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1.
BMJ Case Rep ; 13(8)2020 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-32843381

RESUMO

A 66-year-old man was admitted to hospital with a right frontal cerebral infarct producing left-sided weakness and a deterioration in his speech pattern. The cerebral infarct was confirmed with CT imaging. The only evidence of respiratory symptoms on admission was a 2 L oxygen requirement, maintaining oxygen saturations between 88% and 92%. In a matter of hours this patient developed a greater oxygen requirement, alongside reduced levels of consciousness. A positive COVID-19 throat swab, in addition to bilateral pneumonia on chest X-ray and lymphopaenia in his blood tests, confirmed a diagnosis of COVID-19 pneumonia. A proactive decision was made involving the patients' family, ward and intensive care healthcare staff, to not escalate care above a ward-based ceiling of care. The patient died 5 days following admission under the palliative care provided by the medical team.


Assuntos
Infecções por Coronavirus/complicações , Infarto da Artéria Cerebral Anterior/diagnóstico por imagem , Infarto da Artéria Cerebral Anterior/virologia , Pneumonia Viral/complicações , Idoso , Betacoronavirus , COVID-19 , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Evolução Fatal , Humanos , Infarto da Artéria Cerebral Anterior/complicações , Masculino , Oxigenoterapia , Cuidados Paliativos , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Radiografia , SARS-CoV-2 , Tomografia Computadorizada por Raios X
2.
J Stroke Cerebrovasc Dis ; 29(2): 104488, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31787498

RESUMO

BACKGROUND: We aimed to assess the correlation of lesion location and clinical outcome in patients with large hemispheric infarction (LHI). METHODS: We analyzed admission MRI data from the GAMES-RP trial, which enrolled patients with anterior circulation infarct volumes of 82-300 cm3 within 10 hours of onset. Infarct lesions were segmented and co-registered onto MNI-152 brain space. Voxel-wise general linear models were applied to assess location-outcome correlations after correction for infarct volume as a co-variate. RESULTS: We included 83 patients with known 3-month modified Rankin scale (mRS). In voxel-wise analysis, there was significant correlation between admission infarct lesions involving the anterior cerebral artery (ACA) territory and its middle cerebral artery (MCA) border zone with both higher 3-month mRS and post-stroke day 3 and 7 National Institutes of Health Stroke Scale (NIHSS) total score and arm/leg subscores. Higher NIHSS total scores from admission through poststroke day 2 correlated with left MCA infarcts. In multivariate analysis, ACA territory infarct volume (P = .001) and admission NIHSS (P = .005) were independent predictors of 3-month mRS. Moreover, in a subgroup of 36 patients with infarct lesions involving right MCA-ACA border zone, intravenous (IV) glibenclamide (BIIB093; glyburide) treatment was the only independent predictor of 3-month mRS in multivariate regression analysis (P = .016). CONCLUSIONS: Anterior extension of LHI with involvement of ACA territory and ACA-MCA border zone is an independent predictor of poor functional outcome, likely due to impairment of arm/leg motor function. If confirmed in larger cohorts, infarct topology may potentially help triage LHI patients who may benefit from IV glibenclamide. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01794182.


Assuntos
Artéria Cerebral Anterior/diagnóstico por imagem , Cérebro/irrigação sanguínea , Imagem de Difusão por Ressonância Magnética , Extremidades/inervação , Infarto da Artéria Cerebral Anterior/diagnóstico por imagem , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Artéria Cerebral Média/diagnóstico por imagem , Administração Intravenosa , Idoso , Artéria Cerebral Anterior/fisiopatologia , Circulação Cerebrovascular , Ensaios Clínicos como Assunto , Ensaios Clínicos Fase II como Assunto , Avaliação da Deficiência , Feminino , Glibureto/administração & dosagem , Humanos , Hipoglicemiantes/administração & dosagem , Infarto da Artéria Cerebral Anterior/fisiopatologia , Infarto da Artéria Cerebral Anterior/terapia , Infarto da Artéria Cerebral Média/fisiopatologia , Infarto da Artéria Cerebral Média/terapia , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/fisiopatologia , Admissão do Paciente , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos
3.
J Neurointerv Surg ; 9(2): 147-151, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27382125

