Embolismo cerebral durante vuelo comercial: reporte de caso / Cerebral embolism during commercial flight: case report

RESUMEN Presentamos el caso de un varón de 25 años con antecedentes de consumo de marihuana y tabaco, que durante viaje en vuelo comercial a Cusco presentó disnea, pérdida de conciencia y estado epiléptico. Arribó a esta ciudad presentando hipotensión arterial, murmullo pulmonar abolido, sin recuperación de conciencia. La tomografía de tórax reveló bullas pulmonares y la tomografía mostró neumoencéfalo, diagnosticándose embolia gaseosa cerebral. La hipoxemia asociada a convulsiones y pérdida de conciencia en una persona joven durante el vuelo no es un evento común. La pérdida de la presión en la cabina durante el ascenso parece ser el evento desencadenante en pacientes con enfermedad pulmonar.

ABSTRACT We present the case of a 25-year old man with a history of marijuana and tobacco consumption who, during a commercial flight to Cusco, presented dyspnea, loss of consciousness, and epileptic condition. He arrived in this city presenting arterial hypotension, abolished pulmonary murmur, with no recovery of consciousness. The thorax tomography revealed lung bullae and the tomography showed pneumocephalus. He was diagnosed with cerebral gas embolism. Hypoxemia associated with seizures and loss of consciousness in a young person during a flight is not a common event. Loss of cabin pressure during climb appears to be the triggering event in patients with lung disease.

Aporte de la Resonancia Magnética en el diagnóstico del Síndrome de Embolia Grasa Cerebral. Reporte de cuatros casos / Contribution of Magnetic Resonance Imaging to the diagnosis of Cerebral Fat Embolism Syndrome. Report of four cases

El síndrome de embolia grasa (SEG) es una entidad poco frecuente de difícil diagnóstico clínico y una causa importante de morbimortalidad en pacientes con politraumatismos. Es la manifestación clínica de la presencia de glóbulos grasos en la circulación sistémica y se caracteriza, fundamentalmente, por el desarrollo de insuficiencia respiratoria, síntomas neurológicos y exantema petequial. Se asocia principalmente con complicación de fracturas de huesos largos, aunque puede ser causada por otros tipos de patologías. El diagnóstico se ha basado clásicamente en los hallazgos clínicos. Por este motivo, presentamos cuatro casos donde la Resonancia Magnética (RM) de encéfalo tuvo un rol fundamental en el diagnóstico...

Cerebral Lipiodol Embolism after Transcatheter Arterial Chemoembolization of Hepatocellular Carcinoma / 대한소화기학회지

Transcatheter arterial chemoembolization (TACE) is the mainstay of treatment for unresectable hepatocellular carcinoma (HCC). Although various complications of TACE have been reported, cerebral lipiodol embolism after TACE is rare. We report a 67-year-old man, who had patent foramen ovale and developed cerebral lipiodol embolism after TACE via the inferior phrenic artery. At 20 months after third TACE of 3 cm sized HCC in the left hepatic lobe, computed tomography (CT) revealed about 1.6 cm newly developed HCC in the anterior superior segment of right hepatic lobe. The angiogram revealed the HCC was supplied from the right inferior phrenic artery. Toward the end of TACE, there were accumulations of the iodized oil in the pulmonary vasculature. Immediately after TACE, he complained of weakness in right upper and lower limbs and sensory decrease in right limbs and right hemitrunk. Magnetic resonance imaging revealed a cerebral lipiodol embolism. Transesophageal echocardiography revealed no visible thrombi but contrast-echocardiography using hand agitated saline revealed an intracardiac right to left shunt consistent with patent foramen ovale. Motor weakness and sensory decrease were gradually improved, and all neurological symptoms disappeared over 4 weeks.

Terapia de recanalização endovascular de oclusão da artéria carótida em paciente com acidente vascular cerebral agudo / Percutaneous recanalization of carotid artery occlusion in patient with and acute stroke

Relatamos o caso de uma paciente de 69 anos, que, após a realização de arteriografia carotídea apresentou trombose sintomática da bifurcação carotídea. A paciente foi submetida imediatamente a reperfusão endovascular mecânica, com implante bem-sucedido de stent carotídeo, obtendo reversão completa do déficit neurológivo.

A 69 year-old woman developed symptomatic internal carotid artery thrombosis after carotid angiography. She was immediately submitted to mechanical endovascular reperfusion with successful carotid stent implantation and complete neurological recovery.

Predictive and clinical value of cerebral microemboli detection in cardnic patients

Cardioembolic strokes have a worse prognosis and produce larger and more disabling strokes than other ischemic stroke subtypes. We sought to evaluate the prevalence of High-intensity-transient-signals [HITS] in patients having different cardiac sources of emboli and the value of transcranial Doppler [TCD] in stroke prediction. consecutive cardiac patients were subjected to ECG, transthoracic echocardiography, and TCD examination. a total of 45 cardiac patients were investigated; twenty patients with rheumatic heart disease, 10 with prosthetic valves, and 15 with myocardial ischemia. In all patients, the presence of HITS was not affected by the patients' age, gender, the presence of risk factors, the platelet count or the INR level. Cerebral strokes were significantly higher in patients with HITS than those without. In patients with prosthetic heart valves, 60% was HITS-positive with a mean rate of 14.2 +/- 6.49/ 30 minutes, which was significantly higher than myocardial ischemia and rheumatic heart disease patients. In myocardial ischemia group, a higher prevalence of HITS was found with left ventricular ejection fraction [LVEF] < 55% and left ventricular thrombus.In rheumatic heart and ischemic heart disease groups > 80% of patients treated with antithrombotics and/or thrombolytics did not show any HITS, while in mechanical heart valves only 20% of patients received anticoagulants plus aspirin was HITS-negative. Cerebral strokes are significantly higher in cardiac patients with detected HITS than those without. In patients with prosthetic heart valves, anticoagulants didn 't significantly decrease or clear HITS

