RESUMO
Aortic dissection is diagnostically challenging, especially in pain-free patients. Detection of acute ischemic stroke secondary to painless aortic dissection is a challenge for emergency physicians and neurologists. We report a previously healthy 58-years old female, admitted because of nausea, dizziness, somnolence, a left-sided hemiparesis and arterial hypotension. The electrocardiogram showed atrial fibrillation with ST-elevations and ST-depressions. Perfusion CT-imaging showed a dilatation of the aortic arch and intraluminal structures indicating an intima flap of aortic dissection. Four hours after onset of symptoms the patient died on the way to the cardiac surgery. In conclusion, apart from imaging the aortic arch by computed tomography in acute stroke patients, the electrocardiogram may be indicative for aortic dissection if it shows signs for myocardial ischemia in previously healthy patients.
Assuntos
Dissecção Aórtica/complicações , Fibrilação Atrial/etiologia , Acidente Vascular Cerebral/etiologia , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Neurofibromatosis type I (NF1) has been only rarely reported in association with anti-phospholipid syndrome (APS). We report a 38 year-old female with NF1, who developed a cervix carcinoma at the age of 30 years and was successfully treated with conization, without requiring chemotherapy or radiation. She experienced two miscarriages prior to the diagnosis of the carcinoma. When she was 38 years old, an APS was diagnosed based on repeatedly positive lupus anticoagulant tests. The patient continued to smoke and using oral contraceptives. At 38 years of age she had a myocardial infarction, despite the use of oral anticoagulation. She required coronary stenting. Aspirin and clopidogrel were indicated thereafter.
Assuntos
Síndrome Antifosfolipídica/complicações , Neurofibromatose 1/complicações , Adulto , Síndrome Antifosfolipídica/classificação , Síndrome Antifosfolipídica/diagnóstico , Feminino , Humanos , Infarto do Miocárdio/complicações , Neurofibromatose 1/diagnóstico , Fatores de RiscoAssuntos
Antiasmáticos/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Respiração Artificial , Insuficiência Respiratória/tratamento farmacológico , Doença Aguda , Antiasmáticos/administração & dosagem , Anticorpos Monoclonais Humanizados/administração & dosagem , Asma/complicações , Asma/tratamento farmacológico , Broncodilatadores , Feminino , Humanos , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Testes de Função Respiratória , Insuficiência Respiratória/complicações , FumantesRESUMO
A male with atrial fibrillation for 30 years underwent embolectomy in his right leg at age 78 years. Postoperatively, he received enoxaparin 60 mg/twice a day (bid), and on day 5, phenprocoumon was started. The patient's son, a general practitioner, changed phenprocoumon to dabigatran 110 mg/bid on day 8. Pain in his left calf induced readmission after 5 days. International normalized ratio was 2.5 and D-dimer was 20 µg/mL. Dabigatran was stopped and dalteparin 5000 International Units/bid and 40 µg alprostadil infusions were started. After 8 hours, he became comatose due to basilar artery occlusion and eventually died. This tragic case raises the issue of postoperative use of dabigatran, a recently introduced thrombin inhibitor.
Assuntos
Antitrombinas/efeitos adversos , Arteriopatias Oclusivas/cirurgia , Fibrilação Atrial/tratamento farmacológico , Benzimidazóis/efeitos adversos , Embolectomia , Embolia/cirurgia , Artéria Femoral/cirurgia , Insuficiência Vertebrobasilar/etiologia , beta-Alanina/análogos & derivados , Idoso , Anticoagulantes/uso terapêutico , Antitrombinas/administração & dosagem , Arteriopatias Oclusivas/etiologia , Fibrilação Atrial/complicações , Benzimidazóis/administração & dosagem , Angiografia Cerebral , Dabigatrana , Monitoramento de Medicamentos/métodos , Quimioterapia Combinada , Embolia/etiologia , Enoxaparina/administração & dosagem , Evolução Fatal , Humanos , Coeficiente Internacional Normatizado , Masculino , Femprocumona/administração & dosagem , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/terapia , beta-Alanina/administração & dosagem , beta-Alanina/efeitos adversosRESUMO
Neurofibromatosis type I (NF1) has been only rarely reported in association with anti-phospholipid syndrome (APS). We report a 38 year-old female with NF1, who developed a cervix carcinoma at the age of 30 years and was successfully treated with conization, without requiring chemotherapy or radiation. She experienced two miscarriages prior to the diagnosis of the carcinoma. When she was 38 years old, an APS was diagnosed based on repeatedly positive lupus anticoagulant tests. The patient continued to smoke and using oral contraceptives. At 38 years of age she had a myocardial infarction, despite the use of oral anticoagulation. She required coronary stenting. Aspirin and clopidrogel were indicated thereafter.
Es inusual la asociación entre neurofibromatosis tipo I (NF1) y síndrome antifosfolípidos (APS). Presentamos una paciente mujer de 38 años con un NF1 que desarrolló un cáncer cervicouterino a los 30 años y que fue tratada exitosamente con una conización, sin requerir quimioterapia o radiación. La paciente tuvo dos abortos espontáneos antes del diagnóstico del carcinoma. A los 38 años, se le diagnosticó un APS, basado en pruebas de anticoagulante lúpico que resultaron positivas en repetidas oportunidades. La paciente continuó fumando y usando contraceptivos orales y, a pesar de estar con anticoagulantes orales, tuvo un infarto agudo de miocardio a los 38 años. Se colocó un stent coronario y se indicó aspirina y clopidogrel.