edema, and that vasoconstriction may contribute to the development of ischemia in RPLS.
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J Stroke Cerebrovasc Dis · Nov 2012
Case ReportsBilateral caudate nucleus infarction associated with a missing A1 segment.
We describe a case of bilateral caudate nucleus infarction caused by cardioembolic stroke associated with a variant circle of Willis. The patient was an 81-year-old man with atrial fibrillation who presented with a sudden disturbance of consciousness. When he became more alert a few days later, he was abulic with no spontaneous speech or activity. ⋯ The left A1 segment was absent on 3-dimensional computed tomography angiography. One year later, abulia had completely resolved. Bilateral caudate nucleus infarction with variant circle of Willis is rare.
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J Stroke Cerebrovasc Dis · Nov 2012
Motor outcome for patients with acute intracerebral hemorrhage predicted using diffusion tensor imaging: an application of ordinal logistic modeling.
This study examined the clinical usefulness of magnetic resonance-diffusion tensor imaging (DTI) for predicting motor outcome in patients with intracerebral hemorrhage. We studied 15 subjects (age range, 31-81 years) diagnosed by conventional computed tomography with thalamic hemorrhage, putaminal hemorrhage, or both. DTI data were obtained on days 14-18 after diagnosis. ⋯ When estimated rFA values were <0.7, the estimated probability of an MRC score of 0-1 was close to 80% for the upper extremities and 65% for the lower extremities. Meanwhile, when estimated rFA values were >0.9, the estimated probability of an MRC score of 3-5 was close to 60% for the upper extremities and 80% for the lower extremities. Our data indicate that for patients with intracerebral hemorrhage, DTI is a useful tool for quantitatively predicting motor outcome, suggesting wider clinical applicability of this method for outcome prediction.
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J Stroke Cerebrovasc Dis · Nov 2012
Case ReportsAcute cerebellar infarction associated with intravenous gammaglobulin treatment in idiopathic thrombocytopenic purpura.
Intravenous immunoglobulins (IVIGs) are used for a variety of immunologic and hematologic disorders. Hemorheologic alteration or the rapid increase of platelet counts by IVIG administration can cause thrombotic adverse events. We present a 58-year-old woman with a previous diagnosis of idiopathic thrombocytopenic purpura who developed cerebellar infarction immediately after IVIG treatment. We discuss a possible role of IVIG in cerebral ischemia and management strategies.