Malformación arteriovenosa de la vena de Galeno: reporte de un caso / Vein of galen arteriovenous malformation: a case report

Las malformaciones arteriovenosas de la vena de Galeno comprenden un raro grupo de anomalías congénitas que pueden causar una morbimortalidad importante, especialmente en neonatos, pero también en lactantes y niños mayores. Presentamos un caso de detección prenatal de aneurisma de la vena de Galeno a las 35 + 5 semanas de gestación en el Centro de Referencia Perinatal Oriente. Al examen ultrasonográfico se evidenció una imagen quística supratentorial de 47 por 16 mm, en la línea media del cerebro, asociado a polihidroamnios. El examen con Doppler color demostró el origen vascular de la lesión, con flujo turbulento venoso y arteria. Se realiza resonancia magnética (RM) cerebral fetal que confirma diagnóstico. A las 37 + 2 semanas de gestación se interrumpe el embarazo vía cesárea por inicio de trabajo de parto con monitorización electrónica fetal sospechosa de hipoxia. Evaluado con RM cerebral y angiorresonancia posnatal, en el Instituto de Neurocirugía se declara fuera del alcance terapéutico debido al gran compromiso encefálico. El recién nacido fallece a los siete días de vida. En la presente publicación se realiza una revisión de la literatura referente al tema, destacando la importancia de la consejería prenatal y el manejo multidisciplinario de esta compleja patología.

Clinical outcomes of patients with cardiogenic cerebral emboli in Srinagarind Hospital.

We retrospectively studied the functional outcomes and recurrence rates of patients 15 years and older in whom cardiogenic cerebral embolism was diagnosed at Srinagarind Hospital, Khon Kaen, Thailand, during the period of 1993-2002. Ninety patients were included in this study. Ages ranged from 16-80 years (mean 48.3 years). The majority of cardiac abnormalities were rheumatic heart diseases (with or without atrial fibrillation) and nonvulvular atrial fibrillation. At 3 months and 1 year after stroke, improvement in functional outcome (measured by RDS, motor strength, and GCS) were 74.4% and 55.6%, mortality rates of 13.3% and 16.7%; and recurrence rates of 8.9% and 16.7%, respectively. A GCS < 9 or motor power < or = 1 or RDS > or = 4 upon presentation were poor prognostic factors.

Cerebral embolism Distal subclavian disease as a rare etiology

Subclavian artery occlusive disease is usually secondary to persistent compression caused by thoracic outlet syndrome [TOS] and rarely due to focal atherosclerosis. Emboli from diseased vessel can flow retrograde to the vertebral or carotid arteries to produce ischemic infarct with or without neurological deficit. We are reporting two cases of distal subclavian artery disease presenting with cerebral embolization, an unusual manifestation. Such surgically correctable lesions producing cerebral emboli and stroke needs consideration while evaluating patients with unusual presentation to prevent further occurrence of stroke

Thromboembolism: a rare complication of cardiac hydatidosis.

A cardiac hydatid cyst is rare. We report a case of cardiac hydatid cyst localized in the atria which was diagnosed by two-dimensional echocardiography following a thromboembolic stroke. Surgical resection of the cyst was performed and histopathologic examination confirmed the diagnosis.

MRI features of infarcts with potential cardiac source of embolism in the Yonsei Stroke Registry (YSR), Korea

The determination of the embolic source is crucial to understanding the pathogenesis of ischemic stroke, the initiation of appropriate therapy, and the prevention of recurrent infarctions. In this study we undertook to identify the characteristic features on magnetic resonance images of patients who had suffered from stroke due to cardiac embolism (CE), as classified by TOAST (possible and probable). We retrospectively studied magnetic resonance imaging (MRI) findings of patients with ischemic stroke from the Yonsei Stroke Registry (YSR). On the basis of the TOAST classification, 92 patients were identified to have a potential cardiac source of embolism (PCSE), in which 69 patients were found to have high-risk PCSE and 23 patients medium-risk PCSE. To compare their imaging characteristics, another group of 49 patients who were found to have had a stroke due to large artery-to-artery (ATA) embolism-common or internal carotid artery (CCA, ICA)-were identified. Involvement of the simultaneous superficial and deep territories (58.7%; 6.1%, p < 0.001), and combined new anterior and old posterior circulation (15.2%; 2.0%, p = 0.016) were more frequent in PCSE than ATA embolism. Bilateral anterior hemispheric involvement was also more frequent in the PCSE group, but it did not reach statistical significance (13.0%; 4.1%, p = 0.090). ATA embolism tended to involve only superficial territories compared to PCSE (71.4%; 28.3%, p < 0.001). There were no topographic differences between the high-risk and medium-risk groups. With respect to the etiology of PCSE in our population, atrial fibrillation was the most common. Characteristic MRI features of patients with PCSE, which were not documented previously by computed tomography (CT) included: old and new, involvement of multiple different vascular territories, bilateral anterior hemisphere, as well as anterior and posterior circulation. These MRI features, together with simultaneous superficial and deep territorial involvement, help to differentiate the underlying embolic sources, whether they are cardiac or ATA in origin.