RESUMO

BACKGROUND: The off-label use of flow diverters in the treatment of distal aneurysms continues to be debated. OBJECTIVE: To report our multicenter experience in the treatment of complex anterior cerebral artery aneurysms with the Pipeline embolization device (PED). METHODS: The neurointerventional databases of the four participating institutions were retrospectively reviewed for aneurysms treated with PED between October 2011 and January of 2016. All patients treated for anterior cerebral artery aneurysms were included in the analysis. Clinical presentation, location, type, vessel size, procedural complications, clinical and imaging follow-up were included in the analysis. RESULTS: Twenty patients (13 female) with 20 aneurysms met the inclusion criteria in our study. Fifteen aneurysms were classified as saccular and five as fusiform (mean size 7.3 mm). Thirteen aneurysms were located in the anterior communicating region (ACOM or A1/2 junction), six were A2-pericallosal, and one was located in the A1 segment. Six patients had presented previously with subarachnoid hemorrhage and had their aneurysms initially clipped or coiled. There was one minor event (a small caudate infarct) and one major event (intraparenchymal hemorrhage). Sixteen of the 20 patients had angiographic follow-up (mean 10 months). Eleven aneurysms were completely occluded, one had residual neck, and four had residual aneurysm filling. CONCLUSIONS: The treatment of complex anterior cerebral artery aneurysms with the PED as an alternative for patients who are not good candidates for conventional methods is technically feasible and safe. Mid-term results are promising but larger series with long-term follow-up are required to assess its effectiveness.


Assuntos
Prótese Vascular , Hemorragia Cerebral/cirurgia , Infarto da Artéria Cerebral Anterior/cirurgia , Aneurisma Intracraniano/cirurgia , Adulto , Idoso , Artéria Cerebral Anterior/diagnóstico por imagem , Artéria Cerebral Anterior/cirurgia , Implante de Prótese Vascular , Angiografia Cerebral , Hemorragia Cerebral/diagnóstico por imagem , Infarto Cerebral/etiologia , Infarto Cerebral/cirurgia , Feminino , Humanos , Infarto da Artéria Cerebral Anterior/diagnóstico por imagem , Aneurisma Intracraniano/diagnóstico por imagem , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Estudos Retrospectivos
4.
Ann Otol Rhinol Laryngol ; 125(10): 850-3, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27317314

RESUMO

CASE DETAILS: We present a case of temporal bone mucormycosis in a 71-year-old female with diabetes mellitus who presented to the emergency department with facial nerve paresis, otorrhea, and contralateral hemiparesis. After undergoing a tympanomastoidectomy, the patient's pathology exhibited fungal hyphae consistent with mucormycosis. DISCUSSION: To our knowledge, there have been 9 reported cases of temporal bone mucormycosis, 3 of which presented with facial nerve paresis, all with some subsequent improvement. In this case, facial paralysis persisted at the time of last follow-up (2 months) despite surgery and intravenous antifungals. We also review and summarize the temporal bone mucormycosis literature. CONCLUSION: Temporal bone mucormycosis is a rare and morbid infectious disease, though its outcomes appear to be different for patients who present with isolated temporal bone disease as compared to those individuals who develop temporal bone mucormycosis secondary to a rhinologic source.


Assuntos
Encéfalo/diagnóstico por imagem , Diabetes Mellitus , Hospedeiro Imunocomprometido , Infarto da Artéria Cerebral Anterior/diagnóstico por imagem , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Mucormicose/diagnóstico por imagem , Otite Média/diagnóstico por imagem , Osso Temporal/diagnóstico por imagem , Idoso , Complicações do Diabetes/diagnóstico por imagem , Complicações do Diabetes/imunologia , Paralisia Facial/complicações , Feminino , Humanos , Infarto da Artéria Cerebral Anterior/complicações , Infarto da Artéria Cerebral Média/complicações , Processo Mastoide/patologia , Processo Mastoide/cirurgia , Mucormicose/complicações , Mucormicose/imunologia , Mucormicose/cirurgia , Otite Média/complicações , Otite Média/imunologia , Otite Média/cirurgia , Osso Temporal/cirurgia , Tomografia Computadorizada por Raios X
5.
J Vasc Surg ; 64(1): 15-24, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26971247

