Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Jan 2017
Case ReportsA Case of Hypertensive Encephalopathy with Enlarged Optic Nerve Sheath Measured by Transorbital Sonography.
This case report describes our experience in using transorbital sonography to evaluate pathological changes in the central nervous system in hypertensive encephalopathy. A 49-year-old man with nausea, headache, and mild confusion was diagnosed with hypertensive encephalopathy by brain magnetic resonance imaging (MRI), which revealed vasogenic edema in the bilateral thalamus and the brain stem. Lumbar puncture showed no severe intracranial hypertension. ⋯ An improvement in cerebral vasogenic edema was confirmed by brain MRI. ONSD might be related to the severity of cerebral vasogenic edema. Repeated measurement of ONSD by transorbital sonography may be useful to assess the pathological course and the effect of treatment in hypertensive encephalopathy.
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J Stroke Cerebrovasc Dis · Jan 2017
Case ReportsAcute Cerebral Artery Occlusion by a Calcified Embolus with False Patency Sign on Computed Tomographic Angiography.
Computed tomographic angiography (CTA) is a quick and accurate method in triage to determine recanalization therapies for acute ischemic stroke. To minimize delay in the start of recanalization therapies, performance of CTA immediately after unenhanced brain computed tomography (CT) is recommended as the minimum standard. However, there are some pitfalls related to image interpretation of CTA in acute stroke, such as false patency sign. ⋯ We misinterpreted the CTA image as a patent MCA, and unnecessary brain magnetic resonance imaging caused delay in the start of endovascular thrombectomy. Our findings suggest that calcified cerebral emboli can present with false patency sign on CTA. To avoid misinterpretation of the CTA image and start recanalization therapy as soon as possible, physicians should be aware of false patency sign, especially when unenhanced CT shows hyperdense emboli and CTA findings do not correspond with patients' symptoms in acute ischemic stroke.
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J Stroke Cerebrovasc Dis · Jan 2017
Predictive Value of Modifications of the Prehospital Rapid Arterial Occlusion Evaluation Scale for Large Vessel Occlusion in Patients with Acute Stroke.
Prehospital clinical scales to identify patients with acute stroke with a large vessel occlusion (LVO) and direct them to an endovascular-capable stroke center are needed. We evaluated whether simplification of the Rapid Arterial oCclusion Evaluation (RACE) scale, a 5-item scale previously validated in the field, could maintain its high performance to identify patients with LVO. ⋯ We recommend the original RACE scale for prehospital assessment of patients with suspected stroke for its ease of use and its high performance to predict the presence of a LVO. The use of simplified versions would reduce its predictive value.
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J Stroke Cerebrovasc Dis · Jan 2017
Observational StudyUnattended Hospital and Home Sleep Apnea Testing Following Cerebrovascular Events.
Home sleep apnea testing (HSAT) is an alternative to polysomnography for the detection of obstructive sleep apnea (OSA). We assessed the feasibility of HSAT as an unattended screening tool for patients with a stroke or transient ischemic attack (TIA). ⋯ Unattended HSAT can be feasibly implemented after stroke or TIA. This method facilitates rapid diagnosis and management of OSA in both the outpatient and inpatient settings.