Assuntos
Cefaleia/etiologia , Hemorragia Subaracnóidea/complicações , Adulto , Artérias Cerebrais/patologia , Craniectomia Descompressiva , Cefaleia/diagnóstico , Cefaleia/cirurgia , Humanos , Aneurisma Intracraniano/complicações , Masculino , Hemorragia Subaracnóidea/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Carotid arterial dissections may result from spontaneous or traumatic causes. Postcoital arterial dissections have been reported in both the vertebral and coronary arteries. We report a rare case of spontaneous dissection from the common carotid artery to the internal and external carotid arteries after sexual intercourse, leading to fulminant middle cerebral artery (MCA) territory infarct. Although we restored the flow in the proximal carotid artery with stenting, brain swelling with hemorrhagic transformation was still noted in the region of the right MCA.
Assuntos
Doenças das Artérias Carótidas/etiologia , Dissecação da Artéria Carótida Interna/etiologia , Coito , Infarto da Artéria Cerebral Média/etiologia , Doença Aguda , Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Primitiva , Humanos , Infarto da Artéria Cerebral Média/cirurgia , Masculino , Pessoa de Meia-IdadeRESUMO
Ecstasy, the popular name for 3,4-methylenedioxymethamphetamine (MDMA), is a synthetic amphetamine derivative. It stimulates the sympathetic nervous system, producing serious adverse effects on the cardiovascular system. We present a 20-year-old female patient, who developed subarachnoid hemorrhage (SAH) and death following MDMA and coingestion with other drugs. She suffered from severe headache followed by vomiting, and conscious change 5 hours after an intake of 1 tablet MDMA and other drugs at a dance club. Her blood pressure was 226/164 mmHg, pulse rate 164/min, respiratory rate 30/min on arrival at our emergency department. Diffuse rales were heard over both lung fields. Both pupils' sizes were 4 mm, with sluggish reaction to light. A 12 lead electrocardiograph showed sinus tachycardia, ST depression in the inferior leads and V4 to V6 precordial leads. Laboratory findings revealed normal except a slightly raised white cell count and glucose. Arterial blood gas analysis showed pH was 7.333, with PaCO2 24.6 mmHg, PaO2 151.7 mmHg and HCO3 12.8 mmol/L. Chest x-ray revealed acute pulmonary edema. Urgent computerized tomography scanning of the head demonstrated SAH. Her condition continued to deteriorate, and went to deep coma and shock status. She expired on the second day although we treated aggressively.