Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Nov 2012
Case ReportsThree cases of middle cerebral artery occlusion emergently revascularized with a balloon-expandable coronary bare stent after intravenous tissue plasminogen activator.
Revascularization with emergency stent placement in patients with acute middle cerebral artery occlusion is still controversial in Japan. ⋯ Revascularization with emergency stent placement seems likely to be successful in patients with acute middle cerebral artery occlusion, but clinical symptoms do not always improve in some cases and care is needed in selecting patients for the procedure.
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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
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.
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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.