RESUMO

BACKGROUND: Silent cerebral infarctions (SCIs) can be identified by preoperative computed tomography (CT) scans in patients with severe carotid stenosis being considered for carotid endarterectomy (CEA). It is unknown whether this finding has any effect on perioperative complications or long-term outcome. This study investigates the influence of SCI on early and late complications in asymptomatic patients undergoing CEA. METHODS: All consecutive CEAs undertaken for asymptomatic severe carotid stenosis from 2005 to 2013 were retrospectively evaluated for clinical and anatomic characteristics. SCI was defined as cerebral embolic infarcts in the anterior or middle cerebral artery territory, ipsilateral to the target carotid stenosis, identified on preoperative CT. The end points of the study were to compare the 30-day and long-term stroke and death rate after CEA in patients with and without SCI. All patients were followed yearly through duplex ultrasonography and clinical assessment. Statistical methods used were Cox regression (hazard ratio) and Kaplan-Meier for life-table analysis. RESULTS: A total of 743 CEAs were performed in asymptomatic patients during the study period of which all had CT scans, and 97 (13.1%) demonstrated SCI. All patient stroke and death outcomes at 30 days were 0.5% and 0.7%, respectively. Patients with SCI had a significantly higher 30-day stroke outcome (3.1% vs 0.2%; P = .001; odds ratio, 16.39; 95% confidence interval, 1.33-201.4; P = .02) but not death or stroke/death outcome (0% vs 0.8%; P = .19 and 3.1% vs 0.9%, P = .06, respectively) compared with those without SCI. In addition, at a mean follow-up of 44.3 ± 23.9 months, the patients with SCI had a significantly worse 5-year ipsilateral stroke or any stroke-/death-free survival compared with patients without SCI (86.7% vs 99.0%; P = .001; and 76.9% vs 87.7%; P = .004). SCI was confirmed as an independent predictor of late any stroke/death by Cox regression (hazard ratio, 2.45; 95% confidence interval, 1.29-4.67; P = .006). CONCLUSIONS: Patients who have SCI in the presence of severe carotid stenosis and undergo CEA have significantly worse perioperative stroke and long-term stroke/death outcomes. This data would suggest that asymptomatic patients undergoing CEA who have CT scan evidence of a cerebral infarct have worse prognosis than those with normal CT scans.


Assuntos
Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas , Infarto da Artéria Cerebral Anterior/etiologia , Infarto da Artéria Cerebral Média/etiologia , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/mortalidade , Distribuição de Qui-Quadrado , Intervalo Livre de Doença , Endarterectomia das Carótidas/efeitos adversos , Endarterectomia das Carótidas/mortalidade , Feminino , Humanos , Infarto da Artéria Cerebral Anterior/diagnóstico por imagem , Infarto da Artéria Cerebral Anterior/mortalidade , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Infarto da Artéria Cerebral Média/mortalidade , Estimativa de Kaplan-Meier , Masculino , Tomografia Computadorizada Multidetectores , Análise Multivariada , Razão de Chances , Modelos de Riscos Proporcionais , Recidiva , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler Dupla
7.
World Neurosurg ; 84(6): 1579-88, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26232658

RESUMO

BACKGROUND: Intravenous thrombolysis using tissue plasminogen activator and endovascular treatment for acute ischemic stroke is becoming an established standard therapy. However, there is no consensus in the treatment of patients who are suffering from progressive neurologic symptoms in the later stages. The purpose of this study was to evaluate the safety and efficacy of microsurgical revascularization in such patients with progressive stroke. METHODS: We retrospectively reviewed the clinical and radiological records of 14 consecutive patients with progressive stroke who underwent emergency open surgery for anterior circulation occlusion within 7 days after onset. Surgical candidates were carefully selected on the basis of symptom severity, diffusion-weighted imaging, and perfusion study. Superficial temporal artery to middle cerebral artery bypass was applied for atherosclerotic occlusion, and microsurgical embolectomy was applied for embolic occlusion. RESULTS: Superficial temporal artery to middle cerebral artery bypass was performed in 12 patients, microsurgical embolectomy in 1, and the combination of these modalities in 1. As a result, complete revascularization was achieved in all patients. The National Institutes of Health Stroke Scale scores significantly improved after surgery (at third postoperative day, P < 0.05; at 14th postoperative day, P < 0.01). A favorable outcome (modified Rankin Scale 0-2) was achieved in 12 of the 14 (85.7%) patients. Minor intracerebral hemorrhage occurred in 1 patient and hyperperfusion syndrome occurred in 1 patients; however, the patients subsequently recovered without additional treatment. CONCLUSIONS: Microsurgical revascularization is a feasible treatment option for patients with progressive stroke due to anterior circulation major vessel occlusion.


