Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Oct 2014
Detection of vessel wall lesions in spontaneous symptomatic vertebrobasilar artery dissection using T1-weighted 3-dimensional imaging.
Spontaneous intracranial vertebrobasilar artery dissection (iVBD) is a cause of ischemic stroke and subarachnoid hemorrhage in young adults that can be detected noninvasively by using multisequence magnetic resonance imaging (MRI). However, MRI findings are sometimes difficult to interpret, and its accuracy tends to be suboptimal, especially during the acute period. Therefore, we investigated whether 3-dimensional (3D) vessel wall imaging (VWI) technique could readily detect iVBD lesions in acute phase patients. ⋯ The T1W 3D-VWI can directly visualize vessel wall iVBD lesions during the acute period of stroke compared with multisequence MRI.
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J Stroke Cerebrovasc Dis · Oct 2014
Case ReportsA traveling "spot sign" in recurrent amaurosis fugax and central retinal artery occlusion.
Sudden monocular blindness is frequently caused by central retinal artery occlusion (CRAO) from embolic sources. Treatment options are insufficient, and spontaneous prognosis toward visual recovery is poor. In addition to ophthalmologic evaluation, transorbital sonographic assessment of the central retinal artery may help establish early diagnosis by Doppler sonographic proof of occlusion and, in some cases, by B-mode detection of an intra-arterial "spot sign". ⋯ Thrombolytic treatment did not result in clinical improvement. In conclusion, this case report describes a single case of repeated amaurosis fugax and deterioration to CRAO via embolization into the central retinal artery and consecutive downstream dislodgment. It emphasizes that ultrasound may render valuable diagnostic information in patients with acute central retinal artery embolization toward its embolic etiology and its risk of subsequent deterioration.
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J Stroke Cerebrovasc Dis · Oct 2014
Review Case Reports Meta AnalysisIntracerebral hemorrhage associated with oral phenylephrine use: a case report and review of the literature.
Prior reports have linked both ischemic and hemorrhagic stroke to use of sympathomimetic drugs including phenylephrine. The purpose of this study is to describe the first case, to our knowledge of intracerebral hemorrhage (ICH) after oral use of phenylephrine and to systematically review the literature on phenylephrine and acute stroke. ⋯ It is scientifically plausible that phenylephrine may cause strokes, consistent with the pharmacologic properties and adverse event profiles of similar amphetamine-like sympathomimetics. As RCVS has been well described in association with over-the-counter sympathomimetics, a likely, although not definitive, causal relationship between phenylephrine and ICH is proposed.
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J Stroke Cerebrovasc Dis · Oct 2014
Relationship between diffusion tensor fractional anisotropy and long-term motor outcome in patients with hemiparesis after middle cerebral artery infarction.
Magnetic resonance diffusion tensor fractional anisotropy (DTI-FA) is often used to characterize neural damage after stroke. Here we assessed the relationship between DTI-FA and long-term motor outcome in patients after middle cerebral artery (MCA) infarction. ⋯ The results suggest that DTI-FA is applicable for predicting the long-term outcome of extremity functions after MCA infarction.
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J Stroke Cerebrovasc Dis · Sep 2014
Case ReportsFatal intracranial hemorrhage after intravenous thrombolytic therapy for acute ischemic stroke associated with cancer-related nonbacterial thrombotic endocarditis.
Nonbacterial thrombotic endocarditis (NBTE) is associated with hypercoagulability in patients with inflammatory states such as cancer and autoimmune diseases. Cardiac vegetations caused by NBTE often lead to life-threatening systemic thromboembolism that most frequently affects the brain, spleen, and kidneys. A 54-year-old woman diagnosed with ovarian cancer suddenly developed back pain and left hemiparesis. ⋯ Transthoracic echocardiography then detected aseptic vegetations on the mitral and aortic valves, indicating NBTE associated with ovarian cancer. Because therapies for NBTE are limited to heparinization and control of underlying diseases, thrombolytic therapy for acute embolic stroke in NBTE has not yet been validated. We postulated that thrombolytic therapy for cancer-related NBTE might easily cause hemorrhagic complications because cancer-related NBTE is often similar to the state of disseminated intravascular coagulation.