Assuntos
Revascularização Cerebral , Embolectomia , Tratamento de Emergência , Infarto da Artéria Cerebral Anterior/cirurgia , Arteriosclerose Intracraniana/cirurgia , Embolia Intracraniana/cirurgia , Microcirurgia , Artérias Temporais/cirurgia , Idoso , Angiografia Cerebral , Revascularização Cerebral/efeitos adversos , Revascularização Cerebral/instrumentação , Revascularização Cerebral/métodos , Imagem de Difusão por Ressonância Magnética , Progressão da Doença , Embolectomia/efeitos adversos , Tratamento de Emergência/métodos , Estudos de Viabilidade , Feminino , Humanos , Infarto da Artéria Cerebral Anterior/diagnóstico por imagem , Infarto da Artéria Cerebral Anterior/etiologia , Infarto da Artéria Cerebral Anterior/patologia , Arteriosclerose Intracraniana/complicações , Embolia Intracraniana/complicações , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
9.
J Clin Neurosci ; 19(12): 1730-3, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22999563

RESUMO

The stereotype of repetitive transient cerebral ischemia causing unilateral motor, sensory, or sensorimotor deficits that simultaneously affect the face, arm, and leg, clinically localized to the internal capsule, fits with the description of capsular warning syndrome (CWS). A high proportion of individuals with these symptoms develop subsequent capsular stroke, despite various proposed preventative measures. It has been postulated that the mechanism for such strokes is that of small-vessel single-penetrator disease. We present a patient with repetitive CWS intermingled with crescendo capsular strokes secondary to recurrent artery of Heubner disease. This report causally links CWS-crescendo lacunar strokes and Heubner artery atherosclerotic disease (intracranial branch atheromatous disease).


Assuntos
Infarto da Artéria Cerebral Anterior/complicações , Arteriosclerose Intracraniana/complicações , Ataque Isquêmico Transitório/etiologia , Acidente Vascular Cerebral Lacunar/etiologia , Constrição Patológica/complicações , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/fisiopatologia , Humanos , Hiperlipidemias/complicações , Hipertensão/complicações , Infarto da Artéria Cerebral Anterior/diagnóstico por imagem , Infarto da Artéria Cerebral Anterior/fisiopatologia , Arteriosclerose Intracraniana/diagnóstico por imagem , Arteriosclerose Intracraniana/fisiopatologia , Ataque Isquêmico Transitório/diagnóstico por imagem , Ataque Isquêmico Transitório/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fumar/efeitos adversos , Acidente Vascular Cerebral Lacunar/diagnóstico por imagem , Acidente Vascular Cerebral Lacunar/fisiopatologia , Síndrome , Tomografia Computadorizada por Raios X
10.
Neurol Med Chir (Tokyo) ; 51(1): 72-5, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21273751

RESUMO

A 58-year-old woman with refractory hypertension presented with subarachnoid hemorrhage. Digital subtraction angiography and three-dimensional computed tomography (CT) angiography revealed a ruptured left vertebral artery (VA) aneurysm and an unruptured left middle cerebral artery (MCA) aneurysm. The patient successfully underwent neck clipping of the left VA aneurysm. However, CT obtained just after the operation showed an asymptomatic cerebral infarction along the distribution of medial striate arteries of the right anterior cerebral artery in the caudate nucleus. The pathogenesis of the infarction was unknown. Before clipping surgery of the left MCA aneurysm, detailed examinations to find the cause of her refractory hypertension were performed. Laboratory tests revealed plasma serum level of norepinephrine at 15,521 pg/ml (normal range 100-450 pg/ml). Abdominal magnetic resonance imaging revealed a pheochromocytoma in the right adrenal gland. After preoperative management of the pheochromocytoma, the neck of the left MCA aneurysm was successfully clipped. When the patient awakened from anesthesia, she noticed right hemiparesis and motor aphasia. CT showed cerebral infarction along the distribution of lenticulostriate arteries of the left MCA in the putamen. Her symptoms gradually improved, and the pheochromocytoma was removed by laparoscopic surgery. Sustained severe hypertension and depletion of blood volume resulting from excess catecholamine release from the pheochromocytoma may have caused the complications. Hypervolemic fluid infusion and maintenance of normotensive blood pressure during surgery may avoid such ischemic events.


Assuntos
Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Aneurisma Roto/diagnóstico por imagem , Angiografia Digital , Angiografia Cerebral , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Infarto da Artéria Cerebral Anterior/diagnóstico por imagem , Feocromocitoma/complicações , Feocromocitoma/diagnóstico por imagem , Hemorragia Subaracnóidea/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Artéria Vertebral/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/cirurgia , Aneurisma Roto/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Infarto da Artéria Cerebral Anterior/cirurgia , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Laparoscopia , Pessoa de Meia-Idade , Feocromocitoma/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Reoperação , Instrumentos Cirúrgicos , Artéria Vertebral/cirurgia
11.
J Stroke Cerebrovasc Dis ; 19(2): 169-73, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20189096

RESUMO

The pericallosal artery is rarely associated with intracranial atherosclerotic disease and, until recently, was usually not amenable to endovascular therapy with balloon angioplasty and stenting. We present an elderly patient with postural left leg-shaking episodes secondary to pericallosal artery stenosis, which was treated initially with primary intracranial balloon angioplasty, and subsequently, angioplasty and stenting as a result of recurrent stenosis. Both procedures were preformed without complications, and the patient remained free of symptoms on 6-month follow-up. This case demonstrates unique clinical and neuroendovascular aspects; the isolated postural leg-shaking transient ischemic attacks, initially mistaken for radiculopathy and local joint etiology, were found later to be cerebrovascular ischemic in origin. Moreover, the correlation between the findings of computed tomography perfusion and angiography localized the lesion into the medial frontal lobe and pericallosal artery territory. In addition, the technical aspect provides insight into the current state of neuroendovascular techniques, addressing the difficulty of access into very small and distal intracranial arteries affected by stenosis.


Assuntos
Angioplastia com Balão/métodos , Artéria Cerebral Anterior/cirurgia , Infarto da Artéria Cerebral Anterior/terapia , Ataque Isquêmico Transitório/terapia , Perna (Membro)/fisiopatologia , Stents/normas , Idoso de 80 Anos ou mais , Angioplastia com Balão/instrumentação , Artéria Cerebral Anterior/diagnóstico por imagem , Artéria Cerebral Anterior/patologia , Angiografia Cerebral , Corpo Caloso/irrigação sanguínea , Corpo Caloso/patologia , Corpo Caloso/fisiopatologia , Feminino , Humanos , Infarto da Artéria Cerebral Anterior/diagnóstico por imagem , Infarto da Artéria Cerebral Anterior/patologia , Ataque Isquêmico Transitório/diagnóstico por imagem , Ataque Isquêmico Transitório/patologia , Perna (Membro)/inervação , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Córtex Motor/irrigação sanguínea , Córtex Motor/patologia , Córtex Motor/fisiopatologia , Radiculopatia/diagnóstico , Radiculopatia/fisiopatologia , Recidiva , Reoperação , Espondilose/diagnóstico , Espondilose/fisiopatologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tremor/etiologia , Tremor/fisiopatologia , Tremor/terapia
12.
No Shinkei Geka ; 36(9): 813-7, 2008 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-18800637

RESUMO

We report a rare case of postoperative infarction in the territory of the contralateral recurrent artery of Heubner (RAH) after surgery. A 67-year-old male was treated by the right pterional approach with clipping surgery for an unruptured anterior communicating artery aneurysm projecting inferiorly. Postoperative CT scan revealed infarctions in the left caudate head and the left putamen. In this case, the RAH probably coursed inferiorly to the A1 segment and was behind the aneurysmal dome. These infarctions were considered to result from occlusion of the left RAH because the clip blade extended too far beyond the aneurysmal neck.


Assuntos
Infarto da Artéria Cerebral Anterior/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Idoso , Humanos , Infarto da Artéria Cerebral Anterior/etiologia , Masculino , Complicações Pós-Operatórias/etiologia , Tomografia Computadorizada por Raios X
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